Bill Arneson, director of process and system support at Moffitt Cancer Center, chats with revenue cycle editor Amanda Norris about the strategies the organization uses to recruit revenue cycle talent and think outside the box when it comes to their workforce.
St. Jude Children's Research Hospital's new (and first) chief business innovation officer talks about new ideas and strategies at the renowned pediatric health system.
An expert in human-centered design, Corbin is charged with working with CEO James Downing, MD, and other senior leaders to guide the health system's $12.9 billion, six-year strategic plan, the largest and most ambitious investment in St Jude's 60-year history. This includes roughly $3 billion in planned construction projects.
Prior to joining St. Jude, she spent four years at the San Francisco-based global design and innovation firm IDEO, where she helped St. Jude develop programs like Family Commons and the St. Jude Global Alliance. She was also a principal at the architectural and engineering firm CannonDesign and was administrative director of orthopedic surgery and neurosurgery at a Chicago health system.
Corbin recently sat down—virtually—with HealthLeaders to discuss her new role.
Q: How do you define healthcare innovation?
Corbin: Since the beginning of time people have had problems to solve, and innovation is about solving those problems better than you have before. That applies to healthcare or any other industry. I view innovation as an outcome rather than a thing you do; innovation is the result of creative problem-solving that is guided by particular activities, behaviors, and mindsets. In my experience, you are more likely to see innovation occur when you:
have curiosity and empathy (mindsets);
engage directly with the problem to understand it rather than make assumptions and include a diverse set of people and viewpoints (behavior); and
commit to experimenting and testing possible solutions, incrementally, so that you learn, adjust, and refine (activities).
A lot of the mystery or magic of innovation lies in your ability to be disciplined in tackling a problem differently and in your willingness to keep going when things inevitably get uncomfortable. Change is uncomfortable, yet you can’t have innovation without change.
Q: What are the biggest challenges or barriers to healthcare innovation?
Corbin: Healthcare is a highly regulated industry where risk-taking isn’t as rewarded or as encouraged as it is in the other industries we often look to as examples of being innovative, such as tech or retail. To an extent, it’s a good thing that there is risk aversion and regulation in healthcare--people’s lives and wellbeing are often at the center of many decisions, but not all. One challenge to innovating in healthcare, then, is to be able to see regulation and risk mitigation on a spectrum and not a binary 'yes/no' choice. That opens up space to try new things, to learn and adapt, and to ultimately implement a new or modified solution to the problem at hand. That’s innovation and it applies to all industries, including healthcare.
Q: Is innovation approached or handled differently at a children's health system? How is it different?
Corbin: The fundamental approach to creative problem-solving still applies in pediatric healthcare. There are plenty of areas inside a pediatric hospital or pediatric-focused research institution like St. Jude that, from a business standpoint, function very similarly to adult institutions, or even organizations outside of the healthcare industry.
Catherine Corbin, chief business innovation officer at St. Jude Children's Research Hospital. Photo courtesy St. Jude.
Now for the nuance. The people we’re most often solving or designing for in a pediatric-focused institution like St. Jude are kids. Kids come into the healthcare system with one or more parents, or a designated caregiver, and sometimes siblings. There is a co-dependency within the family unit when the child is the patient and the pain, fear, or hope that a child feels as a patient is going to have immediate ripple effects on the family unit. That family unit, and how all the researchers, clinicians, hospital staff, and so on interact with the family unit, must be considered accordingly. To put it simply, we must take into account the needs of many--the family--when we are trying to solve for one--the child.
Q: What new technologies or strategies would you like to introduce to St. Jude?
Corbin: I’d look to introduce technologies that are relevant to the problem at hand rather than prospectively attempt to bring in technology that’s in need of an application, however exciting or promising it may seem. Arguably, I see my role and team as a strategy that’s already been introduced. St. Jude is committing resources and energy to enabling innovation as we implement our strategic plan and that is a strategic choice that I’m proud to be a part of carrying out.
Q: Are there any current practices or trends that you would like to see discontinued?
Corbin: I would discontinue the use of the phrase 'healing environments' to describe hospitals and healthcare facilities. I remember hearing this phrase when I started my career in healthcare design in the early aughts and it bothered me, but I couldn’t articulate why. It is meant to differentiate an approach to designing modern, patient-centered facilities from many of the utilitarian hospitals of the 1940s and '50s hospital building boom. Yes, some healing does take place inside hospitals, but so much healing--physically, mentally, spiritually--happens outside and independent of the healthcare facility. I’d reframe it as hospitals are 'helping' environments; they’re there in moments of acute need and can absolutely initiate the healing process. Yet our patients and families often have a long road ahead of them once they walk out our doors and I believe we’d do well to recognize that more overtly.
Q: How has your background prepared you for this position?
Corbin: I’ve held a variety of roles across an array of companies, all related to innovation, design, and healthcare in some balance. You could say I’ve sat in a lot of different seats of the healthcare industry table: hospital administrator, patient experience designer, healthcare architect, non-profit board member, managing director responsible for a lot of people’s professional livelihoods. I’m also a parent to two young kids. On any given day, I see life at St. Jude through one or more of these lenses and would like to believe I’ll be valuable to the organization because of that.
Q: What has surprised you about healthcare innovation so far?
Corbin: That the essential and ubiquitous patient care space--the exam room--is still a 10x12-foot box with some chairs, a desk, and freezing cold air blowing on you while you wait nervously in a paper gown on a table. Innovation here is an enigma.
Q:How do you see this role and this department evolving? What's on the horizon?
Corbin: What’s on the immediate horizon is beginning recruitment of my team so that, together, we can build out the department and identify prioritized projects to partner on with other departments and teams at St. Jude. We will start and operate initially as a small team so we can be nimble and adapt our way of working as needed in order to be effective within the larger ecosystem of St. Jude. Longer term, I’d like to see this role and department evolve to a place where design and innovation methods are used in a strategic fashion throughout the organization and aren’t exclusively the domain of me or my team.
The US Drug Enforcement Agency has proposed expanding the rules to allow providers to use telemedicine to prescribe controlled medications. Telehealth advocates say the new rules aren't that helpful.
Federal regulators are taking steps to expand the use of telemedicine in prescribing controlled substances, a key pandemic waiver that has helped behavioral health and substance abuse providers but which is scheduled to end soon.
“DEA is committed to ensuring that all Americans can access needed medications,” DEA Administrator Anne Milgram said in a press release. “The permanent expansion of telemedicine flexibilities would continue greater access to care for patients across the country, while ensuring the safety of patients. DEA is committed to the expansion of telemedicine with guardrails that prevent the online overprescribing of controlled medications that can cause harm.”
“Medication for opioid use disorder helps those who are fighting to overcome substance use disorder by helping people achieve and sustain recovery, and also prevent drug poisonings,” Milgram added. “The telemedicine regulations would continue to expand access to buprenorphine for patients with opioid use disorder.”
While the proposed new rule would be an improvement for some providers, there are limitations. According to the DEA, the proposed rules do not affect telemedicine consults that don’t involve the prescribing of controlled substances or consults with established patients. They would also not affect consults by a care provider to whom a patient has been referred, as long as the referring provider has previously conducted an in-person exam with the patient.
Reaction to the new rules has been mixed. Nathanial Lacktman, a partner in the Foley & Lardner law firm and chair of the firm's national Telemedicine & Digital Health Industry Team, said they were "not what most industry stakeholders were anticipating" in a blog posted today.
"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," he wrote. "In so doing, DEA proposed creating two new limited options for telemedicine prescribing of controlled substances without a prior in-person exam. The options [are] both complex and more restrictive than what has been allowed for the past three years under the PHE waivers. The DEA’s proposal will discontinue the ability for telemedicine prescribing of controlled substances where the patient never has any in-person exam (with the exception of an initial prescription period of no more than 30 days’ supply). Moreover, if the patient requires a Schedule II medication or a Schedule III-V narcotic medication (with the sole exception of buprenorphine for opioid use disorder (OUD) treatment), an initial in-person exam is required before any prescription can be issued."
The proposed rules, which now go through a 30-day public comment period, were drafted with the help of the Health and Human Services Department and US Department of Veterans Affairs.
“Improved access to mental health and substance use disorder services through expanded telemedicine flexibilities will save lives,” HHS Secretary Xavier Becerra said in the press release. “We still have millions of Americans, particularly those living in rural communities, who face difficulties accessing a doctor or health care provider in-person. At HHS, we are committed to working with our federal partners and stakeholders to advance proven technologies and lifesaving care for the benefit of all Americans.”
When the PHE was enacted in January 2020 to help the nation deal with the growing pandemic, a number of waivers and exemptions were put in place by federal and state regulators to help healthcare organizations expand and be reimbursed for digital health and telehealth services. The idea behind this was to allow providers to use virtual and connected health tools and platforms to reduce the spread of the virus and make sure consumers were able to access needed healthcare services.
Many of those waivers were extended until the end of 2024 in the Consolidated Appropriations Act of 2023. But the waiver on the use of telemedicine to prescribe controlled substances wasn't included in that bill.
Passed into law in 2008, the Ryan Haight Online Pharmacy Consumer Protection Act severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.
Writing in their Health Care Law Today blog earlier this year, Thomas Ferrante and Rachel Goodman, partners with the Foley & Lardner Law Firm and members of the firm's Telemedicine & Digital Health Industry Team, say the waiver of the in-person exam during the PHE ensured that "millions of both established and new patients were able to receive medically necessary prescriptions via telemedicine."
"There have been efforts to amend the Ryan Haight Act and encourage the DEA to activate the telemedicine special registration rule before the PHE expires, including pending federal legislation," they wrote. "However, to date, the Ryan Haight Act has not been changed and the DEA has not activated the telemedicine special registration rule."
Telehealth advocates say the new rules don't go far enough, and that the DEA still needs to set up a special registration process so that more providers can use telemedicine for behavioral health and substance abuse treatment.
"The DEA’s proposed rules are not the special registration process that Congress mandated and could gravely disrupt millions of patients’ treatments and care regimens," Robert Krayn, co-founder and CEO of telepsychiatry company Talkiatry, said in an e-mail to HealthLeaders. "Instead of taking inspiration from more modern state-level prescribing policy already introduced in Connecticut and Florida, the rules reinstate obsolete and counterproductive in-person requirements under the guise of novelty. There is nothing novel about sending vulnerable patients back into the dark ages of care delivery."
"Rather than restrict bad actors, this over-corrective proposal disadvantages and disproportionately affects mental health care, preventing responsible physicians and clinical leaders from expanding care access," he added. "The mental health care community must unite and fight for patient access to quality care, regardless of a patients’ location and socio-economic status or the societal stigma attached to their condition."
The 77-page toolkit includes four case studies and frequently-asked questions about how to identify, collect, analyze, and use social determinants of health to address healthcare inequities and access issues.
Federal officials have unveiled new resources to help healthcare organizations gather and use data on health inequities.
HHS defines SDOH as "the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks." This includes home and family, education, work, travel, and digital literacy, among other factors.
Healthcare organizations have been increasingly focusing on SDOH as they shift to value-based care and the concept of treating the "whole patient" on his or her lifelong healthcare journey. That means taking into account and addressing all the factors that affect a patient's health and wellness through programs and partnerships.
Addressing SDOH is complex given the diversity and multisector nature of services (i.e., food, housing, transportation insecurity, clinical care)," ONC staffers Elise Sweeney Anthony, Mark Knee, and Meley Gebresellassie wrote in a blog post announcing the toolkit. "This can present challenges to service coordination due to non-uniform data collection, varied system designs, and differences in information technology (IT) capacities (including for exchange)."
"ONC recognizes the potential of data-driven technologies, including certified health IT, to impact health equity, and we are committed to advancing the use of interoperable, standardized data to represent social needs and the conditions in which people live, learn, work, and play," they added.
The 77-page toolkit is focused on what ONC calls the 10 foundational elements of SDOH information exchange and includes four case studies and frequently-asked questions. It's designed to help healthcare organizations identify both the type and source of SDOH data, collect and understand that information, and use it in collaboration with other organizations to reduce health inequity and improve healthcare access and clinical outcomes.
The New York-based health system is closing care gaps and improving clinical outcomes through a platform that offers multiple opportunities to connect with patients in between medical visits.
A lot happens to patients in between medical appointments, and healthcare organizations are starting to take that into account. From automated messaging programs all the way up to remote patient monitoring and home health visits, they're developing an understanding that healthcare is a continuous journey, rather than a series of isolated incidents.
At Northwell Health, those interactions are handled in an automated care program. Zenobia Brown, MD, senior vice president and associate chief medical officer at the New York-based health system, recently sat down—virtually—with HealthLeaders to talk about how health systems can identify the best opportunities for in-between visit care within larger health strategies, and how they ensure those opportunities drive impact.
Q. Can you give us an overview of Northwell Health's automated care program strategy?
Brown: Northwell’s approach to in-between visit technologies has been ‘What can help us as we try to achieve something that aligns with our organizational need?’ An example of that is that for the past six years we have worked very successfully on our readmission rates. If someone leaves the hospital and then comes back, especially within 30 days, in some cases that represents a clinical failure. We don’t want that for patients. We want patients to be well when they leave our buildings and not need to come back, especially for things that are preventable. So we took a look at how are we interfacing with patients before and after they are in our care. Then we took a look at how we could do that at scale across our 21 hospitals.
Zenobia Brown, MD, senior vice president and associate chief medical officer at Northwell Health. Photo courtesy Northwell Health.
One phrase I love is ‘You can fix any problem with enough money.’ If you have a nurse physically follow every discharged patient home for 30 days, that will work. That will probably keep people out of the hospital. Of course, that is not feasible, and that’s where the technology comes in. That is the disciplined approach that Northwell has taken. We ask ourselves, ‘What are we trying to do clinically? Where is the gap? Can technology help us with this gap?’
Q. How do you measure success with these programs?
Brown: Ultimately what you need is for providers to behave differently, and for patients to behave differently. You need an infrastructure that can respond to the needs of those two parties. If I can’t engage with the patient when and how it is convenient to them, then I have no hope of changing their behavior or what happens to them. But when you are mindful of the patient’s needs and they feel that you will be there for them any time they need it, then the trust is built and then behavior changes.
We want our patients to call us at the first sign that they are having trouble, but we must be asking the questions. We need to be engaged and asking the questions and asking them often. And that’s where the technology comes in. Asking questions multiple times in different ways and at different times when it’s convenient to the patient is what sticks. This creates an infrastructure and provides really good information coming right from the patient. This patient-generated data then comes back to the providers, who can then adjudicate that information.
Q, How many of these programs has Northwell deployed, and how have they helped to reshape in-person care?
Brown: It really spans the gamut of everything from pre-operative, postoperative pain, test results, cancer treatment, COVID-19, etc. It was huge, the ability to do some of this automation during the pandemic. So when you’re looking at big populations and straightforward things that patients don’t want to get tied up on the phone for, it can just be a chat. It lends itself to a lot of use cases.
We talked about patient-generated data and how that extra information is helping us build, reframe, and retool our different programs. For example, a really important issue is the maternal mortality crisis. How do we end that cycle of maternal mortality, particularly amongst Black and Brown women. So we’ve established the Center for Maternal Health and are using automated care programs to stay connected to these women. How are we hearing them? How are we asking them the right questions at the right times when it’s convenient to them? I can now tell you the top reason that moms are escalating back to us through these chats is due to high blood pressure. Based on that information, we can build additional programming to address that specific issue. Post-visit chats that are creating escalations also help us change our behavior during the visit to proactively address some of issues. It’s about enhancing how we deploy our clinical programs as a whole.
Q. Can you provide an example of how an automated care program is improving patient care?
Brown: I’ll give you an example from that high-risk moms program. We talk about patients needing to be approached with the questions in multiple different ways, in ways that are convenient to them. We had a patient who, in her in-person encounter, did not reveal that she was having behavioral health symptoms consistent with severe depression, with suicidal ideation. She revealed that in the chat. When the stakes got lower and she was home and she could just put it in her phone, she revealed that. She already had the appointment, so standard care would’ve meant no further intervention for this mom until her next appointment. But we were able to have another interaction with her that then surfaced this issue, and then we were able to respond to that. That builds trust.
Q.How do your care providers feel about these programs?
Brown: I think it’s been invigorating for the team. In cases where the patient needs it, the team has actually interacted more with the patient. There is always a concern with automation that it is replacing a person, but we don’t see it that way. It helps with scaling, it helps with efficiency, and we actually see additional interactions, but they’re happening when the patients need it. So, let’s say a single nurse can do 10 patient interactions—one interaction per patient, 10 interactions for 10 patients. Well, with automated care, now a nurse can do one interaction for all 10 patients, and then that one patient that might have an issue, they might need 10 interactions themselves. And then there’s everything in between.
Q. What is one piece of advice in terms of identifying opportunities for automated care programs that you might give to another health system considering this strategy?
Brown: This can help with every aspect of patient care, from something very simple to something very complicated. There are many use cases and because you are trying to do something for so many people, this can surface a lot of very helpful information to make people well. Basically, you’re talking about a new way of delivering care and communicating with patients.
The national non-profit has created a Consumer Voices Workgroup to gain information on how consumers access and share their health information, and the challenges they face in doing so.
The Sequoia Project is adding the consumer's voice to the effort to establish a nationwide health information exchange.
The non-profit group this announced the formation of a Consumer Voices Workgroup, designed to gather input from consumers on barriers they face accessing and sharing health information. The work done by this group will help in the development of a Consumer Engagement Strategy Workgroup, which will be formed later this year to develop specific strategies for consumer engagement, access, usability, education, and policy.
“Collectively, the groundwork for health IT interoperability mandated by federal policy and laid by industry innovators can be leveraged by consumers,” Mariann Yeager, The Sequoia Project's CEO, said in a press release. “To realize the promise of consumers actively accessing and using their own information, we must understand their perspectives and the human experience, and the struggles they face in trying to access information they need to care for themselves and loved ones.”
“It is important to have consumer representatives communicate their experiences, needs, and insights to inform what industry can do to make it easier for everyone to access, use, and share their own health data,” said Shannah Koss, executive vice president of community development for Livepact and a co-chair of the group with Grace Cordovano, PhD, BCPA, founder of Enlightening Results. “Our workgroup members and the people they care for have truly heartbreaking experiences—ones that could have been avoided if they had better electronic access to their records and if health information exchange was more broadly and consistently used for patients.”
“Requesting medical records brings everyone dealing with a catastrophic diagnosis to their knees, and it shouldn’t be this complicated,” added Cordovano. “The administrative burden placed on patients and their care partners and caregivers to access, use, and share their health records must be addressed.”
The workgroup is made up of a diverse set of consumers, with half reported more than 11 healthcare visits per year and almost 90% acting as caregivers.
Healthcare organizations are taking a deep dive into healthcare data to personalize care for underserved patients.
Data analytics may seem like a cold, heartless concept, but healthcare organizations are learning how to use data to deliver more compassionate care.
For Robert Paeglow, MD, founder, president, and medical director of Koikonia Primary Care in Albany, New York, compassionate analytics involves using patient information to build a complete healthcare model, identifying and addressing gaps in care. That's especially important to underserved populations such as dual-eligible patients, who might be getting a fraction of the care they need because they only visit a doctor for an immediate health concern.
"You have to be able to understand all that the patient has to deal with in order to be effective," he says. "We can all read a medical textbook, but what good is it if you don’t understand what the patient is going through?"
Paeglow has been practicing medicine for more than 20 years, growing up around and serving some of the poorer neighborhoods around New York's capital city. And while he says he's "not a computer guy," his practice has used an EHR for more than a decade.
Like many care providers, there's a challenge not only in gathering data through the EHR, but it's also putting it to use. And with the spotlight now on health equity and addressing social determinants of health, the emphasis is on finding the right data to impact patient care.
Paeglow's medical practice gets some of its guidance from Belong Health, a digital health company that works with hospitals and health plans to improve what it calls patient-centered care. Belong Health is one of several companies focused on extracting and analyzing data to improve Medicare Advantage and dual-eligible programs.
Mac Davis, the company's vice president of analytics and growth, says providers often need help pulling together information for complex populations.
"It's really our job to make numbers work for people rather than making people work for numbers," he says. "Numbers tend to make healthcare faceless and dehumanize the patient. [Healthcare providers] need analytics that understand value and humanize that process."
But what does that mean? To Davis, it means understanding where and why complex-care patients aren't getting the care they need. Coordinating care with different providers, such as specialists, may be too complicated, or there may be barriers to accessing care, such as work, family or transportation. That's where the gaps occur, and where patients become disenfranchised with the healthcare system.
To coordinate and manage care for those patients, Davis says, providers need to integrate care into daily life and make it easy to access. That means staying close to home.
"Healthcare is very local for these populations," Davis says. "It has to be."
Paeglow, known to his staff, colleagues, and many of his patients as "Doctor Bob," is that connection. He's the first and often only healthcare contact for his patients, and a trusted resource. And Koikonia Primary Care was founded to be that resource for poor and marginalized populations.
"You kind of want to be like Cheers, where everybody knows your name," he says.
But with that name comes a responsibility.
"We're providing healthcare on a shoestring budget," Paeglow points out. "So it's important that we make it as efficient as possible. But how do we do that and still have that personal touch? We have to make sure the resources we have matter to them."
Paeglow says he and his colleagues hold weekly staff meetings to go over the information, identifying trends and predictors that they can address with their patients. They look for specific data points that they can translate into actionable information, targeting issues like diet and exercise, medication adherence, blood pressure, and blood sugar.
"We need [that information] to refine our programs so that they can be more effective," he says.
That includes mental health. Being the primary care provider for underserved populations means identifying and addressing those concerns, Paeglow says.
"These people can't go to a psychiatrist if they don’t have access," he points out.
At Belong Health, Davis says they look not only at patient engagement, but specific interactions over longer periods of time. They develop risk stratification models based on those interactions, and the likelihood that someone will react positively to this advice or that suggestion.
"It's how you use them and how you’re adding to these things that makes a difference," he says. "The ultimate goal of medicine is that people can live their lives outside of medicine … so you’re looking for [interventions that make an impact.]"
Davis says compassionate care is a journey. Built into that strategy is the idea that providers and patients are collaborating on that journey. Patients will stay engaged if the information they get from their care providers is meaningful and effective. Conversely, if the information doesn't mean much, or doesn't produce results, they'll tune out the doctor or nurse, ignore advice, and skip scheduled appointments.
"This compassionate analytics approach is really about building trust," he says.
Paeglow agrees.
"We're like the linchpin that holds everything together," he says. "At the end of the day, it's all about the data you have and can use. And I can't imagine working now without this."
A new American Hospital Association report takes a closer look at the biggest challengers to healthcare's status quo, and challenges traditional providers to be innovative to survive in a competitive primary care market.
The primary care landscape, which accounts for some $260 billion in annual healthcare spending, is ripe for transformation. The growth of direct-to-consumer telehealth and the retail healthcare industry are putting traditional providers on notice: Embrace innovation or fade away as consumers take their healthcare elsewhere.
To understand how to offer primary care in this chaotic landscape, healthcare leaders might do best to look at how disruptors are entering the space. That's the gist of a report from the American Hospital Association, which cites a Bain & Company analysis that indicates 30% of that primary care market could be owned by those non-traditional providers within seven years.
The AHA's "Health Care Disruption: 2023 Outlook" examines how seven of the biggest disruptors--Amazon, CVS Health, UnitedHealth Group, the Walgreens Boots Alliance, and Walmart, and tech companies Apple and Google/Alphabet—has staked their claim in primary care, and used that platform to expand.
"The nation’s largest retail, payer and tech disruptors once again invested billions of dollars in healthcare in 2022, continuing to build out their visions to transform the field," the report notes. "In the short term, these moves helped the companies grab market share in primary care, concierge medicine, virtual care, in-home medical services and elsewhere."
"In many cases, the investments helped companies broaden their footprints as they continue to integrate their expanding vertical healthcare operations in areas like pharmacy benefits management, behavioral health, care coordination, diagnostics and therapeutics, and health information technology," the report continues.
It points out that these disruptors are seeing success by addressing pain points and gaps in healthcare that traditional, fee-for-service providers have failed to correct. And in the future, healthcare will continue to see these innovative care models that focus on value-based care by, among other things, offering multi-disciplinary services that address specific consumer concerns at the time, place, and modality that they prefer.
The Disruptors
Amazon may be the biggest of the disruptors, with its proposed purchase of One Medical, pending a review by the US Federal Trade Commission, poised to dramatically shake up the primary care field. But the online giant is also expanding its pharmacy base with RxPass, and boosting diagnostics, therapeutics and disease management capabilities.
But this path forward isn't assured, or easy. The failure of the company's virtual primary care platform, Amazon Care, is still fresh, and the One Medical partnership is still under review. Critics also question whether Amazon can forge partnerships with health systems and scale its primary care service to stay on par with competitors like Walgreens and CVS.
CVS Health, meanwhile, is laying the groundwork to be the biggest primary care provider, capped off by the recent acquisition of Oak Street Health. The company has also picked up Signify Health and is investing heavily in virtual care and digital health, through both its HealthHUB locations and innovative start-ups and early-stage tech companies. With more than 10,000 retail pharmacies in the US and Puerto Rico, as well as 1,000 MinuteClinics, it's poised to continue growth.
But will the company's reach exceed its grasp? Critics wonder if it's growing too fast, and not laying the right groundwork through partnerships with providers and payers. Management's goal to facilitate 65 billion healthcare transactions by 2030 is a lofty promise.
UnitedHealth Group, which includes Optum, is the one familiar face in the crowd, with a background in the payer market. The company has made a huge push toward diversification, topped off by the $8 billion merger with Change Healthcare this past year and investments in digital health, care coordination and remote patient monitoring capabilities. Now it's focused on value-based care, including an ACO partnership with Walmart, a partnership with HealthEdge and the acquisition of Imperium Health.
And while value-based care is at the top of everyone's to-do list, no one has figured out how to make it work just yet. UnitedHealth Group will have to integrate all of these new partners and programs while also convincing its physicians and members to embrace VBC.
Walgreens Boots Alliance's growth is yet to come, but the company has laid the ground work with its partnership with primary care provider VillageMD and home care company CareCentrix and the acquisition of Summit Health. The company is now poised to expand its presence in the US with co-located primary care practices alongside its pharmacy network, while building out a home healthcare platform.
The big question is whether Walgreens Boots can compete with the likes of Amazon and Walmart and meet its ambitious growth plans. This is uncharted territory for the company, and the best-laid plans don’t always come to fruition.
Walmart, meanwhile, is building on an established base as the nation's largest retailer by adding virtual care, a discount drug platform and even an EHR. The company is betting on its brand and its pharmacies to establish long-term healthcare partnerships, which will be augmented by telehealth services, health centers and enhanced value-based care partnerships. The key to its growth is in creating partnerships with consumers.
But the name and the network won't automatically lead to success. Walmart still has to deliver the kind of healthcare experience that will make customers come back again and again. Like the others, it will have to scale accordingly, and hope it has the resources to support its vision.
Alongside the five retail giants are two technology firms, Apple and Google/Alphabet.
While Apple won't be competing for primary care, the company is aggressively expanding its healthcare platform through devices with the Apple Watch and iPhone, giving payers, providers and researchers new opportunities to connect with the consumer. As Apple continues on this path, it will need to make sure that connection is safe and reliable. The information collected by those devices and used by both consumers and providers has to accurate, meaningful and protected, as well as easy to gather and disseminate.
To expand from that platform, Apple will need to look for other ways to monetize that relationship beyond device sales.
Google/Alphabet has that platform, and will be investing heavily in AI technology and hardware to make healthcare data accessible and easy to use. The company is actively courting the pharma market and investing in technology that enables healthcare organizations to focus on health equity, value-based care and patient engagement. It's also partnering with health systems to tackle specific pain points like radiology support and patient flow.
The question for Google/Alphabet will be whether it can "own" the consumer's healthcare journey and monetize those interactions. Some wonder if the company will expand to include direct care or prescription drugs.
How Can Healthcare Organizations Fit In?
The AHA report concludes with four questions that every healthcare organization should ask:
Do we have an omnichannel presence that provides the convenience, access, transparency, pricing and other information and services that patients want?
Are there partnership opportunities with any of the Big 5 companies transforming primary care?
How can we leverage our strength in established trust and rapport with existing patients to use our outpatient, clinic and virtual services for routine and nonemergent care?
How can we partner with big tech firms around research, data sharing, etc., to improve care?
The implication is clear. Healthcare organizations can't continue with a business-as-usual approach. Consumers are more in control of their healthcare expenses and decisions, and they have the ability to shop around. Likewise, payers and self-insured businesses are looking for better ways to deliver and track healthcare, with the goal of cutting out the tremendous amount of waste that the industry has been supporting for years.
In order to keep up with the disruptors, they may have to be the disruptors.
A new survey commissioned by AHIMA finds that nearly 80% of healthcare organizations are collecting data on social determinants of health, but they're having problems gathering and analyzing the right data, finding trained personnel to do the work and putting that data to use to improve clinical outcomes.
Roughly eight of every 10 healthcare organizations are collecting data on social determinants of health (SDOH), but technology problems are keeping them from using that data to effectively improve clinical outcomes.
That's the takeaway from a new survey commissioned by the American Health Information Management Association (AHIMA) and conducted by NORC at the University of Chicago. The survey, of 2,600 AHIMA members and others, found that providers are facing difficulties standardizing and integrating data, including a lack of training on how to collect, code and use the information. They also are struggling to use the data they have.
“The effective collection, coding, and use of SDOH data are vital to improving health and healthcare outcomes,” Wylecia Wiggs Harris, PhD, CAE, AHIMA's chief executive officer, said in a press release issued by the agency. “Health information professionals play a pivotal role in how SDOH data is collected, shared, and ultimately used to improve health and healthcare outcomes. We look forward to collaborating with policymakers, providers, and key stakeholders to advance comprehensive solutions to address the challenges illuminated by this survey.”
The US Department of Health and Human Services defines SDOH as "the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks." This includes home and family, education, work, travel, and digital literacy, among other factors.
Healthcare organizations have been increasingly focusing on SDOH as they shift to value-based care and the concept of treating the "whole patient" on his or her lifelong healthcare journey. That means taking into account and addressing all the factors that affect a patient's health and wellness through programs and partnerships.
But according to the AHIMA survey, that isn't easy. According to researchers, less than 2% of the claims data of Medicaid and Medicare enrollees includes SDOH.
"Despite the increased attention and emphasis on SDOH, there are real challenges to addressing individual social needs, especially within the healthcare system," a white paper issued with the survey points out. "Historically, the healthcare system has not been oriented to address these issues and significant changes are needed to enable healthcare providers to affect health outcomes through the use of this data. While a multitude of changes are needed, a focus on the documentation of these needs and translating those needs into coded data for actionable use is foundational."
According to the survey, some 78% of respondents collect SDOH data, and 71% of them gather it through the EHR, but they prioritize different elements. Only 44% track housing insecurity, 38% eye economic stability, 36% look at food insecurity, 28& look at transportation, and 17% track education.
"These findings suggest that these variables might not have structured fields in the organization’s ’s EHR that would facilitate collection," the white paper notes.
Among other issues, the survey found that while health systems are collecting the data, they aren't necessarily integrating it in to the EHR.
"The fact that the data may be incomplete, unstructured, and/or buried in inconsistent fields -- such as health concerns, goals, social history, etc.— may limit the integration of this information into the EHR," the study reported. "Broader collaboration among key stakeholders across the health care sector is a critical step to improved collection of SDOH data and ultimately using this data to improve health outcomes. Policy can serve as a crucial lever to advance collaboration between stakeholders with the ultimate goal of improving the collection, coding, and use of clinically-relevant SDOH data to improve health outcomes."
To that end, AHIMA is recommending that HHS lay out what SDOH data healthcare organizations should be collecting, and perhaps offer financial incentives for prioritizing that data.
In addition, the organization recommends that the federal government offer financial and technical support to train healthcare providers on how to collect, code, and use SDOH data, including "a focus on cultural competency coupled with the recognition that different care settings may require different approaches."
Finally, AHIMA is recommending that the federal government provide funding, technical resources, and infrastructure to help providers use that data in coordination with other organizations.
"Many of the solutions to addressing SDOH needs rely on collaboration between the health and social services sectors," the white paper concludes. "This type of cooperation is happening in pockets at the local level. Many providers are reticent to ask their patients about their SDOH needs without first having the community-based support system to which they can refer the patient so that these needs can be met. Federal incentives are needed for states to create better alignment—across coordinating agencies to improve coordination, collection, and, ultimately, impact."
Six healthcare organizations have been selected to implement and test the TEFCA standards as the next step in becoming Qualified Health Information Networks (QHINs), the latest stage in the development of a nationwide healthcare information exchange.
Federal officials have named six healthcare organizations as qualified to implement the Trusted Exchange Framework and Common Agreement (TEFCA), the latest step in the effort to create a nationwide healthcare information exchange.
At a news conference Monday, US Health and Human Services Secretary Javier Becerra presented certificates to the CommonWell Health Alliance, eHealth Exchange, Epic TEFCA Interoperability Services, Health Gorilla, Kno2, and KONZA. Those organizations are now qualified to implement and test TEFCA standards on their way to being designated Qualified Health Information Networks (QHINs).
"This is a significant step for the US health system and one that will advance interoperability at scale for patients, health care providers, hospitals, public health agencies, health insurers, and other authorized health care stakeholders," Micky Tripathi, PhD, the HHS' National Coordinator for Health IT (ONC), and Mariann Yeager, CEO of the Sequoia Project, said in a blog. "Strong privacy and security protections are required of QHINs and their expanded connectivity will help improve the quality, safety, affordability, efficiency, and equitability of health care across the country. Nearly every American that uses the health care system will eventually experience the benefits."
Tripathi and Yeager, whose organization is the TEFCA Recognized Coordinating Entity, said the six networks cover most the nation's hospitals and tens of thousands of providers and process billions of healthcare transactions each year.
Federal officials unveiled the TEFCA guidelines in January 2022, fulfilling requirements of both the 21st Century Cures Act and HITECH Act that called for a clear infrastructure model and governing approach for a nationwide health information exchange. The Trusted Exchange Framework is a set of non-binding principles for health information exchange, and the Common Agreement is a legal contract that highlights those principles.
The Sequoia Project will sign the Common Agreement with each QHIN, after which the QHINs will set up the new connectivity framework, using as a guide the QHIN Technical Framework, which lays out the functional and technical requirements. At the same time, the ONC and Sequioa Project are also developing a TEFCA Health Level Seven (HL7) FHIR Roadmap to ensure interoperability.
