HealthLeaders Innovation and Technology Editor Eric Wicklund talks to Geoffrey Boyce, co-founder and CEO of Array Behavioral Care, about the evolution and future of telehealth in the behavioral healthcare space and the impact of proposed DEA rules on the use of telemedicine to prescribe controlled substances.
The Dallas-based Parkland Center for Clinical Innovation saw great success with its Accountable Health Communities (AHC) program, thanks to the participation of community health workers (CHWs).
Community health workers (CHWs) were found to be one of the critical elements that supported the Parkland Center for Clinical Innovation’s (PCCI) successful five-year implementation of the US Centers for Medicare & Medicaid Services' Accountable Health Communities (AHC) model in Dallas County, Texas.
PCCI and its provider partners and community-based organizations supporting the Dallas AHC model offered innovative and highly effective new technologies and methods to help address health-related social needs (including food, housing, transportation, utilities, and interpersonal safety) of Medicare and Medicaid beneficiaries in Dallas County. But the glue to the entire process was the human touch delivered by CHWs who worked with the program participants every day through a process called 'navigation.'
The work itself was not unique to the program. CMS requires AHC awardees to screen and identify high-risk beneficiaries with health-related social needs (HRSNs) and provide them with active navigation services consisting of referrals to aligned CBOs, accompanied by monthly follow-up calls for up to 12 months or until the documented HRSNs are successfully addressed. CMS provided specific methods, goals, and even scripts for this work.
But what we didn’t count on was the impact of our CHWs in delivering compassionate support to those who were not expecting it but were incredibly grateful to receive it.
The Ideal Beneficiary Screening Setting
A key factor in a successful outreach program such as this is to have the 'Ideal Screening Setting.' When we began implementing the AHC program, we thought we could include screening for HRSNs in outpatient clinical site encounters. However, our CHWs and team realized that screening in outpatient clinic waiting areas was not ideal for the beneficiaries, who were waiting to see a physician or financial department advisor. In addition, because we did not have a private space for conducting the screening, there were concerns that others could hear the conversations with the CHWs. As a result, this process yielded a low rate of completed screenings, making it nearly impossible to meet our CMS navigation targets.
We decided to change our approach to conduct screenings in Emergency Departments. While this yielded a slight increase in the number of completed screenings, the numbers were still not sufficient to meet CMS targets. It's no secret that EDs are extremely busy, and CHWs wanted to be respectful of the clinical staff who had other, more pressing priorities. It was also difficult to get participation from individuals who were focused on more immediate health needs or in pain.
With these lessons learned, we shifted to a telephonic post-clinical-visit screening intervention. Our CHWs could screen beneficiaries through a phone call within five days of their inpatient, ER, or outpatient encounter. PCCI’s data scientists helped make this engagement possible by generating daily beneficiary eligibility call lists for the CHWs. The beneficiaries could communicate in the language of their choice, and could even request a call-back if they did not feel comfortable answering the screening questions at the time of the initial call. This process was the 'Ideal Screening Setting,' and it allowed PCCI to not only meet, but ultimately surpass, CMS navigation targets.
What Successful Outreach Looks Like
Once an eligible beneficiary completed the screening and interview, the CHW provided a list of referrals to CBOs best suited to meet the beneficiary’s needs (help with food, rent, or transportation). Referrals for each beneficiary were based on the CHW’s personal knowledge of available local resources.
The outreach didn’t end with one screening or referral. Following a two-week referral follow-up, the CHWs contacted the beneficiary monthly to determine if any additional referrals were needed, as well as to assess the status of the beneficiary’s experience with the resource list and referrals. If a beneficiary was unsuccessful with a specific CBO, the CHW offered additional guidance or a new referral. This proved beneficial, as beneficiaries often reported new needs not identified during the initial screening stage.
The CHWs had to overcome a number of obstacles, especially the pandemic. Many CBOs limited or changed their hours or even closed unexpectedly. Our CHWs found themselves driving by CBOs to check on their availability while updating the program’s network on the CBOs’ status. This speaks to the dedication and passion our team had in making sure the program participants were well cared for and received the most up-to-date and accurate information.
Additionally, with the help of PCCI’S data scientist, they were able to create a daily automated case management report that identified which beneficiaries needed to be prioritized in the CHW’s caseload and weekly workflow. This enabled CHWs on the team to maintain a caseload of about 200-250 beneficiaries at any one time. Because they were consistent with their monthly follow-ups, the CHWs developed a rapport with beneficiaries, making it easier to learn of concerns or additional needs.
Some of the most pressing concerns outside of CMS' five core HRSNs (food, housing, utilities, transportation, and interpersonal safety) are affordable child-care, baby supplies such as formula and diapers, and medical equipment. These additional needs are incorporated into our CBO directory.
The consistency of our outreach made it possible to conclude that it takes, on average, about 93 days or 4 telephone contacts to be able to resolve a need. During the pandemic we also noted that the CHW phone calls with beneficiaries were longer, especially for those who did not have any family or friends to count on or had to isolate because they were at high risk of infection. This truly speaks to the power of human impact and the willingness of the CHW team to go above and beyond for the beneficiaries they served.
Human Touch is Still the Best Human Service
The results of the program speak to its success in very meaningful ways. For example, the results showed that actively navigated individuals saw a greater decrease in ED visits than those in a comparable control cohort, and they also had a statistically significant reduction in average ED utilization, both while actively navigated and in the 12 months after navigation. They also demonstrated a greater likelihood to seek and keep scheduled outpatient visits compared with the control cohort. These results were included in our manuscript in NEJM Catalyst titled "The Dallas Accountable Health Community: Its Impact on Health-Related Social Needs, Care, and Costs."
These results offer our community greater cost savings and lead to a healthier community, especially for those who are considered the most at-risk. In addition, a survey of participants on their perspectives and experiences yielded these comments:
“It helped me out in so many ways with my first baby. As moms we think everything will be easy, but there was so much I didn’t know about that helped me.”
“It made a big difference for me both emotionally and with my physical needs like food and bills. To know Parkland cares about us means so much!”
“It was nice to hear that there was help. I didn't feel alone.”
A highlight from this survey is the value that participants placed on the connection with their CHWs, underscoring the importance of the human touch in improving the health and well-being of those most at-risk. For our team of CHWs, the positive data and cost savings are great, but their pride comes from knowing they have helped to provide meaningful compassion, care, and support to people who needed it the most.
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The Coalition for Health AI (CHAI) includes Stanford, the Mayo Clinic, Vanderbilt, Johns Hopkins, Google, and Microsoft, and is overseen by a number of federal agencies.
A group of healthcare organizations who have joined together to advance AI adoption has released a set of guidelines designed to help providers use the technology responsibly.
“Transparency and trust in AI tools that will be influencing medical decisions is absolutely paramount for patients and clinicians,” Brian Anderson, MD, a co-founder of the coalition and chief digital health physician at MITRE, said in a press release. “The CHAI Blueprint seeks to align health AI standards and reporting to enable patients and clinicians to better evaluate the algorithms that may be contributing to their care.”
The guidelines, which build upon the White House Office of Science and Technology Policy's (OSTP) Blueprint for an AI Bill of Rights and the AI Risk Management Framework (AI RMF 1.0) developed by the US Commerce Department's National Institute of Standards and Technology (NIST), come at a crucial time for the development of AI in healthcare. The technology has been praised as an exciting new tool and criticized as a dangerous trend.
"In a world with increasing adoption of artificial intelligence for healthcare, we need guidelines and guardrails to ensure ethical, unbiased, appropriate use of the technology," John Halamka, MD, MS, president of the Mayo Clinic Platform and a co-founder of the coalition, said in the press release. "Combating algorithmic bias cannot be done by any one organization, but rather by a diverse group. The blueprint will follow a patient-centered approach in collaboration with experienced federal agencies, academia, and industry."
Launched roughly one year ago, CHAI also includes Berkeley, Duke Health, UCSF, Vanderbilt University Medical Center, Change Healthcare, MITRE, and SAS and counts several federal organizations, including the Centers for Medicare & Medicaid Services (CMS), US Food & Drug Admi9nistration (FDA), and Office of the National Coordinator for Health IT (ONC) as observers.
The group is also collaborating with the National Academy of Medicine (NAM) on separate guidelines for the responsible development and adoption of AI in healthcare delivery.
“We have a rare window of opportunity in this early phase of AI development and deployment to act in harmony—honoring, reinforcing, and aligning our efforts nationwide to assure responsible AI," NAM Senior Advisor Laura Adams said in the press release. "The challenge is so formidable and the potential so unprecedented. Nothing less will do."
The Cleveland health system aims to offer the latest in cellular immunotherapies, including chimeric antigen receptor T-cell (CAR-T) and tumor-infiltrating lymphocytes (TIL) cancer therapies, to more patients.
MetroHealth has opened a new facility aimed at making the latest in innovative cancer treatments and therapies available to more patients, including those affected by social drivers of health (SDOH).
The Cleveland-based health system will be offering cellular immunotherapies, including chimeric antigen receptor T-cell (CAR-T) and tumor-infiltrating lymphocytes (TIL) cancer therapies, in its vector and cellular Good Manufacturing Practice (GMP) facility. Officials say they're the first safety-net hospital in the US to make these services available on-site.
“Overcoming social barriers for the communities we serve is part of MetroHealth’s core mission," William Tse, MD, MetroHealth's division director of hematology and oncology, said in a press release. "This new facility furthers that commitment by providing the next generation of cancer treatments to people in need, regardless of financial status.”
“It is crucial that we address social drivers of health for our community – the factors that matter beyond traditional medical care," added Airica Steed, EdD, RN, MBA, FACHE, the health system's president and CEO. "Whether the need is to access transportation for follow-up appointments, healthy food, or other support systems, MetroHealth is committed to changing the way patients receive care. The launch of our vector and cellular facility will match these holistic support offerings with next-generation treatments and clinical trials, providing our community the access they need to enable the best possible outcomes.”
Health system executives noted that CAR-T therapy, which uses T-cells modified in a laboratory to target specific cancer cells, is only accessible to patients of large academic centers or those with the financial means to travel to the health system. MetroHealth will be offering these treatments through its Institute for HOPE, which addresses population affected by SDOH.
The 1,300-square-foot facility will house the MetroHealth Cellular Immunotherapy and Stem Cell Transplantation Program, and was supported by the Cleveland Innovation District, a collaborative partnership that includes the city's five major medical and academic institutions, the state and JobsOhio.
“MetroHealth is different from most transplant hospitals in that we are able to develop and produce our cellular immunotherapies from A to Z in-house, speeding up delivery of innovative treatments, such as CAR-T therapy production, for both patient treatments and clinical trials," Tse said. "As a result, we are better able to address unmet patient needs and bring therapeutic innovations to our community and beyond.”
Allina Health is seeing immediate results with a technology platform that automates the OR scheduling process and helps match surgeons to times and procedures.
Editor's note: This article appears in the June 2023 edition of HealthLeaders magazine.
Experts have often said that the healthcare industry needs to adopt innovative technologies used by the banking and retail industries to become more effective.
At Allina Health, a platform being called the "Open Table for surgery scheduling" is proving that point.
The Minneapolis-based 12-hospital, 90+ clinic network is using an AI-enhanced software platform developed by digital health company Qventus to map out its operating room schedule. The technology integrates with the EHR and automates a block-based process that formerly took up hours of staff time and effort and caused a considerable amount of stress.
"The old process was manual and hadn't really changed in 20 to 30 years," says William Evans, the health system's vice president of surgical services and orthopedics. "It was inefficient, cumbersome, and laborious."
Evans says Allina Health recognized they would need new technology to both improve OR utilization and revenues and make life easier for stressed staff and surgeons. The old process, in which surgeons were responsible for filling up blocks of time and new or visiting surgeons tried to fit in enough procedures to qualify for block scheduling, left too many holes in the OR schedule and gave surgeons and schedulers headaches trying to map out when they could schedule a surgery or grab procedures in need of a surgeon.
Allina Health decided to implement an enterprise-wide, automated scheduling platform, which works along the same lines as a scheduling platform for tables at a restaurant or seats at a theater.
"Allina Health tends to be on the forward edge of [healthcare innovation]," Evans says. "I think we're always finding new ways to use technology. This just seemed like a perfect place."
In a phased roll-out, the health system partnered with Qventus, based in Mountain View, California, to launch the platform for its DaVinci surgical robots at Abbott Northwestern, then expanded the process to include established surgeons who qualify for block scheduling, then to newer and visiting surgeons who hadn't yet qualified for block scheduling. Surgeons are responsible for scheduling their own procedures, he says, and often struggle to balance their time, running the risk of losing out on prime slots in the OR if they can't stay true to their schedule at least 75% of the time.
Evans says it was important to offer this tool on a voluntary basis, rather than mandating that surgeons use it.
"We want them to embrace the technology because it makes their lives better, rather than forcing it on them as a mandate," he says. "Once they see what it can do (including taking only 20 minutes from submitting a request for OR time to approval), they'll accept it and work with it."
According to statistics supplied by the health system and Qventus, Allina Health, which deployed the new platform in mid-2022, saw 3.5 cases added per OR per month in the first four months, including a 36% increase in cases per surgical robot per month. Evans says that success has enabled Allina Health to not only increase robotic surgeries but also add more robots.
On the other side of the ledger, the platform helped to release more than 100 hours of OR block time earlier each month, enabling surgeons to better manage their schedules and allowing the health system to quickly fill up open spots and times left open due to scheduling errors or unforeseen issues. In addition, the platform automatically schedules 2 out of every 3 elective cases, helping to improve a key revenue generator.
According to Evans, the AI technology not only helps surgeons manage their time, but also matches open slots to surgeons based on their typical use patterns and the health system's needs. It also matches surgeons to available surgeries based on their qualifications.
Evans says the health system saw almost immediate benefits with the platform, with surgeons looking to use the technology to plan their schedules during the first phase of roll-out, which was supposed to be limited to robotic surgeries.
"We quickly exceeded our performance goals," he says, noting the platform significantly reduced the workload for schedulers and allowed them to address other administrative tasks that may have been pushed to the back-burner. The health system also saw a reduction in surgeon and staff turnover, he says, and might be used as an incentive to attract new employees.
"There will be some unexpected benefits that we haven't seen yet," he says. "This frees up a lot of time for surgeons and staff and makes their lives better. That's a huge advantage. Automation was the missing piece of the puzzle there."
In this week's episode, HealthLeaders editor Melanie Blackman is joined by Ronda Lehman, PharmD, market president of Mercy Health's Lima Market in Ohio. During the conversation, Ronda shares insights into her career journey, which started in 1995 in one of the system's hospital's pharmacy departments, the initiatives she's excited to lead in the coming months, and shares advice for aspiring healthcare leaders.
Several groups have issued critical reviews of the DEA's proposed revision of rules regarding telemedicine prescriptions of controlled substances. Some say the revision will imperil thousands of patients.
Telehealth and digital health advocates aren't pleased with the US Drug Enforcement Agency's proposed rules for prescribing controlled substances via telemedicine after the expiration of the COVID-19 Public Health Emergency.
The long-awaited proposal, unveiled in February, had been expected to ease the pathway for healthcare providers to use telemedicine to prescribe medications like buprenorphine without needing an in-person examination. But with the agency's 30-day window for public comments expiring, the vast majority of the 20,000+ comments submitted have been negative.
"Leading professional associations, respected think tanks, and experienced clinicians submitted compelling and noteworthy comment letters explaining how the proposed rule will result in limitations on access to care, harm patients in rural and urban areas alike, and likely result in otherwise avoidable overdoses and deaths when patients are denied access to their medically-important medications," several lawyers from Foley & Lardner wrote in the firm's Health Care Law Today blog.
Nathaniel Lacktman, a partner in the firm and chair of its national Telemedicine & Digital Health Industry Team, was among the earliest commenters on the proposed rules.
"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," he wrote in a February 27 blog. "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."
Lacktman and his colleagues produced a legal guidebook shortly after the proposed rules were unveiled, and submitted a 15-page letter picking apart various aspects of the rules on March 30. Others submitting critical comments (the Foley & Lardner team called it a "tsunami of criticism") include the American Telemedicine Association, the Alliance for Connected Care, and a group composed of members of the Brookings Institution, Harvard Medical School, David Geffen School of Medicine at UCLA, and Harvard T.H. Chan School of Public Health.
Krista Drobac, executive director of the Alliance for Connected Care, said the proposed DEA rules would lead to "immense patient harm," particularly to patients seeking treatment for behavioral health issues. According to the alliance, 65% of all patients living with a substance abuse disorder or overdose diagnosis in 2021 also had a pre-existing mental health condition.
"DEA must find a path to allow the continuation of comprehensive mental health (and substance use disorder--which is often overlapping) treatment to patients through telehealth," she wrote. "While we believe there are many appropriate use-cases for telehealth involving controlled substances, such as palliative care, the vast majority of patients who would be harmed by the rule are relying on telehealth for access to mental healthcare."
The FDA's proposed rules would allow providers to use telemedicine to prescribe 30-day supplies of Schedule III-V non-narcotic controlled medicationsand buprenorphine, the latter specifically for the treatment of opioid abuse disorder, for new patients and without the need for an in-person evaluation. They redefine guidelines that had originally been included in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which 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.
Dozens of federal and state waivers were enacted during the COVID-19 PHE to improve access to and coverage of telehealth services. Many of those waivers were extended to the end of 2024 by Congress, but others—including the DEA waiver on using telemedicine without an in-person visit—will end with the PHE on May 11.
With that deadline looming, the DEA proposed to amend its rules to allow for more telemedicine use. The response was anything but positive.
While many complained that the 30-day comment period was too short, commenters like Foley & Lardner cited several issues with the proposed rules. Foley & Lardner Partner Nathan Beaver, the author of the letter to the DEA, listed 14 changes that the firm feels should be made, including removing requirements for an in-person exam, creating a special registration process for telemedicine providers as directed by the Ryan Haight Act, grandfathering patients being treated via telemedicine during the PHE, and revising the rules to allow providers to refer patients to medical groups, health systems, and other collaborating practices.
"We believe the proposed rules as written will limit access to legitimate healthcare while not promoting the public health and safety goals of DEA," Beaver wrote. "In this comment letter, we provide reasonable suggestions and solutions that will allow DEA to appropriately address diversion concerns while safeguarding patient access to essential telemedicine services including for the treatment of mental health and substance use disorder."
The event in Nashville, co-hosted by HLTH and CHIME, featured a heavy hitting line-up of health system executives and good discussions about workforce and operations priorities.
As ViVE 2023 packs up and the estimated 7,000 attendees depart Nashville, the biggest take-away from this event isn't any product rollout or partnership announcement. It's the guest list.
Craig Richardville, chief digital and information officer for Intermountain Health, said ViVE gave him an opportunity to rub elbows with a number of his peers, share insight into the challenges and opportunities that new technologies and strategies offer, and hear about what other health systems are doing.
"I might see something really interesting and tell (another healthcare executive) about it, or someone will tell me, 'You should check this company out,'" he said during a chat at the Intermountain Health booth in Music City Center's exhibit hall. "It's the chance to meet up and talk with people."
Richardson, later seen enjoying the Black Crowes concert at the Industry Night Reception at the Wild Horse Saloon, was among dozens of health system executives attending ViVE, the colorful second-year event co-hosted by HLTH and the College of Healthcare Information Management Executives (CHIME). The presence of so many decision-makers in the exhibit hall and in sessions on stages situated around the hall lent significant value to the conversations.
Those conversations were about finding a way to stay ahead in challenging times.
Paul Uhrig, chief legal and digital health officer for New York's Bassett Healthcare Network, said many health systems are just focused on survival at this point. They're also focused on the workforce, where Bassett has a 20% vacancy rate in its provider ranks.
With razor-thin margins, staff shortages and competitors entering the space. Uhrig said health systems are looking for very specific solutions to very specific problems, not the newest technology or tools. And they want skin in the game from vendors.
"We own nothing by ourselves," added Tarun Kapoor, MD, Virtua Health's senior vice president and chief digital transformation officer, describing an innovation and technology landscape that has evolved significantly over the past few years, due to the effects of the pandemic and a struggling economy. The focus these days, he says, is on partnerships, either with the vendors or other organizations looking to improve the industry.
Workforce issues, from staffing and provider shortages to burnout and stress reduction, as well as security, revenue cycle development, and business automation, were on everyone's agenda. Telehealth, remote patient monitoring, digital health tools, AI, and solutions specifically designed to help nurses were also top of mind.
And the people who make the decisions were in the room and ready to talk.
During a panel on digital transformation that featured executives from UPMC, LifeBridge Health, Health First and Mt. San Rafael Hospital, the talk was about developing a strategy to overcome roadblocks common to the industry. William Walders, CIO and senior vice president of IDN operations at Health First, noted he has to work with—and more often around—seven different electronic medical records in his bid to "keep up with Domino's Pizza," one of the most successful consumer-friendly companies in the nation.
"This industry is one of the most antiquated industries out there," added Michael Archuleta, chief information officer at Colorado's Mt. San Rafael Hospital. "We should be leading the pack when it comes to innovation."
Archuleta pointed out that technology is often thought of as a cost center in healthcare, when it should be considered a "true value maker," especially at a time when healthcare organizations are struggling with their bottom lines and need to better define value.
That's what other industries, such as retail, hospitality, and banking, have done.
"I can get a massage, a behavioral health appointment, [or] a girlfriend on my phone—why not a doctor?" Walders mused.
Karen Hanlon, executive vice president and chief operating officer at Highmark Health, said health systems need to improve their digital front door to keep up with the competition. And they need to highlight the fact that health systems know how to do healthcare, whereas other entries in the primary care space are in it for the money.
"The best chance of getting that engagement is when the provider is integrally involved," she said.
The theme of playing catch-up to the likes of Amazon, Domino's, American Airlines, and Hilton was common throughout ViVE, but catering to the consumer wasn't the top concern of healthcare leaders. Most were on hand to find solutions to workforce issues, with the idea that improving the workplace for doctors, nurses, IT staff and others would in turn improve clinical operations and outcomes.
"Workforce is the number one issue we're facing," noted Michael Hasselberg, NP, MS, PhD, chief digital health officer at UR (the University of Rochester) Medicine and director of the UR Health Lab, the health system's digital health incubator. "This has rapidly shifted [to the top of the list] over the past six months, and now we're focused on trying to give clinicians their time back."
For vendors, the innovation and technology marketplace has certainly changed. Health systems don't have the time or money to spend on new ideas or strategies that haven't been proven or take several months to establish. They're looking for technology that has already proven its value, integrates well with existing platforms and quickly shows an ROI.
Shez Partovi, chief information and strategy officer at Phillips, said health systems are laser-focused on solutions that help clinicians, especially nurses. They're also looking for technology that can predict and plan out workflows and identify crisis points in the health system, so that health systems can address issues before they become crises.
"They want to be more proactive" and less reactive, he said.
Intermountain's Richardville agreed. He said health systems need to use data and data analytics to better understand and design workflows. More data, and better tools to analyze that data, gives them better opportunities to manage and improve caregiving.
"We're into any and all things digital, and data is digital," he said.
As a result, health systems are looking for partnerships with vendors, rather than one-off deals for point solutions. They want to work together on problems with solutions that can evolve.
"The expectations have changed," said Roy Schoenberg, MD, MPH, president and co-CEO of telehealth giant Amwell, who sees more interest in health systems for agreements with shared risk and less interest in solutions that address only one small part of the system. "The people we sell to are very different from the people we sold to three years ago."
Schoenberg says investment in innovation and technology is more important now, as health systems understand the value of these platforms and tools in affecting value-based care and predicting future pain points. Where once those decisions were solely handled by CMOs, CMIOs and CIOs, now the COO, CFO, and even the CEO are entering the conversation.
And they aren't interested in small talk.
"If you walk in with a sales pitch, those meetings are very, very short," he said.
Indeed, at an innovation panel held at the Bobby Hotel, near the convention center, Julie Murchinson, a former CEO of Health Evolution who's now a partner with Transformation Capital, noted there are more people at the table to talk about healthcare innovation and technology, and they’re measuring value in different terms.
"Pay attention to the CFO," she said. "They're starting to put dollar signs in front of what we care about."
John Beadle, co-founder and managing partner of Aegis Ventures, cited the structural decline of the healthcare business as a particular challenge, and said health systems have to be involved in new business ventures and partnerships to solidify their standing.
Noting the many new entrants to the healthcare space, from Amazon to Walgreens, Beadle said health systems need to focus on getting back into the driver's set and doing what they do best.
That's what many healthcare executives at ViVE mentioned. With all of the challenges facing the industry and competitors looking to claim their piece of the action, healthcare executives need to remember that they know how to best do healthcare. And their decisions on innovation and technology should create a better environment for clinicians and staff, either by improving workflows or automating repetitive tasks.
Only then will they be able to connect with a patient population waiting for them to catch up to the times.
"We need to see our patients and our community as an IT-enabled participant in healthcare," said Tressa Springmann, senior vice president and chief information and digital officer at LifeBridge Health.
Recent CMS and CDC rulings offer hope that health systems will show more love for innovative treatments like digital therapeutics and virtual platforms.
As healthcare executives and digital health companies converge on Nashville this week for ViVE 2023, the prospects for new tools like digital therapeutics and virtual technology seem to be improving.
On the heels of the Centers for Medicare & Medicaid Services' (CMS) decision to create a unique reimbursement code for digital therapeutic company AppliedVR, the Centers for Disease Control and Prevention (CDC) last week approved the use of video-based directly observed therapy (DOT) for tuberculosis treatment, saying the virtual platform could be used as an equivalent to in-person medication monitoring.
"Missed doses of medication or treatment interruptions can lead to suboptimal drug concentrations, acquired drug resistance, longer treatment times, TB treatment failure, and recurrence of TB disease," the CDC said in its March 24 report. "For these reasons, CDC continues to recommend DOT as the standard of care for all persons prescribed TB treatment; however, based on the evidence summary, this report updates the 2016 CDC U.S. clinical practice guidelines (1) to state that vDOT should be considered equivalent to in-person DOT."
In its ruling, the agency said vDOT, which enables care providers to watch patients taking their prescribed medication by video, usually through the patient's smartphone, has seen higher rates of medication adherence compared to in-person monitoring. In addition, the digital health platform is more convenient for patients and providers, can save time and costs for programs, helps patients who can't easily access in-person healthcare and improves patient satisfaction.
The ruling is specific to TB treatment, which can last several months and relies heavily on a patient's ability to take specific medications at specific times.
Among those supporting vDOT is the New York City Department of Health, whose TB control program included vDOT as far back as 2014. The CDC asked the city, which has one of the highest TB rates in the nation (6.1 per 1,000 people, compared to the national average of 2.5) to participate in a study of the value of vDOT, and used the results in its recent ruling supporting the platform.
“Directly observed therapy has been a backbone of our work for a long time and of course the pandemic put a lot of that under threat in restricting people’s movement and their ability to remain adherent on what can be at a minimum 6 months of treatment, if not longer,” New York City Health Commissioner Ashwin Vasan told STAT News in an interview.
“In over 200 patients studied, it was found to be just as effective as traditional DOT, in addition to being more cost-effective because you obviously reduce transportation costs,” he added. “You reduce delays, you reduce trade-offs and opportunity costs because these are visits that can happen over video that would otherwise cause the person to leave work, or leave school, or to leave wherever they are, and present to a clinic to pick up their medications.”
Both the CMS ruling on AppliedVR and the CDC's move to support vDOT give digital health companies hope that the healthcare industry will embrace these new tools and technologies, especially if Medicare, Medicaid, and other payers also support the treatments.
And that's crucial. Many health systems are operating on razor-thin margins and don't have the time or money to invest in new technologies unless there's a clear ROI.
Among the companies benefiting from the CDC announcement is Scene Health, formerly emocha, which offers vDOT services to a number of public health programs across the US for treatment of a wide range of chronic conditions, including substance abuse, asthma, diabetes, and hypertension.
"In recognizing that video DOT is equivalent to in-person DOT, the CDC has modernized the 'gold standard' for medication adherence," Scene Health CEO Sebastian Seiguer, in Nashville for the ViVE conference, said in an e-mail to HealthLeaders.
"DOT is used for all medications in the inpatient setting, but has seen limited use in outpatient care due to high cost and logistical burden," Seiguer said. "Video technology exponentially reduces these barriers making DOT scalable. At the same time, at Scene Health we’ve worked very hard to preserve the person-to-person, supportive engagement that makes DOT work, regardless of delivery method."
In the AppliedVR case, CMS created a unique Healthcare Common Procedure Coding System (HCPCS) Level II code (E1905) for the company's RelieVRx program, which uses virtual reality-based cognitive behavioral therapy. The CMS ruling classifies the technology platform as durable medical equipment (DME).
"It's finally time to more fully embrace ITx [immersive therapeutics] and move toward its use becoming more towards standard of care rather than a 'one off' niche solution in the treatment of chronic lower back pain, for example," Matthew Stoudt, co-founder and CEO of AppliedVR, said in a press release announcing the CMS action.
"We envision immersive therapeutics as a future alternative to a lifetime of pills or costly surgeries," he added. "Enabling broad coverage for the RelieVRx program will deliver a powerful, yet affordable and scalable digital solution for millions of people."
With ViVE on the doorstep, a new survey finds that healthcare decision-makers are looking for technology that addresses workforce shortages, prepares the health system for a recession and improves data management.
Healthcare executives looking to make technology deals at next week's ViVE conference are looking for solutions that address clinician and staff burnout or help the health system weather a potential recession, a new survey reports.
The survey of some 300 decision-makers in healthcare, conducted by Intelligent Medical Objects, also puts data storage and analysis tools at the top of the shopping list, while AI tools aren't yet worth all the flashy marketing.
According to the survey, 94% say they plan to invest in technology that either addresses workforce issues or prepares the health system for a recession.
“Hospital providers face a lot of uphill battles, from data integration to clinician burnout, and this survey shined a light on how data integration can have a positive impact on patient care and day-to-day operations,” Ann Barnes, the company's CEO, said in a press release accompanying the survey. “It’s helpful to understand the most pressing needs as US provider organizations are making bold changes to improve patient care and are adapting their strategies faster than ever before.”
The survey comes as healthcare CIOs and chief digital health officers converge in Nashville next week for the ViVE 2023 conference, and as they and other decision-makers prepare for the Healthcare Information and Management Systems Society's (HIMSS) annual conference next month in Chicago. Both events are expected to feature discussion on a wide range of critical healthcare issues, including staff and clinician shortages brought on by burnout and stress, the upcoming end of the COVID-19 Public Health Emergency, new technologies and programs like telehealth, remote patient monitoring, Hospital-at-Home, digital therapeutics and AI, and federal efforts to improve privacy and security, enforce prior authorization rules and improve interoperability and data sharing.
Data will likely figure in a lot of conversations, according to the IMO survey.
Almost all of the decision-makers surveyed say their organizations must improve the way it uses data to improve healthcare delivery and operations, and 90% said they've had moments in the past where they lost or leaked revenue due to inefficient practices.
The survey shows similar results from other surveys and reports that list workforce management as the top priority of healthcare organizations, many of which are struggling to retain clinicians and field a good IT department. Many are also worried about the economy, with hospital margins at or perilously close to the red and a recent report indicating more than 60 hospitals are at risk of closure.
According to the survey, 71% cited maintaining or improving clinical care quality as the most important internal risk. Some 65% percent cited problems with clinician burnout, while half cited administrative burnout and 45% cited data issues.
The survey also pointed out a continuing issue for healthcare organizations looking to stay on top of the latest technologies while facing staffing issues. Some 84% of those surveyed said their health system is working with more then 20 vendors. Almost a third said software integration was their biggest problem with vendors, while 29% cited inadequate training provided by vendors and 17% reported long implementation timelines.
And that's a problem. With the economy struggling, many healthcare organizations are taking a hard look at new purchases and technologies, and requiring solid proof of ROI before they consider any new purchases. Health systems aren't going to invest in anything new if they don't see immediate and lasting value, and they certainly won't be interested in products that take a long time to install.
Finally, healthcare leaders are interested in AI technology, and both this and another recent survey pointed out that they're using the technology to address back-end operational and workforce management issues. But at the same time, many of those surveyed said the hype currently outweighs the value.
“For technology to have a positive impact on providers, it has to get out of the way and integrate seamlessly into clinical workflows,” Steven Rube, MD, IMO's chief clinical officer, said in the press release. “This survey validated an assumption that … providers needed assistance to seamlessly integrate relevant clinical data in the care of their patients. The pandemic unleashed a torrent of investment in new healthcare software solutions, and provider organizations have struggled to understand which types of software will present the best ROI."
