The Nashville-based health system’s new chief digital & transformation officer says it’s her goal to create lasting relationships between the health system and its patients. And that begins with helping providers.
Ask Anika Gardenhire about transformation, and she’ll bring up a concept that has only recently entered the healthcare lexicon: The idea of stickiness.
“[My] priorities are really building experiences for all of our different [patients] and making those experiences extremely sticky,” says Gardenhire, RN, CHCIO, Ardent Health’s new chief digital & transformation officer. And her goal, she says, is to “be able to have the type of trusted relationship across the [patient’s journey].”
That idea of stickiness, of enticing a consumer to continue to visit Ardent Health and develop loyalty to the Nashville-based 30-hospital for-profit network, is quickly becoming a catchphrase for many healthcare organizations these days. No longer can a hospital sit back and wait for patients for waltz through the front door; hospital leaders need to be proactive, reaching out to people and meeting them where they need or want their care, creating a sense of partnership.
It's not an easy path to follow at a time when healthcare services can be accessed via telehealth networks, or by visiting retail health centers, or even ordered through Amazon, but that’s the nature of consumer-focused care. And health systems and hospitals are finding they have to embrace new ideas like stickiness to create the relationships they need to survive.
Gardenhire, who became Ardent Health’s first chief digital and information officer in 2023, had “information” replaced with “transformation” in her title this past March. The title change reflects a shift in the healthcare narrative toward value-based care, along with the idea that the industry needs to transform itself to meet consumer preferences.
That means, she says, making a connection with the consumer.
“I don’t think there will be a time where a mom looks through the legs and sees a robot delivering the baby,” she says. “That’s always a very human experience. But how do you surround the obstetrician with the right data and the right tools and the removal of tasks that don’t require the very unique art of building a human-to-human connection? Get all of those things out of the way of that connection happening.”
Anika Gardenhire, chief digital & transformation officer at Ardent Health. Photo courtesy Ardent Health.
That’s where the “digital” part of her title comes in. Gardenhire, who spent time as the AVP of digital transformation at Intermountain Healthcare and chief digital officer and chief customer experience officer at Centene before coming to Ardent Health, sees digital health technology as the framework around which the healthcare experience is created. That means giving both patient and provider the technology they need to make the encounter better, from online scheduling to remote monitoring to AI tools that reduce administrative tasks on both ends and smooth out clinical care.
This doesn’t mean using any and all technology at one’s disposal. Gardenhire says Ardent Health’s technology strategy has to be very purposeful and directed.
“If we want healthcare to be a very human experience, then you probably can’t put a lot of shiny baubles between the human connection,” she says. “You need to be thinking very intentionally about how you put technology in the background and … promote human connection.”
For example, Gardenhire says she’s fascinated by what she calls “calm technologies.” They’re the tools that sit in the background, quietly gathering and assessing data (such as the doctor-patient conversation) and enriching care management without standing between the doctor and patient or disrupting the experience.
She also feels that innovation and transformation should have a destination, rather than being a continuous, even incremental, process.
“Sometimes we can get into a place where we’re trickling in transformation and nobody actually knows when to click into it,” she says. “I think that’s really dangerous, especially in our clinical spaces. [We need to] be very clear about this transformation. This is the ‘from’ and the ‘to,’ and we won’t be ‘ing’ing forever.”
In other words, tell your clinicians what you’re doing, and give them ownership over the transformation process.
“At the end of the day it has to be clinician-led transformation,” she says.
Gardenhire sees a lot of opportunities for healthcare innovation, from the supply chain to the hospital room of tomorrow. She anticipates more clinical uses for consumer tech, especially is the industry develops smaller, lighter and more nimble tools that can reliable and securely capture data. And as telehealth and virtual care gather momentum, the idea of transporting a patient from one hospital to another will become as quaint as the rotary phone.
In fact, Gardenhire sees the home as the next big care site, enhanced with technology that can gather daily information, capture social determinants of health, interact with users and connect with care providers.
There will come a time, she says, “when you can actually see that person at home, surrounded by the things they need to care for them and [for them to] manage their chronic diseases, but which allows them to still move through their house and walk their dog down the street, all while they’re monitoring themselves. Or [you’ll have technology] that allows a child with asthma to be monitored during the night and not have to wake up because we can raise the humidity in the room or release a nebulizer without sleep being disrupted.”
“When you imagine all of those things coming together that we’ve built out – not only the applications and not only the cool technology but also the infrastructure,” she concludes. “I think it’s a really awesome time to be in this space.”
A new survey finds that home health agencies are abandoning virtual care due to complexity and a lack of reimbursement. This could hinder efforts by healthcare leaders to extend more hospital services into the home.
Home health agencies embraced telehealth during the COVID pandemic to support patient care, but a growing number are giving up on virtual care, saying it’s too complicated for their patients and unsustainable.
That’s the key takeaway from a study commissioned by the National Institute on Aging and conducted by the University of California, Irvine, and several other universities. Conducted between 2023 and 2024 of roughly 260 home health agencies, it places blame for the drop-off on a lack of Medicare reimbursement, and raises questions about whether home-based care programs can support telehealth at a time when health systems and hospitals are moving more services to the home.
“Our findings suggest that without [Centers for Medicare & Medicaid Services] reimbursement, many agencies may abandon telehealth, potentially missing opportunities to improve care and manage costs as home health demand skyrockets,” Dana Mukamel, a UC Irvine Distinguished Professor of Medicine and corresponding author for the study, said in a press release.
According to the study, published online in Health Services Research, telehealth adoption among home health agencies stood at roughly 23% in 2019, then surged to 65% in 2021, during the height of the pandemic. By 2024, however, 19% of those organizations had opted to discontinue virtual care, due to a lack of Medicare reimbursement and concerns about sustainability.
On a side note, one-third of all the home health agencies responding to the survey haven’t embraced telehealth at all, saying it’s inappropriate for their hands-on model of care. The study was tilted toward organizations that focus on elderly patients, especially those dealing with dementia-related health concerns.
“These patterns suggest that COVID-19 disrupted telehealth’s natural diffusion into home healthcare, which was gaining traction pre-pandemic,” the press release points out. “The study posits that without the pandemic, telehealth might have continued spreading as agencies recognized its benefits. However, the lack of reimbursement and perceptions of telehealth’s limitations for older adults pose barriers to sustained use.”
The study raises two important points.
First, many surveys have shown a decline in telehealth adoption after the pandemic, the inevitable result of patients wanting to get back in front of their doctors after relying almost exclusively on video visits. Telehealth advocates say this pendulum effect should wear off as both providers and patients understand the value of virtual visits and work toward a hybrid strategy that mixes in-person care and telehealth.
The monkey wrench in the works here is reimbursement. Federal and state lawmakers enacted a number of waivers during the pandemic to ease restrictions on telehealth use and boost coverage. While some states have moved to make pandemic-era conditions permanent, the federal waivers are set to end this fall. Many advocates fear that without those waivers, particularly those having to do with Medicare reimbursement, healthcare organizations will scale back their telehealth programs.
Second, there’s the pesky little fact that America’s population is aging, with a large chunk set to hit retirement age soon, and they’re healthier than their predecessors and looking to stay at home and out of the nursing home or assisted living center. The healthcare industry isn’t ready to handle that extra workload – it’s already struggling with workforce shortages and questionable costs. Telehealth offers a channel for providing care to this population while reducing the stress on providers.
While aligning federal policy to improve telehealth reimbursement is a critical piece to telehealth strategy moving forward, the home healthcare industry also needs to rally around virtual care tools and platforms that are effective and intuitive. With health systems and hospitals looking to extend their services into the home, through remote patient monitoring, Hospital at Home and other strategies, they’ll need support from the home health industry to make those services effective and sustainable.
The New Jersey health system is rolling out two new vehicles this summer as part of its Eat Well program, which connects patients to nutritious food and other resources.
The Food is Medicine movement suggests that people who eat nutritious meals will see better health outcomes, and that proper nutrition should be a part of the care plan. The challenge for healthcare innovators lies in connecting patients to the foods they should be buying and preparing.
Virtua Health has been addressing that issue since 2017 with its Eat Well program, which began with a mobile farmer's market and two brick-and-mortar 'Food Farmacies,' where patients could get food 'prescribed' by their primary care providers and access resources on nutrition.
More recently, the New Jersey-based health system has gone mobile, bringing food to those who can't easily get to the market or grocery store.
This past April, Virtua Health unveiled a new Eat Well Mobile Grocery Store, a 40-foot vehicle that visits neighborhoods where food insecurity is an issue. And the health system will soon be adding the Eat Well Mobile Food Farmacy, a mobile version of its brick-and-mortar program that will be dispatched to primary care locations where doctors are prescribing nutritious meals for selected patients.
Identifying the Barriers to Care
Stephanie Fendrick, Virtua's EVP and chief strategy officer, says non-profits traditionally use health needs assessments to gain a better understanding of the barriers to care faced by their patients.
"This assessment has consistently shown us that food insecurity is a top concern in our local community," she said. "So that really put it on our radar."
Stephanie Fendrick, EVP and Chief Strategy Officer for Virtua Health. Photo courtesy Virtua Health.
Fendrick says Eat Well was launched with the idea of giving primary care physicians a tool to address nutrition in care management, particularly for patients who are living with chronic issues. She says those doctors "are some of our biggest champions."
"Our physicians are acutely aware of the fact that it's hard to be healthy if you don't have access to healthy foods," she says. "They know that [with] many of the chronic diseases that they're facing every day, it's important that their patients have access to fresh fruits and vegetables and understand how to make a healthy meal, how to combine different ingredients to create those healthy meals."
The mobile program, Fendrick says, came from an understanding that food insecurity often goes hand-in-hand with transportation barriers. So instead of asking their patients to go to the market, Virtua Health is bringing the market to the patient.
"You can recommend all of that, but if you don't have access to the food, then how is someone going to change their lifestyle and incorporate [healthy eating] into their lifestyle?" she asks. "We felt that the mobile piece of it was important, to take food where people needed it,"
Virtua Health launched its first mobile grocery store in 2020, and April's rollout of a refurbished bus given to the health system by the New Jersey Transit Authority replaces the original bus, which was also a NJ Transit vehicle. A $1.5 million donation this year from the state of New Jersey paid for two vehicles (at $500,000 each), as well as renovations to the health system's distribution center, food and staff.
Fendrick says the mobile food program targets neighborhoods where food insecurity is high. The buses are parked at public locations like health centers, churches and senior housing complexes. Anyone in the neighborhood is welcome to shop at the bus, which offers nutritious foods at prices 40% to 50% lower than retail sites.
in some cases, Fendrick says, the food choices are tailored to the neighborhood's cultural identity. In Camden, for instance, roughly half of the population is Hispanic, so resources are offered in Spanish as well as English and certain foods are added to the bus.
"We're establishing trust with our community," she says.
Virtua Health has a fleet of six vehicles altogether, with three devoted to mobile programs such as pediatrics and cancer screenings. In some instances the health system will pair a food truck with another vehicle to offer multiple services in one location.
"We're really trying to wrap services around our patients to keep them healthy in their communities," Fendrick says.
Prescribing Food as a Part of the Care Plan
The Food Farmacy, meanwhile, is more focused. The program – which now consists of brick-and-mortar Food Farmacies in Camden and Mount Holly – enables primary care providers to prescribe certain food to patients who have food insecurity as well as a chronic condition like diabetes, high blood pressure or heart disease. The program gives patients free groceries that are "medically tailored" to their care plan, as well as access to nutrition counseling and other resources, for up to six months.
"Having access to certain healthy foods is great, but having the knowledge of what to do with them and how to use them to make healthy meals is also a very important part of the program," Fendrick points out.
The new mobile Food Farmacy will offer the same services, and will visit primary care offices (initially in Hammonton and Washington Township) where doctors are giving their patients prescriptions for the program.
According to Virtua executives, the outreach is showing positive results. The mobile grocery store program saw more than 7,500 transactions in 2024 and has grown year over year, while all of the Eat Well programs saw more than 47,000 transactions in 2024, an 8.6% increase over the previous year.
In addition, according to a survey of participants, 94% of customers to the mobile grocery store reported consuming more fruit and vegetables, and 88% say they've prepared more nutritious meals as a result.
Fendrick says this data is important, but the real test of the program's value will come over time, as the health system looks at clinical outcomes. For patients with chronic conditions, short-term details like weight loss, A1c levels and blood pressure will be charted. Over the long run, they'll be keeping track of health and wellness metrics and quality of life.
"That's taking us a little more time to get our arms around," she says. "Are we truly making an impact on their health outcomes?
The long run also means developing connections with the retail community and others to ensure a steady supply of food. Since the program's launch in 2017, more than $10 million in philanthropic donations have been invested in the program.
"We're looking for different types of partnerships and relationships to help keep this sustainable," Fendrick adds.
As for where the program goes from here, Fendrick says she wants to see steady growth for now, along with more education for both providers and patients about the value of good nutrition. She notes that Virtua Health sent one of its buses down to Atlantic City for a while at the request of the governor, and the program was such a success that a local provider is now running its own program there.
And of course, now that Virtua Health has a mobile farmer's market and grocery stores, could a food truck or two not be far behind?
A new tool assesses coronary inflammation, which is often overlooked in measuring the risk of a heart attack. One doctor says this test could detect problems years in advance and save lives.
An AI tool that can detect inflammation in the coronary artery could help clinicians diagnose heart disease much earlier, even decades before the patient shows any outward signs of distress.
CaRi-Heart Technology, developed by Connecticut-based Caristo Diagnostics, was recently given its own Category III CPT code by the American Medical Association’s CPT Editorial Panel, an important step in the path to adoption after FDA approval and, just as important, payer reimbursement. The technology has also shown promising results in trials conducted in 2024 at five National Health Service hospitals in the UK, where reports indicate more than half of patients analyzed by the AI tool had their treatments changed.
To clinicians, the tool could be a critical step forward in the diagnosis and treatment of heart disease, the leading cause of death in the country.
“Cardiology disease is very different than other diseases in terms of how we treat it,” says Stephen Bloom, MD, MSCCT, FASNC, FAHA, FACP, FACC, a cardiologist with Midwest Heart and Vascular Specialists in Overland Park, Kansas, part of the HCA Midwest Health System. “We do mammograms before people have breast cancer. We do colonoscopies before people have colon cancer. And then in cardiology, we wait until they have symptoms, and then we do our best to treat our patient, now with established disease. It doesn't even make sense.”
AI has the potential to analyze data from tests, such as a CT scan, more quickly and with more detail than the human eye. While traditional imaging can identify visible plaques that cause narrowing and blockages, the CaRi-Heart tool zeroes in on perivascular fat, or coronary inflammation, which is overlooked in assessing someone’s heart health.
And since acute MIs occur when non-calcified plaque ruptures, any method for detecting non-calcified plaque better and earlier would save lives.
“[AI] could actually look at each coronary [artery], each segment, if you break it down to three, and [it] can actually summarize not only how much calcified plaque you have, but also non-calcified vulnerable plaque, which has more of a tendency to rupture and cause a heart attack,” Bloom says.
Bloom notes that inflammation can be present in many diseases and measured by a blood test (c-reactive protein (CRP)). However, this blood test is not specific for the heart and less sensitive.
But with coronary CT with AI, clinicians can drill down further than they’ve been able to in the past. Bloom says doctors often use stress testing, but these tests only become positive for heart disease when the patient has a coronary blockage greater than 70%. This can create a false sense of security. Analyzing inflammation with plaque analysis from a CT could create a much better definition of a patient’s cardiac risks.
And it could be done long before any signs of heart disease are evident.
“We can take patients even before they have symptoms and diagnose whether or not they have early coronary disease and treat them with appropriate medication as well as a change in their diet [and] exercise,” Bloom says.
The challenge, as always with new technologies, is reimbursement. Most payers currently don’t cover tests like nuclear cardiac stress testing, MRI stress scans or even coronary CTs unless there are symptoms. Bloom is hoping that the results of the UK tests and the newly approved CPT code will prod payers to cover the CaRi-Heart test.
“The good thing is it’s simple [and] it’s painless and less expensive than nuclear and other tests like MRI, and so it could be the gatekeeper to reducing heart disease by finding it early and treating the patient in the early stages,” he says.
“The next five years will probably dramatically change the way we treat our patients with coronary disease,” Bloom adds, adding that plaque analysis from a CT has only been approved for reimbursement this past year. As more clinicians use these new tools with coronary CT and gather data on its effectiveness, they’ll build a better argument for coverage.
“We will be able to diagnose and treat coronary disease well before symptoms occur and finally reduce heart disease as the number one cause of death today ”.
MedStar Health SVP and Chief Innovation Officer Bill Sheahan says AI will meet its potential to transform healthcare when it improves clinical outcomes. And that will take some time.
As AI programs reach maturity, so, too, will their value. Early-stage tools that are under the spotlight now for cost will succeed in the long run if they also improve clinical outcomes.
That, says Bill Sheahan, senior vice president and chief innovation officer at MedStar Health and executive director of the MedStar Institute for Innovation, is where AI will be truly transformative. And that's how healthcare executives have to think about the future.
"We believe that the real transformative potential of AI will come from integrated, systemwide adoption," Sheahan, a participant in the HealthLeaders Mastermind program for AI in clinical care, said in a recent e-mail Q&A. "Much like the building of a new hospital within a health system, the long-term impact of AI across our health system will be measured in patient outcomes and margins, not millions."
In a HealthLeaders story last December, Sheahan described how the Maryland-based health system was taking a slow and steady approach to AI, with a particular focus on change management. That process has continued with governance.
"Over the past year, MedStar Health's AI governance has matured from a more exploratory, ad-hoc process into a structured and proactive system," he said. "We launched an AI review process involving experts across the enterprise in innovation, legal, compliance, equity, quality and safety, information security, operations, and beyond. Leaders at MedStar Health are empowered to explore and propose AI tools to address their needs and bring them forward for evaluation."
"The overall volume of new AI products and features being added across all areas of the organization, along with a better understanding of the complexity of integrating AI into clinical care, necessitated different approaches to governance and strategy," he added. "AI that is impacting clinical decision-making or that is patient-facing is typically higher-risk and more complex, requiring more internal expertise from our AI COE (Center of Excellence) than what are typically lower-risk clinical administrative or broader business applications (e.g., coding and billing)."
With that process in place, Sheahan says they're now looking ahead.
Bill Sheahan, senior vice president and chief innovation officer at MedStar Health. Photo courtesy MedStar Health.
"As we further establish our governance processes and opportunities, we increase our focus on strategic imperatives in areas with significant transformational potential that are not yet fully addressed within our current vendor ecosystem, either due to product fit or pricing constraints," he says. "Within these areas, we often buy a solution if offerings in the market are more robust and well-defined, while prioritizing an internal build/partnership model in more nascent areas."
Sheahan and others in the Mastermind program have said it's important to point out that AI isn't exactly new. Traditional machine-learning and predictive modeling have been around for quite some time. The addition of large language models, however, has given a boost to generative AI capabilities.
"In the generative AI space, we are integrating various tools throughout our software stack to support a wide range of application areas, ranging from our safety event tracking system to human resources and informatics," Sheahan says. "Exploration of EHR data is under way, utilizing internal tools to extract and code notes and radiology reports to drive workflows for incidental findings and quality."
"We will also soon roll out an internally-built ‘chat' program in phases across our system," Sheahan adds. "This internal alternative to widely-available tools aims to protect data, improve understanding of usage patterns, and support administrative and clinical staff in searching for system-specific information (e.g., human resources policies). More complex future iterations are expected to integrate patient-level clinical information to allow reasoning over both internal and national clinical guidelines."
Sheahan says the large-scale data warehouses that power large language models are also enhancing the value of traditional predictive modeling.
"Currently, we are implementing a next-generation sepsis algorithm and workflow, with plans to expand to pressure ulcers, fall prediction, and other critical events," he says. "We anticipate that older clinical ‘scores,' such as risk prediction calculators involving only a few simplified variables (e.g., falls, readmission, sepsis, etc.) to inform diagnoses and decision-making, will gradually be replaced with more accurate and fully-automated algorithms. We are also expanding our radiology portfolio to increase the number of findings that tools can detect and use for triaging radiologist review."
At this point in the AI curve, however, ROI is still elusive. There have been some great stories about AI tools that have reduced administrative burdens and workflows and helped both doctors and nurses spend less time on the computer and more time in front of their patients. Sheahan says it will take time for the long-term benefits to show.
"Many of these applications still have limited validation, whether for clinical outcomes or ROI," he says. "As an example, ambient dictation offers the advantage of personal scribes at a fraction of the cost, and providers and patients find it improves the quality of their interactions; however, many health systems are still working to fully quantify and capture the impact needed to secure long-term investment in these products."
"Many of the most promising products are enormously challenging to validate for clinical accuracy or safety as well given current tools, such as large language model products that summarize charts or aid clinicians in reaching diagnoses," Sheahan concludes. "These products otherwise have substantial potential to transform clinical care. Improved frameworks and accepted validation models will be necessary to address safety and outcome questions, leading to greater refinement and broader deployment."
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Nursing executives at the nation’s largest rural health system, participating in the HealthLeaders Virtual Nursing Mastermind program, say that ‘extra set of eyes’ is a crucial component to inpatient virtual care.
Virtual nursing programs have seen early success in helping floor nurses reduce time spent in the EHR and doing other administrative tasks. But at Sanford Health, nursing leadership wanted a more interactive platform.
Erica DeBoer, SVP, CNO for the health system that spans 56 hospitals and seven states across the upper rural Midwest, says leadership was intent on using an audio-visual platform from the start, and using the virtual nurse to “be another set of eyes and ears”that nurses in the patient’s room might not notice.
That might include vital signs or pain reassessment that need to be checked haven’t been collected, or a medication that needs to be taken. It also might be a patient showing subtle signs of mental distress, or someone at risk of falling, or a tense situation between a patient and a nurse that needs backup.
“Can we prevent some escalation of patient behaviors,” DeBoer says, “[and] get additional help to the patient room to support our team on the floor?”
That’s not a concern unique to Sanford Health, but it does underscore the value of a virtual nursing platform in providing support to floor nurses. Since the COVID-19 pandemic, health systems and hospitals have been dealing with high rates of nurse stress and burnout and a declining workforce, and they’ve been putting a premium of technologies and processes that improve the nurse’s workload and attract new nurses.
“It’s a recruitment and retention tool, knowing that our workforce is looking for forward-looking organizations that leverage technology to support care and safety,” DeBoer notes.
For the nation’s largest rural health system, keeping and attracting nurses is critical. And that begins with supporting them at the bedside.
DeBoer says the program, which is expanding to 40 more beds and integrating technology through the in-room television, is staffed from within. Nurses can be scheduled for two shifts on the floor and one shift as the virtual nurse, so that both patients and floor nurses know who’s at the other end of the audio-video feed.
As a result, those virtual nurses are also well-attuned to the tasks of the floor nurse, and they’re more apt to spot something that needs to be done. Instead of waiting for the floor nurse to ask for help, they can offer help when they see that need. This shifts the focus of the virtual nurse from a task-oriented workflow to one of observation and support.
It also reduces the friction between floor and virtual nurse, DeBoer says, and facilitates a team-based approach to care.
Advocates say virtual nursing can help providers address another trend: Hospital patients are becoming sicker, and their hospital stays are becoming more complex. That’s putting even more pressure on nurses.
“It’s not uncommon for our patients to travel anywhere from 30 minutes to four hours to receive care in an inpatient setting.” DeBoer says. “By the time they need hospital care, they’re there for a reason. They’re acutely ill in many cases and need to be admitted and require care.”
And while virtual nursing will improve the inpatient experience, DeBoer sees a future outside the hospital as well. Rural health systems like Sanford rely on a network of sites and providers to span long distances and keep remote residents is small communities connected to care. With resources at a premium, that might mean using virtual nurses in skilled nursing and rehab facilities, maybe even the home.
“Our philosophy is that we have the technology, we have the platform, now how can we scale it?” DeBoer says. “Let’s try to see what’s going to work, knowing that a mile saved from being on the road means reduced time away from work, school and the comfort of their own homes.”
In rural communities, that also means expanding the platform to include more care providers, from doctors and specialists to social workers.
“We are focusing on nursing, but the technology doesn’t prevent us from having multiple individuals leverage it to help care for patients in new ways,” she adds.
DeBoer says there’s plenty of agreement among nurses and administration that virtual nursing will stay.
“Our teams are trusting us that this is what the future holds,” she says.
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Atrium Health’s Levine Children's Hospital has launched the first Hospital at Home program in the country that focuses on children and their families.
Few would argue that the hospital is no place for a child. But can the Hospital at Home strategy work for children who would otherwise be stuck in a hospital bed?
Levine Children’s Hospital, part of the Atrium Health network, is putting that theory to the test. The 247-bed hospital in Charlotte, North Carolina, launched the nation’s first program to deliver acute-care services to children at home earlier this year.
Stefanie Reed, medical director of the Pediatric Hospital at Home Program, says the program is modeled after Atrium’s Health’s Hospital at Home program, one of hundreds across the country following the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home (AHCAH) model. That model establishes protocols for home treatment of patients who would otherwise be admitted to a hospital, with a mixture of daily in-person and telehealth visits and remote patient monitoring.
But where those programs focus on adult patients, Levine is targeting a very different population.
“We do things a little bit differently,” Reed says, pointing out that whereas adult-level care focuses on the patient, pediatric care often envelops the whole family. The program aims to bring “wrap-around care” to the patient and family, bringing in a much larger mix of care providers, including pediatric hospitalists, certified nurses and pharmacists as well as specially trained paramedics, child life case management and discharge managers and other specialists.
That’s a different dynamic, she says, focusing on team-based care rather than individual visits or services.
Stephanie Reed, medical director of the Pediatric Hospital at Home Program at Atrium's Health's Levine's Children's Hospital. Photo courtesy Levine Children's Hospital.
“It’s important for us to make sure that we really support families and team members throughout the hospitalization by being really, really available to them in ways that probably you don't need to be on the adult side,” Reed says.
A unique program with unique protocols
In many ways, providing home-based care for pediatric patients is more complex. Aside from the use of specialists, Reed says they’re tracking more metrics. Alongside the basic data on care quality, readmission rates, hospital flow and patient safety, they’re taking a closer look at patient experience with care teams and technology. Among the questions being asked: Is this an easier and better way of doing things than in the hospital?
They’ve also built in some “extra checks and balances,” Reed says. Clinicians are asked to visit more than once a day with families. And a clinician--doctor, nurse or paramedic--is online or at the home every time a medication is administered or the child is interacting with technology.
“Even in these early days there are some really positive things,” she says. “We are definitely seeing a lower readmission rate and revisit to the ED rate. We are certainly seeing our patient satisfaction rates off the charts. I've yet to have a family that that said, ‘You know this was no fun.’ Every single family has said, ‘Thank goodness we could do this.’”
Since the program was launched in February, Reed says 40-50 kids have received care at home, and those numbers are growing.
An effective Hospital at Home program, of course, begins in the hospital. Pediatric patients and their network of caregivers need to be screened well in advance of moving care into the home. Reed says the program runs on an “inclusion/exclusion basis,” meaning anyone from infancy up to age 17 can be eligible. That said, the range is currently limited to the Charlotte area, and children in intensive care or with complex care needs aren’t eligible at this point in time.
Reed says they’ve treated everyone from newborns with jaundice to teens dealing with flu or dehydration—and, most importantly, their families.
“We always start with family-centered care,” she points out. “Families should feel engaged and [be able to] participate in the care of the child from the moment that they come into our care.”
“I joke all the time,” she adds. “I've met more aunties and grandmas and pets because I'm in the house and I can really talk to them about the support that this mom needs.”
Assessing the home environment
They also take a close look at the home, assessing social determinants of health (SDOH) like food, transportation and family dynamics. Social workers and case managers play a role in this evaluation.
“We really want to elevate that environment,” she adds. “We know if we can do a good job, whether they're with us in a brick and mortar [setting] or they're discharging from hospital at home, if we've set that groundwork, then you have a healthier child and the likelihood of them needing to come back to an emergency room drops dramatically.”
Even then, when all the boxes are checked, things crop up, and the care team sometimes has to react on the fly. Reed says one family assured them that they had transportation, but when a paramedic visited the home he found that the car battery was dead. So he stayed around to recharge the battery and make sure the care was working.
The program is entirely voluntary, Reed says. And there are times when the hospital is a better place for care than the home.
“If a family is not ready, if the home environment is not ready, if they need our support in a different way, that's OK,” she says. “We will be there and we can reapproach it [later if necessary].”
Reed says the program can be an important bridge from the hospital to the home for both children and their families.
“It’s hard to leave the hospital and go home, even when you’re ready to go home,” she says. “Having someone there, holding your hand, so to speak, making sure you really, truly have what you need, someone that you can call anytime of the day or night is a value in a support system in itself.”
A new project in Illinois aims to connect at risk mothers-to-be with a remote patient monitoring platform that includes a Fitbit, a phone, and an AI assistant named Nurse Avery.
Google and digital health company Drive Health are launching a remote patient monitoring project in rural Illinois to connect expectant mothers with an AI bot to guide them through their pregnancy.
In a partnership with state officials, selected women in Cook County will receive Google Pixel phones, Fitbit devices and access to the Google Cloud to connect with Nurse Avery, an agentic AI health assistant developed by Drive Health. The Healthy Baby program is expected to engage more than 56,000 women over the next few years.
"The Healthy Baby pilot represents a critical step in maternal healthcare, showing how AI can help deliver personalized, proactive health support directly to underserved mothers," Chris Hein, field chief technology officer for Google's Public Sector division, said in a press release. "Using the AI agent, Nurse Avery, and delivering it through Google Pixel phones and Fitbit devices, the program provides real-time support – managing appointments, monitoring vitals, and offering health guidance directly, aiming to make essential resources more readily available."
The program isn't entirely unique. Health systems and state health departments have been trying to use telehealth and digital health for years to connect with at-risk mothers-to-be and monitor them up to and through childbirth. They're driven by maternal mortality rates that place the U.S. well down the list, among developing nations.
In Illinois, that problem is acute. Roughly one-third of all counties in the state struggle with access to maternal care providers, and more than 90% of hospitals lack adequate mental health resources. Among Medicaid populations nationally, 40% of pregnant women have an undiagnosed or untreated mental health concern.
The Health Baby project takes a multi-pronged approach to connecting with at-risk women. The Fitbit device will be used to track participants' activity as well as monitoring heart and sleep data. That information will be collected on Drive Health's platform on participants' Google Pixel phone, from which they can access personalized health recommendations – and Nurse Avery.
This is where digital health outreach meets AI, offering participants are more personal, interactive platform. According to Drive Health executives, Nurse Avery bridges "the gap between providers and patients," answering questions, prompting care plan adherence and providing information on a variety of health concerns, including nutritional support and folic acid intake coordination, vaccination updates, genetic risk assessment, mental health and stress management, and chronic disease management.
As with any RPM program, the key to success will lie in patient engagement. Will expectant mothers be comfortable with using the devices and interacting with an AI assistant? And will the state see improvements in maternal health outcomes as a result? According to officials, they'll be looking for reduced mortality rates, improved birth weight and more full-term pregnancies, as well as reduced costs tied to better access to timely care.
Houston Methodist is now using virtual nursing across eight acute care campuses, and handling some 500 admits and discharges per day. Many of those nurses are even working from home.
While virtual nursing programs typically begin with one or a few specific functions and outcomes, scaling those programs means creating a comprehensive platform that can handle many services.
Houston Methodist, which launched its virtual nursing program in 2022, is now using the platform to facilitate more than 500 admits and discharges a day across eight acute care campuses, says Steve Klahn, the health system's clinical director for virtual medicine. And at its newest location, Houston Methodist Cypress, that experience is much more immersive.
"The team is piloting care delivery in a more comprehensive fashion with remote virtual nurses," Klahn, a participant in the HealthLeaders Virtual Nursing Mastermind program for the second year, said in a recent e-mail exchange. "This pilot includes rotating bedside nurses through a local virtual operations center and supporting bedside nurses' care for their patients by increased remote documentation assistance, multi-disciplinary rounds participation and virtual consenting."
Steve Klahn, clinical director for virtual medicine at Houston Methodist. Photo courtesy Houston Methodist.
As noted in a 2024 story on the program, Houston Methodist is in it for the long run. That means understanding where the platform can evolve and where executives need to take a step back and evaluate their priorities.
"Maintaining flexibility to all the great ideas [that] come in, while being able to remain standardized in the approach so as to not have to re-educate and change workflows too frequently," is crucial to the program's growth, Klahn says. "We also aim to ensure programmatic efficiency with minimization of wait times, while maintaining 24x7 services with safe and fiscally responsible staffing solutions."
One glimpse of the future might be seen in their staffing strategy. Several participants in the Mastermind program have indicated they're looking at enabling nurses to work from home—a key incentive to retaining current nurses and attracting new ones. At Houston Methodist, which now has 50 RN FTEs dedicated to the program, Klahn says the idea is being pushed along out of necessity. Some 70% of the health system's virtual nurses now work from home, and the gaol is to get that number up to 90%.
"We are currently shifting more of our teams to remote work, as space in our virtual operations center is at a premium," he says. "Our strategy remains for direct hire exceptional staff nurses (no-outsourcing to contracted teams), as well as supporting nurses in times of short-term light-duty assignments."
Klahn says the program is gradually integrating new services as well, including dual medication signoffs, remote witnessing of controlled substance wasting, and VTE prevention rounding.
He says the program's success is due to how well it has been received by both patients and nurses.
"We continue to appreciate high levels of satisfaction with patients, bedside nursing teams, physicians/providers and hospital administrators," he says. "The team does an amazing job of ensuring focused high-quality completion of the clinical support they do on a daily basis."
"The biggest surprise to me is how fast the program grew with the strategy our organization acted upon," Klahn adds. "It was amazing to see how quickly the bedside teams embraced this new approach to patient care, and we were able to quickly deliver on the requests for services to each of our hospitals. The future is very bright for VN programs and we look forward to much more growth in the space."
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The Cleveland Clinic is the latest to partner with a developer of ambulatory surgery centers to take minimally invasive procedures out of the hospital.
Health systems are taking a step toward the hospital of the future by outsourcing minor surgeries.
The latest to do so is the Cleveland Clinic, which announced a partnership this week with Tennessee-based Regent Surgical to build a number of ambulatory surgery centers across the country. These centers are designed to handle minimally invasive procedures, which require little to no hospital stays and shorter recovery times, much of which can be handled at home or in clinics.
As hospitals struggle with workforce shortages and look to reduce costs and their patient census, leadership is looking for alternatives to expensive and resource-intense hospital care, with the idea of saving the hospital for those who need acute care services and will spend several days there.
As a result, the ambulatory surgery market is growing. Fortune Business Insights reports the market size was valued at almost $44 billion in 2022 and projected to grow to more than $75 billion by 2030. There are currently more than 6,000 such centers in the U.S.
Arizona-based Banner Health joined forces with Select Medical in 2018, and now has a network of four private rehabilitation hospitals and outpatient physical therapy programs and services at dozens of Banner Physical Therapy Centers. Mark Garvin, the health system’s SVP of Partnership & Venture Development, says the partnership is part of Banner’s strategy to grow beyond its extensive hospital footprint and provide value-based care where it’s most convenient.
“These are people that wake up every single day and this is what they worry about,” he said in a recent HealthLeaders interview. “They’re experts. They know how to operate. They know how to develop. They know how to grow. It is their wheelhouse.”
Garvin says health systems and hospitals have the advantage over disruptors because of the name brand and the expertise in providing healthcare services.
“We can play in this space differently than the Amazons, differently than other retail organizations, simply because we’ve created these clinically integrated networks,” he says.
Cleveland Clinic, which is internationally known for outsourcing second opinions through The Clinic by Cleveland Clinic, a partnership with telehealth provider Amwell, is banking on new efficiencies with the Regent Medical deal.
“Ambulatory surgery centers provide an important setting for health systems to expand access to surgeries, and to be more efficient in the delivery of services,” Cleveland Clinic CEO and President Tom Mihaljevic, MD, said in a press release. “Regent's capabilities in managing and operating ambulatory surgery centers will enable us to focus on continuing to provide the highest quality care for our patients and will enhance our ability to grow and offer that care to more patients.”
