While President Trump's reconciliation package did reinstate first-dollar coverage for HDHP-HSAs, a collection of waivers aimed at boosting coverage for and use of telehealth didn't make the cut.
Healthcare leaders hoping for good news in President Trump's so-called "Big, Beautiful Bill" were largely disappointed at the outcome. But supporters are saying the fight to extend or even make permanent pandemic-era waivers isn't over yet.
The reconciliation package, approved by Congress on July 3 and signed by Trump on the 4th, makes no mention of most of the waivers, which were put in place during the COVID-19 pandemic to boost coverage for and use of telehealth. Those flexibilities include:
Waiving geographic restrictions on telehealth coverage and use;
Expanding the list of providers able to bill Medicare for telehealth services;
Allowing audio-only telehealth services;
Easing originating site restrictions on telehealth so that the patient can receive treatment at home;
Waiving the in-person requirement for telemental health treatment;
Enabling telehealth service for hospice care; and
Enabling Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to use telehealth.
With those waivers in place, many health systems and hospitals expanded their telehealth platforms during the pandemic and have continued with an aggressive virtual care strategy since then. Should those waivers end, the fear is that telehealth programs across the country will scale back or even be discontinued, hindering access to care for millions of Americans.
One flexibility, however, was included in the "One Big Beautiful Bill Act" (OBBBA): first-dollar coverage for High-Deductible Health Plan-Health Savings Accounts (HDHP-HSAs). That provision had actually been left out of earlier bills but was brought back into the limelight with the OBBBA.
"This legislation will give millions of American workers permanent access to coverage of telehealth services without jeopardizing their HSA eligibility," Kyle Zebley, senior vice predicant of public policy for the American Telemedicine Association and executive director of the organization's ATA Action lobbying arm, said in a press release. "We could not be more pleased and proud of our Congressional policy champions for their steadfast commitment to virtual care, especially amidst significant deliberations and concessions made in order to pass a final bill before the July 4 deadline."
"Telehealth stands out as a bright spot in the final reconciliation package – a policy unicorn – achieving unwavering support from both sides of the isle, in both chambers," Zebley said. "We believe this bodes well for the future of other critical telehealth policies requiring Congressional action. While many of the provisions in final ‘big beautiful bill' now … will create challenges for our healthcare system and the Medicare population, inclusion of this permanent telehealth provision clearly demonstrates the relentless bipartisan, bicameral support that telehealth has experienced over the past five years."
Left unsaid was why that one flexibility was included in the 1,000-plus-page bill but none of the others were, leaving those waivers to expire at the end of September.
Some believe the proposed CMS 2026 Physician Fee Schedule, introduced on July 14, was an attempt to continue momentum for telehealth and digital health that the OBBBA might have blunted. The proposed PFS includes several positive steps, including new billing codes and relaxed requirements for remote patient monitoring (RPM), support for digital therapeutics and a long-sought update to the Medicare Diabetes Prevention Program that would pave the way for virtual care delivery.
Still, the spotlight now is squarely on those telehealth waivers, especially for healthcare executives trying to plan out their virtual care strategies. With margins tight and revenues declining, it will be hard to make up for the lost Medicare reimbursements.
In an e-mail to HealthLeaders, Zebley said the fact that telehealth was included in the OBBBA is an indication that the Trump Administration is taking virtual care seriously – and is open to continued negotiation.
"I strongly suspect, based on past precedent, that we will see an extension, either through a health extenders package or, more likely, as part of a broader government funding bill," Zebley said. "The greatest concern with that path is the risk of a government shutdown, which is always a possibility in Washington but especially so given the heightened political tensions on Capitol Hill at this time.
"At the ATA and ATA Action, we're doing everything in our power to prevent even a momentary lapse in access," he added. "We're actively engaging with our bipartisan champions in both chambers to maintain urgency and keep this issue front and center. These programs have now been in place for more than five years and we must not only prevent disruption, but double down on making them permanent. Only then can we shift fully to advancing the next wave of opportunities in virtual care."
Compounding the urgency is the fast that while the deadline for those waivers is September 30, the House is now in its summer recess and won't return until the beginning of September.
Ambient AI technology is great for capturing the doctor-patient conversation, but are healthcare executives making sure that data is protected?
Healthcare executives who are letting their doctors use AI scribes to capture and code patient encounters need to be careful they aren't exposing or misusing protected health information.
Ambient AI technology, described as the "digital sidekick of modern healthcare," is quickly gaining favor among health systems, hospitals and payers looking to reduce the administrative burden on providers and accurately capture the doctor-patient visit. But those tools, which can easily be downloaded onto a smartphone, could be running afoul of HIPAA.
"Technically, it's a third party listening into the conversation," says Aaron Maguregui, a partner with the Foley & Lardner law firm who specializes in AI and healthcare technology.
An AI scribe, he says, is essentially a service provider, so the healthcare provider using that app, as a covered entity, would need a Business Associate Agreement (BAA).
The challenge is particularly acute at this point in the AI cycle, when vendors are flooding the market with their own products – some from companies new to the healthcare industry and unfamiliar with or ignorant of the regulatory requirements. In many cases these apps can be downloaded by providers and put to use almost immediately.
That's a nightmare for healthcare leaders trying to keep track of what their doctors are using. There are plenty of stories of CIOs and CEOs learning that a doctor in one of their hospitals or clinics is using ChatGPT or some other product on their own.
"There might be some (doctors) that are already enjoying the scribe and you just don't know about it," Maguregui, who also chairs the American Telemedicine Association's Artificial Intelligence Committee, points out. "Technically you could have an unauthorized disclosure of PHI."
Maguregui recently authored a blog on the Foley & Lardner website with Jennifer Hennessy, a data privacy and security attorney with the law firm, on the most common mistakes that healthcare executives make in managing AI scribes. Those pitfalls, he says, can be grouped into two basic issues: Data use rights and patient consent.
Issues around data use are particularly critical, and point to an intriguing catch-22 in the healthcare space. AI needs access to better data to learn and improve, and vendors often will ask for more data in which to train and improve their products. But healthcare leaders are notoriously stingy in granting access to that data.
"It's always interesting to me that the knee-jerk reaction is we don't want you to train AI on our data. And that to me is backwards thinking," Maguregui says. "You want the technology to be efficient and accurate, but you don't want it to use your data. Without that you don't get the full value of AI."
That's especially tchellenging, he says, with tech companies that are new to healthcare, bringing in ideas from other industries.
"There are some really cool stuff out there, but maybe this is their first foray into healthcare and they don't understand that, yes, they can very much ingest all the data that they believe they're allowed to ingest, and then?" he asks. "The output would somehow not be theirs to be able to use, to train their products. That's a very foreign concept to the tech world. … [Those] data use cases, data use rights, those end up being a pretty sticky subject."
On the other hand, Maguregui points out, using AI in clinical care means training the technology on the best data available – including protected health information.
"Specificity counts, and specificity is what we're looking to get to with respect to AI," he says. "We want AI to give specific answers. We want it to be nuanced. Those nuances are going to have to at some point start to take into account identifiable information in order to glean cohorts and cultural differences and social determinants of health, things that we probably want to learn. We want to understand these concepts. But we also need to make sure that we're being cautious with people's privacy rights."
And that's where the second hang-up with AI scribes comes into play. By using a third-party app to record their patient encounters, providers need to secure the patient's permission to be recorded, a requirement included in federal wiretapping laws.
Maguregui says providers need to understand that getting a patient's permission to record their encounter has to be a part of the workflow. And that may be fine in the doctor's office, but what happens when AI captures conversations in the Emergency Department, ICU or even the operating room?
Whatever the case, healthcare executives need to make sure their ambient AI tools are HIPAA-compliant – and they need to make sure their AI strategies take into account the potential for using PHI in future programs.
To that end, in their blog, Maguregui and Hennessy offer five steps that healthcare leaders should take when dealing with AI scribes:
Vet vendors thoroughly;
Build governance into your EHR workflows;
Limit secondary use/training without authorization;
The health system, taking part in HealthLeaders’ AI in Clinical Care Mastermind program, says AI has the potential to radically improve cancer diagnosis and treatment, but only with appropriate guardrails in place.
For cancer care specialists, one small needle of information in a haystack of data could mean the difference between effective treatment and a bad clinical outcome. And that’s where AI holds so much promise.
“AI can look at millions and billions of data points, at images, genomics raw data, at everything we know about the patients clinically, at social factors and other variables, and it can uncover patterns and answer questions,” says Nasim Eftekhari, chief AI and analytics officer at City of Hope.
Eftekhari, a participant in the HealthLeaders AI in Clinical Care Mastermind program, says the Los Angeles based health system, one of the largest and most advanced cancer research and treatment organizations in the country, is very deliberate in how it approaches AI, with a strategy that focuses on considered and steady development. She joined the organization in 2017 as one of its first data scientists, and says AI programs, from good old predictive modeling to generative AI should focus on data quality, good benchmarks, and proper validation.
“Good data beats more data every day,” she stresses.
Cancer care is a complex process, and one in which City of Hope has been fully immersed since its founding in 1913. Yet for all the advances made in diagnosis and treatment, there’s still a lot that healthcare providers don’t know about the disease.
“Cancer is probably the biggest, most difficult, still unanswered question,” Eftekhari says. “We don't even know exactly why it happens, and how to stop it from happening. That’s where the real potential of AI is, to help uncover that can explain some of those unanswered questions and help discover and design better [treatments,]” and better predict the onset of disease.
Eftekhari says generative AI “is a different paradigm” than traditional automation and predictive analytics programs, so City of Hope has had to adjust its guardrails accordingly. Small, incremental steps forward are preferred, as each change in the data can blossom into a much larger problem if unchecked.
Nasim Eftekhari, Chief Ai and Analytics Officer at City of Hope. Photo courtesy City of Hope.
She says healthcare organizations need to monitor their data, update their AI models often, watching for drift, making sure the information used in patient care is the latest available and the results from AI models are the best possible.
“We’re not doing this overnight,” she adds. “Because it’s always about the patient. Every decision that we make at every intersection is always centered around the patient.”
Eftekhari also believes that AI won’t advance in a vacuum, and that health systems and hospitals need to share their data and their methods to support progress. That may go against the idea that data has financial value and that organizations need to erect silos around that information.
To truly move the needle on cancer care, “the answer may lie in mountains and mountains of data that no single organization [may have] on their own.”
As with many other healthcare organizations, embracing AI in clinical care also means dealing with change management. Providers are generally hesitant to adopt new ideas, and need to be nudged forward, often with promises that their workflows will improve. Eftekhari says AI may have the potential to change healthcare, but it still has to prove its value and fight through the skepticism.
“How do you meaningfully deploy a machine learning or AI model in day-to-day workflows and how do you measure the impact?” she asks. “And how do you make sure that these models keep adding value?”
The answer to those questions, she says, may lie in focusing more on the people than the technology. AI will succeed if the providers using the technology are ready for it.
Organizations have strategies to invest in technology, “but what makes it really work is investing in people,” she says. “People who can actually make it work, who can bridge the gap between technology and healthcare. It’s a much smaller investment but it’s usually the hardest to get because it’s not the shiny new toy that everybody wants to have.”
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This Mastermind series features ideas, solutions, and insights on excelling in your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealtLeaders Exchange event, email us at exchange@healthleadersmedia.com.
Idaho's St. Luke's Health is embracing ambient AI not for the clinical benefits (just yet), but because it helps them keep their doctors and nurses.
Small health systems like St. Luke’s in Idaho aren’t embracing AI for the clinical outcomes (though that is a big benefit). They want to help their doctors and nurses, because there aren’t a lot of them to go around.
Provider stress and burnout is a concerning issue for rural health systems, with much of the grief tied to documentation and administrative duties. That’s why healthcare leaders are embracing ambient AI in droves even before the technology has proven its ROI. They want relief now, and will map out the benefits later.
“Our CFO said, ‘Look, we want to make a positive impact on provider well-being,” says Reid Stephan, VP and chief information officer of the Boise-based, six-hospital, not-for-profit network. “If that's all we do with this pilot, I will consider it a success.”
By all accounts, that plan is working.
Working through their Epic EHR, St. Luke’s installed Ambience Healthcare’s AI scribing tool last April, and Stephan says they’re now seeing results. Over the past year, the health system has seen a 38.8% decrease in overall documentation time for clinicians, including a more than 40% drop in after-hours documentation. This translates to a 22% increase in face-to-face time between clinicians and their patients and a 25% reduction in clinician burnout.
Stephan says those numbers translate to happier providers, a key factor in a region where the doctor-patient relationship is as durable as the Rocky Mountains surrounding Boise, a city of some 235,000 people. The idea behind using AI isn’t necessary to increase access to care, but to enrich those care pathways.
“Our approach has been we're not going to pursue supply-side-driven AI opportunities because the amount of supply-side opportunities is enormous and we might get lucky, but more likely we're going to just waste resources and capacity hoping something's going to work,” Stephan pointes out. “So we really focused on the demand-side-driven need we have. And again, it was an obvious one: primary care, in particular. Can we use generative AI specifically to help then with that patient-provider encounter?”
Because of its size, Stephan says the health system isn’t looking to be a trailblazer with AI, but rather wants to use the technology to address its specific pain points.
“We aren’t pioneering this,” he says.
Reid Stephan, VP and Chief Information at at St. Luke's Health. Photo courtesy St. Luke's Health.
There are financial benefits as well. St Luke’s is using a “coding aware” platform, which not only captures the conversation but provides real-time coding of the encounter. The tool is reportedly generating more than $13,000 annually per clinician through more accurate coding and better communications, and Stephan says the deployment paid for itself within five months.
Whether those numbers play out over time remains to be seen. Critics say these AI tools are great at catching early benefits, but long-term results are hazy. Stephan, on the other hand, says as long as his clinicians are happier and engagement is better, the value is there for him.
He also says the results of the first year of implementation have given leadership the support to expand the platform. After starting with family medicine clinicians, the health system is now using the AI tool in some 28 specialties.
“This instilled in us a lot of confidence that we can do this again and again and not have to recreate … across each different specialty,” he says.
In fact, Stephan says he was surprised at how fast clinicians caught on to using AI, and would have considered expanding the pilot sooner had he known the results.
“The word spread across the community, and within a few days or a couple of weeks of the initial rollout of the pilot, we started to have a groundswell of hands being raised,” he says. “’When is my turn? Why wasn’t I part of the pilot? How can I get this sooner?’”
Stephan says it’s important to temper expectations with AI, not only to make sure the hype doesn’t overtake reality but to make sure clinicians know what they’re using. While he tells them AI will improve their workflows, that doesn’t mean management wants them to take on extra patients or patient visits or do more work.
True ROI, he says, comes in a more enriched doctor-patient encounter, where both doctor and patient are more engaged.
“Maybe then the provider is able to pick up on something or hear something that they might have otherwise missed when they’re trying to do the swivel chair game of typing and listening,” he says.
A fleet of planes is just one way that Driscoll Children's Hospital makes sure its patients (and their families) get the care they need.
When your patients are sick children, you bring healthcare to them. And that's where true healthcare innovation happens.
Such is the case with Driscoll Children's Hospital. Based in the southern coastal city of Corpus Christi, Texas, the pediatric health system comprises two hospitals and a number of specialty clinics and care sites covering a 25,000-square mile swath of rural southern Texas roughly the size of South Carolina.
Driscoll was launched in 1953 by Clara Driscoll, an author, politician, activist and rancher who spoke five languages, was a confidant of FDR and was credited as the ‘Savior of the Alamo.' She had a soft spot for children, especially those on the opposite end of the economic spectrum, and upon her death in 1945 left her fortune to a fund that would create the hospital.
Mary Dale Peterson, Driscoll's Executive VP and COO, says it's that "Renaissance spirit" that propels the health system today. Among its accomplishments is a 98.5% survival rate across more than 600 pediatric cardiac surgery cases, one of the best in the country. And their length of stay is among the shortest in the country, with transition housing on the hospital campus to help patients and their families move more quickly from the hospital back home.
"You don't always have to be in the largest urban areas to create greatness," she says.
Mary Dale Peterson, Executive VP and COO of Driscoll Children's Hospital. Photo courtesy Driscoll Children's Hospital.
Healthcare innovation comes in many forms, and at Driscoll it begins with the idea that healthcare access is a priority. That's why Driscoll has a fleet of five planes that cover a 33,000-square mile area each day, ferrying specialists to clinics and transporting children to hospitals.
"We have a history of bringing care to the children where they are," Peterson points out.
She says the service dates back to Jim Simpson, a cardiologist who flew his own plane across the state some 50 years ago to screen remote children for congenital heart disease. The planes, purchased through philanthropic donations, help specialists like the only pediatric rheumatologist in all of south Texas meet with children and their parents, saving them hours-long car trips and days away from home.
And it saves money. Peterson – who was president and CEO of the Driscoll Health Plan from 2005-18 before joining the hospital – says the fleet saves Driscoll millions of dollars in Medicaid costs, while also improving time and access to treatment, which in turn improves clinical outcomes.
"We've saved the state a lot of money by flying our doctors to these communities," she says. "Maybe the new innovation is figuring out how we provide equivalent care to our rural communities that we have in our urban communities."
'What We Want to Do Is Really Look Upstream'
That's not the only instance of bringing care to the kids. Driscoll recently launched a pilot project to embed behavioral health specialists in primary care practices as well as local schools.
Peterson says the idea was borne out of a troubling statistic: A 60% increase in ER visits for children over three years, due only in part to the pandemic. In short, children were experiencing mental health crises, and they and their families weren't recognizing the warning signs or seeking help until the only option was emergency care.
With some grants and philanthropic money, health plan funding and an alternative payment program, Peterson sent specialists out into the communities, coordinating with pediatric primary care practices and five elementary schools and a high school.
"When I got to thinking about it, it's like, how do we prevent children from going into crisis?" she says. "We don't have inpatient mental health services in our hospitals, so they end up in overcrowded EDs. What we want to do is really look upstream."
Another example: In 2007, while head of the Driscoll Health Plan, Peterson studied the data on pre-term births and noticed that 20% of all births were ending up in the NICU, while 30% of all births were medically induced. In addition, there was only one maternal-fetal medicine specialist in south Texas. That led to a $10 million investment to establish clinics and build up the telemedicine program, moves that helped bring the pre-term birth rate down to 9% and save millions of dollars in healthcare costs.
"I've worked 30 years as a physician treating these babies with the ravages of prematurity," she says. "I know we can't prevent every preterm baby, but we can do better."
"There's a lot of, you know, sexy technology that's out there in the surgical realm that I love … but I think there's a whole lot of work that we still have to do in the non-sexy areas that have a huge impact on people's lives," she adds. "And that is in coordination of care and behavioral healthcare, and really helping families who are struggling with these issues."
Data and Dollars
As a former health plan president, Peterson says innovation is predicated on two ideals: New ideas are based on data proving their value and can be justified financially. With a patient population in which some 80% rely on Medicaid, that's a challenge.
"Having an integrated health system where we have a health plan, a physician practice group and the hospital all working together helps with that," she says. So the health plan manages the risk, and the health system turns that into opportunity.
That philosophy has helped her to understand when a new idea doesn't work as much as she might want. Peterson says Driscoll embraced telehealth enthusiastically during the pandemic, which was pretty much the only way to access most care. But after the crisis, she crunched the numbers and found that care management had suffered, and well-child visits and immunizations had dropped.
"We'll offer it to everyone," she says of the virtual care platform, "but patients actually do prefer face-to-face visits."
So Driscoll mixes its platforms, offering virtual care alongside in-person care to meet the needs of its patients and their families. Peterson says she's eager to blend the two with new ideas, like remote patient monitoring and AI. And she's excited about research in genetics and precision medicine that is creating new treatments for children.
"In the past you would just have to tell these families their baby's going to die, but now we have something to offer," she says.
In this week's The Winning Edge webinar, executives from three leading health systems discussed how the platform improves clinical outcomes, reduces hospital overcrowding and costs, and boost patient satisfaction and engagement.
Despite challenges with reimbursement and complexity, the Hospital at Home strategy will be a key element of value-based care from here on.
That's the opinion of executives from three leading health systems who took part in this week's HealthLeaders The Winning Edge panel. They said the program, which enables patients to receive acute-level care in their homes rather than a hospital through a mix of virtual, digital and in-person services, has already proven its value.
Tuesday's panel featured Stephen Dorner, MD, MPH, MSc, chief of clinical operations and medical affairs for Mass General Brigham, which serves roughly 400 patients a month in a program launched in 2017; Daniel Davis, MD, senior medical director of primary care for the greater Charlotte market and senior medical director of continuing health for the Southeast region for Atrium Health, whose program includes one of the first pediatric Hospital at Home platforms in the country; and Logan Davies, MD, MBA, hospital medical director of access and throughput for Ochsner Health, which launched its first acute care at home program a little more than a year ago and is not following the Acute Hospital Care at Home (AHCaH) model favored by the Centers for Medicare & Medicaid Services (CMS).
The three programs follow a familiar pattern but have their own unique variations, which is a strength of the strategy. While roughly 400 health systems and hospitals are following the CMS model and receiving Medicare reimbursements through a pandemic-era waiver due to expire this fall, many others are developing their own programs, with the goal of taking patients out of crowded hospitals, reducing excessive hospital-based costs and enabling patients to recover at home.
Davis said the CMS model offers "an important sign of legitimacy," but it's not the be-all and end-all of the program. Healthcare organizations across the country are struggling to redesign care in a more efficient and effective format, and a model that takes care out of the hospital and puts it in the home fits that plan.
Here's the You Tube presentation of this week's webinar:
The announcement speaks to a subtle shift in the Hospital at Home strategy, and an understanding that care needs to be more integrated and personal
Sometimes the retail experience just doesn't work out for healthcare.
Less than four years after acquiring digital home health company Current Health, Best Buy has sold the company back to its co-founder and former CEO, Christopher McGhee.
The move ends an interesting chapter in the Hospital at Home strategy that saw health systems like OSF HealthCare, Baptist Health, Geisinger, UMass Memorial Health, Atrium Health and Virtua Health use the ‘Geek Squad' to set up patients for home-based care and handle daily monitoring.
"Compared to 2014, many more patients across the U.S. now have access to healthcare outside the hospital," he wrote. "But, ultimately we are still in the early innings of the shift from hospital-based care to home and community-based care."
The Hospital at Home concept focuses on delivering hospital-level care at home to certain patients who would otherwise be hospitalized, using a mixture of telehealth, remote patient monitoring and daily in-person care. The Centers for Medicare & Medicaid Services' (CMS) model, called Acute Hospital Care at Home (AHCaH), took off during the pandemic and now boasts close to 400 health system and hospital partners, with a pandemic-era waiver enabling participants to receive Medicare reimbursement.
While some healthcare organizations have developed their programs internally, using their own doctors, nurses and Mobile Integrated Health (MIH) programs to handle home visits, others rely on home health agencies or even vendors. Many outsource the technology part of the program, using companies like Current Health to evaluate patient homes, set them up with the right technology and handle daily monitoring.
Health systems who partnered with Current Health saw the relationship as a much-needed shot of retail strategy, and the idea of sending the Geek Squad to a patient's home to set them up for home-based care was a good one, enabling the hospital to handle oversight and escalations and leave the daily monitoring to someone else. But Best Buy's decision to get out of the home health business shows there is still work to be done.
Critics of the Hospital at Home strategy say the concept – particularly the CMS model - is too complicated, resulting in more costs and complexity than either the health system or the patient wants. They also question whether patients and their caregivers really want that much care in their homes, disrupting their daily lives and habits, and that those patients should be receiving care in a hospital.
Many of those invested in the Hospital at Home strategy say the program will go on with or without the Medicare waiver, which is set to expire at the end of September unless Congress takes action. But there's also a lot of discussion that the program needs to evolve to become more sustainable, and that a Hospital at Home program will look much different in a year or two than it does today.
The Best Buy decision may force health systems and hospitals to look more closely at how that care is delivered to the home, and to consider a more personal approach.
With that in mind, some providers are either rethinking their approach to the home or putting more effort into working with patients and their families to make the program less intrusive. That would mean replacing the Geek Squad with a hospital-based (or hospital-supported) team.
In his letter, McGhee said Current Health will be "recommitting to our mission" and working on a platform that integrates healthcare with the home setting. That might come as a relief to patients who'd rather see their healthcare delivered by a health system rather than a Big Box store.
Executives from three health systems taking part in this week's The Winning Edge webinar say the strategy is reducing hospitalizations and costs, improving outcomes and scoring very high in patient satisfaction.
Hospital at Home programs are here to stay, regardless of the fate of the Medicare waiver, but they may look a lot different a year from now.
That was the biggest takeaway from Tuesday's The Winning Edge webinar, which featured executives from two of the strategy's leading proponents, Mass General Brigham and Atrium Health, and Ochsner Health, which launched its program a little over a year ago and is pursuing sustainability beyond the model supported by the Centers for Medicare & Medicaid Services (CMS).
Hospital at Home, which aims to treat selected patients at home with a combination of virtual care, remote patient monitoring and daily in-person visits instead of keeping them in the hospital, took off during the pandemic, with support from a waiver that enabled health systems and hospitals following the CMS model to receive Medicare reimbursement. That waiver is due to expire in September, and while there's a strong lobbying effort to make it permanent, many hospital executives have said the program has proven its value and will go on regardless.
Robust Outcomes Point to Sustainability
Daniel Davis, MD, senior medical director of primary care for Atrium Health's greater Charlotte market and senior medical director of continuing health for Atrium's Southeast region, said the CMS model offers “an important sign of legitimacy” for healthcare leaders, but the more important arguments are reduced pressure on overcrowded hospitals, improved health outcomes and very high patient satisfaction scores.
Davis said Advocate Health, the parent health system of Atrium Health, has 13 hospitals participating in the Hospital at Home program, including one of the first pediatric programs in the nation. Advocate's Hospital at Home program, which has been in operation for about five years, serves roughly 115-120 patients a day, or about 16,500 patients since the program began.
Davis said the program, which accepts both waivered (eligible for Medicare reimbursement) and non-waivered patients, has resulted in tens of thousands of saved bed days, a key factor for hospitals who are above capacity every day.
Mass General Brigham runs its Hospital at Home program through five acute care hospitals in the greater Boston area, said Stephen Dorner, MD, MPH, MSc, chief of clinical operations and medical affairs for Mass General Brigham's Healthcare at Home program. The program, which began in 2017, comprises some 70 beds across 72 towns in eastern Massachusetts, serving roughly 400 patients per month.
Dorner said MGB, which pursued Hospital at Home programs separately as Mass General Hospital and Brigham and Women's Hospital before the two merged in 2019, approached the strategy as a means of improving care for growing populations, including the elderly and those with chronic care needs. Leadership understood that these populations would need more care than the health system's brick-and-mortar facilities would be able to give them.
Dorner said the program has shown continued positive results in reducing readmissions and complications, while the patient experience is "off the charts." He said those results will keep the program valuable regardless of the Medicare waiver.
While Ochsner Health is nationally known for its digital health and RPM programs, the New Orleans-based health system is a relative newcomer to the Hospital at Home concept, said Logan Davies, MD, MBA, hospital medical director of access and throughput.
Ochsner's program, which is called Acute Care at Home, centers on three hospitals in and around New Orleans and, after going through what Davies called a “series of stops and starts,” launched roughly a year and a half ago to focus on value-based care patients, which number more than 200,000 in New Orleans alone. Davies said the program cares for about 250 patients a month through a contracted care provider and isn't following the CMS model so that Ochsner can be more creative with how it delivers care in the home.
Davies said Ochsner includes the CFO in planning because the financial and clinical aspects of the Hospital at Home concept should be combined. Just by factoring in the costs of caring for a patient in the hospital against the costs of caring for a patient at home, he said, the Hospital at Home strategy yields an ROI of anywhere between three times and eight times better than the cost of hospital care.
Davies said Ochsner, like every other health system, is waiting to see how Medicare and, especially, Medicaid are affected by the current federal budget negotiations. If the worst-case scenario comes true and drastic cutbacks occur, health systems will need to adjust their Hospital at Home strategies – and that might make the strategy even more important in providing value-based care.
Not a One-Size-Fits-All Model
While all three health systems follow a similar structure, there are many differences that point to the ability of a health system to tailor its program around what leadership wants and needs. For instance, Ochsner Health outsources part of its acute care at home program to a vendor, while Atrium Health uses its own doctors and nurses, as well as paramedics trained through a Mobile Integrated Health program. And while MGB targets populations in defining who would benefit from the Hospital at Home Program, Ochsner looks at the individual patient.
All three agreed, nonetheless, that the concept is a key part of the health system of the future, and it will continue to evolve. They said such programs will improve with the use of more sophisticated RPM technology, enabling providers to track patient biometrics at home and in real time. And they said AI will make a significant impact on care as well, reducing the burden on clinicians and giving them better insights into care management and coordination at home.
Please check back with HealthLeaders on Friday for the You Tube video of this Winning Edge webinar.
Executives from three health systems leading the way in developing Hospital at Home programs will discuss the benefits, drawbacks and future of the concept in this week’s Winning Edge webinar.
Hundreds of health systems and hospitals across the country are using Hospital at Home programs to treat acute care patients at home instead of in the hospital, yet the future of the program is still uncertain.
Advocates swear by the program, saying it reduces wasteful costs and improves clinical outcomes, while critics say the program is complex, leads to extra costs and isn’t best for patients or their families. And the Centers for Medicare & Medicaid Services (CMS), which crafted waivers for its Acute Hospital Care at Home (AHCaH) program during the pandemic to help providers collect Medicare reimbursement, is currently planning to end that waiver in September.
Against this backdrop, HealthLeaders will convene executives from three health systems to discuss the benefits, drawbacks and future of the Hospital at Home program in its latest Winning Edge webinar on Tuesday. The Winning Edge for Moving Forward With the Hospital at Home Strategy will take place at 1 p.m.
The panel promises to be informative. It features Stephen Dormer, MD, MPH, MSc, chief of clinical operations and medical affairs for the Healthcare at Home program at Mass General Brigham, which developed one of the earliest and most successful Hospital at Home programs in the country; Daniel Davis, MD, senior medical director of primary care and senior medical director of continuing health (Southeast Region) for Atrium Health, another front-runner in the Hospital at Home movement; and Logan Davies, MD, MBA, hospital medical director of access and throughout for Ochsner Health, which has developed one the country’s most extensive telehealth and remote patient monitoring platforms.
The panel will discuss how healthcare leaders are defining and developing ROI for these programs, which combine telehealth, remote patient monitoring and in-person care to treat selected patients in their won homes instead of hospitalizing them. We’ll also talk about how technology is integrated into the home setting, how in-person visits by care teams are scheduled, and how patients and their families are included in the planning process.
Close to 400 hospitals and health systems are following the CMS ACHaH program, which features a rigid structure but offers Medicare reimbursement. Many others are trying out different versions of the acute care at home strategy, which eliminates reimbursement but gives them the freedom to develop their own structure.
Advocates say the model could be a key strategy in reducing crowded inpatient units and improving outcomes for rural patients, as well as populations like children, veterans and those with chronic care needs.
An evolving healthcare landscape means the CIO's role is changing. A new HealthLeaders Exchange will take a look at this new hierarchy, where collaboration is the key.
The healthcare C-Suite is evolving, and no position better encapsulates these changes than the CIO. Once considered solely a technology-based role, focusing on EMR adoption and integration, the CIO – be it the chief information or innovation officer (or both) – is assuming more strategic and management duties as the industry embraces new concepts like digital health and transformation.
"Because of those disruptions and because of that focus, now you're a force-multiplier," Aaron Miri, MBA, FCHIME, CHCIO, Baptist Health Jacksonville's EVP and Chief Digital & Information Officer, said during a CHIME CIO panel at VIVE 25 this past spring in Nashville. "It changed the lexicon of CIOs to be talking more like a CFO, or a COO, or a Chief Human Resources Officer."
"I spend part of my day looking at recruitment, part of my day looking at P&L [profit and loss], part of my day looking at futuristic digital transformations and what we can do [to be] disruptive, as well as strategically, where are we going as a health system," he added.
Indeed, while the EMR/EHR still occupies a large chunk of C-Suite time and effort, the onset of new technologies like digital health, virtual care and AI
In a 2024 study supported by surveys of 51 executives from 33 health systems, the National Institutes of Health summarized the newly evolving CIO as having three roles:
Enabling strategic change and transformation;
Developing technology and leadership talent; and
Driving organizational culture.
"As healthcare continues to evolve, the role of the CIO is expected to expand further, requiring a blend of technical and strategic business skills," the article, written by researchers at the Georgetown University Department of Health Management Policy and the University of Alabama at Birmingham', concluded. "This evolution presents opportunities for health systems to enhance their leadership development programs, preparing leaders for the complexities of the contemporary health system sector."
In addition, healthcare leadership is not only redefining the CIO but in some cases reorganizing the C-Suite, either due to budget concerns or the changing face of healthcare transformation. Chief strategy and partnership officers are helping to address disruptors and extend the healthcare organization's traditional footprint, while chief digital health and transformation officers are handling the growing integration of technology in patient care, especially as healthcare moves out of the hospital and into the home. Some organizations are even carving out a leadership role for AI development and management, with the idea that this technology requires full-time stewardship.
At the VIVE panel, Tessa Springman, SVP and chief information / digital health officer at LifeBridge Health, noted she's become more of an educator and facilitator.
"I am the person who is the glue in the organization," she said. "I am constantly educating my peers on what their peers are doing."
"I spend most of my day thinking about, OK, how am I going to improve this business function, how are we going to partner to make this improvement, and will technology help that particular function or not?" she added.
The gist of this evolution is that the CIO is being called upon to work more closely with others in the executive chain, particularly as new programs and strategies require input from a wide variety of sources, including the CFO, the CMO, the CNO, and even the CEO. The top job description of the future may well be "works well with others."
To address this shifting role, HealthLeaders is launching a new Exchange aimed at bringing together top CIOs, chief digital health officers, chief transformation officers and others to network and discuss how technology strategy is changing their roles.
