As the industry assesses the financial damage of the cyberattack, healthcare execs will also be looking at how their technology strategies can be improved
The workaround is a popular healthcare technology term right now.
As healthcare organizations across the country assess the damage caused by the Change Healthcare outage, executives are not only looking at the financial fallout but also the technological repercussions. In short, what will health systems need to do to make sure this doesn’t happen again—or if it does happen, that they have the resources in place to minimize damage?
According to the results of an American Hospital Association survey of roughly 1,000 hospitals released on Friday, some 81% of hospitals found that workarounds enacted to keep operations going during the outage were only “somewhat successful,” while 11% found that workarounds didn’t work at all. And two-thirds of those responding to the survey said it difficult or very difficult to deploy workarounds, particularly in switching clearinghouses.
As has been well-reported, the financial implications are even more alarming. According to the survey, 94% reported being affected financially, with more than half sustaining “significant or serious” damage. About one-third reported impacted to at least half of their revenue and about 60% saw that impact to be more than $1 million a day. Some 44% expect the negatives to continue for another two to four months, and more than 20% have no idea when the tide will turn.
The takeaway is that healthcare executives will need to think long and hard about what they need to do to improve their technology infrastructure, on both the financial and clinical sides.
“These survey findings are another irrefutable reminder that the impact of this cyberattack is far reaching and far from over,” AHA President and CEO Rick Pollack said in a press release accompanying the survey. “When nearly every hospital says they are experiencing a financial loss and half of those say it’s ‘significant or serious,’ with no immediate end in sight, then the debate about whether we need to help them should be over.”
The AHA is one of several organizations calling on federal authorities to take action, and an investigation has reportedly been launched to see whether UnitedHealth Group did anything wrong that led to the attack or caused it to be so damaging.
“We continue to call on Congress and the Administration to take additional actions now to support providers as they deal with significant fallout from this historic attack,” Pollack said. “We also need UnitedHealth Group and commercial payers to step up and support patients and providers on the front lines by waiving prior authorization and timely filing requirements, as well as advancing payments that will allow providers to continue providing 24/7 care to communities.”
Beyond that, healthcare organizations need to take stock of how an incident like this affects clinical care. According to the AHA survey, almost three of every four hospitals reported a negative effect to patient care, and nearly 40% said patients had difficulties accessing care, most often because of disruptions to the health plan authorization process.
AI adoption is fast outpacing governance, and with memories (or nightmares) of EMR adoption and the Change Healthcare outage on everyone’s mind, the pressure is on to set up guardrails
With HIMSS24 in the rear-view mirror, one of the biggest takeaways from the conference was the energy and attendance. Healthcare’s movers and shakers were here, at least for a day or two, and they were making deals and forging partnerships.
And while AI tools and programs were dominating the discussion and deals, a lot of talk was centered on Ai accountability.
While the year-old Coalition for Health AI (CHAI) made early news with its announcement of advisory boards and partnerships, Microsoft unveiled its own Trustworthy & Responsible AI Network (TRAIN), an intriguing collaboration of health systems and federal representatives that aims to create more structure in the move toward governance.
“When it comes to AI’s tremendous capabilities, there is no doubt the technology has the potential to transform healthcare. However, the processes for implementing the technology responsibly are just as vital,” David Rhew, MD, Microsoft’s global chief medical officer and vice president of healthcare, said in a press release. “By working together, TRAIN members aim to establish best practices for operationalizing responsible AI, helping improve patient outcomes and safety while fostering trust in healthcare AI.”
Rhew also commented on LinkedIn on how CHAI and TRAIN will co-exist.
“One way to look at it is that CHAI focuses on ‘the what,’” he wrote. “What is responsible AI (RAI)? What are the RAI principles and standards? ... while TRAIN focuses on ‘the how.’ How does one operationalize RAI? How can organizations collaborate in a privacy-preserving manner, such that data and IP are not exposed? How can we ensure that low-resource settings are able to apply RAI?
Simply put, CHAI helps develop the RAI standards, while TRAIN helps organizations implement them, through the use of technology-based RAI tools and guardrails.”
That post hints at the understanding that while everyone agrees the industry needs guardrails, how we get there will be a challenge. And with all the announcements and talk at HIMSS24 of health systems and hospitals launching AI programs, the urgency to create standards is growing by the day.
Many also don’t want the process to mirror EMR adoption two decades ago. The healthcare industry wasn’t prepared to embrace electronic medical records, leading to more than a few nightmares in implementation and the need for meaningful use guidelines. Now AI adoption is fast outpacing governance, and executives are in some ways nostalgic for the guidance offered by meaningful use.
Add to that the concern around the recent Change Healthcare cybersecurity attack some three weeks ago. The outage filtered into many a conversation at HIMSS24, creating a stir around the section of the exhibit hall given over to cybersecurity companies. While the incident has been tied back to a ransomware gang, more than a few people have wondered whether unchecked use of AI could lead to more data breaches – or whether AI could be used as a tool against attacks.
For example, Nordic Consulting announced at HIMSS24 a partnership with Microsoft Azure and Amazon Web Services to launch a Cloud Innovation Lab, addressing requests from healthcare organizations for help in expanding and managing their data storage capabilities, in part because of the increase in AI programs. Brijeet Akula, a Principal Architect at Nordic Consulting, said company was seeing a lot of business from hospitals and health systems spooked by the outage.
“They have sped up their desire to explore more security methods,” he noted.
So while security may be an outlier, it will add to the urgency to create guardrails around AI. The Biden Administration has set its course with an October 2023 Executive Order on AI and announcements of actions to come, but CHAI and TRAIN offer proof that there will be more players in the game.
Like CHAI, TRAIN has an impressive (and in some cases overlapping) roster. Participating health systems include AdventHealth, Advocate Health, Boston Children’s Hospital, Cleveland Clinic, Duke Health, Johns Hopkins Medicine, Mass General Brigham, MedStar Health, Mercy, Mount Sinai Health System, Northwestern Medicine, Providence, Sharp HealthCare, University of Texas Southwestern Medical Center, University of Wisconsin School of Medicine and Public Health and Vanderbilt University Medical Center, and the organization will be working with OCHIN, a non-profit innovation center with strong ties to Epic.
So even as these organizations are deploying AI in several, if not hundreds, of use cases, the talk in the background is around setting up accountability as soon as possible—especially before those use cases start involving patients.
“Even the best healthcare today still suffers from many challenges that AI-driven solutions can substantially improve,” Peter J. Embí, MD, MS, a professor and chair of the Department of Biomedical Informatics (DBMI) and senior vice president for research and innovation at Vanderbilt University Medical Center, said in the press release.”However, just as we wouldn’t think of treating patients with a new drug or device without ensuring and monitoring their efficacy and safety, we must test and monitor AI-derived models and algorithms before and after they are deployed across diverse healthcare settings and populations, to help minimize and prevent unintended harms. It is imperative that we work together and share tools and capabilities that enable systematic AI evaluation, surveillance and algorithm vigilance for the safe, effective and equitable use of AI in healthcare.”
A HIMSS24 panel discusses how competition and uncertain reimbursements are forcing providers to change their business model
Healthcare providers are starting to rethink what being a provider actually means.
Stung by high costs and low reimbursements for acute care, some health systems are shifting their sights to care management and preventive care. And they’re making patient engagement a priority.
“A great deal of our future is in the outpatient side,” Tressa Springman, SVP and chief information and digital officer at LifeBridge Health, a five-hospital system based in Maryland, said during a panel session Tuesday at HIMSS 24.
She noted that more than 50% of the health system’s quality-based reimbursement score for the state is focused on the patient experience, making that more important than actual clinical care. So they’re now setting their sights on access, convenience, and outpatient interactions.
“We’re really focusing on the community,” she said.
Indeed, smaller health systems and hospitals are being forced to change their priorities just to stay in business. Rural hospitals are shutting down or shifting to emergency care centers. Others are closing their Eds and ICUs, referring patients to stand-alone urgent care centers, and looking more closely at a concierge care strategy.
The HIMSS24 panel, titled “Moving Beyond EHR Engagement: Deploy Consumer-Centric Strategies That Truly Empower Communities,” took a closer look at how providers are making engagement work. They’re listening more to their patients, embracing remote patient monitoring, virtual care, wearables and home-based services, and targeting care management and coordination.
“We want to know more about our patients,” said Eric Alper, MD, vice president, chief quality officer and chief clinical informatics officer at UMass Memorial Health. “The Joint Commission and CMS are actually [demanding] it.”
This strategy isn’t without its challenges. As the title of the session implies, a lot of the information providers need isn’t found in the EHR, and so health systems and hospitals are investing in bolt-on technologies and programs, weaving care in and out of the medical record. They’re paying more attention to social determinants of health (SDOH), and fashioning programs that revolve around the patient’s preferences and needs.
Michael Garcia, vice president and chief information officer at the Miami-based Jackson Health System, noted that his health system is making more of an effort to tailor healthcare to patients who typically have trouble accessing care. At Jackson Health, that includes significant numbers of homeless people, undocumented immigrants, and people who are either incarcerated or recently released from prison.
That strategy is based on necessity. If the health system doesn’t reach out and provide care when and where they need it, he said, those patients will end up in Jackson Health’s already-overcrowded Emergency Department.
All three panelists and their moderator, GetWellNetwork founder and CEO Michael O’Neil, noted that this type of strategy doesn’t have a gameplan or model to work from, and no one has come up with any best practices yet. Providers are on their own in developing these care pathways, and in many cases each is developing a unique strategy.
Then again, today’s consumers aren’t looking for a cookie-cutter approach to engagement.
“The ordinary person doesn’t care how much scale you have in your organization,” O’Neil pointed out.
Springman noted that disruptors are making the primary care space very competitive, and it’s difficult for providers to match what Amazon, Walmart, and others are offering. Somewhat ironically, that’s forcing providers to re-engage with their patients, establishing new relationships that technology has for the past few years interrupted.
“We actually are investing much more in well care than in sick care,” she said.
As the annual conference and exhibition opens this week in Orlando, healthcare executives are looking anxious for some good news, or at least positive ROI
The healthcare industry is in a rough spot right now, buffeted by cybersecurity issues, disruptors with big dreams, workforce declines, labor unrest, mangled mergers and closures. As the annual HIMSS conference convenes in Orlando this week, a lot of people are looking for some good news. We’re at that point in Marcus Welby, MD, or Emergency or St. Elsewhere or ER or Grey’s Anatomy or House or Chicago whatever that the patient is on life support and everyone’s just sitting around waiting for inspiration to strike,
Might AI be that shining moment? Could VR save the day? How about FHIR? Perhaps.
As the camera pans out and HIMSS24 steps into focus, here are a few thoughts on what we’ll be seeing and talking about this week in the land of Disney.
AI comes of age. As this week’s flurry of announcements can attest, healthcare organizations are turning AI loose on some of the industry’s most vexing pain points. The HIMSS agenda is filled with sessions detailing how health systems are using the technology, and a casual walk around the exhibit hall will unveil plenty of vendors armed with use cases and examples of ROI.
Indeed, many of the press releases coming out this week are focusing on new partnerships or capabilities around AI. Providers are collaborating with their EHR providers and digital health companies to move data through the platform more efficiently, giving doctors and nurses what they need at the point of care to improve their work and, ultimately, their work-life balance.
The most popular use case at present is the development of ambient AI tools to capture conversations and convert them to clinical notes. Healthcare executives are eager to see how the technology can take documentation and data entry out of the clinician’s hands, which not only gives the doctor or nurse more time to spend in front of patients but reduces the tasks that cause stress and eat into home and family time. But this isn’t the only example of how the technology is being used, and savvy decision-makers will be looking beyond the obvious to find other use cases that help struggling hospitals improve workflows and reduce cost.
A looming battle over value? While AI use cases are all the rage, there’s plenty of talk about how the technology will be governed. The Coalition for Health AI (CHAI) made news recently with the announcement of several advisory boards and a couple of collaborations aimed at creating guidelines for the ethical use of AI, but that news caused more than a few critics to wonder how a struggling health system might weigh the financial value of an AI tool against its potential to boost clinical outcomes.
The argument isn’t new to healthcare, especially as the industry tries to wrap its arms around value-based care. But the speed at which AI has moved into the healthcare ecosystem is putting pressure on health systems to take a closer look at what the “ethical use of AI’ really means. Can the industry find a common ground on which to measure value? Will recent stories around the use of AI by payers to sort and deny claims be enough of a warning sign to spur meaningful conversation? And will the industry work with the federal government to set the guardrails?
The Change Healthcare ransomware attack is having an impact. As expected, the ongoing cybersecurity attack on UnitedHealth Group’s IT platform is affecting both attendance and conversations. Some health system executives are shortening or cancelling their plans to be in Orlando to deal with the outage, while cybersecurity vendors are using the outage as a conversation starter.
The outage has elevated the “workaround” to a common topic of conversation, as beleaguered healthcare providers look for alternate strategies to keep the doors open in the wake of delayed payments. It has also forced many executives to take a closer look not only at their internal and vendor security protocols, but their cash-on-hand strategies. In fact, healthcare organizations seem more focused on how they can weather the next big cybersecurity incident than on how to prevent it.
This will be a huge topic of conversation at HIMSS. Cybersecurity incidents are occurring with such frequency in healthcare now that organizations are putting more thought into limiting the damage when something happens. And as the Change Healthcare outage proves, healthcare organizations have to plan not only for something that happens to them, but also for something that can affect a large swathe of the industry.
Setting a solid foundation. Finally, one of the bigger takeaways from ViVE was that healthcare organizations were paying more attention to how they gather, store, and manage data. That hasn’t changed in Orlando, and HIMSS’ longtime focus on interoperability will keep that conversation going. Innovation in healthcare these days is less about the new toys and more about how data is used to improve things inside and outside the hospital, clinic, or doctor’s office. From smart hospital rooms of the future that gather and funnel information wirelessly, to remote patient monitoring and hospital at home programs that create a data highway from care team to patient, to SDOH programs that mine data for healthcare challenges and barriers and create programs around addressing those challenges, the connecting concept is connectivity.
While strategies like TEFCA and FHIR aim to create a nationwide interoperability platform, providers are just as interested now in strategies and technology that can handle the data they have or want to have. They want tools to pull it in from outside the enterprise, sort it quickly and efficiently without the need for manual labor, and get it to the right people at the right place at the right time, regardless of EHR platform or HIT framework. They’re looking at more data than they’ve ever had before, and the volume or value certainly won’t decrease.
This week’s conference is more about making those connections that work, finding value in partnerships and technology that make things run easier at a time when healthcare is desperate for efficiency. So any use case this week with solid ROI will be trumpeted, as will any collaboration that “pushes the needle” on improved outcomes.
Healthcare needs some good news before the final credits roll.
The tool is designed to help clinicians identify a common type of ear infection that's often overlooked or misdiagnosed
Clinicians at UPMC and the University of Pittsburgh have developed an AI algorithm that can identify acute otitis media (AOM), one of the most common childhood infections.
While some 70% of children have an ear infection before their first birthday, those infections are hard to spot and are often misdiagnosed as fluid buildup. To identify AOM, clinicians need to peer into the eardrum and identify subtle signs of an infection, often a difficult task when dealing with an infant or small child.
To help clinicians make a better diagnosis, researchers created an AI tool that can analyze a video of a patient’s eardrum, taken by an otoscope connected to a camera.
“Acute otitis media is often incorrectly diagnosed,” Alejandro Hoberman, MD, a professor of pediatrics and director of the Division of General Academic Pediatrics at Pitt’s School of Medicine and president of UPMC Children’s Community Pediatrics, said in a press release. “Underdiagnosis results in inadequate care and overdiagnosis results in unnecessary antibiotic treatment, which can compromise the effectiveness of currently available antibiotics. Our tool helps get the correct diagnosis and guide the right treatment.”
“The eardrum, or tympanic membrane, is a thin, flat piece of tissue that stretches across the ear canal,” he added. “In AOM, the eardrum bulges like a bagel, leaving a central area of depression that resembles a bagel hole. In contrast, in children with otitis media with effusion, no bulging of the tympanic membrane is present.”
Hoberman and his team created the tool by studying more than 1,100 videos of the tympanic membrane in children who had visited a doctor for treatment between 20-18 and 2023. They used the videos to develop two AI models that can detect AOM by studying the features of the tympanic membrane, including shape, position, color, and transparency.
According to Hoberman, the AI tool has a 93% success rate in identifying AOM. That’s better than various studies that have put the success rate of physicians studying a patient’s ear at between 30% and 84%.
“These findings suggest that our tool is more accurate than many clinicians,” he said in the press release. “It could be a gamechanger in primary healthcare settings to support clinicians in stringently diagnosing AOM and guiding treatment decisions.”
Healthcare organizations across the country are developing hundreds of AI tools to aid clinicians, drawing on technology that can often analyze data more efficiently than the human eye. These tools can also store the data in the EHR, enabling clinicians to review their work, show the results to parents, and use the data for training.
Three large health systems have announced plans to put AI to use to address clinical care gaps
Now that they’re seeing AI in action, health systems are putting the technology to use to address clinical care gaps.
WellSpan Health, UMass Memorial Health, and Intermountain Health have all announced new collaborations aimed at using AI in clinical settings. WellSpan Health will be developing ambient AI tools to capture doctor-patient conversations, a compelling use case that was discussed at the recent ViVE conference, while UMass Memorial and Intermountain are targeting chronic care management.
The announcements, on the eve of the HIMSS 2024 conference in Orlando, speak to the rapid state of AI development and deployment, as well as the pressure put on healthcare executives to address problems that are affecting their doctors, nurses, and patients.
WellSpan Health announced this week that it will be deploying Nuance’s DAX (Dragon Ambient eXperience) Copilot throughout the eight-hospital, 220+ care site health system to improve documentation during exam room and telehealth visits. The AI tool is designed to capture provider-patient conversations and create clinical summaries that the care provider can review immediately after the visit and enter into the EHR.
“We have long recognized the central importance of the quality of each patient’s experience in every interaction with our health system and especially with their primary care and other providers,” Hal Baker, SVP and chief digital and information officer for the Pennsylvania-based health system, said in a press release. “With DAX Copilot, we [are] … giving our clinicians additional state-of-the-art tools to lessen administrative burdens, reduce the time needed to complete documentation, enhance their ability to deliver high-quality personalized care and expand access to care. Patients also appreciate the benefits of DAX Copilot knowing that they have their doctor’s full and undivided attention during their visits.”
WellSpan and Nuance, part of Microsoft’s stable of tech companies, have been working together for several years, with an earlier version of DAX deployed in 2020. Health system officials say a survey of providers found that 94% said the technology improved the quality of their interactions with patients, while 85% said it improved their work-life balance.
UMass Memorial Health and Google Cloud, meanwhile, are joining forces to leverage AI and other tools in the treatment of patients living with cardiometabolic diseases, including heart disease, diabetes, kidney disease and obesity.
"Our mission is to provide the best possible care to our patients, and this partnership with Google Cloud is a significant step forward,” Michael Hyder, MD, MPH, executive director of the UMass Memorial Center for Digital Health Solutions and an associate professor of Cardiovascular Medicine, said in a press release issued this week. “By using data-driven insights to identify patients who would benefit from advanced cardiometabolic therapies, we aim to elevate the high standard of care we provide."
And Intermountain Health and Memora Health are partnering to integrate the latter’s technology platform into the 33-hospital, 400+ site health system’s EHR, initially to automate tasks and improve care management for oncology care teams and patients before expanding to other departments.
“The moment a person is diagnosed with cancer, their life changes,” Derrick Haslem, MD, Intermountain’s senior medical director for cancer care, said in a press release issued on Tuesday. “Being able to provide consistent communication with patients to address questions and concerns about their care is critical and very important to us. Memora’s technology helps our busy care teams with daily tasks and empowers them to focus on what matters most: delivering high-quality care to our patients.”
The partnerships point to a need for healthcare organizations to put AI to work now, rather than waiting for governance to catch up.
The Coalition for Health AI (CHAI) is staking its claim as the industry’s best option for creating meaningful and acceptable AI standards
As the drumbeat grows for AI governance, one of the biggest questions is whether the healthcare industry or the federal government should take the lead.
An almost-year-old coalition of health systems and tech companies is addressing that question with plans to work with federal regulators.
The Coalition for Health AI (CHAI), which formed in April 2023 as a collective featuring Stanford, the Mayo Clinic, Vanderbilt, Johns Hopkins, Google, and Microsoft and now comprises more than 1,300 members, recently unveiled its first CEO and board of directors. The group also announced plans to collaborate with both the National Health Council and health standards organization HL7 to “craft a comprehensive framework for the deployment and management of artificial intelligence (AI) within healthcare settings.”
"AI is transforming the practice of medicine in ways that seemed unimaginable just two years ago,” CHAI co-founder John Halamka, MD, MS, president of the Mayo Clinic Platform and chair of the group’s new board of directors, said in a press release. “CHAI will bring together policymakers, technologists, healthcare providers, health plans, and a range of stakeholder advocates to develop guidelines and frameworks for evaluating AI. We have a shared mission to empower clinicians and patients with AI tools that maximize benefit and minimize harm."
The partnership is the latest and largest effort to date to create guardrails around the fast-growing phenomenon of AI in healthcare. Health systems and hospitals are launching AI programs by the hundreds to address administrative and clinical pain points, but many worry that they’re going too fast too soon.
The Biden Administration has been pushing for a combined approach to AI governance, with an October 2023 Executive Order that puts the Health and Human Services Department and the Office of the National Coordinator for Health IT (ONC) at the forefront of regulatory efforts and a December 2023 final order that calls for more rules around transparency by the end of this year.
CHAI’s efforts have drawn support from US Food and Drug Administration (FDA) Commissioner Robert Califf, who spoke about AI at CES 2024 in January and addressed CHAI at a meeting earlier this week.
“As part of our AI strategy, the Agency is collaborating with public/private partners to develop a framework for assessing the potential risks and benefits of healthcare AI—this issue is too large to be contained within the FDA,” he told the group. “We’re also developing guidelines for the responsible deployment and ongoing monitoring of AI-driven health care solutions, including those using both adaptive and generative AI methods. The aim is to adapt general AI regulation and standards where needed to the unique characteristics of the health care sector. For instance, general AI regulations often stress the importance of accountability and transparency, which are also crucial in the health care domain due to the sensitive nature of health-related data.”
But Califf also said he worried that health systems “do not have the infrastructure and tools to make the most important determinations about whether an AI application is ‘effective’ for health outcomes.” He listed two conditions for proper review of AI tools:
First, the industry and federal regulators will need to monitor AI tools continuously, since the technology is constantly evolving and the threat of drift over time. “With the proliferation of AI applications and the fact that they evolve over time, it is unclear how the performance of the models will be monitored at the scale that will be needed,” he noted.
Second, AI governance must include complete follow-up of the population affected by the AI tool. “The lack of an interoperable national approach to enabling follow-up of patients leads to a situation in which none of our health systems have a systematic ability to do the requisite monitoring of the model except for the duration of an acute care hospital admission,” Califf pointed out.
Califf also sounded a note of caution on “effectiveness” metrics for AI evaluation, saying he worried those analyses might focus on a health system’s financial interests rather than whether the technology can improve clinical outcomes.
Aside from appointing MITRE co-founder Brian Anderson, MD, senior advisor for clinical trial innovation at ARPA-H and an associate professor of biomedical informatics at Harvard, as CHAI’s CEO, the group named a board of directors, led by Halamka, and advisory boards focused on health systems and providers, patient and community advocacy, the healthcare industry, start-ups, and the government.
Healthcare executives are looking for technology and ideas that promote connected care, but to make those connections they need to know how to handle data
AI may have ruled the roost at last week's ViVE conference, but the underlying theme to both that event and the upcoming HIMSS conference will be data management.
Simply put, AI won't work unless you know what to do with the data.
Healthcare's decision-makers are focused on information, as both a tool to improve clinical care and a means of defining and extracting value. But as new strategies and technology give hospitals, health systems, payers, and others access to more and more data, there are growing problems with how to analyze and store data, how to push the right data to providers and payers, how to move it from one entity to another, and how to secure it.
Andrew Trister, MD, PhD, chief medical and scientific officer at Verily, Alphabet's research arm, says many healthcare organizations are actually putting the cart before the horse on innovation. They're moving quickly with new programs that use AI tools without taking the time to make sure they have a handle on data storage and analysis.
"The decision-makers aren't thinking ahead," he said. "You have to be very deliberate in how AI is going out."
That's going to be crucial, he says, as healthcare organizations pivot from using AI for back office and administrative tasks to focus on clinical programs that affect patient outcomes.
Data is also the catalyst for the growing number of collaborations between health systems and large tech companies, as hospital executives are quickly realizing they don't have the resources or the expertise to handle what's coming into the enterprise. Whereas Amazon, Google, Microsoft, and others were initially seen as disruptors in the healthcare space, they're now becoming valued partners and collaborators.
Highmark Health, for example, announced a partnership with Google Cloud and Epic to extract and analyze data from its payer and provider platforms to improve care management.
"We're data rich but insight poor," said Richard Clarke, the Pennsylvania-based health system's chief technology officer, echoing a lament that many health system executives are saying. By leveraging the resources of Google, he said, Highmark can pull out and sort the data it needs to put before its care providers, giving them actionable information when they need it.
"They're going to get information that they've never had before," he added, referencing the health system's strategies for addressing social determinants of health and creating virtual care platforms that target health as well as care.
Understanding innovation
Data is both a curse and a cure in healthcare. At ViVE, health systems and vendors touted programs and strategies aimed at reducing the workload for doctors and nurses—a workload that has been built up over the years by new technologies that bring more data into the industry. In a sense, the industry has come full circle, embracing technology to improve healthcare and now looking for ways to clean up the problems caused by technology.
In one sense, the industry's biggest problem has been embracing and adapting to change. EHRs were originally viewed as an important platform for gathering and managing data, but providers weren't ready for the technology, and we all know what happened. At a ViVE panel on innovation, executives from four large and forward-thinking health systems said change management is the first and most important step in introducing new technologies and strategies. The soil has to be tilled and fertilized before new ideas can grow.
That may be why concepts like telehealth and virtual care have taken so long to sprout. Health systems and hospitals saw single-digit adoption until the pandemic, when everyone jumped on the bandwagon out of necessity and adoption surged to roughly 75%. While the pendulum has swung back since then as patients look to restore that in-person connection, both they and their doctors have seen enough data to understand the value of both telehealth and virtual care.
Likewise the acute care at home movement and remote patient monitoring, the subject of more than a few conversations on the ViVE floor. Healthcare providers are intrigued by the data they can get from their patients outside the hospital setting, especially at home, and how that data can be used to improve care management and outcomes.
Those strategies are part of a much larger effort to move healthcare away from periodic, or fee-for-service, care. Harnessing data from outside the traditional healthcare site gives providers and payers more insight into how care can be delivered more effectively.
Jennifer Goldsack, CEO of the Digital Medicine Society (DiMe), says the healthcare industry is coming around to the idea of using technology—specifically, digital health technology—to care for the whole patient, not just the sick or injured patient. She feels healthcare organizations are adopting digital health at a faster pace than expected.
Giving Value to Data
Which brings us back to data, and where events like ViVE, HIMSS and HLTH will go. Interoperability is an important topic because health systems, payers, and others in the industry need to be able to exchange data without barriers or hiccups. Hence the federal push for TEFCA and FHIR. Data that can only live in one place loses a lot of its value.
And data gains value in how it is shared and used. That's why connected care is a buzzword. Some have suggested a connected care showcase, much like the interoperability showcases at ViVE and HIMSS, where attendees can see how data is collected and used to connect disparate elements of the healthcare ecosystem, from providers and payers to social services, housing and food services, employers and retail services, schools and senior care facilities.
Today's healthcare executives are looking for these connections. They want to see technologies like AI and digital health that can collect and use data to connect the dots. And they want those tools and programs to make seamless connections, so that doctors and nurses are spending less time working with the technology and more time working with patients.
“HHS is in regular contact with [UnitedHealth Group] leadership, state partners, and with numerous external stakeholders to better understand the nature of the impacts and to ensure the effectiveness of UHG’s response,” the statement reads. “HHS has made clear its expectation that UHG does everything in its power to ensure continuity of operations for all healthcare providers impacted and HHS appreciates UHG’s continuous efforts to do so.”
“HHS is also leading interagency coordination of the federal government’s related activities, including working closely with the Federal Bureau of Investigations (FBI), the Cybersecurity and Infrastructure Security Agency (CISA), the White House, and other agencies to provide credible, actionable threat intelligence to industry wherever possible,” the agency continued.
For providers affected by the attack, which has all but shut down UHG’s nationwide network for more than two weeks, HHS outlined five steps being coordinated by the Centers for Medicare & Medicaid Services (CMS):
Medicare providers needing to change clearinghouses that they use for claims processing during these outages should contact their Medicare Administrative Contractor (MAC) to request a new electronic data interchange (EDI) enrollment for the switch. The MAC will provide instructions based on the specific request to expedite the new EDI enrollment. CMS has instructed the MACs to expedite this process and move all provider and facility requests into production and ready to bill claims quickly. CMS is strongly encouraging other payers, including state Medicaid and Children’s Health Insurance Program (CHIP) agencies and Medicaid and CHIP managed care plans, to waive or expedite solutions for this requirement.
CMS will issue guidance to Medicare Advantage (MA) organizations and Part D sponsors encouraging them to remove or relax prior authorization, other utilization management, and timely filing requirements during these system outages. CMS is also encouraging MA plans to offer advance funding to providers most affected by this cyberattack.
CMS strongly encourages Medicaid and CHIP managed care plans to adopt the same strategies of removing or relaxing prior authorization and utilization management requirements, and consider offering advance funding to providers, on behalf of Medicaid and CHIP managed care enrollees to the extent permitted by the State.
If Medicare providers are having trouble filing claims or other necessary notices or other submissions, they should contact their MAC for details on exceptions, waivers, or extensions, or contact CMS regarding quality reporting programs.
CMS has contacted all of the MACs to make sure they are prepared to accept paper claims from providers who need to file them. While we recognize that electronic billing is preferable for everyone, the MACs must accept paper submissions if a provider needs to file claims in that method.
The agency also announced that it is working with MACs to address requests from providers seeking accelerated payments, similar to those issued during the pandemic.
Finally, HHS said the incident should spur the healthcare industry to take a serious look at its cybersecurity practices. The agency pointed out that it released a concept paper late last year outlining cybersecurity strategies, and that followed a National Cybersecurity Strategy unveiled a few months prior by the Biden Administration.
“HHS will continue to communicate with the healthcare sector and encourage continued dialogue among affected parties,” the agency concluded. “We will continue to communicate with UHG, closely monitor their ongoing response to this cyberattack, and promote transparent, robust response while working with the industry to close any gaps that remain.”
Both the AHA and AMA have called on federal officials to take action on the two-week old cyberattack, including asking United HealthGroup to be more transparent on its actions to resolve the issue
The American Hospital Association has added its voice to growing calls for federal intervention in the Change Healthcare cyberattack.
In a March 4 letter to Congressional leaders, AHA President and CEO Richard Pollack said the “unprecedented attack,” now more than two weeks old, has severely affected the nation’s healthcare industry. He said the organization has been in touch with UnitedHealth Group officials regarding the outage, asking for more transparency about what happened, a timeline on when the issue would be resolved, and temporary access to advance payments to help providers during the down-time.
“Unfortunately, UnitedHealth Group’s efforts to date have not been able to meaningfully mitigate the impact to our field,” Pollack said in the letter. “Workarounds to address prior authorization, as well as claims processing and payment are not universally available and, when they are, can be expensive, time consuming and inefficient to implement. For example, manually typing claims into unique payer portals or sending by fax machine requires additional hours and labor costs, and switching revenue cycle vendors requires hospitals and health systems to pay new vendor fees and can take months to implement properly.”
In addition, UnitedHealth Group’s “Temporary Funding Assistance Program” that it stood up as part of its response on March 1 will not come close to meeting the needs of our members as they struggle to meet the financial demands of payroll, supplies and bond covenant requirements, among others,” he added. “We will continue to work with UnitedHealth Group as this situation evolves to communicate the state of the field and ensure support for our members and the patients they serve.”
Pollack said the AHA had sent a letter to Health and Human Services Secretary Javier Becerra on February 26 asking HHS to step in and take action. Specifically, they asked Becerra to:
Direct Medicare Administrative Contractors to prioritize and expedite review and approval of hospital requests for Medicare advanced payments.
Issue guidance to payers on how they should be handling payments during this time.
Pressure UnitedHealth Group officials to make sure they’re taking all the necessary steps to remedy the situation, including “implementing a meaningful financial assistance program and engaging in frequent and forthright communication with providers.”
“This incident demands a whole of government response,” Pollack added. “We therefore urge Congress to consider any statutory limitations that may exist for any federal agencies that can assist hospitals at this critical moment. If such limitations exist, the Executive Branch may be unable to provide solutions to ensure our nation’s provider network remains solvent and serves patients.”
Both the AHA and American Medical Association have asked the federal government to take action on what may be the largest and most damaging cyberattack in healthcare to date.
The cyberattack on the IT business of UnitedHealth, which came to light roughly two weeks ago, has crippled operations at thousands of pharmacies across the country, and in doing so affected many more providers. Experts estimate the industry is losing more than $100 million a day due to the outage, which is rumored to have been a ransomware attack.
“Change Healthcare is the predominant source of more than 100 critical functions that keep the healthcare system operating,” Pollack noted in his letter. “Among them, Change Healthcare manages the clinical criteria used to authorize a substantial portion of patient care and coverage, processes billions of claims, supports clinical information exchange, and processes drug prescriptions. Significant portions of Change Healthcare’s functionality have been crippled. As a result, patients have struggled to get timely access to care and billions of dollars have stopped flowing to providers, thereby threatening the financial viability of hospitals, health systems, physician offices and other providers.”