Congress has extended telehealth and Hospital at Home waivers through September. This may be the healthcare industry’s last chance to prove their value.
But the six-month extension isn’t making things any easier for healthcare execs looking to plot long-term strategies. And while supporters are taking heart in the fact that Congress has consistently kept these programs in view, they also know that the cycle of kicking the can down the road has to end. Either Congress or the Centers for Medicare & Medicaid Services (CMS) makes these waivers permanent, or they end them once and for all.
This gives healthcare leaders the summer to make their case for permanent CMS support of telehealth flexibilities and the Acute Hospital Care at Home (AHCAH) program. That means finding and showing data that proves these flexibilities are saving money, reducing complexity and improving clinical outcomes.
Are we ready for the Summer of Telehealth?
Supporters, beginning with the American Telemedicine Association (ATA) and extending to the hundreds of advocacy groups, healthcare organizations and lawmakers that have signed so many letters calling for waiver permanence, have long lobbied for a multi-year extension of anywhere between two and five years. That time frame, they argue, is necessary for healthcare leaders to conduct their studies and pilots and gather the data they need to support these programs.
That’s particularly true of the Hospital at Home movement. Close to 400 health systems and hospitals across the country are following the CMS model, which qualifies them for Medicare reimbursements but is quite complex. Others are forgoing reimbursements to develop their programs to treat patients with acute care needs at home (or, in some cases, a SNF or rehab center).
Stephen Dorner, MD, MPH, MSc, Chief Clinical and Innovation Officer of Mass General Brigham’s Healthcare at Home program, says the regulatory uncertainty is slowing down growth, and he worries what will happen if the waivers are ended. But at the same time, the fact that so many healthcare organizations have invested in this strategy means it does have value.
“We’re in this journey to build out the whole continuum of care in the home” he said at the recent HIMSS 2025 conference and exhibition in Las Vegas.
Dorner is part of a Hospital at Home program that’s widely considered to be one of the best in the country, with services that impact a growing number of patient populations, from those with chronic care concerns to veterans. Supporters point to the published studies by the health system showing how the program saves money and improves clinical outcomes; critics, meanwhile, note those studies are small and hyper-focused, and there’s no guarantee the program can be scaled and sustained.
Dorner says the industry needs time to prove its value—and to tinker with the model to find the right mix of efficiency and outcomes.
“I don’t think that the way it’s structured now is necessarily that way it will be structured forever,” he said. “We need more of a critical mass of information” to prove what works and what doesn’t.
The same goes for the collection of pandemic-era waivers on telehealth expansion and use. Virtual care comprised a small percentage—roughly 15%--of all healthcare interactions before the COVID-19 crisis, at which point providers scrambled to put as many services as possible onto a telemedicine platform to help overcrowded hospitals and enable patients and providers to connect and isolate at the same time.
With the end of the pandemic, many patients expressed a desire to see their providers in person again, swinging the telehealth pendulum in the other direction. Some mistakenly assumed this would be the end of telehealth, but the technology had done enough to reduce access pain points and improve outcomes that patients still asked for it and providers found a way to integrate virtual and in-person care. As a result, the waivers were continued.
Which brings us back to the road ahead. With the waivers extended until September 30, the healthcare industry has the summer to prove the value of these flexibilities. They know the extensions won’t go on forever, and with each passing Congressional action the drumbeat is growing to end them and move on.
Supporters can’t keep recycling thank you notes to Congress and the White House for these extensions and vow to continue working to make them permanent. They’ve been doing that for the last two years, and nothing has changed.
Today’s healthcare innovation landscape is chaotic, and the C-Suite needs to adjust to keep up. Are we ready for a Chief Storyteller or Chief Collaborator?
The chaotic pace of innovation is forcing CIOs to become a jack-of-all trades.
During a recent CHIME panel at ViVE 25 in Nashville, Andy Crowder, CHCIO, CDH-E, SVP, Southeast Region CIO and Enterprise Chief Digital Officer for Advocate Health Care, traced the evolution of the CIO back to the pandemic, when virtual care was all the rage and health systems were scrambling to be innovative.
“I think the role of the CIO or Chief Digital Officer … has been [as] a strategic advisor, part of the C-Suite, tied to strategy,” he said. “We put our feet on the accelerator, and nobody’s taken that off.”
“Because of those disruptions and because of that focus, now you’re a force-multiplier,” added Aaron Miri, MBA, FCHIME, CHCIO, Baptist Health Jacksonville’s EVP and Chief Digital & Information Officer. “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?”
With the promise of AI on the doorstep and against a backdrop of declining workforces, quality and cost problems, razor-thin margins and an uncertain federal response, CIOs and their colleagues are in a tough spot. And many are eager to accept the challenge.
“We want to be that first-stop shop” for innovative ideas, Miri said. “We want to help you co-develop, and more importantly, imagine the art of the possible.”
At a time when healthcare organizations are looking to cut costs, and in some cases culling their C-Suite, the idea of a fluid job description for the CIO might seem like job security. But at a time when innovation needs a hard and fast ROI, it’s incumbent upon CIOs, Chief Transformation Officers, Chief Digital Health Officers and Chief Strategy Officers to gain a better understanding of what it takes to push through a good idea.
And it’s not limited to CIOs. CFOs and those in Revenue Cycle Management need to better understand the clinical side of the organization to develop tools and strategies that benefit both the patient and the purse strings. CMOs want to work with CNOs—and vice versa—to create better relationships between doctors and nurses.
Collaboration has become a necessity, as health system and hospital leadership looks for new ideas that address more than just one pain point or niche problem.
During the CHIME panel, Tressa Springman, SVP and Chief Information & Digital Health officer for LifeBridge Health, said CIOs can’t just sit at their own desks and wait for things to come to them. They have to be storytellers, understanding the environment and the competitive landscape of vendor relations, looking beyond the shiny new toys and hype to assess whether something really will transform healthcare.
“I see myself as the educator,” she said. “I am the person who is the glue in the organization. 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.
This is where HealthLeaders is headed with its new Chief Digital Executive Exchange, scheduled to take place December 4-5 in Washington DC. Designed to bridge the gap between CIOs and their counterparts, this event aims to give digital and information executives the knowledge they need to collaborate and give new ideas the best chance for sustainability and scalability.
Recruitment is underway for this event. Please contact me for details.
Exclusive sponsorship opportunities are also available. For more information, contact Sales@healthleadersmedia.com.
In Alaska, where access to specialist care is challenging and emergency transfers can be harrowing, providers are using AI to speed up diagnosis and improve treatment
Healthcare access and treatment issues in rural and remote areas can mean the difference between life and death for people suffering a stroke. Every delayed minute of care costs roughly 2 million brain cells.
That’s why a consortium of healthcare providers in Alaska is investing in AI to improve the diagnosis and treatment of strokes, which kill about 140,000 people a year.
“There's a lot of time that gets lost and a lot of time that is essentially burned unnecessarily because the standard way that we're used to doing things in medicine is very linear,” says Lucy He, MD, FAANS, a neurosurgeon with Anchorage Neurosurgical Associates and physician sponsor of the Alaska Stroke Coalition, a non-profit established in 2023 to boost care coordination and outcomes in the nation’s most rural state.
In late 2024, the coalition partnered with digital health company RapidAI to launch the Rapid AK Project, a three-year initiative aimed at integrating AI technology at six of the state’s largest hospitals (four other hospitals already have the technology installed). On this platform, specialists at these hospitals can more quickly analyze data sent in by rural providers on stroke victims, improving a care process that saves lives.
Lucy He, MD, FAANS, a neurosurgeon with Anchorage Neurological Associates and physician sponsor of the Alaska Stroke Coalition. Photo courtesy Anchorage Neurological Associates.
According to He, when someone in a remote part of Alaska—about 97% of the state qualifies as remote—suffers a stroke, care providers send CT images to the nearest hospital with stroke diagnosis and treatment capabilities. That process of sending roughly 1,500 images takes about 45 minutes. Specialists then review the images to determine whether the patient needs to be transferred to the hospital for treatment, which usually involves the administering of tissue plasminogen activator (tPA).
In Alaska, that transfer may involve an ambulance, helicopter, and/or fixed-wing aircraft and take hours. Flight crews have 30 minutes to accept the transfer and another 30 to file a flight plan and receive clearance to fly. And after the patient is transported to the hospital, another round of CT images is taken to make sure the patient is still a good candidate for treatment.
Throughout this lengthy process, the patient’s health is declining, reducing the chances that tPA can halt the effects of the stroke and preserve brain function. In some cases, a patient who initially could be saved with tPA might not be saved by the time he or she reaches the hospital.
AI can improve that process, He says, by enabling CT scans to be sent in real time and helping specialists review the images.
“All of a sudden you’ve got an hour that’s been saved,” she points out.
Through the RapidAI platform, she says, care providers and specialists can collaborate and share data more quickly and effectively, analyzing a patient’s chances of recovery and giving everyone – care teams, specialists, transport teams and the patient’s family – a more accurate time frame.
“There's nothing worse than transferring a patient … and then they get here and it's like, no, they're not going to be a candidate,” He says. “Now this patient is far from their family [and] their family still has to fly on their own money down to Anchorage. So it's really about identifying the right patients in a timely manner to make a decision whether it's transfer or stay.”
From Hours Down to Minutes
According to Jeremy Hunter, CMO and CMIO of the Alaska Native Tribal Health Consortium (ANTHC), one of the participating healthcare networks in the Alaska Stroke Coalition, the coalition sees roughly 150 stroke activations a year. Since joining the project, the amount of time needed to assess and begin treatment has dropped from about four hours to roughly 45 minutes.
Those are telling numbers for a population that can be hundreds of miles from the nearest hospital.
“Without a road system, without reliable connectivity in some places, some without running water in villages, it's fascinating delivering care up here,” he says.
Hunter says the AI platform gives local providers more confidence in assessing patients. He can use an app to more quickly share data with specialists. An AI interpretation of a scan, he says, can give emergency care providers some vital information on the severity of a stroke within minutes.
“With stroke medicine, I think it's definitely improving morbidity,” he says. “Even if there isn't an absolute mortality reduction, it's going to be hard to argue that we are not lowering morbidity significantly.”
Using innovative technology to improve stroke assessment and care isn’t exactly new. Health systems and hospitals across the country, from Chicago to Mississippi, have been using telemedicine and digital health tools for years to improve the process, establishing telestroke networks that connect rural care teams with specialists, even using specially equipped EMS vehicles in large cities to improve emergency diagnosis and care.
But while those advances get patients in front of specialists more quickly, AI tools are helping providers see the data they need to see to make critical decisions.
He says AI can drastically reduce the maddening gaps that affect stroke care, improving the chances that a patient will survive and reducing brain damage caused by those delays. He says AI can help providers understand how much of a patient’s brain has been affected by stroke and what can be saved through intervention. This includes a better understanding of whether a patient can be saved by intervention—a literal pain point when a provider has to decide whether to set up an expensive and stressful emergency transfer for a patient in the throes of a stroke.
An Ongoing Path to Better Care
But the technology also gives providers more data, enabling them to understand what causes a stroke and how different treatments work. This can fuel stroke prevention education and resources as well as fine-tuning stroke treatment protocols.
“Really, prevention ultimately is what needs to happen,” she says.
And then there’s cost. Healthcare organizations have little resources to spare on new tech, hence the formation of the coalition and the three-year grant to keep it going. Both Hunter and He say there’s an ongoing effort to sustain this partnership.
“We'll have financial conversations, but I think it is such a vital tool for improving stroke care that unless it's an astronomical number that we just simply can't afford, I don't see how we can go back to not having it,” Hunter says.
He agrees, saying the ROI for this technology should be measured not only in lives saved and emergency transport and ER costs justified, but in education and other resources that help people reduce their stroke risk and providers understand preventive care, diagnosis and treatment.
A continuing resolution now before Congress would extend pandemic-era telehealth and Hospital at Home waivers for six months.
The up-and-down battle over Medicare telehealth and Hospital at Home waivers is on the upswing again, as a proposed bill to fund the government through September includes extensions for both.
But in typical good news-bad news fashion, those proposed extensions would only run to September, leaving health systems and hospitals wondering whether to keep those programs going or shut them down.
According to the American Telemedicine Association (ATA) and several others, the proposed Continuing Resolution unveiled on March 8 keeps in place pandemic-era waivers on key telehealth coverage and the Centers for Medicare & Medicaid Services’ (CMS) Acute Hospital Care at Home (AHCAH) program through September 30. Advocates say this would give Congress more time to negotiate a long-term deal, such as a five-year extension supported by the ATA and others.
“We appreciate Congress taking action to prevent a lapse in these vital telehealth flexibilities,” Kyle Zebley, Executive Director of ATA Action, the ATA’s lobbying arm, said in a press release. “While we would have preferred a longer extension, this step ensures uninterrupted access to telehealth services for patients and clinicians, as we continue working toward permanent solutions that reflect the needs of modern healthcare.”
But “uninterrupted access” is a bit of a misnomer. Many health systems and hospitals are relying on the waivers and using Medicare reimbursements to keep these programs going, and the constant battle over extensions is forcing executives to rethink their long-term strategies. Some have already rolled up certain telehealth programs, while others are delaying or cancelling plans to expand their virtual care platforms, figuring the money being put into those services could be best used elsewhere.
As with the stopgap funding bill passed by Congress last December, the new proposed bill would extend to September 30 the following telehealth flexibilities:
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.
In addition, the bill would extend the CMS waiver for its AHCAH program, enabling the more than 350 health systems following the CMS model to receive Medicare reimbursement.
And like the December bill, several telehealth flexibilities supported by the advocates didn’t make the cut. They include:
First dollar coverage of High Deductible Health Plans (HDHPs) and Health Savings Accounts (HSAs);
Support for virtual care providers in the Medicare Diabetes Prevention Program;
Improved coverage for digital health in home-based cardiology and pulmonary rehab programs; and
The SPEAK Act (HR 6033), which paves the way for accessible telehealth services.
The ATA’s Zebley said the inclusion of the telehealth and Hospital at Home extensions indicate that Congress “has listened” to the intense lobbying effort by the organization and others. But he also acknowledged that “the path forward remains uncertain.” There’s no guarantee that Congress will approve a final bill that includes those provisions.
Tech companies and healthcare providers flocked to Las Vegas this week to talk about the latest innovative tools and strategies. But amid shifting definitions of value, uncertain signals from Washington and increasing pressure to reduce costs and improve outcomes, are healthcare leaders struggling to just stay the course?
The almost frantic pace at HIMSS 25 this week hints at an industry struggling to keep up with the times.
The exhibit hall at the Venetian teemed with people rushing from one event or meeting to the next, making deals or looking to make deals. Technology vendors announced new partnerships, programs and product upgrades at a rate almost bordering on desperation.
Fueled by the advances of AI – in the consumer world as well as healthcare – and digital health, health system and hospital executives are dealing with a rapidly evolving industry. They're being forced to embrace change at a faster rate than they're used to, and in some cases struggling to connect the dots on innovation and ROI. Everybody knows that AI is a transformational tool, and no one wants to be left out.
But healthcare organizations are struggling on several fronts. Everyone is feeling the workforce shortage and looking for ways to keep who they have, attract whoever is out there, or use technology to supplement the workforce. Money is tight, so there's little to spend on new ideas or technology and a strong push to reduce costs and inefficiency.
For Susan Gutjahr, HIT Director for Sparta Community Hospital, the urgency is there to find technology that can help the 25-bed critical access hospital in Sparta, Illinois stay open. The hospital epitomizes the small, rural facility in farming and mining country struggling to keep up with the big boys in Chicago, several hours to the northeast, and St. Louis, 50 miles to the northwest.
"It's hard to find [technology] for us," she says, noting the hospital has had the same EMR since 1997. "We really need to get our foot in the door."
Gutjahr says hospital leadership is eager to find tools to improve patient engagement, an important strategy for small, rural hospitals that are often the linchpin of the community. She says they received federal funding during the pandemic, which they used to boost their virtual platform and reward stressed out staff, but that money is gone now and there's no indication that they'll be getting anything from Washington.
"We need to ask some hard questions about what this [technology] could really bring us," she says.
At the other end of the spectrum is the University of Texas MD Anderson Cancer Center, a well-known health system looking to expand its innovation strategy. Lavonia Thomas, BSN, DNP, MSN, RN, the health system's Chief Nursing Informatics Officer, led a team of nine nurses to HIMSS with the goal of finding the right technology that nurses will actually value and use.
"What are the problems that nurses at MD Anderson have that [can be addressed] here?" she asks. "We want to know what the nurses think. We know that the nurses using [this technology] will determine its return on investment for us."
And that may be the key to HIMSS' sustainability, which took a hit during COVID-19 but seems to be rebounding quite well. The healthcare C-Suite may not be in Las Vegas in big numbers this week, but many have sent executives and, just as importantly, clinicians in their place to get a good look at what's available.
Thomas points out that nurses require different things from new technology than doctors, so they need to check out the tools themselves. An ambient AI tool that's winning rave reviews from doctors for capturing the patient encounter won't address nursing needs.
So while the pressure is on providers to find the technology that works best for them, there's also an increasing amount of pressure on the technology industry to give health system and hospital executives the tools they need.
Srinivas (Sri) Velamoor, President and Chief Operating Officer of NextGen Healthcare, sees an industry in a certain amount of turmoil, looking to keep up with a technology that's being embraced by consumers just as quickly as other industries. The rush to create AI tools that meet the demands of providers is daunting, as are the needs to validate data, monitor on a continual basis, and even share risk with providers.
There's no doubt that AI will transform healthcare, he points out, and some of the larger, more established players in the healthcare technology ecosystem may have to tear themselves down and completely rebuild to meet new demands. Others are changing how they sell their products, especially to not-for-profits, rural hospitals and clinics that have limited resources but need that technology to survive.
So amid all the popcorn, puppies, happy hours and magic tricks on the HIMSS25 show floor this year, there's also a certain amount of desperation. Jump on the bandwagon now or risk being left in the dust. Try out a new tool, forge a new partnership, make a new deal, and look for those KPIs and benchmarks quickly. The clock is ticking.
Announced at HIMSS25, the partnership between the New York health system and Amazon enables patients to confirm their identity in seconds.
NYU Langone Health is launching a new biometric technology platform that’s designed to enable patient registrations through a palm scan.
Announced during the first day of the HIMSS25 conference and exhibition in Las Vegas, the New York health system is partnering with Amazon to launch the Amazon One tool through the Epic EHR platform. The technology enables patients to confirm their identity through a palm scan, which is reportedly more than 99% accurate, less intrusive than other forms of identity verification, and takes place in seconds.
"One of NYU Langone’s goals is to leverage cutting-edge technology to enhance the patient experience,” Nader Mherabi, EVP, Vice Dean and Chief Digital and Information Officer at NYU Langone, said in a press release. “We make all decisions with our patients in mind first and foremost, and we’re always looking for ways to improve their experience through technology. As with all new initiatives and technology of this scale, we will optimize over time and meet the needs of our patients.”
As HIMSS kicks into gear this week, announcements like this are indicative of an industry striving to use innovative technology to improve the patient experience. Health systems and hospitals are under pressure to not only improve clinical outcomes and cut costs, but also make the patient’s care journey more intuitive.
The registration process is a key pain point in healthcare, and health system leaders are looking for ways to reduce the questionnaires and paperwork that make the process longer and more cumbersome, thereby reducing the time a patient can actually spend with their care team.
The partnership takes advantage of a technology now being used in airports, sports stadiums, convenience stores and fitness centers, and marks Amazon One’s largest third-party healthcare deployment to date. It’s also an example of the healthcare industry looking to other industries for innovative ways to solve nagging problems.
According to executives, the Amazon One platform accesses the EHR only to confirm the patient’s identity, and does not access or store any other patient data. Patients are asked to create an Amazon One profile ahead of their visit and link that profile to NYU Langone.
NYU Langone expects to roll out the technology to all locations within the year.
Healthcare leaders may still be looking for ROI and sustainability, but they know AI is here to stay, and they want to make sure they’re on the right path.
Healthcare execs say the hype around AI is justified, but amid all the grand proclamations and catchy metaphors, they’re still trying to figure out where the technology will fit into the clinical workflow.
“We’ve seen the hype but not a lot of substance,” said Nasim Eftekhari, Executive Director of Applied AI & Data Science at City of Hope, who attended the recent ViVE 2025 event and took part in a panel on AI innovation.
Indeed, one of the bigger takeaways from ViVE was that AI is still all the rage, but for all the pilot programs and early use cases, value is still hard to find in clinical care. While rev cycle and financial departments are seeing wins in reduced administrative tasks and better number crunching, clinical leaders are still trying to figure out how to integrate AI into care pathways.
And for every health system and hospital finding success in ambient AI for doctors or in-basket messaging, someone else isn’t seeing the value. If you’ve seen one successful use case, the old saying goes, you’ve seen one successful use case.
Yet with HIMSS 2025 opening this week, healthcare leaders are once again eager to talk about AI. And they’re pretty much agreed that this technology will affect the industry in serious and substantial ways.
“There’s a lot of AI in everything,” said Simon Nazarian, City of Hope’s System EVP and Chief Digital and Technology Officer, who also spoke at ViVE. “But a lot of it is just good old-fashioned automation.”
So where is that next step? And do we really need an a-ha moment to push things forward?
Technology and clinical care have a complicated history, as veterans of the EMR era and “meaningful use” will attest. With those memories to draw from, executives are tentative in fully embracing AI and really want to see what it can do before making a commitment.
That’s nothing new, and it isn’t scaring execs away from using AI. The agenda for this week’s HIMSS 25 conference and exhibition in sunny (hopefully) Las Vegas is filled with discussions about AI and examples of health systems putting the technology to the test.
For many, the catchword now is governance. It’s understood that AI, particularly the generative and predictive models, evolves as it gathers more data. That means healthcare leaders have to monitor not only how they gather and feed data into the machine, but keep an eye on what comes out the other end.
For John Halamka, MD, MS, president of the Mayo Clinic Platform, AI “will be in everything we do.” Speaking at ViVE, he said Mayo is testing several generative AI models, all designed to augment clinical care rather than replace the clinician.
Halamka said health systems and hospitals can launch all the AI tools they want, but they’d better understand the consequences.
“You can move fast and break things as long as you understand the risks of breaking things,” he noted.
That said, Halamka knows AI is transformational. The best endoscopist on the planet will still miss 15% of small polyps, he pointed out, while an AI tool developed at Mayo only misses 3%. And there will come a time, he added, when AI is part of the standard of care, and hospitals could be sued for malpractice for not using it.
It’s just that getting from here to there will take time. And mistakes will be made.
At City of Hope, Eftekhari said AI will save lives. Predictive tools will help clinicians spot health concerns earlier and help them identify the best care pathway.
“With responsible use of AI, we will have the ability to move upstream,” added Nazarian, noting the potential for AI in research to eventually identify and even prevent cancer. “We want to be able to go from bench to bed as quickly as possible.”
So amid all the conversations at HIMSS this week about how AI is being tested or used, executives should understand that whatever they see and hear about won’t necessarily work for them. The stories they hear from one conference to the next will likely be the same. They need to mold the technology to their particular goals.
Halamka says the industry also needs to see both the victories and the failures, and to learn from each. He expects progress to be slow and steady, and the hype to continue until the use cases are proven out.
In HealthLeaders' latest Winning Edge webinar, Stephen Hunter of Allegheny Health and David Higginson of Phoenix Children's Hospital detailed their strategies for developing a virtual care platform that can hold its value.
Virtual care may be an integral part of the so-called "hospital of the future," but that doesn't mean health systems and hospitals can just throw together any old tech platform and see it work. If you build it, they won't necessarily come.
Like any new idea or technology, virtual care needs a sound business plan.
During Tuesday's Winning Edge webinar, two healthcare innovation executives from two very different health systems explained in detail how they've made virtual care work for them and their patients.
For David Higginson, EVP and Chief Innovation Officer at Phoenix Children's Hospital, the challenge lay in creating a sustainable telehealth platform that would meet the needs of their pediatric patients and families, improving clinical outcomes and long-term care concerns. For Stephen Hunter, VP of Digital Strategy and Innovation at the Allegheny Health Network, part of Highmark Health, a virtual care platform had to address immediate care needs for patients while creating a sound business model for the both the health system's population and community health plans and the affiliated health plan's members.
In describing their strategies and challenges, Higginson and Hunter outlined four considerations that every healthcare leader should address when developing a business plan for virtual care that is both sustainable and scalable.
Don't Fall for the Shiny New Thing. While the COVID-19 pandemic proved the value of virtual care, an even more important lesson learned for many health systems was that the biggest, flashiest technology solution isn't always the best. Many providers were setting up simple, easy-to-use telehealth platforms on their own, using the most basic technology, and making them work.
Higginson noted that Phoenix Children's set up a platform using a Zoom API in about three weeks, at a cost of about $12,000. And while that won't likely work for most health systems eyeing a long-term program, it proves that the "flavor of the month" isn't right for everyone. Healthcare leaders need to test out all the technology they can find, keeping an open mind and looking for what works for them.
Selecting the right technology also means looking at the long term. A tool or platform might be good for now, but will it still provide ROI in five years or be rendered obsolete by newer, better technologies? Will a health system become mired in chasing the next big thing or investing in upgrades that dilute or even destroy ROI?
The important strategy here is to be adaptable and flexible. Explore all the options, and understand that sometimes the simplest technology is the best. Plan on upgrades, but don't think that every new thing has to be added to the platform.
Begin With the Patient, and End With the Provider. A virtual care platform might have a great business plan, work like a charm for doctors and nurses and bring a smile to the CFO, but if it doesn't meet the patient's needs, it's toast. That's why it's crucial to begin with the patient's perspective.
Both Higginson and Hunter say a tech platform has to begin with a clear understanding of the problem that needs to be solved, and that means understanding what virtual care means to the patient. The technology has to be easy and intuitive for patients, allowing them to access care and services from their homes. If a provider needs to spend a long time explaining to patients how the technology works, chances of adoption are low.
It's also important to make sure everyone involved in the new program, from doctors and nurses on to pharmacists and HIT staff, knows about all the features and capabilities. Sometimes a great new tool, such as online scheduling of medication refills, is wasted because staff don't realize it's there and they don't tell patients that it's available.
Finally, Hunter noted that patients usually want to be connected to their doctor, not just any doctor on the platform. It's important to set up the platform so that doctors are working with their patients on a continuous care journey (a key component of the business plan is that this relationship captures downstream care opportunities). Don't just connect any patient to any doctor and expect everyone to be happy.
Part of that process is messaging. Providers need to set up a routine that allows patients to send messages to their doctors and create a strategy to triage incoming messages so that doctors and/or nurses answer what needs to be answered.
It should not go unsaid that a platform needs to be seamless and stress-free for the provider as well as the patient. If your adding new tasks or steps to an already-stressed-out doctor or nurse, you might have a hard time getting them to buy in.
Balance Clinical and Financial ROI. Sustainability is a tricky mixture of hard and soft ROI. A great virtual care platform that addresses clinical needs won't survive if it costs a lot of money. At Allegheny Health, Hunter noted that a virtual care platform can address the health system's business needs to expand its patient base and pull in downstream services, like follow-ups and health and wellness services, all of which attract the attention of the health system's associated health plan.
Higginson pointed out that gathering patient stories and anecdotes can be beneficial in more ways than one. They reinforce the health system's mission, prove that virtual care is improving access to care and helping patients and their families, and can be used to prod payers and politicians to support the program. A few good stories could convince a senator or representative to take a closer look at how the state is legislating virtual care or reimbursement, two key barriers to telehealth adoption.
The biggest point to be made here is that ROI is a multi-faceted strategy. Immediate cost and value need to be balanced against long-term costs and benefits. The money spent on technology and staffing may very well be made back in long-term clinical benefits, such as reduced ER visits and hospitalizations, happier patients and less-stressed doctors and nurses. At the same time, a telehealth program that requires continuing tech upgrades so that it won't become obsolete in five years is a bad investment.
Expect to Be Surprised. Few programs work out the way they were planned, and virtual care is certainly no exception. It's OK, even imperative, to have a comprehensive strategy that maps out everything that could happen, right or wrong. Prepare for any eventuality, and then be prepared to be surprised.
For example, Hunter said Allegheny Health had expected that its virtual care platform would see success in addressing access issues in rural areas, but found that urban residents were using the platform much more frequently to access care that they had a hard time finding. Higginson, meanwhile, said Phoenix Children's didn't think much about adding a button to its portal to allow patients to request refills, then saw how much that button meant to patients and their families.
The upshot is that things sometimes work whether we plan that way or not, and it's crucial for healthcare leaders to be prepared for that flexibility. That may mean shelving one virtual care platform and trying out another, or accepting failure and moving on quickly. It may also mean ditching assumptions or preconceived ideas about a technology or strategy and letting something play out a little bit to find its way.
Leaders need to develop a sound business case for virtual care. How can health systems make these platforms both scalable and sustainable?
During these uncertain times, health systems won’t embrace new technology unless there’s a firm understanding of ROI attached. Healthcare leaders need a good, sound business plan to move forward.
This is especially true with virtual care, which was the sweetheart of the rodeo during the pandemic, when providers needed to reduce pressure on hospitals and patients wanted to access care from home. Federal and state regulators even reduced telehealth restrictions to allow more access, and payers like CMS relaxed their rules to reimburse for more virtual care services.
But now that the pandemic has passed, the pendulum has swung back. Many COVID-era waivers have expired, patients are expressing a desire to see their doctors in person, and healthcare executives are tasked with revising or even redefining how virtual care services can be sustained and scaled.
So how do health systems and hospitals define the ROI of a telehealth platform or digital health tool in this day and age? Clinical outcomes, provider workflows and workforce shortages are all part of the recipe, but there also has to be a financial benefit. Can all of these interests co-exist in a business plan?
A recent study of 6 FQHCs in New York found that state Medicaid reimbursement policies are exacerbating workforce shortages and creating a divide between them and hospitals. And that’s doing real harm to their patients.
Federally qualified health centers (FQHCs) are often the only access point for underserved populations needing healthcare services, and telehealth can be a critical tool for improving that access.
But a new study out of Columbia University finds that several FQHCs in New York City are struggling due to inadequate Medicaid reimbursements for telehealth, which exacerbate workforce shortages and create disparities between those safety net clinics and nearby health systems and hospitals.
“Telehealth has many advantages for patients and providers, but only if it’s supported by equitable and sustainable funding policies,” Thalia Porteny, PhD, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health and first author of the study, said in a press release. “Our findings underscore the urgent need for Medicaid reimbursement reforms to address workforce shortages and ensure vulnerable populations can access the care they need.”
Telehealth is often viewed as a crucial element in helping people access care, and was a resounding success during the pandemic in helping hospitals connect with patients, but providers often won’t embrace the technology unless they’re reimbursed for switching away from billable in-person care. That’s especially true of FQHCs and other clinics, who need that support to buy the technology and train staff.
In the study, Porteny and her colleagues interviewed executives and staff from six FQHCs across New York City, and found that inadequate state Medicaid subsidies had caused them to lose about 40% of their mental health staff. Alongside the inadequate payments, restrictive policies around working at home, which were eased during the pandemic, are prompting many mental health workers to leave.
“One participant explained how making mental health practitioners come to the FQHC not only hindered workforce flexibility but did not add clinical value: ‘Every therapist…and psychiatrist [is] making financial sacrifices to work for folks like us, [and now] they have to come to the health center to get on the phone basically, and talk to their patients. And there is zero clinical value to that,’” the study noted.
This, in turn, is contributing to disparities in accessing care.
“One FQHC informed us that they had 700 patients on a waiting list for behavioral health services, because their health center lost half its behavioral health practitioners when they began to require that their practitioners work in the office, rather than remotely,” the study reported.
The study also noted that Medicaid reimbursement policies are designed to support larger health systems and hospitals while hindering small, resource-thin clinics like FQHCs.
“As one noted, ‘When a lot of the rules are made, or when a lot of the emergency fundings for [telehealth] programs come out, they’re all geared through the hospital, and then they expect the hospitals to work with everybody else, where we all know nine times out of 10, that doesn’t happen.... The decision makers at the top who pull the purse strings…are leaning towards hospitals.’” Porteny and her colleagues reported.
The upshot of the study is that FQHCs and other small providers are struggling to embrace telehealth at a time when they should be using the technology to improve access to care. The concern is heightened that those reimbursements may be even further reduced by potential Medicare and Medicaid cuts.
“In the face of potential Medicaid cuts and broader austerity measures, our study’s findings suggest that it would be detrimental to implement cost-cutting measures in telehealth reimbursements in community health centers in New York and more broadly,” Sorcha A. Brophy, PhD, an assistant professor of health policy and management at Columbia’s Mailman School and co-author of the study, said in the press release. “Such budget cuts could exacerbate provider shortages, increase barriers to care for vulnerable populations, and ultimately lead to worse health outcomes. Consequently, this could further destabilize community health centers—a healthcare program that has long enjoyed bipartisan support.”
The study supports improving Medicaid policies toward telehealth, through both better reimbursement and support for work at home plans, digital literacy and training, and other services.
“Participants held a common belief that if telehealth reimbursement policies were well aligned with practitioners’ compensation expectations, as was the case during the COVID-19 PHE response, access and compliance issues would greatly improve in FQHCs because there would be more opportunities and flexibility to see practitioners,” the study concluded.
“As one participant described, ‘Behavioral health compliance went up dramatically [during COVID-19]. Behavioral health was always an area where patients used to cancel or no show. Well, once you had a telemedicine platform for behavioral health, suddenly we had 100% compliance rate.’ Another explained, ‘We used to have a 30% no show, but because of [telehealth during COVID-19] our no-show rates were reduced to like 16%, you know, so it got cut in half.’
