The Arizona-based health system's new SVP of Partnership and Venture Development sees the value of collaboration and being proactive instead of reactive.
As healthcare adapts to a changing landscape and the presence of disruptors, the idea of “traditional” healthcare is being replaced by a network of collaborations and partnerships focused on the consumer’s care journey.
To Mark Garvin, Banner Health’s new Senior Vice President of Partnership and Venture Development, that’s fertile ground for the value-based care system of tomorrow. And it’s his job to steer the Phoenix-based health system in the right direction.
“We can play in this space differently than the Amazons, differently than other retail organizations, simply because we’ve created these clinically integrated networks,” he says.
Garvin has a background in ambulatory care—as chief operating officer for United Surgical Partners International from 2001 until 2020, he oversaw the company’s evolution from a start-up to the nation’s largest developer of short-stay ambulatory surgery centers and hospitals. Now he’s guiding the six-state, 33-hospital network toward a future where care is accessed in many locations.
Banner wants to expand its service offerings and geography “beyond just the acute [care] side,” he says. “What we want to do is grow the diversification as a percentage of the overall business in things that are outside of the traditional acute” care spectrum.
Expanding that footprint means looking beyond “traditional” healthcare to new ideas. Garvin says Banner should not only be open to innovation—they should be leading the way.
Mark Garvin, SVP of Partnership & Venture Development at Banner Health. Photo courtesy of Banner Health.
“Why wait for someone else to come to the table?” he asks. “Why not be part of the creation, either [as] an owner or a partner or in a joint venture?”
One example of the joint venture is Banner Health’s partnership with Select Medical, which began in 2018 and has led to the development of four private rehabilitation hospitals and outpatient physical therapy programs and services at dozens of Banner Physical Therapy centers. The hospitals, which are run by Select Medical under the Banner name, address a growing need for inpatient rehabilitative care for patients who are recovering from strokes, traumatic brain injury and other medical conditions.
“These are people that wake up every single day and this is what they worry about,” Garvin says of Select Medical. “They’re experts. They know how to operate. They know how to develop. They know how to grow. It is their wheelhouse.”
Garvin sees more of those types of arrangements in the future, as health systems and hospitals look beyond their own walls to transform care delivery. He says Banner has to be strategic, as the health system attracts a lot of innovators and start-ups that are looking for Banner to “put them on the map.”
“Is there something real here that we think makes a material difference?” he says. “Does it give us the ability to do things that perhaps in the in the past took a lot more labor and time to get accomplished? We have to ask those questions.”
“We have to do due diligence,” Garvin adds, noting that a good idea now might very well be outdated in 12 months. And while the pace of innovation (think AI) might force healthcare leaders to rush into things, he wants to slow it down a bit.
“Don’t get in too much of a hurry,” he says. “That’s where the mistakes will come in.”
UCSF is launching a remote patient monitoring program aimed at identifying arrhythmias in expectant mothers and improving detection, treatment and long-term care.
Researchers at the University of California San Francisco (UCSF) are enrolling mothers-to-be in a remote patient monitoring study aimed at analyzing how pregnancy affects heart health.
The San Francisco-based university and affiliated health system is partnering with digital health company Vivalink in the BRITE-MOM study, which will use wearable ECG monitors to track participants in real time. The study aims to monitor women with congenital heart disease and pre-eclampsia through pregnancy and six months after delivery to identify signs of arrhythmia.
"Women with congenital heart disease and pre-eclampsia face a significantly elevated risk of arrhythmia during pregnancy, yet data on how and when these arrhythmias occur remain limited," Nicky Herrick, MD, a cardiology fellow at UCSF and one of the study’s principal investigators, said in a press release. "Our goal is to generate a detailed picture of the types, frequency, and symptoms of arrhythmias in pregnancy using wearable technology that allows us to monitor participants safely and remotely."
Healthcare providers are embracing RPM at a rapid pace, with an eye toward tracking their patients outside the hospital, doctor’s office or clinic and understanding how daily life may affect their health. In this particular case the focus is on identifying cardiac complications and reducing maternal mortality, which caused almost 33 deaths per 100,000 live births in the U.S. in 2021, according to the Centers for Disease Control and Prevention.
The study will collect round-the-clock data on heart rate variability, arrhythmia episodes and early indicators of cardiac stress. Often these indicators won’t show up in an office exam, either through testing or talking with patients, so it’s crucial to gather that data as the patient goes through her day.
UCSF says the study will help clinicians better understand arrhythmia patterns that can help guide early detection, clinical intervention and long-term care management.
"By incorporating wearable devices for long-term use, we are able to better capture arrhythmia episodes and early signs of cardiac stress that could otherwise go undetected," added Anushree Agarwal, MD, a UCSF Health cardiologist and co-principal investigator, in the press release.
PPEC programs like Spark Pediatrics give healthcare providers a resource to manage and coordinate care for children with complex care needs. They also give parents a chance to relax a bit, and enable these children to be kids.
Health systems and hospitals play an important role in coordinating care for small children with complex medical needs, who often transfer out of the NICU and into a chaotic and uncertain world.
A model of care called PPEC (Prescribed Pediatric Extended Care) aims to make that process easier for providers, patients and their families.
A concept that’s been around for roughly 40 years, PPEC centers are gaining momentum as the number of “medically complex” children surpasses 3 million in the U.S., straining the resources of both healthcare providers and families. The center-based model, likened to a day care, aims to give these children the care they need alongside the childhood they’re often missing out on.
“We’re helping kids [with complex medical conditions] get access to skilled nursing care,” says Jeffrey Soffen, CEO of Spark Pediatrics, a Florida-based PPEC provider that is working with more than a dozen health systems across three states. “We promote socialization. We promote respite for the families so that they can either have time to themselves or time to go to work or whatever it might be. I'd say right now that's really important.”
There are roughly 180 PPECs in the U.S., located in the 15 states whose Medicaid programs permit the centers (Medicaid requires a prescription for care from the child’s primary pediatrician). Several states, including Missouri, are debating amending their Medicaid program to permit PPECs, but the path forward is slow and uncertain, especially considering the current political climate.
Earlier this year Spark Pediatrics raised $15 million in new investments, with funding from Pittsburgh’s UPMC Enterprises and the Houston’s Memorial Hermann Health System. Soffen says the funds will enable Spark to establish new partnerships in Pennsylvania and Texas, the next step in a plan to expand across the country.
“Spark is creating a new model of care delivery for children with medical complexities that is aimed at improving quality of care and the family experience for this often-overlooked population,” Mary Beth Navarra-Sirio, Vice President of Market Development at UPMC Enterprises, the innovation, commercialization, and venture capital arm of UPMC, said in a January 2025 press release on the funding round. “This aligns well with our focus on creating innovations that impact the lives of patients in meaningful, lasting ways.”
Soffen says medically complex children often begin their lives in the hospital NICU, move through other departments in the hospital, then need care from a wide range of doctors, nurses and specialists when they go home—tasks that often fall on stressed parents. On top of that, there are often delays, some as long as a year, in accessing specialists.
"We Should Be Locking Arms"
That’s where care coordination becomes a necessity.
“Our kids are born in their NICU, they're going back to their hospitals, they're seeing their pediatricians,” Soffen says. “It feels like we should be locking arms, right?”
Spark uses a patient-centered medical home strategy at about half the cost of in-home care, he says. Through a care team that collaborates with specialists, the center offers up to 12 hours of care seven days a week, with a patient-to-staff ratio of 1:3.
“My biggest thing that I want to do is make these kids’ lives easier,” Soffen says. “If you think about a child that we serve, they might have 12-13 specialists. They might have an appointment every week with a different doctor. [Parents] also have to coordinate therapies. So if you have a feeding tube, you've got to be working on swallowing in order [to make] progress and eventually get this feeding tube out.”
“We need to do as many of those things in our center as possible, but we also need to understand who we are and who we are not,” he adds. That means the center focuses on a small care team and coordinates specialist visits, taking the pressure off of parents who would otherwise be scheduling specialist visits at home or transporting their children to doctor’s offices and clinics.
For that reason, Spark Pediatrics—like most PPEC providers—needs to be located near large population centers.
“The more kids that we serve in a center, the more we can do for them, and that's the really powerful thing,” Soffen says. “So if I have 30 kids in my center instead of 10, my ability to attract providers to do virtual visits or come into the center to do a wellness check is a totally different scenario. If they can see 20 kids instead of five kids, that makes it worthwhile.”
That’s why Spark Pediatrics started in Florida and is targeting heavily populated states like Texas and Pennsylvania. Medicaid support is crucial, Soffen says, as almost all of their patients are on Medicaid, and Spark is working with legislators in states like Missouri to expand the number of states they can work in. They’re also talking to private payers about the value of the program.
The UPMC partnership, meanwhile, has an added benefit of an associated health plan, offering opportunities for innovative care arrangements like an ACO.
“An ACO is a is a way for providers to come together to produce better outcomes for their patients and to do it in a cost-effective manner than incentivizes them to do that,” Soffen says. “Why shouldn't we be a part of that if we're able to help them achieve that goal?”
"Why Shouldn't They Have That Chance to Just Be a Kid?"
Soffen says they’ve had good conversations with pediatric hospitals (their partners include Nemours, Joe DiMaggio Children’s Hospital, Orlando Health’s Arnold Palmer Hospital, Palm Beach Children’s Hospital, Baptist Health Jacksonville’s Wolfson Children’s Hospital and Texas Children’s Hospital). But the wider strategy is to partner with any health system that treats medically complex children.
“A big part of our job is to educate, in particular, the hospitals, the discharge coordinators, the care managers, the case managers, the pediatricians, the specialists, the pediatric specialists,” he says. “Those are who our kids are going to every day and they're the ones that put their trust in those institutions to recommend what is best for them.”
The biggest barrier, of course, is funding, and the ongoing chaos in Washington DC over Medicare and Medicaid sustainability casts a shadow over the growth of any PPEC.
That’s why Soffen wants healthcare providers and lawmakers to see not only the financial and clinical value to these centers, but what these facilities can offer to children and their parents.
“You want these kids to have the childhood that you dream about, where they come home from friend's houses or birthday parties or doing arts and crafts, and you put [their artwork] on your window and you're so proud of them,” he says. “Why shouldn’t they have that chance to just be a kid.”
The Charleston-based health center, participating in HealthLeaders’ Virtual Nursing Mastermind program, is ready to move beyond med/surg units and put virtual nurses in the ED, ICU and specialty care programs.
It’s an “exciting time for nursing transformation,” says Emily Warr, Administrator for the Center of Telehealth at the Medical University of South Carolina (MUSC). And that means it’s time for the health system to scale its Virtual Nursing program beyond their med/surg units.
“We have grown significantly, are planning to pilot in room equipment this quarter, and are making great progress with quality and finance metric improvements,” says Warr, a participant in the HealthLeaders Virtual Nursing Mastermind program.
MUSC, which has taken part in the Mastermind program the past two years, is seeing growth at a time when many health systems and hospitals are ramping up their virtual nursing programs to meet a rising demand for effective care transformation. Many are looking to move beyond the initial ROI of improving nurse workflows and well-being and are looking for clear clinical value, such as improved patient outcomes or administrative metrics such as patient length of stay or admission/discharge times.
In a May 2024 HealthLeaders interview, Warr said MUSC had launched an earlier version of virtual nursing that didn’t succeed because it wasn’t sustainable. That led to a second iteration, which focused on specific pain points and targeted tasks in which success could be measured and proven.
“We needed to focus on something that we felt we could impact and choose to measure,” she said, such as “very specific, task-oriented things.”
Fast-forward to today, and Warr says they’ll soon be expanding the program beyond med/surg to the Emergency Department, ICU and other specialty care units.
“We can’t expand fast enough,” she says. “Nursing units across the system are demanding the service and are eager to see the benefits in their work area. I think the specialty units will be interesting to explore and will present scalability challenges, but we look forward to problem-solving those while maintaining a focus on outcomes and efficiency.”
MUSC’s program tracks several metrics, beginning with nursing satisfaction and turnover rates and patient satisfaction scores, all of which have improved with the program. They’re also charting pressure injuries and hospital-acquired infections, time to discharge, quality of information given to patients upon discharge, quality of patient-nurse communications and even time given back to nurses.
The health system is reporting a 10% reduction in nurse time spent in the EMR, a 5% improvement if patient experience tied to communication with nurses at admission, and a 10% improvement in patient throughput, or timeliness to discharge.
Perhaps the only drawback at the moment to expansion, Warr says, is a hiring pause on virtual nurses, which she says is necessary for MUSC to catch up on workflow efficiencies and investigate productivity.
With the transition to other departments within the hospital, she expects to see some new challenges. That includes creating workflows for virtual nurses in the ED that don’t conflict with floor nurses and the many different challenges that influence nursing care in the ICU, including drug administration, sedation, ventilator management and documentation.
And that’s where Warr is focusing her excitement. The expansion of virtual nursing to other departments not only poses new challenges, but opens up the model to new ideas for care management and new outcomes for improvement. That the program has worked so well in med/surg doesn’t mean it will thrive in other environments, but MUSC has the experience and the data to build off of those early gains.
That includes, eventually, new care pathways that extend outside the hospital, even into the home.
“We have virtual nursing roles in all areas of our virtual ecosystem,” she points out.
The HealthLeaders Mastermind seriesis an exclusive series of calls and events with healthcare executives. This Virtual NursingMastermind series features ideas, solutions, and insights onaccelerating your virtual nursing program.Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
CMS spent almost $200 million on remote patient monitoring in 2023, and more providers are embracing the technology to track patient biometrics. That’s why the time is right to align payer policies and reimbursement on high-performing programs.
Healthcare providers are finding increasing value in remote patient monitoring (RPM), and that ROI is tied to Medicare and Medicaid reimbursement. But those payments are limited, and some providers are saying they don’t get enough back to justify the investment in new technology and workflows.
With that in mind, a new report says the time is right to rewrite RPM policy, improving reimbursements and giving providers more opportunities to embrace innovative tools that can improve clinical outcomes.
The report, from the Peterson Center on Healthcare, finds that Medicare expenditures on RPM have grown from $6.8 million in 2019 to $194.5 million in 2023, but that’s still just a small part of overall Medicare spending. The growth is driven by CPT codes approved by the Centers for Medicare & Medicaid Services (CMS) for some remote physiological monitoring (RPM) and remote therapeutic monitoring (RTM) services, as well as a growing number of vendors offering RPM devices and management services and a general desire among clinicians and care teams to track their patients’ biometrics outside of the doctor’s office, hospital or clinic.
That’s why, the report says, policy-makers, providers and payers should come together to improve reimbursement opportunities. The report lists three recommendations:
Align coverage and reimbursement for RPM services to clinical value.
Ensure access to high-impact RPM services.
Improve data collection in RPM tools and programs.
“As we adopt exciting, new technologies that extend care beyond the walls of the doctor’s office, we need to design payment models that align with clinical benefits for patients,” Caroline Pearson, executive director of the Peterson Center on Healthcare, said in a press release. “That means ending ‘forever codes’ that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients’ diseases.”
A Service Ripe for Expansion and Improvement
The report lists four takeaways from a review of CMS data:
Only about 1% of Medicare patients are in remote physiological monitoring programs, and even less are using remote therapeutic monitoring. But those numbers are growing, from 44,500 in 2019 to 451,000 in 2023 for RPM and roughly 52,500 in 2023 for RTM.
Providers are billing RPM services for longer periods of time, from an average of 1.7 months in 2019 to 5.2 months in 2023.
More than half (57%) of all Medicare spending on remote physiological monitoring services focuses on hypertension, while 13% addresses diabetes and 6% targets sleep and waking disorders. For remote therapeutic monitoring, almost 60% targets musculoskeletal disorders, while 5% addresses either respiratory disorders or hypertension.
In 2023, traditional Medicare spent $194.5 million on remote physiological monitoring services and another $10.4 million on remote therapeutic monitoring services, which comes out to an increase per-patient from $154 in 2019 to $431 in 2023.
The report suggests that RPM reimbursement be tied to those specific programs that show the most value.
“Coverage and payment policies should be aligned with this evidence to encourage adoption of solutions that deliver clinical benefits and limit payment for monitoring that is not driving meaningful clinical improvements,” the report states.
Why Are Doctors Embracing RPM?
The report also revealed three key takeaways to clinical value for RPM programs:
The clinical impact of RPM varies by condition.
Clinical benefits from RPM depend on provider engagement with the data collected and the ability to act on that data to improve outcomes.
RPM programs are time-limited, and clinical effectiveness varies depending on the condition.
“These clinical findings suggest that reimbursement for remote monitoring solutions should reflect effectiveness and vary by duration,” the report said. “CMS and other payers should consider developing condition-specific billing guidelines that match the periods of highest effectiveness as evidenced by clinical benefit for each condition.”
“Once an evidence-based time limit for remote monitoring services is reached, continued coverage of these services should require additional clinical justification,” the report continues. “Medical necessity is already a standard in Medicare and Medicaid; this would be a step toward defining medical necessity criteria for remote monitoring technologies.”
As an aside, the report notes that providers currently have no limits on how long they can use RPM for a specific patient, and can be reimbursed “on a monthly basis in perpetuity for anyone with a diagnosed chronic condition, even if they are already well-managed.”
This points to the need for more detailed data on how providers are billing for RPM services and how these variations in the duration and effectiveness of treatment may impact healthcare spending.
The report also gives health system and hospital leaders a blueprint for developing an RPM strategy that makes the most out of available reimbursements. It can also be used to develop more effective programs, either by fine-tuning devices and care pathways for common conditions are creating new treatments to address gaps in clinical care.
Two U.S. Senators have co-sponsored a bill that would create a better pathway for Medicare coverage of FDA-approved AI tools for clinical care.
One of the barriers to AI adoption in clinical care is the lack of a clear financial ROI. A new bill before Congress aims to make that process a little bit easier.
U.S. Senators Mike Rounds (R-South Dakota) and Martin Heinrich (D-New Mexico) are sponsoring the Health Tech Investment Act (S.1399), which would expedite the pathway to Medicare reimbursement for clinical AI tools.
“Medicare patients deserve access to the life-changing care that artificial intelligence-enabled devices can offer,” Rounds said in a press release announcing the bill. “There is currently no clear Medicare payment system for these devices, meaning that it can take years to be approved and paid out by Medicare accurately. This legislation would create that system, improving diagnoses and encouraging the adoption of AI devices in clinical settings.”
The fast-paced development of AI tools in the healthcare space has created a noticeable gap between implementation and governance. According to Rounds and Heinrich, the FDA has approved more than 600 AI-enabled devices, but the Centers for Medicare & Medicaid Services (CMS) “lacks standard or consistent methods for covering and paying for these products.”
And without reimbursement, providers are reluctant to adopt the technology. Many health systems and hospitals, particularly non-profits and rural organizations, are operating on razor-thin margins, and executives won’t likely introduce new tools unless CMS backs them financially.
The bill has garnered support from several advocacy groups, including the National Health Council and the Advanced Medical Technology Association (AdvaMed).
“AI’s role in improving patient care is already evident and increasing, particularly in radiology, where AI can help doctors and other healthcare professionals swiftly analyze medical images, detect illness and abnormalities, and make a more informed diagnosis,” AdvaMed said in a press release. “Moreover, FDA authorized AI-enabled medical devices are poised to save the healthcare system resources due to enhanced diagnostic and therapeutic precision that can help drive efficient and effective care.”
“With AI-enabled medical technologies already making remarkable strides in patient care, and with even more incredible strides ahead of us, now is the time to establish a predictable reimbursement pathway,” Scott Whitaker, the group’s president and CEO, said in the release.
This week's Winning Edge panel explored how ambient AI is being introduced to clinicians, and how the technology will evolve as a decision support tool.
Health systems like Providence and Cedars-Sinai are taking a slow and steady approach to introducing ambient AI to their clinicians, with small pilots that gradually scale upward as doctors become familiar with the technology.
During this week's The Winning Edge podcast, sponsored by Microsoft, Providence Chief Transformation Officer Sara Vaezy and Cedars-Sinai CMIO Yaron Elad, MD, FACC, said the biggest ROI for ambient AI at present is in helping clinicians reduce their administrative workload and spend more time in front of patients.
But they also noted that the technology will eventually become sophisticated enough to give clinicians near-real-time clinical decision support, while also helping to identify and schedule tests and appointments and code the encounters.
Both said it's important to put AI in the hands of doctors who want to use the technology, so that they can demonstrate its value and pass that on to their colleagues. And while the potential to reduce workflow pressures and find time to see more patients may be there, executives shouldn't be suggesting that to their doctors.
Ambient AI is just one of several AI tools being introduced in the clinical space, according to Vaezy and Elad. Health systems and hospitals are also testing the technology on in-box messaging, with the goal of reducing time spent by clinicians checking their messages and answering patient requests more quickly. They're also trialing AI on chart summarization, and looking forward to applying AI to nursing.
Watch the YouTube video below of this week's panel to gain more insight into how AI is being embraced in the clinical space.
Healthcare executives who took part in this week’s Winning Edge panel say ambient AI is helping clinicians reduce administrative stresses, but it will soon be used to add value to the patient encounter.
Health systems like Providence and Cedars-Sinai are embracing ambient AI to improve clinician workflows and reduce administrative tasks, but the real value will come when AI adds clinical value to the doctor-patient encounter.
That’s the long view taken by executives from the two health systems during Tuesday’s The Winning Edge panel, sponsored by Microsoft. And it points to the future of Ai in clinical care as a decision support tool.
Sara Vaezy, Chief Transformation Officer at Providence, and Yaron Elad, MD, FACC, Cedars-Sinai’s Chief Medical Information Officer, said their organizations have both gradually rolled out ambient AI tools to physicians to help them spend less time in front of a computer and more time in front of their patients. The technology is designed to accurately capture the conversation and put that information into the medical record, reducing the amount of time clinicians spend documenting the encounter.
Elad said it’s reasonable to expect that the tool reduces time spent on the computer by 10% to 20%, especially time spent after hours, even at home, tidying up the notes for the patient record. That reduces the clinician’s administrative workload and gives the doctor more time to face the patient—something that not only benefits the doctor, but makes the patient feel more valued as well.
That might not appeal to a CFO looking for financial ROI, but it does set the foundation for improved provider well-being, better patient engagement and satisfaction, and eventually improved clinical outcomes.
That said, the two executives and Jared Pelo, MD, CMIO for Microsoft’s Health and Life Sciences unit, pointed out that clinicians have to “own” the technology and have the time to get used to it on their own terms. Healthcare leaders should not tell them that AI will improve their productivity, such as giving them more time to see new patients; instead, as clinicians settle into their new workflows, they may find the time to address new productivity goals.
Vaezy said Providence is tracking several different metrics on ambient AI, including efficiency and appointment times, to get a baseline on how the tool could have an impact on productivity in the future. Just as important, they’re charting provider and patient satisfaction, and asking clinicians if they’d be disappointed if the tool were taken away, whether they’d recommend AI, whether this tool improves documentation and would this capability compel them to stay with the organization or stay in medicine.
Both Providence and Cedars-Sinai are developing AI tools in other areas as well, including in-basket messaging and chart summarization. And while Vaezy and Elad said the next big advances should come in how AI can be used to improve nurse workflows, both are particularly looking forward to how AI evolves as a clinical decision support tool.
Vaezy pointed out that AI, for the most part, is now being used to reduce complexity and remove administrative burdens, but within two to three years the technology’s value will be in adding to the provider’s toolbox and giving more value to the provider-patient encounter. That might mean coding the encounter and identifying and pushing tests and other appointments.
Elad, meanwhile, said he envisions an AI overlay that gives clinicians almost real-time clinical decision support. This would support the true definition of AI as augmented, rather than artificial, intelligence.
Stay tuned to HealthLeaders this Friday for the YouTube recording of this Winning Edge panel.
A Cedars-Sinai program attaches a substance abuse treatment doctor and social worker to the patient’s care team, improving treatment adherence and creating a better link to post-discharge treatment.
Cedars-Sinai is championing a new care management strategy aimed at linking patients dealing with substance abuse issues to medication-based treatment services after they’ve left the hospital.
The Los Angeles health system’s Substance Use Treatment and Recovery Team (START) pairs an addiction medicine specialist with a social worker or case manager to coordinate post-discharge care plans, including diagnostic assessments, information on treatments, psychosocial support and follow-up phone calls for one month.
The program builds on care transformation strategies that health systems and hospitals are exploring in an effort to redesign inpatient care and boost clinical outcomes. The idea is to create a personalized care team around the patient that includes clinicians and specialists and which can be expanded to include others such as pharmacists and social workers.
“Our program addresses a major challenge across hospitals,” Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, said in a press release. “Even though effective medications exist for opioid use disorders, only a small percentage of hospitalized patients begin treatment during their stay or connect with services after discharge.”
According to a study authored by Danovitch and recently published in JAMA Internal Medicine, patients introduced to START were more than twice as likely to accept medication-based treatment during their hospital stay than those receiving the usual care, and they were almost twice as likely to embrace treatment after discharge.
Those numbers are important as health systems and hospitals try to battle the ongoing substance abuse epidemic, an integral part of the surge in mental health cases and a contributor to crowded Eds and declining public health outcomes.
The study, led by Cedars-Sinai, analyzed 325 patients hospitalized at three hospitals—one in Los Angeles, one in Albuquerque, New Mexico and one in Springfield, Massachusetts—between November 2021 and September 2023, with a final follow-up in December 2023.
Of that group, 164 patients received START care and 161 received traditional care. More than 57%, or 94, of the START patients initiated medication-based treatment (naltrexone, buprenorphine or methadone) during their hospital stay, compared to almost 27%, or 43 of the traditional care patients, and 72%, or 90, of the START patients continued care after discharge compared to 48%, or 50, of the traditional care patients.
“Hospitalization provides a crucial window to involve patients in addiction treatment when they might be most open to it, particularly after experiencing health-related consequences of their substance use,” Jeffrey A. Golden, MD, director of the Burns and Allen Research Institute and executive vice dean for Research and Education at Cedars-Sinai, said in the press release. “These important findings show how the medical community can significantly boost this engagement and help find solutions for the national opioid epidemic.”
Sharp HealthCare's year-old virtual nursing program is now testing a 'VIP experience' that enables nurses to become more active members of the patient care team.
As virtual nursing programs mature in health systems and hospitals across the country, some executives are envisioning a concierge care strategy.
Sharp HealthCare, for example, debuted its VIP platform roughly two months ago in the neuroscience unit in preparation for the opening of the new Sharp Grossmont Hospital for Neuroscience. This expanded co-caring model known as Vitual InPatient nursing services (VIP) leans heavily on patient engagement strategies, with the goal of having the virtual nurse as the patient's guide through the healthcare journey.
Tracy Plume, Nurse Director for the San Diego-based health system, says the new model was co-designed by patient advisors, information technologists and front-line nurses.
"The patients really want to know that someone was behind the scenes monitoring their record, looking at their chart, that nothing was going missed," she says. "They felt that that would make them feel safer, that their care was progressing as it should be. And that they had the opportunity to daily meet with the virtual nurses and ask those questions."
"They get an extra connection with the nurse, a healthcare provider, someone on the care team, to help coordinate that admission to discharge process." Plume adds.
Plume and Susan Stone, Sharp HealthCare's SVP of Health System Operations and System Chief Nursing Executive, recently took part in HealthLeaders' Virtual Nursing Mastermind program. Executives from roughly a dozen health systems met virtually and at an in-person event in Atlanta to discuss how their programs are evolving, where they see challenges, and how this strategy will evolve.
For Sharp HealthCare, virtual nursing is more about care delivery transformation, or crafting a new strategy for inpatient care that involves all the members of the care team. The idea took root in 2023 after a board member witnessed how Providence (another Mastermind participant) was transforming its care team strategy. Stone says she and her colleague spent a year researching the concept and looked at roughly 20 virtual nursing programs across the country.
Roughly one year ago, on April 1, 2024, Sharp launched its first virtual nursing program in two selected units, focusing primarily on handling admissions from the Emergency Department and discharges. The program has now spread to all four of Sharp's hospitals, encompassing about 600 licensed beds and 16.2 FTEs and running seven days a week, 12 hours a day.
Stone says the program focused on admissions and discharges first because those were the key pain points identified by frontline nurses who were included in the planning process. Sharp built is ROI strategy, she says, on reducing those time-consuming processes, thereby improving patient throughput and freeing up beds faster for new patients (Stone says the health system is runs between 85-95% capacity, making available inpatient beds a valuable commodity).
Stone says developing and proving an ROI is daunting, considering the many pain points that a virtual nursing program can potentially address. While patient throughout is one of them, she says, there are many factors beyond the nurse's control that go into how long a patient stays in the hospital.
Susan Stone, SVP of Health System Operations and System Chief Nursing Officer, Sharp HealthCare. Photo courtesy Sharp HealthCare.
"We're still working hard on producing and defending the return on investment," she says.
Other factors include readmissions (a costly pain point for every health system), nurse workflows and well-being, and patient satisfaction and engagement.
And that's where version 2.0, the so-called VIP experience, comes in. Stone and Plume say Sharp leadership wanted to target the patient experience in the evolution of virtual nursing, with a service that creates a care program around the patient.
"We've really taken our program past services and alleviating that administrative burden on the nurse to really being more part of the care team," Plume said.
Plume says the patient experience should always begin "with a warm hug," a feeling that the patient is being cared for by a team, both in the hospital room and behind the scenes. Through the virtual portal, a nurse is keeping an eye on the patient's healthcare data, coordinating with other members of the care team and the patient's family, handling administrative duties and funneling education and other resources to the patient.
She says nurses like the format because it gives them an opportunity to stay in the loop and learn more about their patients.
Whether this program can be expanded to all hospitals at Sharp depends on ROI, which will take time to develop. Stone notes that patient satisfaction rates have soared since the program's inception soaring, a good sign that they're more engaged with the care team and understanding their care at home management plan.
In addition, Stone says discharges are much more timely, and when recently speaking with frontline nurses, they report being able to facilitate patient discharged by 11:30 whereas before it would have been into the late afternoon to facilitate three discharges by themselves.
They are now looking at the possibility of folding other services into the virtual nursing platform, including deterioration alerts, sepsis alerts and the potential to be more efficient with virtual sitting throughout the system. Others have suggested adding virtual visits by specialists, such as diabetes educators.
"To us the future is for all different types of virtual care, and we know that other smart programs will be deployed via the electronic health record system, and we haven't really launched them to their fullest extent," Stone says.
"All of those things are business cases that we need to take one at a time," she adds. "We don't want to go too fast too soon because that could set the program up for failure."
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.
