The EHR company put on its usually flashy show, and while groundbreaking announcements were minimal, there are signs that the industry is starting to look at the technology in a new light.
Epic’s annual User’s Group Meeting (UGM) last week was all that it promised to be: Flashy, upbeat and befitting of the nation’s biggest EHR company.
But for healthcare execs who are part of the Epic universe as well as those on the outside looking in, there wasn’t much that could be called newsworthy. The company and its powerhouse leader, Judy Faulkner, are notorious for playing things close to the vest.
That said, here are the four biggest takeaways:
The AI Hype Machine Rolls On. More than 100 AI-enabled tools are already in the Epic toolbox, according to Faulkner, and the company has an aggressive agenda to develop the technology for both providers and consumers. The announcement puts Epic smack in the middle of the AI race, alongside some of the tech titans with which it’s also collaborating. And with little more than a passing mention of working with others and developing open-source tools, it’s clear that the company is making AI its next big marketing feature.
Playing With Payers? The Epic Payer Platform isn’t revolutionary, nor is it new. But it does address a consistent concern in healthcare: How to get providers and payers to sit at the same table to trade data and tackle key pain points in connecting care with compensation. Faulkner said roughly half of the Epic health system and medical group customers and seven of the nation’s largest payers are connected to the platform, with the goal of reducing denials and improving the prior authorization process. But will payers want to play in this sandbox? And what incentives could Epic offer to get them interested?
Looking to the Little Guys. Epic has long been focused on the biggest health systems and hospitals, to the point that some competitors have changed their approach to focus on smaller providers, from rural hospitals to medical practices, even FQHCs, Rural Health Clinics and specialty practices. Faulkner’s mention of the Washington State Health Care Authority, a collaboration between the state and Epic launched several years ago to support EHR adoption for smaller providers, may be an indication that the company has its sights set on expanding its reach.
Paying Attention to the Patient. From plans to make MyChart a more interactive tool for patients to the grand designs for Cosmos, it’s clear that Epic wants to get more involved with patient-centered care. Cynics will say they’re giving patients that same opportunity to experience the frustration with technology that doctors experienced a few decades back, but this strategy may be the most impactful of all to come out of the UGM. It recognizes that the EHR, for all its perceived faults, has evolved. If patients can draw as much value as clinicians from this platform, the opportunities for care collaboration and—yes, we’ll say it—value-based care are pretty good.
The INN Between offers a wide range of services for homeless patients and those in unsafe living conditions. Health systems and hospitals should take notice.
A unique program in Salt Lake City is managing care for underserved patients who live on the street or in an unsafe location, and helping hospitals reduce ED crowding, improve care coordination and reduce costs in the process.
The INN Between is a nine-year-old program that began as a 16-bed Catholic convent and is now an 80-bed “assisted living facility” of sorts, offering everything from hospice care to rehabilitation and care management services.
The organization addresses a significant care gap for health systems and hospitals who see these patients in their Emergency Departments and ICUs—and who often discharge them to an uncertain care landscape.
“How can they continue to care for the individual if they’re not going to a home?” notes Jillian Olmsted, The INN Between’s CEO and executive director. “And how can they make sure they’re getting back to those appointments?”
Seeking Support from Providers
When the organization first opened its doors, Olmsted says, Salt Lake City’s two main health systems, Intermountain and the University of Utah Health’s Huntsman Cancer Institute, paid a per-bed per-night fee to house discharged patients, but that arrangement soon ended. Intermountain now provides a charitable donation, and The INN Between, which operates year-to-year on a budget of $1.6 million (recently cut down from $2 million), exists on a mishmash of charitable donations, grants, and the occasional federal or state subsidy.
According to Olmsted, an independent study found The INN Between has helped local hospitals reduce the average yearly length of stay for this population by 13.49 days from admission to discharge, representing a 91.44% decrease in hospital utilization and about $47,000 in annual savings per patient.
Olmsted is hoping to present this study to health system executives this fall.
Jillian Olmsted, CEO and executive director of The INN Between. Photo courtesy The INN Between.
“They are the primary beneficiaries of this program aside from the patient,” she notes, and hospitals “are extremely motivated to discharge to someplace other than a shelter.”
She says the organization serves a variety of needs, including hospice and medical respite care. It also acts as a temporary home for patients with complex care issues, such as transplants, recent surgeries and those undergoing cancer treatment, patients with chronic care issues like uncontrolled diabetes, all of which might need a safe home environment in order to qualify for medical care.
“So we help clear up all those barriers for them, maybe help get them on Social Security, get their ID, Social Security card, all the things that prevent them from getting into some sort of housing,” she says.
“We're helping individuals just learn about their medical condition and treatment plans, helping them get that one medical home because oftentimes they've gone from ER to ER or clinic or pain doctor and they don't know where to fill their prescriptions,” she adds. “They don't know how to get their medical records, so we help get them one primary care doctor so that they can be more successful.”
Addressing a Societal Concern
Without a resource like The INN Between, it’s likely a lot of these patients would fall through the cracks. They’d return to the streets or another unsafe living situation, ignore follow-up appointments and prescriptions, and eventually show up in the ED with a more serious health concern, repeating the ED-to-ED cycle.
According to Greendoors, which develops community partnership programs to help the homeless, each visit to an ED costs $3,700; at an average of five ED visits a year, that’s at least $18,500, with much higher costs for frequent users. In addition, homeless patients often spend at least three days in the hospital, at a cost of more than $9,000.
Continuing that thread, roughly 80% of ED visits by the homeless are for medical issues that could have been prevented through preventative care, and the homeless are at a far higher risk of developing chronic health concerns. Little data is available on the cost to the healthcare industry for missed care appointments or unfilled prescriptions. Finally, these costs are usually not recouped by health systems and hospitals.
The national effort to identify and address social determinants of health (SDOH) has in some ways put this issue in the spotlight, and many healthcare organizations are taking a look at how to address these costs and this population. But progress is slow.
Providing a Place to Stay
Olmsted says The INN Between is staffed by some nurses and CNAs, care coordinators and case managers, a wide assortment of volunteers, including chaplains, representatives from Mental Health America, and occasionally social workers or people on internships or some other arranged program. Hospice care is coordinated through the hospice care provider of the patient’s choice. And through the national No One Dies Alone (NODA) program, volunteers are on hand to sit at a patient’s bedside during their final days.
“It's just an extra set of eyes and ears for maybe when someone's no longer able to push the call button,” Olmsted says, adding that each patient who passes away is remembered in a house meeting later on.
She says there are plenty of stories about the people who stay there.
“People come in with rough exteriors, not willing to accept help,” she says. “They've lost trust in healthcare. They've lost trust in homeless services, but here they have their own room and a TV. And they get to choose when they eat, and they have a dresser, and I think it just helps people change and think, ‘Maybe there’s something different for me. Maybe I don't need to just stay in the cycle of homelessness and, you know, in and out of the shelter.’”
The INN Between can’t currently bill payers for its services. Olmsted is working with a lobbyist to push passage of state legislation that would enable them to qualify for a Medicaid waiver that would allow health plans to pay for medical respite care and housing support for homeless beneficiaries as medical expenses.
The push for permanent source of funding is crucial, as is the quest for support from the healthcare industry, including hospitals and health systems. Olmsted says The INN Between serves an important role in the healthcare ecosystem that is often overlooked or addressed by small groups, charities, and the likes of the Ronald McDonald House.
“My hope would just be that if we can have a sustainable funding stream that we would just be a really good model for different states to follow,” she says.
A pilot project coordinated by the Michigan Health Information Network aims to help hospitals share critical patient data with EMS providers and ambulances.
Hospitals often face difficulties accessing data on patients coming into their Emergency Departments. A new health information exchange project in Michigan could help.
The Michigan Health Information Network (MIHIN) recently conducted a pilot with Hillsdale Hospital, Reading Emergency Unit, and Beyond Lucid Technologies to create a secure pathway for information exchange between the EMS provider and the hospital, using MIHIN’s secure network and Beyond Lucid’s technology platform.
During the pilot, an REU ambulance transporting a patient to Hillsdale Hospital was able to send an electronic patient care record containing the patient’s vital signs and other clinical information, including medical history and social determinants of health, to Beyond Lucid’s tech platform. That platform converted the data to a Continuity of Care Document (CCD), which was securely transmitted over the MIHIN network to the hospital, enabling care providers to get an accurate assessment of the patient prior to arrival in the ED.
Secure data exchange in emergency care is a complex pain point for health systems and hospitals, many of which don’t have a secure or reliable pathway to exchange information with EMS providers, ambulances, police and fire departments and other mobile responders. With the advent of digital health technology and health information exchange networks, the push is on to create those pathways so that hospitals can coordinate care for ED patients.
“Ambulance and fire services are often the first point of contact for patients suffering a medical emergency,” Tim Pletcher, MIHIN’s executive director, said in a recent press release on the pilot project. “In these time-sensitive situations, expedient access to accurate patient health information is critical for making informed decisions and providing effective care. The partnership between MIHIN, Reading, Hillsdale Hospital and Beyond Lucid Technologies offers a promising solution for improving access to patient data in pre-hospital settings by providing a more complete picture of a patient's health during critical moments and minimizes the risk of errors associated with incomplete or inaccurate information.”
In a 2023 interview with HealthLeaders, Jonathon Feit, MBA, MA, Beyond Lucid’s co-founder and chief executive, said the healthcare industry has been slow to embrace the idea of a common framework for data sharing in emergencies. He noted that in 2020 the Cleveland Clinic, Essentia and Sanford Health were all unable to integrate EMS-based data into their Epic EHR even though Epic had published the data import specifications on its website.
Secure data exchange in emergency and urgent care is crucial for a number of reasons, not just ED transports.
“Consider prescription medications and substance use challenges," Feit said. "Substance use challenges [can] fester into overdoses due to a lack of visibility into patients’ encounters with care settings across jurisdictional lines. If a patient in Ohio sees a doctor in West Virginia, Kentucky, or Indiana, there is presently no mechanism for the Ohio-based fire or ambulance crews, or hospitals, to know what medications the patient should have been taking, which makes it much harder to surmise what she or he likely took."
Feit said the MIHIN project is an important step forward for interoperability.
“Michigan is a complex prehospital and post-hospital medical transportation ecosystem, and the partners to this project sought to create an onramp for any mobile medical agency to enjoy the benefits of true interoperability across the state,” he said in the MIHIN press release. “It also proves something that deserves to be shouted from the rooftops: This isn’t about fire or EMS or public or private services. It is about continuity of patient care, and getting everyone on the same page so that responders can deliver the most informed care possible.”
While the first phase of the project demonstrated the ability to share date between the EMS provider and the hospital, a second phase targets a familiar idea: A portable patient record that goes with the patient and can be accessed by EMS providers and others.
According to MIHIN, the organization “will create a real-time active care relationship between the patient and the mobile medical agency, enabling it to receive future discharge medication reconciliation reports from participating hospitals, improving medication management for patients.” MIHIN would then be able to share that ambulatory CCD with the patient’s care team.
In addition, MIHIN plans to expand the project to include fire and rescue services in two nearby communities.
At its annual user's conference, the EHR giant unveils a strategy that includes hundreds of AI programs and plans to address inpatient monitoring
As healthcare organizations develop AI strategies that use both in-house talent and outside vendors, Epic is reminding the industry that most of those new tools will work best through the EHR.
And they're even better if you're part of the Epic universe.
The nation's largest EHR vendor launched its 45th annual User's Group Meeting (UGM) on Tuesday with an exposition from company founder and CEO Judy Faulkner and several top executives on past successes, current programs—including a glitzy accounting of health systems and hospitals switching over to the Epic platform--and future plans. And with more than 100 AI applications now in use, the company aims to keep the momentum going.
"Healthcare still has tons of problems and … challenges," she announced, and Epic's goal is to "try to make care better."
Epic's pitch to attendees from every state and 16 countries, both at the Verona, Wisconsin campus and online, was two-fold. The company wants to keep its customers in-house, embracing new services and opportunities rather than adding onto the platform from outside sources (what Faulkner called YOYO, or You're On Your Own). In addition, Epic is looking to establish its capabilities as an AI innovator, with hopes of using the technology as a springboard to more growth.
Faulkner spearheaded this strategy by noting Epic has scored early successes with AI in two clinical care programs currently in the spotlight: e-mail inboxes and the doctor-patient encounter.
According to Faulkner, some 186 healthcare organizations are now using Epic's AI Charting tool, which uses ambient technology to capture the conversation, produce a transcript almost immediately and, after clinician review, enter the data into the medical record.
"A click saved is a click earned," she said.
She and other executives said the company plans to enhance this service to include orders, ED notes, inpatient notes and charting for nurses (a feature that Baptist Health, Duke and Intermountain Health are already testing).
In addition, Faulkner said more than 150 healthcare organizations now use In Basket ART (Automated Response Technology), which uses AI to sort through e-mail messages and, in some cases, provide responses. The tool, she said, saves clinicians about 30 seconds per message and, in many cases, offers patients a more empathetic response than one written by a stressed-out doctor or nurse.
"I think that's kind of funny: The machine is more human than the human," she added.
Proposed enhancements on that tool include meeting summaries, message drafts, conversational search and suggestions.
And while the company has more than 100 AI features now inn use, Faulkner and her executives noted many other possibilities for the technology, including bi-directional faxing, routing claims through the EHR without the need of a clearinghouse, personalized patient reminders and recommendations through MyChart, chronic disease management summaries, and billing code recommendations.
Two areas of particular interest are payers and inpatient services. Company executives said Epic will develop AI tools to help providers work with payers on everything from claims to appeals and billing, and will debut a Professional Billing Exchange this fall.
As the inpatient experience, Faulkner and executives said Epic is designing AI tools to help monitor patients and detect or even prevent falls, as well as tools to automatically identify staff when they enter a room, aid in virtual nursing, and help patients with communications and entertainment options.
As with any user's conference, the Epic presentation was meant to update healthcare organizations on the company's progress, but it also underscored the intense competition in the healthcare marketplace for AI. As Senior Vice President Sumit Rana noted, there will come a time when the health system C-Suite has "AI vs. AI" conversations.
"While AI might not be perfect, it is developing rapidly," he noted. "AI is a force multiplier."
Researchers at Brigham and Women’s Hospital used AI to help understand when radiation treatments can cause dangerous heart arrhythmias.
Healthcare researchers are now using AI to gain a better understanding of when patients should and should not receive radiation as part of their treatment.
In a study published in JACC: CardioOncology, a team from Brigham and Woman’s Hospital used an AI tool to better understand the risk of cardiac arrhythmia for patients undergoing radiation treatment for lung cancer. The results not only could lead to better treatment plans but also improve care for the estimated 1 in 6 patients who experience severe side effects, including death.
“Radiation exposure to the heart during lung cancer treatment can have very serious and immediate effects on a patient’s cardiovascular health,” Raymond Mak, MD, director of clinical innovation for the Department of Radiation Oncology at Brigham and Women’s and corresponding author for the study, said in a press release. “We are hoping to inform not only oncologists and cardiologists, but also patients receiving radiation treatment, about the risks to the heart when treating lung cancer tumors with radiation.”
The study is just the latest effort by health systems and hospitals to apply AI to clinical care pathways.
This research targets patients receiving radiation therapy to treat non-small cell lung cancer (NSCLC), for which arrhythmias can be a common side effect. Because NSCLC tumors and the treatment to eradicate them occur close to the heart, the heart can be affected by those doses of radiation.
The Brigham and Women’s team used AI to gain a more focused understanding of how the heart is affected by that radiation treatment. Researchers analyzed data from 748 patients who had been treated with radiation for locally advanced NSCLC to identify different types of arrhythmia that can occur. They found that 1 in 6 patients experience at least one grade 3 arrhythmia within roughly two years of treatment, and 1 of every 3 of those patients experienced “major adverse cardiac events.”
“An interesting part of what we did was leverage artificial intelligence algorithms to segment structures like the pulmonary vein and parts of the conduction system to measure the radiation dose exposure in over 700 patients,” Mak said in the press release. “This saved us many months of manual work. So, not only does this work have potential clinical impact, but it also opens the door for using AI in radiation oncology research to streamline discovery and create larger datasets.”
Mak and his team concluded that radiation oncologists should collaborate with cardiology specialists when developing radiation treatment plans, including embracing strategies that “actively sculpt radiation exposure” away from the areas of the heart that are susceptible to arrhythmias.
PCORI has issued grants totaling more than $27 million to three research projects comparing virtual care to in-person care.
Three healthcare organizations exploring the use of telehealth in care management are getting grants from the Patient-Centered Outcomes Research Institute (PCORI).
The non-profit, which focuses on clinical effectiveness research (CER), announced more than $27 million in grant awards for three projects comparing care delivery via telehealth against traditional care methods.
"At the center of comparative clinical effectiveness research is a recognition that patients’ needs are diverse and not all treatments or interventions have the same effects for everyone,” Harv Feldman, MD, MSCE, PCORI’s deputy executive director for patient-centered research programs, said in a press release. "These CER studies will generate evidence about how different approaches to care may work better for some patients for health concerns facing different people every day."
The three projects are:
Tapan Mehta, PhD, of the University of Alabama at Birmingham, is receiving almost $11.5 million to study how two different telehealth programs—remote patient monitoring (RPM) and digital health coaching—might help with care management for people living with type 2 diabetes who have multiple chronic conditions and physical disabilities. The study will examine each approach individually as well as together.
Stephen Henry, MD, MSc, and Aimee Moulin, MD, MAS, of the University of California, Davis, are receiving $6.4 million to compare treatments for patients living with substance use disorder (SUD). The research will compare outcomes for patients who start buprenorphine treatment in the emergency department and transition to an outpatient program by telehealth as compared to those undergoing in-person treatment.
Richard Skolansky, DSC, and Kevin McLaughlin, PT, DPT, of Johns Hopkins University, are receiving almost $9.6 million to study the effectiveness of a telerehabilitation program for people living with chronic low back pain against in-clinic treatment.
The grant awards are part of a larger group of 10 awards totaling $165 million for CER research projects. Since 2010, the organizations has awarded more than $4.5 billion in grants for CER research.
New York’s largest health system has launched a production company that is developing scripted and unscripted media content, including documentaries and docudramas. The intent, says Ramon Soto, Northwell’s SVP and chief marketing and communications officer, isn’t to make money or discover the next George Clooney, but to market the brand and give the health system an avenue to produce issues-driven content.
“Northwell wants to just show up differently to consumers, and we compete in a hyper competitive market,” he says. “So when we show up, how do we get a consumer to take notice of Northwell and to choose us … particularly when you have great choices?”
Soto says the strategy encompasses two main goals.
“One, we can invite consumers in and see all the things that happen behind the glass that they never get exposure to,” he says. “And it’s wonderful content. There’s a reason why Grey’s Anatomy is super successful. You show the power of health and how it fuels your life, your love, your passions, your careers, [with] really deep human interest stories.”
“The second part is we found a lot of value in telling stories about socially important topics that society has to have more conversations around,” he adds. “And sadly, there are too many of these.”
The idea for Northwell Studios—and Soto is quick to point out this isn’t a movie studio out in Hollywood developing the next St. Elsewhere or ER—came when the health system was introduced to a pair of Israeli showrunners who had developed successful documentaries and docudramas in Europe and wanted to expand to the UK and US.
The two, Ruthie Shatz and Adi Barnash, signed a contract with Northwell in 2017 to create Lenox Hill, a nine-part documentary on Lenox Hill Hospital that appeared on Netflix in 2020. The success of that show led to Emergency NYC, an eight-part documentary that aired on Netflix in 2023.
A third documentary series, called One South: Portrait of a Psych Unit, is now airing on HBO and some streaming services. It focuses on a unique program developed by Northwell at Zucker Hillside Hospital in Queens for college students at risk of suicide, and follows a handful of those students through their treatment.
And that’s when Northwell leadership decided to become a more active participant in the process.
One South “has been very beneficial in that regard to the point where we said, ‘Look, let's turn this into a business and let's do more of these,’” Soto says. Northwell Studios, launched this year, aims to produce at least two pieces of content per year.
It also highlights what Northwell wants to do with that medium.
“The reality is Northwell has millions of square feet of footage with which we dispense clinical care,” he notes. “We've got 21 hospitals, we’ve got 88,000 employees, hundreds of operating rooms, thousands of doors that consumers can walk through to engage with us, and that is my stage. So that’s where we capture the content, and it can be incredibly compelling content just given the number of people we touch: 2 million unique patient visits a year, 6 million patient encounters.”
Developing Northwell-branded content is tricky, given that the health system doesn’t want the public to assume this is carefully cultivated to make Northwell look good. Soto says story ideas are reviewed by a third party who is neither a Northwell employee nor a member of the production crew to ensure that the content is both entertaining and accurate. Contracts are carefully and meticulously drafted to ensure HIPAA compliance and patient privacy and safety, and the health system has a limited impact on the editing process.
Limited, but necessary. This is about more than just a stray Starbucks coffee cup showing up in Game of Thrones.
“It's fascinating to be in the edit room because I literally have a team of 20 people in there scrutinizing and you have typically a producer, director, maybe five people on the production side of it,” he says. “And we're not shy. Every once in a while you have the inadvertent camera scan across the room and a computer screen is up. And you know, our guys have heart attacks--not really, but we're just hyper-vigilant about that.”
And while Northwell’s doctors may be expert at treating patients and saving lives, that might not translate to the screen. Soto recalls a casting call for one production that drew 55 doctors for four roles—and having to deal with 51 doctors who didn’t make the cut.
“Picking doctors who know when the red light goes on” can be challenging, he says.
Soto noted that Northwell Studios won’t be making a profit for the health system—and that’s important, because Northwell Health is a non-profit entity. The value of this business venture, however, is significant. It’s far better than any billboard, TV ad or newspaper or magazine insert.
“This is about content creation that can do social good, that can benefit the communities that we serve and that allows us to develop brand [recognition],” he says, noting that 1% of all babies born in the U.S. are in Northwell facilities. “We really are intimate partners with consumers along their lives.”
It’s important, Soto says, to not only shine the light on healthcare’s heroes, but to direct that spotlight on important public health and population health issues, such as the high suicide rate among teens and young adults.
‘We lose $100 million a year on behavioral health services,” he says, “yet we created a two-episode docudrama on it because it’s an important social conversation right now.”
Ochsner Health and Kaiser Permanente are the latest to integrate the technology, which documents the patient encounter and prepares it for the EHR.
Healthcare organizations are increasingly drawn to ambient AI as a means of quietly and unobtrusively capturing the doctor-patient conversation.
Ochsner Health recently announced a partnership with Deepscribe to make its ambient clinical documentation tool available on the Epic EHR platform to clinicians in the health system’s 46 hospitals and 370 health and urgent care centers. And Kaiser Permanente has unveiled a deal with Abridge to make a similar AI tool available to clinicians in 40 hospitals and more than 600 sites across eight states and Washington DC.
The technology acts as a medical scribe, listening to the doctor-patient encounter and transcribing the interaction for the medical record. The finished product is available shortly after the encounter, enabling clinicians to quickly review and edit the information before it’s populated in the EHR.
The attraction for healthcare executives is threefold. Ambient AI is designed to target three pain points:
Improve patient care by personalizing care management;
Boost operational efficiency by improving documentation and care coordination; and
Improve data extraction by pulling relevant information from the EHR (and, potentially, other sources) to improve patient care and identify cost savings.
Ambient AI is “probably one of the fastest growing products that we have witnessed in terms of how quickly physicians are taking to it and adopting it,” Harjinder Sandhu CTO at Microsoft’s Health and Life Sciences Platforms and Solutions,” said in a HealthLeaders interview this past February in advance of the ViVE conference in Los Angeles. “It is starting to make an enormous difference in how physicians view their work and their work-life balance.”
Healthcare executives say the tool aims to remove the barrier of technology between patient and doctor, by taking the pressure off of clinicians to document the patient encounter and enabling them to talk and interact with the patient.
“We believe that ambient listening … is a reliable, affordable, and scalable solution which we can use to help alleviate the burden of documentation to our wide group of over 4,000 providers across Louisiana, Mississippi, and Texas,” Jason Hill, Ochsner Health’s innovation officer, said in an e-mail to HealthLeaders.
“There are multiple steps of quality analysis which exist within Deepscribe as well as internally that we have done and continue to perform to ensure that our documentation is of the highest quality and reflective of the patient and provider conversation,” Hill added. “We feel that the capability to access the audio transcripts of the patient/provider interviews provides a superior source of truth vs. the current process, which puts the burden on the provider to remember all of the information that they were required to document.”
Ramin Davidoff, MD, executive medical director and chair of the board with the Southern California Permanente Medical Group, said Kaiser Permanente has worked with Abridge for the past year to integrate the new tool into clinician workflows.
"Our physicians strive to make every interaction with patients matter and work to establish a good rapport with our members so they know they are understood and heard," he said in a press release, noting the tool isn’t used without the patient’s consent. "Creating space for the patient and the physician connection is what inspired us to implement this technology. And we hope that those connections and improved efficiencies will help with the sustainability of the practice of medicine for many doctors."
Stanford Medicine partnered with Microsoft’s Nuance Communications to launch a DAX Copilot ambient AI app this past spring, following a pilot program at Stanford Health Care.
“This could have a transformative impact on the way we provide clinical care,” Niraj Sehgal, MD, CMO at Stanford Health Care, said in a new story published by the health system. AI tools will never replace the clinician, but it might replace parts of their workflow,” Sehgal said.
That could eventually include AI tools that not only capture the conversation, but suggest diagnoses and appropriate treatments.
“As people get more comfortable using AI-powered technology, it creates a fertile ground to continue adapting other tools for the workplace that support providers, freeing them to better care for patients,” Sehgal said.
Mass General Brigham is using a state grant to test an advanced care at home model for patients in need of skilled nursing facility services.
Mass General Brigham is testing a variation of the advanced care at home strategy on SNF care.
The health system is using a $4.6 million grant from the Massachusetts Executive Office of Health and Human Services to develop a short-term rehabilitation program that would be an alternative to traditional skilled nursing facilities, to which roughly 25% of Medicare patients are transferred after a hospital stay.
Health system officials say the program, which will follow the acute hospital care at home strategy, would help alleviate the lack of SNF and rehabilitation beds in Massachusetts, which is causing a logjam in hospitals. A recent report from the Massachusetts Health & Hospital Association indicates almost 2,000 hospital patients in the commonwealth are waiting—some for months--to be discharged into SNF care.
“If successful, this care model may lead to a complete transformation of how we deliver advanced rehab care to our patients,” David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home program and principal investigator of the trial, said in a press release. “There are not enough rehab beds in Massachusetts, and if we can substitute facility-based care with home-based care, we will be able to help alleviate the capacity crisis that our healthcare systems have been experiencing across the state. This would have an immediate benefit for patients, family caregivers and clinicians.”
Advanced care at home programs, sometimes called hospital at home, gained attention during the COVID-19 pandemic as a strategy to reduce hospital overcrowding and give selected patients the opportunity to receive care at home. The typical blueprint includes telehealth and remote patient monitoring services alongside in-home visits, often daily, by a care team.
More than 300 health systems and hospitals across the country are using some form of hospital at home service, many of them following a model developed by the Centers for Medicare & Medicaid Services (CMS), which includes a waiver to meet federal guidelines and be eligible for Medicare reimbursement. That waiver is scheduled to end this year, putting many programs that rely on the reimbursement in jeopardy.
Advocates say the program reduces hospital costs and patient length of stay, while improving clinical outcomes and patient and provider satisfaction. Critics say the program is complex and costly and adds to stress on caregivers and care teams.
The MGB program will enroll 300 patients from five Boston-area hospitals, half of which will receive care in a SNF and half of which will receive care at home. The home-based program will include 24-hour RPM and telehealth services through CNAs and physicians, on-demand care from home health aides and a paramedic-based mobile integrated health (MIH) team, and physical, occupational and speech therapy as needed.
Aside from the traditional metrics of cost of care, length of stay, patient and care provider satisfaction, and rehospitalization rates, this program will also evaluate the effect on family and caregivers.
MGB is one of the leaders in the acute care at home space, having launched an early prototype of the program in 2016. The health system has treated more than 3,000 patients in this program, including more than 1,000 in 2023, and received federal and state approval last year to expand the program to more hospitals.
“Being able to have that kind of vantage point, you can ensure greater health and safety of a patient as you’re tailoring their care plan to their personal environment,” Stephen Dorner, MD, MPH, MSc, chief clinical and innovation officer for Mass General Brigham Healthcare at Home, said in a September 2023 press release announcing the expansion.
This past January, a team of MGB researchers led by Levine published results of a nationwide survey of hospital at home programs. That study found a lower mortality rate among patients treated in acute care at home programs when compared to patients who were instead hospitalized, as well as spending less time in a SNF.
“For hundreds of years, since the inception of hospitals, we’ve told patients to go to a hospital to get acute medical care,” Levine said when the study was released. “But in the last 40 years, there’s been a global movement to bring care back to the home. We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
“Home hospital care appears quite safe and of high quality from decades of research — you live longer, get readmitted less often, and have fewer adverse events.” He added. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
The SNF model isn’t without precedent. Nearby South Shore Health launched a SNF at home program in 2021, during the height of the pandemic, but pivoted to a more traditional acute care at home program because they couldn’t secure payer reimbursement.
"There's a difference between acute and critical care, and certain things we can't do at the home right now,” Kelly Lannutti, DO, the health system’s director of clinical transformation and co-medical director of MIH, told HealthLeaders in an April 2022 interview. “We eased back."
MGB tested its own SNF at home model in 2019, putting 10 patients through the program. Officials said the results “were promising and pointed toward lower cost and a better patient experience compared to traditional SNF care,” but the test was too small to draw more substantial conclusions.
“Now, thanks to this financial award …, we can test this innovative care delivery model that reimagines how we deliver post-acute care,” Levine said in the press release.
New York is issuing $500 million in grants as part of a three-year, $7.5 billion effort to create a network of programs addressing issues like housing, transportation, and food insecurity.
Healthcare CIOs working on a strategy to improve health outcomes in underserved populations would do well to check out New York, which is investing $500 million in a new program addressing social determinants of health (SDOH).
The Social Care Network (SCN) program, unveiled this week by Governor Kathy Hochul, leverages state and federal funding to help Medicaid members access transportation, housing, nutritious meals and other social services. By addressing SDOH barriers, the state aims to reduce healthcare costs and improve outcomes.
“We traditionally invest healthcare dollars in direct patient care, yet it is often the factors ‘outside the exam room’ that most need to be addressed,” New York State Health Commissioner James McDonald, MD, said in a press release. “This historic investment allows these partners to connect patients to factors that often most influence our health, such as finding stable housing, reliable transportation, health insurance and other factors that improve people’s personal health.”
Addressing SDOH and health inequity is a key concern for healthcare leaders, and innovative partnerships like the SCN show potential in pushing the right resources to the right populations. A good proportion of halthcare waste is directly tied to barriers to care, which keep patients from accessing the services they need until their health declines. This leads to expensive health interventions, including ED visits and hospitalizations, and continuing care for medical issues that could have been managed or even prevented.
The $500 million will be disbursed in awards to nine social care organizations across the state. The program, administered through a Medicaid Section 1115 Demonstration Waiver, is part of a three-year, $7.5 million effort, which includes almost $6 billion in federal waiver funding.
As proof of the program’s potential clinical benefits, officials pointed to New York’s Medicaid Redesign Team Supportive Housing Initiative, which provides permanent housing and support services for homeless residents with medical conditions. That program, officials said, led to:
A 40% reduction in hospital inpatient stays
A 26% reduction in ED visits
A 15% reduction in overall Medicaid health expenditures
A 44% reduction in admissions for substance abuse rehabilitation
And a 27% reduction in inpatient psychiatric admissions.
In addition, officials said, the program helped the Medicaid program save $46,500 per person per year by prioritizing treatment for patients with some of the most complex care needs.
“Every year, hundreds of thousands of New Yorkers avoid healthcare due to concerns about money, housing, food, transportation, and other unmet needs,” Zachariah Hennessey, executive vice president and chief strategy officer of Public Health Solutions, one of the nine organizations receiving a grant, said in the press release. “They turn to healthcare only when in crisis and their lives are cut short. Through New York State’s Health Equity Reform initiative, we have a once in a generation opportunity to change this trajectory and ensure Medicaid beneficiaries receive the resources they need on time to achieve optimal health for themselves and their families.”
