WellSpan Health has launched an AI agent named Ana, who's connecting with at-risk patients for screenings that might otherwise be forgotten or ignored.
Healthcare organizations are now using AI to have conversations with patients that doctors and nurses might not have time for—and closing critical population health care gaps that could save lives.
WellSpan Health launched an AI platform roughly one month ago that calls selected at-risk patients to schedule colorectal cancer screenings. The AI agent, called Ana and developed by digital health startup Hippocratic AI, asks patients if they would agree to take the test and, if they agree, arranges to mail a testing kit to their homes.
The so-called AI “agent” is designed to replace either a mailing, a cold-call program often launched out of a health system’s call center or—if the health system doesn’t have those resources—the conversation that a doctor would have with a patient during an annual checkup.
None of those tactics has a high level of success. And as a result, at-risk patients often don’t have those screenings when they should, if at all, increasing the chances of a serious health issue down the road.
WellSpan Health executives decided to use the program to reach out to patients at risk of developing colorectal cancer, identified by their birthdate and family history. Of particular concern were Spanish-speaking patients, who might miss the mailer or the conversation with a doctor because of language issues.
“It’s an opportunity for us to reach out to people in their homes, in their own time, and have a conversation with them that we maybe couldn't staff with a human,” says R. Hal Baker, WellSpan’s SVP and chief digital and innovation officer. “But [with] the right AI, that conversation could be had.”
R. Hal Baker, SVP and chief digital and innovation officer at WellSpan Health. Photo courtesy WellSpan Health.
Baker, a primary care physician, says the program takes pressure off of doctors to fit that task into an already busy care visit and gives them more time to make that visit meaningful.
“Most of my visits are 20 minutes,” he notes. “And while it may take only 30 seconds to have a conversation about colorectal cancer screening, … if I can take any of these things like mammograms and colorectal cancer screening and COVID shots and flu shots out of the visit, and they can happen reliably outside of coming to the office, that gives me more time to discuss what can only be discussed in the exam room.”
Kasey Paulus, MBA, RN, CENP, WellSpan’s SVP and chief nursing executive, says Ana works because she’s designed to be empathetic and engaging. And she can speak Spanish, in which not many doctors or nurses are fluent.
“A sensitive AI that speaks your language [is better than] a well-meaning human who can’t speak Spanish,” Baker says.
And it works. Of the first 455 Spanish-speaking patients contacted by Ana, 15% agreed to screening, Baker says, and the net promoter score was higher than that of English-speaking patients (of which 6% agreed to a screening).
“Not bad for an automated reach-out cold call to people who weren’t expecting it,” he says.
Kasey Paulus, MBA, RN, CENP, SVP and chief nursing executive at WellSpan Health. Photo courtesy WellSpan Health.
Eventually, the health system will see results in clinical outcomes. More screenings will lead to more cancers detected and treated early, improving the quality of life for patients and reducing deaths. Financially, more screenings might boost initial costs but lead to less expensive medical treatments and long-term care later on.
Baker and Paulus say WellSpan worked closely with Hippocratic AI to develop Ana, going through every scenario that the AI agent would face and every question that a patient might ask. Baker says he even tried to confuse Ana during a test by announcing that his birthday was on New Year’s Day.
“We have a very creative and collaborative multidisciplinary team, and those individuals do their best to try to break it before we launch it,” he says. “So we're looking for ways [in which] somebody might trip it up that we didn't even think of, because inevitably that will happen.”
For example, Baker says, “We had to very quickly realize we had needed to add the ability for somebody to say, ‘Please don't call me again.’ “
In launching Ana, Baker says the health system was very careful to make sure that patients know they’re talking to an AI agent. For the first 100 phone calls, a nurse was also on the line to make sure things ran smoothly.
“What we found out was that [the nurse] didn’t have to” be in on the call, he says. “What is novel here is that we have now moved the human in the loop to the human on the tail for our next thousand calls,” meaning a nurse will review the call within a few hours.
With the platform now up and running, Baker and Paulus say they’re giving Ana another task: connecting with patients who are coming into WellSpan for a colonoscopy. Ana will call them ahead of that appointment and go through everything the patient needs to do before the procedure. Again, that task would have been handled by a nurse or call center, if at all.
“The last 48 hours of coaching are really critical,” Paulus says. “And AI can help us where we can't always have somebody on call 24/7 365.”
She says the health system will see the benefits in reduced cancellations and procedures that are started and cut short or unsuccessful.
Baker says the platform may scale up in time as WellSpan explores how Ana can effectively interact with patients and support their healthcare journey. They may use the platform for more population health outreach, or to help patients prepare for other procedures, or even to check up on them and coordinate care after a procedure.
“We recognize that we're boldly going into some uncharted territory and that our AI is not replacing our clinical staff but augmenting the work that they just don't have the capacity to do,” he says.
A new survey finds that poor or ineffective technology is costing the healthcare industry $8 billion a year. Here are the eight biggest culprits.
Healthcare organizations are losing $8 billion a year to ineffective and outdated IT, and few have the money to improve that technology.
That’s the key takeaway from a new survey of more than 900 healthcare professionals by Black Book Research. The study, the third in Black Book’s “What’s Hot and What’s Not in Healthcare IT Investments” series, finds that bad IT investments have jumped significantly since 2017, when those costs were estimated at $1.7 billion, and budget limitations are keeping healthcare leaders from correcting those problems.
"Three-quarters of IT leaders surveyed indicated that they have no plans to allocate funds for replacing these flawed systems in 2025, reflecting a broader trend of financial constraints across the sector," Black Book President Doug Brown said in a press release.
"CIOs are understandably cautious about replacing underperforming systems when the ROI is uncertain, given the track record of many healthcare IT vendors failing to meet expectations. Without clear evidence that a new investment will deliver tangible financial or operational improvements, justifying the expense becomes challenging."
According to the survey, tech limitations are tied to one of more of five key reasons: poor user experience (almost have of those surveyed cited this), lack of interoperability (24%), cost (20%), lack of flexibility (6%) and alert fatigue (2%).
The findings will disappoint healthcare leaders who are counting on their IT platforms—especially their EHRs—to support innovations like AI and virtual care. An ineffective tech platform not only cuts into the ROI of a new program, but adds to the stress and frustration that haunt nearly every health system and hospital and cause burnout and workforce shortages.
Black Book’s study lists eight IT adventures that have plagued healthcare leaders the most:
Overly complex or unintuitive EHRs. Either a scapegoat or a savior for healthcare organizations collecting and managing their data, EHRs haven’t yet fulfilled their promise. According to Black Book, more than three-quarters of those surveyed are still having issues, often with navigation or workflow design, leading to “click fatigue.” In addition, at a time when many smaller health systems and hospitals are being acquired by larger, more stable networks, 91% of small medical practices in the survey say the haven’t been able to transition smoothly to the larger system’s EHR.
Bad telehealth. Virtual care saw a surge in popularity during the pandemic, but in many cases those platforms were adopted quickly and without due diligence. As a result, more than 80% of survey respondents said those telehealth tools are not synching with their EHRs, creating dreaded data silos and duplicate information, and impeding workflows.
Clunky RCM systems. Healthcare organizations have for years tried to automate their revenue cycle management operations to improve efficiency, capture lost reimbursements and reduce manual administrative tasks. Unfortunately, the technology has met expectations. Some 70% of executives surveyed said their RCM tech is either outdated or unable to integrate new tools like AI, leading to longer claims processing times and higher denial rates. Also, just more than 60% said poor claims scrubbing and denial management capabilities are resulting in lost revenue.
Uncooperative HIEs. Health information exchanges offer the potential to connect health systems and enable data sharing. But 28% of medical practices said their EHRs aren’t synching well with the HIE, and 23% cite a lack of data standardization and integration.
Poorly integrated CDS tools. Providers often rely on clinical decision support tech to improve their decision-making and boost clinical outcomes. But according to the survey, 80% say their CDS tools don’t integrate with the EHR, and first-generation tools often generate excessive or unnecessary alerts, leading to “alarm fatigue.”
Lack of patient engagement support. Patient engagement technology, including portals and messaging platforms, are designed to improve the patient-provider relationship. But 77% of hospital executives surveyed said their portals aren’t meeting the needs of their patients, resulting in ineffective communication and engagement. And 88% of those surveyed said smaller, niche products don’t have the integration or mobile-friendly capabilities they need.
Hyped-up AI. AI might be able to address many of healthcare’s biggest pain points, but the technology isn’t there yet. A whopping 96% of executives surveyed said they are facing challenges with ROI, and 92% said they can’t yet rely on the accuracy of the tools and find actionable results. Some 85%, meanwhile, said the tools they’re using to automate diagnostics or treatment planning aren’t yet capable of handling complex or real-world clinical environments.
Interoperability issues. Finally, 31% of the executives surveyed said they’re not happy with their data interoperability vendors, the chief complaints being slow updates and poor API support. This despite federal efforts to create a nationwide interoperability grid, through TEFCA. Many are struggling to adopt (FHIR) Fast Healthcare Interoperability Resources standards, and 8% say they’re stuck with technology that isn’t, well, interoperable.
Virtual care programs for veterans are seeing mixed results. That could help healthcare organizations better understand what works and what doesn’t.
Recent efforts to improve healthcare access for veterans offers insight into which virtual care strategies are working and which ones aren’t.
The success (or lack of) of programs launched by the Department of Veterans Affairs (VA) and the Veterans Health Administration (VHA) could help health systems and hospitals better understand the direct-to-consumer telehealth market.
For instance, the VA recently announced that its tele-emergency care (tele-EC) platform will now be available to veterans across the country, after the success of pilot programs in selected regions. The program, part of VA Health Connect, enables veterans to connect with care providers on-demand through a smartphone and associated app.
“Veterans can now be evaluated for possible emergencies from the comfort of their home,” VA Under Secretary for Health Shereef Elnahal, MD, said in a press release. “Sometimes, you’re not sure whether what you’re experiencing is a minor emergency or not — and tele-emergency care can help you resolve those questions. Veterans can get immediate, virtual triage with a VA medical provider who has direct access to their medical records. This avoids having to potentially drive to the nearest emergency department and wait to be evaluated, if appropriate.”
"I think it's a noble idea,” GAO Healthcare Director Alyssa Hundrup told a Virginia TV station in a recent interview.. “They've put in an effort but, unfortunately, it has yet to be used. VA really needs to be looking at the effectiveness of these sites, where they are, how they're using them, are they getting the word out to communicate with the veterans the availability of these? Otherwise, these sites are sitting there being unused and it's a real missed opportunity.”
So why is the tele-ICU program working but ATLAS is struggling? The issue may be similar to why so-called disruptors like Walmart, Walgreens and CVS Health are struggling to find a healthcare niche with retail clinics.
Tele-ICU is working because it gives veterans access to needed healthcare services from wherever they are, including and especially their homes. ATLAS, meanwhile, still requires veterans to travel to a specific site for healthcare.
That strategy works well for veterans in remote locations where broadband availability and even phone service is weak, and that does address a key barrier to care. According to the GAO report, those 10 ATLAS sites where veterans did access care were successful in helping those veterans and eliminating the need for long drives to the nearest VA center and long waits.
The VHA has responded to the GAO report by saying it will transition from a pilot to a grant program, adding financial sustainability to the equation, but the GAO is also asking the agency to develop benchmarks to measure the success of the ATLAS program on an ongoing basis, much like it does for other telehealth programs. Those benchmarks could help the VHA understand why veterans aren’t going to certain ATLAS sites and enable the agency to create sustainable virtual care programs that will attract veterans.
The examples set by the VA and VHA could also help healthcare leaders to understand how and where consumers want to access care. Consumers, like veterans, prefer on-demand virtual platforms for urgent care needs, while the success of retail clinics and stand-alone services is more nuanced, driven by factors that aren’t yet fully understood.
It’s clear that virtual care can address access challenges—the VA has conducted more than 9 million telehealth visits in each of the past two years—but simply putting together a virtual care platform doesn’t guarantee success. Providers need to understand how, when, where and why patients want to access care and create programs that address the needs and eliminate the barriers.
Healthcare leaders are moving quickly to keep AI growth under control, but are they handling the governance question effectively?
As healthcare organizations move swiftly to embrace AI, leadership is struggling to understand how to make sure governance isn’t pushed aside.
But what does governance really mean in a hospital or health system? And who gets to decide how and where AI is used?
At the recent HIMSS AI in Healthcare Forum in Boston, issues of compliance and liability were front and center for health system executives looking to chart a clear and effective AI strategy. Sunil Dadlani, chief information and digital officer for the Atlantic Health System, said AI regulation must be handled carefully, so that it doesn’t curb innovation.
The challenge lies in deciding where innovation has to take a step back so that compliance and liability can be addressed.
As Albert Marinez, chief analytics officer at the Cleveland Clinic, said, AI introduces “the art of the possible” to healthcare. “We know that there are problems that we can solve with generative AI that we could never solve before,” he said at the HIMSS event.
“Healthcare should be proactive in the establishment and enforcement of AI governance and guidelines,” Jim Barr, MD, Atlantic Health’s vice president of physician value-based programs and CMO of ACOs, said in an e-mail to HealthLeaders. “Governmental oversight will occur, but those in healthcare should display our ability to fully understand the issues and regulate ourselves.”
“Your reason to use AI tools can’t be just the need to say we’re on the cutting edge,” he added. “With ACOs the challenge is designing and managing successful implementation while continually measuring impact and ROI. You need to take into consideration the existing pain points for clinicians, practices and patients, their willingness to change, deploy a transparent QA/validation process to build trust, and a clear customer value proposition.”
Developing a Governance Strategy
So where does governance fit into a health system’s strategy?
Ravi Parikh, MD, MPP, an assistant professor of medicine and health policy at the University of Pennsylvania, assistant professor of medical ethics and health policy at the Perelman School of Medicine and director of the Human-Algorithm Collaboration Lab, says federal efforts to establish a governance framework have resulted in vague guidelines that are a good starting point, but not enough.
“They're sort of general guidelines on monitoring for bias and monitoring for performance drift,” he says. “But how that gets operationalized is actually really variable.”
The first step for many healthcare organizations is the creation of a governance committee, charged with managing how the health system negotiates vendor contracts as well as how AI is developed, tested, used and—most importantly—monitored.
At the HIMSS summit, Shahidul Mannan, chief data, analytics and AI officer at Orlando Health, said many health systems are using AI in small programs across the enterprise, but leadership will have to create an engine to pull everything together on the same track. The trick is deciding who sits in the engine.
Parikh says current committees are “very ad-hoc,” with a mixture of executives from areas such as clinical care, IT, legal, and finance. Few are including the patient voice, which could be a critical oversight as Ai products flood the consumer marketplace and patients ask for AI capabilities to plan and manage their healthcare.
Patrick Thomas, director of digital innovation in pediatric surgery at the University of Nebraska Medical Center, wondered at the HIMSS event whether healthcare leadership is even ready to govern AI for its patients. Patients and providers are doing their own research, he noted, forcing decision-makers to try to keep up.
Understanding the Value of Data
Beyond the makeup of a governance committee, a key function of that committee is to understand data and data analytics, especially when outsourcing AI technology.
In dealing with vendors, health systems need to understand what datasets are used and how that data can affect outcomes. For instance, a company that relies on data from a decidedly white population might not help a hospital or health system whose patient population is ethnically diverse.
And when errors, such as hallucinations, occur, it may be hard to get a vendor to correct them.
“it’s actually really difficult to respond to these hallucinations by modifying the algorithm,” Parikh says. “You might be able to fine-tune and sort of say ‘Hey, we want to avoid this type of output’ and there's certain reward-based mechanisms to do that, but usually that's not in the health system’s control. Usually it's a developer who's having to respond to feedback that they're getting from the health system and then doing some things behind the hood that we don't honestly know about.”
A governance committee also has to be perpetual, and that will cost time and money that smaller organizations don’t have. Many standards now being considered are for basic AI functions, rather than generative or predictive AI, which hasn’t matured enough to be used in healthcare. But those tools will come along soon, and the rules for governing them will have to evolve.
Parikh isn’t convinced that health systems or the federal government will be able to draft standards for an ever-evolving AI landscape. Instead, he expects organizations like the Coalition for Health AI (CHAI), the Trustworthy & Responsible AI Network (TRAIN), or the Digital Medicine Society (DiME) to create standards and adjust them as the technology evolves.
He also says the federal government could, in time, require healthcare organizations to become accredited to use different types of AI, possibly as part of a quality improvement program or even payment policy.
“We [could] have these accreditation systems that signal to developers which institutions are robust for both validating and deploying [AI] technology and which of those might not be certified for large language model generation … but might be more certified for other types of predictive AI solutions,” he says. “I suspect that people are going to realize that some health systems just have more capacity for governance and more data availability to be deploying these tools. And that's a good thing for patients because we don't want to be rolling these things out for patients where errors might be promulgated.”
More than 45 hospitals and another 50 clinics in the Lone Star State will share data and best practices through an HIE platform, giving them important tools to improve care and participate in a new quality payment program.
A network of more than 45 rural hospitals and another 50 clinics in Texas is partnering with a health information exchange to improve data exchange and interoperability, giving the hospitals a better foundation for sustainability.
The Texas Organization of Rural & Community Hospitals (TORCH) is joining forces with C3HIE, a non-profit community HIE in the TORCH clinically integrated network (CIN), which was launched in 2021 to pursue value-based care opportunities. TORCH, which consists of 27 hospitals and 51 clinics, will add more than 20 new hospitals to the CIN through the C3HIE partnership.
The collaboration gives rural hospitals and clinics, many of which are struggling to stay open, an important platform for interoperability. Through the CIN, these organizations can exchange healthcare data through their EHRs, exchanging analytics tools and best practices to improve care management and coordination.
“We know rural hospitals are better together,” John Henderson, president and CEO of Round Rock-based TORCH, said in an e-mail to HealthLeaders. “Our partnership with C3HIE overcomes geographic isolation and connects our hospitals and clinics to help our rural communities.”
“When our rural providers are better connected across the state, they’ll know earlier about treatment outside their county,” he said. “They’ll be able to get [patients] into the clinic quicker for follow up. They’ll also get access to risk assessment tools using community health information to ensure the higher risk patients get the care plans they need [and] improve the ‘right care at the right time’ concept.”
The network also has value-based contracts in place with Aetna, Amerigroup and United Healthcare.
“Rural hospitals that can demonstrate achievement by region will benefit financially from ATLIS,” Henderson said, noting that hospitals could save at least $150,000 per year, which would go back into improving infrastructure and data capture.
Healthcare leaders are eager to move services out of the hospital and into the home, but many aren’t taking into account how they impact patients and caregivers.
Amid the move to patient-centered care, healthcare organizations are moving more services and programs out of the hospital and into the patient’s home. But are they really putting the patient at the center of that care platform?
“Is the home ready?” asks the president and chief impact officer of the Rosalynn Carter Institute for Caregivers. “Most of us would say, ‘Gosh no, not at all.’ They want to take care of (a patient) at home, but the home isn’t ready. And it’s hard even when you’re not [talking about] acute care.”
Fueled by the promise of remote patient monitoring and the acute care at home (or Hospital at Home) strategy, healthcare leaders see the home as a better place than the hospital room for many patients to recover from treatment. Armed with studies that show that patients heal faster and better at home than in the hospital, they’re crafting programs that include everything from digital health and telehealth technology to in-person visits from nurses, doctors, and specially trained paramedics. Some of the more advanced acute care programs include multiple daily visits and technology designed to bring the ICU experience into the home.
But Bhatt says patients—and their family members are caregivers—aren’t prepared for that type of activity in their homes.
Paurvi Bhatt, president and chief impact officer, Rosalynn Carter Institute for Caregivers. Photo courtesy Rosalynn Carter Institute for Caregivers.
“As we know, when you enter anybody's household, no matter what part of the world you're from, you're in someone else's culture,” she says. “The way we organize taking care of each other changes household by household. It's not the same as hospital room by hospital room. There's standardization that needs to happen for clinical outcomes that need to somehow meet with the reality of what might happen at home.”
For example, care teams might not be familiar with cultural, religious, even family practices or habits, not to mention a patient’s own preferences on everything from sanitation to meals to the daily routine of favorite TV shows. Any disruption in those routines can have a negative effect on patient engagement and satisfaction.
And that can affect clinical outcomes. Patients who are disturbed by the commotion around them might not be so inclined to follow doctor’s orders, or they might rush through things just to get everyone out of the house. And already-stressed family members and caregivers might be even more stressed by the intrusion.
To be sure, the home is an intriguing care location, and any health system that doesn’t have a strategy that encompasses home-based care is behind the curve. Earlier this year, a survey of 1,000 U.S. adults and sponsored by digital health company Vivalink found that more than 80% had taken part in some sort of care at home program, 84% said they’d do it again, and 77% said they’d trust their doctor’s recommendation to take part in such a program.
The challenge, Bhatt says, is getting people to think outside the hospital.
Healthcare leadership needs to stop planning these programs solely from a clinical perspective, she says, and look at how the home, its occupants and even the neighborhood are impacted. They need to include patient and caregiver advocates in planning and bring patients and their caregivers into the conversation prior to going into the home.
“Now that the clinical outcomes are starting to demonstrate some value,” Bhatt says, “[let’s bring a] different set of people to the table now and say, ‘OK, now let's look at this.’”
This strategy goes hand-in-hand with identifying and addressing social determinants of health, a popular strategy throughout healthcare these days. A hospital may send someone to the home to assess SDOH, looking at whether the home has broadband and if there’s enough food in the refrigerator, but they too often focus on barriers and pay little attention to how the home—and home life--can shape healthcare delivery.
For example, how can the care team accommodate a patient’s wishes and work with family members and care providers to coordinate activities? How can a care plan be modified to better include family members and caregivers? And what can the hospital do to make sure this program doesn’t create more stress at home?
“Half of the reason why caregivers are unseen is because they believe it's part of their duty to their family,” says Bhatt, who is advocating for a federal Office of Caregiver Health. “We've got to pay attention to them, because if they're not right there and we're not aware of what phase of caregiving are they in, we're going to lose that connectivity.”
Those questions will need to be answered as home-based care programs, such as Hospital at Home, evolve. These strategies may not get much-needed support from payers and the federal government if they end up causing more distress in the home and fall out of favor with the people they’re designed to treat.
“I'm convinced it can work,” Bhatt says, “but I I'm worried about what might happen if we don't start to plan what the [problems] might be and think creatively about how we can [address them].”
Digital health supporters say there’s no evidence of fraud in RPM programs, refuting an OIG report that calls out the fast-growing digital health strategy for misuse.
The federal government’s call for more oversight of remote patient monitoring (RPM) programs isn’t sitting well with digital health advocates.
Following a report this week from the Office of the Inspector General (OIG) hinting at a possibility of fraud in requests for Medicare reimbursement in RPM programs, the Alliance for Connected Care has criticized the “inaccuracies and subjective nature” of that report and called on the OIG to retract it.
RPM is one of the fastest growing programs in the country, popular with health systems and hospitals looking to monitor patients outside the hospital, clinic or doctor’s office. Its growth is tied to two factors: Medicare reimbursement, which began in 2018 when the Centers for Medicare & Medicaid Services (CMS) began coverage for “remote physiological monitoring” (and later for “remote therapeutic monitoring”), and the pandemic, which gave many healthcare leaders a reason to expand telehealth and digital health efforts into the home.
In many cases the ROI for RPM programs is still murky, and Medicare reimbursement is a crucial part of the sustainability and scalability puzzle. Continued growth, especially among smaller health systems and hospitals, will most likely be tied to governmental and payer support.
According to the OIG, RPM use soared tenfold from 2019 to 2022, from 55,000 Medicare enrollees to more than 570,000. As a result, Medicare reimbursement increased from $15 million in 2019 to more than $300 million in 2022, with increases in both the number of enrollees using RPM and the average payment per enrollee.
However, the OIG says 43% of the enrollees in RPM programs aren’t meeting the three requirements for Medicare coverage: (1) enrollees must receive education and assistance setting up the device; (2) the device used must be FDA-approved and internet-enabled, with providers collecting data at least 16 of every 30 days; and (3) enrollees must be part of a treatment management program, in which the provider reviews the data and makes care management decisions.
According to the OIG report, both OIG and CMS have raised concerns that RPM programs are being conducted fraudulently, particularly by digital health and telehealth companies, and CMS doesn’t have any way of identifying how that fraud is taking place.
“In both traditional Medicare and Medicare Advantage, providers use general procedure codes to bill for remote patient monitoring that indicate only which component of remote patient monitoring was provided (e.g., the device or treatment management),” the OIG report stated. “The codes do not include more detailed information, such as the type of device.”
“This lack of transparency limits CMS’ ability to ensure that remote patient monitoring services meet requirements,” the report continued. “For example, without additional information about the types of health data being monitored, CMS cannot ensure that it is paying for remote monitoring of physiologic data (as opposed to nonphysiologic data) as required. The lack of this information also inhibits CMS's ability to assess the effectiveness of remote patient monitoring and make any necessary changes to coverage in the future.”
Those conclusions don’t sit well with the Alliance for Connected Care. In a letter sent Tuesday to Inspector General Christi Grimm, alliance founder Krista Drobac, a partner at Sirona Strategies, listed five inaccuracies with the report and another four instances where she said the report demonstrates bias.
Among the errors, according to Drobac:
The OIG says there is no order requirement for RPM, but that requirement is included in Medicare’s 2021 Physician Fee Schedule as well as in guidance from Medicare Physician Contractors.
There is no CMS requirement that an RPM device be “internet-connected.”
CMS has not officially adopted the 16-days-in-30 data collection rule as a requirement, and said in the 2024 Physician Fee Schedule that it was not a requirement to receive Medicare reimbursement under CPT codes 99457 and 99458.
In addition, Drobac said the OIG report suggests that fraud is being committed when there is no evidence of any wrongdoing. She notes that the surge in RPM use from 2019 onwards is based more on the fact that reimbursement began in 2018. And she urged the agency not to repeat the same mistake with RPM that it has done with “telehealth fraud,” which is more of a telemarketing issue than a telehealth issue.
“There is no context about fraud in the Medicare program,” she wrote. “In the same year that the entirety of RPM claims were $311 million, the false claims alone in Medicare were $31.2 billion. That tells a different story than the misleading headline and pull-out statements in the report. If we applied the fraud amount in the rest of the program of 3-10%, the fraud in RPM would have been between $9.3 million and $31 million in 2022. That’s less than .01% of the fraud in Medicare.”
“We would be happy to work with you on designing and recommending tools to address the real fraud that is happening in the Medicare program,” Drobac concluded. “Better control of inappropriate Medicare enrollment, solicitation, and prescribing while instituting stronger monitoring and audits to ensure fraudulent providers are caught sooner and weeded out of the system.”
Health systems and hospitals are taking a closer look at how they impact the environment. At Valley Children's Healthcare, that begins with a giraffe-shaped microgrid and a 'Green Team'
While innovation strategy is often focused on improving the health of patients and providers, it's ironic to think that the healthcare industry is a major contributor to the decline of the planet's well-being.
Healthcare facilities are among the largest consumers of resources—hospitals alone represent only 7% of all healthcare facilities yet are responsible for almost 70% of total healthcare electricity use. According to the National Academy of Medicine, the healthcare industry accounts for nearly 20% of the GDP, and is responsible for about 8.5% of all carbon emissions in the U.S.
With that in mind, a growing number of hospitals are taking a closer look at how they impact the environment. And they're taking steps to become more environmentally friendly, with strategies that affect everyone from the CEO and CFO down to the cafeteria worker.
Formerly called the Children's Hospital of California, the Madera, California-based health system broke ground this past weekend on a microgrid project that's designed to meet the U.S. Department of Energy's Better Climate Challenge goals of cutting greenhouse gas emissions in half by 2030 and lead to net-zero emissions by 2050.
The microgrid, which includes solar panels, fuel cells and battery storage that will allow the hospital to generate, store and distribute electricity, was financed in part from Inflation Reduction Act tax credits, with benefits over the long term in reduced energy costs. It's expected to cover 80% of Valley Children's Healthcare's energy needs when it becomes operational in 2025 and save about $15 million in energy costs over the next 25 years.
It's also in the shape of the hospital's mascot, George the Giraffe. And that nod to creativity is what's helping to generate enthusiasm for a strategy that affects everyone.
"It brings with it a lot of energy," says Barry.
Danielle Barry, SVP and chief operating officer, Valley Children's Healthcare. Photo courtesy Valley Children's Healthcare.
In more ways than one. Barry says the hospital began its environmental journey in 2022 with a focus on energy resiliency. With a coverage area of 11 counties and an increasing number of wildfires and rolling blackouts threatening operations, leadership wanted to make sure the power would always be on. At the same time, they wanted to have more of an impact on how that power was generated and how it impacted the environment for their young patients.
"This ties into our mission statement to help children live healthier lives," Barry notes. "It's more about wellness and keeping kids healthy."
That feeling isn't limited to pediatric hospitals. A recent report in Nature Climate Change, published by researchers from the Dana-Farber Cancer Institute, finds that both patients and providers are concerned about the environmental impact of healthcare, and they're interested in considering environmental factors when discussing treatment options.
"Our findings point to the need to better educate physicians and health professionals about changes they can make, as well as those they can advocate for within their institutions, which benefit patients but also are less toxic to the environment," Andrew Hantel, MD, who co-authored the study, said in a recent news report. "The goal isn't to shift the burden of climate-informed healthcare decisions onto patients, but to engage with them on these issues and make sure they're a normal part of conversations with their doctors."
And at Valley Children's Healthcare, that begins with the microgrid.
"The microgrid will offer us operational expense savings related to how we procure our power," Barry says. "And that's dollars that we can invest right back into our operations and taking care of kids."
Going Green: A Team-Based Approach
While the microgrid is integral to that strategy, it's part of a multi-phased approach. Valley Children's has also launched a 'Green Team,' comprised of employees from all corners of the organizations, including clinicians, janitors, IT and finance people and cafeteria workers.
Barry says they had no difficulties filling out the Green Team.
"We found a number of team members who really have a passion for this journey, and they have really taken off with creating the plan and the goals related to that work," she says.
Their mission is to take a look at hospital operations from the viewpoint of consuming resources, setting baselines and goals for each department. They've looked at how to reduce the use of gas in the OR, methods for reducing waste—especially plastic and paper—throughout the campus, composting food waste, even finding uses for used coffee grounds. They've even started their own garden and put the focus on using food from local farms.
Barry says she and others involved in the program have to weigh each new strategy or program against the budget. Saving the environment and providing a better future for the kids might sound terrific on paper, but those efforts do come with a price tag.
"Not every idea gets adopted," she says. "With some of them, the cost outweighs the benefits, so we prioritize."
Next Up: Tackling the Transportation Conundrum
The third phase of the program will be even more ambitious. Valley Children's Healthcare will be looking at transportation issues, including their fleet of vehicles and how staff get to and from work each day. Can transports and other delivery services be changed to reduce the number of trips taken? Should the health system switch to electric vehicles? Could shuttle services or other mass transit strategies be combined with scheduling changes to reduce the number of staff driving to work alone each day? And can people be convinced to change their driving habits?
"Some of this will be challenging, because we're talking about culture change," she says. "But that's also what makes it exciting."
That strategy also intersects with the health system's increasing use of telehealth, which studies have shown can have a positive impact on environmental goals.
"Any opportunity to keep a kid closer to their home is something that we're always seeking to be able to do," Barry says.
Barry says she had to learn "an entire new study of information" to understand the ins and outs of environmental stewardship in healthcare, including the number of federal and state agencies that figure into every new idea or program. But that type of innovative thinking, she says, is common in children's hospitals.
"I think because pediatric healthcare does not oftentimes represent a large enough slice of the pie for … government payers or private payers or others, we've had to be very creative and out-of-the-box thinkers," she says. "How do we continue to thrive and survive for the kids that are our future? How do we continue to be innovative in that space?"
Health systems and hospitals are facing competition from retail companies and other so-called disruptors. Executives at a recent HealthLeaders virtual summit explained how they’re addressing that challenge with new programs that meet patient needs and preferences.
How are health systems and hospitals reacting to increased competition? They’re pointing out that no one does healthcare better than your own doctor and nurse.
And while companies like Amazon, Walmart, and Walgreens are seeing mixed success in penetrating the market, they are highlighting inefficiencies in traditional care and pushing healthcare’s decision-makers to embrace concepts like on-demand virtual care and online scheduling.
“We’re competing on convenience, access, experience, cost—all the things that traditional health systems typically struggle with,” said Diedra Kramer, vice president of consumer strategy for Sutter Health. “So I think we’re going to have continue to adapt and change to keep up.”
Kramer and Haddas Lev, associate chief operating officer for ambulatory care services and COO of community health services for Denver Health, took part in the HealthLeaders Disruptors & Retail NOW online summit this past week. Both said their health systems are facing pressure to improve care delivery through patient-centered care, but that pressure is coming more from patients than disruptors.
The conversation targeted a key innovation strategy for healthcare organizations across the country. Consumers are dissatisfied with their healthcare experience to the point that they’re abandoning the traditional primary care provider and seeking on-demand care from non-traditional sources, be it a retail-based virtual care program, a telehealth vendor or a stand-alone clinic.
To keep their patients and stabilize the bottom line, healthcare leaders are embracing consumer-facing care and borrowing certain tactics from other industries, such as retail, banking and travel.
“There are many options for non-traditional healthcare,” said Lev, whose health system serves roughly one quarter of Denver’s population and handles one of every three births. “Many of them are offering really low-cost care with the added benefit of convenience.”
“Healthcare is different,” added Kramer. “But the reality is that our consumers’ expectations are being shaped outside of healthcare, and they’re bringing these expectations to us.”
“Consumers (will) consider, select and stay loyal to something that’s the easiest to navigate, interact and transact with,” she said.
Taking the Friction Out of Healthcare
Both Lev and Kramer said their health systems are embracing strategies aimed at creating frictionless care, using digital health and telehealth technologies that reduce time spent scheduling and waiting for care.
At Denver Health, Lev says the school-based telehealth program, with 19 health centers in public schools across the city offering medical, dental and behavioral health services, is meeting a critical need for healthcare services among school-aged children. And the virtual urgent care program launched a few years back is seeing 10% to 15% growth each year.
And at Sutter Health, Kramer says an online patient scheduling platform has made it easier for patients to make appointments with their care providers, reducing no-shows and cancellations.
These strategies, Kramer said, requires alignment across many departments, including marketing, call center operations, digital health, patient experience and of course clinical care delivery. Likewise, Lev said, a direct-to-consumer (DTC) telehealth strategy requires its own infrastructure, with input on marketing, education, staffing, education and ongoing maintenance.
Lev said health systems must balance the need to be forward-thinking with the concern that these new ideas and technologies cost money, might not be reimbursed and won’t really catch the attention of picky consumers.
“You want to [be] at the forefront and innovative in those spaces, but you don’t necessarily want to be the Guinea pig every time,” she said.
For example, she said, some physicians are using asynchronous (also known as store-and-forward) telemedicine tools to support virtual visits, but Colorado’s Medicaid program isn’t reimbursing for those services. That puts pressure on the health system to decide whether it’s worth the extra money.
“We have to figure out what the ROI is as a whole,” she said. “If we’re able to see that ROI regardless of the reimbursement model, that might be sufficient. But if this becomes a bigger part of our business rather than a supplemental service, … reimbursement for care may be necessary.”
Helping Patients and Providers
And while consumer-centric or patient-facing is all the rage, every health system is dealing with workforce shortages and staff stress and burnout. Few clinicians want to hear that a new tool requires “just one more click,” or that these advances will give them time to see more patients.
“If you’re bringing forward a consumer-first offering or approach, you can’t add burden to your care providers,” Kramer said.
To that end, she said, new programs have to benefit the provider as much as the patient. A virtual care program has to balance patient needs with provider workflows—a challenge that retail companies and other non-traditional entries into the healthcare space might not consider.
New programs like online patient scheduling and AI tools to clean up in-basket messaging should be designed not only to improve convenience and access to care, but take pressure off of providers to handle administrative tasks. In that way they’ll not only improve patient engagement and satisfaction, but also give clinicians more reasons to embrace them.
“That’s something that we’re challenging ourselves to continue to do, to look for those win-wins and make sure that we’re supporting both our patients as consumers and our care teams,” Kramer said.
As the healthcare industry evolves toward value-based care, both Kramer and Lev said they’ll be looking at a care platform that includes collaboration and addresses not only current care needs but health and wellness. That might include partnerships and programs that address housing, nutrition, exercise, even family services.
“Maybe [we’re} partnering with organizations that we wouldn’t necessarily have thought to partner with previously,” Lev said. “We want to address not only their healthcare but their barriers to healthcare.”
At the end of the day, both Lev and Kramer said healthcare leadership has to remember that they’re the experts in delivering care. They have a trusted relationship with patients and the knowledge of how to deliver care, rather than marketing care as a retail product, alongside dryer vents and shower curtains.
“The advantage of the incumbent or actual systems is that we are best positioned to change and transform and actually disrupt healthcare because … we’re connected to our patients,” Kramer said. “They want the connected experience that’s integrated into the system, and we can deliver on that.”
Healthcare providers won't embrace telehealth unless they're reimbursed properly. But advocates say they should be looking at more than just the cost.
With all the talk focused on AI these days, telehealth would like to remind everyone that it’s still around. And it isn’t going away.
In fact, despite announcements to the contrary, health systems and hospitals across the country are embracing telehealth to address key pain points, including access issues and workforce shortages. In many instances virtual care has become the norm, rather than the cool new concept.
“Telehealth [and] telemedicine has just exponentially grown,” says Danielle Louder, director of the Northeast Telehealth Resource Center (NETRC), part of a network of federally funded telehealth resource centers scattered across the U.S., and director of U.S. Programs at MCD Global Health. “We’re seeing more strategic, in-depth and creative approaches across the landscape, including integration of artificial intelligence and augmented reality, and are eager to continue our work with partners to advance the use and impact of telehealth across the region and beyond.”
The NETRC, part of the National Consortium of Telehealth Resource Centers, which consists of 12 regional and two national centers, held its annual conference this week in Nashua, N.H. The three-day event, drawing close to 100 attendees, addressed some of the biggest issues in telehealth, including state and federal regulation, innovative use cases, the growth of AI and remote patient monitoring (RPM), and finding the right business case for scalability and sustainability.
And that’s where things get interesting.
Telehealth had its moment in the spotlight with the COVID-19 pandemic, when as much as 70% of healthcare encounters were done virtually to curtail the spread of the virus. Those numbers dropped after the pandemic as patients sought to return to their doctor’s office, but while some pundits claimed this would end the telehealth experiment for good, most health systems and hospitals still see the value of offering virtual care alongside in-person care.
The challenge lies in understanding the value of virtual care—and explaining it to both hesitant providers and skeptic payers.
Jason Goldwater, president and CEO of Laurel Health Advisors, which has conducted several federal and state studies focused on telehealth value (including an ongoing analysis for the state of Connecticut), says healthcare providers won’t fully embrace telehealth unless they’re paid for the virtual visit at the same rate as they’re paid for in-person care. And insurers, especially private payers, aren’t embracing payment parity.
But Goldwater argues that telehealth has a value that goes beyond reimbursement, and both providers and payers need to understand what he calls social ROI.
“Traditional ROI metrics undervalue what telehealth can really provide,” he said during a presentation at the NETRC meeting. “People should be looking at the full spectrum of benefits.”
For example, he said, telehealth visits improve access to care, enabling patients to meet with providers at the time and place or their choosing. This means fewer missed or canceled appointments, which in turn means better adherence to care management, which cuts down on emergency and adverse health events and improved long-term health and wellness. In addition, telehealth leads to a much higher patient satisfaction rate, which in turn can lead to improved medication adherence.
In addition, a telehealth platform might reduce stress on providers by enabling them to shift from in-person to virtual appointments, creating a daily workflow that doesn’t wear them down. This in turn will improve care outcomes and reduce the operational costs tied to a stressed workforce, including time off and departures.
Telehealth can also enable providers to connect more easily with specialists and other services, reducing the need for multiple appointments for patients and improving care management and outcomes.
And finally, telehealth reduces the environmental impacts caused by travel, giving patients the opportunity to receive care from home and even giving providers a chance to work from their homes on occasion.
Goldwater says these factors aren’t often included in the ROI of a telehealth program because healthcare executives and payers are too often focused on cost.
He recommends that healthcare leaders take the following steps:
Leverage stakeholders to support a good telehealth strategy.
Invest in a data infrastructure to give providers both the information they need to improve care and decision-makers the data they need to prove ROI.
Focus on the long-term benefits of telehealth rather than short-term ROI.
Align incentives to support providers, patients and payers.
Leverage technology to create an effective platform.
Beyond that, he says, healthcare leaders need to create a platform for evaluating telehealth programs that factors in social ROI, and that means creating standardized valuation frameworks and assigning monetary values for all SROI benefits.
For example, a program that improves medication adherence might show the cost to the health system when patients aren’t taking their medications, while a program that reduces provider stress and burnout will show the cost to the health system in increased time off and vacation requests and filling positions because of turnover.
