A new project in Illinois aims to connect at risk mothers-to-be with a remote patient monitoring platform that includes a Fitbit, a phone, and an AI assistant named Nurse Avery.
Google and digital health company Drive Health are launching a remote patient monitoring project in rural Illinois to connect expectant mothers with an AI bot to guide them through their pregnancy.
In a partnership with state officials, selected women in Cook County will receive Google Pixel phones, Fitbit devices and access to the Google Cloud to connect with Nurse Avery, an agentic AI health assistant developed by Drive Health. The Healthy Baby program is expected to engage more than 56,000 women over the next few years.
"The Healthy Baby pilot represents a critical step in maternal healthcare, showing how AI can help deliver personalized, proactive health support directly to underserved mothers," Chris Hein, field chief technology officer for Google's Public Sector division, said in a press release. "Using the AI agent, Nurse Avery, and delivering it through Google Pixel phones and Fitbit devices, the program provides real-time support – managing appointments, monitoring vitals, and offering health guidance directly, aiming to make essential resources more readily available."
The program isn't entirely unique. Health systems and state health departments have been trying to use telehealth and digital health for years to connect with at-risk mothers-to-be and monitor them up to and through childbirth. They're driven by maternal mortality rates that place the U.S. well down the list, among developing nations.
In Illinois, that problem is acute. Roughly one-third of all counties in the state struggle with access to maternal care providers, and more than 90% of hospitals lack adequate mental health resources. Among Medicaid populations nationally, 40% of pregnant women have an undiagnosed or untreated mental health concern.
The Health Baby project takes a multi-pronged approach to connecting with at-risk women. The Fitbit device will be used to track participants' activity as well as monitoring heart and sleep data. That information will be collected on Drive Health's platform on participants' Google Pixel phone, from which they can access personalized health recommendations – and Nurse Avery.
This is where digital health outreach meets AI, offering participants are more personal, interactive platform. According to Drive Health executives, Nurse Avery bridges "the gap between providers and patients," answering questions, prompting care plan adherence and providing information on a variety of health concerns, including nutritional support and folic acid intake coordination, vaccination updates, genetic risk assessment, mental health and stress management, and chronic disease management.
As with any RPM program, the key to success will lie in patient engagement. Will expectant mothers be comfortable with using the devices and interacting with an AI assistant? And will the state see improvements in maternal health outcomes as a result? According to officials, they'll be looking for reduced mortality rates, improved birth weight and more full-term pregnancies, as well as reduced costs tied to better access to timely care.
In New Mexico, new kiosks in libraries look to attract underserved populations by downplaying healthcare uses
A new project in New Mexico is introducing telehealth kiosks to libraries across the state in an effort to improve access to care in one of the nation’s most rural states.
And the key to success may be in not telling anyone it’s a telehealth kiosk.
“The nice thing about the soundproof booths is it doesn’t say ‘telehealth’ all over it,” Deirdre Caporoso, MLIS, the outreach and community engagement librarian for the University of New Mexico Health Sciences Library and Informatics Center, said in a recent story published by UNM Health Sciences. “It doesn’t say ‘health’ all over it or ‘clinic’ or anything like that. It’s a very anonymous booth that can actually be used for a wide variety of things."
Kiosks have a checkered history in healthcare, but the potential for delivering virtual care to hard-to-reach communities and populations is undeniable. That’s why Caporoso, armed with funding from the U.S. Department of Agriculture’s Telemedicine & Distance Learning grant program and the Network of the National Library of Medicine and in a partnership with the New Mexico State Library, is coordinating the installation of four telehealth booths in libraries across the state, along with training staff on how to assist people using the kiosks.
“There are a lot of digital inequities in this state,” Caporoso said in the UNM story. “We still have a lot of communities that don’t have access to any sort of high-speed Internet on a regular basis. But we do have a lot of public libraries—and public libraries have high-speed Internet.”
It’s not an entirely new idea, innovative healthcare leaders looking to expand their reach into communities and rural areas have started programs in libraries, banks, community centers, retail centers, even barbershops and hair salons. Some projects start with just a cubicle and a laptop, while others use kiosks or enclosed rooms.
One key consideration in driving traffic to the kiosks is making them unobtrusive, even almost invisible. Access to care may be a critical barrier in rural and remote areas, but that doesn’t mean people will go out of their way to use a kiosk or booth.
The booths in this program are deliberately low-tech. They’re soundproof, standalone rooms, equipped with a computer connected to the library’s wi-fi network, a microphone and a video camera. They’re big enough to fit a couple people and wheelchair-accessible.
“In New Mexico, so many New Mexican families are multigenerational, and many people are not comfortable seeing a provider on their own,” Caporoso said. “So Grandma can bring an additional person, or mother can go in with a child, pretty comfortably.”
“Sometimes, telehealth is used for things like therapy—support for people that are meeting with different types of mental-health counselors, substance-abuse counselors,” she added. “They need somewhere really private. A lot of people don’t have private places at home. They’re living in smaller homes, larger families. They’re much more comfortable going to the library, where they can go into this nice, comfortable little booth and know that nobody can hear them.”
And they can be used for other purposes, a key attraction for the libraries that deploy them. In the Mescalero Community Library on the Mescalero Apache Reservation, the kiosk will also be used by the tribal language program for language recordings.
Four kiosks have been installed so far, and plans call for an additional 10 to be placed in libraries across the state this fall and early next year.
“New Mexico—it’s a rural state,” Caparoso told UNM Health Sciences. “We have fantastic resources, and our rural towns are definitely one of our greatest resources, but they are lacking access to healthcare. Healthcare is like food and water. People need it in order to get through their day. Telehealth makes it so much safer for people to access healthcare, simply because they don’t have to get in their car and drive maybe six hours to see a doctor. Being able to eliminate a full day in a car is huge for so many people in many communities.”
Houston Methodist is now using virtual nursing across eight acute care campuses, and handling some 500 admits and discharges per day. Many of those nurses are even working from home.
While virtual nursing programs typically begin with one or a few specific functions and outcomes, scaling those programs means creating a comprehensive platform that can handle many services.
Houston Methodist, which launched its virtual nursing program in 2022, is now using the platform to facilitate more than 500 admits and discharges a day across eight acute care campuses, says Steve Klahn, the health system's clinical director for virtual medicine. And at its newest location, Houston Methodist Cypress, that experience is much more immersive.
"The team is piloting care delivery in a more comprehensive fashion with remote virtual nurses," Klahn, a participant in the HealthLeaders Virtual Nursing Mastermind program for the second year, said in a recent e-mail exchange. "This pilot includes rotating bedside nurses through a local virtual operations center and supporting bedside nurses' care for their patients by increased remote documentation assistance, multi-disciplinary rounds participation and virtual consenting."
Steve Klahn, clinical director for virtual medicine at Houston Methodist. Photo courtesy Houston Methodist.
As noted in a 2024 story on the program, Houston Methodist is in it for the long run. That means understanding where the platform can evolve and where executives need to take a step back and evaluate their priorities.
"Maintaining flexibility to all the great ideas [that] come in, while being able to remain standardized in the approach so as to not have to re-educate and change workflows too frequently," is crucial to the program's growth, Klahn says. "We also aim to ensure programmatic efficiency with minimization of wait times, while maintaining 24x7 services with safe and fiscally responsible staffing solutions."
One glimpse of the future might be seen in their staffing strategy. Several participants in the Mastermind program have indicated they're looking at enabling nurses to work from home—a key incentive to retaining current nurses and attracting new ones. At Houston Methodist, which now has 50 RN FTEs dedicated to the program, Klahn says the idea is being pushed along out of necessity. Some 70% of the health system's virtual nurses now work from home, and the gaol is to get that number up to 90%.
"We are currently shifting more of our teams to remote work, as space in our virtual operations center is at a premium," he says. "Our strategy remains for direct hire exceptional staff nurses (no-outsourcing to contracted teams), as well as supporting nurses in times of short-term light-duty assignments."
Klahn says the program is gradually integrating new services as well, including dual medication signoffs, remote witnessing of controlled substance wasting, and VTE prevention rounding.
He says the program's success is due to how well it has been received by both patients and nurses.
"We continue to appreciate high levels of satisfaction with patients, bedside nursing teams, physicians/providers and hospital administrators," he says. "The team does an amazing job of ensuring focused high-quality completion of the clinical support they do on a daily basis."
"The biggest surprise to me is how fast the program grew with the strategy our organization acted upon," Klahn adds. "It was amazing to see how quickly the bedside teams embraced this new approach to patient care, and we were able to quickly deliver on the requests for services to each of our hospitals. The future is very bright for VN programs and we look forward to much more growth in the space."
The HealthLeaders Mastermind series is an exclusive series of calls and events with healthcare executives. This Virtual Nursing Mastermind series features ideas, solutions, and insights on excelling your virtual nursing program. Please join the community at our LinkedIn page.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com.
The Cleveland Clinic is the latest to partner with a developer of ambulatory surgery centers to take minimally invasive procedures out of the hospital.
Health systems are taking a step toward the hospital of the future by outsourcing minor surgeries.
The latest to do so is the Cleveland Clinic, which announced a partnership this week with Tennessee-based Regent Surgical to build a number of ambulatory surgery centers across the country. These centers are designed to handle minimally invasive procedures, which require little to no hospital stays and shorter recovery times, much of which can be handled at home or in clinics.
As hospitals struggle with workforce shortages and look to reduce costs and their patient census, leadership is looking for alternatives to expensive and resource-intense hospital care, with the idea of saving the hospital for those who need acute care services and will spend several days there.
As a result, the ambulatory surgery market is growing. Fortune Business Insights reports the market size was valued at almost $44 billion in 2022 and projected to grow to more than $75 billion by 2030. There are currently more than 6,000 such centers in the U.S.
Arizona-based Banner Health joined forces with Select Medical in 2018, and now has a network of four private rehabilitation hospitals and outpatient physical therapy programs and services at dozens of Banner Physical Therapy Centers. Mark Garvin, the health system’s SVP of Partnership & Venture Development, says the partnership is part of Banner’s strategy to grow beyond its extensive hospital footprint and provide value-based care where it’s most convenient.
“These are people that wake up every single day and this is what they worry about,” he said in a recent HealthLeaders interview. “They’re experts. They know how to operate. They know how to develop. They know how to grow. It is their wheelhouse.”
Garvin says health systems and hospitals have the advantage over disruptors because of the name brand and the expertise in providing healthcare services.
“We can play in this space differently than the Amazons, differently than other retail organizations, simply because we’ve created these clinically integrated networks,” he says.
Cleveland Clinic, which is internationally known for outsourcing second opinions through The Clinic by Cleveland Clinic, a partnership with telehealth provider Amwell, is banking on new efficiencies with the Regent Medical deal.
“Ambulatory surgery centers provide an important setting for health systems to expand access to surgeries, and to be more efficient in the delivery of services,” Cleveland Clinic CEO and President Tom Mihaljevic, MD, said in a press release. “Regent's capabilities in managing and operating ambulatory surgery centers will enable us to focus on continuing to provide the highest quality care for our patients and will enhance our ability to grow and offer that care to more patients.”
AI can help clinicians manage complex conditions and relationships, says the CMIO of Stanford Medicine Children's Health
Pediatric healthcare is a complex undertaking. The doctor-patient experience is far more complicated, involving not just patients of various ages but parents, grandparents, siblings, other caregivers, maybe even a pet or two, real or imaginary. The old standard ‘How are you doing today?’ usually doesn’t do the job in this environment.
“So much of pediatric care is about connection, and about preventative medicine, and about ensuring that you understand the complex interactions between the child, the parent and the provider, and so, so much of that kind of subtle nuance about what is the child doing during the evaluation,” she says. “So much of what we’re assessing is the child’s behaviors [and] the child’s interaction with other people in the room, the child’s body motions. And if you're sitting at a computer and typing the whole time, you're missing all of that very rich data.”
Children’s hospitals have a rich history of embracing innovation, often because the tried-and-true ways of care management for adults don’t necessarily work for kids. Clinicians often have to take new ideas and technology designed for adults and modify them for their own patients.
That’s also true of AI, which, Pageler says, needs to evaluated differently.
Natalie Pageler, MD, CMIO of Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
Take ambient scribes, which are designed to capture the doctor-patient encounter for the medical record.
“We did a rigorous evaluation of how that affected the interaction for children and families, because most of it was developed in the context of a single provider and a single patient,” Pageler says. “Of course, in pediatrics, it's often the patient, a couple parents, a couple kids running around the room screaming. We really wanted to do that evaluation to understand [whether] it could have the same impact for children and families.”
The potential value of these tools for pediatric clinicians is clear. In that busy exam room, a doctor or nurse needs to be attentive to the children as well as the parents, picking up on subtle clues and interactions that could play an important role in diagnosing and treating underlying health concerns.
“We need to make sure they are addressing the true needs of the patient and the family,” Pageler notes.
Just as important, she says, is the connection between the clinician, the patient and the patient’s family, a key dynamic in any healthcare experience but critical to those working with children. Pageler says AI is helping to take the technological barriers out of the exam room and making children and their parents feel more comfortable.
“We’ve had several patients walk out of the room and say, ‘Wow, my provider looked at me the whole time and we got to really talk about this complex challenge I'm having with my child's behavioral issue,’” she says.
Pageler says some doctors have even decided to use AI instead of having a scribe in the room or listening to the conversation from another location. In some cases, she says, Ai is less intrusive to parents and children who want to talk about personal issues and don’t want another person listening to that conversation.
Aside from ambient listening opportunities, Pageler says AI can be a valuable support tool for doctors who are treating patients as young as infants and as old as teens. Different ages often call for different treatments, and the technology can help clinicians gather the information they need to guide their conversations with children, adolescents, parents and other caregivers.
“The relationships are so complex,” she notes. Clinicians have to be “extremely thoughtful” in how they share information with different patients and family members.
Pageler expects clinician decision support to be the next wave of AI innovation, helping clinicians find and use the right data to improve care management and coordination. That’s especially true as healthcare organizations set their sights on health and wellness and prevention opportunities.
As she sums up the value of AI in the pediatric care space, Pageler says the technology enables doctors and nurses to interact with patients, their families and others without the intrusive presence of computers and scribes.
“AI should make care more human, not less,” she says. It will “allow for more humanity” in care management.
A bill introduced in both the Senate and House would Improve Medicare reimbursement for rural providers using RPM technology.
While adoption rates are growing for remote patient monitoring (RPM), rural and remote providers are holding back, due in large part to low Medicare reimbursement. A new bill before Congress aims to change that.
The Rural Patient Monitoring Access Act, introduced this week by U.S. Senators Marsha Blackburn (R-Tennessee) and Mark Warner (D-Virginia) in the Senate and by U.S. Reps. David Kustoff (R-Tennessee), Mark Pocan (D-Wisconsin), Troy Balderson (R-Ohio) and Don Davis (D-North Carolina) in the House, would set a geographic payment floor for RPM reimbursement, enabling rural providers to recoup expenses from Medicare at the same rate as their urban and suburban counterparts.
Supporters say the bill would also ensure that providers are capable of responding to health concerns detected by RPM and that the RPM technology can promptly transmit biometric data at the EHR. It would also give the Centers for Medical & Medicaid Services (CMS) a pathway for reporting data to the Health and Human Services Department (HHS) to evaluate costs savings generated by RPM.
The proposed legislation has a number of supporters, including Marshfield Clinic, Lifepoint Health, SSM Health, Ascension, the University of Virginia Center for Telehealth, the American Telemedicine Association (ATA), the National Rusal Health Association, HIMSS, and the Alliance for Connected Care.
According to a summary of the bill, RPM reimbursement via Medicare is lowest in areas where the prevalence of heart disease, hypertension and diabetes are above average and where access to care providers is problematic.
“Patients in rural and underserved communities deserve the same opportunity to manage their health as those in more resourced areas,” Christ Frost, Lifepoint Health’s CMO and Chief Quality Officer, said in a press release. At Lifepoint, we’ve seen firsthand how high-quality remote patient monitoring can help bridge long-standing access gaps and drive meaningful clinical improvement, especially for chronic conditions like hypertension and diabetes.
The bill comes just two weeks after the Peterson Center on Healthcare released a study that called for improvements to RPM reimbursement, including coverage that aligns with specific services that have shown the most value, improved access to high-impact RPM services and improved data collection from RPM devices.
The study also found that hypertension, diabetes and heart failure are the most common conditions being monitored through RPM.
“As we adopt exciting, new technologies that extend care beyond the walls of the doctor’s office, we need to design payment models that align with clinical benefits for patients,” Caroline Pearson, executive director of the Peterson Center on Healthcare, said in a press release. “That means ending ‘forever codes’ that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients’ diseases.”
Jefferson Health, a participant in the HealthLeaders Virtual Nursing Mastermind program, is strategically expanding its program as it looks for sustainability
Jefferson Health launched its virtual nursing program in 2023, and is expanding its strategy to broaden the virtual observation footprint and include inpatient provider consults. They’re also exploring opportunities to integrate other care team connections, such as diabetes educators.
“For nursing specifically, we completed a second pilot, applied key learnings, and officially launched a formal program with a dedicated, permanent team,” Laura Gartner, DNP, MS, RN, RN-BC, NEA-BC, the health system’s Nursing Informatics Officer and a second-year participant in the HealthLeaders Virtual Nursing Mastermind program, said in an e-mail Q&A. “We have refined the virtual nurse’s core tasks and workflows to enhance support for bedside teams and have collaborated closely with our vendor to optimize the technology. In addition, we have identified other areas across our system where virtual care can further improve patient support and clinical workflows. As we continue to expand, our goal is to integrate virtual care more seamlessly into inpatient operations to enhance efficiency and patient outcomes.”
This includes using the virtual platform for more care team functions. Beyond the first use cases for provider consults, Gartner says they want to expand inpatient consults to help hospitals access specialists in other locations and reduce the need for transfers, which can be stressful and time-consuming. They’re also working to integrate this and other virtual functions into their EHR platform, so that virtual nursing isn’t an added function that complicates nursing workflows.
These additional services cost time and money, though, which is a tough sell in this economy.
Laura Gartner, AVP and Nursing Informatics Officer at Jefferson Health. Photo courtesy Jefferson Health.
“One of the biggest challenges we’ve faced with the virtual nursing program is securing sustainable funding,” says Gartner. “There is strong interest in implementing virtual nursing across various units, as the benefits—such as improved workflow efficiency and enhanced patient support—are widely recognized. However, integrating a virtual nurse into staffing models requires a financial investment, and identifying consistent funding sources has been a barrier. Aligning financial priorities with program expansion remains a key focus.”
To prove that ROI, Gartner says they’re tracking process metrics such as average number of virtual nursing sessions per shift, overall number of sessions, time per session and overall, and the reason for accessing a virtual nurse. They’re also tracking outcomes, including the 30-day readmission rate, falls, falls with injury, HCAHPS scores, voluntary nurse turnover, discharge times, LOS, and incidental overtime, among others. To date, she says, they’ve seen improved HCAHPS scores, shorter LOS times, a decrease in incidental overtime and reduced discharge times.
They’re also on track, she says, to double the use of their meds to beds program, which aims to improve patient education and medication management.
The program also has value that can’t be measured in a metric. Gartner says virtual nursing has had a positive effect on the nurse-patient relationship.
“One of the best parts [of the program] has been hearing the virtual nurses connect with patients,” she says. “These are truly incredible nurses, and through this program, they’re able to spend more focused time with patients than they often could at the bedside. It’s been rewarding for both the nurses and the patients, and a great reminder of the value of meaningful interactions in care.”
Gartner says she was surprised by how nurses were initially apprehensive about the program.
“Even though virtual nursing has a benefit of reducing bedside staff workload, it’s still a big change from how things have traditionally been done,” she says. “Some nurses were worried that we were taking a nurse away from the unit, rather than adding support.”
In fact, the health system has changed its staffing strategy as the program evolves. Where Jefferson Health first used two enterprise resource nurses on temporary assignment, Gartner says, they’ve now switched to two permanent staff members and have plans to add more.
“I’ve found that building trust and understanding takes time, and that’s been a valuable reminder of the importance of clear communication, collaboration, and involving frontline nurses early and often,” she added. “What’s been most encouraging is that, as nurses see the impact firsthand and hear positive feedback from peers, acceptance and enthusiasm grow organically. It’s a journey, but one that’s already showing great promise.”
The Arizona-based health system's new SVP of Partnership and Venture Development sees the value of collaboration and being proactive instead of reactive.
As healthcare adapts to a changing landscape and the presence of disruptors, the idea of “traditional” healthcare is being replaced by a network of collaborations and partnerships focused on the consumer’s care journey.
To Mark Garvin, Banner Health’s new Senior Vice President of Partnership and Venture Development, that’s fertile ground for the value-based care system of tomorrow. And it’s his job to steer the Phoenix-based health system in the right direction.
“We can play in this space differently than the Amazons, differently than other retail organizations, simply because we’ve created these clinically integrated networks,” he says.
Garvin has a background in ambulatory care—as chief operating officer for United Surgical Partners International from 2001 until 2020, he oversaw the company’s evolution from a start-up to the nation’s largest developer of short-stay ambulatory surgery centers and hospitals. Now he’s guiding the six-state, 33-hospital network toward a future where care is accessed in many locations.
Banner wants to expand its service offerings and geography “beyond just the acute [care] side,” he says. “What we want to do is grow the diversification as a percentage of the overall business in things that are outside of the traditional acute” care spectrum.
Expanding that footprint means looking beyond “traditional” healthcare to new ideas. Garvin says Banner should not only be open to innovation—they should be leading the way.
Mark Garvin, SVP of Partnership & Venture Development at Banner Health. Photo courtesy of Banner Health.
“Why wait for someone else to come to the table?” he asks. “Why not be part of the creation, either [as] an owner or a partner or in a joint venture?”
One example of the joint venture is Banner Health’s partnership with Select Medical, which began in 2018 and has led to the development of four private rehabilitation hospitals and outpatient physical therapy programs and services at dozens of Banner Physical Therapy centers. The hospitals, which are run by Select Medical under the Banner name, address a growing need for inpatient rehabilitative care for patients who are recovering from strokes, traumatic brain injury and other medical conditions.
“These are people that wake up every single day and this is what they worry about,” Garvin says of Select Medical. “They’re experts. They know how to operate. They know how to develop. They know how to grow. It is their wheelhouse.”
Garvin sees more of those types of arrangements in the future, as health systems and hospitals look beyond their own walls to transform care delivery. He says Banner has to be strategic, as the health system attracts a lot of innovators and start-ups that are looking for Banner to “put them on the map.”
“Is there something real here that we think makes a material difference?” he says. “Does it give us the ability to do things that perhaps in the in the past took a lot more labor and time to get accomplished? We have to ask those questions.”
“We have to do due diligence,” Garvin adds, noting that a good idea now might very well be outdated in 12 months. And while the pace of innovation (think AI) might force healthcare leaders to rush into things, he wants to slow it down a bit.
“Don’t get in too much of a hurry,” he says. “That’s where the mistakes will come in.”
UCSF is launching a remote patient monitoring program aimed at identifying arrhythmias in expectant mothers and improving detection, treatment and long-term care.
Researchers at the University of California San Francisco (UCSF) are enrolling mothers-to-be in a remote patient monitoring study aimed at analyzing how pregnancy affects heart health.
The San Francisco-based university and affiliated health system is partnering with digital health company Vivalink in the BRITE-MOM study, which will use wearable ECG monitors to track participants in real time. The study aims to monitor women with congenital heart disease and pre-eclampsia through pregnancy and six months after delivery to identify signs of arrhythmia.
"Women with congenital heart disease and pre-eclampsia face a significantly elevated risk of arrhythmia during pregnancy, yet data on how and when these arrhythmias occur remain limited," Nicky Herrick, MD, a cardiology fellow at UCSF and one of the study’s principal investigators, said in a press release. "Our goal is to generate a detailed picture of the types, frequency, and symptoms of arrhythmias in pregnancy using wearable technology that allows us to monitor participants safely and remotely."
Healthcare providers are embracing RPM at a rapid pace, with an eye toward tracking their patients outside the hospital, doctor’s office or clinic and understanding how daily life may affect their health. In this particular case the focus is on identifying cardiac complications and reducing maternal mortality, which caused almost 33 deaths per 100,000 live births in the U.S. in 2021, according to the Centers for Disease Control and Prevention.
The study will collect round-the-clock data on heart rate variability, arrhythmia episodes and early indicators of cardiac stress. Often these indicators won’t show up in an office exam, either through testing or talking with patients, so it’s crucial to gather that data as the patient goes through her day.
UCSF says the study will help clinicians better understand arrhythmia patterns that can help guide early detection, clinical intervention and long-term care management.
"By incorporating wearable devices for long-term use, we are able to better capture arrhythmia episodes and early signs of cardiac stress that could otherwise go undetected," added Anushree Agarwal, MD, a UCSF Health cardiologist and co-principal investigator, in the press release.
PPEC programs like Spark Pediatrics give healthcare providers a resource to manage and coordinate care for children with complex care needs. They also give parents a chance to relax a bit, and enable these children to be kids.
Health systems and hospitals play an important role in coordinating care for small children with complex medical needs, who often transfer out of the NICU and into a chaotic and uncertain world.
A model of care called PPEC (Prescribed Pediatric Extended Care) aims to make that process easier for providers, patients and their families.
A concept that’s been around for roughly 40 years, PPEC centers are gaining momentum as the number of “medically complex” children surpasses 3 million in the U.S., straining the resources of both healthcare providers and families. The center-based model, likened to a day care, aims to give these children the care they need alongside the childhood they’re often missing out on.
“We’re helping kids [with complex medical conditions] get access to skilled nursing care,” says Jeffrey Soffen, CEO of Spark Pediatrics, a Florida-based PPEC provider that is working with more than a dozen health systems across three states. “We promote socialization. We promote respite for the families so that they can either have time to themselves or time to go to work or whatever it might be. I'd say right now that's really important.”
There are roughly 180 PPECs in the U.S., located in the 15 states whose Medicaid programs permit the centers (Medicaid requires a prescription for care from the child’s primary pediatrician). Several states, including Missouri, are debating amending their Medicaid program to permit PPECs, but the path forward is slow and uncertain, especially considering the current political climate.
Earlier this year Spark Pediatrics raised $15 million in new investments, with funding from Pittsburgh’s UPMC Enterprises and the Houston’s Memorial Hermann Health System. Soffen says the funds will enable Spark to establish new partnerships in Pennsylvania and Texas, the next step in a plan to expand across the country.
“Spark is creating a new model of care delivery for children with medical complexities that is aimed at improving quality of care and the family experience for this often-overlooked population,” Mary Beth Navarra-Sirio, Vice President of Market Development at UPMC Enterprises, the innovation, commercialization, and venture capital arm of UPMC, said in a January 2025 press release on the funding round. “This aligns well with our focus on creating innovations that impact the lives of patients in meaningful, lasting ways.”
Soffen says medically complex children often begin their lives in the hospital NICU, move through other departments in the hospital, then need care from a wide range of doctors, nurses and specialists when they go home—tasks that often fall on stressed parents. On top of that, there are often delays, some as long as a year, in accessing specialists.
"We Should Be Locking Arms"
That’s where care coordination becomes a necessity.
“Our kids are born in their NICU, they're going back to their hospitals, they're seeing their pediatricians,” Soffen says. “It feels like we should be locking arms, right?”
Spark uses a patient-centered medical home strategy at about half the cost of in-home care, he says. Through a care team that collaborates with specialists, the center offers up to 12 hours of care seven days a week, with a patient-to-staff ratio of 1:3.
“My biggest thing that I want to do is make these kids’ lives easier,” Soffen says. “If you think about a child that we serve, they might have 12-13 specialists. They might have an appointment every week with a different doctor. [Parents] also have to coordinate therapies. So if you have a feeding tube, you've got to be working on swallowing in order [to make] progress and eventually get this feeding tube out.”
“We need to do as many of those things in our center as possible, but we also need to understand who we are and who we are not,” he adds. That means the center focuses on a small care team and coordinates specialist visits, taking the pressure off of parents who would otherwise be scheduling specialist visits at home or transporting their children to doctor’s offices and clinics.
For that reason, Spark Pediatrics—like most PPEC providers—needs to be located near large population centers.
“The more kids that we serve in a center, the more we can do for them, and that's the really powerful thing,” Soffen says. “So if I have 30 kids in my center instead of 10, my ability to attract providers to do virtual visits or come into the center to do a wellness check is a totally different scenario. If they can see 20 kids instead of five kids, that makes it worthwhile.”
That’s why Spark Pediatrics started in Florida and is targeting heavily populated states like Texas and Pennsylvania. Medicaid support is crucial, Soffen says, as almost all of their patients are on Medicaid, and Spark is working with legislators in states like Missouri to expand the number of states they can work in. They’re also talking to private payers about the value of the program.
The UPMC partnership, meanwhile, has an added benefit of an associated health plan, offering opportunities for innovative care arrangements like an ACO.
“An ACO is a is a way for providers to come together to produce better outcomes for their patients and to do it in a cost-effective manner than incentivizes them to do that,” Soffen says. “Why shouldn't we be a part of that if we're able to help them achieve that goal?”
"Why Shouldn't They Have That Chance to Just Be a Kid?"
Soffen says they’ve had good conversations with pediatric hospitals (their partners include Nemours, Joe DiMaggio Children’s Hospital, Orlando Health’s Arnold Palmer Hospital, Palm Beach Children’s Hospital, Baptist Health Jacksonville’s Wolfson Children’s Hospital and Texas Children’s Hospital). But the wider strategy is to partner with any health system that treats medically complex children.
“A big part of our job is to educate, in particular, the hospitals, the discharge coordinators, the care managers, the case managers, the pediatricians, the specialists, the pediatric specialists,” he says. “Those are who our kids are going to every day and they're the ones that put their trust in those institutions to recommend what is best for them.”
The biggest barrier, of course, is funding, and the ongoing chaos in Washington DC over Medicare and Medicaid sustainability casts a shadow over the growth of any PPEC.
That’s why Soffen wants healthcare providers and lawmakers to see not only the financial and clinical value to these centers, but what these facilities can offer to children and their parents.
“You want these kids to have the childhood that you dream about, where they come home from friend's houses or birthday parties or doing arts and crafts, and you put [their artwork] on your window and you're so proud of them,” he says. “Why shouldn’t they have that chance to just be a kid.”
