A bill before Congress would, if passed, continue COVID-era Medicare telehealth waivers until the end of 2024, while also extending the CMS Acute Hospital Care at Home program for two years.
Congress is expected to pass an omnibus spending bill this week that would extend pandemic-era Medicare telehealth waivers until the end of 2024. The bill would also keep in place the Centers for Medicare & Medicaid Services' (CMS) innovative Hospital at Home program, and continue several other programs aimed at boosting connected health access and coverage.
Among several organizations praising the news is the American Telemedicine Association, which had long warned that the elimination of these waivers and programs would seriously hinder telehealth and digital health adoption.
“The ATA and ATA Action never wavered from our appeal to Congress, to provide stability around the life-saving telehealth flexibilities that have become a relied upon and valued option for healthcare providers and patients," Kyle Zebley, senior vice president of public policy for the ATA and executive director of ATA Action, said in a press release. "Today, our Congressional telehealth champions on both sides of the aisle came through for the American people and for ATA and ATA Action members, by meeting our plea for more certainty around telehealth access for the next two years, while we continue to work with policymakers to make telehealth access a permanent part of our healthcare delivery for the future.”
"The inclusion of a two-year extension of Medicare telehealth and commercial market telehealth flexibilities will make a huge difference to so many Americans," The Alliance for Connected Care said in a separate press release. "The Alliance for Connected Care has been calling for predictability for patients and clinicians while continuing to work toward permanent telehealth authorization. This gives us both."
Generally, the bill, if passed, would:
Remove geographic requirements and expand the list of originating sites for telehealth services;
Expand the list of providers eligible to furnish telehealth services;
Expand telehealth services for federally qualified health centers (FQHCs) and rural health clinics (RHCs);
Delay in-person requirements under Medicare for mental health services furnished through telehealth and telecommunications technology;
Permit audio-only telehealth services, such as phone calls;
Allow the use of telehealth to conduct face-to-face encounters prior to recertification of eligibility for hospice care during the emergency period; and
Mandate a study on telehealth and Medicare program integrity.
The inclusion of audio-only telehealth services is a nice surprise for telehealth advocates. Federal and state regulators have long mandated that telehealth services be audio-visual, and have severely restricted any use of the telephone or an audio-only telemedicine platform for care delivery. But during the pandemic the telephone became a popular tool in regions where access to either telemedicine equipment or reliable broadband is limited. CMS has indicated it will return to those restrictions after the PHE ends, saying the platform isn't reliable enough for care delivery.
The bill would also extend for two years the waiver for the CMS Acute Hospital Care at Home program, an innovative service launched by CMS that allows health systems to shift more care for acute patients from the hospital setting to the home, through a platform that includes remote patient monitoring, telehealth services and in-person care. More than 200 health systems have signed up to take part in the program, and many had said they would be forced to curtail, drastically change, or even cancel the program once CMS support for the program ends.
“We greatly appreciate Congress including extensions the High Deductible Health Plan (HDHP) and Health Savings Account (HSA) telehealth tax provision, giving American workers continued access to needed telehealth coverage without first having to meet annual deductibles, including telemental health services," Zebley said in the ATA press release. "Further, the extension to the Acute Hospital Care at Home Program ensures continued access to this patient-centered care delivery model that is proving to effectively lower cost of care while improving patient health outcomes and satisfaction."
Not all the news was good, however. While the omnibus bill includes several measures aimed at addressing the nation's substance abuse epidemic, it does not include an extension for a waiver that currently allows healthcare providers to prescribe controlled substances via telehealth for substance abuse treatment.
Federal law bans are severely restricts prescriptions of controlled substances through telemedicine. Federal regulation is channeled primarily through the Ryan Haight Act, passed in 2008, which prohibits physicians from prescribing controlled substances electronically until they have conducted an in-person examination, or if they meet the federal definition of practicing telemedicine, which requires that the patient be treated by, and physically located in, a hospital or clinic which has a valid DEA registration; and the telemedicine practitioner is treating the patient in the usual course of professional practice.
The nation’s ongoing opioid abuse crisis is creating a groundswell of support for changes in federal law to make telemedicine and telehealth a more prominent feature in treatment. Congress has been considering bills that would, if passed, create a special registration through the US Drug Enforcement Agency to enable healthcare providers to prescribe controlled substances through telemedicine.
The bill does direct the DEA to implement that special registration process, but the DEA has been asked to start that process for several years and has yet to do so.
While the omnibus bill, if passed as expected, would extend all of these freedoms for another two years, the ATA and others are lobbying to make many of the provisions permanent, rather than just pushing the finish line farther down the road.
“The hard work continues, as we persist in pressing telehealth permanency and creating a lasting roadblock to the ‘telehealth cliff,’" Zebley said. "Additionally, we will continue to work with Congress and the Biden administration to make sure that a predictable and preventable public health crisis never occurs by giving needed certainty to the huge number of Americans relying on the clinically appropriate care achieved through the Ryan Haight in-person waiver.”
Researchers at the University of Illinois and OSF HealthCar are working on a digital health app that would enable providers to better combat false rumors and malicious reports that hinder public health efforts.
Researchers at the University of Illinois are working on a digital health app that would alert providers to healthcare misinformation circulating on social media.
Kevin Leicht, PhD, a sociology professor at UI, and Mary Stapel, MD, community care lead physician for OSF HealthCare Saint Francis Medical Center and assistant program director for the combined Internal Medicine-Pediatrics Residency at the University of Illinois College of Medicine Peoria (UICOMP), are using a $100,000 grant to develop the resource, which would give users real-time alerts about rumors and malicious reports that impact public health efforts.
"What our project actually does is take not only the pre-existing fact-checked data and query it all in one place, it brings it forward in a user-friendly fashion," Leicht said in a press release from OSF Healthcare. "But then it's also trying to come up with a way of adding to this data in a way that's faster than having a human fact checker just scan the web all the time, looking for what the new piece of misinformation is."
Leicht, the science team lead at the Chicago-based Discovery Partners Institute (DPI), and Stapel are using a grant from OSF Healthcare's Jump ARCHES (Applied Research for Community Health through Engineering and Simulation) program, and building on past work, supported by the National Science Foundation, to identify the spread of misinformation about COVID-19 and other debunked medical research.
"If we can even get ahead of that – know what information is circulating and start feeding out more accurate information ahead of time through our community partners; that really could be a game changer when we're thinking about things like pandemics and infectious disease," Stapel said in the press release.
Stapel said the app would help healthcare workers, especially those in community health, to better inform patients and gain their trust at a time when public healthcare workers are struggling against false information that affects their credibility.
"Having humans curate that a little bit … you have content experts that look at that and say, 'Is this dangerous or is it not? Is this trending, is it not?' And then figuring out a way to deliver that to the final customer in a way that requires as little inner interface by them as we can possibly get away with," she added.
A start-up from the Mayo Clinic orbit is partnering with Pfizer to develop an AI-enhanced ECG that can detect cardiac amyloidosis, a progressive disease that's difficult to diagnose early.
A startup launched out of the Mayo Clinic Platform is partnering with Pfizer to develop AI software that can detect cardiac amyloidosis in an electrocardiogram.
Anumana, which was launched in 2021 and is part of the nference software company's portfolio, intends to develop the AI-ECG tool as a software-as-a-medical-device (SaMD) and market the algorithm in the US, Europe, and Japan.
This isn't the first time Anumana has created software addressing cardiac issues. The company has developed AI-ECG algorithms in the past through the Mayo Clinic for detection of low ejection fraction, pulmonary hypertension, and hyperkalemia, all of which have received Breakthrough Device designation from the US Food and Drug Administration (FDA).
The latest software takes aim at cardiac amyloidosis, an often undiagnosed and progressive disease characterized by the stiffening of the walls of the heart, interfering with the function of the left ventricle. Symptoms include shortness of breath, knee pain, bilateral carpal tunnel syndrome, kidney disease, and gastrointestinal issues.
Because the symptoms are so diverse, the condition is hard to diagnose. Earlier detection would give clinicians time to develop more effective treatment plans that would improve clinical outcomes over time.
“The challenge in diagnosing cardiac amyloidosis can prevent patients from getting treatment while the disease continues to progress,” David McMullin, Anumana's chief business officer, said in a press release. “We believe this collaboration [with Pfizer] will demonstrate the power of Anumana’s AI-ECG algorithms to help clinicians intervene earlier, giving them greater ability to improve patient outcomes and prolong lives.”
The project is the latest of many that aim to use AI to spot infinitesimal trends in data that might not be picked up by manual data review until much later.
“AI-ECG solutions alert clinicians to humanly imperceptible patterns in ECG signals, providing an early warning for serious occult or impending disease,” added Paul Friedman, MD, chair of the Mayo Clinic's Department of Cardiovascular Medicine and chair of Anumana’s Mayo Clinic Board of Advisors. “This stands to improve the lives of people with cardiac amyloidosis by improving the speed of triage and care of this group.”
The Medicaid and CHIP Access to Prescription Digital Therapeutics Act, introduced this week in Congress, would create standardized coverage in Medicaid and CHIP plans for approved digital health tools and platforms.
A new bill introduced to Congress aims to improve coverage for digital therapeutics in Medicaid and state Children's Health Insurance Programs (CHIPs).
“Digital therapeutics hold particular value for Medicaid populations with convenient, accessible, and personalized treatment options to address many unmet medical needs,” Andy Molnar, chief executive officer of the Digital Therapeutics Alliance (DTA), said in a press release announcing the DTA's support for the bill. “This legislation would establish more clarity and uniformity in how prescription digital therapeutics are covered by public programs from state to state and is a critical step toward ensuring that these evidence-based treatments get into the hands of those who need them most.”
While the text of the bill wasn't yet available, supporters said it would, if passed, define 'prescription digital therapeutic' for Medicaid coverage, create standardized coverage for digital therapeutics treatments approved or cleared by the US Food and Drug Administration (FDA) in Medicaid and CHIP programs and give the Health and Human Services Secretary the ability to provide technical assistance to states considering such coverage.
The bill represents a growing interest in the use of digital health tools and platforms to treat chronic conditions and other health concerns, giving healthcare providers new options that don’t necessarily include drugs or in-patient treatments.
It also tackles one of the biggest barriers to adoption: payer coverage. Unless payers support these new treatments, providers have little incentive to prescribe them. Some health plans and private insurers have shown support for digital therapeutics, but the industry needs the backing of Medicare and Medicaid plans, who cover many of the populations that would greatly benefit from their use.
In its 2023 Standards of Care, the American Diabetes Association says technology is now a vital part of care management, and all people living with diabates should have access to those tools and platforms.
The American Diabetes Association is emphasizing the value of healthcare technology in diabetes care management in its 2023 Standards of Care.
The revised standards, issued this week, include a section devoted to technology, including continuous glucose monitoring (CGM) devices that allow people living with diabetes to check their blood glucose levels at any time, automated insulin delivery systems and digital health tools that offer coaching and access to resources.
The guidelines recommend that anyone living with diabetes have access to FDA-approved technology to manage their chronic condition, especially seniors and underserved populations. The ADA also points out that technology can be used to improve access to care and care management for those dealing with health inequity, or barriers to care caused by social determinants of health.
“ADA’s mission is to prevent and cure diabetes, a chronic illness that requires continuous medical care, and the release of ADA’s Standards of Care is a critical part of that mission,” Chuck Henderson, the organization's chief executive officer, said in a press release. “This year’s annual report provides necessary guidance that considers the role health inequities play in the development of diabetes, particularly for vulnerable communities and communities of color disproportionately impacted by the disease. This guidance will ensure healthcare teams, clinicians and researchers treat the whole person.”
Digital health technology has been a part of care management for people living with diabetes for years, though the ADA and other organizations, such as the Centers for Medicare & Medicaid Services (CMS) and US Food and Drug Administration (FDA), have been careful to support only technology that passes strict protocols and has proven to improve clinical outcomes.
The ADA's acknowledgement of the value of technology may mark an import step in the value-based care movement.
Earlier this year Kevin Sayer, CEO of digital health company Dexcom, one of the leaders in the diabetes technology space, said the industry is moving on from highlighting the next big thing and focusing more on integration and interoperability.
"Everybody wants everybody to be interoperable and talk to everybody else," he said. "The only way that these platforms are going to be successful going forward is if all the technology works with each other and people using it are engaged."
"It isn't even technological any more," he added. "What people are looking for is access."
Sayer says the diabetes care industry is now transitioning to overall health and wellness, not just tools and platforms that solely address diabetes. That's why a company like Livongo, which was launched by former Allscripts executive Glenn Tullman to help people living with diabetes like his son, has since evolved to address other chronic diseases, as well as integrating with primary care and behavioral healthcare services.
"We've come to understand that the patient's healthcare journey starts long before they were diagnosed with diabetes," Sayer said. "And it involves a lot more than just [diabetes tools and platforms]. It's all about access now, and that can be complex. We have to learn how to make access easier."
The Texas health system is using a diabetes care management program that tracks engagement and pushes targeted resources and interactions to address care gaps and costs.
Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.
United Regional Health Care is seeing good results from a digital health program that ties together prescriptions and supplies, access to education and other resources, and connections to care providers for employees living with diabetes.
Through the program, the Texas-based health system can track per-member costs along with medication adherence and provider-patient interactions, allowing administrators to get ahead of the cost curve on chronic care management. They can spot gaps in care and personalize messages, resources, and incentives tied to lifestyle and care management.
As a result, they're seeing reductions in ED visits and hospitalizations and improvements in short- and long-term clinical outcomes.
"It's been a very positive program for us," says Heather Hormel, senior director of human resources for the health system. "It's a good way for us to remove barriers for people [who live with] diabetes and for those who manage care for people with diabetes."
Healthcare organizations, including health systems and payers, have long sought to improve chronic care management through technology and strategies that focus on more frequent interactions. Many are turning to remote patient monitoring platforms that allow care providers to interact with patients on demand at home, alongside other channels that can handle tasks such as supplies and education.
Heather Hormel, senior director of human resources for United Regional Health Care. Photo courtesy URHC.
United Regional Health Care works with Dallas-based CCS on this program, a partnership that has been in place since 2016. CCS, which began in the home-delivered medical supply business, has more recently expanded into education, monitoring, and clinical support through its LivingConnected program, in which it partners with digital health companies Welldoc and ZeOmega.
"The experience for those living with chronic diseases is fragmented, at best. At worst, it's negatively impacting the health outcomes and actual lives of patients," Marian Lowe, CCS' executive vice president and general manager of digital health, said in a press release. "That's why we're excited to bring together connected device data and marry that to the member's healthcare utilization through this partnership. Only then can we truly do more to help maximize preventive care and minimize unnecessary use of costly emergency department visits and hospitalizations."
To Hormel, the LivingConnected platform gives United Health an opportunity to help manage care for employees who might have difficulty integrating daily health and wellness habits to stay on top of a chronic disease that, if not managed properly, can lead to worsening health and death.
"It's all about engagement," she says. "Doctors are still very much driven by volume, and there are limits to their interactions. Health plans are sometimes able to coordinate those interactions better and can even be more proactive."
Diabetes care might be an ideal test case for this platform. Some 34.2 million Americans are now diagnosed with the disease, and the Centers for Disease Control and Prevention (CDC) estimates roughly one-quarter of all US healthcare costs are tied to diabetes care. Care management, meanwhile, is very much affected by lifestyle choices, including diet and exercise, making it vital that providers work with their patients on care management.
Experts estimate some 90% of people newly diagnosed with diabetes don't get the education they need within the first year to manage their condition properly. That includes learning how and when to test their blood sugar, how and when to administer insulin, how diabetes affects their health (including vision, circulation, and moods), how to spot dangerous health concerns like high or low blood sugars, and even how food choices and exercise affects their health.
"It's very expensive just to get the basics," says Hormel. "And that's before you factor in [lifestyle]. Unless you have diabetes, you probably don’t fully understand what it takes to treat it and manage it correctly."
Programs like LivingConnected also represent a point of confluence for payers and care providers, who can work together to manage a consumer's healthcare needs and costs. There are no delays when a member runs low on testing strips or insulin, or when a visit to a primary care provider or specialist is needed.
An important piece of the puzzle, Hormel says, is coaching.
"That's the key to making all of this work," she says. Members who aren't actively engaged in their care management tend to lose track of what they need to do every day, skipping tests or medication, and falling into bad habits that eventually lead to health issues. A member of the care team can connect through digital health channels and offer encouragement or advice, keeping members engaged in their care.
The concept isn't new or ground-breaking, save for the inclusion of digital health tools that improve home monitoring. These types of programs have been slow to gain traction because of the effort involved to produce patient engagement. But as payers and providers look to manage risk in tandem and get a handle on chronic care costs, they're more willing to fine-tune these programs and invest the time and effort into getting the technology and the frequency of interactions right.
"You have to take a leap of faith on this," says Hormel, who cites the cost of medication and diabetic supplies as a pain point that can be tackled through better care management (and one often overlooked in care management programs). "The more flexibility you can add to the program, the better chance you have of making that connection."
A program like LivingConnected, she says, can look at the data for each member and apply incentives to reach certain participation or wellness goals, funnel personalized education and resources, and even set up a coaching plan that kicks in when a specific member is most likely to need that support. The technology, be it AI software that can sift through a patient's insurance claims or smart devices that can track key physiological signs, activity, or medication use, helps to set parameters for those targeted messages or interactions.
As the healthcare industry continues to struggle with costs, they'll be more willing to adopt programs that combine care and cost management and use technology to improve engagement.
"We're learning a lot [through LivingConnected] about how we can improve engagement," Hormel says. "And we have a lot more to learn. But this is a very good way to learn."
The Cancer Support Community is partnering with Equiva Health on a program to equip rural residents living with cancer with a cellular-enabled tablet that gives them access to resources and care providers.
The Cancer Support Community is launching a telehealth program aimed at improving care management for cancer patients living in underserved parts of the country.
CSC, the largest professionally led non-profit cancer support network, is partnering with New York-based CRM company Equiva Health on the program, with a pilot project scheduled to launch this month in Minnesota. Through Gilda's Club Twin Cities, a CSC network partner, participating residents will get a cellular-enabled tablet allowing them to access resources and connect with caregivers.
“From my own experience growing up in rural Virginia, I know firsthand the challenges that you’re met with when living in a remote rural community,” CSC CEO Debbie Weir said in a press release. “We must overcome rural access barriers by advancing telehealth solutions that can seamlessly connect people to resources, to support, to their communities, and to the oncology community at large.”
The project is the latest in a series of digital and connected health programs aimed at improving care management for those living with cancer beyond the hospital, clinic, and doctor's office. Many use remote patient monitoring tools or telehealth platforms to provide on-demand resources and links to providers, with the idea that remote monitoring can allow providers to identify treatments that don’t work and modify care plans on the fly, improving short- and long-term outcomes.
These services are especially important for patients in rural and other underserved areas who have difficulties accessing care. Research by the Centers for Disease Control and Prevention (CDC) has shown that people living with cancer in rural areas have a higher mortality rate than those living in urban regions.
The program will also take into account a patient's ability to access connectivity for the devices. Those who qualify will be invited to apply for the Federal Communications Commission's (FCC) Affordable Connectivity Program (ACP) through an ISP provider.
The University of Maryland Medical Center's mobile integrated health community paramedicine (MIH-CP) program, which sends specially trained paramedics to the homes of selected patients after hospital discharge, saw increases in first-fill prescription rates and medication adherence, according to a study.
A mobile integrated health community paramedicine (MIH-CP) program launched in Baltimore by the University of Maryland Medical Center helped improve medication adherence for patients with congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), according to a new study.
As reported in a recent issue of Exploratory Research in Social and Clinical Pharmacy, an MIH-CP program, which sends specially trained paramedics to the homes of selected chronic care patients following discharge from a hospital, increased first-fill prescription rates by almost 20% for CHF patients and 25% for COPD patients in the first 30 days. In addition, the program boosted medication adherence by 8% to 14% over 60 days.
The results show promise for an innovative program that's designed to improve chronic care management at home, reduce adverse health events and cut back on 911 calls by so-called "frequent flyers," or patients who often need emergency healthcare services and rack up large healthcare bills.
The Maryland program was coordinated through the health system's Epic electronic health record platform in a partnership with digital health company DrFirst, and focused on pharmacist-led interventions.
“These results are particularly exciting because patients with chronic health conditions are at greater risk of poor outcomes if they don’t take their medications as prescribed,” Colin Banas, MD, MHA, chief medical officer for DrFirst and one of the study’s authors, said in a press release. “Pharmacist-led programs like this have a long history of improving medication use. As value-based care and risk-based contracts grow in prominence, healthcare organizations are turning to innovative ways to manage care for high-risk patients, so they have better health outcomes and stay out of the hospital as much as possible.”
The health system identified high-risk patients with CHF or COPD as they were discharged from the hospital and assigned them to the MIH-CP program for follow-up care. That care includes home visits by a team of community paramedics and a pharmacy technician and a virtual care link to pharmacists, community health workers and a physician or nurse practitioner.
Some 83 patients took part in the six-month study, with 43 assigned to the MIH-CP program and 40 to traditional follow-up care.
The study's authors note that patients with CHF or COPD run a high risk of hospital readmission due to acute exacerbation, leading to high healthcare costs and penalties from the Centers for Medicare & Medicaid Services for preventable rehospitalizations. Part of the problem is that many of these patients don’t follow doctors' orders on medication management.
"Efforts to integrate inpatient and outpatient medication regimens remain critical for the prevention of medication non-adherence during transitions of care and help to identify medication non-adherence at timepoints," the study concluded. "Transition of care programs such as MIH-CP, which incorporate pharmacists as part of the team, support the identification and resolution of critical medication-related problems and medication non-adherence. These types of programs can provide much-needed care and support for a largely underserved community."
Health systems across the country are experimenting with MIH and CP program in various forms and targeting different patient populations. Some create a program through their own EMS services, while others partner with local EMS providers and other community health programs.
Home visits run the gamut as well, with care providers offering chronic care management services, addressing social determinants of health, even just chatting for a while with someone who might be home-bound and lonely.
A new survey from the Merritt Group finds that CIOs value input from key industry and thought leaders, as well as the media, when purchasing technology. And industry events are popular again as well.
Healthcare CIOs considering their next big technology purchase are looking to media and key industry and thought leaders for input on what to buy. And they're not all that interested in Twitter, Facebook, or the latest whitepapers.
That's the takeaway from a survey of 20 CIOs conducted by the Merritt Group, a marketing and PR firm. It speaks to the challenges faced by health system leaders as they sift through the ever-growing vendor landscape to find the right tool or platform.
According to the survey, 90% of CIOs say the endorsements of key opinion leaders and industry influencers add weight to their purchasing strategy, and 70% use the media to influence their decisions. Some 80% get their healthcare news from the media—trade publications, medical journals, professional organizations, and business press—while only 40% look at social media and 20% listen to podcasts.
In a blog accompanying the survey, Shea Lawless, a public relations account executives for the Merritt Group, says the survey results are a sharp turn-around from a previous survey that saw CIOs rank the media as the least favorite source of information.
"This points to the fact that CIOs aren’t looking to the media for [healthcare technology] vendors touting their solutions," she wrote. "Instead, they turn to the media for the seismic trends that will affect their business and patients. Healthcare technology vendors should focus on producing thought leadership content on these trends to educate the media and position themselves as trusted sources."
After media, the outside forces impacting buying decisions drops off. Only half of the CIOs surveyed say pressure from their health system affects what they buy, while 45% are swayed by what their competitors are buying, 35% pay attention to the "buzz around new diseases," and a quarter heed pressure from consumers or patients.
And after a few years of disruption caused by the pandemic, CIOs are interested in the live event circuit again. Three-quarters of those surveyed say they get product and vendor information from events.
"Anecdotally, we have also heard that many events held since COVID-19 are not reaching the same scale and having the same impact they used to," Lawless said in her blog. "Despite that, CIOs still find it to be an important element of their purchasing decisions, so marketers must keep that in mind."
As for vendor-initiated content, 75% of CIOs surveyed say videos work for them, while 65% are partial to case studies and 60% like either vendor websites or webinars. What doesn't click for them are social media (only 40% are interested) and whitepapers (30%).
The senior vice president of care transformation and innovation for the multi-state health system says successful change begins with a focus on processes and workflow.
Editor's note:This article appears in the March 2023 edition of HealthLeaders magazine.
For Michael Schlosser, MD, MBA, the key to innovation and transformation lies in workflows. Figure out how care is delivered first, then improve that process through new technology or strategies.
"We focus a lot on workflows because that's where the changes are going to occur," says the senior vice president of care transformation and innovation at HCA Healthcare. "You'll get better outcomes when you focus on the process first."
Schlosser is at the helm of a pretty big ship. Nashville-based HCA Healthcare comprises 186 hospitals and roughly 2,000 sites of care in 21 states and the UK. The organization set its sights on the health system of the future in 2021, when it created the Department of Care Transformation and Innovation (CT&I) and put Schlosser, then its chief medical officer, in charge.
"Looking down the road is what our office should be doing," he says. "Healthcare moves slowly and changes slowly, so we have to [plan carefully] to make that happen."
Michael Schlosser, MD, MBA, senior vice president of care transformation and innovation at HCA Healthcare. Photo courtesy HCA Healthcare.
To Schlosser, innovation has always been part of the healthcare landscape, even if it does take a while for unconventional ideas to be accepted. But transformation is a new concept, fueled in large part by the challenges created by the pandemic. Health systems and hospitals jumped on the digital health and telehealth bandwagon in droves as COVID-19 took over, and while the technology itself worked well, many organizations had trouble making it interoperable. Workflows and processes weren't well thought out, and care teams struggled to adjust.
"We need to focus on operational transformation," he says.
"Wd caught lightning in a bottle," Schlosser adds, looking back over the past few years. "The pandemic had created an environment interested in … change, which was different than the way things generally happen in healthcare. Adjusting wasn't easy."
As the pandemic fades (hopefully) into the rear-view mirror, he says, healthcare organizations have to adjust their strategies to look forward rather than just keeping up. New technologies and ideas that have proven their value need to be stitched into the fabric of the organization, not bolted onto the side like a new room added to a house. And that means pulling all of the different departments together, from IT to nursing to marketing and PR, to ensure that buy-in is complete and workflows are designed that benefit both provider and patient.
That could be a challenge for a health system as big as HCA Healthcare, but Schlosser says the size and breadth of the organization also offer unique opportunities. The health system has designated two Innovation Hub hospitals, UCF Lake Nona Hospital in Orlando and TriStar Hendersonville Medical Center in Hendersonville, Tennessee, which serve as two unique and individual sites for designing and testing innovative concepts.
"They have the bedside experience to serve as labs," says Schlosser.
But that doesn't mean those two hospitals are the only testing grounds. Schlosser says inspiration is "both structured and unstructured." It's discussed in advisory groups, eyed in other sources outside healthcare, and given the chance to grow in CT&I.
"We've become the funnel for innovation all over the organizations," he says.
As an example, HCA Healthcare identified a particular pain point in the managing of staff and scheduling and the assignment of care teams.
Schlosser says CT&I studied how patients were assigned care teams, built data science tools to create a patient-by-patient grid of care needs, then developed AI software to predict traffic and, in essence, "fill in the blanks" where care gaps surfaced. Working with Google, they created an automated scheduling platform that identifies and matches staff and their capabilities with patient care needs and procedures that need certain competencies.
"It's an iterative design format: Input from stakeholders was crucial at every stage of the process, and this process had several stages," he says. "We decided to test this in the labor & delivery space first because it's bit like a hospital within a hospital, with a lot of opportunities for improvement."
Schlosser says the platform is now in use in three hospitals and has shown improvements in staff satisfaction and time savings. As they measure how the platform optimizes each hospital's staffing and improves patient care, he says, they'll look to expand to L&D units in other hospitals and, eventually, other departments.
Beyond automated scheduling, Schlosser says he wants to tackle documentation, a key pain point and contributing cause to ongoing national epidemic of staff stress and burnout. This will be done not only through automation, but with technology that can capture patient-provider interactions and insert that data into the medical record. A pilot project at UCF Lake Nona Hospital is using smartglasses to record those interactions, allowing providers more quickly and conveniently review and edit their notes in between patient visits.
Schlosser says it's vital now to map out care transformation and innovation over the next five to 10 years, in particular because of the fluid nature of healthcare innovation. With the end of the COVID-19 public health emergency most likely taking place in 2023, it will be important to keep track of expiring waivers and incentives designed to improve telehealth and digital health adoption, and to adjust plans accordingly to continue supporting those programs.
"We're not focused just on technology, but a strategic understanding of how to redesign and enhance care delivery, and all that goes into it," he says. "Now we have a dedicated, focused, multidisciplinary team who wakes up every day thinking about this."