The study found that California FQHCs were still conducting 20% of primary care visits and 40% of behavioral care visits by telephone or audio-only computer platform.
Federally qualified health centers (FQHCs) in California are still delivering healthcare via the telephone, according to a new study from the RAND Corporation, raising the value of a modality only used since the pandemic to boost access.
The study of 30 FQHCs providing services to 1.3 million underserved residents found that, in August of 2022, audio-only telehealth was used for one out of every five primary care visits and two of every five behavioral healthcare visits.
Federal and state regulators relaxed the rules around telehealth access and coverage during the COVID-19 pandemic to enable more people to access care from their homes and help healthcare organizations reduce the spread of the virus. This included allowing providers to connect with patients by phone for some services.
Telehealth advocates say many underserved populations, especially in rural areas, can only access care by telephone, as they can't afford or don't have easy access to computers or reliable broadband. Critics say the platform isn't good enough for many healthcare services, and that a telehealth connection should at least have an audio-visual connection.
While audio-only telehealth permissions will be scaled back with the end of the public health emergency in May and the two-year grace period included in the Consolidated Appropriations Act of 2023 passed by Congress, RAND researchers found that the platform still has considerable value. Some states, including California, have permanently allowed Medicare coverage for audio-only telehealth for some services, especially behavioral healthcare access.
“It is likely that these safety net clinics continued to deliver audio-only visits in high volume because of their role in improving access to health services,” Lori Uscher-Pines, lead author of the study and a senior policy researcher at the nonprofit research organization, said in a press release issued today. “Our study raises important questions about what kind of role we want audio-only visits playing in the care of disadvantaged populations and the public in general going forward.”
According to the study, which tracked the FQHCs' traffic over roughly two years, primary care visits increased by 8.5% from February 2020 to August 2022, while behavioral health visits jumped 23% during that same time. The proportion of audio-only visits, meanwhile, peaked during the height of the pandemic at 67% of primary care visits and 74% of behavioral care visits, and have since dropped back to 21% and 39%, respectively.
While telehealth use has declined in the wake of the pandemic as patients and providers return to in-person services, the platform still has considerable value in helping underserved populations access care and giving consumers more opportunities to connect with their care providers. Many health systems are looking to balance the two or create a hybrid approach to accessing care.
And while the argument over using a telephone or audio-only channel on a computer will continue, the RAND study indicates it's still a viable avenue for access for those who face barriers accessing care.
“It appears likely that audio only visits in these settings will remain widespread in coming years,” Uscher-Price said in the press release. “More research is needed on the effectiveness of audio-only visits to inform their use in safety net settings.”
The Medical University of South Carolina's chief innovation officer says innovation is part of the health system's culture, and something in which everyone takes part.
Jesse Goodwin sees innovation not as a technology issue, but as a mindset.
"Everyone in the organization has something that doesn't work ideally," she says. "We want them to use creative solutions to address those pain points. We're empowering them to take that next step and come up with innovative solutions."
Goodwin is the chief innovation officer at the Medical University of South Carolina (MUSC), helping to develop and guide innovation strategy for one of only two institutions in the country designated as a National Telehealth Center of Excellence. MUSC is an academic medical center, occupying that unique space between a stand-alone university and a health system, so her efforts and goals are both clinical and educational.
"Innovation is center to the MUSC enterprise," she says. "It's in our mission, vision, and values and the first goal of our strategic plan. Other health systems might play lip service to innovation, but we're all being charged here to be innovative."
"It's not a white-coat thing," she adds. "This is in our culture."
Goodwin, who was vice president of development for the Zucker Institute of Applied Neurosciences and director of the medical device practice of a Boston-based intellectual property consulting firm before taking on the CIO role at MUSC, knows a thing or two about technology. Her biography on the MUSC website notes that she's an engineer by training, and she designed a transcatheter aortic valve replacement device for her senior thesis in college.
Jesse Goodwin, chief innovation officer at the Medical University of South Carolina. Photo courtesy MUSC.
But while technology can, at times, be innovative, innovation isn't always about technology.
"Technology is often not the right route to take," she says. "We're not just looking for new apps [or devices]. We need to work harder to expand the definition."
Goodwin says she wants to separate innovation from technology so that people will think beyond just finding an app or tool to solve a problem. In doing so, she says, they'll take a closer look at workflows and other factors that either contribute to the problem or can be altered to solve it. They'll get a better feel of how innovation can lead to transformation.
"That brings more people into the conversation," she says.
That can also make an answer more complex. In her profile, Goodwin notes that research is a driving force in many healthcare advances, though not the only one. In an industry like healthcare, which is undergoing a transformation of its own to value-based care, the patient experience is taking on a much bigger role. Providers must pay more attention to the patients as a collaborator in healthcare and look at new ideas that include engagement and the use of data supplied from the patient.
Goodwin agrees that healthcare innovation took a leap forward during the pandemic, when healthcare organizations jumped at any opportunity to shift to virtual care, often taking leaps of faith with ideas and technology that would have taken years to plan out and prove. The pendulum is swinging back now, toward a better balance of virtual and in-person care, though the emphasis on consumer preference and opportunities to improve access to care and target social determinants of health remains.
"The opportunities [created by the pandemic] really did give us some new ideas," she says.
This includes new platforms for behavioral health treatment, a key pain point coming out of the pandemic, both in the number of people needing access to care and the shortage of providers offering it. Patient access to the health system's digital front door is also a popular topic, as is patient-friendly reporting (finding ways to integrate the patient voice and patient engagement with the medical record) and precision medicine.
A program of which Goodwin is especially proud is the STEM-Coaching and Resources for Entrepreneurial Women (STEM-CREW) program, established last year in a collaboration with the College of Charleston to boost the number of women entrepreneurs in the medical science field. The program is supported by the $2.4 million grant from the National Institute of General Medical Sciences.
"Studies have shown that women start companies with 50% less money and raise 66% less capital than their male counterparts," Goodwin said in a press release announcing the program's launch. "There are a lot of hypotheses as to why this divide exists, and it includes things like implicit bias as well as the willingness of women to seek funds within their own network of contacts. These are barriers to success for women who have already decided to pursue entrepreneurship. The CREW program hopes to address both through coaching, mentorship, and other programmatic support."
Goodwin says MUSC's culture of innovation will certainly help in this effort.
"Not surprisingly, there a big gender disparity at all stages of the process," she says, noting the MUSC was one of the first in the nation to track the gender representation. "But over the last four or five years, we've seen a strong culture of entrepreneurship taking off. This gives us a chance to flip the switch and really create some new opportunities."
That said, there are challenges. The sluggish economy is playing havoc with many healthcare organizations, forcing them to curb expenses and put their focus on workforce issues. Goodwin says the impact is felt everywhere, from nursing to the IT department. New ideas and platforms need to have a solid business case behind them, with a clear definition of value and a good ROI.
"It puts a lot of attention on the organization's efforts to support innovation," she says. "We don’t have the resources—or the access to resources—that we used to have."
And that's where transformation may be more important than technology. It forces creative minds to find ways to solve problems and improve operations and outcomes without sinking money into new technology.
"Innovation is central to the true MUSC enterprise, and it's never going to go away," Goodwin says. "We actually take it as a goal, just like we do with quality metrics."
The Coalition for Health AI (CHAI) includes Stanford, the Mayo Clinic, Vanderbilt, Johns Hopkins, Google, and Microsoft, and is overseen by a number of federal agencies.
A group of healthcare organizations who have joined together to advance AI adoption has released a set of guidelines designed to help providers use the technology responsibly.
“Transparency and trust in AI tools that will be influencing medical decisions is absolutely paramount for patients and clinicians,” Brian Anderson, MD, a co-founder of the coalition and chief digital health physician at MITRE, said in a press release. “The CHAI Blueprint seeks to align health AI standards and reporting to enable patients and clinicians to better evaluate the algorithms that may be contributing to their care.”
The guidelines, which build upon the White House Office of Science and Technology Policy's (OSTP) Blueprint for an AI Bill of Rights and the AI Risk Management Framework (AI RMF 1.0) developed by the US Commerce Department's National Institute of Standards and Technology (NIST), come at a crucial time for the development of AI in healthcare. The technology has been praised as an exciting new tool and criticized as a dangerous trend.
"In a world with increasing adoption of artificial intelligence for healthcare, we need guidelines and guardrails to ensure ethical, unbiased, appropriate use of the technology," John Halamka, MD, MS, president of the Mayo Clinic Platform and a co-founder of the coalition, said in the press release. "Combating algorithmic bias cannot be done by any one organization, but rather by a diverse group. The blueprint will follow a patient-centered approach in collaboration with experienced federal agencies, academia, and industry."
Launched roughly one year ago, CHAI also includes Berkeley, Duke Health, UCSF, Vanderbilt University Medical Center, Change Healthcare, MITRE, and SAS and counts several federal organizations, including the Centers for Medicare & Medicaid Services (CMS), US Food & Drug Admi9nistration (FDA), and Office of the National Coordinator for Health IT (ONC) as observers.
The group is also collaborating with the National Academy of Medicine (NAM) on separate guidelines for the responsible development and adoption of AI in healthcare delivery.
“We have a rare window of opportunity in this early phase of AI development and deployment to act in harmony—honoring, reinforcing, and aligning our efforts nationwide to assure responsible AI," NAM Senior Advisor Laura Adams said in the press release. "The challenge is so formidable and the potential so unprecedented. Nothing less will do."
The Cleveland health system aims to offer the latest in cellular immunotherapies, including chimeric antigen receptor T-cell (CAR-T) and tumor-infiltrating lymphocytes (TIL) cancer therapies, to more patients.
MetroHealth has opened a new facility aimed at making the latest in innovative cancer treatments and therapies available to more patients, including those affected by social drivers of health (SDOH).
The Cleveland-based health system will be offering cellular immunotherapies, including chimeric antigen receptor T-cell (CAR-T) and tumor-infiltrating lymphocytes (TIL) cancer therapies, in its vector and cellular Good Manufacturing Practice (GMP) facility. Officials say they're the first safety-net hospital in the US to make these services available on-site.
“Overcoming social barriers for the communities we serve is part of MetroHealth’s core mission," William Tse, MD, MetroHealth's division director of hematology and oncology, said in a press release. "This new facility furthers that commitment by providing the next generation of cancer treatments to people in need, regardless of financial status.”
“It is crucial that we address social drivers of health for our community – the factors that matter beyond traditional medical care," added Airica Steed, EdD, RN, MBA, FACHE, the health system's president and CEO. "Whether the need is to access transportation for follow-up appointments, healthy food, or other support systems, MetroHealth is committed to changing the way patients receive care. The launch of our vector and cellular facility will match these holistic support offerings with next-generation treatments and clinical trials, providing our community the access they need to enable the best possible outcomes.”
Health system executives noted that CAR-T therapy, which uses T-cells modified in a laboratory to target specific cancer cells, is only accessible to patients of large academic centers or those with the financial means to travel to the health system. MetroHealth will be offering these treatments through its Institute for HOPE, which addresses population affected by SDOH.
The 1,300-square-foot facility will house the MetroHealth Cellular Immunotherapy and Stem Cell Transplantation Program, and was supported by the Cleveland Innovation District, a collaborative partnership that includes the city's five major medical and academic institutions, the state and JobsOhio.
“MetroHealth is different from most transplant hospitals in that we are able to develop and produce our cellular immunotherapies from A to Z in-house, speeding up delivery of innovative treatments, such as CAR-T therapy production, for both patient treatments and clinical trials," Tse said. "As a result, we are better able to address unmet patient needs and bring therapeutic innovations to our community and beyond.”
Allina Health is seeing immediate results with a technology platform that automates the OR scheduling process and helps match surgeons to times and procedures.
Editor's note: This article appears in the June 2023 edition of HealthLeaders magazine.
Experts have often said that the healthcare industry needs to adopt innovative technologies used by the banking and retail industries to become more effective.
At Allina Health, a platform being called the "Open Table for surgery scheduling" is proving that point.
The Minneapolis-based 12-hospital, 90+ clinic network is using an AI-enhanced software platform developed by digital health company Qventus to map out its operating room schedule. The technology integrates with the EHR and automates a block-based process that formerly took up hours of staff time and effort and caused a considerable amount of stress.
"The old process was manual and hadn't really changed in 20 to 30 years," says William Evans, the health system's vice president of surgical services and orthopedics. "It was inefficient, cumbersome, and laborious."
Evans says Allina Health recognized they would need new technology to both improve OR utilization and revenues and make life easier for stressed staff and surgeons. The old process, in which surgeons were responsible for filling up blocks of time and new or visiting surgeons tried to fit in enough procedures to qualify for block scheduling, left too many holes in the OR schedule and gave surgeons and schedulers headaches trying to map out when they could schedule a surgery or grab procedures in need of a surgeon.
Allina Health decided to implement an enterprise-wide, automated scheduling platform, which works along the same lines as a scheduling platform for tables at a restaurant or seats at a theater.
"Allina Health tends to be on the forward edge of [healthcare innovation]," Evans says. "I think we're always finding new ways to use technology. This just seemed like a perfect place."
In a phased roll-out, the health system partnered with Qventus, based in Mountain View, California, to launch the platform for its DaVinci surgical robots at Abbott Northwestern, then expanded the process to include established surgeons who qualify for block scheduling, then to newer and visiting surgeons who hadn't yet qualified for block scheduling. Surgeons are responsible for scheduling their own procedures, he says, and often struggle to balance their time, running the risk of losing out on prime slots in the OR if they can't stay true to their schedule at least 75% of the time.
Evans says it was important to offer this tool on a voluntary basis, rather than mandating that surgeons use it.
"We want them to embrace the technology because it makes their lives better, rather than forcing it on them as a mandate," he says. "Once they see what it can do (including taking only 20 minutes from submitting a request for OR time to approval), they'll accept it and work with it."
According to statistics supplied by the health system and Qventus, Allina Health, which deployed the new platform in mid-2022, saw 3.5 cases added per OR per month in the first four months, including a 36% increase in cases per surgical robot per month. Evans says that success has enabled Allina Health to not only increase robotic surgeries but also add more robots.
On the other side of the ledger, the platform helped to release more than 100 hours of OR block time earlier each month, enabling surgeons to better manage their schedules and allowing the health system to quickly fill up open spots and times left open due to scheduling errors or unforeseen issues. In addition, the platform automatically schedules 2 out of every 3 elective cases, helping to improve a key revenue generator.
According to Evans, the AI technology not only helps surgeons manage their time, but also matches open slots to surgeons based on their typical use patterns and the health system's needs. It also matches surgeons to available surgeries based on their qualifications.
Evans says the health system saw almost immediate benefits with the platform, with surgeons looking to use the technology to plan their schedules during the first phase of roll-out, which was supposed to be limited to robotic surgeries.
"We quickly exceeded our performance goals," he says, noting the platform significantly reduced the workload for schedulers and allowed them to address other administrative tasks that may have been pushed to the back-burner. The health system also saw a reduction in surgeon and staff turnover, he says, and might be used as an incentive to attract new employees.
"There will be some unexpected benefits that we haven't seen yet," he says. "This frees up a lot of time for surgeons and staff and makes their lives better. That's a huge advantage. Automation was the missing piece of the puzzle there."
Several groups have issued critical reviews of the DEA's proposed revision of rules regarding telemedicine prescriptions of controlled substances. Some say the revision will imperil thousands of patients.
Telehealth and digital health advocates aren't pleased with the US Drug Enforcement Agency's proposed rules for prescribing controlled substances via telemedicine after the expiration of the COVID-19 Public Health Emergency.
The long-awaited proposal, unveiled in February, had been expected to ease the pathway for healthcare providers to use telemedicine to prescribe medications like buprenorphine without needing an in-person examination. But with the agency's 30-day window for public comments expiring, the vast majority of the 20,000+ comments submitted have been negative.
"Leading professional associations, respected think tanks, and experienced clinicians submitted compelling and noteworthy comment letters explaining how the proposed rule will result in limitations on access to care, harm patients in rural and urban areas alike, and likely result in otherwise avoidable overdoses and deaths when patients are denied access to their medically-important medications," several lawyers from Foley & Lardner wrote in the firm's Health Care Law Today blog.
Nathaniel Lacktman, a partner in the firm and chair of its national Telemedicine & Digital Health Industry Team, was among the earliest commenters on the proposed rules.
"The proposed rules are intended to bridge between the DEA’s current PHE waivers and a post-PHE environment," he wrote in a February 27 blog. "In so doing, DEA proposed creating two new limited options for telemedicine prescribing of controlled substances without a prior in-person exam. The options [are] both complex and more restrictive than what has been allowed for the past three years under the PHE waivers. The DEA’s proposal will discontinue the ability for telemedicine prescribing of controlled substances where the patient never has any in-person exam (with the exception of an initial prescription period of no more than 30 days’ supply). Moreover, if the patient requires a Schedule II medication or a Schedule III-V narcotic medication (with the sole exception of buprenorphine for opioid use disorder (OUD) treatment), an initial in-person exam is required before any prescription can be issued."
Lacktman and his colleagues produced a legal guidebook shortly after the proposed rules were unveiled, and submitted a 15-page letter picking apart various aspects of the rules on March 30. Others submitting critical comments (the Foley & Lardner team called it a "tsunami of criticism") include the American Telemedicine Association, the Alliance for Connected Care, and a group composed of members of the Brookings Institution, Harvard Medical School, David Geffen School of Medicine at UCLA, and Harvard T.H. Chan School of Public Health.
Krista Drobac, executive director of the Alliance for Connected Care, said the proposed DEA rules would lead to "immense patient harm," particularly to patients seeking treatment for behavioral health issues. According to the alliance, 65% of all patients living with a substance abuse disorder or overdose diagnosis in 2021 also had a pre-existing mental health condition.
"DEA must find a path to allow the continuation of comprehensive mental health (and substance use disorder--which is often overlapping) treatment to patients through telehealth," she wrote. "While we believe there are many appropriate use-cases for telehealth involving controlled substances, such as palliative care, the vast majority of patients who would be harmed by the rule are relying on telehealth for access to mental healthcare."
The FDA's proposed rules would allow providers to use telemedicine to prescribe 30-day supplies of Schedule III-V non-narcotic controlled medicationsand buprenorphine, the latter specifically for the treatment of opioid abuse disorder, for new patients and without the need for an in-person evaluation. They redefine guidelines that had originally been included in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which severely restricts the prescription of controlled substances, and requires an in-person exam by a qualified provider before those drugs can be prescribed via telemedicine. Enforcement is handled by the DEA.
Dozens of federal and state waivers were enacted during the COVID-19 PHE to improve access to and coverage of telehealth services. Many of those waivers were extended to the end of 2024 by Congress, but others—including the DEA waiver on using telemedicine without an in-person visit—will end with the PHE on May 11.
With that deadline looming, the DEA proposed to amend its rules to allow for more telemedicine use. The response was anything but positive.
While many complained that the 30-day comment period was too short, commenters like Foley & Lardner cited several issues with the proposed rules. Foley & Lardner Partner Nathan Beaver, the author of the letter to the DEA, listed 14 changes that the firm feels should be made, including removing requirements for an in-person exam, creating a special registration process for telemedicine providers as directed by the Ryan Haight Act, grandfathering patients being treated via telemedicine during the PHE, and revising the rules to allow providers to refer patients to medical groups, health systems, and other collaborating practices.
"We believe the proposed rules as written will limit access to legitimate healthcare while not promoting the public health and safety goals of DEA," Beaver wrote. "In this comment letter, we provide reasonable suggestions and solutions that will allow DEA to appropriately address diversion concerns while safeguarding patient access to essential telemedicine services including for the treatment of mental health and substance use disorder."
The event in Nashville, co-hosted by HLTH and CHIME, featured a heavy hitting line-up of health system executives and good discussions about workforce and operations priorities.
As ViVE 2023 packs up and the estimated 7,000 attendees depart Nashville, the biggest take-away from this event isn't any product rollout or partnership announcement. It's the guest list.
Craig Richardville, chief digital and information officer for Intermountain Health, said ViVE gave him an opportunity to rub elbows with a number of his peers, share insight into the challenges and opportunities that new technologies and strategies offer, and hear about what other health systems are doing.
"I might see something really interesting and tell (another healthcare executive) about it, or someone will tell me, 'You should check this company out,'" he said during a chat at the Intermountain Health booth in Music City Center's exhibit hall. "It's the chance to meet up and talk with people."
Richardson, later seen enjoying the Black Crowes concert at the Industry Night Reception at the Wild Horse Saloon, was among dozens of health system executives attending ViVE, the colorful second-year event co-hosted by HLTH and the College of Healthcare Information Management Executives (CHIME). The presence of so many decision-makers in the exhibit hall and in sessions on stages situated around the hall lent significant value to the conversations.
Those conversations were about finding a way to stay ahead in challenging times.
Paul Uhrig, chief legal and digital health officer for New York's Bassett Healthcare Network, said many health systems are just focused on survival at this point. They're also focused on the workforce, where Bassett has a 20% vacancy rate in its provider ranks.
With razor-thin margins, staff shortages and competitors entering the space. Uhrig said health systems are looking for very specific solutions to very specific problems, not the newest technology or tools. And they want skin in the game from vendors.
"We own nothing by ourselves," added Tarun Kapoor, MD, Virtua Health's senior vice president and chief digital transformation officer, describing an innovation and technology landscape that has evolved significantly over the past few years, due to the effects of the pandemic and a struggling economy. The focus these days, he says, is on partnerships, either with the vendors or other organizations looking to improve the industry.
Workforce issues, from staffing and provider shortages to burnout and stress reduction, as well as security, revenue cycle development, and business automation, were on everyone's agenda. Telehealth, remote patient monitoring, digital health tools, AI, and solutions specifically designed to help nurses were also top of mind.
And the people who make the decisions were in the room and ready to talk.
During a panel on digital transformation that featured executives from UPMC, LifeBridge Health, Health First and Mt. San Rafael Hospital, the talk was about developing a strategy to overcome roadblocks common to the industry. William Walders, CIO and senior vice president of IDN operations at Health First, noted he has to work with—and more often around—seven different electronic medical records in his bid to "keep up with Domino's Pizza," one of the most successful consumer-friendly companies in the nation.
"This industry is one of the most antiquated industries out there," added Michael Archuleta, chief information officer at Colorado's Mt. San Rafael Hospital. "We should be leading the pack when it comes to innovation."
Archuleta pointed out that technology is often thought of as a cost center in healthcare, when it should be considered a "true value maker," especially at a time when healthcare organizations are struggling with their bottom lines and need to better define value.
That's what other industries, such as retail, hospitality, and banking, have done.
"I can get a massage, a behavioral health appointment, [or] a girlfriend on my phone—why not a doctor?" Walders mused.
Karen Hanlon, executive vice president and chief operating officer at Highmark Health, said health systems need to improve their digital front door to keep up with the competition. And they need to highlight the fact that health systems know how to do healthcare, whereas other entries in the primary care space are in it for the money.
"The best chance of getting that engagement is when the provider is integrally involved," she said.
The theme of playing catch-up to the likes of Amazon, Domino's, American Airlines, and Hilton was common throughout ViVE, but catering to the consumer wasn't the top concern of healthcare leaders. Most were on hand to find solutions to workforce issues, with the idea that improving the workplace for doctors, nurses, IT staff and others would in turn improve clinical operations and outcomes.
"Workforce is the number one issue we're facing," noted Michael Hasselberg, NP, MS, PhD, chief digital health officer at UR (the University of Rochester) Medicine and director of the UR Health Lab, the health system's digital health incubator. "This has rapidly shifted [to the top of the list] over the past six months, and now we're focused on trying to give clinicians their time back."
For vendors, the innovation and technology marketplace has certainly changed. Health systems don't have the time or money to spend on new ideas or strategies that haven't been proven or take several months to establish. They're looking for technology that has already proven its value, integrates well with existing platforms and quickly shows an ROI.
Shez Partovi, chief information and strategy officer at Phillips, said health systems are laser-focused on solutions that help clinicians, especially nurses. They're also looking for technology that can predict and plan out workflows and identify crisis points in the health system, so that health systems can address issues before they become crises.
"They want to be more proactive" and less reactive, he said.
Intermountain's Richardville agreed. He said health systems need to use data and data analytics to better understand and design workflows. More data, and better tools to analyze that data, gives them better opportunities to manage and improve caregiving.
"We're into any and all things digital, and data is digital," he said.
As a result, health systems are looking for partnerships with vendors, rather than one-off deals for point solutions. They want to work together on problems with solutions that can evolve.
"The expectations have changed," said Roy Schoenberg, MD, MPH, president and co-CEO of telehealth giant Amwell, who sees more interest in health systems for agreements with shared risk and less interest in solutions that address only one small part of the system. "The people we sell to are very different from the people we sold to three years ago."
Schoenberg says investment in innovation and technology is more important now, as health systems understand the value of these platforms and tools in affecting value-based care and predicting future pain points. Where once those decisions were solely handled by CMOs, CMIOs and CIOs, now the COO, CFO, and even the CEO are entering the conversation.
And they aren't interested in small talk.
"If you walk in with a sales pitch, those meetings are very, very short," he said.
Indeed, at an innovation panel held at the Bobby Hotel, near the convention center, Julie Murchinson, a former CEO of Health Evolution who's now a partner with Transformation Capital, noted there are more people at the table to talk about healthcare innovation and technology, and they’re measuring value in different terms.
"Pay attention to the CFO," she said. "They're starting to put dollar signs in front of what we care about."
John Beadle, co-founder and managing partner of Aegis Ventures, cited the structural decline of the healthcare business as a particular challenge, and said health systems have to be involved in new business ventures and partnerships to solidify their standing.
Noting the many new entrants to the healthcare space, from Amazon to Walgreens, Beadle said health systems need to focus on getting back into the driver's set and doing what they do best.
That's what many healthcare executives at ViVE mentioned. With all of the challenges facing the industry and competitors looking to claim their piece of the action, healthcare executives need to remember that they know how to best do healthcare. And their decisions on innovation and technology should create a better environment for clinicians and staff, either by improving workflows or automating repetitive tasks.
Only then will they be able to connect with a patient population waiting for them to catch up to the times.
"We need to see our patients and our community as an IT-enabled participant in healthcare," said Tressa Springmann, senior vice president and chief information and digital officer at LifeBridge Health.
Recent CMS and CDC rulings offer hope that health systems will show more love for innovative treatments like digital therapeutics and virtual platforms.
As healthcare executives and digital health companies converge on Nashville this week for ViVE 2023, the prospects for new tools like digital therapeutics and virtual technology seem to be improving.
On the heels of the Centers for Medicare & Medicaid Services' (CMS) decision to create a unique reimbursement code for digital therapeutic company AppliedVR, the Centers for Disease Control and Prevention (CDC) last week approved the use of video-based directly observed therapy (DOT) for tuberculosis treatment, saying the virtual platform could be used as an equivalent to in-person medication monitoring.
"Missed doses of medication or treatment interruptions can lead to suboptimal drug concentrations, acquired drug resistance, longer treatment times, TB treatment failure, and recurrence of TB disease," the CDC said in its March 24 report. "For these reasons, CDC continues to recommend DOT as the standard of care for all persons prescribed TB treatment; however, based on the evidence summary, this report updates the 2016 CDC U.S. clinical practice guidelines (1) to state that vDOT should be considered equivalent to in-person DOT."
In its ruling, the agency said vDOT, which enables care providers to watch patients taking their prescribed medication by video, usually through the patient's smartphone, has seen higher rates of medication adherence compared to in-person monitoring. In addition, the digital health platform is more convenient for patients and providers, can save time and costs for programs, helps patients who can't easily access in-person healthcare and improves patient satisfaction.
The ruling is specific to TB treatment, which can last several months and relies heavily on a patient's ability to take specific medications at specific times.
Among those supporting vDOT is the New York City Department of Health, whose TB control program included vDOT as far back as 2014. The CDC asked the city, which has one of the highest TB rates in the nation (6.1 per 1,000 people, compared to the national average of 2.5) to participate in a study of the value of vDOT, and used the results in its recent ruling supporting the platform.
“Directly observed therapy has been a backbone of our work for a long time and of course the pandemic put a lot of that under threat in restricting people’s movement and their ability to remain adherent on what can be at a minimum 6 months of treatment, if not longer,” New York City Health Commissioner Ashwin Vasan told STAT News in an interview.
“In over 200 patients studied, it was found to be just as effective as traditional DOT, in addition to being more cost-effective because you obviously reduce transportation costs,” he added. “You reduce delays, you reduce trade-offs and opportunity costs because these are visits that can happen over video that would otherwise cause the person to leave work, or leave school, or to leave wherever they are, and present to a clinic to pick up their medications.”
Both the CMS ruling on AppliedVR and the CDC's move to support vDOT give digital health companies hope that the healthcare industry will embrace these new tools and technologies, especially if Medicare, Medicaid, and other payers also support the treatments.
And that's crucial. Many health systems are operating on razor-thin margins and don't have the time or money to invest in new technologies unless there's a clear ROI.
Among the companies benefiting from the CDC announcement is Scene Health, formerly emocha, which offers vDOT services to a number of public health programs across the US for treatment of a wide range of chronic conditions, including substance abuse, asthma, diabetes, and hypertension.
"In recognizing that video DOT is equivalent to in-person DOT, the CDC has modernized the 'gold standard' for medication adherence," Scene Health CEO Sebastian Seiguer, in Nashville for the ViVE conference, said in an e-mail to HealthLeaders.
"DOT is used for all medications in the inpatient setting, but has seen limited use in outpatient care due to high cost and logistical burden," Seiguer said. "Video technology exponentially reduces these barriers making DOT scalable. At the same time, at Scene Health we’ve worked very hard to preserve the person-to-person, supportive engagement that makes DOT work, regardless of delivery method."
In the AppliedVR case, CMS created a unique Healthcare Common Procedure Coding System (HCPCS) Level II code (E1905) for the company's RelieVRx program, which uses virtual reality-based cognitive behavioral therapy. The CMS ruling classifies the technology platform as durable medical equipment (DME).
"It's finally time to more fully embrace ITx [immersive therapeutics] and move toward its use becoming more towards standard of care rather than a 'one off' niche solution in the treatment of chronic lower back pain, for example," Matthew Stoudt, co-founder and CEO of AppliedVR, said in a press release announcing the CMS action.
"We envision immersive therapeutics as a future alternative to a lifetime of pills or costly surgeries," he added. "Enabling broad coverage for the RelieVRx program will deliver a powerful, yet affordable and scalable digital solution for millions of people."
With ViVE on the doorstep, a new survey finds that healthcare decision-makers are looking for technology that addresses workforce shortages, prepares the health system for a recession and improves data management.
Healthcare executives looking to make technology deals at next week's ViVE conference are looking for solutions that address clinician and staff burnout or help the health system weather a potential recession, a new survey reports.
The survey of some 300 decision-makers in healthcare, conducted by Intelligent Medical Objects, also puts data storage and analysis tools at the top of the shopping list, while AI tools aren't yet worth all the flashy marketing.
According to the survey, 94% say they plan to invest in technology that either addresses workforce issues or prepares the health system for a recession.
“Hospital providers face a lot of uphill battles, from data integration to clinician burnout, and this survey shined a light on how data integration can have a positive impact on patient care and day-to-day operations,” Ann Barnes, the company's CEO, said in a press release accompanying the survey. “It’s helpful to understand the most pressing needs as US provider organizations are making bold changes to improve patient care and are adapting their strategies faster than ever before.”
The survey comes as healthcare CIOs and chief digital health officers converge in Nashville next week for the ViVE 2023 conference, and as they and other decision-makers prepare for the Healthcare Information and Management Systems Society's (HIMSS) annual conference next month in Chicago. Both events are expected to feature discussion on a wide range of critical healthcare issues, including staff and clinician shortages brought on by burnout and stress, the upcoming end of the COVID-19 Public Health Emergency, new technologies and programs like telehealth, remote patient monitoring, Hospital-at-Home, digital therapeutics and AI, and federal efforts to improve privacy and security, enforce prior authorization rules and improve interoperability and data sharing.
Data will likely figure in a lot of conversations, according to the IMO survey.
Almost all of the decision-makers surveyed say their organizations must improve the way it uses data to improve healthcare delivery and operations, and 90% said they've had moments in the past where they lost or leaked revenue due to inefficient practices.
The survey shows similar results from other surveys and reports that list workforce management as the top priority of healthcare organizations, many of which are struggling to retain clinicians and field a good IT department. Many are also worried about the economy, with hospital margins at or perilously close to the red and a recent report indicating more than 60 hospitals are at risk of closure.
According to the survey, 71% cited maintaining or improving clinical care quality as the most important internal risk. Some 65% percent cited problems with clinician burnout, while half cited administrative burnout and 45% cited data issues.
The survey also pointed out a continuing issue for healthcare organizations looking to stay on top of the latest technologies while facing staffing issues. Some 84% of those surveyed said their health system is working with more then 20 vendors. Almost a third said software integration was their biggest problem with vendors, while 29% cited inadequate training provided by vendors and 17% reported long implementation timelines.
And that's a problem. With the economy struggling, many healthcare organizations are taking a hard look at new purchases and technologies, and requiring solid proof of ROI before they consider any new purchases. Health systems aren't going to invest in anything new if they don't see immediate and lasting value, and they certainly won't be interested in products that take a long time to install.
Finally, healthcare leaders are interested in AI technology, and both this and another recent survey pointed out that they're using the technology to address back-end operational and workforce management issues. But at the same time, many of those surveyed said the hype currently outweighs the value.
“For technology to have a positive impact on providers, it has to get out of the way and integrate seamlessly into clinical workflows,” Steven Rube, MD, IMO's chief clinical officer, said in the press release. “This survey validated an assumption that … providers needed assistance to seamlessly integrate relevant clinical data in the care of their patients. The pandemic unleashed a torrent of investment in new healthcare software solutions, and provider organizations have struggled to understand which types of software will present the best ROI."
The Rhode Island School of Design's Center for Complexity has developed a new tool that helps non-English patients accurately describe their pain for emergency care providers.
Among the many societal barriers to clinical outcomes is communication. If you don’t speak the same language as your healthcare provider, important things will be lost in translation.
That's especially true in crisis situations such as the Emergency Department, where studies have found that non-English speaking patients have higher morbidity and mortality rates. To tackle that problem, the University of Rhode Island School of Design's Center for Complexity (CfC) is developing technology aimed at translating pain.
Researchers at the center have partnered with Seattle-based "human experience design" company WongDoody to develop Say Your Pain: The Universal Pain Translator, a digital health tool that enables users to describe pain symptoms to care providers. The platform pairs dozens of common pain symptoms, such as throbbing, cramping, burning, and piercing, with animations, enabling care providers to gain a better understanding of a patient's condition and plan care accordingly.
“Humans are complex social organisms whose health is shaped more by the environments they live in and the people they care for than the clinical services they receive," Justin Cook, founding director of the CfC, said in a press release. "The frontier of improving human health is connecting the dots between our biology, our environment and our social lives. This is a complex challenge that demands a creative solution.”
To develop the platform, researchers worked with animators who are experiences in semiotics, or the study of signs and symbols and their use in interpretation, along with more than 30 clinicians. They've designed the tool to be used on most connected devices and, initially, in three core languages: Spanish, Mandarin, and Ukrainian (due to the fact that many Ukrainian refugees are now seeking care from American and Canadian providers).
Cook sees this project as a means of addressing one of the biggest social drivers of health (SDOH) and a key aspect of improving health outcomes for underserved populations.
“Our aim, starting with pain, is to dive directly into the cultural, social and environmental factors that are at the core of human health and develop solutions that make good health and wellbeing available to everyone," he said. "This is critical work in our efforts to achieve health equity.”
It also addresses a considerable challenge in emergency healthcare: Understanding a patient's condition and being able to design a quick and effective care plan.
“Justin and the team at the CfC are committed to bringing humanity back to healthcare," added Grace Francis, WongDoody's global chief creative and design officer, in the press release. "From their deep research and understanding, we were able to spot a design opportunity that can help patients advocate for themselves in medical situations. We hope it will help doctors diagnose faster and more accurately when there’s a language barrier. This has the potential to save lives and could make ER visits less traumatic for patients who don’t speak English."
