A proposal to enable access to MGB services through 37 MinuteClinics across Massachusetts could help more than 100,000 residents.
Mass General Brigham is banking on the evolution of healthcare clinics in pharmacies with a proposal to offer healthcare services through 37 CVS MinuteClinics spread across Massachusetts.
If done right, MGB officials say they could give 120,000 residents better access to care.
The health system and MinuteClinic, a subsidiary of CVS Pharmacy, filed notices with the Massachusetts Health Policy Commission (MHPC) in June to give MinuteClinic patients access to MGB’s care network, first at the clinic and then, if necessary, through referrals to a hospital or specialists in the MGB network.
The proposal gives MGB another outlet to address barriers to healthcare access, while MinuteClinic becomes part of MGB’s healthcare network and ACO. It also signals the pharmacy chain’s interest in diversifying from urgent and convenient care visits to establishing a continuing relationship with its patrons through primary care.
It’s not a new concept. Health systems across the country have been trying, with mixed success, to boost access through a wide variety of channels, from kiosks and telehealth stations in public locations lie libraries, community centers and banks to partnerships with retail locations like pharmacies and supermarkets.
Affected in part by the success of Amazon’s online marketplace, pharmacy chains have been struggling to find sustainability. The CVS strategy aims to move beyond the “quick fix” aspects of a health clinic, offering treatments for issues like fevers, headaches and infections, and create a primary care space that patrons would return to on a regular basis.
In its filing, MGB officials referenced a January 2025 Health Policy Commission (HPC) report that noted Massachusetts residents are having problems accessing primary care. At the same time, nearly half of the commonwealth’s office-based primary care physicians are at least 55, and only 14% of new physicians are choosing to enter primary care.
“MGB recognizes that this crisis in primary care has far-reaching adverse effects for patient care and accordingly is pursuing a number of initiatives to make primary care a more attractive career choice and to improve access to primary care for its patients,” the health system noted. “Built around a scalable Advanced Practice Provider (APP)-led model, MinuteClinic Primary Care will improve access to comprehensive primary care by adding new sites of care and expanding access during evenings and weekends, offering convenient options for patients who might otherwise delay or forgo care. This initiative supports the Commonwealth’s urgent goal of strengthening access to primary care amid a shrinking physician pipeline.”
As part of the deal, MinuteClinic Primary Care will join MGB’s ACO as an affiliated provider organization.
“This affiliation enables MinuteClinic Primary Care’s APP-led model to align with MGB’s high standards for quality and patient trust, while also providing a demonstration of the efficacy of a scalable, advanced-practice-led care model,” MGB officials said in the filing. “Through this relationship, MinuteClinic Primary Care also gains access to MGB’s value-based payer contracts and population health management (PHM) infrastructure, enabling a cost-effective path to operationalizing care management and value-based strategies without duplicating existing systems.”
Both parties anticipate that the network will support roughly 800 APPs, each covering care for about 1,500 patients, improving access to care for some 120,000 patients across the commonwealth.
CMS is proposing expanding coverage of digital health devices used in some behavioral health treatment programs and asking for comments on adding even more devices. But will that be enough to spur adoption?
One line of thinking around the Trump Administration’s MAHA movement is that it might open the door to new ideas for healthcare delivery. Supporters of digital therapeutics may now be seeing that benefit.
CMS’ proposed 2026 Medicare Physician Fee Schedule includes expanded coverage for the use of ‘sensor-based digital health technologies (sDHTs)’ designed to deliver therapeutic interventions. The agency is proposing to:
Extend eligibility under HCPCS codes GO552-554 to include devices classified under CFR 882.5803 (ADHD), expanding upon coverage established in the 2025 Medicare PFS that was limited to devices classified under CFR 882.5801 (psychiatric disorders).
In addition, CMS is considering expanding coverage to FDA-authorized digital therapeutic devices classified under CFR 876.5960 (gastrointestinal conditions), CFR 882.5705 (sleep disturbance in psychiatric conditions) and CFR 882.5804 (fibromyalgia symptoms).
Finally, CMS is seeking feedback on the possibility of creating separate billing codes for digital therapeutic tools that fall below FDA purview and track treatment adherence or patient progress, as well as tools that support healthy behaviors as part of a behavioral healthcare plan.
In a blog on her website, Carrie Nixon, managing partner of the Nixon Law Group, says the proposals mark a “growing support for digital mental health treatment (DMHT) while laying important groundwork for the future of digital therapeutics across a range of clinical use cases.”
“This is a catalytic moment for the life sciences industry,” Jennifer Goldsack, CEO of the Digital Medicine Society (DiMe), said in a LinkedIn post co-authored by DiMe Program Lead Sarah Averill Lott, MPH, CPH. “For the first time, sensor-based technologies are now included alongside AI/ML-enabled and AR/VR tools in a publicly available FDA dataset, with therapeutic area, clearance date, and review panel all listed. That simple act carries weight. It reflects the FDA’s growing recognition that sDHTs are part of mainstream healthcare and drug development. It also brings increased visibility to the growing number of devices authorized for market access that generate data already being used in trials as digital endpoints.”
With this new designation, CMS is recognizing that new devices need to not only monitor patients outside the hospital, doctor’s office or clinic, but also deliver some sort of treatment. This separates digital therapeutics from remote patient monitoring technology, including CMS’ remote therapeutic monitoring (RTM) guidelines.
“Traditional RTM operates on a clear premise: devices passively collect data, providers actively interpret it,” Justin Brochetti, co-founder and CEO of intelligencefactory.ai, said in a LinkedIn post. “A wearable tracking post-surgical knee mobility reports range of motion but doesn’t treat the patient. A spirometer monitoring COPD measures lung function but doesn’t deliver therapy.”
Digital therapeutics, he added, “obliterate this boundary. They actively deliver therapy, not merely monitor patient engagement with it. When a patient works through cognitive restructuring exercises on an FDA-cleared digital platform, that's simultaneously monitoring depression symptoms and treating depression.”
By separating digital therapeutics from RTM technology, CMS is creating a new category of digital health that is FDA-regulated and assessed by different KPIs.
Why Hasn’t Digital Therapeutics Done Better?
The challenge with digital therapeutics has always been sustainability: Will enough doctors offer these services and will enough patients choose to use them. Based on claims data, CMS has seen limited use so far, leading some to question whether providers are scared away from using the technology because they don’t want to pay for it.
In her blog, Nixon lays the blame for low adoption on the challenges of the Medicare Administrative Contractors (MAC) market.
“To date, CMS has not assigned reimbursement for the DTx device to be used with DMHT, deferring to the MACs to establish contractor pricing for each device,” she points out. “Many DTx companies – much less practitioners -- simply don’t know how to approach the MACs to secure contractor-based pricing, which remains the only reimbursement pathway in the absence of a national rate for G0552. For the vast majority of digital health stakeholders, the MAC process is opaque, inconsistently applied, and logistically difficult to navigate.”
“Despite this significant barrier to adoption, CMS proposes retaining the contractor-pricing status for G0552, citing the diversity of technologies in this space and the challenge of establishing a uniform national rate at this stage,” she says.
Because of low adoption rates, there isn’t much data to show that digital therapeutics are improving clinical outcomes – a familiar refrain for many new technologies.
Nixon notes that CMS is also considering creating billing codes for digital therapeutic devices that don’t need FDA approval, such as apps or platforms that support adherence, monitor patient progress or encourage healthy behaviors as part of a treatment plan (think diet and nutrition in chronic care management). The agency is asking for comments on:
Clinical evidence that would support these tools;
How they would fit into behavioral health treatment;
Whether they would need lower-intensity billing codes, and what payment rates would be appropriate; and
How they would be validated and reimbursed.
Laying the Groundwork for Digital Health
With the deadline for comments to CMS on the proposed PFS set for September 12, Nixon calls this a “critical moment” for digital therapeutics advocates. The agency, she says, is not only deciding how digital therapeutics should be supported in the future but how they should be reimbursed.
In his social media analysis, Brochetti said the proposed PFS, pending final approval, could lay the groundwork for a wave of digital health innovation.
“The DMHT framework represents more than mental health policy because it's Medicare's blueprint for regulating active digital therapeutics,” he wrote. “As AI-powered diagnostic tools, VR rehabilitation platforms, and other intelligent healthcare technologies emerge, they'll likely follow this model rather than traditional device categories.”
“This matters for strategic planning because it signals CMS' approach to emerging technologies: specialized frameworks for interventions that don't fit traditional medical device or therapy service categories,” he added.
Ryan Cameron, the hospital's VP of Technology & Innovation, says healthcare understands empathy but not scale, while consumerism can scale but has problems with empathy. Put the two together and big things can happen.
Concepts that have been used in the gaming industry for decades are now helping pediatric surgeons understand exactly what they’re going to do before they even pick up the scalpel.
It’s happening at Children’s Nebraska. In a partnership with Insight Surgery, the 231-bed, Omaha-based pediatric hospital is creating 3D-based personalized surgical planning and cutting guides, allowing clinicians to see how each step of a surgical procedure will take place. The first use case, earlier this year, enabled an orthopedic oncology surgeon to conduct a complex sarcoma surgery of the tibial tubercle and patellar tendon, including an allograft.
"It's really perfect," says Ryan Cameron, EdD, CHCIO, CHD-E, the hospital’s VP of Technology & Innovation, "because the models really come into play for when you're working with multiple surgeons and they're going to try and figure out how to navigate a surgery."
Children’s Nebraska is one of the first hospitals in the nation to have an FDA-approved 3D printing and manufacturing facility on its campus. Cameron says the technology enables clinicians to map out and even practice complex surgeries, vastly improving the outcomes. It allows doctors to reduce the time and size of the surgery by being more precise, reducing trauma and speeding up recovery time, and gives them a visual guide when explaining the procedure to parents and caregivers.
"That's a lot better than saying, 'Hey, I'm gonna take a scalpel and we'll take care of it,’" Cameron notes.
Taking a Non-Traditional Approach to Innovation
Cameron says this type of 'thinking outside the box’ is sorely needed in healthcare, where clinicians look at something that has worked in another industry—say, gaming—and try to apply it to their biggest pain points.
"Technology that used to be very entertainment focused, very gaming focused, because of their consumerism, is now more accessible and more affordable and more ever-present," he says. "We use the very same headsets that you would use to play a video game, and our surgeons are able to take ultra-high resolution CTs and rehearse a surgery and save eight hours. And they're able to reduce multiple surgeries by doing pre-surgical planning."
Ryan Cameron, EdD, CHCIO, CHD-E, Vice President of Technology & Innovation at Children's Nebraska. Photo courtesy Children's Nebraska.
In pediatric healthcare, Cameron adds, this type of innovation is often more of a necessity than a luxury.
"The thing that has surprised me the most with pediatrics is the absence of investment and innovation," he says. "About 22% of the patient population in the United States requires pediatric care. But if you look at both venture capital investment and the number of healthcare startups that are happening, less than 2% are in pediatrics."
"With pediatrics, everything [is] by default, [and innovation] has to be personalized and precise," he adds. While hospitals and health systems catering to adults have the advantage of a very large healthcare innovation technology market to choose from, healthcare executives at children’s hospitals often have to take a new idea or technology and design it specially for their needs.
For example, Cameron says there’s a radiologist on staff "who’s kind of a gearhead. He likes to fix things himself. A cardiologist walks into his office and asks him to build something for one of his patients. And he does it."
Cameron sees a lot of potential in the 3D printer, especially as the industry moves toward bioprinting. An idea once limited to science fiction could someday soon help children in need of transplants, bone and burn reconstructions and other serious health issues
"You think about all the many things where bioprinting is opening the door to a whole new era of healthcare," he says excitedly. "It truly is a profound notion that we could save lives by actually printing organs and tissue in parts."
"Let's say you take part of your leg bone and then move it up into your face so you can do facial reconstruction," he continues. "The fact that that's even possible now, it happens now and it's in front of us, is just remarkable. Because those are the [children] who really need it."
"We’re opening the door to every possibility," Cameron adds.
Looking for Healthcare’s Cutting-Edge Ideas? Try CES
That means looking behind some pretty interesting doors. Cameron, a former self-described "Silicon Valley pirate" and VP of strategy and innovation for an AI company, says he was deliberately hired by the health system in 2022 "to shake things up." He wants to create things, and he sees a very big workbench in front of him.
Cameron dispatches members of his staff every January to CES in Las Vegas, sponsored by the Consumer Technology Association (CTA). The healthcare industry has long been interested in consumer-facing technology and strategies, and more health systems are sending their transformation and innovation people in hopes of finding clinical connections to concepts like wearables, the smart home (and car) and gaming.
Cameron says he sees more potential there than at any of the other, more traditional healthcare events.
"We go to the healthcare conferences and we hear exactly what we expect to hear: Here are the problems [and] here are how our peers are tackling them, but we're don't hear about a lot of big moonshots," he says. "We don't see things that are novel that we can apply into the healthcare space."
"So when you set that horizon much higher, you look at higher education, you look at consumer markets, you look at it all. Even get a little wild, look at children's museums, theme parks, the gaming industry, the entertainment industry," he adds. "Those are places where rapid technology adoption is happening, and you find things that, you know, are really fascinating for us."
"This year, last year and the year before last, we've walked away from CES with at least one technology that's really made a huge impact," Cameron says.
The latest? Holographic communications, and a printer that can print skin-safe tattoos. Theme parks are using them to print cartoon characters on children’s arms. Imagine how they can be used to make kids feel more comfortable in the hospital, or even help them and their parents understand how they’re being treated.
"The possibilities in healthcare are endless," he says.
The Challenge: Balance Empathy With Consumerism
Cameron says all of healthcare—not just pediatric hospitals—needs to embrace this strategy to move forward at a time when transformation is imperative.
"Look at the unexpected places," he says. "Cross-industry collaboration is essential. Healthcare needs to talk to other industries, and vice versa. That's where the really good, exciting innovation comes from. It never happens in a vacuum; it's got to be diversity of thought, diversity of science and engineering, and then the exciting things happen."
Consumerism understands scale but not empathy, Cameron points out, while healthcare understands empathy but has problems with scale.
"And if you get those fine minds talking in the same room, and you can have scale with empathy," he says. "Then you revolutionize how you care for a human being."
Cameron’s advice for other innovation and transformation execs in healthcare? Stop setting the bar low. Raise your horizon.
"Hospitals that are hiring outside of the core discipline of healthcare are seeing success in that they've grown their capability to bootstrap innovation on their own," he says, noting the strong growth of innovation labs and centers and incubators. "They've become a little more brave in terms of thinking about IP and monetization, and thinking like a startup and being more agile and more quick."
"Big tech is trying to figure out how to do healthcare cheaply and make a ton of money off of it," Cameron adds. "And we're trying to figure out how to do healthcare at scale with incredible empathy and high quality. One of us is going to win. I’m betting on me."
A widely panned proposal to regulate virtual prescriptions for controlled drugs isn’t going anywhere. It’s time to bring federal regulators and healthcare leaders back to the table.
Healthcare providers are once again pressuring the federal government to improve the process for using telemedicine to prescribe controlled medications.
“We believe the DEA should consider holding a meeting or forum of leading experts and stakeholders to develop long-term policy for this issue,” Adamec wrote. “Past efforts which did not fully engage stakeholders and Congress had unintended consequences – such as the creation of massive, significant new regulatory burdens on … healthcare systems.”
The debate over allowing qualified providers to prescribe controlled drugs is long and complex, dating back to passage of the Ryan Haight Online Pharmacy Consumer Protection Act of 2008. That legislation set restrictions on how drugs could be acquired online, and tasked the DEA with creating a special registration so that healthcare providers could virtually prescribe those drugs. In 2018, President Trump signed the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act, which tasked HHS and the Attorney General with creating regulations to enable telemedicine prescriptions.
Despite lobbying by members of Congress, healthcare organizations and telehealth advocates, the DEA dragged its feet on creating a special registration. When the pandemic hit, the agency issued a waiver relaxing restrictions on telemedicine use, including allowing selected providers to virtually prescribe controlled substances without first meeting a patient in person.
The DEA has extended those flexibilities through the end of this year, and this past January floated a proposed rule to create that long-delayed special registration process for prescribing by telemedicine once those flexibilities end. But that proposal was met with strong opposition by telehealth advocates, including the ACC and the American Telemedicine Association (ATA), who called on the Trump Administration to nullify the proposal.
While no action has been taken on the proposed rule, telehealth advocates are pinning their hopes on Cole and hoping that new DEA leadership can jump-start the move toward a registration process that would appeal to both the government and providers.
If no action is taken and the waivers expire, the ACC and fellow advocates say many programs that include virtual prescribing and monitoring will likely collapse, hindering access to care for rural and remote patients.
“Telehealth has been crucial in providing a wide range of important health services for Americans, but even more so for those Americans who live in remote areas and locations with provider shortages,” Adamec wrote in his letter to Cole. “Overly broad restrictions will lead to harsh consequences for many Americans relying on telehealth to access health services.”
While President Trump's reconciliation package did reinstate first-dollar coverage for HDHP-HSAs, a collection of waivers aimed at boosting coverage for and use of telehealth didn't make the cut.
Healthcare leaders hoping for good news in President Trump's so-called "Big, Beautiful Bill" were largely disappointed at the outcome. But supporters are saying the fight to extend or even make permanent pandemic-era waivers isn't over yet.
The reconciliation package, approved by Congress on July 3 and signed by Trump on the 4th, makes no mention of most of the waivers, which were put in place during the COVID-19 pandemic to boost coverage for and use of telehealth. Those flexibilities include:
Waiving geographic restrictions on telehealth coverage and use;
Expanding the list of providers able to bill Medicare for telehealth services;
Allowing audio-only telehealth services;
Easing originating site restrictions on telehealth so that the patient can receive treatment at home;
Waiving the in-person requirement for telemental health treatment;
Enabling telehealth service for hospice care; and
Enabling Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to use telehealth.
With those waivers in place, many health systems and hospitals expanded their telehealth platforms during the pandemic and have continued with an aggressive virtual care strategy since then. Should those waivers end, the fear is that telehealth programs across the country will scale back or even be discontinued, hindering access to care for millions of Americans.
One flexibility, however, was included in the "One Big Beautiful Bill Act" (OBBBA): first-dollar coverage for High-Deductible Health Plan-Health Savings Accounts (HDHP-HSAs). That provision had actually been left out of earlier bills but was brought back into the limelight with the OBBBA.
"This legislation will give millions of American workers permanent access to coverage of telehealth services without jeopardizing their HSA eligibility," Kyle Zebley, senior vice predicant of public policy for the American Telemedicine Association and executive director of the organization's ATA Action lobbying arm, said in a press release. "We could not be more pleased and proud of our Congressional policy champions for their steadfast commitment to virtual care, especially amidst significant deliberations and concessions made in order to pass a final bill before the July 4 deadline."
"Telehealth stands out as a bright spot in the final reconciliation package – a policy unicorn – achieving unwavering support from both sides of the isle, in both chambers," Zebley said. "We believe this bodes well for the future of other critical telehealth policies requiring Congressional action. While many of the provisions in final ‘big beautiful bill' now … will create challenges for our healthcare system and the Medicare population, inclusion of this permanent telehealth provision clearly demonstrates the relentless bipartisan, bicameral support that telehealth has experienced over the past five years."
Left unsaid was why that one flexibility was included in the 1,000-plus-page bill but none of the others were, leaving those waivers to expire at the end of September.
Some believe the proposed CMS 2026 Physician Fee Schedule, introduced on July 14, was an attempt to continue momentum for telehealth and digital health that the OBBBA might have blunted. The proposed PFS includes several positive steps, including new billing codes and relaxed requirements for remote patient monitoring (RPM), support for digital therapeutics and a long-sought update to the Medicare Diabetes Prevention Program that would pave the way for virtual care delivery.
Still, the spotlight now is squarely on those telehealth waivers, especially for healthcare executives trying to plan out their virtual care strategies. With margins tight and revenues declining, it will be hard to make up for the lost Medicare reimbursements.
In an e-mail to HealthLeaders, Zebley said the fact that telehealth was included in the OBBBA is an indication that the Trump Administration is taking virtual care seriously – and is open to continued negotiation.
"I strongly suspect, based on past precedent, that we will see an extension, either through a health extenders package or, more likely, as part of a broader government funding bill," Zebley said. "The greatest concern with that path is the risk of a government shutdown, which is always a possibility in Washington but especially so given the heightened political tensions on Capitol Hill at this time.
"At the ATA and ATA Action, we're doing everything in our power to prevent even a momentary lapse in access," he added. "We're actively engaging with our bipartisan champions in both chambers to maintain urgency and keep this issue front and center. These programs have now been in place for more than five years and we must not only prevent disruption, but double down on making them permanent. Only then can we shift fully to advancing the next wave of opportunities in virtual care."
Compounding the urgency is the fast that while the deadline for those waivers is September 30, the House is now in its summer recess and won't return until the beginning of September.
Ambient AI technology is great for capturing the doctor-patient conversation, but are healthcare executives making sure that data is protected?
Healthcare executives who are letting their doctors use AI scribes to capture and code patient encounters need to be careful they aren't exposing or misusing protected health information.
Ambient AI technology, described as the "digital sidekick of modern healthcare," is quickly gaining favor among health systems, hospitals and payers looking to reduce the administrative burden on providers and accurately capture the doctor-patient visit. But those tools, which can easily be downloaded onto a smartphone, could be running afoul of HIPAA.
"Technically, it's a third party listening into the conversation," says Aaron Maguregui, a partner with the Foley & Lardner law firm who specializes in AI and healthcare technology.
An AI scribe, he says, is essentially a service provider, so the healthcare provider using that app, as a covered entity, would need a Business Associate Agreement (BAA).
The challenge is particularly acute at this point in the AI cycle, when vendors are flooding the market with their own products – some from companies new to the healthcare industry and unfamiliar with or ignorant of the regulatory requirements. In many cases these apps can be downloaded by providers and put to use almost immediately.
That's a nightmare for healthcare leaders trying to keep track of what their doctors are using. There are plenty of stories of CIOs and CEOs learning that a doctor in one of their hospitals or clinics is using ChatGPT or some other product on their own.
"There might be some (doctors) that are already enjoying the scribe and you just don't know about it," Maguregui, who also chairs the American Telemedicine Association's Artificial Intelligence Committee, points out. "Technically you could have an unauthorized disclosure of PHI."
Maguregui recently authored a blog on the Foley & Lardner website with Jennifer Hennessy, a data privacy and security attorney with the law firm, on the most common mistakes that healthcare executives make in managing AI scribes. Those pitfalls, he says, can be grouped into two basic issues: Data use rights and patient consent.
Issues around data use are particularly critical, and point to an intriguing catch-22 in the healthcare space. AI needs access to better data to learn and improve, and vendors often will ask for more data in which to train and improve their products. But healthcare leaders are notoriously stingy in granting access to that data.
"It's always interesting to me that the knee-jerk reaction is we don't want you to train AI on our data. And that to me is backwards thinking," Maguregui says. "You want the technology to be efficient and accurate, but you don't want it to use your data. Without that you don't get the full value of AI."
That's especially tchellenging, he says, with tech companies that are new to healthcare, bringing in ideas from other industries.
"There are some really cool stuff out there, but maybe this is their first foray into healthcare and they don't understand that, yes, they can very much ingest all the data that they believe they're allowed to ingest, and then?" he asks. "The output would somehow not be theirs to be able to use, to train their products. That's a very foreign concept to the tech world. … [Those] data use cases, data use rights, those end up being a pretty sticky subject."
On the other hand, Maguregui points out, using AI in clinical care means training the technology on the best data available – including protected health information.
"Specificity counts, and specificity is what we're looking to get to with respect to AI," he says. "We want AI to give specific answers. We want it to be nuanced. Those nuances are going to have to at some point start to take into account identifiable information in order to glean cohorts and cultural differences and social determinants of health, things that we probably want to learn. We want to understand these concepts. But we also need to make sure that we're being cautious with people's privacy rights."
And that's where the second hang-up with AI scribes comes into play. By using a third-party app to record their patient encounters, providers need to secure the patient's permission to be recorded, a requirement included in federal wiretapping laws.
Maguregui says providers need to understand that getting a patient's permission to record their encounter has to be a part of the workflow. And that may be fine in the doctor's office, but what happens when AI captures conversations in the Emergency Department, ICU or even the operating room?
Whatever the case, healthcare executives need to make sure their ambient AI tools are HIPAA-compliant – and they need to make sure their AI strategies take into account the potential for using PHI in future programs.
To that end, in their blog, Maguregui and Hennessy offer five steps that healthcare leaders should take when dealing with AI scribes:
Vet vendors thoroughly;
Build governance into your EHR workflows;
Limit secondary use/training without authorization;
The health system, taking part in HealthLeaders’ AI in Clinical Care Mastermind program, says AI has the potential to radically improve cancer diagnosis and treatment, but only with appropriate guardrails in place.
For cancer care specialists, one small needle of information in a haystack of data could mean the difference between effective treatment and a bad clinical outcome. And that’s where AI holds so much promise.
“AI can look at millions and billions of data points, at images, genomics raw data, at everything we know about the patients clinically, at social factors and other variables, and it can uncover patterns and answer questions,” says Nasim Eftekhari, chief AI and analytics officer at City of Hope.
Eftekhari, a participant in the HealthLeaders AI in Clinical Care Mastermind program, says the Los Angeles based health system, one of the largest and most advanced cancer research and treatment organizations in the country, is very deliberate in how it approaches AI, with a strategy that focuses on considered and steady development. She joined the organization in 2017 as one of its first data scientists, and says AI programs, from good old predictive modeling to generative AI should focus on data quality, good benchmarks, and proper validation.
“Good data beats more data every day,” she stresses.
Cancer care is a complex process, and one in which City of Hope has been fully immersed since its founding in 1913. Yet for all the advances made in diagnosis and treatment, there’s still a lot that healthcare providers don’t know about the disease.
“Cancer is probably the biggest, most difficult, still unanswered question,” Eftekhari says. “We don't even know exactly why it happens, and how to stop it from happening. That’s where the real potential of AI is, to help uncover that can explain some of those unanswered questions and help discover and design better [treatments,]” and better predict the onset of disease.
Eftekhari says generative AI “is a different paradigm” than traditional automation and predictive analytics programs, so City of Hope has had to adjust its guardrails accordingly. Small, incremental steps forward are preferred, as each change in the data can blossom into a much larger problem if unchecked.
Nasim Eftekhari, Chief Ai and Analytics Officer at City of Hope. Photo courtesy City of Hope.
She says healthcare organizations need to monitor their data, update their AI models often, watching for drift, making sure the information used in patient care is the latest available and the results from AI models are the best possible.
“We’re not doing this overnight,” she adds. “Because it’s always about the patient. Every decision that we make at every intersection is always centered around the patient.”
Eftekhari also believes that AI won’t advance in a vacuum, and that health systems and hospitals need to share their data and their methods to support progress. That may go against the idea that data has financial value and that organizations need to erect silos around that information.
To truly move the needle on cancer care, “the answer may lie in mountains and mountains of data that no single organization [may have] on their own.”
As with many other healthcare organizations, embracing AI in clinical care also means dealing with change management. Providers are generally hesitant to adopt new ideas, and need to be nudged forward, often with promises that their workflows will improve. Eftekhari says AI may have the potential to change healthcare, but it still has to prove its value and fight through the skepticism.
“How do you meaningfully deploy a machine learning or AI model in day-to-day workflows and how do you measure the impact?” she asks. “And how do you make sure that these models keep adding value?”
The answer to those questions, she says, may lie in focusing more on the people than the technology. AI will succeed if the providers using the technology are ready for it.
Organizations have strategies to invest in technology, “but what makes it really work is investing in people,” she says. “People who can actually make it work, who can bridge the gap between technology and healthcare. It’s a much smaller investment but it’s usually the hardest to get because it’s not the shiny new toy that everybody wants to have.”
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Idaho's St. Luke's Health is embracing ambient AI not for the clinical benefits (just yet), but because it helps them keep their doctors and nurses.
Small health systems like St. Luke’s in Idaho aren’t embracing AI for the clinical outcomes (though that is a big benefit). They want to help their doctors and nurses, because there aren’t a lot of them to go around.
Provider stress and burnout is a concerning issue for rural health systems, with much of the grief tied to documentation and administrative duties. That’s why healthcare leaders are embracing ambient AI in droves even before the technology has proven its ROI. They want relief now, and will map out the benefits later.
“Our CFO said, ‘Look, we want to make a positive impact on provider well-being,” says Reid Stephan, VP and chief information officer of the Boise-based, six-hospital, not-for-profit network. “If that's all we do with this pilot, I will consider it a success.”
By all accounts, that plan is working.
Working through their Epic EHR, St. Luke’s installed Ambience Healthcare’s AI scribing tool last April, and Stephan says they’re now seeing results. Over the past year, the health system has seen a 38.8% decrease in overall documentation time for clinicians, including a more than 40% drop in after-hours documentation. This translates to a 22% increase in face-to-face time between clinicians and their patients and a 25% reduction in clinician burnout.
Stephan says those numbers translate to happier providers, a key factor in a region where the doctor-patient relationship is as durable as the Rocky Mountains surrounding Boise, a city of some 235,000 people. The idea behind using AI isn’t necessary to increase access to care, but to enrich those care pathways.
“Our approach has been we're not going to pursue supply-side-driven AI opportunities because the amount of supply-side opportunities is enormous and we might get lucky, but more likely we're going to just waste resources and capacity hoping something's going to work,” Stephan pointes out. “So we really focused on the demand-side-driven need we have. And again, it was an obvious one: primary care, in particular. Can we use generative AI specifically to help then with that patient-provider encounter?”
Because of its size, Stephan says the health system isn’t looking to be a trailblazer with AI, but rather wants to use the technology to address its specific pain points.
“We aren’t pioneering this,” he says.
Reid Stephan, VP and Chief Information at at St. Luke's Health. Photo courtesy St. Luke's Health.
There are financial benefits as well. St Luke’s is using a “coding aware” platform, which not only captures the conversation but provides real-time coding of the encounter. The tool is reportedly generating more than $13,000 annually per clinician through more accurate coding and better communications, and Stephan says the deployment paid for itself within five months.
Whether those numbers play out over time remains to be seen. Critics say these AI tools are great at catching early benefits, but long-term results are hazy. Stephan, on the other hand, says as long as his clinicians are happier and engagement is better, the value is there for him.
He also says the results of the first year of implementation have given leadership the support to expand the platform. After starting with family medicine clinicians, the health system is now using the AI tool in some 28 specialties.
“This instilled in us a lot of confidence that we can do this again and again and not have to recreate … across each different specialty,” he says.
In fact, Stephan says he was surprised at how fast clinicians caught on to using AI, and would have considered expanding the pilot sooner had he known the results.
“The word spread across the community, and within a few days or a couple of weeks of the initial rollout of the pilot, we started to have a groundswell of hands being raised,” he says. “’When is my turn? Why wasn’t I part of the pilot? How can I get this sooner?’”
Stephan says it’s important to temper expectations with AI, not only to make sure the hype doesn’t overtake reality but to make sure clinicians know what they’re using. While he tells them AI will improve their workflows, that doesn’t mean management wants them to take on extra patients or patient visits or do more work.
True ROI, he says, comes in a more enriched doctor-patient encounter, where both doctor and patient are more engaged.
“Maybe then the provider is able to pick up on something or hear something that they might have otherwise missed when they’re trying to do the swivel chair game of typing and listening,” he says.
A fleet of planes is just one way that Driscoll Children's Hospital makes sure its patients (and their families) get the care they need.
When your patients are sick children, you bring healthcare to them. And that's where true healthcare innovation happens.
Such is the case with Driscoll Children's Hospital. Based in the southern coastal city of Corpus Christi, Texas, the pediatric health system comprises two hospitals and a number of specialty clinics and care sites covering a 25,000-square mile swath of rural southern Texas roughly the size of South Carolina.
Driscoll was launched in 1953 by Clara Driscoll, an author, politician, activist and rancher who spoke five languages, was a confidant of FDR and was credited as the ‘Savior of the Alamo.' She had a soft spot for children, especially those on the opposite end of the economic spectrum, and upon her death in 1945 left her fortune to a fund that would create the hospital.
Mary Dale Peterson, Driscoll's Executive VP and COO, says it's that "Renaissance spirit" that propels the health system today. Among its accomplishments is a 98.5% survival rate across more than 600 pediatric cardiac surgery cases, one of the best in the country. And their length of stay is among the shortest in the country, with transition housing on the hospital campus to help patients and their families move more quickly from the hospital back home.
"You don't always have to be in the largest urban areas to create greatness," she says.
Mary Dale Peterson, Executive VP and COO of Driscoll Children's Hospital. Photo courtesy Driscoll Children's Hospital.
Healthcare innovation comes in many forms, and at Driscoll it begins with the idea that healthcare access is a priority. That's why Driscoll has a fleet of five planes that cover a 33,000-square mile area each day, ferrying specialists to clinics and transporting children to hospitals.
"We have a history of bringing care to the children where they are," Peterson points out.
She says the service dates back to Jim Simpson, a cardiologist who flew his own plane across the state some 50 years ago to screen remote children for congenital heart disease. The planes, purchased through philanthropic donations, help specialists like the only pediatric rheumatologist in all of south Texas meet with children and their parents, saving them hours-long car trips and days away from home.
And it saves money. Peterson – who was president and CEO of the Driscoll Health Plan from 2005-18 before joining the hospital – says the fleet saves Driscoll millions of dollars in Medicaid costs, while also improving time and access to treatment, which in turn improves clinical outcomes.
"We've saved the state a lot of money by flying our doctors to these communities," she says. "Maybe the new innovation is figuring out how we provide equivalent care to our rural communities that we have in our urban communities."
'What We Want to Do Is Really Look Upstream'
That's not the only instance of bringing care to the kids. Driscoll recently launched a pilot project to embed behavioral health specialists in primary care practices as well as local schools.
Peterson says the idea was borne out of a troubling statistic: A 60% increase in ER visits for children over three years, due only in part to the pandemic. In short, children were experiencing mental health crises, and they and their families weren't recognizing the warning signs or seeking help until the only option was emergency care.
With some grants and philanthropic money, health plan funding and an alternative payment program, Peterson sent specialists out into the communities, coordinating with pediatric primary care practices and five elementary schools and a high school.
"When I got to thinking about it, it's like, how do we prevent children from going into crisis?" she says. "We don't have inpatient mental health services in our hospitals, so they end up in overcrowded EDs. What we want to do is really look upstream."
Another example: In 2007, while head of the Driscoll Health Plan, Peterson studied the data on pre-term births and noticed that 20% of all births were ending up in the NICU, while 30% of all births were medically induced. In addition, there was only one maternal-fetal medicine specialist in south Texas. That led to a $10 million investment to establish clinics and build up the telemedicine program, moves that helped bring the pre-term birth rate down to 9% and save millions of dollars in healthcare costs.
"I've worked 30 years as a physician treating these babies with the ravages of prematurity," she says. "I know we can't prevent every preterm baby, but we can do better."
"There's a lot of, you know, sexy technology that's out there in the surgical realm that I love … but I think there's a whole lot of work that we still have to do in the non-sexy areas that have a huge impact on people's lives," she adds. "And that is in coordination of care and behavioral healthcare, and really helping families who are struggling with these issues."
Data and Dollars
As a former health plan president, Peterson says innovation is predicated on two ideals: New ideas are based on data proving their value and can be justified financially. With a patient population in which some 80% rely on Medicaid, that's a challenge.
"Having an integrated health system where we have a health plan, a physician practice group and the hospital all working together helps with that," she says. So the health plan manages the risk, and the health system turns that into opportunity.
That philosophy has helped her to understand when a new idea doesn't work as much as she might want. Peterson says Driscoll embraced telehealth enthusiastically during the pandemic, which was pretty much the only way to access most care. But after the crisis, she crunched the numbers and found that care management had suffered, and well-child visits and immunizations had dropped.
"We'll offer it to everyone," she says of the virtual care platform, "but patients actually do prefer face-to-face visits."
So Driscoll mixes its platforms, offering virtual care alongside in-person care to meet the needs of its patients and their families. Peterson says she's eager to blend the two with new ideas, like remote patient monitoring and AI. And she's excited about research in genetics and precision medicine that is creating new treatments for children.
"In the past you would just have to tell these families their baby's going to die, but now we have something to offer," she says.
In this week's The Winning Edge webinar, executives from three leading health systems discussed how the platform improves clinical outcomes, reduces hospital overcrowding and costs, and boost patient satisfaction and engagement.
Despite challenges with reimbursement and complexity, the Hospital at Home strategy will be a key element of value-based care from here on.
That's the opinion of executives from three leading health systems who took part in this week's HealthLeaders The Winning Edge panel. They said the program, which enables patients to receive acute-level care in their homes rather than a hospital through a mix of virtual, digital and in-person services, has already proven its value.
Tuesday's panel featured Stephen Dorner, MD, MPH, MSc, chief of clinical operations and medical affairs for Mass General Brigham, which serves roughly 400 patients a month in a program launched in 2017; Daniel Davis, MD, senior medical director of primary care for the greater Charlotte market and senior medical director of continuing health for the Southeast region for Atrium Health, whose program includes one of the first pediatric Hospital at Home platforms in the country; and Logan Davies, MD, MBA, hospital medical director of access and throughput for Ochsner Health, which launched its first acute care at home program a little more than a year ago and is not following the Acute Hospital Care at Home (AHCaH) model favored by the Centers for Medicare & Medicaid Services (CMS).
The three programs follow a familiar pattern but have their own unique variations, which is a strength of the strategy. While roughly 400 health systems and hospitals are following the CMS model and receiving Medicare reimbursements through a pandemic-era waiver due to expire this fall, many others are developing their own programs, with the goal of taking patients out of crowded hospitals, reducing excessive hospital-based costs and enabling patients to recover at home.
Davis said the CMS model offers "an important sign of legitimacy," but it's not the be-all and end-all of the program. Healthcare organizations across the country are struggling to redesign care in a more efficient and effective format, and a model that takes care out of the hospital and puts it in the home fits that plan.
Here's the You Tube presentation of this week's webinar:
