The new rule, announced today, enables healthcare providers to use audio-visual telemedicine platforms to evaluate new patients for methadone treatment programs
Healthcare organizations looking to get a handle on the opioid abuse epidemic can now use telemedicine to extend opioid treatment programs (OTPs) to the home.
The announcement marks the first time in 20 years that HHS has revised its rules to expand treatment options. Healthcare organizations have long been restricted in how they use telemedicine and digital health tools for substance abuse treatment, which often require in-person services that hinder patients who face barriers to access.
“This final rule represents a historic modernization of OTP regulations to help connect more Americans with effective treatment for opioid use disorders,” Miriam E. Delphin-Rittmon, PhD, the HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA, said in an accompanying press release. “While this rule change will help anyone needing treatment, it will be particularly impactful for those in rural areas or with low income for whom reliable transportation can be a challenge, if not impossible. In short, this update will help those most in need.”
Other aspects of the final rule that aid in treatment expansion include making permanent a pandemic-era waiver that allows providers to prescribe take-home doses of methadone; allowing nurse practitioners and physician assistants to order medications for treatment programs (where states allow); removing the requirement that a patient have a history of addiction for at least a year before entering a program; expanding access to interim treatment; and “promoting patient-centered models of care that are aligned with management approaches for other chronic conditions.”
The federal rule continues a nationwide effort to address substance abuse—and, in a larger context, behavioral health issues—through new programs that take into account both the nationwide shortage of qualified providers and barriers to access, including social determinants of health.
“At HHS, we believe there should be no wrong door for people who are seeking support and care to manage their behavioral health challenges, including when it comes to getting treatment for substance use disorder,” HHS Deputy Secretary Andrea Palm said in the press release. “The easier we make it for people to access the treatments they need, the more lives we can save. With these announcements, we are dramatically expanding access to life-saving medications and continuing our efforts to meet people where they are in their recovery journeys.”
The rule doesn’t make all the restrictions disappear. It specifies that providers can use telemedicine to evaluate a new patient for entering methadone treatment but not for prescribing methadone.
Prescribing rules are still very tricky in substance abuse treatment. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 prohibited the online prescription of scheduled drugs, though it did call for a process by which providers could register with the US Drug Enforcement Agency to prescribe some controlled drugs via telemedicine without first needing an in-person evaluation. The DEA never set up that process, despite intense lobbying from the American Telemedicine Association and others to do so.
With the pandemic, HHS established a number of waivers aimed at expanding access to telehealth and digital health, including allowing for virtual prescriptions. Those waivers ended last year with the federal Public Health Emergency, but Congress voted to extend many of them until the end of 2024. The DEA has extended its waiver until the end of the year as well as it works to come up with new, permanent rules to prescribing by telemedicine.
A Kaiser Permanente study of ambient AI scribes used to capture doctor’s notes and enter data into the EHR finds that they are improving the doctor-patient experience, but doctors still need to edit their notes
Ambient AI scribes designed to transcribe patient-physician encounters into the EHR may hold promise in reducing clinician workloads, but they aren’t there yet.
That’s the conclusion drawn from a recent study of more than 3,000 clinicians at the northern California-based Permanente Medical Group (TPMG) who used the technology in late 2023. The study, appearing online today in NEJM Catalyst Innovations in Care Delivery, finds that the AI tool did accurately represent the conversation between doctor and patient, but there was still a significant amount of editing that had to be done.
“Ongoing enhancements of the technology are needed and are focused on direct EHR integration, improved capabilities for incorporating medical interpretation, and enhanced workflow personalization options for individual users,” the study team, comprised of eight Kaiser Permanente researchers and executives, concluded. “Despite this technology’s early promise, careful and ongoing attention must be paid to ensure that the technology supports clinicians while also optimizing ambient AI scribe output for accuracy, relevance, and alignment in the physician–patient relationship.”
While automation and AI technology have been around for several years, the rapid advances of new forms of the technology have created a stir in several industries, including healthcare. AI and large language model (LLM) tools have the potential to not only handle administrative and back-office processes, but reduce workloads and stress for clinicians and staff by handling time-consuming and computer-driven tasks. Ambient AI scribes, for example, are designed to capture conversations and input data into the EHR, giving clinicians and staff the opportunity to interact with patients more freely instead of typing words into a laptop or trying to recall the gist of the conversation later.
While not the first study, the Kaiser Permanente study is one of the largest to test the technology in a clinical setting. It gives healthcare executives valuable insight into where the technology stands now, and what needs to be done to make it more effective.
According to the study, some 6,000 Kaiser Permanente clinicians have been using software-based medical dictation technology for at least two years. In August 2023, TPMG launched a two-week pilot with 47 physicians using an AI scribe; based on positive reactions from the physicians, the organization then secured licenses for 10,000 physicians and staff across several settings.
According to researchers, 3,442 physicians used that tool in the first 10 weeks of implementation for 303,266 encounters, with almost 100 physicians using the tool more than 100 times and one doctor using the tool for 1,210 encounters. Overall, the tool was used more than 19,000 times a week in seven of the 10 weeks studied.
In studying how clinicians and their staff used the technology, the research team identified four aspects of ambient AI scribes that would facilitate effective use:
Facilitate engagement by demonstrating growing and sustained adoption of ambient AI by number of clinicians and percentage of patient encounters across diverse specialties and settings.
Aim for effectiveness by reducing the burden of documentation within and outside of direct patient encounters.
Enhance the physician–patient relationship by increasing the amount of time physicians spend interacting with patients by improving engagement and reducing time spent interacting with a computer.
Maintain documentation quality by developing approaches to assess and safely use ambient AI technology capabilities in transcription and summarization.
And at the end of the study, the team listed four takeaways:
Ambient AI scribes “show early promise” in reducing the burden on clinicians to take notes and spend extra time entering that data into the EHR.
Both clinicians and patients said the technology improved the care experience, and some clinicians called the technology “transformational.”
While a review of AI-generated transcripts resulted in an average score of 48 out of 50 in 10 key factors, that doesn’t mean they can replace clinicians. There were inconsistencies, and clinicians still had to review the notes and make corrections “to ensure that they remain aligned with the physician-patient relationship.”
“Given the incredible pace of change, building a dynamic evaluation framework is essential to assess the performance of AI scribes across domains including engagement, effectiveness, quality, and safety.”
The research team also noted that AI technology is evolving quickly.
“The approaches to robustly evaluate the quality and safety of AI technologies, including tools such as large language models, remain incompletely defined,” they said. “The underlying algorithms and relevant regulations are also continuing to evolve rapidly, which will necessitate ongoing benchmarking, evaluation, and monitoring as the technology improves and vendors bring new software to market. Adoption rates and usage patterns are also expected to change as new user groups and application domains are identified and tested.”
With that in mind, the study offered advice for other healthcare organizations aiming to evaluate ambient AI scribes.
Find clinical champions to overcome barriers to adoption and create a culture that embraces innovative ideas.
Starte with a limited pilot involving a small number of clinicians, then scale up to a regional or larger-scale pilot with “opportunities for clinician and patient feedback that result in ongoing improvement that is tangible to stakeholders.”
Develop monitoring and benchmarking processes “that offer proactive assessment of the tools and their impact on meaningful goals.”
The Tennessee-based health system has migrated its data to a FHIR-based platform and now plans to use AI to address administrative and clinical efficiencies.
Community Health Systems has announced a collaboration to develop generative AI programs on Google Cloud.
The Tennessee-based health system, comprising 71 hospitals and more than 1,000 healthcare sites across 15 states, announced today that it has completed migration to a FHIR-based clinical data platform on Google Cloud.
“The goal of this migration extends well beyond modernizing our data infrastructure,“ Miguel Benet, MD, MPH, FACHE, CHS’ senior vice president of clinical operations, said in a press release. “By building a secure foundation to take advantage of new innovations in AI, we’re able to streamline our clinical providers’ workflow and advance the way we deliver patient care.”
Tech giants like Google, Microsoft, and Amazon are partnering with health systems and hospitals to develop enterprise-level AI programs, combining the data storage and analysis capabilities of the former with the clinical and administrative expertise of the latter. In December, Google unveiled a new suite of healthcare AI models called MedLM, built off the Med-PaLM 2 large language model introduced earlier in the year, as well as an early iteration of its next-gen generative AI model called Gemini.
One of Google’s biggest partners is HCA Healthcare, also based in Tennessee, which has been piloting Ai technology in Emergency Departments (through smartglasses) and to help nurses with documenting patient encounters.
“We’re on a mission to redesign the way care is delivered, letting clinicians focus on patient care and using technology where it can best support doctors and nurses,” Michael J. Schlosser, MD, MBA, FAANS, HCA’s senior vice president of care transformation and innovation, said in a press release. “Generative AI and other new technologies are helping us transform the ways teams interact, create better workflows, and have the right team, at the right time, empowered with the information they need for our patients.”
CHS is looking to build off its centralized data depository on Google Cloud’s health data platform to improve interoperability and drive real-time data analysis. The health system also plans on using Vertex AI and other large language models to target both administrative and clinical efficiencies, even pairing AI with Google Maps to give patients personalized resources in their communities.
With version 2.0 now supporting FHIR-based exchange, Mariann Yeager of the Sequoia Project says the final draft of standards for nationwide interoperability should be unveiled by the end of March.
Healthcare organizations with a vested interest in interoperability should be taking a close look at version 2.0 of the Trusted Exchange Framework and Common Agreement (TEFCA), which now supports FHIR-based exchange.
The government-supported effort to create nationwide interoperability standards has been more than two years in the making, coming out of the 21st Century Cures Act. This past December, five healthcare organizations were the first to be certified as Qualified Health Information Networks (QHINs), giving them the standing to support data exchange.
Yeager says the biggest take-away from version 2.0 is federal recognition of FHIR (Fast Healthcare Interoperability Resources), the HL7 standard that defines how healthcare information can be moved between disparate platforms.
“The most important thing for people to understand is that version 2.0 was revised to support FHIR-based exchange,” she told HealthLeaders. “There are new use cases to support healthcare operations and public health. The other thing is it does permit health systems that participate in TEFCA-based exchange to connect to multiple QHINS, to the extent that they support multiple data sources.”
Yeager also said she expects more conversation around health systems that appoint another entity to exchange healthcare data.
Writing in the HealthITbuzz blog earlier this month, Chris Muir and Alan Swenson of the Health and Human Services Department’s Office of the National Coordinator for Health IT (ONC) said the unveiling of five QHINs and the release of TEFCA version 2.0 “continue the momentum” toward a nationwide interoperability platform this year.
“In the short-term, ONC and the TEFCA RCE anticipate ‘facilitated FHIR’ exchange beginning to be implemented as part of TEFCA exchange as early as the first quarter of calendar year 2024 connected to the release of Common Agreement Version 2,” they said. “As in Version 1, Version 2 of the Roadmap describes facilitated FHIR exchange in which Qualified Health Information Networks (QHINs) provide the network infrastructure to support FHIR API-based exchange between TEFCA Participants and Subparticipants from different QHINs.”
“Specifically, if a TEFCA Participant or Subparticipant wants to obtain a patient’s data using FHIR, they will go to their QHINs to determine who has the patient information,” Muir and Swenson continued. “Patient discovery will take place through the QHIN-to-QHIN interaction, including discovery of the FHIR endpoints for those that have the patient data. The initiating Participant or Subparticipant will then directly (i.e., without going through the QHIN) and securely query each of those endpoints.”
Yeager says she’s excited to see data exchange scaled up to a national level.
“There are different ways in which FHIR is being used,” she said, noting that TEFA had support content exchange and is now embracing native FHIR. “We’re talking about … facilitating FHIR-based exchange with each other. What that enables is nationwide scale. This is an unprecedented opportunity in the US to support FHIR-based exchange at such scale.”
The five QHINs, MedAllies, the eHealth Exchange, Epic Nexus, Health Gorilla, and the KONZA National Network, have been exchanging data since TEFCA officially went live in December. Yeager says “several others” are going through the process to become designated QHINs and other healthcare organizations are preparing to take that route as well.
“They really see FHIR as an important functionality,” she said of the first QHINS.
Aside from gathering information through the public comment period, Yeager says the Sequoia Project will be scheduling public information webinars as well as targeted feedback sessions over the next several weeks to prepare the final version.
Muri and Swenson of the ONC said there are more goals ahead.
“Looking forward, the updated Roadmap describes two more phases of FHIR implementation beyond facilitated FHIR exchange,” they wrote in the blog. “The next phase, QHIN-to-QHIN FHIR Exchange, [will] enable QHINs to leverage FHIR-based exchange for exchange between QHINs while continuing to support non-FHIR approaches within the QHINs’ internal networks.”
“The last phase, End-to-End exchange, would permit a Participant/Subparticipant to seamlessly exchange FHIR data between themselves and other network members through the QHINs and multiple other intermediaries both within a QHINs’ network and through the TEFCA-governed network,” they added.
Yeager expects interoperability to be an ever-evolving process.
“TEFCA is really going to be evolutionary,” she said. “We will definitely be learning as we go, learning and adjusting. … You learn by putting things into practice.”
A new law allows Garden State health systems to expand their Hospital at Home programs to include Medicaid patients and those on private insurance
Health systems in New Jersey are now able to expand their Hospital at Home programs to patients in Medicaid and private insurance, thanks to a new state law.
The Hospital at Home Act, which was passed by the state Legislature and signed by Governor Phil Murphy in September 2023 and enacted into law on January 23, establishes a state Hospital at Home permitting process through the New Jersey Department of Health that is consistent with the Centers for Medicare & Medicaid Services’ Acute Hospital Care at Home Program.
Executives at Virtua Health, which launched its Hospital at Home program two years ago and now offers services through five of its hospitals in the southern part of the state, hailed the new law. Aside from introducing patients in the state’s NJ Family Care and Medicaid programs to the service, the law enables the health system to work with private payers to cover the program.
“We are excited to see Hospital at Home expand in New Jersey through this legislation, and we believe our state can serve as a template for the rest of the country,” Michael Capriotti, MBA, senior vice president of integration and strategic operations for Virtua Health, told the Gloucester City News earlier this week. “It is important that we continually innovate to create the best possible experiences and outcomes for our patients.”
More than 300 health systems and hospitals across the country are following the guidelines set by the CMS program, which includes a waiver, put in place during the pandemic in 2020, that allows the healthcare organization to qualify for Medicare reimbursement. That waiver is due to expire at the end of this year, and supporters are lobbying both Congress and CMS to make that waiver permanent.
The program targets patients who would otherwise be admitted to the hospital, creating a home-based care management plan that includes often-multiple daily visits by care teams, virtual care services and remote patient monitoring. Some programs have added ancillary services to address social determinants of health, imaging and tests, and pharmacy and rehab needs.
New Jersey is one of the first state to establish specific state guidelines for the program.
According to Virtua Health, the health system has enrolled more than 900 patients, representing more than 60 different medical conditions, in the program.
According to a recent national study of the program by researchers at Mass General Brigham—one of the first health systems to launch the program—the Hospital at Home concept has reduced the mortality rate for patient who would otherwise be hospitalized; it has also reduced the escalation rate (returning to the hospital for at least 24 hours) and rehospitalization rate within 30 days of discharge.
“Home hospital care appears quite safe and of high quality from decades of research — you live longer, get readmitted less often, and have fewer adverse events.” David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, said in a press release. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
Federally qualified health centers (FQHCs) are using telehealth and digital health tools to improve access and erase care siloes for millions of underserved Americans
Federally Qualified Health Centers (FQHCs) are often the first point of contact for underserved populations seeking access to care. And often that first impression can make all the difference in accessing care that improves outcomes.
At Kenosha Community Health Center, that first contact is now handled by a nurse who can quickly and efficiently funnel the patient to the right care provider.
“We’re seeing a higher volume of patients with more complex needs, so it’s important that we make this as efficient as possible,” says Mary Ouimet, the Wisconsin-based health center’s CEO. “When you have more than 450 calls a day, that can be a bottleneck.”
Kenosha, part of the Pillar Health network, is one of several FQHCs to collaborate with Conduit Health Partners on nurse triage services. And that’s part of an even larger trend of FQHCs, rural health centers (RHCs), and assorted community health clinics outsourcing some services and using telehealth and digital health technology to alleviate those bottlenecks that keep patients from accessing the care they need.
There are an estimated 1,400 FQHCs and more than 4,400 RHCs in the US, according to the Health and Human Services Department’s Health Resources and Services Administration (HRSA), which supervises funding for those providers. They, along with look-alike (LAL) organizations, provide care and resources for more than 30 million Americans, many of whom can’t afford or access care at a hospital, health systems, or primary care provider.
With the Centers for Medicare & Medicaid Services (CMS) loosening the purse strings on Medicare and Medicaid coverage, these providers are embracing new technologies to improve access to care and resources. At Kenosha, that means instituting a digital nurse triage service that channels the right patients to the right care.
“This is an essential function of the health center,” says Ouimet, who estimates that 100-150 incoming calls a day are now connected to Conduit Health nurses. “These are nurses at the other end who can work with [patients] to coordinate care. The average call time is reduced, and we’re improving time to treatment and bed scheduling. It’s just better care.”
In Massachusetts, meanwhile, an organization serving the commonwealth’s 52 community health centers covering more than 300 sites and 1 million patients is using HRSA grant funding to maintain a technology platform that keeps track of when and where patients receive care. The platform, developed by Bamboo Health, sends real-time notifications to care teams when a patient visits another care provider outside the system, enabling the care team to access admission, discharge and transfer data.
Susan Adams, vice president of health informatics for the Massachusetts League of Community Health Centers, says the technology gives care teams instant digital access to information that would otherwise be siloed away, creating gaps in care that could affect outcomes. She said those care teams had to ask for paper printouts of those visits, then manually enter the data into the patient’s medical record.
“We could be at the printer all day long,” she says.
Thirteen of the Mass League’s CHCs were originally put on Bamboo Health’s platform to monitor some 400,000 patients. According to the organizations, those CHCs saw a 47% reduction in 30-day readmissions among ED patients, a 20% reduction in 30-day readmission among hospitalized patients, and a 33% increase in follow-ups within 30 days of discharge.
The Mass League is now expanding that platform to more CHCs.
“We aren’t getting all the data we need to manage these patients,” Adams says, noting care teams sometimes never learn that a patient has been hospitalized or visited an ED somewhere else unless it comes up in conversation with the patient. The more data we can put into [the patient record] the better chance we have of providing care.”
Having a complete patient record, she says, also helps with chronic care management and strategies to address social determinants of health (SDOH), key care programs that CHCs, FQHCs and other health clinics are being asked to take on.
“I think the challenge will come with managing all of these alerts,” Adams says. “But that’s a good challenge. This gives us a chance to address more care [management and] coordination goals. It’s something that we’ve been waiting a long time to do.”
The collaboration is one of several between health systems and Big Tech to develop and scale AI programs
A partnership between the Cleveland Clinic and IBM is applying AI to cancer care, with the goal of creating better and more effective treatments.
In a study recently published in Briefings in Bioinformatics, the research team reported that it was able to use both supervised and unsupervised AI technology to better understand the molecular details of peptide antigens, the first step in using them to attack cancer cells or cells infected with viruses. Researchers can use this data to tailor vaccines and engineered immune cells.
“In the past, all our data on cancer antigen targets came from trial and error,” Timothy Chan, MD, PhD, chair of Cleveland Clinic’s Center for Immunotherapy and Precision Immuno-Oncology and Sheikha Fatima Bint Mubarak Endowed Chair in Immunotherapy and Precision Immuno-Oncology, said in a press release. “Partnering with IBM allows us to push the boundaries of artificial intelligence and health sciences research to change the way we develop and evaluate targets for cancer therapy.”
The research proves the value of using AI to gather and analyze data faster and more accurately. According to the Cleveland Clinic team, antigen peptides interact with immune cells based on specific features on the surface of those cells.
“Research has been limited by the sheer number of variables that affect how immune systems recognize these targets,” Cleveland Clinic executives said in the press release. “Identifying these variables is difficult and time intensive with regular computing, so current models are limited and at times inaccurate.”
Using supervised and unsupervised algorithms “can highlight subtle but key determinants of peptide immunogenicity within the [atomistic molecular dynamics] trajectory data and can … provide significantly more predictive power over a baseline sequence architecture on peptide datasets,” the research team said in the study.
“These insights highlight how MD can help predict and foster understanding of immunogenicity, and the methods developed here lay a framework for broad HLA [ human leukocyte antigen] allele studies to further elucidate mechanisms of immune responses and inform T cell therapies,” they concluded.
The project was borne out of Discovery Accelerator, a collaboration launched in 2021 to match Cleveland Clinic’s biomedical research capabilities with IBM’s AI and quantum computing technology. It’s one of several partnerships forged between health systems and Big Tech to expand access to AI tools for research as well as administrative and clinical services.
Health systems and hospitals are facing competition from disruptors offering personalized urgent and emergency care. But is that a bad thing?
A new disruptor is taking aim at the healthcare industry’s busiest site: The Emergency Department.
Concierge care programs designed specifically for urgent and emergency care are finding support from consumers who don’t want to wait several hours in an ED, along with primary care providers who don’t want to send their patients there. The service offers a cash-only alternative to the ED and could pull more patients away from hospitals and health systems.
“The experience [of an ED] is so challenging,” says Brad Olson, CEO of Sollis Health, which operates 11 clinics in New York City and the nearby Hamptons, as well as California and South Florida, and serves some 18,000 members. “What makes us different is we’re offering [patients] immediacy.”
Launched in 2016 in New York as Priority Private Care, Sollis is building a business model through partnerships with consumers, primary care providers, and businesses who want to avoid the traffic and time spent in an ED, which sees more than 130 million visits a year. The company offers a concierge care model that bypasses payers, and also offers a range of services that include diagnostics, labs and vaccines, virtual care, specialty care, even house calls.
The model adds another wrinkle to the crowded urgent care market, where hospitals and health systems are already competing with retail and stand-alone urgent care clinics that not only pull patients out of the ED, but offer additional resources and connections that pull a patient further outside the health system’s orbit of care.
Olson is quick to point out that Sollis Health is a disruptor, but not necessarily a competitor to health systems and hospitals—he notes the company has partnerships in place with more than 30 health systems for everything from ED services to specialty consults. He notes one clinic is located not far from Cedars-Sinai in Los Angeles and is partnering with the hospital even while giving consumers an alternative to Cedars-Sinai’s ED.
The ’disruptor’ moniker is important. Olson, a former executive with Peloton and Starwood Hotels & Resorts, brings a retail mentality to healthcare that is propelling companies like Amazon, Walmart, and Walgreens in the healthcare space. He notes that consumers are turning away from hospitals and health systems because of the complexity and cost of healthcare, and they certainly don’t want to wait several hours in a crowded hospital waiting room for fragmented care that leads to more scheduled visits in other locations.
Disruptors like Sollis Health and other concierge care companies are luring consumers away from traditional healthcare organizations with the promise of convenient, personalized care. And Olson says Sollis equips its clinics with ER-trained and boarded clinicians, many of whom also work at nearby health systems. Sollis also offers a range of services that stand-alone and retail urgent care clinics do not.
In the basic business model, Sollis Health partners with primary care providers and businesses who will refer their patients/employees to Sollis for urgent care, with those patients paying out of pocket for services. In some cases a PCP or business will purchase memberships for their patients or employees, figuring the cost of a membership will be much lower than costs associated with going to a hospital or urgent care clinic.
Olson says Sollis Health reaches out to health systems and hospitals to suggest partnerships, particularly in specialty care services, and those organizations haven’t sought out Sollis Health to help with crowded EDs. But the opportunity is there for healthcare executives to see disruptors like Sollis Health as a valuable resource, giving patients another option to access care.
“We definitely don’t compete with them,” he says.
Olson emphasizes that Sollis Health’s growth is in the consumer market, and in building out its concierge care to attract more primary care providers and businesses looking for alternatives to the ED or retail urgent care space. He says payers have expressed interest in this model of care, though the company currently isn’t working with any insurance companies and is focused on membership and cash-only payment plans.
“Our biggest challenge right now is explaining who we are and what we do,” he says. But once that connection is made, the value becomes evident.
Participating providers will receive federal support for integrating mental and physical healthcare services in team-based care
The Centers for Medicare & Medicaid Services is launching a new model to test the integration of mental health and primary care services, giving healthcare organization an opportunity to leverage new strategies and technologies in a team-based care approach.
The Innovation in Behavioral Health (IBH) Model will be tested through the CMS Innovation Center (CMI), which will align Medicare and Medicaid reimbursements through state-based programs. The idea is to create a care management plan for patients living with mental health issues and/or substance use disorder that incorporates mental and physical healthcare.
“The systems of care to address physical and behavioral health conditions have historically been siloed, but there is a direct correlation between people with mental health conditions or substance use disorder and poor physical health,” CMS Deputy Administrator and Innovation Center Director Liz Fowler said in a press release issued Friday. “This model will bring historically siloed parts of the health system together to provide whole-person care--designed to keep people out of the emergency department, ensuring better care management and coordination, and improving their overall health.”
The eight-year program will launch this fall in as many as eight states. CMS is expected to release a Notice of Funding Opportunity sometime this spring.
The model lends federal support and funding to a concept being tested by healthcare organizations across the country. Faced with an onslaught of patients living with behavioral health issues and a shortage of resources, providers are turning to team-based care to give these patients a more comprehensive care plan. The team-based approach also supports the theory that many behavioral and substance abuse issues stem from or are exacerbated by other health concerns, including chronic conditions.
The model also enables providers to fold in services and resources that address barriers to care, or social determinants of health (SDOH), to affect many underserved patients, especially those in Medicare and Medicaid programs.
“Addressing the nation’s behavioral health crisis remains a key priority for CMS,” CMS Administrator Chiquita Brooks-LaSure said in the press release. “Through this model, CMS will support behavioral health practices to provide integrated care and help meet people’s behavioral and physical health and health-related social needs, like housing, food, and transportation, all of which can negatively impact a person’s ability to manage their care.”
CMS officials say the model will incentivize participating providers “to work collaboratively to screen, assess, and coordinate between individuals’ physical and behavioral health needs.” The model also gives providers a chance to use virtual and digital health technologies to improve access to treatment and support services.
According to a recent CES panel, healthcare executives have a ways to go to make that work
As more healthcare services are accessed in or delivered to the home, health systems and hospitals will have to make significant changes to take full advantage of that setting.
A panel discussion at last week’s CES 2024 event in Las Vegas brought to light the challenges facing healthcare organizations who want to use the home for care delivery. For while the technology is in place to deliver care, healthcare executives have to rethink how they collect and use data from the home and interact with consumers.
“It’s not chronic disease [management], it’s not consumer, it’s not patient. It’s life care,” said Leslie Saxon, MD, executive director of the USC Center for Body Computing and a professor of medicine at USC’s Keck School of Medicine.. “Traditional medical care [providers] have to believe that the patient is the consumer. … And the people who are going to drive this market are the patients.”
“We have an untapped resource in the home,” added Hon Pak, a vice president and head of the digital health team at Samsung Electronics. “Fundamentally, we have to change the model” of how care is delivered.
Spurred by a shortage of in-patient beds and staff, health systems have been moving some services to the home. More than 300 health systems across the country are taking part in the Acute Hospital Care at Home (AHCaH) model, which is supported by a waiver for Medicare reimbursement from the Centers for Medicare & Medicaid Services (CMS). That program involves a complex mix of virtual and in-person care.
Jared Conley, MD, PhD, MPH, associate director of the Healthcare Transformation Lab at Massachusetts General Hospital and part of Mass General Brigham’s Hospital at Home program, said the Hospital at Home strategy, which encompasses more than just the CMS-approved model, has been proven to improve clinical outcomes, reduce rehospitalizations and adverse events, and cut healthcare costs. He said he anticipates this will become a standard for clinical care at home in the future.
On the other hand, collecting data from the home and working with consumers to improve their health and wellness is as-yet uncharted territory.
“Ultimately … the goal is prevention,” Conley said. But healthcare organizations don’t have the science, technology, or behavioral health background to gather and use the data yet.
Pak said the Hospital at Home movement “isn’t transformational.”
“We have to have a better understanding of where people are at their life stage,” he said.
Pak, noting that many “amazing innovations [turn into] siloed point solutions that never get integrated,” said healthcare organizations have to learn how to use the home and all that it offers for healthcare transformation. Some 60% of care costs are tied to a patient’s lifestyle, he added, and yet only about 3% of the money spent on healthcare is tied to behavior change.
“The data to date has not given us the linkage” of lifestyle to chronic diseases and care management, he said.
Ed Miller, chief technology officer for the Center of Medical Interoperability at the Connectivity Standards Alliance, said the industry needs to develop standards so that home-based devices and smart technology can share data with healthcare organizations. The technology itself isn’t an issue, he added, but creating pathways for hospitals and health systems to gather and use that data is.
Saxon called it a “profound cultural drive.” Health systems and hospitals are very good at delivering healthcare, she pointed out. But they aren’t skilled at working with consumers to manage health and wellness.
Enter the disruptors, who know how to reach consumers in their homes.
“Given our reliance on digital health, we cannot do this alone,” Conley pointed out. “There’s a huge opportunity to collaborate.”
Healthcare has “a horrible customer experience,” added Saxon. “Who’s good at that? Amazon and Apple are good at what they do. Consumers are going to expect that.”
Healthcare organizations “aren’t going to be the jailbreakers,” she said. “It’s just too much to ask of a busy health system.”