Elevance Health announced at CES that it will give free smartphones to Medicaid program members to help them access healthcare services
Elevance Health is addressing a critical care gap for its underserved members by giving them a smartphone to connect with healthcare resources.
The Indianapolis-based insurer formerly known as Anthem, which announced the program at CES 2024 this past week in Las Vegas, is targeting a Medicaid population that faces barriers to accessing the care they need. According to Elevance, roughly one quarter of American households making $30,000 or less a year aren’t using a smartphone, and 43% don’t have home broadband internet access.
"The lack of sufficient internet connectivity and technology access remains a significant barrier for many – increasing health inequities," Kurt Small, president of Elevance Health’s Medicaid business, said in a press release. “This program aims to directly address this challenge and helps improve the health of the people we serve.”
The program targets a glaring care gap that both payers and healthcare organizations are trying to address through digital health and telemedicine. Consumers who have trouble accessing care often end up in a clinic or hospital later on with a serious health issue that could have been prevented, and which now will cost more to treat and affect long-term clinical outcomes. That, in turn, puts stress on Medicaid and Medicare programs that support those populations.
CES, through its Digital Health Summit, often focuses on using consumer technology to close gaps. This year’s summit track and exhibit halls featured a wide variety of strategies and technologies aimed at helping consumers monitor their health and connect with care providers at the time and place of their choosing.
Elevance Health is targeting the root of the problem: Communication. The company is offering qualified members on Medicaid programs a smartphone with unlimited data, talk, and texting services, as well as customized access to healthcare resources, both digital and virtual, and instructions on how to use the phone.
“Increased availability of digital technologies, such as a smartphone, as well as fast, reliable internet is critical to supporting a person’s health journey," Omid Toloui, Elevance Health’s vice president of innovation, said in the press release. “We believe the digital tools and the custom, curated experience offered through this program can help improve health, make healthcare more affordable, and serve people more equitably.”
The program is supported with funds from the Federal Communications Commission’s Affordable Connectivity Program (ACP) and offered through partnerships with Verizon, Samsung, AT&T, and T-Mobile.
Mark Cuban and Glen Tullman are two of the many disruptors aiming to make healthcare more convenient for consumers. Their advice to healthcare execs: Do more by doing less
As CES 2024 winds down, the message to healthcare executives is simple: Do more by doing less.
The healthcare industry has become too complicated, frustrating patients and stressing out doctors and nurses. As a result, consumers are looking elsewhere for their healthcare, to retail companies, pharmacies, and online companies that promise convenience and transparency.
“You need to start questioning the long-held beliefs of the way you thought things needed to be done,” billionaire investor and businessman Mark Cuban said during a closing session of the two-day Digital Health Summit.
In other words, healthcare executives need to find a way to cut through the complexity and return to the simple process of health and care. And technologies like digital health and AI will help them make that transformation.
Cuban, who launched the Cost Plus Drug Company in 2022 to give consumers access to generic medications, shared the stage at CES with Glen Tullman, the former Allscripts executive who now heads the integrated healthcare benefits company Transcarent. The two are part of the growing ranks of disruptors aiming to make healthcare more consumer-friendly.
Their appearance capped two days of sessions on the value of consumer-facing digital health technology to address a healthcare ecosystem that many say is broken. Advocates say digital health tools like AI can take on some of the industry’s biggest pain points by automating tasks, improving workflows and boosting clinical outcomes.
The challenge is in getting health system executives and payers to take notice. Few made it to Las Vegas this week, giving attendees just a few examples of how health systems are using technology to improve operations and little evidence that payers will pay for it.
Tullman, who launched the successful digital healthcare startup Livongo prior to developing Transcarent, said the industry needs to focus on the consumer experience, embracing new technologies and ideas that make it easier for the consumer to access healthcare at the time and place of their choosing. Technology, he said, should be the foundation of that experience.
“But if people are talking about the technology, that’s a problem,” he added. “Look for technology to simplify things rather than [produce} complications,”
That’s one reason that AI is such a hot topic, at CES and elsewhere. Health systems and hospitals are embracing the technology as a means of reducing administrative and data-intensive tasks, giving clinicians more time to focus on healthcare delivery and giving consumers an easier path to that care.
“There are many practical uses,” said Tullman, whose company has developed an AI tool called 10X—designed, he said, “to make physicians 10 times more proficient.” He predicted AI would “simplify the paperwork” and “improve the quality of the experience.”
Cuban said AI will change the entire healthcare industry, and he predicted “millions” of models and applications. It will, he said, democratize healthcare.
Both said the key to the transformation of healthcare lies in putting healthcare in the hands of the consumer. If health systems and hospitals are slow to make that adjustment, they’ll lose patients to the disruptors who are making the experience more convenient and less costly.
Cuban told a story about his son needing an MRI. Through their health plan, that MRI would cost roughly $2,000. Cuban called the doctor’s office and asked for the cash price, and was told the MRI would cost $470. Some providers, he pointed out, would prefer cash in hand rather than going through the process of scheduling and billing.
“Healthcare is more confusing, more complex, and more costly than ever before,” Tullman added.
As health system execs attending CES 2024 talked of using AI to address specific challenges, the FDA commissioner pointed out that the technology will fundamentally change how healthcare is delivered in the future.
Healthcare executives are in uncharted territory, due to the speed at which AI is evolving. And with that progress, health systems and the federal government are going to have to continually adjust how the technology is governed.
“The assessment of the algorithms needs to be continuous,” US Food and Drug Administration Commissioner Robert Califf, MD, told a packed room during a session Wednesday at the CES 2024 show in Las Vegas. In fact, he added, post-market evaluations of new tools may be more important than pre-market evaluations.
“It’s a different world,” the FDA commissioner added. “The changes are dramatic. … We can see the time when [healthcare] is going to be guided and assisted so much more by algorithms and AI.”
As the massive consumer technology show continues this week, AI is dominating the many exhibit halls and the discussion around the two-day Digital Health Summit, which runs through today. Aside from getting a glimpse at new advances in smart health technology—from smart toilets and bathrooms to smart beds and pillows to more refined wearables and sensors—healthcare execs who braved the typical Las Vegas chaos talked of how AI is already being used to address key pain points like administrative overload, stressed out providers, and siloed care.
“This stuff is so powerful,” Lee Schwamm, MD, chief digital health officer at the Yale New Haven Health System and associate dean of digital strategy and transformation at the Yale School of Medicine, offered during a panel discussion. “Health systems are just now trying to figure out what the business model will be.”
Sara Vaezy, EVP and chief strategy and digital health at Providence and a panelist at the upcoming HealthLeaders AI NOW Virtual Summit later this month, said her health system is working on four distinct AI demonstration projects in a partnership with Microsoft, primarily around automating tasks that affect the clinician workload and improving self-service options for patients.
“It’s just too expensive to deliver care in the way that we normally have,” she said.
Both she and Schwamm pointed out that the use of AI in healthcare will be different than in other industries, primarily because of the inclusion of patient data. Health systems and hospitals need to plan carefully to protect that information, since so much of AI depends on using data to make decisions and advance processes.
“This is a very special space,” Schwamm pointed out.
Califf, whose appearance at CES was as part of the government and policy track, also pointed out the intricacies of healthcare. He noted the industry is gradually shifting from episodic to value-based care, where not just immediate outcomes but long-term outcomes are valued.
“In order to make it work you’ve got to [focus on] complete outcomes,” he said.
Califf said he’s excited about how AI will factor into healthcare in three distinct venues: The home, where more care is being delivered and more patient data is being collected; the operating room, where robotics and digital health are changing how surgical procedures are done; and the clinic, where providers are learning how to use technology to develop care management and coordination plans that surround the patient and become part of his or her journey.
He also noted the advance of wearables, which are becoming more sophisticated, and the rapid pace of development for adaptive AI models such as ChatGPT.
“The chance to learn through algorithms is the basis for so many things we take for granted in life,” he said.
Health Condition Programs gives consumers convenient and virtual access to care management and other services to address chronic health conditions like diabetes and hypertension
Amazon has launched a new service aimed at helping consumers manage their chronic conditions.
Health Condition Programs, which was unveiled on January 8 during the JP Morgan Conference, gives the online retail giant a significant platform in the healthcare space—and another reason for healthcare executives to fret about competition from disruptors. The service gives consumers a virtual link to a personalized care team to help manage their health.
“Amazon wants to make it easier for people to get and stay healthy, and part of that is making it easier to discover the products, services, and professionals that can help them do that,” Aaron Martin, Amazon’s vice president, said in a press release issued by Omada Health, a digital health company that is partnering with Amazon to offer diabetes prevention and care and hypertension care services through the new platform. “Many aren’t aware of the healthcare benefits they are eligible for, that are typically no cost or subsidized by their employer or insurance plan. When customers are shopping for health-related products on Amazon, we can surface these benefits to provide even more support in improving their health, at no additional cost.”
Amazon will partner with companies like Omada Health to cover a wide range of chronic health conditions, creating a care management path that would traditionally be handled by one’s primary care doctor or health system.
The company matches consumers to the appropriate care team based on their online searches and shopping history. Consumers accessing the program can first find out if their employer or health plan covers the Health Condition Program; if the program is covered, the consumer can then access services such as virtual visits, health coaching, remote patient monitoring, and access to online forums and other resources.
The program gives consumers convenient and virtual access to care management, an option to the often complicated task of scheduling appointments with primary care doctors and specialists and visiting doctors’ offices or clinics.
“This partnership is pivotal for Omada, as we are leveraging Amazon’s wide reach to literally meet consumers where they are, just as we do for our members as a virtual-first care provider,” Omada Health CEO and Co-Founder Sean Duffy said in the press release. “Ultimately, the more people we’re able to reach, the larger impact we can have on the rising prevalence of chronic disease.”
The platform gives healthcare executives yet another reason to develop virtual care programs to compete with the disruptors, focusing on convenient access to a trusted healthcare provider or health system.
While much of the focus at CES is on innovative technology, a policy panel on the first day of the event discussed how the government can shape AI standards
With innovation on full display at CES this week, one of the more compelling panel discussions on the first full day focused on the intersection of technology and policy. And the general consensus was that collaboration is best.
“We’re definitely seeing the right incremental steps being taken,” said Matthew Hine, a senior international trade specialist in the Office of Health Industries, part of the U.S. Department of Commerce’s Industry and Analysis business unit.
To wit: The Biden Administration has been focused so far on working with the healthcare industry to develop AI policy, particularly around standards and guidelines. And health system executives have so far said they’re moving cautiously but firmly forward, using the technology where they can but making sure a human still makes the final decision when clinical care is concerned.
Congress isn’t in the loop on developing policy, though some lawmakers have called for more of a say on the matter. And that’s OK with Conor Sheehy, a senior health policy advisor for the minority staff of the Senate Finance Committee.
“It’s not an area where Congress, to my mind, has shown a great deal of expertise … or understanding,” he pointed out.
Both Sheehy and Marisa Salemme, a senior health policy advisor for the majority staff on the Senate Finance Committee, agreed that lawmakers on both sides of the aisle have been in agreement on supporting the use of innovative technologies, such as virtual care. The hope is that Congress will push through a logjam of healthcare-related bills this year, giving health systems more opportunities to use technology.
But the challenges remain. Healthcare is still focused on reimbursing providers for episodes of care, and is only moving slowly towards outcomes-based care. And providers won’t embrace new technology if they’re not incentivized to use it. To that end, both the government and Congress need to come together on incentives that will spur the use of innovative technology.
How or when that happens remains to be seen. And some parts of that conversation are expected to be picked up on Wednesday with the opening of the Digital Health Summit, as well as in a special panel session featuring FDA Commissioner Robert Califf, FTC Commissioner Rebecca Slaughter, and FCC Commissioners Brendan Carr and Anna Gomez.
That’s also why health system executives aren’t flocking to CES to take in the latest innovations in consumer technology, and are instead keeping tabs on the technology from afar. New technology and ideas need room to grow into healthcare, and that isn’t happening at a time when operating margins are thin and hospitals are struggling to stay afloat.
Many of the companies exhibiting in the digital health space at CES have said they’re talking with health systems about small pilot programs, but the key to adoption lies in support from the payers, especially the Centers for Medicare & Medicaid Services. CMS has been traditionally hesitant to embrace new technology like telemedicine and digital health, thougn the gradual move toward reimbursing for remote patient monitoring tools and services has spurred some hope.
“Medicare reimbursement would be huge,” said Aaron Labbe, co-founder and chief technology officer for LUCID Therapeutics, a company that develops music-based treatments for providers and is talking to health systems about using the technology in everything from pediatric care to the ICU. “We need their support.”
A study released today by researchers at Mass General Brigham focuses on the safety and quality of care in the Hospital at Home program, which will be discussed in at least one panel session at this week’s CES 2024 show in Las Vegas.
Advocates are touting a first-of-its-kind national study of Hospital at Home outcomes to convince the Centers for Medicare & Medicaid Services to make reimbursements permanent.
The study, led by researchers at Mass General Brigham and funded by the National Institutes of Health, analyzed clinical outcomes for almost 5,900 patients who were treated in CMS-approved Acute Hospital Care at Home (AHCaH) programs across the country. The research, posted today in theAnnals of Internal Medicine, found that those patients saw a lower mortality rate than if they were hospitalized, incurred fewer rehospitalizations, and spent less time in a skilled nursing facility (SNF).
More than 300 health systems and hospitals have launched Hospital at Home programs since CMS created a waiver for the program in 2020, enabling health systems who follow the agency’s guidelines to qualify for Medicare reimbursements. Other health systems have developed their own acute care at home programs, aimed at reducing stress on inpatient services and giving patients an opportunity to recover more quickly and effectively at home.
The study helps advocates who are lobbying CMS to make the AHCaH waiver, which is scheduled to expire at the end of this year, permanent. Many health systems are dependent on the waiver to sustain their programs, and are struggling to expand or develop long-term plans with the threat of losing that reimbursement.
The Mass General Brigham study was led by David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, one of the first to develop an acute care at home program and study its benefits.
“For hundreds of years, since the inception of hospitals, we’ve told patients to go to a hospital to get acute medical care,” Levine said in a Mass General Brigham press release issued today. “But in the last 40 years, there’s been a global movement to bring care back to the home. We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
Levine and his colleagues analyzed Medicare fee-for-service Part A claims filed between July 2022 and and July 2023 for 5,858 patients across the country who had been treated in AHCaH programs. Of that group, roughly 42.5% were being treated for heart failure, 43% for COPD, 22% for cancer, and 16% for dementia. The mortality rate for that group was 0.5%, the escalation rate (returning to the hospital for at least 24 hours) was 6.2%, and within 30 days of discharge, 2.6% used an SNF, 3.2% died, and 15.6% were readmitted.
“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.” Levine said in the press release. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
Levine also noted that the study found no differences in outcomes for underserved patients, indicating the program could help address some of the barriers that patients face in accessing care.
“There are a number of reasons we think hospital-level care is better at home,” he said. “For one, the discharge process is smoother since we show patients how to take care of themselves right in their homes, where they are also more likely to be upright and move more. In addition, the clinical team has a greater ability to educate and act on the social determinants of health that we see in the home. For example, we can discuss a patient’s diet right in the kitchen or link a patient with resources when we see the cupboards are bare.”
Levine’s colleague, Jared Conley, MD, PhD, MPH, associate director of the Healthcare Transformation Lab at Massachusetts General Hospital, said during a HealthLeaders virtual summit in 2023 that the Hospital at Home program could eventually surpass inpatient care as the highest quality acute care program. The challenge, he said, lies in balancing in-person care with virtual and digital health technology to achieve the best results.
"Think of this as building another brick-and-mortar hospital," he said. "It is very challenging work, but it is so beneficial."
The Hospital at Home concept will be discussed during a panel at this week’s 2024 CES event in Las Vegas. Conley will be taking part in a Thursday panel titled Revolutionizing Health Through Smart Home Innovation, which will be moderated by HealthLeaders Senior Editor Eric Wicklund.
The annual consumer technology event, expected to attract more than 100,000 attendees to Las Vegas next week, will showcase the latest in innovative technology, as well as digital health trends affecting the healthcare industry
Healthcare executives gearing up for the 2024 International CES event next week in Las Vegas are focusing on one big question: How can I use consumer technology and digital health tools to improve the healthcare experience for my patients?
That’s always been the question for healthcare decision-makers intrigued by the massive consumer technology show, which takes over nearly every hall in the Las Vegas Convention Center and Venetian and is expected to draw 130,000 attendees this year. But while healthcare has long been overshadowed by cars, games, entertainment systems, and the odd robot and smart birdfeeder, digital health is now an integral part of the show, with its own space and session track.
The challenge lies in identifying the trends and technologies that hold value for healthcare executives, not just the latest and most innovative gadgets for consumers that a hospital or doctor might like to use. Health systems have long sought to integrate clinical uses with consumer technology to spur adoption and continued engagement, with often mixed results.
That’s especially true in this economy, which leave little room for innovation.
“CES is an opportunity for these digital health innovations to shine brightly in a dark moment in medicine as we face more hospital closures, high rates of clinician burnout, and increasing demand from consumers for a better experience,” Arielle Trzcinski, a principal analyst with Forrester, said in an e-mail to HealthLeaders.
Among the hot topics are, of course, AI, digital health apps, wearables, remote patient monitoring (RPM) tools and platforms, and smart technology in the home setting, a highlight of two concurrent events at CES, the CONNECTIONS Summit hosted by Parks Associates and AARP’s AgeTech Summit. The latter will feature the Samsung Health House, a smart home designed by Samsung in collaboration with AARP to show how seniors can age in place in the future.
“As medical deserts emerge for consumers, there is a growing opportunity for health systems and health insurers to tap into remote monitoring and wearables to empower consumers and keep them connected to much needed care,” Trzcinski added.
For healthcare execs focused on digital health, CES is bringing back its Digital Health Summit, a series of panels taking place Tuesday and Wednesday.in Room 250 of the Las Vegas Conference Center’s North Hall:
Other events of interest for healthcare executives include keynotes by the CEOs of Siemens, Walmart, Intel, Elevance Health, Qualcomm, and Best Buy, along with the CES Innovation Policy Summit, which includes a session titled Can Policy Affect Health Innovation? , a panel on AI governance around the world, and a special series of interviews, called “Conversations with a Commissioner,” that includes FDA Commissioner Robert Califf, FTC Commissioner Rebecca Slaughter, and FCC Commissioners Brendan Carr and Anna Gomez.
And finally, CES gives healthcare executives an opportunity to see where innovation is going in the consumer tech space, even if it is a bit far-fetched for hospitals and health systems at this time. They can look at unique ideas such as smart toilets, toothbrushes and home appliances, footwear and apps that track gait and balance, digital health tools for veterinarians, wearables, health and wellness apps, new sensors that track biometric data, and AR and VR tools.
New research from the Regenstrief Institute gives health system executives specific recommendations on how to use their EHRs to help clinicians identify and prescribe drugs to their patients.
New research out of the Regenstrief Institute gives health system executives specific recommendations on how to use EHRs to reduce dangerous drug-drug interactions.
“Drug-drug interactions are very common, more common than a lot of people outside the healthcare system expect,” Michael Weiner, MD, MPH, a researcher with the US Department of Veterans Affairs, Regenstrief Institute, and Indiana University School of Medicine and senior author of the study, said in a press release. “In the US, these interactions lead to hundreds of thousands of hospitalizations in any given year at an enormous cost. Most of these drug interactions are preventable.”
With the advent of EHRs and digital health technology, health systems are looking to reduce those interactions by pinpointing when they can occur and giving clinicians on-demand access to information to prevent them. But that technology depends on understanding how clinicians prescribe drugs and how they look for dangerous interactions.
“This study was needed because we previously didn’t have a great understanding of how clinicians actually make decisions in assessing these interactions,” Weiner said. “No one had really taken apart the thinking process step-by-step to understand it from the beginning to the end. There's a patient, there's a drug and another drug. There is now a potential interaction. There's been a decision about how to resolve it following an assessment and then a resolution process. Understanding all this is very important if we are hoping to design improvements to the medical system that enhance patient safety.”
The study, recently published in BMJ Open, identified 19 information cues used by clinicians to manage drug-drug interactions, including information on the potential severity of a drug reaction, side-effects, a patient’s expected duration of exposure to an interaction, patient-specific conditions, a patient’s need for those drugs, and the characteristics of safer medications. Using that list, Weiner and his colleagues developed recommendations for designing alerts through the EHR.
They are:
Provide information on the expected range of timing of potential drug-drug interaction effects (days, weeks, months, or years).
Give clinicians a platform to review multiple electronic drug-drug interaction reference sources directly from the alert, side-by-side.
Leverage data analytics to populate drug-drug interaction alerts with "smart" displays of alternative drugs that align with three criteria used by clinicians.
Provide recommendations on the alert along with associated patient characteristics (for example, “monitor, if patient indicates willingness and capability of measuring blood pressure daily”).
Alissa Russ-Jara, PhD, a researcher at the Purdue University College of Pharmacy and US Department of Veterans Affairs, Regenstrief Institute affiliated scientist, and the study’s lead author, said the research highlighted the fact that no two clinicians use the same protocols in assessing drug-drug interactions.
After interviewing all of the clinicians involved in the study, she said in the press release, “many … expressed surprise at how much nuance went into their own decision. Their decisions often occur so rapidly, yet involve so much expertise. Ours was the first study to really unpack that for their decisions around drug-drug interactions.”
“We expect our findings can improve the design and usability of drug-drug interaction alerts for clinicians, and so they can more effectively aid patient safety,” she added. “Our study focused on clinical decision-making, regardless of whether the clinician was warned by an alert or not, so our findings have implications for clinicians, informatics leaders, and patients, and for any EHR system.”
Faced with competition from disruptors, health systems are expanding their pharmacy services to capture additional income and improve clinical care
Amid increased competition from disruptors and retail chains, health systems are expanding their pharmacy operations beyond the hospital, in some cases building stand-alone community pharmacies or co-locating them with clinics to compete directly with the likes of Walgreens, Rite Aid, and CVS.
“It’s a huge opportunity,” says Rebecca Taylor, vice president of the pharmacy service line at UPMC, which now has 17 pharmacies within its network, some located inside clinics. “Ambulatory pharmacies have been around for a long time, but there are a lot of factors that are driving this new opportunity” for health systems to expand their reach.
With intense competition in the healthcare space, health systems are seizing on the opportunity to expand pharmacy services as a means of improving the scope of services they provide to patients. Many want to keep the patient within the hospital’s network, integrating all healthcare services through the medical record, a strategy that segues into the concept of value-based care and the medical home.
Others see the pharmacy as an attractive business line. Through the 340B Drug Pricing Program, health systems can be reimbursed through Medicaid for outpatient drugs sold to uninsured and low-income patients. They’re also looking to capture more specialty pharmacy services and prescriptions lost to neighborhood and community pharmacies, not to mention the profits from other goods and services sold through a retail location.
And while neighborhood and community pharmacies are looking to adopt more healthcare services and become community health centers, they’re also struggling. Rite Aid has filed for bankruptcy, while Walgreens and CVS are closing hundreds of stores, leaving communities without that resource for filling prescriptions. Health systems can fill that gap with their own pharmacies.
Making an Argument for Pharmacy Expansion
Nicole Faucher, MS, president of Clearway Health, a Massachusetts-based company spun out of Boston Medical Center that partners with health systems and hospitals to strengthen their specialty pharmacy programs, says health systems have three primary reasons for expanding their pharmacy services:
Creating a new service line. When patients fill their prescriptions at a local pharmacy, they’re taking business away from the hospital. A health system can keep that business in-house with its own pharmacy service, as well as influencing the patient to consider more health and wellness services and products.
Improving clinical outcomes. By keeping pharmacy services in-house, a health system can link all of those services through the medical record, ensuring continuity of care and reducing gaps in care or siloed services. In addition, the pharmacist becomes an integral part of the care team and the care management plan, improving medication adherence and helping patients with any medication-based issues that might otherwise be delayed or go unanswered.
Improving patient loyalty and engagement. Health systems that include pharmacy services are seen by patients as being more attentive to and involved in care management and coordination. That patient will be more likely to stay with the health system, listen to advice on other services and resources within the health system, and recommend that health system to family and friends.
The decision to expand pharmacy services can’t be taken lightly. These projects are expensive, and they require plenty of research and planning. One look at how Walgreens, Rite Aid, and CVS are doing right now with the healthcare ambitions would be enough to scare anyone away.
“This isn’t just ‘Build it and they will come,’” warns Faucher, who says health system leadership needs to think long and hard about whether to take this on.
Among the considerations that go into planning a pharmacy expansion:
Understanding the patient population and community. Will patients shift their allegiance from local pharmacies to a hospital-run pharmacy?
Site selection and staffing. Will a stand-alone pharmacy work, or should these services be co-located with a clinic, medical offices, or other programs? Building and/or rental costs will figure prominently in this strategy, as will costs for staffing a stand-alone pharmacy.
Delivery. Will this be a traditional pharmacy that handles over-the-counter and walk-in traffic, or will it be strictly mail-order? If the latter, how will deliveries be handled? If the former, will the pharmacy handle prescriptions only or offer other goods and services?
Contract negotiations. A health system will need to handle contracts with pharmacy benefit managers (PBMs), payers, and health plans, along with any delivery services. In addition, there will be contracts with drug distributors to consider.
Sustainability. How much business will a pharmacy need to generate to be sustainable? This will determine what other services or products are offered.
Alongside managing the aspects of a 340B program, Faucher says a health system must also decide how to manage business with other pharmacies. Some 15% of all prescriptions involve medications that are handled by specialty pharmacies.
“There really isn’t a one size that fits” for every health system, she says.
Addressing Both Clinical and Business Goals
At Signature Healthcare, based in southeastern Massachusetts, the decision to expand pharmacy services addressed both clinical and business goals. A significant percentage of the health system’s patient base are members of government health plans, making the 340B program an attractive addition to their bottom line.
“We make a little more of a margin on that,” says Stephen Borges, Signature’s vice president of financial operations.
But the health system also wants to create a more connected health experience for its patients, many of whom are underserved, he says. That means adding pharmacy techs in critical care units, medical offices, and clinics to be part of the care team, and locating a retail pharmacy in their largest physician office building near the hospital.
“We’re reinventing care for our patients,” Borges says.
Signature Health had partnered with the local Walgreens chain prior to this change in strategy, even enabling Walgreens pharmacists to come into the hospital to meet with patients before they were discharged. But there were still gaps in care, he says, that comes with having two separate organizations try to care for the same patient.
“We want our pharmacists to have the ability to do more with our patients,” Borges says. That includes creating a patient assistance program to work with patients who struggle to pay their bills and find other ways of meeting prescription costs.
One of the challenges to implementing this new strategy was getting buy-in from physicians who might not see the pharmacist as a member of the care team. Borges says it took some time and effort to get everyone comfortable with each other; he credits the successful integration to the work of physician champions identified ahead of time by the health system.
Another challenge was getting support from patients who have always gotten their prescriptions filled at the local pharmacy.
“We didn’t anticipate that it would be so hard to convince people to move away from CVS and Walgreens,” Borges says.
Addressing the Patient’s Needs
At UPMC, Taylor says expanding the health system’s footprint to include more pharmacy services gives them the chance to have a greater impact on clinical outcomes.
Pharmacists who are part of the health system and the care team, she says, can work with providers and patients to fine-tune medication management, identifying potential drug reactions and alternatives to costly medications. They can answer patient questions that might not be asked in a separate pharmacy, work with patients who have trouble paying for medications, and collaborate with doctors when a patient struggles with medication adherence or displays adverse effects to taking a certain medication. They can also help the health system with vaccinations and other public and community health outreach programs.
Taylor says the additional service line also enables UPMC to attract and hire skilled pharmacists, especially those who’d prefer to work with a health system rather than a retail pharmacy.
Studies back up the idea that the pharmacist—regardless of whether he/she is employed by the hospital or another company--should be part of the care team. Recent research done at Virginia Commonwealth University found that pharmacists could prevent more than 15 million heart attacks and nearly 8 million strokes and save $1.1 trillion in healthcare costs over 30 years if they were allowed to be more active in managing care for patients.
Taylor sees an improvement in reduced rehospitalizations. Pharmacists who are part of the care team can spot problems before they become serious, she notes, alerting physicians and enabling them to intervene while the patient is at home.
The Impact of Technology
One reason for heightened interest in the pharmacy space is the availability of new technology. Telehealth and digital health tools make it easier for clinicians and pharmacists to communicate with each other and with patients, creating or modifying care plans on the go and prescribing and filling prescriptions virtually. And with the popularity of online and mail-order prescriptions surging, health systems can also take advantage of online platforms to handle prescriptions in bulk and mail them to patients.
“That certainly makes it easier,” says Taylor. “And in the future, there will be other technologies that will make it feasible to do a hub-and-spoke model,” enabling health systems to manage distant pharmacy sites from one central location.
“Internet prescription fills have gone through the roof,” adds Borges.
A report recently issued by the Center for Connected Medicine finds that more than half of health systems with their own ambulatory pharmacies “believe retailers and technology companies are having either a moderate or strong influence on their hospital’s pharmacy strategy.”
According to the report, many health systems are planning to invest in digital health technology to improve their pharmacy services. Among the more popular platforms are integrated patient portals, prescription fills and refills and payments through an app, and medication adherence services (such as reminders).
Faucher, of Clearway Health, says the integration of patient portals and EHRs with pharmacy services gives health systems an opportunity to play a more active role in care management. Doctors can check in with both pharmacists and patients online to make sure prescribed medications are being taken and are effective, while pharmacists and patients can respond more quickly if something isn’t working.
Faucher says health systems have an opportunity to grow their business by single digits with a more aggressive pharmacy strategy, and by double digits if they adopt specialty pharmacy services. Beyond the profit margins, they have an opportunity to improve care by being more of a healthcare partner with patients who are demanding more collaboration with their care teams.
“Health systems need to have a pharmacy strategy,” she says. “This will be a continuing trend.”
Federal officials have unveiled a new strategy to address rising cybersecurity incidents. It includes incentives to improve data security, beefed-up guidelines, and the potential for cuts in reimbursement.
With cybersecurity incidents occurring on an almost-daily basis in the healthcare sector, federal regulators are looking to take a more active role in improving data security.
The Health and Human Services Department has released a new strategy for cybersecurity, centered on four steps aimed at improving the healthcare landscape. The six-page document builds off of the Biden administration’s National Cybersecurity Strategy, which was unveiled last March, and follows recent actions taken by federal agencies to boost security, including the release of healthcare-specific practices and training resources, guidance on medical device security from the US Food and Drug Administration, and new telehealth guidelines from the HHS Office of Civil Rights (OCR).
“The healthcare sector is particularly vulnerable, and the stakes are especially high,” HHS Secretary Javier Becerra said in a release accompanying the strategy. “Our commitment to this work reflects that urgency and importance. HHS is working with healthcare and public health partners to bolster our cyber security capabilities nationwide.”
The information comes at a particularly vulnerable time for the healthcare industry, which has seen an alarming increase in large data breaches and ransomware attacks in recent months. According to the OCR, the industry has seen an almost two-fold increase in large breaches from 2018 to 2022, from 369 incidents to 712, while ransomware attacks have surged 278% in that time.
“Cyber incidents affecting hospitals and health systems have led to extended care disruptions caused by multi-week outages; patient diversion to other facilities; and strain on acute care provisioning and capacity, causing cancelled medical appointments, non-rendered services, and delayed medical procedures (particularly elective procedures),” the HHS report notes. “More importantly, they put patients’ safety at risk and impact local and surrounding communities that depend on the availability of the local emergency department, radiology unit, or cancer center for life-saving care.”
With that in mind, HHS is planning to take a more active role in pushing the healthcare industry to improve its defenses. The agency plans to:
Establish voluntary cybersecurity performance goals for the healthcare sector;
Provide resources to incentivize and implement these cybersecurity practices;
Implement an HHS-wide strategy to support greater enforcement and accountability; and
Expand and mature the one-stop shop within HHS for healthcare sector cybersecurity.
Of particular note are the financial incentives that the government will be offering to health systems who need help becoming more secure. According to the report, the HHS will be launching a program to help struggling hospitals cover the up-front costs of installing “essential” cybersecurity performance goals (CPGs), and a program that offers incentives for hospitals to invest in advanced cybersecurity practices to implement “advanced” CPGs.
In addition, the HHS strategy will include new cybersecurity requirements for hospitals that will be enforced through the Centers for Medicare & Medicaid Services (CMS), an indication that the feds could tie compliance to Medicare and Medicaid reimbursements. As well, the OCR is scheduled to update the Health Insurance Portability and Accountability (HIPAA) Security Rule this coming spring to include cybersecurity requirements.
Not everyone is on board with the HHS strategy. Chris Bowen, founder and chief information security officer for ClearDATA, says the industry should get even tougher.
“While a gesture towards progress, [the strategy] falls critically short of what's imperative in today's climate,” he said in an e-mail to HealthLeaders. “Suggesting voluntary measures is akin to applying a band-aid on a hemorrhage, it's time for HHS to enforce rigorous, non-negotiable cybersecurity standards and to provide the necessary resources and mandates.”
“The sector's talent gap in cybersecurity is no secret, and it places our hospitals at a disadvantage, jeopardizing patient safety,” he adds. “We must look to the strategies of those who have robustly safeguarded healthcare data and replicate their assertive approach. Protecting lives extends beyond the physical realm; it encompasses shielding patients from the lethal threat of cyber-attacks. To accept minimum, voluntary standards is to tacitly endorse a status quo that endangers our patients.”