The Defense Department's health plan will require copays for telehealth services used by military members and their families after waiving those charges for more than two years, while continuing to allow patients and their care providers to conduct some healthcare services by phone.
Military members and their families will soon be charged copays for telehealth visits again, after more than two years of free use, but they'll be able to continue using the telehealth for certain healthcare services.
"The Defense Health Plan faces significant budget shortfalls," they said in the final notice calling to reinstate copayments. "Termination of this provision will save the DoD $4.8M for every month it expires prior to the end of the national emergency, allowing DoD to focus resources on testing, vaccination efforts, and treatment for COVID-19-positive patients."
According to the final rule, the ruling was expected to go into effect on July 1 or when the federal public health emergency expires, but the DoD now says it will set a date at a later time. The PHE is expected to expire in 2023, though that isn't certain.
Telephone calls, or audio-only telehealth services, became popular during the height of the COVID-19 crisis, when both federal and state regulators relaxed the rules to enable care providers to conduct some services on the phone. Opponents have long argued that the phone isn't a reliable technology platform for telehealth services, and that it doesn't meet the guidelines to establish a doctor-patient relationship.
With the pandemic easing, some states have put restrictions back in place on audio-only telehealth services, while others have made coverage permanent. The Centers for Medicare & Medicaid Services, meanwhile, is planning to eliminate Medicare coverage for the modality, except for certain behavioral health services, six months after the federal PHE ends.
According to the DoD, 80,451 healthcare visits were conducted by phone between March of 2020 and September of 2021. In the final rule, officials said those visits were "a small portion of all telehealth claims," but they were well-received by both patients and physician organizations, including the American Medical Association and American College of Physicians.
"Furthermore, the DoD received positive public comments regarding telephonic office visits including multiple requests for the agency to consider it as a permanent benefit," the rule noted.
The Atlanta hospital is the first in the country to receive an AI-enhanced technology platform donated by Medtronic.
Grady Memorial Hospital is using a new technology platform donated by Medtronic to improve colon cancer screening in medically underserved communities.
The Atlanta hospital was the first to receive GI Genius modules through Medtronic's Health Equity Assistance Program. The FDA-authorized technology uses AI algorithms to help clinicians detect colorectal polyps in real time.
"Gastroenterologists at Grady Memorial Hospital perform more than 7,000 colon cancer screening procedures each year among a predominantly Black community," Benjamin Renelus, MD, a gastroenterologist at Grady Hospital, said in an e-mail to HealthLeaders. "Accounting for 80% of the specialty's patient population, Black adults are disproportionately burdened by colon cancer, at greater risk of diagnosis, worse outcome, and death."
Renelus says the technology will help the hospital improve the screening rate by reducing barriers to care faced by Black and other populations.
"There are different obstacles that patients face when they seek colon cancer screenings," he said. "For some, they remain uninsured and may not be aware that they can access screening for colon cancer. At Grady Memorial Hospital, 30% of our patients are uninsured."
"For some, the barrier might be perceived cost, especially considering that the average income of a patient at Grady Memorial Hospital is $20,000," he continued. "For others, there might be a barrier of knowledge: Many may not know that 45 years old is the new recommended age for getting a colon cancer screening. Installing AI-assisted colonoscopy technology ensures that regardless of the barriers patients might face when seeking a colonoscopy, when they come here, they will benefit from technology that helps physicians to detect more cancerous lesions and polyps sooner."
According to Medtronic officials, a multi-center study conducted this past spring and published in the American Gastroenterological Association's medical journal found that AI-enhanced technology helped to improve colorectal polyp detection by some 50%.
"Considering that 90% of patients with certain types of colon cancer can beat it if caught early, the impact of missed polyps can make a dramatic difference for patients," Austin Chiang, MD, MPH, chief medical officer for Medtronic's gastrointestinal business line, said in the e-mail. "As effective as a good gastroenterologist can be while performing a colonoscopy, they are still only human. … By improving a doctor’s ability to detect polyps, AI technology has become critical in the fight against colorectal cancer for providers and patients."
Medtronic's Health Equity Assistance Program, supported by the American Society for Gastrointestinal Endoscopy and Amazon Web Services, aims to get this technology into hospitals and health systems by reducing the initial cost barrier.
The initial plan was to donate 50 modules "to facilities that face the most barriers to accessing the technology and its benefits." Officials now expect to place 133 modules in 62 facilities around the country.
Rice County District Hospital, a 25-bed critical access hospital in the heart of Kansas, is improving inpatient care and critical patient transfers with technology. Officials say the platform is a life-saver and a crucial cog to staying open.
When you're the only critical access hospital around for hundreds of miles, you'd better have the resources for treating patients in need of emergency care—or the means for quickly and effectively getting patients to the care they need.
At Rice County District Hospital in Lyons, Kansas, staff are using patient placement technology to coordinate care for both patients inside the 25-bed, level 4 hospital, and those needing to be transferred to another facility. The platform integrates local EMS and other transport services, such as helicopters and planes, with health systems hundreds of miles away who have the specialists necessary to treat a critically injured patient.
"It has been complex at times, and very stressful," says Bonnie Goans, RN, the hospital's trauma and emergency preparedness coordinator, who remembers instances where it has taken two weeks to get a patient to the right hospital. "The technology we have now is really helping to make things smoother and more efficient."
Bonnie Goans, RN, trauma and emergency preparedness director, Rice County District Hospital. Photo courtesy Rice County District Hospital.
With a population of about 3,500 in a county of only 9,500, Lyons sits right in the middle of Kansas and the Great Plains, an area that could be used as the dictionary definition of "rural." There's plenty of farmland and a few industries, including an ethanol plant. The hospital sees its fair share of farming and industrial injuries, vehicle and ATV accidents, and, like everywhere else, chronic diseases.
And it offers an ideal location to prove the value of innovative new technologies in improving healthcare access and outcomes in rural America.
Of the estimated 6,000 hospitals in the US, according to the American Hospital Association, almost 1,800, or about 30%, are in rural locations. More than 130 rural hospitals have closed over the past decade, and another 600 are at risk of closing.
Telehealth advocates have been pushing virtual technology as an avenue by which these small, remote hospitals can keep more patients in-house and improve access to services and specialists, and Goans says Rice County District Hospital has been using telehealth for a variety of services, including cardiac, pulmonary, and neurological care. But there's only so much a 25-bed hospital with a staff of about 150 can accommodate, and some patients need care that the hospital just doesn't have.
That's where technology comes in—and one's neighbors.
"That's the good thing about being in a small community," Goans says. "Everyone pitches in. Everyone helps when they can."
The hospital has one EMS crew on hand and one backup, as well as access to a few helicopters and fixed-wing aircraft. There's a level 3 trauma center 30 miles away, and a pair of level 1 hospitals in Wichita, roughly 80 miles away. But anything that takes three hours or more "is a no-go," Goans says, because it leaves the community short of resources in case of an emergency.
The old process of arranging transports focused on the telephone, and it basically meant that anyone with hands free would place calls to (a) find the necessary transport and (b) find the right location. Now the information is pulled out of the electronic health record and fed into a platform that scans available health systems for the right clinicians and an available bed, while making sure transportation is available.
"A lot of times in the past it was your doctor making the phone calls because the nurses were busy doing something," Goans recalls. "And there were lots of calls to make. You needed the right doctor at the right hospital, and you needed a room available, and you didn't stop until you had the room. Then it was a race to get the patient on the road" to get to that hospital before that room was taken.
'We were used to being accepted. And suddenly that went away.'
The catalyst for change was the pandemic. That, combined with a nationwide shortage of staff, created a crisis.
Suddenly every hospital was at or near capacity, and everyone was scrambling to find a bed. Hospitals across the state (and the nation) struggled not only to support and care for patients with the virus, but also to care for patients with other health concerns who had to be kept separate from infected patients, while also taking steps to shield doctors and nurses from COVID-19. One news report estimated that nearly 80 patients in Kansas alone died waiting for a hospital bed.
"We were used to being accepted" for a patient transfer, Goans says. "And suddenly that went away."
The pandemic pushed state officials to invest in technology and resources allowing health systems to coordinate care. The state's Department of Health and Environment and Department of Emergency Medicine signed and then extended a contract with digital health company Motient to create a network enabling more than 110 of the state's hospitals and correctional facilities to use the company's Mission Control platform to coordinate transfers.
"In terms of preventative healthcare and resource redeployment, the wealth of data that will come out of a statewide program like this will be invaluable in a few years," Alana Longwell, MD, the chief medical officer at Newman Regional Hospital, a 25-bed critical access hospital in Emporia, about 160 miles from Rice County District Hospital, said in a 2021 press release announcing the contract extension. "We started using the platform to find beds, and now we use it for more than 90% of our transfer patients. The platform lets us slice and dice our data around time-critical diagnoses to help us increase efficiency and improve our transport processes."
At Rice County District Hospital, Goans says the platform reduced the frustration level of staff almost instantly. Doctors are now able to spend more of their time with patients, while nurses handle all of the transportation details, while phone calls are only made to make sure everything is in place.
Goans says the platform allows the hospital to run more smoothly, managing inpatient resources as well as transfers, and gives administrators the data needed to stay on top of things. For a small hospital with razor-thin margins, battling a staff shortage that's affecting the entire country, those capabilities are key to ensuring the right staff are in the right place.
"This does help us to manage care better, and in some cases, keep more of our acute care patients," she says. "Our doctors are practicing at the top of their license now, rather than making phone calls … and we are identifying delays [and gaps] in care that can be corrected more quickly."
The platform also facilitates telehealth and other digital health services, opening the door to more care opportunities on-site and collaborations with larger hospitals and health systems. That's crucial for small hospitals like Rice County District Hospital that aren't going to be expanding any time soon and need to make do with what they currently have at their disposal.
"There will always be a need to transfer patients," Goans says. "That won’t go away." But they can make sure those transports are quick, efficient, and necessary.
Goans expects to use more telehealth and digital health tools in the future to improve care in the hospital and surrounding community. And she has her eye on some new technology as well.
Healthcare is a busy space, with lots of new companies trying to gain a foothold. A new referral network launched by NeuroFlow, bringing together several innovative services onto one platform, may be the answer for health systems looking to expand their behavioral health resources.
The shifting sands of the healthcare sandbox have attracted new players, as telehealth companies, payers and retail giants like Amazon and Google all look to compete for healthcare dollars. But while the line between a vendor and a provider gets murkier, new strategies are emerging that emphasize collaboration rather than competition.
One such example is NeuroFlow, a Philadelphia-based digital health company that has worked in the past with large networks like Jefferson Health and Magellan Federal. Recognizing that the behavioral health service they offer is just one part of the puzzle, the company launched a referral network this past July with a group of similar companies offering behavioral health services. The idea was the create a digital health platform that could be accessed by consumers looking for help as well as health systems seeking resources for their providers and patients.
"The impetus for the referral network is to improve access to behavioral healthcare for all populations, streamlining the relationship between providers and technology platforms, as the adoption of new tools continues to accelerate in the industry,” Chief Executive Officer Chris Molaro said in a press release announcing the partnership with LifeStance Health, Array Behavioral Care, Brightside Health, and Marvin.
“The formation of these referral partnerships will complement the needs of the existing – but evolving – healthcare infrastructure," he added. "Bottom line: if someone needs to see a licensed mental healthcare professional, we will ensure that it happens when it's needed, whether in-person or remotely.”
To understand how this type of platform might be a resource for health system leadership, HealthLeaders sat down for a virtual chat with Parker Reynolds, NeuroFlow's head of strategic partnerships:
Q. How do you choose the healthcare organizations with which you want to partner?
Reynolds: All partners are companies whom we believe have strong clinical expertise and good user experiences. When choosing partners we tried to maximize for a breadth of insurance and state eligibility as well as a breadth of conditions and severities covered. Together, these companies have behavioral health providers in all 50 states and across a variety of health insurance options, and we are in active discussions with several other companies.
Q. Are organizations more receptive to partnerships these days?
Reynolds: I think you’re going to get a different answer from every company, but from NeuroFlow’s perspective, we’re definitely encouraged by the conversations we’re having and alliances that have been formed. Organizations are seeing a need to have connected resources for their patients/members to increase utilization and minimize confusion. There needs to be more education in the market about what technologies are available to providers, and this is one way to achieve that. By aligning these partners, we are helping to dismantle the bureaucratic notion of a patient needing to be 'in network' to receive the right care at the right time. This model allows for different partners to be activated for specific, tailored patient care.
Q: As evidenced by the recent Amazon-One Medical news, competition is increasing in the healthcare space. How do you address that?
There is a healthy competition in the industry as a whole, but Amazon still has a long road ahead. An acquisition comes with a lot of serious, hard to answer questions. For example, what’s the best way to integrate behavioral health into the primary care clinics One Medical owns? This will have massive implications, many which are still unknown.
Q: Has the pandemic changed how healthcare organizations view these partnerships, or how they address access to care for those facing barriers?
Reynolds: I think partnerships like this are a reflection of the industry’s willingness to collaborate and support the various operational needs of healthcare providers today – from large systems to clinics, and even government organizations. We know that the pandemic accelerated the use of digital tools for things like behavioral health care screening. But these partnerships help create a more palatable way for organizations to approach behavioral health integration for the first time.
Q: How will these types of referral networks evolve? What more can they do or what other networks can be created?
Reynolds: We plan to continue to expand our partnerships into more specialty condition areas. For example, chronic pain, OCD, and substance use. Additionally, we will continue to evolve existing partnerships through deeper technical integrations to enable more seamless user experiences that ensure all providers have a complete picture of patient care.
Q: Are large health systems or hospitals interested in these types of arrangements?
Reynolds: We have seen that even large health systems who have their own in-house behavioral health resources are still facing capacity constraints and are open to partnerships to help with segments of their population. Furthermore, these partnerships are not exclusive and by building out the infrastructure and processes, we are able to more effectively triage individuals into the right care providers within the system.
The pharma giant has unveiled DTx Connect, which will enable clinicians to prescribe, through their EMR platforms, select digital health treatments and manage care and adherence.
Pharma giant AmerisourceBergen is jumping on the digital therapeutics bandwagon, with plans to create a platform through which healthcare organizations can access and prescribe novel digital health treatments.
The Pennsylvania-based drug wholesale company this week announced the launch of DTx Connect, an ordering, dispensing, and fulfillment platform designed to help both prescribing clinicians and the growing ranks of digital therapeutics companies offering digital health alternatives to the traditional standard of medication or in-person care.
“While digital therapeutics and diagnostics offer tremendous potential, addressing challenges across the provider workstream and patient journey remain critical to unlocking the value these products have to offer,” Jason Dinger, SVP of Strategy and Innovation at AmerisourceBergen, said in a press release. “Given our role in the supply chain and our portfolio of commercialization services, we are uniquely positioned to build a solution that aims to address unmet needs and helps patients start and stay on physician-ordered products. DTx Connect, in addition to AmerisourceBergen’s patient support and market access consulting services, enables us to deliver enhanced support across the product lifecycle, helping to advance accessibility.”
As defined by the Digital Therapeutics Alliance, digital therapeutics are software-based interventions delivered directly to the patient to treat, manage or prevent a wide range of disorders and diseases, including behavioral health concerns and chronic conditions. Officials say the US market is expected to grow roughly 25% per year through 2030.
The service is designed to integrate with electronic medical records (EMR) platforms, enabling clinicians to ePrescribe through the EMR. With patient engagement technology developed by Twistle, the DTx Connect platform delivers a welcome message to the patient on behalf of the care team via text or a patient portal, along with a link to download the digital therapeutic product and access educational resources.
The platform also enables the care team to text, call, or deliver messages through a companion app to ensure proper use and engagement, along with adherence monitoring, and it allows for patient status alerts, including notifications for patient fulfillment.
Several digital health companies plan to offer services on the platform, according to AmerisourceBergen executives, including pediatric behavioral health company Cognoa, chronic care management company Mahana Therapeutics and Videra Health, which offers AI-assisted video assessment and remote patient monitoring services.
By a near unanimous vote, the US House of Representatives has passed a bill expanding telehealth access and coverage for Medicare services until the end of 2024, while making those flexibilities permanent for FQHCs and RHCs. The bill now goes to the Senate.
Congress is halfway toward extending telehealth flexibilities enacted during the pandemic until the end of 2024.
The US House of Representatives this week passed the Advancing Telehealth Beyond COVID-19 Act of 2021 (HR 4040) by a 416-12 vote, sending the issue on to the Senate. The bill, introduced more than a year ago by US Rep Liz Cheney (R-Wyoming), expands the definition of "originating site" to allow more locations to use telehealth, eliminates facility fees for new sites, expands the list of healthcare providers able to use telehealth, adds audio-only telehealth to the definition of "telecommunications system," and makes permanent the ability of federally-qualified health centers (FHQCs) and rural health clinics (RHCs) to use telehealth under the Medicare program.
These flexibilities were put into place by the Centers for Medicare & Medicaid Services (CMS) at the onset of the COVID-19 crisis to help healthcare organizations expand access to and coverage of telehealth services, with the caveat that they be terminated at the end of the public health emergency (PHE). The bill's goal is to give providers a better idea of how long they have to use those flexibilities before they either end or Congress takes more action.
The bill's passage drew immediate praise from the American Telemedicine Association (ATA) and its lobbying group, ATA Action.
“Today, we took a significant step forward in providing much needed stability in access to care for millions of Americans, with the US House vote to extend key telehealth flexibilities implemented during the COVID-19 Public Health Emergency (PHE) until the end of 2024," Kyle Zebley, the ATA's vice president of public policy and executive director of ATA Action, said in a press release. "We cannot allow patients to lose access to telehealth post-pandemic, and this bill will provide stability through 2024, while giving Congress time to address how to make the policies permanent."
“Telehealth has long been a bipartisan healthcare issue and we now turn to the Senate to ensure this important piece of legislation makes it to President Biden’s desk so he can sign it into law,” he added.
The American Medical Association also weighed in on the issue.
“Increased Medicare-covered access to telehealth has been a lifeline to patients and physicians throughout the COVID-19 pandemic, and the American Medical Association (AMA) is pleased by today’s bipartisan vote in the House," AMA President Jack Resnick Jr., MD, said in a statement. "The COVID-19 public health emergency made plain that care via telehealth should be available to all Medicare patients, especially with their own physicians, regardless of where they live or how they access these services. From continuity of care, broadened access to care, and removing geographic and originating-site restrictions, our hope is that the flexibilities afforded during the public health emergency will be made permanent."
Passage of the bill is significant not only because of the margin of victory in the House – indicating strong bipartisan support for telehealth – but because Congress has taken action on the issue. Dozens, if not hundreds, of bills have been proposed in both the House and Senate these past few years aimed at expanding telehealth access and coverage, many seeking some or all of the flexibilities outlined in the Cheney bill, but very few have seen any votes.
Passage in the Senate is no done deal, even with the House's strong support. But Senator Joe Manchin's (D-West Virginia) recent shift to support the Inflation Reduction Act may hint at a willingness to move forward on other issues as well, including healthcare. And the bill does have the backing of the Biden Administration.
"It is important to continue the availability of expanded telehealth to meet the needs of Medicare beneficiaries and health care providers," the Executive Office wrote in a Statement of Administration Policy shortly before the House vote, noting that telehealth visits increased 63-fold in 2020, especially in rural areas and for behavioral health services. "As we emerge from the worst stages of the COVID-19 pandemic, H.R. 4040 will ensure that the Medicare program continually adapts to provide convenient, quality, accessible, and equitable healthcare."
The Senate can now vote on the House bill, vote on its own version of the bill, combine the two, or do nothing.
And while Senate passage of the bill is now top of mind, advocates will continue to push for permanent expansion for some or all of those flexibilities, arguing that telehealth has proven its value during the pandemic.
The two large health systems are joining forces to use 'the most current data science and years of deidentified patient outcomes to find diseases earlier and start patients on paths to better health more quickly.'
Mercy and the Mayo Clinic have announced a partnership to use data and technology to improve care management.
The deal brings together two large health systems with long and storied track records in innovation and aims to combine their talents in using "the most current data science and years of deidentified patient outcomes to find diseases earlier and start patients on paths to better health more quickly."
“This unique collaboration will eliminate the barriers to innovation in healthcare by bringing together data and human expertise through a new way of working together,” John Halamka, MD, an emergency medicine physician and president of the Mayo Clinic Platform, said in a press release issued this morning. “By working together, we will be able to find the best paths for treatment and diagnosis to benefit patients everywhere. Our union has the potential to transform medicine worldwide.”
We have a unique opportunity today to transform mountains of clinical experience into actionable information that optimizes patient care,” added John Mohart, MD, a cardiologist and president of Mercy communities. “This gives physicians, providers and operational leaders critical information that can ensure patients receive the right treatment at the right time based on millions of previous patient outcomes, while simultaneously improving operational efficiencies and lowering costs. We believe bringing technology and data science to the bedside can provide better patient care, shorter hospital stays and overall better health for people everywhere.”
The collaboration will focus initially on data-sharing for patient outcomes, a natural goal for two early adopters of electronic health records technology. Their work will target two domains:
Information collaboration. Mayo and Mercy will work with data that has been de-identified and secured in a distributed data network accessible to both organizations. They'll use that information to "analyze patterns of effective disease treatment and, more importantly, disease prevention in new ways based upon longitudinal data review over an extended period of time."
Solution and algorithm development and validation. These algorithms, executives say, "will provide proven treatment paths based on years of patient outcomes, representing the next generation of proactive and predictive medicine that can be used by care providers around the world to access best practices in medical care."
Officials say the project may spawn other collaborations involving neuroscience, cardiovascular and complex cancer care and precision medicine, to name a few.
Experts say that obesity rates have doubled over the past two decades, with roughly 42% of the American adult population now fitting that description, and they anticipate that half of the world's population will be obese by 2030. Obese Americans run a much high risk of developing chronic conditions like diabetes and heart disease, and they account for roughly $480 billion in annual direct healthcare costs.
Yet the healthcare industry has long struggled to define obesity.
"Obesity has not been traditionally seen as a disease," says Maria Daniela Hurtado Andrade, MD, PhD, a specialist in endocrinology with the Mayo Clinic and part of the research team. "That limits treatment options" as well as how payers view treatments. "Our goal is to collect all this data to understand how it can lead to a very good understanding of predictors to weight loss and weight loss interventions."
The biobank registry collects biological and clinical data from patients, including DNA, metabolomics, hormones and observational information such as behavioral assessments. The data will help researchers gain a better picture of obesity, and has already been instrumental in mapping out four specific obesity phenotypes.
The Mayo Clinic's Rochester campus is contributing patient outcomes from 2,000 patients undergoing treatment for obesity to the biobank, and it will be participating in the nationwide study aimed at monitoring the phenotypes of patients undergoing a variety of treatments in health systems across the country.
Hurtado sees biobank registries as the next step in the ever-growing precision medicine movement, which aims to not only perfect the gathering of individual data but design treatments that address specific patients or groups of patients.
From that point, researchers focus on phenotypes, or the combination of genes and environmental and behavioral factors that cause certain conditions. Hurtado calls this activity of studying and mapping the function of genes "the Snapchat of the state of health."
"We don’t have that understanding of obesity yet," she says, because the healthcare industry has been slow to characterize it as a disease. "Too many [providers] have a view of obesity as 'You caused it.' They don't see it like they see cancer" or other chronic conditions like diabetes, asthma, and COPD.
According to Phenomix and the Mayo Clinic, there's a movement within healthcare to take obesity more seriously and classify it as a chronic condition, caused by not one specific disease but "a constellation of diseases." While its roots may lie in the DNA, they feel that outside factors including age, race, gender, education, and socioeconomic status also have an impact.
Hurtado says the partnership between Phenomix and the Mayo Clinic is important because it legitimizes the biobank at a time when other research institutes may be developing their own resources, which in turn leads to data silos that hinder research. Officials hope the Mayo Clinic's participation will spur other health systems to join.
“This is an exciting time in the evolution of obesity medicine,” Mark Bagnall, CEO of Phenomix Sciences, said in a May press release announcing the Mayo Clinic partnership. “Our biobanking agreement with Mayo Clinic is an important opportunity to make vast strides in how we understand the complexities of obesity treatment. We believe the biobanking registry investment will better support obesity centers by providing concrete evidence and insights into how DNA and other factors need to be considered in treatment. The upside is significant for patients and payers. Patients get the right treatment the first time and payers avoid paying for a costly trial-and-error approach.”
Hurtado says both the registry and study will be "life-changing."
"In the past, treating obesity has been like shooting in the dark," she says. "Now we're beginning to take it seriously. This will lead to positive outcomes in treatment, which will make payers take interest ... and become more open to coverage."
Vanderbilt University Medical Center has designed an innovative care management program that has helped Metro Nashville Public Schools save thousands of dollars and improve outcomes for its pregnant teachers.
A bundled payment program developed by Vanderbilt Health for the Metro Nashville Public Schools (MNPS) health plan saved more than $400,000 in its first year, while dramatically improving clinical outcomes for expectant teachers and their babies.
The success of the MyMaternityHealth program, says CJ Stimson, MD, JD, chief medical officer at Vanderbilt University Medical Center and Vanderbilt University Employee Health Plans, is based on the idea that patients and their care providers are a team.
"People don't feel like their health systems are going with them on their journey," says Stimson, who's also senior vice president of value transformation in VUMC's Office of Population Health. "So we told them we'll take all the risk."
Bundled payment programs were once considered the future of healthcare and the foundation for value-based care, but there have been just as many failures as successes. In their most basic form, they assign a certain payment that a care provider will receive from a payer for a care path, such as surgery or acute care treatment. The care provider creates a treatment plan based on the knowledge that they will be paid that one amount, accepting the risk that treatment won't become complicated and cost more than what was paid.
The program compels providers to focus on improving outcomes and ensure that each treatment offers value. And it creates an incentive for trying new strategies that reduce costs and boost outcomes.
Stimson, who spent several years as an advisor to the Center for Medicare & Medicaid Innovation, which defined Medicare's bundled payment strategy, says the program gives care providers the freedom to map out how they want a treatment plan to work.
"Our providers were the ones who really designed that clinical experience," he says. "It really kind of liberated them."
CJ Stimson, MD, JD, chief medical officer at Vanderbilt University Medical Center and Vanderbilt University Employee Health Plans and senior vice president of value transformation in VUMC's Office of Population Health. Photo courtesy VUMC.
In this program, providers are given the freedom to follow their care plan without, as Stimson puts it, "asking for permission all the time."
"How you pay for care matters," he says. "This changes how you deliver care. You throw out all the old payment rules and start with a clean slate, and you design the best patient experience that you can."
The program recently earned a KLAS Research Points of Light Award for Vanderbilt Health and Cedar Gate Technologies, which provided the technology infrastructure that allows Vanderbilt to gather and track data and manage their patient population. According to KLAS, the award "celebrates success stories—or points of light—from payers, providers, and healthcare technology companies that work collaboratively to align care delivery with health plan sponsor initiatives to reduce inefficiencies and improve the patient experience."
Stimson says he'd initially proposed musculoskeletal care as an ideal service for a bundled payment plan, but the MNPS health plan suggested maternity care. The health plan was seeing high rates of C-sections and neonatal intensive care unit (NICU) services, two expensive services that are sometimes linked to a lack of preventive care or gaps in maternity care.
The key to an effective bundled program, he says, lies in the data. Care providers need that information to map out a care management plan that anticipates needs before they occur and reacts to trends before they develop into concerns.
"Predictability is important," he says. With that data in hand, providers have a better chance of identifying gaps in care and correcting them, or recognizing that a certain patient may be trending toward a complicated birth and putting resources in place to ease those complications.
Vanderbilt and the MNPS health plan have seen some measurable results since launching the bundled payment program. The c-section rate dropped from 40% to 29%, a 25% reduction over the historical marketplace experience, while NICU spending decreased about 16% in the first year. That amounted to about $400,00 in savings during that first year, alongside an increase in healthy births and a Net Promoter Score in the 90th percentile.
In addition, the program removed out-of-pocket costs for patients, saving each mom-to-be as much as $2,500.
"That's a significant savings," Stimson says. And it's a key metric for this population. Eliminating those out-of-pocket costs reduces stress on new or soon-to-be mothers and their families, taking away a factor that can lead to complex or complicated births and healthcare challenges.
Stimson says the program works because it eliminates one of the biggest hassles in care—who pays for what and when—and gives patients and their care providers the freedom to focus on care. And with data in hand from their technology platform, care teams are more confident in knowing how each patient is doing and can spot trends before they become concerns. Patients, meanwhile, get help when they need it, and are encouraged to follow doctor's orders and maintain healthy habits.
Vanderbilt now has several bundled payment programs up and running: Total joint, spine, bariatric, and cochlear implant services were launched in 2021, and medical weight loss, osteoarthritis, and shoulder pain were added this year. Across these bundles, the health system is seeing roughly 250 enrollments per month so far in 2022.
"We want to keep expanding our portfolio to other service lines," Stimson says.
He'd also like to introduce more telehealth and digital health services, even remote patient monitoring, to create what he calls a "care package" around patients. There might also be room for care navigators to help patients identify and access healthcare services and additional resources.
And he'd like to show off the program to other health systems and explain how it works.
"We don’t have it all licked," he says. "These programs only work if everyone is on board … but this proves that [bundled payment programs] can make a difference."
Amazon has announced plans to buy concierge care company One Medical for almost $4 billion, positioning the retail giant right in the middle of an ever-growing battleground for primary care.
Amazon is getting into the primary care business.
The retail giant has announced that it is acquiring One Medical, the concierge-styled primary care company with a telehealth platform and more than 125 brick-and-mortar locations scattered across the country. The deal, valued at roughly $3.9 billion, would be Amazon's third-largest acquisition, giving the company a physical footprint alongside Amazon Pharmacy and Amazon Care, a virtual care platform for businesses.
“We think healthcare is high on the list of experiences that need reinvention,” Neil Lindsay, Amazon's senior vice president of Amazon Health Services, said in a press release. “Booking an appointment, waiting weeks or even months to be seen, taking time off work, driving to a clinic, finding a parking spot, waiting in the waiting room then the exam room for what is too often a rushed few minutes with a doctor, then making another trip to a pharmacy – we see lots of opportunity to both improve the quality of the experience and give people back valuable time in their days.”
“There is an immense opportunity to make the health care experience more accessible, affordable, and even enjoyable for patients, providers, and payers," added One Medical CEO Amir Dan Rubin, who will continue as CEO.
The announcement fits with the idea that primary care is becoming a hotly contested battleground, featuring competition from traditional healthcare organizations as well as telehealth companies and payers with their own provider networks and retail behemoths like Amazon, Google, Walmart and Walgreens.
All are trying to lay the groundwork for on-demand primary care services, either in person or through virtual care channels. Amazon's strategy is to make that encounter as ubiquitous as buying something on its website.
Nathan Ray, a partner in the healthcare segment of national management and technology consultant West Monroe, said the deal makes Amazon a major player in the ever-shifting healthcare market.
"Amazon continues to make forward progress towards being a broad and dynamic healthcare entity with the acquisition of One Medical, their activity here and in recent past within many of the most actively evolving areas of healthcare has shown they have an evolving strategy towards developing their role in the healthcare marketplace and now entering primary care (and risk contracting) the true center of focus and change after incrementally building relevance in DME, pharmacy, virtual care and employer health," he said in an e-mail to HealthLeaders.
"Amazon and One Medical will have some great opportunities to continue to improve on today’s technology and in particular evolving digital intelligence and engagement technologies that drive intervention, clinician effectiveness, and action based on both historic and real-time data and analytics that underpin the ability to develop and scale successful care models," he added.
Ray noted further that the deal does have some concerns.
"This move tells us both that Amazon is aware of what they lack, but also that they really may not have a grand strategy as of yet but are continuing to find value buying (particularly on the downbeat of the market here) and developing both solutions and services within the healthcare space that give them options," he said.
"The biggest questions I have are when will we begin to see more of Amazon’s signature of technology enablement, easy access, low cost and service quality begin to reveal itself within healthcare through this acquisition, and how might Amazon’s skill with those design elements yield market advantage," he added. "Primary care is a highly dynamic space with payers, providers, and healthcare services and technology organizations all focused on many of the same population health and risk attribution tools and concerns and a slow war of care models, utilization, and financial performance playing out as significant capital has entered from both private and public markets over the last 3-5 years particularly motivated by growth coming from managed care, particularly Medicare Advantage."
