In a Q&A with HealthLeaders, Jessica Beegle, senior vice president and chief innovation officer for LifePoint Health, explains how new ideas and strategies are integrated across the private health system spanning some 30 states and roughly 90 community, rehabilitation, and behavioral health hospitals.
Healthcare organizations address innovation in different ways, and with different management structures. At LifePoint Health, a Brentwood, Tennessee-based private healthcare network operating 63 community hospital campuses, 30 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care in 30 states, it's managed by Jessica Beegle, senior vice president and chief innovation officer.
As part of a continuing series, HealthLeaders is talking with executives at health systems around the country about how they define, manage, and plan healthcare innovation. Here's our conversation with Beegle on how she sees her job, and how it's so much more than "making widgets."
Q. How do you define innovation in healthcare?
JB: Innovation in healthcare is about seeking to solve challenges – access, cost, quality, efficiency, staff burnout – in new ways.
Q. Can you give an example of an innovative technology you’re now testing or using? How about an innovative strategy?
JB: Extending our ability to care for patients outside of traditional care settings and being able to engage with them where, when, and how they want to connect is a foundation of our strategy. With this in mind, one of the most exciting areas where we are expanding our work right now is remote patient monitoring. We’ve been working closely with Cadence on remote care for those with heart failure, and this work has underscored just how much remote monitoring and support can improve experiences and outcomes for patients and their families.
Jessica Beegle, senior vice president and chief innovation officer for LifePoint Health. Photo courtesy LifePoint Health.
While we have many more opportunities to support our patients outside the four walls of our hospitals and clinics in different ways, extending our reach into homes and the community, we are also very focused on supporting our nurses and physicians by bringing in tools that can remove the undifferentiated heavy lifting of some of their current tasks, in an effort to make their jobs easier. We will be announcing a new partnership along these lines in the months ahead.
Q. How should a health system integrate innovation into its mission?
JB: Every health system is unique, and every organization has to determine how and when innovation fits into its strategic plans. At LifePoint, the leadership team has made innovation one of our strategic priorities, along with things like quality and safety and talent development. Having the buy-in and strong support of company leadership from an innovation perspective is critical to our ability to try new things and freely explore opportunities that can help solve pain points for our people. We are focused on evaluating and implementing cutting-edge ideas, partnerships, and technologies that meet patient needs, drive growth, and advance our mission of making communities healthier.
As part of this effort, we created what we call LifePoint Forward, which represents our approach to cultivating ideas and investing in technology-enabled solutions to improve quality, access, and outcomes while lowering costs. Through LifePoint Forward, we are partnering with organizations that are positively disrupting the healthcare ecosystem, building companies and solutions to address new opportunities and areas of unmet market need, and buying capabilities we believe will add value to our organization, the communities we serve, and the broader healthcare system.
Q. Where do you look for innovative ideas or technologies?
JB: We take an 'outside-in and inside-out' mindset to how we approach innovation. I want to make sure that our work and the solutions we bring in or build are focused on the real, on-the-ground needs of our employees who are on the front lines working with patients. It is important for us to seek their feedback and input on what is needed within our system to help them do their jobs every day and help us collectively provide even better care and then look for technologies and solutions to address those needs.
Coupling the perspective from our people in the field with key technology leaders and investors in the market, we closely survey the best-in-class solutions available and assess whether to bring in a current technology/solution or whether there is a gap we may need to build a solution for ourselves. We are fortunate to have our joint venture, 25m Health, an in-house health tech venture studio, to build new companies that are focused on developing new technologies that may be needed within LifePoint communities and beyond.
Q. How do you get buy-in from the administration and staff for a new product or strategy?
JB: First, communication and trust are key. Every discussion I have underscores that our focus is on creating solutions that solve real, everyday problems, and why we believe a particular innovation will realistically solve an issue our teams are facing.
Innovation can be very aspirational at times. I’m the biggest fan of emerging technology and the 'art of the possible' conversations, but I try to balance my own personal excitement with the realities of innovating in healthcare. It’s hard and complicated, but with proper grounding we are making good strides to bring new innovations into our markets to positively impact our patients and staff.
We are regularly pitched by some of the smartest entrepreneurs out there, but often they are too focused on being 100 times better than the existing solutions. I coach a lot of entrepreneurs on balancing the 'art of the possible' of what their technology can do with tempering their pitch to show how they can meet their customers where they are today. This helps set the stage for traditional healthcare companies and new entrants to work well together.
We’ve built trust by listening to our teams in the field, and we maintain it by being as transparent as we can about what challenge a particular innovation is addressing – and what the adoption and implementation of this innovation will really look like. Setting proper expectations up front helps to bring internal and external stakeholders along.
We also have set clear areas of focus to help everyone understand what we are working toward. These include:
Operational Efficiency & Employee Experience: easing operational burdens for our team members by removing the undifferentiated heavy lifting so they can regain time to spend with patients, helping to bring joy back to medicine;
Care Anywhere: meeting people whenever and wherever they need to access care, regardless of the channel. We aim to extend the reach of our care teams outside of the traditional four walls of a hospital to deliver high quality, convenient care to our patients in the setting of their choosing;
Inclusive Health: supporting populations with specific needs, such as women’s health, specialty care, and behavioral health; and
Consumerism: empowering our patients by delivering the right information at the right time, in a dynamic manner, that individuals can understand, to enable them to make more informed healthcare decisions (financial transparency, care navigation, patient empowerment, etc.) for themselves or for a loved one.
Q. Do you incorporate patients/consumers in the planning process?
JB: By getting input from our employees and care settings on where technology and innovation is needed, we are directly incorporating our most important stakeholders into our decision making – both the patients and the staff who are caring for them.
Q. What are the biggest challenges to innovation in the healthcare space? What has surprised you the most about innovation in healthcare?
JB: I come from a more tech-focused background, and a challenge I’ve seen is that the technology and healthcare worlds speak entirely different languages. A big part of my job has been acting as 'chief translation officer,' bridging the gap between tech and healthcare and helping to decipher what challenges our healthcare system is experiencing and which technology capabilities exist that can help address those in a meaningful way.
This language issue is exacerbated by the fact that healthcare is incredibly complex. The industry is often criticized for being slow to adopt technology, but this caution is called for, and vital in some cases, because of the tremendous complexity that exists and the fact that human lives are always what is on the line. We don’t make widgets; we are caring for people during their times of greatest need, and we take this responsibility very seriously.
Q. What would you like to change about the typical health system to make it more innovative or accepting of new ideas?
JB: The challenges of the COVID-19 pandemic have created opportunities – an openness to new ideas, changes in regulation, an acceptance of technology, and a renewed drive to make our health system better. Change, though, which is what innovation is, requires buy-in and understanding. It takes time and focus. It can’t be a part-time job, and it can’t happen in a vacuum. A commitment to innovation has to be part of an organization’s strategy and supported by and encouraged at all levels of leadership.
But those driving innovation can’t be in an ivory tower either. They have to listen to and collaborate with the people in the field caring for the patients, and they have to strive to ensure that any new solution they bring to the table addresses a real-time challenge.
Q. What new technologies or strategies are on the horizon? What are you looking forward to trying out?
JB: I am excited about continuing to work toward extending our care teams’ reach outside of the traditional in-patient hospital setting. The COVID-19 pandemic spurred innovation and interest in receiving care through non-traditional channels, and I’m looking forward to seeing how those remote technologies continue to be used and adapted.
Propelled by more engaged consumers and available digital health devices, healthcare providers are taking that next step and replicating the physical exam at home.
Healthcare organizations are starting to look beyond the video visit to connect with patients at home, with new programs that pull in smart devices, wearables, and other digital health technology to make the experience more than just a video chat.
At MemorialCare, a health system in southern California, administrators have expanded their Virtual Urgent Care platform to include technology that allows patients to conduct guided physicals at home. In a partnership with New York-based TytoCare, the health system is sending handheld examination kits that allow users to conduct examinations of the heart, skin, ears, throat, abdomen, and lungs, and measures, among other things, heart rate and temperature.
"We can actually allow a physical exam to take place in the patient's home," says Mark Schafer, MD, CEO of the MemorialCare Medical Foundation, which comprises more than 300 primary care physicians and 2,000 specialists.
The typical definition of a telehealth visit is an audio-visual platform accessed through a computer, laptop, tablet, or even a smartphone, which allows a consumer to get in front of a healthcare provider when and where needed. That concept was pushed into overdrive during the pandemic, when telehealth use soared and healthcare organizations embraced whatever platform they could find to deliver a virtual visit in place of in-person care.
But many health systems are eager to move beyond that platform. Prodded by consumers who are adopting health and wellness technology and intrigued by digital health tools that capture more relevant data at the point of care, they're moving into remote patient monitoring and direct-to-consumer services that turn the healthcare experience into more than just a conversation.
To that end, health systems like MemorialCare are using technology to enhance collaboration between provider and patient.
"We already had the framework in place around video as one of our first virtual health tools," says Schafer. "That's a nice core capability, but digital and virtual care isn't just video. There are a lot of different ways to access healthcare."
With companies like TytoCare offering products that allow the user to collect more physiological data, health systems are looking to make digital health devices as ubiquitous in the home as the vacuum cleaner or toaster oven. These kits are now showing up in retail stores like Best Buy, Target, and WalMart, as well as in pharmacies and on Amazon. Pick one up, store it in the bathroom closet or cupboard, and pull it out when there's a health concern that would normally necessitate a trip to the doctor's office or ER.
"It changes the way we think about care," says Anne LaNova, MemorialCare's director of virtual care, who tested out the device when she was home dealing with COVID-19.
"MemorialCare is committed to finding ways to enable patients to manage their health through a personalized healthcare experience and ensure that no matter their circumstance, they have easy access to clinic-quality examinations from the comfort of home," Barry Arbuckle, PhD, MemorialCare's president and CEO, said in a press release. "TytoCare enables us to do just that."
Schafer says the challenge will lie in getting the devices into the right homes.
"There is a definite benefit to certain populations," he says, such as expectant and new mothers, families with young children, and people living with chronic conditions who have mobility issues.
While patients can choose to buy their own devices, to get those tools into the right hands, the preferred course of action is to have a care provider recommend that a patient get one (in certain instances the health system can give one to the patient). To help push this program forward, Schafer says MemorialCare started with a dedicated team of physicians and nurse practitioners, to help both patients and other care providers understand the benefits of the technology. Many new programs or strategies begin with physician champions, who help illustrate the benefits and smooth over the rough edges before a certain program is scaled outwards.
"We had to convince [our physicians], but once they tried this out, they were really impressed," says Schafer, who plans on rolling the program out to primary care physicians soon.
The next step, he says, will be collecting data from these encounters, to understand how these devices are used in virtual visits, and whether they improve the experience for patients and give providers the data they need to boost clinical outcomes. This information will enable administrators to fine-tune the program, make plans to expand its reach and— more importantly—convince payers to make this a standard of care.
"This offers a more rich physical exam and gives us more data than a video visit," he says. "We don’t think that video visits are going to go away, but it's good to have more options. The big thing is that we'll be able to try out different use cases," such as patients who often visit the doctor's office or ER for a variety of concerns.
"There's so much more that we want to do in this space," says LaNova, who envisions sending these devices to schools, businesses, urgent care clinics, and other locations to facilitate telehealth services with MemorialCare. They could also become part of the standard of care for health plans, employers, and population health programs looking to monitor and improve urgent care costs.
The devices coming onto the market now "have a lot of different capabilities," says Schafer. "We need to measure benchmarks to find out what works and what doesn't."
More than 200 hospitals are taking advantage of federal waivers to develop and manage Acute Hospital at Home programs. But those waivers won't last forever, and supporters need to prove that the concept should continue beyond the pandemic.
An innovative program that gives healthcare organizations an opportunity to provide ICU-level care for patients at home is facing an uncertain future, even though 202 hospitals and 92 health systems across the country are using it.
The Acute Hospital Care at Home program was developed by the Centers for Medicare & Medicaid Services to reduce expensive hospitalizations and give patients the opportunity to receive care at home. Healthcare organizations were encouraged to launch these programs by CMS waivers enacted during the COVID-19 public health emergency that boost reimbursements and reduce barriers on the use of telehealth and other services.
But with the PHE coming to an end, many participating health systems are scrambling to determine how to keep those programs going without the waivers – and how to redesign them to help populations other than those infected by the virus.
“It would significantly curtail the ability for these programs to either continue or expand,” says Stephen Parodi, MD, executive vice president of external affairs, communications, and brand at The Permanente Federation and associate executive director of The Permanente Medical Group.
Parodi has been guiding the hospital at home strategy at Kaiser Permanente since the health system launched its program in 2014-15. He was a participant in one of two panels devoted to the topic at the recent American Telemedicine Association conference in Boston, and he’s also part of the Advanced Care at Home Coalition (AHCAH), a group of some 20 health systems and connected care advocates lobbying the federal government to continue supporting the program beyond the end of the PHE.
Putting the Concept Into Action
Kaiser Permanente is one of several high-profile health systems that see the hospital at home strategy becoming intrinsic to value-based healthcare. The program is designed to take patients who would otherwise occupy a hospital bed and put them at home, in their own beds, while the health system designs a care plan around them that includes in-person and virtual services. Each program is different, with some health systems incorporating home health services, community paramedicine, pharmacy services, even social services.
"The whole idea of remote patient monitoring has really been taken to the next level with this type of program," Parodi says, .
Supporters say the program reduces expensive hospital stays and costs, saves hospital beds for those who need inpatient care, cuts down on adverse health events and rehospitalizations and improves clinical outcomes.
Carolyn Yang, MD, an internist with Brigham and Women's Hospital and part of their Acute Hospital at Home program and a panelist at the ATA conference, noted that their latest study saw a cost reduction of 38% in the hospital at home program when compared to inpatient costs.
"It is exciting to see this space grow fast," she said.
“We all know the best place in this world is home,” added Swetha Gudibanda, MD, a hospitalist at Wisconsin's Marshfield Clinic who appeared on the same ATA panel as Parodi. “So why not [provide that care] at home?”
Home-based care is far different from inpatient care, and these programs have to be designed and managed carefully to take into account changing workflows, on-demand access to care providers, reliable power sources, even safety and security.
Parodi noted that these programs have to build in redundancies that aren't needed in a hospital setting.
"You've got to think through all these different layers to make sure the program is safe," he said during his panel.
But the home setting also offers care providers a lot more insight into the patient, including diet and exercise habits, family interactions and other issues that might affect one's health.
"We've had instances where there's hoarding, or there [are] 40 cats, or there's a giant snake as a pet," said Margaret Paulson, DO, medical director of the Mayo Clinic's Advanced Care at Home & Home Health programs, which are serving patients in Minnesota, Wisconsin and Florida via a telemedicine hub in Jacksonville, Florida.
Parodi says the Hospital at Home program, in whatever form it's being used, "really is opening doors at a number of levels." It allows the health system to engage with patients at a new level, promoting overall and continued health and well-being instead of episodic care, and it enables providers to identify and address other concerns, including social determinants of health. And it's all built into the patient's daily routines.
"We can literally schedule around the patient's day," he says
"What we're seeing is a level of interaction that's quite different than what we've had before," Parodi adds. "And we'll continue to learn" how to improve that interaction with newer and better services, including medical management, social services and preventive care.
Looking Beyond the CMS Waivers
But that growth will need some help. With the CMS waivers due to end with the PHE, health systems are looking to augment coverage from other payers and redesign aspects of the program that won't be allowed after the PHE, such as the use of telehealth and digital health and certain home health care services. They're also looking at new business cases for the program, such as identifying other patient populations who would benefit from this type of care.
"Hospital at Home is really this shiny bright object right now, which is great, but what is the 'Why?'" asked David Houghton, MD, medical director of digital medicine at New Orleans' Ochsner Health system and an ATA panelist. And Yang, of Brigham & Women's, who was on the same panel, noted that the program "has aligned opportunities" within the payer market, "which is exciting," but more work needs to be done to establish long-term sustainability.
To help the transition from pandemic to post-pandemic healthcare, the AHCAH has thrown its support behind the Hospital Inpatient Services Modernization Act, a bill introduced in both the House and Senate that would extend the CMS waivers for the Acute Hospital at Home program two years after the end of the PHE and require CMS to issue regulations on health and safety requirements for the program, which some see as a step towards making the program more permanent.
“The benefits of advanced care at home will serve patients well beyond the pandemic,” Parodi said in a March 2022 press release by the AHCAH supporting the bills. “By extending these flexibilities, Congress will create a predictable pathway for medical professionals to fully realize advances in the care delivery system that enable patients to be treated with safe, equitable, person-centered care in the comfort of their own homes.”
At the ATA event and in a separate interview, Parodi said those with Hospital at Home programs "need to have outcomes data" to prove the program's long-term value to both Congress and CMS. He said supporters are also asking that the Center for Medicare & Medicaid Innovation (CMMI) study the program.
He said the concept offers more opportunities for health systems to partner with local and community health resources to shape healthcare delivery and push health and wellness resources. And it will help healthcare executives rethink how care is delivered within the hospital itself.
"There's a lot of innovation going on in this space … that will have an impact on healthcare," he says. "And we still have a lot to learn about how to do this."
The organizations are partnering with Brigham & Women's Hospital to create a network of eight health systems that will help other healthcare organizations integrate health equity into their quality and safety practices.
The American Medical Association and Joint Commission are partnering with Brigham & Women's Hospital to create a network of health systems that will help other healthcare organizations integrate health equity into quality and safety practices.
The Advancing Equity through Quality and Safety Peer Network launched in January as a year-long mentorship and networking program for eight early adopter health systems: The Atlantic Medical Group/Atlantic Health; Children's Hospital of Philadelphia; Dana-Farber Cancer Institute; University of Iowa Hospitals & Clinics; Ochsner Medical Center; University of Texas MD Anderson Cancer Center; Vanderbilt University Medical Center; and University of Wisconsin Hospitals & Clinics.
Those health systems will use a Quality, Safety, and Equity framework designed in 2019 by Brigham & Women's and the Institute for Healthcare Improvement (IHI) that "merges patient-centered approaches to quality and safety of care with robust structural analyses of racism and equity to support an overall mission of delivering equitable high-quality care to every single patient." They'll also convene interdisciplinary teams comprised of experts in quality and safety; diversity equity; inclusion and belonging; and population health.
The idea is to create a network that focuses on improving health outcomes for "historically marginalized populations" by training health systems to address gaps in care caused by, among other factors, social determinants of health.
“For the past two years, the COVID-19 pandemic has further exposed systemic inequities in the quality and safety of the patient care experience – including gaps in interpretation services, telemedicine access, and crisis standards of care,” AMA President Gerald E. Harmon, MD, said in a press release. “Through collaborations like the Peer Network, the AMA continues its work to remove the social and structural factors that interfere with patient-centered care – providing health systems with guidance to inform equitable solutions, dismantle inequities, and improve health outcomes for our patients from historically marginalized communities.”
The peer network will focus on four strategies:
Systematically revealing and measuring the omnipresent and toxic effects of structural racism and other inequities on the health and well-being of patients, families, health care workers and communities;
Highlighting the critical role of health care organizations in preventing inequities;
Incorporating equity into the operational DNA of healthcare delivery and innovation; and
Promoting high-quality, safe and equitable outcomes for every patient, family and community served.
“Every patient deserves the right to safe, equitable healthcare,” Joint Commission President and CEO Jonathan B. Perlin, MD, PhD, said in the press release. “The COVID-19 pandemic placed sharp focus on the unacceptable disparities in health outcomes, demonstrating significant work that must be done. All healthcare organizations have a responsibility to identify and address the disparities that their unique patient populations face."
Researchers using deep learning tools to analyze chest radiographs found that they could predict patient costs at one, three and five years and identify high-risk patients, enabling health systems and payers to target care management and preventive health and develop cost and reimbursement plans.
Researchers at the University of California at San Francisco (UCSF) have combined AI tools with chest radiographs to not only help identify patients with potentially serious health issues, but accurately map out their healthcare costs for as much as five years.
The study, published this week in Nature, aims to help healthcare organizations identify patients who will need expensive treatment, allowing them to map out care management plans as well as health and wellness plans. It could also help health systems and payers develop accurate budgeting models for reimbursement.
It also points to the power of machine learning and AI technology in analyzing massive amounts of data to improve not only clinical outcomes but business models.
"This study confirms that radiological imaging indeed contains rich information that may not be routinely extracted by human radiologists but can be analyzed by the power of big data and deep learning," the researchers concluded. "Successfully predicting healthcare expenditure can potentially be an important first step towards improving health policy and medical interventions to address patient care and societal costs."
The study, conducted by a team led by Jae Ho Son and Yixin Chen of UCSF's Center for Intelligent Imaging, used AI technology on 21,872 frontal chest radiographs (CXR) collected from 19,524 patients with at least one year of spending data between 2012 and 2016. The patients were non-obstetric adults who visited the emergency department and received a chest radiograph at the ED or an outpatient facility on that same day.
"The models were developed to identify patients who are likely to incur high healthcare expenditure and predict their subsequent amount of healthcare spending within 1, 3, and 5 years," the study noted. "Unlike physicians who are trained to identify only a handful of imaging biomarkers known to medical literature, our deep learning algorithm is able to take into account thousands of imaging features of weak to moderate correlations with healthcare spending as presented in the training set."
"When a CXR is evaluated by the deep learning algorithm, its pixels are aggregated, transformed, and passed through many layers of filters with each layer extracting different lines, angles, patterns, and associations," the research team said. "As those extracted features are then passed upstream to higher-level filters, they are compared to the thousands of CXR that the algorithm was trained on. All these numbers finally converge to the estimated cost. Considering that CXR tends to be standardized, deep learning algorithms are trained to be extremely sensitive to details that clinical radiologists may not typically recognize."
The researchers noted that the AI platform combines demographic factors, baseline health factors and clinical diseases to map out a patient's current and future cost predictions. This, in turn, can be used to identify high-risk patients who account for the health system's biggest medical expenditures and potentially change that pattern.
"Such predictions can provide an important starting point in identifying high risk patients to achieve reduction in their healthcare spending and encouraging lifestyle modifications and more intensive medical management to achieve better medical and financial outcomes," they noted.
"We believe the use case of the model can go beyond simple actuarial calculation purposes," they wrote. "Though such a model would not be able to provide the precise diagnosis, it can sound an alarm to the patient and primary care doctor that the patient will likely have high healthcare spending in the future. Furthermore, our algorithm could be used in outpatient settings to estimate approximate future healthcare costs such that patients, doctors, and insurance companies would have a reliable indicator to consider when making patient treatment and financial decisions. The identified high-risk patients could be subject to more intensive preventive medical interventions and close follow-up visits to modify patient outcomes."
"The algorithm could also be used to identify patients with CXR that appear normal according to current clinical radiological standards but are still at risk for high medical costs," they added. "Similar to most deep learning algorithms, the application of ours can potentially be automatic, fast, scalable, and relatively low cost when compared to other services in the healthcare system."
The institute is expanding its partnership with COTA to analyze how demographics like zip code, ethnicity, and other socio-economic factors affect cancer care outcomes.
The Miami Cancer Institute is expanding its use of data analytics technology to identify gaps in care caused by social determinants of health.
The institute, part of Baptist Health South Florida, is extending its partnership with COTA, a developer of oncology-based data and analytics tools, to analyze how demographics like zip code, ethnicity, and other socio-economic factors affect care outcomes.
“Delayed cancer diagnosis for a patient frequently leads to poorer outcomes,” Leonard Kalman, MD, the institute’s executive deputy director and chief medical officer, said in a press release. “Our hope is that this collaborative research will identify the patients who are most at-risk for delayed diagnosis so we can increase education and expand access to routine cancer screenings for these populations.”
The issue is in the spotlight now as the nation moves away from the pandemic, which saw a shift from in-person care to virtual care and prompted many people to skip check-ups, wellness visits and other healthcare services they considered unimportant. Healthcare officials say that has led to an alarming decrease in cancer screenings, which could lead to a sharp increase in cancer diagnoses when people finally get around to those check-ups they should have had a year or two ago.
Apart from that, many health systems are now actively targeting social determinants of health, which are described as outside factors that affect clinical outcomes, including geographical, economic, social and societal barriers to accessing care. They're looking at new ways to reduce or eliminate these barriers, including through digital health and telehealth.
COTA has partnered with the Miami Cancer Institute since 2018, most recently applying the company's Real World Analytics (RWA) platform to better understand BRCA testing patterns. The institute is now testing all patients with newly diagnosed metastatic breast cancer for BRCA mutations, with a goal of identifying patients and their family members who are at increased risk.
Under the expanded deal, the institute will analyze curated real-world data, including de-identified electronic health records and claims data, to identify disparities in care management and patient outcomes.
The South Korean automaker is joining forces with California-based NowRx to develop new solutions for the delivery of prescription medications.
Hyundai is steering into healthcare.
The South Korean automaker announced a partnership this month with NowRx, a California-based digital health pharmacy platform, with the goal of launching “a pilot project to explore the use of new solutions in the delivery of prescription medications.”
"Autonomous vehicles are part of our long-term strategic vision for NowRx to further reduce delivery costs at scale,” Cary Breese, CEO and co-founder of NowRx, said in a press release. “We can’t imagine a better company to work with than [Hyundai], which has demonstrated substantial leadership in the autonomous vehicle, and other robotics and automation areas.”
The partnership points to the evolution of pharmacy services to include telehealth and other digital health tools, as healthcare organizations and pharmacies look to provide patient-centered services and turn the physical pharmacy into a healthcare destination.
NowRx offers telehealth services and same-day prescription delivery through a digital health platform that quickly fills e-prescriptions and sends those orders as quickly as possible to the patient. The company currently operates out of eight sites in California and Arizona and has reportedly filled close to 500,000 prescriptions for more than 64,000 customers.
In partnering with Hyundai, the company is looking to expand into the smart mobility solutions space, using autonomous vehicles to deliver prescriptions.
Competition is building in this area, with both Amazon and Walgreens offering prescription delivery services and several health systems partnering with pharmacies to offer retail healthcare services through brick-and-mortar sites. Some are also testing drones as delivery vehicles.
The Community Hospital of the Monterey Peninsula is using digital health tools to improve care coordination and management with patients before and after surgery, while plotting a slow and careful approach to RPM.
As healthcare organizations across the country expand their digital health footprint to improve care coordination, one California hospital is using targeting messaging and videos to help patients before and after surgery.
Community Hospital of the Monterey Peninsula (CHOMP), part of the Monterey-based Montage Health network, is using digital health tools provided by Force Therapeutics to not only better prepare patients for their upcoming procedures, but to ensure they transition quickly into prescribed recovery and rehabilitation programs.
"A lot of things have to be orchestrated within a certain period of time," says Christopher Meckel, MD, an orthopedic surgeon with Monterey Spine & Joint, who's been using the platform for patients undergoing hip or knee replacements. "We used to do this with huge folders of paper, basically a huge data dump of paperwork, and phone calls. That wasn't efficient."
The shift from paper-based to digital hasn't been easy, as anyone who's ever dealt with an electronic medical records platform can attest. The attraction and familiarity of seeing something written down is strong. But paper is cumbersome, and can be misplaced, lost, or destroyed. What's more, directions written down on paper can't be updated or changed to accommodate new care plans unless one wants to print out another set of instructions.
But something that is available in electronic format is accessible at any time on a smartphone, laptop, or computer, allowing patients to access information when and where they need it. And that information can be edited at a moment's notice, allowing care providers to amend or change care coordination and management protocols as the patient progresses. And there's no paper to spill coffee on, have the dog chew up, or lose behind the sofa.
Christopher Meckel, MD, an orthopedic surgeon with Monterey Spine & Joint. Photo courtesy Monterey Spine & Joint.
Meckel says Montage Health and CHOMP were early adopters of the electronic medical record, which he describes as "a pretty good repository of information." The challenge for many health systems has been to make sure the information is stored, analyzed, and used in ways that improve clinical outcomes as well as clinical workflows.
And that, in some cases, has taken a while to figure out.
"It's become better [as a platform for] communication and doling out information," says Meckel. "That's where we saw this opportunity."
Through the EMR, Meckel and his colleagues can send messages, care plans, even videos to patients, helping them to prepare in advance for a surgery and follow a prescribed course of action to recover from surgery.
"The fact that it's asynchronous is fantastic," says Meckel, noting the messages and information can be accessed by the patient at any time. And it cuts down on time spent by the care team on the phone, setting up the next appointment or making sure the patient is following doctor's orders.
This also helps the care team with what often are specific rehabilitation goals after surgery. Care providers can set those goals early and remind patients ahead of time what they need to do when they're at home (including using videos to demonstrate certain exercises). They can monitor a patient's recovery in near-real-time, as opposed to waiting for the patient to come back into the office or call about a health concern. And with scheduled questionnaires, they can learn how the patient is doing every day, and spot trends or concerns that may need to be addressed.
"Some people tend to suffer in silence and think the pain they're feeling [after a procedure] is normal," Meckel says. 'That's why patient-reported outcomes are so important. They tell us more … than we might get" in a conversation in the office.
"You don't want to miss a person who needs help," he adds. "And you want to be able to answer the questions, 'Do I have a happy patient?' 'Does this meet their expectations?' 'Am I doing what I need to do'" to improve their quality of life?
These messages, questionnaires, reminders, links to resources, and videos generated through the EMR to the patient not only improve engagement, they enrich the patient record with more data, allowing care teams to better document clinical outcomes and help the patient toward recovery. They also provide important information to payers looking for value-based treatment plans and can be incorporated into bundled payment programs.
But Meckel points out the platform needs to be designed carefully, and that takes a bit of work on the provider's side to choose the right questions and map out the right care plans.
"A lot of effort goes into designing this," he says. "You need to choose the right questions, and everyone has to be" trained to not only schedule the questions but review the results coming back from patients.
"You want to be able to see that people are answering questions exactly the way you want them to be answered," he says. "It forces us to sit down and decide" not only how to ask a question, but what a care team wants in the answer. Too direct or complex in one direction, or too vague in the other, and the answer will lead to more questions and won't help form the care plan.
Looking into the future, Meckel says the messaging platform also lays the groundwork for remote patient monitoring, a care platform that many health systems are adopting to expand opportunities to treat patients at home. In fact, it may be an ideal way for a small hospital or medical practice to learn the ropes and get the details worked out before advancing to RPM, which may involve telehealth visits and digital health devices that gather physiological data in the home.
For his patients, Meckel wants to expand the platform to incorporate more videos and resources for home-based rehabilitation and exercise. He'd also like to integrate some AI functions to help patients with the basic mechanics of exercise. That's the natural progression for how he's using the platform and he wants to develop it carefully so that it doesn't become too cluttered.
"We need to keep this as simplified as possible," he says, or else his patients will become overwhelmed or lose interest. The easier and more intuitive the platform, the better the likelihood of keeping patients engaged and motivated.
The latest version of the ACC's three-year-old series of TRANSFORM studies, being conducted in Boston and Kansas City, will test whether underserved patients living with chronic cardiovascular concerns can be better managed through a digital health platform that includes wearables and AI tools.
The American College of Cardiology is studying whether digital health technology like wearables and AI can be used to improve care management for people with chronic cardiovascular conditions.
The ACC is partnering with Boston-based Biofourmis on the third and latest phase of its TRANSFORM study, which was launched in 2019 to “leverage EHR data, office-based interventions and partnerships to include the pharmaceutical and medical device industry, health plans, employers, clinicians, and patients.” The latest phase focuses on improving guideline-directed medication therapy (GDMT) in care management.
“TRANSFORM3 will provide real-world data on how cardiologists and other clinicians can more effectively and efficiently manage chronic cardiovascular conditions in underserved populations,” Megan Welch, MD, TRANSFORM3 investigator team member and cardiovascular disease fellow at Massachusetts General Hospital, said in a press release issued by Biofourmis. “Through technology-enabled approaches, we are hopeful that providers will have timely, meaningful awareness of their patients’ health status and adherence to guideline-recommended therapies. Ultimately, what we learn from TRANSFORM3 could lead to accelerated adoption of effective, evidence-based care plans that optimize outcomes and help patients lead longer, healthier lives.”
Researchers aim to study whether devices and platforms that monitor patients throughout the day can improve care outcomes, particularly in patients who can’t or won’t see a doctor on a regular basis. One of the primary benefits behind these remote patient monitoring platforms is that they can establish the baseline for a specific patient and raise an alarm when data indicates a concerning trend, allowing care providers to act quickly to avert a health crisis.
The “Evaluation of Implementation Strategies of Teaching, Technology, and Teams to Optimize Medical Therapy in Cardiovascular Disease (T3),” study will focus on patients living with heart failure with preserved ejection fraction (HFpEF), heart failure with reduced ejection fraction (HFrEF), atrial fibrillation, or cardiovascular risk with type 2 diabetes.
The latest study is broken into three branches. One will focus on patient education (Teach); a second will use digital health devices and AI tools, along with “frontline virtual health navigators” supplied by Biofourmis (Teams) to serve as the first line of resource and help patients manage their care; and the third will use digital health devices and AI tools to improve care management for local care providers (Technology).
The study will be lead by a team of Harvard Medical School clinicians based at Mass General, Brigham and Women’s Hospital, and St. Luke’s Health System in Kansas City.
Penn Medicine researchers have found that the health system's virtual care platform not only allowed Black patients to access care as easily as non-Black patients during the pandemic, but is keeping them coming back for more health services.
Penn Medicine researchers are reporting that a telehealth platform is helping the health system reduce barriers to access for Black patients.
In a study published in Telemedicine and e-Health, researchers from the Perelman School of Medicine at the University of Pennsylvania found that a virtual care program set up during the pandemic allowed Black patients to access care at the same rate as other populations. And that platform is continuing to erase “historic inequities” affecting those patients as the pandemic eases and the health system offers both in-person and virtual care.
“We looked through the entire year of 2020, not just the first half of the year when telemedicine was the only option for many people, and the appointment completion gap between Black and non-Black patients closed,” Krisda Chaiyachati, MD, an assistant professor of medicine at Penn Medicine and the study’s senior author, said in a press release. “Offering telemedicine, even though it was for a crisis, appears to have been a significant step forward toward addressing long-standing inequities in healthcare access.”
The study addresses the validation of telehealth in tackling barriers to healthcare access for underserved populations. Telehealth advocates say virtual care could be an important tool in connecting with people who have problems visiting the doctor’s office or hospital due to geographical, cultural or social issues. Some also worry that telehealth could compound that problem because some populations might not be able to afford, access or use the technology.
Chaiyachati, who oversees the Penn Medicine OnDemand virtual visit program, and his colleagues studied how Black patients in the Philadelphia area accessed their primary care providers in 2019 and 2020, and compared that to PCP access by non-Black patients. Looking at roughly 1 million appointments per year, they found that completed PCP visits by Black patients increased from about 60% in 2019 to more than 80% in 2020, while the completed PCP rate for non-Blacks rose from 70% to more than 80%.
In fact, the study showed that Blacks used telehealth more than non-Blacks, with one-third of the former’s visits conducted by telehealth in 2020 and a quarter of the latter’s visits via virtual care.
“The specific time periods where we saw significant gains made by Black patients came when telemedicine was well-established in our health system,” Chaiyachati said. “This does not appear to be a coincidence.”
Looking more closely at the numbers, Chaiyachati and his colleagues found that Black patients steered clear of healthcare during the height of the pandemic in 2020, when the nation was practically shut down, but those visits rose back up to and even above 2019 levels when the pandemic subsided.
“Telemedicine allowed patients to seek non-urgent primary care despite hesitancy for in-person visits pre-vaccine,” Corinne Rhodes, MD, an assistant professor of internal medicine and assistant medical director of quality in Penn Medicine’s primary care service line and the study’s co-author, said in the press release. “Providing chronic disease management and preventive care helped return primary care offices closer to pre-pandemic business as usual.”
The next step will be to ensure underserved patients continue to use telehealth when it’s available and convenient, allowing providers to address health concerns that extend beyond COVID-19 and which affect long-term clinical outcomes.
