The Department of Veterans Affairs is partnering with Evidation to allow veterans to enroll in a program that helps them monitor their heart health through a smartphone or wearable.
The Department of Veterans Affairs is launching a new program aimed at helping veterans manage their heart health through their smartphones and wearables.
The VA and the Veterans Health Administration Innovation Ecosystem (VHAIE) are partnering with California-based digital health company Evidation to enroll veterans in Heart Health on Evidation, a program co-developed with the American College of Cardiology in 2020. The program will be open to veterans regardless of whether they are living with heart disease.
“Veterans who join Heart Health can track and understand their heart health and chronic conditions outside of the doctor’s office from anywhere,” Arash Harzand, MD, a VHAIE senior innovation fellow, said in a press release. “Daily activity, sleep and mood can have a serious impact on heart health and this program gives Veterans an opportunity to measure and engage with these important personal health metrics.”
The program is one of many to use mHealth technology to expand opportunities for consumers and providers to track and manage chronic conditions outside the hospital, clinic or doctor’s office. The program is accessible through an mHealth app (it’s available via iOS and Android) on a smartphone, and participants can also connect through devices such as a smartwatch.
Programs like that offered by Evidation allow consumers to track relevant data, including activity, weight, diet, moods and symptoms, and access resources on cardiac health and wellness. Users can also get personalized reports that chart their health data over time and share that information with their care providers.
Some programs also partner with healthcare providers as a precursor to remote patient monitoring services, in which providers track patient health on devices over time and use that data to create a care management plan.
HIMSS22 returned to form last week in Orlando with a smaller yet energetic event, and a mission to reimagine health so that it works for everyone.
This year's HIMSS22 conference may have been more about improving the healthcare experience for everyone—healthcare workforce included—than patient care.
The annual get-together of HIMSS made its return to form with a weeklong event last week in Orlando, featuring a smaller but energetic exhibition hall, busy educational sessions, an inspiring closing keynote on mental health by Olympic champion Michael Phelps, and a "let's get back to business" air that recognized the challenges facing the healthcare industry.
And while the theme was "Reimagine Health," the focus was squarely on new technologies and processes that improve workflows and make it easier for providers to deliver care, thus reducing the stress on an overworked and shrinking workforce.
"They can't deliver care if you don't have healthy caregivers," one attendee said in the exhibit hall.
Caused in large part by the pandemic, the healthcare workforce in the U.S. is down to only 450,000, according to Roy Jakobs, chief business leader of connected care for Philips, which opened HIMSS22 at a virtual press briefing. That workforce is expected to be short 3.2 million by 2026, he said, forcing health systems to be creative about how they deliver health and support their employees.
There are many reasons for this shortage, beginning with surging rates of stress, depression, and burnout that are pushing people out of healthcare and causing many others to have second thoughts about joining the workforce. To address these challenges, HIMSS offered dozens of sessions on behavioral health access and innovation for both patients and providers, while several exhibit hall presentations and booths targeted preventive health and wellness, as well as mental health integrations (often through virtual care) with clinical services.
Beyond that, many healthcare companies sought to highlight technology that improves the clinical care process, including AI and digital health tools and platforms that reduce the administrative burden for healthcare providers and improve workflows. The theme running around the convention center was that technology should be used not only to boost clinical outcomes and improve access to care but to make the clinician's job easier.
"The pandemic has fast-tracked how we think about healthcare," said Elise Kohl-Grant, chief information officer at Innovative Management Solutions NY, whose presentation at HIMSS22 focused on how to advance "equitable interoperability" to help underserved communities access behavioral health services that address the social determinants of health.
Speaking in a bustling corridor at the Orange County Convention Center prior to her session, Kohl-Grant spoke about the structural determinants that often define healthcare access, and about how new technology, from natural language processing tools that record and summarize conversations to data-mining tools that pull out relevant information, can help care providers improve their interactions with patients. This means the providers spend less time doing administrative work and more time understanding why a patient needs care and how to better provide that care.
"Simple things like appointment reminders can make a lot of difference," she said. And while those reminders help patients remember and plan for their appointments, a digital health platform that automatically sends out those reminders reduces stress on the providers, helps them cut down on missed appointments, and boost patient engagement.
"We've learned to be more nimble and change when we need to," said Don Gerhart Jr., RPh, who works in pharmacy clinical informatics at Pennsylvania-based WellSpan Health, and led a presentation on using AI for smart data migration and EHR consolidation. Gerhart said health systems that can use new technology to fine-tune the EHR and improve clinical functions not only boost efficiency, but also make clinicians more proficient and even appreciative of the EHR.
And that makes the whole healthcare experience better.
Putting a Spotlight on Innovation
To be sure, the pandemic has changed a lot about healthcare. Beyond the staggering and still-growing toll on patients, it cast a spotlight on a health system that had to pivot quickly and become innovative to handle the surge. Hospitals that had never tried telehealth launched new services within weeks, while others saw their 10-year digital health plan accomplished in a year.
There was clear evidence in the exhibit hall, where Zoom—once considered too simplistic for healthcare—now commands a presence as one of the fastest-growing virtual health platforms. Salesforce, a relatively new entrant into the healthcare industry, highlighted services honed in the business world that aim to improve back-end operations, strengthen patient engagement, and allow care providers to spend less time on a computer and more time with their patients.
Hyland Software offered a presentation of its new connected care platform, featuring technology that pulls in and sorts unstructured data coming from outside the EHR. Get Real Health held a press conference at its booth to unveil CHBase Unify, a "digital front door app platform" that represents the evolution of the personal health record and aims to improve patient engagement. Bamboo Health—formerly Appriss Health and PatientPing—talked up care collaboration and integration at its booth, while symplr and Tegria chatted up the benefits of health systems partnering with tech companies and even outsourcing services to reduce the IT burden.
And while health systems have always had a limited presence in a venue designed to focus on vendors, Intermountain Health planted itself squarely in the middle of the floor with a large booth. The Salt Lake City–based health system has always been one of the leaders in digital health innovation, with a virtual care network spanning several states. Its participation in HIMSS22 points to the challenges that hospitals and health systems now face in increased competition from retail health providers and health plans and telehealth companies that have their own networks of providers.
"It is about patient choice now," said Michelle Machon, RN, MSN, DNP, CPHIMS, CENP, director of clinical education, practice & informatics for the Kaiser Foundation Hospitals, who was in town to anchor a presentation on how technology changed pandemic communications.
Machon said that when the pandemic started, health systems launched virtual care services using whatever they could find, including Zoom, Skype, and Google Chat, because that's what their patients wanted to use. And they were innovating in other areas as well, using baby monitors in the ICU and commercial blood glucose monitors to track patients in isolation.
"Now it's becoming the norm," she said.
Like so many others said at HIMSS, Machon says healthcare will change because the public will want it. They've seen what virtual health can do during a pandemic, and how technology has improved their travel, banking, retail, and dining experiences, and they'll demand that of their care providers or look for someone who will offer that experience.
Healthcare leaders, meanwhile, will look at soaring rates of stress and burnout and ever-shrinking workforces and conclude that a healthy workforce is an imperative, and that means not only addressing mental health needs but making it easier and more efficient for care providers to do their job.
The Federal Communications Commission is finishing off its Connected Care Pilot Program, a three-year, $100 million initiative aimed at supporting more than 100 health systems across the country in buying digital health equipment and extending broadband connectivity to improve healthcare access for underserved communities.
The Federal Communications Commission has announced almost $30 million in funding for 16 projects in 15 states through its Connected Care Pilot Program, which supports healthcare organizations in buying technology or extending broadband connectivity for programs aimed at improving access to care for underserved populations.
With this announcement, the FCC is effectively closing out the $100 million program, which was launched in January 2021 and now supports 107 projects in 40 states and Washington DC.
FCC Chairwoman Jessica Rosenworcel said the program will help the agency map out a strategy for the future of connected care and federal support.
“Although this is the last set of participants we are announcing in this program, it’s not the end,” she said in a separate press release. “That’s because we will be studying the award recipients in this program, the connections they used, and how they helped facilitate care. In fact, at the start of this effort, we announced we would produce a report when the three-year pilot program is complete. But I don’t think we should wait that long. So that’s why I’m announcing a new study today. By this time next year, the FCC staff will develop an interim report about initial lessons learned from this program and the COVID-19 Telehealth Program, which provided nearly $450 million in support for care during the pandemic. I look forward to this report informing our thinking about telemedicine going forward.”
The Connected Care Pilot Program was seen as a means of supporting healthcare organizations in launching or expanding programs through telehealth and digital health channels that address critical health disparities and access issues. It targeted issues like maternal mortality and pediatric healthcare, veterans’ service, behavioral health and substance abuse programs, and broadband connectivity, which often serves as a barrier to accessing care in both urban and rural areas.
The latest round of award recipients includes the Boston Community Medical Group, which will launch a HIPAA-compliant telehealth platform to serve 22,000 low-income patients across Massachusetts; Children’s Hospital of Denver, which is planning a remote patient monitoring program for roughly 200 low-income patients living with medically complex conditions; Christiana Care Health Services in Delaware, which is launching an RPM and telehealth program for prenatal monitoring for an estimated 5,000 low-income patients; the Council of Athabascan Tribal Governments in Alaska, which is expanding RPM and other virtual care services for almost 6,000 veterans and other underserved patients across the state; and the New England Telehealth Consortium, which is expanding its connected care platform to serve more veterans and other patients in New Hampshire and Maine.
In a separate press release, FCC Commission Brendan Carr said the agency needs to “make sure that these services have a stable, long-term funding model” and that program be studied to determine how to develop and sustain more projects.
“Furthermore, it has become clear that there is bipartisan support for legislative measures that may be necessary to keep the success of telehealth going,” he said. “For instance, there have long been a range of licensing and reimbursement issues that held back telehealth prior to the COVID-19 pandemic. In early 2020, the Department of Health and Human Services, with urging from Congress, helped facilitate greater access to telehealth services through the issuance of key waivers. For example, HHS has allowed more types of providers to bill Medicare for telehealth services and granted waivers for the reimbursement of audio-only telehealth services. While these waivers are set to expire at the end of the COVID-19 public health emergency declaration, we cannot afford a return to the status quo once the pandemic ends. We have made too much progress to move backwards.”
With President Biden’s signing of the 2022 Consolidated Appropriations Act at just about the same time Carr penned his letter, Congress did extend many of the CMS telehealth waivers for an additional 151 days after the end of the PHE. Carr’s point is that Congress needs to set a long-term policy for connected health, and he’s advocating for a pair of bills: the CONNECT for Health Act, which has support from more than half of the Senate and would make many of those emergency telehealth provisions permanent; and the Protecting Rural Telehealth Access Act, which would also permanently extend a number of the CMS waivers.
The state funding will go to OSF HealthCare and four federally qualified health centers that have launched a five-year program to develop new technology platforms and services to help underserved communities access healthcare.
Illinois is spending almost $66 million on a new program aimed at helping underserved communities access care.
The state’s Department of Health and Family Services is funding Peoria-based OSF HealthCare and a group of federal qualified health centers (FQHCs) that have launched the Medicaid Innovation Collaborative (MIC). The MIC will use the money to develop innovative new technologies and services that help people struggling with social determinants of health, such as financial issues, housing and food insecurity, which affect how they access healthcare.
“We learned during the pandemic that virtual care was a game-changer for patients, and the new funding will help us implement the latest technologies to expand access to care for underserved communities and vulnerable populations,” Michelle Conger, CEO of OSF OnCall Digital Health, said in a press release. “As a leader in digital health, we are excited to develop, implement and evaluate innovative, evidence-based strategies that will improve health and wellness for all residents in the communities served by OSF and our partners, regardless of their income level or where they live.”
Healthcare organizations across the country are using digital health platforms to address those barriers to care often found in Medicare and Medicaid populations. Without that access, consumers often avoid or skip needed healthcare services, exacerbating chronic conditions, reducing healthy lifestyles and leading to costly healthcare services and reduced clinical outcomes down the road.
OSF OnCall, the health system’s digital health platform, will be working with four FQHCs – Heartland Health Services in Peoria, Chestnut Health Systems in Bloomington, the Eagle View Community Health System in Oquawka, and Aunt Martha’s Health & Wellness in Danville – to equip community health workers and medical care teams with digital health tools to help assess and treat patients, including giving them resources and access to virtual care opportunities.
Those services will include chronic care management, behavioral health treatments, maternal and child health services, cancer screenings, and dental services. In addition, the program will support additional staff at community health clinics, EHR implementations, mobile health units and digital health connectivity in underserved areas.
The project will also create about 100 new healthcare jobs, potentially affected about a third of the state. The MIC is partnering with Illinois Central College in East Peoria to train people to fill those community health worker positions.
Officials says the program’s goal is to provide 1 million episodes of care for Medicaid patients over the next five years, especially targeting the state’s most vulnerable and marginalized communities.
As the conference kicks into gear this week in Orlando, Gartner vice president analyst Mandi Bishop offered five jarring predictions for healthcare and five steps that healthcare leaders should take to address those trends.
Lack of access to virtual care is killing people.
That stark pronouncement was delivered this week by Gartner vice president analyst Mandi Bishop during a virtual presentation by Philips at the HIMSS22 conference in Orlando. It underscores the rapidly shifting healthcare landscape caused in part by the global pandemic and the importance of integrating virtual care with in-person services.
Bishop, called in by Philips to set the tone for its unveiling of the new Philips Healthcare Informatics platform, described "an industry that has been truly disruptive." Affected in no small part by COVID-19, healthcare organizations are adopting digital health technologies at a rapid pace to meet consumer demand and counter growing staffing shortages. At the same time, they're dealing with competition from telehealth companies and retail giants like Amazon and Google, countering cybersecurity threats, and accommodating a trend that sees more services delivered outside the hospital, clinic, or doctor's office and in places like the home.
The industry is learning that the fee-for-service structure that has been in place for decades "is not resilient," Bishop said, and value-based healthcare is finally gaining traction. The challenge lies in making that sustainable.
Bishop outlined five Gartner predictions for the healthcare industry:
By 2025, 40% of the nation's care providers will have shifted 20% of their hospital beds to the home, driven by remote patient monitoring (RPM) platforms and AI services that allow more services to be delivered virtually. Part of this shift is fueled by the hospital at home concept, which sees some intensive care services moving over to the home setting.
By 2025, a digital commerce platform and marketplace for healthcare will connect one quarter of the nation's consumers, payers, and providers. That platform will enable these groups to search for, and in many cases, access or deliver healthcare on demand, bypassing hospitals, clinics, and offices.
By 2025, 10 major employers will be contracting with a major retailer to deliver healthcare services to their employees. Many companies, in fact, are already using health plans that see virtual care as a convenient and less costly alternative to in-person care, and those services will expand as the preventive health and wellness industry builds steam.
By 2025, three quarters of the top 20 life sciences organizations will have dealt with a cybersecurity issue, resulting in roughly $10 billion in revenue losses. Alongside a growing shortage of healthcare providers, cybersecurity is one of the most prevalent concerns among healthcare executives. And the increasing value of healthcare information and the growing complexity of threats to privacy and security isn't making things easier.
And finally, by 2023 some 5% of global deaths will be attributed to a lack of virtual care access. This points not only to the value of virtual care but an ever-growing challenge to accessing care in underserved communities. Simply put, consumers are having problems finding the care they need, and those barriers are putting their lives in danger.
To address these concerns, Bishop laid out Gartner's five recommendations for healthcare leaders:
Invest in so-called hospital at home technologies and strategies to set the groundwork for more RPM and virtual care services.
Prioritize real-time, on-demand data technologies that allow care providers to access the information they need when they need it.
Establish specific values and advantages that one's healthcare organization can focus on in an increasingly competitive marketplace.
Make cybersecurity a priority.
Cultivate digital sensitivity, so that the organization not only adopts virtual care platforms and services but helps consumers who aren't yet acclimated to the digital world.
Adopting—and adapting to—innovation in technology is one of the big themes at HIMSS22 this week. The conference, expected to draw roughly 5,000 attendees over the week to the Orange County Convention Center, is set to the theme of "Reimagine Health," and that's been seen in a flurry of vendor announcements focusing on new connected care technology, ranging from robotics and AI tools to RPM platforms and services that can integrate with the EHR.
From addressing stress and burnout to understanding value-based care, this week's conference asks attendees to reimagine healthcare.
Healthcare leaders are looking for ways to reimagine healthcare at HIMSS22. For many of them, that may begin by looking inward.
Stress and burnout have been a problem in healthcare even before the pandemic, but the COVID-19 crisis has pushed that problem into hyperdrive. Healthcare organizations are dealing with low morale, an exodus of tired and dispirited staff, and a shortage of new care providers to bolster the ranks. And administrators are looking for new ideas to make the workplace better.
Amid the conversations taking place at the Orange County Convention Center this week in Orlando, there is plenty of talk about new technologies and services aimed at identifying stress and burnout in healthcare and giving people on-demand access to care and resources. But a key component to addressing stress might often be overlooked: Collaboration.
"We need to focus on building communities within the hospital," says Jessica Sweeney-Platt, vice president of research and editorial strategy at athenahealth. And that, she says, means bridging the gap between administrators and providers.
Sweeney-Platt and Nele Jessel, MD, athenahealth's chief medical officer, will be giving a presentation this Thursday titled "How the C-Suite and Physicians Can Team Up to Combat Burnout." The session is aimed at pulling executives into the conversation with clinicians so that they can develop strategies that best address why clinicians are stressed out.
And that conversation begins with the electronic health record.
Jessel says the EHR has taken a lot of blame over the past decade for making life miserable for clinicians, and the pandemic's push away from in-person services and toward virtual care has compounded the issue. But the problem may be more one of change management than change itself, and the solution may lie in giving clinicians more time to get used to the technology.
"The negative view of the EHR as adding to their misery clearly has not helped," she says. "That makes it more difficult to see [technology] as an advantage. That point has to be made."
Now, the "technology is good for you" argument might not sit well with a physician population that tends to see the EHR as a billing and regulatory tool, and one that takes them away from their patients and turns them into data clerks. But that technology can be beneficial if clinicians are given the time and support to become comfortable with it.
Jessel and Sweeney-Platt say clinicians should be given protected administrative time to learn how to use the EHR, so that time spent on the EHR is a benefit to clinical care rather than a distraction. That means carving out specific time for training, separate from patient care but not added to the workload, so that clinicians can understand how the technology improves caregiving.
"How can we afford not to do this?" asks Sweeney-Platt, noting the toll that stress and burnout have had on the healthcare industry.
In addition, clinicians are feeling stressed because they're being overwhelmed with data—and again, the blame lies with technology, which allows access to so much unstructured information. Organizations need to prioritize tools and processes that sort through the data and give clinicians what they need, rather than forcing clinicians to do that work, Jessel says.
Jessel and Sweeney-Platt say an important part of addressing stress and burnout in the provider community is understanding why clinicians feel this way and collaborating with them on resources and services that help improve their workloads and mindsets. They also need time and support from the C-suite to adjust to technology.
This goes for virtual care as well. Many healthcare organizations shifted from in-person to virtual care during the height of the pandemic to reduce the burden on hospitals and reduce the spread of the virus. As the pandemic wanes, organizations are trying to find a balance between virtual and in-person care.
Some providers have embraced this shift to telehealth, but many others are wary of the burden on their already-overtaxed workloads, and wondering where virtual care fits in. Jessel and Sweeney-Platt say the C-suite should be highlighting virtual care as a means of improving workflows. Again, that means taking the time to help physicians understand the technology.
"Virtual care has the potential to give autonomy back to physicians," Sweeney-Platt points out. "It can be a better use of your time, and it can save patients time. But it needs to be supported."
As with the EHR, collaboration between the C-suite and physicians is important, Sweeney-Platt and Jessel say. Executives should work with clinicians to identify how to adapt virtual care and to offer support and training where those processes might be stressful.
And that's where those communities come into play.
"To what degree are we making it easy for [care providers] to find community within the organization?" asks Sweeney-Platt, who's particularly interested in the high rates of stress among women. She says the healthcare setting—particularly during the pandemic—may be doing more to isolate providers from their colleagues, depriving them of a critical means of adjustment and support. This, in turn, makes it more difficult for providers to see the benefit in new strategies.
Sweeney-Platt says health system administrators need to emphasize community, so that providers have a shared sense of purpose and experience. They can lean on and learn from each other.
This, of course, leads to the last and newest leg of the triple—now quadruple—aim in healthcare. The shift to value-based care means that healthcare organizations must rethink how healthcare is valued. And the pandemic has moved the goalposts on how value is defined, placing more of an emphasis on quality and access and less on episodic care and repetitive services.
Sweeney-Platt and Jessel also want to see a shift to better care for the caregivers, and a commitment from the C-suite to invest in tools and services that reduce stress and improve workloads. That includes giving them more time to absorb and master the technology they'll be using to care for patients, as well as better access to resources and their colleagues.
The research finds that benefits like ride-sharing services might not save money or improve outcomes at first, but they're very important for people who face barriers to accessing care.
A new study in Health Affairs finds that transportation benefits like ridesharing services aren’t improving clinical outcomes and may even be increasing costs, but they’re quite popular with underserved patients who face barriers to accessing healthcare.
The study suggests that such programs may need to be evaluated differently, with an ROI based on reducing barriers to access rather than saving money or even improving health, at least until the program has been up and running for a while.
“Qualitative analyses revealed that participants were highly satisfied with the program, reporting that it eased financial burdens and made them feel safer, more empowered, and better able to take control of their health,” the researchers said. “These findings suggest that although transportation programs are commonly introduced as ways to contain health care spending, it may be better to think of them as programs to improve health care access for people facing difficult circumstances.”
The research team was led by Seth Berkowitz, MD, MPH, of the University of North Carolina at Chapel Hill and includes members from the UNC Health System. They analyzed the experiences of Medicare beneficiaries accessing care through the UNC Health Alliance accountable care organization (ACO) from the beginning of 2017 through the end of 2019.
Their work focuses on the growing trend of addressing social determinants of health, which are factors that exist outside the healthcare realm but which can affect delivery and health outcomes. They include social and economic factors such as homelessness, work status, child (or parent) care, transportation and cultural and community norms.
In some cases the impact on healthcare is clear – someone without a job will likely forego health insurance and only access care in an emergency – while other factors may take time to play out. The challenge for healthcare organizations is to identify the barriers and develop programs that address them.
“Although nonemergency medical transportation is a required Medicaid benefit, increasing recognition of transportation barriers faced by people with other types of insurance coverage, such as Medicare, has led to innovative programs that seek to overcome these barriers,” Berkowitz and his team wrote in their study. “These programs often use smartphone application–based ridesharing programs, which are marketed as offering more affordable and scalable implementation than traditional transportation services.”
“The premise for many of these programs is to increase attendance for outpatient medical appointments,” they continued. “As the conventional wisdom is that many inpatient admissions and emergency departments can be prevented through outpatient medical care, improving outpatient visit attendance could reduce inpatient admissions, emergency department visits, and health care costs.”
According to the research, those who used the transportation program ended up increasing per-person per-year outpatient visits and spent more money on healthcare services than those who had their own transportation. Yet that group didn’t show any notable decrease in hospital admissions or ED visits.
The results do touch upon one criticism of digital health services: that patients who have access to them will use them more often because they’re convenient, and that will lead to unnecessary healthcare visits and higher costs. Digital health proponents, meanwhile, say these services allow more people to access care who would otherwise go without that care, and that excessive use and costs can be filtered out through careful management.
Perhaps more important is the value of these services to the patients who use them. As Berkowitz and his colleagues note, patients who have problems accessing healthcare were grateful to have that barrier removed through a ridesharing program. This reduces stress and saves them money, while also giving them more confidence in managing their health. Those factors could translate into better outcomes and reduced costs down the road.
Ohio’s Boundless Health gives people with intellectual and/or developmental disabilities (and their caregivers) a healthcare clinic of their own
For people with intellectual and developmental disabilities (I/DD), a trip to the doctor's office or dentist poses unique challenges for both patient and provider. Now an Ohio nonprofit has developed a health center specially designed to provide those services.
I Am Boundless, based in Columbus, has opened Boundless Health, a facility modeled on the federally qualified health center (FQHC) platform that offers a wide range of healthcare services, including primary and specialty care, behavioral health services, and even dentistry, for the I/DD population and their caregivers.
Healthcare providers "are not trained to provide care for these people, and the healthcare system is not built for this," says Patrick Maynard, PhD, the organization's president and CEO. "I have a board member with a 38-year-old daughter who is still seeing her pediatrician."
The challenges are often overlooked, yet critical. A child on the autism spectrum, for example, might not do well in a typical doctor's or dentist's office, and doctors and nurses often don't know how to treat them, thus affecting care outcomes. Some families might forego some healthcare services because of those challenges, travel long distances to a provider who can offer those services, or show up in the local ER.
According to Maynard, studies have found that patients with I/DD and other complex needs are almost two times more likely to be hospitalized than the general population, are prescribed four times as many medications, and generally have a shorter lifespan. They account for 12.4% of the nation's population, yet are responsible for 36% of the nation's healthcare costs.
Patrick Maynard, PhD, president and CEO of Boundless Health. Photo courtesy Boundless Health.
"Systems of care must actively engage people with I/DD in health awareness, self-advocacy, health literacy, and health promotion activities to enable them to participate in their own healthcare through improved access," David Ervin, CEO of The Resource Exchange in Colorado Springs and advisory committee member at the Jerusalem-based National Institute of Child Health and Human Development said in a 2014 paper titled Healthcare for Persons with Intellectual and Developmental Disability in the Community. "People with I/DD, their caregivers, and families are often unable to represent their own health concerns due to a lack of understanding of how complex healthcare delivery systems work and not knowing how or in what circumstance to access and employ institutional and community healthcare systems. Healthcare delivery systems must develop and integrate effective networks of primary care medical providers and other health professionals that can positively impact health outcomes for persons with I/DD."
That, Maynard says, is where Boundless Health could be a game-changer.
He says a clinic that caters specifically to the I/DD population, with care providers trained to treat these patients, "represents a big piece of the pie that has always been missing." The center operates on a strategy of offering whole-person care, integrating services that patient and their families might have a difficult time accessing elsewhere.
"Basically, we're addressing population health," he says.
It's not a simple process. A significant portion of this population is covered by Medicaid, yet Medicaid doesn't cover many of the specialized services that these patients need. So Maynard and his staff have applied to the Department of Health and Human Services' Health Resources and Services Administration to be classified as an FQHC, which would expand reimbursement opportunities.
That alone, Maynard says, is a five-year process.
"It's a laborious process," he says. "You have to take on all the expenses first. The typical healthcare model is based on volume, but we're approaching this differently. We've had to build the business model from the ground up, and work things out as we go along."
The idea is to give these patients and their caregivers not only one place to meet a wide range of vital healthcare needs, but to create an atmosphere that makes them comfortable. Maynard says the physical design of the clinic, with 17 patient rooms, a pharmacy, and space set aside for behavioral health services, is as important as what it offers, with aesthetically pleasing rooms and play areas and workflows that focus on "deliberate and thoughtful time with each patient.”
"We're geared specifically for this population," he says. "And it's not just a healthcare model. It's an integrated healthcare model."
It's also designed for patients of all ages. While the shortage of healthcare providers for infants and children with I/DD is acute, aging parents face growing obstacles finding care for their children as the years go by. And there aren't a lot of providers out there who can treat seniors with I/DD, either. They're often shoehorned into senior living facilities and skilled nursing facilities that don't have the resources to meet their specific care needs.
"The senior service industry is not equipped to care for this population," Maynard points out.
That's why he and his staff are hoping Boundless Health can serve as a model for other clinics around the country. This clinic will serve the central Ohio area, around Columbus, with a goal of treating as many as 7,000 patients in a few years through both the clinic and mobile health services co-located in community centers in cities like Dayton, Cincinnati, Cleveland, and Youngstown.
"We're getting a lot of support from local health systems," Maynard says, noting that newly introduced dental service will be provided with help from the Ohio State University's Nisonger Center. Those health systems, all the way down to local doctors and clinics, see the value in a health center that can cater specifically to patients they have a difficult time accommodating.
That's good for Ohio, but there are 49 other states out there.
Maynard says the health center is designed to give patients and their caregivers one place to visit for a variety of healthcare needs, much like a traditional clinic or FQHC. Thus, the FQHC designation would be important in that it would give other providers in other states a model to replicate.
To prove the value of that model, Maynard and his staff are collecting lots and lots of data.
HHS "is heavily into compliance and quality assurance," he says. "We have a lot to prove."
And, he says, they're looking at how to expand Boundless Health—true to its name—to address other needs and issues, such as social determinants of health. Like any underserved population, people living with I/DD and their caregivers face problems accessing a wide range of services that extend beyond healthcare but affect health and wellness.
"Our growth plans include not only geographic expansion and partnerships, but also enhancing our healthcare services to include specialty practices, such as gynecology, dietetics, hearing loss, and other medical services to provide customized care, as well as expanding our technology to bring traditional and specialty services to where they are needed," Anna Wuerth, the clinic's executive director, said in a press release issued last fall.
"We're looking for ideas all around the country," Maynard adds. "But a lot of this is new. We're kind of pioneering this out there."
A survey of patients who've been prescribed wearables finds some issues with the technology and design, but also a lack of education on how to use the mHealth devices and how they'll improve care management.
A survey of hundreds of patients who’ve been prescribed wearables finds that problems with adoption and engagement are tied not only to technical issues, but also to how providers are prescribing them.
Conducted by Software Advice, the survey of more than 450 patients found that while 86% said the mHealth devices did improve clinical outcomes and their quality of life, even more – 87% – said the devices had given them inaccurate information, and 85% blamed those mistakes on usability issues.
Specifically, of those were reported getting inaccurate data from their wearable, 54% said it wasn’t clear how they were supposed to upload data from the devices to their care provider, while 31% said the interface was confusing and 15% said the device malfunctioned. In addition, 65 percent said they had to contact their doctor’s office to correct the mistakes, adding tasks to the care process that wearables are designed to eliminate.
“User experience is such a massive element of developing these devices, and patients need to be able to easily understand how to engage with these tools in order to get the most out of them,” the article points out.
The problem is more than just technical. When asked to list the biggest drawbacks to using wearables, 39% cited security vulnerabilities with protected health data and 17% cited IT issues. But 31% said the devices lead to less frequent office visits, thus negatively affecting their relationship with their care provider, while 8% cited reduced quality of care and 5% said wearables complicate care management.
Those three concerns point not as much to the technology, but to how care providers may or may not be preparing their patients to use wearables. Providers need to not only research mHealth devices and choose those that would best help their patients, but work with those patients on how to collect and send data.
More importantly, they should be able to explain why wearables are important to care management, and how these devices can improve collaboration and clinical outcomes while reducing unnecessary tasks and costs.
The healthcare industry has long looked at the consumer-facing wearables market with both envy and skepticism, longing for the popularity of Apple and Fitbit while saying the data coming from those devices isn’t reliable or accurate enough for clinical care. That gap was seen in the survey as well, with only 9 percent saying their prescribed device performs better than a commercial device and 43 percent liking commercial devices over prescribed devices.
That said, while developers of medical grade wearables may have a ways to go to be considered stylish, those devices are usually more appropriate for clinical care. And it’s up to providers to make that point and help patients adjust to using wearables.
“It stands to reason that patients who are dealing with confusing interfaces or who don’t understand how to interact with their devices won’t get the most out of them,” the article notes. “Prescribers need to be fully aware of their patients’ comfort levels with technology in order to offer user training and support that is tailored to individual patients’ abilities and knowledge base.”
That, too, can be an issue. When asked to rate their “technological literacy,” 20% said its excellent and 58% said it was good, but the remaining 22% said they were either average, poor or very poor in their knowledge to technical issues. Providers need to know when their patients aren’t comfortable with technology (and not just assume someone is tech-savvy) and find ways to help them.
To that end, when asked how they would like to be taught, 67% asked for a help desk or support team that could be contacted for assistance, while 57 percent wanted in-person training on how to use the device and 28 percent asked for “a library of resources and references to help troubleshoot and resolve device issues on my own.”
Finally, despite all the challenges to musing wearables, patients are seeing value to them.
According to the survey, roughly half of those patients surveyed say wearables contribute to “a better understanding of my health,” a key component to patient engagement and the idea that patients should be in more control of managing their health and wellness. Some 27% percent, meanwhile, said the device improve quality of care, 15% said they allow one to receive remote care (such as in the home or office), 5% cited improved collaboration with providers and 4% said the devices “simplified management of my condition.”
Those numbers are low, but that may be because the idea of using wearables for care management is still in its infancy, and the barriers to adoption and sustainability need to be addressed.
The Los Angeles health system has launched an Artificial Intelligence in Medicine (AIM) division and published studies highlighting how AI can be used to help care providers diagnose and improve care outcomes.
Cedars-Sinai Medical Center has launched a new division to explore than value of AI in clinical care.
The Los Angeles-based health system, long known for its innovative work with virtual reality, is developing the Artificial Intelligence in Medicine (AIM) division with an eye toward using machine learning technology to support care providers. The unit will be led by Sumeet Chugh, MD, an associate director of the Smidt Heart Institute.
"Through the use of applied artificial intelligence, we can solve existing gaps in mechanisms, diagnostics and therapeutics of major human disease conditions which afflict large populations," the program’s creator, Paul Noble, MD, a professor of medicine and chair of the Department of Medicine, said in a press release. "The future of medicine lies in decoding enormous amounts of phenotypic and genotypic patient data."
"Using a disease-based approach, AIM will enable cross-disciplinary connections between clinicians, scientists, and trainees at Cedars-Sinai at multiple levels," added Chugh, the Pauline and Harold Price Chair in Cardiac Electrophysiology Research and an expert in sudden cardiac arrest. "We hope to function as innovators and custodians of patients’ healthcare interests and needs. And, most important, we are bringing discoveries directly to patient care."
The new division has hit the ground running. AIM recently published a study in the Journal of Nuclear Medicine that analyzed how AI can be used to identify heart attack risk in patients with a history of coronary artery disease.
"Because the actual risk for recurring heart attacks differs greatly among patients, predicting future risk in patients with existing coronary artery disease can be challenging," Piotr Slomka, PhD, a professor of medicine in the Division of Artificial Intelligence in Medicine and lead author of the study, said in the press release. "Predicting risk, however, becomes easier and more efficient with the use of artificial intelligence."
In addition, research by AIM was recently published in JAMA Cardiology that evaluated a new AI tool that’s designed to identify hypertrophic cardiomyopathy and cardiac amyloidosis – and to help clinicians determine one from the other.
"These two heart conditions are challenging for even expert cardiologists to accurately identify, and so patients often go on for years to decades before receiving a correct diagnosis," Da Ouyang, MD, a cardiologist in the Smidt Heart Institute, member of the division of AIM and senior author of the study, said in the press release. "Our AI algorithm can pinpoint disease patterns that can’t be seen by the naked eye, and then use these patterns to predict the right diagnosis."