New research on the value of digital health in hypertension care finds that these devices work best when they connect the patient to a care provider or team who can provide medication management.
A new analysis of digital health tools for hypertension tracking says they are truly effective if they include medication management features, such as a virtual care link.
The report, from the Peterson Health Technology Institute (PHTI), finds that devices that only transmit data to a care provider or focus on behavior change “are less effective and do not provide clinically meaningful improvements,” whereas devices that enable patients to connect with a care team to manage prescribing and dosing “deliver rapid and clinically meaningful improvements in blood pressure that outperforms usual care.”
The research highlights a crucial aspect of remote patient monitoring that has long plagued health systems and hospitals. RPM devices might be great at gathering data in between healthcare visits, but unless that data is used in a meaningful way, it’s wasted.
The key here is that RPM programs need to combine tools with access to care providers who can help patients act on the data being gathered. That may be through an app or other virtual care link, and it could be synchronous or asynchronous.
The results hold true for any chronic condition. In this case it’s hypertension, which affects roughly 120 million Americans, of half of the country, and only about 27 million, or one-quarter, are managing their blood pressure. The rest are at high risk of a variety of health emergencies, like heart attack and stroke.
“Too many people are living with uncontrolled hypertension, but there are effective digital solutions to help patients improve their cardiovascular health, save lives, and lower spending over the long run,” Caroline Pearson, the PHTI’s executive director, said in a press release accompanying the study. “Digital medication management solutions support healthcare providers with virtual teams to monitor blood pressure and adjust medications to help bring patients into control within months rather than years.”
PHTI evaluated 11 digital health tools: Blood pressure monitoring devices from AMC Health, HRS and VitalSight; medication management tools from Cadence, Ochsner Digital Medicine and Story Health; and behavior change tools from Dario, Hello Heart, Lark, Omada and Teladoc (Livongo). The three categories were evaluated for clinical effectiveness and economic impact.
All three categories were found to increase net health spending initially, though the medication management tools had the best potential to offset those costs with improved clinical outcomes over the long term.
In terms of clinical effectiveness, the blood pressure monitoring devices were found to be slightly better than usual care in reducing blood pressure but not enough to be clinically meaningful, while the behavior change tools saw limited incremental declines in blood pressure.
Executives in HealthLeaders' Mastermind program on AI in RCM and finance operations say the technology will help them integrate with other departments in the health system and even work with patients to pay their bills.
Imagine an AI tool that can calculate a patient’s bill factoring in insurance coverage, a health plan’s tendency to deny a certain claim, and social determinants of health that may factor into the patient’s ability to pay. Then imagine that tool helping a hospital to work with the patient on a payment plan, compare its pricing structure with competitors and track social media mentions.
AI is seen as a tool to reduce administrative work and help clinicians get in front of their patients, but in the revenue cycle management and finance space, sometimes it’s hard to see beyond the dollars and cents and measure AI’s true impact.
Participants in HealthLeaders’ Mastermind program on the use of AI in RCM and financial operations connected those dots during a recent roundtable in Chicago, where they discussed the evolution of a technology already well-entrenched in their departments. One aspect of that conversation was to use AI to bridge the financial and clinical sides of the hospital.
AI has been put to work in the RCM and finance space over the past few years to address administrative tasks and do the number-crunching and data retrieval that would normally occupy staff time. Now the focus has shifted to generative AI, in which RCM and financial data is used to give staff pathways to better results; and on the horizon is predictive AI, which will give staff better ideas about where those pathways end.
Not only will the technology evolve, but how health systems and hospitals use it will change as well.
Beyond the applications in coding and denials management, executives see an opportunity for AI to learn how payers deny claims and help RCM staff proactively address, even avoid, those denials, or to tackle the complexities of the prior authorization process to reduce friction. As these tools evolve, Jane Lombardo, director of revenue cycle optimization at Stanford Health Care, said RCM staff will become “stewards” of the technology, overseeing how it’s applied and monitoring its effectiveness.
Steven Kos, MSHCA, CHCIO, senior director of revenue cycle applications at Florida’s Baptist Health, said the development of AI tools will also compel healthcare organizations to rethink RCM and finance skillsets, perhaps adding staff who are skilled at revenue cycle informatics, revenue integrity and patient advocacy or engagement.
Shannan Bolton, Stanford Health Care’s vice president of optimization and performance improvement, sees AI becoming a powerful tool for education and financial counseling, helping patients to both understand their financial responsibilities and the options available to them for paying their bills.
“That’s where we fall short with patients,” she said.
And Christina Slemp, MHA, MSHI, vice president of revenue cycle for Tennessee-based Community Health Systems, added that AI can help reduce the stress for patients by giving them the information they need quickly, rather than waiting around for explanations.
In fact, RCM are in the unique position to integrate clinical and financial data, helping both patients and their care teams. Some health systems are already experimenting with ambient AI to capture the doctor-patient encounter and code that encounter at the same time.
That strategy can also apply to patient scheduling, Bolton says, identifying a key element of the revenue cycle and a hotspot. Patient scheduling drives revenues when handled in an efficient manner, but it can also cause headaches when patients struggle to schedule their appointments or miss them. Ai tools that enable patients to self-schedule and help providers coordinate their workflows.
Beyond helping patients to schedule their appointments, RCM and financial executives say AI will become critical in reducing the complexity around billing and collections. That includes working with payers to fine-tune coverage and reduce denials and working with patients to make sure they understand and can pay their bills.
And that’s where the technology may make the biggest impact in the future.
Kos and Clark Casarella, PhD, senior data scientist at Sanford Health, said Ai will be used to improve the way hospitals and health systems work with patients on their financial responsibilities, creating a patient scorecard of sorts that researches in real time their ability to pay a bill. And Bolton pointed out that the technology can help organizations better understand why a patient has financial insecurity, thereby addressing the underlying social determinants of health that affect the revenue cycle process.
At the end of the day, patient financial responsibility is just one small part of a healthcare organization’s RCM and financial operations, but it’s an important and often-overlooked part. And it’s one that will become more important as the healthcare landscape shifts closer to patient-centered and value-based care. AI has the potential to help, giving both patients and providers the data and tools they need to work together.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
The Parkland Center for Clinical Innovation has developed a new tool that enables providers to better understand the challenges that a specific neighborhood faces in accessing healthcare services.
The Dallas-based innovation center, which was spun out of Parkland Health in 2012, recently debuted the Community Vulnerability Compass (CVC), a data tool that pulls in ZIP codes, census information, and neighborhood-level information to better understand the health, resiliency and economic vibrancy of a particular neighborhood.
The goal, says Steve Miff, PCCI’s president and CEO, is to dig down deep into the many barriers that effect healthcare access and help health systems and hospitals design care pathways to boost clinical outcomes in underserved populations.
“Our health does not really become, doesn't start and doesn't end in our clinics [or] in our hospitals,” Miff said during a recent HealthLeaders podcast. “It really starts and continues in where we live, where we work, where we play, [and] where we pray. [This helps in] understanding and knowing [how to] be able to address those elements that oftentimes are barriers to access the health of communities.”
The CVC analyzes 26 different factors, including food insecurity, paycheck predictability, insurance coverage, education, internet availability, mobility, transportation, sidewalks, affordable housing, green space, clean air and crime statistics, to give providers a picture of a neighborhood’s healthcare options. And that, in turn, gives providers a roadmap to improving care for a specific patient.
“Now we have much richer information about that individual [that is put] into those databases that these organizations use,” he said. “It’s being used for planning, it's being used for patient outreach, it’s being used for placement of resources, and it’s being used to be able to coordinate activities and resources specific to that community on how individuals can be helped in their journey.”
Miff said the tool will not only help providers improve care management, but enable them to collaborate with various public and community health organizations on projects that can improve entire neighborhoods, even towns and cities. That might include public housing developments with better access to healthcare, food programs in areas where access to healthy food is limited, or mobile health programs in areas with a high percentage of cancer or chronic diseases.
“To understand vulnerability, we need to be able to collaborate and create those connected communities, and we need to use [this data] at scale,” he said.
To listen to the HealthLeaders podcast with Steve Miff, click here.
The annual healthcare innovation event had plenty of heady conversation and high-profile speakers, but execs were more focused on how new ideas are now being put to use.
As HLTH sinks into the Nevada sunset and attendees (and their spouses/partners) figure out just how much they spent in the casinos, a look back reveals some interesting insights into how healthcare innovation is evolving.
AI was, of course, the dominant topic, indicative of the emphasis that everyone is placing on this technology to, in essence, "save healthcare." But we've been talking about AI for a few years now, and the conversations are shifting from what it can do to what we should be doing with it now. Anyone still talking about the low-hanging fruit is behind the curve and in danger of losing out to competitors who are using mature tools.
Ai governance is, of course, a separate conversation, and one that many healthcare execs should be following. Healthcare organizations are embracing AI so rapidly that they're in many cases making the rules on the fly, while collaborative efforts like CHAI and TRAIN are playing catch-up with standards and best practices. Sadly, a main stage session featuring Brian Anderson of CHAI, David Rhew of Microsoft, Christine Silvers of Amazon One Medical and Melanie Fontes Rainer of the Health and Human Services Department's Office of Civil Rights drew a small audience (much less than the session featuring Lenny Kravitz just a short while later).
Getting More Specific About AI
On the exhibit hall floor, healthcare executives and others were talking about what they're doing now with AI, especially generative and predictive tools. Dan Shoenthal, VP and chief innovation officer at the University of Texas MD Anderson Cancer Center, said he was finding value in conversations with other executives and in the smaller, more focused sessions taking place in meeting rooms outside the exhibit hall.
During an exhibit hall session on Monday titled "Payer-Provider Arms Race," executives from Providence, Ardent Health, Sanford Health Plan and Doximity talked primarily about how they're using AI now, rather than how the technology might improve that often-testy relationship between providers and payers. Sara Vaezy, EVP and chief strategy and digital officer at Providence, did note that AI will help to "level the playing field" for providers and payers, and by giving both sides—and, more importantly, consumers—transparency, they'll be able to have more meaningful interactions.
The changing discussion on AI may have also led to a subtle shift in the mood at HLTH as well. Two years ago the celebrations were turned up a notch or two, buoyed by larger happy hours and food carts in the exhibit hall, vendors flush with cash from financing rounds and larger, more colorful booths. This year the atmosphere was (for the most part) less showy and more focused. The optimism is still there, due in large part to AI, but there's less attention to putting on a splashy display at a time when the industry is dealing with cost, quality and workforce issues. Even the celebrities who graced the stage in larger numbers were there to discuss important issues, not just give HLTH extra cachet.
And it's not all about AI, either. The Food as Medicine/Food is Health movement still had a significant presence in the exhibit hall, as well as a few interesting panels, though it's a bit disappointing that the effort hasn't grown much. Maternal health, behavioral health, environmental issues, global health and nursing innovation all staked their claim to the innovation landscape.
Moving Care Out of the Hospital and Into the Home
The acute care at home/hospital at home strategy also had its moments, starting with the continued presence of Best Buy and its Geek Squad for Healthcare booth. Caroline Yang, MD, associate clinical director of Mass General Brigham Healthcare at Home—one of the more advanced programs in the country—noted that health systems and hospitals are beginning to move beyond the rigid Medicare model and experiment with new ideas and patient populations. That may be a critical strategy as healthcare leaders look to move more services into the home setting and experiment with remote patient monitoring (RPM), telehealth, mobile-integrated health (MIH) and home health services.
Of course, innovative concepts like hospital at home need support from payers to be scalable and sustainable—at least in the early stages. The hospital at home movement saw a surge during the pandemic, as hospitals sought to isolate infectious patients and reduce the strain on overwhelmed clinical staff. That surge was supported by waivers from the Centers for Medicare & Medicaid Services (CMS) reducing restrictions on telehealth and RPM use and boosting Medicare reimbursements.
Those waivers are set to expire at the end of this year, but the rumor around HLTH is that the waivers will be extended, perhaps for another five years. Yang said an extension would be good for the industry, giving health systems and hospitals more time to gather the data needed to prove that these programs reduce costs and improve clinical outcomes.
Another extension may be on the table for the somewhat controversial effort to expand virtual prescribing for controlled medications. Prescribing by telehealth has been severely limited for years under the Ryan Haight Act, passed in 2008. That legislation put the onus on the U.S. Drug Enforcement Agency (DEA) to create a special pathway so that provider could be approved to prescribe controlled drugs for treatment of substance abuse, mental health, and other issues.
HHS unveiled a waiver during the pandemic so that providers could use telehealth, with the idea that the DEA would get around to setting up that registration process. The DEA still has not set up that pathway, despite pressure from a large group of providers and telehealth advocates as well as lawmakers. The rumor out of HLTH is that the waiver will be extended perhaps one more year, and that advocates will look at either having Congress force the DEA to establish that process or perhaps bypass the DEA altogether and a find a different means of enabling provider to prescribe by virtual channels.
Beyond those issues, healthcare's innovation executives came away from HLTH with a good idea of where the industry is heading. Scott Arnold, EVP and chief digital and innovation officer at Tampa General Hospital, and Rachel Feinman, vice president of innovation for Tampa General's TGH InnoVentures arm, said execs are looking beyond the next great widget or piece of technology to create and sustain a patient's entire healthcare journey. That means embracing new ideas on care management and coordination, as well as SDOH and navigation.
"There are parts [of this journey] that we may not be able to do as well," Feinman said. In order to become experts—and, in fact, stewards—of the patient journey, she said, they need to keep looking for inspiration from all angles inside and outside the healthcare industry.
The healthcare industry's annual showcase of innovative ideas is off to a good start. Here's what attendees are talking about.
This week's HLTH 2024 event in Las Vegas is giving the industry's innovators a chance to make their case for new technologies and strategies. But at a time when healthcare seems as fragmented and costly as ever, what are themes here that really resonate?
Here are three gleaned from the first two days in Sin City.
AI is Still the Talk of the Town
AI is as big as ever, and very few conversations in the Venetian don't include some mention of how revolutionary the technology will make healthcare—for the health systems and hospitals, the payers and, most importantly, the patient. In fact, it's the consumer/patient who stands to really influence how healthcare evolves. They're using AI tools to better understand their healthcare needs and options, and they're connecting with both their health plans and their care providers (or providers recommended to them) to map out that healthcare journey.
The talk on the HLTH 2024 floor is that payers and providers may be jumping all in on AI, but they have to develop their strategies carefully and purposefully to meet patient/consumer needs and preferences. And that means understanding how to use data coming in from all angles, including some very non-traditional channels. In short, AI is revolutionary, but it's important to learn how to surf that wave rather than go under.
Healthcare Collaboration Will Focus on Navigation
That may be the biggest theme coming out of HLTH, and it's something Glen Tullman and Transcarent are emphasizing with their release of WayFinding, an AI-powered platform for benefits navigation, clinical guidance and care delivery. True disruptors in the healthcare space recognize that so many health systems and hospitals offered limited pathways to care for their patients, while payers rely on the "in-network" strategy to guide members on a certain path. But the healthcare marketplace is much larger, with new options and ideas available to the consumer almost daily.
As AI evolves and true innovators understand the marketplace, they'll create platforms on which consumers can select what services they need, with AI in the background analyzing their needs and giving them the relevant options. Providers will need to be transparent with what they can offer, and payers will be on hand to manage the financial strategies and give guidance. Primary care, specialists, behavioral healthcare, pediatric care, oral and eye care, rehabilitation providers even services that address SDOH like nutrition counselors and alternative therapies will have a place on this platform.
It's admittedly an ambitious and optimistic view of the healthcare landscape of the future, but that's what AI could do if applied strategically. And it's what consumers will demand as they come to realize how they can control their healthcare choices.
From Niche Services to an Enterprise Platform
Again, the platform. But from the healthcare executive's perspective, this is where health systems and hospitals can develop their presence. Healthcare is inundated with services and technologies that address specific populations or conditions. The Exhibit halls of events like HLTH, ViVE, CES, HIMSS and ATA all feature companies offering unique and specialized services or technologies. Those solutions may be quite effective, but health systems and hospitals have to look at a much larger patient base.
Healthcare leaders are now interested in enterprise-wide platforms that can allow care providers to better coordinate and manage care for their patients. They'll put a premium on interoperability, and tools and services that can integrate with the health system and its technical infrastructure (the EHR). The ongoing workforce shortage will put a premium on services that can be delivered on virtual channels, allowing providers to reach the patient without straining the already-stressed enterprise.
And this is how providers can best address SDOH. Using AI and other tools to understand the challenges and needs of their patients, they can populate this enterprise platform with programs and services that address those challenges. And they'll be able to scale out these services to reach larger populations, improving sustainability.
These are all, admittedly, optimistic strategies. But that seems to be the mood at HLTH this year, amid the usual trappings of Las Vegas and the parade of celebrities on the Main Stage putting their name and face to high-profile public health issues. Healthcare may be in a rough place right now, beset by cost and quality issues, clashes with payers and a declining workforce, but there are innovative ideas out there that deserve attention. And with AI, the chances are good they'll get their chance.
HLTH 2024 kicked off Sunday in Vegas with a pledge to go boldly forth with innovation. But in a city known for its splashy promises, it's the details that will matter.
Scalability and sustainability are two of the primary barriers to healthcare innovation. A great tool or strategy won't succeed if it can't expand past the small pilot and prove itself across a larger network or population.
As HLTH 2024 kicked off this week in Las Vegas, healthcare executives and vendors anted in on the optimism that accompanies an event focused on innovation.
But behind the glitz and glamour and the celebrities gracing the main stage, that question remains: What new idea really will take hold and change a struggling industry for the better? And what hard questions should executives be asking themselves as they evaluate each new technology and strategy?
For Kaiser Permanente Chair and CEO Greg Adams, that answer may lie in Risant Health, the company launched a year ago to drive value-based healthcare by creating a national network of high-performing health systems.
"Our healthcare system is not living up to its full potential," he said during a main stage interview to kick off HLTH. "It's time for us to lead. It's time for us to be bold. It's time for us to take risks."
But what—and how—will those risks result in sustained success?
For Risant Health, the idea is to acquire health systems and create a national network that can apply value-based concepts at scale. Risant has already gathered in Geisinger and Cone Health (in which KP plans to invest a hefty $1 billion), and Adams outlined on Sunday the company's continuing quest to pull five or six community health systems into the fold by 2026.
Adams emphasized they aren't looking to bail out a struggling network—a hint to the ongoing M&A activity that is seeing large health systems swallow up smaller hospitals, a tactic that has its successes and its Steward Health Care fiascos. Kaiser Permanente, one of the handful of healthcare organizations that includes both providers and health plans, wants to acquire health systems that are doing OK on their own and moving forward with value-based care strategies.
This, Adams, said, is about optimization, and putting into play strategies that many health networks are talking about but not really embracing.
Adams Said Risant Health has helped Geisinger realize a 1% improvement in its cost structure in six months, and he anticipates an improvement of 2% to 3% for partner health systems over a year. More importantly, he said, those in the Risant Health orbit will have access to guidelines, care pathways and other tools aimed at reducing costs, boosting outcomes and improving workflows. He noted Kaiser Permanente is getting ready to roll out more than 200 primary care guidelines to its own provider network, all aimed at giving care teams an established set of best practices.
Now that kind of optimism is common at an event like HLTH, where cool ideas like food as medicine, primary and behavioral care integration, genomic medicine, hospital at home and using AI to reduce heart attacks and identify and treat cancers at an early stage are discussed at length on stages, in the exhibit hall and in the hallways of the Venetian.
The trick is to move beyond all the talk. Many a great idea has been given the spotlight in past events, only to gradually fade away because it can't be scaled or sustained. And the concept isn't entirely new. General Catalyst launched HATCo roughly last year and earlier this year acquired Summa Health under the idea of creating a "proof of concept" for VBC. Just this month, four significant health systems announced the formation of Longitude Health, with the goal of bringing transformative ideas to scale.
Adams is coming into this with the numbers and the pledge, fortified by HLTH's theme this year of being bold, to be a front-runner in transformative thinking. The challenge will lie in understanding and implementing a value-based care strategy at a time when "value" is a debated concept.
As with anything at HLTH, the idea is great, and over the next two days there will be plenty of discussion about this and other lofty goals. The key will be to answer the hard questions that come up and define success at a time when so much of healthcare is just a struggle to move forward. That's what being bold is all about.
The annual HLTH conference kicks off next week with an array of topics and an unusual amount of star power. But what are healthcare leaders looking for?
Healthcare innovation takes the stage in Las Vegas next week with HLTH, but attendees heading to Sin City for the latest in health and wellness may be looking for something a bit more inclusive than in years past.
As the industry transitions, albeit slowly, to patient-centered care and embraces ideas like AI and virtual care, healthcare leaders are looking for comprehensive solutions, rather than new tools and programs that target certain conditions or populations.
It’s part of what Meghan Cassidy, senior director of sales and product development for market and network services at Cleveland Clinic, calls “point solution mania.”
“I understand why the industry started there, but now it seems there are hundreds of those types of solutions in the market,” she says. “So I am hopeful that this year [people] will come to try to figure out how to weave all of those solutions together.”
“They all have great ROI, they all have great patient outcomes, but they're ultra-segmented right now,” she adds.
Healthcare has long had this issue, and events with large exhibit halls are ideal places to view the expanse of vendors driving innovation. But the industry is in a tough place right now, struggling to address cost and quality issues and workforce shortages, and it needs programs and tools that can be applied across the enterprise, not bolting onto platforms but integrating with them—what Cassidy calls “the quilt that ties it together.”
HLTH is somewhat unique in that it attracts healthcare organizations and companies that are interested in whole patient care, rather than healthcare information technology or clinical care. So the reasons and the opportunities for integration are more apparent. And that’s why topics like food as medicine, women’s health, mental health, psychedelics and art and music treatments have a place in the exhibit hall and in sessions.
That’s also what draws a unique cross-section of the healthcare industry to Sin City. Cassidy, for example, is focused on programs and tools that would help Cleveland Clinic deliver healthcare services to employers. It’s an evolving field that hospitals and health systems are exploring, and one that the so-called disruptors like Amazon and Google have been targeting.
“They're not offering an app for something anymore,” she points out. “They're going in and saying, ‘Let's share risk with these primary care facilities or primary care companies and try to change the care and get more people into their primary care doctor up front. And that will of course lead to cost savings later on down the line.”
With primary care as the focal point of healthcare access, many tools and programs are aimed at reducing barriers to access and facilitating a seamless primary care visit, whether it be in person or virtual. But true innovators in this space are also expanding the definition of primary care to include more preventive health and wellness opportunities, with the idea that a consumer/patient and care provider are on a journey together.
HLTH gives healthcare executives an opportunity to expand that conversation, looking at different ways, both strategic and technological, to configure care management and coordination. And it wouldn’t be a healthcare conference if AI weren’t included in that discussion.
But HLTH also tends to draw the big names and organizations, offering solutions that those hospitals and health systems can afford to try out. Cassidy says she’d like to see more tools and strategies for smaller and more rural organizations.
“There's a lot of marquee names that are out there that are saying what they do, but they represent very large companies and have large pockets,” she says. “With the small employers who are struggling, like the mom and pop shops on the corner, thinking about more ways to intervene and help them would be very, very interesting and effective.”
And while this event in particular carries the glitz and glamor that Las Vegas attracts, there are a few more celebrities than in past years—evidence, perhaps, of the energy brought to bear on issues like maternal health, mental health and chronic conditions. First Lady Jill Biden will talk about women’s health research during a Main Stage session on Wednesday, while entertainers John Legend, Halle Berry, Maria Shriver, Lennie Kravitz and Lance Bass are scheduled to appear as well.
Regardless of the star power, HLTH offers healthcare leaders an intriguing look at how the industry is evolving beyond episodic care, and how new ideas and technologies can shape their organizations to deliver what patients not only need by want.
Allegheny Health, a member of the HealthLeaders Mastermind program on AI in revenue cycle managemet and finance operations, is using the technology to help executives understand the data and make better decisions.
Healthcare has a people problem, especially in revenue cycle management and finance operations. There just aren’t enough people filling those roles, and the competition with other industries is fierce.
This is where AI fits in.
Whereas the human touch is a critical part of clinical care, when numbers are concerned, the fewer hands the better. Revenue cycle and finance managers are looking for AI tools to reduce human interaction in areas like coding, claims, denials and prior authorizations.
“We’re all trying to remove touches from the claims process,” says Brian Ice, vice president of clinical revenue cycle for the Allegheny Health Network. “We’re all trying to come up with ways to make that process more efficient.”
“We look at AI for any workflow that's high volume [and] requires a lot of analysis,” he adds. “If it requires looking through clinical documentation or large data sets to respond. We're trying to use AI to help drive and make those workflows more efficient.”
Ice, a participant in the HealthLeaders Mastermind program on AI in revenue cycle and financial operations, says RCM and finance executives have been working with automation for years, and they’re leery of the flood of vendors coming into the space with so-called AI tools that really don’t use AI.
“Vendors that say they can do what we're looking for are a dime a dozen,” he says. “There's a lot of them out there that say they can do different things. Finding a vendor that's a good fit for your organization, that integrates well with your electronic health record, that has the right price tag associated with it,” is an elusive goal.
And what Ice is looking for now is AI that can learn the complex algorithms involved in rev cycle and finance operations and generate pathways to efficiency. Apart from transcribing documents and analyzing utilization workflows, that might mean identifying the right codes, smoothing out the prior authorization process, even predicting when a payer might issue a denial and working toward a quicker resolution.
We want to “take some of the back and forth out of it,” Ice says, adding that payers are also interested in using Ai to improve collaboration with providers.
The key, Ice says, is to have AI do the number-crunching and analysis and give RCM and finance executives the data they need to make those collaborations meaningful, whether it’s in plotting the right pathway for patients to pay their bills or working with health plans to align care management with coverage.
Ice says AI is still a new technology, and one that needs careful monitoring as it learns the workflows. Every outcome generated by an AI program still needs to be checked by the “human in the loop.”
“When you automate something, you're trying to do something at a high volume to produce a significant amount of output without human intervention,” he says. “So if you have quality issues in that space, you can create a pretty significant mess for yourself in a hurry.”
That may not always be the case, however. The hope is that AI tools in RCM and finance eventually become reliable enough to run in the background, enabling those humans in the loop to focus on other tasks.
For now, Ice says, Allegheny Health has an expansive governance team in place, representing a wide range of departments within the health system. Their tasks range from reviewing vendors and products to monitoring the development and installation of all AI programs to continuous quality control.
“There's still an extreme amount of investigation and research that goes into approving these technologies before they would ever be … deployed within our system,” he says.
The HealthLeaders Mastermind program is an exclusive series of calls and events with healthcare executives. This AI in Finance Mastermind series features ideas, solutions, and insights on excelling your AI programs.
To inquire about participating in an upcoming Mastermind series or attending a HealthLeaders Exchange event, email us at exchange@healthleadersmedia.com
Four large health systems have joined forces to launch Longitude Health. They're hoping that economy of size can overcome the barriers to innovation and actually implement value-based care.
Collaboration has become a key strategy in healthcare innovation.
The partnership aims to combine the resources of the four health systems to invest in strategies and technology that look to improve care management and coordination, health and wellness, and system improvement. A press release issued by Providence says the new group intends to make "multiple strategic investments" within two years and will invite other health systems to join them.
"Longitude Health will scale the next generation of capabilities faster and more effectively than if individual health systems attempted to do so themselves," Pete McCanna, CEO of Baylor Scott & White Health, said in the press release. "We aim to set a new standard, demonstrating that new approaches can optimize organizations performance and quality and drive positive systemic change to benefit patients."
While the announcement is short on details, it points to the idea of developing programs or deploying new technology—perhaps even spinning out new business lines--that can scale out quicker and more effectively, improving the chances of sustainability. The press release lists the organization's three main initiatives as transforming business models, improving health system performance and empowering healthier futures.
The collaboration also creates a sizable organization to work with payers on value-based care.
"Healthcare requires new approaches," David Callender, MD, Memorial Hermann's president and CEO, said in the release. "Health systems must expand their core focus areas beyond care delivery and into new business creation and services that will drive high-value care. Through this collaborative approach, we aim to take the lead in designing solutions that drive operational transformation and translate into tangible benefits for the patients and communities that we serve."
While partnerships aren't entirely new in healthcare, the idea of getting disparate health systems to work together has usually come in the form of M&A deals. Kaiser Permanente launched Risant Health in 2023 to create a value-based care network, has so far acquired Geisinger and Cone Health and plans to add another three or four health systems in the next five years. Meanwhile, Transcarent, a digital health company launched in 2020 by Glen Tullman, unveiled its "National Independent Provider Ecosystem" in 2023 with 10 health systems (including Memorial Hermann and Baylor Scott & White).
The new group's CEO is Paul Mango, a former executive at the U.S. Department of Health and Human Services (HHS) and the Center for Medicare & Medicaid Services (CMS), as well as a former partner at McKinsey and a gubernatorial candidate in Pennsylvania. The CFO is Brett Moraski, who held VP roles at Highmark Health and Wellpoint and was a founding managing partner at SEMCAP Health and operating partner at Frazier Healthcare Partners.
The CEOs of the founding health systems—McCanna, Callender, Carl Amato at Novant Health and Rod Hochman, MD, at Providence—will serve on the board of directors, with McCann as chair.
WellSpan Health has launched an AI agent named Ana, who's connecting with at-risk patients for screenings that might otherwise be forgotten or ignored.
Healthcare organizations are now using AI to have conversations with patients that doctors and nurses might not have time for—and closing critical population health care gaps that could save lives.
WellSpan Health launched an AI platform roughly one month ago that calls selected at-risk patients to schedule colorectal cancer screenings. The AI agent, called Ana and developed by digital health startup Hippocratic AI, asks patients if they would agree to take the test and, if they agree, arranges to mail a testing kit to their homes.
The so-called AI “agent” is designed to replace either a mailing, a cold-call program often launched out of a health system’s call center or—if the health system doesn’t have those resources—the conversation that a doctor would have with a patient during an annual checkup.
None of those tactics has a high level of success. And as a result, at-risk patients often don’t have those screenings when they should, if at all, increasing the chances of a serious health issue down the road.
WellSpan Health executives decided to use the program to reach out to patients at risk of developing colorectal cancer, identified by their birthdate and family history. Of particular concern were Spanish-speaking patients, who might miss the mailer or the conversation with a doctor because of language issues.
“It’s an opportunity for us to reach out to people in their homes, in their own time, and have a conversation with them that we maybe couldn't staff with a human,” says R. Hal Baker, WellSpan’s SVP and chief digital and innovation officer. “But [with] the right AI, that conversation could be had.”
R. Hal Baker, SVP and chief digital and innovation officer at WellSpan Health. Photo courtesy WellSpan Health.
Baker, a primary care physician, says the program takes pressure off of doctors to fit that task into an already busy care visit and gives them more time to make that visit meaningful.
“Most of my visits are 20 minutes,” he notes. “And while it may take only 30 seconds to have a conversation about colorectal cancer screening, … if I can take any of these things like mammograms and colorectal cancer screening and COVID shots and flu shots out of the visit, and they can happen reliably outside of coming to the office, that gives me more time to discuss what can only be discussed in the exam room.”
Kasey Paulus, MBA, RN, CENP, WellSpan’s SVP and chief nursing executive, says Ana works because she’s designed to be empathetic and engaging. And she can speak Spanish, in which not many doctors or nurses are fluent.
“A sensitive AI that speaks your language [is better than] a well-meaning human who can’t speak Spanish,” Baker says.
And it works. Of the first 455 Spanish-speaking patients contacted by Ana, 15% agreed to screening, Baker says, and the net promoter score was higher than that of English-speaking patients (of which 6% agreed to a screening).
“Not bad for an automated reach-out cold call to people who weren’t expecting it,” he says.
Kasey Paulus, MBA, RN, CENP, SVP and chief nursing executive at WellSpan Health. Photo courtesy WellSpan Health.
Eventually, the health system will see results in clinical outcomes. More screenings will lead to more cancers detected and treated early, improving the quality of life for patients and reducing deaths. Financially, more screenings might boost initial costs but lead to less expensive medical treatments and long-term care later on.
Baker and Paulus say WellSpan worked closely with Hippocratic AI to develop Ana, going through every scenario that the AI agent would face and every question that a patient might ask. Baker says he even tried to confuse Ana during a test by announcing that his birthday was on New Year’s Day.
“We have a very creative and collaborative multidisciplinary team, and those individuals do their best to try to break it before we launch it,” he says. “So we're looking for ways [in which] somebody might trip it up that we didn't even think of, because inevitably that will happen.”
For example, Baker says, “We had to very quickly realize we had needed to add the ability for somebody to say, ‘Please don't call me again.’ “
In launching Ana, Baker says the health system was very careful to make sure that patients know they’re talking to an AI agent. For the first 100 phone calls, a nurse was also on the line to make sure things ran smoothly.
“What we found out was that [the nurse] didn’t have to” be in on the call, he says. “What is novel here is that we have now moved the human in the loop to the human on the tail for our next thousand calls,” meaning a nurse will review the call within a few hours.
With the platform now up and running, Baker and Paulus say they’re giving Ana another task: connecting with patients who are coming into WellSpan for a colonoscopy. Ana will call them ahead of that appointment and go through everything the patient needs to do before the procedure. Again, that task would have been handled by a nurse or call center, if at all.
“The last 48 hours of coaching are really critical,” Paulus says. “And AI can help us where we can't always have somebody on call 24/7 365.”
She says the health system will see the benefits in reduced cancellations and procedures that are started and cut short or unsuccessful.
Baker says the platform may scale up in time as WellSpan explores how Ana can effectively interact with patients and support their healthcare journey. They may use the platform for more population health outreach, or to help patients prepare for other procedures, or even to check up on them and coordinate care after a procedure.
“We recognize that we're boldly going into some uncharted territory and that our AI is not replacing our clinical staff but augmenting the work that they just don't have the capacity to do,” he says.
