After roughly a decade of sometimes political wrangling, a new law mandates that payers reimburse providers for covered services offered via telehealth.
Long-standing barriers to telehealth adoption in Pennsylvania are coming to an end with the passage of a new law that includes coverage parity.
Governor Josh Shapiro last week signed into law SB 739, ending a decade-old battle to ease barriers that have kept hospitals and health systems in the Keystone State from embracing virtual care. The new law requires health insurers and managed care plans to reimburse providers for any covered services that are offered through telehealth, as well as setting accessibility standards for state Medicaid and Children’s Health Insurance Program (CHIP) coverage.
“Every Pennsylvanian deserves to have access to quality, affordable healthcare when and where they need it – and it shouldn’t be up to an insurance company to pick and choose what they cover,” Shapiro said in a press release. “More and more Pennsylvanians are relying on telemedicine to see their doctors, and this bill requires insurers to cover services delivered via telemedicine the same way they cover traditional in-person services. My administration will continue to work across party lines to expand access to healthcare for all Pennsylvanians, including those in our rural communities.”
The signing ends more than 10 years of efforts by telehealth advocates to get a parity law on the books. More than 40 states now mandate coverage parity, which requires payers to reimburse providers for telehealth services if they offer those same services in person. Some also require payers to reimburse at the same rate as in-person care, which is called payment parity.
The bill was sponsored by State Senator Elder Vogel, Jr., a Republican from rural Rochester who has long argued that the state needs to reduce telehealth barriers to improve access to care in rural and remote regions where brick-and-mortar providers are scarce and in-person visits are challenging. Some 33 Pennsylvania hospitals have shut down in the past 20 years, with 15 occurring in just the last five years, according to the state.
Vogel first sponsored the bill in 2016, but it never got out of committee. At least two versions introduced since then were shot down by Democratic lawmakers after Republican lawmakers added amendments to ban the use of telemedicine in abortion care. In 2020, then-Governor Tom Wolf, a Democrat, vetoed the bill after it was passed along party lines.
Among those supporting the new law is the Hospital and Healthsystem Association of Pennsylvania (HAP), a membership organization comprising more than 230 hospitals and health systems in the state.
“Today’s passage of Senate Bill 739 is a long-sought win for Pennsylvania patients and health care providers,” HAP president and CEO Nicole Stallings said in a press release. “Telehealth helps meet patients where they are, increasing access to routine and preventative care to improve health outcomes. It also extends the reach of providers at a time when the commonwealth’s growing need for care is outpacing the professionals available to deliver it.”
AWS is providing $10 million in grants to health systems and hospitals for pediatric research using AI and the company’s cloud storage platform.
Three pediatric health systems are receiving $1 million each to support ongoing programs using AI and cloud computing to improve children’s healthcare.
The announcement underscores the hype surrounding AI in healthcare and the efforts by tech companies to partner with health systems for long-term projects that require lots of data storage. Health systems and hospitals are hampered in developing AI programs because of the cost of storing and moving around data, and these partnerships can give them the leeway to improve research and develop new programs.
Adam Resnick, director of CHOP’s Center for Data Driven Discovery in Biomedicine, said AI can be a vital factor in developing treatments for pediatric cancers, which make up less than 1% of all cancers diagnosed annually in the U.S.
“(D)espite being a rare disease, pediatric cancers truly provide a unique proving ground for new technology because of their dependency on real-time discovery and collaborative networks,” he said in the AWS press release announcing the awards.
Research on pediatric diseases and treatments is often limited because of the size of the patient population. Most studies are small-scale and limited, and the pharma industry has little incentive to pursue treatments. In fact, innovation in pediatric care is often based on adult models that are adapted to fit children, with less-than-optimal results.
AWS is banking on its considerable could storage resources to improve what it calls the sandbox in the cloud, giving healthcare providers access to large amounts of de-identified and anonymized data to improve research.
“What’s driving discovery, in the most immediate term, is enabled by the cloud,” Elaine Mardis, PhD, co-executive director of the Steve and Cindy Rasmussen Institute for Genomic Medicine at Nationwide Children’s Abigail Wexner Research Institute, said in the AWS release.
With so many organizations engaged in AI these days, a key question moving forward will be how health systems and hospitals share that information, and which processes are proprietary. That may be where value is determined.
“What we really want to do is make rare cancers less rare by providing this comprehensive information to those who really want to investigate for a variety of discovery-based goals,” Mardis added.
Disruptors are discovering that healthcare can't be run like a shopping center
Another disruptor is exiting the primary care space.
Walmart has announced the sale of its MeMD virtual care program to Fabric, a one-year-old telehealth startup whose healthcare partners include OSF HealthCare, MUSC Health, Highmark, Luminis Health, and Intermountain Health. The move comes just months after the retail giant announced the closing of its virtual care platform and a significant number of its in-store health centers.
MeMD was launched in 2010 and acquired by Walmart in 2021.
Fabric, which offers a multi-faceted virtual care platform for businesses and payers as well as healthcare providers, said the deal would enable it to expand its base and build in-demand behavioral health services. The company secured $60 million in Series A funding in February, with investors including General Catalyst and Salesforce Ventures.
“This acquisition aligns with our strategic vision to transform healthcare delivery through innovative technology and exceptional patient care,” Founder and CEO Aniq Rahman said in a press release. “The combination of our teams, technology, and clinicians strategically positions Fabric to quickly expand across payers, employers, and provider organizations.”
The deal highlights the ongoing challenge of creating a retail primary care model that combines value with sustainability. Many companies are finding that while consumer-facing retail strategies hold promise in improving the healthcare experience, that doesn’t mean a healthcare service can be run like a retail store.
Sanford Health’s remote patient monitoring program in northern Minnesota is giving pregnant women access to critical care services and resources
In rural and remote parts of the country access to care is limited. That’s a double whammy for pregnant women seeking care not only for themselves but for their children.
To Johnna Nynas, MD, OB-GYN, the rural landscape and challenging economy of northern Minnesota offers plenty of challenges for pregnant women in that region. The Sanford Health Bemidji doctor is not only dealing with climate, transportation, and lack of childcare, but also the closure of four labor & delivery clinics over the past five years.
“What we were seeing is fewer patients getting the minimum recommended number of visits or starting their prenatal care very late,” she says. “And there’s not a lot of other hospitals, (so) when patients choose not to come to Sanford for their women’s healthcare, they’re not going to another hospital system. They’re just not getting care, and that’s unacceptable.”
To address those challenges, Nynas helped to launch a remote patient monitoring program that allows Sanford Health care teams to monitor the health of those patients and gives those women access to local and state resources through a network of programs. The project is funded by a 2021 $3.67 million U.S. Department of Health and Human Services Rural Maternity and Obstetric Management Strategies (RMOMS) grant.
It also caught the eye of CNN, which recently named Nynas one of its Champions for Change.
Health systems and hospitals are embracing RPM and telehealth as a crucial strategy to connect with underserved populations. Residents of rural and remote areas, especially those in minority populations, often face a high risk of adverse health outcomes and elevated chronic care concerns. Through smartphones and connected devices, care teams can reach them on demand in their homes or communities, managing care and providing support.
“They can get their care from wherever they are,” says Nynas, whose coverage area includes three Native American reservations in a county whose population is 23% Native American.
A Multi-Layered Outreach
The program launched by Nynas through Sanford Health is multi-tiered, beginning with a communications platform that enables the health system to connect with patients at home and arrange rides to care appointments when necessary. It has also launched a connected care network with local and community physicians and clinics, equipping them with virtual care technology to facilitate telehealth visits when the women can’t make it to their in-person appointments or need an urgent virtual care visit. Those outlying clinics also act as hubs, enabling patients to use wi-fi services they might not be able to access at home, link up with specialists for virtual appointments and even download and send digital health data to their care teams.
Lastly, patients who agree to participate are sent home with a blood pressure monitor and fetal heartbeat monitor and are asked to have a weight scale handy. This enables Nynas and her team to monitor those patients daily, jumping in quickly if anything seems out of the ordinary or needs a closer look.
Nynas says the RPM platform gives her an opportunity to see a different side of her patients than she sees in the exam room.
“If I see a patient who looks polished – she’s showered, she’s dressed nicely, she looks well – in the clinic, I’m missing that … maybe there’s some really big struggles at home,” she says. “Maybe there’s a lot of stressors at home. Maybe she’s very depressed, and when I see that patient in her own environment, I get a better idea of how things are going for her and who she is. And that helps me be a better provider.”
The platform also encourages patients to be more engaged in their health. Nynas says the program is set up to educate patients about “red flag symptoms,” so they might identify those symptoms on their own; at the same time, they’re spreading the word with friends and family.
That community connection is important. A critical element of Nynas’ program is the collaboration between Sanford Health and other resources.
“We were really strategic,” she says, in joining forces with public health and Medicaid programs, non-profits, and other healthcare services. “We learned a lot about what each other does.”
A Lifeline for Women in Need of Help
The program can be a lifeline—literally—for high-risk mothers-to-be. Nynas says all patients are screened at the onset of the program and connected with a high-risk care coordinator to help them access additional services, including ride services, nutrition counselors and other resources addressing SDOH. That initial screening alone, she says, helped the health system boost referrals by 600%.
The health system also used some of the grant funding to add a home health nurse to help with screenings, education, and other tasks associated with a home visit. Nynas says the program’s 2023 goal was to arrange home healthcare visits for 40 pregnant women; they ended up connecting with more than 350 people.
And while the program creates a network of care for women during their pregnancy, that network continues past the baby’s birth. Nynas notes that many maternal health programs seem to forget about the mom at a crucial time: Right after the baby is born.
“It’s kind of crazy to think that, when you have a baby, the baby has a visit in 24 or 48 hours after discharge, and then one week, and then two weeks, and six weeks, and so on and so forth,” she says. With the mothers, meanwhile, “we see them at six to eight weeks [for] one time, and that seems not in keeping with the spirit of what we should be doing as healthcare providers.”
Nynas mixes in stories of success amid the challenges. She references one former patient who was homeless and dealing with substance abuse when she was pregnant, and has since completed a treatment program and will soon have a home for herself and her children.
That said, the challenges are daunting. Providing medical care and support is the easy part, Nynas says. The hard part is “paperwork and firewalls”: Appealing to payers for any sort of coverage they can provide, and working with the Indian Health Service and other federal and state agencies to make sure all the boxes are checked and requirements fulfilled.
And then there’s the HHS grant, which is due to run out soon.
“Those of us in the collaborative, we meet in-person quarterly to talk about what’s next over the next three months, what are our goals over the next six months,” Nynas says. “At our last quarterly meeting it became really abundantly clear that people are anxious about the grant ending and what’s going to happen to our collaborative. When that was brought up [and we said] do you think we should keep meeting, there was a unanimous ‘yes.’ “
“There was a value to us continuing to work together, whether it was funded or not,” Nynas says, “because it was the right thing to do for the women and the right thing to do for our communities.”
The poll of 1,000 U.S. adults finds strong support among those who have used the program, with more than 80% saying they’d use it again.
One of the more popular arguments for launching a hospital at home program is that patients prefer to be treated from the comfort of their own home rather than stay in a hospital. A new survey proves that point.
According to a survey of some 1,000 U.S. consumers aged 40 and older, more than 80% of respondents who have taken part in such a program have had a positive experience, and 84% said they’d participate in the program again to get home sooner.
By contrast, less than 2% reported a negative or very negative experience, and about 16% said they were not likely to try the program again.
The survey, sponsored by digital health company Vivalink, adds fuel to efforts to make Medicare guidelines and reimbursements for the program permanent, and to compel more providers and payers to support the program. Well over 300 health systems and hospitals across the country are receiving Medicare reimbursements under the Acute Hospital Care at Home (AHCaH) model developed by the Centers for Medicare & Medicaid Services (CMS), but CMS is on track to end that program after this year.
CMS support—especially the reimbursements—is crucial to the growth of the strategy. Many healthcare organizations launched AHCaH programs during the pandemic, when CMS unveiled the program to address overcrowded hospitals and inpatient staffing shortages. Without that support, many health systems and hospitals will likely shut down those programs to reduce costs and focus on more business-friendly services.
Proponents argue that hospital at home programs, also called acute care at home programs, can reduce costs by cutting down on expensive hospital-based services, and they will show improved clinical outcomes over the long run. That argument is based in part on the idea that patients are more comfortable at home and will be more likely to follow doctor’s orders and care plans. A more engaged patient, in turn, will heal better and more quickly.
The survey finds that patients are indeed interested in staying in their own beds rather than a hospital room. For example. some 77% of those surveyed said they’d trust their doctor’s recommendation to take part in such a program. And the top reasons they’re willing to do so are the convenience and comfort of home (46%), avoiding exposure to infections in the hospital (23%), and confidence in remote patient monitoring (18%).
The reasons for taking part in a hospital at home program are surprisingly varied, and point to the potential for these programs to treat more patients. Some 30% were treated at home for infectious diseases or respiratory disorders—the reason CMS launched the program in the first place. Roughly 46%, meanwhile, were treated for heart-related conditions, and almost 38% were involved in cancer treatment or recovery.
In addition, almost 38% of respondents taking part in a hospital at home program were being treated for neurological disorders, and 34% were being treated for diabetes.
Finally, just under half of the respondents who had taken part in a hospital at home program said the RPM devices were easy to use, while the roughly 16% who said they wouldn’t use the program again cited difficult with the RPM devices as their biggest problem.
Abbott and the National Association of Community Health Centers and partnering on a national effort to develop and launch innovative programs that use healthy eating and nutrition to combat chronic diseases and other health concerns.
Eight health centers across the country have been selected to test innovative “food as medicine” strategies as part of a national effort aimed at helping providers to integrate nutrition into their care plans.
The Innovation Incubator, launched by Abbott and the National Association of Community Health Centers (NACHC), will give each health center $30,000 to develop new programs over the next six months. The goal is to create new strategies that can be adopted by the network of 1,400 health centers across the country, as well as other health systems and hospital looking to address a key social determinant of health.
"Food insecurity severely impacts the health of underinvested communities," NACHC President and CEO Kyu Rhee, MD, MPP, said in a press release. "As the nation's largest primary care network, health centers' highly effective and innovative integrated model of care reaches beyond the walls of the traditional exam room to not only prevent illness but also address the social drivers that may cause poor health. Our focus this year is to create sustainable, effective strategies that solve food challenges and improve nutrition."
The effects of food insecurity, which studies have shown affects roughly 13% of U.S. households, go hand-in-hand with clinical outcomes. Chronic diseases like diabetes, high blood pressure, asthma, COPD, and cardiac issues are hampered and even worsened by a lack of nutrition. And while the impact is most acutely felt in underserved populations who have problems accessing good food, the concept of eating for good health needs to be taught to everyone regardless of social standing.
Healthcare organizations are embracing food as medicine strategies in an effort to tackle SDOH and bend the curve on skyrocketing costs for chronic care management. Some of the tactics used so far have included programs that deliver healthy foods and prepared meals to patients, partnerships with local food markets, health eating incentive programs, even virtual cooking and nutrition classes.
The participating health centers are Affinia Healthcare in St. Louis; Asian Health Services in Oakland; Cabin Creek Health Systems in Charleston, West Virginia; Delaware Valley Community Health in Philadelphia; White Couse Clinics in Richmond, Kentucky; Mainline Health Systems in Monticello, Arkansas; Tri-Area Community Health in Laurel Fork, Virginia; and Urban Health Plan in New York.
They’ll be launching experimental projects over the next six months, and will be called on to create pitches for one of two additional awards in the fall. The NACHC will share the results of the programs with its network of community health centers, affecting some 31 million people.
"In response to higher rates of both food insecurity and chronic illnesses that can be better managed through healthier diets, Urban Health Plan and many of our community partners in the Bronx have prioritized making healthy food accessible to residents through food pantries, farmers markets, and regular food distribution events," Paloma Izquierdo-Hernandez, the health center’s president and CEO, said in the press release. "We're planning to bring in local chefs to help educate our community on preparing healthier meals with a focus on affordable and culturally relevant foods that can be found locally.
The incubator, in its second year, was launched by the NACHC’s Center for Community Health Innovation, which has been instrumental in getting health centers to tackle the digital divide through telehealth, patient portals and digital and health literacy programs.
The health system, participating in the HealthLeaders Virtual Nursing Mastermind program, sees the innovative program as just one part of a lasting ‘connected care’ digital health transformation strategy.
At Houston Methodist, virtual care is ingrained into care delivery, and virtual nursing is part of the connected care process, rather than some shiny new thing. The trick, say health system leaders, is to combine short-term ROI that shows financial benefits with long-term results that demonstrate true value-based care.
Stave Klahn, Houston Methodist’s System Clinical Director for Virtual Medicine, says the virtual nursing program was launched in June 2022, and now comprises 35 nurses and 30 FTEs across 1,400 beds in seven hospitals. The program, he says, includes many KPIs, with an understanding that each little change in the process of care can contribute to value down the road.
“We really focus heavily on time durations of each activity that we do,” he says. And to get results, one looks at the “so many feeder things that lead up to that.”
Houston Methodist is one of a dozen health systems across the country that participated in the HealthLeaders Virtual Nursing Mastermind program, which consisted of three virtual roundtable and a two-day live event this past week in Atlanta. The goal of the program is to foster intensive discussions around virtual nursing, diving into what makes a program work, how to overcome challenges to sustainability, and what metrics to track to measure success or identify pain points.
Klahn and Sarah Pletcher, MD, MHCDS, Houston Methodist’s SVP and Executive Medical Director for Strategic Innovation, say the program started with the intention of improving nurse well-being by fine-tuning workflows, and added goals from that point. Alongside addressing admission and discharge times, key elements of a patient’s length of stay, they’re looking at care coordination and management and documentation compliance.
Analytics and reporting are part of the process, Klahn says, because “you’ve got to demonstrate ROI early on.”
Pletcher says the program has to be flexible and nimble. While health system leadership is focused on reducing costs and saving money, virtual nursing programs should be showing off a mixture of hard and soft ROI—appealing to the hearts and minds as well as the wallets. And always be ready to try new things.
“You may get credit for helping with something in the beginning but then a year later people forget or are looking for new value,” she says.
Houston Methodist’s program is one of the more advanced in the country, with a dedicated virtual nursing workforce (Klahn says they look for nurses with at least two years of experience and a wide range of backgrounds) and a central virtual operations center, as well as opportunities for virtual nurses to work from home. They’re also in the final stage of installing wall-mounted technology in all of their patient rooms and using wearables to track patient vital signs.
Klahn says it’s important to include the nurses in each phase of planning a virtual nursing service, and show them the value of virtual nursing so that they’ll support it. That includes clearly identifying the roles for both virtual and floor nurses. ’Customers’ of any new care models like virtual services do notice when they’re included in the design process, and they’re more comfortable with suggesting tweaks and new ideas for making processes more efficient.
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The retail giant is folding its nearly two-year-old Amazon Clinic business into Amazon One Medical, saying the move makes things easier for consumers accessing care.
Amazon is consolidating its healthcare services under one brand, bringing its on-demand virtual care offering together with its primary care platform.
Amazon Clinic, which launched nearly two years ago to give members access to virtual care visits for more than 30 non-acute health issues, is being rebranded as Amazon One Medical’s pay-per-visit telehealth service. The platform, available in every state, offers single-visit prices of $25 for a messaging visit or $49 for a virtual visit, alongside monthly and annual subscriptions.
“It’s simply too hard to get the medical care you need, when you need it, and affordably—long waits, high costs, and impersonal care make it unnecessarily difficult for many patients today,” Neil Lindsay, senior vice president of Amazon Health Services, said in a blog on the company’s website. “We’re focused on improving both the occasional and ongoing medical care experience.”
The announcement—coming on the same day that Walgreens announced plans to rid itself of VillageMD and close a significant number of pharmacies in the U.S.—gives the retail giant a more focused footprint in the increasingly volatile primary care market. And it gives health system and hospital leaders a clear model to compare or contrast their own direct-to-consumer strategies, particularly in telehealth.
The challenge for industry decision-makers is understanding where Amazon is competitive with traditional brick-and-order healthcare organizations, and why. Analysts have often said the retail giant could be a true disruptor in the space by offering more convenient access to care to consumers put off by the bloated hospital or clinic healthcare experience.
And yet Amazon has had as many misses as hits in the space, including the failed Haven and Amazon Care programs. Health system and hospital executives argue that primary care is a very difficult field in which to establish a foothold, particularly for organizations that focus on profit rather than long-term health and wellness.
The group, comprised of health systems and vendors, has released an Assurance Standards Guide for AI in healthcare and is seeking public comments for the next 60 days.
A coalition of health systems and AI companies working with the federal government on AI standards is seeking public comments on a new draft framework for responsible use of AI in healthcare.
“Shared ways to quantify the usefulness of AI algorithms will help ensure we can realize the full potential of AI for patients and health systems,” Nigam H. Shah, MBBS, PhD, chief data scientist for Stanford Health Care and a co-founder and board member of CHAI, said in a press release. “The guide represents the collective consensus of our 2,500 strong CHAI community including patient advocates, clinicians and technologists.”
Formed in 2023, CHAI includes Stanford, the Mayo Clinic, Vanderbilt, Johns Hopkins, Google, and Microsoft. It now boasts more than 2,500 members and has been working with the National Health Council and health standards organization HL7.
CHAI executives say the guide, part of a package of documents called the Assurance Reporting Checklists, aligns with the National Academy of Medicine’s AI Code of Conduct, the White House Blueprint for an AI Bill of Rights, several frameworks from the National Institute of Standards and Technology, the Cybersecurity Framework from the Department of Health and Human Services Administration for Strategic Preparedness & Responses.
Also included are six use cases for AI:
Predictive EHR Risk Use Case (Pediatric Asthma Exacerbation)
Imaging Diagnostic Use Case (Mammography)
Generative AI Use Case (EHR Query and Extraction)
Claims-Based Outpatient Use Case (Care Management)
Clinical Ops & Administration Use Case (Prior Authorization with Medical Coding)
Genomics Use Case (Precision Oncology with Genomic Markers)
“We reached an important milestone today with the open and public release of our draft assurance standards guide and reporting tools,”. Brian Anderson, MD, CHAI’s president and chief executive officer and an associate professor of biomedical informatics at Harvard Medical School, said in the press release. “This step will demonstrate that a consensus-based approach across the health ecosystem can both support innovation in healthcare and build trust that AI can serve all of us.”
UPMC has sold a virtual consult tool developed during the pandemic to virtual care company eVisit and, along with MedStar Health, is investing in the company to foster future innovation opportunities.
A virtual consult tool developed by UPMC during the height of the COVID-19 pandemic is being sold to eVisit to enhance its inpatient telemedicine platform.
At the same time, both UPMC Enterprises and MedStar Health are investing in the Arizona-based virtual care company “to pursue co-development opportunities.”
The transactions point to the shifting nature of health system-based telemedicine and the value of hospital-vendor partnerships in expanding enterprise-wide platforms. More and more healthcare organizations are the seeing the benefits of developing and marketing their own capabilities to companies who can then integrate those tools into a much larger platform.
"Our guiding mission at UPMC Enterprises is to develop solutions to the clinical needs identified by the thousands of physicians at UPMC who provide lifesaving care to our patients," Brenton Burns, executive vice president at UPMC Enterprises, said in a press release. "When we create something like the teleconsult technology that so brilliantly achieves that goal and becomes a vital part of our clinical operations, we look for partners who can help us make it available to clinicians and patients outside our walls. We're excited to have found that partner in eVisit. Bringing these two technologies together creates a powerful end-to-end virtual care platform."
UPMC developed the technology in 2020 to facilitate virtual consults between bedside clinicians and specialists in stroke, neurology, critical care, psychology, and toxicology. The idea behind the tool was to help clinicians in rural locations and those beleaguered by a crush of pandemic patients to access help on demand, improving care management and speeding up care coordination. According to the health system, the tool has facilitated 40,000 consults and curbed wait times by 92%.
Bolting that capability onto eVisit’s virtual care platform will give more health systems the opportunity to use it. That includes Maryland-based MedStar Health, which has worked with eVisit since 2018 and collaborated with the vendor to develop its MedStar Health Connected Care transformation model.
"Our growing partnership with eVisit continues to redefine what is possible with care delivery powered by the best digital innovation and expertise," William Sheahan, the health system’s chief innovation officer and executive director of the MedStar Institute for Innovation, said in the release. "As we expand our work together, we sharpen our focus on acute care to strengthen newer capabilities such as virtual nursing, while continually pushing past boundaries through bold new innovation and action across the continuum of care."
