A recent study of 6 FQHCs in New York found that state Medicaid reimbursement policies are exacerbating workforce shortages and creating a divide between them and hospitals. And that’s doing real harm to their patients.
Federally qualified health centers (FQHCs) are often the only access point for underserved populations needing healthcare services, and telehealth can be a critical tool for improving that access.
But a new study out of Columbia University finds that several FQHCs in New York City are struggling due to inadequate Medicaid reimbursements for telehealth, which exacerbate workforce shortages and create disparities between those safety net clinics and nearby health systems and hospitals.
“Telehealth has many advantages for patients and providers, but only if it’s supported by equitable and sustainable funding policies,” Thalia Porteny, PhD, an assistant professor of health policy and management at Columbia University’s Mailman School of Public Health and first author of the study, said in a press release. “Our findings underscore the urgent need for Medicaid reimbursement reforms to address workforce shortages and ensure vulnerable populations can access the care they need.”
Telehealth is often viewed as a crucial element in helping people access care, and was a resounding success during the pandemic in helping hospitals connect with patients, but providers often won’t embrace the technology unless they’re reimbursed for switching away from billable in-person care. That’s especially true of FQHCs and other clinics, who need that support to buy the technology and train staff.
In the study, Porteny and her colleagues interviewed executives and staff from six FQHCs across New York City, and found that inadequate state Medicaid subsidies had caused them to lose about 40% of their mental health staff. Alongside the inadequate payments, restrictive policies around working at home, which were eased during the pandemic, are prompting many mental health workers to leave.
“One participant explained how making mental health practitioners come to the FQHC not only hindered workforce flexibility but did not add clinical value: ‘Every therapist…and psychiatrist [is] making financial sacrifices to work for folks like us, [and now] they have to come to the health center to get on the phone basically, and talk to their patients. And there is zero clinical value to that,’” the study noted.
This, in turn, is contributing to disparities in accessing care.
“One FQHC informed us that they had 700 patients on a waiting list for behavioral health services, because their health center lost half its behavioral health practitioners when they began to require that their practitioners work in the office, rather than remotely,” the study reported.
The study also noted that Medicaid reimbursement policies are designed to support larger health systems and hospitals while hindering small, resource-thin clinics like FQHCs.
“As one noted, ‘When a lot of the rules are made, or when a lot of the emergency fundings for [telehealth] programs come out, they’re all geared through the hospital, and then they expect the hospitals to work with everybody else, where we all know nine times out of 10, that doesn’t happen.... The decision makers at the top who pull the purse strings…are leaning towards hospitals.’” Porteny and her colleagues reported.
The upshot of the study is that FQHCs and other small providers are struggling to embrace telehealth at a time when they should be using the technology to improve access to care. The concern is heightened that those reimbursements may be even further reduced by potential Medicare and Medicaid cuts.
“In the face of potential Medicaid cuts and broader austerity measures, our study’s findings suggest that it would be detrimental to implement cost-cutting measures in telehealth reimbursements in community health centers in New York and more broadly,” Sorcha A. Brophy, PhD, an assistant professor of health policy and management at Columbia’s Mailman School and co-author of the study, said in the press release. “Such budget cuts could exacerbate provider shortages, increase barriers to care for vulnerable populations, and ultimately lead to worse health outcomes. Consequently, this could further destabilize community health centers—a healthcare program that has long enjoyed bipartisan support.”
The study supports improving Medicaid policies toward telehealth, through both better reimbursement and support for work at home plans, digital literacy and training, and other services.
“Participants held a common belief that if telehealth reimbursement policies were well aligned with practitioners’ compensation expectations, as was the case during the COVID-19 PHE response, access and compliance issues would greatly improve in FQHCs because there would be more opportunities and flexibility to see practitioners,” the study concluded.
“As one participant described, ‘Behavioral health compliance went up dramatically [during COVID-19]. Behavioral health was always an area where patients used to cancel or no show. Well, once you had a telemedicine platform for behavioral health, suddenly we had 100% compliance rate.’ Another explained, ‘We used to have a 30% no show, but because of [telehealth during COVID-19] our no-show rates were reduced to like 16%, you know, so it got cut in half.’
AI is everywhere (that’s nothing new) at this year’s event, while RPM is getting some good attention. But what about the weather?
As ViVE 2025 races toward its snowy conclusion and attendees figure out whether they have to revise their travel plans, here are a few observations from the first two days of this very entertaining conference.
AI is Everywhere. That’s no surprise, really. During a CHIME panel on Monday, Aaron Miri, Baptist Health Jacksonville’s EVP and Chief Digital & Information Officer, said technology is a differentiator in attracting new clinical talent, a key pain point at a time when nearly all health systems are struggling with workforce shortages. Dangling an ambient AI tool in front of a potential hire seems to be doing the trick.
During a separate panel, Michael Pfeffer, Chief Information and Digital Officer at Stanford Health Care, noted that ambient AI is more popular than any other technology they’re used. If management introduces a new tool and then discontinues it, no one will complain, he said. But if they shut down the AI tool, he’ll be flooded with angry e-mails.
“That doesn’t happen with technology,” he said.
And it’s not just doctors and nurses that are affected by AI. Theresa Meadows, SVP and CIO of the Cook Children’s Health Care System, said during the CHIME panel that they’re investing in new community-based training programs to address the workforce shortage throughout the system. With new AI programs comes a need for IT and Rev Cycle staff that know how to use the technology.
And at a time when budgets are tight, Andy Crowder, CHCIO, CDH-E, Advocate Health’s Enterprise Chief Digital Officer and SVP and CIO for the health system’s southeast region, said they’re spend as much on technology this year as they’ve spent over the past five years.
The message is clear. AI is affecting the industry at all levels, and health systems and hospitals need to have an enterprise-wide strategy in place to make sure they’re doing all they can to make that transition easier. That doesn’t necessarily mean setting up a specific AI governance committee or policy, but understanding that tech now has a set at the strategy table.
AI is helping to redefine the CIO’s role as well. Crowder said he’s both an advisor and an educator, while Miri said CIOs are now called upon to be CFOs and CMOs to facilitate AI adoption.
Medicare may need a reboot. That’s the opinion of Sachin Jain, MD, MBA, President & CEO of the SCAN Group and Health Plan. Jain said he’s cautiously optimistic that the Trump administration—in particular, potential CMS chief Mehmet Oz—will take a good look at Medicare and lean toward Medicare Advantage.
Traditional Medicare “has gotten a free ride,” he said, but hasn’t evolved with the rest of the country. It “doesn’t provide the benefits that people really need,” and that MA plans are embracing, like dental and vision coverage, and services like virtual care that address social drivers of health.
It’s safe to say Medicare and Medicaid are on everyone’s minds, because many health systems and hospitals rely on CMS to support coverage for those populations. Several executives attending ViVE said they were hopeful that CMS waivers for telehealth and Hospital at Home would be renewed before they expire at the end of this month, but resigned to the fact that those waivers might soon end. The pressure is on the industry to prove the value of virtual care.
During the CHIME panel, Meadows pointed out that pediatric hospitals like Cook Children’s are especially sensitive to the Medicare/Medicaid discussion because so many of their patients are on those programs. Any changes to those programs will seriously affect a hospital’s bottom line.
RPM is gaining steam. Remote patient monitoring, long the potential game-changer for home-based care, is building a nice following. During a panel on the future of wearables, Sarah Pletcher, MD, MHCDS, Chief Digital Health Officer and SVP and Executive Medical Director of Strategic Innovation at Houston Methodist, said continuous patient monitoring programs using wearables in the ICU and in-patient units have done so well that they’re looking at using the technology to support patients outside the hospital.
“The sky’s the limit on what we can do with that,” she said.
At the same time, she and Esther Kim, ScD, RD, LDN, Head of Emerging Technologies and Solutions at Mass General Brigham, said there are still gaps between the consumer-facing wearables that the public traditionally uses, like smartwatches and activity trackers, and the clinical grade technology favored by doctors and nurses. Clinicians don’t want to see a patient’s daily step counts or event their heart rate.
“It is important to consider how you’re going to curate all that data,” Pletcher said.
Both noted that clinicians want to see data from wearables that’s meaningful to them, and that can be used to identify and act on health concerns. Two months of heart rate or blood sugar data will be overwhelming, but a program that can sift through the data and give clinicians insight into deviations, irregularities or trends will be valuable. And that’s where AI will likely come into play.
RPM programs will also require some commitment on the part of the patient.
“It’s not just about the vitals,” Kim said. These types of programs need to be developed to address a patient’s lifestyle, and to effect changes that improve health and wellness.
“It isn’t the tech or the regulatory [concerns],” added Pletcher. “It’s getting people to change their behaviors.”
The evolution of pharmacy services. Another area of innovation is medication monitoring. Health systems and hospitals are investing in their pharmacy services to improve the nation’s dismal medication adherence rate and, in doing so, boost clinical outcomes.
There are several reasons for this. As evidenced by the plight of Walgreens, CVS and Rite-Aid, community pharmacies are struggling, and many are closing. Disruptors, meanwhile, are leaning heavily into online and mail-order services. Health systems and hospitals are countering this by beefing up their own pharmacies and co-locating pharmacy services with primary care clinics.
In addition, with the advent of RPM and virtual care, hospital leaders are rethinking the role of the pharmacist. They’re including the pharmacist or pharmacy tech in care teams, and giving them the opportunity to collaborate with patients on medication management and adherence. This also takes the pressure of doctors and nurses.
And finally, will the healthcare industry start recognizing the folly of scheduling major events during the winter? So many conversations this week have started with, ‘How was your trip?’ The wintry weather disrupted many travel plans, with attendees and even some speakers delayed or even forced to cancel their plans. And with a few inches of snow expected in Nashville tonight and tomorrow morning, more than a few people are more concerned now with how they’ll get home than what they’ll see here today.
Still, this is ViVE, and the vibe has been good. Healthcare executives do relish the opportunity to get out of the office and meet in person to talk about innovation and transformation.
As ViVE 2025 kicks off in Nashville, health system and hospital leaders are faced with a challenging path toward innovation. Can they agree on what works and what doesn’t?
Amid the uncertainty of the Trump administration and the hazards of winter travel, ViVE 2025 kicked off this week in Nashville with a focus on digital transformation and innovation. The four-day event is expected to draw about 8,000 attendees.
Co-produced by HLTH and CHIME (the College of Health Information Management Executives), ViVE boasts a busy agenda—and a refreshing number of panels that feature health system and hospital executives, who are making up roughly one-quarter of the attendees this year.
And despite the goings-on in Washington and the wintry weather, the focus of this week’s conversations will fall squarely on figuring out how to make transformation work.
At a time when the healthcare industry is struggling, healthcare leaders have to find a way to make things better. And while new ideas like AI might seem like the solution to much of what ails the industry, many are finding they can’t just plug in technology and watch it make everything better. The industry as a whole is reluctant to change, shrugging off disruptors with the admonishment that “healthcare is hard” and stubbornly clinging to a status quo that isn’t working.
In fact, it’s almost as if “innovation” is becoming a dirty word. Execs are wondering if the idea is just a lofty concept, suitable for high-minded discussion but not implementation. Where are the concrete examples of healthcare innovation that are pushing the industry forward, demonstrating both sustainability and scalability?
We’re going to find out this week.
The answer may lie in how the industry identifies value. Hospital leaders often approach a new program with two different goals, playing financial ROI against clinical improvements. But one doesn’t have to counteract the other. Sometimes the measurements just need to be redefined.
During a Sunday afternoon panel on care collaboration, Bonnie Clipper, DNP, MA, MBA, RN, CENP, FAAN, a nurse futurist and founder and CEO of the Virtual Nursing Academy, pointed out that healthcare is changing whether we like it or not.
“Just consider the visual of a robot inserting your catheter or a robot doing your surgery,” she said.
Transformation, she explained, is inevitable. And it’s up to the healthcare industry to set the goalposts and define the ROI. Instead of being told how innovation will happen, healthcare leaders, from the C-suite on down to doctors and nurses, need to embrace those changes and mold these new technologies and ideas to fit their needs.
This week, healthcare leaders from a wide swath of organizations across the country will discuss what innovation and transformation mean to them, and how AI, virtual care, digital health and other technologies and ideas will work for them. They will be defining the value.
They might not even agree on that value, but if something works for them, that’s moving the needle forward. Best practices and common goals might sound nice, but transformation doesn’t have to mean everybody’s following the same blueprint.
Perhaps some are shooting for goals that are too high. Allen Taylor, MD, FACC, regional chair of cardiology for MedStar Health’s Washington DC region, pointed out that doctors and nurses may have a different perception of innovation than the C-suite.
“Yoga mats don’t solve [physician burnout and] wellness,” he said, referencing one of the key pain points in healthcare. Clinicians, he said, want to have tools that will improve their ability to care for their patients, whether it be an AI algorithm that reduces their time on the computer or a device that enables them to gain better insight into their patient’s health condition.
And while many might be looking for that splashy program that saves millions of dollars and countless lives, Taylor added, doctors and nurses just want something that moves the needle a little bit forward. They don’t necessarily want to be faster, just better.
“Small things will work for us,” he said. “Solve a problem for us and we will redeploy the assets elsewhere.”
Mass General Brigham and the Huntsman Cancer Institute are joining a federally funded program to create an all-purpose mobile vehicle to deliver hospital-level care in rural and remote regions of the country.
PARADIGM "aims to address the current challenges in rural health by creating a scalable vehicle platform that can provide advanced medical services outside of a hospital setting," the project’s website states. "Building on recent developments in fields ranging from satellite communication to medical device miniaturization, this mobile care platform will allow health providers to meet rural patients where they are."
"If successful, PARADIGM hopes to develop a mobile platform capable of delivering many different types of cutting-edge services – including multi-cancer screenings, hemodialysis, perinatal care, and much more," the website continues. "With medical technology no longer tied to a specific place – but instead available on a platform that can travel to even the most remote locations – rural patients will thus be able to access the care that they need within their own communities."
The five-year project is split into five areas:
Designing distributed hospital-level care;
Producing an integrated care delivery platform;
Harmonizing diverse medical device data within a single system;
Building a miniaturized, ruggedized CT scanner; and
Creating intelligent task guidance software to help health workers perform activities beyond their usual training.
David Levine, MD, MPH, MA, clinical director of Research & Development at Mass General Brigham Healthcare at Home and director of Ariadne Labs’ Home Hospital Program, will lead a team developing the DEMOCRATIZE mobile clinical platform for rural care delivery, designed to operate independent of the physical location of rural home hospital programs.
Julian Goldman, MD, FASA, an anesthesiologist, director of the Medical Device Interoperability & Cybersecurity Program at Mass General Hospital and medical director of Mass General Brigham Biomedical Engineering, will lead a team tasked with creating a scalable platform, called PARADIGM-ICE, that will integrate data from medical devices and EHR systems into a secure, standardized ecosystem.
Rajiv Gupta, MD, PhD, vice chair of Clinical Operations in the Department of Radiology, an associate radiologist in the Divisions of Neuroradiology and Cardiovascular Imaging, and director of the Advanced X-Ray Imaging Sciences (AXIS) Center at Mass General Hospital, will lead a team developing a compact, lightweight, rugged and self-shielded CT scanner for use in resource-restrained environments.
The Huntsman Cancer Institute, meanwhile, will be modifying its Huntsman at Home program, a Hospital at Home care model for rural patients in cancer treatment programs, to operate through a mobile medical vehicle that includes advanced imaging, testing and treatment capabilities.
The other organizations participating in the PARADIGM program are:
The University of Michigan, which will use its VIGIL platform to equip care providers with AI-guided task support for specialized services;
The Mission Mobile Medical Group of Greensboro, North Carolina, which will integrate its care delivery platform, a pod-based modular health service that can be dropped into remote locations like cargo containers on a train to deliver remote care services;
Homeward Health of Kentwood, Michigan, which will develop a mobile care model using community engagement, human-centered design and partnerships;
10XBeta, of Brooklyn, New York, which will develop an interchangeable modular care infrastructure to support multiple uses cases;
Planned Systems International (PSI), of Columbia, Maryland, which will leverage a multi-purpose vehicle platform and unique "arm and rack" design to facilitate rural clinical workflows;
SRI International, of Menlo Park, California, which will use both its POET medical interoperability platform, designed to integrate diverse medical devices in resource-constrained environments, and its Multi-Tags system, which uses machine-learning and large language models to support clinicians across multiple tasks; and
Micro-X, of SeaTac, Washington, which will use its lightweight, carbon nanotube-based CT scanner, designed for mobile imaging care in underserved communities and radiology deserts.
Mouneer Odeh, the health system's inaugural Chief Data and AI Officer, says it's important to understand how data works before putting AI to use.
AI may be all the rage these days, but Cedars-Sinai's new Vice President and Chief Data and AI Officer says there's a reason "data" precedes "AI" in his title.
"The fuel for AI is the data," says Mouneer Odeh, MA, who was appointed to the new role ithis past December. He points out that for AI to work as intended, it has to be based on good data, and so healthcare leaders need to understand all about data management and analysis before they dig into the potential.
Ai is all about "leveraging the power of data through its full spectrum," he says. And at its heart is the "continuum of data-driven intelligence."
Odeh comes to Cedars-Sinai—and the West Coast—from Virginia's Inova Health System, where he served as vice president of analytics for four years. Prior to that, he was the vice president of enterprise analytics and chief data science at Thomas Jefferson University and Jefferson Health and, before that, a director at Quest Diagnostics.
Odeh's role is pivotal, as the healthcare industry moves to both embrace and govern the fast-moving AI landscape. Health systems and hospitals are piloting AI tools and services at a pace not seen before.
"There is a recognition that in the future, computational biomedicine will become increasingly important for both research as well as clinical care," he says. "It's almost like a new technology of clinical care that's being layered on top of all the other things that we've done over the last 100 years."
Mouneer Odeh, MA, VP and Chief Data and AI Officer at Cedars-Sinai. Photo courtesy Cedars-Sinai.
"It's also so incredibly important for streamlining operations [and] for improving the experience of our caregivers, nurses and doctors, as well as for our patients."
Getting a handle on AI means addressing many moving parts, a challenge that some health systems have assigned to a committee and others to an executive. In the press release announcing Odeh's appointment, Cedars-Sinai officials praised him as a "change agent" with a grasp of data analytics, data science and health information, and noted that he—as the health system's first-ever data science and AI executive—"will lead enterprise-wide efforts to harness data analytics and AI to drive innovation across care delivery and administrative functions."
The health system sees Odeh as a facilitator, overseeing "a diverse team of professionals spanning advanced analytics, research, infrastructure, governance, data science and business intelligence" and collaborating with departments throughout the enterprise to forge a comprehensive AI policy.
Odeh says that collaboration will be important. He wants to see a health system that encourages its clinicians to use AI, but to also be comfortable and competent when they use it. That means carving out some time for them to sit back and learn.
"Our goal is to empower" clinicians to use AI responsibly, he says. "Channel that positive energy and give them a way to do it in a productive way that actually is appropriately governed, and with safeguards in place."
That also means making sure everyone is on the same page about what AI can do and where it is going.
"We are looking to make sure we have a cohesive ecosystem so that we're not doing one-off little AI solutions here and there," he adds. "We're really trying to build it in a scalable way that will allow us to deploy dozens and hundreds of use cases."
Odeh acknowledges the hype surrounding AI, and says he understands how that can affect a health system's efforts to maintain and monitor the technology. But he also notes that AI is different than past innovations, like the electronic medical record, because it's being embraced and used by consumers at home and elsewhere. It's more like the internet or the smartphone, two ideas that took time to develop and expand.
The real challenge, he says, is not in the technology—advanced data and predictive analytics tools have been around for a long time—but in how it can be used. The pressure is on the industry to improve outcomes, reduce costs and stabilize a stressed-out workforce, and that pressure will intensify as workforce issues continue and the growing population of seniors demands better care options.
"You have the capability to do something amazing, but you also have the pressure and the urgency," he says.
"AI is just one of those where we think the world has changed, you know, within a year or two," Odeh says. "And then we realize it's a lot harder and it takes a lot longer, but we probably don't even realize just how transformative this truly will be."
"People tend to overestimate the impact of technology in the short run and underestimate the impact in the long run," he adds, citing Amara's Law. "But I think over the next 10 years what we will achieve in the healthcare space will be truly amazing. It will be probably 10 times what we've been able to do with data and analytics in the last decade."
Executives from six health systems will participate in two hour-long virtual panels on Wednesday, discussing how AI services and tools will evolve to be sustainable and scalable.
AI is still top of mind for nearly every health system and hospital across the country, but many have moved beyond the initial stages of piloting a new service or tool and are looking for sustainable and scalable uses.
Executives from a six health systems will talk about those next steps in HealthLeaders’ AI NOW virtual conference this Wednesday. Subtitled “Where Do We Go Next?”, the event features two hour-long panels, which take place at 10 a.m. and 11:10 a.m. ET.
The discussion will focus on how healthcare executives are factoring sustainability into their AI strategies. What goes into determining whether a new service or product can maintain value beyond that first one or two years, and how do executives ensure that it keeps its value (or evolves) five or 10 years down the road? How is value measured, and how is governance handled?
This discussion will take a more in-depth look at how AI will evolve in the clinical space. With health systems and hospitals looking to maximize the value of new technologies, it’s imperative that executives look beyond the initial ROI of AI and understand how it can scale outward to address more used cases. What will a particular tool or service look like in five or 10 years, and how can it be designed now to ensure that value down the road?
Together, these panels can act as a blueprint for health systems and hospitals looking to move beyond the cool new use or tech toy and create sustainable, scalable programs that truly transform healthcare delivery.
Kaiser Permanente and Tufts have launched a resource for best practices in developing a food is medicine strategy. Highmark Health and Geisinger are among the founding health systems.
Healthcare leaders looking to launch or refine Food is Medicine strategies now have a center of excellence to explore best practices and other resources.
Kaiser Permanente and Tuft’s University’s Food is Medicine Institute at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy have officially launched the Food is Medicine National Network of Excellence. The center’s founding members include Highmark Health, Geisinger, Elevance Health, Blue Cross and Blue Shield of North Carolina, CVS Health and Devoted Health.
The network addresses a fast-growing innovation in healthcare: The idea of using food and nutrition in care management. Providers are finding that the right diet can improve clinical outcomes and are developing programs and partnerships to help patients access the food they need.
Last year the Food is Medicine Coalition, comprised of community-based non-profit food providers, released a 32-page accreditation standard aimed at giving providers and other organizations guidance on developing medically tailored meals and meal plans.
“Each year, suboptimal diets and food insecurity cause more than 500,000 deaths and cost the U.S. economy $1.1 trillion in healthcare and lost productivity,” Dariush Mozaffarian, director of the Food is Medicine Institute, said in a press release announcing the Network of Excellence. “By working together, we can scale evidence-based nutritional interventions that are driving change, improving health, and reducing disparities.”
Kaiser Permanente has long been at the forefront of this strategy. The health system launched a collaboration with grocery technology company Instacart during the HLTH conference in 2023 to study how California residents living with chronic conditions and enrolled in the state’s Medi-Cal Medicaid program can access food and resources on healthy eating.
"We know food and nutrition insecurity is felt by people in the communities we serve, as well as for by millions of Americans nationwide," Pamela Schwartz, MPH, executive director of food security at Kaiser Permanente, said in a press release. "Identifying best practices to address these inequities is essential to building healthier communities."
Kaiser Permanente and the other organizations involved in the new Network of Excellence will focus on three priorities:
Members will develop frameworks to assess the impact of Food is Medicine interventions, measuring health outcomes and cost-effectiveness.
The network will share insights and identify opportunities to optimize program design and delivery.
Members will promote the effectiveness of Food is Medicine through industry engagement and communication with policymakers and the public.
While turmoil in Washington jeopardizes a CMS waiver, health systems are looking at two specific populations to support and sustain the Hospital at Home strategy.
Whether or not it’s reimbursed by Medicare, the Hospital at Home concept is a good idea. The challenge lies in finding the right mix of patients, technology and workflows to create sustainable value for the health system.
Two distinct populations, seniors and rural residents, could prove critical to the success of that strategy.
At Sanford Health, a Hospital at Home program launched less than two months ago is giving the nation’s largest rural health system key insights into how to improve access to care and support providers and rural communities. The program, which adheres to the Centers for Medicare & Medicaid Services (CMS) Medicare-reimbursed model, aims to ease overburdened inpatient services and give rural patients an opportunity to recover at home rather than in a hospital bed.
Susan Jarvis, chief operating officer for Sanford Fargo and Health Network’s north region, says the health system is starting slowly with this program, with a current capacity of four patients at any one time. And while the focus is on patients in Fargo, which has a primary service area of 250,000, the goal is to extend out into rural regions where patients would truly benefit from recovering at home.
“We have a concentrated population in the Fargo/Moorhead area, but once you get out even into the 25-to-30-mile radius, it gets pretty rural out there,” she says.
That, she says, is where small, critical-access hospitals often have to transfer patients rather than manage care for them, and where a transfer can cover hundreds of miles, take hours, and separate patients from their family and community.
“That’s where we need this,” she says.
Like other Hospital at Home programs, Sanford Health’s model is a complex mix of virtual and in-person services, emanating from the hospital. The health system uses a virtual nursing platform and digital health tools to maintain a link with patients at home and coordinates daily visits with its in-house paramedicine program.
Jarvis says Sanford Health is using specific criteria for patient eligibility, focusing now on diagnosis-related conditions like pneumonia and dehydration as well as patients who’ve been in the hospital “and really just need monitoring for a couple of days.” Patients are evaluated through the ED, the prime candidates being those who are admitted and placed in overflow or holding rooms and waiting for a bed upstairs.
In time, as the workflows are defined and data is collected, the health system plans to expand both its patient eligibility criteria and the number of patients who can be treated in the Hospital at Home program, perhaps even creating a hub-and-spoke program that connects other hospitals in the Sanford Health network with small communities.
Jarvis says one surprising challenge has been getting patients interested in the option.
“They’re saying, ‘You’re telling me I need to be in the hospital, but I can go back home?’” she notes, saying some patients feel that because they need hospital-level care they should be staying in the hospital.
“We’re spending a lot of time with patients before they are [admitted],” she says, as well as developing additional marketing materials to address the home effect and caregivers.
Many patients can’t get out of the hospital soon enough, and that’s where the Hospital at Home strategy could gain steam. The argument in favor of the strategy has long been that many patients prefer their own bed to a hospital bed, and that they recover faster and better at home, where they can sleep more comfortably, use their own bathroom, eat their own food, play with their own pets and children and watch their own TV.
The value of this program in rural areas, Jarvis says, will undoubtedly grow. People living in small communities don’t want to travel long distances for healthcare (as an aside, on the day the program was launched, temperatures across South Dakota were 30 to 40 degrees below zero), and healthcare providers in those communities don’t want to send them elsewhere. A Hospital at Home program, she points out, will rely on “boots on the ground” resources, like the local critical care hospital, doctors, home health aides and even social services, to give that patient the necessary care. And those billable services will support the local community.
That’s also what the growing senior population wants to do—and that’s where this type of program could see even more growth.
Sanford Health’s Hospital at Home anticipates addressing the care demands of a growing senior population, which is demanding services and technologies that allow them to age in place, avoiding grueling trips to and from the hospital or doctor’s office.
Addressing the Growing Need for Senior Care at Home
Improving home-based care for seniors was a pervasive topic at CES 2025, particularly in the Digital Health Summit and exhibit hall, which included large sections devoted to the smart home and AARP-supported services.
Some of the conversations there revolved around using remote patient monitoring (RPM) and Hospital at Home to bring care to seniors.
“The home is right there waiting for us,” said Gabrielle Goldblatt, partnerships lead for the Digital Medicine Society (DiME), which participated in the Digital Health Summit and had a booth in the AARP pavilion. “We can’t be spending billions of dollars on just another way to go to the hospital.”
And while hospitals are focused on the home front right now, they could pivot with the Hospital at Home strategy to other sites like skilled nursing facilities (SNFs) or assisted living complexes.
Doug Leidig, president and CEO of Asbury Communities, a Maryland-based collection of 11 senior living locations, said the network of close to 2,000 not-for-profit communities around the country should be partnering more extensively with healthcare providers to improve care services. But during a panel at the AARP’s Age Tech Summit, he also noted senior living communities aren’t incentivized to invest in healthcare technology.
“There is so much technology out there now that people become paralyzed” with indecision, he said, pointing out the need for innovating partnerships with healthcare technology companies and providers. “We could be their lab.”
Leidig noted the average senior has five doctors and eight to 12 prescribed medications, making it critical that they have reliable platforms in the home with which to communicate with their care team.
Hon Pak, who heads the digital health team at Samsung Electronics, said healthcare providers are the key to improving the smart home. Tech companies and others can create the best smart home available, layering sensors and digital health tools to capture data and enable virtual care, but unless the consumer has a good relationship with the care team, that technology won’t provide value.
“If you just say, ‘Hey, something’s wrong; go see your doctor,’ that’s an incomplete solution,” he pointed out.
“We need hospitals and provider groups to come in,” added Amelia Hay, VP of startup programming & investments at AARP Innovation Labs.
And that’s what DiME is doing. The organization is partnering with the Consumer Technology Association (CTA), UMass Chan Medical School and UMass Memorial Health on the Connected Health Collaborative Community, an effort to create sustainable and scalable Hospital at Home programs. Participating members include Highmark Health and the Mayo Clinic.
“Right now we need to understand the guardrails and provide education,” she said. “That starts with bringing people into the same room for these conversations.”
And at an uncertain time, with a new administration vowing to shake things up and prospects of a continued CMS waiver for Hospital at Home programs up in the air, these conversations may keep the strategy alive.
At Sanford Health, Jarvis says the waiver may be the key to survival for their program in its current state. She said she’d like to see the proposed five-year extension make it through current Congressional talks.
“I think it's going to be hard without that CMS funding, and [there] won't be nearly as many patients eligible for the program, and you know the payers tend to follow the lead of what happens with CMS,” she says.
“I really think five years will be a great time frame for proof of concept.”
Intermountain Health’s new high-powered collaboration aims to create a network of connected hospitals, sharing services and providers and reducing transfers. Could this be the model to solve access and care barriers?
The key to rural health access may very well be telemedicine. And a coalition launched by Intermountain Health may be the model for that strategy.
The Salt Lake City-based health system, which has a footprint in several rural states, is joining forces with Microsoft, Epic, Gates Ventures and West Health to develop a hub-and-spoke telemedicine platform aimed at connecting small critical-access and large hospitals in a network that facilitates virtual care and reduces transfers and travel.
Dan Liljenquist, Intermountain’s Chief Strategy Officer, says the partnership, unveiled last December but in planning for a while, aims to address healthcare disparities and access issues across rural America. Roughly 60 million people, or 20% of the nation’s population, are struggling to find the care they need, while 20% of the county’s rural population live in counties without any hospitals.
And those problems are growing. At least 25 hospitals closed in 2024, and more than 700 rural hospitals—about a third of all rural hospitals in the U.S.—are in danger of shutting their doors.
“What you’re starting to see is a significant disparity in how healthcare is delivered,” he says. “Cancer mortality rates are 2% in urban communities and 15% in rural communities. Why? Because it takes forever to go get care, and people are choosing just not to get care because it’s a three-hour drive and there’s nothing they can do. Or you have a stroke and you’re three hours away. So you have sick people driving by a critical access hospital trying to get to a big city where the specialists are.”
Intermountain’s strategy isn’t entirely new. The health system has long been recognized for its telemedicine and digital health programs and strategies. But Liljequist notes many of those programs have existed in their own silos, serving certain populations or hospitals; whereas this effort aims at an enterprise-wide platform that connects not only hospitals and other sites within Intermountain, but outside the network as well.
“What if we systemize all of this and create what we call a virtual hospital?” he asks.
The effort started, he says, with a plan to lay down a telemedicine infrastructure to stabilize small, rural, critical-access hospitals, giving them on-demand access to clinicians to help them treat more of their patients rather than sending them on costly and risky transfers to larger hospitals. That network now serves roughly 33 hospitals within Intermountain as well as about 40 outside the health system who contract for telemedicine access.
Liljenquist says the cost to those small hospitals is small, but the service helps them to keep an extra 13% to 18% of their patients. This not only reduces transfer costs but allows the hospital to capture charges and improve care management.
“That’s a big, big deal, and it’s a big deal for patients because they don’t have to travel,” he says. “It’s a big deal for the community because we’re able to bring real-time expertise to the bedside. You oftentimes don’t need immediate surgical care. It’s ‘I need somebody with hands on the ground to do this or that [while being] coached by another doctor who’s a specialist.’”
Liljenquist envisions critical-care access hospitals using this platform to access on-demand specialists from Intermountain, enabling on-site staff to care for patients who would otherwise be transferred to a larger facility. This, in turn, improves the hospital’s census, stabilizing finances and keeping patients in their community, closer to home.
“You're paid on a DRG or on a code based on the complexity of the case and the more complex you can handle locally, the better your reimbursement is,” he notes.
This is especially important, he says, in light of the growing senior population, which will demand care closer to home (not to mention the roughly one-quarter of Intermountain’s doctors and nurses that are Baby Boomers themselves).
Collaboration with key technology and healthcare organizations is important, Liljenquist says, because Intermountain can’t do this alone. A telemedicine platform spanning not only hospitals but health systems needs good digital health tools and a strong EHR to coordinate data storage, analysis and exchange, hence the participation of both Epic and Microsoft.
“The biggest challenge is that our doctors sometimes have 15 different logins to 15 different EHRs to try to do that,” he says.
And with this strategy taking aim not only at the growing senior population but access and equity issues affecting rural communities, both the Gates Foundation and West Health are on board.
“It's not just consolidating programs, systematizing what we do, agreeing on all the technology, but really mapping and making sure that that when we go out and offer these services that we're offering them consistently,” he says.
Liljenquist sees this platform as a model that could be embraced by other large health systems, creating hub-and-spoke telemedicine networks across the country.
“What can we share and what we're hoping is, is that there's interest from other folks who say, ‘Oh, we might be able to do something similar,’” he says. “We might be able to learn. We might be able to create really a unique overlay that helps stabilize rural healthcare nationwide. That's what we're interested in figuring out.”
Nuvance Health is partnering with a digital health company to monitor and manage care for patients at home who are dealing with cognitive issues, including dementia. The platform also allows providers to spot early signs of decline.
Many people use brain-stimulating activities, like crossword puzzles or quizzes, to get up to speed in the morning or stay alert during the day. Healthcare providers are now finding that these activities, delivered through a mobile device, can help them monitor and even treat patients at home.
At Nuvance Health, clinicians are integrating Neuroglee Connect into care management for patients at neurology and primary care practices across New York and Connecticut. The digital health interventions are designed for patients with mild cognitive impairment and early-stage dementia.
“I'd like them to take ownership of their healthcare,” says Paul Wright, SVP and system chair of the Neuroscience Institute at Nuvance Health and the John and Joanne Patrick Endowed Chair for Advanced Technology in Neuroscience. “This begins their adoption of [the concept of] ‘This is your body, this is your mind, this is your health, and … being healthy is an active process.’ So I'd like them to be engaged and active.”
Digital health tools are gaining momentum with healthcare organizations thanks to the prevalence of mobile health devices in the home. Paired with remote patient monitoring programs, they offer care providers an easy portal to the patient beyond the regularly scheduled six-month checkups in the doctor’s office. Clinicians can draw patient data from these platforms to monitor health outcomes like medication adherence and effectiveness and moods.
With Neuroglee Connect, Wright is looking for a connection to his patients.
“I want to see that there is engagement,” he says. “That's because if you're not, if you're doing this and you're not engaged, then it's not meaningful.”
Through that engagement, which can include games, education, memory compensation, reminiscence and health and wellness activities, Wright says he can monitor patients’ cognitive abilities, even spotting declines or other concerning trends before either the patients or their caregivers notice any differences.
“We have the capabilities now to predict people who are not going to be doing well,” Wright says.
The platform also includes resources and education for caregivers, including support for managing anxiety and stress. Wright says these platforms not only allow the care team to include friends and family—who often see things before doctors or nurses do—but also give them the support they need.
Describing this technology as a platform isn’t unintentional. Digital health tools are part of a much larger care pathway, and the ability to have patients and caregivers access them at the time and place of their choosing (most often the home) gives providers a platform to manage and coordinate care that goes well beyond one app.
Forward-thinking healthcare leaders are using these platforms to develop remote patient monitoring programs that can track a wide variety of patient data in the home, which in turn can impact care management plans. Based on that data, clinicians can adjust, prescribe or discontinue prescribed medications, add educational or wellness resources, even schedule in-person checkups or specialist consults.
Wright says Neuroglee Connect also allows Nuvance to give its primary care providers more opportunities to care for patients they would otherwise send to specialists, like neurologists. Those specialists are in short supply and high demand, he notes, so the more opportunities to have PCPs handle some of the care, the better.
“We're able to, by going through primary care, deliver care to more people normally who would never have accessed it,” he adds.
