PPEC programs like Spark Pediatrics give healthcare providers a resource to manage and coordinate care for children with complex care needs. They also give parents a chance to relax a bit, and enable these children to be kids.
Health systems and hospitals play an important role in coordinating care for small children with complex medical needs, who often transfer out of the NICU and into a chaotic and uncertain world.
A model of care called PPEC (Prescribed Pediatric Extended Care) aims to make that process easier for providers, patients and their families.
A concept that’s been around for roughly 40 years, PPEC centers are gaining momentum as the number of “medically complex” children surpasses 3 million in the U.S., straining the resources of both healthcare providers and families. The center-based model, likened to a day care, aims to give these children the care they need alongside the childhood they’re often missing out on.
“We’re helping kids [with complex medical conditions] get access to skilled nursing care,” says Jeffrey Soffen, CEO of Spark Pediatrics, a Florida-based PPEC provider that is working with more than a dozen health systems across three states. “We promote socialization. We promote respite for the families so that they can either have time to themselves or time to go to work or whatever it might be. I'd say right now that's really important.”
There are roughly 180 PPECs in the U.S., located in the 15 states whose Medicaid programs permit the centers (Medicaid requires a prescription for care from the child’s primary pediatrician). Several states, including Missouri, are debating amending their Medicaid program to permit PPECs, but the path forward is slow and uncertain, especially considering the current political climate.
Earlier this year Spark Pediatrics raised $15 million in new investments, with funding from Pittsburgh’s UPMC Enterprises and the Houston’s Memorial Hermann Health System. Soffen says the funds will enable Spark to establish new partnerships in Pennsylvania and Texas, the next step in a plan to expand across the country.
“Spark is creating a new model of care delivery for children with medical complexities that is aimed at improving quality of care and the family experience for this often-overlooked population,” Mary Beth Navarra-Sirio, Vice President of Market Development at UPMC Enterprises, the innovation, commercialization, and venture capital arm of UPMC, said in a January 2025 press release on the funding round. “This aligns well with our focus on creating innovations that impact the lives of patients in meaningful, lasting ways.”
Soffen says medically complex children often begin their lives in the hospital NICU, move through other departments in the hospital, then need care from a wide range of doctors, nurses and specialists when they go home—tasks that often fall on stressed parents. On top of that, there are often delays, some as long as a year, in accessing specialists.
"We Should Be Locking Arms"
That’s where care coordination becomes a necessity.
“Our kids are born in their NICU, they're going back to their hospitals, they're seeing their pediatricians,” Soffen says. “It feels like we should be locking arms, right?”
Spark uses a patient-centered medical home strategy at about half the cost of in-home care, he says. Through a care team that collaborates with specialists, the center offers up to 12 hours of care seven days a week, with a patient-to-staff ratio of 1:3.
“My biggest thing that I want to do is make these kids’ lives easier,” Soffen says. “If you think about a child that we serve, they might have 12-13 specialists. They might have an appointment every week with a different doctor. [Parents] also have to coordinate therapies. So if you have a feeding tube, you've got to be working on swallowing in order [to make] progress and eventually get this feeding tube out.”
“We need to do as many of those things in our center as possible, but we also need to understand who we are and who we are not,” he adds. That means the center focuses on a small care team and coordinates specialist visits, taking the pressure off of parents who would otherwise be scheduling specialist visits at home or transporting their children to doctor’s offices and clinics.
For that reason, Spark Pediatrics—like most PPEC providers—needs to be located near large population centers.
“The more kids that we serve in a center, the more we can do for them, and that's the really powerful thing,” Soffen says. “So if I have 30 kids in my center instead of 10, my ability to attract providers to do virtual visits or come into the center to do a wellness check is a totally different scenario. If they can see 20 kids instead of five kids, that makes it worthwhile.”
That’s why Spark Pediatrics started in Florida and is targeting heavily populated states like Texas and Pennsylvania. Medicaid support is crucial, Soffen says, as almost all of their patients are on Medicaid, and Spark is working with legislators in states like Missouri to expand the number of states they can work in. They’re also talking to private payers about the value of the program.
The UPMC partnership, meanwhile, has an added benefit of an associated health plan, offering opportunities for innovative care arrangements like an ACO.
“An ACO is a is a way for providers to come together to produce better outcomes for their patients and to do it in a cost-effective manner than incentivizes them to do that,” Soffen says. “Why shouldn't we be a part of that if we're able to help them achieve that goal?”
"Why Shouldn't They Have That Chance to Just Be a Kid?"
Soffen says they’ve had good conversations with pediatric hospitals (their partners include Nemours, Joe DiMaggio Children’s Hospital, Orlando Health’s Arnold Palmer Hospital, Palm Beach Children’s Hospital, Baptist Health Jacksonville’s Wolfson Children’s Hospital and Texas Children’s Hospital). But the wider strategy is to partner with any health system that treats medically complex children.
“A big part of our job is to educate, in particular, the hospitals, the discharge coordinators, the care managers, the case managers, the pediatricians, the specialists, the pediatric specialists,” he says. “Those are who our kids are going to every day and they're the ones that put their trust in those institutions to recommend what is best for them.”
The biggest barrier, of course, is funding, and the ongoing chaos in Washington DC over Medicare and Medicaid sustainability casts a shadow over the growth of any PPEC.
That’s why Soffen wants healthcare providers and lawmakers to see not only the financial and clinical value to these centers, but what these facilities can offer to children and their parents.
“You want these kids to have the childhood that you dream about, where they come home from friend's houses or birthday parties or doing arts and crafts, and you put [their artwork] on your window and you're so proud of them,” he says. “Why shouldn’t they have that chance to just be a kid.”
The Charleston-based health center, participating in HealthLeaders’ Virtual Nursing Mastermind program, is ready to move beyond med/surg units and put virtual nurses in the ED, ICU and specialty care programs.
It’s an “exciting time for nursing transformation,” says Emily Warr, Administrator for the Center of Telehealth at the Medical University of South Carolina (MUSC). And that means it’s time for the health system to scale its Virtual Nursing program beyond their med/surg units.
“We have grown significantly, are planning to pilot in room equipment this quarter, and are making great progress with quality and finance metric improvements,” says Warr, a participant in the HealthLeaders Virtual Nursing Mastermind program.
MUSC, which has taken part in the Mastermind program the past two years, is seeing growth at a time when many health systems and hospitals are ramping up their virtual nursing programs to meet a rising demand for effective care transformation. Many are looking to move beyond the initial ROI of improving nurse workflows and well-being and are looking for clear clinical value, such as improved patient outcomes or administrative metrics such as patient length of stay or admission/discharge times.
In a May 2024 HealthLeaders interview, Warr said MUSC had launched an earlier version of virtual nursing that didn’t succeed because it wasn’t sustainable. That led to a second iteration, which focused on specific pain points and targeted tasks in which success could be measured and proven.
“We needed to focus on something that we felt we could impact and choose to measure,” she said, such as “very specific, task-oriented things.”
Fast-forward to today, and Warr says they’ll soon be expanding the program beyond med/surg to the Emergency Department, ICU and other specialty care units.
“We can’t expand fast enough,” she says. “Nursing units across the system are demanding the service and are eager to see the benefits in their work area. I think the specialty units will be interesting to explore and will present scalability challenges, but we look forward to problem-solving those while maintaining a focus on outcomes and efficiency.”
MUSC’s program tracks several metrics, beginning with nursing satisfaction and turnover rates and patient satisfaction scores, all of which have improved with the program. They’re also charting pressure injuries and hospital-acquired infections, time to discharge, quality of information given to patients upon discharge, quality of patient-nurse communications and even time given back to nurses.
The health system is reporting a 10% reduction in nurse time spent in the EMR, a 5% improvement if patient experience tied to communication with nurses at admission, and a 10% improvement in patient throughput, or timeliness to discharge.
Perhaps the only drawback at the moment to expansion, Warr says, is a hiring pause on virtual nurses, which she says is necessary for MUSC to catch up on workflow efficiencies and investigate productivity.
With the transition to other departments within the hospital, she expects to see some new challenges. That includes creating workflows for virtual nurses in the ED that don’t conflict with floor nurses and the many different challenges that influence nursing care in the ICU, including drug administration, sedation, ventilator management and documentation.
And that’s where Warr is focusing her excitement. The expansion of virtual nursing to other departments not only poses new challenges, but opens up the model to new ideas for care management and new outcomes for improvement. That the program has worked so well in med/surg doesn’t mean it will thrive in other environments, but MUSC has the experience and the data to build off of those early gains.
That includes, eventually, new care pathways that extend outside the hospital, even into the home.
“We have virtual nursing roles in all areas of our virtual ecosystem,” she points out.
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CMS spent almost $200 million on remote patient monitoring in 2023, and more providers are embracing the technology to track patient biometrics. That’s why the time is right to align payer policies and reimbursement on high-performing programs.
Healthcare providers are finding increasing value in remote patient monitoring (RPM), and that ROI is tied to Medicare and Medicaid reimbursement. But those payments are limited, and some providers are saying they don’t get enough back to justify the investment in new technology and workflows.
With that in mind, a new report says the time is right to rewrite RPM policy, improving reimbursements and giving providers more opportunities to embrace innovative tools that can improve clinical outcomes.
The report, from the Peterson Center on Healthcare, finds that Medicare expenditures on RPM have grown from $6.8 million in 2019 to $194.5 million in 2023, but that’s still just a small part of overall Medicare spending. The growth is driven by CPT codes approved by the Centers for Medicare & Medicaid Services (CMS) for some remote physiological monitoring (RPM) and remote therapeutic monitoring (RTM) services, as well as a growing number of vendors offering RPM devices and management services and a general desire among clinicians and care teams to track their patients’ biometrics outside of the doctor’s office, hospital or clinic.
That’s why, the report says, policy-makers, providers and payers should come together to improve reimbursement opportunities. The report lists three recommendations:
Align coverage and reimbursement for RPM services to clinical value.
Ensure access to high-impact RPM services.
Improve data collection in RPM tools and programs.
“As we adopt exciting, new technologies that extend care beyond the walls of the doctor’s office, we need to design payment models that align with clinical benefits for patients,” Caroline Pearson, executive director of the Peterson Center on Healthcare, said in a press release. “That means ending ‘forever codes’ that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients’ diseases.”
A Service Ripe for Expansion and Improvement
The report lists four takeaways from a review of CMS data:
Only about 1% of Medicare patients are in remote physiological monitoring programs, and even less are using remote therapeutic monitoring. But those numbers are growing, from 44,500 in 2019 to 451,000 in 2023 for RPM and roughly 52,500 in 2023 for RTM.
Providers are billing RPM services for longer periods of time, from an average of 1.7 months in 2019 to 5.2 months in 2023.
More than half (57%) of all Medicare spending on remote physiological monitoring services focuses on hypertension, while 13% addresses diabetes and 6% targets sleep and waking disorders. For remote therapeutic monitoring, almost 60% targets musculoskeletal disorders, while 5% addresses either respiratory disorders or hypertension.
In 2023, traditional Medicare spent $194.5 million on remote physiological monitoring services and another $10.4 million on remote therapeutic monitoring services, which comes out to an increase per-patient from $154 in 2019 to $431 in 2023.
The report suggests that RPM reimbursement be tied to those specific programs that show the most value.
“Coverage and payment policies should be aligned with this evidence to encourage adoption of solutions that deliver clinical benefits and limit payment for monitoring that is not driving meaningful clinical improvements,” the report states.
Why Are Doctors Embracing RPM?
The report also revealed three key takeaways to clinical value for RPM programs:
The clinical impact of RPM varies by condition.
Clinical benefits from RPM depend on provider engagement with the data collected and the ability to act on that data to improve outcomes.
RPM programs are time-limited, and clinical effectiveness varies depending on the condition.
“These clinical findings suggest that reimbursement for remote monitoring solutions should reflect effectiveness and vary by duration,” the report said. “CMS and other payers should consider developing condition-specific billing guidelines that match the periods of highest effectiveness as evidenced by clinical benefit for each condition.”
“Once an evidence-based time limit for remote monitoring services is reached, continued coverage of these services should require additional clinical justification,” the report continues. “Medical necessity is already a standard in Medicare and Medicaid; this would be a step toward defining medical necessity criteria for remote monitoring technologies.”
As an aside, the report notes that providers currently have no limits on how long they can use RPM for a specific patient, and can be reimbursed “on a monthly basis in perpetuity for anyone with a diagnosed chronic condition, even if they are already well-managed.”
This points to the need for more detailed data on how providers are billing for RPM services and how these variations in the duration and effectiveness of treatment may impact healthcare spending.
The report also gives health system and hospital leaders a blueprint for developing an RPM strategy that makes the most out of available reimbursements. It can also be used to develop more effective programs, either by fine-tuning devices and care pathways for common conditions are creating new treatments to address gaps in clinical care.
Two U.S. Senators have co-sponsored a bill that would create a better pathway for Medicare coverage of FDA-approved AI tools for clinical care.
One of the barriers to AI adoption in clinical care is the lack of a clear financial ROI. A new bill before Congress aims to make that process a little bit easier.
U.S. Senators Mike Rounds (R-South Dakota) and Martin Heinrich (D-New Mexico) are sponsoring the Health Tech Investment Act (S.1399), which would expedite the pathway to Medicare reimbursement for clinical AI tools.
“Medicare patients deserve access to the life-changing care that artificial intelligence-enabled devices can offer,” Rounds said in a press release announcing the bill. “There is currently no clear Medicare payment system for these devices, meaning that it can take years to be approved and paid out by Medicare accurately. This legislation would create that system, improving diagnoses and encouraging the adoption of AI devices in clinical settings.”
The fast-paced development of AI tools in the healthcare space has created a noticeable gap between implementation and governance. According to Rounds and Heinrich, the FDA has approved more than 600 AI-enabled devices, but the Centers for Medicare & Medicaid Services (CMS) “lacks standard or consistent methods for covering and paying for these products.”
And without reimbursement, providers are reluctant to adopt the technology. Many health systems and hospitals, particularly non-profits and rural organizations, are operating on razor-thin margins, and executives won’t likely introduce new tools unless CMS backs them financially.
The bill has garnered support from several advocacy groups, including the National Health Council and the Advanced Medical Technology Association (AdvaMed).
“AI’s role in improving patient care is already evident and increasing, particularly in radiology, where AI can help doctors and other healthcare professionals swiftly analyze medical images, detect illness and abnormalities, and make a more informed diagnosis,” AdvaMed said in a press release. “Moreover, FDA authorized AI-enabled medical devices are poised to save the healthcare system resources due to enhanced diagnostic and therapeutic precision that can help drive efficient and effective care.”
“With AI-enabled medical technologies already making remarkable strides in patient care, and with even more incredible strides ahead of us, now is the time to establish a predictable reimbursement pathway,” Scott Whitaker, the group’s president and CEO, said in the release.
This week's Winning Edge panel explored how ambient AI is being introduced to clinicians, and how the technology will evolve as a decision support tool.
Health systems like Providence and Cedars-Sinai are taking a slow and steady approach to introducing ambient AI to their clinicians, with small pilots that gradually scale upward as doctors become familiar with the technology.
During this week's The Winning Edge podcast, sponsored by Microsoft, Providence Chief Transformation Officer Sara Vaezy and Cedars-Sinai CMIO Yaron Elad, MD, FACC, said the biggest ROI for ambient AI at present is in helping clinicians reduce their administrative workload and spend more time in front of patients.
But they also noted that the technology will eventually become sophisticated enough to give clinicians near-real-time clinical decision support, while also helping to identify and schedule tests and appointments and code the encounters.
Both said it's important to put AI in the hands of doctors who want to use the technology, so that they can demonstrate its value and pass that on to their colleagues. And while the potential to reduce workflow pressures and find time to see more patients may be there, executives shouldn't be suggesting that to their doctors.
Ambient AI is just one of several AI tools being introduced in the clinical space, according to Vaezy and Elad. Health systems and hospitals are also testing the technology on in-box messaging, with the goal of reducing time spent by clinicians checking their messages and answering patient requests more quickly. They're also trialing AI on chart summarization, and looking forward to applying AI to nursing.
Watch the YouTube video below of this week's panel to gain more insight into how AI is being embraced in the clinical space.
Healthcare executives who took part in this week’s Winning Edge panel say ambient AI is helping clinicians reduce administrative stresses, but it will soon be used to add value to the patient encounter.
Health systems like Providence and Cedars-Sinai are embracing ambient AI to improve clinician workflows and reduce administrative tasks, but the real value will come when AI adds clinical value to the doctor-patient encounter.
That’s the long view taken by executives from the two health systems during Tuesday’s The Winning Edge panel, sponsored by Microsoft. And it points to the future of Ai in clinical care as a decision support tool.
Sara Vaezy, Chief Transformation Officer at Providence, and Yaron Elad, MD, FACC, Cedars-Sinai’s Chief Medical Information Officer, said their organizations have both gradually rolled out ambient AI tools to physicians to help them spend less time in front of a computer and more time in front of their patients. The technology is designed to accurately capture the conversation and put that information into the medical record, reducing the amount of time clinicians spend documenting the encounter.
Elad said it’s reasonable to expect that the tool reduces time spent on the computer by 10% to 20%, especially time spent after hours, even at home, tidying up the notes for the patient record. That reduces the clinician’s administrative workload and gives the doctor more time to face the patient—something that not only benefits the doctor, but makes the patient feel more valued as well.
That might not appeal to a CFO looking for financial ROI, but it does set the foundation for improved provider well-being, better patient engagement and satisfaction, and eventually improved clinical outcomes.
That said, the two executives and Jared Pelo, MD, CMIO for Microsoft’s Health and Life Sciences unit, pointed out that clinicians have to “own” the technology and have the time to get used to it on their own terms. Healthcare leaders should not tell them that AI will improve their productivity, such as giving them more time to see new patients; instead, as clinicians settle into their new workflows, they may find the time to address new productivity goals.
Vaezy said Providence is tracking several different metrics on ambient AI, including efficiency and appointment times, to get a baseline on how the tool could have an impact on productivity in the future. Just as important, they’re charting provider and patient satisfaction, and asking clinicians if they’d be disappointed if the tool were taken away, whether they’d recommend AI, whether this tool improves documentation and would this capability compel them to stay with the organization or stay in medicine.
Both Providence and Cedars-Sinai are developing AI tools in other areas as well, including in-basket messaging and chart summarization. And while Vaezy and Elad said the next big advances should come in how AI can be used to improve nurse workflows, both are particularly looking forward to how AI evolves as a clinical decision support tool.
Vaezy pointed out that AI, for the most part, is now being used to reduce complexity and remove administrative burdens, but within two to three years the technology’s value will be in adding to the provider’s toolbox and giving more value to the provider-patient encounter. That might mean coding the encounter and identifying and pushing tests and other appointments.
Elad, meanwhile, said he envisions an AI overlay that gives clinicians almost real-time clinical decision support. This would support the true definition of AI as augmented, rather than artificial, intelligence.
Stay tuned to HealthLeaders this Friday for the YouTube recording of this Winning Edge panel.
A Cedars-Sinai program attaches a substance abuse treatment doctor and social worker to the patient’s care team, improving treatment adherence and creating a better link to post-discharge treatment.
Cedars-Sinai is championing a new care management strategy aimed at linking patients dealing with substance abuse issues to medication-based treatment services after they’ve left the hospital.
The Los Angeles health system’s Substance Use Treatment and Recovery Team (START) pairs an addiction medicine specialist with a social worker or case manager to coordinate post-discharge care plans, including diagnostic assessments, information on treatments, psychosocial support and follow-up phone calls for one month.
The program builds on care transformation strategies that health systems and hospitals are exploring in an effort to redesign inpatient care and boost clinical outcomes. The idea is to create a personalized care team around the patient that includes clinicians and specialists and which can be expanded to include others such as pharmacists and social workers.
“Our program addresses a major challenge across hospitals,” Itai Danovitch, MD, chair of the Department of Psychiatry and Behavioral Neurosciences at Cedars-Sinai, said in a press release. “Even though effective medications exist for opioid use disorders, only a small percentage of hospitalized patients begin treatment during their stay or connect with services after discharge.”
According to a study authored by Danovitch and recently published in JAMA Internal Medicine, patients introduced to START were more than twice as likely to accept medication-based treatment during their hospital stay than those receiving the usual care, and they were almost twice as likely to embrace treatment after discharge.
Those numbers are important as health systems and hospitals try to battle the ongoing substance abuse epidemic, an integral part of the surge in mental health cases and a contributor to crowded Eds and declining public health outcomes.
The study, led by Cedars-Sinai, analyzed 325 patients hospitalized at three hospitals—one in Los Angeles, one in Albuquerque, New Mexico and one in Springfield, Massachusetts—between November 2021 and September 2023, with a final follow-up in December 2023.
Of that group, 164 patients received START care and 161 received traditional care. More than 57%, or 94, of the START patients initiated medication-based treatment (naltrexone, buprenorphine or methadone) during their hospital stay, compared to almost 27%, or 43 of the traditional care patients, and 72%, or 90, of the START patients continued care after discharge compared to 48%, or 50, of the traditional care patients.
“Hospitalization provides a crucial window to involve patients in addiction treatment when they might be most open to it, particularly after experiencing health-related consequences of their substance use,” Jeffrey A. Golden, MD, director of the Burns and Allen Research Institute and executive vice dean for Research and Education at Cedars-Sinai, said in the press release. “These important findings show how the medical community can significantly boost this engagement and help find solutions for the national opioid epidemic.”
Sharp HealthCare's year-old virtual nursing program is now testing a 'VIP experience' that enables nurses to become more active members of the patient care team.
As virtual nursing programs mature in health systems and hospitals across the country, some executives are envisioning a concierge care strategy.
Sharp HealthCare, for example, debuted its VIP platform roughly two months ago in the neuroscience unit in preparation for the opening of the new Sharp Grossmont Hospital for Neuroscience. This expanded co-caring model known as Vitual InPatient nursing services (VIP) leans heavily on patient engagement strategies, with the goal of having the virtual nurse as the patient's guide through the healthcare journey.
Tracy Plume, Nurse Director for the San Diego-based health system, says the new model was co-designed by patient advisors, information technologists and front-line nurses.
"The patients really want to know that someone was behind the scenes monitoring their record, looking at their chart, that nothing was going missed," she says. "They felt that that would make them feel safer, that their care was progressing as it should be. And that they had the opportunity to daily meet with the virtual nurses and ask those questions."
"They get an extra connection with the nurse, a healthcare provider, someone on the care team, to help coordinate that admission to discharge process." Plume adds.
Plume and Susan Stone, Sharp HealthCare's SVP of Health System Operations and System Chief Nursing Executive, recently took part in HealthLeaders' Virtual Nursing Mastermind program. Executives from roughly a dozen health systems met virtually and at an in-person event in Atlanta to discuss how their programs are evolving, where they see challenges, and how this strategy will evolve.
For Sharp HealthCare, virtual nursing is more about care delivery transformation, or crafting a new strategy for inpatient care that involves all the members of the care team. The idea took root in 2023 after a board member witnessed how Providence (another Mastermind participant) was transforming its care team strategy. Stone says she and her colleague spent a year researching the concept and looked at roughly 20 virtual nursing programs across the country.
Roughly one year ago, on April 1, 2024, Sharp launched its first virtual nursing program in two selected units, focusing primarily on handling admissions from the Emergency Department and discharges. The program has now spread to all four of Sharp's hospitals, encompassing about 600 licensed beds and 16.2 FTEs and running seven days a week, 12 hours a day.
Stone says the program focused on admissions and discharges first because those were the key pain points identified by frontline nurses who were included in the planning process. Sharp built is ROI strategy, she says, on reducing those time-consuming processes, thereby improving patient throughput and freeing up beds faster for new patients (Stone says the health system is runs between 85-95% capacity, making available inpatient beds a valuable commodity).
Stone says developing and proving an ROI is daunting, considering the many pain points that a virtual nursing program can potentially address. While patient throughout is one of them, she says, there are many factors beyond the nurse's control that go into how long a patient stays in the hospital.
Susan Stone, SVP of Health System Operations and System Chief Nursing Officer, Sharp HealthCare. Photo courtesy Sharp HealthCare.
"We're still working hard on producing and defending the return on investment," she says.
Other factors include readmissions (a costly pain point for every health system), nurse workflows and well-being, and patient satisfaction and engagement.
And that's where version 2.0, the so-called VIP experience, comes in. Stone and Plume say Sharp leadership wanted to target the patient experience in the evolution of virtual nursing, with a service that creates a care program around the patient.
"We've really taken our program past services and alleviating that administrative burden on the nurse to really being more part of the care team," Plume said.
Plume says the patient experience should always begin "with a warm hug," a feeling that the patient is being cared for by a team, both in the hospital room and behind the scenes. Through the virtual portal, a nurse is keeping an eye on the patient's healthcare data, coordinating with other members of the care team and the patient's family, handling administrative duties and funneling education and other resources to the patient.
She says nurses like the format because it gives them an opportunity to stay in the loop and learn more about their patients.
Whether this program can be expanded to all hospitals at Sharp depends on ROI, which will take time to develop. Stone notes that patient satisfaction rates have soared since the program's inception soaring, a good sign that they're more engaged with the care team and understanding their care at home management plan.
In addition, Stone says discharges are much more timely, and when recently speaking with frontline nurses, they report being able to facilitate patient discharged by 11:30 whereas before it would have been into the late afternoon to facilitate three discharges by themselves.
They are now looking at the possibility of folding other services into the virtual nursing platform, including deterioration alerts, sepsis alerts and the potential to be more efficient with virtual sitting throughout the system. Others have suggested adding virtual visits by specialists, such as diabetes educators.
"To us the future is for all different types of virtual care, and we know that other smart programs will be deployed via the electronic health record system, and we haven't really launched them to their fullest extent," Stone says.
"All of those things are business cases that we need to take one at a time," she adds. "We don't want to go too fast too soon because that could set the program up for failure."
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To inquire about participating in an upcoming Mastermind series or attending a HealtLeaders Exchange event, email us at exchange@healthleadersmedia.com.
What's the best way to ensure an ambient AI tool fits into the clinical workflow and produces the right ROI?
Ambient AI is all the rage these days, with health systems and hospitals testing out new tools and launching pilots aimed at quickly integrating the technology into their clinical workflows.
But like any other innovative idea, healthcare leaders can't expect to just turn it on and watch it transform clinical care. They need to map out exactly how AI will affect the workflows of their doctors, nurses and other staff, identifying the risks and benefits and determining how to collect and measure the right metrics.
In this week's HealthLeaders Winning Edge webinar, sponsored by Microsoft, executives from two top health systems will discuss how they're implementing ambient AI in their organizations, negotiating the challenges and identifying a clear ROI for executive and clinical buy-in.
Sara Vaezy, chief transformation officer at Providence, and Yaron Elad, MD, FACC, chief medical informatics officer at Cedars-Sinai, will be joined by Jared Pelo, MD, FACEP, chief medical information officer for Microsoft's Health & Life Sciences Division, for a discussion on one of the hottest topics in healthcare. They'll look beyond the hype and dig into the challenges of change management, scalability and ROI.
And while so many hospitals are testing the technology and reporting early successes in reducing administrative stress and improving workflows, the panel will dig into how these tools are positioned for sustainability and long-term value. How can financial and clinical ROI be factored beyond the initial year or two of use? And where else can this technology be deployed across the enterprise?
Tuesday's panel, The Winning Edge for Clinical Implementation, is part of AI Technology Week, a weeklong examination of the role technology plays in the healthcare community.
A new survey of the healthcare C-Suite finds that different executives have different ideas on governance. And they’re not sure about ROI, either.
A new survey of healthcare C-Suite executives finds that while many are taking a good look at generative AI, they’re not doing what they should to support scalability or sustainability.
The survey of 300 executives from American healthcare organizations, conducted by Accenture Managing Directors Tejash Shah and Kaveh Safavi and Health Industry Lead Researcher Daniel Owczarski, indicates 83% are piloting gen AI tools, but only 10% are investing in the data infrastructure needed to deploy the technology beyond the pilot.
There’s also a disconnect on who should oversee AI strategy. Some 28% of CEOs said they’ should be responsible for redefining jobs and roles impacted by AI, but only 5% of C-Suite executives agree. About 80% say the Chief Digital Officer or Chief Digital and Artificial Intelligence Officer should have that role, and less the 4% believe the CNO or CMO has any part to play in this.
“This perception overlooks a crucial reality: The labor shortage is most acutely felt by the clinical workforce, particularly nurses,” the report’s authors stated. “Clinical leaders will play a pivotal role in ensuring that gen AI-driven workflows deliver sustainable value and improved efficiency.”
“The true benefits of gen AI come from fundamentally changing how work gets done, which requires collaboration across leadership levels,” they continued. “Clinical leaders, such as CNOs and CMOs, should play a central role in redefining work models, identifying tasks for automation and empowering staff with tools that simplify their jobs. These efforts will help address the pressures faced by frontline teams and ensure that gen AI-driven solutions enhance care delivery.”
Who’s Piloting The AI Ship?
The biggest takeaway here is that health system and hospital leadership doesn’t appear to have a firm AI governance strategy in mind. They’re differing not only on who should be in charge, but downplaying the infrastructure needed to ensure growth.
Healthcare executives taking part in the HealthLeaders AI in Clinical Care Mastermind program have voiced those concerns as well. William Sheahan, SVP and Chief Innovation Officer at MedStar Health, said leadership has to understand how data is gathered, stored and managed to get a good handle on the transformative potential of AI. That may include investing in data management technology that hasn’t been updated in decades.
"How do we get our people, our nurses, our doctors, our clinicians, our revenue cycle teams, to understand how the technology supports the future of their work?" he told HealthLeaders during an interview last year. "We can't just focus on deploying the fun new technology and expect that organically it's going to change your business, right?"
The survey’s authors say the industry’s conservative approach to technology is playing a role in this disconnect. Only about half of the executives surveyed report strong alignment between the organization’s overall strategy and its technology goals. And while 60% expect an ROI for AI within a year, 95% are anticipating only moderate ROI over the next five years because they aren’t investing enough in the infrastructure needed to maintain that pace of growth.
“This underinvestment puts healthcare organizations at risk of falling further behind — both in meeting the growing demand for care and in keeping pace with competitors who integrate technology and strategy seamlessly,” the authors noted.
What To Do About ROI?
The survey also offers interesting insights into how ROI is being measured.
When asked how gen AI would impact healthcare, executives were bullish on administrative improvements but not so sure about either clinician well-being or clinical outcomes.
According to the survey, when asked how gen AI would improve their organization, 83% cited increased employee efficiency and 82% said the technology would drive revenue growth, yet only 17% cited improved clinical decision-making and only 6% said the tools would empower patients.
In terms of outcomes, 82% of those surveyed listed revenue growth, while 77% mentioned productivity gains, but only 20% cited employee satisfaction, 9% cited either cost reduction or employee retention, and 6% cited error reduction.
This goes against the grain for a vast number of health systems and hospitals launching AI scribes, many of whom are focused on reducing clinician stress and burnout and improving workflows. It could also point out that while many are targeting workplace well-being, the emphasis is still on financial ROI.
Mastermind participants Roopa Foulger, Vice President of Digital and Innovation Development at OSF HealthCare, and Jonathan Handler, MD, OSF’s Senior Fellow for Innovation, said healthcare leadership is struggling to understand what ROI really entails.
“How do we measure it?” Handler asked during a HealthLeaders interview last year. “How do we assess it? How do we validate it? And I think that gets harder, not easier, with some of the new large language models and the generative AI that’s out there. Because now, instead of algorithms built on a use case by use case basis, you’ve got this general purpose model – how do you evaluate all the things that it can do?”
“There are so many other ways to measure the value that is created,” he added. “Determining the right things to measure, which may not always be the easiest things to measure, is critical.”
Plotting The Right AI Strategy
In its report, Accenture offered four steps that healthcare executives should take to make sure they’re on the right path for AI development:
Build a reinvention-ready digital core. “Leaders should prioritize initiatives and technology investments such as enhancing data quality, democratizing data access, migrating to the cloud and building robust data governance frameworks,” the report said. “These actions will create a flexible and adaptive digital core, ready to support emerging technologies.”
Strengthen data quality and strategy. “Organizations seeing strong returns on technology investments prioritize centralized data management and data modernization,” the report noted. “They ask critical questions such as: Are processes and tools connected across functions to provide shared access to data and analytics? Is the data standardized, secure and easy to use?”
Prioritize responsible and secure AI deployment. “An organization’s readiness to scale gen AI depends on its ability to manage, mitigate and protect against these and related risks,” the report said. “Proactive strategies can minimize downtime and reduce the risks posed by evolving threats and expanding attack surfaces. Continuous monitoring and assessment of technological constraints, data integrity and cybersecurity measures are essential for building resilience and enabling faster, more efficient recovery in the event of an incident. Secure scaling of AI also requires deploying tailored LLMs and developing a workforce skilled in harnessing these tools.”
Expand your base of expertise beyond your own people. “Increasingly, external influencers are driving transformation across healthcare, helping shape standards and practices that promote innovative approaches,” the report said. “Healthcare providers partnering with academic institutions or leading researchers are already seeing tangible benefits. One such collaboration led to the development of advanced care protocols, resulting in reduced patient recovery times and higher satisfaction rates. This effort also attracted additional funding and support, accelerating innovation and establishing a robust framework for future advancements.”
