Physicians will review every response before they're sent to patients to ensure the 'human touch.'
Ochsner Health this month is launching a pilot program that uses artificial intelligence to send "simple messages" to patients through its MyOchsner app portal.
Under the program the AI drafts responses to routine patient queries, which will be reviewed and edited by physicians before they're forwarded to patients. The hope is that the AI will accelerate physician responses to patient queries while also reducing the time that physicians are spending each day in front of a screen responding to reams of email messages from patients, and allowing them more face time with patients.
The first phase of the pilot will include about 100 Ochsner clinicians across the sprawling health system's 46 hospitals and hundreds of care venues that will use Microsoft's Azure OpenAI Service linked with Epic's electronic health record software, testing simple messages unrelated to diagnoses or clinical judgments.
"Ochsner has long been a leader in using digital tools to improve the patient experience," Ochsner CMIO Louis Jeansonne, MD says. "Now we are looking at how technology can simplify workflows for our clinical staff, which should significantly reduce the hours they are spending away from patients."
In a media release describing the pilot, Ochsner clinicians stressed that no AI generated responses would be sent to patients without being reviewed by their providers to ensure
a "human touch." The tech is incorporated into clinical workflows with HIPAA-compliant encryption for privacy.
"The AI will generate a draft for the clinician to review and send. It's meant to help clinicians respond more quickly to patient messages, so patients can get answers to their questions sooner," Ochsner Chief Application Officer Amy Trainor says. "And it will reduce time our clinicians are spending on computers so that they can spend more time doing what they do best—direct patient care."
Once seen as a niche or novel component of care delivery, EHR messaging expanded rapidly during the coronavirus pandemic and it has grown to become a virtually ubiquitous tool for most providers. However, a growing number of physicians have complained that they're overwhelmed by email responses, often spending several hours each day to complete them.
A study in the Annals of Family Medicine found that primary care physicians were spending more than half of their workday, nearly 6 out of 12 hours, addressing EHR messages. More than four million medical advice requests were sent to physicians via the MyOchsner app in 2022.
Some health systems are confronting the growing use of electronic messaging by charging patients a small copay. Cleveland Clinic, for example, charges three billing rates for virtual queries based on the amount of time a physician needs to complete the task.
To facilitate the process, the Centers for Medicare & Medicaid Services in 2020 created three billing codes for e-visits.
Maryland-based Mindoula has a footprint in 23 states and the District of Columbia.
Community Health Systems, Inc. says it will partner with population health specialist Mindoula to integrate virtual mental health services at CHS's more than 700 primary care venues across 15 states.
Franklin, TN-based CHS says it will use Mindoula's Collaborative Care program to offer patients behavioral health assessments, map out care regimens, and schedule follow-up and additional virtual or in-person care, as needed.
"By integrating behavioral care with primary care, we can help our providers address the whole health of their patients," says CHS CMO Lynn Simon, MD. "Our partnership with Mindoula will help ensure mental health care is readily available for our patients. It will also help address the behavioral health provider shortage by enhancing virtual access to these critical services."
The Mindoula Messenger app provides HIPAA-compliant "clinically-validated patient assessments" and provides patients with messaging for medication reminders and other treatments, secure two-way video, phone and encrypted email. Those assessments provide "actionable intelligence" for primary care physicians monitoring their patients, Mindoula says.
The dearth of mental health clinicians across the United States has been well-documented, even as the need for mental healthcare access increases.
The U.S. Census Bureau said that about 30% of the U.S. population self-reported some level of depression or anxiety in 2021, at the height of the COVID-19 pandemic. The bureau estimated that 122 million Americans -- 37% of the population -- lived in 5,833 "mental health professional shortage areas", with a projected additional 6,398 mental health providers needed to fill the gaps.
According to the Centers for Disease Control & Prevention, more than 48,000 Americans committed suicide in 2021, making it the 11th leading cause of death in the nation, while 1.7 million Americans attempted suicide. In addition, the National Institutes of Health estimates that 3 million Americans are addicted to opioids or in recovery.
As states – and especially rural areas -- deal with this dearth of mental healthcare providers, CHS CEO Tim Hingtgen says virtual access behavioral health specialists is becoming more critical.
"A sustainable future for our healthcare systems relies on our ability to deploy innovative solutions that leverage both technology and human interactions to help patients access the clinical resources they need and that also support our clinicians in their practice of medicine," Hingtgen says.
Mindoula, based in Silver Spring, MD, has a footprint in 23 states and the District of Columbia.
The announcement comes just one week Walgreens CEO Rosalind Brewer's sudden departure.
Executives at Walgreens and clinical technology provider Pearl Health say the partnership they announced Tuesday will accelerate the drug retailer's expansion into value-based care.
John Driscoll, president, U.S. Healthcare, of parent Walgreens Boots Alliance says the partnership demonstrates that "Walgreens is committed to being the partner of choice for providers and health systems looking to transition quickly and effectively to value-based care."
"Our partnership with Pearl Health allows us to reach more communities faster and enable comprehensive, affordable care that improves long-term health outcomes and fosters healthier communities," Driscoll says.
New York City-based Pearl Health, launched in 2020, specializes in value-based care and compensation software and tech platforms for independent primary care physician groups. The partnership with Walgreens will leverage that expertise with the retailer's complementary services that include prescription drugs, medication adherence, immunizations, care gap closure, diagnostics, and patient discharge transitions.
"Our technology-powered value-based care model aligns seamlessly with the healthcare services Walgreens offers, particularly in the most vulnerable communities," Pearl Health CEO Michael Kopko says. "With a focus on proactive, coordinated care, we'll collaborate to deliver a better solution to providers and ultimately deliver high-quality services to patients, while managing their care efficiently. We're very excited about the implications of this partnership for patients in Medicare and beyond."
The partnership is the latest in a concerted push by Walgreens to expand its footprint in value-based care. The Deerfield, IL-based company in 2020 bought a minority stake in VillageMD, the primary care provider, and in 2021 paid $5.2 billion for a 63% majority stake in the primary care provider, which operates more than 680 locations across the U.S., including 200 next to the Walgreens drugstores.
In January, VillageMD finalized its $8.9 billion acquisition of primary and multi-specialist care provider Summit Health-CityMD that was backed by a $3.5 billion stake from Walgreens, and includes a minority stake with Evernorth, a Cigna Corp. subsidiary.
Walgreens has also bolstered its home-based care resources with investments in CareCentrix and specialty pharmacy company Shields Health Solutions.
The Pearl partnership announcement comes just one week Walgreens CEO Rosalind Brewer's sudden departure.
The key to getting doctors on board is to present them with the evidence, and then put it to a vote.
One of the biggest hurdles in supply chain is gaining physician support for clinical product procurement.
In this interview, Dan Hurry, president of Advantus Health Partners, the Cincinnati based supply chain mangement and group purchasing organization, says the key to getting doctors on board is to present them with the evidence, and then put it to a vote. Hurry spells out the process that he recommends in this, the first of a two-part interview with HealthLeaders. This transcript has been edited for clarity and brevity.
HL: How big of a factor is physician preference in supply chain?
Dan Hurry: From aqualityofcare, fromaneconomic, andfromanefficiencystandpoint,it'sprobably60%ofwhatyoushouldbetalkingaboutandworkingonatanygiventime. Theactivityisrevolvingaround the ORs, the cathlabs,becausethat’s the implantspace,whetherit'scardiac, whether orthopedic, thosearethepredominantspaceswheretheengagementbetweenaphysician and a manufacturingrep andyouroperationalleadersinterconnect.
Would hospitals always belookingforthelowestcost? No.They’re lookingfor what’s thebestoutcomeforthepatientathand. Nowwiththat,it'salwaysdebatableabout whatisthebetterproduct. So, weleanintoclinicalevidenceinallthosescenarios. Thecostofgoods, howmuchwe'rebuyingitforisonlyonepartoftheequation.
HL: Where is the potential for conflict?
DH: In manycases it may berelationshipsthatamanufacturer'srephaswithaphysician. WhatistheirroleintheOR or the cathlab, andhowdoesthatimpactchoice?That spaceisalwaysunderscrutiny with the potential for conflict, butthere'susually asuperficialpointthat'sbroughtforward, so weleanintomostoftheevidenceand thatallcomesfromthephysicians’ sideofthehouse.
We collectandorganizedataonthefront end, andwe puttogether a “factpack.” Using cardiacrhythmdevicesasanexample, we ask what thepatient looks like, howthephysiciansusethe devices, wheredotheyusethesedevices, whatdoesthatlooklikefromeitheraregionaloranationalmarketshareutilizationperspective, whatdo theoutcomeslooklike with anyparticulardevices, etc.
Thefactpack yields datathat allows somecomparablesbetweendifferentscenarios,differentcompanies,differentproducts,whateverthatlookslike.Onceyougetthathomeworkdone,it'stimetoengagethephysicians andseewhat thestate of the unionlookslike.
Typically, there will beaverybriefengagementwith the physicians onthefrontend,beforegatheringthedata,telling them we'regoing to reviewthis.Whenwe'vegotbigger,betteranddeeper data,we'llengageyou onadeeperlevel.
Thenwhenweengagethemonallthefacts,they'rescientists, theywanttoseethedatatheywanttoseewhatthislookslike,andwehavesomedialoguefromthere.Ultimately, we ask wheredowewanttogowiththeproductbasedonitsleadwiththatclinicalevidence?Thenwe'llask howdowenegotiatefor thebestqualityproducts.
HL: How important is volume in price negotiations?
DH: We’ll use the Costcomodelasanexample.Theyusuallydon'tputsub-qualityproductsontheirshelves.Theynegotiateforthebestqualitywithinacategoryorproductmixandmatchwhatdeservesshelfspace.Wedothatat thefrontend.Whataretheproductsthatdeservesomeshelfspace,where weagreethat thisisaqualityproductmadebyaqualitycompany with outstanding outcomes?Howdowenegotiate to comeupwiththeeconomicpackagetosupportcontinuoususe?
Oncethat's done, there is a perpetual review, withcontinuousimprovementexercisesconstantlyengagedwithcategorymanagementteams of cross-functionalplayers in quality,clinical, economicandoperations.
HL: To whatdegreeiscostpartoftheequation?
DH: Wedonotchaselow-costgoods.Wechasethebestqualitygoodsandthendrivethebesteconomicoutcomeforthosequalitygoods. Cost is always a factor, but it is a tertiary concern, behind outcomes and quality.
We contract with afewoutsidecompaniesthatarerunbyphysicianswho doindependentassessmentsofoutcomes, quality,theattributesassociatedwithanygivenproduct. We’ll ask if theseassessmentsalignwithourphysicians’ experience. Theymayormaynotagreewithan analysis andthat'swherewewanttogaintheir input.
HL: Who has the ultimate say in what product is purchased?
DH: We have a cross-function of folks, physicians, C-suiteexecutives, quality,economics, finance.Supplychainis runbyacertaingroupoffolks that gothroughthisprocess. There’s a vote andaproxyandwhat welandonandwhat'sapproved.It'snoindependentgroup inandofitself.
Once we'velandedon therightproduct or productmix,like anyotherconsumer,wenegotiatebasedonattributes,ourcommitmenttotheproducts, theoptimallogisticssolution,whatdo ourpaymenttermslooklike, everythingthatkindofsupportstheeconomicequationfortheproductsthatwe'veselected. There’s no rocketscienceout there.
The FDA is providing a one-year soft launch for the Drug Supply Chain Security Act mandates, effective November 27.
Pharmaceuticals suppliers, manufacturers and other stakeholders are being urged to use the looming "stabilization period" for the Drug Supply Chain Security Act (DSCSA) to reach compliance with federal interoperability regulations, and "not take your foot off the gas."
The Food and Drug Administration on August 30 said it would exercise enforcement discretion during the one-year period, effective Nov. 27, 2023, "to accommodate additional time that trading partners in the pharmaceutical supply chain may need" to validate DSCSA mandates.
At a Healthcare Distribution Alliance seminar in late August, stakeholders were cautioned that the stabilization period is not an opportunity to slack off on compliance.
"The point of the stabilization period isn't to take your foot off the gas," Gregg Gorniak, vice president of the Manufacturer Operations and Data Services and Secure Supply Chain Lead, Cencora, told attendees at the seminar, while urging them to prioritize meeting the interoperability requirements laid down in DCSCA.
"This whole thing is around the safety of the patient," Gorniak says. "We need to make sure we get it right."
That advice was seconded by FDA officials who attended the seminar.
"This [stabilization period] should not be viewed as justification to stop implementation," Leigh Verbois, FDA director of Drug Security, Integrity and Response, told the gathering. "We want this implementation to be done by 2024."
Connie T. Jung, FDA senior advisor for policy, told the gathering that the agency's actions is "only intending for the stabilization period to apply to [FDA's final guidance for Enhanced Drug Distribution Security Requirements Under Section] 582(g)(1)," and emphasized."
"This does not mean to stop anything," she says.
Stakeholder Concerns
The HDA and other drug supply chain stakeholders have raised concerns with the FDA about DSCSA's requirements and the "uneven state of industry readiness for November 2023, underscoring that the progress of implementation and the law's single compliance date for all trading partners could lead to supply chain disruptions and interruptions to patient care."
HDA CEO / President Chip Davis praised the FDA's decision to ease into the mandate, saying "the agency heard the concerns of distributors, manufacturers and pharmacists and provided guidance that will ultimately minimize the potential for disruptions in the short term."
The FDA says it will use the stabilization period to fine-tune DSCSA guidance, with a focus on wholesaler/3PL provider licensing. Additionally, the agency is planning to survey small dispensary readiness and hold additional public hearings.
Help for Independent Pharmacists
In particluar, independent pharmacies have raised concerns about the special compliance challenges facing smaller dispensaries.
"If you look at most of the larger chains, they're ready, or they [would have been ready] to flip this on in November, but not necessarily be getting data because their trading partners may not be ready to send data," Ilisa Bernstein, chief lobbyist for the American Pharmacists Association, told seminar attendees.
"But for the small dispensers, the independent pharmacies ... they were just not ready."
However, the ATA urges tighter privacy provisions for physicians.
TheAmerican Telemedicine Association and affiliate ATA Action are voicing support for the Centers for Medicare & Medicaid Services' proposed rule for the 2024 Physician Fee Schedule, which the advocates note extends into the new year the telehealth flexibilities put forward during the COVID-19 public health emergency.
"The proposed rule is, overall, positive for the telehealth community and patients, and looks beyond the now-expired COVID-19 public health emergency to continue the expansion of telehealth services, providing much needed clarity for physicians and other stakeholders across the country," Kyle Zebley, ATA senior vice president, public policy, and executive director, ATA Action says in an 11-page letter sent this week to CMS Administrator Chiquita Brooks-LaSure.
However, Zebley says the proposed rule raises privacy concerns for physicians.
"During the PHE, CMS did not require providers to list their home address when most care was provided virtually," he says. "We urge CMS to permanently allow providers to bill their practice address in order to maintain the confidentiality and security of the provider’s home address, especially for those providing mental health services. It is imperative that this flexibility not be allowed to expire at the end of 2023."
The death toll from the wild fires hit 99 on Tuesday, with dozens more fatalities expected.
Teledoc Health is offeringfree 24/7 virtual primary healthcare services for survivors, first responders and other Hawaii residents affected by Maui's devastating and deadly wildfires.
The offering by the Purchase, NY-based telehealth provider will give affected residents access to healthcare professionals for nonemergency services including nonnarcotic prescription drug refills by calling Teledoc Health at 855-225-5032. Emergency cases are referred to 911.
"When medical resources are already strained during natural disasters, virtual care can help patients manage wildfire-induced flare ups of chronic illnesses, such as asthma," Teladoc Health CMO Vidya Raman-Tangella, MD, says in a media release. "Virtual care is a proven solution that supports community health during these times, and we are grateful to provide access to care as Hawaii rebuilds and recovers from the fires."
At least 99 people have been confirmed dead from the wildfires, and the number could double over the next 10 days, Hawaii Gov. Josh Green told CNN.
"It is a tragedy beyond tragedies," the governor said about the fires that started sweeping parts of the island last week.
Teladoc has routinely offered free virtual care to people living in areas that have devastated by natural disasters, including hurricanes, wildfires, tornadoes, floods, power outages and blizzards for non-emergency illnesses including respiratory infections, urinary tract infections, and prescription drug renewals.
The collaborative focuses on neurosurgery, rheumatology and drug-resistant epilepsy.
Cincinnati Children's Hosptial and Indiana's Parkview Health have expanded their decade-long collaborative to include remote pediatric specialty care consultations for patients in their service areas, the nonprofit providers announced jointly.
Cincinnati Children's pediatric experts will be available to consult with outpatients at Fort Wayne's Parkview Regional Medical Center as part of a larger plan to eventually connect other medical specialties through virtual care.
"This new collaboration leverages Cincinnati Children's excellence in pediatric neurosurgery, rheumatology and drug-resistant epilepsy with the pediatric expertise and knowledge of Parkview Health medical providers," Ken Tegtmeyer, MD, medical director of the Center for Telehealth at Cincinnati Children's, says in a media release.
"We remain committed to working with Parkview Health and families in the Fort Wayne region to ensure that their children get the specialized care they deserve in a convenient setting and at the most appropriate level."
The health systems, 180 miles apart, began collaborating on trauma services consultations over the past decade. In 2018, they started a telehealth collaboration for cardiology, gastroenterology and general surgery. This latest collaborative broadens the consultations to include pediatric neurosurgery, rheumatology and drug-resistant epilepsy for children living in northeast Indiana and northwest Ohio.
Parkview Health, formed in 1995, operates 10 hospitals, including Parkview Women's & Children's Hospital and a network of primary care and specialty physicians.
"The goal of our new, enhanced collaboration with Cincinnati Children's is to better meet the needs of our community," says Tom Miller, MD, physician executive, Women and Children's service line, Parkview Health.
"Our collaboration is patient-centered and will increase access to Cincinnati Children's specialty care for Fort Wayne area families. This could reduce or even eliminate the need for travel to receive specialized pediatric care," he says.
"For patients who require care at Cincinnati Children's, a coordinated approach for referrals and local follow-up appointments will streamline the experiences of these families."
The estimate included $125.5 million for states and $515.7 million for the federal government.
Forty states and the federal government lost out on $641 million in 2020 because the states' separate Children's Health Insurance Programs were not required to seek rebates from drug makers, a federal data brief shows.
Federal law requires states to use the Medicaid Drug Rebate Program (MDRP) to get rebates for Medicaid-covered outpatient prescription drugs provided through Medicaid or Medicaid expansion. However, that rebate mandate does not apply for separate Children's Health Insurance Program (CHIP) drugs.
Using estimates by state agencies, the data brief by the Department of Health and Human Services' Office of the Inspector General sought to identify drug rebates that states could have collected if their separate CHIPs had been mandated to get MDRP rebates.
"If federal law were to require states to obtain rebates under the MDRP for separate CHIP drugs, the 40 states that operated separate CHIPs could, according to our estimates, have invoiced, collected, and directly received $641.2 million from the drug manufacturers for calendar year 2020," OIG reports.
The estimate includes $125.5 million for states and $515.7 million for the federal government.
The data brief contains no recommendations. CMS was not obligated to respond, and did not.
Nearly half of respondents ages 50-64 with mounting medical expenses report taking on credit card debt to pay bills.
Relentless annual increases in health insurance premiums and deductibles are outpacing wage growth for many working older Americans with employer-sponsored health plans, a new Commonwealth Fund study shows.
The study finds that more than half (54%) of low-income adults and nearly one-third of adults with moderate incomes are underinsured, and face higher out-of-pocket costs which nearly half of respondents say led them to skip or delay care.
Among the findings:
Nearly half (47%) of low-income older adults, and more than one-third (35%) of those with moderate income, said it was very or somewhat difficult to afford their premiums.
54% of those with low income and nearly one-third with moderate income were underinsured, meaning that they had high out-of-pocket costs and/or deductibles relative to their income.
Nearly half of those with low income reported skipping or delaying needed care because of cost.
Difficulties paying medical bills and paying off medical debt loads affected 44% of older adults with low income and two of five of those with moderate income.
Nearly two-thirds (63%) of those struggling with medical bills and debt were not confident they have enough money to retire — more than double the rate for older adults without problems paying their medical bills.
Nearly half (46%) of respondents with medical bill problems reported taking on credit card debt to pay off their bills, one-third received a lower credit rating because of their bills, and more than a quarter exhausted their savings to pay their bills.
The data was taken from the Commonwealth Fund’s 2022 Biennial Health Insurance Survey of more than 8,000 adults ages 19 or older and conducted by the research firm SSRS.
The analysis focused on 1,978 respondents ages 50-64 with low and moderate incomes. Low income is defined as less that 200% of the federal poverty level or $27,180 for an individual and $55,500 for a family of four in 2022. Moderate income is between 200% and 400% of poverty, or $54,360 for an individual and $111,000 for a family of four.
