The initiative is intended to improve delivery of patient care.
LifePoint Health is partnering with Google Cloud to improve data interoperability, patient monitoring, and virtual care throughout the multi-state healthcare network.
The multi-year strategic partnership is intended to transform healthcare delivery in communities across the United States through LifePoint's implementation of GoogleCloud's Healthcare Data Engine (HDE).
"The ability to deliver next-generation care comes from effectively combining clinical expertise with the latest technological advancements—not solely one or the other," David Dill, chairman and chief executive officer of LifePoint Health, said in a press release. "We are excited to combine the high-quality clinical care and scale of LifePoint's diversified healthcare network with the innovation, agility, and security of Google Cloud HDE, so we can enhance how we deliver the right care to our patients at the right time and through the right channels. This partnership is a meaningful milestone in our pursuit of advancing community-based care, and we look forward to working with Google to fulfill our mission of making communities healthier."
Based in Brentwood, Tennessee, LifePoint Health currently encompasses 89 health systems and 170 additional sites of care in 30 states with more than $6 billion in revenues.
Google Cloud's HDE combines and organizes data from multiple sources, including medical records, clinical trials, and research data. LifePoint will use this data to help the patient's care provider.
HDE grants clinicians near real-time, holistic views of patient longitudinal records, and provides advanced analytics and AI in a secure, compliant, and scalable cloud environment. Google Cloud managed services support HIPAA compliance and leverage Google's BigQuery multicloud data warehouse for robust processing.
LifePoint Health said HDE will help it create digital solutions and care models, interoperate with innovative third-party solutions, and ensure consistent care across more than 60 acute care facilities, more than 30 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the nation.
As an example of the interoperability challenges to be overcome, EHR data throughout LifePoint Health exists in many disparate EHR systems, the companies said.
The companies said they share a steadfast commitment to assuring patient data privacy and security, through HDE's reliable infrastructure and secure data storage, along with LifePoint Health's security, privacy controls and processes.
Atrium Health Sanger Heart & Vascular Institute is using a new portable system that increases the time and range of viable organ transports.
Atrium Health's Sanger Heart & Vascular Institute is using a new technology platform developed by digital health company TransMedics that preserves donated hearts, enabling transplant teams to expand travel time and reach more patients in need of a heart transplant.
The TransMedics Organ Care System (OCS) is designed to prolong the amount of time a donated heart can be viably transplanted, allowing health systems who perform transplants to expand their coverage area for donors and recipients.
“Once a heart is removed from a deceased donor due to cardiac death, the portable system revives the heart and keeps it beating, infusing it with blood from the donor that is supplemented with nutrients and oxygen,” Eric Skipper, MD, a cardiothoracic heart transplant surgeon at Atrium Health Sanger Heart & Vascular Institute, said in a press release. “The system also allows us to carefully assess the heart’s functional quality and viability for transplant before we reach the operating room to perform the transplant.”
In the past, the Charlotte, North Carolina-based Sanger Heart & Vascular Institute transplant team only accepted donor hearts within a 500-mile radius, as the organ could only be placed in cold storage for four hours. The new technology expands that range, because the heart can be kept viable for up to eight hours and be transported from up to 1,000 miles away.
The new technology also permits acceptance of higher-risk hearts, including those from older donors and donors who are initially put on life support before withdrawing care, a condition commonly known as donation after cardiac death.
Atrium Health officials said the institute recently completed its first heart transplant using the OCS platform.
“This was a patient who was potentially looking at a long wait for an organ transplant,” Skipper said in the press release. “But because of the ability to utilize this technology, they were able to receive a heart very quickly.”
In April 2022, the US Food and Drug Administration approved use of OCS to preserve hearts for transplant after cardiac death. Results from a multi-center clinical trial compared the use of the technology to the traditional cold storage method of preserving donated hearts during transport. Using the OCS resulted in 90 patients (of the 180 randomized and transplanted patients) receiving organs that were previously unable to be used prior to this technology, the clinical trial results reported. Those recipients had a one-year survival rate of 93.3%, as opposed to an 87.3% one-year survival rate among the control group where OCS was not utilized.
“We were always limited to accepting organs from donors who suffered immediate brain death,” Joseph Mishkin, MD, an advanced heart failure transplant cardiologist at Sanger Heart & Vascular Institute, said in the press release. “We now can accept organs from donors who have suffered an irreversible brain injury but do not meet formal brain death criteria. In these instances, the family has decided to withdraw care. The donor’s organs can now be a life-saving gift for others.”
More than 3,300 people are on the waiting list across the US for a heart transplant. Of those, 95 are in North Carolina, according to the US Department of Health & Human Services Organ Procurement and Transplantation Network.
“We face a nationwide shortage of donated organs," Mishkin said. "I expect this technology to transform the transplant industry, increasing the national donor supply and helping us transplant more patients in need."
Few health systems have a chief application officer, but that role is growing as health systems expand their technology base and address growing privacy and security considerations.
The leading national organization for healthcare IT executives is putting new emphasis on the value and quality of applications and data.
CHIME launched AEHIA in 2014 as the first professional organization serving healthcare's senior information technology applications leaders, during the surge in digitization of medical records enabled by Obama administration initiatives. That focus has since widened to reflect an increased emphasis on data as well.
Johnston is the vice president, chief application officer, and Epic program executive at Baptist Health, a Jacksonville, Florida-based five-hospital system with about 1,100 beds and roughly 160 ambulatory clinics.
While only a handful of health systems have a chief application officer, Johnston believes there will be many more in the future.
Stacey Johnston, MD, vice president, chief application officer, and Epic program executive at Baptist Health in Florida. Photo courtesy Baptist Health.
"When I went to the [CHIME] CIO boot camp, there were three of the 40 of us," Johnston says. "Some organizations have it as a senior director."
Applications in health systems are not plug-and-play. The need for executive oversight of their management has grown as different healthcare departments acquire these systems during operations, Johnston says.
Baptist Health went live with its implementation of Epic on July 30, replacing previous electronic health records software. That platform will be used when the health system opens a sixth hospital in December.
"We felt Epic was scalable to whatever size organization Baptist would end up becoming," Johnston says.
Johnston joined Baptist Health in August 2018 as its chief medical information officer, spearheading online training of physicians as the pandemic surged. But she also found herself responsible for some of Baptist Health's more complex applications, including those in the system's pharmacy, labs, and cancer clinics.
"Our new CIO leadership explained that in most institutions, the CMIO just focuses on physician workflow adoption," Johnston says. "The team being built up to support application adoption doesn't typically report to CMIOs. So I was given the choice of remaining as CMIO, or moving into this role of chief application officer."
There was a lot to do after she switched roles in November 2021.
"Some of the apps we found were 20 years old, and people weren't even using them," Johnston says.
"We didn't even have a contract. Part of my process was to review contracts to determine [if it was] needed to move forward as we're moving into Epic. How long do you have to keep that system up and running?"
In at least one case, the answer was to keep the older application running for a time, even after the Epic go-live, to validate infectious disease reports Baptist Health was sending to the National Health Safety Network and the Florida Department of Health.
It's no exaggeration to say that many hospitals are running hundreds of applications, and as some of these are retired, a chief application officer must oversee what is to become of the data generated by these applications.
Another role popping up in healthcare organizations is the chief data officer. At Baptist Health, that role is filled by a vice president of data intelligence and decision science, who also happens to be a physician, Johnston says.
Johnston's main task as chief application officer is to maintain Baptist Health's applications. She describes this role as "patching appropriately, reviewing data and archiving, determining how long you keep that data, that you're consistently doing the quarterly Epic upgrades, and turning on all the features and functionality."
Recently, AEHIA leadership has also been concerned about the importance of adequately protecting patient data as new threats emerge.
"We are just now in my opinion, getting to the point where CEOs, CFOs, COOs, and boards of healthcare provider organizations are starting to understand the seriousness of this security issue," says David Finn, vice president of AEHIS for CHIME, as well as CHIME's Association for Executives in Healthcare Information Security (AEHIS). "We're only going to be as strong as everyone we connect to."
Executives in charge of applications face twin challenges of late: The information blocking rules due to take effect on October 6, and recent lawsuits alleging that Facebook enabled patient tracking on health system and hospital Web sites.
Regarding the Facebook allegations, "they got marketing to give them a place inside the organization," Finn says. "No one stopped them to say, what data are you getting, and how are you using it? It's very difficult to separate privacy from security. Clinical practice depends on trust. The doctor has to trust the data, and the patient has to trust the data. It all comes down to the data. I've been saying that for 20 years."
Regarding information blocking, "interoperability is going to be problematic as it rolls out," Finn says. "We defined the data, its elements and how it should be expressed. We didn't define any of the requirements of our own privacy and security. We're going to have to do something, and that's probably going to mean spending some money at our individual provider organizations."
In addition, patients don't always understand the implications of releasing their data through apps such as Apple Health, which may then be accessed by third-party apps, Johnston says.
"We have changed our consents a little bit, so patients can opt out of interoperability, data sharing, or [Epic] Care Everywhere," she says.
Despite tension between marketing and IT, health system leadership must ensure that the two work together to promote common initiatives, such as digital front doors. Executives with titles such as chief digital officer are playing a large role in making these happen, Johnston says.
As for AEHIA, Johnston says her immediate priority is to rebuild its board, which suffered some attrition due to job transitions and the pandemic.
"Standing the board back up is probably going to take a good couple of months," she says.
Johnston will remain as board chair into 2023 to help complete the organization's rejuvenation.
"As chief application officer, you have to be an advocate," she says. "It's your responsibility to both your patients and your organization to make sure if there's something that you felt could be done differently, to do whatever it takes."
The Centers for Medicare & Medicaid Services has proposed a 12% reduction in reimbursement for CPT codes supporting RPM. Health systems and advocates say that could affect a service that has been known to reduce unnecessary hospitalizations by 50%.
A provider of remote patient monitoring services to several health systems in six states warns that proposed cuts in Medicare reimbursement could endanger those services, which it says are saving thousands of Medicare dollars per patient served.
New York-based Cadence, which partners with health systems in Alabama, Arkansas, North Carolina, Washington, Wisconsin, and Michigan, recently submitted comments to CMS on the proposed cuts (the comment period is slated to end on September 6).
"By driving better patient outcomes, we're reducing emergency room visits by up to 50% for patients who are enrolled in Cadence programs and decreasing their cost of care by $5,000 on average," says Chris Altchek, the company's founder and chief executive officer.
Cadence, which has partnered with LifePoint Health, Community Health Systems, and ScionHealth, is one of dozens of telehealth companies in the rapidly growing RPM space, which saw a surge of interest when the pandemic pushed health systems to curtail in-person services and push more programs onto virtual platforms. Proponents say RPM will continue to grow as healthcare executives see the value in improving care management for patients in their own homes.
Among other stakeholders expressing concern about the cuts so far are the American Telemedicine Association, and Altchek hopes the American Hospital Association, the Alliance for Connected Care, and the Federation of American Hospitals will also file concerns.
Like many others using RPM, Cadence is targeting care management for patient with chronic health conditions, including congestive heart failure, hypertension, and type 2 diabetes. About a quarter of its patient base lives in underserved areas, where RPM programs may be a lifeline for people who face barriers to accessing care.
Chris Altchek, founder and chief executive officer of Cadence. Photo courtesy Cadence.
"CMS has done a lot of good work trying to focus on these chronic conditions," Altchek says.
Under current CMS guidelines, CPT code 99454 specifically reimburses providers for devices and transmission of data to collect vital signs from patients at home. RPM programs typically send digital health devices, such as blood pressure cuffs, weight scales, and blood glucose monitors, home with patients, who monitor their health, send data back to care teams and collaborate on managing their care.
"These cuts run counter to CMS' stated goals of improving patient outcomes, advancing health equity, and reducing spending through the use of remote patient monitoring technology," states the Cadence letter to CMS.
Altchek is hoping the groundswell of support for RPM programs and criticism of the proposed cut will spur CMS to reconsider.
"CMS is aware and engaged on this topic," he says. "Something could change. They spent a lot of time, almost 10 years, building out a framework to allow these codes to come into play, so they're as motivated as anybody else to make sure they don't limit innovation that they sparked before it can really take hold."
Altchek says accountable care organizations (ACOs) using RPM programs supported by Cadence are seeing a 19% savings on average total cost of care.
"We're sharing everything we have [with CMS] and have offered to update them every six months on the total cost of care savings across our patient population," he says.
CMS has scheduled a 2023 policy review of the cuts affecting 99454 and related CPT codes 99453 (patient onboarding), 99457 (first 20 minutes of monitoring and delivering care to a patient remotely), and 99458 (the next 20 minutes).
"We were not listened to last year, but next year, they've scheduled a real conversation around it," Altchek says.
The policy review will be conducted by the RVS Update Committee, a volunteer group of 32 physicians and other healthcare professionals who advise Medicare on how to value a physician's work.
"My guess is it would go through that process, and then CMS would take it under review as part of its rulemaking," says Meryl Holt, head of legal and chief compliance officer at Cadence.
CMS is also somewhat constrained by existing law. "CMS as the agency is somewhat restricted by the legislative framework that's in place, so they have limited tools with which to actually affect change with particular codes," Holt says.
Should appeals to CMS fail, Altchek says a push for a legislative solution is another option.
"CMS data show that among original Medicare beneficiaries aged 65 years and over, the prevalence of CHF, type 2 diabetes, and hypertension was 13%, 25%, and 58%, respectively," says Cadence's letter to CMS. "This translates into direct medical costs, which for heart disease (excluding stroke) totaled $281 billion in 2015 and $237 billion for diabetes in 2017. Using RPM services to manage these conditions will improve patients’ access to quality care, while also alleviating the burden on clinicians and Medicare spending."
If the CMS reimbursements decline, Altchek says Cadence would withdraw from serving certain regions rather than reducing the quality and quantity of remote patient monitoring.
"We won't deliver the service if we don't think we can do it in a way that's a high-quality way," Altchek says.
HHS has been criticized for inadequate help with complex regulations that will take effect in October
Some household names in healthcare are asking the Department of Health and Human Services to be more specific in its rules to cut down on information blocking practices.
The Mayo Clinic, Ascension, and AdventHealth have joined organizations such as the American Health Information Management Association (AHIMA) and the College of Healthcare Information Management Executives (CHIME) in expressing their concerns in an August 18 letter to HHS Secretary Xavier Becerra.
"Significant knowledge gaps still exist within the provider community with respect to implementation and enforcement of Information Blocking Regulations," the letter states. "Many independent, small, rural and solo medical practices are still unaware or underinformed about information blocking requirements. This likely plays a major role in allegations that providers are blocking access to patient data."
The coalition has asked for more emphasis on education and less on enforcement in the requested guidance.
Among the specific actions sought in the letter:
Define foundational concepts in information sharing, such as good practices, better definition of requests for information sharing, and ways for information sharers to demonstrate good intent.
Create a frequently asked questions document including use cases and scenarios to supplement the current information blocking rule guidance.
Provide deeper technical assistance to support efforts to comply with information blocking regulations.
The letter also urged HHS to open more channels of communication, including a toll-free support line or interactive live chat "in the spirit of the resources HHS provided for HIPAA implementation in the 1990s and early 2000s" to assist providers.
Other signatories include the Healthcare Leadership Council, Marshfield Clinic Health System, American Academy of Family Physicians, American Medical Informatics Association, Consortium for State and Regional Interoperability, Epic, and the Health Information and Management Systems Society (HIMSS).
The technology cuts log-in times by 70% and leverages other cost-saving cloud efficiencies.
A hybrid cloud architecture is slashing log-in times and optimizing IT costs at a Montage Health.
Led by Tahir Ali, chief technology officer and chief information security officer, the Monterey, California-based health system's virtual desktop infrastructure (VDI) initiative is saving $298,000 yearly in productivity gains by clinicians, as well as other infrastructure costs.
That figure, Ali says, comes from slashing the initial system log-in times of each clinician from 100 seconds to 30 seconds, helping to improve more than 100,000 patient visits annually, and also aiding in rapid response to emergent care situations.
"Some people call it agile infrastructure," he says. "Consumption-based IT is where we set up different infrastructure in a way where we can scale it very quickly."
In the background, the system creates Windows-based virtual machines only when a staff member logs in, with sessions remaining available for up to six hours after initial log-in. After clinicians log out or time out, the system deletes these virtual machines, leaving only the saved data residing in Montage servers. In between log-in and log-out, clinicians' desktops can follow them from workstation to workstation, instantly available with a swipe of their badges.
The system "makes sure [that] if we have ebbs and flows, we have enough capacity on demand to give," Ali says.
Tahir Ali, chief technology officer and chief information security officer at Montage Health. Photo courtesy Montage Health.
Such an arrangement is well-known to retailers dealing with surges in computing demand during peak buying seasons, but is relatively novel in healthcare IT, he says.
"I thought, why not do it for the hospital?" he says. "We have to have people physically in the hospital at a certain time vs. maybe the middle of the night. We can do the same thing in IT."
At the heart of Montage Health's data center is a refrigerator-sized data hardware appliance provided and maintained by Dell, which creates and maintains the APEX Private Cloud that manages the provision and release of computing resources to Montage Health staff.
For further scalability, the private cloud is connected via triply redundant 10 gigabit-per-second links to the internet, where Montage maintains public cloud 'pilot lights' at Amazon Web Services as well as Microsoft Azure clouds.
"I understand that running on the cloud is expensive," Ali says. "The key is running on the cloud pay-per-use. We have [a few] VDI sessions if somebody is working from home. If we need something, we start to build that [public cloud] stack."
In the event of a disaster, Montage Health can quickly scale up those public services to meet unexpected demand, Ali says.
"The pilot light is very cheap, and we are running it inside our data center," he says. "And you have to have a multi-cloud strategy. Each cloud vendor has its strengths and weaknesses."
Montage Health's specialized VDI infrastructure can also tap the private cloud's graphics processing unit (GPU) resources to help radiologists and cardiologists read images.
Beyond the improved clinician productivity, Ali says Montage Health's infrastructure saves money compared to traditional hybrid cloud architectures.
"The traditional way is, you have your VDI infrastructure fully blocked," he says. "You have a replica of at least 70% of the same capacity running on a 'backup data center.' All licensing, hardware, and support is twice as much, because you're running in two different places. We run it in one place."
This hyper-converged infrastructure depends upon the APEX Private Cloud's 80 gigabits-per-second backplane, which eliminates the need for cables to connect the servers operating in the private cloud. Additional FSLogix software from Microsoft, powered by Active Directory, allows individual clinicians' desktop profiles to be delivered to workstations when the clinicians log in, displaying only those applications required for each clinician's work, further boosting system efficiency. If they move to different workstations during their workday, those profiles and applications follow them from workstation to workstation.
A change in how Montage Health conducts video calls internally and externally played a role in the timing of the move to the new infrastructure last November.
"Skype was going to go away, and Microsoft Teams was going to come in, and our traditional hardware was not capable at that time to run Teams with a video," Ali says.
It also was a time of standardizing after employing a variety of video call technology across the enterprise.
"We wanted to converge into a single face of Montage," Ali says. "When patients come to our facility, it doesn't matter if it's ambulatory, the hospital, even our wellness center. It's a single company called Montage Health, and we will take care of them accordingly."
The new architecture also lends itself to a zero-trust data security strategy.
"We have a product that has a full trending of every single packet that goes from one place to another place," Ali says. "If there's any deviation, the flag goes up, and they take [devices] off the network automatically.
"I can bring the technology to a cutting edge. But the security needs to be a little ahead of that."
The national retailer is the first large employer to join the Quality Care Collaborative, which supports quality improvement in radiology services.
Walmart has announced it will take part in a new program aimed at improving the quality of radiology services and advancing value-based care initiatives.
The program, known as the Quality Care Collaborative (QCC), is the first national program to bring together payers, providers, and self-insured employers to improve the quality of radiology at scale, according to sponsoring companies Covera Health and Nuance Communications. It's supported by the Agency for Healthcare Research and Quality (AHRQ).
"The Quality Care Collaborative is a great example of the unique impact that we and our provider clients can have on patient care by leveraging our Precision Imaging Network and the nationwide scale we have in radiology," Peter Durlach, Chief Strategy Officer at Nuance Communications, said in a press release. "This is an AHRQ certified patient safety program that can provide radiologists at their own discretion with additional AI-powered quality insights in their native workflows to help them continue to deliver the highest level of patient care, help combat the commoditization of radiology, all while knowing that their data is protected."
"We're excited about the collaboration between Covera and Nuance and the positive impact it can have on improving the quality of care for all, as well as improving health equity by increasing access to quality care in local communities," added Lisa Woods, Walmart's vice president for physical and emotional well-being.
Clinicians may share data with and receive insights from the QCC to improve care quality in a safe and trusted environment. The platform protects patient data against discovery and restricts any sharing with payers. Any radiology practices in participating payers' networks can opt-in to the QCC for no cost to access quality analytics and clinically validated AI tools to augment existing quality improvement programs. Participating payers and self-insured employers are offered improved quality and better outcomes for their member populations.
The company had been accused of discriminatory hiring practices against Blacks and Asians.
Cerner Corp. has resolved a preliminary finding of discrimination in hiring Black and Asian job applications between 2015 and 2019.
In an agreement with the U.S. Department of Labor’s Office of Federal Contract Compliance Programs (OFCCP), Cerner signed a multi-establishment conciliation agreement that will pay $1,860,000 in back pay and interest to 1,870 job applicants who applied for jobs as medical billing account/patient account specialists, system engineers, software interns and technical solution analysts.
These applicants had applied for positions to work at five facilities in Missouri and Kansas, specifically at its Cerner Oaks Campus and Cerner Innovations Campus in Kansas City, Missouri; and at its Cerner Corp. and Cerner Continuous Campus North Tower in Kansas City, Kansas.
An OFCCP compliance review found that Cerner Corp. violated Executive Order 11246, prohibiting federal contractors from discriminating in employment based on race, color, religion, sex, sexual orientation, gender identity or national origin.
"Working together, the Office of Federal Contract Compliance Programs and Cerner Corp. will ensure that the issues identified in this compliance evaluation are resolved and that Cerner puts into place procedures to ensure compliance with equal employment opportunity laws," said Office of Federal Contract Compliance Programs Regional Director Carmen Navarro, based in Chicago.
Cerner also agreed that its hiring procedures will be monitored and free from discrimination. The company did not admit liability, and denied the allegations filed by OFCCP.
Cerner provides technology under federal contracts with the Centers for Disease Control and Prevention, and the U.S. Department of Veteran Affairs.
OFCCP continues to identify applicants or workers who may be entitled to monetary relief and/or consideration for job placement as a result of OFCCP’s compliance evaluations and complaint investigations during the time period under investigation.
The Florida-based IDN has cared for almost 240 patients at home, instead of in the hospital, since launching the program, and expects to expand the platform to give more patients that option.
Health First is seeing great success with its Hospital at Home program, launched during the pandemic with a waiver from the Centers for Medicare & Medicaid Services, and officials at the Florida-based integrated delivery network say they'll be using remote care management strategies long after the COVID-19 crisis ends.
So far, three of the four hospitals in the system have shifted care for 238 patients from the hospital to the home since the program began in June 2021.
About 11% of those patients had to return to the hospital, the vast majority being treated for worsening COVID-19 conditions, says Mark Rosenbloom, MD, vice president of clinical transformation at Health First.
"We've had no mortalities, we've had no falls, we've had no pressure injuries," he says. "We have about a 6% hospital readmission rate, which means if you go through the program and you're discharged, there's about a 6% chance you may have to be readmitted to the hospital for anything. That's a lot lower than our all-cause, all-payer readmission rate."
Mark Rosenbloom, MD, vice president of clinical transformation at Health First. Photo courtesy of Health First.
Patients are supportive of the program, which replaces acute inpatient care with a program that combines telehealth and digital health services with in-person care at home. Press Ganey surveys show 87% would recommend the program, and 93% give it an overall positive rating, Rosenbloom says.
The program has an overall length of stay of 4.4 days, and as of June 2022, the health system is seeing positive contribution margins, Rosenbloom says.
While patients approve of the program, Rosenbloom says, it took a little more time for providers to buy in.
"Change in healthcare comes slowly, and with time, our providers are seeing the benefits of this program for patients," he says.
Of the 238 patients released to the program, Rosenbloom estimates that 10% to 25% of those were released directly from emergency departments back to their homes.
"We are working to get them from the ED to the home without having to be admitted to the hospital," he says.
Current Health has supplied the remote patient monitoring and care management technology used by Health First. Typical programs use digital health tools to capture patient data at home and telehealth platforms to facilitate on-demand communications and virtual visits with the patient's care team, integrated with in-person visits by care team members or home health aides. While most programs are designed to collect and transmit patient data on demand, some can be configured to monitor a patient around the clock, in real time.
"This isn't [an] ICU at home," Rosenbloom says of the Health First program. "We don't need minute-by-minute vital signs, we just need smart vital signs. There was a learning curve. Who needs what remote patient monitoring? How do we set the alarms?"
After-hours monitoring is handled by Health First's ICU team through a telehealth connection. Initially, that team was inundated by alerts throughout the night, and the health system had to learn how to set parameters to sift out non-emergency alerts and focus on the critical trends. Since making those adjustments, Rosenbloom says, the number of alerts has been reduced.
Many homes in Florida are built with concrete blocks, which can thwart connectivity via either cellular or Wi-Fi connections. To solve that problem, Current Health added additional access points as needed.
The CMS waiver was enacted during the COVID-19 public health emergency (PHE) to help health systems launch hospital-at-home programs and receive Medicare coverage for some of the services. Roughly 220 health systems have taken advantage of that waiver.
That waiver is scheduled to end when the PHE concludes, likely next year, but Rosenbloom anticipates Health First will continue with the program regardless.
"We were planning a hospital at home program even before the waiver program as part of our move to becoming more consumer-centric," he says. "We would find a way to continue if the waiver did go away."
"I have to think, however, that that genie is out of the bottle. It's hard to imagine that all of a sudden, we're going to stop doing care at home, especially when there's such a movement around it, and legislation in front of Congress about moving care to home."
Over time, Rosenbloom says, the program has expanded to cover more diagnoses. For example, Health First recently expanded the platform to include patients with renal vein thrombosis.
"We've had some diverticulitis patients," he says. "The typical diagnoses are pneumonia, cellulitis, heart failure, dehydration, COPD, bronchitis, and asthma, but we've expanded beyond that. We've treated some GI bleeding, thrombocytopenia, and hyponatremia."
"We focus more on what’s best for the patient than a specific diagnosis," he adds.
The success of the program is also giving Health First some ideas on how to improve care for high-risk health plan members.
"In the future, we could use remote patient monitoring to monitor their health and intervene early, keeping them from having to go to the hospital," he says.
For Health First leadership, the key is getting staff and patients to think differently about hospital care.
"We're working on a marketing campaign," Rosenbloom says. "I'd love for patients to show up in the ED and say, 'I want you to put me in your hospital at home program.' We're starting to get the word out there."
Brave Health, whose telehealth platform delivers mental health services to patients in 18 states, is joining forces with MedArrive to collaborate on home-based services.
Virtual mental healthcare consists of many things, but no one wouldn't typically confuse it with "boots on the ground" care.
Brave Health aims to change that through a partnership with MedArrive, a provider network of skilled paramedics, EMTs, and other healthcare professionals delivering a mix of in-home healthcare services, diagnostics, health assessments, and other preventative health measures.
The collaboration combines Brave Health's telehealth platform with mobile integrated health services offered by MedArrive, giving both new opportunities to improve access to care.
Based in Miami, Brave Health now operates in 18 states. Through the new partnership, if a MedArrive care team identifies an eligible health plan or Medicaid member in need of mental health support, they can immediately refer that member to Brave Health's behavioral health providers and schedule care within a few days. Conversely, if Brave Health identifies an eligible health plan member that may benefit from MedArrive's home health services, it will then work with that health plan's case management team to coordinate support.
In this interview, Brave Health CEO and co-founder Anna Lindow talks about the challenges of serving a predominantly Medicaid-insured population receiving virtual mental healthcare services. This interview has been lighted edited for brevity and clarity.
HealthLeaders: Why would a health system partner with Brave Health, rather than with traditional mental health partners?
Anna Lindow: For some patients, having a virtual option is a better option for them. 20% of our patients live in towns of 2,500 people or fewer, so it's not uncommon that a patient is going to go back to a home that's far from any provider. We have lots of patients who, even if they don't live in a rural area that may have transportation barriers, behavioral health fits into their life better if they can do it virtually.
Anna Lindow, co-founder and CEO of Brave Health. Photo courtesy of Brave Health.
Our goal is to make a commitment to the discharge planner to make the process of making referrals seamless for them. They need to put a date and time appointment into that discharge plan. We get that to them quickly and seamlessly. Our focus on Medicaid is pretty uncommon, and something we've seen as a huge opportunity and need. It was always where we wanted to go.
HL: There's a shortage of therapists. You're out there competing with every other provider to recruit those therapists. How do you do it?
Lindow: These are people who've devoted their lives to being healthcare providers in a community. Logistically, though, you're right, there's no surplus of behavioral health providers. We can recruit providers to work for Brave who live all over the country.
HL: Is internet access an issue if they're rural?
Lindow: Even since I started working in this field five years ago, I've seen a lot of improvement. When we started Brave, smartphone adoption among Medicaid beneficiaries was lower than the American adult average. That has changed. The government programs that furnished cell phones have evolved. Second, I do think we've seen broadband access improve. There's certainly more work to be done, but it's improving. The pandemic has helped to demystify what being a care provider in a telehealth setting is like.
HL: MedArrive is a provider of EMS services. So this seems like another piece of the puzzle.
Lindow: There's so many things we can do with virtual care, but we cannot be in the home physically. Brave can't exist in a vacuum. We want to work with the organizations that are doing great work on the ground.
HL: Is the role of MedArrive not just to facilitate services and treatments, but also to evaluate a particular patient's social situation, their lives, their living arrangements? Are you counting on them to provide that input back to you as part of this?
Lindow: I don't want to speak for them in terms of exactly the scope of their services. But I think your point is well taken, that you get information when you go into someone's home. They are seeing an individual in a setting where they may get cues or information that tells them, hey, I think behavioral health services could help this person. They could say, I'm sitting right there with you. How would you feel about this? And if the member says yes, [MedArrive] can say, how can we get that started right now? Let me give Brave a call.
HL: You have to be striking a careful balance there between helping the patient and at the same time respecting their privacy.
Lindow: Absolutely. That patient has to say yes. Our job in the context of this partnership is to help people who are ready for services and want services to get them more seamlessly.
HL: Are the Brave Health encounters always with camera on?
Lindow: There have been some flexibilities around audio during the pandemic, but typically, it's an audio-visual set of services.
HL: Can you do group therapy with a virtual system?
Lindow: Yes, we can and we do. One of my favorite things about group therapy in a telehealth setting is group therapy is typically designed around some kind of shared characteristic or experience. If somebody lives in a relatively rural area, or even in a city, what are the chances you're going to find eight people who can commit to 7 p.m. on Thursday, who live within half an hour? Whereas we're able to bring together people from Tallahassee to Tampa to the Florida Keys.
HL: To what degree are you a prescriber of medications?
Lindow: We have psychiatric providers as well as therapists. The majority, not all, but the majority of patients do receive both services.
HL: There's been a pulling back from the willingness to open the pocketbooks of payers during the pandemic. Is that an issue for you?
Lindow: It's so specialty dependent. There are some specialties where what happens in the office can never be replicated virtually. But there are dynamics with behavioral health that uniquely position our field for long-term telehealth delivery.
HL: What's your growth trajectory?
Lindow: In the very beginning of 2020, our world changed. And the fact that we had this model suddenly went from being relevant and interesting to critical. We were really fortunate that we happened to be ready and in a position where we could help. That caused dramatic growth for us. We grew by 20x in 2020. By the beginning of this year, we started to diversify to become a national virtual community mental health center, and now our patients are across the country, but the majority are in Florida, New York, and Texas.
