The proposed Physician Fee Schedule includes, among other things, Medicare coverage for care management using telehealth and digital health tools, as well as coverage for some digital therapeutics devices used in behavioral health treatment
Healthcare providers will have more opportunities to receive Medicare reimbursements for digital health and virtual care programs under the Centers for Medicare & Medicaid Services’ proposed 2025 Medicare Physician Fee Schedule.
In what is roundly considered a positive step forward for healthcare innovation, CMS is showing support for care management programs that embrace new technologies and strategies to meet patients where they are, rather than paying providers to entice them into the doctor’s office or hospital.
Advance Primary Care Management Codes
Perhaps most surprising to analysts is CMS’ efforts to incorporate virtual care into primary care to push the healthcare industry toward value-based care. CMS is proposing three new “Advanced Primary Care Management” HCPCS codes that focus on interactions with patients at the time and place of their choosing.
In a blog post, Carrie Nixon and Kaitlin O’Connor of Nixon Gwilt Law say the new codes are not based on time spent with a patient, but focus on specific activities by clinicians and using technology to address patient needs.
“The Advanced Primary Care Management (or APCM) HCPCS codes bundle elements of the existing Chronic Care Management (CCM) and Principal Care Management (PCM) codes set with Communications Technology-Based Services (CTBS) codes for virtual check-ins, remote evaluation of images, e-visits, and interprofessional consults to create what CMS refers to as an “enhanced care management” bundle,” they wrote. “Unlike CCM and PCM services, the APCM codes are not time-based – meaning, care management services that do not meet the 20 or 30-minute requirements for CCM or PCM would be billable under APCM.”
Nixon and O’Connor also noted that CMS is expanding the rule to allow non-physician care providers, such as nurse practitioners and physician assistants, to order and bill for those services, as long as any practitioner who bills for those services “Intends to be responsible for the patient’s primary care and is the continuing focal point for all needed healthcare services.”
The three new codes are:
GPCM1: Advanced primary care management services provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month. Approximate reimbursement is $10 per patient per month.
GPCM2: Advanced primary care management services for a patient with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the elements included in GPCM1, as appropriate. Approximate reimbursement is $50 per patient per month.
GPCM3: Advanced primary care management services for a patient that is a Qualified Medicare Beneficiary with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, which place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, provided by clinical staff and directed by a physician or other qualified health care professional who is responsible for all primary care and serves as the continuing focal point for all needed health care services, per calendar month, with the elements included in GPCM1, as appropriate. Approximate reimbursement is $110 per patient per month.
Telehealth Flexibilities
In other news, CMS is proposing to continue a Medicare waiver through 2025 that enables providers to bill for telehealth services delivered from their homes while using their practice location for billing purposes.
More than 100 healthcare organizations had lobbied CMS to continue that waiver or even make it permanent, saying it reduces stress and burnout and enables clinicians to design virtual care programs that are more flexible to their lifestyles and that don’t need costly and complex on-site telehealth centers.
Separately, CMS did not create any new CPT codes for telehealth services that duplicate existing telehealth-eligible services covered by Medicare. The Alliance for Connected Care praised that decision, saying, “We believe that telehealth is a modality for providing health care, it is not a different service.
Digital Therapeutics Coverage
Also, the proposed 2025 PFS is showing some love for the digital therapeutics sector, with reimbursement for some behavioral health treatments that use FDA-approved devices. Specifically, the proposed rules offer reimbursement for the first 20 minutes, and then for an additional 20 minutes, of treatment using a “digital mental health treatment” (DMHT) device.
The new codes are:
GMBT1 (Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan). CMS is proposing contractor pricing for GMBT1 and seeking comments on which national pricing methodologies may be considered, including crosswalks.
GMBT2 (First 20 minutes of monthly treatment management services directly related to the patient’s therapeutic use of the digital mental health treatment (DMHT). CMS proposes a direct crosswalk to CPT code 98980 (RTM first 20 minutes), that is assigned a work RVU of .62 and has a 2024 National Payment Amount of $50.60 (non-facility) and $30.29 (facility).
GMBT3 (Each additional 20 minutes of monthly treatment management services directly related to the patient’s therapeutic use of the digital mental health treatment (DMHT). CMS proposes a crosswalk to CPT code 98981 (RTM each additional 20 minutes), that is assigned a work RVU of .61 and has a 2024 National Payment Amount of $39.95 (non-facility) and $29.96 (facility).
In an e-mail, the Digital Therapeutic Alliance hailed the proposal as “the first acknowledgement of a pathway for reimbursement for a certain sector of digital therapeutic interventions,” and said they set “a precedent for Medicare coding, coverage, and reimbursement that can be applied to additional therapeutic categories.”
According to Nixon and O’Connor, DMHT devices, also known as digital CBT devices, “refer to software devices cleared by [FDA] that are intended to treat or alleviate a mental health condition, in conjunction with ongoing behavioral healthcare treatment under a behavioral health treatment plan of care, by generating and delivering a mental health treatment intervention that has a demonstrable positive therapeutic impact on a patient’s health.”
One issue with the proposed rule, Nixon and O’Connor say, is the language used to define what devices will be covered. Because it requires only that the software meet the FDA’s definition of a device but doesn’t specifically state that a device be FDA-cleared, the rule could disqualify and device that is subject to FDA enforcement discretion or exempt from FDA pre-market clearance.
Clearing Up Coding for FQHCs and RHCs
The proposed 2025 PFS didn’t offer any good news for federally qualified health centers (FQHCs) or rural health centers (RHCs), which have been lobbying for increased use of and reimbursement for telehealth and digital health services for years. In the proposed rule, CMS is eliminating HCPCS G0511, under which FQHCs could bill for remote physiological monitoring and remote therapeutic monitoring services, and telling FQHCs and RHCs to bill under existing CPT codes for care management (including the proposed APCM codes).
The change is designed to clear up reported confusion over what services could be billed under HCPCS G0511, but Nixon and O’Connor noted that it could mean less reimbursements for FQHCs and RHCs.
Other Proposals
Finally, the proposed 2025 PFS includes the following:
Permanent coverage of two-way, real-time, audio-only telehealth services, such as the telephone, “for any telehealth service furnished to a beneficiary in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system but the patient is not capable of, or does not consent to, the use of video technology.” This would enable providers to expand treatment services in rural and remote areas where broadband is limited, as well as for patients who can’t access audio-video telemedicine.
Reimbursement for audio-only telehealth services for periodic assessment of patients undergoing substance abuse disorder (SUD) treatment when video is not available.
Reimbursement for audio-only telehealth services used in initial intake for SUD patients seeking methadone treatment when video is not available.
Extending the definition of “direct supervision” to include access by audio-video telemedicine, rather than requiring everyone to be in the same room. CMS is also proposing to add audio-visual telemedicine access to a permanent definition of direct supervision.
Coverage for remote supervision (such as telehealth) of physical therapists and occupational therapists over PT assistants and OT assistants as permitted by state laws. This would open the door to more telehealth therapy services.
A continuation of the policy to “allow teaching physicians to have a virtual presence for purposes of billing for services furnished involving residents in all teaching settings, but only in clinical instances when the service is furnished virtually (for example, a three-way telehealth visit, with the patient, resident, and teaching physician all parties in separate locations) through December 31, 2025.”
CMS will accept public comments on the proposed 2025 PFS through September 9.
A licensure compact for social workers would enable health systems and hospitals to expand telehealth outreach and include social workers in more programs.
A new licensing compact could help health systems and hospitals improve efforts to address social determinants of health and use telehealth to expand behavioral health outreach.
The U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) is issuing four grants worth a collective $2.5 million through the License Portability Grant Program (LPGP) to create a multi-state social worker licensure compact. Through the compact, license social workers will be able to practice in member states without the need to apply for a license in each state.
“Social workers are essential to expanding access to behavioral healthcare services,” HHS Deputy Secretary Andrea Palm said in a press release. “HRSA is leading the way in growing the behavioral health workforce both by training more providers and by breaking down barriers to allow the workforce to make mental health and substance use disorder services more accessible across the country.”
Telehealth advocates say multi-state licensure compacts can be an important tool for overcoming licensure barriers and expanding virtual care networks across the country. They allow healthcare organizations to expand programs across state lines and into areas where healthcare resources—especially specialists—are scarce.
Social workers are a critical element of behavioral health and SDOH programs because they can help connect patients to resources beyond the traditional healthcare network, helping to address barriers that include housing, transportation, education, employment and cultural and family issues.
“Social workers are on the frontlines in responding to the administration’s priorities, including meeting children’s mental health needs, responding to the opioid epidemic, and addressing maternal depression,” HRSA Administrator Carole Johnson said in the press release. “Today’s announcement is a critical step in helping social workers serve people in need, particularly in rural and underserved communities across the country.”
The OrganOx replicates conditions inside the human body to keep livers viable during the journey from the donor to the recipient.
New technology is helping healthcare organizations improve transplants by preserving the organ during its journey from the donor to the recipient.
One such innovation is the OrganOx, a portable “pump” now being used by Intermountain Health for liver transplants. Officials say the technology, which has been used in more than 35 liver transplants since December 2023, could save hundreds of lives and improve the quality of life for thousands of people.
“This is potentially life-changing for the thousands of patients on the national waiting list for a liver transplant, and the more than a thousand patients a year who die waiting for a liver to become available,” Richard Gilroy, MD, a transplant hepatologist and Intermountain Health’s liver transplant medical director, said in a recent press release from the Utah-based health system. “Because of this technology we are able to use livers from donors that would previously not even have been considered for donation.”
The OrganOx includes a pump that functions as the heart and an oxygenator that functions as the lungs. When a human liver is placed inside the device, they combine to function as a human body would, keeping the liver oxygenated and maintained at normal body temperature until it can be transplanted.
“This technology allows the donor liver to remain viable for longer periods of time, extending the time from organ removal to transplant from just hours to more than one day, and potentially travel longer distances between donor and recipient sites,” Jean Botha, MD, the medical director of Intermountain Health’s abdominal transplant program as well as Intermountain Primary Children’s Hospital’s pediatric transplant program, said in the press release. “The device also enables real-time assessment of liver function and quality, which may help to increase the pool of suitable organs for transplantation.”
The OrganOx is one of several devices and platforms developed over the past few years to improve transplants. Some aim to preserve organs longer outside the body, while others are using data analysis tech technology, including AI, to match donors faster and more efficiently with those in need of new organs.
The technology aims to improve clinical outcomes for the estimated 10,000 organ transplants performed each year and improve chances for the estimated 10,000 people on the waiting list for a new organ. According to experts, 17 people die each day on a waiting list, and a new name is added to a waiting list every 10 minutes. With livers in particular, it’s estimated that more than 2,000 are discarded each year because they don’t survive the typical process of cold preservation or are damaged by oxygen deprivation.
The strategy does come with some controversy. The process of keeping organs alive outside the donor’s body is called a normothermic regional perfusion, or an NRP transplant. When a device like the OrganOx is used, the process is called normothermic machine perfusion, or NMP. A recent NPR story shed light on the debate, highlighted by the American Journal of Bioethics, over whether the process keeps the body technically alive and blurs the definition of death.
In an e-mail to HealthLeaders, Botha said both NRP and NMP are saving lives.
“Actually, the two modalities are not in competition with each other but rather complimentary,” he wrote. “NRP is our preferred modality for all DCD (Donation after Circulatory Death) donors, in addition to increasing the utilization of DCD organs (livers and kidneys), it improves the outcomes of both.”
According to Botha, recent research comparing NMP to the traditional method of cold storage on a hypothetical cohort of 432 patients found that NMP allowed 54 additional successful transplants and saved hundreds of additional lives through the availability of more liver grafts and a reduction in waitlist mortality. This also improved the quality of life for liver transplant recipients.
Intermountain has done more than 1,000 liver transplants--including living-related, deceased donor, and split implantation--since launching its liver transplant program in 1986. Officials say the program has grown threefold since its launch, making it the third fastest-growing liver transplant program in the country.
Botha says the OrganOx is currently kept at Intermountain Medical Center in Murray, Utah, though it’s portable enough to be deployed from the donor’s operating room table to nearby transplant centers. The company is now putting a similar device through trials for kidney perfusion.
Commonwealth Care Alliance President and CEO Chris Palmieri says healthcare organizations need to look to private capital to support innovation, especially as they use new technology to address key care gaps.
With many healthcare organizations struggling to stay in the black, the idea of raising private capital to spend on innovation seems outlandish.
Chris Palmieri, president and CEO of the Commonwealth Care Alliance and founder of the CCA’s healthcare innovation accelerator, Winter Street Ventures, begs to differ.
“Private capital has proven able to able to improve care delivery and efficiency in ways that can serve patients and the broader healthcare system also in a positive way,” he says in this week’s HealthLeaders podcast.
With the Steward Health collapse and disruptors like Walgreens and Walmart retreating from the primary care space, hospitals and health systems are giving more thought to how they raise capital to address care gaps. Palmieri says state and federal governments might step in to improve oversight of deal-making, but that won’t stop forward-thinking health systems and hospitals from pursuing partnerships.
“Private capital is a critical point of any innovation lifecycle,” he says.
Primary care may be “a necessary and fertile access point for healthcare,” Palmieri says, but that doesn’t necessarily translate into scalability and success for either healthcare organizations or private capital. As proven by the struggles of disruptors to gain traction in the space, no one has a good model. To crack that code, he says, investors and health systems “need a different way to think about making investments.”
A key factor for hospitals and health systems is the alignment of goals. What’s the organization’s underlying reason for bringing in private capital? Will it affect the organization’s culture or its goal of value-based care? Are long-term objectives clear and attainable? And what happens when the organization faces headwinds?
With primary care such an uncertain landscape, Palmieri says investment dollars are going into programs that address access to care, particularly for underserved populations. In addition, he says, there’s interest around programs and platforms that combine primary care with other services, such as those that address social determinants of health.
In addition, many healthcare organizations and investment companies are targeting the behavioral health space, including substance abuse treatment. And with the number of people over age 65 expected to eclipse the number of people under age 18 by 2030, there’s a lot of interest in the growing senior care market.
“Our [healthcare] system today is not built for this demographic shift,” Palmieri says.
Palmieri says the rise of consumer-focused healthcare is greatly impacting senior care, as seniors are finding their voice and asking for services that help them stay at home longer and away from assisted living. They’re the ones driving innovation in programs and tools that deliver care to patients when and where they prefer.
“The future of healthcare is going to be about the people who need and use the services, not the people who provide those services,” he points out.
Health systems are investing heavily in the patient experience. At Springfield Clinic, that strategy is critical to continued sustainability in a complex market.
Despite recent missteps by disruptors in the primary care space, the greatest threat to health systems and hospitals is retail healthcare. That’s why it’s important not to overlook the patient experience.
And patients don’t want to deal with paperwork, especially when they’re not feeling well.
Healthcare organizations are using digital health tools and telehealth portals to reduce the administrative burden on patients seeking care and shorten the time between entry and treatment. They’re also embracing remote patient monitoring and other platforms that bring care directly to the patient.
For an industry that traditionally waits for patients to come to them, it’s a new strategy.
“[Healthcare] is a very antiquated process,” says Zach Kerker, chief brand and advocacy officer at Springfield Clinic. “From how you schedule appointments, to how you complete processes in order to get in to see your physician, to coming into the office and having your last name shouted at you and being marched through a room of people, it’s a cold cattle-call-like experience.”
The Illinois clinic, comprising more than 650 physicians and roughly 80 specialties, is addressing engagement with a patient experience department, led by Kerker, who joined the health system in 2018 after a career in sports reporting and digital sports development.
Kerker is acutely aware of the inroads made by Amazon and others in fashioning a retail healthcare experience that focuses on convenience and accessibility. Today’s consumers, he says, favor that experience over the visit to a doctor’s office, clinic, or hospital. When they’re sick, he says, all they want is care.
That’s why health systems and hospitals are prioritizing their innovation efforts on making healthcare more personal. They’re investing in strategies and technology that reduce the paperwork and improve scheduling processes, including more intuitive patient portals and tools that allow patients to schedule their own appointments online.
It’s not an easy investment to make, given the trying times for many hospitals and health systems trying to stay in the black.
“It’s difficult to do because the economics of healthcare are very difficult right now,” Kerker notes. “But what I would say is it is an investment and it does bear fruit, and if you want longevity in a world where everybody can give it to you quick and easy, who’s going to give you their heart? Who’s going to show up and be emotionally invested with you? Is going to matter in this space.”
The results of that strategy are seen in improved patient satisfaction scores, as measured by surveys and valued by the Joint Commission, among others. Kerker says those efforts are helping Springfield Clinic keep their patients and attract consumers in a complex healthcare environment.
Kerker says that engagement strategy actually begins before the patient sets foot in the hospital. Supported by digital health tools, the health system reaches out to a patient before an appointment to gather information, including insurance details and all data pertaining to the visit.
“So when you walk in the door, we’re welcoming you,” Kerker says. “You’re walking in and we’re not demanding information from you, which is not a particularly warm experience. We’re asking you quite literally what can we do to help you and care for you today?”
To make that possible, Springfield Clinic partnered with Health Note to handle patient self-scheduling, intake and clinical documentation and integrate data collection with the health system’s athenahealth EHR. The two had first worked together in 2021, creating a digital front door for a small, rural urgent care facility; that project saw a bump in patient satisfaction scores and a sharp increase in at-home completion of forms and led to a much larger installation in 2022.
Kerker sees technology partnerships as a key to success. Health systems and hospitals don’t have the expertise or the resources to develop and manage their digital footprint, so they need partners to handle the details. This also gives leadership more time for focus on change management.
“The most ironic part about this is that people understandably expect that technology reduces the human interaction,” he points out. “But what we’ve tried to do is use technology to complement a better human experience.”
A challenge for many health systems is finding a digital health platform that can accommodate the nuances of different specialties and departments, rather than relying on a one-size-fits-all approach. Kerker advises sitting down with the vendor to map out how a patient would access each department or specialist, and what protocols would be needed to support that journey.
That’s where the retail industry has a head start. Companies like Amazon, Apple and Microsoft have the consumer experience figured out, whereas healthcare has to catch up.
“We are behind most industries in adopting this technology,” Kerker notes. And while some of the bigger disruptors are having problems figuring out healthcare, he says, healthcare leaders shouldn’t be lulled into complacency.
They “are very smart and they will figure these things out,” he says.
Healthcare organizations have an advantage over disruptors in their history of caregiving, but that can only go so far. Kerker says hospitals and health systems need to build on those relationships by making the healthcare experience more modern and convenient. That’s why staff and clinicians at Springfield Clinic are encouraged to greet patients at the door, call them by their first names, thank them for coming in today, and ask what can be done to make their visit better.
Kerker says the patient experience will improve as the technology gets better, especially as new tools like AI speed up the process.
“We’re at the doorstep of kind of growing out of that stage of clunkiness in the technology side and into a more fluid experience,” he says.
Healthcare providers are using AR and VR technology to improve surgical outcomes. Is it working?
While the healthcare industry is still waiting for the Star Trek tricorder, some doctors are apparently now using x-ray glasses.
That’s the news out of New Jersey, where two neurosurgeons have performed successful spinal surgeries using an FDA-cleared AR technology that allows them to “see” a patient’s anatomy during the procedure.
“Augmented reality allows us to advance what we can see inside the spine with pinpoint accuracy to apply various forms of instrumentation in the least invasive way,” Roy Vingan, MD, co-founder of New Jersey Brain and Spine (NJBS), said in a press release. “It is a navigation tool that gives us information in the operating room that is deeper than an x-ray.”
"It's kind of a wow moment, like looking through a telescope and seeing the stars,” he added. “Suddenly, the world is open to you in a different way."
AR and VR (virtual reality) technology have been making slow and steady progress into healthcare, with benefits for patients as well as providers. Health systems and hospitals are experimenting with the technology as a decision support tool, giving clinicians a new and often far more detailed look at what they’re examining.
At NJBS, Vingan and Patrick Roth, MD, a neurosurgeon and co-founder, are using the Augmedics xvision Spine System, which uses a transparent near-eye-display headset to show the position of surgical tools superimposed over a patient’s CT data. That image is viewed by the surgeon through a headset during surgery.
NJBS surgeons have used the technology on more than 40 surgeries over the past half-year, while Augmedics says their technology has been used to help treat more than 6,500 patients in 24 states. Nationally, dozens of health systems, including the Mayo Clinic, Johns Hopkins, and UConn Health are using the technology in surgeries, mostly since 2019 or 2020.
Advocates say the technology improves minimally invasive surgeries by allowing surgeons to more accurately guide their instruments, as well as any implants. This enables more precise surgeries, smaller incisions, and better clinical outcomes, including less pain and shorter recovery time for patients.
It’s also a marketing tool. Alongside innovative technology like surgical robots, health systems and hospitals are using AR/VR capabilities as a means of attracting new surgeons at a time when workforce shortages are common and top talent is hard to attract.
"We believe that one of the strengths of our practice is that the surgeons have the flexibility to contextualize, improvise, and think outside of the box,” Roth said in the press release. “We can lean in to advances and provide the very best care available."
After roughly a decade of sometimes political wrangling, a new law mandates that payers reimburse providers for covered services offered via telehealth.
Long-standing barriers to telehealth adoption in Pennsylvania are coming to an end with the passage of a new law that includes coverage parity.
Governor Josh Shapiro last week signed into law SB 739, ending a decade-old battle to ease barriers that have kept hospitals and health systems in the Keystone State from embracing virtual care. The new law requires health insurers and managed care plans to reimburse providers for any covered services that are offered through telehealth, as well as setting accessibility standards for state Medicaid and Children’s Health Insurance Program (CHIP) coverage.
“Every Pennsylvanian deserves to have access to quality, affordable healthcare when and where they need it – and it shouldn’t be up to an insurance company to pick and choose what they cover,” Shapiro said in a press release. “More and more Pennsylvanians are relying on telemedicine to see their doctors, and this bill requires insurers to cover services delivered via telemedicine the same way they cover traditional in-person services. My administration will continue to work across party lines to expand access to healthcare for all Pennsylvanians, including those in our rural communities.”
The signing ends more than 10 years of efforts by telehealth advocates to get a parity law on the books. More than 40 states now mandate coverage parity, which requires payers to reimburse providers for telehealth services if they offer those same services in person. Some also require payers to reimburse at the same rate as in-person care, which is called payment parity.
The bill was sponsored by State Senator Elder Vogel, Jr., a Republican from rural Rochester who has long argued that the state needs to reduce telehealth barriers to improve access to care in rural and remote regions where brick-and-mortar providers are scarce and in-person visits are challenging. Some 33 Pennsylvania hospitals have shut down in the past 20 years, with 15 occurring in just the last five years, according to the state.
Vogel first sponsored the bill in 2016, but it never got out of committee. At least two versions introduced since then were shot down by Democratic lawmakers after Republican lawmakers added amendments to ban the use of telemedicine in abortion care. In 2020, then-Governor Tom Wolf, a Democrat, vetoed the bill after it was passed along party lines.
Among those supporting the new law is the Hospital and Healthsystem Association of Pennsylvania (HAP), a membership organization comprising more than 230 hospitals and health systems in the state.
“Today’s passage of Senate Bill 739 is a long-sought win for Pennsylvania patients and health care providers,” HAP president and CEO Nicole Stallings said in a press release. “Telehealth helps meet patients where they are, increasing access to routine and preventative care to improve health outcomes. It also extends the reach of providers at a time when the commonwealth’s growing need for care is outpacing the professionals available to deliver it.”
AWS is providing $10 million in grants to health systems and hospitals for pediatric research using AI and the company’s cloud storage platform.
Three pediatric health systems are receiving $1 million each to support ongoing programs using AI and cloud computing to improve children’s healthcare.
The announcement underscores the hype surrounding AI in healthcare and the efforts by tech companies to partner with health systems for long-term projects that require lots of data storage. Health systems and hospitals are hampered in developing AI programs because of the cost of storing and moving around data, and these partnerships can give them the leeway to improve research and develop new programs.
Adam Resnick, director of CHOP’s Center for Data Driven Discovery in Biomedicine, said AI can be a vital factor in developing treatments for pediatric cancers, which make up less than 1% of all cancers diagnosed annually in the U.S.
“(D)espite being a rare disease, pediatric cancers truly provide a unique proving ground for new technology because of their dependency on real-time discovery and collaborative networks,” he said in the AWS press release announcing the awards.
Research on pediatric diseases and treatments is often limited because of the size of the patient population. Most studies are small-scale and limited, and the pharma industry has little incentive to pursue treatments. In fact, innovation in pediatric care is often based on adult models that are adapted to fit children, with less-than-optimal results.
AWS is banking on its considerable could storage resources to improve what it calls the sandbox in the cloud, giving healthcare providers access to large amounts of de-identified and anonymized data to improve research.
“What’s driving discovery, in the most immediate term, is enabled by the cloud,” Elaine Mardis, PhD, co-executive director of the Steve and Cindy Rasmussen Institute for Genomic Medicine at Nationwide Children’s Abigail Wexner Research Institute, said in the AWS release.
With so many organizations engaged in AI these days, a key question moving forward will be how health systems and hospitals share that information, and which processes are proprietary. That may be where value is determined.
“What we really want to do is make rare cancers less rare by providing this comprehensive information to those who really want to investigate for a variety of discovery-based goals,” Mardis added.
Disruptors are discovering that healthcare can't be run like a shopping center
Another disruptor is exiting the primary care space.
Walmart has announced the sale of its MeMD virtual care program to Fabric, a one-year-old telehealth startup whose healthcare partners include OSF HealthCare, MUSC Health, Highmark, Luminis Health, and Intermountain Health. The move comes just months after the retail giant announced the closing of its virtual care platform and a significant number of its in-store health centers.
MeMD was launched in 2010 and acquired by Walmart in 2021.
Fabric, which offers a multi-faceted virtual care platform for businesses and payers as well as healthcare providers, said the deal would enable it to expand its base and build in-demand behavioral health services. The company secured $60 million in Series A funding in February, with investors including General Catalyst and Salesforce Ventures.
“This acquisition aligns with our strategic vision to transform healthcare delivery through innovative technology and exceptional patient care,” Founder and CEO Aniq Rahman said in a press release. “The combination of our teams, technology, and clinicians strategically positions Fabric to quickly expand across payers, employers, and provider organizations.”
The deal highlights the ongoing challenge of creating a retail primary care model that combines value with sustainability. Many companies are finding that while consumer-facing retail strategies hold promise in improving the healthcare experience, that doesn’t mean a healthcare service can be run like a retail store.
Sanford Health’s remote patient monitoring program in northern Minnesota is giving pregnant women access to critical care services and resources
In rural and remote parts of the country access to care is limited. That’s a double whammy for pregnant women seeking care not only for themselves but for their children.
To Johnna Nynas, MD, OB-GYN, the rural landscape and challenging economy of northern Minnesota offers plenty of challenges for pregnant women in that region. The Sanford Health Bemidji doctor is not only dealing with climate, transportation, and lack of childcare, but also the closure of four labor & delivery clinics over the past five years.
“What we were seeing is fewer patients getting the minimum recommended number of visits or starting their prenatal care very late,” she says. “And there’s not a lot of other hospitals, (so) when patients choose not to come to Sanford for their women’s healthcare, they’re not going to another hospital system. They’re just not getting care, and that’s unacceptable.”
To address those challenges, Nynas helped to launch a remote patient monitoring program that allows Sanford Health care teams to monitor the health of those patients and gives those women access to local and state resources through a network of programs. The project is funded by a 2021 $3.67 million U.S. Department of Health and Human Services Rural Maternity and Obstetric Management Strategies (RMOMS) grant.
It also caught the eye of CNN, which recently named Nynas one of its Champions for Change.
Health systems and hospitals are embracing RPM and telehealth as a crucial strategy to connect with underserved populations. Residents of rural and remote areas, especially those in minority populations, often face a high risk of adverse health outcomes and elevated chronic care concerns. Through smartphones and connected devices, care teams can reach them on demand in their homes or communities, managing care and providing support.
“They can get their care from wherever they are,” says Nynas, whose coverage area includes three Native American reservations in a county whose population is 23% Native American.
A Multi-Layered Outreach
The program launched by Nynas through Sanford Health is multi-tiered, beginning with a communications platform that enables the health system to connect with patients at home and arrange rides to care appointments when necessary. It has also launched a connected care network with local and community physicians and clinics, equipping them with virtual care technology to facilitate telehealth visits when the women can’t make it to their in-person appointments or need an urgent virtual care visit. Those outlying clinics also act as hubs, enabling patients to use wi-fi services they might not be able to access at home, link up with specialists for virtual appointments and even download and send digital health data to their care teams.
Lastly, patients who agree to participate are sent home with a blood pressure monitor and fetal heartbeat monitor and are asked to have a weight scale handy. This enables Nynas and her team to monitor those patients daily, jumping in quickly if anything seems out of the ordinary or needs a closer look.
Nynas says the RPM platform gives her an opportunity to see a different side of her patients than she sees in the exam room.
“If I see a patient who looks polished – she’s showered, she’s dressed nicely, she looks well – in the clinic, I’m missing that … maybe there’s some really big struggles at home,” she says. “Maybe there’s a lot of stressors at home. Maybe she’s very depressed, and when I see that patient in her own environment, I get a better idea of how things are going for her and who she is. And that helps me be a better provider.”
The platform also encourages patients to be more engaged in their health. Nynas says the program is set up to educate patients about “red flag symptoms,” so they might identify those symptoms on their own; at the same time, they’re spreading the word with friends and family.
That community connection is important. A critical element of Nynas’ program is the collaboration between Sanford Health and other resources.
“We were really strategic,” she says, in joining forces with public health and Medicaid programs, non-profits, and other healthcare services. “We learned a lot about what each other does.”
A Lifeline for Women in Need of Help
The program can be a lifeline—literally—for high-risk mothers-to-be. Nynas says all patients are screened at the onset of the program and connected with a high-risk care coordinator to help them access additional services, including ride services, nutrition counselors and other resources addressing SDOH. That initial screening alone, she says, helped the health system boost referrals by 600%.
The health system also used some of the grant funding to add a home health nurse to help with screenings, education, and other tasks associated with a home visit. Nynas says the program’s 2023 goal was to arrange home healthcare visits for 40 pregnant women; they ended up connecting with more than 350 people.
And while the program creates a network of care for women during their pregnancy, that network continues past the baby’s birth. Nynas notes that many maternal health programs seem to forget about the mom at a crucial time: Right after the baby is born.
“It’s kind of crazy to think that, when you have a baby, the baby has a visit in 24 or 48 hours after discharge, and then one week, and then two weeks, and six weeks, and so on and so forth,” she says. With the mothers, meanwhile, “we see them at six to eight weeks [for] one time, and that seems not in keeping with the spirit of what we should be doing as healthcare providers.”
Nynas mixes in stories of success amid the challenges. She references one former patient who was homeless and dealing with substance abuse when she was pregnant, and has since completed a treatment program and will soon have a home for herself and her children.
That said, the challenges are daunting. Providing medical care and support is the easy part, Nynas says. The hard part is “paperwork and firewalls”: Appealing to payers for any sort of coverage they can provide, and working with the Indian Health Service and other federal and state agencies to make sure all the boxes are checked and requirements fulfilled.
And then there’s the HHS grant, which is due to run out soon.
“Those of us in the collaborative, we meet in-person quarterly to talk about what’s next over the next three months, what are our goals over the next six months,” Nynas says. “At our last quarterly meeting it became really abundantly clear that people are anxious about the grant ending and what’s going to happen to our collaborative. When that was brought up [and we said] do you think we should keep meeting, there was a unanimous ‘yes.’ “
“There was a value to us continuing to work together, whether it was funded or not,” Nynas says, “because it was the right thing to do for the women and the right thing to do for our communities.”
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