A study released today by researchers at Mass General Brigham focuses on the safety and quality of care in the Hospital at Home program, which will be discussed in at least one panel session at this week’s CES 2024 show in Las Vegas.
Advocates are touting a first-of-its-kind national study of Hospital at Home outcomes to convince the Centers for Medicare & Medicaid Services to make reimbursements permanent.
The study, led by researchers at Mass General Brigham and funded by the National Institutes of Health, analyzed clinical outcomes for almost 5,900 patients who were treated in CMS-approved Acute Hospital Care at Home (AHCaH) programs across the country. The research, posted today in theAnnals of Internal Medicine, found that those patients saw a lower mortality rate than if they were hospitalized, incurred fewer rehospitalizations, and spent less time in a skilled nursing facility (SNF).
More than 300 health systems and hospitals have launched Hospital at Home programs since CMS created a waiver for the program in 2020, enabling health systems who follow the agency’s guidelines to qualify for Medicare reimbursements. Other health systems have developed their own acute care at home programs, aimed at reducing stress on inpatient services and giving patients an opportunity to recover more quickly and effectively at home.
The study helps advocates who are lobbying CMS to make the AHCaH waiver, which is scheduled to expire at the end of this year, permanent. Many health systems are dependent on the waiver to sustain their programs, and are struggling to expand or develop long-term plans with the threat of losing that reimbursement.
The Mass General Brigham study was led by David Levine, MD, MPH, MA, clinical director for research and development for Mass General Brigham’s Healthcare at Home, one of the first to develop an acute care at home program and study its benefits.
“For hundreds of years, since the inception of hospitals, we’ve told patients to go to a hospital to get acute medical care,” Levine said in a Mass General Brigham press release issued today. “But in the last 40 years, there’s been a global movement to bring care back to the home. We wanted to conduct this national analysis so there would be more data for policymakers and clinicians to make an informed decision about extending or even permanently approving the waiver to extend opportunities for patients to receive care in the comfort of home.”
Levine and his colleagues analyzed Medicare fee-for-service Part A claims filed between July 2022 and and July 2023 for 5,858 patients across the country who had been treated in AHCaH programs. Of that group, roughly 42.5% were being treated for heart failure, 43% for COPD, 22% for cancer, and 16% for dementia. The mortality rate for that group was 0.5%, the escalation rate (returning to the hospital for at least 24 hours) was 6.2%, and within 30 days of discharge, 2.6% used an SNF, 3.2% died, and 15.6% were readmitted.
“Home hospital care appears quite safe and of high quality from decades of research — you live longer, get readmitted less often, and have fewer adverse events.” Levine said in the press release. “If people had the opportunity to give this to their mom, their dad, their brother, their sister, they should.”
Levine also noted that the study found no differences in outcomes for underserved patients, indicating the program could help address some of the barriers that patients face in accessing care.
“There are a number of reasons we think hospital-level care is better at home,” he said. “For one, the discharge process is smoother since we show patients how to take care of themselves right in their homes, where they are also more likely to be upright and move more. In addition, the clinical team has a greater ability to educate and act on the social determinants of health that we see in the home. For example, we can discuss a patient’s diet right in the kitchen or link a patient with resources when we see the cupboards are bare.”
Levine’s colleague, Jared Conley, MD, PhD, MPH, associate director of the Healthcare Transformation Lab at Massachusetts General Hospital, said during a HealthLeaders virtual summit in 2023 that the Hospital at Home program could eventually surpass inpatient care as the highest quality acute care program. The challenge, he said, lies in balancing in-person care with virtual and digital health technology to achieve the best results.
"Think of this as building another brick-and-mortar hospital," he said. "It is very challenging work, but it is so beneficial."
The Hospital at Home concept will be discussed during a panel at this week’s 2024 CES event in Las Vegas. Conley will be taking part in a Thursday panel titled Revolutionizing Health Through Smart Home Innovation, which will be moderated by HealthLeaders Senior Editor Eric Wicklund.
The annual consumer technology event, expected to attract more than 100,000 attendees to Las Vegas next week, will showcase the latest in innovative technology, as well as digital health trends affecting the healthcare industry
Healthcare executives gearing up for the 2024 International CES event next week in Las Vegas are focusing on one big question: How can I use consumer technology and digital health tools to improve the healthcare experience for my patients?
That’s always been the question for healthcare decision-makers intrigued by the massive consumer technology show, which takes over nearly every hall in the Las Vegas Convention Center and Venetian and is expected to draw 130,000 attendees this year. But while healthcare has long been overshadowed by cars, games, entertainment systems, and the odd robot and smart birdfeeder, digital health is now an integral part of the show, with its own space and session track.
The challenge lies in identifying the trends and technologies that hold value for healthcare executives, not just the latest and most innovative gadgets for consumers that a hospital or doctor might like to use. Health systems have long sought to integrate clinical uses with consumer technology to spur adoption and continued engagement, with often mixed results.
That’s especially true in this economy, which leave little room for innovation.
“CES is an opportunity for these digital health innovations to shine brightly in a dark moment in medicine as we face more hospital closures, high rates of clinician burnout, and increasing demand from consumers for a better experience,” Arielle Trzcinski, a principal analyst with Forrester, said in an e-mail to HealthLeaders.
Among the hot topics are, of course, AI, digital health apps, wearables, remote patient monitoring (RPM) tools and platforms, and smart technology in the home setting, a highlight of two concurrent events at CES, the CONNECTIONS Summit hosted by Parks Associates and AARP’s AgeTech Summit. The latter will feature the Samsung Health House, a smart home designed by Samsung in collaboration with AARP to show how seniors can age in place in the future.
“As medical deserts emerge for consumers, there is a growing opportunity for health systems and health insurers to tap into remote monitoring and wearables to empower consumers and keep them connected to much needed care,” Trzcinski added.
For healthcare execs focused on digital health, CES is bringing back its Digital Health Summit, a series of panels taking place Tuesday and Wednesday.in Room 250 of the Las Vegas Conference Center’s North Hall:
Other events of interest for healthcare executives include keynotes by the CEOs of Siemens, Walmart, Intel, Elevance Health, Qualcomm, and Best Buy, along with the CES Innovation Policy Summit, which includes a session titled Can Policy Affect Health Innovation? , a panel on AI governance around the world, and a special series of interviews, called “Conversations with a Commissioner,” that includes FDA Commissioner Robert Califf, FTC Commissioner Rebecca Slaughter, and FCC Commissioners Brendan Carr and Anna Gomez.
And finally, CES gives healthcare executives an opportunity to see where innovation is going in the consumer tech space, even if it is a bit far-fetched for hospitals and health systems at this time. They can look at unique ideas such as smart toilets, toothbrushes and home appliances, footwear and apps that track gait and balance, digital health tools for veterinarians, wearables, health and wellness apps, new sensors that track biometric data, and AR and VR tools.
New research from the Regenstrief Institute gives health system executives specific recommendations on how to use their EHRs to help clinicians identify and prescribe drugs to their patients.
New research out of the Regenstrief Institute gives health system executives specific recommendations on how to use EHRs to reduce dangerous drug-drug interactions.
“Drug-drug interactions are very common, more common than a lot of people outside the healthcare system expect,” Michael Weiner, MD, MPH, a researcher with the US Department of Veterans Affairs, Regenstrief Institute, and Indiana University School of Medicine and senior author of the study, said in a press release. “In the US, these interactions lead to hundreds of thousands of hospitalizations in any given year at an enormous cost. Most of these drug interactions are preventable.”
With the advent of EHRs and digital health technology, health systems are looking to reduce those interactions by pinpointing when they can occur and giving clinicians on-demand access to information to prevent them. But that technology depends on understanding how clinicians prescribe drugs and how they look for dangerous interactions.
“This study was needed because we previously didn’t have a great understanding of how clinicians actually make decisions in assessing these interactions,” Weiner said. “No one had really taken apart the thinking process step-by-step to understand it from the beginning to the end. There's a patient, there's a drug and another drug. There is now a potential interaction. There's been a decision about how to resolve it following an assessment and then a resolution process. Understanding all this is very important if we are hoping to design improvements to the medical system that enhance patient safety.”
The study, recently published in BMJ Open, identified 19 information cues used by clinicians to manage drug-drug interactions, including information on the potential severity of a drug reaction, side-effects, a patient’s expected duration of exposure to an interaction, patient-specific conditions, a patient’s need for those drugs, and the characteristics of safer medications. Using that list, Weiner and his colleagues developed recommendations for designing alerts through the EHR.
They are:
Provide information on the expected range of timing of potential drug-drug interaction effects (days, weeks, months, or years).
Give clinicians a platform to review multiple electronic drug-drug interaction reference sources directly from the alert, side-by-side.
Leverage data analytics to populate drug-drug interaction alerts with "smart" displays of alternative drugs that align with three criteria used by clinicians.
Provide recommendations on the alert along with associated patient characteristics (for example, “monitor, if patient indicates willingness and capability of measuring blood pressure daily”).
Alissa Russ-Jara, PhD, a researcher at the Purdue University College of Pharmacy and US Department of Veterans Affairs, Regenstrief Institute affiliated scientist, and the study’s lead author, said the research highlighted the fact that no two clinicians use the same protocols in assessing drug-drug interactions.
After interviewing all of the clinicians involved in the study, she said in the press release, “many … expressed surprise at how much nuance went into their own decision. Their decisions often occur so rapidly, yet involve so much expertise. Ours was the first study to really unpack that for their decisions around drug-drug interactions.”
“We expect our findings can improve the design and usability of drug-drug interaction alerts for clinicians, and so they can more effectively aid patient safety,” she added. “Our study focused on clinical decision-making, regardless of whether the clinician was warned by an alert or not, so our findings have implications for clinicians, informatics leaders, and patients, and for any EHR system.”
Faced with competition from disruptors, health systems are expanding their pharmacy services to capture additional income and improve clinical care
Amid increased competition from disruptors and retail chains, health systems are expanding their pharmacy operations beyond the hospital, in some cases building stand-alone community pharmacies or co-locating them with clinics to compete directly with the likes of Walgreens, Rite Aid, and CVS.
“It’s a huge opportunity,” says Rebecca Taylor, vice president of the pharmacy service line at UPMC, which now has 17 pharmacies within its network, some located inside clinics. “Ambulatory pharmacies have been around for a long time, but there are a lot of factors that are driving this new opportunity” for health systems to expand their reach.
With intense competition in the healthcare space, health systems are seizing on the opportunity to expand pharmacy services as a means of improving the scope of services they provide to patients. Many want to keep the patient within the hospital’s network, integrating all healthcare services through the medical record, a strategy that segues into the concept of value-based care and the medical home.
Others see the pharmacy as an attractive business line. Through the 340B Drug Pricing Program, health systems can be reimbursed through Medicaid for outpatient drugs sold to uninsured and low-income patients. They’re also looking to capture more specialty pharmacy services and prescriptions lost to neighborhood and community pharmacies, not to mention the profits from other goods and services sold through a retail location.
And while neighborhood and community pharmacies are looking to adopt more healthcare services and become community health centers, they’re also struggling. Rite Aid has filed for bankruptcy, while Walgreens and CVS are closing hundreds of stores, leaving communities without that resource for filling prescriptions. Health systems can fill that gap with their own pharmacies.
Making an Argument for Pharmacy Expansion
Nicole Faucher, MS, president of Clearway Health, a Massachusetts-based company spun out of Boston Medical Center that partners with health systems and hospitals to strengthen their specialty pharmacy programs, says health systems have three primary reasons for expanding their pharmacy services:
Creating a new service line. When patients fill their prescriptions at a local pharmacy, they’re taking business away from the hospital. A health system can keep that business in-house with its own pharmacy service, as well as influencing the patient to consider more health and wellness services and products.
Improving clinical outcomes. By keeping pharmacy services in-house, a health system can link all of those services through the medical record, ensuring continuity of care and reducing gaps in care or siloed services. In addition, the pharmacist becomes an integral part of the care team and the care management plan, improving medication adherence and helping patients with any medication-based issues that might otherwise be delayed or go unanswered.
Improving patient loyalty and engagement. Health systems that include pharmacy services are seen by patients as being more attentive to and involved in care management and coordination. That patient will be more likely to stay with the health system, listen to advice on other services and resources within the health system, and recommend that health system to family and friends.
The decision to expand pharmacy services can’t be taken lightly. These projects are expensive, and they require plenty of research and planning. One look at how Walgreens, Rite Aid, and CVS are doing right now with the healthcare ambitions would be enough to scare anyone away.
“This isn’t just ‘Build it and they will come,’” warns Faucher, who says health system leadership needs to think long and hard about whether to take this on.
Among the considerations that go into planning a pharmacy expansion:
Understanding the patient population and community. Will patients shift their allegiance from local pharmacies to a hospital-run pharmacy?
Site selection and staffing. Will a stand-alone pharmacy work, or should these services be co-located with a clinic, medical offices, or other programs? Building and/or rental costs will figure prominently in this strategy, as will costs for staffing a stand-alone pharmacy.
Delivery. Will this be a traditional pharmacy that handles over-the-counter and walk-in traffic, or will it be strictly mail-order? If the latter, how will deliveries be handled? If the former, will the pharmacy handle prescriptions only or offer other goods and services?
Contract negotiations. A health system will need to handle contracts with pharmacy benefit managers (PBMs), payers, and health plans, along with any delivery services. In addition, there will be contracts with drug distributors to consider.
Sustainability. How much business will a pharmacy need to generate to be sustainable? This will determine what other services or products are offered.
Alongside managing the aspects of a 340B program, Faucher says a health system must also decide how to manage business with other pharmacies. Some 15% of all prescriptions involve medications that are handled by specialty pharmacies.
“There really isn’t a one size that fits” for every health system, she says.
Addressing Both Clinical and Business Goals
At Signature Healthcare, based in southeastern Massachusetts, the decision to expand pharmacy services addressed both clinical and business goals. A significant percentage of the health system’s patient base are members of government health plans, making the 340B program an attractive addition to their bottom line.
“We make a little more of a margin on that,” says Stephen Borges, Signature’s vice president of financial operations.
But the health system also wants to create a more connected health experience for its patients, many of whom are underserved, he says. That means adding pharmacy techs in critical care units, medical offices, and clinics to be part of the care team, and locating a retail pharmacy in their largest physician office building near the hospital.
“We’re reinventing care for our patients,” Borges says.
Signature Health had partnered with the local Walgreens chain prior to this change in strategy, even enabling Walgreens pharmacists to come into the hospital to meet with patients before they were discharged. But there were still gaps in care, he says, that comes with having two separate organizations try to care for the same patient.
“We want our pharmacists to have the ability to do more with our patients,” Borges says. That includes creating a patient assistance program to work with patients who struggle to pay their bills and find other ways of meeting prescription costs.
One of the challenges to implementing this new strategy was getting buy-in from physicians who might not see the pharmacist as a member of the care team. Borges says it took some time and effort to get everyone comfortable with each other; he credits the successful integration to the work of physician champions identified ahead of time by the health system.
Another challenge was getting support from patients who have always gotten their prescriptions filled at the local pharmacy.
“We didn’t anticipate that it would be so hard to convince people to move away from CVS and Walgreens,” Borges says.
Addressing the Patient’s Needs
At UPMC, Taylor says expanding the health system’s footprint to include more pharmacy services gives them the chance to have a greater impact on clinical outcomes.
Pharmacists who are part of the health system and the care team, she says, can work with providers and patients to fine-tune medication management, identifying potential drug reactions and alternatives to costly medications. They can answer patient questions that might not be asked in a separate pharmacy, work with patients who have trouble paying for medications, and collaborate with doctors when a patient struggles with medication adherence or displays adverse effects to taking a certain medication. They can also help the health system with vaccinations and other public and community health outreach programs.
Taylor says the additional service line also enables UPMC to attract and hire skilled pharmacists, especially those who’d prefer to work with a health system rather than a retail pharmacy.
Studies back up the idea that the pharmacist—regardless of whether he/she is employed by the hospital or another company--should be part of the care team. Recent research done at Virginia Commonwealth University found that pharmacists could prevent more than 15 million heart attacks and nearly 8 million strokes and save $1.1 trillion in healthcare costs over 30 years if they were allowed to be more active in managing care for patients.
Taylor sees an improvement in reduced rehospitalizations. Pharmacists who are part of the care team can spot problems before they become serious, she notes, alerting physicians and enabling them to intervene while the patient is at home.
The Impact of Technology
One reason for heightened interest in the pharmacy space is the availability of new technology. Telehealth and digital health tools make it easier for clinicians and pharmacists to communicate with each other and with patients, creating or modifying care plans on the go and prescribing and filling prescriptions virtually. And with the popularity of online and mail-order prescriptions surging, health systems can also take advantage of online platforms to handle prescriptions in bulk and mail them to patients.
“That certainly makes it easier,” says Taylor. “And in the future, there will be other technologies that will make it feasible to do a hub-and-spoke model,” enabling health systems to manage distant pharmacy sites from one central location.
“Internet prescription fills have gone through the roof,” adds Borges.
A report recently issued by the Center for Connected Medicine finds that more than half of health systems with their own ambulatory pharmacies “believe retailers and technology companies are having either a moderate or strong influence on their hospital’s pharmacy strategy.”
According to the report, many health systems are planning to invest in digital health technology to improve their pharmacy services. Among the more popular platforms are integrated patient portals, prescription fills and refills and payments through an app, and medication adherence services (such as reminders).
Faucher, of Clearway Health, says the integration of patient portals and EHRs with pharmacy services gives health systems an opportunity to play a more active role in care management. Doctors can check in with both pharmacists and patients online to make sure prescribed medications are being taken and are effective, while pharmacists and patients can respond more quickly if something isn’t working.
Faucher says health systems have an opportunity to grow their business by single digits with a more aggressive pharmacy strategy, and by double digits if they adopt specialty pharmacy services. Beyond the profit margins, they have an opportunity to improve care by being more of a healthcare partner with patients who are demanding more collaboration with their care teams.
“Health systems need to have a pharmacy strategy,” she says. “This will be a continuing trend.”
Federal officials have unveiled a new strategy to address rising cybersecurity incidents. It includes incentives to improve data security, beefed-up guidelines, and the potential for cuts in reimbursement.
With cybersecurity incidents occurring on an almost-daily basis in the healthcare sector, federal regulators are looking to take a more active role in improving data security.
The Health and Human Services Department has released a new strategy for cybersecurity, centered on four steps aimed at improving the healthcare landscape. The six-page document builds off of the Biden administration’s National Cybersecurity Strategy, which was unveiled last March, and follows recent actions taken by federal agencies to boost security, including the release of healthcare-specific practices and training resources, guidance on medical device security from the US Food and Drug Administration, and new telehealth guidelines from the HHS Office of Civil Rights (OCR).
“The healthcare sector is particularly vulnerable, and the stakes are especially high,” HHS Secretary Javier Becerra said in a release accompanying the strategy. “Our commitment to this work reflects that urgency and importance. HHS is working with healthcare and public health partners to bolster our cyber security capabilities nationwide.”
The information comes at a particularly vulnerable time for the healthcare industry, which has seen an alarming increase in large data breaches and ransomware attacks in recent months. According to the OCR, the industry has seen an almost two-fold increase in large breaches from 2018 to 2022, from 369 incidents to 712, while ransomware attacks have surged 278% in that time.
“Cyber incidents affecting hospitals and health systems have led to extended care disruptions caused by multi-week outages; patient diversion to other facilities; and strain on acute care provisioning and capacity, causing cancelled medical appointments, non-rendered services, and delayed medical procedures (particularly elective procedures),” the HHS report notes. “More importantly, they put patients’ safety at risk and impact local and surrounding communities that depend on the availability of the local emergency department, radiology unit, or cancer center for life-saving care.”
With that in mind, HHS is planning to take a more active role in pushing the healthcare industry to improve its defenses. The agency plans to:
Establish voluntary cybersecurity performance goals for the healthcare sector;
Provide resources to incentivize and implement these cybersecurity practices;
Implement an HHS-wide strategy to support greater enforcement and accountability; and
Expand and mature the one-stop shop within HHS for healthcare sector cybersecurity.
Of particular note are the financial incentives that the government will be offering to health systems who need help becoming more secure. According to the report, the HHS will be launching a program to help struggling hospitals cover the up-front costs of installing “essential” cybersecurity performance goals (CPGs), and a program that offers incentives for hospitals to invest in advanced cybersecurity practices to implement “advanced” CPGs.
In addition, the HHS strategy will include new cybersecurity requirements for hospitals that will be enforced through the Centers for Medicare & Medicaid Services (CMS), an indication that the feds could tie compliance to Medicare and Medicaid reimbursements. As well, the OCR is scheduled to update the Health Insurance Portability and Accountability (HIPAA) Security Rule this coming spring to include cybersecurity requirements.
Not everyone is on board with the HHS strategy. Chris Bowen, founder and chief information security officer for ClearDATA, says the industry should get even tougher.
“While a gesture towards progress, [the strategy] falls critically short of what's imperative in today's climate,” he said in an e-mail to HealthLeaders. “Suggesting voluntary measures is akin to applying a band-aid on a hemorrhage, it's time for HHS to enforce rigorous, non-negotiable cybersecurity standards and to provide the necessary resources and mandates.”
“The sector's talent gap in cybersecurity is no secret, and it places our hospitals at a disadvantage, jeopardizing patient safety,” he adds. “We must look to the strategies of those who have robustly safeguarded healthcare data and replicate their assertive approach. Protecting lives extends beyond the physical realm; it encompasses shielding patients from the lethal threat of cyber-attacks. To accept minimum, voluntary standards is to tacitly endorse a status quo that endangers our patients.”
MIT researchers are working on an ingestible that vibrates when swallowed, tricking the stomach into thinking it’s full
Can a vibrating pill help healthcare providers create sustainable and effective weight loss treatments?
That’s the question researchers at the Massachusetts Institute of Technology are trying to answer as they experiment with the latest in healthcare ingestibles. The MIT team has developed a pill enhanced with technology that is programmed to vibrate for about 30 minutes after being swallowed, activating receptors within the body that signal the stomach is full.
“For somebody who wants to lose weight or control their appetite, it could be taken before each meal,” Shriya Srinivasan, a former MIT graduate student and assistant professor of bioengineering at Harvard University who’s leading the study, said in an MIT news piece. “This could be really interesting in that it would provide an option that could minimize the side effects that we see with the other pharmacological treatments out there.”
Characterized by the popularity surrounding new drugs like Ozempic and Wegovy, healthcare providers are looking for new ways to address obesity and weight-related issues, which play a role in many chronic health conditions. Some 42% of US adults are affected by obesity, and it’s estimated that more than 160 million Americans are on a diet at any given time and spending more than $70 billion a year on commercial weight-loss plans, supplements and other diet programs.
Yet for all the products and treatments on the market, many people struggle to consistently stay within a diet plan, primarily because habits are very hard to break. Healthcare providers have long struggled to design treatment plans that are sustainable and keep patients engaged over the long run.
Digital health tools, such as digital therapeutics, aim to tackle that challenge by targeting behavior change.
One method of tackling behavior change is by tricking the body into thinking it’s full. For Srinivasan and Giovanni Traverso, an associate professor of mechanical engineering and MIT and a gastroenterologist at Brigham and Women’s Hospital, that led to the creation of the VIBES pill, which vibrates in the stomach, affecting the vagus nerve, which then sends messages to the brain that the stomach is full.
Srinivasan, Traverso, and their research team tested the VIBES pill on Yorkshire pigs, who were given the pill 20 minutes before being fed. They found that the pill not only stimulated the release of hormones that signaled satiety, but also reduced the animals’ food intake by about 40%.
The study, which was funded by the National Institutes of Health, Novo Nordisk, and the National Science Foundation, among others, is still in its early stages.
“The behavioral change is profound, and that’s using the endogenous system rather than any exogenous therapeutic,” Traverso said in the MIT news story. “We have the potential to overcome some of the challenges and costs associated with delivery of biologic drugs by modulating the enteric nervous system.”
“For a lot of populations, some of the more effective therapies for obesity are very costly,” added Srinivasan. “At scale, our device could be manufactured at a pretty cost-effective price point. I’d love to see how this would transform care and therapy for people in global health settings who may not have access to some of the more sophisticated or expensive options that are available today.”
Federal regulators are scrambling to create guidelines for the ethical use of AI in a number of industries. Will healthcare collaborate or stake its own claim to governance?
As we head into the new year, the hot topic on every healthcare executive’s minds is AI. And one of the biggest questions surrounding the technology centers on who will regulate it.
The Biden Administration set the tone this past October with an Executive Order that places much of the federal regulatory burden on the Health and Human Services Department and the Office of the National Coordinator for Health IT (ONC), a position held by Micky Tripathi. HHS then set the schedule with a final order in December that calls for more transparency in AI tools used in clinical setting by the end of the coming year.
While much of the action so far focuses on the technology vendors who are designing AI tools, health system leaders are keeping a close watch on how the federal government will affect their use of the technology. Many health systems are developing and using their own tools and platforms and pledging to maintain ethical standards in any clinical applications.
“We have a culture of responsibility that goes alongside agile innovation,” Ashley Beecy, MD, FACC, medical director of AI operations at NewYork-Presbyterian and an assistant professor of medicine at Weill Cornell Medical College, said in a HealthLeaders interview earlier this year, prior to Biden’s Executive Order. “Health systems have a unique opportunity” to establish their own standards for the proper use of AI.
Tarun Kapoor, MD, MBA, senior vice president and chief digital transformation officer at New Jersey-based Virtua Health, says healthcare organizations have the clinical background needed to develop effective and sustainable AI governance. They know how it’s going to be used in healthcare, and can focus on the nuances that federal regulators might miss.
“We have to get a lot better at [regulating AI] because we’re the ones using it,” he says.
Like many health (if not all) health systems using AI these days, Virtua Health has a policy that any AI services have a human being in the loop, meaning no actions are taken on AI-generated content until they’ve been reviewed by at least one flesh-and-blood supervisor. At this stage, when most projects are trained on back-office tasks, that’s a safe bet; but when the technology works its way into clinical decision-making, that additional step may be critical.
“Always put physicians in front of those decisions,” says Siva Namasivayam, CEO for Cohere Health, a Boston-based company that focuses on using AI to improve the prior authorization process. He says the technology should be used to enhance the physician’s role—what he calls “getting to the yes factor—rather than replacing it.
“We never use AI to say no,” he adds.
But who gets to make those decisions? The Biden Administration wants to be part of that chain of command, and is setting its sights on a collaborative environment, having secured voluntary pledges from more than three dozen health systems, payer organizations, and technology vendors to use AI responsibly. The agreement centers on a new catchphrase for ethical use: FAVES, which stands for Fair, Appropriate, Valid, Effective, and Safe.
The healthcare industry, still smarting from having electronic medical records forced on them before they were really ready for adoption, is playing nice for now. But in many hospitals, the C-Suite is facing pressure to take command of AI governance and make it an industry priority.
“You govern yourself at a level higher than the law,” says Kapoor.
He notes that health systems like Virtua Health are being very careful in how they use the technology, and not just green-lighting any potential use.
“Just because you can say anything and create your own [projects] doesn’t mean I’m going to let you say anything and do them,” he points out.
Kapoor says healthcare providers will understand the flaws in AI technology and the risks they present better than anyone outside the industry. And health systems like Virtua Health are addressing these challenges with steering committees that comprise not only clinical leaders but those in finance, IT, legal, and operational areas of the organization.
Arlen Meyers, president and CEO of the Society of Physician Entrepreneurs, a professor emeritus at the University of Colorado School of Medicine and Colorado School of Public Health, says the industry has to step up and show leadership at a time when AI governance is still in flux. He notes hundreds of healthcare organizations have created dedicated centers of excellence for AI, and some have vowed to develop ethics and standards of use. Consumers, as well, could get into the act, helping to form an ‘AI Bill of Rights’ for patients.
“Right now, nobody trusts the government or the industry to regulate this,” he says. “When you look at who should be regulating what … the industry should be setting the guardrails.”
This next year will be pivotal in establishing governance for AI, as more and more health systems use the technology and push the boundaries beyond administrative use and into clinical applications. While the Biden administration is looking to fast-track regulation through HHS and the ONC, many wonder whether the healthcare industry will wait that long, or let a federal agency propose the first rules.
Others are wondering what it will take to create regulations that will work. One look at the current debate over interoperability and data blocking standards makes it clear that just because rules are created doesn’t mean they’ll be readily accepted.
“In the end, you follow the money,” says Meyers, who anticipates that healthcare and government will have to come to some sort of agreement to create something long-lasting. “That’s how the [rules] will be made.”
Redesigning post-discharge care to include mental health resources can reduce return visits and rehospitalizations and improve recovery and clinical outcomes
Health system leaders are constantly looking for strategies to reduce rehospitalizations. A new study says redesigning post-discharge care to include mental health services, including through digital health and virtual channels, could cut that return rate in half.
The study, conducted by a team of researchers at the University of Washington, focuses on the millions of hospitalizations each year that are caused by a traumatic injury. Many of those patients return to the hospital after discharge because of mental health issues tied to that trauma, with as many as 40% dealing with post-traumatic stress disorder (PTSD).
Improving the care coordination process after a hospital visit is one of the top innovation challenges facing health systems. So many care gaps are created when the patient leaves the hospital and heads either to a rehab or SNF facility or back home. Doctor’s orders and prescriptions are forgotten or even ignored, care plans are interrupted or dropped altogether, and recovery is delayed, often leading to negative clinical outcomes, including rehospitalization.
The study, led by Laura Prater, PhD, MPH, MHA, an assistant professor at The Ohio State University of Public Health, and published in the Annals of Surgery, tracked 171 patients who were treated at a University of Washington trauma center. Half were treated via the traditional process, and half were involved in a five-year, three-step program that included enhanced care specific to mental health needs during hospitalization and 24/7 access to mental health services after discharge.
According to the study, 27% of patients undergoing traditional care were rehospitalized within three to six months, compared to 16% of patients involved in the mental health intervention program. After 12 to 15 months, 31% of the traditional-care patients were back in the hospital, compared to 17% of those in the intervention program.
“Being able to manage PTSD and other mental health concerns early on and receive regular follow-up support can prevent adverse long-term health problems and increase a survivor’s ability to live a productive, meaningful life,” Prater said in a press release issued by The Ohio State University.
The intervention program included digital health tools aimed at offering on-demand services to those patients.
“The immediate text message or phone call response to questions and concerns is potentially the most meaningful element of the intervention, from the perspective of the survivors,” Prater said. “A lot of places use MyChart or another form of messaging, but responses can be delayed and that is problematic if someone is feeling overwhelmed. Having an immediate connection helped patients and their families to feel like they weren’t in it alone.”
The study reinforces research done earlier this year at Vanderbilt University, which used a National Institutes of Health grant to study new methods of addressing post-intensive care syndrome (PICS), which can affect as many as 80% of patients discharged from a hospital after an ICU stay. That study found that a reconfigured post-discharge care management and coordination program focused on virtual care could reduce rehospitalizations and improve clinical outcomes.
Both studies point to a need to change how hospitalized patients are treated after they leave the hospital, with more emphasis placed on the traumatic nature of a hospital stay and improved access to mental health services to help patients recover—mentally as well as physically—from their health concerns.
“Being in the emergency department is traumatic in its own right, plus returning to the scene where you first received care following an injury or assault is not ideal,” Prater said in the press release. “Managing trauma and the mental health fallout from that trauma is best done at home, where you’re in a safe location.”
The supermarket chain is redesigning its in-store health clinics to focus on seniors in Medicare plans, who often face challenges accessing primary care and are looking for better services.
A new partnership aims to give seniors another option for primary care: The supermarket.
Kroger Health, the healthcare arm of the Cincinnati-based retailer with more than 2,700 grocery stores in 35 states and the District of Columbia, is joining forces with the Better Health Group to focus its 225 Little Clinic in-store walk-in clinics on primary care services for seniors on Medicare, including Medicare Advantage plans.
Kroger joins a growing list of disruptors from other industries entering the healthcare market with consumer-focused primary and specialty care services. Companies like Amazon, Walmart, Publix, Google, and national pharmacy chains like Walgreens, CVS Health, and Rite Aid are all looking to replicate the success of the retail experience in healthcare for people who face barriers to accessing care or are more comfortable going to a store than a hospital or doctor’s office.
Some within the healthcare industry have called this the battle for primary care, with health systems and medical practices looking to keep their patients and attract new ones in the face of competition from outside organizations. According to a Bain & Company study issued in 2030, these disruptors could capture 30% of the primary care market within six years.
“As the industry continues to shift toward value-based reimbursement, there has been an increase of nontraditional players and models in primary care,” Erin Ney, MD, an associate partner at Bain & Company, said in a press release accompanying the report. “As we look ahead, rising costs, physician shortages, consumerism and digital disruption will continue putting pressure on traditional healthcare models, paving the way for additional growth of models that promote more efficient care, improved outcomes and reduced total cost.”
Health system executives have been urged to improve the patient experience, including adopting virtual care and digital health tools, and embrace retail strategies that focus on convenience and reliability.
With organizations like Kroger, Amazon, and Walmart offering alternatives to the doctor’s office or hospital, experts say health systems need to identify and focus on what they can offer that others can’t—which in many cases is the connection to a respected hospital or medical group. Critics, meanwhile, say cost, complexity, and challenges to access are turning consumers away from healthcare and opening the door for the disruptors.
The Better Health Group, which launched in 2016 at Physician Partners, operates more than 160 VIPcare clinics focused on senior services and partners with more than 1,200 providers. Officials at both Kroger Health and Better Health say the partnership will advance value-based care for a population desperately in need of focused services and better access to care.
The collaboration will begin at selected Kroger supermarkets in the Atlanta area before branching out in 2024 to other stores.
A hardware breakdown prompted Deborah Heart and Lung Center to outsource its data storage services. How do other health systems decide if and when to make that move?
Health systems have different motivations for migrating to the cloud. A catastrophic disk failure may be the best reason.
That’s what happened at the Deborah Heart and Lung Center, an 89-bed New Jersey-based hospital that focuses exclusively on cardiac, vascular, and lung disease. In 2015, the hospital’s systems pretty much shut down for close to two days after a drive ceased to function on its in-house electronic health record (EHR) system.
As the healthcare industry embraces more technology (especially digital health tools) and ramps up its data collection and analysis capabilities, how that data is stored and protected becomes critical. A July 2021 online survey by the College of Health Information Executives (CHIME) found that more than 80% of health system executives are conducting at least some services in the cloud, while nearly 10% are fully invested in the cloud and some 60% are adopting a hybrid approach.
The reasons for moving to the cloud are numerous. According to KLAS, roughly half of health systems are doing so to reduce costs and capital expenses, while 40% see the cloud as an opportunity to expand resources they don’t have on-site. Almost 30% are using the cloud to enhance services or capabilities, while 11% are looking to improve system performance and 9% see opportunities to improve data security.
That was the motivation for the Deborah Heart and Lung Center.
“It took everything down,” says Rich Temple, the hospital’s vice president and chief information officer, who’d come onto the job just six weeks prior. “It kind of came right out of the blue. We were struggling mightily to try to get backup [up and running]. It was the longest two days of my life.”
Temple says the health system had backups in place just for this occurrence, but the initial disk failure was so profound that some of the backups were corrupted as well. Ultimately, a backup file was restored and, two days later, the system was finally brought back up.
Shortly thereafter, leadership decided to outsource data storage and management for its EHR to CloudWave, healthcare data security experts.
Rich Temple, vice president and chief information officer, Deborah Heart and Lung Center. Photo courtesy Deborah Heart and Lung Center.
Moving to the cloud isn’t cheap—that’s the top concern and barrier that health system executives cite in making the decision whether to outsource those services, though studies have suggested it doesn’t take long for a health system to recoup those costs in savings. In a tight economy, with many health systems struggling to stay in the black, giving the green light to a costly capital expenditure isn’t easy.
“We knew then we couldn’t risk that happening again,” Temple says. “But you don’t do this as a money-saver. You do it for risk-avoidance.”
Aside from the initial cost, many health systems struggle with the operational changes required to make the switch. Every department is affected by the transition, requiring the C-Suite to get out ahead and develop a comprehensive change management strategy.
“It’s truly a multi-dimensional project,” says Temple. “We knew there were going to be a lot of twists and turns, and there were even more twists and turns than we expected.”
One familiar problem, he says, was getting buy-in. Despite the chaos caused by the disk failure, some providers were hesitant to want to adapt to a new system and expressed worries about what are commonly called “last-mile issues,” or problems unforeseen and encountered just as the new system is turned on.
“We’ve always done down-time drills, but everyone is so dependent on electronic health records,” says Temple, noting the health system has been using EHRs since 1998.
Temple says the health system worked long and hard to make sure the transition from on-site to cloud was as seamless as possible. That meant identifying everyone who would need access to the system and determining what they could and couldn’t access, creating licensing and multi-factor authentication and understanding the bandwidth needed to support back-and-forth operations, even understanding all the different platforms within the health system that have some interaction with the EHR.
In addition, he says, the fallout caused by the disk failure gave the Deborah Heart and Lung Center’s leadership the opportunity to look more closely at how the hospital handles its technology at a time when things aren’t working. What should a disaster recovery and business continuity model look like? And how should that model be adjusted when outsourcing certain operations to the cloud? Additionally, how does a health system create a plan to stay up and running after a data breach or a ransomware attack?
“Make sure your eyes are wide open before you start,” Temple concludes.
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