The health plan is issuing more than $4 million in grants to nine organizations through an innovative program to improve access to care and services for more than 75,000 homeless people in Los Angeles County.
A Los Angeles-based health plan is investing more than $4 million in an innovative program to improve healthcare access and services for the region's growing homeless population.
L.A. Care, which serves close to 3 million people in Los Angeles County, is awarding grants of up to $500,000 to nine organizations through its Street Medicine Initiative. The organizations will use the money to improve healthcare access through care management, preventive screenings, vaccinations, mental health screenings, and connections to housing and social services.
“L.A. Care’s Street Medicine Initiative will increase the number of street team members and services offered to the most vulnerable people in our communities, many of whom are L.A. Care members,” John Baackes, the health plan's CEO, said in a press release. “A secondary purpose of this initiative is to assist people experiencing homelessness with their Medi-Cal applications. The last thing we want is for people to needlessly lose health coverage simply because there was no address to send their renewal packet.”
The effort targets a care gap that affects the entire healthcare ecosystem. Without good access to care and other services, homeless populations can experience ever-worsening clinical outcomes, including serious chronic disease and several mental health issues. This, in turn, places a strain on public health agencies, community health clinics, and health systems, many of whom don’t see these patients until it's too late to help them.
The need for improved healthcare access is particularly acute in Los Angeles County, which declared a State of Emergency on Homelessness this past June. Officials estimate more than 75,500 residents are classified as homeless, an increase of 9% in just one year.
Funding for the program will come from California's Housing and Homelessness Incentive Program (HHIP), which was launched by the state with matching funds from the American Rescue Plan Act. HHIP is a voluntary incentive program enabling Medi-Cal managed care plans to receive reimbursement for programs that address social determinants of health.
Coordinated by Community Care of West Virginia and Aetna Better Health for West Virginia, the program will provide on-demand emergency psychiatric care and care coordination for children and adolescents within 24 hours.
A new program being launched in West Virginia aims to give children access to in-person or virtual emergency psychiatric evaluations within 24 hours.
The Critical Access to Pediatric Psychiatry (CAPP) WV program is being launched by Community Care of West Virginia, a federally qualified health center serving some 50,000 patients across 17 community health centers, 51 school-based healthcare sites and seven pharmacies, along with Aetna Better Health of West Virginia, part of the CVS Health portfolio. Aetna Better Health of West Virginia is providing $1.5 million to support the new program.
The program aims to reduce the number of children and adolescents seeking emergency behavioral healthcare in ERs—a significant care gap affecting health systems not only in West Virginia but across the country—and direct children to the right resources within the state. West Virginia's health department is currently under a federal mandate to improve services for at-risk children, including those in foster care, following a Justice Department investigation that found more than 300 children in group residential care and psychiatric facilities outside the state, due in part to a shortage of in-state resources.
“We’re always working to improve access to essential pediatric psychiatric assessments for children and families in West Virginia, regardless of their location,” Kathy Szafran, executive director of Aetna Better Health of West Virginia's Mountain Health Promise program, said in a press release. “Due to limited availability of adolescent psychiatrists, children experiencing a behavioral health crisis can spend significant time in the emergency room waiting to be evaluated."
"With the coordination between Community Care and Aetna, we can now offer a virtual pediatric psychiatric evaluation anywhere in West Virginia usually within 24 hours," she added. "In conjunction with the Aetna care coordination team and Critical Access to Pediatric Psychiatry, the needed assessment and care coordination for ongoing services can be available throughout the state for under-resourced children. The goal is to get children assessed, level of care identified, and appropriate services coordinated as soon as possible. Our current outcomes are promising, keeping children with family and with the services needed.”
Along with in-person and telehealth-based care, the program will also establish a mobile mental health clinic that can be dispatched as needed to underserved communities.
CAPP WV could be a model for many states and healthcare organizations that have been dealing with a surge in ER traffic since the pandemic. Roughly half a million children are evaluated for behavioral health concerns in emergency departments each year, according to the American Academy of Pediatrics, and as little as 20% are getting the help they need, including adequate follow-up care and the right medication.
CAPP WV addresses four key pain points. As described by officials, they are:
On-demand access for Aetna members to specialized pediatric psychiatry services. The program will work with pediatricians and primary care providers to provide on-demand behavioral health services for Aetna members.
Timely psychiatric evaluations in emergencies. In situations where in-person psychiatric care is unavailable, the program will expedite psychiatric evaluations within 24 hours, including through virtual care.
Support for small rural healthcare providers. The program will offer ER consults and follow-ups for small rural healthcare providers who lack access to their behavioral health and/or pediatric specialists, giving them access to the resources they need to treat more of their patients instead of directing them elsewhere.
Ensuring connected care. For children and adolescents with medication needs who are placed on waitlists, the program will coordinate care management with established behavioral health providers to continue the care pathway.
Mass General Brigham researchers say the large language model AI chatbot is almost as good in making clinical decisions as a med school graduate
Healthcare executives looking for support in developing a ChatGPT tool for their clinicians should take a look at the latest research coming out of Boston.
Investigators from Mass General Brigham have found that a large language model (LLM) AI chatbot is 72% accurate in making clinical decisions across all medical specialties and phases of care, and the tool is 77% effective in making a final diagnosis.
Those results make a good case for using the technology as a clinical decision support tool for clinicians—but not, as some might fear—a replacement.
“Our paper comprehensively assesses decision support via ChatGPT from the very beginning of working with a patient through the entire care scenario, from differential diagnosis all the way through testing, diagnosis, and management,” Marc Succi, MD, associate chair of innovation and commercialization and strategic innovation leader at Mass General Brigham and executive director of the MESH Incubator, said in a press release announcing the study's results.
“No real benchmarks exist, but we estimate this performance to be at the level of someone who has just graduated from medical school, such as an intern or resident," he added. "This tells us that LLMs in general have the potential to be an augmenting tool for the practice of medicine and support clinical decision making with impressive accuracy.”
The study, recently published in the Journal of Medical Internet Research, is the latest step in the whirlwind romance between healthcare and AI, and LLMs like the ChatGPT tool in particular. While some fear the technology could someday supplant clinicians, those who've been in the arena for a while say it holds value in giving clinicians the information they need at their fingertips to make decisions.
And those study results subtly point out that while LLMs are good, they aren't good enough to replace anybody.
In the study, Succi noted that ChatGPT was only 60% effective in making differential diagnoses, and it was only 68% accurate in making clinical management decisions, such as deciding what medication to prescribe after making a correct diagnosis.
“ChatGPT struggled with differential diagnosis, which is the meat and potatoes of medicine when a physician has to figure out what to do,” Succi, who co-authored the study, said in the press release. “That is important because it tells us where physicians are truly experts and adding the most value—in the early stages of patient care with little presenting information, when a list of possible diagnoses is needed.”
AI in clinical care needs "to include clinician voices at the front end, not as an afterthought," American Medical Association President Jesse Ehrenfeld, MD, MPH, said during the AIMed Global Summit this past June in San Diego.
The AIMed conference, which saw attendance skyrocket to some 1,500 people from last year to this year, served as a forum to discuss how the technology (called "augmented intelligence" rather than artificial intelligence") should be slowly and gradually adopted by healthcare. Ehrenfeld pointed out that the industry botched the roll-out of the electronic health record by rushing things and forcing clinicians to use the platform before they were comfortable with it.
"There is enthusiasm about this disruptive technology," he said, but "the existing regulatory framework is clearly not equipped to handle" AI governance.
That's why studies like that done by Mass General Brigham and pilot projects are important. Healthcare leaders need to see how the technology can and should be used before they use it.
Hospital officials say they'll be doing more research on AI tools like ChatGPT, including studying whether the technology can improve patient care and outcomes, particularly in areas where access to information and resources is strained or limited.
"Mass General Brigham sees great promise for LLMs to help improve care delivery and clinician experience,” Adam Landman, MD, MS, MIS, MHS, chief information officer and senior vice president of digital at Mass General Brigham and the study's co-author, said in the press release. “We are currently evaluating LLM solutions that assist with clinical documentation and draft responses to patient messages with focus on understanding their accuracy, reliability, safety, and equity. Rigorous studies like this one are needed before we integrate LLM tools into clinical care."
Rick Evans, senior VP and chief experience officer at NewYork-Presbyterian, says patient engagement and activation are crucial to health systems, and that executives need to focus on confidence rather than complacency.
No member of the healthcare C-suite has been affected more by the shift to consumer-directed care than the chief experience officer, sometimes called the chief patient experience officer.
This role was once defined as one of service excellence, and the executive was responsible for ensuring that the healthcare organization was delivering top-notch service, according to standards established by the health system. But with the rise of patient-centered care, that role has shifted radically around to focus on the delivery of care and services that meet the patient's expectations.
"We now ask ourselves if we're inspiring confidence," says Rick Evans, MA, senior vice president and chief experience officer at NewYork-Presbyterian. "Not happiness, but confidence. And with that, are we providing convenience?"
Rick Evans, senior vice president and chief experience officer, NewYork-Presbyterian. Photo courtesy NewYork-Presbyterian.
Evans has spent seven years as the CXO at NYP, but his 20-plus-year career has always been focused on how the patient interacts with the health system. He spent seven years earlier in his career as vice president of support services and patient-centered care with NYP, then moved up the I-95 corridor to Boston to spend four years as CXO at Massachusetts General Hospital before returning to the Big Apple.
To Evans, the CXO position is now all about technology and communication, though he's quick to add that it's not a technology position. His responsibilities focus on creating an overarching strategy to engage with the patient, and to work with other members of the C-suite to "facilitate good, consistent, clear, and compassionate communication" with patients.
Technology plays a large part in that strategy, and telehealth and digital health have helped to transform that platform into a real-time communication tool. Whereas patient interactions were once measured by phone calls and printed questionnaires, healthcare organizations now have at their disposal a wide range of tools to engage and evaluate ongoing relationships. This includes online surveys, messaging platforms, and other resources that allow the patient to interact on their own schedule.
"We also have a lot more data that can help us make [communications] more meaningful and move the needle [on quality of care]," Evans says.
Patient engagement, as well as the fast-rising concept of patient activation, are measured most often in HCAHPS scores, which come out of the federal HCAHPS Hospital Survey. But while that survey enables a health system to measure itself against other health systems, the precision of digital health tools enables health system executives to drill down and determine what that hospital or network is doing right and wrong in communicating with patients and meeting their needs.
"We want to ask those questions that our patients are uniquely qualified to answer," Evans points out. That, in turn, will go a long way toward creating programs and services that attract and keep patients.
"That messaging is important," he adds. "We're always looking to create that meaningful connection to give [patients] the services they need. You're not in a hotel or Disney World. You're in a hospital."
Patient engagement efforts require a healthcare executive to look both outside the health system and within. Workforce shortages can affect services, which in turn can affect the patient's healthcare experience. Staff stress and burnout can affect morale, which in turn affects the workplace, which in turn can affect what a patient experiences in that environment.
"You can not succeed as a chief experience officer if you do not understand the workflows," Evans says. "Without them we're just blowing into the wind."
And while the pandemic exacerbated those staffing issues, it also highlighted the opportunities of using telehealth to both address workforce gaps and improve access to care for patients. The ability to offer virtual care alongside in-person care, either as a supplement or a replacement, helps patients who face access challenges and who also want more convenience. By giving patients more ways of accessing care, they'll be more inclined to continue their healthcare journey with the health system.
"You're always thinking about sustainability in the patient experience," Evans says.
That said, there's always a chance that a health system will go too far in its attempts to connect with patients. Just because the technology is there to reach out to patients in real time doesn't mean it has to be used that way. CXOs need to map out a strategy that takes into account which communication channel a patient prefers, as well as how often a patient might wish to be contacted and when.
"How do we not get creepy?" Evans asks.
The goal, he says, is to position the health system as a trusted resource, one in which a patient has confidence. Hospitals—and their CXOs—must know when to reach out and how to connect, and offer resources that meet patient needs and expectations.
As healthcare organizations move more services into the home, a 'living lab' smart home in Orlando's innovation community offers ideas on how to integrate healthcare with daily life.
As health systems embrace the value of the home in care coordination and management, a "living laboratory" built in the shadows of Walt Disney World is giving healthcare executives new perspective on how their healthcare programs can better integrate with home life.
The program aims to attract healthcare executives who are moving more services out of the hospital and into the home, as well as those who want to see how a smart home can collect and transmit data that could be used in clinical care management.
"This is a real home in a real neighborhood on a quiet street that is also a living lab," says Gloria Caulfield, vice president of strategic alliances at the Tavistock Group, Lake Nona's developer, and executive director of the Lake Nona Institute, which includes the WHIT House. "And we're always in the loop on what's next."
Gloria Caulfield, vice president of strategic alliances, Tavistock Group. Photo courtesy Tavistock Group.
According to Caulfield and Juan Santos, Tavistock's senior vice president of brand experience and innovation, WHIT House offers healthcare executives a different look at innovation. Each room in the house features a wide array of technological projects, from smart appliances, toilets, and beds, to 3D printers that can print pharmaceuticals or nutriceuticals to the latest in sensor-embedded windows, lighting, water purification, and gardening concepts.
The healthcare industry has taken notice. Nemours opened its children's hospital in Lake Nona in 2012, and has been among the nation's leaders in pediatric care innovation. HCA Healthcare is a partner, says Caulfield, as is the Veterans Administration and the University of Central Florida College of Medicine and the University of Florida College of Pharmacy. Those health systems and companies like Johnson & Johnson, Verizon, and KPMG are all part of the 650-acre health and life sciences park, while the nearby Lake Nona Performance Club puts innovation to the test in fitness and athletics.
Another neighbor is Fountain Life, a recently launched concierge-style healthcare provider that focuses on gathering top healthcare specialists to create centers of excellence for precision care.
According to officials, health systems are particularly interested in bedroom design, especially in pediatric care. As acute care at home programs gain traction, healthcare executives are focused on how patients can be treated in their own beds, rather than a hospital bed, and how bedroom technology can capture and transmit relevant data back to care teams. The same strategy applies to bathrooms, where technology can track medication adherence, dental care, weight and other vital signs, and urinary and bowel output.
Another area of interest is the kitchen, especially as healthcare organizations address social determinants of health in care management. Technology associated with food preparation, hydration, nutrition measurement, and meal tracking can play important roles in a variety of programs, from chronic care management to behavioral health.
Home design is also important to healthcare executives designing programs that allow seniors and those with physical and developmental disabilities to stay at home, as well as for patients needing to rehab at home after a hospital stay.
Caulfield and Santos note that while healthcare organizations across the country are launching innovation centers and labs, WHIT House looks beyond healthcare innovation in the healthcare space to study how it can be integrated into the home and daily life. The idea, says Caulfield, is to make healthcare a natural part of the home, so that it's included in design and building plans and even marketed as such by realtors.
"Health usually isn't a factor in home-buying," says Santos. "And that needs to change. [WHIT House] changes the way you interact with your home. The kitchen, for example, is absolutely full of design details that make it healthier."
Juan Santos, senior vice president of brand experience and innovation, Tavistock Group. Photo courtesy Tavistock Group.
"The whole point of this is that in designing things the way they are we can maybe change behaviors," he adds. "We strive to be a living lab."
"We're a Switzerland health and life sciences cluster," jokes Caulfield, who's also executive director of the Lake Nona Impact Forum, an invitation-only event that aims to elevate the innovation discussion. "We bring in the best people to talk about the most pressing matters in relation to healthcare and innovation. And we want everybody to be a part of that conversation."
That strategy synchs well with two trends in healthcare: The shift in care and services from the hospital to the home and the emphasis on identifying and addressing social determinants of health.
As health systems implement acute care at home and remote patient monitoring programs, they're taking a closer look at the home environment to better integrate medical technology that can gather and send data back to the care team. Smart homes would offer more of those opportunities, from WiFi platforms to sensor-embedded furniture and appliances that could facilitate data gathering and transmission.
And as healthcare providers look to understand the underlying, nonclinical factors that affect clinical outcomes, a smart home that can tell care providers what a patient is eating and how often, how much sleep and exercise a patient is getting, even when a patient uses the bathroom, will add to that wealth of information that can impact care coordination and management.
WHIT House "is continuously working" to validate those tools and technology, says Santos, noting the house schedules themes to highlight certain users or programs, such as aging in place, mental healthcare at home, the bedroom as a reference lab (there are 20 to 30 ongoing tech projects alone in that room, he says) and the importance of good sleep.
"We're actually trying to go beyond smart," he says. "We want to be responsive and be smart with a purpose."
12 healthcare organizations across the country will create a network to develop and test new programs aimed at tackling the nation's high maternal mortality rate.
Twelve healthcare organizations will be creating a network of federally funded research centers aimed at tackling the nation's high maternal mortality rate and promoting maternal health equity.
The health systems were selected by the National Institutes of Health to take part in the Maternal Health Centers of Excellence program, which includes $24 million in first-year funding and a seven-year budget of roughly $168 million. Ten will serve as research centers, while the 11th will serve as a data innovation and coordinating hub and the 12th will be an implementation science hub.
“The magnitude and persistence of maternal health disparities in the United States underscore the need for research to identify evidence-based solutions to promote health equity and improve outcomes nationwide,” Diana W. Bianchi, MD, director of the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), said in a press release. “Through collaborations with community partners and others, the Maternal Health Research Centers of Excellence will generate critical scientific evidence to help guide clinical care and reduce health disparities during and after pregnancy.”
The new program crystallizes an ongoing national effort to curb health issues and deaths among expecting and new mothers and their infants, particularly in underserved populations. The nation saw more than 1,200 such deaths in 2021, or roughly 33 per 100,000 live births, a much higher number than many developed countries.
Several healthcare organizations have launched programs that use digital health and telehealth platforms to address maternal health. These platforms connect care teams to patients on demand at home, enabling those patients to connect with providers and access support and resources when and where they need the help. Some remote patient monitoring programs have also been launched to monitor at-risk mothers and their children during and after pregnancy.
The following health systems will participate as research centers:
Avera McKennan Hospital, Sioux Falls, South Dakota, Maternal American-Indian Rural Community Health (MARCH), principal investigator Amy J. Elliott, PhD.
Columbia University, New York City, NY Community-Hospital-Academic Maternal Health Equity Partnerships (NY-CHAMP), principal investigator Uma Reddy, MD.
Jackson State University, Jackson, Mississippi, Delta Mississippi Center of Excellence in Maternal Health, principal investigator Mary D. Shaw, PhD.
Medical College of Wisconsin, Milwaukee, Addressing Key Social-Structural Risk Factors for Racial Disparities in Maternal Morbidity in Southeastern Wisconsin (ASCEND WI), principal investigator Anna Palatnik, MD.
Michigan State University, East Lansing, Maternal Health Multilevel Intervention/s for Racial Equity (MIRACLE) Center, principal investigator Cristian Ioan Meghea, PhD.
Morehouse School of Medicine, Atlanta, Center to Advance Reproductive Justice and Behavioral Health among Black Pregnant/Postpartum Women and Birthing People (CORAL), principal investigator Natalie Dolores Hernandez, PhD.
Stanford University, Stanford, California, Stanford PRIHSM: Preventing Inequities in Hemorrhage-related Severe Maternal Morbidity, principal investigator Yasser Y. El-Sayed, MD.
Tulane University, New Orleans, Southern Center for Maternal Health Equity, principal investigator Emily Wheeler Harville, PhD.
University of Oklahoma Health Sciences Center, Oklahoma City, Center for American Indian/Alaska Native Resilience, Culture, and Maternal Health Equity, principal investigator Karina M. Shreffler, PhD.
University of Utah, Salt Lake City, ELEVATE Center: Reduction of Maternal Morbidity from Substance Use Disorder in Utah, principal investigator Torri D. Metz, MD.
In addition, Johns Hopkins University in Baltimore will serve as the hub for data innovation and coordination, with Andreea Creanga, MD, PhD, serving as principal investigator. And the University of Pennsylvania in Philadelphia will serve as the implementation science hub, under the direction of principal investigator Meghan Brooks Lane-Fall, MD.
The Sentinel Event Alert, titled "Preserving Patient Safety After a Cyberattack," informs health system leadership on how to react once an attack has been detected.
With healthcare cyberattacks on the rise, the Joint Commission has issued guidance for health system executives on how to react once a data breach has been detected.
The Sentinel Event Alert, titled Preserving Patient Safety After a Cyberattack, lists a number of steps that health system leadership should take to ensure that patient care is safe. One of those most important recommendations is that leadership include all hospital staff in the process, not just IT staff.
“Cyberattacks cause a variety of care disruptions – leading to patient harm and severe financial repercussions,” David W. Baker, MD, MPH, FACP, the Joint Commission's executive vice president for healthcare quality evaluation and improvement, said in a press release. “Taking action now can help prepare healthcare organizations to deliver safe patient care in the event of future cyberattacks. The recommendations in the Sentinel Event Alert, as well as The Joint Commission’s related requirements on establishing and following a continuity of operations plan, disaster recovery plan and more, can help healthcare organizations successfully respond to a cyber emergency.”
The recommendations include:
Evaluate hazards vulnerability analysis (HVA) findings and prioritize hospital services that must be kept operational and safe during an extended downtown.
Form a downtime planning committee to develop preparedness actions and mitigations, with representation from all stakeholders.
Develop and regularly update downtime plans, procedures and resources.
Designate response teams. Create an interdisciplinary team to mobilize during unanticipated downtime events.
Train team leaders, their respective teams and all staff on how to operate during downtimes, including specific incidents that would cause downtime to go into effect.
Establish situational awareness with effective communication throughout the organization and with patients and families.
After an attack, regroup, evaluate and make necessary improvements. Take steps to recover and protect systems.
A digital health collaboration aims to give health systems and health plans access to both virtual visits and on-demand house calls for fragile patients living with cardiovascular disease.
Healthcare organizations looking for a more proactive method of care management for patients with cardiovascular disease should take note of a new collaboration that combines 24/7 virtual access to specialists with house calls.
MedArrive, a Texas-based company active in the mobile integrated health space, is partnering with Heartbeat Health, a New York-based provider of virtual cardiology services. The partnership will give patients access not only to specialists for a telehealth visit but also on-demand EMS providers and specially-trained paramedics for house calls.
The collaboration seeks to address the more than $320 billion, or 15% of the nation's total healthcare budget, spent each year on treating or managing cardiovascular disease (CVD). And it focuses on managing care at home, rather than waiting for patients to visit their doctor or a hospital.
Mobile integrated health and community paramedicine are fast-growing strategies being used by health plans and health systems to improve care and outcomes for so-called fragile patients, or those who often access emergency care services. The concept involves sending trained personnel, such as a paramedic, to a patient's home for on-demand or routine care management, thereby reducing the chance for health concerns that result in a 911 call and transports to the ER.
The MedArrive-Heartbeat Health partnership take particular aim at the Medicaid population, many of which experience barriers to accessing on-demand care. More than 25% of that population is living with CVD, and a significant percentage of that population has a high risk of developing CVD.
"Heart disease may be the number-one killer of all people in our country, but in the intricate web of health disparities, the vulnerability of individuals on Medicaid to heart disease is an undeniable fact," MedArrive Co-founder and CEO Dan Trigub said in a press release. "They face a perfect storm of limited access to quality healthcare, socioeconomic challenges, and systemic inequalities that amplifies their risk.”
Through the partnership, now being marketed to health plans, members living with CVD can access on-demand visits by a MedArrive care team, which can connect via telemedicine to cardiologists employed by Heartbeat Health for further care management and coordination.
"The integrated approach holds significant importance for engaging underserved populations, including people in rural regions or economically disadvantaged urban areas where accessing cardiology care presents greater challenges," the two companies said in the press release.
The chief of pediatric hematology, oncology, and stem cell transplantation at Stanford Medicine Children's Health says new ideas in immunotherapy, stem cell transplants, gene therapy, and gene editing are helping care providers do things they've never done before.
Innovation in pediatric healthcare often focuses on the tiniest of factors affecting the tiniest of patients. And Tanja Gruber, MD, PhD, says research around the makeup and functions of the gene are enabling care providers to get a better idea of how to tackle cancer.
HealthLeaders recently sat down—virtually—with Gruber, chief of pediatric hematology, oncology, and stem cell transplantation at Stanford Medicine Children's Health to discuss innovative ideas like immunotherapy, stem cell transplants, gene therapy, and gene editing, and how they're helping to improve outcomes for millions of children.
Q: What new technologies or strategies are you now incorporating into care management?
Gruber: This is an exciting area of pediatric oncology. The community is very proactive about new science and technology within the clinical space, and that is opening doors to new care models and treatment plans for children and adolescents. Current areas of innovation specific to pediatrics are in immunotherapy, stem cell transplant, gene therapy, and gene editing.
For example, at Stanford Medicine Children’s Health, we have a large chimeric antigen receptor (CAR) T-cell therapy program, which boosts a child’s own immune system to target specific proteins on cancer cells and fight the disease. This has been used for types of leukemia and lymphoma, and there are currently clinical trials exploring this modality for other types of cancers and tumors.
Tanja Gruber, MD, PhD, chief of pediatric hematology, oncology, and stem cell transplantation, Stanford Medicine Children's Health. Photo courtesy Stanford Medicine Children's Health.
This is important because we believe in multi-modality through a combination of treatments, and multi-disciplinary via specialties across the care spectrum. In pediatrics (and pediatric cancer), it’s not enough to treat the disease itself. We must incorporate other healthcare professionals as a part of a long-term, holistic treatment plan – whether physical therapy or mental health. It’s also worth noting that artificial intelligence (AI) is an emerging topic in the pediatric community. The adult field has led the charge here; however, pediatrics is starting to get more involved.
Q: What are the challenges you deal with in using these new treatments?
Gruber: Location or proximity to specialty care facilities and children not being able to administer certain tests for themselves present a new set of challenges. Immunocompromised children also face a plethora of different challenges from their adult counterparts that require unique treatment plans. We saw this during the pandemic. The pediatric community was incredibly cautious around viruses, and relied on vaccinations to help prevent complications that can happen with infections and infectious diseases.
Another growing area of concern is that earlier detection and treating children with cancers earlier in life will likely result in more strain on the healthcare system as they venture into adolescence and adulthood. Survivors need to be monitored post-treatment, they need frequent follow ups, and they need to be watched closely as they grow. Add onto this the physical, mental, and emotional toll that cancer treatment places on the body at a time when children are growing and vulnerable, and you see the critical importance of holistic, multi-disciplinary care.
Q: Do you feel there is enough healthcare innovation directed toward pediatric care, or is it difficult to find the right technology and/or companies to address what you need?
Gruber: Our community is very proactive about pediatric healthcare innovation from a technology and strategies perspective. However, one area that we must continue to advocate for is drug development. We cannot be left out of that conversation. Currently, the industry is looking into mandates and requirements for certain portions of research and development spend to be targeted to pediatrics. This is – and will continue to be – a game changer.
We’ve also seen impressive responses from patients on clinical trials. The conversation is about education. Enrolling children in clinical trials takes on more complexity – how you communicate with families, how you coordinate with research, how you gather consent, how you administer care, and more. I’ve been really impressed with how the pediatric community has provided innovative care opportunities and world-class treatment through clinical trials.
Q: How have advances in stem cell transplants and gene therapy affected pediatric care?
Gruber: A lot of the work with gene therapy has been geared toward inherited disorders as opposed to cancer, but that is shifting. And it will be critically important in the long run to make sure pediatrics isn’t left out of this conversation.
With stem cell transplants, the positive results are clear. A lot of people might not be aware, but this care has been around for decades and is continuing to evolve. In fact, Stanford Children’s Pediatric Stem Cell Transplantation program was established in the 1980s, and we have transplanted more than 1,000 patients since that time.
Currently, we are identifying ways to evolve stem cell transplantation, including using new antibody-based methods instead of traditional chemotherapy or radiation to prepare patients’ bodies for the transplant. As a part of this, we’re working with our community via the Pediatric Transplantation & Cellular Therapy Consortium and the Blood & Marrow Transplant Clinical Trials Network to advance these innovations.
Q: What new technologies or strategies are on the horizon for pediatric healthcare? What are you looking forward to using?
Gruber: A topic that’s being discussed in the industry is early detection. Typically, pediatric and adolescent patients do not have access to earlier screenings, as childhood cancer is rare. That is changing as research shows genetic mutations that drive certain inherited disorders also increase the risk of childhood cancer.
Another example, which is still in its infancy, is identifying predisposition for pediatric patients. This opens up so much opportunity for care. This can be the result of individual testing, family testing, or other genetic warning signs. It encourages adolescents to take control of their healthcare and puts a focus on providers helping patients make a smooth transition into adult care.
We are having ongoing conversations in pediatrics about when to start screenings and how to educate patients and families. We are fortunate at Stanford Medicine Children’s Health as we have access to that transition with our colleagues from Stanford Health Care. As an industry, this isn’t common, so more work needs to be done.
Q: What has surprised you, good or bad, about how technology is incorporated into pediatric care?
Gruber: A wonderful surprise has been how well patients and families are responding to clinical trials – and how our population continues to advocate for pediatric innovation. Speaking to patients and families about how clinical trials and technology innovations can improve care and deliver better outcomes has been a positive experience.
Similarly, seeing the community rally around these initiatives to make sure all patients, regardless of location, are made aware of and have access to state-of-the-art care has been heartwarming. For me, the fact that the patient has not been lost in technology conversations shows the true desire of our pediatric provider community to do whatever it takes to improve outcomes for sick children.
Q: Has technology allowed you to collaborate more with other healthcare providers on a patient's care? If so, how has this improved care?
Gruber: Collaborate is the perfect word to describe how we’re able to improve care, together, with our network of healthcare providers. In California, pediatric patients have access to clinical trials that are funded through philanthropy. Collaboration allows us to extend the reach of our world-class care centers and provide greater access to care throughout rural areas or underrepresented communities.
The pediatric oncology community and Stanford Medicine Children’s Health are mindful about health equity, and there are efforts to leverage resource-rich hubs to help patients and families overcome travel, housing, treatment concerns, and more when it comes to getting cancer care to underrepresented minorities in outlying communities. With the help of philanthropic efforts and initiatives like the Ronald McDonald House, pediatric patients and families who otherwise would typically not be able to participate in clinical trials are supported. This would not be possible without collaboration.
Q: How do you see your role evolving?
Gruber: Patient-centered care, backed by research and innovation, remains at the heart of our roles in pediatrics. However, in recent years, shifts have taken place that put a greater emphasis on communication. Communication, both between researchers and practitioners, as well as between providers and families. With new technology comes a need for education. But technology for technology’s sake doesn’t help patients in the long run.
Encouraging communication between these groups is crucial to ensure research and innovation is targeted, providers feel technology can be applied in a way that makes sense for the patient, and patients are aware of the care options they have and feel comfortable with what lies ahead. You add in the push for multi-disciplinary treatment and the movement for health equity, and those communication lines become even more critical to advancing pediatric care.
The University of Washington School of Medicine and Scene Health are continuing a federally funded project that uses video-based remote patient monitoring to treat people dealing with substance abuse issues at home rather than in a clinic.
Editor's note: This article has been amended to add the annual cost to health systems of medication non-adherence.
A multi-state pilot program overseen by the University of Washington School of Medicine will test whether an innovative remote patient monitoring program for methadone treatment can improve outcomes for patients living with substance abuse.
UW is partnering with Baltimore-based digital health company Scene Health, formerly emocha Mobile Health, on the program, which is funded by a $1.96 million small business innovation research award from the National Institute on Drug Abuse. The pilot will use Scene Health's video directly observed therapy (video DOT) platform, which enables patients to film themselves taking their medication and send that video to their care provider.
The pilot comes at a crucial time for a healthcare industry struggling to address an epidemic in substance abuse and looking for new ways to reach patients at home who can't or won't visit a clinic or doctor's office for regular treatment. Methadone has proven effective in treating opioid use disorder (OUD), but it's commonly taken by patients in a clinic or doctor's office.
It also addresses an issue plaguing healthcare organizations across the board: Medication adherence. Studies have shown that patients need to take their medications at least 80% of the time for that treatment to take effect, yet in the US adherence rates are typically at 50% or lower. RPM and digital health platforms that can boost that adherence rate could help health systems tackle $500 billion in preventable costs each year tied to treatment and hospitalizations.
That's where Scene Health comes into play. The company, spun out of Johns Hopkins, has proven the value of video DOT in treating patients living with hepatitis C, and is partnering with providers and some Medicare and Medicaid MCOs to address remote treatment for hypertension, asthma, diabetes, organ transplants, and sickle cell disease. In addition, the Centers for Disease Control and Prevention (CDC) announced this past March that video DOT meets the standard of care for programs treating patients with tuberculosis.
Some healthcare providers offer doses of methadone that patients can take home, so that they don't have to go to a clinic or office to keep up with their treatments, but federal regulations are very strict, greatly limiting those opportunities. During the pandemic the Substance Abuse and Mental Health Services Administration (SAMHSA) relaxed those rules to allow more home-based treatment, but the old rules are scheduled to go back into effect in May 2024.
Another issue is funding. Some healthcare providers steer clear of methadone treatment because of limited opportunities for reimbursement, and payers want proof that these services, including RPM, improve adherence and outcomes. Congress is considering reauthorizing The SUPPORT for Patients and Communities Act, a set of addiction treatment and recovery services that will expire on September 30 and which include funding for programs that provide remote treatment options.
The UW partnership is the second phase of an ongoing project to prove the value of this platform for treating OUD. The first phase, a 60-day pilot launched during the pandemic, proved the feasibility of the platform and saw a boost in medication adherence, while a subsequent qualitative study proved that the technology was more convenient for both patient and providers and gave patients more opportunities for continuous treatment.
The goal now is to push the platform out on a much larger scale and prove its value as an OUD treatment not only to regulators but to payers.
"Findings from this phase will inform the evidence-based policy changes required to extend the use of video DOT technology for remote monitoring of methadone maintenance therapy, increasing access to care and advancing patient-centric outcomes for individuals with opioid use disorder," Judith Tsui, a professor of medicine at the UW School of Medicine and one of two clinical investigators for the pilot, says in a press release.
"Currently, SAMHSA’s regulations differentiate between a ‘supervised dose’ and a ‘take-home dose,'" says Scene Health CEO Sebastian Seiguer. "This project explores the possibility of creating a middle ground for patients and OTPs: a supervised take-home dose. With the recent declaration by the Centers for Disease Control that remote/video DOT sessions are equivalent to in-person DOT, the time has come to revolutionize methadone treatment."
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