An automated messaging platform helped Penn medicine save two lives per week during the early days of the pandemic by allowing care providers to monitor patients at home.
An automated messaging platform that helped Penn Medicine monitor patients with COVID-19 at home is being credited with saving two lives per week during the early days of the pandemic.
The platform, called COVID Watch, sent AI-enhanced text messages to patients twice a day, asking about their symptoms. If patients reported worsening symptoms, they were sent follow-up questions, then called by designated clinical staff at the hospital, who could recommend hospitalization.
According to a study supported by the National Institutes of Health and the Patient-Centered Outcomes Research Institute (PCORI) and recently published in the Annals of Internal Medicine, nearly 20,000 patients have been monitored at home since the platform was launched on March 23, 2020. In the eight months after the program’s launch, only three of the 3,448 patients died within 30 days of enrollment, compared to 12 patients in a similar-sized group who weren’t in the program, and five died within 60 days, compared to 16 outside the program.
The research team, from Penn Medicine’s Perelman School of Medicine, concluded that COVID Watch reduced a patient’s chances of dying by 68 percent, and that 1.8 lives per 1,000 patients were saved over the first 30 days and 2.5 patients per 1,000 were saved at 60 days.
“Automation isn’t something that will replace human clinical care, but it is something that can extend it,” David Asch, MD, a co-author of the study and executive director of the Center for Health Care Innovation, said in a press release. “Without an automated system to help us watch over the thousands of COVID patients in our community, our doctors and nurses would have been stretched even thinner than they were. This is a promising model for the future.”
Penn Medicine’s program fits neatly into the strategy behind remote patient monitoring, or expanding care management options for patients at home instead of admitting them to a hospital or waiting for them to visit their doctor’s office or a clinic. By creating a platform that uses automated and intuitive messaging to connect with them twice a day, the health system is able to monitor them daily and take action if they’re trending downward. The platform is designed to catch patients before they become serious and require hospitalization.
To manage the program, the health system created a small team of nurses focused on tracking those patients at home. Those nurses can very easily track 1,000 patients around the clock, as well as provide support, such as helping to arrange tests and discussing the results.
“At the beginning of the pandemic, we instinctually thought patients needed extra support at home, even if they weren’t sick enough or ill yet. And if they were to get very sick, we wanted to help them get to the emergency department earlier, so COVID Watch was our solution,” Krisda Chaiyachati, MD, medical director of Penn Medicine OnDemand, an assistant professor of m and co- primary investigator of the study, said in the press release. “Our evaluation found that a small team of five or six nurses staffing the program during some of the most hectic days of the pandemic directly saved a life every three to four days.”
Researchers also noted that the platform works well across all populations, including communities that traditionally face barriers to accessing care.
“We saw a higher proportion of higher-risk patients and also low-income and Black patients enrolled in COVID Watch, but the fact that we measured a significant benefit associated with enrollment in the program is a good indicator that there truly is a treatment benefit for everyone,” M. Kit Delgado, MD, an assistant professor of emergency medicine and epidemiology, deputy director of the Penn Medicine Nudge Unit, and the study’s lead author and co-primary investigator, said in the press release. “It’s crucial that we found all major racial and ethnic groups benefited because non-white and low-income communities have had disproportionately higher infection rates, lower access to care, and higher death rates. This implies that this model of care could have reduced disparities in COVID outcomes if it was scaled up more broadly to these communities.”
Penn Medicine officials noted the platform was originally modeled to monitor at home patients living with chronic obstructive pulmonary disease (COPD), and was redesigned to handle COVID-19. Now they’ll look to see how the platform can be reconfigured to monitor other patient populations, such as those with chronic care needs.
Intermountain Healthcare and several other healthcare providers are using drones to deliver prescriptions, medical supplies, and telemedicine platforms.
Intermountain Healthcare will be using drones to deliver prescriptions and other medical supplies to homes in and around Salt Lake City.
The multi-state health system, based in Salt Lake City, has announced a partnership with Zipline, a San Francisco-based medical product delivery company. The deal will enable Intermountain to used drones to ship specialty pharmaceuticals and homecare products to homes within 50 miles of the health system’s distribution center.
“Making access to healthcare faster and more convenient will lead to better health outcomes for our patients,” Intermountain President and CEO Marc Harrison said in a press release.
“Patients can connect with providers from the home, and then receive the medications and supplies they need in a matter of minutes, directly to their doorsteps,” said Keller Rinaudo, co-founder and CEO of Zipline, which has facilitated more than 200,000 drone deliveries and is currently involved in programs in Ghana and Rwanda. “For example, a cancer patient could receive her medication without ever leaving her home. Or a single parent could get his child’s antibiotics without a trip to the pharmacy. Instant access to care is not just about convenience. It comes down to making healthcare more equitable, efficient, and reliable for people, regardless of where they live or their circumstances.”
Health systems have been experimenting with drones over the past few years to deliver medical supplies to remote locations and facilitate the transfer of time-sensitive lab tests and specimens from one healthcare site to another, particularly in congested areas such as Los Angeles or regions with rough terrain such as the Rockies or Appalachians.
WakeMed Health & Hospitals in North Carolina, University of Utah Health, and Kaiser Permanente are all working with UPS to use drones as healthcare delivery vehicles, while CVS Health has partnered with UPS Flight Forward to use drones to deliver prescriptions to residents of The Villages, a Florida retirement community of more than 135,000 residents.
In San Diego, the Rady Children’s Institute for Genomic Medicine has been working with Deloitte to study how drones might improve care for seriously ill children. And researchers at the University of Cincinnati launched a program aimed at using drones to make telehealth house calls. The program, still in pilot phase, would send drones equipped with an audio-visual telemedicine platform and a waterproof compartment for carrying supplies or test samples into homes.
“When the COVID-19 pandemic began, we saw a need for telehealth care delivery drones to provide healthcare in the home and in locations where access to care is not readily available,” Debi Sampsel, telehealth director for UC’s College of Nursing, said in a new release supplied by the university.
Intermountain officials expect to develop the program in early 2022 and launch it by mid-year.
Gov. Phil Murphy says payers should be able to negotiate payment for telehealth services with healthcare providers.
New Jersey Gov. Phil Murphy has tapped the brakes on payment parity for telehealth, telling supporters he’s hesitant to make permanent a tactic that has been an emergency measure during the pandemic.
Murphy, a cautious supporter of telehealth in the past, has conditionally vetoed SB 2559, which would have mandated that payers – including the state Medicaid program – reimburse healthcare providers for telehealth services at no less than the rate they pay for in-person services.
“Approving this bill would amount to a very heavy thumb on the scale in favor of providers vis-à-vis carriers, in an area traditionally left to private negotiations,” he said in a lengthy notice attached to the veto. “Moreover, the cost to carriers – which would be felt both by those paying 3 premiums and taxpayers alike – could be substantial. And, while the cost of providing telehealth may be the same as or higher than the cost of providing in-person care in the short term, providers could realize significant cost savings over the long term, as expanding telehealth options might bring reductions in clinical space, support staff, and other expenses.”
Long a controversial strategy, payment parity has become popular during the pandemic as means of convincing hesitant care providers to try out telehealth, with the promise that they’ll be paid at the same rate as for in-person care. But opponents, including many in the insurance industry, say payers should be able to negotiate their own reimbursement rates, and that telehealth over the long run will actually reduce costs and save money.
Murphy’s action keeps the state’s current payment parity mandate in place through the end of 2023 to give the state Department of Health time to study the issue and make a policy recommendation, and to give lawmakers the time to decide whether they want to revise the legislation. Murphy also said that he would be recommending amendments to the Legislature “to remove some of the restrictions placed on carriers in order to ensure that carriers continue to have the flexibility they need to adapt to changing circumstances.”
Murphy’s veto isn’t unique. While most states and the federal government enacted a flurry of emergency rules to expand telehealth coverage and access during the height of the pandemic, many of those measures are ending. Some states have made those rules permanent, particularly for mental health and substance abuse services, while others are waiting on the federal government to enact long-term telehealth policy.
Telehealth advocates worry that an abrupt end to these emergency measures will force health systems to discontinue telehealth programs and patients to lose access to needed services. Opponents say the measures may have worked well during the pandemic but won’t be successful in the long run.
Murphy took a similar tack with proposals to allow medical marijuana providers to prescribe via telehealth. The governor initially vetoed the proposed legislation earlier this year, saying it created too many legislative hoops to jump through. He approved an amended bill in July.
Murphy argues that the concept of payment parity is good, in that it forces payers, providers and patients to think of telehealth on the same level as in-person care. But the concept hasn’t been fully thought out, and it might do more harm than good in the long run, he says.
“We do not yet have a full understanding of whether or how pay parity could negatively affect patients,” he said. “Notably, the federal Centers for Medicare & Medicaid Services has not yet taken a permanent position on pay parity. And, although providers must meet the same standard of care for telehealth as for in-person care, the quality of care could be impacted. In the short term, the flexibility afforded by expanded access to telehealth has greatly benefited New Jersey residents who may not have the time or resources to receive in-person care when local in-network options are limited. But I am concerned that in the long term, pay parity could over-incentivize telehealth, further limiting in-person options. This could be especially detrimental for those in underserved communities.”
The Federal Communications Commission is issuing awards to 75 healthcare organizations through the COVID-19 Telehealth Program, which helps providers in launching or expanding telehealth platforms to address healthcare access issues cauded by the pandemic.
The Federal Communications Commission has announced 75 more awards to help healthcare providers use telehealth technology to address healthcare needs during the pandemic.
The FCC announced the fourth round of awards from the COVID-19 Telehealth Program, which was originally launched in 2020 to help providers acquire telecommunications services, information services, and connected devices to improve access to care. The agency had been given $200 million in 2020, ran out of money in the middle of the year, and was given roughly $250 million from the Consolidated Appropriations Act at the end of 2020 to continue the program this year.
With this week's announcement, roughly $166 million has been awarded to 280 programs, with at least one program in every state and territory and the District of Columbia receiving funding. The FCC's Wireline Competition Bureau will now give the remaining applicants time to revise their applications before choosing more awards.
"Advances in telehealth continue to help bridge the gap in health care for our most vulnerable populations and keep Americans connected with their doctors, nurses, and health care providers in the face of the pandemic," Acting FCC Chairwoman Jessica Rosenworcel said in a press release accompanying the third round of awards announced last month. "With today's announcement, the FCC has approved more than $123 million in applications for Round 2 of its COVID-19 Telehealth Program—nearly half of the amount allotted in the 2021 Consolidated Appropriations Act. We remain committed to helping facilitate even more innovative health care efforts in every corner of our country."
The program is designed to reimburse healthcare providers for certain expenses tied to expanding connected health platforms during the ongoing COVID-19 pandemic, and to help underserved populations access care through technology. Providers are required to submit detailed invoices to qualify for reimbursement.
The program runs alongside the FCC's Connected Care Pilot Program, a separate, $100 million effort to use technology to improve access to care for underserved populations, especially veterans and those in rural regions. The FCC had announced a third round of awards in late October.
The Centers for Medicare & Medicaid Services is making it easier for healthcare providers to use telehealth – including the telephone – to deliver mental health and substance abuse care to patients in their homes.
The Centers for Medicare & Medicaid Services is expanding coverage for the use of telehealth technology in underserved areas and for the delivery of mental health services.
In its final rule for the 2022 Physician Fee Schedule, released this week, the agency has amended its rules to allow beneficiaries to receive care in their homes "for the purposes of diagnosis, evaluation, or treatment of a mental health disorder." This ends the long-debated practice of excluding a patient's home from the list of originating sites for telehealth services, and gives providers the opportunity to craft telehealth programs that reach patient where they live.
As part of that service, CMS is mandating that the provider and patient must meet in person at least six months prior to adopting virtual visits, and that an in-person exam be conducted at least once every 12 months thereafter, with some exception allowed due to "beneficiary circumstances."
The agency is also changing its definition of telehealth to include audio-only platforms, the most common of which is the telephone, for these home-based telehealth visit for mental health services. The move reflects a surge in telephone use during the pandemic, when providers were replacing in-person care with telehealth visits and patients were looking for easier ways to access care—especially in dealing with stress, depression, anxiety and substance abuse.
"The COVID-19 pandemic has highlighted the gaps in our current healthcare system and the need for new solutions to bring treatments to patients, wherever they are," CMS Administrator Chiquita Brooks-LaSure said in a press release. "This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options."
CMS officials emphasized that coverage for audio-only telehealth services is limited to mental healthcare services furnished by providers who use two-way audio-visual telehealth platforms (often called video visits), but whose patients either can't or don't want to use that platform. The agency is also clarifying that mental health services can include treatment for substance use disorders (SUD).
The agency is making permanent several measures enacted during the ongoing public health emergency (PHE) caused by the pandemic to expand telehealth access and coverage. And the moves come as both federal and state lawmakers look to establish long-term policies that combine in-person care with technology platforms that improve access to care, including telehealth and remote patient monitoring.
The efforts address a surge in mental health and substance abuse issues tied to the pandemic, and the reluctance of many healthcare providers to embrace telehealth without reimbursement, especially in treating underserved populations who rely on Medicare and Medicaid.
In this vein, CMS is also establishing permanent coverage for mental health services delivered via telehealth through federally qualified health centers (FQHC) and rural health clinics (RHC), two types of care providers that have traditionally targeted underserved populations, but which haven't been reimbursed for telehealth services.
On a related note, the agency is extending dozens of telehealth services allowed during the PHE through the end of 2023. Coverage for those services would have expired at the end of 2021, but CMS has said it wants more time to study how these services have impacted care delivery and clinical outcomes. The move gives providers more time to gather data on the effectiveness of their telehealth services, which could be used to convince CMS to make coverage permanent.
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