A study conducted by Stanford Medical found that hypertension patients who shifted from in-person care to virtual visits during the height of the pandemic were better able to manage their blood pressure.
More than three-quarters of hypertension patients who accessed a virtual care platform during the height of the pandemic saw an improvement in blood pressure management, according to a study recently published in a Mayo Clinic journal.
The study, conducted by Stanford Medicine’s Shriram Nallamshetty, MD, and researchers from San Francisco-based Included Health, focused on roughly 570 patients who switched from in-person visits to video visits offered by Included Health between March 2020 and February 2021. It found that 438 patients, or 77% of the group, saw improvements in their blood pressure readings, with a majority seeing improvements of more than 10%.
“With recent reports that rates of adequately controlling hypertension in the US have declined over the last decade, virtual care has demonstrated to be an effective model to provide improved hypertension care,” Nallamshetty, who co-authored the study, published in this month’s Mayo Clinic Proceedings: Innovations, Quality & Outcomes, said in a press release. “For chronic conditions like hypertension, we must consider the impact of the virtual care model in raising the standards of care for all patients.”
According to the Centers for Disease Control and Prevention, roughly 47 percent of American adults are diagnosed with hypertension, and yet only one in four have their blood pressure under control. Both of those numbers have risen significantly during the pandemic, which has kept patients from accessing in-person care and caused more to become less vigilant in managing their blood pressure.
Healthcare organizations and digital health advocates are pointing to studies like the Stanford research that indicate virtual care can take the place of in-person care when needed, and can even improve care management by allowing patients and their care providers to connect and collaborate more frequently and conveniently.
Through a virtual platform, patients can also access other care management resources, and providers can support treatment by emphasizing the value of diet and exercise in hypertension management.
“The results of this study suggest that a holistic approach to hypertension management, attending to lifestyle changes and appropriate medications, is effective through virtual video primary care visits nationwide,” the study concluded. “We did not find notable differences between patients in terms of rural or metro location, sex, ethnicity, or other factors, other than adherence to therapy.”
Faced with a surge in virtual visits and a growing population of limited English proficiency (LEP) patients, clinicians at Massachusetts General Hospital developed a three-pronged approach to tackling the language barrier and improving access to care for underserved populations.
Healthcare organizations may see virtual care as the key to helping underserved populations access care, but things don’t work so well if those patients have problems understanding English.
With a surge in virtual care caused by the pandemic and a growing population of limited English proficiency (LEP) patients, clinicians at Massachusetts General Hospital launched new protocols to make sure the Boston-based health center was reaching people who needed to be reached. The developed three specific strategies aimed at tackling what could be a considerable barrier to care.
“With an increased reliance on virtual care for health care during the pandemic, it’s important to make sure we are not increasing disparities for patients who have language barriers,” Aswita Tan-McGrory, MBA, MSPH, director of the Disparities Solutions Center and administrative director of the Mongan Institute at MGH, said in a press release. “Also, addressing challenges with these three strategies will actually increase care and access for all patients.”
“We really had to put ourselves in the patient’s shoes and walk through all workflows to make sure language and health literacy needs were being addressed,” added Esteban A. Barreto, PhD, MA, director of Evaluation of Equity and Community Health at MGH. “Our findings suggest that as health systems continue to address such needs, patients with limited English proficiency should be able to have an active role in managing their own health which, in turn, may positively impact their health.”
First, the team identified the five top languages spoken by MGH’s patient population and launched a targeted campaign in multiple languages aimed at reaching people with limited technology and health literacy. The campaign was designed to extol the benefits of MGH’s digital health channels and giving them an easy pathway to enrollment.
In addition, the health system made 43 Amazon Fire tablets available through an affiliated community health center to patients with LEP and technology barriers, and paired participants with a bilingual students intern to learn how to use the tablet to access healthcare resources.
“We have successfully enrolled our first cohort of patients, and the pilot is still ongoing and will provide insights and recommendations for engaging patients with LEP in accessing virtual visits,” Tan-McGrory and her colleagues said in the article. “Our feasibility pilot highlighted that creative solutions may need to include a partnership with payers, community-based organizations, and faith-based organizations to provide broadband hotspots that patients can use to access virtual care.”
Second, to address privacy concerns from patients, MGH created a script that described how the health system protects information through the Health Insurance Portability and Accountability Act (HIPAA), and under what circumstances patient information can be shared. They also created cards in multiple languages outlining he rights and protection of immigrants under the US Constitution. Finally, the team identified a need to educate clinicians about whether and how to ask patients and family members about their immigration status.
“They also should avoid documentation of such status on a patient’s medical record to reduce stigma or unnecessary risk should immigration enforcement officers obtain access to the medical record,” Tan-McGrory and her team pointed out.
Third, MGH partnered with Doximity to develop a browser-based platform, one that doesn’t require the user to download an app, that can be used to create customized text messages in different languages and initiate a video visit. That platform can also be used to link in medical interpreters, either in advance or on demand. Finally, the health system customized its EHR platform to allow virtual visits that include interpreters, including third-party interpreters if none are available in-house.
“Healthcare organizations will undoubtedly rely heavily on virtual visits to provide patient care in the future,” the team concluded in its article. “As such, they will need to take all these challenges into consideration if they are to provide high-quality care and address disparities for patients with LEP.”
“Unfortunately, virtual visit platforms and systems are by default built for the technology-literate, English-speaking patient who has a smartphone, tablet, and/or computer,” they added. “Given the likelihood that payment reimbursement for audio-only visits will be reduced or discontinued after the public health emergency ends, healthcare organizations and policy makers should consider the impact on access to virtual care for those without broadband or technology. Ideally, systems, workflows, and platforms must be reviewed by staff who have the lived experience of low digital literacy, language barriers, and lack of access to technology or broadband. We have recently partnered with CRICO, our medical malpractice insurer, to develop best practices for the conduct of virtual visits.”
Along with Tan-McGrory, the lead author for the report, and Barreto, the senior author, the team included Lee H. Schwamm, MD, Christopher Kirwan, PhD, and Joseph R. Betancourt, MD, MPH.
The platform, developed in France and used now in Europe and Canada, will enable health systems in the US to conduct ultrasounds via telemedicine, expanding the reach to remote and rural patients and improving diagnoses and clinical outcomes.
A New Jersey health system will be the first in the country to offer digital health-enabled ultrasound technology developed in France.
Officials at the Robert Wood Johnson University Hospital (RWJUH), part of the RWJBarnabas Health health system, and Rutgers Robert Wood Johnson Medical School (RWJMS) say the MELODY platform enables providers to conduct imaging through a telemedicine platform, enabling patients to access the service in more locations and providers to improve clinical outcomes.
“Imagine that a patient comes to an Emergency Department in the middle of the night and there are no sonographers present to perform the imaging exam that he or she needs,” Partho Sengupta, MD, FACC, Chief of Cardiology at RWJUH and the Henry Rutgers Professor of Cardiology and Chief of the Division of Cardiology at RWJMS, said in a press release. “In the very near future, we can connect with a sonographer at another hospital or from their home to perform a cardiac ultrasound exam that could be lifesaving.”
The platform, approved for clinical use by the US Food and Drug Administration and already being used in Europe and Canada, consists of a robotic arm, the ultrasound machine and video conferencing technology that allows clinicians at different locations to communicate with the patient. It was developed by AdEcho Tech, based in Naveil, France.
By incorporating digital health capabilities, executives say the platform not only allows smaller, rural and remote health systems to conduct ultrasounds, but also allows them to connect virtually with specialists who can facilitate more and better diagnoses.
Sengupta said integrating AI technology into the platform could improve the service even more, giving providers a more robust clinical decision support tool.
“Many cardiovascular diseases remain undetected for a long time and can be silent killers,” Sengupta said. “Combining robotic tele-ultrasound technology with new and existing AI capabilities will provide us with a tremendous opportunity for early detection and treatment of cardiovascular disease in our communities and help us save lives.”
Executive say the platform also helps to address the chronic shortage of ultrasound technologists and sonographers in the country, reduces injuries and strain caused by repetitive movements in manual ultrasounds, and could reduce exposure to infectious diseases like COVID-19 and radiation.
Clinicians at the two hospitals tested the platform in January, and are working to make the service available to patients later this year.
Baptist Health in Arkansas is adapting digital health tools and platforms to improve inpatient care, a pathway that may change how hospitals of the future do their business.
Virtual care technology is giving health system administrators new ideas on how to deliver care inside the hospital.
Baptist Health is one of many health systems using digital health to improve its ICU services and connect care providers throughout the Arkansas-based 11-hospital network, improving care at the bedside and enabling small, rural hospitals to reduce transfers and care for more patients. Executives say the platform, which has been in use for roughly 14 years, allows them to coordinate care from the main hospitals in Little Rock and give outlying hospitals with fewer resources the support they need.
"We're improving care at the bedside," says Kourtney Matlock, corporate vice president of population health. "We can expand our specialists' reach beyond our Little Rock locations and help [rural sites] keep more of their patients."
That's especially important as the health system deals with the pandemic, which has filled up hospital beds and strained workloads. And it will be important beyond COVID-19, as hospitals look to move services onto virtual platforms and reconfigure inpatient care so that those occupying hospital beds are the ones who really need hospital-based care.
"This isn't just about how we use technology," says Danny Kennedy, the health system's IS field services manager. "It's about how we use our hospitals."
Kourtney Matlock, corporate vice president of population health, Baptist Health. Photo courtesy Baptist Health.
As the healthcare industry moves toward the concept of hospitalizing the sickest patients, it's turning the concept of remote patient monitoring around. Telemedicine platforms and digital health tools are being deployed within the hospital setting to capture more patient data and send it directly to who most needs it, no matter where that care team member is located. That may be the nurse down the hall at a central station who's keeping track of all the patients in a specific area, the hospitalist in Little Rock assigned to watch patients in a small hospital a few hundred miles away, or the specialist who's keeping an eye on a patient with complex care needs at another hospital.
Matlock says Baptist Health had been using a physician group in Israel to remotely monitor its ICU patients up until 2019, when it shifted to a model that kept its care providers within the health system. That's been part of a long-term strategy, she says, to develop inpatient virtual care that makes the best use of staff and allows clinicians to practice at the top of our license.
"We've had a lot of these conversations for years," she says. "We want to be able to utilize our staff differently" and create workflows that benefit them.
Both Matlock and Kennedy say Baptist Health has had many physician champions for virtual care, but there were also a lot of clinicians who didn't want to move in that direction.
Danny Kennedy, IS field services manager, Baptist Health. Photo courtesy Baptist Health.
"A lot of physicians were skeptical at first," Kennedy says. "We could just never get them on board prior to COVID. Now they're coming to us."
The pandemic changed that, bringing not only clinicians but entire health systems into the digital health ecosystem and cramming five to 10 years of innovation into two years. And while technology was trained on caring for infected patients and reducing the chances of exposure for care teams, forward-thinking health systems were eyeing strategies that took them beyond the pandemic, where digital health would be used inside the hospital to refine and direct care to where it would be most needed.
That requires a different way of thinking, and one that is challenging health system leaders to recognize that tomorrow's hospital will be considerably different. It will involve more integration, as services are coordinated through digital health channels, and an understanding of how nurses and doctors can be redeployed to improve care management.
Remote patient monitoring will play a significant part in the reimagined hospital of the future, where patients receive more care at home. But that's still a ways off. Matlock notes that Baptist Health had been using an RPM program since 2003, but dropped it roughly two years ago because reimbursement wasn't there to support the service.
"It'll be back," she says. "I see it as one big offering."
It may also include the hospital-at-home concept being shepherded by the Centers for Medicare & Medicaid Services, which combines RPM, telehealth, and in-person services to care for patients at home who might otherwise be in the ICU. That could help hospitals relieve stress on inpatient services and give more patients an opportunity to recover at home, where studies have shown they tend to have more positive clinical outcomes.
Matlock expects that Baptist Health will use some of the technology and strategies they're now using in their ICUs to transition into a hospital-at-home program.
For now, the health system is focusing on the inpatient network. This includes coordinating care with the smaller, more remote hospitals in their network, where ICUs are either small or nonexistent and a patient transfer to a larger hospital might take dozens of phone calls. Linking to the larger hospitals in and around Little Rock enables those small hospitals to expand their ICU capabilities, even create ICU beds where they didn't have any, and care for more patients, keeping them closer to home and their families instead of shipping them off somewhere distant.
In some cases, Baptist Health is using telemedicine carts to manage care, and many rooms are being equipped with tablets that synch with a virtual care platform developed by New Jersey-based Caregility and the health system's Epic EHR, allowing not only providers to connect with the patient record but giving patients a means of connecting with friends and family, or for those who need interpreters.
"That was a big satisfier for us," says Kennedy.
He also notes that some clinicians were hesitant to embrace monitoring and caring for patients in other hospitals, fearing it would add to their workloads and be unreliable. But many were convinced as they used the technology, he says, and worked with clinicians in those other hospitals to coordinate care.
"Everyone is a lot more receptive to the concept now that they've used it," he says.
The platform has also allowed Baptist Health to expand the reach of its specialists, giving those smaller hospitals access to pulmonologists, infectious disease and wound care experts, and lactation consultants—neurology consults are being handled through a third party—with more services on the way. This once again allows those smaller hospitals to provide more and better care for the people in their surrounding communities, an important factor at a time when many small hospitals are struggling to stay afloat.
Matlock says Baptist Health has been contacted by other healthcare systems about those services, but currently doesn't have the staff or the bandwidth to expand. She says the health system might someday fine-tune its platform to a point where it can market those services through a new business line.
All that is in the future, of course. But it's tucked into a long-term strategy that mirrors the direction of the healthcare industry. Health systems need to reimagine how care is delivered, expanding the platform to cover patients no matter where they need that care, and offering services that interact with the communities they serve. The hospital may sit at the geographical center of that platform, but it will no longer be where everyone goes to get care.
Researchers at the University of California at San Francisco have developed an AI tool embedded in the EHR that can help clinicians identify which patients don't need to be woken up during the night to check on vitals.
An EHR tool that uses AI to predict vital signs could be used in hospitals to reduce nighttime check-ups and give patients a better chance to geta good night’s sleep.
That’s the take-away from the study conducted at the University of California at San Francisco and published in JAMA Internal Medicine. It points out that the clinical decision support tool could be used to identify low-risk or stable patients and reduce overnight disruptions in sleep, thus improving the patient’s health and well-being and preventing sleep issues like insomnia.
Researchers analyzed data from more than 1,900 patient encounters involving about 1,700 patients at UCSF between March and November of 2019, and created an algorithm that measures sleep promotion vitals (SPV), or normal nighttime vital signs. When embedded in the EHR, the algorithm could alert care team members that the patient has a 90% chance of maintaining normal vital signs overnight.
“No difference was found between groups in delirium incidence, but physicians usually agreed with the assessment of the clinical decision support tool and therefore discontinued overnight vital sign checks,” the researchers reported. “The intervention group experienced 31% fewer vital sign checks per night with no change in the rates of intensive care unit transfer or code blue alarms.”
The idea is to use technology to better manage data coming in to clinicians and refine workloads to cut out unnecessary tasks or identify important ones. With this particular CDS tool, clinicians could reduce unnecessary disruptions for some patients and concentrate overnight care teams on patients needing more strenuous monitoring.
This could also improve patient engagement and clinical outcomes, due in large part to the positive effects of a good night’s sleep.
The research was led by Nader Nafjani, MD, of the UCSF Department of Medicine, and supported by colleagues Mark J. Pletcher, MD, MPH, and Sajan Patel, MD, as well as Andrew Robinson, BS, from the University of California at San Francisco Medical Center.
Health Net has awarded a $3 million grant to Hazel Health to expand its virtual care platform into another 200 elementary schools in 10 California counties.
A California health plan is investing $3 million in school-based virtual care.
Health Net announced earlier this month that it has awarded a $3 million grant to Hazel Health, enabling the telehealth company to expand virtual primary and behavioral healthcare services to some 200 K-12 schools in 10 California counties.
The award comes at a time when school-aged children are under immense pressure, due in large part to the pandemic, which has interrupted in-person learning and strained home life. In many cases, school districts have sought to keep their healthcare services open during shutdowns or shifts to online care on the belief that children need that access to care.
"At no time in any of our lives has access to meaningful health services been more important for children," Travis Gayles, chief health officer of San Francisco-based Hazel Health, said in a press release. "Every child should have access to high quality health care no matter their zip code or family income. Hazel's platform has enormous potential to close the gaps in healthcare equity, and we are thrilled that Health Net's sponsorship will help advance that critical goal."
Hazel Health, which reportedly serves some 2 million children in school districts in several states, is working with roughly 130 school districts in California. In Health Net, the company is partnering with a health plan that’s part of the state’s Medi-Cal program, which provides resources for the state’s most underserved populations.
Aside from offering access to healthcare services for children who might not have that access through family channels, virtual care platforms give schools an opportunity to care for students and staff on-site, rather than discharging them to seek care at a doctor’s office or clinic 9and putting more strain on student’s families). They can also offer much-need behavioral health or chronic care management services.
Advocates say these services reduce absentee rates and improve student health and engagement, which in turn boosts test scores and morale. According to Health Net officials, students accessing school-based virtual care services return to class 85% percent of the time, resulting in about 2,300 saved hours of education time.
The two companies are partnering on an innovative program addressing the social determinants of health, with a service that offers free transportation to consumers to healthcare appointments and other resources.
CVS Health is partnering with Uber Health on a new program to tackle a persistent barrier to healthcare access: Transportation.
The two are joining forces to help consumers use free ride-sharing services to access medical care and other services. The program will launch first in Atlanta, Hartford and Columbus, OH, with plans to expand to other areas later.
"We've long known that access to reliable transportation can help address critical gaps in care that often disproportionately affect vulnerable communities,” Caitlin Donovan, global head of Uber Health, the healthcare arm of the San Francisco-based ride-sharing company, said in a press release. “With the past two years of the pandemic only further highlighting today's health inequities, it's more important than ever for communities to have the tools they need to bridge care gaps and achieve better patient and population health outcomes."
The partnership is one of many unique and innovative programs aimed at addressing the social determinants of health, factors outside the clinical orbit that affect health and wellness. CVS Health, based in Rhode Island, is addressing six of those factors – transportation, food, employment, education and housing – in its new Health Zones program, which will use and integrated strategy to tackle those issues.
"Our Health Zones initiative allows us to make a real impact on the health of communities across the country by working closely with organizations that share our commitment to addressing social determinants of health," Ellen Howard Boone, senior vice president of corporate social responsibility and philanthropy and chief sustainability officer for CVS Health, said in the press release. "With the Uber Health platform, we'll provide critical transportation to people within communities who need it most, giving them access to healthcare services so they can live healthier lives and to jobs and educational programs that can help them reach their full potential."
CVS Health is launching this program in five communities to start: Atlanta, Columbus and Hartford, as well as Fresno, CA, and Phoenix.
The announcement comes as Uber Health strengthens its healthcare arm with the hiring of its first-ever chief medical officer, Dr. Michael Cantor, and partnerships with digital health companies Papa, which links seniors with college-aged caregivers, Surgo Ventures, which addresses maternal health issues, and ScriptDrip, which focuses on medication delivery.
Health system executives are taking a close look at the social determinants of health as well, as they can affect not only access to care but clinical outcomes, particularly in underserved populations. Along with forging partnerships to address barriers, they’re also using digital health tools and platforms to boost access to care.
CVS Health’s program comes as the pharmacy chain positions itself in the rapidly growing field of retail locations offering healthcare services, alongside the likes of Walgreens, Walmart and Amazon and either in competition or partnerships with health systems. They’re looking to attract business through the direct-to-consumer telehealth market as well as with health plans who can include these services for their members.
The Cincinnati-based eye benefits company has agreed to pay $600,000 and enhance several privacy and security protocols following a data breach that affected some 2.1 million patients in the US
In a deal with AG Letitia James, EyeMed Vision Care agreed to pay the fine as well as adhere to several conditions:
Maintaining a comprehensive information security program that includes regular updates to keep pace with changes in technology and security threats, as well as regularly reporting to the company's leadership any security risks;
Maintaining reasonable account management and authentication, including requiring the use of multi-factor authentication for all administrative or remote access accounts, and reviewing such safeguards annually;
Encrypting sensitive consumer information that it collects, stores, transmits and/or maintains;
Conducting a reasonable penetration testing program designed to identify, assess, and remediate security vulnerabilities within the EyeMed network;
Implementing and maintaining appropriate logging and monitoring of network activity that are accessible for a period of at least 90 days and stored for at least one year from the date the activity was logged; and
Permanently deleting consumers’ personal information when there is no reasonable business or legal purpose to retain it.
“New Yorkers should have every assurance that their personal health information will remain private and protected,” James said in a press release. “EyeMed betrayed that trust by failing to keep an eye on its own security system, which in turn compromised the personal information of millions of individuals.”
According to the complaint, unknown hackers gained access at an EyeMed e-mail account in June 2020 for about a week, enabling them to search certain records dating back six years. The hackers used that information to send roughly 2,000 phishing e-mails in July, seeking log-in credentials for more accounts. The company spotted the e-mails, shut down the hackers’ access and began informing affected customers in September.
“The Office of the Attorney General determined that, at the time of the attack, EyeMed had failed to implement multifactor authentication (MFA) for the affected email account, despite the fact that the account was accessible via a web browser and contained a large volume of consumers’ sensitive personal information,” James’ office said in the press release. “Additionally, EyeMed failed to adequately implement sufficient password management requirements for the enrollment email account given that it was accessible via a web browser and contained a large volume of sensitive personal information. The company also failed to maintain adequate logging of its email accounts, which made it difficult to investigate security incidents.”
The breach affected 98,632 New York residents, the AG’s office said.
EyeMed is part of the global Luxottica eyewear and eyecare chain.
Coordinated Behavioral Care, a provider-led nonprofit, is trying out new technology and tactics to help patients transition back into their communities.
Healthcare organizations are discovering that they need a lot more data than what can be found in the medical record to treat patients with behavioral health issues, and they're using digital health tools and platforms to improve that process.
At Coordinated Behavioral Care (CBC), a provider-led collaboration of 16 nonprofits in New York City, care providers are using a variety of tools and platforms in treatment, including email and messaging, virtual visits, and ride-sharing resources.
"People do not belong in the hospital," says Barry Granek, LMHC, senior director of CBC's Pathway Home program. "They belong in the community, and we are doing everything we can to make sure that can happen."
CBC is among the hundreds, if not thousands, of healthcare organizations nationwide to take aim at the social determinants of health, those factors that sit outside the clinical realm but have a profound effect on healthcare. They include home environment, transportation, diet, exercise, job security, community trends, finances, and even legal issues.
Barry Granek, LMHC, Senior Director of the Pathway Home program at Coordinated Behavioral Care in New York City. Photo courtesy CBC.
CBC's Pathway Home program is an example of how that strategy is put into action. The program offers a transitional care model for patients going from the hospital or similar institutional setting back into the community. It operates under the assumption that the healthcare landscape is fragmented and siloed, and uses digital health and partnerships—including care coordination and management, expedited housing placement, skills-building and engagement, collaboration and meetings with family and community health services, and even some financial support—to make that transition.
Addressing Engagement Through Motivation
Among the partners in Pathway Home is Wellth, an NYC-based digital health company that targets care plan adherence. With the company's help, CBC built out a digital health platform that uses behavioral economics to address why patients don't follow doctors' orders or health habits. The platform uses an mHealth app to create an on-demand line of communication with patients, reminding them to take their medications, monitor their health, eat healthy meals, and gives patients small financial rewards and video offerings when they meet those goals.
"We focus on motivation," says Granek. The Wellth platform, he says, creates a level of engagement that resonates with patients, especially as they move from a strictly controlled environment to one that gives them more freedom to make choices and develop lifestyle habits. The ability to communicate with those patients at any time and place through digital health gives care providers the opportunity to make an impact when it matters the most—during times of stress, at meals, or when one is supposed to be taking medication.
Wellth's platform is one of many aimed at addressing the tricky topic of adherence through patient engagement, namely by offering rewards and encouragement. Providers have long struggled with finding the right tone or button to push to grab and keep their patients' attention. In the past, those incentives were often restricted by the infrequency of visits to the doctor's office and perhaps reinforced by mailings or the occasional phone call.
Digital health and virtual visits have changed that game, giving providers the opportunity to connect on demand. That's especially true as the nation deals with the pandemic.
When COVID-19 became commonplace in early 2020, healthcare organizations shifted to virtual care to reduce the spread of the virus. In many cases, both providers and consumers tried out digital health for the first time, using mHealth apps and telehealth platforms on mobile devices to keep the lines of communication open and manage care needs.
Those tools and strategies are taking hold now, both by patients becoming accustomed to digital health and providers looking to sustain that connection for care management.
"I think it's going to be more and more important as our world changes," says Granek, pointing to the adoption of digital access technologies in everything from banking and retail to travel and grocery shopping. "We're becoming more comfortable" with the technology.
Alongside that is an understanding that the pandemic has pushed depression, stress, and anxiety to unheard-of levels, in turn, straining the resources of care providers. In-person treatment can't be the only option anymore.
"We need a variety of options," says Granek.
A Strategy for Embracing Innovation
The Pathway Home program sits within CBC's Innovation Hub, where new ideas and technologies are tried out. Granek and his colleagues check out dozens, if not hundreds, of concepts and technologies, looking for ideas that they think can and will work.
"We've seen companies that come to us too early," he says. "They're not fully realized or they come to us for expertise." With the latter, companies see CBC as a place in which to integrate clinicians, rather than including them earlier on.
With the behavioral healthcare palette expanding to address issues outside of clinical treatment, CBC casts its net far and wide for innovative services like ridesharing, or nutrition counseling, or housing placement. Each can play a part in care management, contributing to a program that gives its patients a better chance at positive outcomes.
Granek notes that CBC works with a variety of partners, including managed care organizations (MCO). The company exists as a collaboration of several nonprofits, designed to sit alongside health systems and give consumers more options for care. But it also speaks to the value of working together in a more integrated healthcare network.
To that end, Granek would like to see more interest from payers, many of whom have been slow to embrace digital health without the proof that it's improving outcomes.
"We are seeing that some of them are starting to get into the business," he says. "You need that proof of concept, and you need the data to back it up. And that can take several years to complete all the pilot studies and come back to [payers]."
"We want to be early adopters, but not too early," he adds. "So, we'll choose carefully, shed the things that don't work, and double down on the things that do."
And as much as digital health can be used to address the social determinants of health, it can also serve as a barrier. Not everyone knows how to use the technology needed to access healthcare.
"We spend a good amount of time just teaching people how to use the technology," Granek says. "The resources exist … but they have to be easy to access and use if you want people to use them. And that makes implementation a challenge, because you might have to teach staff how to use [these devices] before you even get to" the patients.
That aside, Granek says CBC's commitment to learn will keep the organization on the right path as the healthcare ecosystem progresses. He looks forward to more partnerships in the future, perhaps some integration with social media channels to reach patients in their comfort zones and wants to create a more complete map of available resources in NYC, perhaps by integrating with location services.
"We want to manage the in-between and provide [support] around the visits," he says.
“PCORI proudly continues its important and unique role as the nation’s leading public funder of patient-centered comparative clinical effectiveness research,” PCORI Executive Director Nakela L. Cook, MD, MPH, said in a press release. “In a world of seemingly endless health information sources, and misinformation about clinically effective interventions, sound data that can help people make sense of their many options in a complex health care environment has never been more important.”
In all, PCORI has unveiled eight funding opportunities, known as PCORI Funding Announcements, or PFAs, that offer the potential for almost $300 million in total funding.
The organization, long known for its support of digital health research, has an ambitious goal of funding $1.8 billion in research projects over the next three years, including targeted funds to support clinical effectiveness research (CES) studies on alcohol abuse among teens, delirium in older adults, and mental health concerns in individuals with intellectual and developmental disabilities. PCORI has set aside about $100 million for those three topics.
The largest funding announcement in this group, the Broad Pragmatic Studies PFA, which will offer funding of $5 million to $10 million for five-year CER studies in four categories: addressing disparities; assessment of prevention, diagnosis and treatment options; communication and dissemination research; and improving healthcare systems. Some $162 million has been set aside for those projects.
Another PFA sets aside up to $12 million for studies on improving patient-centered CER to withstand scientific scrutiny. And three more PFAs, totaling $23.5 million, target projects that implement results of PCORI-funded research and advance approaches to effective shared decision-making in practice settings.
PCORI is also seeking public comment through the end of January on its proposed Research Agenda, which would set the ground rules for future funding of CER projects and other research initiatives.
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