Even before the COVID-19 pandemic, healthcare consumers sought convenient, more affordable ways to access healthcare. The pandemic rapidly accelerated this trend, encouraging healthcare organizations to develop and deploy patient-centered telemedicine services that gave consumers what they wanted. Due to its versatility, accessibility and cost-effectiveness, I believe consumer demand for telemedicine will only continue to increase.

After witnessing the need for more telemedicine in the early pandemic, Envision increased its investment in and deployment of virtual services to include teleneurology, maternal-fetal medicine, transitional care, neonatology and direct-to-consumer occupational medicine, among many others.

To effectively deliver virtual care, organizations must collaborate with technology companies to create platforms that are easy for both patients and clinicians to use.

One of the programs we’re proudest of is our ET3 virtual emergency medicine program, which launched in January 2021 with our strategic partner, Global Medical Response (GMR) and other EMS agencies. We are now active with the program in 17 states across the U.S. ET3, or Emergency Triage, Treat and Transport, is a voluntary initiative in partnership with the Centers for Medicare & Medicaid Services (CMS) that incentivizes appropriate utilization of emergency medical services. Coupled with Community Paramedicine (CP), which dispatches a caregiver following non-emergent 911 calls, these programs deliver a patient-centered emergency response by supporting the right care at the right time in the right place.

Our Virtual Health Services team uses two-way, real-time audio/video on mobile devices to bring local emergency medical services (EMS) responders together with Envision’s national network of more than 60 EMS medical directors and 3,500 board-certified emergency medicine clinicians. We serve more than 100 U.S. counties and 20 million patients in the ET3 program.

Challenges transitioning from brick-and-mortar to virtual

With the numerous virtual health technology platforms available, it can be challenging to find the right platform that meets the exact functionality required for a given service while having the right level of configuration to match the needs of Envision’s virtual health programs.  

Using our ET3 care program as an example, Envision’s leading team of clinical and operational experts worked closely with our platform vendor to develop functionality beyond “out-of-the-box” features. The results were new technology features and workflows that allowed for streamlined platform functionality while focusing on the patient-clinician experience. Partnering with a high-quality technology vendor that is willing to collaborate with your organization and take an innovative approach to their platform’s features is critical.

In addition to being functionally flexible, virtual health platforms must be easy for providers to use. The technology must work as intended. Otherwise, the platform may create challenges that can lead to underutilization. I often find myself saying that we have to make the virtual “front door” easy for patients to walk through. We have a responsibility to provide them with a positive care experience. Any virtual service must be easy to access and use. Complex registration and login processes or connectivity issues related to audio and video functionality will only create user frustration and, over time, a lack of patient utilization.

Embracing emerging healthcare technologies

To ensure our virtual health platforms like the one used for ET3 provide a positive experience, we routinely ask patients for their feedback. A patient recently explained that they were hesitant to call 911 as they did not want to go to their local emergency department. The EMS team, in partnership with an Envision emergency physician, assessed and treated the patient via a virtual emergency visit. With the patient’s health and safety top of mind, the care team determined the patient’s condition was not high risk and it was not clinically necessary for the patient to go to the ED. The patient told us, “I can’t believe I was able to speak to an ER physician from my living room couch. My family and I are so grateful we didn’t have to go to the emergency room.”

When I think about the positive benefits of emerging virtual health capabilities, I think about the real impact we have on patients’ lives. With the help of technology, we are helping patients access the most appropriate care when and where they need it most.

Naturally, embracing and implementing emerging technologies comes with a learning curve. Telemedicine regulations at the federal and state levels were expanded dramatically during the COVID-19 pandemic. However, the need for permanent legislation still exists for everything from interstate licensure compacts to telemedicine reimbursement dynamics. Public and commercial health insurers must also keep up with the demand from consumers and the need to reimburse clinicians.

While virtual healthcare expands patients’ access to care, improves patient outcomes and drives healthcare costs down, how quickly and to what extent this takes place will be influenced by regulatory and insurer dynamics.

I am confident that virtual care is the future of healthcare delivery. Consumer demand for more convenient, low-cost service models is here to stay and will only increase with time as consumers become more selective in how they access care. To effectively deliver virtual care, organizations must collaborate with technology companies to create platforms that are easy for both patients and clinicians to use.

As the healthcare system continues to evolve, more providers will likely adopt or expand virtual health capabilities. Those providers that are open to embracing innovative changes and virtual services are better suited to meet patients’ unique and ever-changing needs.

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As health systems navigate their way through an unparalleled age of technological advancement, CIOs can tap into an overwhelming number of state-of-the-art solutions capable of driving their digital transformation strategies forward. From wearables to mobile health devices, augmented reality to machine learning, the choices are seemingly endless.

And while all this technology is captivating, it also can be blinding. It’s too easy for health systems to let technology run the business of health care. Instead, it’s the business of health care that must drive the technology, because digital transformation will only make a real impact on a health system if it ultimately helps to improve care delivery and patient outcomes.

We’re fortunate at Atlantic Health System to have innovative, diverse leadership and a team of health care professionals covering a span of generations—baby boomers, Gen Z’ers, millennials and Gen X’ers—that embody this philosophy. Working together, we tackle digital transformation with a single question: What is the problem we’re trying to solve? Many times, the answers come from the clinical side rather than the technical side.

This methodical, collaborative approach gives us a system of checks and balances that ensures the technologies we invest in will help us achieve a specific ROI. It also allows us to make technological enhancements that augment—and not replace—the care our health care professionals deliver. We always include the human element in our workflows to strengthen the patient-clinician bond.

Over the past 12 – 18 months, we’ve seen encouraging results from two particular technologies: AI and Big Data. In both cases, the primary measurement is how well these solutions can help health care professionals treat disease sooner, creating better health throughout the communities we serve.

How AI enhances Medical Imaging

As Atlantic Health System grows and cares for more people, delivering highly sophisticated medical imaging takes high priority. As we searched for optimal imaging solutions, we prioritized technology that could help our radiologists and health care professionals get more efficient, find abnormalities faster and contact patients sooner for follow-up tests and appointments that can save lives.

To achieve these goals, we implemented three highly integrated solutions. The first, a modern picture archive and communication system (PACS), streamlines the entire radiology workflow.

By integrating our PACS solution with our Epic EHR, our radiologists can now access patient information and images from a single cloud-based system with enterprise-grade security that offers enhanced protection from ransomware and other malicious attacks. Our clinicians report high satisfaction with the quality of images on our new PACS system.

The second tool in our radiology arsenal is a FDA-approved decision support software solution. It uses AI to scan large volumes of images (such as CT scans), flag images that contain abnormalities and move them to the top of a radiologist’s or health care professional’s to-do list.

While the technology flags suspected acute pathologies, the human element is the key factor in this workflow. That’s because it’s the clinician who reviews the flagged images, identifies potential life-threatening anomalies—intracranial hemorrhage, acute spinal fractures, pulmonary emboli—and expedites patient care so patients with the most acute needs get seen right away.

Rounding out our medical imaging technology cycle is a radiology report management solution. It uses AI and NLP to comb through clinical notes and imaging scans. It then notifies the care team if and when patients need to follow up. This helps our health care professionals close the loop with patients faster and find potential diseases earlier.

We used EDAP data to identify potential COVID-19 hot spots and quickly ramp up supplies, staffing and resources in facilities that served those communities.

Viewing Big Data from an enterprise-level

Most businesses today are ingesting more data than ever before, and health care is no exception. However, most health care organizations have data spread across multiple legacy systems or locked in department-specific silos, which reduces the ability to act on that data. We faced the same challenge of bringing data together so we could make optimal business decisions.

Our answer: building an Enterprise Data and Analytics Platform (EDAP). The EDAP solution gathers data from 63 different sources, including our Epic EHR, claims data, health quality data, financial data and more. EDAP allows us to ingest, curate, create and model data, giving us a robust data pipeline capable of creating predictive and prescriptive models.

In addition to investing in EDAP, we’ve recruited highly skilled data scientists and aligned them with each vertical inside our health system. The expertise of our data analysts, combined with EDAP technology, allows us to identify operational, financial and clinical efficiencies and ultimately improve patient care.

One real-world example of how EDAP benefits patient care came during the COVID-19 pandemic. We used EDAP data to identify potential COVID-19 hot spots and quickly ramp up supplies, staffing and resources in facilities that served those communities.

Fueling adoption of innovative technologies

Implementing emerging AI-powered technologies and other modern solutions is just one part of the battle. The second is fully adopting them. At Atlantic Health System, we incorporate both e-learning and in-person instruction to make sure all health care professionals and users know how to use the technology, understand the workflow and interpret the data they’re reviewing, fueling widespread adoption and competency.

And while AI and Big Data are showing the best results for us right now, we’re also introducing many other emerging platforms—from customer experience technology to machine-learning-driven solutions and even augmented reality. Each is at a different maturity level. By looking at these solutions through the lens of problem-solving, then taking a pragmatic approach to implementation and training, we’ll keep developing innovations that help us expand the number of people we can help in our communities and enhance the care we provide them.

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By Debbie Welle-Powell, Chief Population Health Officer, Essentia Health

Digital Care is here to stay. 

The COVID-19 pandemic accelerated change to a new model of care; a virtual (digital) model built to deliver care at the right time, all in the comfort of the patient’s home.

Health care systems, including Essentia Health, were challenged by the pandemic to deliver necessary care differently. Prior to COVID, we offered limited retail E-Visits and remote patient monitoring (RPM) only to high acuity chronic heart failure patients. When the pandemic hit, we took a quantum leap forward, resourced our change management capability and fast-tracked the adoption of digital technology. With the technology platform in place (built), we were able to move quickly to direct-to-consumer services that kept our patients safely in their homes. This technology also kept our providers and staff safe by limiting the number of patients on campus and reducing viral transmission in the community. Today our direct-to-consumer digital programming includes on-demand video visits, retail E-Visits, RPM, and our newly approved CMS Hospital at Home waiver program. 

A shift in mindset is occurring with our clinicians. They are trusting the technology to deliver timely and safe care.

This new model of care is generating higher patient satisfaction scores, showing we are truly improving the patients’ experience.

Essentia Health’s Story and the Impact of Virtual Care

1. The Numbers. Essentia led other health systems in Minnesota with well over 604,000 telehealth visits since the pandemic started. Our expanded RPM Program prevented 102 hospital admissions and prevented 67 emergency department visits. This work generated savings of approximately $2.5 M across Medicare, Medicaid and commercial populations. Essentia holds thirteen total cost of care contract agreements totaling 180,000 at-risk lives. When we appropriately reduce utilization, these earnings are reinvested in chronic care programs, enhanced technology applications and analytical tools. Negotiating value-based, risk contracts has been a key to our success as an integrated health system and Level 3 NCQA Accredited ACO because we are able to measure the impact of closing gaps in care and quantify making health care more affordable.   
   
   
2. Screening Social Determinants of Health (SDOH) and Social Needs. The COVID-19 pandemic placed a great deal of strain on our communities. At the beginning of 2020, we were just piloting a social needs screening program asking our patients about food insecurity, transportation and financial strain. In April 2020, we rapidly scaled up social needs screening to ensure our 75 primary care and pediatric clinics were offering this screening to all of our patients. To date, we’ve offered this screening to more than one million patients, with 46% (420,330) of patients responding. We found that a significant increase in requests for social needs (particularly food) was reported. As a result, more community health workers were hired, and our relationships with community partners were expanded. We’ve been able to successfully connect more than 2,000 patients with the community resources they needed.
   
   
   In April 2021,  building on our work, we launched RESOURCEFUL, a free, online, public resource directory, through a partnership with Aunt Bertha. Its name “RESOURCEFUL,” reflects our desire to bring community assets to our patients. The program makes it easy for patients to identify resources close to them, empowering them to seek needed information to help themselves. We are widely promoting this to our patients and community. The process has truly been collaborative in nature, with our community partner organizations helping us name, brand and promote the site.
   
   
3. Evolving New Care Team. As our care models evolve, so too must the care team. With the successes in implementation and growth of virtual visits and RPM for both COVID and chronic care patients, we recently approved a permanent Essentia 24/7 Telehealth Care Team. It is  essentially backup to primary care services, however, performed remotely with digital technology. Now, on a 24/7 basis, we provide on-demand care to our patients, along with annual wellness visits and advance care planning. A shift in mindset is occurring with our clinicians. They are trusting the technology to deliver timely and safe care. With RPM devices, we are seeing our emergency medicine physicians, cardiologists, and hospitalist coming to us and asking if we can deploy the devices in the patient’s home. RPM is becoming a standard of care for patients with conditions such as diabetes, enabling them to manage their diet and blood sugar levels with wearable push/pull devices.
   
   
   Our hospitalists, paramedics, pharmacists, social workers, and nurses are developing clinical competencies to provide care in a different environment with our hospital-at-home program. We can see that the care team of the future is going to be heavily influenced by digital technology and the data it produces. Care team members must have skills on how to integrate technology and data into their care of the patient, and we must expand our definition of the “Team”, as we will see the patient and his/her devices become more of an active member in the plan of care, in this virtual world.

The Challenges of Virtual Care. There are still many challenges and barriers with telehealth to overcome. From parity in reimbursement, and state licensure, to the technological challenge of broadband connectivity and integrity, we must assume the virtual/digital care model will continue to evolve. There is also the need to cut through the noise and distractions, help make the data timely and more meaningful, and provide ongoing education to our clinicians. In addition, there are new, non-traditional stakeholders in the health care ecosystems too, such as regulators, financiers and intermediaries who will shape the future. As is the constant, this too will change.

In Summary

The disruptive nature of the COVID pandemic forced us to re-think the care delivery model and optimize the digital and virtual delivery system. It continues to force us to evolve, to adopt and to expand upon the new care model. Consumers are increasingly willing to share their personal data through “wearable” technology and bluetooth-enabled devices. Additionally, this new virtual model of care is empowering consumers to take control of their well-being in ways that were impossible just a few short months ago. Health systems and clinicians with deep roots in care delivery must ask themselves how to best use this new technology, and its data, to transform what well-being and virtual care delivery means in the future. The future is not as far off as it seems. In fact, it’s at your very finger tips. 

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By Valmeek (Vick) Kudesia, VP Clinical Informatics and Advanced Analytics, Commonwealth Care Alliance^®

“I’m a doctor and an engineer. I build things to take care of people.”

The first overnight of my medical internship was spent working in the medical intensive care unit (ICU). One of my patients, “John,” suffered an esophageal perforation—a serious side effect of cancer treatment. Soon after John’s arrival to the ICU, I called my attending physician to discuss the results of the many laboratory tests and procedures. He listened quietly as I interpreted the long list of data and then asked, “Vick, when do you think he will die? Would he want his family by his side? Would they want to be by his side?” At that moment, I had a sobering realization. My attending physician helped me understand that all the data pointed to a complete story about John—he would die on my watch, unable to advocate for himself, and my job was to keep him alive so that he could pass away (humanely) with his family by his side.

In healthcare, data could be the vehicle for decision-making and learning. Unfortunately, some of the increased use of data and electronic documentation in healthcare has also led to undesirable (or de-humanizing) outcomes (such as risk stratification algorithms that reinforce systemic racism by underestimating the medical needs of African Americans). To minimize these undesirable outcomes, data should proactively show clinicians the “whole story” associated with a person’s needs, particularly if that person is unable to ask for help or doesn’t know all the ways that help is needed.

In my current role at Commonwealth Care Alliance^® (CCA) leading Clinical Informatics and Advanced Analytics, I have seen firsthand the power of data when these invisible factors are delivered directly to clinicians daily.

The COVID-19 pandemic brought greater emphasis to the “invisible factors” that impact health. These can include systemic racism, housing and food insecurities, loneliness, fear, inability to visit pharmacies or grocery stores, inability to visit clinics, closures of food pantries, closures of community services, changes in services or common areas in senior housing, and other relevant social determinants of health (SDOH). These factors are very important to a person’s whole story, but they are often invisible to both clinicians and patients. Broader use of data to capture and reveal the effects of these invisible factors is needed to humanize—instead of de-humanizing—data-informed processes in healthcare. This is specifically important in value-based care or other risk-bearing contracts where the whole story is critical to achieve high-quality care.

The recent rise of reverse extract transform load (ETL) data technologies will allow data and the latest analytical insights to more easily travel from an analytic environment to “everyday work software” and inform employees when that insight carries the most value (such as when speaking with a customer via phone or chat). Data and insights will play a broader and proactive role in employees’ daily experience—like an “ally” that delivers specific insights even if the employee doesn’t know what to ask.

Imagine what might happen if healthcare

1) broadened its use of data and analytics by describing interactions between SDoH factors and clinical outcomes and

2) proactively informed clinicians (at the point of care) of SDoH factors and outcome interactions specific to their patient.

Data would be a proactive therapeutic ally that unveiled a complete story of how to help a patient, even if neither clinician nor patient knew to ask. For example, a patient might have a higher risk of decompensated congestive heart failure than suggested by their level of heart function because they do not have reliable transportation to a grocery store to obtain healthier foods. This is an essential information to display to a clinician in an EHR at the point of care. Value-based or risk-bearing care arrangements are also likely to gain greater financial advantages from this complete and proactive information.

In my current role at Commonwealth Care Alliance^® (CCA) leading Clinical Informatics and Advanced Analytics, I have seen firsthand the power of data when these invisible factors are delivered directly to clinicians daily. At CCA, every day during the COVID-19 pandemic resulted in a deeper appreciation for a patient’s whole story and how these invisible factors can impact health and quality of life. During COVID-19, CCA accelerated its use of technology to meet the new understanding of patients’ needs. For instance, to better meet the medical, behavioral, and social needs of our members—many of whom didn’t know how to ask for help—we launched medical and behavioral health virtual care visits, deployed smart-speakers in homes to help monitor patients remotely, and utilized proactive paramedic home visits with remote patient monitoring and predictive analytics to reduce the need for unplanned acute care. We also faced and overcame many obstacles related to data and system integration/interoperability, wireless/cellular broadband availability, and rapidly changing logistics (e.g., timed expiration of COVID-19 vaccine vials once opened).

Clinicians often work to “pull the right data” or “put in the right data” so that they can “do the right work.” In contrast, imagine a world in which, every day, the right clinicians, without asking, received the right data needed to fully care for every patient. Healthcare has an opportunity to use the same emerging technologies that maximize commerce but direct those technologies to maximize our understanding of every patient. Through this humanizing use of data, we create a therapeutic ally that unveils patients’ needs and differences in an actionable, humane way and reinforces person-centered care.

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The healthcare industry is at the forefront of digital innovation and evolution. Advancing digital technology adoption has the potential to improve the health care consumer and patient experience and also transform care delivery. While these advancements enable efficiencies that benefit both patient and provider, the methods in which these technologies are utilized can tip the scale on their impact.

Patient care journeys through the healthcare system vary widely. Therefore, there is no single approach in improving experience. Patients access the health system for different types of medical care. They have different communication preferences based on digital literacy and/or access to digital devices. While many patients who live on their computers day to day enjoy the speed and convenience of digital medicine, a large portion of patients find these tech-enabled interactions to be cold and emotionless. Without consideration of each individuals’ exclusive needs, blanket technological solutions are bound to further the digital divide experienced by wide swoth of healthcare consumers.

Despite the inherent challenges associated with infusing digital technology into current care operations, communicating the “why” can help with change management. One “why,” is that digital technology has the ability to improve the patient experience in a seamless, efficient manner.  For example, creating an experience that includes robotic process automation and artificial intelligence offers benefits like expedited completion of documentation, simplified coverage validation, streamlining bill payment, as well as automated prescription refills, to name a few.  These technologies have a two fold benefit of making the experience more simple for the patient, and more cost-efficient for the health system.

Digital technology can also improve provider experience and patient care. Simplified interactions through recording, automated patient outreach, and using artificial intelligence to detect disease more quickly in diagnostic testing are just a few tools helping to lighten the load and prevent burnout of our healthcare professionals.   

COVID-19 created an optimal case study that exemplified the opportunity technology brought to bare. Organizations saw the use of automation, chatbots, conversational AI and application program interfaces (API) leveraged on a coordinated, large scale for testing, vaccination, and communication processes. COVID-19 required massive scalability with limited human resources, which only technology could sustain across the world. Learnings were derived from each organizations’ approach and adaptability was required as demand ebbed and flowed. The ultimate challenge to maintaining a positive technology implementation experience was predicting and creating a sustainable patient journey through a rapidly changing environment. One of the greatest examples of this principle was the finding that virtual visits between patients and providers can be an efficient and effective way to render health care. Needless to say, out of necessity, technology was catalyzed in medicine through the COVID-19 pandemic.

In order to realize the benefits of digital technology in healthcare the design process is critical. It is necessary to engage patients and providers continually throughout the process.  Understanding critical aspects of our patient and provider needs will lead to successful solutions.  For patients, it is imperative to understand social health as well as physicial health. Access to devices, broadband and digital literacy will all impact the experience. It will be necessary to design digital strategies with these factors in mind. Not including these factors in the design will lead to a divide among our most vulnerable patients who need help accessing care. For providers, it is important to create solutions that actually improve their workflow and ability to produce better outcomes. Digital solutions that add more work or are difficult to use will ultimatily fail.

The manner in which we deploy digital technology will determine its utility. Technology is a part of a solution to a problem but is not the solution. In order to be successful, it will be necessary to keep the patient in the center of the design.  Understanding inherent complexities will allow us to truly transform patient and provider experience and redesign care delivery, all while lowering the total cost of care. All laudible goals that have been elusive, on a larger scale, until now.

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In terms of sickness and loss of life, the events of the last 18 months related to the COVID-19 pandemic have been altogether unprecedented in modern times. Even as the pandemic ravages communities across the nation and around the world, silver linings have emerged in terms of innovation enabling the provision of healthcare. The rapid adoption of various information technologies in response to the pandemic and their effective use by both healthcare practitioners and the underlying operations engines are testament to our ability to adapt.

Regulatory Reckoning

There were several major catalysts to patients, the broader healthcare community, and caregivers embracing novel methods of receiving and providing care during a pandemic, not the least of which was the expansion and acceptance of telehealth, virtual check-in, and e-visits under the 1135 Waiver. The waiver created a pathway for providers to administer and bill for a broader range of clinical services than had been possible in the past. Even with communities in lockdown and many hospitals and clinics severely curtailing elective procedures, patients still require consultation with their providers. Fortunately, the increasing comfort of both patient and provider with this modality of care evolved virtually overnight as COVID gripped the nation in ways never before witnessed.

Mental Health and Addiction Recovery

A key area of opportunity relates to virtual mental health consults, advising patients with a substance use disorder, and timely availability to pediatric psychiatric care. Remote patient monitoring enabled through an application on a smartphone, can send reminders to a recovering patient to collect a blood-alcohol reading through a wireless handheld breathalyzer. FDA-approved precision digital therapeutics are emerging as powerful tools in transforming specific behaviors. Managing depression via periodic inquiries to quantitatively measure mood scores and tracking trends over time can be critical to recovery and avoiding regression.  Finally, through immediate 24/7 access via virtual visits, parents, caregivers, and counselors have rapid access to pediatric psychiatric specialists during an agitation event.

Security Confidentiality and Compliance

Several aspects that now require greater scrutiny in this emerging virtual health domain involve security, confidentiality, and HIPAA compliance. The nuance associated with patient and/or caregiver consent, appropriate access to electronic patient data, and de-identification or anonymizing of aggregate data collected via wearable devices for population health research must be prioritized and reconciled. Also, secure billing and collections, valid prescription refill requests, and having both technology and process protocols in place must help in minimizing fraud.

Extending Critical Care to Rural Communities

While Texas is home to 3 of the top 10 largest cities in the country, there are broad swaths of the state that remain very rural with limited local access to quality care. Many of these hospitals do not have continuous access to intensivists, but virtual ICUs has changed this landscape with the present ability for a remote clinician to now not only review documentation of a critically ill patient’s record but also monitor any number of clinical diagnostics in real-time support of bedside care teams. Also, video consultation allows even deeper, more meaningful interaction and collaboration with these local care teams.

There’s no better time to refocus on how we as healthcare leaders can serve as advocates and offer solutions to these emerging realities.

Refocusing on Healthcare Disparities

The increase in telemedicine adoption has also illuminated very real healthcare disparities, inequitable access to quality care, and helped clarify this notion of a “digital divide” within various demographic and socioeconomic cohorts. Lack of broadband internet access severely limits or makes impossible, meaningful virtual interactions between patient and provider, remote monitoring of the chronically ill through wearable devices, and real-time mental health or addiction management assessments. Increased use of technology within the provision of care carries with it a real possibility of marginalizing communities of color, elderly populations, those who are less technology-savvy, and populations who cannot afford high-performance data plans. There’s no better time to refocus on how we as healthcare leaders can serve as advocates and offer solutions to these emerging realities.

The Emerging Virtual Workforce

Even as labor shortages have tightened the availability of skilled nurses in the last 18 months, an emerging reality has firmly established among many faculty and administrative functions within the healthcare sector: the virtual workforce is both effective and sustainable.  The immediate response by healthcare administrators to the rapid spread of the pandemic was to move large business-critical back-office functions like Finance, IT, and HR to virtual worker models. Within academic medical centers across the country, teaching environments that were traditional in-person didactic instruction got transitioned to 100% virtual almost overnight. As organizations adapted to these remote or hybrid work arrangements largely without significant negative impact on operations, the acknowledgment that virtual workforces can be successful came into focus. Remote and hybrid worker models are here to stay.

Conclusion

One reality the pandemic has reinforced is that crisis can quite effectively drive process, operations, and applied technology innovation. Virus or not, our missions of providing healthcare and driving clinical research discovery while also educating the next generation of providers and researchers remains unchanged. Information Technology will continue to prove instrumental in meeting our respective communities and their needs where they are. If necessity is indeed the mother of invention, then perhaps pandemics, even with all of the human tragedy they impart, can serve as catalysts to healthcare modernization in a meaningful and lasting way.

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Connected health has been a target without focus for more than twenty years, that is up until two years ago. The COVID-19 pandemic has accelerated connected health adoption around five years, but the 21^st Century Cures Act came into place, payers adopted reimbursement strategies that embrace connected health. As a result, we are seeing development in technology solutions that are more refined and user-friendly.  

Pre-COVID, Luminis Health was piloting video telemedicine visits. Our goal then was to have greater than 100 video telemedicine visits in a month. Two of the problems faced at that time were structuring a telemedicine program that ensured reimbursement for telemedicine encounters and finding ways to encourage providers to change their business approach when things were working just fine.  

Luminis Health was also piloting take-home wearables for expectant mothers that would automatically populate the patient’s chart. The appeal of this program was to control pre-eclampsia in expectant mothers. The barrier here was finding blood pressure cuffs that our development team could integrate with. Many of the cuffs used proprietary protocols or had limited ways to integrate their data.  

Looking toward the horizon, connected health technologies are here to stay and each healthcare organization will have to maintain and expand their footprint in these spaces.

After the emergence of COVID-19 in the United States, our telemedicine adoption numbers raced past what just a month earlier was a lofty goal. Instead of discussing how the team could drum up support for 100 video telemedicine visits per month, we were looking to scale our support and architecture to support 13,000+ video telemedicine visits in a month.  

Our remote patient monitoring program also grew dramatically. In May of 2020, we were awarded an

Federal Communications Commission (FCC) telemedicine grant that allowed us to procure single-use low acuity monitors. These monitors were distributed to two groups of patients. The first group was returning home after an inpatient hospitalization for COVID-19 and met a specific set of criteria. The second group was referred to the program by their primary care provider with the goal of preventing emergency department admissions. Patients would then use their personal smartphone, or one that we provided, to integrate to the monitoring device and transmit the data to our clinical care coordination teams and primary care providers. Using this solution, we were able to have 549 patients either recover from COVID-19 at home or monitor patients that were at risk of needing emergency services and proactively provide care before the need for the emergency department presented.  

What changed? In that brief period of time, we found payers remove barriers to reimbursement, we were fortunate enough to receive a grant to help shoulder the cost of the single-use low acuity monitors, a market had been established for cost-effective connected health devices, and perhaps most importantly, patients and clinicians have embraced this shift in care delivery and saw the value to care it provided.  

Pre-COVID, numerous concerns were elevated around patient hesitancy or access to technology, and to a lesser degree, the level of trust for data not captured in the exam room. Now, most will agree that patients have less of a technology barrier as we once thought, and that wearable data or remote patient monitoring is reliable data that can positively impact patient care.  

Luminis Health was better positioned to respond to all of these changes due to active deployment of controlled pilots such as telemedicine and remote patient monitoring. Several years earlier, we made the active decision to have a dedicated software development team that we could leverage to accelerate changes to software systems. We also have executive support from the CEO down to run these pilots in a risk-controlled and patient-centric way. These factors allowed Luminis Health to pilot the operationalization of connected health technologies. Once conditions were right, we were able to rapidly scale both the technology and operationalization footprints.  

Looking toward the horizon, connected health technologies are here to stay and each healthcare organization will have to maintain and expand their footprint in these spaces. The reasons are simple: healthcare organization next door will be, patients are going to continue to expect it, and healthcare disruptors will be capitalizing in this area. 21^st Century Cures Act mandates data exchange, which will empower patient choice. Consequently, healthcare disruptors that offer such healthcare products have significant room to grow. 

At Luminis Health, we are tackling many of these strategies with our new digital front door experience that prioritizes patient access while minimizing the need for staff access. For example, we are focusing on expanding and allowing patients to schedule a broader number of types of visits directly on the provider’s schedule without having to place calls or wait for callbacks. We are also investing in technologies that allow for more seamless sharing of information and data from the patient to the provider and the provider to the patient. Lastly, we are exploring how we can leverage our technologies and operational experience to provide telemedicine visits on-demand without having to wait for a scheduled slot with a caregiver.  

Wearables, telemedicine, remote patient monitoring, and other connected health technologies are truly exciting, but this also presents a new way of operating. The sheer amount of data and expectation for immediacy is causing transformation. These technologies create new and different workloads for our caregivers at a point in time when we are at crisis levels in terms of provider and nurse satisfaction. All of this data needs to be assessed by the care teams, and actions will need to be taken. This is where I personally hope to see more technology focus. Advanced surveillance algorithms and mechanisms are needed for the next evolution of connected health.  

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What happens next is of critical importance. “In the past year, health systems have come to accept that their digital journey is just beginning. Weaving these new capabilities into integrated care models, effective growth strategies, and workforce enablers will be critical to health systems’ success, and for many hospitals, survival,” says Linda Finkel, CEO of AVIA. “Retail-first entrants, digital-first behemoths, private equity-backed disruptors, and aggressive payers seeking to provide care themselves moved faster than health systems, many with far deeper pockets.” 

The risk for health systems is real and the stakes for their communities are high. As health systems get serious about digital transformation, Linda has been at the forefront of helping them shift to digital-first operations through her work as the leader of AVIA. The company was founded on the simple belief that healthcare must benefit from the digital renaissance that other industries have experienced. “AVIA understood that simply implementing standalone digital solutions isn’t enough,” says Linda. “Digital isn’t a strategy. Digital should accelerate a health system’s most important strategies and must be tightly linked to those. Further, they need to be integrated into cohesive platforms that actually have real impact on patients and providers, and move key metrics that matter—not just sound innovative. AVIA was built to do just that.” 

Linda has led the team at AVIA for over seven years, first as President and then as CEO, inspiring action and helping health systems integrate digital into their DNA. “What keeps me inspired and passionate about the work we’re doing at AVIA is our clear commitment to making health and care better in the country,” says Linda.  “I believe digital is one of the fastest, most enduring routes to drive change, improve care, and reduce health disparities. AVIA believes that health systems have a critical and central role to play in their communities and in the future of healthcare, even if that future looks different than today.” AVIA’s industry presence is the result of this clear mission, an unwavering commitment to results, and an innovative business model, and their partnership with over 50 health systems across the country shows the value and impact of their work. 

Transforming From Doing Digital to Being Digital

When COVID-19 made digital a necessary part of success for health systems, AVIA was perfectly positioned to guide organizations from “doing digital” to “being digital”. “In the past, we found that only more innovative health systems were doing this strategic digital work,” says Linda. “COVID-19 changed that – now, every health system and hospital needs to be thinking about digital, and the broad applicability of our work has sparked significant interest in AVIA’s expertise from health systems across the country.” 

In order to drive their digital transformation work at health systems, AVIA has developed a unique model that best serves the individual needs of each health system, working where strategy meets execution. The various teams within AVIA are all designed to connect their clients to the digital expertise they need, when they need it, and across all areas of healthcare.

“The teams in our Centers of Excellence include the country’s leading experts on digital impact on healthcare and the opportunities within consumerism, care, and operational transformation,” says Linda. “The Centers work closely with our Members in collaboration with our Consulting team, who marries traditional health system strategy with our unique understanding of how digital capabilities can support that strategy. Our Client Engagement team partners with each health system along their journey, serving as a digital transformation guide and building enduring relationships with our clients. AVIA Connect, our on-demand digital insights platform, further enables health system leaders to efficiently educate themselves on a digital space, find solutions and understand the experiences of other leaders with those companies.” 

AVIA helped the health network align leadership around a vision and provided a high-level roadmap for implementing and scaling digital solutions to address the health system’s operational and consumer-facing opportunities and challenges.

Spearheading Change with Membership and Consulting

Underscoring their commitment to being true partners to health systems is AVIA’s unique Membership model. Member health systems gain access to the industry’s leading experts in digital transformation, unlocking digital insights, targeted advisory support, and peer connections to inform how they leverage people, processes, and technology to become a digital-first organization. “The AVIA Network helps our Members understand where to place their bets in digital for the greatest potential impact,” says Finkel, “and allows health systems to face down disruptors.”

Membership isn’t the only way that AVIA partners with health systems to drive digital change. “Our consulting team partners with health systems to build digital strategies that accelerate their enterprise goals, drive alignment on that vision, create tangible roadmaps, and structure governance to drive impact,” says Linda. “Our Membership services, in turn, allow them to build out those digital capabilities at an accelerated pace with more speed and less risk. Each offering powers up the other.” 

AVIA’s impact is clear when put into action. One AVIA Member, a leading regional health network based in Pennsylvania and New Jersey, leveraged AVIA’s expertise to help them think about digital more broadly, spurred by COVID-19. The client engaged with AVIA on an enterprise digital strategy project following a strategy presentation to the health network’s board in January 2020. AVIA helped the health network align leadership around a vision and provided a high-level roadmap for implementing and scaling digital solutions to address the health system’s operational and consumer-facing opportunities and challenges.

Driving Digital Transformation with Leading Experts

AVIA’s work with Members and consulting clients are driven by their Centers of Excellence, which gives the health systems access to healthcare’s leading experts on digital transformation. “The Centers of Excellence have deep knowledge of the digital capabilities that accelerate digital strategies, where systems should be making their bets, and how to organize a system to execute,” says Linda. 

The Center for Consumerism, Center for Operational Transformation, and Center for Care Transformation address the most pressing challenges related to digital transformations. The Center for Consumerism is focused on driving strategies that drive growth, improve access, and deliver unique consumer and patient experiences, while the Center for Operational Transformation helps health systems integrate automation across clinical, financial, and business areas to enhance efficiencies. The Center for Care Transformation is committed to rethinking key aspects of patient care delivery using digital solutions, improving care for underserved populations, and implementing value-based care models across the industry.  

Enabling Innovation with AVIA Connect, Healthcare’s Digital Marketplace 

Underpinning AVIA’s offerings is AVIA Connect, a flagship platform and free marketplace that brings together digital health companies and health system buyers to streamline the vendor selection process. It delivers industry insights and research, vendor and product profiles, technology landscapes, and vendor experiences from health system peers. The platform showcases the digital company landscape for a wide variety of different capabilities, ranging from remote patient monitoring to virtual visits. “AVIA Connect helps health systems find the right digital solutions for their needs and hear directly from peers about their experiences with the tools,” says Linda. “For digital health companies, it provides a means to gain visibility with their target audience and help their next customer find them.” 

Looking to the Digital Future

As we move into 2022, Linda sees no signs of healthcare’s digital renaissance slowing down, and AVIA plans to increase their impact across the industry. In the first half of 2021 alone, six new health systems joined AVIA as Members, tapping into the company’s network to aid them in driving digital transformation. 

Looking to the future, AVIA expects a continued growth in the demand for digital transformation services. “There’s no way around it – digital transformation is hard,” says Linda. “It’s more important than ever for health systems to reassess everything from their capital investments and digital governance to the depth of talent in key areas requiring digital innovation. Like other industries before them, they have an advantage as incumbents—until they don’t. Now is the time to act.” 

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I have been a CFO in healthcare for 30 years, I’ve seen a lot of revenue cycle issues that are new and a lot that are recurring and never seem to get fully resolved. Healthcare is changing so fast that keeping up is critical and technology can make a significant difference.

Let’s start at the front-end, scheduling a patient. Technology is available that allows patients and physicians to schedule procedures without any assistance from hospital staff. This technology can be a simple as downloading an app on your phone and using it to schedule tests and or procedures. This saves a lot of labor time for the healthcare system and increases patient and physician satisfaction. Not all hospitals have this capability. Many front-end systems don’t interface with each other very well. There are ways to have these systems “talk” to each other.

Hire appropriate leaders, set up the proper structure, provide the necessary technology, and ensure the team members are well trained.

Health systems continue to have challenges with denials. No matter how good a health system is with preventing and overturning denials, the payors will continue to find new ways to deny or recoup payments that have been earned by the providers. Many providers continue to purchase expensive denial management systems to track and trend denials. Some systems have incredible metrics and graphics that help you determine the root cause of these denials and underpayments. I have found that others don’t do a very good job in determining whether a denial really exists. Providers also deal with disparate systems. Many patient accounting and denial systems don’t talk to each other. 

Over 20 years ago, Providers wrote scripts and keystroke emulation to trick computers to think a person was sitting at a keyboard. Today they call it Robotic Process Automation (RPA) and companies charge a lot of money for RPA to interface systems. RPA has been around for quite a long time under other names. Fully integrated systems were difficult to come by years ago, but now are available. However, RPA may help the Providers that can’t afford to replace systems. 

There are newer technologies that are becoming more available. Artificial Intelligence (AI) is one of them. Most providers are not yet taking advantage of what AI can do. For those providers that embrace AI, this technology can learn and improve processes. Bi-directional interfaces are also more common now. These systems and tools make it possible to have high-performing revenue cycles.  

There are so many other issues to deal with in the revenue cycle, such as upfront collections, payor contracting, and medical necessity, that I have not even mentioned. Each is important and needs attention.

COVID-19 has created turmoil in the healthcare industry, certainly more than ever before in my career. Staffing is extremely difficult and is very expensive due to higher wages, travelers, sign-on bonuses, and more. Social distancing at work has created even more issues since most organizations don’t have as much space as they need. Today, we need almost twice the space for the same number of people. The revenue cycle is not exempt from staffing shortages. 

Unvaccinated team members continue to isolate at home for a couple of weeks when they contract COVID-19 or are exposed to others that may have been infected. Government subsidies have made it increasingly difficult for Providers to hire entry-level staff. 

There is also the issue of team members preferring remote work, whether at home or the beach. Many organizations have worked on improving their culture for many years and they may be finding that their culture is eroding, and customer service is suffering. How do you instill a culture when your team members never interface with the others they work with, except over the phone, or through virtual meetings? 

COVID-19 also impacted collection activity. Some Providers stopped billing patients for their financial portion as a sense of community responsibility, and then at some point had to restart that process. Reimbursement also changed because of COVID-19. Medicare paid for uninsured patients with COVID-19 and also added an additional 20 percent payment for patients with COVID-19. Providers need to ensure that they receive these payments. Many expensive drugs provided to patients with COVID-19, like Remdesivir, are reimbursed by Medicare, in addition to the DRG or APC payment. However, the right “J” codes must be used appropriately. The Charge Description Master must have the appropriate codes, the coding teams need to ensure the codes are on the bill, and the collection teams must ensure these payments are received. The revenue integrity team also should have the responsibility to ensure the appropriate processes and procedures are in place to receive the appropriate revenue.

Let’s not forget about Clinical Documentation Improvement (CDI). There is a tremendous amount of revenue that may be left on the table if the clinical documentation in the medical record lacks proper wording. Technology has helped physicians answer queries from the CDI team more efficiently and timely. Now physicians can even respond to the queries on their cell phones. 

As you can see, there is a lot to do in the revenue cycle to ensure your organization is paid appropriately. Things continue to change, and I don’t think this will slow down. Hire appropriate leaders, set up the proper structure, provide the necessary technology, and ensure the team members are well trained. Don’t forget how vital it is to measure and monitor the results on an ongoing basis. With all that in place, you will help to ensure the financial viability of your organization.   

The post How is Technology and COVID-19 Impacting the Healthcare Revenue Cycle? appeared first on HealthTech Magazines.

Few, if any, of our cohorts in healthcare IT could have foreseen the unveiling of a global outbreak in the early days of 2020. And while my health system had dabbled in telemedicine for well over a decade, we were woefully unprepared, as were many, when the first wave slapped our doors shut. By the second month into the public health emergency, our volume had increased by 2000% over pre-COVID days. We had moved the needle by years in a matter of months, even weeks.

Telehealth proved its value during the pandemic out of necessity. And now, we must not let it lose its luster.

The pandemic offered little hope to humanity, save one thing. The hope of innovation, out of necessity and desperation, in the form of a digital paradigm shift in healthcare. Seemingly overnight, all of the fears and skepticism of this emerging care model were swept away, and telehealth was embraced by the masses. Out of the most challenging and heartbreaking year for many of us, our families, friends, and colleagues, I offer these perspectives on what it taught us.

1. The policy was not in line with the times. Prior to the PHE, CMS limited telehealth access to only rural areas – and only at facilities designated under the antiquated provisions of the Social Security Act. Fortunately, Congress acted quickly to temporarily waive the geographic restrictions on telehealth and allow social communication technologies, such as FaceTime, to be used without repercussion. It is yet to be determined whether these waivers will remain in effect long term.
   Despite the uncertainty…
   
   
2. Telehealth became the safer, and sometimes, the only choice. Almost immediately, all routine visits and elective surgeries were canceled to accommodate the surge of COVID cases flooding our EDs and ICUs. Personal protective equipment was at a premium as we struggled to understand the epidemiology of this disease. “Tele-” (aka “distant-”) health provided a natural barrier between the virus and our caregivers, and it allowed our patients to be seen without in-person contact. In just two short months, we had completed over 80,000 such visits.
   Nonetheless…
   
   
3. Adoption was a choice. Even with the high demand for virtual care during the pandemic, there was no guarantee that telehealth would be leveraged to its full potential for various reasons. Lack of familiarity, technology hurdles and frustration, the perception (or reality) of creating more work for the caregiver, etc. Human nature will almost always gravitate toward the easier or more comfortable path if the change is not purposeful.
   And so, we learned…
   
   
4. It must be simple to use and readily available. The core tenets that “everyone knows how to use Zoom” and “everyone has a smartphone” turned out to be fundamentally flawed. In fact, nearly 1 in 3 of our patients were deterred by the so-called “every day” technologies that most of us in healthcare IT take for granted.
   This created its own challenge…
   
   
5. Keeping patients in touch with family was critical. One unintended consequence of restricting all visitation was the isolation that bore down on our patients. Solving this became a crucial use case for telehealth. Staff was using their own social media accounts and personal devices to make sure that patients could see their loved ones – sometimes for the last time. We now have purpose-built tools for patient-family communication and even a virtual companionship program for those who just need someone to talk to. Which supports the notion…
   
   
6. Telehealth aligns with consumer expectations. Perhaps for the first time in modern medicine, our patients want to choose when and how they receive healthcare services. They want convenience, access, value, and an overall positive experience. As such, telehealth aligns with consumerism in the same way that Amazon appeals to online shoppers. Why wait weeks to be seen in person by a specialist when an online consultation is available on-demand, 24×7?
   But this revealed…
   
   
7. Health inequity exists in telehealth, too. Our own data suggests that factors such as age, race, language, and socioeconomic status disproportionately exclude minorities with regard to access and utilization of telehealth.
   Which demonstrates…
   
   
8. The need for video interpreter services is growing. I consider it a requirement for almost any program today. Yet, it presents its own unique challenges in terms of bridging the connection at the right time with the right language interpreter. The promise of NLP translation – the likes of which Google already offers – would be a game-changer in this space.
   And yet…
   
   
9. Telehealth is exciting, but it’s not innately different. Telehealth is just another tool in the proverbial toolbelt. It will continue to evolve rapidly. And hopefully, in the not-so-distant future, it will become an integral part of how we deliver timely, quality care.
   That said…
   
   
10. Telehealth is not for everyone or every situation. We will never replace in-person doctor visits, at least not in my lifetime. Telehealth has its purpose, much like a hammer does with a nail. But thanks to COVID – as odd as that may sound – it has emerged as a practical and promising answer to many of the challenges we face in healthcare today.
    So, in conclusion…
    

Telehealth proved its value during the pandemic out of necessity. And now, we must not let it lose its luster. Telehealth has been a novelty for far too long. Today my organization considers it one of our top strategic priorities. We cannot allow this genie to go back in the bottle.

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