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A survey of reported this weekend during an annual meeting of oncologists found that almost all cancer specialists will keep using telehealth after the pandemic ends—but perhaps not for every type of visit.

The American Society of Clinical Oncology (ASCO), which held a virtual meeting for the second year, shared results commissioned by its Telehealth Survey Task Force. Chris Manz, MD, MSHP, a medical oncologist with Dana Farber Cancer Institute, said 200 physicians completed the survey; respondents offered a good geographic distribution, representing 42 states.

Respondents were evenly split between practices of 20 clinicians or fewer and those with more than 20 clinicians. Of those taking the survey, 72% were medical oncologists.

Those who responded said using telehealth for symptom management and survivorship care has clear benefits, but 68% said it fell short for first-time visit, when doctors prefer to see the patient in person. Only 8% of the respondents said they did not plan to use telehealth at all after the pandemic.

Respondents were asked how they used telehealth for different types of visits as the pandemic hit a peak in January 2021. At that time, 51% said they were using the technology for at least half of survivorship visits in the past 30 days; by contrast, only 19% said they had used telehealth for at least half of their 

 visits, when topics such as palliative care or advanced care planning may be discussed.

Manz said the appropriateness of using telehealth for a specific type of visit wasn’t the only consideration.

“Respondents reported that a number of patient, clinician, practice, and financial factors were barriers to using telehealth,” he said. Most frequently cited: patients’ access to technology, and the patients’ limited proficiency with telehealth technology. Both cited by about 80% of clinicians.

“Overall,” Manz said, “respondents in this small survey reported telehealth utilization, quality of telehealth, and preferences for post-pandemic telehealth use that often varied with the type of visit. However, clinicians highlighted a number of barriers that can inform policies around telehealth in the coming months and years.”

Articles

Survivorship care and symptom management were the best uses of the technology in cancer care, according to survey results presented during this weekend's meeting of the American Society of Clinical Oncology.

Telehealth Will Stay, but Not for Every Visit, Oncologists Report

Artificial intelligence (AI) is making its way into more areas of healthcare. What are some of the pros and cons of using AI?

When used in discreet areas of healthcare, AI has shown a lot of great potential, particularly for imaging of all kinds. For example, remarkable progress is being made in using AI and machine learning (ML) to analyze images of complex medical conditions – such as autonomous diagnosis of conditions like diabetic retinopathy. There are also a lot of unproven claims about AI’s abilities to solve all of healthcare’s issues, so amid all the hype we have to be careful to not overpromise the value of AI – while also ensuring, first and foremost, that AI is safe.

Another essential component is the end-users need to know what the AI is doing and how much they can trust it. Healthcare professionals can’t become overly reliant on this technology and use it to replace the human element, as this can result in missed diagnoses and inappropriate care decisions. AI is not a panacea for all of medicine’s woes, but rather a powerful tool, and one tool of many.

What settings will benefit most from the use of AI?

VisualDx works in the field of clinical decision-making and we’re really excited about the benefits from visible light ML and ML of radiological images where the interpretation of images of all kinds is augmented by computers. The analysis of such images will play a crucial role in allowing radiologists, ophthalmologists, pathologists, dermatologists, etc. to have accurate second opinions to make the right diagnosis and improve outcomes for all patients. Patients also benefit directly from using AI based symptom checkers and other patient facing educational tools.

Does the use of AI benefit some populations more than others?

It shouldn’t. However, there have been many discussions and instances of AI being trained on one population but then used across many other diverse populations. In dermatology, you wouldn’t want to train your machine algorithms on light skin and then make the claim that the tech works equally well for patients that have pigmented skin. The training set for AI and ML models has to match the population where the AI is being used. We have to be careful in ensuring the work we’re achieving with AI is equitable and representative.

There has been some controversy involving AI due to reports that some algorithms perpetuate racial bias. What are the consequences of this in healthcare?

The consequences can be extreme on the diagnostic side with AI prone to racial biases. Particularly, this can be seen in dermatology if the imagery used to train the AI is not representative of pigmented skin. For example, redness of the skin can be a sign of inflammation or serious infectious disease, but inflammation seen on brown skin doesn’t appear red, it usually looks like a deep brown. AI needs to be trained to detect the colors of inflammation and serious infectious diseases on all skin tones or else we risk missing serious infectious diseases in people of color that could be diagnosed and treated.

What can AI developers do to ensure that AI systems do not contribute systemic racial inequalities?

Train AI on data sets that are representative of the entire patient population. If the AI is being developed to support a population with a significant Asian, Hispanic, or Black community, for example, those algorithms must be fed data that matches the population’s racial breakdown in order to avoid the bias that is otherwise inevitable.

When making decisions on whether to incorporate the use of AI technology, what questions should health systems be asking?

Health systems need to understand the quality of the data that the AI is trained on. System developers need to instill a level of trust that they’ve taken all measures and precautions to ensure the size and quality of the training sets for AI and ML is equitable and free of bias. Health systems can’t rush into adopting AI, they first must be able to ensure the AI is explainable and safe. Decisions should not singularly focus on AI but should start by asking ‘how can we augment decision-making through medical information technology’ which could be a blend of AI and other clinical decision support tools. AI is only one component of many in a growing digital health technology ecosystem.

A conversation with Art Papier, MD, CEO and co-founder of VisualDX.

The Benefits of AI in Healthcare, Right Before Your Eyes

During last month’s meeting of the American College of Cardiology (ACC) Scientific Session, 

 showed a large number of cardiologists feel burnt out from treating patients during COVID-19, and about 41% cite shortcoming of their health system—things like failing to make sure staff had adequate food and housing if they had to stay away from their families, while at the same time cutting pay. In the final installment from a recent with interview with 

™ Ascension’s Joseph Cacchione, MD, FACC, executive vice president, Clinical & Network Services, said the multi-state health system’s CEO, Joseph Impicciche, JD, MHA, gave a different directive as the pandemic began. Cacchione—who is a fellow of the ACC—said his marching orders were to take care of the team.

Health systems during the pandemic are dealing with the effects that it has had on their staff. And do you have both short- and long-term strategies to support your staff in the months and years ahead?

: At the beginning of the pandemic, our CEO told [Executive Vice President and Chief Operating Officer], Craig Cordola and me, there's two things I want you to just always frame everything: take care of the patients and take care of our associates. And that was a pretty solid, direct directive that always made us feel like we always knew where to land things.

So, number one, we didn't lay off a worker during the pandemic. We paid everybody, including our physicians, our nurses—everybody was paid. We had no layoffs, and we supported people through the pandemic. So that was a big, a big thing for us.

And then we also created resources for our employees. We had virtual counselling, spiritual care—all able to be accessed virtually. For a lot of our frontline workers who did not want to potentially take COVID back into the home, we paid for hotel stays. We had a meal program where people could go in and pull meals, prepaid, premade meals, and bring them home with them to their families.

It was a multi-channel approach to supporting the associates during this. Number one, keeping them all; number two, continuing to pay them at the same level; number three, really attending to their own personal needs and mental health needs. And so many of our employees were affected either directly by the COVID or indirectly, so we supported them at a time when they needed that.

We've seen a very dramatic increase in number of behavioral health visits for our employee population. We've seen a higher suicide rate. And these are were just a mirror of the national landscape, in that mental health visits, opioid addiction, and suicide rates are up at an all-time high in this country. And I think it's because of COVID. …

I'm a cardiologist and we deal with life and death situations; what healthcare workers have always been able to do is compartmentalize—whatever happened at work, they left it at work, or they went home and they were able to compartmentalize it in their brain. What happened with COVID is they weren't able to compartmentalize, because then when that went up, when they went home, they still had the scare of COVID. They still had this fear of COVID for their own family that I might bring COVID into the house. And so, they were not able to compartmentalize like they normally do to deal with the stress of your life and death situations.

And our frontline workers, I have to say that the frontline healthcare workers just performed admirably at a time of under such stress and personal sacrifice, that I think health care that will forever be heralded in the in health care lore of just how healthcare has responded to this. I stopped short of the word, “hero.” And I think they've just they've done their job at the highest level. And I would say many of them are heroes the way they behaved. But I for me, I've worked virtually, so I sometimes I felt like I was abandoning our teams, but our teams just performed at a level that I was so proud of to be part of Ascension and part of healthcare.

Videos

Joseph Cacchione, MD, FACC, executive vice president of Clinical & Network Services at Ascension, discusses how his company was able to provide care and support to patients and staff during the pandemic.

Dr Cacchione: Mantra at Ascension During COVID-19 Was, Take Care of the Patients, Take Care of the Staff  

™ recently sat down with Ascension’s Joseph Cacchione, MD, FACC, executive vice president, Clinical & Network Services, for a wide-ranging discussion on vaccine distribution and hesitancy and other challenges of healthcare delivery during COVID-19. 

This segment has been lighted edited for clarity.

Could you tell us about efforts to bring the COVID-19 vaccine to the communities that you serve?

: We’ve been strongly advocating for the vaccine with our patients early on. The populations that we were reaching out to started with our own employees, and getting our own employees vaccinated. We made vaccinations available very early to many of our employees. … We knew that supply was not going to be the issue—that eventually it was going to be about hesitancy. And so, it was very much pushing anybody who was willing to get a vaccine—we wanted to get them a vaccine—that we had plenty of supply. And then the second wave [involved reaching out to our patients and looking; what we did was a multi-channel approach: we had mass vaccination sites, we partnered with communities, we partnered with other providers. For us, it was an “all hands on deck” approach to getting everybody vaccinated [who] wanted to be vaccinated.

More importantly, [was] what we did through our practices. Through our advanced analytics, we mined our data looking for those patients [who] are most at risk for COVID—those with high-risk conditions, the most vulnerable populations. We actually use a social deprivation index—looking at those ZIP codes, and we reached into those communities and proactively called those patients, and said, “Please come in, you qualify for the vaccine based on the current criteria. …We want you to be vaccinated.” And we had a fair amount of success getting some of those people in at a time when others might not have had much success.

“We’ve also now partnered with Phreesia and the Commonwealth Fund, and have data now on several hundred thousand patients on vaccine hesitancy through an online portal. We tried to understand why people are refusing to get the vaccine or hesitant to get the vaccine.”

All health systems are facing the challenge of some level of vaccine hesitancy among the staff. Do you have a particular strategy for how you're dealing with this issue at Ascension?

: Early on, it was about urging and educating and making it readily available. That was the approach. And now we've hit a plateau in our employee population, it's probably still about two-thirds of our people are vaccinated. And unfortunately, our working population is a microcosm of the U.S. population. A lot of our people with high social vulnerability index scores—even in our employee group –are the people not vaccinated. So, we've been proactively reaching out, we can convert about one in five of them to get the vaccine by continually proactively reaching out, or having their physicians reach out. But we're at a plateau right now. And I'm somewhat worried about that. I think once [the vaccine] comes off of emergency use authorization [and receives full FDA approve], I suspect we'll get a little bit more prescriptive about that; we may require the vaccine going forward.

Ascension's use of a multi-channel approach to get COVID-19 vaccines to their communities was beneficial in improving access, said Joseph Cacchione, MD, FACC, executive vice president of Clinical & Network Services at Ascension.

Ascension’s Dr Cacchione Discusses How the Health System Brought Vaccines to the Communities It Serves

 spoke with Justin Williams, CEO of Noteworth. We discussed Noteworth’s recent partnership with Geisinger and the development of ConnectedCare365, a predictive analytics tool aimed at aiding physicians and patients with chronic disease management. We also talked about how this technology has the potential to help other patient populations and why similar tools are needed now more than ever.

Podcasts

Justin Williams, CEO of Noteworth, discusses how predictive analytic tools can improve the quality of care for patients with chronic diseases, discharged hospital patients, and patients from rural communities.

Podcast: Why the Time is Right for Predictive Analytics

The drive toward quality metrics demands a certain amount of standardization, but that doesn’t mean individual hospitals across a multistate system must lose all their local flavor, said Joseph Cacchione, MD, FACC, executive vice president, Clinical & Network Services, who recently sat down for an interview with 

Your operations spanned 20 different states in very different diverse parts of the country What

processes do you have to balance the need for quality standards across your whole system, while still being able to adapt to the local conditions in each market?

: We tell people, we want to be as standard as possible, but as different as necessary. And, I will say that quality care is a rallying and a levelling, that we always fall on. [During COVID-19] We released almost 250 treatment guidelines on care delivery. And all of those treatment guidelines, as well as operational issues went through the [Executive Vice President and Chief Operating Officer], my partner, 

, and me. We signed off on every one [and had teams working to get them to front-line staff]. When things would change, when the science would change, when the CDC would make new recommendations, we would push those out to the front line. So, the front-line staff didn't have to spend the time finding the new guideline, seeing what the new guideline was. If a new drug came out, when remdesivir came out, we push that out and created the documents to help [the staff], “Here's the how to give remdesivir here's what you need to do. Here's how you create an infusion clinic for this, for a COVID-sensitive infusion clinic.”

So, we leveraged our national quality infrastructure to help push those guidelines and help standardize care. … From the time that we started [to] the time that we got to the end of calendar year 2020, our mortality rates have evolved differently.

Joseph Cacchione, MD, FACC, executive vice president of Clinical & Network Services at Ascension, explained the advantages of working in a multi-state system during a pandemic and how Ascension catered its response to better serve diverse populations.

“Standard as Possible, Different as Necessary,” Is Ascension’s Approach to Quality Across Multistate System, Dr Cacchione Says

Houston Methodist staff say requirement “unlawful.” 

As more hospitals and health systems require staff to receive coronavirus vaccines, some are pushing back. On Friday, 117 staffers at Houston Methodist sued, saying they don’t want to be “guinea pigs.” The suit, filed in state court, claims the requirement violates medical ethics standards based on the Nuremberg Code, which bars experiments on human beings without their consent. The code emerged after World War II in response to atrocities Nazis committed against prisoners in concentration camps. According to 

, this strategy is being deployed around the country by groups resisting COVID-19 vaccination requirements. Elsewhere, the University of Louisville became the first in the state of Kentucky to require the 

CNN Report: Health systems sues thousands during pandemic. 

Since March 2020, Community Health Systems Inc., 

 against patients over allegedly unpaid medical bills, according to an investigation by CNN. The health system, which runs 84 hospitals mostly inn the South, has pursued litigation even as other hospital chains have eased up on litigation during the pandemic. Health system officials told CNN that legal action is the last resort when patients do not pay their bills. The network’s review found that patients were taken to court for bills as small as $201 and as high as $162,000. Most did not hire a lawyer or fight the complaints, which led to default judgments against them, and CHS would then move to garnish wages to collect payment. Patient advocates told CNN that in these cases, low-income patients can be left in financial ruin, especially given the circumstances of the pandemic. The network cited documents filed with the Securities and Exchange Commission to report that CHS enjoyed its most profitable year in at least a decade in 2020, earning $511 million in net income and paying top executives millions of dollars in bonuses.

Steven Smith, chief executive officer of Huntsville Memorial Hospital, will retire effective Tuesday, the 

. Anne Woodard, chair of the Board of Managers, Walker County Hospital District, shared, “We are ever thankful for Steve’s leadership, his endurance and dedication, especially during the hardships over the past year through the pandemic.” In a statement, the hospital’s leadership recognized Smith for leading turnaround efforts including hiring Jim Jenkins, chief financial officer, and Linda Lawson, MSN, RN, HACP, chief nursing officer; and staff development efforts. Joe Thomason, senior vice president of Hospital Operations for Community Hospital Corporation (CHC), will serve as Interim CEO during a search for a CEO replacement.

MED MOVES: Hospital workers sue over vaccine mandate; health system sues patients

Michigan was one of the hard-hit early states; Ascension, which operates 15 hospitals in the state, was able to quickly learn about treating COVID-19 and share those lessons across the system, said Joseph Cacchione, MD, FACC, executive vice president, Clinical & Network Services, who recently sat down for an interview with 

Some states where you operate are among those that were hit very hard in the early days of the pandemic. What lessons has Ascension learned that you can share across the health system and across other health systems?

: Michigan was hit very hard very early, and it's actually just getting over its third wave of a surge. And, I would say, for us, it was about from the vaccine standpoint, I think we treated Michigan just the way we treat everybody else. And that was get as many people vaccinated as we possibly could. From an overall standpoint, though, we, as a health system, were able to leverage our size and scale to assist Michigan when it was peaking. And then vice versa, when other markets were peaking. We could shift resources to other markets. So, we learned a lot about how to treat patients, how many patients were going to [become ill] when Michigan peaked early. We learned a lot about the treatment, and we saw a reduction in mortality over the course of the pandemic, from about 35% in patient mortality, now down to less than 10% of inpatient mortality. So, it's come down quite a bit. And it's because of our learnings through the pandemic, and, and learning so those markets that peaked at different times, and then redeploying resources was an important part of our approach to the pandemic.

 Are there specific advantages that having a multi-state health system offers during a pandemic?

: Specifically, what we're able to do is create a critical staffing pool of nurses from other states that would be able to go to Michigan or wherever we were peaking. We actually paid them a premium to go there to support their colleagues. That was the first thing.

There are videos from the Kansas market that was sent as a video “card” to Michigan—saying, “We're coming to help,” that was a real tear jerker, because they saw the Michigan people under stress, and it was just a great way for the health system to come together.

The second thing we did was as a health system, with PPE—and our supply chain group really did a phenomenal job of procuring PPE during this. We never once had any PPE that was not real or counterfeit PPE. We never once ran out of anything--gowns, gloves, masks, eye shields—and we’ve helped other health systems with masking and gowns when we could, and so we felt very blessed.

We had the resources to purchase and overpurchase when everything and anything came available, and that at one point we actually had direct shipments coming from China—to our docks—to supply our health system, and candidly, other health systems. Similarly, with ventilators, we created a virtual ventilator stockpile. So, when a market was surging, we would send additional ventilators to that market. We had a pool of ventilators that were sitting on the sidelines, waiting to see where they were needed. And we would ship ventilators off. As a health system, we were redeploying the resources, and those were specific examples of how we redeployed those resources in a way that made us made it made it much more tolerable.

Joseph Cacchione, MD, FACC, executive vice president of Clinical & Network Services at Ascension, described some of the lessons he learned from operating in states that were hit hard during the early days of the COVID-19 pandemic.

Dr Cacchione Shares Ascension’s Lessons From the Pandemic’s Challenging Early Days

Ascension, with 151 hospitals in 20 states, is distinguished by both its size and its mission: as a faith-based organization, the health system is “dedicated to transformation through innovation across the continuum of care.” 

Data analytics has played an important role in helping Ascension identify which patients needed COVID-19 vaccines and care for chronic conditions during the pandemic, according to Joseph Cacchione, MD, FACC, executive vice president, Clinical & Network Services, who recently sat down for an interview with 

™ for a wide-ranging interview that covered vaccine delivery and hesitancy, as well as aspects of the multi-state health system's response.

Segments appearing over the next week have been edited lightly for clarity.

 The pandemic has brought to light issues of healthcare equity, how does Ascension’s position as a mission-driven health system drive your response to this issue?

: The one thing that the pandemic did demonstrate is there is a lack of health equity. And so, part of our response was proactively reaching out to those high-risk social vulnerability index folks. That was the first thing that we did, and [we] collected that data on people and [were] able to have a robust analytics program. We're able to reach find those socially vulnerable patients, and bring them in proactively—not just for COVID, or COVID vaccines, but also to urge them to come back and get their screening, get their diabetes care for all the things that we do to care for people we were doing that proactively and bringing people in. And we also now collect data on social determinants of health. And we have data on over 400,000 people, and under identifying who's at risk based on social determinants, food insecurity. And we've now partnered with a company called 

 which inventories resources around the country that we can then [use]. So, if somebody identifies food insecurity as one of their social determinants, we can direct them to the app or the Aunt Bertha site, or the physician themselves to look at the app or the site and say, “Here are two food pantries that you can access food from, you meet the criteria, this will help you with your food insecurity.” So, [we’re] doubling down on better understanding social determinants and how they're impacting care long term.

Joseph Cacchione, MD, FACC, executive vice president of Clinical & Network Services at Ascension, discusses how collecting data on social determinants on health  and food insecurity helped address health equity during the pandemic.

Data Helps Drive the Mission of Helping the Most Vulnerable During COVID-19, Dr Cacchione Says

Jesse Zuckerman, MD, is a general surgery resident at the University of Toronto.

Red blood cell transfusions are common in patients who have surgery for gastrointestinal (GI) cancer. GI cancer patients are at high risk for requiring transfusions because of their underlying malignancy, poor nutrition and previous chemotherapies. But, like any medical intervention, transfusions are not risk-free.

Research over the past 30 years has consistently shown an association between transfusions and poorer outcomes following surgery, including postoperative morbidity and mortality, cancer recurrence and increased costs.

Guidelines and programs from the American Association of Blood Banks, the National Institute for Health and Care Excellence, and several others recommend limiting transfusion use to patients who truly need it. Even with this guidance, substantial variation in transfusion practice continues.

Research links higher transfusion rates with poor outcomes

My colleagues and I wanted to understand the relationship between variation in transfusion use among individual surgeons and hospitals and its impact on surgical outcomes in GI cancer surgery.

For the study that we presented during Digestive Disease Week 2021, we analyzed 59,964 records for patients undergoing elective GI cancer resection from 2007 to 2019 involving 81 hospitals and 616 surgeons. We found adjusted frequency rates for red blood cell transfusions varied widely, from 7.4% to 36.4%for surgeons, and 8.4% to 30% for hospitals. Higher surgeon and hospital transfusion rates were independently associated with higher rates of morbidity and mortality. Adjusting for the surgeons’ case mix, for every 10% increase in their rate of transfusion, the rate of 90-day morbidity and mortality both increased by 4% and 0.3%, respectively. Similar differences in morbidity were observed among hospitals.

These results highlight the importance of efforts aimed at minimizing use of red blood cell transfusions and reducing variation in transfusion practices. It is crucial to target the users of transfusions—surgeons and hospitals—with tools that can be used to change practice and limit transfusion to patients who actually need it.

It takes a long time to change practice. The first trial on restrictive transfusions was published in 1999, and guidelines encouraging restrictive transfusion practices have been around for over a decade. While there has been some change, variation continues for a variety of reasons:

It is often easier to transfuse than to optimize patients before surgery.

 Optimizing anemia status before GI cancer surgery takes time. While time is not always available, surgery can often be postponed, allowing time to prepare the patient. We should make it easier for physicians to prevent transfusions than to prescribe them.

Misperceptions linger about possible benefits of transfusion

Early studies suggested that transfusions may generate an immunomodulatory response. Since the mechanisms for inferior outcomes with transfusions are not entirely clear or accepted, the persistent doubt in transfusion-related immunomodulation may remain an obstacle to changes in practice. Many physicians still do not accept the potentially detrimental effects of transfusion. Surveys have shown that up to half of surgeons doing GI surgery are unlikely to investigate for anemia before surgery, and many don’t believe in the potential implications of providing perioperative transfusion.

Interventions to Reduce Transfusion Variation

Interventions at different levels can help change practice. Educational materials, guidelines or workshops can be provided at the unit level. Hospitals can provide decision supports with order sets or order entries that need blood lab approval before a transfusion can be performed.

Health systems can create system-level change through departmental policies or establishing protocols or algorithms along with financial incentives. In addition, health systems can monitor and provide performance feedback for physicians and institutions, providing them with necessary information to modify their practice. Those performing below evidence-based standards can then evaluate their processes of care and identify opportunities for improvement.

Health care leaders can concretely improve the quality of care by maintaining performance metrics of transfusions for physicians and institutions. This key measure will enhance both individual and organizational accountability by monitoring critical benchmarks that will help to produce lasting changes in practice.

Jesse Zuckerman, MD, is a general surgery resident at the University of Toronto. Dr. Zuckerman presented findings of the study, “The contribution of surgeon and hospital variation in transfusion practice to outcomes for patients undergoing gastrointestinal cancer surgery: A population-based analysis,” abstract 326, during 

, on May 22, at 10 a.m. EDT. This study received funding from the following: Ministry of Health and Long-Term Care Clinician Investigator Program, Sunnybrook Alternative Funding Plan Innovation Grant, Canadian Institute of Health Research Canada Graduate Scholarship, Canadian Institute of Health Research New Investigator Award, and Canadian Institutes of Health Research Project Grant (FRN #154131).

It is crucial to target the users of transfusions—surgeons and hospitals—with tools that can be used to change practice and limit transfusion to patients who actually need it.









Higher Transfusion Rates in GI Cancer Surgery Associated with Worse Outcomes

Cynthia Horner, MD, is the medical director for Amwell and has been a board-certified family physician for 25 years.

For three out of five consumers who experienced a virtual visit last year, COVID-19 prompted their first foray into telehealth, according to a 

. But while urgent care was once the biggest draw for telehealth consumption, that trend flipped during the pandemic, when scheduled visits—especially with specialty and primary care physicians—took center stage.

Now, as healthcare leaders consider where and how to embed telehealth into their member or patient experience for the long haul, it’s critical to examine how virtual care can lead to better health outcomes.

The following use cases provide insight into why virtual primary care (VPC) is quickly becoming the new house call and what it takes to provide optimal value with a VPC program from a physician’s perspective.

Case Number 1: Jumpstarting A Relationship With a Primary Care Provider

Lisa*, 26, a newly diagnosed, insulin-dependent person with diabetes, recently moved to the East Coast. She graduated law school, started a job, and acquired new insurance, yet she did not have a primary care physician in her newly established community. When it came time to refill her medication, Lisa chose telehealth for its convenience—as an attorney, she works 65 to 70 hours a week—and to establish a new relationship with a primary care provider.

It quickly became clear that Lisa’s health needs went beyond the request for a prescription refill. Lisa had not been seen by a clinician in six months, and her blood sugar levels had skyrocketed to 250, even while taking medication. Because of her struggles with keeping her diabetes under control, Lisa showed signs of retinal inflammation, a condition that is typically accompanied by kidney damage and, if left unchecked, could quadruple her risk of heart disease and triple her risk of stroke.

Lisa’s virtual primary care provider assessed her condition with the help of a home glucometer, digital blood pressure cuff, and a scale. She also used video to examine Lisa’s overall physical condition, looked for swelling in Lisa’s feet and ankles and worked with Lisa to determine whether she had lost any sensation in her feet. With these tools, Lisa’s virtual primary care provider could perform 90% of the exam that otherwise would have been conducted in person.

The virtual primary care provider adjusted Lisa’s medication and ordered laboratory tests to dig deeper. She also referred Lisa to an ophthalmologist for a retinal screening and to a diabetes educator and an endocrinologist. When Lisa expressed concern regarding how she would find an ophthalmologist in a new city, her virtual primary care physician worked with her to find a close-to-home option and sent an electronic referral. Today, Lisa’s blood sugar levels are at non-diabetic levels, the strain on her retina and kidneys has been resolved, she’s exercising regularly, and she feels great.

Key to success: digital reminders for follow-up care

. So many patients with chronic disease become lost in the follow-up process, primarily due to difficulties in accessing care. While telehealth helps eliminate access-to-care challenges, digital reminders ensure that patients stay on top of follow-up appointments.

Case Number 2: Providing More Personalized Care Intervention

Gerald*, 54, suffered from chronic obstructive pulmonary disease (COPD) after a long history of smoking. He had recently changed insurance and did not have a primary care provider. He was also afraid to leave his house to receive in-person care, given his increased risk for developing a severe case of COVID-19. When Gerald learned that his health plan offered virtual primary care visits, he sought treatment for an increasingly productive cough.

It did not take long for the virtual primary care physician to discover that Gerald faced significant challenges controlling his COPD. Gerald used his steroid inhaler at twice the maximum dose to help with his cough, and he relied on his rescue nebulizer every four hours. His overuse of these medications was causing heart palpitations—a concern if left unchecked.

Often, patients with chronic disease purchase personal biometric monitors to keep track of their vital signs at home, so Gerald’s physician incorporated tools such as a pulse oximeter into his exam. She could also tell by listening to Gerald’s cough that he was wheezing. She prescribed medications that would help Gerald with his breathing and help prevent pneumonia from mucus buildup. She also changed the type of medication Gerald used in his inhaler to decrease the impact on his heart. Today, Gerald not only feels much better, but he’s also reduced his risk of heart failure, stroke and other complications, while avoiding having to seek care in the hospital.

Key to success: getting a glimpse into a patient’s home life.

One of the benefits of meeting with Gerald via video is that the virtual physician could ask Gerald to demonstrate how he used his inhaler and could take a look at Gerald’s nebulizer machine. The physician discovered that Gerald used his inhaler incorrectly, while the tubing on the nebulizer machine, which was 10 years old, was cracked. Gerald’s physician taught him a better technique for using his inhaler during that first video session and ordered new tubing for his machine—small changes that ensured he would receive the full benefit of his medications.

It’s important to note that patients do not need to have chronic health problems to benefit from virtual primary care. The experience of Isabella*, 34, is one example. Isabella chose virtual primary care for a mild residual cough that she developed after recovering from COVID-19.

Prior to her virtual primary care appointment, Isabella hadn’t seen a primary care physician in three years. A close look at her medical history indicated that Isabella underwent a pap smear a few years earlier that came back with mildly abnormal results, but Isabella never scheduled a follow-up appointment

The primary care provider discussed the need for further testing with Isabella and connected her with an OB/GYN who could meet Isabella’s needs.

Key to success: paying attention to patients’ care needs beyond the stated reason for the visit

 In Isabella’s case, the convenience of telehealth prompted her to schedule a virtual primary care visit, but the careful eye of her virtual provider enabled Isabella to avoid delayed care, reducing the potential for worrisome health risks. This approach also can help to improve Healthcare Effectiveness Data and Information Set (HEDIS) measure performance.

COVID-19 demanded that providers find creative ways to safely interact with patients, catapulting telehealth into the mainstream. As leaders continue to look for ways to leverage telehealth to provide affordable, evidence-based care that result in better outcomes, virtual primary care should be a top-of-mind consideration in 2021 and beyond.

Cynthia Horner, MD, is the medical director for Amwell and has been a board-certified family physician for 25 years. She has conducted more than 22,000 telehealth visits, having served as a full-time telehealth provider since 2016.

* Names have been changed to protect patients’ privacy.

As healthcare leaders consider how to embed telehealth into their member or patient experience for the long haul, it’s critical to examine how virtual care can lead to better health outcomes.

Is Virtual Primary Care the New House Call? Three Real-World Examples

Press Ganey was recently granted authorization by CMS to deploy the Primary Care First Patient Experience of Care Survey (PCF PECS).

The program comes as part of CMS’s five-year plan to improve quality and patient experiences while keeping costs low for patients receiving primary care. Press Ganey will begin administering surveys during the inaugural PECS administration period starting Sept. 28 and ending Dec. 21, 2021. The surveying firm will continue to administer surveys throughout the rest of the five-year program.

The CMS intends to measure the impact of the Primary Care First Model, a payment model that supports the delivery of value-based care, by using a targeted set of patient experience assessments. These assessments include CG-CAHPS 3.0 and PFC-centric questions focused on five domains:

The delivery of timely care, appointments, and information.

The quality of communication carried out by providers to patients.

The degree of attention to care by other providers.

The support received by patients taking care of their own health.

Press Ganey’s real-time digital surveys, those of which have already been in circulation, will be supplemented by the new in-person survey methods. Gathering patient experience insights from the use of both digital and in-person data collection methods will optimize PCF program performance.

The approval of the PCF PECS program paired with a recent SPH Analytics acquisition makes Press Ganey the only firm certified to conduct all CMS and NCQA-mandated experience surveys. Survey feedback will gather data necessary to improve the experience of patients with complex and chronic conditions.

“We are proud to receive CMS approval to provide a solution to help drive and sustain improvement in the primary care setting,” said Daniel Litwer, Chief Client Officer at Press Ganey, 

. “Feedback from patients will produce critical insight into how this model impacts and reshapes the experience for those with complex and chronic conditions.”

Following authorization from the CMS, the healthcare survey specialist will create methods to gauge patient experience.

CMS Authorizes Press Ganey to Administer Primary Care First Patient Experience of Care Surveys

Josh Hetler is the executive vice president for Business Intelligence, DataLink.

In the wake of revenue loss related to COVID-19, smaller hospitals, public hospitals and rural hospitals are among those most likely to face 

 and may be at risk of closing or merging. If patients don’t receive non-emergent care, health outcomes will decline. This will impact patient 

 and performance, which are increasingly tied to financial incentives by private payers and CMS.

 have seen an overall reduction in claim volume, particularly in commercial lines of business, as members lose employer-sponsored coverage. Additionally, there has been a drop in emergency department, inpatient and office visit claims across all plan types.

In this uncertain environment, healthcare leaders must take proactive steps to close care gaps and ensure patients can access the level of care they need to prevent disease and control chronic conditions. This means finding new ways to tap into operational efficiencies and adopt tools that deliver a 360-degree view of the patient and intelligent analytics to identify care gaps and closure opportunities for quality and risk adjustment.

During the COVID-19 pandemic, primary care visits dropped

with many Americans temporarily putting off going to the doctor. Experts speculate that this will lead to a decline in health 

 and a rise in potentially negative consequences for those who delayed preventive screenings and treatments. The decrease in doctor visits has also led to unaddressed care gaps and strained revenue for many health systems. In fact, providers averaged a

 in visits remains largest among surgical and procedural specialties and pediatrics. 

 show smaller decline for more severe conditions, such as stroke and acute myocardial infarction, compared to visits related to less severe conditions, such as dermatitis and conjunctivitis. Analysis of electronic health record (EHR) data for breast, cervical and colon cancer screenings showed an even sharper decline beginning in early March of 2020 followed by an increase in screenings, although screening rates have remained far below 2019 levels. By mid-June of 2020, weekly volumes for cancer screenings remained roughly 30% to 35% lower than their pre-COVID-19 levels.

 that the COVID-19 pandemic has accelerated the move toward value-based payment, which could disrupt traditional utilization patterns and fee-for-service payment. Such a shift requires more intense focus around data-sharing to support improved outcomes.

Payers should look for opportunities to alleviate provider administrative burden, including increasing access to 

 and adjusting value-based payment programs to focus on outcome improvements that are within provider control. Success for providers and payers will depend upon leveraging data to highlight opportunities for quality improvement and sharing data to aid identification of at-risk members.

 around member diagnoses, procedures and outcomes, they should expect the majority of information for risk analyses to reflect pre-COVID periods. This means that they will not yet see drastic changes in risk scores that are proportional to member changes in utilization for several months.

 will be key to understanding the pandemic’s effect on cost-of-care trends and member risk profiles, and how to manage and triage care in ways that most effectively add value.

To turn this crisis into opportunity, payers can implement 

 to close care gaps, while simultaneously aligning with ongoing quality improvement initiatives:

Identify highest-risk individuals with claims data 

other tools that also enable providers to prioritize patients for outreach and face-to-face visits.

Ensure messages reach their target demographic

 and identify member preferences for engagement, such as texting versus a phone call.

Help members better understand their virtual care

 visit opportunities and encourage its use for ongoing healthcare management needs, especially for behavioral health counseling.

Support follow-up with patients to not only assess 

the effectiveness of outreach and engagement tactics, but also understand strategies that don’t work.

It will be equally important to partner with a population health management solution that offers data analytics and the highest level of data connectivity. These solutions enable payers and providers to better address member healthcare needs, monitor vulnerable populations and take steps to enhance health and reduce risk. The goal is to improve outcomes and strengthen payer performance—for now and beyond the pandemic.

Data connectivity for members, payers and providers has become increasingly important since the passing of the 21st Century Cures Act—which is intended to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. The right population health management solution offers connectivity with EHRs, health information exchanges (HIEs) and the bi-directional data feeds between these systems to extract continuity of care document (CCD) data.

 Real-time reporting and drill-down dashboards forvisibility into membership health metrics and utilization.

. Improves value-based contract performance andprovider engagement, educates and assists the care team on using the technology solution to enhance focus on the appropriate member care key performance indicators (KPIs) and documentation.

 Increases quality care gap closures and leverages data from multiple sources to proactively close gaps in care.

 Improves hierarchical condition category codes (HCCs) recapture documentation to ensureaccurate diagnoses of chronic conditions and risk adjustment accuracy.

 Improves clinical outcomes andalleviates the provider administrative burden of using multiple platforms for care coordination—with proven high provider utilization rate.

 Manages and housesmember data from multiple payers for provider office visits, lab test results, medication adherence and hospitalizations.

. Promotes team collaboration across the care continuum, providing a holistic, real-time view of the entire spectrum of patient care, improving patient care delivery and driving value by reducing operational costs.

An innovative and advanced value-based care enablement solution gives providers more time to spend caring for patients and access to data from multiple payers, with real-time reporting and dashboards at the point of care. This level of data capture enhances patient engagement, improves clinical outcomes, increases quality care gap closures and improves value-based contract performance for a more sustainable healthcare system.

Following a checklist improves data capture, enhances patient engagement, and increases access to care.

 Efficient Data Connectivity Mitigates Economic Impact of Pandemic

Alan Payne, chief information officer at Sensyne Health. We discussed some of the major ethical concerns experts have regarding the use of artificial intelligence (AI) in healthcare. We also talked about how these issues can impact quality of care and what healthcare organizations can do to help avoid them.

Alan Payne, chief information officer at Sensyne Health, discusses some of the ethical concerns regarding the use of artificial intelligence (AI) in healthcare and what organizations should do to mitigate potential data security and bias issues.

Is Virtual Primary Care the New House Call? Three Real-World Examples

CMS Authorizes Press Ganey to Administer Primary Care First Patient Experience of Care Surveys

Efficient Data Connectivity Mitigates Economic Impact of Pandemic

Podcast: AI Ethical Concerns and How to Mitigate Them With Alan Payne

Your Legacy EHR Data is at Risk: The Case for Proactive Information Archival

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