All about the new interoperability rules with Michael Michela

Latest From Data Book

Neal Singh explains why healthcare organizations are turning to this strategy

Contract Lifecycle Management

Healthcare groups react to the updated CDC guidance

The New Mask Rules

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.

Articles

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.

Podcasts

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.

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

Jim Yuhas serves as chief financial officer for Legacy Data Access and operating partner for Cadrillion Capital.

Healthcare technology teams worry about managing data that’s right in front of them—in whatever server, electronic health record (EHR), radiology, financial or billing system the organization is using. With a primary focus on daily operations, conversions, integrations and system optimization, IT resources are always strained. With plenty of priorities, it’s likely they’re 

 thinking about legacy data, a lifetime of disparate information systems with protected health information (PHI) quietly operating in the basement.

But then, a mainframe starts overheating. Or a hard drive starts clicking. Or a lawyer subpoenas patient records for a malpractice case—and there’s a tight deadline for turnaround. In 2021, these types of data emergencies are becoming increasingly more common as legacy systems age, which is why data archiving is such a critical component to a health system’s overall data and risk management strategy.

Health Information Technology for Economic and Clinical Health (HITECH) Act,

 which sped up the healthcare information age, healthcare data has grown exponentially. According to 

, by 2025, there will be 463 exabytes of data created each day worldwide, which is the equivalent to 2.13 million movies. Researchers estimated in 2019 that as much as 

 is health-related (based on the yottabyte scale).

The more data we have, the greater our burden to manage it properly; or the wide range of devastating legal, clinical and financial consequences of poor legacy data management will escalate. 

Legacy Data: Understanding the Costs of Mismanagement

The mere thought of archiving data in a sensible, sustainable way — before waiting until a data emergency — is about as exciting as the idea of engaging with a legacy email account. 

Imagine logging into the email account you created in 2005, which you’ve since abandoned, in order to find an old message sent by a former colleague in 2010. The big difference is that information contained within legacy servers is likely far more critical to protect than an email thread with former colleagues sent to a legacy POP address. It’s also far more costly to protect PHI too: maintaining an operating license on a legacy system is a six-figure monthly expense for large organizations, before the consideration of indirect costs of hardware, support teams. And the consequences of abandoning that data are more severe than losing access to a 20% off Bed Bath Beyond coupon.

The data held by a healthcare system’s machines carries monetary and security risks. If a healthcare system can’t produce data within a given timeframe, it could be asked to pay steep penalties, either in the form of fines or legal settlement fees. For example: If the healthcare system’s legacy data is somehow exposed or compromised (for example, via a ransomware attack) the organization faces civil monetary fines for violating HIPAA plus significant reputational damage.

These potential consequences don’t include the avoidable duplicative costs an organization incurs every month for maintaining and licensing two or more HIPAA-complaint record sets (the old and the new).

Moreover, no financial figure can touch the clinical significance of improper data management: If a patient needs an operation, and the healthcare system can’t access critical, but dated, patient medical information, physicians could miss something big that could change the patient’s care plan—and outcomes.

For these and other reasons, healthcare organizations shouldn’t wait until a physical, legal, or clinical “fire” before considering a better approach for managing data.

Here are four considerations when updating your data archiving strategy:

 A smart data archival strategy will include extraction, backup, access, reporting, migration, streamlining, and active archiving. It’s a lot. But the right partner will simply take the reins and should put negligible weight on the healthcare IT department. For example, you should never be asked to convert or standardize your own data. Not only will this place a massive burden on your team, but the whole archival process will take weeks, if not months, longer than it should. Experience matters.

. Saving on high monthly maintenance fees is great, but almost nothing comes close to the cost of a security breach—both from fines and reputation damage. Between 2009 and 2020, there were 3,705 healthcare data breaches of 500 or more records reported to the (HHS Office for Civil Rights. When working with a prospective vendor, healthcare leaders should always inquire about an organization’s approach to protecting health information at every step of the archival process.

 Expertise is particularly useful when it comes to data archival. Every healthcare IT department knows that the dynamics of a revenue cycle management vendor system is dramatically different from a mainframe-based system, as are the variety of internally created systems. When it comes to speed of archival, it’s smart to find a partner that’s already navigated hundreds of computing languages, not to mention departmental, operational and technical specifications. This matters when it comes to turnaround time and accuracy. If a data vendor has to subcontract with a consultant, that could cause delay and impacts the ability of an organization to quickly and efficiently shuttle their data from a legacy system to a new archival solution.

User experience is often one of the more confusing areas of data archival. Many systems, such as EHRs and practice management systems, leverage sleek, artificial intelligence (AI)-driven portal designs to minimalize administrative burden on staff. Archival strategy is a bit different. The objective is to lower cost and risk with as little disruption as possible, often most efficiently done by mimicking the previous system, but specifically for archival use. This minimizes training and unnecessary workflow delays, as your teams enter into familiar replicas of old systems with one access point for all archived systems.

These are all things healthcare organizations should consider as they head into spring-cleaning mode and look for ways to ease operations, archive old data, and protect themselves for when a data emergency does arrive. With awareness and consideration of all the avoidable risks and costs maintaining legacy systems, organizations must prioritize their archival planning. This creates the opportunity for healthcare organizations free to focus on managing the data that’s right in front of them, instead of worrying whether a hazardous situation or PHI catastrophe will leave them scrambling.

Jim Yuhas serves as chief financial officer for 

 and operating partner for Cadrillion Capital. Prior to joining Cadrillion, Yuhas was at Banc of America Securities as a syndicate member on the Special Situations desk within the Global Debt platform. He has more than a decade of LBO, recapitalization and leveraged finance experience. Previously, he was a CPA with KPMG.

Unless health IT teams become more proactive, a wide range of legal, clinical and financial consequences resulting from poor legacy data management will escalate.   

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

Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include 

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.”

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.

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 wave of health system retirements continues, with Baptist Health South Florida CEO Brian Keeley announcing plans to retire Wednesday after nearly 50 years of service, according 

 from the health system based in Coral Gables, Florida. Keeley will retire next year and will be succeeded by Albert “Bo” Boulenger, the current executive vice president and chief operating officer (COO), who now assumes the title of president. Keeley began his career at Baptist Hospital in 1969 as an administrative resident and was named assistant administrator in 1973, following four years in the U.S. Navy Medical Service Corp. Keeley became chief operating officer of Baptist Hospital in 1979 and CEO in 1986, and has led the multihospital system since the merger of Baptist Hospital with South Miami Hospital and Homestead Hospital in 1995. Keeley is credited with leading the health system’s digital transformation efforts, which aimed to make the Baptist Health South Florida the “Amazon Prime of healthcare.” The 11-hospital system now has nearly 24,000 employees.

Vice President for Government and Community Affairs Tom Lewis will retire from Johns Hopkins University and Medicine will retire after 16 years at the institution, where he is credited with strengthening relationships with surrounding communities. Lewis came to Johns Hopkins in 2005 as director of State Affairs in a newly consolidated office spanning Johns Hopkins University and Medicine, and he became vice president four years later. According 

, Lewis made an immediate impact in garnering state support for capital projects at Johns Hopkins as part of a broader strategy to boost Maryland's economic development and intellectual capital, including projects in technology and cell therapy. Lewis, who had previously served as chief of staff for two speakers of the Maryland House of Delegates, secured state funding for new clinical buildings in East Baltimore; gaining funding support for the Maryland Advanced Research Computing Center, which vastly increased the capacity for researchers at Johns Hopkins and the University of Maryland, College Park to pursue big data projects; and partnering with Johns Hopkins Tech Ventures to win state support for the Maryland Center for Cell Therapy Manufacturing in East Baltimore.

The wave of post-pandemic retirements continues.

MED MOVES: Retirements at Baptist Health South Florida, Johns Hopkins

The Supreme Court on Thursday tossed a lawsuit that once again threatened the Affordable Care Act (ACA), ruling 7-2 that Republican-led states who brought the case lacked legal standing to challenge the law.

For the third time, an increasingly conservative court left intact the law’s protections that require coverage for preexisting conditions, created Medicaid expansion, promote health screenings and preventive care, and launched novel, value-based payment strategies within the agency that manages Medicare and Medicaid.

The ruling comes as President Joe Biden has tried to build on the ACA and create new incentives for states that have not expanded Medicaid to do so, amid mounting evidence that having health coverage reduces mortality.

 and was joined by Justices Elana Kagan and Sonia Sotomayor, as well Chief Justice John Roberts and two appointees of President Donald Trump, Justices Brett Kavanaugh and Amy Coney Barrett. The opinion focused on the fact that individual states governed by Republicans, along with individual plaintiffs, had failed to show “a concrete, particularized injury fairly traceable to the defendants,” and thus could not challenge the law on constitutional merits.

The latest challenge, led by Texas, began after Trump’s 2017 tax law eliminated the enforcement mechanism for the ACA’s individual mandate. On those grounds, the Republican-led states tried to assert that the entire law must fall, even provisions unrelated to the requirement that all Americans have health insurance.

Today, the Supreme Court’s majority found that the states failed to make their case that the de facto end of the mandate would cause them harm, which would create grounds to challenge the entire ACA.

“Unsurprisingly, the States have not demonstrated that an unenforceable mandate will cause their residents to enroll in valuable benefits programs that they would otherwise forgo. It would require far stronger evidence than the States have offered here to support their counterintuitive theory of standing, which rests on a ‘highly attenuated chain of possibilities.’”

Justice Clarence Thomas wrote a concurring opinion, stating, "Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today."

An estimated 20 million people had gained coverage under the law at a peak in 2017, but there was some loss of coverage during the Trump administration. More recently, more than 1 million people signed up for coverage through the ACA under a 

 authorized by the Biden administration due to the COVID-19 pandemic. The American Rescue Plan reduced premiums, and additional proposals would make those premium cuts permanent.

While many legal experts had questioned the merits of the Republican states’ challenge, the addition of Justices Neil Gorsuch, Kavanaugh, and Barrett to the court raised concerns among the law’s supporters about what would happen once the case reached the highest court. Gorsuch and Justice Samuel Alito dissented, but the other Trump appointees ruled with majority on the narrower question of standing.

The latest challenge was argued in November, just after Barrett joined the court, and the defense was organized by a group of officials from Democrat-led states. Their leader was former California Attorney General Xavier Becerra, recently confirmed as Biden's HHS secretary.

The ACA is now one of the most litigated pieces of legislation in history. It survived an initial challenge after its passage in 2010, although the court did reshape the law by allowing states to opt out of Medicaid expansion.

However, that decision ended up creating an environment for research comparing health outcomes between expansion and non-expansion states, and now data are pouring in that show how populations with health coverage benefit in multiple ways—those 

 who are able to manage their disease suffer fewer complications.

Veterans of the Obama administration who helped write and implement the ACA were surprised and pleased this morning, and said the decision opens the door for the Biden administration to improve the law.

“Bottom line—this is incredible,” former Obama administration policy official Kavita Patel, MD, told MSNBC. “It’s a chance for the Biden Administration to try to take back some of what the country lost when the individual mandate was taken away. … Not being a lawyer, I don’t think you could have a clearer path saying, ‘this is it.’”

“It’s not a close call in terms of the law, and not a close call in terms of who we are as a country,” said former Acting CMS Administrator Andy Slavitt.

Chiquita Brooks-LaSure, now CMS Administrator with chief responsibility for implementing the law, recalled her work on its passage during her tenure with the House Ways and Means Committee. 

"Millions of Americans can breathe a sigh of relief following today’s Supreme Court 7-2 ruling upholding the Affordable Care Act," she said. "This victory assures access to affordable and comprehensive health insurance for patients and families across the country."

She pointed to the fact that 12 states have still not expanded Medicaid, but the Biden administration hopes that will now change.  "Through the ACA, and hand-in-hand with CMS, dozens of states have expanded Medicaid – bringing quality coverage to our family and neighbors who need it most. We will continue to partner with states because we know 4 million more Americans stand to gain access to quality health coverage in the remaining states."

Other supporters of the ACA also called for working to improve the law.

"CareFirst is pleased that the key provisions of the Affordable Care Act remain in effect and will continue to promote access to affordable health insurance for the individuals we serve and all Americans,” said Brian D. Pieninck, president and CEO of CareFirst BlueCross BlueShield. “CareFirst looks forward to continuing our work with federal and state policymakers to maintain and improve access to healthcare throughout our region."

Officials from the Robert Wood Johnson Foundation called for an end of “meritless attacks against a milestone law. … It is time now for our nation to resume its path toward achieving universal health care coverage.”

MED MOVES: Retirements at Baptist Health South Florida, Johns Hopkins

Supreme Court Upholds ACA, Says States Lacked Standing

Launching the Right Mobile Strategy for a Post-COVID Environment

Podcast: Home Dialysis Machines and Cloud-Computing with Leslie Trigg

Key Factors to Drive Healthcare Engagement for Lasting Behavioral Change

Featured Content

Latest From Data Book

Contract Lifecycle Management

The New Mask Rules