Neal Singh explains why healthcare organizations are turning to this strategy

Contract Lifecycle Management

A family physician offers three case studies in virtual primary care

The New House Call?

In Our Podcast, Sundar Kamak Shares How Technology Can Help

Curing Supply Chain Woes

Hospitalizations for eating disorders among adolescents increased significantly during the COVID-19 pandemic, according to 

In the first 12 months of the pandemic, the number of hospitalizations among patients ages 10-23 with eating disorders more than doubled at Michigan Medicine. The center admitted 125 patients with eating disorders in that time, compared to an average of 56 per year between 2017 and 2019.

The pandemic may have triggered or worsened symptoms in teens with eating disorders and those who were at risk for eating disorders, according to the authors.

“These findings emphasize how profoundly the pandemic has affected young people, who experienced school closures, cancelled extracurricular activities, and social isolation. Their entire worlds were turned upside down overnight,” said lead author Alana Otto, M.D., M.P.H., an adolescent medicine physician at University of Michigan Health C.S. Mott Children’s Hospital.

The study also suggests that admission rate at Michigan Medicine increased steadily in those 12 months, with the highest rates being between nine and 12 months after the pandemic began. Rates have continued to climb after March 2021. This may be due to delayed care and in-person visits for conditions unrelated to COVID-19, the study said.

This research only reflects a small portion of people with eating disorders during the pandemic, however other studies have found similar trends. “Although our findings reflect the experience of a single institution, they’re in line with emerging reports of the pandemic’s potential to have profound negative effects on the mental and physical health of adolescents across the globe,” Otto wrote.

Other institutions are reporting the pandemic’s profound effects on mental health among teens. Experts at Johns Hopkins Bloomberg School of Public Health 

 on the pandemic’s double whammy on well-being: the disruption of peer-to-peer interactions, and the severing of ties to teaches and coaches who form a “safety net” and are trained to intervene if they see a teenager showing signs of distress.

Otto also mentioned that medical attention is not the end of treatment for adolescents with eating disorders, but the beginning. “Access to care was already limited before the pandemic and now we’re seeing an increased demand for these services. As we see a wave of young people coming to the hospital for urgent medical concerns related to eating disorders, we need to be prepared to continue to care for them after they leave the hospital.”

Articles

One study author noted that access to mental health care was already limited before the pandemic, and now demand is increasing.

Hospitals See Spike in Adolescent Eating Disorders During Pandemic

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

Hospital mergers are a prime target in President Joe Biden’s expansive executive order that calls on federal departments and agencies to reshape what he called a “booming” economy by putting workers first and ensuring consumer protections.

The order spans sectors from banking to transportation with 72 specific initiatives, including several that target healthcare, which is already undergoing upheaval amid the COVID-19 pandemic, which has exacerbated shortages of doctors and nurses, strained supply chains, and pushed veteran administrators into retirement.

“For decades, corporate consolidation has been accelerating,” a statement issued with the order reads. “In over 75% of U.S. industries, a smaller number of large companies now control more of the business than they did twenty years ago. This is true across healthcare, financial services, agriculture and more. That lack of competition drives up prices for consumers.”

The statement cited data claiming that mark-ups have tripled, raising costs for necessities like prescription drugs, hearing aids, and internet service—which became essential during the pandemic as telehealth became the only way to see a doctor.

Key items in Biden’s executive order include:

Empowering antitrust agencies, including the Federal Trade Commission, to address problems surrounding consolidation in certain industries, including healthcare, where mergers have left some rural areas with no hospital.

Making it easier to change jobs, including between states, by reducing occupational licensing requirements and limiting non-compete agreements.

Reducing prescription drug prices by allowing programs run by states and tribes that import drugs from Canada.

Promoting more procurement opportunities for small business with federal agencies.

The order creates a White House Competition Council the track progress on the initiatives and agencies’ response.

Consolidation in healthcare over the past decade—mergers of hospitals into larger systems, acquisition of practices, and vertical integration of health plans and pharmacy benefit managers (PBMs)—has drawn fire from consumer and antitrust advocates who say the trend works against keeping down costs, especially when one looks at some individual markets.

The order directs the Justice Department and the FTC to examine guidelines on hospital mergers to ensure that patients are not harmed.

Recent trends also work against reining in the price of prescription drugs, because powerful PBMs can dictate which drugs appear on formularies, demand rebates, or impose fees. Just this week, a study by authors at USC’s Schaeffer Center found that Medicare overspent by $2.6 billion in 2018 on commonly prescribed generic drugs compared with prices charged by Costco.

Biden’s order directs HHS to do the following:

Support hospital price transparency rules and to finish implementing bipartisan federal legislation to address surprise hospital billing. This is significant, because many wondered the fact of the transparency rules imposed at the very end of the Trump administration.

Restore a rule from the Obama era that insurers selling plans under the federal marketplace, created by the Affordable Care Act, must have at least one standard design to serve as a benchmark for consumers to compare with other companies. This concept was scrapped under the Trump administration.

Directs the FDA, which is part of HHS, to work with states and tribes on safe import practices under the Medicare Modernization Act of 2003.

Increases support for generic and biosimilar drugs and allows 45 days for a comprehensive plan to combat high prescription prices.

Empowers FTC to ban “pay for delay” and similar practices that keep low cost drug or biosimilar options off the market.

Hospital Mergers Targeted in Biden Executive Order

This week, CHE welcomes Mary Starmann-Harrison, whose career in healthcare administration spans more than 40 years. During her 10 years as CEO of Hospital Sisters Health System, Starmann-Harrison has spearheaded the expansion of hospitals and physician groups in both Illinois and Wisconsin. She will retire in July.

This transcript is lightly edited for clarity.

As you retire from Hospital Sisters Health System, what initiatives are you most proud of?

 Not so much initiatives, but I am most proud of our colleagues. We have a tremendous group of colleagues that are completely committed to our mission and serving our patients in an incredible way. 

We've had major growth over the past 10 years. We've built new hospitals, we've expanded our physician groups. We've had some major strategic initiatives that have really advanced our mission.

 If you could select one major healthcare advance that you knew would be important as soon as it happened, what was it and why?

The major healthcare advance that I remember being the most dramatic was the advancement of laparoscopic surgery. In the very early days of laparoscopic surgery, people were not sure it was going to be something of the future. And it started with laparoscopic gallbladder surgery, and it went into almost every area: urology, [gastrointestinal], cardiac. And it really changed the world from doing open procedures that required hospitalization and weeks of recovery time, to outpatient surgery with a very short recovery time of a couple of days. So, I really think that was probably the most dramatic change, especially in clinical medicine, that I have experienced.

Conversely, is there something that happened in healthcare during your career that was dismissed as unimportant early on, that turned out to be extremely important—for good or ill?

You know, I think the advancement of ambulatory surgery, when it first started, there were a lot of folks that thought it wouldn't be as successful as it turned out to be. A lot of people felt, no, you needed the backup of a huge hospital. And, that did not prove to be true. People just were not sure that was going to work, and look where it went and where it is today.

 What are some challenges you’ve faced during your career? How did these challenges impact your leadership?

 Certainly, [there have been] financial challenges over the years. There've been several situations in the past four decades where we had major changes in reimbursement for hospitals and health care facilities. We had disruptive changes in our markets. 

I think what the learnings were, is make the difficult decisions sooner rather than later. And always have compassion as you carry out those decisions. You have to make the hard decisions, but you can always carry them out with a lot of compassion. And so that was my big learning.

 Can you discuss the growth of technology during your time in healthcare? What has been good—and not so good—about the growth of technology in healthcare?

Well, I see most of the changes in technology as being very good. We already talked about laparoscopic [surgery], which was a game changer in terms of clinical medicine. But think of the electronic health record, which did not exist at the beginning of my career and what it has achieved today for continuity of care for patients. It's remarkable. 

And, telehealth [started] as a budding technology, and then the pandemic hit, and it's here to stay. It was a lifesaver during the pandemic. Many patients were able to get care that they might not have gotten if it had not been for telehealth. So, those are just a couple of examples over the years that I think have made a great difference, a wonderful difference, in health care.

 What are the one or two biggest challenges that you see for the next generation of healthcare leaders?

The two things that come to mind immediately is the speed of change. It's going to be much more rapid and we're going to have to be much more nimble as we go forward. 

So, that would be the first, and then the second would be that healthcare is competitive now. We're going to have non-traditional competitors in healthcare, and that can change the game. So, I think we have to be prepared for people entering parts of healthcare that have traditionally not participated in healthcare.

 What advances do you see at Huntsville Hospital in the next five years?

I see organic growth as well as inorganic growth. As we look at our footprint in Illinois and Wisconsin, I also see an increase in the number of ambulatory facilities that we have in the system. And I see continued growth of our physician partners.

 What are you looking forward to in retirement?

Well, first, I'm really looking forward to enjoying time with my husband and my family. You know, I have two adult children and they're a little bit spread out, but we will have plenty of time to visit. I'm also looking forward to traveling with friends. We have a lot of good friends who have just retired and so that's in the plans for sure. 

I love to play golf, although I'm not a good golfer because I do not play enough to be good. So, I'm hoping I will have an improved golf game. And, you know, volunteering, having fun, providing services for others in a volunteer effort. And then I'd love to read. So, I will get to read my mystery novels whenever I want.

Videos

Second installment of Turning Points, a Chief Healthcare Executive™ video series that invites retiring hospital and health system CEOs to share insights on how the healthcare landscape has changed and what challenges await the next generation of healthcare leaders. 

TURNING POINTS: Hospital Sisters’ Mary Starmann-Harrison Advises, “Make the Difficult Decisions Sooner Rather than Later”

Health systems that want to save money on a major cost of delivering care might look no further than their nearest Costco.

That’s what a health economics research team from the Leonard D. Schaeffer Center at the University of Southern California to highlight Medicare pays an extra $2.6 billion for generic drugs, thanks to layers of middlemen who negotiate prices for government—but pocket some of the savings. The study, led by Erin Trish, PhD, appeared 

When reimbursement policies eliminate cost-sharing for some prescriptions—making the “cost” invisible for some patients—those taking the drugs don’t realize that the government is spending billions for prescriptions cost less at nearby warehouse outlets, such as Costco.

The authors point out that while there’s been plenty of attention to brand name drugs with eye-popping list prices, most of the drugs that Americans take—both in the hospital or at home—are generic medications. In fact, 88% of Medicare Part D prescriptions dispensed in 2018 were generic, so any savings retained by pharmacy benefit managers (PBMs) could quickly add up.

The findings suggest these practices, which work against Medicare, beneficiaries, and the taxpayers, deserve a closer look, Trish said in a statement released by USC.

“Our analysis shows that in systems like Costco’s, where incentives are set up to deliver value directly to the consumer at the pharmacy counter, that’s what happens,” said 

 and an assistant professor of pharmaceutical and health economics at the USC School of Pharmacy. “It’s time to fix those incentives in the Medicare Part D system to put the patient first.”

To conduct their study, the team compared what Medicare Part D plans paid for 184 commonly prescribed generic drugs, including patient out-of-pocket costs, with the cash prices that Costco members were charged for the same drugs in the years 2017 and 2018.

They found the government overpaid, and by a lot: after analyzing 1.4 billion Part D claims, they found Medicare overpaid 13% in 2017 and close to 21% in 2018, compared with the Costco customers.

For those who take regular prescriptions for a chronic condition—which many seniors do—the savings at Costco escalated. Members who took advantage of the 90-day fill option in 2018 saved whopping 53% over what Medicare plans paid. Medicare plans overspent. Medicare plans overpaid on 30-day and 90-day fills by 43%, the study found.

PBMs have been in the crosshairs from government leaders and advocacy groups alike in recent years. Vertical integration with payers has made them more powerful, and 

 many states have taken action to protect consumers and their own Medicaid budgets. Federal legislation has been introduced to limit or 

, but any effort to rein in PBM practices will have unforeseen effects. Advocacy groups in the cancer care community say efforts to stop spread pricing have resulted in the creation of new classes of fees to get revenue another way.

For those who take regular prescriptions for a chronic condition—which many seniors do—the savings at Costco escalated.

For Proof of Government Inefficiency in Drug Purchasing, They Went to Costco

On this week's episode of Data Book, Chief Healthcare Executive™ spoke with Peter Urbanowicz, managing director and co-head of Alvarez and Marsal’s Healthcare Industry Group. We discussed the FDA’s recent shift in priorities to address supply chain issues, device shortages, and the backlog of drug approvals as well as how technology can help. We also talked about how hospitals are handling these issues and what they can do as they wait for the FDA to catch up.

Podcasts

Peter Urbanowicz, managing director and co-head of Alvarez and Marsal’s Healthcare Industry Group, discusses the FDA’s new focus in addressing supply chain and device shortages posed by the COVID-19 pandemic and what hospitals should be doing in the meantime to adjust.

Waiting for FDA to Catch Up: What Hospitals Can Do to Address Supply Chain and Device Shortages

Deirdre Ruttle is chief marketing officer, InstaMed, and head of Wholesale Payments Healthcare Marketing, J.P. Morgan Chase & Co.

Trends in Healthcare Payments Eleventh Annual Report

, there is a troubling disconnect between consumer expectations and payment realities in healthcare. In this year’s report, a large portion of providers are once again missing the correlation between the patient healthcare payments experience and overall patient loyalty and satisfaction. Legacy processes that depend on staff intervention and paper statements continue to dominate the industry. This persistent oversight puts patient loyalty and satisfaction at risk for provider organizations.

Providers who already faced payment challenges now confront new ones, due to effects of COVID-19 on their revenue. The financial losses for providers this past year were massive, stemming from shutdowns related to the pandemic. The focus on recovery will likely dominate budget discussions and provider strategy for years to come.

The pandemic highlighted how much the healthcare industry needs to catch up in the digital world. The word “contactless” is now ingrained in our common vernacular and is expected in every possible consumer experience. Consumer sentiments show the demand for contactless experiences that are also digital and convenient has been on the rise for years, and 2020 might be the year where the importance of this rising demand was fully realized. For providers to rebuild in a post-pandemic future, the benefits of contactless channels will be crucial to cut costs, promote efficiency and improve collections.

Troubling Disconnect Between Providers and Consumers

Year after year, the trends consistently show a disconnect between consumer preferences and their actual healthcare payment experience. For instance, 66% of consumers receive medical bills in the mail, yet only a small percentage want to return the payment through the mail—only 14% of consumers prefer to pay medical bills via mailed paper check. Additionally, 86% of consumers pay recurring bills online, but 58% of providers rely on mailed paper statements to collect.

Many providers still do not see how that disconnect affects their organization, as 42% of providers think collection efforts have no impact on the patient experience. Loyalty to a provider organization may depend more on payments, as more than half of consumers would consider switching providers for a better payment experience.

Consumers are responsible for the cost of provider visits more frequently and for higher amounts than in the past. This trend in payment responsibility stands to further bind consumer loyalty to the payment experience in healthcare, especially as consumers engage with providers for medical bills more often. For providers, the increase in payment interactions can ultimately be an opportunity to avoid patient attrition, as well as increase revenue.

The Financial Impacts of the COVID-19 Pandemic on Healthcare Organizations

The shutdowns and fear of COVID-19 caused a sharp decrease in provider visits, with huge effects on revenue. As a result of the decrease in visits, healthcare spending was down 2% over the previous year, the first decrease in recent years. Even as the restrictions were reduced in 2020, patient volume did not return to pre-pandemic levels as 73% of providers reported a lower volume of patients after initial shutdowns.

The decrease in healthcare spending and lower overall patient volumes put a strain on providers. Many providers reported their primary financial concern was related to the impact of the COVID-19 pandemic on their revenue cycle. Outside funding was critical for many providers to remain in business. The focus on recovery will likely dominate budget discussions and provider strategy for years to come.

Digital Channels and Experiences Are a Key to Recovery

Outside of the COVID-19 pandemic, provider organizations have not kept pace with the digital growth experienced in other industries. Throughout the healthcare industry, paper and manual processes still dominate provider processes related to patient check-in and collections:

72% of providers use paper and manual processes for check-in

81% of providers leverage paper and manual processes for collections

The current processes providers use for patient collections require valuable resources. However, that investment does not guarantee that a payment is received. Six in 10 providers report that a balance can take more than a month to collect. Even after a balance is collected, there is no guarantee that the amount owed is the same as the amount paid. Nearly all providers report issuing patient refunds.

Savings await providers who leave paper collections behind and fully adopt electronic payment processes. Even a single visit with fully electronic transactions could offer a significant savings for providers. The potential of electronic transactions should be a key consideration for providers as they rebuild in the post-pandemic future.

Smaller Provider Organizations Benefited from Pre-Pandemic Digital Focus

Payment trends in smaller provider organizations offer hope for what can be accomplished with contactless payment channels. Payment data shows that organizations with 15 or fewer physicians saw growth in contactless payment channels for 2020:

Smaller organizations saw a 55% increase in online payments growth

Smaller organizations saw a 64% increase in automated payment plan growth

These organizations may have been better positioned for the challenges of 2020 by relying on streamlined payment channels and processes already in place. Both payment channels allow organizations to increase collections with minimal staff involvement and fewer resources, such as paper statements. The efficiency of contactless payments may have attracted smaller organizations needing to increase cash flow without additional costs, even before the pandemic.

Payment trends in smaller provider organizations offer hope for what can be accomplished with contactless payment channels. This segment of providers saw payment growth in self-service and automated channels, even during a pandemic when non-essential services were closed. The financial consequences of the pandemic will require providers of all sizes and specialties to find remedies for their payment challenges quickly.

The trends indicate that the clearest path forward for providers will be paved with digital, contactless payment and communication channels, which can improve the payment experience and ultimately help providers collect more from patients at lower costs.

Consumer sentiments show the demand for contactless experiences that are also digital and convenient has been on the rise for years, and 2020 might be the year where the importance of this rising demand was fully realized.

Provider Trends in Healthcare Payments: Missing the Connection with Consumers

Bevey Miner serves as Health IT Strategy/Chief Marketing Officer for J2 Global Cloud Services.

Clinicians and staff at medical practices across the United States are surely breathing sighs of relief now that the worst effects of the coronavirus pandemic are behind us.

Providers have been particularly troubled as they try to keep practices solvent and operating after the country first shut down in March 2020. During that initial closure, 

 dropped by 60%. By the end of July, however, visit volumes rebounded to 10% less than levels seen before the pandemic.

Still, the huge decrease in patient volumes created a preventive care vacuum that clinicians tried to fill. But with only so many hours in the workday and a static number of clinical and administrative staffers, providers have felt there is little they could do to increase capacity.

Much like telehealth visits and remote monitoring took center stage during the pandemic, emerging collaboration and interoperability technologies can help practices do more with the same staff. By making the care process more efficient, technology can relieve administrative burdens, help clinicians participate more fully in integrated, patient-centered care and refill depleted practice coffers.

 during the first five months of the pandemic, including 29% who missed a preventive care visit and 26% who didn’t show for a general outpatient appointment. Consequently, between February and August, physician practice revenue dropped 32%.

A July survey of 3,500 physicians showed that 8% had permanently 

, with another 4% planning to do so within the next year.

Conducted in September 2020, a survey of primary care clinicians showed that a physician in nearly 20% of practices had either retired early or was planning to do so. Another 15% indicated that someone had left or was planning to leave for other reasons. The same survey showed that about 50% of physicians pegged their mental exhaustion as the highest they’d experienced, and 7% worried they couldn’t keep their practices solvent past December.

Besides the heartache of closing practices—even temporarily—and furloughing staff, providers also had to contend with higher supply expenses for protective equipment, spoiled supplies such as vaccines that expired during the downturn, and ongoing expenses for rent and equipment.

As practices continue to ramp up, leaders should be examining every area of operation, every piece of technology and every staff member to bring new efficiencies to the practice. Healthcare is still plagued with paper processes and suffers from inefficient workflows, which ultimately reduces productivity. And although the number of required healthcare jobs has been growing, productivity hasn’t kept pace. Over the period from 2001 to 2016, healthcare accounted for 9% of U.S. economic growth but created 29% of net new jobs, 

 in relationship to job creation. This is not a problem we can throw more people at. Only efficient technology can scale at a level necessary to lower costs.

A small-scale study aimed at the Quadruple Aim — reducing costs while improving population health, patient satisfaction and team well-being — demonstrated that small changes can have an 

. Reducing the administrative burden on practices can increase throughput, making staff more productive and efficient. The intervention group was able to offer 48% more patient appointment slots than the control group.

Effective communications technology that strengthens ties among your practice and other providers and healthcare facilities throughout the care continuum is critical to your future success. New rules from the CMS require electronic communications among an increasingly large variety of healthcare providers, including primary care physicians.

These rules are designed to increase interoperability and patient-centered care as people transition among providers and care settings. For example, one newly enacted rule requires hospitals, psychiatric hospitals and critical access hospitals to send electronic notices of 

 (ADT) to established healthcare providers. Another opens up patient access to their health records by setting rules around information blocking that encourage interoperative care.

As another example, telemedicine visits and remote monitoring provided a lifeline for many practices last year as patients avoided in-person treatment. Telehealth visits comprised about 

 from mid-March through mid-June 2020, a 23-fold increase from Jan. 1 to March 17, 2020, according to a study.

Practices must embrace new technology in order to fully participate in patient care.

Modern Communications Fuel Interoperability Strategies

 still use standalone fax machines as a communications source. Providers send and receive patient data, referrals, and other data, including protected health information (PHI) that then must be collected, collated, scanned and attached to the patient record, a slow and painstaking process that reduces administrative efficiency and creates barriers to care.

In the new interoperative care environment, practices that make referrals, for example, want to know that referred patients are immediately contacted for an appointment. In the same vein, ADT notifications should be acted on immediately, so the continuity of care is maintained as patients transfer among settings. Increasingly, providers and facilities are paid one rate for services across settings, which makes the timeliness of care critical to prevent readmissions.

Paper faxes require additional processing steps to become actionable, including manual data entry that can introduce errors that compromise patient care. Cloud fax technology and more robust communications platforms convert faxes to electronic documents that can flow directly to the patient record and arrive at an administrator’s inbox for immediate attention. Additionally, EHRs can be mined with natural language processing and artificial intelligence capabilities to help practices better understand—and care for—their patient populations.

Imagine creating cohorts of patients with similar conditions for chronic care monitoring that can bring in additional revenue while at the same time meeting quality improvement measurements. Reducing manual processes also frees up office staff to proactively contact patients who have missed visits or are due for labs and preventive screenings. Responding immediately to referrals and ADT notifications endears your practice to referral partners, increasing the likelihood of continued collaboration.

Physician practices were hit particularly hard by the pandemic as offices closed and patients delayed care even after offices reopened. Now that patient visits are returning to prepandemic levels, savvy providers are exploring ways to do more with the same staff.

robust communications platform designed to support interoperability

 can not only replace the physical fax machine, it can help a practice become more efficient and collaborative to increase referrals, patient and clinician satisfaction, and revenue.

Bevey Miner serves as Health IT Strategy/Chief Marketing Officer for J2 Global Cloud Services, who are the creators of the 

Consensus healthcare data-sharing platform

, the leader in HIPAA-compliant healthcare fax technology. With over 20 years of experience in healthcare technology and digital health, she has been instrumental in leading strategy, product management, business development, marketing and commercialization.

By making the care process more efficient, technology can relieve administrative burdens, help clinicians participate more fully in integrated, patient-centered care and refill depleted practice coffers.

Collaboration Technologies Can Help Practices Recover from Pandemic Challenges

Pete McCanna, left, and Jim Hinton of Baylor Scott & White.

Texas’ largest not-for-profit health system will have a new CEO in 2022, as Dallas-based Baylor, Scott & White announced Thursday that CEO Jim Hinton will retire and hand the reins to President Pete McCanna, effective January 1.

"Jim’s visionary leadership has been transformational. He energized and aligned our teams around shared commitments to our patients and communities," Holdings Board Chair Ross McKnight said in a statement. "He raised the bar for what it means to be a successful, faith-based, not-for-profit system and has driven a strategy that is making Baylor Scott & White one of the most consumer-centric health organizations in the country."

Hinton is credited with transitioning Baylor Scott White in a direction “to make quality healthcare more accessible and affordable for Texans,” the statement read. The board’s statement focused on Hinton’s efforts to emphasize patient safety, improve employee engagement, and improve operational performance each year of his time as CEO, including a final year of unprecedented challenges responding to the COVID-19 pandemic.

He arrived January 16, 2017, after 33 years leading the not-profit-Presbyterian Healthcare Services, New Mexico’s largest provide. By July 2017, Hinton had recruited McCanna to lead the Office of the President, thus creating a succession plan. McCanna previously served as Presbyterian’s chief financial officer before moving to a higher position at Northwestern Memorial Healthcare in Chicago.

The transition will occur January 1, 2022.

MED MOVES: Baylor Scott & White Announces Transition Plan 

Carlos Meléndez is the chief operating officer and co-founder of the artificial intelligence and software engineering services firm, Wovenware.

 essential workers are those who “conduct a range of operations and services that are typically essential to continue critical infrastructure operations.” These occupations, while determined by individual states, generally include healthcare workers, along with those who work in grocery stores, pharmacies, child care, energy sectors and non-profits. More than a year ago, many of us probably never really heard of the term, 

Alongside the heroic humans who have been stepping up to the plate regardless of their occupation, artificial intelligence (AI) has joined the front lines. It is assisting humans in their work and making the insurmountable challenge of finding a vaccine, diagnosing COVID-19, helping people get vaccinated, helping insurance claims get paid or assuaging public concerns a reality.

It’s no wonder that AI spending in the healthcare and pharmaceutical industries is expected to increase from $463 million in 2019 to more than $2 billion over the next five years, 

according to a recent study by ABI Research

. In an industry where AI has been trying to find its place and prove it’s ready for primetime, the pandemic has helped it proven its worth.

Consider the following examples of how AI, in all its forms, has battled the pandemic.

. From Moderna, Pfizer and Johnson & Johnson to countless other vaccines still in development, the speed at which highly effective treatments have been developed is unprecedented. A process that would normally take 10 years was reduced to months. Collaboration between government and industry and accelerated approval timelines have much to do with it, but AI also played a critical role. Since science is grounded in data, deep learning 

algorithms have been able to examine the virus’ complex structure

, and sort through thousands of components to identify those that are most likely to trigger a robust immune response. Likewise, machine learning has made it possible to create models that can learn and find patterns within available data and make inferences from previously unseen data. And, deep learning is taking that a step further, allowing features to be extracted automatically from raw data.

. Thankfully, many people are becoming vaccinated, but COVID-19 remains a major health threat. AI is helping researchers develop ever more accurate, convenient and faster testing so that infected people can be treated and isolated as soon as possible. Machine learning and computational modeling are allowing researchers to study the ways different techniques and materials can improve the accuracy and response time of screening procedures. At 

, machine learning is helping scientists use routine healthcare data from the electronic health records of thousands of patients to predict COVID-19 in patients coming to the emergency department.

more than 448 million vaccine doses had been administered worldwide

, and it’s only the tip of the iceberg. For every person vaccinated, it’s essential that the batch and lot numbers are recorded along with the name and location of every person who received one. In addition, for two-dose vaccines, there needs to be a way to easily prompt the patient to return for a second dose. It’s overwhelming to capture that information alone by administrators, so AI is helping to process that data. Much faster than would be humanly possible.

AI is also helping to fairly distribute vaccines. Last winter in Minnesota, 

demand for the vaccine has surpassed supply

. A predictive AI algorithm is helping to identify which of the patients are in the highest risk group in order to prioritize appointments.

. As hospitals work to treat sick patients first and foremost, the financial toll of COVID-19 is just beginning to be realized on hospitals, health systems and payers. In fact, the AHA estimates a total four month financial impact of $202.6 billion in losses for America’s hospitals and health systems. The mounting costs, claims and settlements are creating a backlog of administrative processing, yet new AI-driven document processing solutions are handling many cases so that humans can focus on the anomalies and address more strategic issues. AI is enabling faster and more accurate processing of customer data, while also helping to identify and address fraudulent claims more easily.

th strict no-visitor policies in place, hospitals are not only trying to take care of sick patients, but to also answer incoming calls about symptoms or patient updates. Chatbots are helping to answer questions, direct callers more quickly and easily than would be possible with human staff alone.

For example, Providence Saint Joseph Health turned to technology to help it more effectively manage three critical stages of care: triage, testing and treatment, relying on chatbots to assist during the triage phase. By visiting its 

, people can find out more about which symptoms might indicate the virus, and figure out if they should be seen by a health professional. This chatbot is connected to a virtual patient care visit which enables people to discuss their symptoms with a nurse practitioner. It has had overwhelming success with the public; in its first day of use alone, 

more than 500,000 people used the chatbot

. While computer vision has made its way into the medical diagnostics field, helping to detect anomalies in x-rays and other mediums, it’s being put to use in new ways. Advanced computer vision algorithms are helping to detect COVID-19 in airports, train stations and other public areas. AI-driven computer vision models are monitoring travelers to identify any suspicious breathing patterns or fever, using infrared cameras. The data is the uploaded to a server where the AI algorithm processes the data.

Another interesting way computer vision is being applied is by monitoring movement and traffic using video data. In this way, computer vision is able to read images of people in busy areas and identify locations that may not be practicing safe social distancing or mask wearing, and areas that may need better urban planning.

From deep learning models, to chatbots and computer vision, AI has become a silent partner to essential, front-line workers during COVID-19. While it has been under the very worst of circumstances, it has proven its value in supplementing the brilliant work of humans, and will continue to gain traction in telehealth, discovery and diagnostics well into the future.

Carlos Meléndez is the chief operating officer and co-founder of the artificial intelligence and software engineering services firm, 

, which helps companies achieve customized digital transformation to propel their businesses to the next level. With expertise in business strategy and software engineering, Meléndez has a strong track record bringing game-changing AI, machine learning and deep learning solutions to organizations across a variety of industries.

Here are six ways that AI has played a critical role in conquering the pandemic.

An Essential Worker During COVID-19 Wasn’t Even Human

™ a new video series, Turning Points, which invites retiring health system CEOs to reflect on the revolution they have witnessed in healthcare, the growth of healthcare technology, and what challenges they foresee for the next generation of healthcare leaders.

Our first guest is David Spillers, who will retire this month after 40 years in healthcare, including the last 15 as CEO of Huntsville Hospital Health System. Spillers has seen his health system grow from a single hospital to a dozen and seen revenues multiply five-fold, all while reaching smaller communities in Alabama.

This transcript is lightly edited for clarity.

: As you retire from Huntsville Hospital, what initiatives are you most proud of?

: Building a system—it’s got to be right up there at the top. When I got here, we were basically one hospital, [and] we just added our 12th this week. So, [there’s been] some fairly substantial growth.

We've gone from net revenues of about $400 million to just over $2 billion. So, [there’s been] substantial growth over those years. And I'm proud of that because we're public, not-for-profit. We've been able to really go out into the region, and a lot of these smaller communities wouldn't have health care if we hadn't reached agreements to work with those communities and bring those hospitals into our system. So, I’m very proud of the fact that we have extended the reach of health care, and we're trying to meet the needs of multiple communities.

 When you ask that question, I immediately think of something clinical, and I'm not a clinical person, certainly not a doctor. But I'll never forget the first conversation we had about transaortic valve repairs—TAVRs—and thinking about the change of opening someone's chest to do valve repairs versus going through a catheter, and how that would change cardiac care.

But then, [there’s] the thought of, as I've watched it develop, the numerous things we can do using catheters as opposed to opening up the body to do procedures. When TAVR started, it was experimental; there were very few patients that we would do it on. But as with most things, once it proved to be effective, and the price came down—which happens with that type of new procedure and technology—a lot of people were benefiting from very minimally invasive procedures that at one time were major procedures.

 Conversely, is there something that happened in healthcare during your career that was dismissed as unimportant early on, that turned out to be extremely important—for good or ill?

 So, this one affects healthcare, just as any other business.

You know, I've got an IT background, so you would think I would have thought about this. But the iPhone really changed everything in healthcare and every other business. But I look at what we do today, I looked at the past year with COVID, and the way we communicate, the way we work in different locations, and how much more productive we are now and how much easier it is to communicate with people. And I think that really started with the iPhone.

The other [would be] handheld computers, which today are so unbelievably powerful that I can be anywhere having this conversation with you. I could be between meetings having this conversation with you.

And I think when used appropriately, not only does it make you much more efficient than I ever thought we would be, but there’s virtually no reason not to be able to communicate information to people in a very, very quick way. And that's important for a variety of reasons, right?

: I've thought about this question, and there's been a variety of challenges. I mean, we just got through COVID, which was something that none of us had ever experienced before. Clearly there was no playbook for COVID—we didn't know what to do in a worldwide pandemic. And I learned from that process—or at least it reinforced what I thought I knew in that process—and that is when you have built an organization with really bright, talented people in times of crisis, they get very creative and do whatever it takes to get the job done.

And I would expand that, too. In my career here, the 15 years I've been here, we've had at least four major healthcare incidents. We had a huge bus wreck, we had a major mass shooting, at one time. We had tornadoes that came to our area and pretty much devastated us—took our power away for almost a week—and devastated a lot of homes, injured a lot of people. And then COVID. And again, in every one of those, you got to plan but you don't follow the plan. You do whatever it requires at that point in time, and [the] people that you least expect to show up to help, show up to help. And it gives me faith and optimism in the human race, because whenever there's a problem we all seem to put aside our differences and help other people. It's just too bad that we have to have a crisis for people to do that.

 I think the move from invasive to minimally invasive [procedures] in a variety of areas. And we just talked about TAVR, we could talk about interventional neuro [and] interventional radiology and the ability to take stroke patients and get the clot out very quickly so there's no long-term damage. And now we're doing joint replacements in an outpatient basis and sending people home the same day.

Technology is certainly allowing people who previously may not have been strong enough to have surgery to have procedures. So, it's opened up healthcare to other people; it's allowed people to recover quicker, get back to work, [experience] much less pain and much shorter recovery times. I think all those are very positive for the people and for the hospital because we can get people through the system quicker.

I think the downside is the cost of that technology. It's just hard to imagine how we're going to be able to afford healthcare in the future, because every time one of these technologies becomes available, it quickly becomes the standard. And then the requirement to capitalize the equipment you need and the supplies you need to do those types of things can be massive. If the reimbursement takes a long time to catch up, and if it does catch up, then you've got the whole insurance issue. How does insurance pay for a procedure that used to be $10,000 that's now $30,000 because you're using a $2 million piece of equipment [and] $2,000 worth of disposable [supplies]? So, somewhere along the way, our country's gonna have to rationalize all that benefit versus cost, and how we pay for it in the long run.

 What changes to the use of technology would you recommend?

 We're in an environment where, and I can give you this whole discussion on healthcare economics, why I think costs are way too high in healthcare. But, if somebody comes out with a better device, or perceived better device, physicians have to adapt to that better device or patients will go there under the perception that it's better. So, that gives vendors a lot of leverage on the cost side of what they charge.

And, you know, I don't know the best way to fix that. I wish I did. If I did, I could probably go on the road and make a fortune after I retire from this job. But again, as to one of those things I think that [the] country is gonna have to address over the next five to 10 years, we do not have an unlimited amount of money to spend on all this new technology. [It's] sometimes very beneficial, but sometimes it's not.

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