The COVID-19 crisis is accelerating the future of healthcare. In fact, I’d like to argue that the future is here today as demonstrated in digital health. Within weeks, this pandemic spread across our healthcare system, shutting down the traditional care delivery model and forcing us to adopt technology.
Supporting patients in a social distancing time did not provide many options but to turn to the advancements that already exist. We simply had to turn to the existing technology available and flip the switch to deploy our future healthcare model.
This is most evident with the rise of telehealth usage in lieu of point-of-care facilities such as doctor’s offices. Since the coronavirus outbreak telehealth has experienced a surge of 1,700%, particularly supporting mental health patients.
But what do patients need during this crisis and will they adopt technology as future healthcare models? We recently surveyed Medisafe users to better understand their concerns and needs during this outbreak. What we discovered is that patients are extremely appreciative of the ability to touch base, acknowledge this crisis and ask “how can we help?”
Noting that this is a primary concern, and with more than 7,000 patients responding, a majority of whom are very concerned about the coronavirus and its effects, we need to think about how to best reach a community in need an empathetic solution is needed more than ever.
Additionally, with the recent surge in telehealth to compensate for social distancing it is evident that are gaps in the daily connections and check-ins required from patients managing medications.
A majority of patients are in some form of social distancing and 55% of patients indicated that they are concerned that the coronavirus will interfere with their medication regimens. Enter the role of the digital companions. From a telemedicine solution, digital companions can offer additional insights as well as aiding in isolation by deploying guidance in a rapid response while offering a human touch in times of isolation.
Digital health technologies also offer support beyond a virtual “check-in” that can digitally handhold patients with their everyday needs, especially those managing chronic conditions or multiple medications. Digital companions keep patients continuously connected with condition management and care givers. For example, patients on multiple medications or managing complex doses or even taking injections require additional support at while at home to remain adherent to their treatment.
Digital health platforms are adept to support patients during this time, bridging isolation and bringing healthcare support into their home. In fact, more than 42% of our patients indicated that they have changed their traditional treatment routines by adopting telehealth. In addition to telehealth, digital companions offer features to keep patients connected.
Following the survey, we opened unlimited Medfriend capabilities which digitally connects family or friends with the patient’s medication schedules. Immediately, we saw Medfriend engagement activity triple. In fact, one user replied, “My mental health isn’t great right now, so knowing that you’ll tell my Medfriend if I haven’t taken [my medication] is great.”
Connection to care givers is also critical to digitize the care support teams. Fewer field support home visits are also creating concerns with patients, “I appreciate the help you’re giving. My doctor put me in home isolation 2.5 weeks ago for my sake, the only people I see are my caregivers but now they are not allowed to visit.”
Digital health that connects the daily interactions of patients with care support teams fill a critical gap. Clinicians can monitor their patient panels by following tracked activities and in fact scale their monitoring capabilities of one to many. Digital companions keep patients on therapy but also notify care support teams when patients behavior is at-risk. The combination of high-tech and high-touch is quite powerful to support patients managing chronic conditions.
Ultimately, humanizing your digital capabilities goes a long way. Digital health at its core operates on sophisticated data-driven AI to deliver personalized interventions at time of need. It’s within each of these interactions that the digital support becomes more and more relevant for patients establishing a digital relationship, trust and loyalty. However, during a crisis we also need to make sure to “check-in.”
We are all human on each end of this digital connection and when dealing with medical conditions alone during a crisis a human touch goes a long way, best stated by a patient: “I’m good. Just knowing that you are out there is a good feeling.”
As the coronavirus outbreak limits individual movement across the country, organizations are turning to remote solutions to stay operational.
As a result, demand for telehealth has skyrocketed — prompting health insurance payers, who haven’t always covered telehealth services, to reconsider coverage.
In April, the Centers for Medicare and Medicaid Services (CMS) made one of the most significant changes to Medicare/Medicaid coverage of the past few years. It announced it would expand coverage to more than 80 different telehealth services. Now, some insurers in the private sector are beginning to follow suit.
Here is how the pandemic is changing attitudes toward telehealth — and also the potential long-term impacts of coronavirus and telehealth service expansion.
Medicaid/Medicare and Telehealth Coverage Expansion
Many patients, wanting to reduce their chance of contracting or spreading COVID-19, are electing to avoid doctor’s offices. For some people — like the immuno-compromised and elderly — it’s no longer safe to have a checkup or routine visit. At the same time, many doctors have temporarily shut their practices and begun offering telehealth services to those who still need consultations and regular check-ins.
Others who have kept their practices open aren’t sure for how long it will be possible or responsible to do so.
The result has been an explosion in demand for telehealth services, as well as expanded offerings. Many of them, however, weren’t previously covered by Medicare or Medicaid, the public health programs that insure 34% of all Americans.
Early in April, the pressure pushed CMS to expand Medicare and Medicaid to cover 85 additional telehealth codes — including group psychotherapy, physical therapy evaluations and prosthetic training. The move came after Congress passed a coronavirus spending bill that included $500 million in telehealth coverage and several major private insurers announced they would waive copays for virtual doctor’s visits and other telehealth services.
Potential Impacts of Expanded Telehealth
The most immediate impact of the coverage expansion will be making medical services much more accessible. Current research shows that, while in-person visits are typically more effective, telehealth is great at expanding the availability of medical services. It may also help health care facilities reduce costs and improve patient satisfaction.
Tech innovations are improving senior care by breaking down data and communication silos. That’s important in normal times and infinitely more so during times of crisis, when clear, timely communication and flexible access to care become crucial to the health and well-being of senior care residents, staff, and family members.
Here’s a look at how four key technology innovations are improving senior care and how the COVID-19 pandemic is highlighting strengths and shortcomings that fly under the radar during normal times.
1: Healthcare Systems that Talk to Each Other
A lot of senior living communities are excellent at delivering care but struggle with managing communications. And it’s no wonder: when you’re juggling multiple communication points for health records, medication administration, and communication (with staff, residents, and family members), it’s hard to keep everyone updated in ways that are both timely and HIPAA compliant.
That can be a pain point in the best of times; during a crisis like the COVID-19 pandemic, it can be dangerous.
High-risk residents may not be adequately isolated from social events, for example, if staff don’t see EHR updates in a timely fashion. Or a family member might miss an email about lockdown and visit a resident’s direct entrance, risking the spread of pathogens.
The good news is that technology that consolidates EHR, eMAR, and messaging into a single platform can streamline communications and eliminate the risks that result from missed messages and mixed signals. And these platforms don’t have to come with a months-long onboarding process; as part of our response to the current pandemic, we launched 280 communities onto our platform in just 10 days.
2: More Efficient Staff-to-Staff Communication
Too often, retirement community staff spend time documenting, reviewing, and tracking down messages from other shifts that they’d rather spend interacting with residents. Digital staff-to-staff communication platforms can eliminate that problem by facilitating communication.
For example, mobile apps can show highlights from a previous shift, including anything unusual or that requires attention. And because such apps are HIPAA-compliant and accessible from mobile devices, staff members can view key information before starting a shift, meaning they can hit the ground running each day – particularly important during crises, when policies and procedures might change from shift to shift.
Another key benefit of digital communication platforms is that they help ensure staff are accessible in case of an emergency, which can help keep everyone in a community healthy and safe. And because this tech makes it possible for messages to be conveyed fast, from anywhere, it helps reduce the total amount of time workers spend on communications and therefore maintain work-life balance.
By David Shelton, chief executive officer, PatientMatters.
More than half of Americans have experienced the sick feeling that comes with opening a medical bill they assumed would be covered by insurance. Surprise medical bills are on the rise, often driven by services administered at an in-network facility using out-of-network providers.
A Journal of the American Medical Association(JAMA)analysis of privately insured patients showed that between 2010 and 2016, inpatient admissions with an out-of-network bill increased 16%, and emergency department (ED) admissions with out-of-network billing went up more than 10 percent.
As alarming as the number of surprise bills is the impact on patients’ pocketbooks. In the same timeframe, potential patient liability skyrocketed from $804 to $2,040 for inpatient services and from $220 to $628 for ED visits.
Price transparency and accurate estimates are critical to preventing surprise bills and giving patients more control over their healthcare spending. Many providers are experiencing increases in self-pay patients, often because patients have a high-deductible plan that requires significant out-of-pocket before coverage kicks in. As such, patients need the ability to compare prices across providers and get accurate estimates of what they’ll owe before making healthcare decisions.
Why healthcare bill estimates are so difficult
Many factors contribute to the historical absence of bill estimates, but it starts with healthcare payment system fundamentals. Unlike other industries where transactions involve a buyer and a seller, healthcare brings in a third party, the payer, who is typically reluctant to reveal publicly what they pay various providers for services. Contracts, discounts, coding and other variables make it inherently difficult to achieve price transparency.
Price transparency progress
A step toward more price transparency came when the Centers for Medicare & Medicaid Services (CMS) required hospitals to publish their chargemasters online, starting January 1, 2019. Unfortunately, neither consumers nor many hospital employees could translate the data into usable, patient-specific bill estimates. In fact, more than half of hospitals in a 2019 survey said the move created further confusion.
In June 2019, President Trump issued an Executive Order to improve healthcare price and quality transparency. CMS later issued a final rule expanding current requirements for hospitals. These include providing a machine-readable file containing negotiated rates for all items and services annually and a consumer-friendly display of gross and negotiated rates for 300 “shoppable” items and services, including 70 defined by CMS. Insurers would also be required to provide members personalized out-of-pocket costs for all covered services in advance. These new rules are planned to take effect Jan. 1, 2021.
By Carl Kunkleman, senior vice president and co-founder, ClearDATA.
Carl Kunkleman
Working in the world of healthcare security and compliance, I find one of the biggest dangers organizations face is having a false sense of security that their PHI is adequately protected. I’ve done hundreds of security risk assessments, and I have yet to find one single organization that did not have a security gap they were unaware they had in one or more of their administrative, technical or physical safeguards.
Add to this, the complicated current state of healthcare battling COVID-19, and we are likely to see administrative systems that have gaps in off-boarding or off-boarding employees, technical infrastructures that didn’t have time or resources for patch management, and physical scenarios in makeshift triage units with compromised physical safeguards that simply cannot be addressed in the current haste to stop the spread of the virus.
Sadly, this sense of chaos creates the ideal conditions for the hackers of the world looking to infiltrate via phishing, malware and ransomware and more. Once this spread is arrested and we all get a moment to catch our breath and assess business practices, a good move would be to conduct a security risk assessment known as an SRA. Your internal teams and resources are stressed, overworked and possibly burned out and an SRA can identify security gaps that will inevitably arise and present an actionable plan to remediate. This will help reduce risks while protecting your organization’s finances and reputation while we all find out what “getting back to normal” will mean.
Right now, we are all doing everything we can. And the Department of Health and Human Services recognized that with their decision last week to waive penalties for providers that are serving patients through everyday communications technologies during the COVID-19 public health emergency. A security risk assessment this summer will help you put the compliance health of your organization back in order. In addition to the HIPAA requirement that you have an SRA on file annually, it helps unite your team in a strategic path forward by articulating what your highest and lowest risks are, before a hacker uncovers them.
Because an SRA covers administrative, technical and security safeguards, your entire organization will benefit from the process. I continue to find organizations who think their PHI is protected because they have password protected their computers and mobile devices. Our penetration testing has revealed that passwords are relatively easy to defeat. We continue to find gaps in encryption, patch management and even with PHI inventories. If you don’t know where all of your PHI resides, how can you protect it?
Healthcare interoperability and enhanced information sharing continued to improve healthcare quality, safety and cost for U.S. patients and providers, according to the Surescripts 2019 National Progress Report. The nationwide health information network processed 19.15 billion secure transactions in 2019, while connecting 1.78 million healthcare professionals and organizations with actionable patient data for 95% of the U.S. population.
“With the COVID-19 pandemic impacting patients and providers across the globe, a trusted nationwide health information network has never been more critical,” said Tom Skelton, chief executive officer of Surescripts. “In 2019, doctors, nurses, pharmacists and others across the Surescripts Network Alliance made remarkable progress transforming interactions with patients and driving significant improvements in care quality, safety and costs.”
In 2019, healthcare professionals saw the benefits of leveraging actionable patient information to enhance the prescribing process with greater automation, improved workflows, and increased price transparency. For example:
In 2019, prescriber enablement for e-prescribing reached 79%, with 1.79 billion e-prescriptions filled, bringing the rate of e-prescribing to 80% of all prescriptions.
The number of e-prescriptions filled for controlled substances reached 134.2 million, representing 38% of controlled substance prescriptions—up 12% from the year prior, with 49% of prescribers enabled for the technology.
The volume of real-time benefit checks at the point of care increased by 336% with more than 250,000 prescribers using the service (a 233% increase).
Electronic prior authorizations increased by 132%, driven by a 58% increase in provider adoption of the tool.
Further, clinicians accessed actionable patient insights to obtain a more complete picture of their patients’ care histories and make more informed care decisions. For example:
Surescripts delivered 2.18 billion medication histories, a 19% increase, while use of Medication History for Populations increased nearly 200%.
Record Locator & Exchange delivered 333.8 million links to clinical document locations and 143.2 million documents listing where patients had previously received care. Nearly 136,000 clinicians used the service—a 28% increase in 2019.
In 2019, more than 648,000 individuals and organizations sent 37.7 million Clinical Direct Messages (a nearly 20% increase from 2018).
In the midst of this significant progress, Surescripts maintained network-wide uptime of approximately 99.999%, maintained HITRUST CSF Certified status for privacy, security and risk management practices, improved the networkwide Quality Index Score for e-prescription accuracy by 10%, and helped migrate most of the network to the National Council for Prescription Drug Programs’ (NCPDP) new e-prescribing standard (SCRIPT Standard Version 2017071).
Current Health announced that it has launched a collaboration with Mayo Clinic to develop remote monitoring solutions that accelerate the identification of COVID-19-positive patients and predict symptom and disease severity in patients, healthcare workers and other at-risk individuals in critical service sectors.
Using digital biomarkers collected by Current Health’s FDA-cleared remote monitoring sensors and platform, experts from Mayo Clinic and Current Health will also be able to expedite identification and assessment of treatment efficacy and improve care for patients with or at risk of COVID-19 infection. Through this collaboration, Current Health and Mayo Clinic aim to improve patient outcomes while preserving and optimizing health system capacity worldwide.
Today, more than 40 hospital systems around the globe use Current Health’s remote patient monitoring platform to monitor and manage patient health. These systems are now increasingly using Current Health to monitor and manage patients infected with COVID-19 at home and in the hospital. The next stage is to use digital biomarkers collected by the Current Health solutions, such as temperature, heart rate, oxygen saturation, activity and posture, to develop AI-based algorithms that can detect and predict symptom and disease severity to enable proactive treatment.
This collaboration will leverage Current Health’s existing patient database – which already includes anonymized vital sign data and raw physiological sensor data from hundreds of patients infected with COVID-19 and thousands of uninfected patients – as well as algorithms developed by Mayo Clinic, which will be used to provide individualized care to patients with complex and critical medical conditions. By working together, Current Health and Mayo Clinic hope to scale data analytics, add to Mayo Clinic’s major advancements in accelerating COVID-19 detection and diagnosis, and further efforts to understand and treat this disease.
“Our collective ability to save lives hinges on our ability to understand this virus quickly. COVID-19 has presented in many ways across different people, which has made it very challenging to understand the virus and how it develops,” said Chris McCann, CEO and Co-Founder, Current Health. “By combining our platform with the deep medical and scientific expertise that exists at Mayo Clinic, we seek to explore both known and novel biomarkers, as well as how they manifest in entirely diverse populations. This will be critical to determining how we define, and enable effective treatment of, this disease.”
“Combatting the COVID-19 pandemic is our number one priority,” said Jordan D. Miller, Ph.D., who directs the Center for Surgical Excellence and leads the investigative team at Mayo Clinic.
“Real-world, continuous data – from patients infected and not infected with the disease – is essential to understanding and predicting how the disease presents and evolves,” says Abinash Virk, M.D., an infectious disease expert at Mayo Clinic. “If we are successful in accomplishing our goals, we believe we will improve how patients with COVID-19 are identified, monitored, managed, and ultimately help with their recovery.”
Mayo Clinic will also become an investor in Current Health as part of this collaboration.
United States Senators Lamar Alexander (R-Tenn.) and Mark Warner (D-Va.) introduced legislation that will ensure rural hospitals can keep up with the cost of providing care and curb the trend of hospital closures by boosting their Medicare payments.
“Last year, the Trump Administration updated the formula that determines how much Medicare will reimburse hospitals for patient care, taking into account, among other things, the cost of labor in that geographic area – called the Medicare Area Wage Index. And because of this change, Alan Levine, who leads Ballad, announced a $10 million investment in pay increases to nurses. However, these changes are temporary and will expire in three years, and many hospitals are concerned that hospital reimbursements could revert to the lower rates,” Alexander said.
“Given COVID-19 impacts on rural hospitals, any changes that lower reimbursement would have significant impact. Tennessee has the second highest rate of hospitals closures in the country, with 13 hospitals having closed since 2010, and this is, in large part, due to lower reimbursements. This legislation will help keep up with the cost of providing care and help curb the trend of Tennessee rural hospital closures by setting an appropriate national minimum for the Medicare Area Wage Index.”
“The current payment policy has long placed some of Virginia’s most rural hospitals at a disadvantage and made it more difficult to provide quality care in communities that need it most,” Warner said. “The COVID-19 public health emergency has made it more important than ever to do everything we can to support our rural hospitals and this legislation is absolutely critical in doing that.”
The legislation the senators introduced today, along with Senators John Cornyn (R-Texas), Doug Jones (D-Ala.), Marsha Blackburn (R-Tenn.), Tim Kaine (D-Va.), David Perdue (R-Ga.) and Richard Shelby (R-Ala.) would:
Establish an appropriate national minimum (0.85) for the Medicare Area Wage Index (AWI)
Ensure rural hospitals are paid for the care they provide while preserving the existing reimbursements for urban hospitals
Ensure fairness in reimbursements for hospitals across the country, including many hospitals that are facing closure in rural areas
Fix severe and disproportionate disadvantages that unfairly penalize hundreds of communities and hospitals across the United States
The Medicare Area Wage Index, which is a formula Medicare uses to reimburse hospitals, is much lower for states like Tennessee and Virginia because the formula is based labor costs, which vary across the country. Medicare accounts for about 43% of reimbursements for hospitals nationally, according to the American Hospital Association.
More than half of Americans have experienced the sick feeling that comes with opening a medical bill they assumed would be 