- Healthcare organizations across the country are using connected health and mHealth tools to help them tackle the challenges associated with value-based care.
But as more organizations continue their shifts away from fee-for-service payments, value-based care models need to reflect innovation in the technology space, according to speakers at Xtelligent Media’s third annual Value-Based Care Summit held in Boston.
At the end of the day, connected health means using technology to connect not just with individual patients, but with your entire health system community, according to panelist Gina Altieri, Enterprise Senior Vice President of Corporate Services & Chief of Strategy Integration at Nemours Children’s Health System.
“It means connecting to your community, not just connecting to the patients that are coming to your health system but connecting to your community in which you practice, to help them help patients be healthy,” Altieri said. “It includes, from a technology perspective, connecting to families, where the families are or where the children are. So we connect to children while they're in school, we connect while they are in daycare, we even connect while they're on vacation.”
Matt Fisher, chair of the health law group at Mirick O’Connell, agreed.
“It's trying to develop that broader community and be able to get the connections among the other providers that her patients are seeing and then also just frankly within the system that she works in, because sometimes some people are not as responsive as others,” he explained. “And it's really wanting to get that good back and forth going.”
Implementing digital health is becoming a standard in healthcare, just as technology in banking or other service areas has become the standard, noted Heather Meyers Sr. Manager, Digital Health and Virtual Care for Boston Children’s Hospital Innovation and Digital Health Accelerator.
“In the financial services, you don't call it connected finances or digital finances,” she remarked. “We hope that everything that you do for online banking is what your healthcare will look like in the next few years.”
And now that healthcare providers have created these digital technologies, they are seeing the benefits in their value-based care arrangements. Simply by virtue of payments being capitated and value-based, healthcare organizations have leveraged connected health to make quality care fit within their budgets.
“Regardless of what the patients want, there's just less money and you've got to figure out how to more effectively deal with what you're getting,” Fisher explained. “All these value-based systems put more of a premium on out of the hospital care, whether it's in the home, in the community, ambulatory. They don't want people in a hospital bed.”
Foremost, connected health allows patients to access their providers remotely. This is essential in follow-up care, a service that can mitigate costlier health episodes in the future, Meyers said.
“If we can do a check in 48 hours after or 24 hours after that patient has left our hospital, just to give that peace of mind, has been really effective,” she noted. “For some of these nurse check-ins, even if there's not a revenue stream, just keeping that patient in their home has been really significant.”
Offering virtual care options has also enhanced the quality of care some providers can give. For example, with behavioral health patients or patients with complex cognitive needs, delivering care via telehealth has been essential.
“With the video visits and our behavioral health clinics, our psychiatrists and psychologists have really seen that because those children are in their natural environment, they're in a comfortable space,” Meyers stated. “So we actually feel like we're diagnosing them, treating them more appropriately because they're not these traumatized patients who are coming in here kind of frozen essentially.”
Connected health has also allowed organizations to build out the care team, which is a key part of delivering value-based care, Altieri noted.
“We also have a lot of partnerships where we work with other community hospitals in the area who maybe have a pediatric unit but they don't have the level of pediatric sub-specialists at those community hospitals,” she explained. “We do have our telehealth cart set up in a variety of intensive care units so that the physicians at those community hospitals can access a pediatric specialist very simply, to either help with the care plan or make a determination if that child is really in the best setting for that child.”
Part of what has helped Nemours and Boston Children’s is determining the best technology for patient needs and helping patients connect to those tools.
For example, Altieri has found that patients want a single platform that makes healthcare easier to navigate.
“There are millions of million medical apps on the device market right now and they're not being used,” Altieri explained. “So they can't be very good if they're not being used. They're only as effective as people use them. What we've decided to do is stop having all these different kinds of ways that families interact with Nemours and build one way that they interact with us.”
This means offering patient data access, access to appointment scheduling, access to provider messaging, and simple bill pay.
There is also an important patient education component to all of this, Meyers added. Connected health tools truly are only as good as patients use them, the panelists agreed, and to ensure patients engage providers need to teach them how.
“If we can decrease the length of stay by getting patients hooked up on different type of devices that are appropriate, we've seen good effects of that,” Meyers explained. “That also requires, from a practical standpoint, really boots on the ground folks at our bedside with those patients of getting them equipped. We have bedside patient educators, navigators to really help patients through that.”
Now that organizations have proven the utility of connected health in value-based care, these payment models need to catch up to innovation and patient needs. This can be as simple as redesigning reimbursement models to reflect providers’ use of mHealth and patient engagement technology.
As noted above, organizations like Nemours and Boston Children’s are integrating their technology suites deeply into their value-based care initiatives. So much so that they are starting to outpace the reimbursement regulations that have been put in place by the government and private payers who do value-based contracting.
“Reimbursement is very much lagging in our state,” Meyers said. “We're the only state to not have Medicaid reimbursement for a lot of these connected care platforms. So we work very heavily with our government relations team to actually show the value of connected health.”
In the short term, organizations need to closely examine reimbursement models and design their technology offerings around them.
Those in federal value-based payment programs will certainly face more rigid regulations, Fisher acknowledged. This will require more scrupulous contract examination and creativity about deploying connected health.
“If you're in a federal program or a state program, look at the regulations,” he advised. “Telemedicine is definitely gaining more acceptance and you're getting a lot more leeway in some of these demonstration models like the MSSP or, here in Massachusetts on the state level, you've got the opportunity to push in the boundaries of where maybe there wasn't reimbursement under traditional fee for service Medicare.”
Organizations contracting with private payers will have more wiggle room, he said. After examining the terms of a value-based care contract, healthcare organizations can negotiate room for reimbursement for connected health tools.
“The key is to look at which program you're in and figure out where the wiggle room is, and then you can drive a wedge in there to really innovate,” Fisher said. “And if you're finding that there are barriers to where you really want to go, that's an advocacy opportunity.”
Healthcare policy also needs to recognize that organizations are integrating these technologies into their value-based care initiatives.
Nemours and Boston Children’s both work to acknowledge the social determinants of health when deploying their patient engagement technologies.
While both organizations find that most of their patients, even those who are low income, have access to smartphones and internet connection, there are other considerations they need to make.
“We have an ACO patient family advisory board, we have a primary care family advisory board, so we also went to them and kind of listened to what the concerns were,” Meyers said, explaining that PACs offered recommendations for introducing technology to certain populations.
Those advisory councils found that offices with large populations that might not have high English language proficiency – one of their clinics is 60 percent Spanish-speaking – might need different technology education opportunities.
“We have noticed that it requires a little bit more guidance, so we do have tutorial videos that are playing in our waiting rooms and everything,” Meyers explained. “But the technology was there. It was very much more of the education piece of, ‘I don't know if this is private. I don't know if I would choose that.’”
Additionally, Meyers and her team found that some patient populations may not be able to keep up with the technology updates that their apps require. So while most of their patients have access to a smartphone, the smartphone might not have the storage or the software that apps require.
Nemours encountered similar situations and adjusted their app innovation to accommodate those needs, Altieri said.
The hospital system also found some regulatory restrictions when introducing technology to populations experiencing some socioeconomic challenges.
“But from a legal perspective, we were trying to figure out if in fact we could be providing devices to families,” Altieri noted.
But due to beneficiary inducement laws, organizations can’t do that. While Nemours may simply be trying to implement a technology program to address the social determinants of health, legal restrictions apply, Fisher explained.
“The giving of a device, that's where the regulations I think just aren't caught up to where we need to be,” he said.
“You have beneficiary inducement regulations as part of the civil monetary penalty act on the federal level. That means you can't give something of value to a patient to get them to use your services or you're going to get whacked.”
Organizations like Nemours are simply trying to give patients tools that will help their health in the long-run. But these regulations weren’t designed with value-based care or the social determinants of health in mind, Fisher explained.
“It's really just kind of reflective of the fact that all these regulations are rounded in a fee for service world where the concern was patient turns,” he noted. “You can bill more and get more from the government. Whereas in value-based care, you have one pot of money and that kind of goes out the window.”
Healthcare technology is in the here and now, the panelists agreed. These tools help build out care teams, keep patients integrated in treatment decisions, and connect patients to care that they otherwise could not receive.
As healthcare continues to trend in this direction, it may be incumbent on policymakers and providers alike to collaborate to create regulations that enable this level of technology use.