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Data Governance: Addressing Data Defense and Offense

by Bailey Amber
written by Bailey Amber

As a chief data officer, healthcare CEO, or other executive in the industry, you know how vital data governance is across all departments and within your organization’s supply chains. The well-being of your patients and company depend on it. By adhering to comprehensive yet practicable data governance policies, your organization can reduce risks associated with inappropriate handling and use of critical information while simultaneously optimizing operational performance. Grounding strategies for implementing effective data governance in the healthcare sector is critical.

What is data governance and why it matters

Data governance is a process for managing data assets in an organization, with the primary goal of ensuring data interoperability and data quality. Healthcare data governance is especially essential as it allows organizations to ensure that data is secure and also accessible in communities where data sharing and data privacy are of major importance. Health Level 7 (HL7) and Fast Healthcare Interoperability Resources (FHIR) are two standards used within data governance strategies to enable better data management, and consequently, a better patient experience. With the help of data governance, disparities can be addressed in healthcare organizations, allowing for greater equity when it comes to patient care in healthcare delivery settings. Therefore, data governance should be seen as an important feature of any successful organization that strives to leverage technology to provide comprehensive healthcare experiences.

As per MIT’ s survey, Chief Data Officers priorities were as follows:

  • Establishing clear and effective data governance (51%)
  • Improving data quality (48%)
  • Building and maintaining advanced analytics capabilities (42%)
  • Building and maintaining business intelligence capabilities (36%)
  • Data monetization capabilities (21%)
  • Data, analytics, and AI ethics (21%)

Data governance also ranked highest when chief data officers were asked to rank their top three priorities, with 45% citing clear and effective data governance as a top concern.

Key challenges in the healthcare industry when implementing data governance

The healthcare industry is complex, and implementing data governance can present certain challenges when it comes to collaboration between various stakeholders. Data silos, legacy systems , and data inconsistencies can all present obstacles to effective data governance. Additionally, the implementation of new technologies must be accompanied by policies to ensure their compliance with regulatory requirements. Finally, data privacy and  security are also major concerns in the healthcare industry and must be addressed when implementing data governance strategies.

Consideration

A solid data governance program is essential to ensure the proper management of valuable healthcare data and the associated risks, such as data privacy, quality control and security. Implementing effective data governance requires a comprehensive plan that involves various strategies throughout the entire value chain. Some strategies include conducting internal policy reviews, forming governing bodies responsible for developing and implementing standards, policies and procedures that apply to teams across organizations, leveraging technology to provide insights into usage trends, developing communication plans with stakeholders regarding policies and processes, ensuring transparency in leadership roles related to this governance program, monitoring compliance activities and encouraging user feedback through surveys and focus group interviews. These steps are necessary for successful implementation of a data governance program in the healthcare sector.

How to ensure proper data governance

Proper data governance is essential to ensure the efficient and accurate operation of an organization. It involves creating static rules, dynamic management processes and a comprehensive set of business objectives which must be met to protect the integrity of data within the system. Best practices can include investing in high-quality security tools, educating personnel about applicable regulations and legal requirements related to data management and setting up internal procedures for compliance monitoring. Additionally, incorporating artificial intelligence into existing data platforms could help with predictive analytics that can create even more secure solutions moving forward. Taking these steps can help organizations set up a robust process for data governance which will allow them to remain compliant while maximizing their operational efficiency.

Conclusion 

To summarize, data governance is an essential tool for healthcare organizations to ensure trust, transparency and compliance within their data systems. There are several key challenges that organizations face when trying to implement proper guidelines including the need for effective communication and change management strategies. Artificial Intelligence can enable healthcare organizations to make better use of their data and optimize the process of data governance.

Ultimately, a successful adoption of data governance in healthcare requires both good planning and execution as well as robust monitoring mechanisms. With the promised benefits of improved patient outcomes, reduced costs, better personnel organization and more efficient operations, now is the time for healthcare systems everywhere to embrace the practice of implementing an effective data governance program.

Photo: Galeanu Mihai, Getty Images

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Celebrating Women in Health Care Starts with Reimagining your Workforce

by Bailey Amber
written by Bailey Amber

These are challenging times for health care, and particularly for women in health care. Consider that nearly 78% of the health care workforce is represented by women.

When I look at the pressing challenges affecting health care today from inflation, shrinking margins, staffing shortages, turnover, and supply chain disruptions, I think about how these issues may be disproportionately affecting women. It can happen in a trickle-down effect and spur a vicious cycle where understaffing may lead to poor patient experiences, discouraging future visits and further suppressing health system revenue. This scenario can fuel overwork and burnout for women whose hands touch all aspects of care delivery. This cycle – often exacerbated by the challenges of our times – can take a toll on our female workforce and their own health and well-being.

Inflation adds to the burden in an insidious way as well. Rising costs can mean that more patients may put off screenings, prevention, and early treatment. Thus, they may show up to emergency rooms and doctor’s offices sicker, possibly with more advanced stage diseases.  This situation can be more costly for the patient’s health and wallet but can also be costly to our female workforce resulting in fewer hands to care for more acute patients.

Not surprisingly, stressed, short-staffed environments can jeopardize patient outcomes.

We need to invest

These circumstances explain why a vast majority (85%) of health system leaders recently said in a Deloitte survey that staffing challenges would have a “major impact” on their 2023 strategies. More than nine in 10 surveyed said investing in their workforce was “important or “very important.”

Although these intentions are encouraging, well-meaning executives will likely be forced to balance workforce investment with the need to maintain profitability. This month, as we recognize International Women’s Day and Women’s History Month, let’s commit that every dollar that’s invested in the strained, largely female health care workforce pays off.

Can we do it? 

I believe we can, and there’s no better time than now. The right approach can improve workforce performance and satisfaction for women throughout an organization. I recommend new initiatives from the top that show support for women, starting with an all-important listening initiative to help ensure that women (and others) feel heard and that eventual solutions are on target with their needs.

Here’s how

Specifically, I recommend the 3Rs: retain, reengage, and reimagine. One main principle of the 3Rs is to carefully blend quick wins with longer-term transformation.

  • Retain – Focus on improving working conditions right out of the gate. This could start with identifying problems that are high on priority lists, relatively easy to solve, and address them right away. Brush up on effective leadership behaviors and communicate transparently. Examples of quick wins could be new support for childcare, flexible scheduling, job sharing, mentorship arrangements, and remote work options. Also look for ways to show appreciation through nonmonetary rewards like gratitude days, celebrations, and wellness resources. Other quick retention measures could be more direct, such as retention bonuses or launching a new mental health service to help provide additional support during difficult times. Small wins can help build momentum and demonstrate your commitment to women in your organization.
  • Reengage – Strive to help women feel empowered. Encouraging women to identify root causes of stress and dissatisfaction, and to propose ideas for a better workplace experience is important. Here is where you can clarify and formalize efforts to reflect their specific needs from career paths to professional development to growth opportunities. Another reengagement measure could be reassessing your total rewards program and adjusting the mix of benefits, pay, and other rewards. This can also be where you can transform the culture by fostering greater inclusion, addressing safety (psychological and physical), and encouraging courageous decision-making. Effective reengagement can give women a true sense of ownership in the organization. They should believe their workplace can be a satisfying and rewarding one in which to advance their career and wellbeing.
  • Reimagine – Think big! (And big doesn’t have to mean expensive.) Examine from a 30,000-foot level what work is done, how it’s done, where it’s done, and who does it. Identify the key operations that need re-engineering to help optimize the human experience and transform care delivery.

Examples of reimagination could be events or initiatives that support women to share their stories or foster mentoring.  Reimagination also could be offloading, outsourcing, or automating administrative tasks so that more time can be dedicated to delivering work that is most meaningful and impactful. Or go further and restructure roles – for example, creating interdisciplinary care teams that help everybody operate at the top of their license. Other moves could include intelligent new-hire onboarding, optimization of permanent and travel RNs, intelligent patient placement, and automated discharge planning.

Admittedly, the biggest, most “reimagined” ideas may have to be rolled out in phases as health care seeks to balance financial realities with workforce improvements.

This year, let’s take action to reimagine the health care workforce for women. With so much of health care resting on women’s shoulders, it’s time we retain, reengage and reimagine health care with women leading the change. Our future workforce and our health depends on it.

Photo: FotografiaBasica, Getty Images

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Why Point-of-Care Diagnostic Filtering, Interoperability Are Essential in the Age of TEFCA, QHINs

by Bailey Amber
written by Bailey Amber

interoperability, rope, braid

Health data interoperability recently took a major step forward when the U.S. Department of Health and Human Services announced the first six organizations as Qualified Health Information Networks (QHINs) under the Trusted Exchange Framework and Common Agreement (TEFCA).

Many predicted the coming “data tsunami” once the floodgates opened and information was shared more widely, and discussed how increased interoperability would create both opportunities and challenges. When the QHIN approvals were announced, Micky Tripathi, National Coordinator for Health IT, mentioned “operational friction in interoperability” and the challenges of moving information between enterprises — which is a primary issue that QHINs seek to address.

The challenge of finding diagnostically relevant data

As more information flows freely between systems, it will create an even bigger challenge for clinicians: finding diagnostically relevant information amidst the flood of incoming data. Healthcare information is currently organized using different terminologies and coding systems to support classification of information into separate domains such as diagnoses, labs, medications, orders, procedures, etc., primarily to support billing transactions and internal system workflows. The terminologies and codes are not organized to enable a clinician to quickly see how well a condition is being managed for a specific patient.

Clinicians are already frustrated with their EHRs, in part because of difficulties finding the information they need to determine how well a condition is being managed or if a patient is responding to treatment. Under value-based care, it is more critical than ever for clinical users to see longitudinal views of diagnostically relevant information for each of a patient’s conditions so they can take appropriate action and document accordingly.

This means clinicians need systems that do more than just support the coding of diagnoses and transactions; they also need their systems to diagnostically filter information at the point of care and present them with actionable views. In other words, clinicians require a new form of clinical decision support that presents the specific information needed to make decisions – regardless of the source. That new capability might be called “diagnostic interoperability.”

Time for new tools

The 21st Century Cures Act, TEFCA, and the imminent establishment of QHINs will, for the first time, make the long-awaited advent of interoperability a reality. Systems will be sending SNOMED, ICD-10, CPT, RxNorm, LOINC, HCPCS, and a host of other codes and narrative notes back-and-forth as part of the data tsunami, leaving it to the receiving systems to make sense of it for clinicians. The timing is perfect for the adoption of a new set of tools that make diagnostically relevant information discoverable and actionable by clinicians at the point of care.

A core requirement for these new tools is to enable a clinician to select any diagnosis, problem, or clinical issue for a patient and quickly view the hallmark indicators for that problem.

TEFCA, QHINs, FHIR and terminology standards will facilitate the transmission and receiving of information, but the critical task for clinicians will be finding the information needed to assess, evaluate, manage and treat a specific problem. Clinical users need to quickly view the symptoms, history, physical exam findings, test orders and results, therapies, comorbidities, sequalae and other data points related to any specific condition.

In the new world of interoperability, incoming information will be in a variety of terminologies and formats: ICD10-CM and SNOMED for problems and diagnoses, LOINC and CPT for lab orders and results, CPT, HCPCS, and ICD10-PCS for procedures and therapies, RxNorm and NDC for drugs, and a number of other specialized code sets. While these code sets and terminologies are useful for classifying information in a specific domain, they were not designed to work together to present a comprehensive view of a condition, nor for use by clinicians at the point of care.

Current EHRs typically organize this information into separate “tabs” or “buckets” in the medical record. To monitor the course of a disease, a user must navigate between sections and spend time hunting for the relevant details – which takes time that could be better-spent interacting with the patient and managing their condition. The EHR may contain all the relevant information a clinician needs for decision making, but finding the precise details they need is not always easy.

A better way

In the world of value-based care, the effective monitoring and management of chronic conditions requires that all relevant information for a diagnosis be instantly available to the clinician at the point of care, without requiring clinicians to waste precious time searching for details. A better way would be to empower clinicians with a clinical toolset that allows them to select any condition and immediately see a diagnostically organized view of all the relevant details. Such technology could replace manual searches by automatically filtering information for diagnostic relevancy based on the codified details and using natural language processing and mappings to organize the items.

In addition to diagnostic filtering and presentation, the ideal clinical toolset must also integrate with existing system workflows and provide point-of-care services to evaluate the patient’s medical record for adherence to clinical best practice guidelines and mandated quality measures, appropriateness of diagnostic coding, and sufficiency of documentation.

Without a new set of tools that clinicians can access at the point of care, the availability of information from QHINs will increase provider burdens because they will struggle to find the information needed to evaluate a patient, take action, complete documentation, and move to the next patient.

Basic interoperability is about to become real. The next step is diagnostic interoperability – which could very well be the impetus for value-base care success and for the transformation of EHRs from clinician burden to essential tool.

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Cerebral Admits That it Wrongly Shared Data of 3.1M Users

by Bailey Amber
written by Bailey Amber

Close Up of Illuminated Glowing Keys on a Black Keyboard Spelling Data Breach 3d illustration

After months of criticism about its data privacy practices, Cerebral admitted that it wrongfully shared the private health information of 3.1 million of its users. This admission comes in the form of a March 9 letter to users and March 1 government filing.

Cerebral is a mental health platform specializing in the virtual treatment of mental health conditions, mainly ADHD, anxiety and depression. In its letter, the startup said it had used pixel technologies, which are third-party analytics tools made by companies like Meta, Google and TikTok.  

These tools are usually free and can give companies insight into the way consumers use their platforms, but the tech companies who provide this software can also use patient data to profile users as they browse. People usually aren’t aware that they are opting in to having their activity tracked because they are simply checking a box when reviewing an app or website’s terms of use and privacy policies, which few people take the time to read.

Cerebral said it has used tracking technologies since it began operations in October 2019. After reviewing its use of these tools, the company found out on January 3 that it had disclosed its patients’ protected health information to third parties without having obtained the necessary assurances required by HIPAA.

The startup assured users that it had “promptly disabled, reconfigured, and/or removed” its tracking technologies. It also said that it discontinued data sharing with any third parties that are unable to meet all HIPAA requirements, as well as enhanced its information security practices and technology vetting processes.

The following types of information were disclosed in the breach: clinical data about patients’ visits and treatments, mental health self-assessment responses, appointment dates, health insurance/ pharmacy benefit information, insurance co-pay amounts, name, phone number, email address, date of birth, IP address, Cerebral client ID number and demographic data.

The type of information disclosed varied depending on how extensively each patient used the platform. Cerebral said that no patients had their Social Security number, credit card information or bank account information leaked, no matter how they used its services. The company also told its patients that it is not aware of any misuse of their data.

This HIPAA violation is not Cerebral’s only recent legal woe. Last year, one of the company’s former executives sued the startup, claiming that it had fired him for calling out the company’s prescribing practices. Matthew Truebe, Cerebral’s ex-vice president of product and engineering, had criticized the company for being too hasty when prescribing young people addictive stimulant drugs like Adderall. His lawsuit came shortly after some Cerebral employees told media outlets that the startup was taking advantage of pandemic-era prescribing regulations that allowed providers to prescribe addictive drugs without requiring an in-person examination.

But Cerebral is far from the only company to suffer negative consequences after using pixel technology. 

A week ago, the Federal Trade Commission reached a $7.8 million settlement with virtual mental healthcare provider BetterHelp for sharing its patients’ sensitive health data with advertisers like Facebook, Snapchat, Criteo, and Pinterest. In a statement, BetterHelp — which was acquired by Teladoc in 2015 — said its settlement is not an admission of wrongdoing. 

The FTC also recently accused consumer-focused digital healthcare platform GoodRx of failing to notify users that it sold their personal health information to Google, Facebook and other tech companies. To settle the case, GoodRx agreed to pay a $1.5 million penalty for failing to report its leakage of user data to third parties, but did not admit to wrongdoing. 

Additionally, the Northern District of California filed a class action lawsuit this past summer against Meta, the UCSF Medical Center and the Dignity Health Medical Foundation, claiming that they have been illegally collecting patients’ health data for targeted advertising.

Photo: Paul Campbell, Getty Images

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3 Ways Digital Health Can Curb Opioid Use

by Bailey Amber
written by Bailey Amber

Not too long ago, in the 1990s and 2000s, the health care system’s best solution for chronic pain was an opioid prescription. Today, of course, we know that opioids are highly addictive and deadly, only to be used as pain relief in moderation with careful oversight.

Still, even after more than a decade of trying to curb opioid use, overdose deaths continue to ravage the country, with each year’s death count higher than the last. In a single 12-month period ending in April 2021, more than 75,000 people were estimated to have died from opioid overdoses – nearly 20,000 more deaths than the previous year.

Clearly, the nation’s strategies to lessen opioid-related deaths are not working. Even though opioids are off the table in many instances, people still experience pain. So how do we address pain management effectively with little or no opioids?

One solution is digital health, an effective – though underutilized – tool for pain management. In my role as a chief clinical officer of a virtual physical therapy platform, I get to see firsthand how solutions like these can help reduce opioid reliance and regain mobility.

Recently a patient with a significant amount of pain and reliance on opioids began virtual physical therapy. Through the program, she began the process of learning how to safely move without injuring herself. With this practice, she was able to overcome her fear of movement, which is a typical reaction for those living in pain. The patient regained her independence in activities she used to enjoy, simple things like going out to dinner with friends or putting away the dishes, and her reliance on opioid medication was reduced.

She explained how she could do things she couldn’t do before, such as lift some heavier things, and how her mobility increased. Most importantly, she was no longer in pain all the time and had significantly reduced the use of medication.

As we see in this example, virtual physical therapy can help individuals overcome barriers that they thought could only be solved by medication. When leveraged correctly, digital health offers three advantages over in-person care and can reduce the need for opioids and improve pain management.

Get upstream on pain management

Digital health allows us to get upstream of chronic pain problems by connecting with patients early and before it feels unmanageable. Many health plans now offer members access to various digital programs, which they can sign up for without needing a referral from a provider or having any existing health conditions. By lowering the barrier to access, digital health providers and their partners can begin building relationships with members even before they enter the medical system.

For example, once a member is onboard, digital health programs have the ability to identify people in pain or at risk of pain and offer to begin working with them before their pain becomes chronic. Dealing with chronic pain is both physically and emotionally stressful. It can cause depression and greatly reduce a person’s quality of life. The development of chronic pain is even associated with structural and functional changes in the brain.

Building a solid foundation to manage pain early on will allow patients to better cope. And, better pain management strategies are thought to also undo or prevent the changes in the brain that can propagate pain and lead to emotional disorders.

As Benjamin Franklin famously said: “An ounce of prevention is worth a pound of cure.”

Accessibility, when pain is calling

Access to brick-and-mortar clinics is restricted to certain hours and days of the week. Conversely, digital health can fit into the palm of someone’s hand, with programs that are accessible 24 hours a day, seven days a week.

Access is vital because chronic pain doesn’t mind a schedule. A pain crisis can occur at any time. Having unlimited access to digital health programs – such as virtual physical therapy or mindful meditation – during a crisis can help reduce suffering and promote patient empowerment.

For patients, digital health tools are something tangible, something real they can use in the moment to lower and manage their pain. That in itself can make a world of difference for the person suffering, helping them turn away from the need to use opioids for pain relief.

Providers gain increased insights

In collaboration with digital health, health care providers gain access to robust data that they wouldn’t normally get through in-office visits.

Digital health programs that track members’ progress and monitor outcomes are able to present providers with regular updates and insights into their patients, such as physical activity level, medication intake monitoring, pain level, function level and engagement. That level of granularity is not possible through regular medical or wellness check-ins with a primary care doctor.

It isn’t uncommon for one doctor to tell a patient the pain isn’t a big deal, while another prescribes pain pills. Digital health can act as the connective tissue among solutions, patients, providers and clinics, improving communication among a patient’s care team and keeping them up-to-date in real-time. With all the providers on the same page, it is easier to maintain consistent messaging around pain, avoiding those mixed messages.

The power of digital health in helping people manage pain is clear, yet it remains untapped potential. All the players, from digital health vendors to payers and providers, need to work together to make it a scalable reality.

More than 200 hundred people are dying a day from an opioid-related overdose. Having access to alternative opioid options for pain management is essential in lowering this outrageous death toll.

Photo: sorbetto, Getty Images

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J&J Drug for Rare Infant Blood Disorder Achieves Main Goal of Phase 2 Test

by Bailey Amber
written by Bailey Amber

Johnson & Johnson drug nipocalimab is in late-stage clinical testing in a rare neuromuscular disorder, and if it stays on track could become the third-to-market drug in its class for that indication. But the pharmaceutical giant now has encouraging preliminary data from a separate test in a rare blood disorder affecting fetuses, helping to build the therapy’s case in a life-threatening disease with no approved therapies.

The data announced Monday are from a Phase 2 clinical trial in severe hemolytic disease of the fetus and newborn (HDFN). Stemming from the incompatibility of the infant’s blood type and the mother’s blood type, this disease leads to the mother’s blood crossing the placenta and attacking fetal red blood cells. The resulting anemia can become fatal to the fetus.

Nipocalimab is intended to reduce levels of antibodies implicated in several antibody-driven diseases. The drug is itself an antibody designed to selectively bind to the Fc receptor (FcRN) of immunoglobulin G (IgG), the most common antibody circulating in the blood. J&J’s Janssen Pharmaceutical Companies division said Monday that Phase 2 results showed most of the pregnant patients who received the experimental drug and achieved a live birth did not need an intrauterine transfusion throughout the entire pregnancy, which was the main goal of the study. The number of patients achieving this goal was not specified.

Katie Abouzahr, vice president, autoantibody portfolio development leader at Janssen Research & Development, said in a prepared statement that the full Phase 2 results will be presented at an upcoming scientific medical meeting. She added that the company plans to advance the drug to a pivotal Phase 3 study in this indication.

Nipocalimab joined the J&J pipeline in 2020 via the pharma giant’s $6.5 billion acquisition of Momenta Pharmaceuticals, a biotech that developed drugs by analyzing the interaction of antibodies and receptors that modulate immune responses. Nipocalimab was Momenta’s lead asset, having reached pivotal testing in warm autoimmune hemolytic anemia (WAIHA), a rare disorder in which antibodies destroy healthy red blood cells.

Momenta had envisioned nipocalimab as applicable to multiple autoimmune conditions. J&J embraced that potential and is currently testing the drug in nine clinical trials—six in immunology and three in neuroscience. Those studies span diseases characterized by alloantibodies, which are produced following exposure to a foreign antigen, such as the maternal antibodies that lead to HDFN; diseases characterized by autoantibodies produced in response to the body’s own tissues; and rheumatological disorders such as rheumatoid arthritis and lupus.

Under J&J, nipocalimab has reached pivotal testing in myasthenia gravis, in which autoantibodies interfere with the communication between nerves and muscles. In 2021, FDA-approval of Argenx’s Vyvgart in myasthenia gravis made it the first FcRn-targeting drug to pass the agency’s regulatory bar. The biotech is also developing the drug for other rare antibody-driven disorders. UCB is on Vyvgart’s heels with rozanolixizumab, an FcRn-blocking drug that was submitted for FDA review last month.

The pivotal study of nipocalimab in myasthenia gravis is expected to produce data in 2024, J&J Chairman and CEO Joaquin Duato said during the company’s presentation last month at the J.P. Morgan Healthcare Conference. The most advanced immunology clinical test of the FcRn-targeting drug is the pivotal test in WAIHA. That clinical trial may have a data readout this year, Duato said. A Phase 2 test in rheumatoid arthritis is also expected to yield data this year, he added.

Photo: Niels Wenstedt/BSR Agency, via Getty Images

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Let’s Focus on Behavioral and Mental Health in Rural Communities

by Bailey Amber
written by Bailey Amber

If there’s a silver lining to the past two years, the pandemic brought mental health to the forefront.

Studies show that one in five adults will experience a behavioral health disorder yearly. The number is almost certainly higher in rural areas.

Anxiety and depression rates among adults reached 42% during the pandemic, according to data secured by the National Center for Health Statistics in partnership with the U.S. Census Bureau.

About a fifth of the population lives in rural areas. While mental health issues aren’t necessarily higher in rural areas, rural residents receive less frequent mental health treatments and often have more limited access to doctors and counselors who specialize in mental health.

In rural communities, patients often go directly to the emergency room with mental health issues. Unfortunately, these hospitals’ emergency rooms often do not have a safe waiting area for psychiatric patients or patients in crisis.

Sometimes patients can wait hours before a hospital can find the right place. Unfortunately, this scenario diverts one or more nurses away from their primary emergency room or acute care responsibilities because they must stay with that patient one-on-one until the hospital can find somewhere for them.

This scenario often plays out in hospitals and compounds an existing problem.

Rural areas already struggle with an acute shortage of medical personnel and particularly nurses. With patients coming in with urgent, life-threatening medical issues, hospitals need their nurses to focus on those patients.

In the next 12-18 months, healthcare providers — especially rural providers — have an opportunity to lay the foundation that will stem the volume of patients with mental health issues from going to the emergency room. Instead, organizations can see these patients receive the help they need and deserve.

Telemedicine will be more prevalent

Amid the pandemic, rural mental health providers increasingly deployed telehealth to reach more patients. Organizations can use that technology to treat patients, schedule counseling sessions, and hold outpatient and one-on-one sessions.

Telehealth options took off as a “necessary evil” amid the pandemic. In the post-pandemic world, it will be necessary for survival and a bit easier to roll out from a staffing standpoint.

To deliver counseling — whether via telehealth or in-person — healthcare providers must find these qualified counselors out there that can conduct the actual telehealth sessions.

More than that, rural health clinics can relieve hospitals of the need to be the sole provider of mental health counseling for children or adults. These rural health clinics or their outpatient clinics serve as a route to provide health and care by using telehealth, bringing that telehealth into their outpatient offerings.

Furthermore, tapping into larger health systems — specifically, their psychiatric units — for advice and help will enable smaller providers to expand their offerings without increasing staffing and outlaying capital on new services.

While we’re making progress, building those bridges and making those connections takes time.

Growing the connection is paramount

One challenge with telehealth offerings is that not everybody has a computer or a reliable network connection. The good news is that nearly everybody has a smartphone, which has helped patients and providers stay connected.

The federal government has allocated billions of dollars to expand broadband connectivity. Moving forward, some healthcare providers may take a more active role in advocating for the expansion of reliable broadband in rural areas to ensure telemedicine becomes an even more viable option for underserved communities.

As community leaders, healthcare providers and perfectly positioned to advocate for this expansion.

Increased use of analytics will help predict outcomes

Perhaps the most significant trend we’ll see in the next 12-18 months is the increased use of analytics to predict patient outcomes.

Incorporating analytics into enterprise resource planning (ERP) systems allows organizations to monitor and capture data better. That will help organizations gain more insight into where the shortfalls are and what we need to do to improve.

This insight improves strategic planning because organizations can look at those numbers for a more complete picture of what’s happening.

Smaller rural hospitals benefit from ERP systems to help them survive, but since the implementation of ERP systems, I see these hospitals using data more often to capture what’s happening with trends and growth in their marketplace. This technology helps organizations manage their financials and see the bigger picture of what’s happening and what is needed.

For example, I’ve seen this technology specifically benefit diabetic populations in rural areas. Recent trends show that the diabetic population is climbing in rural areas. Now healthcare providers can use technology to help decide whether they need to bring on board diabetic counseling or teach classes with a nutritionist.

Technology can be applied in the same manner to mental health. It helps inform organizations where their shortfalls are and where they can add or enhance services.

More conversation means more clarity.

Ideally, every small town in America would have a psychiatrist. Many rural hospitals are integrating these services into their practices, recognizing the need for psychiatric services. These expansions include adding geriatric psychiatry units to help older populations.

While the expansions are helpful and much-needed, they won’t change the situation overnight. It’s a process that takes a while to develop and hire and train the staff, and organizations still need a medical director and a psychiatrist to oversee it.

Everything won’t be solved with staff, but it certainly will make a good step.

Mental health often isn’t talked about in rural areas. Unfortunately, it still carries a stigma and all the technology in the world won’t change that.

Solving the mental health crisis in rural areas still comes down to people acting — no action is too small.

If there’s one change in the next 12-18 months, let’s hope there’s an increased awareness and openness to talking about mental health, especially in our rural communities.

We’ve already done the hardest part: bringing it to the forefront. Now, we just need to see it over the finish line.

Photo: marekuliasz, Getty Images

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Health Net Tries To Keep Medi-Cal Members Informed As Medicaid Redeterminations Loom

by Bailey Amber
written by Bailey Amber

Medicaid, coverage,

As many as 15 million people could lose Medicaid coverage when the continuous enrollment provision ends March 31, according to the U.S. Department of Health & Human Services. That’s why Health Net, an insurance provider in California, launched its “Review to Renew” campaign Wednesday to ensure Medi-Cal members are aware of this transition.

The continuous enrollment requirement was part of the Families First Coronavirus Response Act, which was enacted in 2020 and bars states from disenrolling people from Medicaid during the public health emergency. In return, the states receive enhanced federal funding. The continuous enrollment provision resulted in Medicaid enrollment rising considerably compared to before the pandemic. But the Consolidated Appropriations Act, signed into law in December, will now end the continuous enrollment requirement March 31. 

This means that Medi-Cal, California’s Medicaid program, will return to asking members to renew and review their eligibility information, a process called redetermination. Medi-Cal provides coverage for about 13 million people in the state.

Health Net is a subsidiary of Centene Corporation and provides health plans to individuals, families and businesses who qualify for Medi-Cal or Medicare. It serves about 3 million people. Its “Review to Renew” campaign will leverage print and digital media — such as mail, interactive voice response calls, text messages, social media, digital advertisements and posters — to make Medi-Cal members aware of the deadline and provide them with resources to retain coverage.

“Through our Review to Renew campaign, Health Net wants to ensure millions of Medi-Cal members are aware of the upcoming deadline and resources to maintain their health coverage, while encouraging all Medi-Cal members to review and update their household information,” said Dr. Ramiro Zúñiga, vice president and medical director of Health Net.

In addition, Health Net will provide educational materials at several cultural and community events to help Californians understand the process for renewal.

Doing this outreach and education work is necessary to make Americans aware of the end of the continuous enrollment requirement after so many years of not having to go through redetermination, Zúñiga added.

“Given that California has not gone through the redetermination process in almost three years, informing members of this change is crucial. If not informed, many members may end up without continuation of coverage,” Zúñiga said. “Maintaining health coverage helps Californians stay healthy and live their lives to the fullest.” 

A recent Kaiser Family Foundation report showed what could happen to those who don’t renew their Medicaid coverage. Prior to the pandemic, 65% of people disenrolled from Medicaid and the Children’s Health Insurance Program experienced a period of being uninsured, according to the report. This includes 17% of people who were uninsured for the full year after disenrollment. 

Photo: designer491, Getty Images

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Self Care

Intermountain Partners with Story Health to Better Manage Heart Failure Patients’ Care Plans

by Bailey Amber
written by Bailey Amber

Intermountain Healthcare recently partnered with a startup named Story Health to help manage patients’ heart failure by increasing access to specialty care. Under the partnership, Intermountain clinicians are working with Story’s health coaches to help patients keep up with their treatment plans while they’re outside the walls of the doctor’s office.

Founded in 2020 and based in Cupertino, Story has raised over $26 million to date, according to Crunchbase. Like many digital health startups, the idea to form the company came from the CEO’s personal experience with the U.S. healthcare system.

Story CEO Tom Stanis’ father suffered a stroke years ago. Though much time has passed since the event, it’s still a struggle to manage his recovery.

“This gap between the intensivist and the coordinating primary care physicians is a place where many of us fall behind. Our specialists are overburdened — unable to manage the constant tweaking and deluge of data being generated from patients at home. Primary care is often out of the loop, not knowing or having the confidence to optimize a complex ongoing recovery process. My father fell into this hole,” Stanis said.

Patients are presenting to clinicians with increasing complexity and incomplete care experiences, he pointed out. This problem is made worse by the fact that clinicians are short on time. Constricted by growing administrative tasks and shortened appointment lengths, clinicians often do not have the time they need to contextualize a patient’s full story (hence the startup’s name) and how that story can directly impact their outcome, Stanis said.

To address this issue, Story’s platform offers two key solutions. 

The first is its electronic health record-integrated AI. This technology allows providers to easily connect disparate data from various sources, such as EHRs, medical devices, remote patient monitoring databases and lab results.

“By leveraging data, we can find patients that need support and then automate a personalized care plan based on clinical guidelines, which can be further customized by the physician. This removes the administrative requirements for clinicians to find those patients that aren’t at optimal or goal therapy and makes it easier to get them back on track with the care plan,” Stanis declared.

Once a personalized care plan is established, Story integrates a human touch element. Through its health coaches (which are real people, not AI bots), Story helps ensure that the care plan is followed and the treatment goal is achieved.

Stanis said that Story’s health coaches are an essential part of the business because they serve as an extension of the clinician to identify and resolve challenges like medication optimization, lab draw coordination, transportation arrangements and prescription assistance. These coaches also respond to patient questions via texts and calls.

Story is currently focused on cardiology and heart failure because only 1% of heart failure patients receive the appropriate medications, Stanis pointed out. 

The startup partnered with Intermountain because the startup is seeking to expand its reach and serve more patients. Stanis declined to comment on whether Story’s services are covered for Intermountain patients or how the partners will measure the success of their collaboration. However, Story said that whitepapers detailing the program’s results will be published later this year.

Photo: kieferpix, Getty Images

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Self Care

Paytient Secures $40.5M for Its Benefit Helping Patients Pay for Care

by Bailey Amber
written by Bailey Amber

Financial technology company Paytient announced Tuesday that it raised $40.5 million in Series B funding, which will help the company grow its benefit that helps patients pay for out-of-pocket healthcare costs.

Columbia, Missouri-based Paytient is the creator of Health Payment Accounts (HPAs), which are available for employers, health systems and insurers to offer to employees and members. Users receive a Paytient Visa card, without undergoing a credit check, and can download the Paytient app. When members use the card for a healthcare service, Paytient pays the provider and then the member chooses a payment plan with no interest or fees through the app. They can select the timeline to pay the cost back, as well as a source for payment, such as through a payroll deduction or bank account.

“We preload that card with credit and then that money just sits available to them that they can use to turn any unexpected out-of-pocket medical, dental, vision or veterinary expense,” said Brian Whorley, co-founder and CEO. “Functionally, Paytient is like a healthcare wallet that’s always full.”

The funding round was led by Mercato Partners Traverse Fund and included participation from Bertelsmann Investments. In total, the company has raised $63 million. Existing investors include Lightbank, Felicis Ventures, Inspired Capital, Box Group and Left Lane Capital.

Mercato Partners Traverse Fund chose to invest in Paytient to ease Americans’ financial troubles, said Joe Kaiser, managing director of the investor.

“Working Americans are under more financial stress than ever, and they need a solution that empowers them to access care while taking the stress out of healthcare spending,” he said in a news release.

With the money, the company plans to advance and grow its product, as well as meet demand from potential employer and insurer partners. It has about 700 partners, including Centene, Cigna, Coupe Health, Beta Health and R.R. Donnelly. Paytient serves about 700,000 people.

There’s a need for medical payment assistance, Whorley argued. About 91% of consumers have experienced a payment-related issue in the past, a recent survey from health benefits company Gravie and Wakefield Research found. Paytient aims to fix this issue, Whorley said.

“Our whole goal is to improve the ability of people to better access and afford care,” he said. “That’s our mission.

Other companies that provide financial assistance for healthcare expenses include fintech company Stilt through its product called Onbo and Rectangle Health through its product called Care Now, Pay later.

Photo: claudenakagawa, Getty Images

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