– Conversa Health raises an additional
$8M, expanding its Series B round to $20M for its automated virtual care
platform, totaling $34M in funding to date.
– The Series B round, first announced at $12 million in
June, was co-led by Builders VC and Northwell Ventures, the corporate venture
arm of Northwell Health, New York’s largest healthcare provider with 23
hospitals and 800 outpatient facilities.
– Founded in 2014, Conversa enables health systems to
virtually engage, monitor and manage patients more effectively and efficiently
than ever before—for chronic care, acute discharge, perioperative, oncology,
OBGYN, prevention and wellness, and more. Conversa’s automated care platform
engages patients at high frequency and scale while triaging to
higher-touch/cost care venues when necessary, optimizing and improving the use
of telehealth e-visits, phone calls, and in-person consults.
– Conversa will use the additional Series B funds to
continue to scale its technology platform, expand its library of automated
virtual care digital pathways, and fuel growth with new and existing
– COVID-19 care deferrals lead to three major boomerang
conditions that payers and providers must proactively address in 2021,
according to a newly released report by Prealize.
– COVID-19’s hidden victims—those who avoided or deferred
care during the pandemic—will increasingly return to the healthcare system, and
many will be diagnosed with new conditions at more advanced stages. Healthcare
leaders must act now to keep this boomerang from driving worse outcomes and
Many procedures and diagnoses fell significantly in 2020,
with several dropping nearly 50% below 2019 levels between March and June. Total
healthcare utilization fell 23% between March and August 2020, compared to the
same time period in 2019.
To explore the full scope of healthcare utilization and
procedural declines in 2020, and assess how those declines will impact
patients’ health and payers’ pocketbooks in 2021, Prealize Health conducted an
analysis of claims data from nearly 600,000 patients between March 2020 and
Prealize identified the three predicted conditions likely to
see the largest increase in healthcare utilization in 2021:
1. Cardiac diagnoses will increase by 18% for ischemic
heart disease and 14% for congestive heart failure
These increases will be driven by 2020 healthcare
utilization declines, for example, patients deferring family medicine and
internal medicine visits. These visits, which help flag cardiac problems and
prevent them from escalating, declined 24% between March and August of 2020.
“Cardiac illnesses are some of the most serious and
potentially fatal, so delays in diagnosis can lead to significant adverse
outcomes,” said Gordon Norman, MD, Prealize’s Chief Medical Officer.
“Without early recognition and appropriate intervention, rates of patient
hospitalization and death are likely to increase, as will associated costs of
2. Cancer diagnoses will increase by 23%
Similar to cardiac screening trends, significant declines in
2020 cancer screenings will be a key driver of this increase, with 46% fewer
colonoscopies and 32% fewer mammograms performed between March and August 2020
than during that same time period in 2019.
“Cancer doesn’t stop developing or progressing because
there’s a pandemic,” said Ronald A. Paulus, MD, President and CEO at RAPMD
Strategic Advisors, Immediate Past President and CEO of Mission Health, and one
of the medical experts interviewed for the report. “In 2021, when patients
who deferred care ultimately receive their diagnoses, their cancer sadly may be
more advanced. In addition, an increase in newly diagnosed patients may make it
harder for some patients to access care and specialists—particularly for those
patients who are insured by Medicaid or lack insurance altogether.”
3. Fractures will increase by 112%
This finding, based on combined analysis of osteoporosis
risk and fall risk, is particularly troubling for the elderly patient
A key driver of increased fractures in 2021 is the number of
postponed elective orthopedic procedures in 2020, such as hip and knee
replacements. These procedural delays are likely to decrease mobility, and
therefore, increase risk of fractures from falls.
“In elderly patients, fractures are very serious events
that too often lead to decreased overall mobility and quality of life,”
said Norman. “As a result, patients may suffer from physical follow-on
events like pulmonary embolisms, and behavioral health concerns like increased
Why It Matters
“These predictions are daunting, but the key is that providers and payers take action now to mitigate their effects,” said Prealize CEO Linda T. Hand. “It’s going to be critical to gain insight into populations to understand their risk at an individual level, build trust, and treat their conditions as early as possible to improve outcomes. The COVID-19 pandemic has challenged every aspect of our healthcare system, but the way to get ahead of these challenges in 2021 will be to proactively identify and address patients most at risk. We’re going to see proactive care become an important driver for success next year, as providers and payers seek to mitigate unnecessary and expensive procedures that result from 2020’s decreased medical utilization. The right predictive analytics partner will be critical to providers and payers being able to take the right course of action.”
HIT Consultant sat down with Mike McSherry, CEO, and co-founder of Seattle-based digital prescription platform Xealth to discuss digital health lessons learned in 2020 and what we can expect in 2021. As Xealth’s CEO, Mike also works with Duke Health, UPMC, Atrium Health, and The Froedtert & the Medical College of Wisconsin health network where he uses his background in digital health to connect patients and care teams outside of traditional care settings.
HITC: In 2021, How can digital health reduce race and minority disparities in healthcare?
McSherry: The U.S. has struggled with health disparities, which this pandemic has widened. Many of these disparities can be linked to access, which digital health can assist with – telehealth makes care virtual from any location, clinical decision support can reduce human errors, remote patient monitoring helps keep patients home while linked to care.
Digital health removes hurdles related to transportation, taking time off work, or finding childcare in order to travel in-person for an appointment. It brings care to the patient instead of the other way around, making access simpler. Care through these pathways is also more cost-efficient.
There are still hurdles to overcome. Broadband is widespread but not everywhere and inclusive design of these tools should be considered. How digital tools, including wearables, are built should address differences in gender and ethnicity, especially as these tools are used more frequently in clinical trials, so as not to inadvertently perpetuate disparities.
HITC: Why some hospitals are offering digital health tools to staff but not patients?
McSherry: There are a few factors at play when hospitals offer digital health tools to staff but not patients. One, most health systems are not currently deploying system-wide digital health initiatives, leaving the decisions to individual departments or providers. This can lead to inconsistent patient experiences and more data siloes as solutions are brought in as one-offs.
The second issue is reimbursement. A hospital acting as an employer offering digital health tools as part of its benefits package is different than a patient, who must rely on their health insurance, whether it is a public or private plan. The fact healthcare organizations see digital health tools as a perk shows their value. Now, it is time for CMS and commercial payers to consistently enable their use to help providers care for patients and incorporate digital health as clinicians see fit.
HITC: How hospitals can remain competitive in 2021, especially after tighter margins from COVID-19?
McSherry: Large tech companies, like Google and Amazon, and huge retailers, including Walmart and Best Buy, are looking to deliver the promise of health care that has so far eluded the industry. Venture capital money has been pouring in for funding innovation, with digital health funding hitting a new high in 2020.
These initiatives are all racing to control health care’s front door and if hospitals don’t innovate as well, they run a very real risk of having patients turn elsewhere for care. Payers are also building digital front doors and telling members to go there. People have long expressed their desire to have the same consumer experience in health care that they receive in other industries. The technology is there. It needs to be incorporated with the correct care pathways.
One silver lining during the COVID-19 pandemic is that it showed fast-moving innovation can happen in health care. We worked with hospitals to stand up workflows around telehealth in four days and remote patient monitoring in seven days – an amazing pace. The key is to keep this stride going once we are on the other side of this crisis.
Providers are becoming more digitally savvy to engage patients and deliver holistic care. Hospitals should support this.
HITC: What will be Biden’s impact on COVID-19, how hospital leaders should respond, and what it means that we have a divided congress?
McSherry: Under the current administration, telehealth rules have been relaxed, at least temporarily, along with cross-state licensure so providers are better able to build a front door strategy, helping organizations roll out remote patient monitoring and chronic care management apps. Biden has been a proponent of digitalization in health care and will have a broader engagement. This could lead toward more funding and more covered lives.
A divided Congress will not make much easy for the Biden administration, however, getting on the other side of this pandemic as quickly and as safely as possible is best for everyone. Biden has shown he will make fighting COVID-19 a top priority.
HITC: Will remote patient monitoring become financially viable for hospital leaders in 2021?
McSherry: Why does a diabetic patient need to have every check-in be in-person or a healthy, pregnancy met every few weeks with an in-person visit as opposed to remote monitoring for key values and a telehealth check-in in place of a couple of those visits? Moving forward, hospitals will see the benefit of remote monitoring in terms of lower overhead, along with better patient engagement, outcomes and retention.
To make this work, providers must share risk, and determine digital strategies around attracting patients and then manage them in a capitated way with more digital tools because of the cost efficiencies.
HITC: How do we foster tighter physician-patient relationships?
McSherry: Patients trust their doctors, period. The struggle is going to be more obvious as more people do not have a PCP and turn to health care with a bandage approach to take care of an immediate concern. That will lead to entire populations without that trusted bond who are sicker when they finally do seek care, due to the lack of continuity and engagement early on.
By connecting with people now, where they are comfortable, there is a tighter physician-patient relationship by making it more accessible and reciprocal.
– The digital diabetes market is on track to reach $1.5
billion dollars by 2024, according to a new report by Research2Guidance.
– The confident growth of digital diabetes care will be driven by the growth of the global addressable market for digital diabetes services. Between 2019 and 2024, the number of diagnosed diabetics with access to smart devices is set to increase from 109 million to 180 million.
– Digital diabetes solutions have disrupted the diabetes
care market and are changing overall chronic care, targeting not only diabetes
but also its various comorbidities, such as obesity, hypertension, and
– The report, The
Global Digital Diabetes Care Market 2020: Going Beyond Diabetes Management focuses on the continued expansion of
digital diabetes providers into other chronic conditions (vertical expansion)
and new service opportunities (horizontal expansion), highlighting the market’s
strategic direction in the next few years. This expansion will create new
revenue opportunities, improve payer acceptance, and grow user bases beyond the
diagnosed diabetes audience.
– In the report, the Top 10 market players LifeScan Inc., Ascensia Diabetes Care, Informed Data Systems (One Drop), mySugr (Roche), H2 Inc., Livongo Health, Omada Health, Abbott, Dexcom, and Dario Health are profiled with their offerings, mobile app portfolio performance, and strategy analysis, as well as Top 10 country profiles (market opportunity size, number of solutions, downloads, number of users, Top 5 players).
– DAS Health Ventures acquires healthcare
and managed IT company Randall Technology Services (RandallTech).
– This acquisition adds Allscripts® PM
and EHR solutions to the DAS portfolio of supported products, and DAS Health
has now added additional staff in Texas that will create opportunities for
greater regional support of its entire solutions portfolio.
DAS Health Ventures, Inc., an industry leader in health IT and management, announced today it completed the acquisition of Randall Technology Services, LLC (RandallTech) healthcare and managed IT company based in Amarillo, TX. As part of DAS’ growth strategy, this most recent expansion further strengthens its position in the US healthcare technology space.
Acquisition Enhances DAS Health Market Reach
DAS Health actively serves more than 1,800 clients, and
nearly 3,500 clinicians and 20,000 users nationwide, with offices in Florida,
Nevada, New Hampshire and Texas, and a significant employee presence in 14 key
states. This acquisition adds Allscripts® PM and EHR solutions to the DAS
portfolio of supported products, and DAS Health has now added additional staff
in Texas that will create opportunities for greater regional support of its
entire solutions portfolio.
Increased Support for Existing RandallTech Clients
Randall Technology’s clients will gain an increased depth of support, and a substantially improved value proposition, as DAS Health’s award-winning offerings are robust, including managed IT / MSP services, practice management, and EHR software sales, training, support and hosting, revenue cycle management (RCM), security risk assessments (SRA), cybersecurity, MIPS/MACRA reporting & consulting, mental & behavioral health screenings, chronic care management, telemedicine, and other value-based and patient engagement solutions.
Financial details of the acquisition were not disclosed.
The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting. According to CDC statistics, 94% of patient mortalities associated with COVID-19 were simultaneously suffering from preexisting conditions, leaving a mere 6% of victims with COVID-19 as their sole cause of death. However, while immediate prospects for a mass vaccine might not be until 2021, there is some hope among rural hospital health information technology consultants where the pandemic has hit the hardest.
The fact that four in ten U.S. adults have two or more chronic conditions indicates that our most vulnerable members of the population are also the ones at the greatest risk of succumbing to the pandemic. From consultants laboring alongside healthcare administrators and providers, all must pay close attention to patients harboring 1 of 13 chronic conditions believed to play major roles in COVID-19 mortality, particularly chronic kidney disease, hypertension, diabetes, and COPD.
Vulnerable rural populations must be supervised due to their unique challenges. The CDC indicates 80% of older adults in remote regions have at least one chronic disease with 77% having at least two chronic diseases, significantly increasing COVID-19 mortality rates compared to their urban counterparts.
Health behaviors also play a role in rural patients who have decreased access to healthy food and physical activity while simultaneously suffering high incidences of smoking. These lifestyle choices compound with one another, leading to increased obesity, hypertension, and many other chronic illnesses. Overall, rural patients that fall ill to COVID-19 are more likely to suffer worsened prognosis compared to urban hubs, a problem only bolstered by their inability to properly access healthcare.
Virus Helping Push New Technologies
COVID-19 has shown the cracks in the U.S. healthcare technology system that must be addressed for the future. As the pandemic unfolds, it’s worth noting that not all lasting effects will be negative. Just as the adoption of the Affordable Care Act a decade ago spurred healthcare organizations to digitize their records, the COVID-19 pandemic is accelerating overdue technological shifts crucial to providing better care.
Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that connect patients with both urgent and preventive care without their having to leave home. Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that use video to connect patients with both urgent and preventive care without their having to leave home.
Even if COVID-19 were to fade away on its own, the next pandemic may not. Furthermore, seasonal influenza serves as a reminder that healthcare is not a skirmish, but a prolonged war against disease. Rather than doom future generations to suffer the same plight our generation has with the pandemic, now is the time to develop innovative IT strategies that focus on protecting our most vulnerable citizens by leveraging existing healthcare initiatives to focus on proactive responses instead of reactive responses.
On the Right Road
While some of the most vulnerable people are the elderly, rural residents, and the poor, the good news for them is that CMS has long advocated the use of preventive care initiatives such as Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM) to track these geriatric patients. To encourage innovation in this sector, CMS preventive care initiatives provide generous financial incentives to healthcare providers willing to shift from conventional reactive care strategies to a more proactive approach focused on prevention and protection. This should attract rural hospital CEOs who have been struggling even more than usual because of the virus.
These factors led to the creation of numerous patient CCM programs, allowing healthcare executives and providers to remotely track the health status of geriatric patients suffering from numerous chronic conditions. The tracking is at a rate and scope unseen previously through the use of electronic media. Interestingly enough, the patients already being monitored by CCM programs overlap heavily with populations susceptible to COVID-19. To adapt existing infrastructure for the COVID-19 pandemic is a relatively simple task for hospital CIOs.
As noted earlier, one growing CCM program that could be retrofitted to deal with the COVID-19 pandemic are the use of telehealth services in rural locations. Prior to the pandemic, telehealth services were one of the many strategies advocated by the CDC to address the overtaxed healthcare systems found in rural locations.
Better Access, Funding and User Experience for Telehealth
Today, telehealth is about creating digital touchpoints when no other contact is possible or safe. It offers the potential to expand care to people in remote areas who might have limited or nonexistent access, and it could let other health workers handle patient screening and post-care follow-up when a local facility is overwhelmed. As a study published last year in The American Journal of Emergency Medicineaffirms, virtual care can cut the cost of healthcare delivery and relieve strain on busy clinicians.
Telehealth has also gotten a boost from the $2 trillion CARES Act stimulus fund, which provides $130 billion to healthcare organizations fighting the pandemic. The effort also makes it easier for providers to bill for remote services.
The reason for the CDC and hospital administrators’ interest in telehealth was that telehealth meetings could outright remove the need for patients to travel and allow healthcare providers to monitor patients at a fraction of the time. By simply coupling existing telehealth services with CMS preventive care initiatives focused on COVID-19, rural healthcare providers could detect early warning signs of COVID-19.
Integration Key to Preemptive Detection
This integration at a faster and far greater scale could mean much greater preemptive virus detection through routine telehealth meetings. The effect of telehealth would be twofold on hospitals serving rural and urban health communities. It could slow the spread of COVID-19 to a crawl due to decreased patient travel and improved patient prognosis through early and intensive treatment for vulnerable populations with two or more chronic health conditions.
This integrated combination would shift standard reactive care to patient infections to a new monitoring methodology that proactively seeks out infected patients and rapidly administers treatment to those most at risk of mortality. This new combination of preventive care and telehealth services would not only improve patient and community health but would relieve the financial burden incurred from the pandemic due to the existing CMS initiatives subsidizing such undertakings.
In conclusion, preventative care targeting patients with pre-conditions in rural locations are severely lacking in the context of the COVID-19 pandemic. By leveraging CMS preventive care initiatives along with telehealth services, healthcare providers can achieve the following core objectives.
First, there are financial incentives with preventive care services that will relieve the burden on healthcare systems. Second, COVID-19 vulnerable populations will receive the attention and focus from healthcare providers that they deserve to slow the spread through the use of early detection systems and alerts to their primary health provider. Third, by combining with telehealth service, healthcare providers can efficiently and effectively reach out to rural populations that were once inaccessible to standard healthcare practices.
– Priority Health launches its virtual-first coverage
option with MyPriority Telehealth PCP plans, using top platform Doctor On
– Members who choose one of the MyPriority Telehealth PCP
plans will have a doctor assigned as their primary care physician (PCP) through
Doctor on Demand and all visits will take place virtually.
Health announced the launch of their new MyPriority Telehealth PCP plans
that will go into effect on January 1, 2021. The new plans are designed for
consumers who are seeking health coverage that is virtual-first and are
comfortable with online interactions with providers. Priority Health is now the
first insurer in Michigan to offer this type of virtual-first product.
How It Works
Members who choose one of the MyPriority Telehealth PCP
plans will have a doctor assigned as their primary care physician (PCP) through Doctor on Demand and all visits will take place
virtually. The member will need a referral from their doctor to seek care in a
traditional office setting with a specialist, as needed. Emergency care does
not have this same restriction.
The new Telehealth PCP plan options, while virtual-first,
still provide members with the same level of comprehensive coverage as a
traditional plan. Members who choose a Telehealth PCP plan will have full
coverage for preventive care and will also have access to added benefits like
reduced copays on prescription drugs, diabetes and chronic condition
management, global emergency assistance through Assist America, and discounted
prices for gym memberships.
Why It Matters
“There is no doubt that telehealth is here to stay. Throughout the COVID-19 pandemic, we have seen a massive and sudden shift in the way health care is typically delivered, and many consumers used virtual care for the first time,” said Carrie Kincaid, Vice President of Individual Markets at Priority Health. “With more and more people realizing that telehealth can be a safe and convenient option for certain types of care, we knew that now was the right time to launch this innovative plan option.”
“This Telehealth PCP plan acts as a primary care doctor, urgent care, behavioral health, preventive health and chronic care provider all with the convenience of being able to seek care from the comfort and safety of home,” Kincaid noted. “We listened to what consumers want, and we are excited to bring this new offering into the market.”
Since COVID-19 emerged as a major health threat, virtual care has taken off. As many as 46% of patients reported in late April that they had used telehealth to replace a canceled healthcare visit in 2020, while 48% of physicians said they had started using telehealth to treat patients.
While a shift in care models was necessary to address business continuity amid the pandemic, these trends also represent positive movements as a growing body of evidence supports the real-life benefits of telehealth. Remote models of care are connected to safe and effective consultations across many use cases, low exposure to viruses, and much-needed access to care.
Yet the fact that physician adoption isn’t higher suggests two things:
1) Physicians may be taking a ‘wait and see’ approach in the hopes that patients will want to return to in-person care as economies reopen; or
2) Some physicians haven’t yet figured out their long-term telehealth strategy. In truth, many providers are treating telehealth as a “stop-gap” — or temporary — solution until life returns to normal.
But given the increasingly positive data around telehealth as a safe alternative to in-person care, as well as its track record in successfully treating patients, it’s time for providers to reframe their thinking. In the future, practices will need a healthcare strategy that balances virtual with in-person care.
As recently as ten years ago, telehealth reimbursement was largely limited to patients in rural areas, as payers didn’t yet see the value of compensating doctors for virtual encounters.
Today, most payers and providers recognize the value of telehealth on some level amid rising demand for services and severe professional shortages. In particular, remote care models have proven their worth during the pandemic as an effective means of preventing the spread of disease. Greater acceptance of telehealth is further demonstrated by the recent decision to relax HIPAA requirements by HHS’ Office of Civil Rights (OCR), allowing more providers and patients to virtually connect through FaceTime, Zoom, or other two-way communications systems during the current pandemic.
This is an important first step, although many providers remain resistant to change for a variety of valid reasons. Some of these include discomfort with remote care models, reimbursement concerns, and the cost of deploying telehealth.
Performing medicine in a way that doesn’t align with one’s training feels unnatural, and some providers have said that virtual encounters feel less personal. The fact is that most clinicians weren’t trained to diagnose patients remotely or engage over a screen and are simply hesitant to embrace this approach to care.
Also, providers may have trepidation about not getting paid. While CMS and private payers have expanded coverage, multiple healthcare providers have reported that bills are being delayed or only partially paid by health plans.
With limited insight into the potential return on that investment, concerns over the cost of implementing telehealth are also reasonable. A physician who is consulting with patients remotely through FaceTime, for example, might wonder if the investment in a more secure, robust telehealth platform will make sense in 12 months, should a COVID-19 vaccine materialize.
Yet by not adopting a more permanent telehealth solution, providers may be hurting themselves down the road. Patients increasingly believe virtual care is highly effective, and some even prefer it. According to a SYKES consumer survey administered in March, 60% of 1,441 respondents said the COVID pandemic has increased their willingness to try telehealth.
Also, while HHS has relaxed HIPAA enforcement at the moment, there’s no indication this will continue. Healthcare organizations will need to ensure that the platform or program they’re using is designed to keep protected health information (PHI) safe.
Investing in the Future
Given the upward trajectory of telehealth, it benefits providers to thoughtfully invest in the right strategies and solutions now to extract the greatest value and return on investment down the road. Here are four steps to take, when shifting to a long-term telehealth strategy:
– Identify needs. Many primary-care practices may have seen a bump in interest in telehealth due to COVID-19, while specialty practices may see increases stay steady, even when fears of the coronavirus fade. When planning long-term, put patient needs first: In what ways can telehealth improve care delivery, going forward? Look at data, such as virtual-visit utilization patterns, to see where there are opportunities to grow telemedicine (e.g., expanding chronic care management) based on needs.
– Consider workflows. The ideal telehealth program doesn’t interrupt clinical workflows – it enhances them. If you’re using a ‘stop-gap’ video conferencing solution to provide telemedicine, is it easy to integrate practice notes with your EHR? Or, do you have to take extra steps to document patient encounters for clinical and billing departments?
–Seek supportive partners. You can use any number of technology platforms to conduct telemedicine encounters, but not all platforms are created equal. When looking at implementing a telehealth platform, consider not only ease of use, and interoperability, but also what a particular vendor is offering: How well the telehealth platform in question can accommodate the needs of a particular specialty? What are existing clients are saying about things like training, vendor support, and the patient experience?
– Proactively engage. Your patients have most likely heard of telehealth, but they may not realize that telehealth is multifaceted and can be used to diagnose conditions such as skin disorders or allergies and can be just as effective as in-person visits. Educating patients about telehealth’s benefits, and making it easy for them to try telehealth, is essential to success.
Expanding telehealth’s role in the medical practice benefits everyone, from physicians to patients to payers. Moving past the “stop-gap” mentality now will reap greater benefits in the future, regardless of whether we’re in the midst of a pandemic, or simply trying to provide excellent care on a day-to-day basis.
About Roland Therriault
is the President and Executive Vice President of Sales at InSync Healthcare Solutions, a provider
of integrated EHR and practice management software, revenue cycle management
services and medical transcription to thousands of healthcare professionals
throughout the United States. Roland Therriault manages all operations of the
company, driving its go-to-market strategy and overseeing all sales activities.
His experience in healthcare and technology includes more than 20 years of
direct and channel sales, strategic planning and business development. Prior to
joining InSync, Roland served as Vice President of Sales for MD On-Line, a
provider of acute and ambulatory clinical and practice management solutions.
Living through a pandemic is stressful and anxiety-inducing. Stay-at-home measures are compounding this stress, resulting in social isolation and unprecedented economic hardship, including mass layoffs and loss of health coverage. Fully understanding the impact of these pernicious trends on overall mental health will take time. However, precedents like the Great Recession suggest that these trends are likely to worsen the conditions driving suicide and substance-related deaths, the “deaths of despair” that claimed 158,000 lives in 2017 and contributed to a three-year decline in US life expectancy among adults of all racial groups.
Even before the emergence and spread of COVID-19, the US was experiencing a behavioral health treatment crisis: 2018 data showed that only 43% of adults with mental health needs, 10% of individuals with SUD, and 7% of individuals with co-occurring conditions were able to receive services for all necessary conditions.
The treatment gap is staggering, and COVID-19 is exacerbating it: an estimated 45% of adults report the pandemic has negatively impacted their mental health, to say nothing of the disruption of essential in-person care and services. In a similar vein, a recent CDC report has highlighted the staggering and “disproportionately worse mental health outcomes, [including] increased substance use, and elevated suicidal ideation” experienced by “younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers.”
Consistent with the CDC report’s findings, the crisis can be felt most acutely by the very workforce that must deal with COVID-19 itself. Hospitals, health systems, and clinical practices – together with other first responders – comprise the essential front line. They bear the burden of their employees’ stress and illness, and must also cope with the many patients who present with a range of mental illnesses and substance use disorder (SUD).
But providers don’t have to face this burden alone: numerous behavioral health-focused digital solutions can support providers in meeting their most urgent needs in the era of COVID-19. Many of these solutions have made select services available for free or at a discount to healthcare providers in recognition of the immense need and challenging financial circumstances. Some solutions also help systems take advantage of favorable, albeit time-sensitive, conditions, enabling them to lay the foundation for broader behavioral health initiatives in the long term. Several of these solutions are described below, in the context of three key focus areas for health systems.
Focus Area 1: Supporting the Frontline Workforce
Health system leaders need to keep their workforces healthy, focused, and productive during this period of extreme stress, anxiety, and trauma. Providing easily accessible behavioral health resources for the healthcare workforce is therefore of paramount importance.
Health systems should consider providing immediate, free access to behavioral health services to employees and their families and consider further extending that access to first responders, other healthcare workers, and other essential services workers in the community.
Many digital product companies are granting temporary access to their services and are expanding their offerings to include new, COVID-19-specific modules, resources, and/or guidance at no cost.
Fortunately, the market is rife with solutions that have demonstrated effectiveness and an ability to scale. However, many of these rapidly-scalable solutions are oriented toward low-acuity behavioral health conditions, so it is important that health systems consider the unique needs of their populations in determining which solution(s) to adopt.
The following are several solutions to consider:
Online CBT solutions. These tools are being used to expand access to lower-acuity behavioral health services, targeting both frontline workers and the general population. MyStrength, SilverCloud and others have deployed COVID-19-specific programming.
Text-based peer support groups. Organizations are using Marigold Health to address loneliness and social isolation in group-based chat settings, one-on-one interactions between individuals and peer staff, and broader community applications.
Focus Area 2: Maintaining Continuity of Care
As the pandemic continues to ripple across the country, parts of the delivery system remain overwhelmingly focused on containing and treating COVID-19. This can and has led to the disruption of care and services, of particular significance to individuals with chronic conditions (e.g., serious mental illness (SMI) and SUD), who require longitudinal care and support. Standing up interventions — digital and otherwise — to ensure continuity of care will be critical to preventing exacerbations in patients’ conditions that could drive increased rates of ED visits and admissions at a time when hospital capacity can be in short supply.
In the absence of in-person care, many digital solutions are hosting virtual recovery meetings and providing access to virtual peer support groups. Additionally, shifts in federal and state policies are easing restrictions around critical services, including medication-assisted treatment (e.g., buprenorphine can now be prescribed via telephone), that can mitigate risky behavior and ensure ongoing access to treatment.
The use of paraprofessionals has also emerged as a promising extension of the historically undersupplied behavioral health treatment infrastructure. Capitalizing on the rapid expansion of virtual care, providers should consider leveraging digital solutions to scale programs that use peers, community health workers (CHWs), care managers, health coaches, and other paraprofessionals, to reduce inappropriate hospital utilization and ensure patients are navigated to the appropriate services.
The following are several solutions to consider:
Medication-assisted therapy (MAT) via telemedicine. These solutions provide access to professionals who can prescribe and administer MAT medications, provide addiction counseling, and conduct behavioral therapy (e.g., CBT, motivational interviewing) digitally. Solution companies providing these critical services include Eleanor Health, PursueCare, and Workit Health.
Behavioral health integration. Providing screening, therapy, and psychiatric consultations in a variety of care settings — especially primary care — will help address the increased demand. Historically, providers have had difficulty scaling such solutions due to challenging reimbursement, administrative burden, and stigma, among other concerns. Solutions like Valera Health and Concert Health were created to address these challenges and have seen success in scaling collaborative care programs.
Recovery management tools for individuals with SUD. WEConnect Health and DynamiCare Health are both offering free daily online recovery support groups.
Focus Area 3: Leveraging New Opportunities to Close the Treatment Gap
As has been widely documented, the pandemic has spurred unprecedented adoption of telehealth services, aided by new funding opportunities (offered through the CARES Act and similar channels) and the widespread easing of telehealth requirements, including the allowance of reimbursement for audio-only services and temporarily eased provider licensure requirements.
Tele-behavioral health services are no exception; the aforesaid trends ensure that what was one of the few high-growth areas in digital behavioral health before the pandemic will remain so for the foreseeable future. This is unquestionably a positive development, but there is still much work to be done to close the treatment gap. Critically, a meaningful portion of this work is beyond the reach of the virtual infrastructure that has been established to date. For example, there remains a dearth of solutions that have successfully scaled treatment models for individuals with acute illnesses, like SMI or dual BH-SUD diagnoses.
Health system leaders should continue to keep their ears to the ground for new opportunities to expand their virtual treatment infrastructure, paying particular attention to synergistic opportunities to build on investments in newly-developed assets (like workforce-focused solutions) to round out the continuum of behavioral health services.
COVID-19 has all but guaranteed that behavioral health will remain a major focus of efforts to improve healthcare delivery. Therefore, health systems that approach today’s necessary investments in behavioral health with a long-term focus will emerge from the pandemic response well ahead of their peers, having built healthier communities along the way.
About Victor Siclovan
Victor Siclovan is a Director on the Medicaid Transformation Project at AVIA where he leads work in behavioral health, chronic care, substance use disorder, and Medicaid population health strategy. Prior to AVIA, Victor spent nearly 10 years at Oliver Wyman helping large healthcare organizations navigate the transition to value-based care. He holds a BA in Economics from Northwestern.
The impact of the coronavirus crisis is shining a bright light on many of the challenges facing the U.S. healthcare system.
So much more than a lack of primary care physicians and hospital beds, the all-hands-on-deck approach to combating the spread of COVID-19 has forced patients fearful of engaging with the healthcare system for needs unrelated to the virus to put elective procedures, routine care and timely treatment for chronic or critical conditions on the back burner.
Compounding these issues, fears surrounding visiting the doctor’s office have forced primary care facilities to lay off or furlough clinicians and staff, deferring or skipping clinician salaries in some cases. When it comes to epidemic illness, primary care professionals serve as the first line of defense, preventing patients from flooding emergency rooms and hospitals when they don’t actually need to be there. However, in spite of the need for access to affordable primary care, many primary care practices will not survive the pandemic.
Despite new CDC guidance showing people with underlying medical conditions like diabetes or hypertension are at increased risk for severe illness from COVID-19, most regular wellness check-ups, cancer screenings, and nonemergency procedures have been put on hold. While COVID-19 is responsible for more than 140,000 deaths in the U.S. alone, experts predict this delay in care for chronically ill patients has resulted in a “silent” death-toll — and one that continues to climb as the world waits for a vaccine.
In the meantime, what can hospitals and clinics in the U.S. do to better serve chronic care patients and ensure no one else falls through the cracks during the pandemic?
Healthcare generates a lot of data for patient records. It’s crucial that hospitals and medical clinics have the ability to analyze that data to identify and categorize vulnerable patients who are either:
– high-risk due to potential coronavirus-related complications or
– require regular check-ups because of care related to chronic illness, mental health, or addiction.
Facing the aforementioned barriers to primary care and treatments, many chronic and crisis care patients are exponentially more vulnerable to the impact of the virus. Even if these patients do not contract COVID-19, the regression that can happen when a condition is not properly managed can be equally dangerous.
Data analysis that allows healthcare providers to stratify patient population risk and engage patients based on care needs provides caretakers the information they need to create personalized treatment plans that ensure the needs of chronic and crisis care patients are not neglected.
Safe and Continuous Outreach
Healthcare clinics that traditionally rely on in-office visits are now scrambling to provide access to their patients through telemedicine and virtual visits while navigating the challenging new landscape of billing codes and payment rules for these services. Previously derided as less than effective medicine, telemedicine, and virtual visits have become necessary to reduce staff exposure, preserve personal protective equipment (PPE) and minimize the impact of patient surges on facilities.
Because systems have had to adjust the way they triage, evaluate and care for patients through the use of methods that do not depend on in-person services, telehealth, and virtual care services are helping provide necessary care to at-risk patients while minimizing the transmission risk of the virus that causes COVID-19 to healthcare personnel and other patients.
From phone calls and telemedicine appointments to apps, surveys, and regular check-ins, advances in technology empower hospitals and clinics to prioritize relationships that build the foundation enabling continuity of care, even using a new channel to communicate. Through proactive communication with patients about helpful resources and the option for virtual visits, providers can see significant success in their commitment to continued engagement with — and care for — patients.
Dedicated Patient Advocacy
Good patient-provider relationships foster better communication, which drives improved health and wellness. As such, it’s important that hospitals and clinics have ongoing and dedicated patient advocates to reach out to high-risk and chronic care patients.
By serving as the link between a patient’s care provider and the real world, patient advocates strive to ensure that patients have access to the care and resources they need. Whether that involves access to prescriptions, medical supplies, food, financial assistance, mental health programs, or workforce navigation, care coordination needs to extend beyond simple community referrals.
In the face of a global pandemic, patients often face complicated decisions concerning their health and overwhelming obstacles to receiving care. Ongoing, dedicated patient advocacy offers guidance that helps patients navigate the complicated health system, ensuring they get the care and support they need throughout the continuing COVID-19 outbreak.
Despite efforts to safely reopen businesses and get employees back to work, the virus itself has not gone away. With practitioners fearing the spread of the disease, patients afraid to keep their in-person appointments and clinicians being redirected to emergency rooms or coronavirus test sites, primary care doctors are seeing their patients far less frequently, and patients are struggling to effectively maintain their health.
That strain on the primary care system will continue. However, by moving to value-based care models, such as advanced primary care, that leverage data, and analytics to identify and categorize vulnerable patients, facilitate safe and continuous outreach to these patients through telemedicine and other virtual means and have dedicated patient advocates reaching out to high-risk and chronic care patients, hospitals and clinics can continuously serve their most vulnerable patients throughout the duration of the coronavirus crisis.
About Dr. Kayur Patel
Dr. Kayur Patel serves as Chief Medical Officer of Proactive MD. A practicing physician with extensive experience in internal and emergency medicine, his specialty lies in bringing physicians and hospital leadership together in order to convert healthcare challenges into opportunities for growth. He is a nationally-recognized authority and a national speaker on the subject of quality in healthcare.
– Current Health has partnered with Dexcom to add continuous
glucose monitoring (CGM) capabilities to its remote patient monitoring (RPM)
platform – enhancing care and improving outcomes for diabetics.
– Dexcom CGM data will transmit directly into the Current
Health wearable and platform for review by the care management and clinical
teams, improving post-discharge and chronic care of diabetes patients outside
– Through this partnership, Current Health is now able to
offer a complete view of patients’ health indicators, no matter where that
patient is located – a critical need as keeping patients out of the hospital is
even more important than ever with the COVID-19 pandemic. With these insights,
healthcare providers are able to proactively address issues associated with
diabetes and provide the best possible care.
Current Health today
announced it has partnered with Dexcom to
add continuous glucose monitoring (CGM) capabilities to Current Health’s AI-poweredremote patient
monitoring (RPM) platform. By continuously monitoring patients’ glucose
levels – largely considered the fifth vital sign – the Current Health platform
will empower health systems to secure actionable and comprehensive insights
into overall patient health, resulting in improved patient outcomes and
decreased healthcare costs.
As part of the integration, Dexcom CGM data will transmit
directly into the Current Health wearable and platform for review by the care
management and clinical teams, improving post-discharge and chronic care of
diabetes patients outside the hospital. Dexcom and Current Health is supplied
pre-configured and ready to go out of the box with a setup time of less than 5
minutes, the patient applies Dexcom and the Current Health wearable, so
continuous vitals and continuous glucose are immediately available for review
by the care management or clinical team. The integration will be an optional
add-on for patients using the Current Health wearable, offered first to
patients with diabetes. The integration will become widely available later this
COVID-19 Underscores Need for Continuous Glucose Monitoring
With an estimated 463 million people across the globe
– or one out of every 11 adults – suffering from diabetes, health systems need
insight into patients’ whole health – including glucose levels – to best manage
at-risk patients. With people with diabetes particularly vulnerable to a
variety of illnesses, including cardiovascular disease, nerve damage and
Alzheimer’s disease – not to mention COVID-19 –
healthcare providers need to be able to continuously monitor glucose levels to
ensure they can proactively address issues associated with diabetes and provide
the best possible care.
“Our focus has always been on delivering the best care to people with diabetes through continuous glucose monitoring,” said Matt Dolan, senior vice president and general manager of new markets at Dexcom. “By integrating our leading CGM system into Current Health’s RPM platform, we can expand the clinical utility of our technology and also offer a more comprehensive view into a patient’s whole health. These factors together mean that more patients will get the best care possible.”
“The numbers don’t lie,” is a famous old adage and quite appropriate with regard to the rapid rise and deployment of telehealth solutions in the medical community. It may have taken a global pandemic for society to recognize and investigate the rewards of its adoption, but statistics reveal that telehealth’s moment has indeed come. And it certainly seems like it’s here to stay.
How did we come so far, so fast? By undertaking forward-thinking policies and bold action, the health care industry nimbly and quickly adopted this technology to mitigate the immediate threat of COVID-19’s lethal contagiousness.
As it pertains to effectiveness, the federal government’s overwhelming response to shore up commerce, industry, and unforeseen unemployment levels has been met with mixed reviews. But the designated programs specific to the healthcare industry have been an undeniable success. Thanks to a sudden and massive infusion of funding and support for telehealth medicine, initiated by federal and state governments, the health care industry is witnessing a historic sea-change in its processes, procedures, and practices. The widespread, rapid adoption of telehealth solutions is the prime example.
Beyond the impact of funding, now in the hundreds of millions of dollars, the utilization of telehealth also benefited from additional measures which simultaneously boosted its appeal for trial and adoption. For the first time, health care providers were permitted to use telehealth to treat Medicare patients, opening the door for insurance companies and state governments to follow suit.
Subsequently, many of the nation’s largest private insurance providers then took it a step further—waiving copays for patient consultations via telehealth. For both the insured and uninsured, the elimination of out-of-pocket costs is likely to increase consumer trial and adoption of virtual physician visits. The bold and swift decisions to relax certain restrictions and requirements within the traditional health care model has created fertile ground for telehealth’s trial and adoption.
The use of telehealth as a practical solution has been available for some time, but its adoption by consumers faced difficulty, as many perceived virtual visits would not measure up to the value of in-person doctor appointments. But recent research and surveys on telehealth’s usage reveal this barrier may be crumbling. In April, Sage Growth Partner (SGP) and Black Book Market Research collaborated on a survey revealing that, prior to COVID-19, only a quarter of respondents had used telehealth. But amidst the backdrop of our current pandemic, nearly 60% of those surveyed say they are now likely to consider telehealth in addressing their personal health care needs. Additionally, other studies have concluded that after an initial trial of telehealth, a majority of consumers expressed high levels of satisfaction with their experience—and a strong likelihood of follow-up use.
Yet only viewing the benefits of telehealth through the narrow lens of a physician-patient consultation is to overlook its full value proposition across the health care industry as a whole. What are some other examples of how telehealth is changing the health care landscape for the better? Here are a few ways in which its adoption and use are improving our models of caregiving:
Protecting our Collective Health
Amidst the COVID-19 pandemic, an obvious benefit is the option to seek care remotely while maintaining isolation through the practice of social distancing. There are no crowded waiting rooms or hospital hallways to deal with, thereby lessening the risk of exposure and infection to patients and caregivers alike.
Meeting the Caregiver Demand
In some areas of the U.S., a steep demand for health advisors has spiked, due to postponement of elective surgeries and the need for ongoing treatment of patients with chronic health care conditions. Pack Health, Birmingham, Al. chronic care coaching provider utilizes certified Health Advisors to help patients get access to care options while helping them develop self-management skills to gradually improve their conditions. With a surge of over 50,000 new patients, the company rapidly transformed its onboard training program to a telehealth platform to meet the demand for new hires. In doing so, Pack Health was able to scale up staffing much faster and cheaper than ever before.
Impact on Rural Health Care
According to the consultants at Guidehouse, one in four rural hospitals are deemed high-risk for closing—and this was reported before the pandemic. Through the use of telehealth platforms, a large portion of the rural United States can now receive access to clinical care services and at-home monitoring services. In effect, telehealth can become a new tool to help alleviate rural America’s serious deficit of accessing critical care.
Impact on Mental Health Care
The rise in telehealth adoption is also having a positive effect for patients who require access to mental health services. Even before the pandemic, many people with various mental health needs chose not to seek treatment due to perceived social stigmas. Using telehealth as a solution, they can now obtain access to providers, care, therapy, and treatment in the privacy of their homes. Likewise, those patients already under the care of mental health professionals are able to keep routine appointments, in spite of COVID-19’s disruption.
As for telehealth’s future, it is certain to benefit in multiple ways from its current trial by fire. Perhaps there is no better proving ground for assessing its total value proposition than during a global health crisis that shows no sign of relenting. Being at the right place at the right time can be an invaluable proving ground and the future of the telehealth industry appears to be positioned for staggering growth. In April, Global Market Insights, market research, and consulting company released a report predicting the telemedicine market will reach $175.5B by the year 2026.
Furthermore, healthcare providers need to think of telehealth as only one component of comprehensive care. Patients need to have several different touchpoints throughout the healthcare continuum to ensure the best quality of care. Examples of these touchpoints include advanced biometric wearables, real-time data collection, and advanced analytics to provide actionable data for patients and care teams.
As technology continues to drive the rapid pace of improvements in digitalization, platforms, high-speed broadband access, and mobile devices, the widespread adoption of telehealth and telemedicine solutions will become even more commonplace. As a result, the ever-increasing capacity to improve our traditional health care delivery models may indeed be forever changed for the better.
About Ernie Ianace
Ernie Ianace is the Executive Vice President of Sales and Marketing at VitalTech® Affiliates, LLC. Based in Plano, TX, VitalTech is a rapidly growing provider of fully integrated digital health solutions and smart biomedical wearables that provide real-time monitoring for patient wellness and safety. The company’s connected care platform, VitalCare®, enables health systems, skilled nursing facilities, home health providers, physicians, and senior living facilities to streamline workflows while improving health outcomes, increasing patient safety, and lowering the cost of care.
– Doctor On Demand raises $75M in Series D
funding led by General Atlantic to expand comprehensive virtual care.
– Doctor On Demand is seeing record usage
this year – up 139% – for COVID-19 screenings, routine health issues, chronic
conditions and behavioral health.
San Francisco, CA-based Doctor On Demand, today announced it
has raised $75 million in Series D funding led by General Atlantic, a leading
global growth equity firm, with participation from existing investors. The
funds will be used to accelerate Doctor On Demand’s investments in growth and
further expand access to high-quality, comprehensive virtual care for patients
Founded in 2012, Doctor On Demand offers immediate,
video-based access to top physicians and psychologists for just $40 per visit,
with no subscription fees for partners via the iPhone, iPad,Android and
desktop. With over 98 million covered lives and a 4.9/5 patient
satisfaction rating, Doctor On Demand is the preferred
virtual care provider of consumers, health plans and employers. The company’s
unmatched technology platform and clinical model of fully employed providers
gives patients a continuum of care and the ability to build trusted, personal
relationships with their providers.
Following robust growth in 2019, Doctor On Demand
experienced accelerated momentum in the first half of 2020, with the COVID-19
pandemic driving increased demand for the company’s integrated medical and
behavioral health services. The company more than doubled its covered lives in
the past six months, propelling Doctor On Demand to its 3 millionth virtual visit.
In response to the public health emergency, the company mobilized quickly to
roll out its critical virtual medical services to 33 million Medicare Part B
beneficiaries across all 50 states, just weeks after the Centers for Medicare
and Medicaid Services (CMS) expanded coverage to allow for the reimbursement of
telemedicine visits for this high-risk patient population.
While COVID-19 has driven a sharp increase in utilization of
Doctor On Demand’s urgent care and behavioral health services, more than half
of the company’s 2020 future growth is focused on the continued expansion of
its Virtual Primary Care offering. This service enables health plans and
employers to deliver cost-efficient, comprehensive virtual care inclusive of
integrated behavioral health, 24/7 everyday & urgent care, and chronic care
management to their populations while reducing costs.
“In April 2019, Humana and Doctor On Demand launched On
Hand™, a first-of-its-kind health plan that centered on comprehensive virtual
primary care,” said Chris Hunter, Segment President, Group and Military
Business at Humana. “This new plan design represented a paradigm shift in
healthcare, and demonstrated that our members can and will build long-term
relationships with primary care providers and care teams in a virtual-first
“Even before the pandemic, we recognized the importance of
providing integrated, virtual medical and emotional health care for our
associates,” said Adam Stavisky, SVP, US Benefits at Walmart. “Our early
decision to partner with Doctor On Demand helped us respond quickly as the
crisis hit, allowing us to immediately meet the care needs of our associates
and their families where and when they need it.”