The annual healthcare innovation event had plenty of heady conversation and high-profile speakers, but execs were more focused on how new ideas are now being put to use.
As HLTH sinks into the Nevada sunset and attendees (and their spouses/partners) figure out just how much they spent in the casinos, a look back reveals some interesting insights into how healthcare innovation is evolving.
AI was, of course, the dominant topic, indicative of the emphasis that everyone is placing on this technology to, in essence, "save healthcare." But we've been talking about AI for a few years now, and the conversations are shifting from what it can do to what we should be doing with it now. Anyone still talking about the low-hanging fruit is behind the curve and in danger of losing out to competitors who are using mature tools.
Ai governance is, of course, a separate conversation, and one that many healthcare execs should be following. Healthcare organizations are embracing AI so rapidly that they're in many cases making the rules on the fly, while collaborative efforts like CHAI and TRAIN are playing catch-up with standards and best practices. Sadly, a main stage session featuring Brian Anderson of CHAI, David Rhew of Microsoft, Christine Silvers of Amazon One Medical and Melanie Fontes Rainer of the Health and Human Services Department's Office of Civil Rights drew a small audience (much less than the session featuring Lenny Kravitz just a short while later).
Getting More Specific About AI
On the exhibit hall floor, healthcare executives and others were talking about what they're doing now with AI, especially generative and predictive tools. Dan Shoenthal, VP and chief innovation officer at the University of Texas MD Anderson Cancer Center, said he was finding value in conversations with other executives and in the smaller, more focused sessions taking place in meeting rooms outside the exhibit hall.
During an exhibit hall session on Monday titled "Payer-Provider Arms Race," executives from Providence, Ardent Health, Sanford Health Plan and Doximity talked primarily about how they're using AI now, rather than how the technology might improve that often-testy relationship between providers and payers. Sara Vaezy, EVP and chief strategy and digital officer at Providence, did note that AI will help to "level the playing field" for providers and payers, and by giving both sides—and, more importantly, consumers—transparency, they'll be able to have more meaningful interactions.
The changing discussion on AI may have also led to a subtle shift in the mood at HLTH as well. Two years ago the celebrations were turned up a notch or two, buoyed by larger happy hours and food carts in the exhibit hall, vendors flush with cash from financing rounds and larger, more colorful booths. This year the atmosphere was (for the most part) less showy and more focused. The optimism is still there, due in large part to AI, but there's less attention to putting on a splashy display at a time when the industry is dealing with cost, quality and workforce issues. Even the celebrities who graced the stage in larger numbers were there to discuss important issues, not just give HLTH extra cachet.
And it's not all about AI, either. The Food as Medicine/Food is Health movement still had a significant presence in the exhibit hall, as well as a few interesting panels, though it's a bit disappointing that the effort hasn't grown much. Maternal health, behavioral health, environmental issues, global health and nursing innovation all staked their claim to the innovation landscape.
Moving Care Out of the Hospital and Into the Home
The acute care at home/hospital at home strategy also had its moments, starting with the continued presence of Best Buy and its Geek Squad for Healthcare booth. Caroline Yang, MD, associate clinical director of Mass General Brigham Healthcare at Home—one of the more advanced programs in the country—noted that health systems and hospitals are beginning to move beyond the rigid Medicare model and experiment with new ideas and patient populations. That may be a critical strategy as healthcare leaders look to move more services into the home setting and experiment with remote patient monitoring (RPM), telehealth, mobile-integrated health (MIH) and home health services.
Of course, innovative concepts like hospital at home need support from payers to be scalable and sustainable—at least in the early stages. The hospital at home movement saw a surge during the pandemic, as hospitals sought to isolate infectious patients and reduce the strain on overwhelmed clinical staff. That surge was supported by waivers from the Centers for Medicare & Medicaid Services (CMS) reducing restrictions on telehealth and RPM use and boosting Medicare reimbursements.
Those waivers are set to expire at the end of this year, but the rumor around HLTH is that the waivers will be extended, perhaps for another five years. Yang said an extension would be good for the industry, giving health systems and hospitals more time to gather the data needed to prove that these programs reduce costs and improve clinical outcomes.
Another extension may be on the table for the somewhat controversial effort to expand virtual prescribing for controlled medications. Prescribing by telehealth has been severely limited for years under the Ryan Haight Act, passed in 2008. That legislation put the onus on the U.S. Drug Enforcement Agency (DEA) to create a special pathway so that provider could be approved to prescribe controlled drugs for treatment of substance abuse, mental health, and other issues.
HHS unveiled a waiver during the pandemic so that providers could use telehealth, with the idea that the DEA would get around to setting up that registration process. The DEA still has not set up that pathway, despite pressure from a large group of providers and telehealth advocates as well as lawmakers. The rumor out of HLTH is that the waiver will be extended perhaps one more year, and that advocates will look at either having Congress force the DEA to establish that process or perhaps bypass the DEA altogether and a find a different means of enabling provider to prescribe by virtual channels.
Beyond those issues, healthcare's innovation executives came away from HLTH with a good idea of where the industry is heading. Scott Arnold, EVP and chief digital and innovation officer at Tampa General Hospital, and Rachel Feinman, vice president of innovation for Tampa General's TGH InnoVentures arm, said execs are looking beyond the next great widget or piece of technology to create and sustain a patient's entire healthcare journey. That means embracing new ideas on care management and coordination, as well as SDOH and navigation.
"There are parts [of this journey] that we may not be able to do as well," Feinman said. In order to become experts—and, in fact, stewards—of the patient journey, she said, they need to keep looking for inspiration from all angles inside and outside the healthcare industry.
The healthcare industry's annual showcase of innovative ideas is off to a good start. Here's what attendees are talking about.
This week's HLTH 2024 event in Las Vegas is giving the industry's innovators a chance to make their case for new technologies and strategies. But at a time when healthcare seems as fragmented and costly as ever, what are themes here that really resonate?
Here are three gleaned from the first two days in Sin City.
AI is Still the Talk of the Town
AI is as big as ever, and very few conversations in the Venetian don't include some mention of how revolutionary the technology will make healthcare—for the health systems and hospitals, the payers and, most importantly, the patient. In fact, it's the consumer/patient who stands to really influence how healthcare evolves. They're using AI tools to better understand their healthcare needs and options, and they're connecting with both their health plans and their care providers (or providers recommended to them) to map out that healthcare journey.
The talk on the HLTH 2024 floor is that payers and providers may be jumping all in on AI, but they have to develop their strategies carefully and purposefully to meet patient/consumer needs and preferences. And that means understanding how to use data coming in from all angles, including some very non-traditional channels. In short, AI is revolutionary, but it's important to learn how to surf that wave rather than go under.
Healthcare Collaboration Will Focus on Navigation
That may be the biggest theme coming out of HLTH, and it's something Glen Tullman and Transcarent are emphasizing with their release of WayFinding, an AI-powered platform for benefits navigation, clinical guidance and care delivery. True disruptors in the healthcare space recognize that so many health systems and hospitals offered limited pathways to care for their patients, while payers rely on the "in-network" strategy to guide members on a certain path. But the healthcare marketplace is much larger, with new options and ideas available to the consumer almost daily.
As AI evolves and true innovators understand the marketplace, they'll create platforms on which consumers can select what services they need, with AI in the background analyzing their needs and giving them the relevant options. Providers will need to be transparent with what they can offer, and payers will be on hand to manage the financial strategies and give guidance. Primary care, specialists, behavioral healthcare, pediatric care, oral and eye care, rehabilitation providers even services that address SDOH like nutrition counselors and alternative therapies will have a place on this platform.
It's admittedly an ambitious and optimistic view of the healthcare landscape of the future, but that's what AI could do if applied strategically. And it's what consumers will demand as they come to realize how they can control their healthcare choices.
From Niche Services to an Enterprise Platform
Again, the platform. But from the healthcare executive's perspective, this is where health systems and hospitals can develop their presence. Healthcare is inundated with services and technologies that address specific populations or conditions. The Exhibit halls of events like HLTH, ViVE, CES, HIMSS and ATA all feature companies offering unique and specialized services or technologies. Those solutions may be quite effective, but health systems and hospitals have to look at a much larger patient base.
Healthcare leaders are now interested in enterprise-wide platforms that can allow care providers to better coordinate and manage care for their patients. They'll put a premium on interoperability, and tools and services that can integrate with the health system and its technical infrastructure (the EHR). The ongoing workforce shortage will put a premium on services that can be delivered on virtual channels, allowing providers to reach the patient without straining the already-stressed enterprise.
And this is how providers can best address SDOH. Using AI and other tools to understand the challenges and needs of their patients, they can populate this enterprise platform with programs and services that address those challenges. And they'll be able to scale out these services to reach larger populations, improving sustainability.
These are all, admittedly, optimistic strategies. But that seems to be the mood at HLTH this year, amid the usual trappings of Las Vegas and the parade of celebrities on the Main Stage putting their name and face to high-profile public health issues. Healthcare may be in a rough place right now, beset by cost and quality issues, clashes with payers and a declining workforce, but there are innovative ideas out there that deserve attention. And with AI, the chances are good they'll get their chance.
HLTH 2024 kicked off Sunday in Vegas with a pledge to go boldly forth with innovation. But in a city known for its splashy promises, it's the details that will matter.
Scalability and sustainability are two of the primary barriers to healthcare innovation. A great tool or strategy won't succeed if it can't expand past the small pilot and prove itself across a larger network or population.
As HLTH 2024 kicked off this week in Las Vegas, healthcare executives and vendors anted in on the optimism that accompanies an event focused on innovation.
But behind the glitz and glamour and the celebrities gracing the main stage, that question remains: What new idea really will take hold and change a struggling industry for the better? And what hard questions should executives be asking themselves as they evaluate each new technology and strategy?
For Kaiser Permanente Chair and CEO Greg Adams, that answer may lie in Risant Health, the company launched a year ago to drive value-based healthcare by creating a national network of high-performing health systems.
"Our healthcare system is not living up to its full potential," he said during a main stage interview to kick off HLTH. "It's time for us to lead. It's time for us to be bold. It's time for us to take risks."
But what—and how—will those risks result in sustained success?
For Risant Health, the idea is to acquire health systems and create a national network that can apply value-based concepts at scale. Risant has already gathered in Geisinger and Cone Health (in which KP plans to invest a hefty $1 billion), and Adams outlined on Sunday the company's continuing quest to pull five or six community health systems into the fold by 2026.
Adams emphasized they aren't looking to bail out a struggling network—a hint to the ongoing M&A activity that is seeing large health systems swallow up smaller hospitals, a tactic that has its successes and its Steward Health Care fiascos. Kaiser Permanente, one of the handful of healthcare organizations that includes both providers and health plans, wants to acquire health systems that are doing OK on their own and moving forward with value-based care strategies.
This, Adams, said, is about optimization, and putting into play strategies that many health networks are talking about but not really embracing.
Adams Said Risant Health has helped Geisinger realize a 1% improvement in its cost structure in six months, and he anticipates an improvement of 2% to 3% for partner health systems over a year. More importantly, he said, those in the Risant Health orbit will have access to guidelines, care pathways and other tools aimed at reducing costs, boosting outcomes and improving workflows. He noted Kaiser Permanente is getting ready to roll out more than 200 primary care guidelines to its own provider network, all aimed at giving care teams an established set of best practices.
Now that kind of optimism is common at an event like HLTH, where cool ideas like food as medicine, primary and behavioral care integration, genomic medicine, hospital at home and using AI to reduce heart attacks and identify and treat cancers at an early stage are discussed at length on stages, in the exhibit hall and in the hallways of the Venetian.
The trick is to move beyond all the talk. Many a great idea has been given the spotlight in past events, only to gradually fade away because it can't be scaled or sustained. And the concept isn't entirely new. General Catalyst launched HATCo roughly last year and earlier this year acquired Summa Health under the idea of creating a "proof of concept" for VBC. Just this month, four significant health systems announced the formation of Longitude Health, with the goal of bringing transformative ideas to scale.
Adams is coming into this with the numbers and the pledge, fortified by HLTH's theme this year of being bold, to be a front-runner in transformative thinking. The challenge will lie in understanding and implementing a value-based care strategy at a time when "value" is a debated concept.
As with anything at HLTH, the idea is great, and over the next two days there will be plenty of discussion about this and other lofty goals. The key will be to answer the hard questions that come up and define success at a time when so much of healthcare is just a struggle to move forward. That's what being bold is all about.
The annual HLTH conference kicks off next week with an array of topics and an unusual amount of star power. But what are healthcare leaders looking for?
Healthcare innovation takes the stage in Las Vegas next week with HLTH, but attendees heading to Sin City for the latest in health and wellness may be looking for something a bit more inclusive than in years past.
As the industry transitions, albeit slowly, to patient-centered care and embraces ideas like AI and virtual care, healthcare leaders are looking for comprehensive solutions, rather than new tools and programs that target certain conditions or populations.
It’s part of what Meghan Cassidy, senior director of sales and product development for market and network services at Cleveland Clinic, calls “point solution mania.”
“I understand why the industry started there, but now it seems there are hundreds of those types of solutions in the market,” she says. “So I am hopeful that this year [people] will come to try to figure out how to weave all of those solutions together.”
“They all have great ROI, they all have great patient outcomes, but they're ultra-segmented right now,” she adds.
Healthcare has long had this issue, and events with large exhibit halls are ideal places to view the expanse of vendors driving innovation. But the industry is in a tough place right now, struggling to address cost and quality issues and workforce shortages, and it needs programs and tools that can be applied across the enterprise, not bolting onto platforms but integrating with them—what Cassidy calls “the quilt that ties it together.”
HLTH is somewhat unique in that it attracts healthcare organizations and companies that are interested in whole patient care, rather than healthcare information technology or clinical care. So the reasons and the opportunities for integration are more apparent. And that’s why topics like food as medicine, women’s health, mental health, psychedelics and art and music treatments have a place in the exhibit hall and in sessions.
That’s also what draws a unique cross-section of the healthcare industry to Sin City. Cassidy, for example, is focused on programs and tools that would help Cleveland Clinic deliver healthcare services to employers. It’s an evolving field that hospitals and health systems are exploring, and one that the so-called disruptors like Amazon and Google have been targeting.
“They're not offering an app for something anymore,” she points out. “They're going in and saying, ‘Let's share risk with these primary care facilities or primary care companies and try to change the care and get more people into their primary care doctor up front. And that will of course lead to cost savings later on down the line.”
With primary care as the focal point of healthcare access, many tools and programs are aimed at reducing barriers to access and facilitating a seamless primary care visit, whether it be in person or virtual. But true innovators in this space are also expanding the definition of primary care to include more preventive health and wellness opportunities, with the idea that a consumer/patient and care provider are on a journey together.
HLTH gives healthcare executives an opportunity to expand that conversation, looking at different ways, both strategic and technological, to configure care management and coordination. And it wouldn’t be a healthcare conference if AI weren’t included in that discussion.
But HLTH also tends to draw the big names and organizations, offering solutions that those hospitals and health systems can afford to try out. Cassidy says she’d like to see more tools and strategies for smaller and more rural organizations.
“There's a lot of marquee names that are out there that are saying what they do, but they represent very large companies and have large pockets,” she says. “With the small employers who are struggling, like the mom and pop shops on the corner, thinking about more ways to intervene and help them would be very, very interesting and effective.”
And while this event in particular carries the glitz and glamor that Las Vegas attracts, there are a few more celebrities than in past years—evidence, perhaps, of the energy brought to bear on issues like maternal health, mental health and chronic conditions. First Lady Jill Biden will talk about women’s health research during a Main Stage session on Wednesday, while entertainers John Legend, Halle Berry, Maria Shriver, Lennie Kravitz and Lance Bass are scheduled to appear as well.
Regardless of the star power, HLTH offers healthcare leaders an intriguing look at how the industry is evolving beyond episodic care, and how new ideas and technologies can shape their organizations to deliver what patients not only need by want.
Allegheny Health, a member of the HealthLeaders Mastermind program on AI in revenue cycle managemet and finance operations, is using the technology to help executives understand the data and make better decisions.
Healthcare has a people problem, especially in revenue cycle management and finance operations. There just aren’t enough people filling those roles, and the competition with other industries is fierce.
This is where AI fits in.
Whereas the human touch is a critical part of clinical care, when numbers are concerned, the fewer hands the better. Revenue cycle and finance managers are looking for AI tools to reduce human interaction in areas like coding, claims, denials and prior authorizations.
“We’re all trying to remove touches from the claims process,” says Brian Ice, vice president of clinical revenue cycle for the Allegheny Health Network. “We’re all trying to come up with ways to make that process more efficient.”
“We look at AI for any workflow that's high volume [and] requires a lot of analysis,” he adds. “If it requires looking through clinical documentation or large data sets to respond. We're trying to use AI to help drive and make those workflows more efficient.”
Ice, a participant in the HealthLeaders Mastermind program on AI in revenue cycle and financial operations, says RCM and finance executives have been working with automation for years, and they’re leery of the flood of vendors coming into the space with so-called AI tools that really don’t use AI.
“Vendors that say they can do what we're looking for are a dime a dozen,” he says. “There's a lot of them out there that say they can do different things. Finding a vendor that's a good fit for your organization, that integrates well with your electronic health record, that has the right price tag associated with it,” is an elusive goal.
And what Ice is looking for now is AI that can learn the complex algorithms involved in rev cycle and finance operations and generate pathways to efficiency. Apart from transcribing documents and analyzing utilization workflows, that might mean identifying the right codes, smoothing out the prior authorization process, even predicting when a payer might issue a denial and working toward a quicker resolution.
We want to “take some of the back and forth out of it,” Ice says, adding that payers are also interested in using Ai to improve collaboration with providers.
The key, Ice says, is to have AI do the number-crunching and analysis and give RCM and finance executives the data they need to make those collaborations meaningful, whether it’s in plotting the right pathway for patients to pay their bills or working with health plans to align care management with coverage.
Ice says AI is still a new technology, and one that needs careful monitoring as it learns the workflows. Every outcome generated by an AI program still needs to be checked by the “human in the loop.”
“When you automate something, you're trying to do something at a high volume to produce a significant amount of output without human intervention,” he says. “So if you have quality issues in that space, you can create a pretty significant mess for yourself in a hurry.”
That may not always be the case, however. The hope is that AI tools in RCM and finance eventually become reliable enough to run in the background, enabling those humans in the loop to focus on other tasks.
For now, Ice says, Allegheny Health has an expansive governance team in place, representing a wide range of departments within the health system. Their tasks range from reviewing vendors and products to monitoring the development and installation of all AI programs to continuous quality control.
“There's still an extreme amount of investigation and research that goes into approving these technologies before they would ever be … deployed within our system,” he says.
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Four large health systems have joined forces to launch Longitude Health. They're hoping that economy of size can overcome the barriers to innovation and actually implement value-based care.
Collaboration has become a key strategy in healthcare innovation.
The partnership aims to combine the resources of the four health systems to invest in strategies and technology that look to improve care management and coordination, health and wellness, and system improvement. A press release issued by Providence says the new group intends to make "multiple strategic investments" within two years and will invite other health systems to join them.
"Longitude Health will scale the next generation of capabilities faster and more effectively than if individual health systems attempted to do so themselves," Pete McCanna, CEO of Baylor Scott & White Health, said in the press release. "We aim to set a new standard, demonstrating that new approaches can optimize organizations performance and quality and drive positive systemic change to benefit patients."
While the announcement is short on details, it points to the idea of developing programs or deploying new technology—perhaps even spinning out new business lines--that can scale out quicker and more effectively, improving the chances of sustainability. The press release lists the organization's three main initiatives as transforming business models, improving health system performance and empowering healthier futures.
The collaboration also creates a sizable organization to work with payers on value-based care.
"Healthcare requires new approaches," David Callender, MD, Memorial Hermann's president and CEO, said in the release. "Health systems must expand their core focus areas beyond care delivery and into new business creation and services that will drive high-value care. Through this collaborative approach, we aim to take the lead in designing solutions that drive operational transformation and translate into tangible benefits for the patients and communities that we serve."
While partnerships aren't entirely new in healthcare, the idea of getting disparate health systems to work together has usually come in the form of M&A deals. Kaiser Permanente launched Risant Health in 2023 to create a value-based care network, has so far acquired Geisinger and Cone Health and plans to add another three or four health systems in the next five years. Meanwhile, Transcarent, a digital health company launched in 2020 by Glen Tullman, unveiled its "National Independent Provider Ecosystem" in 2023 with 10 health systems (including Memorial Hermann and Baylor Scott & White).
The new group's CEO is Paul Mango, a former executive at the U.S. Department of Health and Human Services (HHS) and the Center for Medicare & Medicaid Services (CMS), as well as a former partner at McKinsey and a gubernatorial candidate in Pennsylvania. The CFO is Brett Moraski, who held VP roles at Highmark Health and Wellpoint and was a founding managing partner at SEMCAP Health and operating partner at Frazier Healthcare Partners.
The CEOs of the founding health systems—McCanna, Callender, Carl Amato at Novant Health and Rod Hochman, MD, at Providence—will serve on the board of directors, with McCann as chair.
WellSpan Health has launched an AI agent named Ana, who's connecting with at-risk patients for screenings that might otherwise be forgotten or ignored.
Healthcare organizations are now using AI to have conversations with patients that doctors and nurses might not have time for—and closing critical population health care gaps that could save lives.
WellSpan Health launched an AI platform roughly one month ago that calls selected at-risk patients to schedule colorectal cancer screenings. The AI agent, called Ana and developed by digital health startup Hippocratic AI, asks patients if they would agree to take the test and, if they agree, arranges to mail a testing kit to their homes.
The so-called AI “agent” is designed to replace either a mailing, a cold-call program often launched out of a health system’s call center or—if the health system doesn’t have those resources—the conversation that a doctor would have with a patient during an annual checkup.
None of those tactics has a high level of success. And as a result, at-risk patients often don’t have those screenings when they should, if at all, increasing the chances of a serious health issue down the road.
WellSpan Health executives decided to use the program to reach out to patients at risk of developing colorectal cancer, identified by their birthdate and family history. Of particular concern were Spanish-speaking patients, who might miss the mailer or the conversation with a doctor because of language issues.
“It’s an opportunity for us to reach out to people in their homes, in their own time, and have a conversation with them that we maybe couldn't staff with a human,” says R. Hal Baker, WellSpan’s SVP and chief digital and innovation officer. “But [with] the right AI, that conversation could be had.”
R. Hal Baker, SVP and chief digital and innovation officer at WellSpan Health. Photo courtesy WellSpan Health.
Baker, a primary care physician, says the program takes pressure off of doctors to fit that task into an already busy care visit and gives them more time to make that visit meaningful.
“Most of my visits are 20 minutes,” he notes. “And while it may take only 30 seconds to have a conversation about colorectal cancer screening, … if I can take any of these things like mammograms and colorectal cancer screening and COVID shots and flu shots out of the visit, and they can happen reliably outside of coming to the office, that gives me more time to discuss what can only be discussed in the exam room.”
Kasey Paulus, MBA, RN, CENP, WellSpan’s SVP and chief nursing executive, says Ana works because she’s designed to be empathetic and engaging. And she can speak Spanish, in which not many doctors or nurses are fluent.
“A sensitive AI that speaks your language [is better than] a well-meaning human who can’t speak Spanish,” Baker says.
And it works. Of the first 455 Spanish-speaking patients contacted by Ana, 15% agreed to screening, Baker says, and the net promoter score was higher than that of English-speaking patients (of which 6% agreed to a screening).
“Not bad for an automated reach-out cold call to people who weren’t expecting it,” he says.
Kasey Paulus, MBA, RN, CENP, SVP and chief nursing executive at WellSpan Health. Photo courtesy WellSpan Health.
Eventually, the health system will see results in clinical outcomes. More screenings will lead to more cancers detected and treated early, improving the quality of life for patients and reducing deaths. Financially, more screenings might boost initial costs but lead to less expensive medical treatments and long-term care later on.
Baker and Paulus say WellSpan worked closely with Hippocratic AI to develop Ana, going through every scenario that the AI agent would face and every question that a patient might ask. Baker says he even tried to confuse Ana during a test by announcing that his birthday was on New Year’s Day.
“We have a very creative and collaborative multidisciplinary team, and those individuals do their best to try to break it before we launch it,” he says. “So we're looking for ways [in which] somebody might trip it up that we didn't even think of, because inevitably that will happen.”
For example, Baker says, “We had to very quickly realize we had needed to add the ability for somebody to say, ‘Please don't call me again.’ “
In launching Ana, Baker says the health system was very careful to make sure that patients know they’re talking to an AI agent. For the first 100 phone calls, a nurse was also on the line to make sure things ran smoothly.
“What we found out was that [the nurse] didn’t have to” be in on the call, he says. “What is novel here is that we have now moved the human in the loop to the human on the tail for our next thousand calls,” meaning a nurse will review the call within a few hours.
With the platform now up and running, Baker and Paulus say they’re giving Ana another task: connecting with patients who are coming into WellSpan for a colonoscopy. Ana will call them ahead of that appointment and go through everything the patient needs to do before the procedure. Again, that task would have been handled by a nurse or call center, if at all.
“The last 48 hours of coaching are really critical,” Paulus says. “And AI can help us where we can't always have somebody on call 24/7 365.”
She says the health system will see the benefits in reduced cancellations and procedures that are started and cut short or unsuccessful.
Baker says the platform may scale up in time as WellSpan explores how Ana can effectively interact with patients and support their healthcare journey. They may use the platform for more population health outreach, or to help patients prepare for other procedures, or even to check up on them and coordinate care after a procedure.
“We recognize that we're boldly going into some uncharted territory and that our AI is not replacing our clinical staff but augmenting the work that they just don't have the capacity to do,” he says.
A new survey finds that poor or ineffective technology is costing the healthcare industry $8 billion a year. Here are the eight biggest culprits.
Healthcare organizations are losing $8 billion a year to ineffective and outdated IT, and few have the money to improve that technology.
That’s the key takeaway from a new survey of more than 900 healthcare professionals by Black Book Research. The study, the third in Black Book’s “What’s Hot and What’s Not in Healthcare IT Investments” series, finds that bad IT investments have jumped significantly since 2017, when those costs were estimated at $1.7 billion, and budget limitations are keeping healthcare leaders from correcting those problems.
"Three-quarters of IT leaders surveyed indicated that they have no plans to allocate funds for replacing these flawed systems in 2025, reflecting a broader trend of financial constraints across the sector," Black Book President Doug Brown said in a press release.
"CIOs are understandably cautious about replacing underperforming systems when the ROI is uncertain, given the track record of many healthcare IT vendors failing to meet expectations. Without clear evidence that a new investment will deliver tangible financial or operational improvements, justifying the expense becomes challenging."
According to the survey, tech limitations are tied to one of more of five key reasons: poor user experience (almost have of those surveyed cited this), lack of interoperability (24%), cost (20%), lack of flexibility (6%) and alert fatigue (2%).
The findings will disappoint healthcare leaders who are counting on their IT platforms—especially their EHRs—to support innovations like AI and virtual care. An ineffective tech platform not only cuts into the ROI of a new program, but adds to the stress and frustration that haunt nearly every health system and hospital and cause burnout and workforce shortages.
Black Book’s study lists eight IT adventures that have plagued healthcare leaders the most:
Overly complex or unintuitive EHRs. Either a scapegoat or a savior for healthcare organizations collecting and managing their data, EHRs haven’t yet fulfilled their promise. According to Black Book, more than three-quarters of those surveyed are still having issues, often with navigation or workflow design, leading to “click fatigue.” In addition, at a time when many smaller health systems and hospitals are being acquired by larger, more stable networks, 91% of small medical practices in the survey say the haven’t been able to transition smoothly to the larger system’s EHR.
Bad telehealth. Virtual care saw a surge in popularity during the pandemic, but in many cases those platforms were adopted quickly and without due diligence. As a result, more than 80% of survey respondents said those telehealth tools are not synching with their EHRs, creating dreaded data silos and duplicate information, and impeding workflows.
Clunky RCM systems. Healthcare organizations have for years tried to automate their revenue cycle management operations to improve efficiency, capture lost reimbursements and reduce manual administrative tasks. Unfortunately, the technology has met expectations. Some 70% of executives surveyed said their RCM tech is either outdated or unable to integrate new tools like AI, leading to longer claims processing times and higher denial rates. Also, just more than 60% said poor claims scrubbing and denial management capabilities are resulting in lost revenue.
Uncooperative HIEs. Health information exchanges offer the potential to connect health systems and enable data sharing. But 28% of medical practices said their EHRs aren’t synching well with the HIE, and 23% cite a lack of data standardization and integration.
Poorly integrated CDS tools. Providers often rely on clinical decision support tech to improve their decision-making and boost clinical outcomes. But according to the survey, 80% say their CDS tools don’t integrate with the EHR, and first-generation tools often generate excessive or unnecessary alerts, leading to “alarm fatigue.”
Lack of patient engagement support. Patient engagement technology, including portals and messaging platforms, are designed to improve the patient-provider relationship. But 77% of hospital executives surveyed said their portals aren’t meeting the needs of their patients, resulting in ineffective communication and engagement. And 88% of those surveyed said smaller, niche products don’t have the integration or mobile-friendly capabilities they need.
Hyped-up AI. AI might be able to address many of healthcare’s biggest pain points, but the technology isn’t there yet. A whopping 96% of executives surveyed said they are facing challenges with ROI, and 92% said they can’t yet rely on the accuracy of the tools and find actionable results. Some 85%, meanwhile, said the tools they’re using to automate diagnostics or treatment planning aren’t yet capable of handling complex or real-world clinical environments.
Interoperability issues. Finally, 31% of the executives surveyed said they’re not happy with their data interoperability vendors, the chief complaints being slow updates and poor API support. This despite federal efforts to create a nationwide interoperability grid, through TEFCA. Many are struggling to adopt (FHIR) Fast Healthcare Interoperability Resources standards, and 8% say they’re stuck with technology that isn’t, well, interoperable.
Virtual care programs for veterans are seeing mixed results. That could help healthcare organizations better understand what works and what doesn’t.
Recent efforts to improve healthcare access for veterans offers insight into which virtual care strategies are working and which ones aren’t.
The success (or lack of) of programs launched by the Department of Veterans Affairs (VA) and the Veterans Health Administration (VHA) could help health systems and hospitals better understand the direct-to-consumer telehealth market.
For instance, the VA recently announced that its tele-emergency care (tele-EC) platform will now be available to veterans across the country, after the success of pilot programs in selected regions. The program, part of VA Health Connect, enables veterans to connect with care providers on-demand through a smartphone and associated app.
“Veterans can now be evaluated for possible emergencies from the comfort of their home,” VA Under Secretary for Health Shereef Elnahal, MD, said in a press release. “Sometimes, you’re not sure whether what you’re experiencing is a minor emergency or not — and tele-emergency care can help you resolve those questions. Veterans can get immediate, virtual triage with a VA medical provider who has direct access to their medical records. This avoids having to potentially drive to the nearest emergency department and wait to be evaluated, if appropriate.”
"I think it's a noble idea,” GAO Healthcare Director Alyssa Hundrup told a Virginia TV station in a recent interview.. “They've put in an effort but, unfortunately, it has yet to be used. VA really needs to be looking at the effectiveness of these sites, where they are, how they're using them, are they getting the word out to communicate with the veterans the availability of these? Otherwise, these sites are sitting there being unused and it's a real missed opportunity.”
So why is the tele-ICU program working but ATLAS is struggling? The issue may be similar to why so-called disruptors like Walmart, Walgreens and CVS Health are struggling to find a healthcare niche with retail clinics.
Tele-ICU is working because it gives veterans access to needed healthcare services from wherever they are, including and especially their homes. ATLAS, meanwhile, still requires veterans to travel to a specific site for healthcare.
That strategy works well for veterans in remote locations where broadband availability and even phone service is weak, and that does address a key barrier to care. According to the GAO report, those 10 ATLAS sites where veterans did access care were successful in helping those veterans and eliminating the need for long drives to the nearest VA center and long waits.
The VHA has responded to the GAO report by saying it will transition from a pilot to a grant program, adding financial sustainability to the equation, but the GAO is also asking the agency to develop benchmarks to measure the success of the ATLAS program on an ongoing basis, much like it does for other telehealth programs. Those benchmarks could help the VHA understand why veterans aren’t going to certain ATLAS sites and enable the agency to create sustainable virtual care programs that will attract veterans.
The examples set by the VA and VHA could also help healthcare leaders to understand how and where consumers want to access care. Consumers, like veterans, prefer on-demand virtual platforms for urgent care needs, while the success of retail clinics and stand-alone services is more nuanced, driven by factors that aren’t yet fully understood.
It’s clear that virtual care can address access challenges—the VA has conducted more than 9 million telehealth visits in each of the past two years—but simply putting together a virtual care platform doesn’t guarantee success. Providers need to understand how, when, where and why patients want to access care and create programs that address the needs and eliminate the barriers.
Healthcare leaders are moving quickly to keep AI growth under control, but are they handling the governance question effectively?
As healthcare organizations move swiftly to embrace AI, leadership is struggling to understand how to make sure governance isn’t pushed aside.
But what does governance really mean in a hospital or health system? And who gets to decide how and where AI is used?
At the recent HIMSS AI in Healthcare Forum in Boston, issues of compliance and liability were front and center for health system executives looking to chart a clear and effective AI strategy. Sunil Dadlani, chief information and digital officer for the Atlantic Health System, said AI regulation must be handled carefully, so that it doesn’t curb innovation.
The challenge lies in deciding where innovation has to take a step back so that compliance and liability can be addressed.
As Albert Marinez, chief analytics officer at the Cleveland Clinic, said, AI introduces “the art of the possible” to healthcare. “We know that there are problems that we can solve with generative AI that we could never solve before,” he said at the HIMSS event.
“Healthcare should be proactive in the establishment and enforcement of AI governance and guidelines,” Jim Barr, MD, Atlantic Health’s vice president of physician value-based programs and CMO of ACOs, said in an e-mail to HealthLeaders. “Governmental oversight will occur, but those in healthcare should display our ability to fully understand the issues and regulate ourselves.”
“Your reason to use AI tools can’t be just the need to say we’re on the cutting edge,” he added. “With ACOs the challenge is designing and managing successful implementation while continually measuring impact and ROI. You need to take into consideration the existing pain points for clinicians, practices and patients, their willingness to change, deploy a transparent QA/validation process to build trust, and a clear customer value proposition.”
Developing a Governance Strategy
So where does governance fit into a health system’s strategy?
Ravi Parikh, MD, MPP, an assistant professor of medicine and health policy at the University of Pennsylvania, assistant professor of medical ethics and health policy at the Perelman School of Medicine and director of the Human-Algorithm Collaboration Lab, says federal efforts to establish a governance framework have resulted in vague guidelines that are a good starting point, but not enough.
“They're sort of general guidelines on monitoring for bias and monitoring for performance drift,” he says. “But how that gets operationalized is actually really variable.”
The first step for many healthcare organizations is the creation of a governance committee, charged with managing how the health system negotiates vendor contracts as well as how AI is developed, tested, used and—most importantly—monitored.
At the HIMSS summit, Shahidul Mannan, chief data, analytics and AI officer at Orlando Health, said many health systems are using AI in small programs across the enterprise, but leadership will have to create an engine to pull everything together on the same track. The trick is deciding who sits in the engine.
Parikh says current committees are “very ad-hoc,” with a mixture of executives from areas such as clinical care, IT, legal, and finance. Few are including the patient voice, which could be a critical oversight as Ai products flood the consumer marketplace and patients ask for AI capabilities to plan and manage their healthcare.
Patrick Thomas, director of digital innovation in pediatric surgery at the University of Nebraska Medical Center, wondered at the HIMSS event whether healthcare leadership is even ready to govern AI for its patients. Patients and providers are doing their own research, he noted, forcing decision-makers to try to keep up.
Understanding the Value of Data
Beyond the makeup of a governance committee, a key function of that committee is to understand data and data analytics, especially when outsourcing AI technology.
In dealing with vendors, health systems need to understand what datasets are used and how that data can affect outcomes. For instance, a company that relies on data from a decidedly white population might not help a hospital or health system whose patient population is ethnically diverse.
And when errors, such as hallucinations, occur, it may be hard to get a vendor to correct them.
“it’s actually really difficult to respond to these hallucinations by modifying the algorithm,” Parikh says. “You might be able to fine-tune and sort of say ‘Hey, we want to avoid this type of output’ and there's certain reward-based mechanisms to do that, but usually that's not in the health system’s control. Usually it's a developer who's having to respond to feedback that they're getting from the health system and then doing some things behind the hood that we don't honestly know about.”
A governance committee also has to be perpetual, and that will cost time and money that smaller organizations don’t have. Many standards now being considered are for basic AI functions, rather than generative or predictive AI, which hasn’t matured enough to be used in healthcare. But those tools will come along soon, and the rules for governing them will have to evolve.
Parikh isn’t convinced that health systems or the federal government will be able to draft standards for an ever-evolving AI landscape. Instead, he expects organizations like the Coalition for Health AI (CHAI), the Trustworthy & Responsible AI Network (TRAIN), or the Digital Medicine Society (DiME) to create standards and adjust them as the technology evolves.
He also says the federal government could, in time, require healthcare organizations to become accredited to use different types of AI, possibly as part of a quality improvement program or even payment policy.
“We [could] have these accreditation systems that signal to developers which institutions are robust for both validating and deploying [AI] technology and which of those might not be certified for large language model generation … but might be more certified for other types of predictive AI solutions,” he says. “I suspect that people are going to realize that some health systems just have more capacity for governance and more data availability to be deploying these tools. And that's a good thing for patients because we don't want to be rolling these things out for patients where errors might be promulgated.”
