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Evidence Supports Telemedicine, DTx Co's Secure Funds, AWS's Health Data Lake-The HSB Blog 12/15/20

Yes, Evidence Does Support Telemedicine

“Our Take”: The COVID-19 pandemic has transformed how care is delivered as areas affected by the pandemic have to adopt social distancing practices to stop transmission of the deadly disease. While the crisis has presented the U.S. healthcare delivery system with unprecedented challenges, telehealth's rapid adoption has allowed healthcare delivery to adapt its model almost instantaneously. Telemedicine serves as an innovative and effective approach in providing secure, safe, and real-time help to patients in need while improving their health outcomes. Telehealth can be a replacement for in-person visits in cases where it has been shown to be comparable or better relative to in-person appointments. In addition, as regulatory restrictions were lifted out of necessity, providers found themselves able to provide essential services to patients with limited access to healthcare services in under resourced communities. Despite the many benefits telehealth has brought to society, many barriers remain that have adverse effects on greater efficiency of telemedicine appointments.

Description: Telehealth brings enormous value to managing population health interventions since it has lower overhead than facility based services, can broaden geographic reach, and can extend service offerings to areas that may not be able to support certain specialties on their own. During the public health emergency (PHE) the delivery of telehealth services was eased by the rapid legislative and regulatory changes to payment and privacy requirements, particularly the temporary waivers of certain delivery restrictions and new coverage by CMS, which have broadened access and facilitated payment for more services. For example, according to a survey conducted by the COVID-19 Healthcare Coalition, telehealth and remote care services have proven critical to managing the pandemic while ensuring uninterrupted care for 100 million Americans with chronic conditions. In addition, according to the U.S. Dept of Health and Human Services, telehealth and related technologies are transforming the way care is delivered to underserved populations who face burdensome travel times as well as those balancing the multiple demands of family, work, and other activities where telehealth can facilitate continuity of care. Telehealth has addressed a number of concerns that will remain after the pandemic, including a severe provider shortage and the growing gap in access to care for rural communities and vulnerable populations. Moreover, as we have seen, the increased availability of telehealth services has reduced disease exposure for staff members and patients, preserved personal protective equipment, and minimized the patient surge in facilities.

Implications: The evidence from the rapid increase in deployment of telehealth services during the pandemic has demonstrated that telehealth services are an effective adjunct and sometime substitute for in-person care, are particularly good in certain service lines, and will be an efficient component of care delivery in the years ahead. Moving forward a challenge will be sustaining the regulatory relief achieved during the pandemic, integrating virtual care into workflows and striking the optimal balance between in-person visits and virtual care. In terms of service lines, a 2018 article in Health Affairs entitled “The Current State of Telehealth Evidence: A Rapid Review” as well as a number of other peer reviewed articles have found telehealth services to be comparable or better relative to in-person appointments in behavioral health, cardiovascular disease, diabetes, and even physical rehabilitation. In addition, a June 2020 study published in Gastroenterology found that 67% of Penn Medicine gastroenterology and hepatology patients surveyed found their video and telehealth appointments as “positive and acceptable substitutes to in-person appointments, while 80% of their clinicians surveyed “were ‘somewhat/very satisfied’ with the medical care they were able to provide their patients”. Telehealth can fill an essential and longstanding need in our health system, but complications remain to make telehealth a viable option for patients and providers. Caregivers must also take into account constraints on broadband availability and accessibility limitations for seniors as well as the physically challenged. Operational obstacles include measuring and improving return on investment, expanding telehealth services, true integration of virtual care into care models and sustainability. In regard to ROI, as we have noted earlier, stakeholders and providers need to think about indirect and intangible costs which are more difficult to incorporate into current business models, but which which should be measured For example, data has shown that patient satisfaction and engagement is improved via telehealth, as they are saving fuel, time, and money by employing telehealth services. There has also been a reduction in missed appointments, which adversely impact patient health and the economics of physician practice operations. In February 2020, Ohio State Wexner Medical Center found missed appointments decreased markedly with the implementation of telehealth with overall missed appointments down over 35% and a decline of almost 24% in missed appointments for Medicaid patients. To keep up with the momentum, telehealth should deliver care that is respectful and responsive to individual patients’ preferences, needs, and values by ordering timely, efficient, and equitable access. A recent Brooking Institute report recommended the following steps: 1) increased investment in broadband access, 2) support of nationwide interoperability, 3) deployment of new fraud detection methods, 4) broadening of regulatory relief, 5) continuing to leverage telehealth to address health disparities.

Digital Therapeutic Companies Click and Pear Raise Growth Capital/Funding

Event: Digital therapeutic (DTx) companies are growing more popular as the pandemic continues with several companies recently coming to market. Click Therapeutics, a DTx company that treats mental health disorders, raised $30 million through an investment of growth capital from K2 Health Ventures, while Pear Therapeutics, a company which treats substance use disorder, opioid use disorder, and most recently, insomnia, raised $80 million via a Series D funding with Softbank’s Vision Fund. These applications are defined by the Digital Therapeutics Alliance as “evidence-based therapeutic interventions driven by high-quality software programs to prevent, manage, or treat a medical disorder or disease.” These treatments undergo Food and Drug Administration (FDA) review and approval and may be over-the-counter or require a prescription.

Description: Click Therapeutics, Inc. develops software and applications to treat unmet medical needs and uses an adaptive data science platform (Clickometrics) to personalize the user experience to optimize engagement and outcomes. Click currently has an industry-leading smoking cessation program available through payers, providers, and employers, and is also working on other high-burden therapeutic areas, such as Major Depressive Disorder (MDD), Schizophrenia, Acute Coronary Syndrome (ACS), Chronic Pain, Insomnia, COPD and Obesity. Click’s smoking cessation program has features like controlled breathing, social engagement, medication access and adherence, digital diversions, and financial incentives. Pear Therapeutics discovers, develops, and delivers software to improve outcomes for patients. Where it has products to treat substance use disorder, opioid use disorder, and chronic insomnia, it's also developing products to treat schizophrenia, IBS, pain, PTSD, migraines, and more. Pear patients can also be connected through the app to dedicated advocates there to support them through the treatment. reSET, the service that treats substance use disorder, provides cognitive behavioral therapy (CBT) as an adjunct to a contingency management system to increase abstinence from a patient's substances of abuse during treatment. Pear plans to use the recent investment to accelerate reimbursement coverage for its three products. Both Click Therapeutics and Pear Therapeutics are designed to be used independently or in conjunction with biomedical treatments.

Implications: The biopharma space is transforming digitally and has garnered significant investment interest (with three of the larger DTx companies, Click, Pear and Akili Interactive, raising almost $750M from inception to date). With 9 DTx currently on the market (including those given clearance due to the public health emergency) the space is ripe for development despite the fact that CMS has yet to specify a clear path for reimbursement for these products and regulations appear to be lagging behind real world behavior. For example, the two largest pharmacy benefit managers CVS and Express Scripts have both launched digital formularies for the evaluation and reimbursement of such technologies, with CVS covering five such products. While reimbursement and efficacy standards remain issues to be addressed and solved over time we expect the regulatory apparatus to catch up to technological developments. Moreover, given that DTx are software based they present the potential for significant cost savings and applications to value-based care such as reduced development costs and risks vs. biopharmaceuticals, improved measurement and reporting of patient adherence as well as the potential for better patient engagement. DTx can also improve convenience by offering patients on-demand access to care, including the ability to treat and diagnose certain conditions earlier

Amazon Web Services to Launch HIPAA-Eligible Data Management Service

Event: On Tuesday December 8th, Amazon Web Services (AWS) announced the launch of HealthLake, a cloud storage, and analysis service available to healthcare and life sciences organizations. The service will allow organizations to store, tag, index, standardize, query, and apply and analyze data in the cloud as well as automatically structure information into HL7’s fast healthcare interoperability resources (FHIR) standard. Amazon views Artificial Intelligence in healthcare as potentially one of its next revenue drivers, and anticipates the market could reach over $19B by 2026 driven in part by demand for telemedicine and remote monitoring services.

Description: The broad adoption of electronic health records and telemedicine has led to a dramatic increase in the amount of digitized health data in recent years however organizations are often unable to use sophisticated techniques such as machine learning to unlock insights into the data since data in medical records, like clinical notes, and forms (ex: insurance claims, x-rays, scans, labs) need to be prepped and standardized before analytical work can begin. HealthLake uses machine learning trained to understand medical terminology to identify and tag each piece of clinical information, index events to a timeline view, and enhance data with standardized labels so that providers can easily search all of this information. HealthLake automatically structures data into the FHIR format so that information can be easily and securely shared between health systems and with third-party applications. For example, clinical data is often siloed and incompatible even among departments of the same organization. HeathLake offers solutions to such problems and curtails cost burden and operability differences. Amazon noted that EHR vendor Cerner and population health IT vendor Orion Health have implemented HealthLake to address their data management needs. HealthLake’s potential lies in its ability to quickly ingest patient data from various diverse sources and transform the data to perform advanced analytics to unlock new insights and serve many initiatives across population health.

Implications: With HealthLake, healthcare organizations can reduce the time it takes to transform health data in the cloud from weeks to minutes. Healthcare companies generate huge volumes of information, (ex: medical histories, medication and diagnoses records), however, given most of this data is unstructured and stored in different locations it can be difficult to match together and run analytics on. While healthcare organizations often build custom rules-based tools to automate the process of analyzing unstructured data and tagging clinical information, the systems often fail to gain complete insights because data needs to be standardized (ex: inability to account for spelling variations, typos and grammar errors). HealthLake can eliminate the need for organizations to build costly and complex analytics applications to discover trends and relationships in their data and make accurate predictions. HealthLake will join AWS’ other HIPAA compliant offerings including Transcribe Medical.

Employee Benefit Trends in 2021: Diversity, Equity, and Inclusion

Event: Recently, BenefitsPro published an article detailing “Employee Benefit Trends in 2021” noting that employers were focused on improving diversity, equity and inclusion. The article pointed out that as 2021 approaches, companies selecting employee benefit plans are expected to adopt new policy priorities for coverage. The values of diversity, equity, and inclusion (DEI) are experiencing increased interest on corporate boards as are an emphasis on environmental, social, and corporate governance (ESG). These priorities are expected to have implications for the composition of coverage employee health benefit policies.

Description: Diversity has affected the content of employee benefit plans in the past, and experts believe that trend will continue. More varied needs for employees of different demographics include items such as transgender-related health services, in-vitro feritlization (IVF)/fertility coverage, mental health services, and adoption support. The pandemic exposed the needs of coverage equity in employee benefit plans. One-size-fits-all plans that leave little room for flexibility in coverage for employees with different priorities have not served everyone well. Single parents have separate needs than employees without children or with adult children. Finding childcare became an issue during the stay-at-home orders for parents of young children. Social benefits are also on the rise. Examples of these include elder and child care, as well as student loan repayment benefits. Adoption of these policies should continue and expand.

Implications: The trend in prioritizing DEI in employee benefit plans has largely positive implications for the health and financial stability of employees in general. As employers have adjusted to working from home and other challenges of the pandemic, and with almost a year of experimentation under their belt they will be able to set standards and deliberately pursue strategies of greater inclusion remotely (ex: remote interviewing, remote internships). While the trend of more inclusive benefits was accelerated by the pandemic and the greater societal demands for social justice, the “trajectory towards inclusive benefits will continue and become increasingly prevalent and ...will permeate across all company sizes and industries”. Moreover, although one positive effect of the pandemic will be that employers will not be as limited by geography in recruitment and can attract a more diverse pool of talent, the pandemic has also “highlighted the need for better benefits for women, working parents as well as low-income individuals.”

How This New Jersey Health System is Training Physicians to Deliver Bad News Over Telehealth

Event: On December 9th, Globe Newswire reported The Orsini Way, a healthcare communication company that focuses on improving patient experience and outcomes, is launching a new telehealth communication training program based on the “Breaking Bad News” program. This program is designed to teach medical professionals how to communicate difficult news more effectively with patients using telehealth solutions. With the increase in the use of telehealth platforms for the delivery of care during the COVID-19 pandemic, this will not only help to improve patient understanding of outcomes, but also improve patient provider relationships as well.

Description: During these unprecedented times, healthcare professionals have been forced to pivot to telehealth platforms as their primary sources of communication with their patients. Along with communicating healthcare needs, they are also tasked with delivering difficult news to patients and their families. According to the article, research shows that 71% of patients have experienced a lack of compassion when receiving difficult news from a physician. As a result, Englewood Health, a leading hospital and healthcare system chose to become the first health system to participate in the Orsini Way telehealth communication training. The training is provided via video conferencing and includes improvisational actors playing patients to simulate real-life scenarios for healthcare professionals. Participants later receive their footage along with coaching sessions from certified instructors. The program is looking to expand to other healthcare organizations and recently launched new interactive and virtual learning modules centered towards improving overall communication and building relationships between patients and providers.

Implications: The implementation of training programs such as this within healthcare systems, is essential for positive patient experience and outcomes. According to the article, residents at Englewood health now have greater confidence and skills to lead conversations with patients and their families due to the training. The article noted that many medical schools don’t typically prepare new practitioners to confidently communicate difficult news to patients and their families via telehealth. Therefore, to ensure that their teachings are timely and relevant to what is occurring in today’s society, training such as these need to be implemented to ensure confidence, compassion and positive outcomes. The pandemic has changed the vehicle medical professionals use to communicate with patients and it is important that health professionals are well-prepared.


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