Dr. Anthony Fauci addresses the American Heart Association Scientific Sessions.

AHA: Fauci Says Long-term Follow Up Needed to Understand COVID-19 Effects

Podcasts

MHE's Briana Contreras spoke with Amy Dirks Stevens, EVP of Digital Strategy Performance and Practice Lead at AVIA health, for this week's episode of Tuning Into the C-Suite. The two talked about automation in health systems and how it can be a solution to challenges such as budget issues and creating more efficiency in the workplace. Also discussed were areas where health system leaders can begin to leverage artificial intelligence.


Automation in Health Systems and how it can be a Solution per Amy Dirks Stevens of AVIA

Videos

Thomas P. Leist, MD, PhD, discusses secondary progressive MS, more specifically how very early control of the disease gives the patient the best chance for long term stability and gives the patient, the best chance of not entering the secondary state.

Tackling Secondary Progressive Multiple Sclerosis Early on Benefits Patients in a Number of Ways

If the boom in new C-suite titles in healthcare — such as chief experience officer, chief growth officer, and chief analytics officer — “

 new priorities and cultural shifts” inside organizations, what new titles should we be on the lookout for in the year ahead?

The must-do list of priorities for health systems in 2021 is long: recover the bottom line, provide front-line care for the pandemic, address health inequities, reduce provider burnout, and prepare for value-based care. Health systems won’t have the bandwidth to get to these important goals if they don’t first prioritize reducing the burdens and frustrations of outdated processes, duplicative reporting, and reliance on paper instead of digital data.

My vote for new title in 2021: Chief Burden Reduction Officer

Healthcare is rife with inefficient processes that sap the energy of clinicians, increase healthcare costs, and place unacceptable strain on patients. Duplicative paper-based workflows drive much of this. Efficiency and human-centeredness tend to be seen as opposing forces. Not so here. Making healthcare more efficient — by eliminating crazy-making paper processes — will make it more humane. The C-suite should reflect that goal.

Hospital COVID-19 data reporting is a stark example of this challenge. 

“Hospitals have struggled with [COVID hospital reporting requirements, which] … have added to their administrative burdens in the midst of a pandemic. Hospitals have been asked, cajoled and are now being forced to provide that data daily,” reported 

. Staff and providers inside hospitals are slogging through processes of manually 

, emailing, phoning-in, and even mailing COVID reports to local health departments, the state, and the federal government.

COVID data reporting is just the start. Data requests will explode once the final data blocking rule is in effect next year. The information management component of hospital operations is on a steep upward trajectory, and it’s going to create an entirely new set of costs and burdens for hospitals.

Patients are longing for health systems to take on this work. To start, patients don’t want to fill out the darn clipboard. They want to be sure their records are shared for all referrals. And they don’t want emergency departments flying blind when they show up unexpectedly. Most importantly, they want to give up their job as their own chief health record sherpa. My dear friend, who was frequently hospitalized, once said to a hospital CEO: “My undying loyalty will go to the hospital that takes on the burden of collecting and managing my health records for me.” Health systems deeply disrespect patients when they waste their time.

In 2021, hospitals have a unique opportunity to use automation and digital data to reduce the burden of these new requirements and of existing inefficient paper-based processes that are breaking the backs of hospital teams and patients. The goal should be to reduce waste — and bring humanity back to healthcare. It’s clear that the burden of inefficiency is contributing to high healthcare costs. The U.S. spends more than $15 billion a year, and 785 hours per physician, reporting quality measures. At Stanford Medicine, they estimate losing almost $8 million a year to physician burnout.

A Chief Burden Reduction Officer could be the central point of leadership for this priority, creating time- and process-based measurements for patients, staff, and providers alike and taking ownership of data-driven healthcare workflows. Processes that are ripe for efficiency updates today include prior authorizations, concurrent review, managing chart requests, HEDIS data collection, quality review, COVID reporting, referrals, and even chart completion.

Partnerships with a health information exchange (HIE) can be an important part of the solution. Today, Arizona’s Health Current is 

working with hospitals to automate COVID reporting

is helping patients directly access their health records

, relieving burden on health systems. Indiana’s IHIE is 

simplifying COVID lab reporting for health systems

. There’s a lot more that health systems and HIEs could do together to reduce burden.

My hope is that a Chief Burden Reduction Officer could serve as a powerful advocate for valuing the time of providers, staff, and patients. And through this work, not only will the financial operations of healthcare organizations improve, so will the lives of the people involved. All of these processes — the email, the paper, the intake form, the chart download, the fax — they are fundamentally wasteful of this beautiful human energy that we desperately need to transform healthcare. We are a nation facing multiple health crises. We need to free precious human time to address them.



Author, Claudia Wiliams, is Founder & CEO of Manifest MedEx.

Articles

If the boom in new C-suite titles in healthcare — such as chief experience officer, chief growth officer, and chief analytics officer — “reflect new priorities and cultural shifts” inside organizations, what new titles should we be on the lookout for in the year ahead?


Bringing Humanity Back to Healthcare — Do Hospitals Need a Chief Burden Reduction Officer?

Fred Lublin, MD, says it's possible health professionals can develop some biomarkers and find some differences in advanced MRI metrics in finding Secondary Progressive Multiple Sclerosis.



Determining SPMS as Biological Instead of Classification

, an employee-owned company that owns 275 supermarkets in eight Midwestern states. announced today the launch of its newest subsidiary, Vivid Clear Rx. The new subsidiary will offer affordable pharmacy benefit management services to Hy-Vee’s more than 88,000 employees as well as other employers looking to maximize their employee benefits spending.

“Health care spending continues to be a leading concern for employers across the country, and every business wants to make sure they are providing the best benefits for their employees at the best value,” said Randy Edeker, Hy-Vee chairman, CEO and president, in a press release.

“With the launch of Vivid Clear Rx," he continued, "we’re leveraging our experience in the pharmacy industry and the expertise we’ve gained from serving millions of pharmacy patients to help other employers make the most of every health care dollar they’re investing in their employees.”

Vivid Clear Rx will offer a full range of flexible pharmacy benefit management services, powered by RxSense’s RxAgile enterprise technology, which will provide clarity to those utilizing the company’s services. RxSense is providing Vivid Clear Rx with a full-service suite of modules for pharmacy benefit management that will supplement assets that Hy-Vee already owns and operates. RxSense’s analytics product RxIQ will provide Vivid Clear Rx with real-time health plan performance insights through customizable data dashboards; financial, operational and clinical action alerts; and the ability to quickly evaluate data by claim type, pharmacy or geography.

“We are very excited to offer services in partnership with RxSense, as we know their data platform will help businesses, including Hy-Vee, make even better decisions when it comes to employee benefits and pharmacy spending,” said Mike Agostino, senior vice president for pharmacy business development at Hy-Vee and president of Vivid Clear Rx, in the company press release.  “We look forward to helping Hy-Vee and many other employers around the country gain better insights into their pharmacy benefits spending as well as bring greater value to their health care programs.”

Hy-Vee, which is headquartered in West Des Moines, Iowa, a suburb of Des Moines, has annual sales revenue of $10 billion, according to the press release.

The subsidiary, called Vivid Clear Rx, will provide PBM services to help the company's 88,000 employees better manage their healthcare costs.



Hy-Vee Launches New Pharmacy Benefits Manager Subsidiary 

With approval of the Pfizer-BioNTech COVID-19 happening as early as next week, attention is shifting how it and other COVID-19 vaccines will be distributed and administered. 

Certainly pharmacists and possibly dentists and optometrists will be playing  an important role in administering the COVID-19 vaccine. HHS announced in late October that CVS and Walgreens had agreed to administer COVID-19 vaccines to residents of nursing home and other long-term care facilities. The 

 reported this week that the two pharmacy chains are on track to deliver most of the vaccine doses to about 15,600 nursing homes and 29,000 assisted-living facilities.

Meanwhile, the CDC’s Advisory Committee on Immunization Practices voted 13-1 on Tuesday to recommend that residents and employees of long-term care facilities be among the first to be vaccinated along with healthcare workers. CDC Director Robert Redfield must accept the committee’s recommendations before it becomes official CDC policy. But even after that happens, the CDC’s policies are only recommendations; state-level officials  decide how to prioritize vaccine. They are expected to follow the CDC’s recommendations, perhaps with some adjustments because of conditions in their states, but they don’t have to.

Vaccines and Related Biological Products Advisory Committee

 is scheduled to meet next Thursday, December 10, to consider an emergency use authorization for the Pfizer-BioNTech vaccine. Based on the data reported so far, it seems very likely that the committee will vote in favor of the authorization. The 

 reported this week that federal officials have plans to ship 6.4 million doses within 24 hours of when the FDA approves an emergency use authorization for a vaccine. The 

 reported that Pfizer will be shipping its vaccines in special coolers, each containing about 1,000 doses. The coolers are necessary because the Pfizer-BioNTech vaccine must be stored at a temperature of -94 degrees Fahrenheit. The newspaper reported that most of those receiving sites will be at hospitals that can keep the vaccine doses at that temperature or use them up quickly.

Meanwhile, an increasing number of different sorts of healthcare providers are poised to administer the COVID-19 vaccines once they become more broadly available. 

 reported this week that professional organizations representing dentists and optometrists in California have been talking to state officials there adding vaccination to their permitted activities. Minnesota and Illinois already have laws on the books that allow dentists to give flu shots to adults, according to the news services, and last year, Oregon became the first state to allow dentists to give any vaccine.

CVS and Walgreens are poised to vaccinate residents and employees of long-term care facilities. Dentists and optometrists are angling to be among the healthcare professionals who could administer the COVID-19 vaccines.

Government, Drug Companies Gearing Up to Distribute COVID-19 Vaccine

As the world remains battling the coronavirus pandemic, there are still significant and unmet needs for those fighting chronic conditions and disorders like opioid use disorder (OUD).

OUD is currently the number one cause of death in Americans under 50 and with the COVID-19 pandemic, the crisis is expected to worsen. For those battling addiction, quarantining and social distancing have resulted in disruptions of treatment and recovery services and limited access to mental health services and support patients so desperately need.

Sharon Walsh, Ph.D., director of the University of Kentucky Center on Drug and Alcohol Research, says COVID-19 has definitely presented some added challenges to the efforts to reduce the impact of the opioid epidemic. Kentucky, as well as other states, saw a sharp increase in overdose deaths back in the spring after widespread quarantine guidelines were put in place, Walsh says.

"While the media may be saturated with coverage of COVID-19 right now, the opioid epidemic is not forgotten – not by the researchers looking for better ways to prevent and treat addiction, not by the clinicians who worked quickly to transition to telehealth and retain patients in care, and certainly not by those who are living or struggling with this disease every day," she adds.

The pandemic is impacting those with opioid use disorder in many similar ways to how it is impacting everyone. Increased isolation, stress and anxiety are exacerbating symptoms for many of those who suffer from mental health disorders such, as depression, Walsh says. 

However, that stress is an important trigger for relapse to drug use in those who are successfully abstaining. In addition, many recovery support services have historically been provided in group settings and there is reduced capacity for this due to social distancing. Loss of jobs and income may create challenges for individuals to seek or remain in treatment due to costs, she adds.

Another challenge toward this specific group is some of the organizations providing services to people with opioid use disorder have been hindered. 

For example, syringe service programs provide critical harm reduction and health education. Many of the people who use these services aren’t in treatment, so it is a critical touch point for meeting people and helping to navigate them into evidence-based care. However, syringe services programs are often run by public health departments, and they’ve had to deploy their staffing and money to address COVID, which has taken priority away from the opioid crisis. They have been trying to figure out how to convert syringe services into a format that’s outdoors.

According to Michelle Lofwall, M.D., professor of behavioral science and psychiatry in the University of Kentucky College of Medicine, there is a need for medication options to treat OUD.

Medication treatment is incredibly important for patients to have access to, Lofwall says. It provides a clear reduction in risk for death and provides the opportunity for a successful remission from this disease so the person can have a meaningful recovery. 

Opioid use disorder is a disease of the brain, not a lack of willpower, she says. It's about more than withdrawal. While withdrawal from opioids can be dreadful - physically and mentally – we know that stopping medication treatment after getting someone through withdrawal is not adequate treatment for most.

"Study after study shows the same results - that the vast majority of people who attempt to stop using opioids “cold turkey” or stop medication treatment after just a few weeks or a few months are very likely to relapse," Lofwall says. "And losing tolerance without ongoing medication treatment can result in a deadly overdose even after a single use – this is in part why opioid addiction is so fatal. A single slip to opioid use, particularly street heroin that often has highly potent fentanyl now, can be deadly."

Lofwall says there are three medications used to treat opioid use disorder: methadone, buprenorphine and naltrexone. Each medication works a little differently, but all act on mu-opioid receptors in the brain so cravings are reduced and the effects of illicitly used opioids are blunted when they are used; the euphoria and liking of the illicit used opioids as well as the respiratory depression are blocked. Thus, it is a waste money to use and one is less likely to stop breathing and overdose when on medication. Two of the medications, methadone and buprenorphine, also give patients relief from opioid withdrawal.

"Medication really gives patients a fighting chance to be driven less by cravings and withdrawal, to stay alive, and to make different decisions – to have more of their free will back – so that they are in a better position to work with their treatment provider to get into remission from opioid use disorder and their life back," she adds. "Medication is a necessary part of many people’s recovery, which is a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential."

For those affected with OUD, there are still services patients can access for their care.

The ability to offer telehealth appointments for opioid use disorder has been incredibly important this year, Lofwall says. 

"Prior to COVID-19, we were not able to initiate outpatient buprenorphine treatment by telehealth as an outpatient practice, but the laws have changed during the pandemic," she says. "We are still offering in-person visits as well, under strict COVID protocols. There are some patients who still benefit from and need in person visits – whether it is because they need the in-person human interaction or there is a need for a physical exam that cannot be done via telemedicine, or they may not have access to the technology or Wi-Fi that allows for videoconferencing."

Some patients are doing well doing telehealth for consultations and group therapy remotely. Continuing to offer both options for patients is going to be critical for addiction treatment in the coming years, even while working toward getting COVID-19 under control. 

As a physician, Lofwall has gotten more additional information from doing telemedicine due to seeing seeing patients in their own home environment or sometimes at their worksite. For example, you can see their living environment and sometimes hear from their family who cannot often come into the office, which gives insight about whether they may be struggling or thriving.

Walsh says the distribution of naloxone is another important element to reducing deaths from opioid use, and the more avenues used to get naloxone out in the community, the better. 

"We need to think creatively about how to continue other support services during the pandemic to reach as many people as possible," Walsh adds. "As I mentioned before, syringe services are crucial for both harm reduction and health education, and we are working with organizations to find ways that we can offer these services safely, particularly through the winter when it becomes more difficult to keep everyone outdoors."

As the world remains battling the coronavirus pandemic, there are still significant and  unmet needs for those fighting chronic conditions and disorders like opioid use disorder (OUD).

How COVID-19 Is Affecting Those with Opioid Use Disorder

Several years ago, more than 2,000 physicians indicated in a survey that significant proportion of medical care is unnecessary and ineffectual. Responses to the 

 suggests that more than a fifth of overall medical care is unnecessary as is more than a fifth of all prescribed medications. The same is true of nearly a quarter of all tests, the responses suggest, and more than 11% of all procedures. Malpractice, patient demand and the difficulty of accessing medical records were cited as the top reasons for this bloat and waste in our healthcare system.


The costs associated with unnecessary care easily pass $200 billion per year, according to the Institute of Medicine.

 as administrative, operational or clinical.If we itemize waste and cost as duplication of services, medical errors, or operational inefficiency that is detrimental or unneeded, it is obvious that other industries would have long ago chopped these expenditures.

The good news is that moving away from the fee-for-service model toward value-based care gets us part of the way toward a more cost-effective healthcare system because it removes the incentive to provide care that is duplicative or unnecessary.

But we have the opportunity today to go further. The pandemic, for better or for worse, has hit a giant reset button on our country’s healthcare utilization. Americans are postponing wellness visits, childhood immunizations, diagnostic testing and surgical procedures. People with chronic diseases such as diabetes and heart disease have put off appointments with specialists.

With patients by and large staying home, now is the ideal time to re-evaluate our healthcare system.

When they begin returning in larger numbers to the physician offices, clinics, and hospitals, they should be doing so only for the care they need. Patients will be venturing from home to get back to in-person care.

This is our chance to make sure that waste and ineffectual healthcare are left behind when something close to normal healthcare resumes.

In our current environment, healthcare leaders have the chance to design a new vector or hit the reset button on strategies to achieve long-term financial sustainability and resilience in case of future unanticipated health crises. They should take a hard look at care delivery in the past, separate out unneeded care and take steps to make sure it doesn’t come back when healthcare as a whole springs back to life. It is only high-quality, cost-effective care we bring back with a vengeance.

So how should healthcare decision-makers approach this challenging of winnowing out unnecessary healthcare?

Healthcare leaders have been discussing this for quite some time, and the range of different approaches can be boiled down to four areas along with steps that healthcare organizations can take.

reassess their organizations’ information systems

Can we stop, pause or override duplicate testing or procedures at the point of ordering?

Can all team members view the expenses related to testing and procedures before final order entry?

Are expense profiles distributed on a quarterly basis to healthcare providers?

2. Evidence-based medical assessment and total outcomes review

Healthcare organizations should conduct a thorough analysis of all current protocols, guidelines, algorithms and standing order sets to make sure they are linked to expense profiles and benefit the risk-scoring assessment system. Outcome assessments should link back to technology integration and 

 to weigh new opportunities, maintain long-term sustainability and identify any barriers to success using quality improvement process tools.

Organizations should conduct a detailed analysis of the key categories of social determinants of health (SDOH) and their elements, then decide how many can be implemented and on what timeframe. Which of these programs will require a partner in order to successfully implement? Goals related to the value and impact of SDOH should be reset quarterly.

Healthcare leaders should develop a straightforward method to 

 results and outcomes with all team members for the benefit of the communities their organizations serve. This will move us toward more “

Waste and unnecessary care has plagued our healthcare system for years. Just as patients must stop asking for treatments they don’t really need, we must stop offering it. The key to making that happen will be better analysis and dissemination of important health data, followed by a slew of new policies.

When patients return to the clinics and the medical centers, there’s no reason they should be bringing our healthcare system’s chronic wasteful ways with them.

, a senior healthcare executive, is a director for healthcare strategy for GuideHouse.

, a serial physician entrepreneur, is currently co-founder and CEO of a health IT company, Abacus Insights.

 COVID-19 pandemic may present an opportunity to hit a reset button on American healthcare that could winnow out unnecessary, wasteful services and prescriptions.

Could the Pandemic Put an End to Medical Overtreatment?

Five governors have served as HHS secretary and two of the top candidates for HHS secretary in the Biden administration would make it six.

According to numerous media reports, New Mexico Gov. 

, J.D., are among the finalists to head the 

 that includes the FDA, the CDC, CMS and the National Institutes of Health.

Other people in the running for the post include 

, M.D., MBA, who served as surgeon general during the latter part of the Obama administration and is co-chair of President-elect Joe Biden’s COVID-19 task force, and 

, M.D., M.P.H., secretary of the North Carolina Department of Health and Human Services.

Lujan Grisham, who was on a shortlist to be Biden’s running mate and is co-chair of his transition team, may be the strongest possibility. 

reported last week that she and Murthy are the two frontrunners.

 reported that the HHS pick had come down to Lujan Grisham, Murthy or Raimondo.

If either Lujan Grisham or Raimondo were to become HHS secretary, they would join Abraham Ribicoff, Otis Bowen, Tommy Thompson, Mike Leavitt and Kathleen Sebelius as secretaries who were governors before taking the reins at HHS or, as it was previously known, the Department of Health, Education and Welfare, according to a recent 

 blog post about past HHS secretaries, written by Richard Sorian. If Murthy gets the job, he would be the first HHS secretary in a Democratic administration who is a physician.

Lujan Grisham might have an edge over the other possible picks because she has some outside political support. A large majority of the Congressional Hispanic Caucus signed a letter this week that called on Biden to name her HHS secretary, 

Lujan Grisham was head of New Mexico’s State Department of Health from 2004 to 2007 and represented the state’s 1st Congressional District, which includes most of Albuquerque, from 2013 to 2019 before being elected governor of New Mexico. As governor, she has taken strong steps to stem the COVID-19 pandemic, including the imposition of a mask mandate that requires that they be worn in public except when the person is eating, drinking or exercising.

A company that she co-founded has been a source of some controversy and criticism of Lujan Grisham. 

 reported in 2018 that the company, called Delta Consulting Company, was paid more than $2 million to run the state’s high-risk pool between 2014 and 2017.

The news site reported, also in 2018, that she had underreported the amount of money she received from the Delta Consultig on her congressional financial disclosure forms. 

story cites unnamed critics as saying that the state kept its high-risk pool open because of the clout of Lujan Grisham and her co-owner, Debbie Armstrong, a New Mexico state legislator. But — again, according to 

 — Lujan Grisham sold her 50% share in Delta Consulting Company prior to announcing her campaign for governor.  

Murthy’s support of gun control measures and his framing of gun violence as a public health issue made him a controversial pick for the surgeon general’s position. About a year went by between his nomination and his eventual confirmation by the Senate in 2014 because of opposition from the National Rifle Association and the reluctance of some moderate Democrats to support him. 

Murthy was fired by President Donald Trump in early 2017 before his four-year term as surgeon general was over.

The surgeon general’s position is largely advisory but ican serve as a platform to raise healthcare issues; the 1964 surgeon general’s report that connected smoking cigarettes to lung cancer, heart disease other illnesses is a prime example. Murthy addressed the opioid crisis when he was surgeon general with the Turn the Tide Rx campaign, which included a mass mailing to healthcare professionals. In late 2016, 

Facing Addiction in America, the Surgeon General’s Report on Alcohol, Drugs, and Health

Prior to becoming surgeon general, Murthy was a strong supporter of the ACA, and he founded a physicians’ organization in 2009 to support the law at a time when the American Medical Association took a neutral stance on the Obama administration's signature healthcare reform, according to 

New Mexico Gov. Michelle Lujan Grisham and former Surgeon General Vivek Murthy appear to be the frontrunners for HHS secretary in the Biden administration.

Biden's HHS Secretary: Possible Picks

About 64% of U.S. patients are likely to switch to a new healthcare provider if their current provider doesn’t meet their expectations for managing COVID-19 concerns, according to a new report from Accenture.

Patients are looking for a safer, more secure and convenient healthcare experience — including strict sanitary and safety protocols as well as virtual care options, the report collected from more than 4,600 respondents, says.

In addition, those who believe their healthcare providers handled COVID-19 poorly were three times more likely than satisfied patients to say they will either delay seeking services for at least a year or never return to that healthcare provider.

“Our research clearly shows that the patient experience matters now more than ever,” says Jean-Pierre Stephan, managing director of Accenture Health, in the report. "This should be interpreted as positive news because it means the future is in the hands of healthcare providers to embrace change and provide better healthcare experiences. We’re advising providers take this opportunity to offer a holistic, digital approach that centers on the patient’s access to quality care and post-care services; this will better position healthcare providers for long-term growth.”

The report suggests four ways to improve the patient experience:

Address patient concerns in a personalized manner

: Communicate specific actions taken to protect patients — such as offering separate entrances, allowing contactless payment and online paperwork, or even describing the advanced level of protective gear used by staff. When possible, physicians should deliver the message directly.

 Address unique patient needs and ease COVID-19 concerns before a patient steps foot into the office or enters a virtual waiting room. Embed new safety and wellness protocols and practices throughout every interaction, from finding a doctor to scheduling an appointment or completing registration in advance of a visit. In fact, the survey found that 74% of patients are now likely to use online chat or texting to provide check-in information before their appointment if such a service is available.

 Develop new models that use more virtual care, from bookings to meetings, so those who remain wary of in-person care have more options. Patients have indicated a strong desire for this to happen. In a survey Accenture conducted in May, 60% said  based on their experience using virtual care and devices during the pandemic, they want to use technology more for communicating with healthcare providers and managing their conditions in the future. 

 Actively monitor local and national social channels to gather real-time insight into patient perceptions and community sentiment. This enables quick operational pivots to address consumer needs and measure progress along the way.

“While many health systems have improved safety protocols in light of COVID-19, they must also make the patient experience a top priority, not just to convince people to return, but also to lead the way in re-imagining the future of healthcare,” Stephan says. “In this new future of care, health systems need to provide effective, trusted, reliable care—both in person and virtually—while instilling confidence and demonstrating safety and respect. Otherwise, patients are likely to switch to other providers who are reinventing how healthcare services are delivered.”