As part of NJBIZ’s latest virtual discussion, experts from New Jersey-based organizations weighed in on how technology can be used to make health care delivery more efficient, inclusive and sustainable.
Moderated by NJBIZ Editor Jeffrey Kanige, the Sept. 26 panel featured: Susan Loughery, associate executive director, Catholic Charities, Diocese of Trenton, a provider of integrated health and human services to over 100,000 individuals in Central New Jersey; Paul Marden, CEO for New Jersey, Pennsylvania, and Delaware, UnitedHealthcare, which has about 1.6 million people in the Garden State carrying some type of plan through the insurer; and Kash Patel, executive vice president, chief digital and information officer, Hackensack Meridian Health, the state’s largest hospital network.
During the hour-and-a-half roundtable, panelists dove into topics such as the latest developments on electronic health records, potential uses of artificial intelligence in health care settings and whether technology can help narrow the socioeconomic gap in treatment outcomes.
They also weighed in on which pandemic-era innovations have proven to be valuable for patients, providers and insurers. After the onset of the COVID-19 crisis, health care executives were forced to move quickly to ensure patients could continue accessing care in a manner that was safe, leading to some very innovative changes, particularly when it comes to technology.
Not only are some of those offerings here to stay, but they’ve expanded to better serve patients and providers.
Marden said, “Virtual care exploded during the pandemic for obvious reasons and we’ve continued to build on options for members … Now, I think people expect to have access to virtual care through their health plans. And so, we’ve provided some choice. We have 24/7 access to virtual care. We’ve made it convenient so that members can access that through their smartphone or their computer tablet – however they want to do it. But, they have choice of virtual care options.
“I think 88% of Americans are going to continue to use virtual visits when they can, when it’s appropriate. The second piece is really around virtual behavioral care because members have much higher compliance and prefer seeing behavioral health providers virtually in many cases,” said Marden, who noted there’s also been expansion into other specialties, like musculoskeletal, and expects further growth into different areas as time goes on.
Patel agreed, saying, “The demand is there. COVID sort of ignited it and the regulatory environment sort of caught up. But it’s absolutely here to stay.”
“The switch from telehealth to ‘I want to go and see a real physician’ is also important and not a separate appointment. It’s the continuum of care and we need to make access to either a specialty referral or the physician care piece much easier,” he said.
According to Patel, Hackensack Meridian is also experimenting with the use of chatbots to help direct a patient to the right doctor or specialist.
“Where you can have an interactive conversation with an avatar to answer all your initial questions – basic ones – sort of a triage,” he said. “At some point, I do see that technology evolving into more and more of an enhanced AI experience,” Patel explained.
“Chat virtual is a part of everyday life and in so many aspects of people’s lives, so using that functionality in the health care space is evolving and I think it can be leveraged extremely effectively. And obviously, you have to monitor exactly what you’re going to offer and how you offer it to make sure that it’s appropriate. But I do believe that most people expect those types of options to be available in health care,” said Marden.
“We added Talkspace [online therapy platform] as an option for behavioral health care because it was something that members were utilizing. Now, that’s not for everybody, but there was a percentage of the population that had success with it and so we made that one of our options, for example.”
“So, I think this is about trying to meet people where they are and giving them options that they’re comfortable with. And so that is one of the options. In addition to in person therapy or other types of therapy that are available to members who want to access it,” he said.
When it comes to wearable devices – such as smart watches that capture health-related data, like steps, calories burned, heart rate and sleep habits – Patel said there aren’t any clinical regulations right now regarding how that information can be interpreted.
“So, what’s happening is what we’re finding is there are layers in the middle. Taking that data and sort of making recommendations right around the number of steps you should take number calories, you should eat, etc. We’re finding individual physicians who are engaging looking at that data as an extra piece of information to help with that episode of care,” he explained.
“The physician is looking at the trends and sort of any deviation from that,” Patel said. “That’s what the tech is providing now—a summary of all that luminous data.”
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For remote monitoring, Patel said there are numerous guidelines issued by the U.S. Food and Drug Administration on validated devices.
“There’s a whole new sort of business that we’re calling ‘hospital at home’ that’s evolving in America. It’s this notion that instead of being admitted into a hospital bed, you go home for care, but the hospital, in turn, will take care of you as if you were in a hospital setting,” he explained.
“And so the equipment needed for remote monitoring is very different. Like bed sensors, weight scale safety phone calls, the ability to call a nurse, call a doctor or on-site visit by a nurse. It’s a very structured element of care and that remote sort of monitoring piece is a business and need that is growing. The demands there and regulations are changing to support it more and more each year,” Patel said.
“And we, just like many other hospitals, are going to centrally start to develop services in hospital at home, which is what I would say formalize remote monitoring,” he said.
Marden said, “From a wearable perspective, you could take it from a number of different angles. But if members are actually willing to wear a wearable you can actually leverage that for clinical purposes, but also for wellness.”
“Some of the clinical uses are if a member wants to wear a continuous glucose monitor. We actually will sell level funded products that manage diabetic costs. And what we found is that if we have a member that signs up for our level 2 program, they’re agreeing to wear a CGM, sync it so that they have access to that, and obviously UnitedHealthcare – if they’re willing to do that,” he said.
“What we found is that the clinicians have better real time data into their blood sugar levels throughout their day, their week, their month and it helps identify when their blood sugar is spiking and when it isn’t, so they can talk to their physician and see how they can modify their behavior to avoid those peaks and valleys,” he said. “So that’s been highly successful in helping people control their blood sugar if they’re diabetics.
“At the end of the day, if they agree to do that, they save money and the company saves money. And they’re healthier,” Marden said. “We also will incentivize our members if they have a wearable, our rewards program that all our members have access to will reimburse members based on the steps that they take during the day. If they hit milestones, they get money deposited in their account, or they can get a debit card mailed to them. So, you know, it really spans from clinical uses all the way to wellness, I think. We’re really trying to incorporate wearables into health insurance for better outcomes,” Marden said.
Loughery said, “We do a lot with remote patient monitoring where we’re able to use smart tools, smart pulse, smart stethoscope to extrapolate data and really paint that picture of everything that’s happening with that patient. And where the impact is, is around prevention. It gives us a whole dashboard for prevention individualized for that patient and that reduces their risk for hospital readmissions or ED [emergency department] visits.
“There’s tremendous opportunity with wearables, as well. It just becomes a natural part of everyone’s day to day; looking at their wellness and assessing how they’re doing individually and being proactive in reaching out to their providers when they’re seeing something on their wearable that might be an indicator of something more serious,” she said.
As for electronic health records, panelists agreed that there’s been dramatic improvement in recent years but more needs to be done.
Loughery said, “Twenty years ago, electronic health records were customized for each individual provider, whether it be a hospital system, large hospital system, or a community provider that might be specializing in mental health. And now what we’re seeing with electronic health records is a movement toward structured, validated data. And where that gives us opportunity with interoperability is that we can extrapolate this data.”
She explained, “We can pull this data out and we can push it to the regional health exchanges and have that complete data picture on a particular patient. It also allows for having a patient portal where a lot of patients have multiple portals depending on their different providers.
“As we move toward structured data and the electronic health records become more synergistic. We have a lot of opportunity to then create a better technology experience for that patient,” she said.
Marden said, “From an insurer perspective, when a member goes to seek care somewhere whether they’re filling a script, or they’re seeing a provider of any type, that provider wants to get paid, they will submit a claim to their insurance company for that service. So, we will have a lot of information on that member from all their providers. And if we’re administering the prescription drug, we’ll have that information as well. So, we have a very rich data set on all of our members, and what we are trying to do as fast as we can is push that data out directly to providers into their own EMRs.
“We are currently pushing out information to over 600,000 doctors nationally. There’s a number of different EMR systems that we will integrate directly in, and what that helps with is it just gives that physician information they wouldn’t necessarily have right in their EMR; they can actually get benefit information on that member,” Marden explained.
“They’ll be able to get prescription drug information. What is the lowest cost? Or what’s the copay for a medication available to that member and if there’s a prior authorization required. A lot of times if we are hooked into the electronic medical record of that provider that’s done automatically,” he said.
“We are pushing this out as aggressively as we can with provider systems [that] weren’t engaged with many here. We’ve got thousands in New Jersey that are linked up to this. A lot of the health systems have been consolidating, so we have to work with them when they’re ready for it,” Marden explained. “We are ready and we want to engage more because we think it’ll enhance the member experience and make it easier on the provider experience.”
Panelists agreed that artificial intelligence has the potential to transform the practice of medicine and delivery of health care in a way that improves patient experience, addresses staffing shortages and reduces the rising cost of care.
Patel said, “With the advent of technology around AI, there have been some amazing conversations going on the last 12-18 months we’ve been in the thick of it. We’re a huge partner with Google specifically, so we’ve been working with them and others.”
Potential uses include employing the technology to help radiologists screen results quicker and condensing the notes a clinician reviews from dozens of pages to just a few paragraphs, he said.
While there is wariness surrounding potential misuse of AI by “bad actors,” Patel noted that Hackensack Meridian created a committee made up of data scientists, bioethicists, physicians and lawyers to help govern how – or if – the technology will be put into practice.
Patel said, “We have these sort of gate reviews, where it goes from ideation to where does it make sense? Does anything make sense? Is it feasible? So, everybody in the room has an opportunity to have a conversation about it. Is it safe? Is it equitable? Is it the right thing to do? Can we even act on this? Is it actually actionable? We have all of these questions at every gate review, about every AI sort of conversation that we’re creating.
“We’re learning all the time, so we might speak to a partner about it or another health system, too … We have to be really deliberate and methodical about how we’re rolling it out,” he said.
Amid labor shortages and heavy workloads, health care providers are increasingly exploring artificial intelligence and automation to improve operational efficiencies and innovate care delivery models.
Patel said, “We’re looking at it to ease the burden on nurses around education and upon discharge. And looking at efficiencies on how we can do things remotely and internally from an operations perspective for things like documentation.”
Loughery said, “We’re looking at it in the context of efficiency and business process and augmenting where we have resources, staff resource shortages and making it a tool for the clinical managers. And we’re doing that in a couple of different ways. We’re looking at transportation routes, and how do we facilitate? How do we use AI to maximize our routes and our transportation? We’re looking at it in the context of clinical supervision. How does it become a meaningful tool for clinical supervisors to really evaluate how their staff are doing. And I think there’s a tremendous opportunity.
“But I also get concerned about us creating a data footprint or an AI footprint that is not comprehensive enough for those that might be falling under the radar—that might not be accessing the broader health care system, that might be accessing the system in a fragmented way through maybe a charity care clinic here, or a mental health clinic there. And, you know, how do we make sure that when we’re looking at AI for data-driven decisions and developing algorithms that we have that complete picture and avoid something like a black swan effect where we have unintended consequences,” she said.
Technology may be changing health care delivery, with tools like AI and chatbots enabling providers to hand off administrative and repetitive tasks, but providers must also consider how to maintain human contact in an increasingly digitally driven landscape.
Patel said, “When you’re sick, you want to speak to a human being. But when we talk about the cost, the chatbot idea is about reducing the cost, the burden and the challenge with the physicians’ time. So, we’re training the chatbot to have a more empathic conversation.”
“It’s not a clinical ‘Pick 1, Pick 2’ conversation anymore. The tech now is listening to nuances in English and the context in the words,” he explained. “The training of these things are now model based, so there’s a lot of thought going around into how we’re interacting.
“As we’re digitizing the experience more and more, as we’re having more and more digital interactions and we are making a note of empathy. So, when we look at other vendors that are developing this – new startup companies are organizing this – they’re also building a thought process around empathy,” he said.
“We’re definitely conscious of that as we’re digitizing more and more. It will become really, really, really important to ensure that a patient feels that they have a human connection, because when you’re really miserable the last thing you want to do is speak to a robot,” Patel added.
Although the pandemic accelerated the adoption of technology, improving access for some segments of the population, it also disproportionately affected other groups and worsened global health outcome gaps. As a result, existing disparities are in even sharper focus, but panelists are hopeful better outcomes can be achieved if all stakeholders work together to improve health equity.
Patel said, “It’s a growing gap. While we can come up with ideas and use cases to try and reach a broader audience – creating mechanisms for transport, for education, for translation services – that gap is just getting bigger and bigger.”
“It’s not a technology solution or doing it out of goodwill,” he said. “There is a need from a larger sort of setting here, from public health, to do something about this. Cities have tried organized efforts for Medicaid waivers, which is a large amount of money available for underserved communities. But the environment is such that these activities start and end, then start and end. And we don’t necessarily get the continued support that’s required to make it happen.
“So, between new models of care and technology, we’ll get to so many people, plus some more, but we’re not going to get to everybody unless we have a broader, more wholesome conversation about public health,” Patel commented.
Loughery said, “Telehealth, technology and health care just exploded during the pandemic. We had a lot of latitude for being in different places of service, and what we quickly learned because we were in the field the entire time is that we had to innovate very quickly because there were issues around facilitation. With seniors, for example, being able to access a telehealth appointment was something that really needed side-by-side support of a community health worker.”
“Then, there’s the issue of tech equity and being able to have a technology device with a data plan where you can engage in telehealth. So, we did a lot of facilitation. Nurse-led community health workers, really supporting individuals who struggled to be part of this new technology health care environment,” she explained.
“We see the need for a lot of integration for our patients – for the homeless, for individuals with disability and individuals who have struggles navigating the system to connect in a lot of different ways … With telehealth and telemedicine [you’re able] to bring a lot of those services directly to that individual where they’re at. In addition, it brings specialty providers, which are oftentimes a challenge to access for individuals who are in poverty,” said Loughery, who went on to say, “Being able to bring the technology to individuals where they’re at, you can really design a care plan around the needs of that individual and include the language, capability, specialty providers and really wrap around all social determinants of health. There’s lot of opportunities here.”
She added, “In thinking about the new opportunities that we have with technology for us and community services, and in particular, for community public health for individuals who can’t access the system, the ability to have more providers is critical—and specialty providers. And what technology does is it gives us a broader footprint to augment and to offset where we have those provider shortage areas and individuals that might have a lack of transportation, a lack of child care and inability to travel in order to get that health care.”
Marden said, “There are absolutely certain places and a percentage of the population that do have issues with access. And we try and identify those by looking at our data for interactions with a health care system, whether it’s filling a script or a claim, whatever it may be … But we’re trying to identify people who actually are having problems accessing the system.”
While Marden stated that “the majority of the population and membership has access,” UnitedHealthcare is “trying to make sure we have a lot of options available for those folks, and then for those who need help, we’re trying to get them help in various ways.”
“In the context of our overall public health, if we want to reduce disparities, we have make technology widely available to everyone who needs it. Because it currently isn’t and so we are starting to see that the gap widen for individuals who went into the pandemic already with significant health disparities,” Loughery said.
Reducing that gap and exploring what is best for the residents of New Jersey will require cooperation between “payer, provider and state government,” she went on to say.
“We’re doing a lot of work in terms of informing our colleagues at Department of Health Division of Mental Health and Addiction Services on what could be or what the opportunities are, what we’ve seen in the field, and what we see that we need going forward. And right now, we’re functioning under a lot of temporary waivers. And so, we’re at that point where it’s time to develop what the system will look like. And it’s a collaboration of every stakeholder, including the patients and the voices of the community on what they need and what they prioritize as important in their health,” she said.
When it comes to reaching those without access, Marden said he believes UnitedHealthcare has made “a great deal of progress” but “clearly we need more of it.”
“It’s getting into the communities that are underserved to provide them with money resources to get the care that they need. Because I think as a society, we all pay for that when somebody’s condition deteriorates. It’s going to result in higher medical care and lots of other downstream costs associated with somebody who cannot get healthy, who doesn’t have stable housing, who’s hungry. And so, I think that we need to continue to invest in ways to get underserved communities and better resources so that they can live better,” he said.
And I really do believe that there will be an ROI for everybody living in any community if we can lift those folks up,” Marden said. “I think, it’s everybody’s responsibility, no matter what industry. If you’re an insurer, you’re a provider, you’re just a business. I think that, ultimately, we all pay the price when those folks are neglected, and it just results in lower quality of living and higher costs for everybody. And now prevention can go a long way. So, I think it’s multifaceted … I think everybody would agree that certainly more funding, more attention, more resources in that community will benefit everybody.”
Editor’s note: This article was updated at 10:17 a.m. ET on Oct. 6, 2023, to clarify a remark from Paul Marden that 88% of Americans, and not UnitedHealthcare members, will continue to use virtual visits.