Digital Health USA 2024

Delivering patient-centric care through sustainable health innovation

The continuing shift towards a home and digital healthcare hybrid presents daily challenges. Healthcare leaders are working against a tide of regulation, licensing, trust, and change management as new solutions become available.

While the transformation towards digital health will not be simple or quick, it will have myriad positive outcomes for patients. Health systems, payer companies, and solutions providers must lobby together to persuade Congress about the benefits of virtual care. As we emerge from the COVID crisis, we take away new learnings, from novel ways to communicate with patients to addressing the needs of underserved communities.

At Reuters’ Digital Health USA 2024 event, we heard from 50 influential speakers in US healthcare, ranging from rural health systems to government departments and everything in between. Resounding themes included the importance of patient trust and communication, the challenges in delivering virtual care, the need for standardization and data sharing, and the long-term benefits of a patient-centric, hyper-personalized model.

Building trust through virtual care models

The merits of digital health innovation, including telehealth, artificial intelligence (AI), and remote monitoring are almost limitless. Chief of Virtual Care & Digital Health Eve Cunningham illustrated one example, speaking on a panel on behalf of non-profit health system Providence.

“Our large-scale telemedicine programs benefit thousands of people in rural communities. We’ve seen a million ambulatory visits with our virtual urgent care, plus 1,600 patients managing congestive heart failure and hypertension through remote monitoring.”

In the panel, Driving Healthcare’s Quest for Limitless Capacity Behind the Mass Expansion of Virtual Care, Sanford Health’s Chief Medical Officer for Virtual Care David Newman echoed these sentiments. He noted that patients are more open to virtual care than anticipated, but this is because Sanford Health invests so much in patient trust. “We’re interested in improving relationships, so patients’ on-call doctors will be the same ones who handled the tele-consult.”

Communication is the cornerstone of effective virtual care. Fellow panelist Linda E. Jones, Managing Director at Marsh McLennan, states that the top complaint in virtual care negligence cases is communication. Specifically, patients feel that information is being held back, or that there isn’t sufficient follow-up for cases like blood sugar monitoring. Technology can help to bridge these communication gaps, as we see in our Koda Health case study below.

Laura Wilt, Chief Digital Officer at Sutter Health, discussed the ‘Trust Triangle’ in her presentation, The Roadmap to Cultivating and Scaling Digital Health Innovation. She cited authenticity, logic, and empathy as three key factors for healthcare partnerships. While there must be trust between patients and doctors, this trust must extend to all stakeholders.

Addressing the challenges in delivering digital healthcare

Beyond trust and communication, healthcare providers need to address change management if they are to provide equitable, accessible care. David Mitchell, Partner at Mercer, proposed a solution during the panel. “We have to reimagine care, thinking about the work itself. Each year, we survey tens of thousands of providers and caregivers. In the last two years, flexibility has continued to come up. We managed to pair this with resilience – for example, reducing the turnover of ambulatory nurses by 90% by introducing hybrid working patterns.”

Newman adds that it was not patients who needed convincing about virtual care, but doctors. “I presented evidence with medical studies showcasing the benefits. I asked them how often they use textbooks today. This approach convinced a neurosurgeon to go fully digital.” In other cases, both patients and doctors gave positive feedback to tools such as virtual reality or augmented reality, mimicking the patient-doctor experience in a patient’s home.

Change management also crosses over with scaling, which Cunningham at Providence acknowledged was an issue. “Three years in, we are struggling to scale because it’s logistically challenging. But we need to innovate because we don’t have enough beds, and 10,000 people are aging into the Medicare system every day.

Scale is not possible without innovation, as noted in Wilt’s presentation. “Innovation is not about the outcome but what you learn on the way. With innovation, you can learn how to scale, how to go faster, and which partners to choose. But innovations are novel, so we don’t scale these. Instead, we scale solutions.”

She added that these solutions must offer the right technology at the right time, citing AI. “We have been working on a solution to stop physicians from feeling overwhelmed. Using generative AI, we crafted GPT large language model (LLM) responses to patient messages. We also automated dashboard processes and used ambient documentation products. This has helped us save 500,000 hours.”

Technology can also help with other issues such as licensing, which is currently inconsistent. “There are challenges across state lines such as licensing and tort laws,” said Jones at Marsh McLennan. This may cause legal disputes if doctors are not licensed to practice virtually for a patient in another state. Cunningham adds that while she is licensed in all 50 states, the process has been cumbersome.

At Sanford Health, providers address these problems by looking at their patients’ lifestyles. Mitchell added: “We’re based in the north but a lot of our patients go south in the winter, so we have providers licensed in Arizona, Texas, Florida. It’s not a nationwide solution but it works for our patients.”

Why data sharing and standardization are key

In a keynote speech, Dr. Micky Tripathi discussed How HHS Is Enabling 21^st Century Digital Infrastructure.  Tripathi is the National Coordinator for Health IT at the Office of National Coordinator (ONC) for Health Information Technology, part of the US Department of Health and Human Services (HHS).

He began by addressing the significant uptake in digital data sharing since 2010. At the time, just 5-10% of healthcare providers were using electronic health records. Today, that is the case for 80% of ambulatory physician offices and 97% of hospitals. “This provides a foundation for our country’s fragmented healthcare delivery system, creating consistency that is tied together by our certification programs.”

He added that the ONC’s main focuses are on building out a digital foundation with schemes such as the Long-Term Post-Acute Care Health Information Technology Collaborative, which supports accessible healthcare IT policies and standards. “How can we encourage the sharing of information despite the blocks in place? First, all HHS agencies, such as the FDA, NIH, or DC, must embed ONC-approved standards in all those regulations.”

This is particularly helpful for organizations that work with multiple HHS agencies, who may feel overwhelmed by different approaches and data standards. The ONC’s role is to make this more consistent, thereby making interoperability easier.

In the same vein, Tripathi stated that there is no nationwide public health data model, but rather thousands across the country. The ONC have introduced a range of initiatives to address this, focusing on areas like behavioral health and cancer research. This helps to standardize data sets, making information available to everyone including payers, providers, public health agencies, and patients. Tripathi suggested a need for a “committed code of conduct” to address the ethics of AI.

Saving time with standardization

American healthcare is in crisis, with a nationwide clinician shortage and 85 core health areas set to be understaffed in the near future. Mitchell at Mercer commented that healthcare providers must “bend the curve” to overcome these growing challenges.

“We could bend the curve upwards by adding more healthcare labor, looking at skills rather than certifications. Or we could bend it downwards by reducing demand. We need to automate, optimize, and standardize. That labor isn’t coming back. It’s so important to save time with standardization.” With interventions from government departments like the HHS, providers can reduce their administrative workloads.

Making care patient-centric with hyper-personalization

Digital tools such as AI are helping healthcare providers make decisions at scale, but a hybrid virtual and at-home model encourages personalization. Tripathi cited the “first significant AI healthcare regulation,” noting that the ONC had first begun to propagate rules in December 2023.

“The rule requires that EHR developers enable transparency in the AI-enabled tools. This gives hospitals and clinicians full visibility, helping them to evaluate treatment and aid patient decision-making.” Crucially, these regulatory approaches account for diversity – ensuring every patient, regardless of background, has access to unbiased treatment.

Panel moderator Nancy Foster, Vice President for Quality & Patient Safety Policy at American Hospital Association, asked if virtual care was taking business away from rural care centers. Newman responded: “We have no interest in taking other people’s patients. It’s about partnerships. We use virtual care to secure inpatient subspeciality visits.” Cunningham reinforced his statement, adding that virtual care is empowering smaller hospitals, keeping patients in one place and educating local communities.

This resulted in a unanimous decision that hybrid models can benefit patients most, addressing up to 80% of appointments virtually without limiting access to other care. Mitchell added: “The future of care is hyperpersonalized, depending on age group, demographic, location. I can choose my access point and that may change over time.” Cunningham noted the benefits of virtual translation services, while Newman stated that Sanford Health still has brick-and-mortar clinics in smaller communities.

Taking into consideration staff shortages, heavy admin tasks, and evolving regulation, there has never been a stronger case for virtual healthcare. Innovations in LLMs, AI-powered dashboards, and remote patient monitoring are saving providers critical time. In tandem, patients feel more empowered to make decisions, and have more access to care regardless of background or location. In the long term, healthcare teams should focus on trust to overcome communication problems, ethical concerns, and the ongoing challenge of providing equitable healthcare for all.

Introducing Koda Health: Digital Health Startup Challenge Winner

Digital Health 2024 saw forward-thinking insights from leading voices in the US healthcare space. It also shone a spotlight on burgeoning startups with a vision to change the face of patient care. The Digital Health Startup Challenge hosted five pitches from digital health startups, with the winner decided by a judging panel and audience vote. This year’s award went to Koda Health, who have made significant strides since the COVID-19 pandemic to transform Advance Care Planning (ACP).

We spoke to CEO Tatiana Fofanova, who explained Koda’s mission and goals. “We offer a one-year supported entrepreneurship or founder and residence program. We recruit three people from complementary backgrounds to come to the Texas Medical Center, where they’ll spent a year discovering the biggest issues within a particular vertical.”

Koda Health started as part of the Texas Medical Center Biodesign Fellowship, wherein its founders sought to address problems in today’s healthcare system. As the pandemic hit, the team saw the impacts of these problems firsthand, with a particular focus on ACP. Their mission is to offer clinically supported conversations, often discussing difficult topics such as end of life care.

“We help with the process of planning care in advance. Operationally, this is very complicated. Rates of ACP are in single digits across the country, and – even less for minoritized populations.”

Koda Health addresses these planning concerns by improving communication and access to care. One way they deliver this is through a patient-facing web application, which helps to educate patients with personalized videos. These cover difficult themes like CPR, dialysis, and medical power of attorney.

After patients have provided their data, Koda Health then generates state-specific legal documents, which can be notarized virtually on the platform. This data is then shared with electronic health records and with the patients themselves. “We offer this service for free because these health systems need to understand what the patients need, and patients need to feel heard at every point in their healthcare journey.”

Koda’s solution challenges the status quo because it offers a comprehensive planning process, complete with legal documents. This makes care accessible to people of all backgrounds and abilities – as Fofanova adds, the average user age is 78. “We speak to patients and get more data than just demographic information alone. We talk about things like the choices they’d like to make at the end of their life. Our engagement rate is five times higher than the national average.”

These rates are equal across race, gender, and socioeconomic status – helping Koda to address health concerns of those in underserved communities. In just four years, they have run several rounds of venture capital to build out a legal product in 50 states, available in English and Spanish. From serving a dozen patients, Koda Health now improves access for 700,000 people.

Their innovations have also been instrumental in cost savings, moving away from paper processes and focusing resources on that crucial end of life stage. “So many Medicare dollars are spent in the last 12-18 months of life. We want to help people get the best value out of this.”

In just four years, Koda Health have set trends from improved communication to AI-powered automation. Having already influenced regulatory bodies on key ACP matters, there’s no telling where they could go next.

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