Tag Archives: healthcare

Care at Home Isn’t New – But Scaling It Is the Real Breakthrough

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When you look back at healthcare delivery over the decades, care at home is not new. Home Care (VNA) has been around for over a century, and gained significant traction with the expansion of Medicare in the 1960’s. By the 1980’s, VNA was considered part of the “continuum of care” for most large healthcare systems.

Johns Hopkins University began development of the first Hospital at Home program in the U.S. in the 1990s. But it wasn’t until the early 2010s that I started hearing the term “hospital at home”. It was a vision that our Chief Medical Officer at a Midwestern academic health system started promoting internally.

CMS formalized the Acute Hospital Care at Home (AHCaH) waiver program during COVID as part of their response to the capacity crisis. As of late 2022, CMS had approved over 250 hospitals.

In early 2023, my daughter who is a Nurse Practitioner told me there was an opening for the Director of Advanced Practice Providers (NP/PA) for Home Hospital at her health system – Mass General Brigham. She had been the Chief Nurse Practitioner on a growing Orthopedic/Spine Surgery inpatient service at one of their community hospitals for over 11 years at that point. I was quick to encourage her to apply, telling her that it represented the future and was a great opportunity.

Fast forward to today and that program is one of the largest in the country and is operating at scale.

But why do so many hospital at home programs fail or struggle to scale? The complexities and challenges are significant yet the benefits for hospitals, patients and their families are tangible.

You can learn more in our StarBridge Advisors blog, “The Rise of Care at Home: Healthcare’s Most Important Shift is Already Underway” by John Campbell.  I’ve known John since the early 2000s when we were colleagues as CIOs within the Mass General Brigham (MGB) health system. His experience and insights are invaluable to anyone navigating care at home programs whether from an operational, clinical or technological perspective. John brings deep expertise in home-based care models, digital transformation, and care delivery innovation. At MGB he led technology strategy for Healthcare at Home and Post-Acute Care – translating vision into scalable, patient-centered programs.

I will be joining John and David Muntz this Wednesday August 6th from 3-4 PM ET for a ProNexus Advisory sponsored Real Talk live event titled: “Care at Home: Healthcare’s Next Frontier is Already Here”. You can register here.

It should be a lively and enlightening conversation!

The Next Chapter: Smarter Aging for You, Your Family, and Your Future

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I’ve been thinking about aging a lot lately. Birthdays are coming up for my husband and me – neither of us is getting any younger. Friends my age are losing older spouses. Friends my age are dealing with health issues of spouses. And younger friends are dealing with health issues of their elder parents. Extended family members are considering what level of services they may have to arrange in the near future or move into a more age-friendly situation.

And then there are the uncertainties surrounding Social Security, Medicare and Medicaid facing all of us. Not to mention the stock market.

Last week I wrote about the importance of social connection – especially as we age.

59 million people in the U.S. are 65 or older. Based on personal experience and decades working in healthcare, here is some advice on aging whether it applies to you or a loved one:

    • Keep active mentally and physically. Maintain social connections with family and friends. Embed yourself in a community to avoid isolation. Develop a new hobby that involves learning something new to avoid stagnation. Make it something you can do for years to come.
    • Be your own advocate with your healthcare providers or find a family member to help advocate for you.
    • If you have a clinician in the family, listen to them. They can advise and help interpret what might seem like confusing and overwhelming medical information.
    • If you have a non-clinician in the family who works in healthcare and knows how to navigate to get access to the right kind of care and specialists, let them help you.
    • Plan ahead and talk with your family about your plans. Make a retirement aging plan. Outline the decision points – for example, what would be the trigger that it’s time to move out of your house or apartment and into a care facility or to have services come to you. Maybe it is when you are unable to do stairs, have a significant fall risk, or are unable to do activities of daily living (ADL). Avoid having a reactive approach. Make the necessary changes when you want to and can, not when you are forced to.
    • Recognize when it is time to give up the big, too much to maintain, multi-story single family home you raised your family in for something smaller, simpler with single floor living.
    • Recognize when you need help and get it. It may mean having services come into your home or moving into a Continuing Care Retirement Community (CCRC) where you can progress from independent living, to assisted living, to memory care if needed, to skilled nursing care.
    • If you have family members who can help you with aging members of your family, figure out how everyone can play a role whether they live locally or not.
    • If you are a caregiver for a loved one, recognize when you need the help of others or services in your home.
    • Lastly, hospice is not just about the final days of life. There are varying levels of hospice care to consider and make use of when the time comes.

As for my husband and me, we moved from a big single-family home into a townhouse neighborhood in a planned community a few years ago. It is a multi-level townhouse with a master bedroom and bath on the first floor. How we use our upper and lower levels today (office space, guest bedroom, art studio, and family room) can change if stairs become difficult at some point. We will still have a guest bedroom for family and friends to visit and a family room for the grandkids to play in.

We have a will and family trust setup. We have advanced directives. We invested in long-term care insurance decades ago. We plan to review all this and our overall financial assets with our daughters in the near future so they are fully aware and don’t have to worry.

Do we have more planning to do? Yes. We will do it together and proactively in the years to come.

Related Post:

Fostering Social Connection for Health and Well-being

 

When Politics Threaten Healthcare: Will You Stand Up?

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If you work in healthcare, you understand the importance of public health, disease prevention, and research. Even if you don’t work in healthcare, you and your family use a range of health services and count on having access to some of the most advanced healthcare in the world.

But the new administration in DC may be causing you concerns as a healthcare professional and/or consumer of healthcare. Maybe you are concerned that the new Secretary of Health and Human Services (HHS) is anti-vaccine and anti-science. On the other hand, you may be optimistic about potentially positive changes around processed foods as he says he will “Make America Healthy Again”. The irony of those two points is not lost on me.

Maybe you are worried about cuts to Medicaid and Medicare. But you hear leaders in Washington say that will never happen. Or maybe you are a veteran concerned that your health benefits and services will be reduced. Maybe you or a family member care about cancer or Alzheimer research. All of these are legitimate concerns shared by millions of Americans.

I shared a post on LinkedIn a week ago that included a link to the 42-page list of grants that the National Institute of Health (NIH) had cut. As Dr. Michael Wagner, President and CEO of Care New England said in the original post, “most of the grants targeted for termination focused on:

    • LGBTQ+ health and gender-affirming care
    • Racial and ethnic disparities in health outcomes
    • Mental health and trauma among marginalized populations
    • Social determinants of health and health equity
    • Vaccine access, behavior, and hesitancy research”

He went on to write, “This appears to be less about performance and more about realigning federal policy priorities—away from equity-focused, community-based, and prevention-oriented work.”

But maybe none of those grant cuts impacted you directly.

This week there were significant HHS cuts, and many programs were gutted. I’d be surprised if one of them didn’t directly impact you. Continue reading →

Staying Positive, Telling the Truth, and Defending Care: Timely Advice for Health Leaders

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In the weeks following the November 5th election, I significantly reduced my news intake, but I continue to read and stay informed as I encourage everyone to do. Objective perspective and advice on how to navigate the changes we are going through as a country is always welcome. I was struck last week by an insightful article that one of our best healthcare leaders wrote. I’ve highlighted his articles in the past in this blog. His latest is one of the best things I’ve read in recent weeks. You guessed it – I’m talking about Michael Dowling, President and CEO at Northwell Health.

On this 4th anniversary of what has become known as “January 6” or simply “J6” on social media, and as we watch the way a peaceful transition of power is supposed to be, Dowling’s advice to healthcare leaders is timely. In the article, “Michael Dowling: 6 priorities for health leaders in a new era of change and disruption”, published in Becker’s Hospital Review on January 2nd, he discusses 6 key areas to consider:

  1. Maintain a positive attitude.
  2. Tell our positive story.
  3. Be a conveyor of truth.
  4. Be supportive of new opportunities.
  5. Defend access to care.
  6. Values matter.

While they all resonate with me, #3 really strikes a chord as we consider some of the potential new faces who will be leading and influencing healthcare in the new administration. As Dowling says: “We must never waver from our responsibility to preserve credibility and trust in evidence-based science. Scientific discoveries and their resulting treatments have had profound, positive benefits in increasing the lifespan of people worldwide. We must not be afraid to denounce skeptics who promote misinformation and stoke public fears.”

The last point is also a powerful one for me, yes, values do matter. As Dowling says: “Now more than ever, we as healthcare leaders need to promote the values of decency, respect, integrity, honesty and trust. We must be positive role models who embrace a sense of unity, togetherness and community — not anger and resentment.”

Leadership is hard. Staying true to your values is hard. But we owe it to those we serve.

Related Posts:

Towards a more civil society

The healing power of humanity

What do healthcare CEOs want from technology in 2024 and beyond?

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When do you stop wishing people “Happy New Year”? Probably soon if not yesterday. When do you stop reading recaps from 2023 and predictions/forecasts for 2024? It depends. When do you stop listening to what healthcare CEOs are saying is important to them? Never!

I’ve seen two pieces recently from healthcare CEOs that are worth sharing here.

First off a very powerful message from Michael Dowling, President and CEO at Northwell Health published in Becker’s Hospital Review on January 2 – “The most pressing question to start the year”.  He reminds us of our mission as we start the new year.

“Health is how we work together to build a sense of community. Having a healthy community also requires everyone doing what they can to tone down the political rhetoric and social media-fueled anger that is polarizing our society. Health is bringing back a sense of civility and respect in our public discourse, and promoting the values of honesty, decency and integrity.”

 The second is a piece from Becker’s Health IT published on December 19 – “Health system CEOs’ tech wish list”.  Here is what’s on the technology wish list for the next three years:

    1. Seamless care coordination applications
    2. Drivers of elite patient experience
    3. Automation everywhere
    4. Precision medicine capabilities
    5. AI-driven technology to support the workforce
    6. Health equity and population health boosters

Sound familiar? Does this align with what you are hearing from your healthcare executive team?

You may be wondering how you do this with limited budgets due to continued financial constraints and the workforce challenges of recruiting enough staff and the right talent. The job of health IT leaders is as challenging as ever but as exciting as I’ve seen in my several decades in healthcare. Finding ways to take costs out and create capacity, optimizing existing investments, hiring talent and retooling to ensure your team is ready to deliver on the new demands – those are some of the leadership challenges for 2024.

Related Post:

From reflection to action – preparing for 2024

 

From reflection to action – preparing for 2024

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It’s that time of year when you can find 2023 recaps and 2024 predictions everywhere you watch, listen to, or read content. In health IT, we are no exception to this. My StarBridge Advisors colleague, David Muntz, has written our final blog post of the year that health IT leaders may find useful – “12 Steps to Prepare for 2024 – Big Challenges – Bigger Opportunities”.

David is one of the kindest people I know. It is a true pleasure to have been on this StarBridge venture with him for the past 7 years and to have known him far longer than that from when we were CIO colleagues. It is no surprise that he starts his post by talking about how important it is to model kindness, mercy, and compassion in all that we do. He notes the workforce challenges that organizations face and the importance of recognizing that healthcare is a people business. He goes on to address specific opportunities in DEI, digital health, AI, security, and much more.

He closes with a call to make the best of these opportunities in 2024 to improve health and care in our communities, our nation, and our world. After all that is our common goal! I encourage you to add his blog post to your end of year reading list.

All the best to you in 2024! May it be a healthy, peaceful year filled with kindness.

Healthcare as a right in more progressive countries   

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I wasn’t going to write anything this week since my husband and I just returned from an 18-day trip with Road Scholar – The 4 Nordic Capitals. We spent 3-4 days in each – Copenhagen, Oslo, Stockholm, and Helsinki. It was everything I had hoped it would be! But no one hopes for jet lag and feeling like a zombie the first day or two back.

So, on day 2 of re-entry, I was up very early after too short a night’s sleep as my body adjusts to the 7-hour time difference. Why not start writing? I learned so much on the trip and have lots to share in due time. No question that we can learn a lot from these progressive Nordic countries – Denmark, Norway, Sweden, and Finland.

I visited three of these capital cities when we were on a cruise in the Baltic Sea in 2018. But having only 6-8 hours in a port is nothing like immersing yourself for a few days and really learning about the country – their history, political structure, culture, social services, technology, and more.

A day with a Road Scholar tour like this includes a 1-2 hour lecture from the local guide or an outside expert and then guided tours to a variety of sites with usually some free time late afternoon to explore on your own.

Let’s start with how progressive they are. I could start from various angles – a strong focus on sustainability, extensive public transportation infrastructure, free education through the university level, lengthy required maternity/paternity leaves, and of course their healthcare system.

From my lecture notes, here are a few data points I captured on healthcare:

In Finland, healthcare is not completely free but pretty close. Prescriptions are subsidized and you pay a maximum of 700 euro in a year ($769.37 using today’s conversion rate). Think about the people you know in the U.S. who are paying thousands a month for just one critical prescription. Hospitalization is 49 euro a day regardless of what it is for ($53.86 using today’s conversion rate). Think about people in the U.S. who have to declare medical bankruptcy due to hospital bills or deplete their life savings for nursing home care. (A 2015 study by the Kaiser Family Foundation found that medical bills caused 1 million U.S. adults to declare bankruptcy every year and that 26% of Americans aged 18 to 64 struggle to pay medical bills. Medical bankruptcy is almost unheard of outside the U.S.)

In Sweden medical care is free until you are 19 years old and dental care is free until you are 24. For medical care you pay $25 per visit or procedure. After a maximum of $720 per year you don’t pay. (Local guide spoke in dollars vs euros for us).

Yes, people in these countries have high tax rates but their dollars go to services for the entire population. Healthcare is just one example – they truly believe healthcare is a right with every citizen having equal access to services.

More to come on lessons from the Nordic countries in future weeks….

Divided opinions on AI in healthcare

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Are you and your doctor ready for AI? While patients may be getting more comfortable with AI, how healthcare professionals embrace AI is critical to its evolution and eventual use.

Boston Children’s Hospital and Harvard Medical School conducted a poll in May among 3,317 adults age 18 and over in the U.S. and included a sample of 357 healthcare workers who were asked about how AI is already affecting their jobs, and how it might continue to do so in the future.

So how comfortable are healthcare professionals with AI? According to the study, “Healthcare professionals are somewhat divided in their opinions of AI: 23% think the use of AI in healthcare will help more than it hurts, 33% think it will hurt more than it helps, and 42% think it will equally help and hurt.”

Another interesting but not surprising poll result is the age differentiation. According to the study, “Younger adults express more comfort with AI-led healthcare, with 40% of those 18-34 saying they would be comfortable with a primary care appointment led by AI, vs. just 24% among those 65 and older.”

A Becker’s story, published June 29 by Giles Bruce, “Where Americans want and don’t want AI in healthcare: 7 things to know”, provides the following highlights from the study:

    1. Two-thirds of Americans believe AI will play a bigger role in healthcare five years from now.
    2. 34 percent expect AI to be better than healthcare providers at treating patients without bias.
    3. 1 in 4 are comfortable with AI-led therapy.
    4. 22 percent expect AI to be better than medical professionals at diagnosing conditions.
    5. 12 percent said their healthcare providers currently use AI to augment treatment, diagnosis or communication.
    6. 83 percent of medical professionals don’t currently use AI.
    7. A third of healthcare providers say AI will do more harm than good.

AI is already being used in many ways in healthcare and will continue to evolve. IT leaders need to stay current as it evolves, leverage their existing vendor partners, carefully assess the new niche players and their claims, develop AI skills within their teams, partner with clinical and operational leaders to find ways to experiment that make the most sense for their organization, and learn from other organizations who are more advanced users of AI.

Bill Russell’s This Week Health podcasts often cover AI so it’s a great resource for keeping up and hearing what the issues are and how it is being used in different organizations. One of the newest episodes is TownHall: The Potential and Unknowns of AI and Emerging Tech in Healthcare, Part 1, a conversation between Dr. Brett Oliver, Family Physician and Chief Medical Information Officer at Baptist Health and John League, Managing Director, Digital Health Research at Advisory Board.

As my favorite television news anchor likes to say, “watch this space”.

Related Posts:

AI and AI – Use them Responsibly

AI in healthcare – is 2023 the breakout year?

Navigating the AI landscape in healthcare: HIMSS23 recaps and more

The transformative power of bold leadership in healthcare

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With reproductive rights and LGBTQ+ rights under attack in so many states, it was good to see the Summer 2023 Issue of the Brigham magazine in the mail this week. This issue is titled “Care for Every Body – Embracing Inclusive Medicine”. As a former VP and donor to Brigham and Women’s, I receive the paper copy to read. You can access it online here.

The main articles include:

  • Sex & Gender Glossary – essential terms and definitions for understanding sex, gender, and well-being.
  • Pro-Care. Pro-Patient. – describing how the Department of Obstetrics and Gynecology is working toward reproductive justice for all patients. An alarming data point: If all abortions in the U.S. were to stop, 24% more people would die from pregnancy complications and 39% more non-Hispanic Black people would die.
  • Soul Meets Body – describing how the Center for Transgender Health is breaking barriers and providing state-of-the-art, life changing care for trans and gender diverse people. An alarming data point: 46 states have proposed 491 anti-transgender laws in 2023, more than the previous four years combined.
  • Women ≠ Tiny Men – describing how physician-researchers are working to balance the scales for women’s health.

These articles and the programs described represent bold leadership in healthcare and what we should expect from healthcare providers.

Just as the Winter 2022 Issue titled “Standing Tall for Justice – Cultivating Equity and Inclusion in Medicine” was bold leadership as it covered racial equity in healthcare. And just as Michael Dowling, President and CEO at Northwell Health in New York, regularly shows us what bold leadership means. He doesn’t shy away from controversial issues as he addresses the issue of gun violence and calls for civility and decency in our public discourse.

Dr. Robert Higgins, President, Brigham and Women’s Hospital and EVP, Mass General Brigham comments in the introduction to the Summer 20223 Issue – “While forging the road toward a more inclusive healthcare systems is not an easy or immediately achievable goal, it is a vital commitment we must make. Our sense of humanity depends on it.”

Are you uncomfortable being a bold leader? Do you embrace or shy away from the DEI discussion? The DEI Committee of CHIME is hosting a webinar this Friday, June 30, at 12PM EDT that I highly recommend. It is titled “DE&I in Healthcare 2.0 – Getting Comfortable Being Uncomfortable in a Safe Space Zone”. Please follow this link to register if you want to learn how to stay DEI focused in an anti-DEI climate.

In a recent podcast interview, I was asked about some of the unique challenges and opportunities of being a CIO in the healthcare sector compared to other industries. I commented on how being in healthcare is mission driven and how we can make a difference in people’s lives. Leaders of our nation’s leading healthcare systems being willing to address the difficult issues and care for every person is one of the reasons I am passionate about working in healthcare.

What we do matters.

Related Posts:

Leadership means being bold and taking on the tough issues

Towards a more civil society

When is enough enough?

The healing power of humanity

 

Unlocking the power of time: insights from an inspiring leader

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Today is the longest day of the year and the official start of summer. This longest day leads me to reflect on how we spend our time.

I recently had the pleasure of interviewing Saad Chaudhry, Chief Digital and Information Officer at Luminis Health, for a Townhall episode on This Week Health. Saad is an inspiring leader on so many levels so preparing interview questions was easy. I had heard Saad talk in the past about what he calls his Manifesto of Time, so I wanted to make sure we discussed it in the interview. For Saad, looking at the number of hours the average person has in their lifetime means looking at how we choose to spend it and whether we give or take time from others.

As a health IT leader, he says we are in the business of time. He is committed to giving time back to staff and patients. He asks in his manifesto – “Does a process/technology/policy steal time from a fellow human? Is there a better alternative to simplify the experience?” He challenges us to make systems and processes easier for patients and staff, giving time back rather than taking more time from them.

I can’t say it nearly as well as Saad, so I encourage you to read The Manifesto of Time and listen to the short clip on time from our interview – Spending Time: Why It’s Important to Maximize Giving Back Our Most Valuable Commodity. We covered much more in the full interview if you are interested and willing to spend 30 minutes of your time listening – A Realigned Role, Generational Diversity, and Giving Back Time.

I know your time is precious – thanks for reading and listening!