The COVID-19 pandemic has catalyzed a profound transformation within the healthcare sector, revealing an urgent need to modernize and enhance the way care is delivered. Amidst the global crisis, healthcare providers were compelled to swiftly adapt and integrate new technologies, striking a balance between ensuring medical accessibility and adhering to social distancing mandates. This period of accelerated digital adoption has provoked hope regarding the potential of cutting-edge generative artificial intelligence (AI) technologies—capable of generating outputs ranging from poetry to complex computer programs with near-human fluency—to revolutionize healthcare.

There’s no room for error in medicine, so while the whimsical errors of generative AI are often harmless in other contexts, they can bear serious implications in a field where stakes are invariably high. So, the question remains – how do we improve nurses’ experiences with technology without invoking further trouble?

The Need for Merger

The healthcare sector continues to face the issue of burnout among workers. The extensive paperwork required for electronic health records (EHR) is notably frustrating, especially for nurses who depend on technology for precise documentation of patient interactions. 

Surveys from Canada in 2022 indicate that nearly 70% of nurses thought about changing their jobs, with more than 40% considering exiting the profession due to various factors, including staffing shortages, salary reductions, and workplace hazards. Additionally, the ageing baby boomer generation is contributing to a demographic shift, increasing the demand for nursing care and heightening the risk of burnout among nurses of all ages.

Conversely, the adoption of technology offers significant opportunities to transform nursing practices. Real-time location services (RTLS) and AI show potential for enhancing the capabilities of existing digital tools like EHR and nurse call systems. Industry specialists suggest that RTLS and AI could address the challenges of handling large patient volumes by simplifying crucial daily operations, thereby organizing, and streamlining patient care. Hospitals that have embraced these technologies report notable improvements, including a 94% increase in task management efficiency and a 31% reduction in response times for services.

Technology Education

Introducing new practices into any healthcare discipline is by no means easy. Disrupting existing standards that work can cause more damage than benefit, hence the need for appropriate training around the new health technologies awaiting integration into the industry. Educational technologies, including simulations and virtual environments, have become indispensable in developing nurses’ competencies, deeply embedding principles of quality and safety into their professional ethos. 

Looking forward, the Future of Nursing Report 2020–2030 envisions a healthcare system supported by nurses proficient in these digital innovations, leveraging them to address social determinants of health and bridge health equity gaps. This shift signifies a broader movement in nursing education toward utilizing technology not only as a teaching tool but as an essential component of modern medical practice, aimed at enhancing patient care efficiency and efficacy.

The Technologies Driving Change

Despite the considerable strides made in recent years, the integration of digital technology within nursing continues to encounter significant hurdles. A persistent issue has been the profession’s struggle to stay abreast of the swift advancements in digital technologies and their profound influence on society at large. This gap has, in turn, constrained the potential advantages these innovations could offer to both nursing practice and patient care. In response to these persistent challenges and in anticipation of future demands, there’s a pressing need for nursing to undergo a comprehensive digital transformation. Below are just a few of the technologies driving this change.

Telehealth Programs

Telehealth programs and digital advancements have drastically reshaped nursing, breaking the barriers of traditional healthcare environments to provide remote monitoring, coaching, and triage for patients, especially those with chronic conditions. Additionally, nursing call systems have become essential in improving communication between healthcare providers and patients. These systems alert staff to urgent patient needs or dangers, like fall risks, enabling swift action to enhance care efficiency in critical moments. Patient data management has now become streamlined through the use of ERHR systems as they offer a unified, easily accessible database that facilitates simple documentation and data exchange among professionals. 

The integration of mobile technology, RTLS, and “smart systems” through EHRs and nurse call systems has led to significant improvements in healthcare delivery, with some hospitals noticing a 94% improvement in overall task volume and 31% reduction in service response time. These technologies, allow nurses to anticipate service provider arrival times, enhancing patient communication and preparation. They also support services like patient transport and meal delivery, streamlining operations and allowing nurses to concentrate on core healthcare needs. Despite the benefits, this shift introduces challenges in policy, ethics, and adaptation, particularly for seasoned nurses unfamiliar with digital tools. Addressing these hurdles requires comprehensive training and support from healthcare systems to ensure nurses are proficient and comfortable with these technologies, ultimately improving their work experience and retaining skilled staff.

Putting it All Together

Nursing leadership at every level is urged to champion and meaningfully invest in the integration of nursing practices with digital health technologies. The imperative to adapt and incorporate digital innovations, from data analytics to virtual care models and the collaborative creation of digital health tools, is undeniable. Notwithstanding is the urgency behind the matter: delay or inaction could significantly set back the nursing profession, compromising its ability to deliver superior patient care in an increasingly digital future.

The current challenges facing nurses worldwide—intense workloads, staff shortages, and skill mismatches—underscore the urgent need for a transformative approach that prioritizes systemic support and technological empowerment. Embracing digital advancements offers a path to alleviating these pressures, enabling nurses to achieve a balance between their well-being and professional responsibilities. 

About Connie Moser

Connie Moser is a serial entrepreneur with several successful exits to her credit and more than 30 years of experience building healthcare information technology organizations. Connie is known industry wide as a true leader who relentlessly pursues growth through realized customer value, all while building loyal teams that routinely follow her to new opportunities. Connie’s success is data-driven, accomplished through validated growth metrics gained via strategic acquisitions, effective sales bundles, and business process streamlining through automation. As the Chief Executive of Navenio, a UK-based technology company focused on logistical intelligence in healthcare, she is validating her leadership skill with successful revenue transactions as she did as the CEO of Verge Health (now RLDatix) and building a strong presence in the US and global healthcare market. Team empowerment and mentoring younger employees has been a constant throughout her lengthy career and a source of deep satisfaction. Her mentorship extends to her work as a long-time board member of her alma mater Ripon College since 2013.   

In the evolving landscape of the healthcare industry, technology advancements play a pivotal role in enhancing efficiency, accuracy, and helping reduce the workload on overburdened staff. Despite significant progress in interoperability, traditional methods, such as faxing, continue to be a cornerstone of document exchange in healthcare organizations. However, the industry is now turning to Intelligent Document Capture and automated data extraction solutions to propel healthcare workflows into the next generation.

Next Generation Faxing enables Data Extraction

While faxing may seem like a relic of the past, it has evolved to accommodate the demands of the digital era. Many healthcare organizations still rely on faxing due to its trusted security and the familiarity it offers to healthcare professionals. However, as the industry struggles to connect to the myriad of interoperability standards, there is a growing need for next generation faxing functionality.

Secure cloud faxing has emerged as a game-changer in the quest to modernize healthcare workflows. This technology goes beyond the traditional fax machine by leveraging faxing in the cloud, converting analog faxes into a secure exchange network.  Moving to a digital document delivery system, also enables new capabilities that are not available to those on an analog (or POTS) fax line, such as OCR and data extraction.

Improving Efficiency, Accuracy, and Interoperability 

One of the primary benefits of automated data extraction solutions in healthcare is the significant improvement in efficiency and accuracy.  With digital faxes over the cloud, it is easy to convert handwritten or printed text from faxed documents into machine-readable data. This capability not only streamlines data entry processes but also opens the door to a myriad of possibilities for data interpretation and integration.  

By extracting data from faxed documents, healthcare professionals can minimize manual data entry errors and reduce the time spent on administrative tasks. This newfound efficiency allows both clinical and clerical staff to redirect their focus towards value-added tasks and patient care, improving overall healthcare delivery.

The seamless integration of extracted data extracted into Electronic Health Records (EHR) is a significant step towards achieving comprehensive interoperability in healthcare. By populating EHR systems with accurate and contextually rich data, healthcare providers can access a more complete and up-to-date patient history. This integration facilitates improved care coordination, reduces errors, and enhances overall patient outcomes. 

Considerations When Evaluating Solutions 

Despite the promising advantages of secure cloud and digital faxing, challenges such as data security and regulatory compliance still exist. Data extraction processes must also adhere to standardized formats, ensuring compatibility and coherence in information exchange.  

Healthcare organizations must carefully evaluate and implement solutions that align with industry standards and regulations to ensure the confidentiality and integrity of patient information. The ideal solution should also have the scalability and adaptability required to accommodate future regulatory shifts. Most importantly, healthcare organizations should ask their cloud fax providers for third-party attestations of compliance – it is the only way to ensure privacy of your patients’ PHI. 

Overall, in the relentless pursuit of advancing healthcare, secure cloud faxing and data extraction solutions stand out as transformative technologies. By harnessing the power of these solutions, healthcare organizations can move beyond the limitations of traditional faxing, ushering in an era of enhanced efficiency, accuracy, and data-driven decision-making. As the industry continues to embrace innovation, the integration of digital faxing into healthcare workflows is poised to play a pivotal role in shaping the future of patient care.

About Ben Manning

As Director of Product Management at etherFAX, Ben Manning helps to guide the mission and vision of etherFAX by aligning the product roadmap to the long-term strategy. Ben has a proven track record of driving profitable growth for products and services across healthcare IT, pharmaceutical market research, and HR consulting firms. Previously, Ben was Vice President of Product Management at Vyne.

When it comes to the patient experience, time isn’t on our side. U.S. adults spend the equivalent of an entire workday each month coordinating care for themselves and/or their family, according to a Harris poll. The same poll found that 56% of American adults wait more than a week for an appointment, while many others skip healthcare altogether, with 30% saying they don’t have the time and 25% saying it takes too long to get an appointment. Even when patients get an appointment, they wait again (in the waiting room, exam room, and to be checked out) which affect patient satisfaction scores.

The good news is that AI tools are ready to make significant improvements to the patient experience, especially when it comes to giving patients and clinicians their time back. Doing so increases access and leads to better healthcare experiences and outcomes. For providers, better patient experiences also mean higher productivity and improved performance metrics, thanks in part to a 2020 rule from CMS that links the quality of the patient experience with reimbursement. But in order to understand how best to deploy AI tools, we first need to discuss the barriers to care.

What’s standing in the way?

The healthcare system is facing a “perfect storm” of increased demand for services, a workforce shortage, a burned-out labor pool, and rising costs. Healthcare providers are also producing, managing and consuming more data than they ever have before. Today, healthcare data makes up 30% of the world’s data volume, which is impossible for physicians, nurses, clinical assistants and other industry professionals to handle with paper or spreadsheet-based processes. The trillion-dollar US health care industry won’t be able to simply throw people and money at the problem. Instead, the industry needs to use AI and other technologies to do more with less.

On the demand side, the U.S. has an aging population. According to the Office of Disease Prevention and Health Promotion, people age 65 years and older made up 17 percent of the population in 2020, but by 2040 that number is expected to grow to 22 percent, increasing demand for healthcare services. An aging population also impacts the supply of healthcare services. According to the American Nurses Association, nurses are retiring faster than new nurses can be trained. Meanwhile, an aging physician population, along with burnout from the pandemic, prompted the AMA to declare, “the physician shortage crisis is here.” Worse, these supply and demand challenges are further exacerbated by rising healthcare costs. According to a PwC report, in 2024 the industry is facing a 7% year-over-year cost increase, up from 5.5% and 6% in 2022 and 2023, respectively. In addition, more patients are searching for value-based care, which requires healthcare providers to spend more time managing patients proactively, instead of reacting once there is a problem that needs to be addressed. With these combined challenges, it’s no wonder healthcare workers are pressed for time, more stressed and retiring early.

But while this perfect storm undermines the ability to deliver great patient experiences, physicians and healthcare systems also have to consider the challenges around consumer expectations. The paradigm shift is also here, patients are now consumers of healthcare services and demand the same service and attention they get from other industries along with empathy, sympathy and precision medicine. They expect omnichannel communications that flow seamlessly between text, email, and in-person visits. This includes timely responses and status updates, as well as always-on customer service. In other words, patients expect healthcare experiences to mirror the digital experiences encountered everywhere else in their busy lives. But that expectation isn’t being met, according to the Harris poll, which found that 65% of respondents said coordinating and managing healthcare is “overwhelming” and “time-consuming.” 

How AI tools can improve the patient experience

While it’s tempting to think about the futuristic aspects of AI, it’s important to ground any discussion of AI tools in the here and now in order to improve the patient experience. It’s important to use AI tools as a supplement, not a replacement, for human interaction. After all, the goal is to free up time to focus on people and communicate in a timely manner. A Journal of Public Health article is instructive. The authors identified a range of factors that influence patient experience, then grouped them into three interconnected themes:

• Providing safe, timely, and effective treatment 
• Fostering human connections with caring and attentive staff
• Providing a comfortable and healing environment   

Broadly speaking, healthcare providers should measure every AI tool against the impact it has on one or more of these themes. But, for the sake of clarity, let’s address three situations where AI can return time to patients and providers: when accessing care, during provider visits, and after the visit. 

Access

AI tools are especially promising here because so many of the things support staff do to move patients through the system, like scheduling and providing standardized instructions, are ripe for automation. This approach to administrative activities frees up time for physicians to provide value-based proactive, rather than reactive, care.

In fact, automated communication tools that can benefit from AI upgrades are already in use. Improvements to scheduling, routing patients to the correct provider, and instructing patients on what they need to do to prepare for routine procedures, like colonoscopies, are all within our reach. 

If deployed thoughtfully, these tools can super-charge support staff by freeing them up to address specific non-routine issues. But remember, these AI chat tools need to be safe, which means they must be trained on approved, evidence-based data sets, rather than the open web. Moreover, AI-driven communication solutions need to personable, helpful, and easy to use in order to make the best use of a patient’s time.

The visit

Consider an AI tool most doctors are probably already familiar with: transcription. Obviously, an AI transcription tool needs to be HIPAA compliant, but it also needs to make patients feel like their privacy is of the utmost concern. In other words, patients need to be able to trust AI tools as much as they trust the providers who use them. 

How does AI transcription improve the patient experience? Transcription frees up doctors and nurses to spend more time with their patients and sufficiently explain new treatments, the latest test results and other key details. But it’s not just about having more time, it’s about creating quality time when doctors are able to focus on the patient, not the chart. Moreover, an AI tool can integrate communications from other channels (phone, email, text, etc.) into in-person visits, so that providers have the full picture and patients feel listened to, without needing to repeat themselves. 

These kinds of tools also have a positive impact on the healthcare system because AI transcription decreases routine work for providers and administrative staff. AI as the adjunctive faculty takes barriers to care and turns them into improved quality, value, informed decisions and satisfaction. With those extra hours, providers can see additional patients, improving both access and quality of care for everyone. 

After the visit

AI tools can also make a big difference for patients after they leave the doctor’s office or hospital. Currently, providing patients with discharge instructions or instructions for medication is time-consuming, impersonal, and insufficient. Anecdotally, patients see this whenever a prescription is filled at the pharmacy, waiting around for an overworked pharmacist to read us boilerplate instructions. If the patient doesn’t have any questions, it’s just a waste of time and money. But if patients do have questions, it’s often difficult to get timely answers. An AI tool that walks patients through these kinds of instructions on their own time, with accurate information pulled from doctor-approved sources, would be more efficient and cost effective. 

AI also provides a more personal experience because it has unlimited time to repeat instructions and provide answers to follow-up questions that deal with relevant patient information. For example, 87% of hospitals report using pre-translated discharge instructions for patients who don’t speak English. That means non-English speakers are denied the opportunity for personalized discharge instructions. An AI tool could quickly and cost-effectively translate a provider’s personalized discharge instructions, as well as translate question responses, for millions of Americans who cannot access care in their preferred language.

AI Creates the Patient Experience Demanded Today

AI will transform healthcare, but as technology leaders think about next steps, it’s critical to use these tools to provide care that meets today’s patient expectations for quality. Prioritizing personalization that scales to meet rising demand should be the foremost priority. Likewise, healthcare providers need always-on communications tools to expand access to patients who don’t have the time to navigate the current system. Finally, the industry must prioritize AI tools that reduce costs so that human healthcare providers aren’t seen as bottlenecks in a bureaucracy, but instead as trusted and compassionate healers.  

About Michael Zacharski

Michael Zacharski, CEO of Brand Engagement Network (BEN), is a seasoned executive with 20+ years of experience driving growth and innovation in the technology industry. Throughout his career, he has founded and operated multiple businesses, contributing to various utility patents that underpin advertising technology and omnichannel communications. He holds a bachelor’s degree from New York University.

Though AI has successfully been utilized in healthcare for decades, a Pew Research Center survey revealed that 60% are uncomfortable with their provider relying on AI for their own healthcare. 

This dichotomy is therefore likely due in part to a lack of awareness and understanding around the technology. Before the public is forced to understand complex, revolutionary, future-state technological developments in healthcare, they must understand how the technology is safely used today.  Examples of this technology in motion include: 

• The pulse oximeter, also called a plethysmograph or pleth, uses AI to calculate blood oxygen saturation based on the difference in transmission of red and infrared light in pulsating blood. It was developed in 1972 and widely adopted in clinical practice in the 1980s and 1990s.
• The MRI (magnetic resonance imaging) scanner has been widely used and incorporated AI since the 1980s to detect conditions including brain tumors, multiple sclerosis, strokes, and infections. Modern AI applications for MRI can improve the speed and quality of scans and help with interpretation and diagnosis.
• The echocardiography machine, widely used with AI since the 1980s, uses sound waves to show how blood flows through the heart to search for heart conditions. According to this article in the Journal of Imaging, “Artificial intelligence can use raw echocardiography images/videos to automatically provide structural or functional measurements but also to identify disease states. This ability is based on AI’s capacity to automatically analyze features from images that may be too subtle to be detected by the human eye.”
• AI also can accurately identify normal and abnormal chest X-rays, according to this article and this study. 
• Other recent studies show that AI has a 100% success rate in spotting melanomas and a 20% better success rate than human radiologists in detecting breast cancer.

These are just a few of the many AI applications present in medical devices today. Each is an assistive technology that provides accurate measurements to health professionals, enabling them to chart the next steps more effectively. None of the technologies mentioned replace human jobs, but instead, enable healthcare professionals to be more accurate and efficient at their jobs, ensuring the best level of patient care possible. 

Beyond using AI for measurements and image interpretation, the next frontiers of AI in healthcare include information systems, some patient interaction, and even possibly robotic surgery. Here are some guidelines to help ensure accurate and safe AI deployments in new applications:

Start With The Back Office

In addition to developing patient-care applications, there is much that AI can do to help with time-consuming back-office administrative tasks that also improve patient care. These include:

• Clinical data abstraction: AI can be used as an assistive technology to automate painstaking and time-consuming data entry, with a required human in the loop to verify accuracy. This enables healthcare professionals to spend more time on patient care, and less on repetitive manual data entry. AI can also mine the hyperscale data sets of clinical registries and share anonymized treatment approaches including comorbidities and medical histories. This can help improve outcomes for current patients with similar conditions to those successfully treated in the past. 
• Drafts of clinical summaries: Generative AI systems such as GPT can save time by instantly creating drafts of clinical summaries, also called patient-visit or after-visit summaries, based on physicians’ notes. Generative AI correspondence is also a possibility, but like any AI application in healthcare, should never be sent directly to patients without human review, due to the possibility of inaccuracies or hallucinations.

Only Develop AI Applications That Can Access Sufficient Supporting Data

AI requires statistically significant data to operate; small data sets are insufficient for AI algorithms to be accurate. A condition or procedure that involves only 50 patients per year across the United States won’t provide enough data for AI to evaluate, compute a patient pathway or indicate whether, for example, a treatment is a normal or abnormal practice for the population with that condition. AI applications should operate on vast data sets and as wide a sample of the population as possible.

AI Applications for Patient Care Require Many Trials.

AI applications for patient care should not be immediately dismissed as too risky so that progress is not hampered. There are, however, potential quicker wins with back-office applications versus patient care applications (which generally require many trials before being put into practice). All patient-care AI applications should help clinical professionals do their job, as they are not equipped (and never will be) to replace them. Accuracy is paramount, and a human in the loop is essential to operate and interpret AI applications for patient care.

AI Is Not New

Although AI may be perceived as generally new, it was invented in the 1950s and has been included in software for medical devices since the 1970s. Almost all medical devices include AI software, except purely analog devices such as analog stethoscopes and hypodermic needles. If the public were more aware of facts like these, it is likely that some of the concerns regarding AI use in healthcare may subside. 

There currently is an explosion of interest and investment in AI, which is now featured in the marketing materials of most healthcare technology vendors. Before this “AI mania,” which was partially fueled by the launch of ChatGPT in November 2022, AI was usually simply called “software.”

About Matt Hollingsworth

Matt Hollingsworth is the co-founder of Carta Healthcare. His passion for improving patient care developed while helping his mother, a five-time cancer survivor, navigate the U.S. healthcare system and communicate her conditions to providers.

In 2017, Matt Hollingsworth founded Carta Healthcare, dedicated to creating a healthier future by advancing the technology surrounding data practices in healthcare. Today, Carta Healthcare is a leader in delivering improved data-gathering solutions to healthcare systems related to a patient’s diagnosis, treatment, and outcomes. Carta Healthcare’s solutions have revolutionized the processes surrounding registry databases, resulting in markedly faster data collection, superior quality of data, and considerable cost savings for healthcare providers.

Matt holds an MBA from Stanford University, where he also worked in the Systems Utilization Research for Stanford Medicine (SURF Stanford Medicine) lab, researching methods for using information technology to reduce equipment waste and improve patient care. It was through his work at Stanford that he and colleagues founded Carta Healthcare. Before receiving his MBA and founding Carta Healthcare, he was a researcher at CERN (Conseil Européen pour la Recherche Nucléaire) and a member of the team that discovered the Higgs boson, an important discovery in particle physics. Matt received bachelor’s and master’s degrees in physics from the University of Tennessee, Knoxville.

About Dr. Andrew Shin

Andrew Shin, MD, is an Associate Professor in the Division of Cardiology at Lucile Packard Children’s Hospital at Stanford University and the Executive Medical Director, Innovations & Clinical Effectiveness for Stanford Children’s Health. His research has leveraged microsystems, improvement science and high-reliability to better understand the intersection between the quality and efficiency of healthcare delivery. As the Medical Director for Systems Design for Utilization Research for Stanford (SURF MEDICINE), Dr. Shin translates his research to continuously improve the value of healthcare utilizing high-throughput advanced analytics such as machine learning and artificial intelligence. He completed his pediatric residency, along with a dual fellowship in pediatric cardiology and pediatric critical care at Boston Children’s Hospital. Dr. Shin is the Associate Medical Director for Cardiovascular Intensive Care Services and serves as a board member for Pediatric Congenital Heart Association, Carta Healthcare and as liaison for the American Heart Association’s Leadership Committee of the Council on Quality of Care and Outcomes Research.

It’s a perfect storm of financial pressures facing healthcare provider organizations – from rising costs to labor shortages to constrained capacity – that stymies revenue growth. Growing challenges with payer payments only exacerbate these issues. According to a Kaufman Hall report, 73% of leaders surveyed said claims denials, which was the top revenue cycle issue in 2022, had increased in 2023.

The cost of denials is staggering. A recent data analysis revealed that providers spent nearly $20 billion in 2022 on efforts to resolve delays and denials across payers. More than half of the total – about $10.6 billion – came from denied claims that were appealed and ultimately paid. 

The traditional approach for providers has been to rely on medical professionals, including physicians and nurses, to help capture revenue at risk in denied claims by writing appeals. The need to hire clinical expertise to pursue such claims further adds to already substantial costs. The average cost to challenge a $43.84 denied claim will increase by $13.23 for a general inpatient stay and $51.20 for inpatient surgery. With an average of three rounds of appeals, providers are often waiting up to six months after care is delivered to receive payment, which can impact the ability for providers to maintain operational balance sheets. 

Moreover, there is a cascading effect on patients, increasing stress and detracting from the patient experience. For example, if a patient undergoes an outpatient procedure, such as a knee replacement, but then experiences complications that result in an overnight stay, the patient may not even realize their stay could be at issue. Even though the overnight stay was necessary to address complications and prevent deterioration, if the claim is denied, balances may become the patient’s responsibility, and the steps in the process are often confusing for patients. 

Prevent denials upfront

Providers now have the option to apply modern technology – including analytics, automation, and AI – to help improve their claims management processes to not only prevent denials upfront but also identify improvements to continuously hone processes, and efficiently resolve denials that can be overturned. Throughout the process, AI augments human expertise to reduce denials, reduce AR days and improve financial performance.  One method in which AI technologies can help organizations is with coding accuracy and compliance, so claims can be submitted along with appropriate documentation, resulting in fewer denials. 

The typical process for appealing a clinical denial is time-intensive, often requiring multiple rounds, resulting in long payment delays. Using AI technology to ingest, parse, and summarize text portions of the patient record can speed up and improve the entire process. AI-enabled analytics can pinpoint likely denials as well as identify trends by payer, clinical indication, etc. Providers can then focus more attention on those denied claims that are most likely to be successfully overturned. 

AI technologies also equip organizations with valuable data. Leveraging advanced analytics tools, organizations can identify areas for improvement to continuously optimize claims processes from start to finish. With a focus on preventing delays and denials, insights gained from both successful and unsuccessful appeals can be applied to better substantiate each claim upfront in the ever-changing payer landscape. 

Resolve denials accurately and efficiently

For each appeal, a clinician must formulate a strategy by reviewing a patient’s chart – potentially hundreds of pages of history, notes, and summaries – to assess the patient’s situation, treatment, existing conditions, and comorbidities. In minutes, AI can review the patient record and summarize all pertinent information for the type of appeal required, including the key identifiers, an accurate clinical summary, and the clinical argument to substantiate the claim. 

In addition, with manual chart reviews, people may miss key details or overlook important trends. Today’s AI technologies can efficiently and accurately go through the entire patient record in minutes to identify the points critical to depicting the complexity of the patient case. AI doesn’t get tired or experience stress – it can consistently and reliably pull together the data points needed for an effective appeal. 

Using AI in this way makes clinicians appeal editors rather than appealing authors. Instead of reading hundreds of pages and writing from scratch, clinicians review and fine tune the appeal drafted by AI to ensure it presents a compelling, accurate case to the payer. By integrating people services and technology capabilities, the time to resubmit claims can be reduced from hours to minutes – upwards of 75% in time savings. Such time savings on administrative and medical staff offers the added and critical benefit of enabling clinicians to focus on applying their expertise at the top of their license, which reduces their burden, relieves burnout, and improves job satisfaction and staff retention. 

Overcome AI adoption challenges 

Provider organizations evaluating AI solutions for the revenue cycle need to consider governance, change management, as well as policies and procedures to overcome common adoption challenges, including:

• Concern that AI will replace jobs: The best approach – proven by AI’s successful use by leading health systems today – is for AI to support, not replace, human decision-making. Providers should involve end users and other stakeholders right from the start to understand the most pertinent issues, build a solution that truly benefits end users, and gain buy-in along the journey. 
• Compliance and patient privacy: Publicly available solutions, such as ChatGPT, can put organizations at risk. However, adopting a robust framework and a closed environment enables providers to build upon their policies and procedures to productively manage patient privacy and compliance. 

Transform processes for sustainable growth

Healthcare organizations that adopt AI for high-value, high-cost administrative processes, such as clinical claims denials, will be better equipped to navigate today’s healthcare challenges. AI-enabled technologies can help organizations improve efficiency and clinician job satisfaction, more successfully resolve denied claims and apply their success to prevent future claim denials. In addition, AI can make the process more seamless for payers by making appeals more consistent and accurate, requiring fewer iterations. Most importantly, healthcare providers spend more time treating patients, and those patients receive better experiences – from care to cost. All told the resulting increases in revenue and cash flow can put healthcare organizations on stronger footing for sustainable growth, supporting better outcomes for all. 

About Steve Albert

Steve Albert is Executive Vice President and Chief Product Officer for R1. He joined R1 following the acquisition of Cloudmed where he also served as Chief Product Officer. Steve has over two decades of leadership experience in new market development and product innovation for enterprise-scale data management and analytics organizations. He leads R1’s product vision and roadmap, drives product innovation, and helps grow the company through expansion into new markets. Prior to joining Cloudmed, Steve held product and market development leadership roles at 1010data, Mastercard, Equifax, and GeoPhy. He has extensive experience leading and scaling go-to-market, product, and data science teams that delivered product-led revenue growth.

Throughout history, new and emerging technologies have helped revolutionize and advance the field of medicine, allowing medical professionals to develop groundbreaking new procedures, work towards cures to previously incurable diseases, and much more. Healthcare practitioners are always looking for ways to use emerging technologies to transform their work, and today one of the top technologies available to revolutionize the healthcare space is Augmented Reality (AR) and Virtual Reality (VR).

Over the past decade, AR and VR technology have become increasingly mainstream, with devices like the Oculus Rift, Meta Quest and the newly-released Apple Vision Pro making their way into consumers’ hands. As these technologies become more commonplace, they invite new opportunities for medical professionals to integrate them into clinical practices and workflows.—AR and VR have the potential to transform and enhance the way providers deliver healthcare services. 

As the world becomes more interconnected globally, there is an unprecedented need for healthcare professionals to collaborate effectively. AR and VR have emerged as the most optimal and immersive solutions for bringing together medical experts with niche skill sets, even when distance makes it impossible to be physically present. 

The Recent AR/VR Boom

While AR and VR technology has been around for some time, recent advancements have significantly expanded their capabilities in the medical field, from creating virtual environments for simulating procedures and providing hands-on learning experiences to overlaying data and offering immersive feedback for visualizing critical patient information. These applications have been dramatically expanded upon with recent technological advancements; now, doctors can interact with life-size 3D scans of patients, practice surgical techniques in highly detailed virtual environments, and gain deeper empathy by experiencing simulations from their patients’ perspectives.

AR/VR has the power to connect healthcare professionals from different locations, enabling them to collaborate and share their expertise when it matters most. In challenging medical situations, specialists can be brought in virtually to contribute their unique perspectives and skills, ensuring the best possible outcome for the patient. AR/VR can revolutionize medical education by allowing students to collaborate and learn together in immersive, interactive environments. By simulating complex procedures and real-world scenarios in a safe, controlled setting, this technology prepares future healthcare professionals to work effectively as a team and handle real-world situations with greater confidence and skill.

Empowering Medical Collaboration through AR and VR

When adopting AR/VR technologies, healthcare professionals must consider both the benefits for their practice and patients, as well as the technological requirements for successful implementation. Doctors should approach these technologies with a threefold perspective, assessing how they can address their challenges, enhance patient care, and drive innovation in the medical field. Professionally, AR/VR can streamline workflows, improve diagnostic accuracy, and facilitate remote collaboration. For patients, these technologies offer enhanced education and personalized treatment plans, tailored to each individual’s unique needs and preferences.

However, to successfully implement AR/VR in medicine, healthcare providers must ensure seamless integration and optimal performance. Communication via AR/VR technologies must operate on a strong and reliable network infrastructure to prevent disruptions during critical procedures. Healthcare providers must work closely with technology partners to ensure that the communication and collaboration functionality in their AR/VR systems are built on a solid foundation of high-speed, reliable, low-latency networks. Latency and signal loss could be a challenge in medical settings, particularly during remote collaborations and training where issues could prevent everyone from being on the same page and seeing important demonstrations in real time, which could in turn affect a doctor’s performance when presented with the scenario in a life-threatening situation.

In addition to network performance, privacy and security should be top priorities to prevent breaches of patient data. AR/VR systems should be designed with robust security measures that comply with relevant healthcare regulations, such as HIPAA. These measures should include HIPAA compliance, end-to-end encryption, access controls and SOC2 compliance/ISO certification to protect sensitive patient information. 

As AR and VR technologies continue to advance, their potential to transform medical collaboration and improve patient care is immense. By addressing the challenges and embracing the opportunities presented by these technologies, the healthcare industry can look forward to a future where distance is no longer a barrier to providing the best possible care to patients worldwide.

Looking to the Future

The AR/VR healthcare market is projected to reach $9.7 billion by 2027, indicating the value and importance of these technologies in the space. As technology advances, practical use cases and possibilities will expand. AR overlays will become more immersive and interactive, with new use cases like augmented surgery already emerging. Soon, doctors will interact with AR overlays remotely, conducting advanced procedures and collaborating on cures globally.

Collaboration has always been the key to medical advancement, with groundbreaking discoveries and lifesaving cures resulting from combined knowledge and skills. AR/VR now allows doctors to collaborate in immersive virtual environments, providing real-life and hands-on experience. This technology is crucial for improving medical innovation and patient care, driving the field of medicine forward.

About Wyatt Oren

Wyatt Oren is the Director of Sales for Education, Future of Work, and Telehealth at Agora, a global leader in real time communication, classroom technology, and virtual learning. In his role, Wyatt helps businesses, entrepreneurs, and institutions make experiences within AR/VR, mobile, metaverse, and desktop applications more engaging for users. Before joining Agora, Wyatt co-founded the EdTech platform, Applejax, as well as the social app, Barhero Inc, which went on to be acquired by Airtab, inc in 2018.

When interacting with industries such as retail, hospitality, and finance, we’ve all become accustomed to quick, effective, and personalized customer service. It’s no surprise that when it comes to healthcare, consumers are now seeking a better customer experience on par with the quality of the clinical care they have come to expect. Today’s members and patients are looking for their health plans and providers to accommodate their technology preferences and provide convenient, empathetic, and helpful interactions as they navigate the healthcare ecosystem. 

An Accenture report found that navigation difficulties, including challenges with digital/online services, were driving factors for 80% and 49% of individuals who left their provider and payer groups, respectively. It is clear that healthcare organizations must adapt their technologies based on evolving expectations to avoid losing business – and deploying advanced, intelligent digital consumer experience (CX) solutions that incorporate AI can be a game-changer. 

To maximize the potential of digital tools in enhancing member/patient engagement, satisfaction, and growth, organizations must tailor them to target segments’ specific needs, ensure they provide a human-centric element, and establish appropriate AI safeguards.

Customizing CX strategies for diverse populations

Healthcare consumers are growing increasingly open to adopting digital solutions, driven by the convenience factor and desire for greater control over their health, but age and socioeconomic factors can strongly impact needs. Populations covered under Medicare, Medicaid, Marketplace, and Commercial insurance plans have diverse levels of tech-savviness and access, and customizing digital solutions to align with these distinct customer segments is crucial to ensure adherence to care plans. 

Medicare’s older generations typically value clear instructions, support, and easy access to human representatives and may require straightforward solutions (i.e. mailed communications and calls from advocates). In contrast, Medicare’s younger consumers anticipate advanced features like health tracking and integrated data and are more inclined to engage via digital communication channels (like chatbots, Interactive Voice Response/IVR, websites, and SMS) and the latest health apps. 

In the case of Medicaid, where the population may have limited internet availability and rely on basic mobile devices, healthcare organizations should implement low-bandwidth digital solutions to optimize engagement and yield more favorable outcomes. 

Marketplace and Commercial consumers, typically accustomed to the latest digital innovations, expect personalized care and fitness and health management tools. Wellness programs and integrated lifestyle apps will enhance their overall experience. 

Boosting engagement with personalized, human-centric experiences 

According to McKinsey & Company, 76% of consumers report being frustrated by impersonal interactions. Differentiating customers’ experiences and providing a human-like connection is critical to their satisfaction, and individuals are more likely to engage when they are comfortable with the technology at work. 

Healthcare CX solutions should be able to offer multiple contact channels – such as email, chat, voice, and SMS – based on the individual’s preference, and organizations can further optimize engagement by equipping users with straightforward ‘how-to’ guides for digital resources. One health plan that implemented omnichannel outreach for members with pre-existing conditions realized a 300% increase in appointments scheduled and more than 100K member-initiated calls. 

Call center advocates’ ability to ‘actively listen’ to the customer is another critical component of a human-centric experience and plays a vital role in continuously refining and enhancing solutions. Organizations can leverage AI’s abilities to understand the customer’s voice, capture notes during calls, analyze speech and sentiment to help prompt the next best action, and train agents. This application of technology also alleviates some of the multitasking that falls on advocates, enabling them to focus their attention on the customer. In the example of a health plan that assisted newly hired advocates with AI-based tools, advocates achieved 15% higher accuracy and 12% higher member satisfaction than those without the support tools. 

Organizations should augment their AI capabilities with the human touch, especially in complex customer support scenarios, and tools must be trained in empathetic interactions that address not only the patient’s/member’s immediate needs, but also anticipate their future requirements. Human-centric communications are key to enhancing engagement, efficiency, productivity, and CX.

Applying safeguards to avoid potential AI pitfalls 

Understandably, uncertainties exist around trust, credibility, and lack of humanistic care in AI-based solutions, as the technology is relatively new. Incomplete, inconsistent, and inaccurate data can potentially introduce biases and errors into the analysis, affecting reliability and validity and hindering data exchange and collaboration abilities. AI systems need a significant amount of data for training, reducing concerns around security and patient privacy. Additionally, the lack of standardization hampers the integration of advanced technologies like AI, and lagging legislation and policies in this area open doors for liability issues. 

Fortunately, there are ways to mitigate these challenges, such as establishing well-thought-out data strategies for standardizing data practices and implementing interoperability frameworks. Establishing zero-trust security approaches, utilizing AI to augment human decision-making, and prioritizing patient-centric care are equally crucial to safeguarding members’/patients’ security, earning their trust, and accelerating adoption.

Emphasis on CX continues to grow

CX has become a necessity throughout the entire healthcare landscape and leaders are taking notice. Harvard Business Review Analytics Services found that 60% of surveyed healthcare executives consider CX improvements a priority. As consumer expectations continue to rise based on other industries’ rapidly accelerating capabilities, healthcare is at a crossroads in which it must leverage new tools or risk falling behind. Ultimately, healthcare consumers’ satisfaction is key to keeping them engaged in their care plans, improving outcomes, and enabling organizations to thrive amongst competitors.

About Becky Watkins

Becky Watkins is the Senior Vice President, Client Solutions, at ResultsCX and is responsible for building the company’s integrated go-to-market strategy for business development and serving as the senior point of contact for all clients. Becky brings over 30 years of experience to ResultsCX, with experience from the BPO industry, including an extensive 10 years dedicated to healthcare solutioning and outsourcing.

Employers incur approximately $575 billion each year due to their employees’ poor health, and the number of employees who spend at least $100,000 a year on medical care rose by 50% between 2013 and 2021.^, Much of these costs are driven by fragmented care, improper benefits utilization, and poor health literacy.

Today, members have greater choices regarding where they receive their care. In a single year, they may use an urgent care center, a pharmacy clinic, a retail clinic, a specialist, and a telehealth service. While it is convenient to have so many options, there is no single point of care overseeing the member’s best interest. This can lead to conflicting care plans, duplicate tests, medication interactions, greater costs, and poor outcomes. 

A great way to mitigate this type of fragmented care is to engage members in a way that helps them better understand their unique health needs and how best to utilize their benefits for the best outcomes and lowest costs. Doing so also helps improve a member’s health literacy, or “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” High health literacy is essential for proper utilization and optimal outcomes. Low health literacy is estimated to cost employers and insurers $4.8 billion annually in excessive administrative costs.

How to promote member engagement

The word “engagement” is not the same as “touches.” Touches might constitute employee emails or meetings that include information about their benefits or how to develop healthy lifestyles. These are valuable, but they don’t constitute true engagement. Active engagement is when members take action to engage with caregivers, seek education about their unique health needs, and know how best to navigate the healthcare system to get the care they need. 

The following five elements are essential to an effective active member engagement program:

• Includes care navigation, case management, disease management, and utilization management
• Provides personal health nurses—registered nurses with diverse clinical experience 
• Actively facilitates member-provider engagement to reduce the risk of fragmented care
• Customized to each member’s goals and unique health needs
• Includes assessments of non-medical factors like SDOH

How an active engagement program benefits employers

There are numerous benefits employers can realize by implementing an active member engagement program. These include the following:

• Can lower medical costs by 5.3% and reduce hospitalizations by 12.5% through enhanced support for better decision-making 
• Reduce overall medical costs through improved benefits utilization
• Lower absenteeism and presenteeism
• Improve member health and productivity
• Enhance member satisfaction with their medical benefits

According to Healthcare Finance, “Proactive efforts by health plans to engage with members – by providing advice on how to control costs or helping to coordinate care – drive significant improvement in overall customer satisfaction.”

How an active engagement program benefits members

Members who are more engaged in their healthcare journey take greater responsibility for making changes needed to improve their health. Additional benefits include the following:

• Customized care and guidance through personal health nurses (PHNs) for reduced fragmentation and optimal outcomes
• Support for chronic conditions with continuous monitoring, medication management, and guidance for their specific health condition(s)
• More timely interventions to prevent minor issues from becoming major health problems
• Sustainable behavioral change through improved accountability and healthier habits
• Prioritization of preventative care for a better quality of life

Success Story

A multi-national manufacturer implemented an active member engagement program to promote better primary care utilization and to provide better benefits navigation using personal health nurses (PHNs). The PHNs provide an individualized approach that helps members better navigate the care continuum to find the right care in the right setting at the right time. The program included the following elements:

• Dedicated one-on-one collaboration and care planning with a registered nurse
• Interventions that coordinate care, medications, and other benefits and resources
• Technology that prioritizes highest-risk members for outreach and engagement
• Integration with health plans, pharmacy benefit managers, third-party administrators, healthcare provider networks, and other benefit solution vendors

Once high-risk members were identified within the manufacturer’s 40,000 regional workforce, the company implemented a multipronged engagement plan that included:

• Deploying community-based PHNs to facilitate conversations and discover opportunities to coordinate care and eliminate barriers to care access
• Multifaceted campaign to promote program awareness, including print, web, and social media
• Virtual health fairs
• Navigating members to the proper level of care, including bidirectional referrals with behavioral health benefits provider

The results were beyond the company’s expectations and included:

• 85% employee engagement
• 95% employee satisfaction
• 3.13:1 return on investment

The bottom line

It is unlikely that healthcare premiums will come down anytime soon. Therefore, employers need to do all they can to help improve their employees’ health. Employing an active member engagement program is an excellent place to begin. 

About Mary Bacaj, Ph.D.

As President of Value-Based Care (VBC) for Conifer Health Solutions, Mary Bacaj is responsible for leading the company’s business unit that delivers population health management and financial risk management services to more than 250 organizations. Conifer VBC is uniquely positioned as a partner to employers and unions, risk-bearing healthcare providers and health plans.

Mary joined Conifer Health in 2014 as Vice President of Strategy to help the company identify and implement solutions that ensure individuals receive the right care at the right time, while healthcare providers are aligned to improve the health of the population. She is a recognized subject matter expert in pay-for-performance programs, hospital and physician alliances, and healthcare reform.

Prior to joining Conifer Health, she was an Engagement Manager at McKinsey & Company, where she worked with senior executives at health systems and health technology companies on strategic challenges, such as population health management, hospital and physician mergers and acquisitions, and risk-based contracting.

The synergy of artificial intelligence (AI) and medical imaging has opened new horizons for healthcare. AI-mediated computer vision has been in use in oncology for more than 20 years; however, its arrival in other medical fields, notably dentistry, is more recent. Dentistry is particularly notable here, because while relatively few people have seen an oncologist, almost everyone sees a dentist at least every few years. The application of AI in dentistry, thus, extends to a much broader population. Rapid advances in AI oblige us to consider system design choices in light of possible futures that we may discern only indistinctly today. In healthcare, the stakes are high–higher, arguably, than in any other areas of AI deployment.

The family of machine learning algorithms most often used in medical imaging and diagnostic applications is called “discriminative,” as they are techniques for discriminating between existing data points. Discriminative systems are trained to classify data in order to determine the likelihood that a feature exists in the signal data (an early-stage lung nodule in a chest CT scan, for example). These algorithms should not be confused with the “generative” algorithms applied in popular new AI tools like ChatGPT or DALL-E, which create – or “hallucinate” – entirely new data points that in some way resemble the data on which they are trained. 

The ability to fabricate outputs so believable that we are unable to see that they are fabrications has raised concerns about the application of generative algorithms in some arenas–including medicine, where human health is at stake. Those concerns will no doubt moderate the deployment of generative algorithms in healthcare. The algorithms with the greatest immediate utility in medicine, however, are discriminative. Discriminative algorithms are measured by the objective accuracy of their output, not their semblance of accuracy, and, like all machine learning algorithms, they are able to ingest and draw value from data at a rate that far exceeds human capacity.

The linkage between AI and data clearly has enormous potential significance for medicine. Unfettered access to medical data hones the precision of diagnostic tools and the ability of AI to detect patterns in large volumes of data will reveal connections and interactions that we do not now suspect. The bottleneck of hypothesis – the requirement to begin with a theory in order to define and obtain funding for medical research – is eliminated when the data itself yields answers without waiting for questions to be asked.

Currently, medical information systems are largely of the “walled garden” type: They are held within a practice, insurer, or medical center with limited outside access. In order to make the best use of data generated within these systems, methods of anonymizing and pooling large masses of patient data will be needed, together with scalable AI systems capable of scouring immense reservoirs of multimodal data. 

Of course, unchecked access to medical data adds to the ethical considerations that attend any discussion of AI-integrated healthcare. As AI technologies require vast amounts of data to improve accuracy and efficacy, the question of how to protect patient privacy while leveraging data insights becomes increasingly complex. The General Data Protection Regulation (GDPR) in Europe and the Health Insurance Portability and Accountability Act (HIPAA) in the United States offer frameworks for data protection and privacy, but they currently fail to account for the considerable value that data brings. 

As interoperability of digital systems continues its exponential growth, we can expect an overwhelming increase in the novel information that is produced by AI. Consider that the rapid advancement of AI technologies often outpaces regulatory measures, however, and it becomes apparent that finding an ideal balance between innovation and privacy will require considerable effort from all corners of the healthcare system. That effort must begin with thoughtful collaboration between policymakers, technologists, and healthcare providers.

To maximize tomorrow’s benefits, we need to think today about the most efficient ways to foster interconnectivity and the most effective ways to overcome complex questions about privacy, ownership, intellectual property, and system supervision. We should, for example, develop ethical guidelines around health data that account not only for the privacy of patients (as GDPR and HIPAA do) but also for the benefits that new innovative technologies can bring to patient care.

In medicine – as opposed to, say, advertising – data is a public good. The challenge for medicine in the digital age will be to find ways of pooling information for the common benefit of all patients, while still protecting individual privacy and preserving the privatized nature of our healthcare system. 

About Cambron Carter
Cambron Carter is the Co-Founder and Chief Technology Officer at Pearl, the global leader in dental artificial intelligence solutions. Prior to co-founding Pearl, Cambron served as the Director of Engineering, Computer Vision at GumGum.

Patient data interoperability sounds like industry jargon, but it’s a vital piece of providing timely and accurate patient care. Since 1996, when the Health Insurance Portability and Accountability Act (HIPAA) became law, there have been good advances in patient data interoperability, but as a whole, the industry has not embraced them. 

Sharing data through faxing and CDs is still very common. As recently as 2023, between 30  and 47 percent of hospitals across all sizes reported still using fax or mail to send and receive patient records, according to the Government Accountability Office. 

Only 40 percent of hospitals electronically integrated data from other hospitals outside of their system and a meager 30 percent of skilled nursing facilities exchanged data outside of their walls, according to the Office of the National Coordinator for Health Information Technology. 

Relying on outdated record-sharing methods can delay the opportunity for patients to take advantage of life-altering care. Hospitals and healthcare systems can do better.

The time to referral should be days, not weeks (or longer)! A leading opportunity to improve patient outcomes is by decreasing the time it takes for patients to receive appropriate treatment and get on the road to recovery as quickly as possible. 

Healthcare interoperability – it’s so promising, but confusing at the same time. 

In 2009, the Health Information Technology for Economic Clinical Health Act (HITECH Act) was passed, incentivizing the use of electronic medical records (EMRs). This drove the use of Electronic Health Record systems (EHRs) in acute care hospitals to 84 percent by 2015. As recently as 2022 the Trusted Exchange Framework and Common Agreement (TEFCA) was published to establish universal governance and policies for interoperability, simplify the secure exchange of information and allow individuals to gather their healthcare information. 

While we have made leaps, the challenges are still vast. The number of channels to obtain records has grown: 

• Direct to provider
• Direct to ROI (release of information) vendor
• HIE (health information exchange)
• Network

Within those channels, there are still a wide array of methods for information to be exchanged: 

• API
• Portal
• Secure messages
• Fax/call
• Mail

Progress has been made, and the infrastructure is there, but it’s not being leveraged by everyone or even by every organization. This makes the process more complex than it needs to be. If a provider needs records and images for a patient, where do they start? In which channel do those exist? What is the fastest method to receive them? How do they request and receive those records? The list of questions goes on and on. 

Now is the time for healthcare systems to embrace interoperable technology to gain a competitive market edge and improve patient outcomes. 

We have the capability to seamlessly collect, clinically organize and deliver comprehensive medical histories for patients — but why are hospitals and clinics still sending faxes and calling providers? If these organizations were to fully embrace the available technology, it would not only improve patient outcomes but enhance the clinician experience as well. 

One of the largest delays in care is caused by the time it takes to collect, organize and deliver medical histories. Without access to a patient’s comprehensive past, that critical first appointment can be delayed for days or weeks and can negatively impact potentially life-changing treatments. 

Maximizing healthcare interoperability and even integrating technology like Artificial Intelligence (AI) can help efficiently determine the best, most efficient route to gather and request complete medical histories. This allows medical professionals to offer patients more immediate care and enables enhanced communication between physician providers and patients. 

The benefits of embracing healthcare interoperability include improved clinician experience, more meaningful first appointments, reduced patient leakage, reduced time to treatment and improved patient outcomes. Leveraging EHRs and supporting healthcare technology helps providers connect efficiently with other providers and release of Information (ROI) vendors, HIEs and networks in the right way. From there, clinically organized, comprehensive medical histories can be delivered in a timely manner. 

Instead of physicians waiting days or weeks and then having to sift through hundreds of pages of disparate medical records to find a few items of importance, healthcare systems can embrace interoperability and AI to decrease the time to treatment for patients. Requests for records, images and pathology materials can be received directly through EHRs and, in turn, a clinically organized, complete medical history can be delivered. That information can also appear seamlessly within the clinical workflow. 

Clinicians can avoid the need to hunt for information within a mountain of unorganized records and, instead, spend more time focusing on their patients.  

Let’s all keep the goal in sight: Advance the delivery of life-altering care by providing clinicians with clinically organized patient histories in a timely manner—a top solution to help improve patient outcomes. 

About Dan Torrens

Dan Torrens is CEO of eHealth Technologies, a leading healthcare technology company advancing the delivery of life-altering care through innovative record retrieval and image exchange solutions. 

Medicare providers in hospitals and skilled nursing facilities (SNFs) are adjusting to new split/shared services documentation and billing regulations rolled out by the Centers for Medicare and Medicaid Services (CMS) as part of the 2024 Medicare Physician Fee Schedule (MPFS) final rule. The most notable change within the new regulations, which took effect on Jan. 1, 2024, is the finalization of CMS’s definition of the “substantive portion” of a split/shared evaluation and management (E/M) visit.

First introduced in 2022 in response to public comments asking CMS to allow either time or medical decision-making (MDM) to serve as the substantive portion, the 2024 definition of split/shared services  is: 

“More than half of the total time spent by the physician or nonphysician practitioner performing the split (or shared) visit, or a substantive part of the medical decision making,” 

Understanding who is considered to have spent the substantive portion of the visit is crucial in 2024 as it determines who will bill Medicare for such visits. 

The Definition in Action

The new split/shared services billing requirements apply only to services provided in hospital or SNF settings (no office visits) when patients are seen during a primary E/M visit by both a physician and a nonphysician practitioner (NPP) such as a physician assistant, advanced practice registered nurse, nurse practitioner, clinical nurse specialist, or other nonphysician provider. Under the previous year’s rule, physicians would typically bill for the time spent by any number of clinicians to see, examine, consult with, and treat the patient using an FS modifier to denote the shared charges. Now, however, the billing or listed provider must be the person who spent the majority of time or MDM on the patient encounter.

To determine who reports the split/shared visit and which code level is used, CMS relies on the list of activities included in CPT E/M Guidelines that count toward total time, according to The American College of Surgeons. Those activities include:

• Preparing to see the patient
• Obtaining and/or reviewing separately obtained history
• Performing a medically appropriate examination and/or evaluation
• Counseling and educating the patient, family, and/or caregiver
• Ordering medications, tests, or procedures
• Referring and communicating with other healthcare professionals, when those actions are not reported separately
• Documenting clinical information in the electronic or other health record
• Independently interpreting results that are not separately reported and communicating those results to the patient, family, and/or caregiver
• Care coordination that is not separately reported

According to CMS guidelines, physician and NPP time does not include the following activities:

• Performing other services that are reported separately
• Travel
• Teaching that is general and not limited to discussion required for management of a specific patient 

Finally, the AACP reports that documentation under the 2024 split/shared services rules should identify both practitioners. However, the medical record should be signed and dated only by the billing practitioner.

Taking Action

Complying with the 2024 split/shared services regulations will necessitate adopting new coding and auditing workflows. Coders and auditors will also need to outline documentation processes to ensure appropriate documentation is captured during patient visits and MDM – physician vs. NPP – must be appropriately reported to ensure compliant billing for split/shared services. While CMS does not define “appropriate documentation,” Coding Intel shares that “the only way for a physician and NPP to describe his/her contribution to the service is to document an individual note describing the portion of the service (they) performed.”

Physicians and NPPs will need to be trained on these documentation needs, which will also necessitate updates to claim scrubber software.  Finally, documentation processes must ensure time records don’t show overlaps between physicians and NPPs, who are likely to require credentialing with payors to obtain a billing identification number.  

Minimizing Challenges 

Successfully adjusting to 2024 split/shared services billing requirements calls for comprehensive education for auditors, coders, and providers, along with a proactive audit strategy and deployment of robust technology tools to support billing audits.

Given the broad impact of these new split/shared services policies, internal audit workflow tools capable of separating the servicing provider from the billing provider during the audit process would be a sound investment. These tools provide the granularity auditors need to identify instances when the service provider does not match with the service provided. They also enable an improved root cause analysis for ferreting out process errors and provide valuable feedback to informed targeted ongoing provider and coder education. 

The 2024 split/shared services billing rules provide greater transparency into care processes and better align reimbursement. Nonetheless, impacted providers and organizations are understandably apprehensive over the potential impact they will have on day-to-day workflows, timely compensation, audit risks, and the bottom line – all of which can be minimized with a proactive strategy encompassing education, audits, and workflow tools. 

About Shanta Lewis

Shanta Lewis, CPC, CRC, CPC-I is the Product Owner at MDaudit, a company that enables healthcare organizations to reduce compliance risk, improve efficiency, and retain more revenue streams by providing workflow automation, risk monitoring, and built-in analytics and benchmarking capabilities – all in a single integrated cloud-based platform.

In 2022, the Centers for Medicare & Medicaid Services (CMS) proposed the creation of a centralized physician directory. The proposal sought to address three pressing challenges facing both healthcare providers and patients within the United States healthcare system:

• Fix the pervasive issue of inaccuracies and inconsistencies in provider directories. Studies have consistently revealed high error rates in directory listings, with inaccuracies ranging from incorrect contact information to outdated network affiliations.
• Promote transparency and empower healthcare consumers. A centralized physician directory would offer patients a comprehensive and standardized source of information, enabling them to make informed decisions about their healthcare providers.
• Combat physician burnout by fixing administrative inefficiencies faced by healthcare providers. 

Any such centralized database is likely years away from becoming a reality, leaving healthcare providers stuck maintaining their own directories. It may seem straightforward, but the unfortunate reality of provider data management necessitates immediate action.

Directory Challenges and Why They Matter

Manually sending directory updates to insurers is a burdensome task that costs practices nearly $3 billion each year. It requires physicians to spend hours updating data rather than delivering direct patient care, and it still doesn’t ensure accuracy. Recent research found that physician information held within directories of five major national health insurers was inconsistent in four out of five entries.

This isn’t a shot at providers; far from it. Managing directory data such as location, specialties, contact information, and network affiliations is hard, mainly because it’s constantly changing. Who can blame medical practices for struggling to keep up when a third of directory information changes every year? What’s more, there is no standardization for sharing updates; quite the opposite. Data exchanges between payers and providers occur through disparate methods, such as faxing, sharing spreadsheets over email, data scraping, and cold-calling, rather than on a shared platform. For providers coordinating with numerous health plans, each with its own method of sharing provider information, the complexity of directory management escalates exponentially.

The regulatory landscape only strengthens CMS’ case for a centralized physician directory. The implementation of the NSA intensified the need for providers to submit data more frequently to avoid non-compliance. Still, directories too often lack the capability to identify non-compliant entries, hampering regulatory adherence and data accuracy. When a single incorrect entry can levy heft fines on providers and payers alike – and lead to patients facing delays in care access – the stakes of inaccurate provider data are laid bare. 

The Role of Automation in Driving Provider Value 

The infrastructure to create a transition to a centralized directory is woefully lacking. And while the merits of such an initiative are debated, the challenges healthcare providers face in maintaining and updating provider information continue to mount. The fragmented directory landscape contributes to data inaccuracies and places significant burdens on providers that waste revenue and delay patient care. 

Although health systems and payers require more robust technological frameworks to support the transition to a unified provider directory, there is reason to be optimistic that industry improvements are on the horizon. Yes, the challenges healthcare providers face in maintaining and updating provider information are undeniable, but agnostic, technology-enabled solutions that facilitate seamless data exchange and synchronization processes are helping.

Last year’s CAQH Index tracked $89 billion spent conducting administrative transactions and found the industry can save $18.3 billion by transitioning to fully electronic transactions. By embracing data management platforms that centralize data exchange, healthcare systems and payers can alleviate provider burdens, improve patient experiences, and ultimately ensure better outcomes for all. Of course, these solutions must address key challenges such as data fluctuations, standardization issues, and regulatory compliance. 

The traditional approach, reliant on manual processes, is no longer sufficient, necessitating the adoption of neutral solutions for accurate data exchange. Automation has emerged as a critical solution to overcome these hurdles, offering the ability to update and synchronize provider information in real-time, continuously. By automating tasks such as data entry, validation, and updating, healthcare providers can reduce administrative overhead and devote more resources toward delivering high-quality patient care.

About Eric Demers, CEO Madaket Health

Eric Demers is the CEO of Madaket Health. He believes we can transform healthcare delivery through the power of data and interoperability. With more than 25 years of global healthcare experience, Eric has built and scaled leading technology and service companies, from early stage to Fortune 100. He is highly sought-after for speaking and consulting on international health, having advised global entities and governments on critical issues facing healthcare. A growth-minded leader, Eric has founded three companies and exited two. Eric previously served in strategy-focused executive roles at IBM, Accreon, MEDecision and Orion Health. He is a graduate of Brandeis University and The George Washington University School of Medicine and Health Sciences.

The biopharmaceutical market within the Japan and Asia-Pacific (JAPAC) region has grown consistently since 2010, specifically for emerging biopharmas (EBPs). In fact, in 2018, 80% of all biopharma pipeline projects in JAPAC were EBPs, accounting for 75% of the total clinical trial volume in the region. This growth benefits contract research organizations, pharma organizations and patients alike, but several factors must be considered for drug development safety and regulatory operations in JAPAC countries.

Global health authorities in differing regions have varying requirements, so successfully launching a drug program requires in-depth knowledge and expertise of each authority’s specifications. For the JAPAC region, this includes particular quality and compliance standards, as well as cultural nuances. In this context, the key to navigating safety and regulatory requirements lies in understanding the areas that set JAPAC countries apart.

The distinguishing factors

JAPAC countries have unique safety and regulatory distinctions compared to the typical standards of the rest of the world. Unlike most other countries that accept English language resources, Japan and China, for example, require bilingual language proficiency to process adverse event reports, provide updates to global counterparts and submit regulatory reports to the local health authorities. As adverse events are processed within a bilingual database, operational staff within the organization must be proficient in reading and writing. Management staff must share updates with global counterparts, so speaking proficiency is required on their part. 

While all regulatory authorities have high standards for quality and compliance, Japan’s health authority, the Pharmaceuticals and Medical Devices Agency (PMDA), and China’s health authority, the National Medical Products Administration, are especially stringent. Both authorities expect 100% compliance from organizations operating within their boundaries

The JAPAC landscape: Requirements in Japan and China

Across the countries in JAPAC, Japan and China are countries with more rigorous compliance requirements. We will dive into some of their processes to illustrate how in the same region the steps taken for compliance differ. 

Japan’s PMDA has many safety and regulatory distinctions. In terms of good pharmacovigilance practices, there are three designated roles for the marketing authorization holder (MAH): Souseki, Anseki and Hinseki. This team works together to maintain quality and compliance for an organization. Their main responsibilities include training, self-inspection, detailed recordkeeping and early post-marketing pharmacovigilance, which is required for all newly approved products. 

In fact, for six months post-launch, appropriate usage information is shared with medical institutions and any adverse drug reactions are monitored closely. It is the responsibility of the MAH, and the Souseki, Anseki and Hinseki, to ensure work is performed in compliance with both the pharmaceutical company’s procedures as well as regulatory standards. In terms of outsourcing, the service provider is expected to complete annual self-inspections at every operations site. 

Furthermore, an in-country clinical caretaker (ICCC) is appointed if the MAH does not have a presence in Japan. The ICCC is responsible for reporting safety information from global clinical trials and post-marketing adverse events to the PMDA. They are also in communication with the sponsor, who is the MAH of the active pharmaceutical ingredient. 

In comparison to Japan, China has fewer distinctions. While the country adheres to the guidelines provided by the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use, there are some additional requirements. The MAH, in this case, must have a designated safety point of contact, and if outsourcing, the requirements for the pharmacovigilance system master file (PSMF) should be fulfilled. Though there is no language requirement for a PSMF, the document is required to be written in Chinese if the product is only marketed in China. For global distribution, a PSMF in English is necessary to avoid repeated translation.

China also requires a local person for pharmacovigilance (LPPV) to ensure consistency at a local level as well as a regional level. As per the LPPV requirements, within the first 30 days of receiving the initial drug approval certificate, the MAH is expected to complete registration in the National Adverse Drug Reaction monitoring systems. Subsequent updates are required to be provided within 30 days of the change date.

Understanding the requirements 

For organizations starting in the JAPAC region as an EBP, creating a structure aligned with all local requirements is critical. A staff with bilingual language proficiency will also be extremely beneficial, particularly if the organization plans to move into Japan, as this will eliminate silos and communication gaps between Japanese and global PV counterparts. 

It is also key to rely on technology that can handle, manage and analyze large data sets. This enables organizations to bring fully compliant products to market more efficiently. The applications of technology for JAPAC safety and regulatory operations are vast, and these may include:

• Bilingual safety databases support case processing efforts in Chinese and Japanese
• Artificial intelligence-empowered translation tools reduce the time and effort required for manual translation
• Robotic process automation is an asset for foreign case assessment and entry for PMDA reporting 
• Workflow management tools improve case allocation, monitoring and compliance 
• Narrative automation customizes and creates templates

Technology can be one crucial component for operating in the JAPAC region. By relying on advanced solutions, organizations can successfully launch a drug program with efficiency and accuracy. 

Ensuring patient safety and product efficacy while maintaining compliance with regulatory standards is critical, and the right technology and human knowledge of regional nuances can help ease the transition into the JAPAC region. 

As the region’s biopharma market continues to rapidly expand, organizations must understand the challenges and different needs of the countries they operate. EBPs will need to plan for success and build strategies that map the unique requirements of the countries in which they are developing different initiatives.  

About Hye Jin Choi, R. Ph., Senior Director of Regulatory Affairs and Drug Development Solutions, IQVIA Asia Pacific

Hye Jin Choi joined IQVIA in 2018 and provides regional leadership of Regulatory Affairs and Drug Development Solutions for business expansion across JAPAC. Hye Jin leads the efforts of client engagement and integrated solutions. She interacts with various JAPAC biopharma companies with global drug development ambitions. She also offers regional and global regulatory advisory for proposal strategy development and closely collaborates with IQVIA’s regulatory and drug development leaders to help customers who require regulatory expertise for business in the global markets.  Located in South Korea, Hye Jin has over 29 years of experience across the various healthcare industry sectors, including biomedical research institutes, R&D-based biotechs, and global CROs.

About Dr. Jayawant Fuke, Senior Director of Lifecycle Safety, IQVI
Dr. Jayawant Fuke joined IQVIA in 2019 and provides leadership for the JAPAC regions for Safety Operations, Medical Information and Project Management. Jay provides operational and strategic oversight for safety projects in the JAPAC region and works closely to develop JAPAC centric solutions and operational delivery plans. Located in India, Jay has over 16 years experience managing large global deals in pharmacovigilance.

The digital market is flooded with health apps. Over 90,000 offers were introduced to patients and healthcare providers alike in 2020 alone, with this number continuing to rise in response to mounting healthcare system pressures. 

It therefore comes as little surprise to learn that 53% of all digital health apps are uninstalled within 30 days of download. People are more than happy to trial them but fail to achieve continued adherence, oftentimes because the app hasn’t provided them with sufficient value to justify usage.

Standing out and ensuring app ‘stickiness’ has thus become imperative, especially considering that even successful, well-developed ventures can fail if continued adoption doesn’t follow. Take Pear Therapeutics, for example, which recently went bankrupt, although its reset substance use disorder program was the first ever digital therapeutic tool to receive FDA clearance. 

So, how can the hurdles to continued healthcare provider (HCP) and patient adoption be overcome in this saturated landscape? 

To answer this question, it’s important to first understand what the challenges are.

What are the hurdles for healthcare providers?

1. Market saturation

More often than not, healthcare providers will overlook valuable apps simply because there are so many of them already on the market. Unrivalled quality and proven long-term results are required to stand out and make them take note. 

2. Interoperability 

Doctors and nurses are busier than ever. As such, logging into multiple systems daily poses a challenge. HCPs require system interoperability for seamless data access if they are to adopt and continue using a specific digital health product. 

3. Data security

Given their professional duty to protect patient data, HCPs are naturally reluctant to make use of any new technologies that might compromise data security, too. All compliance and security information must therefore be made accessible to them. 

What are the hurdles for patients?

1. App selection

Much like healthcare providers, patients can quickly become overwhelmed by choice. It can also be difficult for them to find an app that aligns best with their needs, particularly given that people tend to have multiple concerns or comorbidities and want an app that covers as many of these needs in one place, to avoid spending too much time recording details in multiple systems.

2. A lack of added value

Whilst symptom tracking for a specific condition can be useful, apps often fail to add sufficient value to patients’ lives, leading to discontinuation in use. With apps, its very much a case of ‘out of sight, out of mind’ so, people need a valid reason to return regularly. A lack of personalization or limited integration with other healthcare apps can thwart this just as much as a lack of validation, regulatory oversight or unreliable data accuracy. An absence of healthcare provider involvement will only exacerbate the disconnect between the app and the user’s overall healthcare journey. 

3. A need for comprehensive solutions

When patients are forced to use different apps for different, often interrelated, health conditions, they can soon become frustrated, feeling that they have to simplify their struggles to conform with the requirements of each system. They might be asked a question about chest pain, for example, only for this to be immediately flagged as an emergency, although they know that this is actually due to hypermobility and costochondritis. They may therefore avoid recording this pain altogether, eroding their trust in the app’s capabilities and meaning any doctors involved in their healthcare via the app aren’t getting the complete picture, either. 

Why is it difficult for pharma and healthcare companies to achieve this in their digital offers?

Unfortunately, it can be difficult for companies to overcome these barriers using traditional development methods. 

An alarming 80% of digital health solutions fail from pilot to scale, usually due to the high costs and long development times that app building entails. 

When building from scratch, the average minimum viable product (MVP) takes up to 24 months to develop, making it difficult to keep up with and respond promptly to evolving real-world needs and concerns. Whilst full ownership over the creative process can be a benefit, it usually comes at a million-dollar cost – something that’s simply not worth it given that the wait to launch, on top of continuous maintenance costs and the need to hire developers, can outstrip any profits – Pear Therapeutics proving an excellent case in point. 

Vendor-led, off-the-shelf solutions can also be costly, in addition to being difficult to scale. Whilst they can offer greater speed to market in certain cases, adaptations very much depend on the vendor, with a lack of flexibility making it difficult to scale across other disease states. As such, customers remain frustrated with their limited apps. 

Whilst standard PaaS (platform as a service) solutions can help to resolve this lack of real-world applicability to a limited extent, companies are still held back by the tech vendor, which continues to restrict flexibility whilst charging for each change or customization. As a result, pharma and healthcare companies ultimately find themselves struggling with adherence, due to the lack of personalization, agility, and timely deployment. 

What can be done to resolve this problem? 

Low-code no-code platforms designed specifically for the healthcare and pharmaceutical sector provide an affordable, compliant way out of this rut. 

Put simply, low-code no-code platforms provide a visual approach to development, where companies can ‘drag and drop’ their desired app features and components from a pre-existing library into an easy-to-use interface to create a digital health tool – no development experience required. This ultimately means that they are no longer reliant on the tech vendor for changes and can make as many changes as they like, when they like, quickly and easily in response to user needs or feedback in almost real-time. This goes a long way towards creating an app that adds real value, ultimately securing improved adherence from healthcare providers and patients alike. 

Another benefit of no-code development is scalability. Once you’ve created a product that works well for one condition or regional area, it’s easy to replicate it for others. This opens the doors to wider-ranging solutions that add greater value, without placing too much initial strain on the budget or risking early failures by investing all funds into a large-scale app before learning what works. 

Likewise, the more sector-specific no-code platforms facilitate greater integration with other healthcare systems, making it easier for doctors to access patient data without having to deal with multiple logins or added stress. When patients see that their data is of use to their doctors and care teams in this way, they are much more likely to continue using tools, too. 

Of course, compliance is essential too, meaning it’s vital to opt for a regulated platform designed specifically for pharma and healthcare sectors. With regulated no-code, pharma and healthcare providers can easily adhere to complex standards whilst also adapting to any evolutions in compliance frameworks. 

Navigating the future of healthcare with no-code precision

The adoption of digital health initiatives by HCPs and patients alike necessitates a revolutionary approach. Low-code no-code platforms offer a solution to the myriad of barriers standing in the way of success, ensuring a seamless, cost-effective and adaptive journey towards a future where digital health tools are not just an option but a value-adding necessity. 

About Shameem C Hameed

Shameem C Hameed is the Founder and CEO of blueBriX , a leading DevOps platform for digital health, which enables the fast and effective build of new solutions, from ideation to scale.

The physical therapy profession, encompassing both Physical Therapists (PTs) and Physical Therapist Assistants (PTAs), is navigating through a period of unprecedented challenge. Recent data highlights concerning trends – not only did the sector see the departure of 15,000 PTs, or 11% of the existing workforce, between 2021 and 2022, but there has also been a consistent 5% annual decrease in applicants to PT programs over the last three to four years. These developments signal an urgent need for innovative and sustainable solutions. The factors contributing to this decline are complex, involving burnout, a desire for better work-life balance, and a shift towards careers that demand less physical and emotional strain. As we progress through 2024, the imperative to adapt and innovate within the sector, fully recognizing the contributions and needs of both PTs and PTAs, has never been more critical.

Addressing Burnout with Innovative Care Models

Burnout significantly contributes to the workforce challenge, with traditional care models demanding extensive in-person sessions that exacerbate stress and job dissatisfaction. It’s essential to look beyond merely increasing caseload efficiency. Transforming the care model to enhance PTs’ working conditions and job satisfaction is crucial, directly influencing patient care quality.

Introducing Hybrid Care Models

Hybrid care models represent a vital innovation, merging traditional in-person treatments with digital health solutions for a more flexible approach. This innovation aims to alleviate the pressures on PTs by:

• Reducing administrative burdens, freeing PTs to concentrate on patient care
• Supporting flexible work arrangements to improve work-life balance and combat burnout
• Enabling remote patient monitoring, optimizing patient outcomes while managing workloads effectively

Such models do not advocate for PTs to increase their patient numbers simultaneously but to manage them more effectively, especially those needing direct intervention. Remote Therapeutic Monitoring (RTM) emerges as a key player in this scenario. RTM bridges the gap between clinic and home, offering PTs detailed insights into patient progress. This facilitates timely interventions without expanding direct contact hours, potentially preventing PT burnout.

Advancements in Digital Health – Mobility as a Health Indicator

Crucially, digital health advancements now allow for the nuanced monitoring of mobility, providing insights into overall health well beyond basic activity tracking. Analyzing mobility under real-life conditions unveils subtle changes that can guide more personalized and proactive care strategies. This capability empowers PTs to act precisely when needed, enhancing outcomes and sustaining their workload.

Moreover, technology fosters a more engaging experience for patients. Engaged patients are more likely to adhere to their treatment plans, leading to better health outcomes and a more rewarding professional environment for PTs, who witness the tangible benefits of their work.

Economic Pressures and Technological Solutions 

The healthcare sector, facing increasing economic pressures, finds a viable solution in technologies that enhance clinic operations and patient management. These technologies, especially with the advent of Remote Therapeutic Monitoring (RTM), offer significant economic benefits. By allowing for the reimbursement of non-physiological data monitoring, RTM expands the scope of billable services beyond traditional physician-led care, directly impacting the financial well-being of healthcare providers. Adopting such innovations not only addresses operational efficiencies but also represents a strategic approach to navigating financial challenges, ultimately supporting the sustainability and growth of healthcare services.

Leveraging Data for Enhanced Patient Care

Employing technology to access real-time data on patient progress revolutionizes PT care delivery. Tools that offer insights into patients’ mobility and progress enable PTs to craft informed care plans, swiftly adjust interventions, and focus on those in immediate need. This approach not only boosts care delivery efficiency but also significantly improves patient outcomes.

Looking Towards a Sustainable Future

The future growth and sustainability of the physical therapy profession hinge on embracing change. By adopting technology-driven care models that streamline operations, enhance patient engagement, and deliver actionable insights, we can navigate the challenges of a diminishing workforce and therapist burnout.

A collaborative effort among healthcare providers, tech innovators, and educational bodies to reinvent PT service delivery is imperative. Such collective action promises to establish a healthcare ecosystem that supports the well-being of both patients and therapists alike, ensuring the enduring vitality of the physical therapy profession as an indispensable element of healthcare services.

About Patrick Tarnowski, PT, MBA, Chief Commercial Officer, OneStep

As Chief Commercial Officer at OneStep, Pat is accountable for the company’s US market entry through strategic provider partnerships. His deep healthcare experience as a leader in health plans, health systems, medical devices, startups and digital care delivery support and enable OneStep’s growth and scale. As an entrepreneur, Pat has successfully launched and scaled care delivery companies, digital solutions that focused on health and wellbeing, disease management and virtual care and worked with providers to achieve success in value-based payment models. He received his degree in physical therapy from Boston University and his master’s in business administration from the University of St. Thomas. A lifelong learner, Pat has also held several academic appointments and is a grant reviewer for the National Science Foundation’s SBIR seed fund and served as an Industry Mentor for their I-Corp Innovation program. He has been the principal investigator in numerous clinical studies and is the Vice President of Professional Practice of the Minnesota Chapter of the American Physical Therapy Association’s and the Minnesota Cancer Alliance Steering Committee.