American Well: A Viral Solution

The case presents an overall look at American Well, its position within the telehealth market, and a look at the market and market affecting factors. The following analysis will be conducted using the information presented in the case and will identify strengths, weakness, strategies and provide discussions of special topics

Mobilizing medicine: a design response to the accessibility and cost issues in health care

textNationally, there is increasing concern over the accessibility, cost, and quality of the American health care system. While the quality of the care given is generally out of the control of designers, it has received increased attention in recent years, as is evidenced in the trends of healing gardens, private patient rooms, and improved social settings. As beneficial as these trends are to the patients they serve, they often have a negative effect on overall accessibility and cost of care due to the constant construction and renovations needed and their largely urban presence. While quality health care is very important and should not suffer as a result, how can designers address nonenvironmental sustainability issues of cost and access in the American healthcare system? Due to the trend in increasing cases of chronic illness, as opposed to more pathogenic ailments of the past, the necessity for all healthcare settings to be highly controlled and sterile environments should be reevaluated. While less popular and not as fully developed as the typical facilities most Americans are familiar with, an increase in mobilized health care units could be a solution to the lack of economic and social access and sustainability in the current healthcare model while still providing safe, quality care. By examining current instances of mobile clinics, I will explore the design requirements necessary to make mobile clinics accessible and cost effective. In addition, I will look for facilitators and barriers to these systems, such as improvements in mobile communication technologies and lack of stakeholder support.Architectur

N.C. Medicaid Reform: A Bipartisan Path Forward

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race. The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers. This report is submitted to North Carolina’s policymakers and citizens. It assesses the current Medicaid landscape in North Carolina, and it offers recommendations to North Carolina policymakers concerning: (1) the construction of Medicaid Managed Care markets, (2) the potential and dangers of instituting consumer-driven financial incentives in Medicaid benefits, (3) special hotspotting strategies to address the needs and escalating costs of Medicaid\u27s high-utilizers and dual-eligibles, (4) the emerging benefits of pursuing telemedicine and associated reforms to reimbursement, regulation, and Graduate Medical Education programs that could fuel telemedicine solutions to improve access and delivery. The NC Medicaid Reform Advisory Team includes: Deanna Befus, Duke School of Nursing, PhD ‘17Madhulika Vulimiri, Duke Sanford School of Public Policy, MPP ‘18Patrick O’Shea, UNC School of Medicine/Fuqua School of Business, MD/MBA \u2717Shanna Rifkin, Duke Law School, JD ‘17Trey Sinyard, Duke School of Medicine/Fuqua School of Business, MD/MBA \u2717Brandon Yan, Duke Public Policy, BA \u2718Brooke Bekoff, UNC Political Science, BA \u2719Graeme Peterson, Duke Public Policy, BA ‘17Haley Hedrick, Duke Psychology, BS ‘19Jackie Lin, Duke Biology, BS \u2718Kushal Kadakia, Duke Biology and Public Policy, BS ‘19Leah Yao, Duke Psychology, BS ‘19Shivani Shah, Duke Biology and Public Policy, BS ‘18Sonia Hernandez, Duke Economics, BS \u2719Riley Herrmann, Duke Public Policy, BA \u271

Best practices to establish susccesful mobile health service in a healthcare setting

Alternative healthcare programs have been steadily flooding the health care market, with the most notable being mobile health. Mobile health, more popularly known as mHealth, is expected to generate upward of $59 billion dollars. This is astonishing, considering the mHealth market is still in its infancy as an alternative healthcare model. Still, there are over 100,000 mHealth smartphone applications and platforms on the market. The concept of offering affordable medical services that are accessible to anyone, at any time and in any place appeals to the mission and purpose of healthcare organizations. However, a large number of the studies and publications on mHealth are associated with the technologies behind mHealth and provide very little information on the practices and challenges associated with implementing mHealth, especially within a medical facility. For this reason, it was important to learn from executive health IT professionals who have successfully implemented mHealth services within the US healthcare system. Accordingly, the purpose of this study was to identify the practices used and challenges faced by CIOs in implementing mHealth technologies. The study also obtained recommendations CIOs believe are associated with successful mHealth services. This was a qualitative study that used a phenomenology lens focused on the viewpoint of CIOs and the growing phenomenon of mHealth as a part of the U.S. healthcare system. This approach allowed the research to obtain data on the lived experiences of seven CIOs through semi-structured interviews who were identified as top experts by Becker Hospital Review publications. The analysis of their experiences revealed 13 best practices for mobile health implementation. The findings in this study aimed to identify how mHealth services could expand access to medical services by outlining key considerations and resources required for successful implementation

An Exploration into the Benefits, Challenges, and Potential of Telehealth in the United States: A Mississippi Case Study

Healthcare in the United States is in need of new solutions to provide access to care for all and decrease the rising costs of care. Telehealth is a developing model of healthcare delivery, and it will provide effective and equitable solutions to increase access to healthcare across the nation. As models of healthcare rapidly change, telehealth will continue to progress, but it is necessary for policy to complement the rapidly changing healthcare environment so that telehealth implementation can be successful. Along with access, telehealth has the opportunity to address many convenience barriers to healthcare, including distribution and number of practitioners, location barriers, and appointment availability. This thesis provides an exploratory literature review of the background, benefits, challenges, and potential of telehealth in the United States and provides original research into telehealth in Mississippi. Mississippi is a unique state when it comes to healthcare, and it is a leader in telehealth across the nation. The goal of this original research is to explore healthcare in Mississippi and learn from healthcare administrators about the healthcare needs in Mississippi and how telehealth can provide solutions to current health barriers. The research was gathered through semi-structured interviews of healthcare administrators from three different sites in Mississippi, ranging from a rural wellness center to the largest telehealth center in the state. After completion of the interviews, the interview data were recorded in the form of notes and a synthesis document was drafted explaining the common themes of telehealth in Mississippi. The results of the research were comparable to literature review; there was an emphasis on barriers to telehealth implementation such as reimbursement and health policy. Another commonality was that health systems and practitioners generally want to use telehealth services, but there currently are too many barriers to successful telehealth implementation for it to be a sustainable model. In order for telehealth to be successfully implemented, there needs to be more research, lobbying, and advocacy efforts to make prompt and effective change in health policies in the United States

A Telehealth Explosion: Using Lessons from the Pandemic to Shape the Future of Telehealth Regulation

From board rooms, to classrooms, to Saturday Night Live skits, the video conferencing app Zoom became a seemingly overnight sensation as a way to connect while businesses were shuttered and individuals were forced to stay at home when the coronavirus pandemic erupted in the United States in March 2020. From 10 million daily users in December 2019 to over 200 million daily users by March 2020, the company founded in 2011 became a market leader as the country tried to figure out how to continue business as usual—to the extent possible—during the global pandemic. While hospitals prepared for the onslaught of patients suffering from COVID–19, many physicians and physician offices around the country not tasked with treating patients suffering from COVID–19 shuttered their doors along with other businesses and contemplated ways in which they could still render necessary care to their patients.4 How could physicians advise or diagnose patients who exhibited coronavirus symptoms without exposing other patients to coronavirus? How could physicians who were themselves immunocompromised or at special risk if they were to contract COVID–19 continue to treat their patients? How could patients feel comfortable seeking care for non-COVID–19 related conditions without feeling like seeking such care could expose them to the virus? In short, providers were facing many of the same dilemmas that other businesses have been facing during the global pandemic, and just like the 200 million fellow Americans who turned to Zoom, the health care industry likewise looked to technology

Assessing the Impact of Health Policy Reforms on Vulnerable Populations: A Social Science Perspective

Through the view of social science, this study takes a critical look at how changes to health policy affect people who are already at risk. As countries around the world make big changes to their health care systems, it's important to figure out how these changes affect weak and marginalised groups. Our study uses a social science approach to look into how changing health policies affect the lives of disadvantaged groups by exploring the complex web of social, economic, and cultural factors that affect them. The method uses a mix of quantitative and qualitative data analysis, with conversations and focus group talks with people from a range of disadvantaged groups to get more in-depth ideas. Through a broad lens, we want to find out the complex ways that changes in health policy interact with social factors that affect health, affecting the availability, cost, and quality of healthcare for weak groups. Early results show that vulnerable groups bear an unfair amount of the load, showing differences in healthcare outcomes, hurdles to entry, and differences in healthcare service. The study also explores the role of social support networks, community engagement, and cultural competence in mitigating or exacerbating the effects of health policy reforms on vulnerable populations.The implications of this research extend beyond academia, offering practical insights for policymakers, healthcare professionals, and advocacy groups to formulate inclusive policies that address the unique needs of vulnerable populations. By fostering a deeper understanding of the social dynamics at play, this study contributes to the ongoing discourse on health equity and informs evidence-based interventions aimed at safeguarding the health and well-being of society's most marginalized members

Telemedicine: An Augmentation Strategy to Mitigate the Primary Care Shortage

According to the Association of American Medical Colleges, the primary care workforce shortage in 2025 will exceed 46,000 primary care physicians. Healthcare business leaders in Gwinnett County, Georgia have not evaluated the advantages and disadvantages of telemedicine (TM) to mitigate the workforce shortage. The purpose of this qualitative descriptive study was to determine factors primary care physician administrators consider when deciding to implement TM as a potential solution for the growing physician shortage. A purposive sample of 20 primary care physician administrators located in Gwinnett County, Georgia was drawn. The theory of disruptive technology was the conceptual framework. Data collected stemmed from semistructured interviews with each participant and review of organizational plans and workflow documents. Data were recorded, transcribed, and coded to develop themes. Three themes morphed from the study: TM awareness and education, TM cost and reimbursement, and TM implementation and utilization. Results indicated that awareness and education of leaders toward TM requires improvement, costs, and reimbursement were variables for deciding to implement or not implement TM, and TM implementation requires knowing the appropriate use of TM. The implications for positive social change include the potential for primary care physician administrators to positively influence the healthcare workforce shortage by adding flexibility to manage patient workflow with TM. Additionally, the potential for physician administrators to utilize TM for healthcare access, creating savings in transportation, energy consumption, and resource optimization, may provide better access to hard-to-reach populations

THE POLICY FOLLOWS: A NEW THEORY FOR DEVELOPING A VALUE-BASED, POST- PANDEMIC HEALTH CARE SYSTEM IN THE UNITED STATES

Health care policy making, particularly as it relates to technology and innovation, is extraordinarily complex and often fraught with unforeseen consequences. This thesis explores the intricate political history and economic underpinnings of the American health care system, which have created the most expensive, and many would argue— most inefficient—system in the world. More specifically, it examines the impact of technology and innovation on the evolution of that system. The Policy Follows approach to health care policy making introduced in this thesis, provides a clear and forward- thinking approach to integrating research, evidence, and expertise into the creation of informed and impactful health policy. Recent, relevant case studies illustrate the pitfalls of aggressive or poorly-informed health care technology policies advanced by political or industry agendas without the guidance of adequate scientific support. I examine the impact of the COVID-19 pandemic on the health technology landscape, with particular attention to the precipitous expansion of telehealth and virtual care services as a means of addressing the associated challenges, and discuss the imminent policy and regulatory questions facing the health care system as it emerges from this unprecedented national state of emergency. Prior to the pandemic, the growth and adoption of telehealth across the country was greatly inhibited by a several key barriers, particularly state-by-state variation in policies, the conflicting incentives of a fee-for- service based system, and an overall lack of rigorous research to guide development. The Policy Follows approach elucidates the path forward, guided by research and expertise, to developing evidence-based health technology policies that will facilitate the post-pandemic transformation of health care in the U.S. into a more equitable, efficient, cost-effective, and integrated system