Health System Experiences and Challenges: Now and Moving Forward

As we turn a corner on the pandemic, health systems are gauging the array of post-pandemic effects in many spheres, including three key areas: digital health, artificial intelligence and machine learning, and financial health.

But even before the global health crisis, systems were challenged by constant evolution in this dynamic trio. Two leaders keeping close tabs on these experiences are Nazleen Bharmal, MD, PhD, associate chief of community health and partnerships at Cleveland Clinic Community Care, and Nirav Vakharia, MD, president of the Cleveland Clinic Medicare Accountable Care Organization.

“Those are three among perhaps several seismic shifts in how various healthcare stakeholders interact,” said Dr. Vakharia, who is also Cleveland Clinic’s associate chief for value-based operations. “To make that transition, ideally we’ll achieve more synchronization across the habits that make that possible.”

Dr. Bharmal and Dr. Vakharia, both of whom also practice primary care, shared health system perspectives related to digital health, AI and machine learning, and financial health, along with ideas on how to move forward.

Digital Health

With far more patients turning to virtual health services during the pandemic than before, health systems had no choice but to quickly prove such platforms could deliver quality care. Within their system, they used a team-based approach that reached 20,000 ambulatory care and 14,000 chronic disease patients through population-based telehealth programs, said Dr. Bharmal, who is also a HIMSS Global Health Equity Network Member.

The pandemic also catalyzed different types of digital care.

“We were not just screening for COVID symptoms or chronic conditions in a clinical sense, we were also getting an opportunity to address patients’ behavioral and social needs,” Dr. Bharmal said. “I know of several examples where patients identified a social need, connected with a social worker, and received a host of services from community-based organizations, including food, testing and housing. That’s been a huge shift in thinking about some of the opportunities available through digital health.”

While virtual health presents significant cost savings to health systems, Dr. Vakharia said, they bear the responsibility to also tap this technology for the greater good.

“What we imagine going forward is, whenever we leverage technology and bring it into that really sacred relationship between doctors, nurses and patients, it’s for the purposes of strengthening that relationship—not as a substitution for it,” he said. “I think over time we’ll see patients be a lot more willing to interact with a computer for some basic healthcare needs, but for now we’re still at the early stages of the digital healthcare revolution.”

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AI and Machine Learning

Of all the potential benefits AI and machine learning offer—including supporting clinical decision-making and saving money—the prospect of streamlining mountains of data motivates health systems that are also aiming to “be good stewards of healthcare resources,” Dr. Vakharia said.

“The reason clinically or operationally we want to leverage more insights we derive from AI and machine learning approaches is to ensure we’re directing those resources to areas where they’ll do the most good,” he said. “Tools like this allow us to find the proverbial needle in the haystack because we’re collecting so much information on patients.”

“Intuition is certainly part of the clinical equation,” Dr. Vakharia said. “But supplementing that with very specific suggestions on who and when we might intervene in order to drive better outcomes long-term is most exciting.”

In the years ahead, Dr. Vakharia said, AI and machine learning tools should be refined to hit a particular sweet spot—enhancing precision health approaches without creating more work for clinicians and health systems.

“Some portion of AI we’re using in healthcare is telling us things we already know, such as if a patient is at risk of needing hospitalization. We need it to round the corner to telling us things we can try to keep that patient healthy,” he said. “Further, the next step is to automate the implementation of those things so I don’t have 30 extra clicks to become aware of these signals.”

Financial Health

While acknowledging a lack of transparency surrounding healthcare costs vexes many patients and clinicians, these stakeholders often don’t realize that health systems are hard-pressed to address this due to the complexity of tailored care solutions, Dr. Bharmal and Dr. Vakharia say.

“It’s very easy to present the cost for a specific service—such as a CAT scan—but most healthcare needs aren’t just a single service,” Dr. Vakharia said. One example Dr. Vakharia shared is diabetes care for one patient might include more shared medical appointments but be medication-heavy for another. “That’s where price transparency starts having some challenges.”

“It’s not just a one-size-fits-all,” said Dr. Bharmal, adding that addressing patients’ social needs that influence health often “don’t have clear price tags.”

“But we’re trying to meet patients where they’re at and think about approaches that don’t necessarily have a specific, one-time cost,” she said.

Meanwhile, the pandemic served to illuminate the “risk of having a rather narrow and undiversified business model” for systems still operating under a fee-for-service model, Dr. Vakharia said.

“Many health systems that are more broadly diversified—providing not just hospital services, but adjacent business around health tech or in-home care—showed they’ve weathered the pandemic better than ones that aren’t.”