In 2021, estimated revenue from the U.S. healthcare industry was $2,709.9 billion. The industry focused on medical technology, research and innovation. Hospitals spend more than $852 billion on goods and services annually and generate more than $2.8 trillion in economic activity.
Those numbers provide the big picture. At a granular level, the goal of healthcare is to keep individuals out of the hospital and keep communities healthy.
The healthcare industry is always innovating, developing new technology and best practices to better serve individuals and communities. Worldwide, healthcare workers faced enormous challenges since spring 2020. The pandemic wasn’t the only thing driving innovation and technology, but it accelerated the use and creation of new technologies.
The Future of Healthcare
The COVID pandemic pushed the need to treat patients while keeping physicians and medical personnel safe, healthy and on the job. One way to do that is through systems known variously as telehealth, telemedicine or remote health.
In northern Nevada, the Renown Transfer and Operations Center is an 8,000 square foot facility with 30 big screen monitors in the front of an operations room. It’s manned 24/7, 365 days a year by a team of professionals who manage logistics of community health.
Through the center, professionals are able to tell when a patient is having an emergency, which ones are in the hospital or being monitored in their home and even who needs to be transported by helicopter.
The system is designed to give Renown a “finger on the pulse” approach to managing healthcare and logistics. The center serves as an operations hub to coordinate care for population health in the region.
In southern Nevada, UMC offers 24/7 online care, providing diagnoses for patients who don’t need hospital attention but a telehealth visit.
“I expect more than 40 to 50 percent of our visits in the future will be done by telehealth,” said Mason VanHouweling, president & CEO, University Medical Center (UMC).”That [care] integrates with our electronic health record, ‘EPIC’, so there’s more IT, technology and capital investment.”
“Healthcare is going to be delivered on a more mobile and ambulatory basis, and telehealth has allowed us to do that,” said Karla Perez, regional vice president, acute care division, Universal Health Services, the parent company for Valley Health System in southern Nevada. “That means the patient doesn’t have to come into the office but can stay at home and connect with a physician via telehealth medicine.” Most telehealth systems are sophisticated enough to do a good job of simulating a traditional patient visit where they are sitting in front of their doctor. Unless there’s a need for the physician to touch the patient, visits can be handled by phone, or better, through online conferencing platforms.
“Over the last 24 months, through the pandemic, the largest place where we saw technology rise to the occasion was through the ability to conduct medical visits via telemedicine or in a virtual manner, as the pandemic forced us to consolidate and shut down clinics,” said Dr. Robert McBeath, CEO, Southwest Medical Associates.
Southwest Medical has had a telemedicine department running 24/7 since 2014. When the pandemic hit, it was simply a matter of scaling up the system from eight to more than 400 physicians.
There’s been a rebound of patients wanting in-person visits as the pandemic wanes, but the volume of online visits has risen 300 percent, indicating virtual works for a lot of patients. “It’s on demand. You’re talking with a physician in five to seven minutes,” said McBeath. Electronic medical records are integrated directly with the system.
Population Health
The second way to coordinate care in communities is through population health. It’s the macro look at the micro– or individual–level of healthcare. Population health refers to an approach to health that aims to improve outcomes for an entire group of individuals.
“When we think about population health, we’re thinking about all the dynamics that impact care to an individual,” said Perez. “Social determinants play a big factor–are you eating a healthy diet? Are you exercising? Do you have access to see a physician? Population health management looks at the individual and all the needs of that individual.” That includes preventative medicine, since most people access healthcare only when sick or injured. Then, if they can’t get into a doctor’s office when it’s urgent, they end up in the emergency room, or hospitalized, increasing the level of care needed and the costs.
The concept of population health has been around for some time but really gained traction when the Affordable Care Act passed in March 2010. At Renown, the concept has been referred to as “value based care”. This type of care is looked at through a ratio of clinical plus service outcomes over total cost of care. The overall concept looks at a population and segments it to insure the best clinical and service outcomes at the lowest possible expense.
Health outcomes can be broadly defined as clinical outcomes and service outcomes: How well people are treated, how well they did from a clinical perspective. It’s possible, using population health measures, to segment the population into groups of individuals based on kinds of diseases, like cardiology versus cancer, or by age groups, conditions, behavioral health challenges, insurance status—Medicare, Medicaid or private insurance.
Valley Health is part of an accountable care organization (ACO), a population health management entity working to improve quality of care while looking for ways to control healthcare costs.
“A really strong population health management program will improve access, improve quality and reduce costs,” said Perez.
Where the challenge comes in is with granular information about populations in segments. Looking at 3.5 million people in Nevada, it’s difficult to see where the challenges are, or how challenges are different between subgroups. For example, Nevada is ranked at the bottom in mental health metrics. Therefore, it’s important to note that, unless it’s a focus, mental health problems can be diluted in other healthcare outcomes and overlooked when looking at a patient’s care.
This is one of the challenges the Renown Transfer Center has been designed to alleviate. The center provides a way to treat one patient, one family member at a time, while still aggregating people into a population in order to better serve their needs. In a way, that’s regionalized care, which is common, like having trauma departments and neonatal care units. These are some of the reasons healthcare systems are organized differently based on where the best outcomes and service needs are to achieve the lowest cost.
The Renown Transfer Center isn’t the hospital systems only foray into population health measures. A few years ago, the Healthy Nevada Project was created and implemented throughout the state. The project combines clinical data, environmental data and social determinants of health with genetic testing results into a data warehouse to identify trends and patterns of illness and disease statewide.
Renown partnered with Desert Research Institute as well as University Medical Center in southern Nevada, and University of Nevada, Reno School of Medicine in northern Nevada.
“We think we can deliver better healthcare for Nevadans by thinking innovatively and creatively with partners to serve people differently than we have in the past,” said former president and CEO of Renown Health, Dr. Anthony Slonim.
Tools for delivering healthcare differently include the transfer center, viewed as a logistics hub, and telehealth, designed to provide coordinated and effective healthcare. The need for change is being driven largely by consumer demand.
Healthcare via Robots
Technology meets surgeon with advancements in robotic surgery. The Da Vinci Surgical device came out in 2000, setting the stage for advancements in technology and improving outcomes in patient care and diagnostics. Robotic surgery offers a range of minimally invasive services, with models dedicated to certain types of surgeries.
Robotic surgery, compared to open surgery, usually results in less scarring, less blood loss, smaller incisions, reduction of need for pain medications and a shorter hospital stay. This, in turn, allows patients to be back on their feet as fast as possible, said VanHouweling. UMC is among the first hospitals to do robotic pediatric surgeries.
Advances in robotic surgeries mean advances and improvements in surgical outcomes. A dedicated robotic knee replacement system uses a series of X-rays to create 3D models of the patient’s knee for a more customized approach to the patient’s anatomy. The ROSA® system UMC uses utilizes a camera and optical trackers to ensure the patient’s slightest movements are taken into account when positioning the implant.
Healthcare at the Speed of Light
The pandemic pushed advances in healthcare technology and practices because there was no choice but to move fast to meet demands. Labs changed procedures. Providers set up alternate care sites in parking garages and parking lots, and instituted drive-through testing and vaccines for COVID. Integrated command centers compiled community health electronic records so providers could share information.
Nevada Hospital Association (NHA) collected information on hospitalizations for COVID, providing it to state agencies and the federal government. They also connected hospitals who floundered under the weight of pandemic demand so another might help out, said Patrick Kelly, president & CEO, NHA.
COVID pushed healthcare technologies to advance faster than they would have without the emergency. Early on physicians realized COVID was a pulmonary disease and that ventilators were not the right solution. It was monoclonal antibodies, rapidly developed through the pandemic, that made the difference, said VanHouweling.
UMC’s testing lab and fast results time became essential in the midst of the pandemic and have become a standard since. The hospital was also among the first organizations to introduce a monoclonal antibody infusion for high risk COVID patients.
“Our lab became a nationally recognized cutting-edge lab that supported our healthcare system in the state,” said VanHouweling. UMC began providing faster testing for the community, eventually providing 1.5 million tests in Nevada. “We had capacity up to 10,000 a day. We never hit that, but we always had enough staff, supplies and testing sites to be able to do that,” he said.
“I think we’ve responded well, be it vaccines, the monoclonal antibody, and now that we have new oral antivirals that are being introduced and are highly effective at preventing hospitalization and severe disease, hopefully we are on the back end of this pandemic and moving into the endemic phase,” McBeath added.
Healthcare by the Numbers
(Of Providers, and Patients)
Nevada healthcare has a long history of being understaffed. There simply aren’t enough doctors and nurses, respiratory therapists, pharmacists and other healthcare professionals to care for the people in the communities they serve. Basically, there aren’t enough people to care for the people. There’s a need for healthcare systems to partner with schools of medicine and to reach into higher education, or even high school, to find students willing to consider a career in medicine.
Telehealth can help manage numbers when there aren’t enough doctors. The more patients a physician can see remotely, the more patients that doctor can treat. During the pandemic a number of physicians, who were themselves high risk, had to leave the workforce to be protected from COVID. Telehealth provided a way back in and allowed them to treat patients.
There’s a need to change how healthcare is delivered. New technologies help patients and families. Innovative, consumer-based programs engage patients and their families, making them part of the decision-making process. Providers are looking for ways to work with their patients on their healthcare, rather than just treating issues as they arise.
Changing healthcare delivery includes healthcare on demand. Or at least on the individual’s schedule rather than on the schedule of a hospital or physician. This shift ties into a population health strategy, but it’s also something patients and consumers are begining to demand. However, in order to change delivery systems, the system needs people.
“Workforce is a major concern,” said Kelly. “The nursing shortage that existed before the pandemic has been exacerbated by the pandemic. As a state we really need to address workforce. [We need], particularly, nurses but also physicians, med techs, phlebotomists, surgical techs, just a lot of different positions. [We need them], not just in hospitals but in all healthcare facilities. We need to see if we can expand our nursing programs and also look at expanding certificate programs. Then with physicians, we need to look at having more graduate medical education programs in the state, so they remain in the state after graduation.”
“We’re rethinking how we deliver care,” said Perez. Hospitals are developing concepts around team nursing where each nurse works to the top of what they’re licensed for. This means nurses who can provide the most medical care aren’t the ones walking patients through the halls and changing linens.
Medical workforce shortages can also affect community health. Population health works to keep patients out of the hospital but, if they can’t get in to see the doctor and get sicker, they could end up in ER or the hospital. This uses more resources and costs more.
“I definitely think that, over an extended period of time, the workforce shortage of healthcare workers would definitely impact the health of a community,” said Perez.
Healthcare systems work with schools of medicine to train new doctors. But there’s a need for residency programs. Statistically, if a physician completes residency in a state, over half will remain in that state to practice. If they complete both medical school and residency in the state, more than three-quarters will remain. Southwest Medical trains 10 family practice residents every year. This is the third year of the program, and the first 10 residents will graduate in July.
“The workforce shortage is a challenge,” said VanHouweling. “We had it before the pandemic, and it will continue after. Certainly, technology does help with some efficacies and dealing with patients and turnaround times.” For example, UMC’s lab saw dramatic innovations during the pandemic. Diagnoses and results that would have taken hours or days were being turned around in less than an hour, meaning patients could be discharged back home or to the next level of care faster.
“I think where appropriate, we embrace technology, but at the end of the day, it’s people that are taking care of other people, not automation. Definitely there’s going to be a partnership with science and technology, and certainly that has advantages, but we’re always going to be committed to our people and our caregivers,” said VanHouweling.
