Hospitals establishing hubs for digital health operations

Health systems are moving forward with investments in virtual care despite dealing with continued uncertainty over reimbursement.

Medicare reimbursement for telehealth remains temporary after Congress passed a six-month extension of COVID-19-era waivers last Friday. Questions about what happens long term haven't hampered enthusiasm for virtual care at health systems. Instead, organizations are figuring out how to be smart about their telehealth and remote patient monitoring investments and centralizing their operations with digital health hubs.

Related: Tech investments hang in the balance at rural hospitals

These centralized hubs allow health systems such as UMass Memorial Health to collaborate across virtual care teams and use the technologies in the most efficient manner, said Dr. Eric Alper, chief quality officer and chief clinical informatics officer.

“Ever since COVID, I've been meeting with our CEO on a monthly basis to talk about how digital is going to help us to achieve our overall strategy,” Alper said. “It just got to a point where it felt like having all of the work that we're doing, investing in all these different service lines, and working with different vendors, it made sense for [all of it] to be in the same location.”

Here is how three health systems are centralizing their digital health operations.

UMass Memorial Health

UMass Memorial opened a 20,000-square-foot hub in September for its virtual care and remote patient monitoring programs. The health system wanted to centralize the functions and bring together the caregivers doing remote care, Alper said. 

“We feel that these digital strategies will not only help us reduce the total cost of care, but by having everyone together, it'll help to create operational improvements and synergies between the different areas that are working in the same location,” Alper said. “We can share the same space. We can go have a conversation with someone instead of having to, you know, call them up on the phone or send text messages.”

The health system repurposed a floor in one of its administrative buildings in Worcester, Massachusetts to launch the center. It includes nearly 100 employees who work in its electronic intensive care unit and remote video monitoring programs as well as various at-home and telehealth services. The team monitors around 1,000 patients and Alper said he sees the potential to grow in the coming years.

The hub cost $2.3 million to open. Moving those functions outside the hospital freed up hospital space for clinical uses.

The potential expiration of Medicare waivers for hospital-at-home and telehealth reimbursement would affect operations but the system plans to continue making investments in digital health, Alper said.

Guthrie Clinic

Guthrie Clinic provides care across six hospitals and nearly 75 clinics in New York and Pennsylvania. Many of its patients are in rural locations where access to care is challenging, said Dr. Edmund Sabanegh, president and CEO of the Sayre, Pennsylvania-based system.

“We cover 10,000 square miles across two states,” Sabanegh said. “We've got a really big, drawn out area. It's got mountains, it's got limited roads, so you've got challenges.”

Operating in rural environments can mean a dearth of resources and a workforce that's stretched thin, which is why Guthrie launched its Pulse Center in May 2023. The center, housed in one of its facilities in Horseheads, New York, centralizes Guthrie’s virtual intensive care unit and nursing teams so they can remotely monitor patients and track which patients might need to be transferred to other facilities within Guthrie. The work primarily involves patients who are within Guthrie Clinic but Sabanegh envisions expanding it to monitor patients being treated within their homes as well.

The command center, which is home to 85 employees, has been a major win for clinicians, Sabanegh said. It lightens the nursing workload and gives vital experience to younger clinicians coming into the workforce, he said.

“We had a lot of nurses coming straight out of training that were going into high-acuity settings. We really needed to give them a backstop and support, and that's what the virtual nursing was about,” Sabanegh said. “When you're straight out of training and it's 2 a.m. and you're in the ICU, you're not alone.”

The command center has led to improved safety outcomes for patients and lower costs. Sabanegh said Guthrie cut its temporary nursing labor costs by 50% and improved retention rates among its existing clinicians.

Mercy

Mercy was an early believer in virtual health services. The Chesterfield, Missouri-based health system began investing in virtual care in the mid-2000s and unveiled its hub, Mercy Virtual Care Center, in October 2015.

“The commitment we made 20 years ago was that regardless of where you are within Mercy, and regardless of the time of day, day of the week, facility or location of where you’re at… you would receive the same high-quality care and that we can standardize that care and support it in a centralized fashion,” said Dr. Gavin Helton, primary care president at Mercy Virtual Care Center.

At the center, housed in a 125,000-square-foot building located in Chesterfield, a suburb of St. Louis, clinicians virtually monitor inpatient care across the 50-hospital system as well as patients in its hospital-at-home program. The virtual center has around 650 full-time employees, Helton said.

Helton declined to disclose the costs associated with the center but said the upfront investment is a potential barrier to launching this kind of hub. The return on this investment is not immediate, he said.

“Looking into the future, the financial return on investment will come as Mercy, along with other health systems, are held directly accountable for total cost of care and the quality that is provided,” Helton said. “That’s the long-term strategy, that we've committed to. It’s also why it would be really difficult for someone to start to make this investment today.”