NEJM Catalyst

In the December issue: leadership for artificial intelligence, cybersecurity, pediatric firearms injuries, behavioral health treatment, public health and care delivery collaboration, diabetes care, and improving care after gynecologic oncology surgery. ?? View the issue: https://nej.md/4fSCcsb ?? Read/listen to the editor letter, How Collaboration Leads to Health Care Transformation: https://nej.md/3ACpFKJ ?? Insights Report: The Rising Risks of Cybersecurity Breaches: https://nej.md/4exclF3 with expert advisor Jigar Kadakia ? In Depth: A Hybrid Care Model to Manage Diabetes Mellitus in the United Arab Emirates: https://nej.md/3UX1hKs ???? Case Study: Together Care: Transforming Perioperative Care for Patients Undergoing Benign and Oncologic Gynecologic Surgery: https://nej.md/4fxVLGm ?? Article: Advancing the Quintuple Aim Through Public Health and Health Care Collaboration: Perspectives from Washington State: https://nej.md/48Tj2Ah ?? Article: Improving Treatment and Lowering Costs for Behavioral Health Patients Through a Value-Based Care Program: https://nej.md/3Z8x0ed ???? Commentary: Health Care Leadership in the AI Era: A Seventh Test for the Decade Ahead: https://nej.md/4fNkSW9 with our Editor-in-Chief Thomas Lee, MD ?? Commentary: Moving Beyond Thoughts and Prayers: Creating a Firearm-Related Injury Task Force: https://nej.md/3YLfPhB

In 2 weeks, December 11, 12-2pm ET - "Health Care Workforce Innovation: Solutions to the Staffing Crisis." Sign up here: https://nej.md/3YQeLJp #NEJMCatLive Agenda and speakers: Opening Talk: Fred Cerise, President & CEO, Parkland Health Session 1, "Workforce Innovation: Leadership and Culture"" Jimmy Duncan, SHRM-SCP, SPHR, Chief HR Officer, OU Health; K. Kelly Hancock, DNP, RN, NE-BC, FAAN, EVP & Chief Caregiver Officer, Cleveland Clinic; Thomas Lee, MD (moderator), Editor-in-Chief, NEJM Catalyst Innovations in Care Delivery Session 2, Executive Sponsor Q&A Sasha Preble, VP for Strategy & Growth, Optum Advisory Services; Ed Prewitt (moderator), Editorial Director, NEJM Catalyst Session 3, "Workforce Innovation: Technology and Care Redesign": Kathleen L., Associate Chief Transformation Officer, Penn Medicine, University of Pennsylvania Health System; Kristine Lee, MD, Associate Executive Director of Virtual Medicine, The Permanente Medical Group, Inc.; Jenny Shand, Associate Professor of Health Services and Population Research, University College London; Namita Seth Mohta (moderator), Executive Editor, NEJM Catalyst

Patients with psychotic disorders or severe substance use disorders historically have not been well served by traditional fee-for-service care systems, leading to disproportionately high rates of treatment failure, ED visits, inpatient hospitalizations, and a high total cost of care. This case study presents the implementation of Cityblock Health’s Advanced Behavioral Health program, a model of care led by specialized community health workers, designed to boost access to interventions such as second-generation long-acting injectable antipsychotics, medications for opioid use disorder, medications for alcohol use disorder, contingency management, care coordination, and social care navigation. Members enrolled in the program for a period of 10 months had a statistically significant 19.7% decrease in inpatient utilization and an 11.5% decrease in total per-member, per-month cost of care compared with a quasi-control group. Further research is needed to determine the contribution of each program element to those effects. Since its original implementation, Cityblock has expanded the program to five additional markets and is conducting ongoing research: https://nej.md/3Z8x0ed Ruby Mehta, David Dayan-Rosenman, MD, MS, Daniel Sellinger, Michael Anderson, MD, MBA, Cityblock Health

The Covid-19 pandemic resulted in remarkable collaboration between public health and health care institutions. But without intentional efforts, the end of the U.S. Public Health Emergency could lead to a return to an era when these institutions’ relationships were more limited and their population health improvement efforts less integrated. This is concerning, given that collaboration between public health and health care will be needed to overcome the multiple health crises facing the United States today. The Washington State Department of Health (WA-DOH), the state public health agency, identified health systems and workforce transformation as one of its five strategic priorities. To further define and operationalize its vision for health systems and workforce transformation, WA-DOH conducted an environmental scan that led to the identification of six priorities for public health and health care to align on systems strengthening, as follows: (1) enhancing robust whole-person care; (2) the primary care and rural health safety net; (3) health workforce intelligence and development; (4) population health intelligence; (5) innovation and learning; and (6) health system resilience. WA-DOH is using this six-priority framework to execute its vision for health in Washington, in line with the Quintuple Aim for health care improvement and the fundamental public health goal of ensuring an effective system that enables equitable access to the services and the care people need to be healthy. Public health agencies at the state or local level, looking to partner to improve health care delivery in their jurisdictions, can take advantage of the six-priority framework expounded in this paper: https://nej.md/48Tj2Ah Charles Chima, MD, DrPH, Les Becker, MBA, PMP, Kristin Peterson, JD, Jessica Todorovich, Umair A. Shah, M.D., M.P.H.

Artificial intelligence has huge potential to transform health care delivery. But organizations are largely not ready, according to an NEJM Catalyst Insights Council survey. Hear from health care leaders about embracing AI: https://nej.md/3C6eCtj (free, sponsored by Deloitte)

We need to consider the opportunities autonomous AI can offer in health care. Robert Wachter, UCSF Department of Medicine, discusses the balance between the desire for using AI technology in health care and the concerns about the risks and challenges: https://nej.md/3ZnncMz

How can we bridge gaps in health care by leveraging advanced tech to unify health data and derive meaningful insights? Nasim Afsar, MD MBA MHM, Oracle Health, addresses the significant gaps that persist in global health care despite ongoing improvement efforts: https://nej.md/4i42Joc

Less than a week left to submit manuscripts for an upcoming special issue centered on value-based care! For submission details, see https://nej.md/3Xw3X23. Deadline: Saturday, November 30

How can generative AI and innovative communication tools enhance health care practices and improve patient experiences across various medical fields? Jacqueline Shreibati, MD, FACC from Google explores the transformative potential of generative AI in health care: https://nej.md/413rF9p

Automated texting platforms offer the promise of interacting with patients in real time and reducing the burden on clinical teams to triage concerns. The population of patients with gynecologic cancer is characterized by high symptom burden and consequent high utilization of the ED while navigating treatment, especially in the perioperative setting. Similarly, high ED utilization has been noted among benign gynecologic patients undergoing surgery. A text-based program that triages patient concerns and promptly engages clinical teams for acute concerns could have particularly high utility in these patient populations, but as of 2021 had not been validated. In 2021, Penn Medicine, University of Pennsylvania Health System began developing a novel text-based remote monitoring program called Together Care within the Division of Gynecologic Oncology with the aim of reducing unplanned patient encounters, including patient contacts, ED visits, and readmissions. This program initially used a fake backend texting platform that was iterated across multiple mini-pilots and transitioned to a fully automated texting algorithm that was scaled to other divisions within the Department of Obstetrics and Gynecology. The authors share both their utilization of innovation methodology and their key takeaways from developing this automated platform: https://nej.md/4fxVLGm Leslie Andriani, Ashna Aggarwal, Nick Bailey, BSN, RN, Emily Seltzer, Sirithepphavanh Oliver, Lisa Mills, Mary DeAgostino-Kelly, Ashley Haggerty, Nawar Latif