Leapfrog Technology for LMICs: Lessons From Accountable Care Organizations Coupled with Point-of-Need (PON) Diagnostics

Overview

In an era where technological advancements continually reshape our daily lives, one concept has increasingly garnered attention for its transformative potential: leapfrog technology. Originating from the children's game where players jump over one another, "leapfrogging" in the development realm refers to bypassing intermediary stages to rapidly adopt advanced systems or methods. Although applicable across various sectors, this idea holds particular promise for healthcare.1

Accountable Care Organizations (ACOs) represent collaborative groups of doctors, hospitals, and other healthcare providers, all voluntarily coming together to provide coordinated, high-quality patient care. The principal aim is to ensure patients receive the right care at the right time and to enable healthcare providers to prevent medical errors and avoid unnecessary duplication of services. Within this paradigm, there is a prominent shift from reactive to proactive care, emphasizing preventive measures and efficient management.2

On the other hand, Point of Need (PON) diagnostics refers to tests conducted at or near the patient's location, ensuring immediate knowledge and potential treatment options. This method is a departure from traditional diagnostic methods, which often involve sending samples to distant labs, resulting in delayed results and subsequent care.

However, while both ACOs and PON diagnostics represent advances in their own right, the fusion of these approaches with mobile phone access creates "leapfrog technology" and presents a formidable solution for healthcare challenges, especially in Low and Medium Income Countries (LMICs). LMICs, often grappling with infrastructural and financial constraints, can immensely benefit from this integrated approach. By harnessing the efficiency and coordinated care model of ACOs, the immediacy of PON diagnostics, and the rapid advancement potential of leapfrog technology, there is an opportunity to redefine healthcare delivery in these regions, ensuring more equitable, timely, and effective care.

Accountable Care Organizations (ACOs)

Background and Benefits

Despite many changes in the healthcare landscape, two central themes have consistently dominated the discourse: the challenge to improve healthcare quality and the need to manage skyrocketing healthcare costs. The concept of Accountable Care Organizations was born in the nexus of these two challenges.

The Shared Savings Program was established under Section 3022 of the Affordable Care Act, which added a new section 1899 to the Social Security Act. The Shared Savings Program is an initiative that encourages healthcare providers to work collaboratively in Accountable Care Organizations (ACOs).3 These ACOs are tasked with enhancing healthcare quality for Medicare beneficiaries while reducing unnecessary costs. By aligning financial incentives, the program aims to transition from a volume-based care model, where providers are paid for the number of services they render, to a value-based model, where providers are rewarded for improving patient outcomes and health efficiencies.4  If ACOs meet specified quality benchmarks and achieve savings beyond a certain threshold, they are eligible to receive a portion of the savings with Medicare.5, 6

Central to the ethos of ACOs is the belief that healthcare should be coordinated and accountable. Rather than treating individual symptoms or illnesses in isolation, ACOs ensure that care is provided in a manner that considers the patient's overall health status, including underlying conditions, previous medical history, and potential future risks. This coordinated approach fosters an environment where medical practitioners work collaboratively, leveraging shared resources and expertise to offer optimal care pathways for patients. As a result, patients receive a continuum of care, from primary check-ups to specialized treatments, without unnecessary overlaps or gaps.

Moreover, with the accountability factor built into the model, ACOs have a direct stake in the outcomes of the care provided. They are incentivized to ensure quality and efficiency since their compensation is often tied to patient outcomes and cost savings. This shift from volume-based to value-based care rewards health systems for providing superior care at lower costs.

Recognizing the potential of ACOs in revolutionizing healthcare outcomes, the Centers for Medicare & Medicaid Services (CMS) took proactive steps to foster ACOs' growth and integration into the broader healthcare framework. On November 2, 2011, CMS introduced a final rule detailing the Shared Savings Program's specifics which covered eligibility, governance, quality measures, and monitoring.7

Following the final ruling in 2011, ACOs emerged on April 10, 2012, as an innovative approach in the healthcare arena, aiming to address the fragmented nature of care delivery that often resulted in suboptimal patient outcomes and expensive, redundant, and sometimes even contradictory treatments.3 

Rather than treating healthcare as a series of isolated interventions, ACOs seek to view and treat the patient's health more holistically. By promoting provider coordination and focusing on patient-centered care, ACOs aspired to enhance the overall patient experience, leading to better health outcomes.4

Pairing ACOs and Telehealth

Telehealth is the utilization of electronic and telecommunication technologies to support and deliver long-distance health care, education, and health-related services. It enables those in remote or underserved areas to receive video consultations, remote patient monitoring, and access to healthcare services otherwise limited due to location or socio-economic status.8

The fusion of telehealth and Accountable Care Organizations (ACOs) represents an evolutionary step in modern healthcare. Together, they promote a more accessible, integrated, and efficient model, particularly essential in reaching vulnerable populations9 and reshaping healthcare delivery in low- and middle-income countries (LMICs).

Expanding Care Reach Using Technology

The introduction of telehealth into the ACO framework amplifies the latter's capabilities. Telehealth platforms, which encompass virtual consultations, remote monitoring, and digital health records, eliminate geographical constraints. Through telehealth services, patients can receive expert advice, regular check-ups, and even specific treatments from the comfort of their homes. For ACOs, this could mean a broader patient base, better tracking of patient health, and the ability to intervene proactively, enhancing the overall quality of care.10

Tapping into Existing Networks in Underserved Areas

One of the most significant advantages of telehealth is its ability to leverage existing technological infrastructures, even in remote or underserved areas. Many LMIC regions, while lacking in advanced medical facilities, already have robust mobile networks. ACOs can utilize these networks to offer telehealth services, ensuring that healthcare reaches those with limited or no access. This approach not only expands care reach but also ensures cost-effective solutions that resonate with the local context.

Case Studies of ACOs Utilizing Telehealth Capabilities11

Telehealth has proven to be an essential care delivery tool for accountable care organizations (ACOs) across the U.S., especially during the COVID-19 pandemic. The pandemic brought regulatory flexibility, allowing ACOs to provide telehealth services without geographic limitations, even from a beneficiary's home. Moreover, payment parity was instituted between telehealth and in-person visits. Telehealth usage in Medicare ACOs soared to 23% of total visits in April 2020. The utilization rate was notably higher for high-need patients, like those with Alzheimer's or heart failure. Telehealth played a pivotal role in the ACOs' strategy during the pandemic, enabling uninterrupted care and helping them achieve financial targets amidst uncertainties.

MultiCare Connected Care

This ACO experienced a fourfold surge in telehealth usage during the pandemic. They use both asynchronous and synchronous telehealth methods, ensuring patients receive care where they are.

Northwestern Medicine ACO

Prior to the pandemic, telehealth represented only a slight portion of their services. However, by March 2020, over 60% of their ambulatory encounters were via telehealth. They employ various synchronous telehealth tools and certain specialties, like psychiatry, to maintain a high telehealth usage rate.

Privia Quality Network

They have conducted nearly 2 million telehealth visits across various health services. They offer training and have their proprietary platform, highlighting the importance of backups like audio-only calls.

During the pandemic's peak, in-person visits plummeted. Telehealth became especially crucial for ACOs to achieve their financial benchmarks. Temporary regulations expanded access to telehealth, leading to increased reimbursements. MultiCare Connected Care and Privia Quality Network both saw millions in shared savings in 2020, attributing much of the savings to telehealth.

Pairing ACOs and Diagnostic Testing

As ACOs navigate the challenging waters of providing high-quality, coordinated care while curbing expenses, innovations from various sectors emerge as invaluable allies. Advancements in the medical and technological fields, such as precision medicine, remote patient monitoring, efficient and convenient testing solutions, and personalized treatments, align seamlessly with the ACO model.

Remote-monitoring technologies, such as devices and software that track patient health parameters continuously,12 and point-of-care (POC) testing options allow healthcare professionals to intervene at critical moments, ensuring timely care and potentially avoiding more severe health complications later.13 By tailoring testing, medical decisions, treatments, practices, and products to individual patients, healthcare providers can offer a more holistic approach, leading to better preventative care, thereby reducing the need for expensive interventions later on.14

For decades, traditional laboratory testing has been the backbone of medical diagnostics. Despite this method's precision and reliability, it can be costly - in health, time, and money.

Transporting samples, processing them, and then communicating results to the patients and their healthcare providers often means prolonged waiting periods, which can be a significant impediment in urgent cases.

However, the landscape of diagnostic testing began to shift with the emergence of Point of Care diagnostic tools. Spurred by technological breakthroughs and the clamor for immediacy, POC diagnostics introduced devices and kits capable of delivering results at or near the clinic or location where the test was administered. What traditionally stood as point-of-care testing within a clinical setting is poised to shift to Point-of-Need (PON) testing for several compelling reasons that we will further explore.

Point-of-need (PON) Diagnostics is a healthcare testing model that facilitates diagnostic processes where the patient's need arises, regardless of the conventional clinical settings. Unlike traditional laboratory tests or POC tests that are tethered to clinical environments, PON Diagnostics transcends these boundaries, seamlessly merging with digital care platforms and telehealth paradigms.15

Imagine a single mother suspecting a UTI. Instead of grappling with taking time off work or accessing a clinic, she can use a PON test. Coupled with connected health platforms, PON test results can be instantly shared with a clinician, enabling a timely telehealth consult. This method not only fast-tracks her treatment but also aids in antibiotic stewardship, ensuring that antibiotics are used judiciously to combat resistance.

Annually, 14 billion laboratory tests are ordered in the U.S., influencing 70% of today's medical decisions.16 However, a significant gap exists: despite its burgeoning adoption and potential to streamline care, telehealth lacks a crucial element – at-home diagnostic testing. Enter PON Diagnostics, which promises to fill this void.

Critical attributes of PON Testing include:

• Test is authorized by FDA for OTC (soon PON designation).

• Test is ordered by a licensed clinician as medically necessary.

• Results are digitally captured to be used in clinical workflow.

• Testing is associated with an authorized CLIA-waived lab.

• Public health reporting is carried out (as applicable).

PON Diagnostic Testing17

The need for prompt medical responses in today's interconnected world underpins the significance of PON testing. Shifting paradigms from POC to PON testing is not just about convenience- it is about optimizing healthcare, reducing hospitalizations, reducing debilitating healthcare costs, and preserving lives.

Some of the benefits of PON diagnostics include:

Relationship to Accountable Care Organizations (ACOs)

ACOs are healthcare collectives focused on improving patient outcomes while optimizing costs. The PON diagnostic model holds transformative potential for ACOs, fundamentally reshaping care delivery and patient management.

Rapid Results and Clinical Decision Making

One of the foremost advantages of PON diagnostics is the speed at which results are generated. Healthcare providers no longer need to wait days for lab results; instead, they can make informed clinical decisions within hours or even minutes. This immediacy can be life-saving, allowing for timely interventions and treatments.

Cost-Efficiency and Resource Reduction

PON diagnostics can be a game-changer in reducing healthcare costs. Reducing the transportation of samples and centralized lab processing can translate to direct cost savings and a reduction of potential hospital admissions and associated expenses.

Healthcare Access

PON diagnostics remove barriers like geography and socio-economic challenges, bringing vital testing directly to patients. This approach democratizes healthcare, enabling broader and timely medical access for many who faced constraints in traditional setups.

Enhanced Patient Experience and Empowerment

PON testing shifts some power back into the hands of patients. Patients can have near-immediate access to their health data and be more actively involved in their personal healthcare. This empowerment and the convenience of not waiting days for results significantly enhance the overall patient experience.

Decreased Disease Burden

By allowing swift at-home treatments, PON diagnostics reduces the need for patients to visit clinics, minimizing the spread of infectious diseases. This approach is crucial for everyday scenarios and more significant public health crises, acting as a protective shield for communities.

Potential for Early Detection and Monitoring

The accessibility and speed of PON diagnostic tools make them ideal for regular monitoring and early detection of diseases. For chronic conditions or diseases that necessitate regular monitoring, like diabetes or heart conditions, PON diagnostic devices can provide continuous data, allowing patients and doctors to stay informed and adjust treatments as needed. 

With the rise of telehealth, ACOs are exploring ways to make remote consultations more holistic. PON testing fills the diagnostic gap, ensuring telehealth sessions are as comprehensive as in-person visits.

Pairing PON Diagnostic Testing and Telehealth

Mobile phones have become ubiquitous in low- and middle-income countries, even in areas with limited access to other technologies or infrastructure. Their widespread adoption offers a unique opportunity for healthcare leapfrogging. These devices can:

• Provide Direct Access
  Mobile phones can host applications for health education, virtual consultations, and data logging.

• Serve as Data Transmission Tools
  Mobile networks can facilitate transmitting diagnostic results from remote areas to centralized facilities.

• Support Health Monitoring
  Through mobile apps, patients can track their health metrics and receive timely reminders or alerts.

Integration of Mobile Networks with PON Diagnostics

Swift Data Transmission to Healthcare Providers

By harnessing the power of mobile networks, PON diagnostic results can be transmitted instantly to healthcare providers, irrespective of their location. This swift data transmission ensures that patients receive timely feedback and interventions despite being miles from the nearest health facility.

Real-Time Results and Timely Interventions

With PON diagnostics connected to mobile devices, results can be processed and presented in real time. This immediate insight into a patient's health status can allow healthcare providers to make timely and informed decisions, ensuring optimized interventions and treatment plans.

Challenges and Limitations

While Point of Need (PON) diagnostic tools have revolutionized healthcare in many ways, they are not without their challenges. For this vision to be fully realized, the critical matter of reimbursement must be addressed.

Telehealth and remote PON testing have the potential to revolutionize healthcare, but their widespread adoption hinges on clear reimbursement policies from the Centers for Medicare & Medicaid Services (CMS). Recognizing the cost-effectiveness and potential of remote POC testing, the CMS must formulate policies that incentivize healthcare providers to adopt this model.J Moreover, collaboration between the CMS and the FDA is vital to ensure innovative progression and patient safety.

For ACOs to adopt PON testing, these tests must be included in clinical workflows and reimbursed by CMS. Reimbursement would be the cornerstone, incentivizing their use and driving consumption. Furthermore, it reduces the friction patients often experience when trying to access prescriptions.

The Current State vs. Potential Future

• Patients: Presently, patients must leave their homes for diagnostic testing and face limitations with telehealth. In the envisioned future with PON testing, they would have frictionless at-home diagnostics and expanded connected care options.

• Providers: Now, providers grapple with minimal home testing capabilities and routine care scenarios automation. With PON diagnostics, testing becomes part and parcel of connected care models, and mundane tasks are streamlined.

• Payors: They currently face the high cost of routine testing and gaps in the telehealth service model. PON testing promises reduced costs and efficient chronic condition management.

• Pharma: There is a current lack of home testing capabilities for decentralized trials, and patient data can be costly or limited. PON could revolutionize this by allowing real-time decentralized diagnostics.

ACOs, combined with PON diagnostics, have the potential to redefine healthcare delivery. As more home-based tests become available, ACOs have the opportunity to champion this innovative care delivery method, ensuring more comprehensive and patient-centric care.

Some benefits of incorporating PON Diagnostics into the ACO framework include the following:

• Patient-Centricity: Designed with patients in mind, PON allows testing to be conducted in diverse settings, from homes to remote locations, without the confines of a clinical setting.

• Clinical Integration: Unlike standalone Over-the-counter (OTC) tests, PON is intricately woven into reimbursable clinical workflows, ensuring the continuity of care.

• Digital Synergy: PON tests are designed to harmonize with digital healthcare platforms, enabling real-time data capture, sharing, and analysis.

• Regulated Oversight:  PON tests are subject to regulatory approvals and are performed under the guidance of licensed clinicians to promote safety and efficacy.

• Public Health Commitment: In alignment with broader healthcare objectives, PON diagnostics can be integrated with public health reporting systems when applicable.

Beyond financial considerations, the CMS's endorsement and promotion of PON testing is a testament to its commitment to bridging healthcare disparities. By waiving site limitations and integrating non-public technology platforms, they ensure that a patient in rural America receives the same quality care as someone in a metropolitan area. These accommodations are the essence of equitable healthcare – ensuring every individual has unhindered access to quality care regardless of socio-economic or geographical constraints.

Centralized labs are renowned for their precision, stemming from strict quality controls, advanced tools, and expert technicians. In contrast, PON testing devices, especially newer versions, may not consistently achieve this precision, potentially impacted by environmental influences or improper handling. While these devices are designed for convenience, ensuring their accuracy demands comprehensive training, from sample collection to result interpretation. Amplifying the challenge, the rapid evolution of PON diagnostics sometimes surpasses regulatory frameworks, tasking authorities with the dual responsibility of ensuring devices meet stringent safety standards while fostering innovation in the field.

Case Studies

PON Testing in Pandemics (e.g., COVID-19)

The COVID-19 pandemic showcased the urgent need for rapid, widespread, and reliable testing. Traditional laboratory tests, while accurate, often faced backlogs, resulting in delayed results. Point of Need (PON) testing emerged as a pivotal solution. Rapid antigen tests, for instance, could be administered at testing sites, homes, or even airports, producing results in minutes. This immediate feedback was essential for contact tracing, isolating confirmed cases, and making informed decisions about treatment and quarantine. Additionally, PON tests played a crucial role in monitoring the safety of large gatherings or verifying the health status of travelers. While challenges like varying sensitivity levels compared to PCR tests existed, the sheer speed and accessibility of PON tests proved invaluable in managing the pandemic's spread.18

PON Diagnostics in Managing Chronic Diseases19

Chronic diseases require regular monitoring for effective management. Traditionally, patients would need to make frequent visits to clinics for tests like glucose levels or blood pressure measurements. With the advent of PON devices, this paradigm shifted dramatically. For example, diabetics can now use continuous glucose monitors (CGMs) that provide real-time glucose readings, alerting them to dangerous spikes or drops. Similarly, wearable tech like smartwatches can monitor heart rhythms, potentially detecting irregularities like atrial fibrillation. These PON solutions offer patients the convenience of self-monitoring and empower them with immediate data, enabling proactive management of their conditions. Patients can often avoid severe complications or hospitalizations by catching and addressing potential issues early.

Value-Based Care Innovations: The MomCare Initiative in Nairobi20 

Innovative approaches to value-based care are not exclusive to developed countries but are also gaining traction in low- and middle-income countries. For instance, in Nairobi, Kenya, an initiative called MomCare by PharmAccess is setting new standards. This program provides comprehensive care for expectant mothers and meticulously tracks both clinical outcomes like complications during pregnancy and patient-reported outcomes, including experiences during childbirth and success in breastfeeding. This gathered information becomes instrumental in refining and motivating healthcare provider practices. The mobile health platform of PharmAccess, known as MTIBA, streamlines the data collection processes and facilitates payments to healthcare providers. The success of programs such as MomCare underscores the inherent advantage LMICs have by not being weighed down by entrenched, outdated systems, highlighting their potential to leapfrog in healthcare innovation. As these nations continue to pivot towards value-based care and experiment further, it becomes clear that such endeavors can reach their pinnacle in impact and scope.

Leapfrog Tech Potential of PON Diagnostics, Telehealth, and ACOs

Integration with Digital Health Platforms

The horizon of PON healthcare is expanding beyond standalone devices and tests, evolving towards seamless integration with digital health platforms. This evolution means PON devices will be able to provide immediate results and instantly upload, analyze, and store the results on cloud-based platforms accessible by both patients and healthcare providers. Such integration streamlines health monitoring, facilitates remote consultations, and enhances personalized care. For instance, a PON device monitoring heart rhythms can instantly relay data to a patient's digital health record, triggering alerts for anomalies and making interventions more timely.21

Role of Artificial Intelligence and Data Analytics

The vast amounts of data generated by PON devices present an opportunity for deeper analysis and insights. Artificial Intelligence (AI) and advanced data analytics can mine this data for patterns, predictions, and personalized recommendations. For example, an AI-powered PON tool for diabetics might not just monitor glucose levels but predict potential spikes based on dietary inputs, physical activity, and historical data. Such predictive analytics can guide patients towards better health outcomes, shifting the healthcare model from reactive to proactive.22

The Leapfrog Pathway to Healthcare Equity in LMICs

Low- and middle-income countries (LMICs) often grapple with infrastructural constraints, financial limitations, and historical disparities. These challenges, ironically, position them uniquely to bypass the incremental growth pattern seen in many developed nations. Instead of following the conventional path, LMICs have the opportunity to adopt and integrate advanced technologies and practices directly, enabling them to "leapfrog" several stages of healthcare evolution and accelerate progress.

For many LMICs, introducing leapfrog technologies is not merely about catching up but rapidly advancing to the forefront of modern healthcare. By embracing innovations such as telehealth, PON diagnostics, and mobile data transmission, LMICs can quickly benefit from immediate diagnostics, treatments, and care coordination improvements. Investing in advanced technologies can sometimes be more cost-effective in the long run than building traditional healthcare infrastructures. With a foundation built on the latest technologies and practices, LMICs can more seamlessly integrate future innovations.

Accountable Care Organizations (ACOs) emphasize an integrated approach, where various healthcare providers collaborate to offer comprehensive, patient-centered care. For LMICs, this can translate to more effective resource allocation, improved patient outcomes, and enhanced satisfaction levels. The potential of the leapfrog pathway, when combined with ACO principles and PON diagnostics, paints a promising future for healthcare in LMICs. By decentralizing healthcare and promoting local interventions through telehealth and PON diagnostics, communities can be empowered to take charge of their health, fostering a culture of prevention and wellness. In the coming decades, as LMICs embrace a leapfrog approach, what was once considered a disadvantage—being a late adopter—might very well become LMICs' most vital asset in carving out a cost-effective, equitable, and advanced healthcare landscape.

Conclusion

Guided by an unwavering commitment to elevate patient care, curtail unnecessary expenses, and streamline processes, ACOs have illuminated a transformative pathway that underscores the significance of coordinated and patient-centric healthcare. This commitment is reflected in CMS's dedication to refining models that yield enhanced health outcomes, aiming towards a 2030 vision where all traditional Medicare beneficiaries benefit from integrated, whole-person care.23

In recent years, the incorporation of Telehealth services has emerged as a key driver to bridge healthcare disparities, especially in LMICs. The expansive capabilities of telehealth can elevate the existing frameworks established by ACOs, amplifying their impact and reach.11

PON Diagnostics signifies more than a term; it represents a monumental paradigm shift in healthcare diagnostics. By adopting the concept of leapfrogging, the industry can bypass traditional stages and immediately adopt more advanced and efficient systems. For ACOs, integrating PON testing can bridge the gap between conventional, reactive care and an anticipatory, patient-focused, and economically prudent healthcare model. As the healthcare terrain evolves, PON Diagnostics, with its leapfrog potential, is set to lead, steering ACOs into a revolutionary era.

Given the unique challenges LMICs face – from inadequate infrastructure to limited resources – the leapfrogging potential of Telehealth and Point-of-need Diagnostics can fast-track their progression into contemporary healthcare standards. These components foster a mutually beneficial partnership: Telehealth provides instant remote consultations, and PON Diagnostics delivers prompt and precise results, bypassing the usual wait times associated with traditional lab tests. This synergy has the power to bypass decades of incremental advancements, launching LMICs directly into the next stage of healthcare. 

Although obstacles remain, the vision of a patient-driven, technologically progressive, and universally accessible healthcare system is within reach. Point of Need testing, bolstered by the solid foundation of ACO infrastructure and advocated by the CMS, coupled with the leapfrog approach, harbors the transformative power to re-envision healthcare, ensuring true equity and accessibility for all.

References

1Yayboke E, Crumpler W, Carter WA. The Need for a Leapfrog Strategy. CSIS Commentary. April 10, 2020. Available at:  https://www.csis.org/analysis/need-leapfrog-strategy.

2Centers for Medicare & Medicaid Services. Accountable Care Organizations (ACOs): General Information. CMS. Available at:  https://www.cms.gov/priorities/innovation/innovation-models/aco.

3Centers for Medicare & Medicaid Services. First Accountable Care Organizations under Medicare Shared Savings Program [Internet]. Available at: https://www.cms.gov/newsroom/fact-sheets/first-accountable-care-organizations-under-medicare-shared-savings-program.

4National Academy of Medicine. Sustainable Success in Accountable Care [PDF]. 2016. Available at: https://nam.edu/wp-content/uploads/2016/04/Sustainable-Success-in-Accountable-Care.pdf.

5MedicareACO. Requirements and Benefits of Becoming an ACO [Internet]. Available at: https://medicareaco.com/requirements-and-benefits/.

6Centers for Medicare & Medicaid Services. Program Guidance and Specifications [Internet]. Available at: https://www.cms.gov/medicare/medicare-fee-for-service-payment/sharedsavingsprogram/program-guidance-and-specifications#Program_Participation.

7Federal Register. Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations [Internet]. 2011. Available at: https://www.federalregister.gov/documents/2011/11/02/2011-27461/medicare-program-medicare-shared-savings-program-accountable-care-organizations.

8NEJM Catalyst. What Is Telehealth? Telehealth: The delivery of health care, health education, and health information services via remote technologies. NEJM Catalyst Innovations in Care Delivery 2018;4(1). doi:10.1056/CAT.18.0268. Available at:  https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0268.

9Mechanic R, Perloff J, Perlman A, Pal S. ACOs’ Use of Telehealth During the COVID-19 Pandemic. West Health Institute. Published May 25, 2021. Accessed October 2, 2023. Available at:  https://www.institute4ac.org/wp-content/uploads/2021/05/IAC_WHI-8__Virtual_White-Paper_2021_FINAL_updated-5.21.211-1.pdf.

10Modi PK, Kaufman SR, Portney DS, Ryan AM, Hollenbeck BK, Ellimoottil C. Telemedicine utilization by providers in accountable care organizations. Mhealth. 2019;5:10. Published 2019 April 3. doi:10.21037/mhealth.2019.03.02. Available at:  https://mhealth.amegroups.org/article/view/24918/html.

11How Telehealth Helped Keep ACOs Afloat During the Pandemic. MHealth Intelligence. April 29, 2022. Available at:  https://www.mhealthintelligence.com/features/how-telehealth-helped-keep-acos-afloat-during-the-pandemic.

12Vegesna A, Tran M, Angelaccio M, Arcona S. Remote Patient Monitoring via Non-Invasive Digital Technologies: A Systematic Review. Telemed J E Health. 2017;23(1):3-17. doi:10.1089/tmj.2016.0051.

13Price CP. Point of care testing. BMJ. 2001;322(7297):1285-1288. doi:10.1136/bmj.322.7297.1285.

14Fiandaca, M.S., Mapstone, M., Connors, E. et al. Systems healthcare: a holistic paradigm for tomorrow. BMC Syst Biol 11, 142 (2017). Available at: https://doi.org/10.1186/s12918-017-0521-2.

15Hansen S, Abd El Wahed A. Point-Of-Care or Point-Of-Need Diagnostic Tests: Time to Change Outbreak Investigation and Pathogen Detection. Tropical Medicine and Infectious Disease. 2020; 5(4):151. Available at: https://doi.org/10.3390/tropicalmed5040151.

16Centers for Disease Control and Prevention. Strengthening clinical labs to combat outbreaks. CDC. [Internet]. Available at: https://www.cdc.gov/csels/dls/strengthening-clinical-labs.html.

17Clifford LJ. The pros and cons of point-of-care testing vs laboratory testing. MLO Online. Published October 23, 2018. Available at: https://www.mlo-online.com/continuing-education/article/13017084/the-pros-and-cons-of-pointofcare-testing-vs-laboratory-testing.

18Iliescu FS, Ionescu AM, Gogianu L, et al. Point-of-Care Testing-The Key in the Battle against SARS-CoV-2 Pandemic. Micromachines (Basel). 2021;12(12):1464. Published 2021 November 27. doi:10.3390/mi12121464.

19Teladoc Health. Teladoc Health Makes A1C Testing Easier for Members with Diabetes. [Internet]. Available at: https://business.teladochealth.com/newsroom/press/release/Teladoc-Health-Makes-A1C-Testing-Easier-for-Members-with-Diabetes/. 

20U.S. Agency for International Development. Leapfrog to Value: A Framework for Improving Health Outcomes in Low- and Middle-Income Countries. May 2022. Available from: https://www.usaid.gov/sites/default/files/2022-05/Leapfrog_to_Value_Report.pdf.

21Parihar, A, Yadav, S, Sadique, MA, et al. Internet-of-medical-things integrated point-of-care biosensing devices for infectious diseases: Toward better preparedness for futuristic pandemics. Bioeng Transl Med. 2023; 8(3):e10481. doi:10.1002/btm2.10481

22Vashistha, R., Dangi, A.K., Kumar, A. et al. Futuristic biosensors for cardiac health care: an artificial intelligence approach. 3 Biotech 8, 358 (2018). Available at: https://doi.org/10.1007/s13205-018-1368-y.

23Centers for Medicare & Medicaid Services. CMS Innovation Center Strategic Direction Whitepaper [Internet]. Available at: https://innovation.cms.gov/strategic-direction-whitepaper.