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Ascension’s cross-market layer
Ascension, with 110 hospitals and nearly 2,000 care sites, is building what it calls a virtual care infrastructure layer across nine states. The goal is to let a physician, nurse practitioner, physician assistant or nurse work across every EHR instance in the system without separate logins. A teleneurologist could see a stroke patient in Wisconsin and, half an hour later, a patient in Florida.
Current services include teleneurology, telepsychiatry, tele-infectious disease and same-day virtual care. Onsite nurses help run exams with remote neurologists. Leaders describe virtual care as an entry point to in-person services, not a replacement, and say services are being designed for Medicaid, Medicare and uninsured patients as well as the commercially insured. Next steps include virtual support for transitions from the hospital or emergency department to home.
Stanford’s route around a waiver
Stanford Health Care took a different path. California rules kept it from fully using CMS’s Acute Hospital Care at Home waiver, so it built an ambulatory-based transitional care program to shorten stays and ease discharge bottlenecks. The program enrolled more than 1,000 patients in its first year, runs a daily census of about 45 and has expanded to 10 neighboring counties through home health partners. Because it does not depend on the waiver, it kept running during the earlier federal shutdown, when some waiver programs paused or shrank.
What leaders can apply
- Build once, use everywhere: A shared platform across markets lets scarce specialists cover more sites. Count how many EHR instances and logins stand in the way today.
- Design for policy risk: Programs that depend on a temporary waiver can stop when policy does. Favor models that also work under standard rules.
- Start with lower-risk pieces: Stanford’s leaders advise beginning with telehealth, nursing and physician leadership instead of waiting for a complete hospital-at-home build.
- Measure access and flow: Track specialist coverage, transfers avoided, length of stay and discharge delays, not just visit counts.
- Staff for it: Some clinicians prefer virtual roles. Recruit and schedule them as a distinct team with clear onsite partners.
Archive entry for May 25, 2026, added Nov. 11, 2026.