Patient Access Groundhog Day

McKesson has been putting together some funny healthcare cartoons and now they’ve put out a funny video as well. While it’s funny, it’s also annoying to realize how real this video is for patients. We should be able to do better.

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Operationalizing Health IT Discoveries

I’ve been talking a lot lately with people about how we take the health IT discoveries made at one hospital and apply them to another hospital. In a recent conversation I had with Jonathan Sheldon from Oracle, he highlighted that “Many organizations don’t care about research, but just want a product that works.”

I agree completely with this comment from Jonathan. While there are some very large healthcare organizations that do a lot of research, there are even more healthcare organizations that just want to see patients in the best way possible. They just want to implement the research that other organizations have done. They just want something that works.

The problem for big companies like Oracle, SAP, Tableau, etc is that they have the technology to scale up many of these health IT discoveries, but they aren’t doing the discovery themselves. In fact, most of them never will dive into the discovery of which healthcare data really matters.

In order to solve this, I’ve seen all of these organizations working on some sort of partnership between IT companies and healthcare research organizations. The IT company provides the technology and the commercialization of the product and the healthcare research organization provides the research knowledge on the most effective techniques.

While this all sounds very simple and logical, it’s actually much harder in practice. Taking your customer and turning them into a partner is much harder than it looks. Most healthcare organizations know how to be customers. It takes a unique healthcare organization to be an effective partner. However, this is exactly what we have to do if we want to operationalize the health IT discoveries these research organizations make.

We’re going to have to make this a reality. There’s no way that one organization can discover everything they need to discover. Healthcare is too complex as it is today. Plus, we’re just getting started with things like genomic medicine and health sensors which is going to make healthcare at least an order of magnitude more complex.

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Population Health Tech Will Lag Until Standards Emerge

There’s little doubt that healthcare organizations will continue to partner up with peers and acquire physician practices. The forces that drive healthcare network development are only intensifying as time goes by, particularly as the drive toward value-based payment moves ahead. But there’s a lot more to making such deals work than a handshake and a check. To make these deals work, it’s critical that networks become experts at population health management — and unfortunately, that’s going to be tough.

While merging health systems into ACOs or acquiring referring physicians has merit, this strategy won’t grow the steadily dropping pace of hospital admissions, notes William Faber, M.D., senior vice president of the GE Healthcare Camden Group. “Though clinically integrated networks do enlarge the patient base, one of their aims is also to reduce the percentage of admissions from that base,” making it unlikely that the networks will grow admissions, he points out.

To make a clinically integrated network successful, it certainly helps to take the initiative – to get to market more quickly than competitors – and to do a better job of controlling costs of care and demonstrating higher quality and service. Where things get stickier, however, is in managing that care across a large group. “The creation of a clinically integrated network must not be just a marketing or physician alignment strategy – it must truly enable effective population health management,” he writes.

And this, I’d argue, is where things get very tricky. Well, judge for yourself, but I’d argue that the HIT industry is ill-equipped to support these goals. Despite many years of paper-chart experimentation with population health, and several with population health technology, my sense is that the tech is far behind what it needs to be. Health IT vendors won’t get far until providers do a better job of defining what they need.

A different mindset

The truth is, this generation of EMRs is designed to track individual patients across an experience of care. While CIOs can add a layer of analytics technology to the mix, that is a far cry from creating tools that natively track population health trends. Looking at populations is simply a different mindset.

Admittedly, vendors will tell you that they’ve got the problem licked, but if they were completely candid many would have to admit that their products aren’t mature yet. Until someone creates an EMR or other basic tool which is designed, at its core, to track group health trends, I foresee more half-baked hacks than results.

What’s more, I doubt the health IT business will be able to help until it has at least an informal standard to which such products must adhere. Should such tools measure costs of care by diagnosis code? Compare such costs to national standards? Highlight patients in outpatient settings whose tests or exams suggest a crisis is about to happen? If so, which settings, and what cutoffs should be tracked for test scores? Does such a system need natural language processing to scour physician notes for trigger words, and if so which ones?

Without a doubt, medical and business executives leading integrated networks will come together and develop more answers to these questions. But until they do, health IT vendors won’t be able to help much with the population health challenge.

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Perfect Description of Current Digital Health App Market

In this interview with Dr. John Torous, he perfectly describes the current digital health app market:

There are some useful apps currently available today that many patients would benefit from — and there are also some frightening ones that no one should ever use. Jennifer Nicholas of the Black Dog Institute in Australia published a paper looking at the quality of apps for bipolar disorder on the Apple and Android app stores. The results were not encouraging and to use the words from her paper, “the content of currently available apps for bipolar disorder is not in line with practice guidelines or established self-management principles.” She even found one app telling patients to drink hard alcohol if they had trouble falling asleep. Researchers have revealed similar findings for apps offering to help with substance abuse, suicide, anxiety, and depression.

We know there are many great apps out there, but there are a lot more unhelpful and even dangerous ones out there too.

This is exactly the problem today. Although, it’s worth noting Dr. Torous’ cautious words “would benefit from”. He didn’t say that digital health apps would cure disease, prevent mental health issues, solve health problems, or some other stronger statement. However, digital health apps could provide some benefit.

Although, he also points out that many of them shouldn’t be used at all. In fact, many of them could be doing a lot of damage. That’s a scary thought.

Most of the digital health apps I’ve seen are quite benign. They may not produce the desired results, but they also aren’t going to really harm a patient either. That’s the good thing, but it’s going to change. In order to differentiate themselves, these apps are going to have to do more. Along with that curve, we’re going to have plenty of digital health apps selling the digital health “snake oil” which has become so popular since the AMA talked about EHRs as digital “snake oil.”

Considering how most providers are approaching digital health, I’m not afraid that they’ll get hit with digital snake oil health apps. However, most of these apps are going straight to the consumer. That means that doctors have to know about the apps that do work, but also the apps their patients are using on their own. That’s going to make for an extremely hard situation for doctors. My guess is most will just set aside any apps they don’t know about as risky, but that has its own danger.

Regardless of whether a clinic wants to deal with digital health apps or not, they’re coming and your patients will be using them. It behooves every clinic to think about their digital health strategy.

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Health Catalyst Eliminates Client Restrictions on Solicitation and Hiring in its Contracts

Salt Lake City – June 21, 2016 Health Catalyst, a leader in healthcare data warehousing, analytics and outcomes improvement, today announced it is eliminating the provision in its standard client service contracts that prohibits its clients from soliciting for hire or hiring Health Catalyst team members.  Health Catalyst will continue to honor restrictions preventing solicitation of client employees by Health Catalyst.

“We are committed to working with our clients as long-term partners, and focusing on long-term customer success is our first operating principle,” said Dan Burton, CEO of Health Catalyst. “Our contractual restriction to prevent clients from soliciting or hiring our team members puts up a wall between us and our clients that could inhibit our work together. We want to eliminate any barriers that might prevent our clients from achieving and sustaining clinical and financial outcomes improvements.”

This is Health Catalyst’s second move in recent months to cement a culture of open collaboration and partnership among its clients and its team members. In May, the company officially removed the non-compete provision from its standard employment agreements that prohibited its team members from being employed by organizations that compete with Health Catalyst following employment with Health Catalyst, and announced that it would not seek to enforce such non-compete provisions in existing employment agreements.

“Our company’s purpose is to enable outcomes improvement at scale,” Burton continued. “If in some instances that purpose can be furthered by our clients hiring one of our team members, and this is of interest to our team members then we don’t want to prevent that. In fact, we view it as a sincere compliment when our clients value our team members’ contributions so highly that they express interest in hiring our team members.  Ultimately, we hope each of our team members remains committed to enabling outcomes improvements at scale, whether as a team member or as an alumni of Health Catalyst.  We seek to enable our team members’ long-term career success whether inside or outside the company.”

The decision to eliminate client obligations in non-solicitation clauses supports a client-focused culture that has been acknowledged by Health Catalyst clients and by third-party industry analysts. In its latest report on healthcare business intelligence, Enterprise Healthcare BI: The Search for Outcomes,”  KLAS Research revealed that Health Catalyst’s “strategy of prioritizing client relationships and outcomes result[ed] in the highest client reviews of any vendor for insights and outcomes.”

The decision also supports a work culture that has received recognition as one of the nation’s best from organizations including Gallup, Glassdoor, Modern Healthcare, Becker’s Healthcare and Rock Health.

About Health Catalyst

Health Catalyst is a mission-driven data warehousing, analytics and outcomes-improvement company that helps healthcare organizations of all sizes perform the clinical, financial, and operational reporting and analysis needed for population health and accountable care. Our proven enterprise data warehouse (EDW) and analytics platform helps improve quality, add efficiency and lower costs in support of more than 70 million patients for organizations ranging from the largest US health system to forward-thinking physician practices. For more information, visit https://www.healthcatalyst.com, and follow us on Twitter, LinkedIn and Facebook.

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Healthcare Disruption – #HealthDisruptors Blab Chat – June 21, 2016

We’re really excited to be holding our 2nd Health Disruptors Blab chat on June 21, 2016 at 10 PM ET (7 PM PT). Yes, we realize this is late for many of you on the east coast, but that should make for some fun late night conversations. Most of the health disruptors I know send me emails at all hours of the day and night, so hopefully this time will work out for most. We’re continuing to evaluate the time and changing it as our schedules permit and as the community desires.

If you’re not familiar with the format and approach of the Health Disruptors blab, you can read more details here.

Melissa McCool (MindStile and STI Innovations) will be the host for this month’s Health Disruptors chat where we’ll talk about “Solving the Problems of the Upstream Determiners of Health.” To start the discussion, here’s the big overarching question we’d like to discuss along with some questions that dive a little deeper into the topic.

Big Question:

  • How can we solve the problem of the upstream determiners of health?

Diving Deeper:

  • What does this mean exactly?
  • Whose job is it?
  • What are some creative ways to address this issue?
  • If I had a magic wand, I would solve this problem by…
  • What is the role of tech?
  • Who and what companies are being most disruptive to healthcare?

If you’ve never used blab before, it’s really easy to use. You can watch and participate in the chat on blab itself or in the embed below. Just visit this blog post or the blab page on June 21, 2016 at 10 PM ET (7 PM PT) and you can join in on the conversation.

We’re planning to start off holding these monthly on the 3rd Tuesday of every month.

Also, feel free to use the #HealthDisruptors hashtag for things you learn or hear on the blab chat as well. Thanks in advance for those who spread the word about this new endeavor. We think it could grow into a really special community.

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HHS Announces Major Initiative to Help Small Practices Prepare for the Quality Payment Program

Over the last few weeks, the Department of Health and Human Services (HHS) has made several important announcements related to the Quality Payment Program, which has been proposed to implement the new, bipartisan law changing how Medicare pays clinicians, known as the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA. Today, we are announcing $20 million to fund on-the-ground training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer.

These funds will help provide hands-on training tailored to small practices, especially those that practice in historically under-resourced areas including rural areas, health professional shortage areas, and medically underserved areas.

“Doctors and health care providers in small and rural practices are critical to our goal of building a health care system that works for everyone,” said Secretary Burwell. “Supporting local health care providers with the resources and information necessary for them to provide quality care is a top priority for this administration.”

As required by MACRA, HHS will continue to award $20 million each year over the next five years, providing $100 million in total to help small practices successfully participate in the Quality Payment Program. In order to receive funding, organizations must demonstrate their ability to strategically provide customized training to clinicians. And, most importantly, these organizations will provide education and consultation about the Quality Payment Program at no cost to the clinician or their practice.

“The bipartisan MACRA legislation gave us the tools to improve Medicare and make it modern and sustainable by improving the incentives for and lowering the burden on clinicians,” said Dr. Patrick Conway, acting principal deputy administrator and chief medical officer for the Centers for Medicare & Medicaid Services. “Real change must start from the ground up, and today’s announcement recognizes this reality by  getting doctors the resources they need to provide better, smarter care.”

Organizations receiving the funding would support small practices by helping them think through what they need to be successful under the Quality Payment Program, such as what quality measures and/or electronic health record (EHR) may be appropriate for their practices’ needs. Organizations would also train clinicians about the new clinical practice improvement activities and how these new activities could fit into their practices’ workflow, or help practices evaluate their options for joining an Alternative Payment Model.

“Providing these tools to help physicians and other clinicians in small practices navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients,” said B. Vindell Washington MD, MHCM, FACEP, principal deputy national coordinator. “As with the Office of the National Coordinator for health ITs funding for regional extension centers, this assistance will help health care providers leverage health information technology to enhance their practices and the care they deliver.”

Awardees will be announced by November 2016.  HHS encourages all qualified organizations to apply for this funding.

To learn more about today’s announcement and how to apply, please contactMQIDTA@cms.hhs.gov.

For more information on the Quality Payment Program, please visit:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program.html

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Methods of Data Exchange in Healthcare

Jane Sarasohn-Kahn has a great chart on her Health Populi blog which shows how healthcare shares health data:
Healthcare Data Sharing Methods and Options

The chart is great even if the results are pretty awful. Plus, the data is a little dated. I wonder how those numbers have changed since early 2015.

Amazing that the top 3 forms of data exchange in healthcare were old analogue technologies: paper, information (phone), and fax.

This will come as no surprise to anyone in healthcare. I do find it interesting that the 4th most popular method is scanning the documents directly to the provider. That illustrates that most clinics would love to have an electronic option for sharing data, but there’s not an easier way. The options that are currently available are too hard. If they were easier, then I believe almost every practice would adopt them.

With all the benefits of direct exchanges, HIE, portals, Direct, FHIR, etc, it’s amazing that a simple document scan sent directly to a clinic is more popular. It makes me take a step back and wonder if we’ve over complicated the process of health data exchange.

Would the best option be to step back and make exchange much easier? Could we strip out all the extra features that are nice but impede participation from so many?

I can’t wait for the day that my health data is available wherever it’s needed. The first step to that reality might be taking a step back and simplifying the exchange of data.

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Hospitals’ Progress Towards Value Based Reimbursement

After posting the value based reimbursement research results that were shared by McKesson Health Solutions in anticipation of the AHIP Institute, I came across this infographic from Health Catalyst about hospitals participation in value based reimbursement.

This infographic illustrates a slower adoption of value based reimbursement, but it does illustrate that pretty much every hospital is participating in value based reimbursement. The other thing that stood out to me in this infographic was how small hospitals are going to have a hard time accessing the capital they need to manage this shift. This should be troubling to those of us in healthcare. Those smaller hospitals play an important role in our healthcare system.

Hospitals Progress to Value Based Reimbursement

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Technology is Just a Tool, It’s Not The Solution to Healthcare’s Problems

Today I’m dipping my toes in an area that’s not familiar with me. I’m attending the AHIP Institute conference in Las Vegas. For those not familiar with AHIP, it’s a coming together of the health plans across the US. This group is particularly interesting when you remember that most healthcare providers are also health plans today. In fact, we’re quickly seeing the merging of healthcare providers and payers.

The conference has just begun, but it’s already clear to me that there’s a general tone that technology is going to play a major role in the future of healthcare delivery. What also seems to clear to me is that most of these people aren’t sure what role technology will play.

The problem I think many of these people have is that they think that technology can be implemented to solve all their problems. That’s not how it works. Technology in and of itself is not a solution to most problems. Technology is just a tool. How you use that tool can be effective or not. Plus, you have to make sure that you have the right tool. If you need to drive a nail into a piece of wood, a screwdriver doesn’t do you much good.

I’d also add that even if you have the right tool, you still need the right plan. If you’re trying to build a table and you have the blueprints for a chair, then you’re not going to get the result you want. My gut tells me that most of these people are overwhelmed by the operational requirements of their day to day job and so they don’t have any time to actually explore what solutions are out there for their problems.

I agree with those at AHIP that technology shows a lot of promise. However, we need to spend a lot more time making sure we’re using the right solution at the right time in the right place. That’s a challenge we haven’t quite solved.

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