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Consumerism is the answer to health care? Maybe not

By MATTHEW HOLT

After 3 days at the Health 2.0 conference, everyone is agreed with Jane Sarasohn-Kahn that more consumer choice and better transparency and an “Amazon like shopping experience” would improve health care. In fact in her wonderful book, Consuming Health, Jane talks a lot about the dark side of putting this much pressure on consumers, but I just had an experience that revealed what might go wrong. Bear with me, this does get back to health care…

The short answer is that BestBuy‘s home appliance service delivery and fulfillment seriously sucks. It has gone off the rails in a massively bad way. You’d think they’d have a multi-platform CRM that worked but it’s a disaster

The story. The washer in an apartment I used to live in but now rent out broke after 9 years–fair enough. And I spent a long time on a customer IM chat with Best Buy figuring out if there was an available washer that would stack under the still working dryer (which was stacked on top of it). But the answer was no.

So in the same IM chat the Best Buy agent suggests a replacement washer and dryer, and all the stuff required to put it in, and added installation and delivery. And he gets me a page where I can fill in my details, credit card and buy it all, then return to the chat to set a delivery date. Pretty snazzy BUT apparently the agent forgot to add removing the old ones to the order (even though most of the conversation was about the old ones!) Remember that for later…

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Health in 2 Point 00, Episode 95 | Health 2.0 Wrap-Up Edition

Jess and I are at Health 2.0 for Episode 95 of Health in 2 Point 00! To wrap up the conference, Jess and I talk about Jonathan Bush’s reappearance in health care on the stage at Health 2.0, with Firefly Health, with echoes of this direction in primary care by Tony Miller on the insurance panel. We talk about all the winners at Health 2.0, including the RWJF Challenge winners, Ooney with Prehab Pal and Social AI Impact Lab, and Omny who won Launch. My favorites from the conference were Indu Subaiya’s Unacceptables panel with two amazing speakers, Melissa Hanna, CEO of Mahmee & Joia Crear Perry, Founder and President of the National Birth Equity Collaborative. Catch highlights from Jess’s panel on social movements in health care as well! —Matthew Holt

Health 2.0: Why I’m (Freaking) Excited…and a (Bit) Concerned

By DAVE LEVIN, MD

The 2019 Health 2.0 conference just wrapped up after several days of compelling presentations, panels, and networking. As in the past, attendees were a cross section of the industry: providers, payers, health IT (HIT) companies, investors, and others who are passionate about innovation in healthcare.

Tech-enabled Services

One of the more refreshing themes of the conference was an emphasis on how health IT can enable the delivery of services. This is a welcome perspective as too often organizations believe that simply deploying technology will solve their problems. In my 30+ years in healthcare, I’ve never seen that work. What does work is careful attention to the iron triad of people, process, and technology. Neglect one of these and you will fall short of your goals. Framing opportunities as services that are enabled and enhanced by technology helps us avoid the common pitfall of believing “Tech = Solution” and forces us to account for process and people.

Provider Burn-out and Health IT

Several sessions focused on the impact technology is having on end-users, especially clinicians. One session featured a “reverse-pitch” where practicing physicians “pitched” to health IT experts on the challenges they face, especially with EHRs, and what they need in order to do their job and have a life. This was summed up elegantly by a physician participant as, “Please make all the stupid sh*t stop!” There’s increasing evidence that the deployment of EHRs is a major factor for clinician burnout and the impassioned pleas of the attendees resonated throughout the conference.

Other sessions explored how to we might address these problems with improvements in user-interface design, workflow, and interoperability. Demonstrations of advanced technologies like voice-driven interfaces, artificial intelligence, enhanced communications, and smart devices show where we are headed and hold out the promise of a more efficient and pleasing HIT for providers and patients.

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Why Should Anyone Care About Health Data Interoperability?

By SUSANNAH FOX

This piece is part of the series “The Health Data Goldilocks Dilemma: Sharing? Privacy? Both?” which explores whether it’s possible to advance interoperability while maintaining privacy. Check out other pieces in the series here.

A question I hear quite often, sometimes whispered, is: Why should anyone care about health data interoperability? It sounds pretty technical and boring.

If I’m talking with a “civilian” (in my world, someone not obsessed with health care and technology) I point out that interoperable health data can help people care for themselves and their families by streamlining simple things (like tracking medication lists and vaccination records) and more complicated things (like pulling all your records into one place when seeking a second opinion or coordinating care for a chronic condition). Open, interoperable data also helps people make better pocketbook decisions when they can comparison-shop for health plans, care centers, and drugs.

Sometimes business leaders push back on the health data rights movement, asking, sometimes aggressively: Who really wants their data? And what would they do with it if they got it? Nobody they know, including their current customers, is clamoring for interoperable health data.

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We Can Stop America’s Surge in Opioid-Dependent Babies

By STUART H. SMITH

Imagine a massive public health crisis in the United States that affects tens of thousands of people. Now imagine that the government had a simple tool at its disposal that could prevent this kind of physical and psychological trauma. You might think that I’m writing about America’s deadly outbreak of gun violence, which has made headlines this summer from Dayton to El Paso.

But actually I’m talking about a different crisis that affects even more people – all of them children — and which could be sharply reduced with one simple step that lacks the bitter political animus of the gun debate. The issue at hand involves babies born to mothers who used opioids during pregnancy – babies who tend to develop a condition called Neonatal Abstinence Syndrome, or NAS.

Experts say that state and federal governments have grossly underestimated the number of NAS babies currently born in the United States, as the addiction crisis triggered by Big Pharma’s greed in pushing painkillers refuses to fade. They say an accurate accounting would find a minimum of 250,000 children — and possibly two or three times that every year born with NAS. These kids will face chronic symptoms such as trembling and seizures, gastrointestinal problems, and an inability to sleep. Their numbers are more than eight times higher than the last official estimate from the government.

For more than a year now, I’ve been working with a team of attorneyscalled the Opioid Justice Team who are fighting for any settlement of the massive court fight pitting more than 2,000 localities against Big Pharma to include a medical monitoring fund for the estimated hundreds of thousands of kids born with NAS syndrome. But our team has also been pushing for radical measures that would prevent many of these unfortunate cases.

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Taking on Facebook for Health Data Privacy: Fred Trotter, CareSet Systems

By JESSICA DaMASSA, WTF HEALTH

While patients can often find comfort, compassion, and support in Facebook Groups dedicated to their health conditions, they don’t realize that their identity, location, and email addresses can be found quite easily by other members of their closed group — some of whom may not have well-meaning purposes for that information. Called a Strict Inclusion Closed Group Reverse Lookup (SICGRL) attack, this is a privacy violation of unprecedented magnitude. 

Fred Trotter is one of the leaders of a group of activists co-led by Andrea Downing and David Harlow that is taking on Facebook to correct this health data privacy violation. 

While this interview was filmed at Health Datapalooza in the Spring of this year, Fred has just published an update that details how Facebook continues to ignore the issue and remains unwilling to collaborate on a solution. 

Catch up on the background behind this data privacy issue — currently, one of the most important opportunities we as healthcare innovators have to learn about what NOT to do when it comes to user privacy and sensitive data. 

I Have a Strong Relationship with my Bank but I Almost Never Go There. How Could this Translate to Primary Care?

By HANS DUVEFELT, MD

Imagine if your bank handled all your online transactions for free but charged you only when you visited your local branch – and then kept pestering you to come in, pay money and chat with them every three months or at least once a year if you wanted to keep your accounts active.

Of course that’s not how banks operate. There are small ongoing charges (or margins off the interest they pay you) for keeping your money and for making it possible to do almost everything from your iPhone these days. Yes, there may be additional charges for things that can’t be done without the bank’s personalized assistance, but those things happen at your request, not by the bank’s insistence.

Compare that with primary care. The bulk of our income is “patient revenue”, what patients and their insurance companies pay us for services we provide “face to face”. We may also have grants if we are Federally Qualified Health Centers, mostly meant to cover sliding fee discounts and what we call “enabling services” – care coordination, loosely speaking.

Only a small fraction of our income comes from meeting quality or compliance “targets”, and those monies only come to us after we have reached those goals – they don’t help us create the needed infrastructure to get there.

Then look at how medical providers are scheduled and paid. We all have productivity targets, RVUs (Relative Value Units – number and complexity of visits combined) if our employer is paid that way and usually just straight visit counts in FQHCs (because all visits are reimbursed at the same rate there). Sometimes we have quality bonuses or incentives, which truthfully may be the combined result of both our own AND other staff members’ efforts.

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Health in 2 Point 00, Episode 94 | Healthy.io, Smile Direct Club, and Period Tracking?

On Episode 94 of Health in 2 Point 00, Jess asks me about Healthy.io’s $60 million raise for at-home urine testing for kidney diseases, with the NHS on the hook & coming to the US, and Smile Direct Club going public with a $9 billion valuation—but quickly tanked (although to $7 billion). In other news, there’s a period tracker scandal with Maya and MIA Fem apps sharing sensitive data about women’s cycles and sexual activity with Facebook. Find out what Jess & I are looking forward to at Health 2.0 this week as well. See you there! —Matthew Holt

The Opportunity in Disruption, Part 2: The Shape of Today’s System

By JOE FLOWER

The system is unstable. We are already seeing the precursor waves of massive and multiple disturbances to come. Disruption at key leverage points, new entrants, shifting public awareness and serious political competition cast omens and signs of a highly changed future.

So what’s the frequency? What are the smart bets for a strategic chief financial officer at a payer or provider facing such a bumpy ride? They are radically different from today’s dominant consensus strategies. In this five-part series, Joe Flower lays out the argument, the nature of the instability, and the best-bet strategies.

Healthcare CFOs must look at the environment in which their system lives: Since 2007 the actual costs for the average middle-class family for many of the basics of life have decreased in real terms, while their actual costs for healthcare have risen 25%, or even more counting co-pays, deductibles, and out-of-pocket expenses. This long, continuing rise in the costs along with the continuing and increasing unreliability of the healthcare system (“Will it actually be there for me when I need it? Will it bankrupt me?”) create unyielding disruption.

Instability: Omens

I am no fortune teller, but here are some things we can see right now that give us a sense of what’s coming.

  • Political shift: Public opinion has shifted. When polled about actual policies, healthcare has been cited repeatedly as the top concern of voters across the country. Voters’ top concerns are cost, the risk to patient protections in the ACA, and threats to “reform” Medicare by weakening it. The popularity of “single payer” proposals is a direct result of the cost and uncertainty of healthcare, a simple cry to “Do something!” Under this pressure we are more likely to see drastic solutions proposed and passed at the federal and state level or embodied in regulatory changes and lawsuits against industry practices.
  • Degradation of American life: With the opioid epidemic, the rise in suicides, the actual regression in life expectancy, and the increasing income and wealth divide, people increasingly feel that the healthcare industry is just not helping. They feel it is in fact part of the problem. The feeling that there is no one there to help us adds to the desperation of many parts of American society and heightens the political cost of the healthcare issue.
  • Public awareness: Healthcare is intensely personal, visceral. It’s crazy-making. Surprise bills, balance bills, other bills slipped through loopholes in the fine print or even in unwritten industry practices—what the industry considers standard operating procedure, the customers view as shocking, aggressive, and financially crushing.
  • The rebellion of the buyers: The percentage of buyers—such as employers, unions, and pension plans—telling various polls that healthcare costs represent a major problem for their business has more than doubled in the last five years and is now a majority. Buyers are pushing for choices to control costs and manage quality. They are beginning in greater numbers to demand reference pricing tied to Medicare rates, direct access to competitive bundled prices, and price transparency through centers of excellence, high performance networks and accountable care organizations. Some 65% of employers plan on implementing direct primary care in onsite or near-site clinics by 2020. Buyers are increasingly willing to take their beneficiaries elsewhere if your business can’t meet their demands.
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Health Innovation in Seattle & the Pacific Northwest | Maura Little of Cambia Grove

By JESSICA DaMASSA, WTF HEALTH

In the Pacific Northwest, “accelerator-slash-think tank” Cambia Grove is quickly expanding as the region’s go-to healthcare innovation hub. Fully funded by Cambia Health Solutions, the organization is functioning as a neutral party to bring startups and healthcare system incumbents together to identify innovation priorities. What else is happening in health tech in Seattle, especially with a few of those famous big consumer tech companies headquartered up there? Tune in to find out!

Filmed at the Together.Health Spring Summit at HIMSS 2019 in Orlando, Florida, February 2019.

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