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Month: March 2015

King v. Burwell: Will the Supreme Court Save the Republican Party from Itself?

flying cadeuciiLast week, the Supreme Court heard arguments in the most recent and pernicious attack on the Affordable Care Act – aka Obamacare.  In the absence of a dysfunctional Congress, the case would be beneath the dignity of Court:  it addresses no complicated legal issues that might guide future decisions of lower courts.   Instead, the Supreme Court has been asked to decide whether a drafting error resulting in one unfortunate phrase in the much maligned 2000 page law –“Exchange established by the States” — means that more than 6.3 million citizens would not be eligible for federalsubsidies allowing them to afford commercial (i.e. – non-governmental) health insurance.

Ordinarily, Congress is expected to fix such drafting problems itself.  Each year Congress pass dozens of “Technical Corrections” bills to fix such errors in prior legislation.  These bills are akin to software patches that are regularly released by companies to fix unanticipated “bugs” previously release programs.  But this is no ordinary legislation.  Having spent six years vilifying for President Obama and has supporters for passing legislation that improves American lives it is far too late in the day for the Republican Congress to replace demagoguery with common sense.

So this issue is now in the lap of the Supreme Court, with its well-known partisan divide of four liberals, four arch-conservatives, and Justice Kennedy, who as the “swing vote” effectively decides many of the most divisive cases himself.  The Court can decide to gloss over this drafting error, as proposed by the Obama Administration, or apply its language to devastating effect.   Prior Supreme Court cases—i.e. “precedent” in the jargon of the law—can be found to support either position.   In the end, there have been few cases in which the Court has more judicial freedom – assuming precedent ever really binds the Court – to do whatever it wants in keeping with the Justices own political biases.Continue reading…

Apple’s ResearchKit is Not (Yet) Ready For Primetime – But Soon? A Medical Researcher’s Perspective

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I am a clinician and a clinical trialist. Medical research in some form or another (performing it, consuming it, reviewing it, editing it, etc.) occupies much of my time. Therefore, you can imagine my excitement while watching Apple’s product announcement yesterday when they introduced a new open source software platform called ResearchKit. Apple states ResearchKit could:

“revolutionize medical studies, potentially transforming medicine forever”

ResearchKit allows clinical researchers to have data about various diseases collected directly from a study participant’s iPhone (and perhaps other devices in the future — see below). The software is introduced as a solution to several important problems with current clinical studies, such as:

  • limited participation (the software allows everyone to participate; anyone with an iPhone can download a specific app for every study they want to participate in)
  • frequent data entry (patients can enter data as often as required/desired, rather than only at limited opportunities such as hospital or clinic visits)
  • data fidelity (currently-used paper patient “diaries” are prone to entering implausible or impossible values — the iPhone can limit the range of data entered)

Specifically, the website states:

ResearchKit simplifies recruiting and makes it easy for people to sign up for a study no matter where they live in the world. The end result? A much larger and more varied study group, which provides a more useful representation of the population.

This is a bold claim. We’ll see below that it doesn’t yet ring true.

Continue reading…

Validic meets Cerner–Drew Schiller speaks

Validic is one of the more interesting companies in what we define as the “data utility layer.” They’ve had a bit of a meteoric rise in the past 2 years, and now have over 45 employees, over 90 customers and are now one of the main names that come up when the conversation turns to “how do we get all that device data into the EHR?” Today they announced a new deal with Cerner (release here). This is the quick interview with CTO Drew Schiller.

[youtube width=”450″ height=”275″]https://youtu.be/yvlXdAQb9lY[/youtube]

Apple Research Kit is Open Source But Is It “Open”?

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For now, the answer is “we don’t know”.

But… the question is very important and worth tracking over the coming months. Let’s not assume that open source will equate to “open”.

What is ResearchKit?

Apple’s press release provided an overview of ResearchKit:

Apple® today announced ResearchKit™, an open source software framework designed for medical and health research, helping doctors and scientists gather data more frequently and more accurately from participants using iPhone® apps. World-class research institutions have already developed apps with ResearchKit for studies on asthma, breast cancer, cardiovascular disease, diabetes and Parkinson’s disease.

…With hundreds of millions of iPhones in use around the world, we saw an opportunity for Apple to have an even greater impact by empowering people to participate in and contribute to medical research,” said Jeff Williams, Apple’s senior vice president of Operations. “ResearchKit gives the scientific community access to a diverse, global population and more ways to collect data than ever before.”

Many members of the research community have had high praise for ResearchKit. For more details and perspectives about ResearchKit, see the list of articles appended at the bottom of this post.

Continue reading…

Understanding Value-Based Purchasing

Value-based care is one of the most misunderstood and controversial areas in a rapidly evolving healthcare system. This helpful webinar introduces and clarifies many of the core concepts involved in the transition to the value-based model.  You’ll get a walk through of programs offered by CMS. Learn how programs are measured.  Hear about the success of programs to date. Find out what organizational changes are necessary for the transition.

Hosted by Bobbi Brown, Vice President, Financial Engagements at Health Catalyst this event will be held Wednesday, May 13th at 1 PM EST and is free of charge. Bobbi’s healthcare finance background includes high profile roles as an executive with Kaiser Permanente, Sutter Health and InterMountain. Register now to guarantee your spot.

Do Value-Based Payments Lead to Higher Doctor-Satisfaction Scores?

Jack CochranRecently we wrote a blog post promoting the benefits of shifting from fee-for-service to value-based payments. We praised the recent decision by leaders at the U.S. Department of Health and Human Services (HHS) to accelerate that shift, and we were then and remain convinced this shift paves the way for better, more affordable care.

There were some strong reactions to the post.

Some people think capitated payments have been discredited, others believe the change from fee-for-service will change little. One physician told John Irvine, editor at The Health Care Blog, that he got the impression from our post that we were saying value-based payments would make physicians lives easier. “Really?” Irvine’s doctor friend said. “You’re making my life easier? Prove it.”

How Will the Practice of Medicine Change?

We didn’t actually use the word easier in the post though we did say that “increasingly, physicians seek liberation from the constraints of fee-for-service in order to focus on the overall health of their patients. Value-based payments allow doctors to do exactly that.” So we definitely hear what Irvine’s friend is saying — and we understand his frustration. Has there ever been a time when so many physicians have been worn thin — angry with the direction of our health care system?

Irvine invited us to respond to his friend and we thought we would do so by soliciting the thoughts of Scott Young, MD, executive director of Kaiser Permanente’s Care Management Institute and associate executive director for Clinical Care and Innovation at The Permanente Federation.

“Easier?” said Dr. Young. “No, value-based payments don’t make doctors’ lives easier. But I think it does make the practice of medicine more rewarding and fulfilling.”

Continue reading…

Value-Based Health

flying cadeuciiIn recent weeks, the market has reacted to a few noteworthy headlines, all involved with or touching upon value-based discretionary actions, and many with the not-so-hidden question: What’s In It for Me or WIIFM?

  • CMS announced that by 2016 30% of fees in health care should be paid for through a value-based system, moving away from fee-for-service.
  • ACO results have shown ambivalent outcomes.
  • Outcomes-based contracts have permeated the Hepatitis C cost-nado (that’s a cost sharknado, the kind that fiercely defies cost controls and takes over all noise about payment reform and patient preferences).
  • Reference-based pricing is a good/bad troublemaker in the middle of the value-based travails.

The latest rampages have appeared on two national and highly-regarded blogs: The Health Care Blog [Value-Based Reform] and The Health Affairs Blog [Go Slow on Reference Pricing].

As one of the loudest proponents on value-based designs, I lift the curtain again to show the thinking behind the movement from fee for service to value-based designs. All of these items above discuss the message of payment reform, or system alignment, but they are intensely linked to the patient-consumer ability to make the right choices, choose the right sites for care, and pay the right amount for services rendered to achieve health security.

This last—health security—should be at the heart of the US health system.

▪      It’s the place where patient competency is built and tested over time, as the patient becomes aware of health risks and chooses to modify behaviors to lower the risk.
▪      It’s the place where, when there are acute or emergent symptoms, there is no question but that the patient will be able to access the appropriate and affordable care in the safest possible setting, hopefully receiving care that delivers the patient back to functional health.
▪      It’s the place where caregivers and administrators are paid a competitive wage for serving the needs of the patient and getting the patient back to the best health possible.

Continue reading…

From Google to New Reimbursement Models, Digital Health Trends for 2015

Ryan BecklandThere is no question that 2014 was an exciting and eventful year for digital health. Even with all of the advancements and innovations in 2014, this year promises to be even better. The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

Maybe we have not quite achieved this synergy yet, but the trends emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.. To understand the convergence that is taking place in digital health, we need to examine the key emerging trends in technology, healthcare and business.

Technology

 Connecting to Smart Clinical Devices

Technology has advanced to the point that we are constantly hyper-connected to a variety of networks and devices. We have handheld diagnostic tools on our person continuously generating an astounding amount of data.

The types of health devices that are connectable and disseminating data are rapidly changing. Tools are emerging like flash thermometers that do not require physical touch, which diminish contamination risks, and smart EpiPen casings that automatically alert medical professionals during an allergic reaction.

These devices are not only becoming less expensive, but they are also starting to be reimbursable by insurers. Thus, over time these devices will replace traditional, non-connected products. Clinical devices are increasingly designed as Bluetooth-enabled, allowing for the real time collection of patient data, and providing better access and outcomes for patients.

Continue reading…

Livongo–update on the “new diabetes meter experience”

I spent a day in Chicago last week and caught up with Stephanie Kowalski from Livongo. This is the company that has a very cool new blood glucose meter, with cloud communication, and a careteam and coaching function built in. The CEO is ex- Allscripts boss Glen Tullman (no stranger to building big companies) and the product launched at Health 2.0 last Fall. Take a look at the video to get a sense of the user experience and hear more about the company’s rapid evolution (and to hear me almost choke to death!)

[youtube width=”425″ height=”325″]https://www.youtube.com/watch?v=NUSNb0oxF4M[/youtube]

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