Not Actually Fake News

Trump appointees cheered by both Republicans and Democrats. Venture capitalists venting about too much investment cash. Data nerds decrying the deification of artificial intelligence.

For two days, Health Datapalooza 2018 offered a glimpse of a Washington where all sides work in harmony “to improve Americans’ health through better data,” in the words of Eric Hargan, deputy secretary of Department of Health and Human Services (HHS).

Not to mention the goal of improving health care economics. Enable digital health entrepreneurs to earn millions of dollars in profits, goes the logic, and their innovations will help the feds and others avoid paying many more millions of dollars in health care bills.

Health Datapalooza began nine years ago as a showcase for public-private data partnership. The shining example back then was the way the release government meteorological data had paved the way for online apps like weather.com. What was significant at this year’s event was not so much the sweeping rhetoric as the signals sent by HHS that it will accelerate the push by previous administrations towards value-based payment.

So, for instance, Seema Verma, the administrator of the Centers for Medicare & Medicaid Services (CMS), said CMS will ask private insurers and state Medicaid programs to require hospitals to provide patients with their own data electronically. The Medicare program wants to make that requirement part of the “conditions of participation” for hospitals in Medicare; i.e., do this or you can’t participate in the program that’s your largest customer.

“The expectations of CMS have changed,” said Verma. “Patients can never again be kept in the dark with regard to their health care information.”

This CMS requirement would have enormous economic consequences. Information is power, and consumers would gain the power to share information in person or online with other hospitals and doctors anywhere. Patients might even be able to access a direct-to-consumer decision support tool of the type that could benefit from the streamlined approval process for digital health products announced by Dr. Scott Gottlieb, commissioner of the Food and Drug Administration.

“If we need disruption to deliver the care Americans deserve, then disruption is on the way,” declared Hargan.

This was impressive, but more deeds need to follow the words. For example, Verma’s assertion that the form in which data is released will easily sync with online apps does not appear to be part of the formal proposed changes. We’ll have to wait and see how well the rah-rah of Datapalooza survives the reality of Lobbyist-palooza.

Meanwhile, as the conservatives were countenancing disruption, the venture capitalists were bemoaning the allure of easy money. Emma Cartmell, who heads her own firm, told of a non-health care company that had come to her seeking a $1 billion health care acquisition simply because the health care market is so alluring. Venrock’s Bryan Roberts summarized the situation this way: “The capital environment is as permissive as it’s ever been,” with more money than good ideas.

Even with a good idea, the daunting health care sales cycle has not changed. The VCs emphasized that entrepreneurs must be “brutally honest” about ensuring that their product can provide a concrete return on investment in just 12 to 18 months. That’s a formidable hurdle.

In a similar reality check, Sumit Nagpal, a veteran entrepreneur and managing director of Accenture, said his firm’s consumer survey found that individuals still prefer in-person care to online artificial intelligence (AI) tools. In that same vein, Jen Horonjeff, founder of the Savvy patient coop, noted that while AI is popular in theory, consumers remain “very skeptical” about privacy and monitoring issues in actual practice.

Health Datapalooza has always been more technocratic than partisan. This year was more sedate than some. (At the end of the 2015 event, as I chronicled, three exuberant participants pulled out flasks of whiskey to share.) This time, what stood out was the atmosphere of collegiality and shared goals, even among those with genuine (and expressed publicly) disagreements on how to reach those goals.

For me, one small moment away from the spotlight stood out. Backstage, Susannah Fox, the last HHS chief technology officer under the Obama administration, greeted her successor in the Trump administration, Bruce Greenstein, with a hug.

That’s not the kind of camaraderie you see on either CNN or Fox. And yet, for all that, it was not in any way fake news.

Michael Millenson is President, Health Quality Advisors and a contributing editor to THCB.

Categories: Uncategorized

7 replies »

  1. Well written. Patients can never be kept in the dark with regard to their health care information.

  2. The big companies always get away with it if the leaders of the country allow it.

  3. Pity that Good Seema Verma went to DataPalooza while bad twin Seema got hold of her Twitter account

  4. An accurate digest of DP this year. I attended. I agree it was surprising to find the Trump appointees so heartily embracing the approaches, and even some specific projects, launched under Obama and Bush 2. Verma seemed particularly passionate about putting info in consumers’ hands. But of course there was a lot not mentioned–the massive undermining of the the ACA insurance marketplaces, bad juju at the VA, and the mess at CDC. As Michael says, we’ll see how things roll out in coming months.

  5. Thanks Michael. I did not go to Datapalooza this time because this model of interacting with our federal government is financially incompatible with my role as unpaid volunteer for a non-profit advocacy org and nobody offered to let me attend for free.

    That said, I think your post nicely captures my impression from other media. CMS, VA, and HHS are saying the right things to actually break down the silos of censorship over decisiin support information, patient mobility, and eventually, hopefully, meaningful practice innovation.

    Your post also presents the lack of actual action in this direction and the risk of another liast-minute hijack like we have with DirectTrust. In this case, the threat comes from CARIN alliance as a bureaucracy for trust or grading of certain apps vs. others. The net result, as with DirectTrust is to fragment the aplication space and put innivators at the mercy of the incumbents.

    The most hopeful words I heard came from Don Rucker. His call for Persistent Access is key to the patient experience and economic viability of patient and physician-centered services. It suggests that we can get to treating the patient’s chosen service providers as first-class citizens in health information exchange. Dare we hope #FHIR/#OAuth Refresh Tokens will be in @ONC_HealthIT guidance. Dare we hope for #OAuth Dynamic Client Reg’n as well?

    Will CMS and VA and All of Us include Refresh Tokens and Dynamic Client Registration in BlueButton 2,0 and MyHealtheData to lead the way?

  6. One more time….Nothing will solve the cost and quality problems of our nation’s healthcare without a neighborhood focus, community by community. Even with a meaningful solution for the problem of universal health insurance, the institutional codependency between the payers of healthcare and the providers of Complex Healthcare will not be solved. The cost and quality problems will only come under a national solution when enhanced Primary Healthcare is offered, equitably and ecologically, to each citizen’s neighborhood, community by community. There is absolutely no reason to believe that our current strategies and commitments will substantially improve anything. In the meantime, our nation’s declining level of Social Capital, community by community, is causing a loss of social mobility, entrenched poverty, worsening maternal mortality (for > 40 years), increased frequency of mass shootings, worsening homicide/suicide, high infant mortality (< 1 month of age), child neglect and worsening substance addiction. Healthcare reform and these other issues all require a community driven effort to promote their own Social Capital investment.

    Accept the following contemporary definition of Social Capital:
    .the attributes of TRUST, COOPERATION and RECIPROCITY
    .that a community transforms into its Social Discourse and
    .it citizens express more commonly for resolving the Social Dilemmas
    .they encounter daily within the Civil Life of their Community
    .WHEN generational Caring Relationships become more prevalent
    .between and within the networks of the community's citizens, especially
    .by the enduring Caring Relationships originating from with
    .the Neighborhood Network formed by the Family of each community's citizen.

    You say: how do we start? Begin a community-wide tree planting project based within the neighborhood associations of the city. Two citizens on a block jointly pick one other person on the block to approach about planting a tree on their property. The city works out a way to distribute the installation of a limited number of trees annually with a neighborhood monitoring process: starting very small and supporting its annual community-wide expansion.

    I attended the third Datapolooza and understand the prospects for its immediate ability to virtually any problem. Be sure to check in with your own Primary Physician about these possibilities for our nation's current healthcare during the next 7 years.