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Month: August 2018

How Much Are We Paying For a Choice of Insurers?

By Patricia Salber, MD

A number of years ago, a family doc friend of mine took me on a tour of his small group practice.   He proudly showed me the exam rooms, his medical equipment, and other parts of the facility that related to patient care.  Then we came to a large room with a bunch of desks piled high with paper.  He explained, bitterly, that this part of his office was for the people he had to keep on the payroll to do nothing but deal with insurers.  This administrative expense was cutting his margins to the bone and did not help him take better care of his patients.  He eventually left practice, to pursue a second career as a physician executive – a job that was, for him, more remunerative and more satisfying.

Part of the problem is that physicians in the US have to deal with multiple health plans – each with its own set of managed care rules, formularies (or list of approved drugs), requirements for prior authorization, rules for billing, submission of claims, and adjudication.  Until recently, almost all of this administrative work was done by phone or fax.  Picture this:  rooms full of practice-based nurses talking to insurance company nurses about the details of a case that may or may not lead to payment for medical care.

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Physician, Feed Thyself …

By Margaret Polaneczky, MD

This post first appeared on The Blog That Ate Manhattan.

All this medical food blogging has gotten me to thinking about the similarities between chefs and doctors.

What is the same

1. They’ve got the whites and the chef’s hat, we’ve got the greens and the caps and masks.

2. Both require intensive training with a clear hierarchy of ascent.

3. The chef and the surgeon are captains of their respective ships – the kitchen and the OR.

4. Skill with sharp instruments is necessary for both professions.

5. We both work long hours, including nights and weekends.

6. If we both do our jobs right, our clients walk out feeling better than when they walk in.

7. We have JCAHO, they have Frank Bruni.

8. A knowledge of organic and biochemistry is essential in both cooking and medicine.

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The Evolving Role and Stature of Health Information Management (HIM)

By SETH KNELLER



Several companies with roots in the Health Information Management (HIM) sector have emerged in recent years to address the gaps and limitations associated with most EHR deployments.  Although some of these companies have been around for years, and are sometimes incorrectly “boxed” as providing commoditized services in the areas of transcription and release of information services, several have developed exceptional new technology in the fields of clinical language comprehension and analytics that is highly relevant for the business objectives of the most progressive health systems.

The unique ability of certain firms to impact the evolution of the clinical documentation and analytics landscape stems from:

  • The much broader scope of data they can access and analyze due to their ability to source and organize both structured and unstructured clinical data.
  • Their position at the middle of the RCM value chain where clinical data capture and analysis intercept with complex regulatory and financial concepts that are designed to align reimbursement with the appropriateness of care being delivered.
  • Their potential to rationalize “siloed” functions in health systems related to case management, care coordination, utilization review, and compliance at a time when providers are responding to new reimbursement and risk-shift models that require them to operate more like payers.

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By RACHEL KATZ

Healthcare’s Silicon Valley problem: can startups really work with healthcare organizations?

Startups and healthcare organizations: fundamental foes or perfect partners?

When opposites attract: how startups and healthcare organizations can improve care together

Silicon Valley wants to love healthcare. The industry is enormous and full of inefficiency, which is to say, perfect for technology investment. So it comes as no surprise that venture money in healthcare technology startups has quadrupled since 2011 to $4.5BN in 2015. Moreover, the government wants to invite Silicon Valley-style innovation in healthcare. In January, CMS leaders stated that the next wave of EHR policy will focus on promoting startup innovation in healthcare by incentivizing open APIs and interoperability. Everyone agrees—so let’s just get going, right?

Here’s an important truth to recognize on the eve of what some like to call the “disruption of healthcare”: Silicon Valley and healthcare are fundamentally at odds. In technology we fail fast, launch and iterate, proudly make mistakes and learn from them. In medicine, the first principle is “do no harm.” Entrepreneurs are obsessed with growth–exponential growth, hypergrowth, 10X growth–and the faster the better. Conversely, in healthcare organizations, progress is measured in months and years. My company is currently in Y Combinator, a three-month accelerator program. I have had phone calls with healthcare organizations that took longer than that to schedule.

The philosophies and operations of the two world are at odds in many ways. Too many well-intentioned startups have come up against these tensions and lost steam.

Despite this, healthcare organizations and startups can make perfect partners. I believe more startups should try to serve healthcare organizations, and more healthcare decision-makers should choose to work with startups. Here are some lesser-discussed advantages for both sides.

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Decentralization and home health kits: Thoughts from Health 2.0

By Joe Flower

Take a look at this video from the Worrell design firm, who took part in the recent Health 2.0 confab in San Francisco. They took some insights from following ER folks around and charting their workflow into designing a better way for people to interact with the health system from their homes. At about the 4-minute mark, they start discussing what kind of home health kit/device would work, and then there is a demo of a mother consulting about her child’s flu, and getting actual testing, care, and monitoring from a live nurse remotely, all from this kit. According to the member of the design team whom I spoke with, the kit shown is a real prototype, and all the technology used is currently available.

What this says to me in the frame of my discussion of change in healthcare: If the technology is all there, why don’t we do this already? Because in a fee-for-service system there is no billing code for remote care. But: We are going to see many more healthcare organizations move into ACO-like risk contracting relationships with customers. If the healthcare organization is at risk for the costs of the care for the family in the demo, treating them in the home through such a device (one device per family) could be far cheaper, faster, and more effective than getting them to come into an urgent care clinic — cheap enough that the healthcare organization would simply buy the devices and give them to the covered families.

So as major provider organizations move into risk-contracted relationships, actual medical care that would now be taking place in the built clinical environment would be taking place in the home, supported by a live nurse monitor in a dedicated environment at the clinic. The home becomes an extension of the clinic, not only for the chronically ill and frail elderly whom we now might tend with home care, but for the well family in primary care.

Why Developers Should Enter Health IT Contests

By Fred Trotter

Patient safety is a movement within healthcare to reduce medical errors. Medical errors are a substantial problem in the healthcare industry, with a size and scope similar to car accidents: approximately the same number of deaths per year, about the same number of serious injuries. Personally I think working in patient safety is the simplest way for a geek to make a meaningful difference.

With that in mind I would like to promote a new developer contest sponsored by the Office of the National Coordinator (ONC), Partnership for Patients and hosted by Health 2.0: Ensuring Safe Transitions from Hospital to Home Challenge. As the name suggests, the contest is focused on the process of handing a patient over from an in-patient environment (in the hospital) to an out-patient environment (all the care that is not in a hospital).

I will be one of the judges for this contest and there are already enough “star players” submitting as teams in the contest that I know judging is going to be hard. The first prize is $25,000. That kind of money starts looking like seed-round funding rather than just a pat on the head. That is intentional on the part of both Health 2.0 and ONC. These contests are a way for ONC to find really amazing health IT ideas and help them transition into more substantial projects, with no strings attached. If you can prove to the judges that you have the best new idea and you can flesh it out well enough to make it clear that it has a chance of working, then you can walk away with enough cash to launch that idea. But don’t take my word for it.

Of course, even just submitting in the contest is a good way to get the attention of various investors.

Generally, the coordination of care in the United States is one of the greatest weaknesses in the system. Doctors here in the U.S. are generally well educated and held to high standards. As long as a doctor has a good understanding of your situation and has taken responsibility for your care, the U.S. healthcare system provides excellent care, on par with any other national system. The problem comes when a healthcare transition occurs, where a different doctor takes responsibility without necessarily getting all the needed information and sometimes without knowing that they are “on the hook” for care. Healthcare in the United States is coordinated via fax machines, and coordination for payment, which is sometimes associated with transitions of care, frequently uses ancient EDI standards. When this coordination fails things turn into a kind of communication comedy, which really would be quite funny except that there are sometimes tragic consequences. It actually helps to have a somewhat morbid sense of humor working in healthcare, since laughter, even inappropriate and macabre laughter, can help to manage the stress and pressure inherent in this high-stakes environment.

There are new standards and technologies available for the coordination of care during transitions that ONC is specifically encouraging in this contest, including the Direct Project, which is of course a favorite of mine (I am a sometimes-developer on the project).

These new technologies allow you rethink the basic assumptions in healthcare coordination, (i.e. Direct is basically “email that doctors can use without breaking the rules”) and should enable teams without extensive health IT experience to do something truly innovative.

More importantly, Partnership for Patients and ONC are providing specific guidance about content. Partnership for Patients is an HHS program that “partners” with hospitals and clinics that have committed to proactively reduce patient error and complications. The Partnership has very specific goals: “To reduce preventable injuries in hospitals by 40 percent and cut hospital readmission by 20 percent in the next three years by targeting those return trips to the hospitals that are avoidable.” This contest is only a small part of how they hope to achieve those goals.

CMS has released a patient checklist for hospital discharge, and the contents must be incorporated into winning contest submissions. But I can tell you from previous judging experience, thinking that “incorporate” = “regurgitate” is not a winning strategy. Instead, try to get your head around the complex hospital discharge phenomenon. PubMed is your friend. In my experience doing something amazing with one of the checklist items would be a better strategy then doing something derivative with all of the items. Doing something amazing with all of the items on the checklist would obviously win, but it may be impossible to do that well. (I’d be happy to be proven wrong on this.)

My day job is with the Cautious Patient Foundation (CPF). They hire me to write software to improve the communication between doctors and patients, which is part of their mission to provide software tools that enable patients to help reduce their own medical errors by being fully engaged, educated and aware. If the healthcare system were a highway the Cautious Patient Foundation would be a defensive driving course. CPF has a grant program that they use to fund innovations that impact patient safety. Contest participants are encouraged to submit their ideas to the Cautious Patient Foundation grant process. We are interested in innovative ideas that impact patient safety generally, not just in transitions of care. So if you have a winning patient safety concept that does not fit into this particular contest, we might be interested.

Moreover, there is nothing to stop you from submitting the same technology to one of the other Health 2.0 contests or even to another joint ONC/Health 2.0 contest. Many of these contests could easily be won by an application that does something with a patient safety impact. If you have a great idea for improving healthcare with software, just wait … there will eventually be a contest asking for just the kind of innovation you have.

All of this is to say: There is some real money in these developer contests. Traditional health IT experts who feel trapped can use contests to fund and promote their non-traditional ideas. Developers who are new to the field of health IT can use the contests as a way to break in and get attention for their ideas. Great ideas that improve the healthcare system can get traction, funding and attention. If you can get your great idea working and you submit it to one of these developers contests you can get some feedback.

Maybe your idea actually sucks, but if you knew why, then you could come up with a new idea that really would be great. In any case, it is pretty hard for a developer to just lose by participating in these contests. Worst case scenario is that is ends up being a free education. Who knows? You might be an important part of another developer’s free education.

No matter what, working on software that addresses patient safety issues is one of the few ways that a software developer can impact quality of life rather than convenience of life. These contests, especially the in-person code-a-thons, are fun enough that you might even find yourself forgetting that you are changing the world.

Fred Trotter is a recognized expert in Free and Open Source medical software and security systems. He has spoken on those subjects at the SCALE DOHCS conference, LinuxWorld, DefCon and is the MC for the Open Source Health Conference. This post first appeared at O’Rielly Radar.

He is co-author of Meaningful Use and Beyond. THCB readers can buy the ebook at 50% off until the end of November by mentioning “HITBlog.”

The Value of Moodscope

By Seth Roberts

In 2007, Jon Cousins started tracking his mood to help NHS psychiatrists decide if he was cyclothymic (a mild form of bipolar disorder). After a few months of tracking, he started sharing his scores with a friend, who expressed concern when his score was low. Jon’s mood sharply improved, apparently because of the sharing. This led him to start Moodscope, a website that makes it easy to track your mood and share the results.

I was curious about the generality of what happened to Jon — how does sharing mood ratings affect other people? In January, Jon kindly posted a short survey about this. More than 100 people replied.

Their answers surprised me. First, in a survey about sharing your mood — not about tracking your mood — most respondents did not share their mood. It is as if, in a survey about being tall, most respondents were not tall. Second, although Jon’s mood sharply rose as soon as he started sharing, this was not the usual experience. Sharing helped, some people said, but other people said sharing hurt. For example, one person said her mood was used against her in arguments. Finally, the respondents gave all sorts of persuasive reasons that rating their mood helped them. To me, at least, the value of mood rating isn’t obvious. I can list a dozen hypothetical benefits but whether they actually happen is unclear to me. I rated my mood for years and did it only to learn about the effects of morning faces. MoodPanda, another mood-rating site, gives a few brief vague unenthusiastic reasons to track your mood. And their site is all about mood rating.

In contrast, Moodscope users were clear and enthusiastic about the value of tracking. Here are some reasons they liked mood-tracking:

It is useful to look back sometimes to help you find ways of ‘keeping up’ a positive mood/outlook.

My mood range has definitely narrowed since starting mood stabilizers, so using Moodscope has given me solid evidence that the treatment is working well. I also run statistical analyses of my mood charts against variables like sleep, medication use, and alcohol consumption. The correlations were not particularly meaningful using a 9-point Likert-like scale from a standard mood chart. When I used my Moodscope scores instead, I suddenly found that some of the correlations are (ridiculously!) statistically significant, which also made me feel more certain about what I need to do and change to better manage my mental health.

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Navinet: Health 2.0 Poster Child

By KIM KRUEGER & MATTHEW HOLT

What was once an enterprise software company designing bespoke systems for each client has over the course of the past three years transitioned to a national network-as-a-service with configuration tools and a soon-to-come open API. Could there be a better example of Health 2.0 in action? Say hello to the ‘new’ Navinet, a 15 year-old network that connects over 400,000 providers to more than 40 health plans, covering more than 47 million lives.

Matthew Holt spoke with Navinet CEO Frank Ingari about both Navinet’s stealthy evolution, as well as the company’s new goals moving forward. Navinet still performs the core handful of transactions health care providers have always used the system for — eligibility checks, payment status, referral approval, and treatment authorization among others – but now with a connected network, the emphasis is on collaborative workflow and combining clinical information with reimbursement transactions to improve care.

Ingari said it best: the health care communication infrastructure sucks. Consumers know it, and it isn’t any better for payers and providers. To hear more about how Navinet plans to be that communication infrastructure health care is so sorely missing, watch the interview below.

Kim Krueger is a Research Analyst at Health 2.0 where Matthew Holt is the Co-Chairman.  

Looking to Get Funded? Thoughts From An Entrepreneur Who Just Did

By PASCAL LARDIER

GET_imagePascal Lardier, Health 2.0 International Director, recently interviewed Omri Shor, CEO of Medisafe, for the EU funded GET Project. Shor has showcased Medisafe on stage at Health 2.0 several times and recently closed a $6 million Series A funding round. His advice? Shor says “Investors care about two things: the product market fit and the business model fit.” Read on for more.     

Pascal Lardier: Omri, to start can you say a few words to describe your solution and what it does?

Omri Shor: For sure. MediSafe is an intelligent medication management platform helping people manage their medications correctly. When we go into details, we’re a cloud and apps company. We have apps, iPhone and Android, that are synced together for a cloud service that we have developed.

In general, we remind people to take their medications. We keep a log of what they took and what they didn’t take. And we’re able to share that data back with physicians. The new layer that we’ve just added is a personalized feed that is dealing with more than just a reminder, it’s now dealing with persuasive technology to make sure that patients understand the need to take their medications as well as the ability to track some measurements and vital signs inside MediSafe and correlate this with the medication that the patient has actually taken.

PL: Can you say a few words about your niche in digital health? How many competitors and what makes MediSafe different and better than other solutions?

OS: MediSafe is dealing with a big problem called medication non-adherence. The niche is actually patient engagement, specifically in the medication management space. There are hundreds of companies from cloudware companies to software companies to app companies. We’ve chosen to be mobile-first because we thought that this is the best place to help patients manage their medications mostly because we all engage with our smartphones so much and we think it’s only going to grow. We have iPhone, Android, and we have smart watches now as well. Some of that have already come, some of that are coming just around the corner.

In the medication management space in terms of apps, there are hundreds of competitors. MediSafe’s first differentiator is the user experience. We’re quite fanatic about user experience. We made sure that we are well-designed. MediSafe looks like a virtual pill Box. We have the design patent on the way that we integrate with the users.

The second piece that differentiated us from the beginning is our ability to sync via the cloud. We have the ability to sync family members. That means that if my father who is diabetic accidentally didn’t take his meds, I get notified and I can help him get reminded and make sure that he takes his meds or at least that he thinks of taking his meds.

These were the first things that differentiated MediSafe. Currently, the most important thing that is differentiating us is that we’ve taken a personalized approach. That means that we’ve created a feed that is dealing with patient’s condition, medication, et cetera. This feed is communicating to the patient how important it is to take his meds safely, correctly, that it would actually help him; and the ability to connect back to the healthcare system and back to the physician to make the physician more knowledgeable of the immediate outcomes of the medications that the patient is taking.

One other thing that is now differentiating MediSafe is that we currently have well over a million downloads of our solution with hundreds of thousands of active users. This is putting us in a position, I would say, in the class that just a handful of the medication management solutions were actually able to achieve. And this is accelerating, so we will see more of those users coming to choose MediSafe to manage their medications correctly.

PL: You have jumped ahead to my next question. The user experience, the personalized approach, this is what makes you different in the eyes of the users. This is why they’re going to choose MediSafe rather than another solution. My next question is, specifically in your niche that you described with hundreds of solutions, what did you think exactly make a difference in your discussions with investors?

OS: Investors care about two things. Investors care about the fact that there is a product market fit. That means that patients are using our solution. The second thing that investors care about is that there is a business model fit. That means that our customers, pharmaceutical companies, are willing to pay us money for the use of MediSafe and for different things that we do with them. These two together, the growth that we’ve seen organically without investing money and marketing and the ability to monetize users, brought them to the conclusion that the company has the ability to be a leading company or a leading solution for a multi-billion dollar problem.

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The Individual Mandate, a Brief History — Part I Conservative Origins

By BRADLEY LATINO

In recent years, politicians of every stripe have eaten their words about the wisdom of requiring all Americans to possess health coverage. This hasn’t been real news since the 2007 Democratic primary debates, when candidate Obama claimed his reasons for opposing the mandate were similar to those expressed by Hillary some 15 years ago.

A few years later it was President Obama’s turn. And by 2010, the entire Republican party performed a synchronized heel-face turn, virulently opposing the solution they advocated decades earlier. All of this culminated with the recent passage of the “Repealing the Job-Killing Health Care Law Act” in the House, by which point the mandate had become a 21st century Intolerable Act.

The media have dutifully reported each foible as if such strategic backpedaling were something new under the sun. But the 22-year path to ACA § 1501(b) is a story in its own right, a sort of philosophical history of American health reform policy.

Part I – The think-tank solutions (1989 – 1992)

Back in the late 1980s, the individual mandate wasn’t controversial at all–just another idea being kicked around in conservative think tanks. Although economist Mark V. Pauly, an adviser to the first Bush administration, is often cited as the mandate’s creator, conservative thinkers Stuart M. Butler and Edmund F. Haislmaier were dreaming up similar proposals at the Heritage Foundation as early as 1989.Continue reading…