Michael Gould is AVP of Interoperability Strategy at ZeOmega, a utilization/care management company that predominantly helps payers manage population health for about 50m covered lives including AmeriHealth Caritas, home care company HealPros and more. Since 2016 they have also been in the interoperability game since they bought Health Unity. Since Michael came over to ZeOmega from Independence Blue Cross a few years back he’s been helping the data/API integration that replaces a lot of the fax and phone-based prior-auth. He told me about the cross-sell between the two sides of the company, in part driven by the new CMS regulations about prior auth–Matthew Holt
matthew holt
THCB Quickbite: Steve Yaskin, Health Gorilla
Steve Yaskin is CEO of Health Gorilla and probably the only non-lawyer who has read the entire 21st Century Cures Act, and decided that there was a business buried in it. If we are going to fix the data access problem and then move that data to where it is needed in the patient care experience, it’s a good bet that Health Gorilla’s health information network will be a big part of that future. Steve told me about the company, its technology for patient identity and matching (among others), and what it means to be an official QHIN exchanging data using FHIR. Will consumers and providers on their behalf demand access to data? Steve & Health Gorilla have raised over $80m to bet “yes”, and are doubling revenue every year–Matthew Holt
Anil Jain, Chief Innovation Officer, Innovaccer
For a while now Innovaccer has been aggregating data from different databases around health systems (think different EMRs). They have been overlaying information over that data to clinicians and providers for thinks like care gaps. Now they are bringing in claims data to look for patients or plan members, and of course they have their own AI chatbot to help make that data more accessible to clinicians and administrators. Chief Innovation Officer at Innovaccer Anil Jain, who in a former life was at Cleveland Clinic spinoff Explorys (a data pioneer that got sucked into IBM), told me about Innovaccer’s tech and where the providers and payers using their tools are now — Matthew Holt
A Life Well Lived, Fights Well Fought
By KIM BELLARD
I first became aware of Casey Quinlan in 2017, when she published an article in Tincture, which I was helping to edit. In it, she discussed how she’d had her medical history and advance directive tattooed on her chest, out of frustration with the lack of health information exchange in healthcare. As she said, “ALL. THOSE. FUCKING. FORMS. ON. CLIPBOARDS.”
Well, I thought: she sounds like an interesting person.
I started following her on Twitter, enjoying her outspokenness and agreeing with many of her points of view. Then early in the pandemic Matthew Holt started THCB Gang podcast, and I got to participate in many of them with her as a co-panelist. It was sometimes hard to get a word in edgewise, but when she was on we always knew it was going to be an extra-lively session. And the stories she could tell…
I never met Casey IRL. I never worked with her. I never even had a one-on-one conversation with her, unless you count Twitter replies. There are large parts of her life that I don’t know anything about. But, boy, the force of her personality, the strength of her will, the sharpness of her intellect, and the fearlessness of her spirit were always clear.
She fought her cancer as fiercely as she lived her life generally. We knew the end was inevitable, but it nonetheless was hard to imagine. There have been outpourings of support on Twitter, on CaringBridge, and elsewhere. I have to mention in particular the efforts of Jan Oldenburg, who was there with her near the end and also took on the various bureaucracies on Casey’s behalf when Casey was no longer able to.
Casey’s passing is a loss to her friends, her followers, and the patient community at large. And to those of us who got to know her even a little bit.
In Memoriam: Mighty Casey has moved on
Casey Quinlan, our friend and frequent THCB Gang member, died today. She may have gone quietly but she for sure lived her life way out loud. It’s not unexpected; she was diagnosed with a recurrent stage 4 cancer two years back, and I was lucky enough to have dinner with her on a rare east coast trip last June. She was hoping to come to the West Coast late last Fall but was too sick to make it. It looked like things were getting better and she was on THCBGang in February but soon things turned and she spent the last few weeks in hospice. She leaves a huge hole in the patient advocacy movement and a huge wave of love from her friends today on Twitter. And she remains the only person who has come up to me after I gave a talk and shared a shot of bourbon from her hip flask at 9 am! The talk was about the US health care system. So we both needed it! We’ll miss you Casey… Matthew Holt
THCB Quickbite: Ines Vigil, SVP Transformation & Services, Clarify Health Solutions
Ines Vigil, SVP Transformation & Services, Clarify Health Solutions talked with me at HIMSS23. A quick discussion about what Clarify Health does, and why the health system needs a huge database of 330m patients. Quick clue is that payment negotiations and benchmarking of clinical performance is the biggest demand, and Ines now actually heads up a consulting group that providers need to be overlaid on that data–Matthew Holt
HIMSS Takeaways: Size Doesn’t (Always) Count, Johnny Appleseed and MomGPT
By MICHAEL L. MILLENSON
Live and in-person once again, HIMSS 2023 attracted more than 30,000 attendees to the exhibit halls and meeting rooms of Chicago’s sprawling McCormick Place. Although no one person could possibly absorb it all, below are some harbingers of the health care future that stayed with me.
Size Doesn’t Count. Exploring the remote byways of the cavernous exhibition areas, it became clear that it’s not the size of the booth, but the impact of the product that counts. At a pavilion highlighting Turkish companies, for instance, R. Serdar Gemici stood in front of a kiosk that might fit into a walk-in closet.
The display listed an impressive roster of clients for a chronic care management platform, prompting me to stop to learn more. The smartphone user interface for “Albert,” the namesake product of Albert Health, the company Gemici co-founded and leads, immediately impressed me as one of the simplest and yet comprehensive I’d seen. (Indeed, the company website boasts of the “world’s simplest health assistant.”) Albert Health has begun working with England’s National Health Service and large pharmaceutical companies, though I found myself wondering how the name resonates in the Turkish- and Arabic-language versions the company touts.
Another far-off cluster of kiosks hosted a company called Dedalus, which promised an interoperable, whole-person care platform. A demo included a graphic showing a breadth of holistic personalization and collaboration capabilities I’d not seen elsewhere. It turns out that while Dedalus only entered the U.S. market in late 2021 – which explains why, as the nice woman showing me the presentation noted, Americans mostly haven’t heard of it – Italy-based Dedalus Global’s software and services are used in more than 40 countries by over 6,700 health care organizations.
Oh.
Size Does Count. When I sat down with Dr. Jackie Gerhart, Epic’s vice president of informatics, and Seth Hain, senior vice president of research and development, at their very large and very busy booth, I had in mind Epic CEO and founder Judy Faulkner’s reputation as a tough, my-way-or-the-highway businesswoman. But Gerhart and Hain were so nice and down-to-earth, earnestly extolling the company’s culture of collaboration, that it was initially as disorienting as watching Elon Musk help a little old lady across the street. (A colleague assured me that, yes, this is actually the way many Epic employees act.)
Nonetheless, Epic remains a 500-pound gorilla, with a third of the hospital electronic health record (EHR) market. Its Cosmos platform, containing records from over 184 million patients and 7 billion encounters in all 50 states, is the largest integrated database of clinical information in the nation. The company is currently working to integrate Microsoft’s ChatGPT generative AI with Cosmos’s data visualization capabilities, which presents fascinating possibilities.
Ask around, though, and you’ll discover that not all hospitals are comfortable with Epic’s control of information. There will certainly be competitors, perhaps including the Mayo Clinic Platform.
A colleague related that many years ago big tech firms marketing their own EHRs warned prospective customers that choosing Epic meant relying on a company that might not be around very long. Instead, those competitors aren’t. Underestimating all those nice (and perhaps some not-so-nice) people at Epic would be a serious mistake.
Continue reading…Obesity is crippling the US, but there are solutions
By STEPHANIE TILENIUS
Well over a third of Americans are obese — and the percentage keeps growing at a staggering rate. Over the last twenty years, obesity prevalence grew from 30% to 42% of the US population and rates of severe obesity nearly doubled. If we don’t make serious changes to our healthcare system, it’s scary to think where we’re headed in a few short years.
The fact is, obesity is far from a cosmetic condition. It can be a devastating disease and was classified as such by the American Medical Association in 2013. Obesity is the leading risk factor for deadly diseases like type 2 diabetes, heart disease, stroke, and at least 13 types of cancer.
If we don’t stop the obesity epidemic in its tracks now, we’re in for a world of hurt. People’s lives, the healthcare system, and, by extension, the US economy could be headed for collapse if we continue to ignore it. Cardiometabolic conditions like obesity, heart disease, stroke, and diabetes cost the US healthcare system upwards of $500 billion a year in healthcare costs and another $147 billion in lost workforce productivity for heart disease and stroke alone.
And yet private and government-sponsored health plans are dragging their feet to address obesity head on. They know most people jump from health plan to health plan every few years, so they’re willing to take the chance that their members with obesity won’t develop high-cost complications soon enough to justify treatment now. And yet treatment could reverse the effects of obesity and downstream chronic disease, saving lives and billions of dollars in the long run.
Continue reading…Can we trust ChatGPT to get the basics right?
by MATTHEW HOLT
Eric Topol has a piece in his excellent newsletter Ground Truth‘s today about AI in medicine. He refers to the paper he and colleagues wrote in Nature about Generalist Medical Artificial Intelligence (the medical version of GAI). It’s more on the latest in LLM (Large Language Models). They differ from previous AI which was essentially focused on one problem, and in medicine that mostly meant radiology. Now, you can feed different types of information in and get lots of different answers.
Eric & colleagues concluded their paper with this statement: “Ultimately, GMAI promises unprecedented possibilities for healthcare, supporting clinicians amid a range of essential tasks, overcoming communication barriers, making high-quality care more widely accessible, and reducing the administrative burden on clinicians to allow them to spend more time with patients.” But he does note that “there are striking liabilities and challenges that have to be dealt with. The “hallucinations” (aka fabrications or BS) are a major issue, along with bias, misinformation, lack of validation in prospective clinical trials, privacy and security and deep concerns about regulatory issues.”
What he’s saying is that there are unexplained errors in LLMs and therefore we need a human in the loop to make sure the AI isn’t getting stuff wrong. I myself had a striking example of this on a topic that was purely simple calculation about a well published set of facts. I asked ChatGPT (3 not 4) about the historical performance of the stock market. Apparently ChatGPT can pass the medical exams to become a doctor. But had it responded with the same level of accuracy about a clinical issue I would be extremely concerned!
The brief video of my use of ChatGPT for stock market “research” is below:
Implementation May Be a Science, But, Alas, Medicine Remains an Art
By KIM BELLARD
I’ve been working in healthcare for over forty (!) years now, in one form or another, but it wasn’t until this past week that I heard of implementation science. Which, in a way, is sort of the problem healthcare has.
Granted, I’m not a doctor or other clinician, but everyone working in healthcare should be aware of, and thinking a lot about, “the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services” (Bauer, et. al).
It took a JAMA article, by Rita Rubin, to alert me to this intriguing science: It Takes an Average of 17 Years for Evidence to Change Practice—the Burgeoning Field of Implementation Science Seeks to Speed Things Up.
It turns out that implementation science is nothing new. There has been a journal devoted to it (cleverly named Implementation Science) since 2006, along with the relatively newer Implementation Science Communications. Both focus on articles that illustrate “methods to promote the uptake of research findings into routine healthcare in clinical, organizational, or policy contexts.”
Brian Mittman, Ph.D., has stated that the aims of implementation science are:
- “To generate reliable strategies for improving health-related processes and outcomes and to facilitate the widespread adoption of these strategies.
- To produce insights and generalizable knowledge regarding implementation processes, barriers, facilitators, and strategies.
- To develop, test, and refine implementation theories and hypotheses, methods, and measures.”
Dr. Mittman distinguished it from quality improvement largely because QI focuses primarily on local problems, whereas “the goal of implementation science is to develop generalizable knowledge.”
Ms. Rubin’s headline highlights the problem healthcare has: it can take an alarmingly long time for empirical research findings to be incorporated into standard medical practice. There is some dispute about whether 17 years is actually true or not, but it is widely accepted that, whatever the actual number is, it is much too long. Even then, Ms. Rubin reminds us, it is further estimated that only 1 in 5 interventions make it to routine clinical care.
Continue reading…
