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The Vanishing Hospital: ASCs Follow the Consumer

Call it what you want, disruption or evolution, but when two of the largest for-profit hospital chains, HCA Healthcare and Tenet Healthcare, and one of the largest insurance intermediary services companies, Optum (part of UnitedHealth Group), invest billions of dollars in capital for building new care settings, everyone should take notice. From freestanding ambulatory surgery centers (ASCs), to urgent care centers, to retail pharmacy-sponsored clinics and employer co-located clinics, the disruption of care delivery is all around us.

How does General Community Hospital compete with Walmart, CVS and Walgreens (retail clinics)? How does it compete with Urgent Care Centers? How will it compete with freestanding ASCs? How does a hospital stop consumers’ desire for savings and convenience? How does it stop physicians’ own desire for convenience and efficiency? This is the disintermediation of hospitals in a very big way! General Community Hospitals can zero base care, but they need to have answers more in line with a consumer retail operation than those of a charity. How many product lines does a focused factory operate?

Continue reading…

Headlines We Won’t See In 2017

Earlier, I offered a sarcastic headline view of the coming year.  Yet, underlying these headlines are some more serious issues that we as an industry have to address.  They may not happen this year, but we need to continue to make progress.  Wouldn’t it be awesome if for once we under predicted what will happen?

Healthcare Organization Wakes Up In Strange Place, Reports Massive Headache

Reality:  Many organizations are not quite sure what hit them – they have purchased and implemented a number of systems, sometime more than once, in the last several years and now are waking up to the reality that that might not be enough or even the right set of technologies for the emerging payment models.  Return on investment is hard to show, debt used to finance purchases along with stimulus funds are coming due.  System after system has had to report negative results on financial reports due to higher than expected costs, longer than anticipated implementations.  It’s enough to give any CIO a headache.

Healthcare Interoperability Finally A Reality

Reality:  Interoperability remains elusive despite ongoing talk and the creation of various coalitions.  Sometimes it seems that few want to actually solve the problem.  Healthcare organizations are afraid to lose patients to competitors.  Vendors are fighting for the last remaining market share, and aggressively seeking to displace others, and using local market coverage as a selling point.    Sure there are lots of sites now propped up showing FHIR APIs – but in reality these are mostly read-only and not particularly functional.

Foolproof Security Strategy Unveiled:  Don’t Click on $h!t

Reality:  We expect to continue to see rise in reported security incidents.  Attackers are not script-kiddies, but sophisticated hacking businesses making hundreds of millions a year in paid ransoms.  Our industry has a large surface area – with lots of organizations and millions of employees on millions of computing devices.  Our treatment facilities are filled with millions of connected devices monitoring at the bedside.  Like in any public health crisis, we need to not just wait around for the all-powerful anti-biotic.  We need to do basic hygiene well – patching, training, monitoring and rapidly responding to small outbreaks before they become bigger.  We are an industry that has experience in facing one set of viruses – we need to turn that thinking on securing our systems and keeping them healthy.

Affordable Care Act Files for Divorce, Claims Infidelity

Reality:  It is uncertain what the final fate of the Affordable Care Act will be.  Chances are that some changes will be made – too much public bluster was made about repeal for there to be any backing down, but the potential real harm that may come to the electorate that loses coverage or sees prices resume their rapid rise, will prove to be a check on full-scale repeal.

Family Physician Found Dead in Pool of Alphabet Soup

Reality:  It is challenging to remain in a small practice today.  There is an ever changing set of requirements and initiative from payers and from government entities and it can all sound like a pool of random letters.  For example, MACRA is now in effect and yet surveys show that many providers have no idea what it means or what is involved.  Radiology providers will soon have to ensure that ordering doctors begin using clinical decision support management (CDSM) tools to subject orders to appropriate use criteria (AUC) that were developed by Provider Led Entities (PLEs).  This is on top of HIPAA, HITECH, OPPS, and many others.

Consumer-Driven Healthcare Recalled, Engagement Engine Too Weak

Reality:  For all the talk about consumer driven healthcare, there seems to be little change in the position patients find themselves.  There remains little pricing information, payment terms and coverages are difficult to understand for the average reader, and Health Savings Accounts aren’t much other than a new form of deductible for insurance companies.  Most consumer online tools provide little utility, other than provider-out reporting.  Patients continue to have difficulty getting access to medical records in any useable form.  Mobile applications seldom exist, and when they do few if any are on par with the experiences of other tools like Uber, Amazon, Snapchat or Facebook.  It’s bad enough if you are reasonably healthy; it’s worse if you are trying to manage a chronic illness.  You can completely organize a complex trip on a phone, but just try to pay a healthcare claim, set up a number of visits to a variety of providers, or understand what you need to do next to care for yourself.

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Headlines We Expect To See In 2017

Every year, around this time, we are inundated with healthcare industry predictions. Most of these seem to be more retrospective than forward thinking – taking what seem to be fairly obvious trends and simply saying “Finally, this year will be the year that [fill in the blank] happens!”  Well, here are my predicted headlines for 2017.

  • Healthcare Organization Wakes Up In Strange Place, Reports Massive Headache

A Healthcare Organization reportedly just woke up this morning in a stranger’s apartment, with a massive hangover. Note on pillow says, “Thanks for a great night, big spender. I haven’t had so much fun in a long time. Had to go run a few API errands, but feel free to stay as long as you’d like. Oh, it looked like you may have overdone it – aspirin in the bathroom. Love, EMR xxoo. ”

  • Healthcare Interoperability Finally A Reality

Today Epic announced that it had finally penetrated 100 percent of the healthcare market and therefore interoperability was no longer an issue. The final CIO holdout was quoted saying, “We decided that we could no longer resist the movement. We give up.”

  • Foolproof Security Strategy Unveiled: Don’t Click on $h!t

After years of investment and study, one Chief Information Security Officer seems to have found the cure to all information security problems plaguing hospitals. “After careful observation, we noticed a common pattern among our users: they click on links sent to them in email. Once we told them to stop clicking on them. As a result, we noticed our ransomware problem begin to clear up. Sure, our employees don’t get to find out if they’ve won a vacation package, or if they can help out a Nigerian princess, but we are safer.”

  • Affordable Care Act Files for Divorce, Claims Infidelity

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Esther Dyson & Rick Brush Interview at Health 2.0

Five communities. Ten years. One objective: to create business models that make better health attainable – and sustainable – for all. Esther Dyson and Rick Brush joined me at Health 2.0’s Fall Conference to talk about the exciting launch of their innovative population health initiative, The Way to Wellville.

Jonathan Bush Interview at Health 2.0

Hello THCB Readers, I’m Jessica DaMassa. At Health 2.0’s Fall Conference, Matthew Holt and Indu Subaiya set me up with a camera crew and open access to the influencers, leaders, investors, and startups who graced the stage at this November’s meeting in Santa Clara. Over the course of two days, I asked more than 60 different interviewees from across the health continuum to share their point-of-view on the future of healthcare. Our goal was to capture the “state-of-play” in health innovation and contribute as many answers as possible to that elusive question: What’s going to be disrupted next?

All 60+ interviews are available for your guilty binge-watching pleasure on Health 2.0 TV, or you can stay tuned to THCB as we share some of the best-of-the-best. If you have any recommendations for future interviews (live or online), or want me to talk to you, I’ll be starting a longer series of interviews including showing tech demos. So please get in touch via @jessdamassa on Twitter. Thanks for watching! —Jessica DaMassa

Jonathan Bush, CEO of AthenaHealth, spoke at Health 2.0’s Fall Conference about the potential of networked medicine as a way to transform both the way healthcare is delivered and consumed. After his panel discussion, we got his take on where we can expect the next big disruption in healthcare. Here’s a hint (and a Jonathan Bush-ism to look out for): “ACO’s are kind of a training bra for becoming your own insurance company…”

Harnessing Data and Analytics to Transform the Healthcare Industry

sam-osbornAs organizations in every industry invest heavily in business intelligence and analytics to transform their business models, healthcare providers are looking for opportunities to catch up. The challenges to digital transformation in the healthcare industry are significant, but the opportunities are tremendous as applying modern analytics can dramatically speed and improve quality of care while also creating opportunities for new revenue streams and customer retention.

Take, for example, the transformational opportunities presented by applying analytics to Electronic Health Records (EHRs). By applying a layer of advanced analytics to EHRs, providers can identify areas for improvement and opportunity, which is especially important when you consider that these insights can anticipate outcomes and inform actions that can directly affect (and improve) the standard of care.

Analytics aren’t just improving the quality of patient care; they are creating entirely new revenue opportunities in the healthcare industry. MediGain for example, which provides revenue cycle management services to medical practices, hospitals and other care providers, was able to harness advanced analytics to combine data from 300+ sources to deliver on-demand revenue management analytics to their clients. As a result, reporting time was reduced from weeks to near real-time, greatly improving client performance while earning MediGain 1044 percent ROI.

These are just a few examples of healthcare companies leveraging their data and analytics to transform their businesses. These services are no longer optional offerings; Nucleus Research confirms that customers are demanding accessibility to analytics in their daily workflow, meaning that organizations need adapt and offer these solutions in order to remain competitive.

GoodData recently partnered with Anne Moxie, Sr. Analyst of Nucleus Research and Ian Maurer, CIO at MediGain to create a webinar that features the latest strategies and tactics that healthcare companies are using to turn their data and analytics into a profit center, click this link to view on-demand session.

Sam Osborn is head of content at GoodData. This is post is published in conjunction with GoodData‘s sponsorship of the Health 2.0 Conference

Ian Morrison Interview at Health 2.0

Hi, today on THCB I’m glad to introduce Jessica DaMassa a new face who’ll be doing many more interviews in the future, focusing on thought leaders in health and health technology.–Matthew Holt

Ian Morrison is probably the best known health care futurist in America, despite being a Scottish-Canadian-Californian. He gave the keynote at last Fall’s Health 2.0 Conference, and gave his thoughts about the role of technology in the future of care delivery.

Want to help Technologies for Healthy Communities?

Health 2.0 is actively expanding Technology for Healthy Communities and looking for large healthcare organizations and foundations to help support technology adoption at a community level.

Technology for Healthy Communities is a dynamic pilot program designed to catalyze the adoption of technologies in communities. The program fosters the development of sustainable partnerships to address the social determinants of health in the under-served regions that need it the most. Over 200 innovators across the U.S. submitted applications to the program, and through curated matchmaking and access to funding, selected innovators were matched with three participating communities to conduct pilot projects.

Snapshot of the three pilots:

  • Spartanburg, SC: ACCESS Health Spartanburg, a non-profit agency primarily working with the uninsured population, is piloting with Healthify to provide community interventions for social determinants of health at the point of care. With support from Spartanburg Way to Wellville and the Mary Black Foundation, the pilot aims to address current pain points in community health care, such as the inefficiency of addressing social needs of patients and helping to make case management easier.
  • Jacksonville, FL: The City of Jacksonville and the Health Planning Council of NE Florida, with support from the Clinton Foundation is piloting with CTY to deploy its signature product, NuminaTM. With this technology, bicycle and pedestrian traffic data will be collected to assess current safety conditions and plan improvements in the built environment for residents to be more physically active.
  • Alameda County, CA: The Community Health Center Network is piloting with Welkin Health to implement a case management tool that engages members and eases current healthcare worker burden. Together, they will pilot this case management tool in four centers to help community health workers to effectively and efficiently coordinate care.

Due to the high demand from tech innovators and communities, Health 2.0 is expanding the program to new communities, tech startups and organizations who can benefit from technology adoption. By addressing the social determinants of health, the program has the potential to implement unique tech applications and address some of the most important systemic issues at the community level.

Health 2.0 is looking for partners such as foundations, large health systems and corporations who want to support pilots to test innovations in communities, interact with the fastest growing startups in the tech scene, and help create business opportunities for technology companies. Program sponsors will also have the opportunity to address local health needs by bringing exciting, new technologies to under-served regions across the U.S.

The program will focus on tools that support access to a healthy lifestyle, in categories such as:

  • Access to healthcare services
  • Food insecurity
  • Affordable housing
  • Behavioral/mental health

If you are interested in partnering with Health 2.0 to help deliver technology to communities, contact patrick@health2con.com to learn about opportunities to support the program.

Alexandra Camesas is a program manager at Catalyst @ Health 2.0

CareCloud raises $31.5m–Interview with CEO Ken Comee

Just in case you didn’t realize there still is a world going on despite last week’s election. Back in health technology, a systemic change is happening as older client-server companies (like McKesson) retreat or open up their technology (Allscripts) while investors still believe that there’s a big market for SMAC technology and cloud-based systems to run the next generation of American health care. More evidence of that today with the news that CareCloud has raised another $31.5 million to double down on the already large bet placed on it by its investors as a platform for growing medical groups. I talked to CEO Ken Comee about the company, the state of the market, and what he expects to do with the money! — Matthew Holt

So what does Trump mean for new health tech?

Matthew-Holt-colorI’m a pundit who like everyone else was surprised by Trump’s victory in the (profoundly undemocratic and hopefully-to-be-abolished-soon) electoral college, and everything I say here is prefaced by the fact that there was very little discussion of healthcare specifics by Trump. So there’s no certainty about what will happen–to state the obvious about his administration!

What we do know is that Trump said he’d repeal & replace the ACA and the House has voted to repeal it many times (but the Senate has only once & Obama has always vetoed that repeal). A full and formal repeal requires 60 votes in the Senate which it won’t get with the Democrats holding 48. Note that the Democrats needed 60 votes to to forestall a Republican filibuster in order to pass the ACA in 2010. That 60 vote total is a very rare state of events which existed for only only one year–from Jan 2009 until Scott Brown won Ted Kennedy’s old seat in Jan 2010 and one we likely won’t see again for many years.

But this doesn’t does not mean things will continue as usual for two reasons. Congress can change the budget with the Republican 52 seat Senate majority, and the Administration can change regulations and stop enforcing them. So we have to assume that the new Administration and its allies(?) on the Hill will roll back the expansion of Medicaid which was responsible for most of the reduction in the uninsured (even if it didn’t happen in every state). They’ll also reduce or eliminate the subsidies which enable about 10m people to buy insurance using the exchanges. Both of those were in the repeal bill Obama vetoed, although in the bill the process was delayed for 2 years.

This of course may not happen or may be replaced by something equivalent because many of the people who voted for Trump (the rural, white, lower-income voters) fall into the category of those helped by the law, and in a few of his remarks he’s also said that he’ll be taking care of them. Even this week Senator Wicker (R-Mississippi) said that they weren’t going to take away 20 million people’s insurance. In Kentucky which went from a Democratic to Republican governor 2 years ago, the new administration ended their local exchange (from 2017), but in fact not much consequential happened as people were sent to the Federal exchange. If there are changes to the exchanges and the individual mandate or they’re both abolished, there’ll be lots of commotion but it won’t be completely system changing.

My day job at Health 2.0 involves running a conference and innovation program based on a community of companies using SMAC technologies to change health care services and delivery–either by starting new types of health care services or selling those technologies to the current incumbents. So I’m acutely interested in what happens next, albeit somewhat biased about my preferences!

Overall I think that (unlike many other areas of American life) health care technology won’t be that greatly affected. Continue reading…

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