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
I’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…
As a Democrat, I can only hope this is a Dewey defeats Truman moment, but at 2.00am ET on Nov 9, President Trump with a Republican House and a open Supreme Court seat seems to be our new reality. For the health care establishment, this is a bombshell. It’s been easy for Congressional Republicans to vote to repeal the ACA when they knew Obama would veto it. But what happens next when Trump is happy to sign the “repeal”?
It’s hard to figure out what’s there in terms of putting together to “replace” either in the Congressional Republicans or in what passes for policy in what passes for the Trump camp. As Margalit Gur-Aire said on THCB recently other than one speech with some stale talking points about block grants for Medicaid and selling insurance across state lines, Trump seems to have no ideas about health care. (To be fair he doesn’t seem to have any ideas about anything, or he claims they’re a secret).
Then we have the issue of his relationship with Congress. Now he’s President he may declare a truce, but then again he might decide to tweet into oblivion Paul Ryan and the many others who wouldn’t support him. And he might of course self-immolate as he tries to manage his business, his relationship with Russia and his soon to be launched TV network–while actually having to be President.
But if he’s going to end Obamacare, Trump is going to have to worry about two things. First, he has said that he wants to repeal it but is going to make sure everyone can buy health insurance, even if they have preconditions. When the middle aged white working class who voted for Trump discover that their Medicaid and their health insurance goes away, and that insurers wont sell them insurance if they’re not a good risk, they might be unhappy.
Second, the other people who are going to be unhappy are the health care industry stakeholders. Health care is a series of complex legislative and market interactions. As a consequence of the ACA, most health insurers, providers and even pharma or device companies have made huge changes to their business strategy. Those business strategies and investment are now six years old. Like Wall Street and corporate America, Trump is going to make the health care establishment deeply uncomfortable. The question is, once big pharma, insurers and providers lean on the Administration, will anything actually change, or will we see the route towards value-based care continue?
Not only that, but the sea-change that is just starting in the shift from FFS to value-based payments from Medicare & CMS is underway because the country can’t afford continued health care cost growth. That remains the same. Eventually that reality will impinge even on a Trump administration.
So what happens next? Well it’s amateur hour and we’ve all failed to predict it thus far, so it’ll be tough to do it now. But health care will be a sideshow.
Oh, and time to repeal the frigging electoral college.
I never ceased to be amazed by how smart young clinicians solve problems that they see. Michelle Longmire was in residency at Stanford working with colleagues building point solutions when she realized that what they needed was an easy platform on which to develop medical grade apps. Her company Medable was the result. Then she realized that the other big market was clinical researchers, who now have access to Apple’s ResearchKit, but need an easy way to build a study without using developers. I interviewed her recently and she built a study for me using Medable’s new Axon product.
More about Health 2.0 Rasu Shrestha, CIO at the University of Pittsburg Medical Center, will be joining me on stage this afternoon in our Provider Symposium (on his birthday) and again on Tuesday, September 27th for our Information Blocking, APIs & App Stores: The State of Play in Data Access session. Below is the interview I had with him a couple of weeks ago about how a huge medical center like UPMC deals with the innovation side of the house. Not too late to sign up and come to Health 2.0 and come hear what else Rasu has to say!
My old friend and former boss Ian Morrison will be giving the keynote at Health 2.0’s 10th Annual Fall Conference on the afternoon of Tuesday, September 27th. Ian was President of Institute for the Future in the 1990s, founded the Strategic Health Perspectives service, and is in more health care board rooms and conference halls than almost anyone. At Health 2.0, Ian will share his latest insights into the future of health care. Did we tell you he’s the pre-eminent jokester on the health care speaking circuit? Well he is! You can still Register and come hear what else Ian has to say! But here’s a taster — Matthew Holt
By now you all know that the 10th Annual Health 2.0 Fall Conference is next week. What you may not know is that it’s a great place to meet delegates from across the world. In particular both tech companies and providers & government officials from from Scandinavia will be there next week. Below are Ase Bailey (TINC in Silicon Valley/Innovation Norway) & Anne Lidgard (VINNOVA/Innovation Sweden) talking about the Nordic group’s visit to Health 2.0. By the way, for those in the Bay Area, there’s a reception with the Nordic delegation at the Nordic House in Palo Alto on Thursday night — Matthew Holt
Today I’m happy to release some really unique data about a pressing problem–the ability of small tech vendors to access health data contained in the systems of the major EMR vendors. There’ll be much more discussion of this topic at the Health 2.0 Provider Symposium on Sunday, and much more in the Health 2.0 Fall Annual Conference as a whole.
Information blocking, Siloed data. No real inter-operability. Standards that aren’t standards. In the last few years, the clamor about the problems accessing personal health data has grown as the use of electronic medical records (EMRs) increased post the Federally-funded HITECH program. But at Health 2.0 where we focus on newer health tech startups using SMAC (Social/Sensor; Mobile OS; Cloud; Analytics) technologies, the common complaint we’ve heard has been that the legacy–usually client-server based–EMR vendors won’t let the newer vendors integrate with them.
With support from California Health Care Foundation, earlier this year (2016) Health 2.0 surveyed over 100 small health tech companies to ask their experiences integrating with specific EMR vendors.
The key message: The complaint is true: it’s hard for smaller health tech companies to integrate their solutions with big EMR vendors. Most EMR vendors don’t make it easy. But it’s a false picture to say that it’s all the EMR vendors’ fault, and it’s also true that there is great variety not only between the major EMR vendors but also in the experience of different smaller tech companies dealing with the same EMR vendor. All the data is in the embedded slide set below, with much more commentary below the fold.
I am thrilled that Health 2.0 is today announcing a new program aimed at improving diversity in the field of health technology. This will run all year (and hopefully beyond) and will start at the Health 2.0 10th Annual Fall Conference on Sept 25-8, where we will host a group drawn from populations that are underrepresented in the health technology field. There’ll also be a dedicated session on the topic on Sept 26 at 12.15pm that has been generously supported by the Robert Wood Johnson Foundation. Matthew Holt
The Problem: There is a lack of diversity among health technology innovators and a shortage of technologies that meet the needs of minority audiences. Technology is a powerful tool that can help improve health outcomes and alleviate problems within our current health system. As our society grows increasingly diverse and gaps in health among different populations increase, there is an urgency to develop solutions for underserved communities and diversify the population of innovators who are creating these solutions.
The Conference Support Program: The Diversity in Health Technology Conference Support Program, supported by the Robert Wood Johnson Foundation, encourages individuals interested in diversifying the health technology field and who are interested in, or currently engaged with, health technology, to attend Health 2.0’s 10th Annual Fall Conference (Sept 25-8). Individuals from populations that are underrepresented in the health technology field are particular encouraged to apply. The conference support will include complimentary access to the annual conference. Conference support recipients will be required to attend the “Diversity in Health Technology” workshop. The workshop will serve as the formal kickoff to a year-long campaign focused on engaging more diverse voices in health technology. Conference support recipients must also attend and participate in two webinars hosted by Health 2.0 to further review the diversity in technology issue, submit a post-conference summary to Health 2.0 of the individual’s conference experience that Health 2.0 may use for a white paper on the diversity issue and a summary about specific activities the individual plans to do over the next year to address diversity in technology.
For more information and to apply to join the program, visit the Diversity in Health Technology site.
A new report out from the American Health Policy Institute and Leavitt Partners further quantifies what we already know: a handful of employees are responsible for the bulk of employers’ health care spending. The new report documented that among 26 large employers, 1.2 percent of employees are high cost claimants who comprise 31 percent of total health care spending. Interestingly enough, the report was released on the heels of news yet again that high deductible health plans continue to be more popular than ever as a strategy for employers to control costs, with employee cost sharing expected to rise yet again this year.
And yet high deductible health plans may do more to bend the cost trend for healthy employees by reducing spending on items like pharmaceuticals and lab testing but not on inpatient care.
The least heathy employees quickly blow through their deductible, and their health issues are so acute and their bills so large, they don’t shop around for care. So what is a large employer or any purchaser concerned about these high cost claimants to do?
Consumerism in how we typically think of the concept doesn’t seem to be working. For example, according to McKinsey,most healthcare consumers are not doing their homework – they aren’t researching costs or their choice of providers. And even for the handful that do use price transparency tools, new research shows this doesn’t result in savings. It’s not that patients with serious health conditions don’t want to understand their condition, the latest evidence-based treatment options, who are the best physicians, and treatment costs. It’s just that they need assistance curating and interpreting this complex information.Continue reading…