In some interesting news this week, Inland Empire Health plan (IEHP), a major Medicaid health insurer in southern California with about 1.2 million members, and its contractor Preveon Health announced that they were “extending a pilot” with Surveyor Health, for their MedRiskMaps product.
This is interesting for a bunch of reasons. First it’s a good example of how technology is now being applied to help with the almost absurd complexity of modern medicine–complexity that technology has both added to and may yet cure. Secondly, Surveyor Health has been building its technology for several years and (FD) I’ve been advising them off and on since 2009 and know the principals well. Thirdly, and this is mostly for grins, it represents some of the absurd language used to describe our crazy health care system.
What does the tech do? Surveyor Health’s technology is very
complex optimization technology that examines the incredible number of symptoms
and interactions undergone by patients taking multiple medications. As you know
most chronically ill patients are on upwards of half a dozen medications and some
are on many more. The more medications, the more the potential for serious and
sometimes fatal drug-drug interactions, side effects and more. You only have to
think of the litany of celebrity drug deaths (Michael Jackson, Prince, Anna Nicole
Smith, Health Ledger, Tom Petty, to name a few) to understand the seriousness
of the issue. Erick von Schweber, a real theoretical physicist and CEO of
Surveyor Health tells me that when you get above 11 drugs the calculations
involved are more complex than what Google has to do to index the web. (And yes,
he now is allowing me to call it AI!)
As U.S. providers continue their slow but steady march away from fee-for-service reimbursement and toward value-based payments, they’re increasingly seeking means of addressing patients’ health-related social needs. That’s because social determinants of health—life circumstances including socioeconomic status, housing, education, and employment—are estimated to have at least twice the impact on risk of premature death than health care. So addressing them is an important part of value-based strategies aiming to improve health while reducing health care costs.
Hennepin Health, a safety-net Accountable Care Organization (ACO) serving Medicaid patients in Minneapolis, Minnesota, is an encouraging example of the trend. Hennepin Health’s ACO is a partnership between the county’s local Human Services and Public Health Department, a local teaching hospital, a Medicaid managed care health plan, and a Federally Qualified Health Center. Its innovative care model is designed to meet the unique needs of the partners’ shared, “high-risk” members, whose complex combination of issues—such as mental illness, addiction, homelessness and/or other hallmarks of social deprivation—often prevent them from accessing or receiving appropriate care through the traditional health system.
The ACO is staffed by an integrated care team comprised of
physicians, nurses, pharmacists, social workers and community health workers.
Unlike traditional care processes, which often only involve medical assessment,
Hennepin Health’s begins with an assessment of members’ social needs, like
housing and food insecurity, or lack of transportation and unemployment, so
that its care team can tackle those barriers to health in conjunction with
members’ medical problems. And throughout members’ care, the team strives to
develop and maintain a trusting relationship with members, many of whom have
been let down by traditional health care, so that they can continue to identify
and assist with more health and social needs over time.
Results thus far has been impressive—according to a Commonwealth Fund case study, the ACO’s medical costs fell an average of 11% per year between 2012 and 2016. And, between 2012 and 2013, its members’ emergency room visits decreased by approximately 9%, with hospital admissions remaining flat and outpatient visits increased by 3.3%. Assuming its results have continued on the same trajectory (we could not find more recent figures), Hennepin Health’s innovative care model shows significant promise.
But does it have the potential to disrupt America’s traditional, episodic, acute care delivery model? We put it to the test with six questions for identifying a Disruptive Innovation.
Health coaches are playing an ever-more important role in healthcare, but there’s no one single authority when it comes to finding one — or vetting them for that matter — until now. Marina Borukhovich, CEO of startup YourCoach, talks about how she hopes to disrupt health coaching after she learned the value of having a ‘squad’ of experts help her through her cancer journey. Joining in is Eugene Borukhovich, of Bayer G4A, who serves as an advisor to YourCoach and is also Marina’s husband — possibly making them the “Beyonce & Jay-Z” power couple of digital health.
Filmed at JP Morgan Healthcare Conference, San Francisco, January 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
The Office of the National Coordinator (ONC) and the Centers for Medicare and Medicaid (CMS) have proposed final rules on interoperability, data blocking and other activities as part of implementing the 21st Century Cures Act. In this series, we will explore the ideas behind the rules, why they are necessary and the expected impact. Given that these are complex and controversial topics open to interpretation, we invite readers to respond with their own ideas, corrections and opinions. In part three of this series, we look at how the new USCDI draft helps foster innovation.
____________
The U.S. Core Data for Interoperability
(USCDI) draft is a step forward toward expanding the 21st Century
Cures Act. The Cures Act was helpful in moving the needle for interoperability
and defining data blocking. The latest draft of the USCDI is meant to further specify
what data should be shared freely.
In this article, we’ll look at the data added
to the Common Clinical Data Set (CCDS) used for ONC certification. We’ll walk
through the proposed plan to add more data over time. And we’ll explore why
this is a step in the right direction toward increased data sharing.
New Shared
Data
The bulk of the datasets in the USCDI comes
from the Common Clinical Data Set (CCDS), which was last updated in 2015. The
new USCDI draft adds two types of data:
Clinical notes: both structured
and unstructured. EHRs store these notes differently, but both are important
and helpful in data analysis.
Provenance: an audit trail of the data, showing where it
came from. It is metadata, or information about the data, that shows who
created it and when.
The Fast Healthcare Interoperability Resources (FHIR) have created standards around APIs used to access health care data. APIs developed under the FHIR standard aligns with the USCDI to meet the proposed certification rules. The USCDI draft recommends using a FHIR compliant API to access the data.
Facebook is releasing an EMR? Jim Cramer is going to work at Epic? April Fools! On today’s actual Health in 2 Point 00 Episode 76, Jess asks me about the follow up from Health Datapalooza, which ended with the government saying they will be changing the world and that everyone should join them in their initiative to innovate digital health. AHRQ & CMMI ran digital health challenges, and CMMI will be doing an AI challenge for $1 million for startups in the space. Speaking of the government, Seema Verma was in the news for her PR spending and as I said “Evil Twin Seema” and “Good Seema” are joined at the hip and they should “not screw around on the PR front”. In other news, MountSinai launched a digital health institute to develop advances in artificial intelligence and other emerging health care technologies spaces. Clover Health laid off a ton of people, and according to me, they are starting to get serious because running a Medicare Advantage plan is hard work — Matthew Holt
One of the fastest growing chronic condition management companies in healthcare, Livongo just made some big new hires and minted a new category in health tech called “Applied Health Signals.” What’s this? Well, if your new health solution ties together devices, data science, coaching, and clinical management, YOU might be an Applied Health Signals company. CEO Glen Tullman walks us through the new concept, shares his insight on the good & bad of consumer tech companies heading into health… then explains the strategery behind changes to the company’s C-suite and confronts the rumors I’ve been hearing about an IPO.
Filmed at the JP Morgan Healthcare Conference in San Francisco, CA, January 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
I’ve worked in enough start ups to know that creating
something from nothing can be hard. It is especially tough when you must create
a market and explain to people that what you’re doing isn’t nearly as heretical
as it may sound. When my friends and I started Subimo in 2000, people wondered
why they’d use our product to learn about hospital performance when (in their
words) all they really needed was to have their doctor to tell them which
hospital they should use. What people eventually realized was that there is
variation in outcomes by hospitals and even by service lines within hospitals.
That’s why the recent spate of articles about the newly
emerging direct-to-consumer companies in health care – the ones that are
condition-specific like HIMS, Ro and Keeps – fascinate me. These are companies
that have leveraged all we know about direct-to-consumer marketing and have identified
an unmet market need. In some respects, they’re not dissimilar from companies
like Simple Contacts or 1.800 Contacts or Visibly – companies that offer a
convenient way for people to get what they need (in this case, good vision). Or
companies that offer behavioral health services directly to consumers.
What do these companies have in common? Aside from a strong marketing
foundation, they have identified a market need that can be met with a new
approach that leverages technology. They are convenient, offer a high level of
customer service and may even be easier to work with than traditional players.
Big news out of Mountain View, California today as Facebook COO Sheryl Sandberg announced that the social networking giant was going to formally enter the EMR business. Sandberg explained that Facebook already has all Americans and most of the world’s population on its system and that adding a little bit of information about their health would be trivial given that it’s easy with AR to abstract that information from their profiles, not to mention that everyone’s phone is already sending data back to Facebook.
In particular, Sandberg highlighted the fact that Facebook has already captured almost all the personal health information of many people with cancer and plenty of other rare diseases in the thousands of health communities that it has been pushing hard over the past few years. Not only have those individuals not known what Facebook is allowing third parties to do with that data, or which hackers have already stolen it in a SICGRL hack, but they have also found it impossible to extract themselves or their data from those groups. As Sandberg says “We already have the EMR business model down, now we just have to provide the products”
When it was pointed out to Sandberg that Facebook didn’t actually have any professional EMR tools that could be used by clinicians or doctors, a scruffily dressed guy hiding his bad haircut under a hoodie grabbed the mike and shouted “We’ve seen the schlock that Epic, Cerner and the rest put out–my wife has to use it and she spends every evening catching up on her data entry. Shouldn’t be too hard for our engineers to knock that off–just ask those guys at Snapchat.” Sandberg commented that while EMR vendors move slowly and break things, Facebook has shown over the years that it can do that much faster. “Have you seen what we did to American democracy or the EU?”
Later today Cerner stock was trading off 25%. When asked, an Epic spokesperson commented that even if you added their ages together, Sandberg and Zuckerberg were far too young to run a proper EMR company.
How are ‘digital therapeutics’ different than what we’ve already been doing in ‘digital health’? Eugene Borukhovich, Global Head of Digital Health for Bayer, talks about how he thinks eventually the term ‘digital health’ will just disappear. What’s behind this prediction? Listen in to find out.
Filmed at JP Morgan Healthcare Conference, San Francisco, January 2019.
Jessica DaMassa is the host of the WTF Health show & stars in Health in 2 Point 00 with Matthew Holt.
Get a glimpse of the future of healthcare by meeting the people who are going to change it. Find more WTF Health interviews here or check out www.wtf.health.
Bayer’s G4A team launched their 2019 program today, so here’s a little help for anyone curious about the state of pharma startup investment and what it takes to land a deal there these days.
I had the chance to pick the brain of Bayer’s
Global Head of Digital Health, Eugene Borukhovich, during JP Morgan Healthcare
Week and pulled out these three gloriously thought-provoking soundbites from
our conversation to give you some insight as to the mindset over at big Bayer.
“Digital therapeutics are shining light on the convoluted, complex mess of digital health”
If you’ve wondered what lies ‘beyond the pill’
for Big Pharma, wonder no more. It seems the answer is digital therapeutics.
Eugene predicts that “within the next couple of years, ‘digital health’ as a
term will disappear,” and calls out organizations like the Digital Therapeutics
Alliance for their efforts to set standards around evidence-base and behavior
modification so regulators and strategic investors alike can properly evaluate
claims made by health tech startups. As time goes on, it looks like efforts to
‘pharma-lize’ the ways startups take their solutions to market will increase,
pushing them into more traditional go-to-market pathways that have familiar and
comforting guidelines in place. As Eugene says, “Ultimately, what we say in my
team, is that it’s about health in a digital world today.” Sounds like that’s
true for both the products he’s seeking AND the way pharma is looking to bring
them to market…
“These multi-hundred million [dollar] press releases are
great to a certain extent, but what happened to the start-up style mentality?”
When asked about Big Tech getting into Big
Health, in the end, it seems, Eugene shakes out to be in favor of the ‘Little
Guy’ – or, at least, in their approach. Don’t miss his comments about
“cockiness in our healthcare industry” and how Big Tech is working around that
by partnering up, but the salient point for startups is that big companies still
seem very much interested in buddying with smaller businesses. It’s for all the
same reasons as before: agility, the ability to iterate quickly, and the
opportunity to do so within reasonable budgets. Eugene offered this telling
rhetorical musing: “Just because it’s a combination of two big giants…do you
need to do $500 million? Or, do you give some…traction, milestone, [etc.]…to
prove it, just like a start-up would?”
“In large organizations, transformation equals time, and…we
don’t have time.”
“To me,” says Eugene, “the biggest challenge is
actually landing these inside the organization.” He’s talking about novel
health solutions – digital therapeutics or otherwise – after learning from
previous G4A cycles. Culture, precedent, and years of market success loom large
in big healthcare companies across the ecosystem, which is one reason why innovation
inside them is so challenging. Eugene says he’s “a big believer in a small team
– even in large organizations – to take something by the cojones, and get shit
done, and move it forward, and push the envelope from the bureaucracy and the
process.” There’s a sense of urgency to ‘innovate or die’ in the face of the
growing competition in the healthcare industry. “Back to this earlier
conversation around whether it’s tech giants or other companies,” he adds, “it
is a race to the speed of the organization. How quickly we learn and how
quickly we make the decisions. Bottom line, that’s it.”
There’s plenty more great insights and trend
predictions where these came from, plus the juicy details behind how G4A itself
has pivoted this year. Check out the full interview now.
