The Health Care Blog – Page 263 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Susannah Fox on Teens & Digital Health Study

Jul 31, 2018

By JESSICA DAMASSA, WTF Health

How are teens and young adults engaging with digital health? Results of a national survey asking just that were released today by Susannah Fox (Former CTO at US Dept of HHS) and her research partner, Victoria Rideout.

You can check out the full report of the findings here, but I spoke with Susannah in April, just as she and Victoria were starting to draw some insights from their work.

Hearing her talk about the survey at this stage of synthesis is not only unique (most researchers won’t talk until the findings are published) but more so because it adds a layer of understanding to the final results now that they’re here.

We get her candor about how teens and young adults are a wildly viable – yet very overlooked – market for digital health…

We see how she’s trying to formulate a much larger hypothesis about what healthcare can learn about social media from a generation that has never lived without it and, more importantly, view it as having a positive impact on their well-being…

And, probably most inspiring to me, we see an approach to health data that stands out for its warmth. For it’s love, really. In a world of big data and clinical trials, it’s endearing to hear from someone who is taking a more anthropological approach and who has fallen absolutely, head-over-heels in LOVE with the personal side of her dataset.

As we all clamor for a patient-centered end, we’d be remiss to underestimate the value of a human-centered starting point. Watch Susannah Fox for a strong model of how this can be done in health research.

Filmed at Health DataPalooza, Washington DC, April 2018. Find more interviews with the people pushing healthcare to better tomorrow at www.wtf.health.

Digital Health and the Two-Canoe Problem

Jul 31, 2018• 1

By DAN O’NEILL

Digital Health and the Two-Canoe Problem

As healthcare gradually tilts from volume to value, physicians and hospitals fear the instability of straddling “two canoes.” Value-based contracts demand very different business practices and clinical habits from those which maximize fee-for-service revenue, but with most income still anchored on volume, providers often cannot afford a wholesale pivot towards cost-conscious care. That financial pressure shapes investment and procurement budgets, creating a downstream version of the two-canoe problem for digital health products geared toward outcomes or efficiency. Value-based care is still the much smaller canoe, so buyers de-prioritize these tools, or expect slim returns on such investment. That, in turn, creates an odd disconnect. Frustrated clinicians struggle to implement new care models while wrestling with outdated technology and processes built to capture codes and boost fee-for-service revenue. Meanwhile, products focused on cost-effectiveness and quality face unexpectedly weak demand and protracted sales cycles. That can short-circuit further investment and ultimately slow the transition to value.

To skirt these shoals, most successful innovators have clustered around three primary strategies. Each aims to establish a foothold in a predominantly fee-for-service ecosystem, while building technology and services suited for value-based care, as the latter expands. A better understanding of these models – and how they address different payment incentives – could help clinicians shape implementation priorities within their organizations, and guide new ventures trying to craft a viable commercial strategy.

Who Cares About the Doctor-Patient Relationship? A Review of “Next In Line: Lowered Care Expectations in the Age of Retail- and Value-Based Health”

Jul 30, 2018• 8

By KIP SULLIVAN, JD

A mere two decades ago, the headlines were filled with stories about the “HMO backlash.” HMOs (which in the popular media meant most insurance companies) were the subject of cartoons, the butt of jokes by comedians, and the target of numerous critical stories in the media. They were even the bad guys in some movies and novels. Some defenders of the insurance industry claimed the cause of the backlash was the negative publicity and doctors whispering falsehoods about managed care into the ears of their patients. That was nonsense. The industry had itself to blame.

The primary cause of the backlash was the heavy-handed use of utilization review in all its forms –prior, concurrent, and retrospective. There were other irritants, including limitations on choice of doctor and hospital, the occasional killing or injuring of patients by forcing them to seek treatment from in-network hospitals, and attempts by insurance companies to get doctors not to tell patients about all available treatments. But utilization review was far and away the most visible irritant.

The insurance industry understood this and, in the early 2000s, with the encouragement of the health policy establishment, rolled out an ostensibly kinder and gentler version of managed care, a version I and a few others call Managed Care 2.0. What distinguished Managed Care 2.0 from Managed Care 1.0 was less reliance on utilization review and greater reliance on methods of controlling doctors and hospitals that patients and reporters couldn’t see. “Pay for performance” was the first of these methods out of the chute. By 2004 the phrase had become so ubiquitous in the health policy literature it had its own acronym – P4P. By the late 2000s, the invisible “accountable care organization” and “medical home” had replaced the HMO as the entities that were expected to achieve what HMOs had failed to achieve, and “value-based payment” had supplanted “managed care” as the managed care movement’s favorite label for MC 2.0.

Will Computers Really Replace Radiologists?

Jul 29, 2018• 1

By SAURABH JHA

There is hope, hype and hysteria about artificial intelligence (AI). How will AI change how radiology is practiced? I discuss this with Stephen Borstelmann, a radiologist in Florida and a scholar in machine learning.

Listen to our discussion on the Radiology Firing Line Series, hosted by the Journal of the American College of Radiology and sponsored by Healthcare Administrative Partners.

About the author:

Saurabh Jha is a radiologist and contributing editor to THCB. He hosts the Radiology Firing Line Podcasts

Giving Consumers the Tools and Support They Need to Navigate Our Complex Healthcare System

Jul 27, 2018• 8

By CINDI SLATER, MD, FACR

As physicians and healthcare leaders, we are already well aware that the majority of patients do not have the information they need to make a medical decision or access to appropriate resources, so we didn’t need to hear more bad news. But that is precisely what new research once again told us this spring when a new study showed that almost half of the time, patients have no idea why they are referred to a GI specialist.

While the study probably speaks to many of the communications shortcomings we providers have, across the board our patients often don’t know what care they need, or how to find high-value care. Last year, my organization commissioned some original research that found that while a growing number of patients are turning to social websites such as YELP, Vitals, and Healthgrades to help them find a “high quality” specialist, the top-ranked physicians on these sites – including GI docs – are seldom the best when we look at real performance data. Only 2 percent of physicians who showed up as top 10 ranked on the favorite websites also showed up as top performers when examining actual quality metrics. (The results shouldn’t surprise you as bedside manner has little to no correlation with performance metrics such as readmission rates).

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As providers and health care leaders, we lament that our patients are not better informed or more engaged and yet across the board, we have not given them the tools or resources they need to navigate our complex system. But now for some good news: all hope is not lost, and patients can become better consumers, albeit slowly, if we all do our part.

Health in 2 Point 00, Episode 41

Jul 26, 2018

After the longwinded-ness of last episode, Jessica DaMassa runs a tight ship today. Lantern’s demise, GSK & 23andme’s huge deal, yet another big chunk of change for American Well, and what was going on at #GoogleNext18 with Google Cloud in health –all asked by Jessica and answered by me, in under the 2 minute wire–Matthew Holt

AI to the Rescue: 5 Semi-Finalists Advancing Through the RWJF AI and the Healthcare Consumer Challenge!

Jul 24, 2018

By DIANA CHEN

Decision making is a daunting task. Combined with navigating health insurance jargon, scattered health information, and feeling crummy as you rush to find care during the onset of a cold, making decisions can be an absolute nightmare. However, artificial intelligence (AI) enabled tools have the potential to change the way we interact with and consume healthcare for the better. AI’s ability to comprehend, learn, optimize and act are keys to organizing the varying nuisances of the healthcare experience.

In a 2018 survey by Accenture, healthcare consumers indicated they would likely use AI for after hours care, support in navigating healthcare services, lifestyle advice, post-diagnosis management, etc. While AI in health is not limited to these functions, the report highlights consumers’ trouble in making informed healthcare decisions, hence this may be an area where AI can truly help.

Health in 2 Point 00, Episode 40

Jul 24, 2018

In this episode Jessica DaMassa asks about the thunder from Down Under, well the noise about the My Health Record program in Australia, the latest on women in health IT from Rock Health, and nearly gets to Click Therapeutics $17m round…all under the watchful gaze of Buddha–Matthew Holt

Making Sense of the Health Care Merger Scene

Jul 23, 2018• 11

By JEFF GOLDSMITH

In the past 12 months, there has been a raft of multi-billion-dollar mergers in health care. What do these deals tell us about the emerging health care landscape, and what will they mean for patients/consumers and the incumbent actors in the health system?

Health Systems

There have been a few large health system mergers in the past year, notably the $11 billion multi-market combinations of Aurora Health Care and Advocate Health Care Network in Milwaukee and suburban Chicago, as well as the proposed (but not yet consummated) $28 billion merger of Catholic Health Initiatives and Dignity Health. However, the bigger news may be the several mega-mergers that failed to happen, notably Atrium (Carolinas) and UNC Health Care and Providence St. Joseph Health and Ascension. In the latter case, which would have created a $45 billion colossus the size of HCA, both parties (and Ascension publicly) seemed to disavow their intention to grow further in hospital operations. Ascension has been quietly pruning back their operations in markets where their hospital is isolated, or the market is too small. Providence St. Joseph has been gradually working its way back from a $500 million drop in its net operating income from 2015 to 2016.

Another notable instance of caution flags flying was the combination of University of Pittsburgh Medical Center (UPMC) and PinnacleHealth, in central PA, which was completed in 2017. Moody’s downgraded UPMC’s debt on the grounds of UPMC’s deteriorating core market performance and integration risks with PinnacleHealth. As Moody’s action indicates, investor skepticism about hospital mega-mergers is escalating. Federal regulators remain vigilant about anti-competitive effects, having scotched an earlier Advocate combination with NorthShore University HealthSystem in suburban Chicago. The seemingly inevitable post-Obamacare march to hospital consolidation seems to have slowed markedly.

However, the most noteworthy hospital deal of the last five years was a much smaller one: this spring’s acquisition of $1.7 billion non-profit Mission Health of Asheville, NC, by HCA. This was remarkable in several respects. First, it was the first significant non-profit acquisition by HCA in 15 years (since Kansas City’s Health Midwest in 2003) and HCA’s first holdings in North Carolina. While Mission’s search for partnerships may have been catalyzed by a fear of being isolated in North Carolina by the Atrium/UNC combination, Mission Health certainly controlled its own destiny in its core market, with a 50% share of western North Carolina. Mission was not only well managed, clinically strong and solidly profitable, but its profits rose from 2016 to 2017, both from operations and in total.

Is the Conservative Establishment Against Entitlement Reform?

Jul 22, 2018

By Avik Roy

One of the oddest aspects of the last six months has been the degree to which the Republican base has embraced symbolic (9-9-9) over substantive (Paul Ryan) positions on entitlement reform from the GOP Presidential field. Why is this happening? Over at Redstate.com, bastion of populist conservatism, Dan McLaughlin thinks he has the answer. But in fact, his essay answers a different question: why it is that conservative voters remain woefully unprepared to tackle the fiscal challenges ahead.

“There’s been a lot of talk,” Dan opens, “about the struggle between the GOP ‘Establishment’ and ‘Outsiders,’ sometimes—but sometimes not—meaning the Tea Party…it’s time to clarify the core issue that has people…scratching their heads at their own constituents.” So what is it that divides conservatives? Is it social issues? Knowledge of French? “The answer is a simple one: it’s almost entirely about spending.”

According to Dan, the divide between the Establishment and the Outsiders is their commitment to reducing government spending. “There is general philosophical agreement among both Republicans and conservatives about [the need to reduce spending]. Where the fault line lies is in exactly how far we are willing to go to do something about it.” According to Dan, the establishmentarian candidates are “the two Northeasterners,” Mitt Romney and Rick Santorum, with Rick Perry and Ron Paul as the outsiders and Newt Gingrich “in the middle.”