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Above the Fold

A Great Leap Forward (Or Backward) For the National Health IT Agenda?

Mar 5, 2017• 2

By JOHN HALAMKA, MD

At HIMSS, I listened carefully to payers, providers, patients, developers, and researchers. Below is a distillation of what I heard from thousands of stakeholders.

It is not partisan and does not criticize the work of any person in industry, government or academia. It reflects the lessons learned from the past 20 years of healthcare IT implementation and policymaking. Knowing where we are now and where we want to be, here are 10 guiding principles.

1. Stop designing health IT by regulation

Through its certification program, ONC directs the specific features, functionality, and design of electronic health records. As a result, technology developers devote the majority of their development resources to fulfilling government requirements instead of innovating to meet market and clinician demands. The certification program has established a culture of compliance in an industry ready for data-driven innovations. ONC’s role in the health IT industry made sense eight years ago when IT adoption in healthcare lagged considerably behind all other sectors, but today the certification program impedes a functioning market and must be reformed.

Imagine Ransomware, For Your Body

Mar 3, 2017• 2

By JOE FLOWER

Wired has an article up, “Medical Devices are the Next Security Nightmare.” It’s all about how vulnerable almost all of these implantable devices and hospital telemetry devices are, with old, unpatchable operating systems, open ports, all that.

Let’s just think about this. Imagine someone hacking your implanted defib or insulin pump.

Wait. No need. Imagine just getting an email telling that they have hacked into it. They have the keys to your body’s engine. And they want something in return for not turning it off.

“Give us your credit card and bank account information — all of it. Now. Or we will start screwing up your body, a little bit or a lot, whenever we feel like it, dumping all the insulin into the bloodstream at once. Or just giving you a heart attack. You have until 5pm EST.

New “kid” on specialty ACO block –Chuck Saunders, Integra Connect

Mar 3, 2017

By MATTHEW HOLT

One of the more surprising announcements at HIMSS17 (or anywhere so far this year) was that a company led by some well known health tech veterans has both invested a ton of money and been off the ground for some time, while being very quiet about it. Integra Connect is the company and it’s a tech and services company providing ACO/APM/MACRA/ MIPS-type services for high cost specialty care (think cancer). CEO Chuck Saunders was at Aetna’s Healthagen group (and before that Broadlane/WebMD/EDS and some others I forget) and the Chairman (and source of most funding) is Raj Mantena who built several companies in the specialty pharmacy space (inc ION and Oncoscripts). Integra Connect already over 1,000 employees and several large physician groups as customers and I spoke with Chuck about the (high cost and pretty large) niche they’re in and how they’re working.

Yep, Health Care Is Complicated

Mar 2, 2017• 4

By STEVE FINDLAY

Yes, Mr. President, health care is complicated.

So glad you now understand this. But, um, within 24 hours of acknowledging that complexity, you made a speech to Congress that backtracked.

Namely, you once again said ACA repeal and replace legislation would “expand choice, increase access, lower costs, and at the same time provide better healthcare” even as you referred to Republican ideas and proposals that would, in fact, not easily achieve any of those goals, according to independent analyses.

You also said: “The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we will do.”

An achievement devoutly to be wished—if by lowering health care prices and costs. If achieved by making insurance skimpier or through even higher deductibles and co-pays, not so good.Continue reading…

Kyruus “load balancing” health care — Julie Yoo Interview

Mar 2, 2017

By MATTHEW HOLT

Continuing my interviews with various health tech players from HIMSS17, Julie Yoo MD may be one of the brightest people in health IT. She and her colleague Graham Gardner founded Kyruus to deal with one of the most complex problems in health care. The issue is the patient accessing the right doctor/provider, which is somewhat equivalent to getting everyone in the right plane to the right vacation (or in computer speak “load balancing“). While this sounds simple it’s a very complex issue with both a huge data problem (tracking which doctors are available and do what) and a rationalization issue (what patient needs what). Julie explains the problem and how Kyruus works with provider systems to fix it.

How to Blow Up the Health Insurance Market In One Easy Step

Mar 2, 2017• 19

By ROBERT LASZEWSKI

I call support for giving insurance companies the ability to sell insurance across state lines the cockroach proposal.

As bad as it is, you just can’t kill the damn thing!

Last night, President Trump once again listed this idea in his address to Congress as one of his health care talking points.

Any candidate that suggests such a scheme only shows how unsophisticated he and his advisers are when it comes to understanding how the insurance markets really work––or could work.

I gave a speech to 750 health insurance brokers and consultants in DC last week.

When selling health insurance across state lines, something Trump and a number of other Republican presidential candidates have been pushing, was mentioned the audience literally laughed. That’s what health insurance professionals who spend their days in the market think of it!

This is about as dumb an insurance “reform” idea as has ever been proposed.

This is nothing more than an attempt to take the market back to the days of cherry picking risk––figuring out how to sell policies to only the healthy people. If this were ever enacted it would only serve to shuffle the healthy people into one set of health insurance policies and the sick into another thereby driving down costs for the healthy and in return just driving costs up for the sick––and accomplishing nothing toward fundamentally making insurance cheaper.

Cirrus MD — Text Connecting Your Doctor

Mar 1, 2017

By MATTHEW HOLT

Last week was HIMSS17, the biggest health IT conference and as per usual I ran around interviewing various techies. I’ll be releasing these interviews over the next few days and weeks–Matthew Holt

First up is a rather fun live demo I did with Cirrus MD‘s medical director Blake McKinney. Cirrus MD is a niche player in the telehealth space, and has spent the last few years building out a text-based tool which is now being rolled out in Colorado and Texas. How does it work in practice? Well funnily enough, I happened to have a medical condition that needed to be checked out by a doctor. So here’s a real impromptu demo that shows how it works and gives a good idea of the user experience.

Paying Doctors For Outcomes Makes Sense in Theory. So Why Doesn’t it Work in the Real World?

Mar 1, 2017• 18

By STEPHEN SOUMERAI and ROSS KOPPEL

For decades, the costs of health care in America have escalated without comparable improvements in quality. This is the central paradox of the American system, in which costs outstrip those everywhere else in the developed world, even though health outcomes are rarely better, and often worse.

In an effort to introduce more powerful incentives for improving care, recent federal and private policies have turned to a “pay-for-performance” model: Physicians get bonuses for meeting certain “quality of care standards.” These can range from demonstrating that they have done procedures that ought to be part of a thorough physical (taking blood pressure) to producing a positive health outcome (a performance target like lower cholesterol, for instance).

Economists argue that such financial incentives motivate physicians to improve their performance and increase their incomes. In theory, that should improve patient outcomes. But in practice, pay-for-performance simply doesn’t work. Even worse, the best evidence reveals that giving doctors extra cash to do what they are trained to do can backfire in ways that harm patients’ health.

Costs of A Hospital Monopoly in One Underserved County

Feb 28, 2017• 27

By NIRAN AL-AGBA, MD

There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance, and government. It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs, and ultimately reduce care quality as a result. Lawmakers should focus on this “first pillar” of cost control as they go back to the drawing board.

In 2010, there were 66 hospital mergers in this country. Since the Affordable Care Act went into effect the rate of hospital consolidation has increased by 70 percent. By creating incentives for physicians and health providers to coordinate under accountable care organizations (ACOs), the ACA hindered the ability of regulators to block hospital mergers while incentivizing hospital consolidation.

What the IBM Watson – MD Anderson Split Means. And What It Doesn’t Mean.

Feb 28, 2017

By THCBist

Last week’s news that MD Anderson Cancer Center has pulled the plug on its two year partnership with IBM-Watson led many critics to wonder out loud if the machine-learning revolution is in trouble, and if Big Data could be about to become the latest tech industry buzzword to die a well-deserved death. It’s a little more complicated than that, argues HealthCatalyst’s Dale Sanders in this can’t-miss presentation. The problems with the MD Anderson-Watson partnership probably say more about the “Big Data Industry” and the goings-on at IBM as they do about the technology. Still, there are important lessons we can learn from the episode.

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