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Above the Fold

Value-Based Health

Mar 11, 2015• 36

By CYNDY NAYER

In recent weeks, the market has reacted to a few noteworthy headlines, all involved with or touching upon value-based discretionary actions, and many with the not-so-hidden question: What’s In It for Me or WIIFM?

CMS announced that by 2016 30% of fees in health care should be paid for through a value-based system, moving away from fee-for-service.
ACO results have shown ambivalent outcomes.
Outcomes-based contracts have permeated the Hepatitis C cost-nado (that’s a cost sharknado, the kind that fiercely defies cost controls and takes over all noise about payment reform and patient preferences).
Reference-based pricing is a good/bad troublemaker in the middle of the value-based travails.

The latest rampages have appeared on two national and highly-regarded blogs: The Health Care Blog [Value-Based Reform] and The Health Affairs Blog [Go Slow on Reference Pricing].

As one of the loudest proponents on value-based designs, I lift the curtain again to show the thinking behind the movement from fee for service to value-based designs. All of these items above discuss the message of payment reform, or system alignment, but they are intensely linked to the patient-consumer ability to make the right choices, choose the right sites for care, and pay the right amount for services rendered to achieve health security.

This last—health security—should be at the heart of the US health system.

▪      It’s the place where patient competency is built and tested over time, as the patient becomes aware of health risks and chooses to modify behaviors to lower the risk.
▪      It’s the place where, when there are acute or emergent symptoms, there is no question but that the patient will be able to access the appropriate and affordable care in the safest possible setting, hopefully receiving care that delivers the patient back to functional health.
▪      It’s the place where caregivers and administrators are paid a competitive wage for serving the needs of the patient and getting the patient back to the best health possible.

From Google to New Reimbursement Models, Digital Health Trends for 2015

Mar 10, 2015

By RYAN BECKLAND

There is no question that 2014 was an exciting and eventful year for digital health. Even with all of the advancements and innovations in 2014, this year promises to be even better. The growth in business cases for new models of healthcare delivery and integration of digital health technology is reaching the point of convergence — creating powerful synergies where there was once only data silos and skepticism.

Maybe we have not quite achieved this synergy yet, but the trends emerging in 2015 will move the industry much closer to the long-awaited initiatives in connected, value-based care.. To understand the convergence that is taking place in digital health, we need to examine the key emerging trends in technology, healthcare and business.

Technology

Connecting to Smart Clinical Devices

Technology has advanced to the point that we are constantly hyper-connected to a variety of networks and devices. We have handheld diagnostic tools on our person continuously generating an astounding amount of data.

The types of health devices that are connectable and disseminating data are rapidly changing. Tools are emerging like flash thermometers that do not require physical touch, which diminish contamination risks, and smart EpiPen casings that automatically alert medical professionals during an allergic reaction.

These devices are not only becoming less expensive, but they are also starting to be reimbursable by insurers. Thus, over time these devices will replace traditional, non-connected products. Clinical devices are increasingly designed as Bluetooth-enabled, allowing for the real time collection of patient data, and providing better access and outcomes for patients.

Livongo–update on the “new diabetes meter experience”

Mar 10, 2015• 2

By MATTHEW HOLT

I spent a day in Chicago last week and caught up with Stephanie Kowalski from Livongo. This is the company that has a very cool new blood glucose meter, with cloud communication, and a careteam and coaching function built in. The CEO is ex- Allscripts boss Glen Tullman (no stranger to building big companies) and the product launched at Health 2.0 last Fall. Take a look at the video to get a sense of the user experience and hear more about the company’s rapid evolution (and to hear me almost choke to death!)

[youtube width=”425″ height=”325″]https://www.youtube.com/watch?v=NUSNb0oxF4M[/youtube]

Make Your Organization a HIMSS15 Standout!

Mar 10, 2015

In MARKETPLACE

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A limited number of promotional opportunities remain. Contact Michelle Noteboom for details on options and to reserve your spot.

HIT Newser: What’s the ICD-10 Contingency Plan?

Mar 9, 2015• 3

By MICHELLE RONAN NOTEBOOM

AMA: What’s the ICD-10 Contingency Plan?

The AMA and about 100 other physician groups urge CMS to develop an ICD-10 contingency plan in the event of a “catastrophic” backlog following the October 1 transition. The organizations want CMS to make public its plans to make advanced payments or reimbursements for services already rendered, work with ONC to ensure EHR systems are ICD-10 ready, and confirm contractors won’t audit for the correct code.

The silver lining here is that these organizations are (finally) not asking for a delay in implementing ICD-10. CMS apparently has drafted a contingency plan in the event of claims process disruptions but does not plan to make it public. In this age of more transparency, CMS needs to make the plan public – even though provider groups will surely find fault with the plan. But, isn’t it better to continue moving the conversation forward, just in case of there is a catastrophe?

Why Data Handoffs Matter

Mar 9, 2015• 12

By JORDAN SHLAIN, MD

Chief information officers (CIOs) and chief medical information officers (CMIOs) have spent the better part of two decades on a quest for interoperability; yet, their Achilles heel lies in the “information” part of their titles. If information is the sole beacon of efficiency and value, the invaluable contours of human suffering, personal preferences and humanity itself are lost.

Information is the first step to developing knowledge and understanding, but what physicians and patients rely on in the real clinical setting, rife with changes, are knowledge, understanding and empathy. The cold, hard calculus of a=b does not always apply when dealing with people because they are much more complex and complicated than binary machines with screens. If it were so easy, there would be no problem reaching 100% compliance with medication or a plan of action.

Sadly, all data lives in a database; which might as well be called a wait-a-base; after all, the data just sits there and waits for someone to look at it.

The fundamental problem with today’s information architecture is that all data are not created equal. Data, information and knowledge degrade with each new doctor that becomes involved. In addition, systems design lacks an understanding of how the human computer works in the context of illness, anxiety or uncertainty. Healthcare is a people business in need of data, not a data business in need of people. Data are the means; people are the beginning and the end.

Open Sourcing What Works in Health & Wellness

Mar 9, 2015

By DAVID CHASE

Few argue that we have a fully optimized healthcare system. In fact, many argue the opposite. I have good news for you. All of the components of a high achieving health ecosystem have not only been created — they have been proven with solid evidence backing them up.

The future is here. It is just unevenly distributed. — William Gibson

Mr. Gibson could have been speaking about healthcare when he made this oft-cited quote. Unfortunately, while we have the components to fix health and healthcare, they are scattered all over the country and world. Healthcare, in it’s present state, is a design failure given the money, smarts and compassion that we invest. Put simply, it rewards the wrong activities. We pay for illness and treatment, and we get more illness and treatment. Even if we had a perfectly designed health ecosystem, the emerging convergence of new genomic insights, smartphones and mobile Internet, the Internet of Things, sensors, wearables and changed reimbursement models creates an enormous new challenge.

Does the ACA Actually Mandate Free Checkups?

Mar 8, 2015• 88

By CHRISTIAN GLASON

“Where in the Affordable Care Act (ACA) does it mandate that every health insurance policy must include a free annual checkup?”

I posed this question to Al Lewis and Vik Khanna in the comments of their recent post entitled: The High Cost of Free Checkups, where they argue against the Affordable Care Act (ACA) provision that requires “free checkups for everyone.” They cite a recent New York Times Op-ed authored by ACA co-architect, Dr. Ezekiel Emanuel, that essentially debunks the link between annual checkups and overall health outcomes. For Lewis and Khanna the solution is simple, we need to “remove the ACA provision that makes annual checkups automatically immune from deductibles and copays.” But for me there’s an enormous problem with their argument: The ACA doesn’t actually have any such provision.

After raising the issue in the comments section of the post, Mr. Lewis responded informing me that: “It’s definitely there” and “You’ll have to find it on your own, though — I unfortunately have to get back to my day job.” What Mr. Lewis doesn’t consider with his quick dismissal, is that I have already looked. I’ve combed through the law and other policy guidance, rules and regs; searching for any mention of this required annual wellness exam, physical, visit, or any other linguistic derivative. It doesn’t exist.

It turns out that while the law does require that an annual wellness visit be covered (sec. 4103. “Medicare coverage of annual wellness visit providing a personalized prevention plan”), this requirement is specific to Medicare beneficiaries and does not apply to individual or group plans. Beyond this particular section you won’t find any mention of a requirement within the ACA.

So what gives? Lewis and Khanna aren’t the only ones who’ve mentioned this “free” Obamacare benefit. Even when researching this piece I had to engage in a lengthy discussion with a friend who is a healthcare policy advisor, unexpectedly defending my position. This claim has to be coming from somewhere, surely people smarter than me have gotten it right?

When Good Patient Engagement Goes Bad

Mar 8, 2015• 7

By HOLLY KORDA

The rush to implement patient portals to meet Meaningful Use Stage 2 deadlines has focused most attention on getting the technology up and running, and convincing patients and providers to move to shared communication online. Hospitals and health systems have implemented portals with the help of incentives from the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, and patients and providers have been migrating to them at a slow but steady pace.

I am one of the patients eager to see this move to transparency, and have been a user of my health system’s portal from the start. But I’m far from a happy customer and my experience leaves me scratching my head. Sure, I can get online without a problem, and I can read my results.

Recently, I read online that my results were “probably benign (not cancer)” and it would be important to follow up with retesting in six months. This news, delivered with no phone call or follow up from the hospital or my primary care provider, was disconcerting. The specter of cancer was anxiety producing, as it would be for many, especially with no clinical context for interpreting my test results.

I never received human follow up. When finally I reached someone at the hospital to set up an appointment for a retest, I asked about the portal and the message and was referred to the hospital IT Department. Hmmm…I wondered. What does this mean? Is this what patient engagement is all about?Continue reading…

Race, Ethnicity and Patient Engagement

Mar 7, 2015• 6

By MICHAEL MILLENSON

A few years ago, I was upgraded to First Class on a flight from California back to Chicago. Not long after I settled in, a tall, muscular man easily four inches taller than me walked up to my aisle seat in the first row and prepared to sit by the window.

I envisioned him spending hours hemmed in by the bulkhead and offered to switch places. We began to talk, and soon he shared that his seatmates often hesitate to engage him in conversation. Women and even some men will turn or stiffen in their seats in order to send a clear body-language message.

That’s what happens when you’re a large, physically imposing black guy. People make assumptions. When it comes to patient engagement, we often make assumptions, too.

We minimize the influence of race, gender and ethnicity, or we confuse it with socio-economic status. We assume that “people like us” have communication preferences like us. We downplay the doctor-patient relationship and overemphasize technology.

Race and Ethnicity Matter

In truth, race and ethnicity matter as much in medicine as in the rest of the society. For example, whites, African-Americans and Latinos share the same expectations of their physicians, a study in Health Services Research found, but “patients from different racial and ethnic groups report differing experiences…when using well-validated measurement tools.” Translation: the perception reflects reality.