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Up-and-Comers 2018: MDLive and OCHIN Inc.

June 6, 2018
by David Raths
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The last two of this year’s six up-and-coming health IT vendors, as selected by Healthcare Informatics

Each year, to accompany our Healthcare Informatics 100 list of the largest companies in U.S. health information technology, we profile fast-growing companies that could very well make the list in the future. Below are write-ups of the final two companies that made this year’s Up-and-Comers rendition. The write-ups of the other four companies can be read here and here.

New Executive Team Leads Telehealth Company MDLive as It Enters ‘Hyper-Growth Mode’

As health systems and payers continue to embrace telehealth for both high- and low-acuity care, the vendors that have been laying the groundwork over the last decade are in a position to benefit from their experience. One of those vendors is MDLive, which provides 24x7 care in all 50 states and is one of the largest providers of telehealth care in the nation.

In 2017, MDLive’s membership more than doubled to nearly 25 million members, with a 43-percent increase in visits on its cloud-based platform.

“The company was started with a vision of how to create the largest virtual medical care medical group in the nation, and how to provide excellent care to as many people as possible at a time when there is a demand/supply mismatch,” says Lyle Berkowitz, M.D., chief medical officer and executive vice president of product strategy, who came to MDLive in 2018 from his position as director of innovation at Northwestern Medicine. The Sunrise, Fla.-based company also has a new CEO, former Allscripts executive Rich Berner.

Lyle Berkowitz, M.D.

Berkowitz and Berner plan to build on MDLive’s success. “My vision and Rich’s are similar,” Berkowitz explains. “The model is not simply virtualizing care, because that is not as scalable as it needs to be to solve all the demand we have. We are looking at how we automate and virtualize and optimize the whole care experience using a combination of people, processes and technology to take care of millions of people in a way that makes most sense to them.” He says MDLive can act as the front door, and triage to a higher level of care if need be. “Patients are highly satisfied, and doctors are happy,” he adds.

MDLive also helps health systems by treating people who would have ignored their care until they got so sick that they needed the emergency room or they might have gone to the ER unnecessarily, which clogs up the system, Berkowitz says. “In an era when we have primary care and emergency room access issues, the more we can take routine and repeatable care and figure out how to offer it in a highly configurable fashion, everybody wins,” he says.

Launched in 2009, MDLive partnered with large health plans such as Humana and it has received $73 million in funding from investors. “That provided the breadth and scale to build a continually improving product instead of going door to door to sell to every physician office,” Berkowitz says. The company also started working with employers and in the last two years it began expanding its health system customer base too.

Consumer demand is also a strong driver. Many people are surprised to learn they have some kind of insurance coverage for telehealth. “Once they are aware, they start using it,” he says. Upwards of 40 percent of visits are repeat patients.

Berkowitz says that health plans have really embraced telehealth. “Initially they were scared of telehealth because they were worried about extra cost, but they found it decreases ER utilization and increases savings.”

While the growth in 2017 was impressive, Berkowitz says the potential is even greater. “In the first quarter of 2018 compared to 2017, there was more than a 100-percent increase year-over-year in visits. We are in hyper-growth mode right now, and there is a lot of room to grow.”

 

Acquisitions, Organic Growth Extend Reach of OCHIN’s Health IT Services, Research

It might seem unusual for Healthcare Informatics to include a nonprofit organization on its annual list of Up-and-Comer companies, but OCHIN Inc. is no ordinary nonprofit health IT services provider. Founded in 2000 to provide EHR support services to federally qualified health centers (FQHCs) in Oregon, the organization now serves 450 organizations with more than 10,000 clinicians across the nation. In 2017 it had revenue of $59 million, up 35 percent from 2016. Its workforce grew 20 percent to 382 people.

The division that offers Epic hosting and support for community health providers has grown to 23 states and is negotiating contracts in new states including New York, South Carolina and Louisiana. “We could add another five states to that in the next 12 to 18 months,” says CEO Abby Sears, who has been with Portland-based OCHIN since its inception.

Sears explains how the organization ramped up over the years. After OCHIN began deploying a hosted Epic implementation for five FQHCs, its executives realized they had to scale it up to spread the cost across more providers. It started getting requests from providers in other states and began growing. “We grew really fast starting in 2009 and 2010 with the HITECH Act, and Affordable Care Act,” she says. “We really took off in 2010 and on average we have seen a 24-percent growth rate, year after year,” she says. 

Abby Sears

Over the years, OCHIN has added professional services offerings such as billing, practice facilitation coaching, compliance and risk assessment, and evaluation services.

After previously buying the Oregon Health Network, last year OCHIN acquired the California Telehealth Network (CTN). Sears says those organizations are useful to OCHIN because its customers are on hosted platforms for EHRs. The telehealth organizations help provide the subsidies for medical-grade networks, crucial for reliability. CTN also hosts a telehealth policy resource center. “That complements where the industry is going and was an area where we didn’t have a lot of resources, so we wanted to bring that in house,” Sears explains. “It is an important part of where we needed to go. Some of our clinics are in very rural areas.”

Research has always been part of OCHIN’s mission. Its advance research data warehouse grew by 540,000 patients in 2017 and it has more than 40 employees in its research division. It received $8.3 million in research grant funding in 2017 and participates in the Patient Centered Outcome Research Institute (PCORI) as one of its clinical data repository networks.

In addition to the CTN, OCHIN also added a NextGen offering in 2017 by integrating two health IT services companies, Voxent and PTSO.

So has OCHIN’s rapid growth made Sears’ job more challenging? “It does add some complexity,” she says. “We are growing so much we have a hard time recruiting people who understand and have the same mission-driven approach to delivery that we do.” In regard to the organizations it has acquired, the real challenge was looking at the business model of all three organizations and redesigning them to be more value-added for the customers OCHIN serves, which also meant renegotiating contracts. In most cases, those customers got more services than before at a lower price, Sears says. “With the growth, we were able to redesign and reduce administrative overhead and leverage that back into pricing. That was a risky thing to do for a nonprofit, but it was important to stabilize the customers.”

There is no sign of OCHIN slowing down. Because both OCHIN and the recently acquired PTSO had roots in the federal Health Resources & Services Administration (HRSA), they still qualify as a “health center controlled network.” What does that mean? “It means we can apply for and get additional funding that focuses on outcomes work,” Sears explains. “We do technology assistance, project work and innovation work around driving outcomes with clinics.”


2018 Seattle Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

October 22 - 23, 2018 | Seattle


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Survey: Who Will Shake Up Healthcare? C-Suite Leaders Weigh In

August 20, 2018
by Heather Landi, Associate Editor
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With new, disruptive entrants coming into the healthcare market, which company is poised to have the biggest impact on healthcare? The majority of C-suite leaders have their eyes on Amazon to shake up healthcare, according to a recent survey of healthcare C-level executive leaders.

Reaction Data, a market research firm focused on the healthcare and life sciences industries, surveyed about 100 healthcare organization leaders on which companies will have the biggest impact on healthcare, and why for its recently published report on healthcare disruption and the future of the healthcare market. The report also looks at emerging technologies and healthcare organizations’ future technology plans.

About 80 percent of the healthcare leaders surveyed are C-level executive leaders—27 percent CEOs, 17 percent CIOs, 17 percent chief nursing officer (CNOs), 17 percent CFOs and 7 percent revenue cycle management directors. Almost half of the respondents were from hospitals.

According to the survey, 59 percent of provider organization leaders think Amazon will be the most disruptive, with 75 percent of CEO respondents choosing Amazon as having the most potential for real disruption. Fourteen percent of respondents cited Apple, 8 percent selected Google, 7 percent chose Microsoft, 4 percent said IBM, 3 percent cited Walmart and less than 3 percent said Salesforce.

The report cites one CEO’s comment: “[Amazon has] visionary leadership and the ability to make the change happen.”

The report also breaks down the number of comments each vendor received per attribute, with 14 attributes such as “name recognition,” “ability to commodify,” “progressive/innovative,” “predictive analytics,” and “affordable.” Amazon received the most comments and, based on those comments, appears to have the most diverse attributes, according to the report, as respondents cited the company for all 14 attributes.

Amazon has made several moves into the healthcare space, including its acquisition of PillPack, an online pharmacy startup, back in June. Earlier this year, Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. announced that they were launching an initiative to improve satisfaction and reduce costs for their companies’ employees. Details of that joint venture have been vague, but experts have pointed to reducing healthcare fraud and administrative costs as key areas that the companies will focus on.

The report also summarizes the work underway at Apple, Google and Microsoft, including Apple and Google’s ongoing efforts to develop their devices and apps and continued development of artificial intelligence (AI); Microsoft’s work with St. Jude Children’s Research on genomics and advancing cloud and AI and IBM’s work in cloud, encryption and data mining. Salesforce allows providers to utilize its cloud CRM tool to manage patients and store data.

Reaction Data also surveyed respondents on emerging technologies, and 29 percent cited telemedicine as a technology that will have the biggest impact, although telemedicine has been around for decades. Twenty percent of respondents cited AI. Only 2 percent cited blockchain, despite all the buzz that technology has been generating. Combined, virtual services/telehealth and AI accounted for almost half of the responses. What’s more, 15 percent cited interoperability, 13 percent selected data analytics, 11 percent cited mobile data and 7 percent said information security. Cloud was cited by 3 percent of respondents.

The number one use case for telemedicine is reaching patients who live in rural areas, according to a quarter of respondents, with the same percentage citing “follow up care” and “managing specific patient populations.”

With regard to AI and machine learning, the vast majorty, 65 percent, of respondents said the technology was “important” and 16 percent said it was not important; 19 percent were neutral. However, while providers clearly see the technology as important, more than half of respondents (53 percent) are at least a year away from adopting it, and many are three years away from adoption. Twenty-eight percent said they plan to adopt AI in one to two years, while 25 percent said they are 3-plus years away from adopting the technology. What’s more, 15 percent have no plans to utilize AI. Fourteen percent of respondents said their organization has been using AI for a while, 11 percent plan to adopt the technology in the next year and 7 percent have adopted some AI.

Breast imaging is by far the main use case for AI, according to the report, with three-quarters of respondents citing this area for AI adoption. The report also breaks down what providers are looking for in AI technology—convenience (33 percent); interoperability (27 percent); technology (18 percent); predictive analytics (11 percent); affordability (5 percent) and progressive/innovative (2 percent).

The report also looks at business trends in healthcare, noting that there have been dozens of mergers and acquisitions recently. These include provider/provider, vendor/vendor, and payer/payer relationships. Now the lines are being blurred as entities are crisscrossing into new spaces. “Examples include CVS acquiring Aetna, Optum purchasing Advisory Board, PinnacleHealth getting picked up by UPMC, Walgreens partnering with NewYork-Presbyterian, Apollo buying LifePoint Health and merging it with RCCH HealthCare Partners, and many others,” the report states.

The survey also gauged healthcare provider organizations’ acquisition plans. While 61 percent said they plan to remain independent, the survey found that 39 percent of provider organizations are currently planning to either acquire other organization, execute a merger, or sell to a larger organization, which points to a dynamic market becoming even more in flux.

“The impacts to the vendors who sell to these organizations, to the payers who negotiate with them, to the care providers who work for them, and to the patients who are treated by them, could be significant. It isn’t an overstatement to say that it is critical to keep a very close watch on this market dynamic,” the report states.

With a significant percentage of organizations planning to change their ownership structure and make-up in the next few years, along with organizations adopting new technologies, and with new entrants moving in, it appears that there will numerous forces at work to shake up healthcare soon.

 

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Will IBM Watson Repeat History?

August 15, 2018
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Recently, there have been some articles about IBM Watson and healthcare.  In particular, a blog by John Lynn speculates on the “health” of IBM Watson in healthcare.

I’ve had my own personal experiences with IBM in healthcare.  While with GE, we did a joint venture with IBM in the early days of PACS and RIS, and I was an original IBM MedSpeak/Radiology reseller in the early days of speech recognition.  In both cases, IBM did not have the financial wherewithal to play the long game in terms of the technology and exited both.

Interestingly enough, MedSpeak/Radiology was not the first foray into digital dictation for IBM, so they exited that business multiple times.  I also have to say, MedSpeak/Radiology was a pioneering technology that was very competitive.  It just wasn’t the business case the IBM management was looking for.  Similarly, IBM’s effort with GE toward RIS and PACS was naively predicated on employing IBM’s RIS product, and not on interoperability with other RIS vendors.

There are countless business examples of companies launching products based on great expectations, only to have them fail to achieve those expectations.  There are also countless examples of companies getting into products that have no relevance to existing businesses because the think they have a “better mousetrap.”  One that comes to mind is GE.  Years ago, GE developed in their research center an electric garden tractor which was very innovative for the 1970’s.  Unfortunately, when GE attempted to bring the product to market, they discovered they did not have a single market channel that addressed lawn-care equipment!  GE ended up selling it to Bolens for a fraction of the development cost.  And, in retrospect, it was premature given the current fascination with electric vehicles!

I am not implying that IBM hasn’t done its homework on IBM Watson.  I suspect it may be more of two other factors at play.  One, it’s a question of chicken and egg.  Is the advancement of Artificial Intelligence more about the application or the platform?  Secondly, does IBM have the infrastructure to succeed?  In the case of the first factor, IBM is more about the platform than the application.  In the second case, the same could be said for the platform versus the application, as IBM does not have a significantly parallel channel that would address AI applications.

I think this is why IBM initially acquired Merge Technologies, as they saw it as both a “sandbox” to learn imaging, but they may have also seen it as a potential distribution channel.  With further understanding, they were quick to learn that attempting to develop and market applications through Merge would make them a competitor to other viable players such as GE, Philips, and Siemens.  That resulted in a move to create “consortiums” that could develop applications on the IBM Watson platform, thus broadening the appeal of IBM Watson across a broader distribution channel.

The question going forward is – has IBM learned from its history of past healthcare ventures?  If IBM can make a business case for addressing Watson as the platform for AI, it might be a stronger case than trying to be the end point for AI.  This would be consistent with its strength in computational platforms in business, which have classically been a better business model than applications (OS2 or Lotus vs. Microsoft Windows and Office anybody?!). 

I recall the OS2 days versus Microsoft Windows.  As a fan of OS2, I had hoped it would succeed.  Unfortunately, as I learned, there were very few applications for OS2, which is ultimately why people purchased personal computers in the first place.  If IBM had been smart, they would have given OS2 software licenses away in an attempt to build consumer demand for the development of applications.  Unfortunately, that didn’t happen, and I doubt there are any OS2 users out there today.

If IBM can take stock of its history, there is a fighting chance for IBM Watson to be a significant factor in healthcare.  But, the company will need to learn how best to foster the development of AI applications.  In his blog, John Lynn relates the experience of Lukas Wartman of the McDonnell Genome Institute at the Washington University School of Medicine in St. Louis, who laments on how much faith one can put in the results (of using Watson).  As with past technologies, we are at the tip of the iceberg in terms of applying the technology.  Here’s hoping that IBM can figure this one out, be in it for the long game, and live up to the hype of IBM Watson!

 

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Analyzing Blockchain’s Evolution in Healthcare: Two Experts Dive into the Details

August 15, 2018
by Rajiv Leventhal, Managing Editor
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Two healthcare leaders at KPMG believe that blockchain activity in healthcare will ramp up in the next 12 to 24 months

Earlier this year, five prominent healthcare organizations—Humana, MultiPlan, Quest Diagnostics, and UnitedHealth Group’s Optum and UnitedHealthcare—announced they would be launching a blockchain-based pilot program with the aim to improve healthcare data quality and reduce administrative costs. The organizations said they would be specifically examining how the technology could help ensure that the most current healthcare provider information is available in health plan provider directories.

While many more details of this initiative are not yet known, this announcement has opened the eyes of other healthcare IT leaders who have become increasingly curious about this emerging technology. For instance, at the Nashville Health IT Summit earlier this summer, a senior executive from MultiPlan, which is part of this pilot project, was asked about his perspectives on the research and development work done on blockchain in healthcare in the past few years.

To this point, two leaders at KPMG—Arun Ghosh, the firm's U.S. blockchain leader; and Michael B. Yetter, director, healthcare management consulting—recently spoke with Healthcare Informatics about the impact of this new initiative, what the greatest use cases are for blockchain in healthcare today, and how quickly providers and payers might start moving into full-scale projects. Below are excerpts from that discussion.

What are you hearing about blockchain right now as it relates to its greatest use cases in healthcare? What are people most bullish about?

Yetter: From a client perspective, things are a bit on the early side. But [we often see that] as many emerging technologies gain momentum in some other sectors, you will see the pathway through pharma and then into healthcare with payers and providers. We are seeing that same pattern here. On the ground in the healthcare space, especially amongst payers and providers, we’re starting to see more interest in meaningful pilots. We have had some earlier adopters doing proof of concepts and pilots—many around claims or aspects of claims management, and some around the regulatory impacts of the supply chain.

Michael B. Yetter

We are starting to see the nature of conversations around what those use cases could be become increasingly sophisticated around things such as consortiums on provider data, and making sure the historical challenges around getting provider data to agree across multiple entities—who are either submitting or processing claims—that those specific data elements or attributes or shared or reconciled in a better way. So that’s one good example for where you are starting to see collaboration.

Ghosh: The additional capability that blockchain provides, versus traditional EHR (electronic health record) systems, and other enterprise technology that exists today, is that from the time of an encounter to the time of discharge, we see blockchain being piloted around records and interactions with the patient, but also interactions with the pharmaceutical ecosystem—from drug provisioning or procurement to drug administration. Even with the Obama administration saying that we need EHRs across the board, it’s still nascent in terms of who has access to what kind of record and what kind of electronification exists.

Arun Ghosh

So blockchain is coming as the next level of granularity: if we can provide immutable records that are now at the time of pre-diagnosis all the way to wellness, we can track getting better, but also not returning to the hospital. Now, we have a story. Between payers, providers, pharmaceuticals, and distributors, we are seeing varying levels of interest and adoption. They are saying, “let’s pilot a certain part of this,” but there is still no end-to-end view yet, from what we have seen.

What are your thoughts on the MultiPlan/Humana/Optum/Quest/United initiative? Would you classify this as a meaningful pilot?

Yetter: From an outside view, and we haven’t been directly involved, it’s my understanding that this collaboration is focused on provider data sharing. I would classify that as more meaningful because they are bringing multiple parties together to solve for a specific use case and problem. So it goes beyond the earliest conversations, going back a year or more, that were more about learning and understanding the technology. Now they are saying that they get the technology, so let me apply this to a problem we have and something that we can enhance in the industry. And seeing multiple big players involved is encouraging.

Some have said that the greatest use of blockchain in healthcare could be improving on how HIEs (health information exchanges) operate today. Do you agree?

Yetter: I don’t think this is achievable in the short term, and there is the bigger picture of truly getting to a complete HIE—and when I say complete, I mean the truly clinical data that is shared between entities, and ideally something that is more accessible to the patient. The ingredients are there for blockchain to make that significantly more usable, and something that can be potentially controlled and accessed by the actual patient or member. And the patient or member can then have the ability to access the information, and also to permission through some of the mechanisms through blockchain, the sharing of that data or specific parts of the data to others who need it in the healthcare environment. There is a lot of good capabilities there that will evolve in this direction to have blockchain enabling more advanced HIEs, but it will be several steps along the pathway before we truly get to that transformation.

Ghosh: Part of this [potential] disruptive model is that it’s the true democratization of healthcare data—if my data is now being “streamed” into a blockchain, I have ownership of it. So the hypothesis of value here is that if the individual can control his or her data, and then can choose who to share it with—the plan, provider, or someone like Nike or Under Armour—the concept is that there are rewards, such as avoiding rehospitalizations.

How can healthcare organizations better prepare their infrastructures now to implement blockchain in the future?

Yetter: I think the blockchain [implementation] would be more of an add-on, especially in the near term. And I think you will see some of the major vendors out there, be it EHR or adjudication systems, start to consider and build in aspects of blockchain into their own platforms. So there will be a broader enablement that will naturally flow into the infrastructure as it moves forward. But in the near term, there is a good opportunity to add blockchain capabilities to what they already have, and then leverage it for specific cases of pilots or at-scale activities.

Ghosh: The big thing to recognize is that the way enterprise blockchain is evolving, from an infrastructure perspective, it is becoming augmentative rather than disruptive. So you can take an EHR and then you can augment the whole EHR workflow, from encounter to discharge, on the blockchain, [while maintaining] what the traditional EHR looks like. You don’t have to transmit all the data, like you would do in a data warehouse, into another ecosystem. You can leave it as source and hash parts of it on the blockchain as you build the blocks along the workflow. The enterprise blockchain vendors are making this easy to adopt.

There has been plenty of back-and-forth about just how much security blockchain can provide. What are your thoughts on this?

Ghosh: Anytime you encrypt data, it can always be decrypted. A blockchain is nothing but a distributed database at the end of the day. If you have access to that database that doesn’t have a consensus mechanism attached to it, then it is a little insecure. Looking at the T.J. Maxx breach a few years ago, people were swiping their credit cards and the transmission from the point of fail system to the storage system was being intercepted; that was the hack. In the same way, from the time that the traditional system would write to the blockchain, you can intercept that data, and that’s when the insecurity could come into play. And those standards are still evolving. There is no vendor out there that can not only encrypt the transmission protocols between source and blockchain, but also ensure that the blockchain itself is secure.  

What predictions could you offer for blockchain’s continued evolution in healthcare?

Yetter: In 12 to 24 months, you will see a lot of fast-moving activity, and with the changing nature of conversations and the work being done now, there is a clear signal that we are at a bit of an inflection point. But I think we will accelerate the meaningful work in this space and bring the technology in. Going back to the idea of acceptance and use of emerging technologies in other sectors first, we are seeing blockchain in place in financial institutions in meaningful ways. So in the next year or two, I think we will see the same thing in healthcare, whether it’s aspects around provider data, or getting into exposing things to the patient or member so they have greater control. We’ll see a lot of energy and investment in that space.

Ghosh: I think that beyond the pilots that you see today, the voice of the customer will be increasingly automated with enterprise blockchain. Within healthcare, the issue is, how do you provide greater autonomy, depending on who has the data and where? It’s not one or two companies that are trying to do something; it’s five or 10 that want to get together before someone else beats them to it.

 

 


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