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Healthcare Leaders on Unlocking the Value of Disruption: “Digital Innovation Needs to be a Strategic Priority”

October 23, 2018
by Heather Landi, Associate Editor
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Health systems are feeling the pressure from digital disruptors coming into the market along with the increasing demand to be more consumer-focused, noted one healthcare CIO during a recent healthcare innovation conference.

“We are going to be disrupted by Apple and Amazon, if we don’t change,” Adam Landman, vice president and CIO of Boston-based Brigham and Women's Hospital, said during a panel discussion at the FT Digital Health Summit in New York City last week.

At the same time, however, many forward-thinking healthcare executives see digital technology as a tool that can be leveraged to support value-based care with the aim of better patient outcomes at lower cost.

During the FT Digital Health Summit, sponsored by Financial Times Live, a panel of healthcare industry leaders, including Landman, along with Chet Robson, medical director, clinical programs and quality for Deerfield, Ill.-based Walgreens and Nelia Padilla, global lead, digital health at IQVIA, a company that provides technology solutions and contract research services, discussed the role of digital technology in achieving value-based care as well as the significant barriers to adopting digital solutions and the headway their organizations are making with digital innovation.

Speaking to the challenges, Landman, who also is an emergency physician, noted the oft-cited analogy that the leaders of healthcare provider organizations have one foot in two canoes—fee-for-service and value-based care. “A small percentage in most healthcare systems right now are in value-based care, and, in most health systems, in general, a much larger component is in fee-for-service. Many of us truly want to go to value-based care and embrace those practices, but I think it’s just very challenging. We’re only seeing some of the potential to the movement to value-based care.”

When asked by an audience member about why the adoption of digital technologies in healthcare was not occurring at a more rapid pace, the panelists cited a number of barriers, including the current lack of an evidence base around digital tools and health outcomes.

Operationally, digital innovation needs to be a priority, Landman said. “It takes a leadership mandate and it takes funding along with it, and it needs to become a strategic priority,” Landman said. “One of the challenges we face, on the provider side, there are a lot of competing priorities right now, and some are non-discretionary.” He noted the investment in implementing and optimizing electronic health records (EHRs). “That’s going to provide the base for this next stage of digital health. That’s one example of a must-do, and there are others in the regulatory and compliance space that need to be done.”

Digital technology adoption requires a balanced approach in healthcare, Robson noted. “It’s not only about, is it convenient for the consumer, but in healthcare, it’s also about, is it going to provide the best outcome for them?” he said. The Walgreens app has been downloaded 55 million times and the company fills about 3 million prescriptions a day through digital refill services, he said. Walgreens also operates 9,500 retail stores. “When you have engagement that solves a need for a patient, it definitely gets adopted,” he noted.

Progress with Digital Innovation and Unlocking the Value of Disruption

Padilla noted that healthcare is ripe for disruption from consumer-facing startups and digital companies because the space has lacked a consumer focus, citing startups that have developed apps to triage patients. “It’s difficult for institutions and for long-established players in the industry to go beyond the innate barriers, or some of the incentive systems, to actually offer some of these services."

Healthcare providers often engage the "worried well," Landman said, "or the patients that will adopt the Fitbits and who have their records going to Apple Health, but not the really sick patients, the ones who need additional monitoring and care." He added, "That’s been a continued challenge, along with trying to align the incentives so that we focus more on sicker patients. And we have been working with behavioral economists, psychologists and the whole team to think of creative ways to truly engage patients who need care the most."

Bringing to the discussion his experience as both an IT leader on the health system side, including formerly chief medical information officer (CMIO) at Adventist Health Partners, and an execuive leader on the retail side, Walgreens' Robson said, “As health systems, we tend to look at patient engagement as a push, we’re going to push the patients towards what they need to do. Being on the retail side, we try to attract patients and we are looking at it as a pull; we’re trying to make it fun, easy and meaningful to them. Then it’s about trying to connect those things together, both from the outpatient side and the hospital side, I think that’s how we can help to move the curve.”

At Brigham Health, clinical and IT leaders have found that data and analytics can be used to develop personalized approaches and “direct the right tools to the patients that need them the most,” Landman said.

“What we also found is that technology alone is not an answer. An app is just one component of a larger program and you really need to invest in the people resources around that program, which is typically a nurse coordinator or a social worker,” he said. “You’re engaging the patient with the app, and you’re offering tech support and services to make sure they are up and running and know how to use it, but then you are interacting with them. A social worker or care coordinator is monitoring the feedback and engaging with the patient. I’ve seen very few [programs] that will succeed with digital alone; it’s a bigger program commitment.”

Landman added, “We found this model, and the general principle is that all of us need to work together to truly achieve the vision of the quadruple aim, or value-based care. We need technology, we need the insurers and payers, we need the providers, the pharmaceutical companies, to all come together and be open to collaborating and thinking about new things. And then we need to try things and for things that we do get up and running, then iterate on them, and when we do find success, scale them.”

The panelists also noted that new data sources, such as patient-reported outcomes data and data from consumer wearables and sensors, will play a key role in driving value-based care forward, but there is more work that needs to be done to make that data clinically meaningful to physicians.

“We haven’t scratched the surface with new data sources that we can pull together, things as simple as sensors detecting if a patient has moved,” Landman said. He cited Brigham Health’s ongoing Home Hospital program to bring acute care to the home for patients who would normally be admitted to an inpatient facility. As covered in a July 2017 Healthcare Informatics article, the Home Health program, which is overseen by David Levine, M.D., a practicing general internist and research fellow at Brigham and Women's Hospital and Harvard Medical School, entails placing patch wearables on patients at home to monitor patient vitals as well as steps taken.

Citing the results of that program, Landman said, “What’s most predictive of how well a patient is doing is actually how ambulatory they are, so a simple sensor and an accelerometer that’s measuring how often they are getting up and how many steps they are taking, that’s extremely predictive of how they are doing,” he says. “As we connect and link these data sources, we unleash a whole new world of possibility. If we can partner with our academic colleagues and do the rigorous scientific studies and validate them, I think we can start learning a whole lot more about how to better manage patients and how to measure surrogate markers of clinical outcomes.”

Walgreens is making headway to engage patients using digital tools, Robson said. For example, the company developed an online tool called Find Care Now that helps connect consumers with healthcare services—whether in-person at a pharmacy, via phone or virtual consultation—based on the individual’s location, by zip code. “The idea is, how do we begin to take that information about individuals and make it actionable to help connect people to the correct resources to address whatever issue they are having,” Robson said.

At Brigham Health, a multidisciplinary team has been using a texting tool, developed by a company called Medumo, to enhance colonoscopy screenings. The tool provides patients with a digital colonoscopy prep guide in advance of their procedure, through instructions sent via text messages. The tool also sends appointment reminders and links to Brigham’s digital wayfinding system on the day of the appointment. Patient feedback indicates that patients feel more prepared for the procedure.

“With this simple use case, which we piloted both at Brigham and Women’s colonoscopy and endoscopy clinics as well as MGH (Massachusetts General Hospital), we saw decreases in no-show rates of over 30 percent. That’s a significant ROI,” Landman says. “We have some very encouraging results and we’re starting to expand that tool to other procedural areas and use cases. This is an example of where it’s meeting a real need and there are some palpable ROI that resonates with our CFOs that lets us then build this platform out.”

Panelists also noted other examples of health systems providing services to patients to support their use of digital technology at home. Ochsner Health System in southeast Louisiana introduced an “O Bar” service, a health information “genius bar” concept, at its Center for Primary Care and Wellness. “We’re going to see more of that as these interventions gain traction,” Landman said. In fact, Robson said Walgreens is considering a “genius bar” concept at retail locations.

On the technology side, panelists also noted that no one digital technology company currently offers a consolidated platform that integrates with health systems while also providing patients the ability to seamlessly share their data. Right now, we’re in the fertile field stage of innovation where lots of best-of-breed solutions are popping up. But, I do think soon we need to see some consolidation. I hope over time that we’ll see some convergence of some of these great solutions into a true platform that you can buy that offers a seamless platform for both the system and the patients,” Landman said.

He also noted, “I think these aggregation tools that take sensor data, patient-reported outcome data, and pull that together and create displays for clinicians that are easy to access and layer clinical decision support on top of them, those tools are going to be quite powerful.”

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Take the Lead to Deploy Emerging Technologies for Improved Outcomes

December 14, 2018
by Brad Wilson, Industry Voice, former CEO of Blue Cross and Blue Shield of North Carolina
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It is a thrilling time to work in healthcare. As the former CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross N.C.), I have had the opportunity to be at the forefront of using new technologies to improve outcomes for our members. Now as a member of the CitiusTech advisory board, I continue that focus on emerging technologies, such as artificial intelligence (AI), and the potential to accelerate the shift to value-based care and improve the healthcare system in material ways.

AI is starting to make a distinct impact in helping providers deliver more effective care, lower costs and create a more consumer-friendly healthcare system. Blue Cross NC recently piloted the use machine learning, a type of AI, to identify spikes in prescriptions for a costly medication. The company reached out to doctors who had been prescribing the medicine in significant numbers. Alerting just one particular physician practice to a generic equivalent brought estimated annual savings of $750,000 for Blue Cross NC customers. The potential of AI is not measured only in dollars, but cost savings are an important consideration.

Machine learning works by applying sophisticated algorithms to rich datasets from electronic medical records (EMRs), patient-reported data, claims and a host of other sources. To be successful, this requires both access to data and significant investment to support the depth and breadth of data analytics capacity and capability.

Yet, historically, one of the biggest barriers to value-based models has been providers’ and payers’ possessiveness of their own data. There is a good business reason for that possessiveness: competitive advantage. The different parts of the healthcare system do not want competitors to use shared data to steal business. But the guarding of data drives healthcare costs higher and, more importantly, makes delivering better, more personalized healthcare more difficult. In the past, power came from hoarding information; today, there is power in serving as an information hub.  Healthcare providers and payers are starting to understand this and there is more willingness to work together in sharing what has traditionally been closely held information.

As consumers’ voices gain in numbers and decibels, it’s clear that analytics technologies that can lead to better care at lower cost are desperately needed, particularly for payers. But the entire healthcare industry needs to move more rapidly. Health plans need to enrich, deepen and widen their analytics capabilities as quickly as possible. If they don’t, we will continue to see disruptors like Google, Apple, and Amazon enter the healthcare market—companies that have a demonstrated ability to be nimble and maximize the impact of their data.

For both providers and payers, forward-thinking organizations recognize that building their own data analytics solutions is not always the answer. Often there is not enough time, resources or enough of the right talent to deliver the capacity and capability required. Fortunately, robust turnkey solutions coupled with deployment expertise are available to efficiently and cost-effectively integrate data and analytics within an organization’s clinical, financial and administrative processes.

As health plan executives map out their strategic plans, look to these emerging technologies as accelerators for leveraging data to manage risk, optimize performance, engage consumers, enhance population care, and improve clinical outcomes to reduce readmissions and further drive evidence-based medicine. The opportunity is here to transform healthcare delivery in significant ways. Success will go to those organizations that understand the potential of these new technologies and take the lead to deploy them effectively—today. 

Brad Wilson is former CEO at Blue Cross and Blue Shield of North Carolina and is a member of the new CitiusTech Advisory Board. Mr. Wilson joined Blue Cross NC in 1995 as General Counsel and held a variety of senior-level positions before being named CEO in 2010. Under his leadership, Blue Cross NC grew to a $9 billion company serving over 3.8 million customers. Mr. Wilson has also served as Director of the BCBS Association, AHIP and numerous other national and state healthcare organizations.


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Investors Have Strong Interest in HIT Sector, Despite Valuation Concerns

December 13, 2018
by Heather Landi, Associate Editor
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Healthcare IT remains a hot investment sector despite concerns about these companies being overvalued, according to KPMG-Leavitt Partners 2019 Investment Outlook, a survey of health care investment professionals.

Looking ahead to 2019, more than a third of respondents (34 percent) said they were most interested in investing in health care IT, followed by care management (31 percent), home health (23 percent), retail-centric medical groups (22 percent) and primary care practices (21 percent).

New York City-based KPMG and Leavitt Partners, based in Salt Lake City, surveyed 175 respondents online from corporations, health systems, investment banks, venture capital and private equity firms between September 17, 2018 and October 21, 2018. Of those surveyed 32 percent were C-suite executives; 29 percent were principal, partner or managing director; 32 percent were vice president or director; 6 percent were analysts/associates and 2 percent held other titles.

“We are not surprised by the great deal of interest in health care IT and care delivery outside the hospital,” Governor Mike Leavitt, founder of Salt Lake City-based Leavitt Partners and former Utah Governor and U.S. Health & Human Services Secretary said in a statement. “As health care continues to march toward value, the emphasis on moving care to lower cost sites and enhanced coordination will continue, and those who can increase quality and lower cost will win.”

According to an October report from Rock Health, 2018 is already the most-funded year ever for digital health startups. Digital health funding in this past third quarter soared to $3.3 billion across 93 deals, pushing 2018 funding to $6.8 billion, already exceeding last year’s annual funding total, which was $5.7 billion, by more than a billion dollars.

Drilling down into respondents’ predictions for investment activity in 2019, in the health care and life sciences market, 96 percent of respondents see either a lot or a moderate amount of investment in health IT and data next year, while a similar percentage (90 percent) see significant or moderate investment in outpatient services. Forty-four percent forecast a lot of investment in post-acute care services, 39 percent predict significant investment in provider services and about a quarter of respondents believe there will be a lot of investment in managed public programs, payer service providers and pharmaceutical and biotech manufacturers. Eighteen percent believe there will be significant investment in medical device and diagnostics and medical equipment.

The survey results indicate there is concern that health IT is overvalued, yet investors believe there is some room to climb.

The majority of investment professionals see health care IT investments as an overvalued sector (64 percent), yet 40 percent expect the valuations to increase in 2019 while 51 percent see them staying the same. About two-thirds of respondents (62 percent) think the health IT sector will grow faster than the market in 2019, and three quarters of investment professionals see increasing competition in the health IT market. Investors also estimate that the average purchase price multiple, in terms of EBITDA, will be 12.5 for the health IT sector in 2019. Survey respondents expect ongoing demand for tools to help with consumerism will impact investment and deal making in the sector, according to the survey.

About four in ten respondents believe the healthcare market is experiencing a “moderate bubble,” while 9 percent believe the bubble will likely burst.

Care management solutions for risk-bearing providers, a highly competitive sector which helps coordinate care of the chronically ill or seriously injured, are expected to be the second highest sector for investment behind health care IT, similarly driven by trends of consumerism and increased focus on early care interventions.

Looking at potential drivers of M&A activity in the health care and life sciences sector in the coming year, 64 percent of respondents cited cost consolidation and economies of scale, while 45 percent cited accretive acquisition strategies. Forty percent of respondents see changing payment models as a driver of M&A activity, and 38 percent cited pressure from competition. Other drivers cited by respondents include expansion/divestiture of service areas (25 percent), geographic expansion/contraction (24 percent), revenue synergies (22 percent), need to deploy cash on balance sheet (17 percent), and regulations and legislation (13 percent).

“Deals are largely being driven by the need for savings, economies of scale, and improving cash flow or accretive earnings per share,” Carole Streicher, Deal Advisory leader for healthcare & life sciences at New York City-based KPMG, said in a statement. “Secondarily, there is a bit of a defensive posture motivating investments as health care organizations contend with competition and reimbursement models connected to quality and efficiency, as well as the entrance of tech firms investing in the sector.”


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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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