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How Providence St. Joseph Health is Moving Along on its Data Transformation Journey

June 18, 2018
by Rajiv Leventhal
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“What health systems need to do is recognize that digital health is here to stay and that data is a foundation for that ecosystem to be sustainable”

A PSJH senior executive discusses the chief data officer role, how the health system is making better use of its data, what’s new on the analytics front, and how challenging PSJH’s innovation journey has been thus far.

At Seattle-based Providence St. Joseph Health (PSJH), innovation and digital transformation are key enterprise themes as the organization’s senior IT executives continue to push forward into new healthcare technology endeavors. To this end, about two-and-a-half years ago PSJH—a health system that includes Providence Health & Services and St. Joseph Health, with facilities in Alaska, California, Montana, New Mexico, Oregon, Texas and Washington—hired Vijay Venkatesan as the system’s senior vice president and chief data officer.

Venkatesan, who before coming to PSHJ was working at Northern California-based Sutter Health as the vice president of enterprise data management, recently spoke to Healthcare Informatics about what the chief data officer role entails, how PSJH is staying ahead of the curve to make better use of its data, what’s new on the analytics front, and how challenging the health system’s innovation journey has been thus far. Below are excerpts of that discussion.

What is involved in your role as chief data officer? What are the core responsibilities?

My role is about how to create a climate for leveraging data as an asset. And what does “data as an asset” mean? Are we able to land information, harmonize information, and then make it available for the various uses of the data that people have? For example, when you think about data in healthcare, it is about connecting the patient experience, how to create that patient experience across the continuum, and making sure it is available for the various data users. And then make sure that by using that information, we are able to drive better care quality and patient experiences on the other end.

Vijay Venkatesan

What is involved in “creating a climate for leveraging data” and what are some strategies for transforming the data culture?

In the healthcare setting, because of legacies or histories for how we have [developed] systems, there are various IT systems. You have multiple EHRs (electronic health records) and ancillary systems, meaning data is all over. So how do you create a cultural transformation of the data? The first thing we had to work on when I came onto the role at PSJH was figuring out how to get people to say, “Can we become shared producers and shared consumers of the data?” So if different data repositories exist across the system, how do you create a way to get that data in one place?

What we did was embrace the big data paradigm. We created a data lake where we invited our other data asset owners to contribute their data into the lake, in exchange for data they want or don’t have access to. So we created a culture of convergence, to bring data in one place and share each other’s information so that the collective organizations benefit.

The second step we are working on is creating a harmonizing data layer—think about it as your iTunes data catalog, where your albums in iTunes are categorized by rock, pop, alternative, etc. It’s the same idea. Now that we have data in one place, how do we create albums from the data? So an album could be a view of the organization’s financials, or a view of the clinical care quality side, or the revenue cycle, or the supply chain, or pharmacy. Think about it as albums with galleries. So that’s the transition we are in around thinking about data as an organizational asset.

Data and analytics is clearly a key part of what you do. In what ways are PSJH leveraging analytics to improve care and for population health purposes?

On the population health side, we have built a platform called Community Pathways to Health, which looks at Medicare and Medicaid populations at-risk, tries to organize them by the level of risk each patient has, and then we [find out], what are the right ways to engage those patients?

In that context, we are also embedding social determinants of health to create a risk score or predictive score to say, how do we look at our limited resources and what’s the best way to apply them across the patient population we have so we can effectively manage their care?

On the other side, we are also building a mobile-first strategy where we are looking at building a no-show app for our clinics, as no-shows are significant in healthcare since there is a big cost burden associated with them. So we built a mobile app running as compliment to the EHR where the urgent care staff can see a prediction on which patients might not show up for an appointment and then call them to try to get them to come in.

And on top of that, we are working on a model to see if we can “double book,” just like airlines double book seats. Can we find a way to effectively manage that slot better? And we are using artificial intelligence (AI), machine learning, and a predictive and mobile strategy to do all of that together. So far, we have reduced cancelations by 10 to 15 percent, which is significant for some of these clinics.

When thinking about this type of innovation and data transformation, how much of a driver is the transition to value-based care?

I think there are two disruptions in healthcare that are noticeable and significant. One is, within health systems, there is tremendous pressure on sustainability—how do we become sustainable in an era of lower reimbursements and value-based care in its truest sense?

On the flip side, we have a lot of industry disruption happening through technology organizations and companies, which is what I call “disruption at the edges.” What health systems need to do is recognize that digital health is here to stay and that data is a foundation for that ecosystem to be sustainable. The majority of care will be outside of your four walls, and though telehealth: we have to meet the patient where he or she is. That’s a real change itself. People who are practitioners of data and analytics must recognize that data itself will be varied and in different contexts, and we have to create a ubiquitous patient experience.

The other side is creating meaningful applications that leverage the analytics at scale. A lot of the analytics you see is very “point solution” still; it doesn’t create interoperability both in the data and technology sense, and it doesn’t create an integrated patient experience. At PSJH, we are very focused on that integrated patent experience, and working backwards from that, what are the right things to do on the data and technology sides to enable interoperability that delivers the integrated experience?

Is PSJH doing more now with AI and machine learning?

On all of these applications that I mentioned, there is a significant component of machine learning embedded in. As for AI, people consume healthcare not because they want to, but because they need to. So we need to make sure that when we introduce concepts such as AI and machine learning, we still focus on that patient-provider relationship. We need to uphold the integrity of that interaction. We try to think about where does AI benefit, enhance, or add value to that experience of the patient-provider relationship? That’s the business we are in. We are very deliberate about AI. You will hear in the industry that AI adoption is low in healthcare; but it’s not that it is low, it’s that we are focused on applying AI to the right places and where it’s appropriate because we want to maintain the integrity of the patient-provider relationship.

Can this innovation journey be challenging for providers who are not used to this type of change?

The way to think about it is, for health systems in general, it’s like Maslow's hierarchy of needs. You have areas in health systems looking for basic information and others that are ready to do robotic process automation. There are extremes and some health systems don’t know where to start. Do you meet the basic needs of food, shelter, clothing, and security, or do you go for that transformation?

At PSHJ, we have taken a deliberate strategy in that we need to both strengthen our core—how we manage our data—but we also need to transform for the future at the same time. This is not a linear discussion. You need to think about it as remediate and stabilize what needs to be stabilized, but don’t ignore the foundation building and the transformation of the future. So we look at the business problems we are trying to solve, and what’s the appropriate way to either advance innovation, advance the foundation, or to stabilize or stop doing something because it’s not value-enabling.

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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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