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How Will New Entrants in the Healthcare Space Impact Provider Organizations? One Leading Consultant Offers His Perspective

April 6, 2018
by Heather Landi
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Earlier this week, a cross-industry panel representing financial, health, technology and life science leaders discussed the implications of accelerating digital disruption in healthcare during a webcast hosted by Ernst and Young (EY), the New York City-based advisory services firm.

The panelists dissected the opportunities made possible by digital disruption, what these changes may mean to stakeholders across the health value chain and what organizations can do to seize the upside of technological disruption. In the last three months, non-traditional players, such as technology companies like Apple and Amazon, have made significant moves into the healthcare space, signaling a growing convergence of the American healthcare industry.

Jacques Mulder, who moderated the panel discussion, is the U.S. health sector leader for Ernst & Young, and, he is a 25-year healthcare industry veteran with a focus on working with pharmaceutical and biotechnology companies. In his consulting work, he helps U.S. healthcare clients navigate complex issues, bringing innovation to the healthcare delivery system.

In an interview with Healthcare Informatics Associate Editor Heather Landi after the webcast, Mulder shared his personal take on many of the topics explored during the panel discussion, including the connotations of U.S. healthcare industry convergence and what health system and hospital executive leaders should be doing to navigate the changes that are coming. And he discusses why healthcare organizations will have to fundamentally change how they deliver care and how they engage with patients in the face of aggressive competition from new players in the market. Below are excerpts from that interview, edited for length.

During the panel discussion, there was talk about the convergence of the U.S. healthcare industry.  What exactly does that mean?

I’m been talking and writing about this topic for years now, and I’ve always held the position that changes are required to fix or better healthcare, and many of these changes are not going to come from the healthcare industry itself. We’ve been following these series of non-traditional entrants into the market, and many of those have been announced in deals that were made public over the last couple of weeks, such as announcements from Google and Amazon. It basically comes down to this—companies that are technology-based and information-based organizations have developed significantly faster in their ability to create platforms upon which not only transactions happen but also where they use their deep analytics skills and data management skills to a much better effect than the healthcare system does it.

Looking ahead, what will this mean for the healthcare industry, and specifically for healthcare provider organizations?

It really is a shift to keep consumers at the center of care, which rides on the back of this whole concept of consumerization or consumerism, where patients are becoming a lot more informed about their own healthcare and also taking the reins into their own hands a little more. They’re doing their own research, and, for that reason, we have to start treating patients as customers, the same way we do in [the] retail and consumer goods [industries]. The missing link has always been the technology to make these things real. The growth and acceleration of technology is making things possible today that weren’t possible just two or three year ago. That pace is incredible; those technologies almost double in their capabilities every year. I think that it’s suddenly hit a point where the healthcare industry is saying: technology is surpassing what I’m currently offering, my consumers are educated and they are demanding a lot more of me. For that reason, I need to find ways to provide a customer experience or a patient experience that far exceeds what I’m doing today and, oh, by the way, if I want to keep these covered lives, I’m going to have to be competitive in the market, as it pertains not only to their health but also their satisfaction in the engagement of the services.

Convergence is really about, how do you start using and integrating the mobile apps, the wearable devices, such as the Fitbit, Garmin watch or Apple watch, and how do you start integrating those pieces of information in the overall health and wellness of patients? At this point, as those organizations assume risk for outcomes, they’re not only treating sick people, they’re also having to take care of healthy people so that they don’t become sick, so the technology allows them to do that. The healthcare industry is playing catch up, and the convergence is happening because there are people and technologies out there that can do a better job of most aspects, outside of patient care, than the industry itself can do.

The panel discussion covered many topics as it relates to digital disruption, vertical integrations and mergers and acquisitions in healthcare. What were the big takeaways from that discussion?

Provider organizations are going to have to be a lot more flexible and engaging. They’re going to have to be a lot more respectful of patients’ needs and requests, and that’s a switch in the focus. Healthcare organizations, specifically provider organizations, are going to be burdened with standing behind and being measured on the quality of clinical care they provide, as well as the wellness of populations that they serve, which is a dramatic shift from today. I think that touches on how do you change the clinical pathways and, more specifically, how do you change physician and caregiver attitudes and behavior in this changing dynamic of servicing the patient, rather than servicing the insurer? Those are the big things.

And, you have to consider the amount of transparency that’s being brought by technology and by consumers being more informed and shopping around more. To take a parallel from the car industry, you can find an application that tells you, in your area, what a Honda Civic sells for, with the same features, and you can find the best price. That transparency doesn’t yet exist in healthcare, so it’s going to become a price and a quality discussion very quickly that a consumer is going to be able to see. An organization’s ability to charge premium prices is going to evaporate dramatically, and I think that forces us into a fundamental change of the business model.

What should health system and hospital executive leaders be doing right now to strategize and leverage the opportunities that disruption brings?

There are two things—there is a lot of activity going out right now around mergers and acquisitions really for the purpose of scale. You have to make sure you have enough scale and size to adequately be competitive in a risk-based environment. And then secondly, we talked about bigger and then getter better, or getting smarter, which means the use of technology and other tools to better engage with patients, to be able to customize patient care, and to treat those patients with an aim toward client retention and client satisfaction that really wasn’t the case before. That’s going to require a fundamental shift in how care is delivered.

The options that are in front of provider organizations are so many that it’s difficult to decide what to do. What’s important is to clearly identify the things that are critical for you, as an organization, in this ongoing journey of how you want to enhance the patient experience and how much risk you want to assume. You need to get clarity on that, and then identify who your partners are that you can collaborate with to get this done. This is not a one-person show anymore. I think embracing those partnerships and having a willingness to use technologies and platforms that may not be your own or may not have been developed in your organization, that’s going to be a critical piece.

I’ll reiterate that the way the healthcare system is going is not sustainable, under any circumstance. With 18 to 19 percent of GDP [gross domestic product] and 5 to 6 percent growth, it’s one of the fastest growing industries or sectors in the word and, specifically, in the U.S. I do not think that cost cutting is going to get us out of any of that situation; we’ve been doing that for 15, 20 years, and it’s not changed anything.

Where we’re going to, I think, is a real realization by organizations that I need to embrace these technologies, and fundamentally change the way I deliver care and the way I engage with patients, and have that drive down costs, versus trying to get an extra 2 percent over my pharmaceutical benefit. I think we’re going to see physician and caregiver accountability increase, and that’s going to be linked to the performance of those organizations. They [physicians] are going to be required to change and behave differently, and that change is probably one of the biggest and most formidable change challenges that we have in this country. And, frankly, if they do not do it, other companies that are entering the market now that are much more efficient and much more focused on solving the client problem, will eat their lunch.

While many see healthcare as ripe for disruption, there is the argument that consumer tech companies like Apple and Amazon face major challenges in trying to shake up the healthcare industry. What is your take on that?

I may look at it in a slightly different way; I don’t think these new entrants necessarily want to take over the provision of healthcare, but what they are interested in is managing or owning the platform upon which healthcare and healthcare services are brokered. There is a difference between owning healthcare and being a critical participant. What I do think is that companies that are smart, and specifically employers—the employer, outside of the federal government, is the ultimate payer for healthcare, along with us as the patients with our out-of-pocket co-pays—the employers are saying the solutions that you’re giving the healthcare system are not adequate, and I will embrace other technologies, such as the Amazon platform or Google’s capability, to figure out how to better treat a specific disease or how to better intervene in the wellness of care, and then they will collaborate with clinical organizations to adopt different ways of doing it. But, those caregiver organizations are probably not going to do it themselves. These new entrants are not going to change the market by trying to own it, they will change the market because their technologies will be used by existing healthcare players to enhance their own businesses.


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N.Y. Hospital Conducts Digital Assessments of Patient Interactions

November 13, 2018
by David Raths, Contributing Editor
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Upstate University Hospital uses Vocera Rounds mobile app to gather data, provide feedback
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Physicians at Upstate University Hospital in Syracuse, N.Y., are using a mobile app to collect data about hospitalists’ behaviors during patient interactions in order to provide real-time feedback.

Amit Dhamoon, M.D., Ph.D., internist at Upstate University Hospital and associate professor of medicine at SUNY Upstate Medical University, said he was looking for a way to improve physician-patient communications.

“It is still unclear why some physicians really connect with patients and some just are not able to,” he said. “It is unclear why certain patients trust certain doctors more than others. We want to look at some basic behaviors.”

His team decided to do the digital assessment using a customized version of Vocera Rounds, a mobile application that enables clinicians to collaborate in responding to patient feedback and closing care gaps. “We needed a way to collect the data, relay it, and analyze it,” he said.

Fourth-year medical students who are going into internal medicine join the team of hospitalists on their rounds and serve as “silent shoppers,” Dhamoon said. They focus on the communication aspects of each interaction, and enter their observations into an iPad.  Residents and physicians also use the app to conduct a brief patient survey after the encounter. 

Among other things, they assess:

• how much time the provider was in the room;
• whether the provider introduced themselves;
• whether they sat down at eye level with patient; and
• At the end of conversation, did they ask if there were any questions?

Dhamoon said patients may pick up on body language or other things that physicians are not even cognizant of. “We are focusing on how to treat gall bladder disease or make their pneumonia better. We are focusing on the medicine,” he said. “We have to do that, but we also have to communicate what we are thinking.”

In an academic medical center, it is not unusual for teams of eight to nine doctors, residents and students enter a patient’s room. “Sometimes they don’t know what to do with their hands, so they stand with their arms crossed in front of them,” Dhamoon said. “For the patient, who is lying down with an ailment, it can almost feel like an inquisition.”

Dhamoon says hospital rooms are sometimes cramped and there is not a chair available. “I can say that it should be the gold standard that we are at eye level, so it doesn’t send a message to the patient that we have one foot out the door. But if we don’t have the basic tools in place, like a chair, then it is not going to work.”

Dhamoon and his colleagues are studying the effectiveness of this training approach and its impact on patient satisfaction measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.  “My colleagues are incredible people. I want our patients to see how incredible they are. We get in our own way sometimes.”



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GetWellNetwork Acquires HealthLoop

November 9, 2018
by David Raths, Contributing Editor
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Company seeks to provide comprehensive digital patient and family engagement platform

GetWellNetwork, a Bethesda, Md.-based company offering a platform for improving patient engagement, has acquired Silicon Valley startup HealthLoop.

The acquisition expands 280-employee GetWellNetwork’s reach into nearly 700 healthcare providers. Mountain View-Calif.-based HealthLoop’s platform enables care teams to engage patients before and after admission through automated, daily check-ins. Customers include Advocate Aurora Health, UCSF Health and LifeBridge

GetWellNetwork said it is combining its nearly two decades of experience implementing patient engagement solutions with 30-employee HealthLoop’s expertise in mobile technologies and digital care management. The move is designed to catalyze growth in the ambulatory space and signals its plans for more investment in cross-continuum tools to connect patients, families and providers.

GetWellNetwork was named one of Healthcare Informatics’ “Up and Comer” companies back in 2014. In an interview then, CEO Michael O’Neil described how the company uses the TV set in a hospital room to enhance patient engagement. To deal with pain management, GetWellNetwork has a workflow called the pain assessment pathway. If a patient is on a morphine pill, the system interrupts the TV show every hour to ask the patient to rate their pain on a scale. "If I report a certain threshold or below, it is simply going to document that in Epic, Cerner or Allscripts," O'Neil said. "If I report a five or above, it will document but also, through a Vocera badge, signal a nurse to go to the room. That is one pathway we help deploy, where pain management is a service or quality metric that a particular organization is trying to move the needle on. We are working with healthcare systems with the courage to take the 'patient-centered mission' off the poster in their office and bring it to the point of care."

In a prepared statement about the most recent acquisition, O’Neil said:  “Adding HealthLoop to our portfolio advances our strategy to provide the most comprehensive, end-to-end digital patient and family engagement platform. The changing nature of the how and where care is delivered requires dynamic solutions to meet modern engagement challenges. With HealthLoop as part of the GetWell portfolio, we’re excited to help health care organizations rethink and accelerate their digital strategies.”




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Dr. Mark Smith’s Five Tasks for the Healthcare Sector

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Founding CEO of California Health Care Foundation challenges industry to allow laypeople to do some tasks now done by professionals
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A good keynote address gets us to challenge our assumptions and consider some new possibilities in our field, often bringing in ideas from other disciplines or markets. That is what Mark Smith, M.D., M.B.A. founding president and CEO of the California Health Care Foundation, did last week at the annual meeting of the Patient Centered Outcomes Research Institute (PCORI) in Washington, D.C.

Dr. Smith is a professor of clinical medicine at the University of California, San Francisco, and a visiting professor at the University of California, Berkeley. As a clinician, served on the front line of the HIV/AIDS epidemic in San Francisco. From 1996 to 2013, he led the California Health Care Foundation, where he helped build the organization into a leader in delivery system innovation, public reporting of care quality, and applications of new technology in healthcare. In his PCORI talk he laid out five tasks for the field, which I will paraphrase here:

1. Continue to work with providers and patients to develop robust clinically specific measures of quality.

2. Accelerate the integration and automation of quality measures into the work flow of care delivery as opposed to separate flow of funds, personnel and work.

3. Develop instruments to measure and improve self-care capability and work with industry on enabling technology that would allow laypeople to do tasks now done by professionals.

4. Think about non-creepy ways to use social media, search, shopping and other non-health data to inform care of patients.

5. Develop, promote and deploy nimble, adaptive research methodologies.

I want to touch on a few of these in detail because I think he made interesting points, some of which are counter-intuitive or go against the grain of current thinking. For instance, Task No. 1 involves quality measures, and Smith acknowledged that there are legitimate complaints from clinicians about the terrible burden in our current system of measurement. “But the answer to that is not a search for five magic measures” useful in all settings, he said. Smith added that the call for fewer measures is a false path.

The current measures are imprecise and often not compelling to patients and professionals, he stressed. The key is to develop measures that are relevant to patients and clinically significant. “We have all sorts of things important to hospitals, doctors and CFOs and CMOs,” he said. “We are just now learning how to create robust measures that are important to patients. I believe those will only be compelling to patients and their doctors if they are clinically specific. When I hear people say we need fewer, better measures, I say no, we need more better measures.”

Smith went into a few reasons why measurement is so challenging in healthcare. “Our IT systems are so primitive that the burden of collection, analysis, and reporting is substantial,” he said. “The answer is more clinically specific measures with greater integration into workflow.” In no other sector of the economy, he pointed out, are the systems for monitoring the quality of the process different from the established and funded system to do the process itself. “We have to Integrate the process of measuring quality and collecting information from patients with the view toward the ergonomic and economic integration into the work flow,” he said.

Smith turned to the concept of patient engagement, noting that everyone has a different definition. “In the early part of 21st century, patients should be engaged in the co-production of healthcare services. It is an extreme notion, but I have been known for being extreme sometimes,” he said.

In fact, Smith focused a good deal of his talk on the idea of co-production. He pointed to the fact that other industries have taken advantage of technology to allow customers to co-produce a service. For instance, people book their own travel now instead of using a travel agent; they use an ATM or bank online instead of getting money from a teller. “Those industries have economic incentive to involve us in the transaction that used to be one way from the professional to us,” he said.

Smith stressed healthcare could do more of that, citing examples such as patients in Great Britain taking their own blood pressure and managing hypertension with medications based on the results. Or patients being trained to test coagulation. Some patient cohorts are doing self-dialysis.

“We have a system that does not take advantage of modern IT,” he added, “because our payment system is based on early 20th century notion of healthcare and how it should be delivered. The only way the practitioner gets paid is if you go somewhere to get information.”

Health systems are starting to move toward involving patients in scheduling decision making, and reporting outcomes. The Open Notes movement is a big improvement in the co-production of information about patient health, but clearly Smith is envisioning more revolutionary changes.

Perhaps the most controversial topic he touched on was No. 4, finding non-creepy ways to use social media, search, shopping and other non-health data to inform care of patients. He asked the audience to imagine clinicians having access to what Google Amazon, and Facebook know about you. “I know that is creepy,” he stressed. “I get there are privacy concerns. We need to think of non-creepy ways to do it. Social media is like nuclear energy,” he added. “It can be used for good or ill. We need to try to integrate that profound deep knowledge about you into the management of your care.”

How you respond to that suggestion may reflect in part which generation you come from. Personally, I recoil from the idea of my primary care doctor reviewing my social media streams or my shopping bill from Whole Foods. But Smith said the search is for a non-creepy way to do that, so I will withhold judgement until I hear an idea that doesn’t sound creepy or Big Brother-ish to me.

But overall, Smith left the PCORI audience with a lot of ideas to consider, and he applauded PCORI researchers for “trying to figure out what is important to patients and get the right instruments to measure it.”

PCORI, he said, “is on the cutting edge of the most important thing we can do: spend time and effort and money on things that are important to patients rather than to professionals. We are just at the beginning of that process.”







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