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From Value-Based Care to AI, Imaging Leaders Look to Radiology’s Future

October 10, 2016
by Heather Landi
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Medical imaging leaders are facing a number of challenges in the ongoing transformation of care delivery, yet many of the key market forces that are changing the field also are pushing imaging toward innovation, according to many imaging informatics leaders at a recent conference in New York City.

At a conference focused on driving innovation in imaging, leading radiologists and imaging informaticists shared their perspectives on the future of medical imaging and the role that imaging plays in the transition to value-based care and population health initiatives. The event was sponsored by New York City-based Ambra Health, formerly DICOM Grid, a medical data and image management company.

There are key industry forces pushing radiology to innovate, notably care delivery transformation, imaging consumerism and the overall growth outlook for the radiology field, Lea Halim, senior consultant at Washington, D.C.-based The Advisory Board’s Research and Insights division, said.

Halim also said there are industry and economic trends impacting the growth outlook for imaging. The diagnostic imaging services market is saturated, as rapid expansion in the provider landscape has quickly absorbed available market share and, in recent years, there have been fewer new modality or advanced technology opportunities, and, at the same time, economy-driven influences are driving patients to put off radiology exams, she said. “Imaging leaders need to look at new growth opportunities alongside traditional outpatient growth,” she said.

Halim said imaging leaders need to focus on and invest in expanding screening exam services, as screening provides a unique opportunity for imaging’s involvement in the shift to value-based payment and care delivery. An aging population combined with an emphasis on population health initiatives means the demand for screening exam services will likely grow, she said, and imaging leaders should consider leveraging screening programs to promote early diagnosis within their patient populations. Beyond mammography screening exams, imaging leaders should consider providing lung cancer screening, CT colonography, abdominal aortic aneurysm (AAA) screening and even the more exploratory cardiac CT for calcium scoring screening.


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With more providers taking on risk through participation in accountable care organizations (ACOs) and mandatory bundled payment models, radiology’s hospital partners and referring providers are increasingly focused on controlling total cost and utilization management.

“There is a view is that care delivery transformation has had little effect on imaging—you’re not directly taking on risk or involved in new payment models. But, you don’t get a free pass. It’s relevant to radiologists and radiology providers. With the proliferation of alternative payment models it impacts how providers think about cost as more are taking on risk,” she said.

The simple truth, she said, is that diagnostic imaging is emerging as a top area in which there is an opportunity for cost savings. However, it also could be an opportunity for imaging to be a care transformation partner by helping provides share images as well as standardizing protocols and standardizing care.

“Imaging must establish its value under population health management, as the role of imaging is not as clear as we’d like it to be. If you’re not at the table, then you’re on the menu as far as utilization reduction when it comes to population health strategy,” she said.

According to Halim, there are three key opportunities for imaging leaders to align imaging initiatives with health systems’ population health goals—utilization management, which can improve quality and reduce costs; screening programs, which can impact patient risk escalation; and incidental finding management, which can help keep patients loyal to the health system.

“Moving forward, how do I communicate my value to the CEO? How do I communicate what imaging contributes to population health effort? How do we communicate that we’re the people who hold the key to appropriate diagnosis and treatment?” Halim asked.  

What Does “Quality” Look Like for Radiology

Measuring and demonstrating quality in the radiology field in the ongoing shift to value-based care is a substantial challenge, according to imaging informatics leaders at the conference.

Geraldine McGinty, M.D., a radiologist and assistant chief contracting officer at New York City-based Weill Cornell Medicine, said, “Most of the population health work that I’ve been involved in has been around primary care and its important work to manage chronic disease. We have a lot to contribute and we need to develop better ways to demonstrate how we contribute and measure how we are contributing.”

She continued, “With the MACRA [Medicare Access and CHIP Reauthorization Act of 2015] legislation, there have been some specialty-specific metrics and there has been some work crafting episodes of care that are imaging focused. We have a huge opportunity to demonstrate our value and develop metrics so we will be rewarded for that.”

“What impact does radiology have? How does what I do impact care and affect the lives of patients? The challenge is that we really don’t know,” Eliot Siegel, M.D., professor and vice chair, research informatics systems, at the University of Maryland School of Medicine, department of diagnostic radiology, said.

“There have been discussions about studying outcomes. Is the radiology helping my patients? And looking at appropriateness criteria. One area you can measure is the outcomes and the definition of quality has to be tied to outcomes, but it’s a big black box right now. I’d like to see more efforts track the impact it has on patients,” said Siegel, who also is chief of radiology and nuclear medicine for the Veterans Affairs Maryland Healthcare System.

A CT scan performed at the right time can have a significant impact on patient outcomes, “but the question is, what is our actual cost to providing care and contrast that to the impact on care?” Siegel said.

Halim outlined several ways imaging can succeed under new care delivery and payment models. Under an ACO model, imaging leaders can provide imaging sharing technology to ACO referring provider partners and leverage screening programs to promote early diagnosis. When hospital partners and referring providers are participating in a bundled payment model, imaging leaders can identify utilization trends of bundled services and leverage freestanding sites to minimize imaging follow-up costs, she said. With a capitated payment model, radiologists can promote appropriate ordering to reduce unnecessary imaging and create incidental finding protocol to ensure necessary follow-up care, she said.

“I think image sharing should be an area of extensive focus for imaging leaders. When they take on the responsibility for the health of a population, the ability to view images in real time and to share images throughout the course of a patient’s treatment can be critical to keeping down costs and elevating quality,” she said.

The Impact of Machine Learning and AI

McGinty and Siegel both see machine learning and artificial intelligence having a substantial impact on radiology.

Siegel cited a recent article published in the Journal of the American College of Radiology titled, “The End of Radiology? Three Threats to the Future of Practice of Radiology,” which cautioned that machine intelligence could end radiology as a thriving specialty.

“I can reassure you that there is no chance that radiologists will be replaced by computers,” he said. “We’ve awakened to realize that the technology is out there and there are some very interesting applications.”

According to The Advisory Board, machine learning is a set of algorithms that can learn complex patterns and make predictions from data. Deep learning is a subset of machine learning that aims to mimic the way the human brain functions by attempting to create artificial neural networks. This type of learning has shown a lot of promise in areas important to radiology, such as image recognition.

“While an algorithm can correctly identify a picture of a dog, reading an MRI or CT or doing other modalities is a different challenge,” Siegel said. “At this point, so far, they are just barely scratching the surface.”

“It’s something we have to really think about and I’m engaged and excited about it and it has the potential to expand the scope of what we can do. We have nothing to gain by sticking our heads in the sand,” McGinty said.

Looking ahead, there is the potential for deep learning algorithms to transform the radiologist’s role. Algorithms that pre-read images for radiologists could vastly cut down on read times, improve radiologist accuracy, and shift some workload from reading to reporting.

Imaging Consumerism

Halim of The Advisory Board sees the rise of healthcare consumerism as having a long-term impact on imaging.

“Consumers are increasingly shopping for healthcare, and imaging leads the pack for services that are shoppable, so we must deliver on their preferences,” she said. Citing on-demand services such as Uber, she noted, “Where consumers are coming from, they are used to getting what we want, when we want it, at a price that’s acceptable.”

Imaging providers need to adapt to consumers demands by providing transparent prices which entails providing price estimates to patients and offering price competitive options. Imaging providers also need to provide timely care by extending their hours, offering online scheduling and providing timely results. “We need to offer convenient locations, such as having accessible freestanding clinics, and billing on a lower fee schedule,” she said.

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Kaiser Creating Evidence-Based Complex Care Models

January 17, 2019
by David Raths, Contributing Editor
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Work aligns with recently published ‘Blueprint for Complex Care’

The National Center for Complex Health and Social Needs recently published a “Blueprint for Complex Care” to develop a collective strategy for promoting evidence-based complex care models. Recognizing that many patient issues have root causes that go beyond the medical, the Blueprint seeks to identify best practices for breaking down silos between the social care delivery system and healthcare.

Perhaps no health system has devoted as many resources to complex care as Kaiser Permanente. Its Care Management Institute, a joint endeavor between the Permanente Medical Groups and Kaiser Foundation Health Plan, has established Complex Needs as one of its national quality initiatives. It has named regional complex care leaders, created common quality measures across regions and established a complex need research arm called CORAL. (Kaiser Permanente has eight Permanente Medical Groups and regions, more than 12.2 million members, more than 22,000 physicians and 216,000 employees.)

In a Jan. 16 webinar presentation, Wendolyn Gozansky, M.D., vice president and chief quality officer, Colorado Permanente Medical Group and national leader for complex needs at the Care Management Institute, described Kaiser Permanente’s efforts and used some personal anecdotes to explain their goals.

She said Kaiser Permanenteis working on the concept of developing core competencies and tools to support a longitiudinal plan of care for patients with complex needs. “These are the folks for whom the usual care is not meeting their needs,” she said. “How do you recognize them and make sure their needs are being met?”

Gozansky gave an example from a patient she had just seen the previous wekend. This women had fallen and broken her hip. She had several chronic conditions, including significant asthma, yet she was not on an inhaled steroid.

“One concept I love from the Blueprint is that this field is about doing whatever it takes to meet the needs of the person in front of you,” she said. In speaking to the woman, she came to understand that singing in a church choir was the most important thing in her life, and the inhaler medication was making her hoarse and unable to sing.  She was fairly isolated socially except for church. “My goal was to get her rehabbed and leverage the patient-defined family that is supportive. Her goals are to sing, so we need to do what is possible to get her back to that. We have to capture that information, put it into a long-term plan of care. The goal is not to get her out of rehab but to get her singing in choir.”


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The health system has to work on care that is preference-aligned. The woman is not on a steroid inhaler but her care is preference-aligned. How does the health system assure that everyone knows they are doing the right thing?

Gozansky said the beauty of Permanente Medicine is that its setup involves an employed medical group focused on value, not volume. They can interact with health plan partners in delivery of new systems of care. “It is a virtuous cycle about value and person-centered care. This is what our complex needs team is trying to understand.”

She described the journey so far: In 2015 there were pockets of work being done across the eight Kaiser Permanente regions. In 2016 they established complex care as a national qualitiy iniative. “We knew we were not meeting these patients’ needs. We had to figure out the right way to do that.” They also realized that most of the previous research on the topic involved examples that were not in integrated systems such as Kaiser Permanente. “We had to figure it out in an integrated system,” she said.

 In 2017 they started working on cross-regional learning — for instance, taking a program from Colorado and trying it in Southern California. Then they sought to align quality measures. In 2018 they got funding to create CORAL, the complex needs research arm.  

The Care Management Institute has created a “community of practice” on complex care to break down silos within the organization and bring together research, operational and administrative executives. They also want to work with external stakeholders to make sure what they are developing is scalable, Gozansky said.

Mark Humowiecki, senior director of the National Center for Complex Health and Social Needs, also spoke during the webinar. He said one of the goals of the Blueprint was to get a clearer definition. Some people get confused about terms such as “hotspotting” and complex care, he said. He said there is a recognition that these patients’ needs are crossing traditional silos, so “there is a need to connect care for the individual but also at the system level.”

The goal, he added, is to create a complex care ecosystem by developing in each community system-level connections between social care delivery and healthcare, which in the past have operated too independently.  The five principles are that complex care is person-centered, equitable, team-based, cross-sector and data-driven. One of the Blueprint’s recommendations is to enhance and promote integrated cross-sector data infrastructures.



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NIH’s All of Us Program Teams with Fitbit for Data Collection

January 16, 2019
by Heather Landi, Associate Editor
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The All of Us Research Program, part of the National Institutes of Health (NIH), has launched the Fitbit Bring-Your-Own-Device (BYOD) project. Now, in addition to providing health information through surveys, electronic health records, and bio-samples, participants can choose to share data from their Fitbit accounts to help researchers make discoveries.

According to All of Us research program officials, the project is a key step for the program in integrating digital health technologies for data collection.

The All of Us Research Program, established by the White House in 2015, aims to advance precision medicine by studying the health data of 1 million diverse Americans over the next five years. One aim of the project is to include groups that have been historically underrepresented in research. As of September 2018, more than 110,000 people have registered with the program to begin the participant journey, and more than 60,000 have completed all elements of the core protocol.

The participants are sharing different types of information, including through surveys, access to their electronic health records and blood and urine samples. These data, stripped of obvious identifiers, will be accessible to researchers, whose findings may lead to more tailored treatments and prevention strategies in the future, according to program officials.

Digital health technologies, like mobile apps and wearable devices, can gather data outside of a hospital or clinic. This data includes information about physical activity, sleep, weight, heart rate, nutrition, and water intake, which can give researchers a more complete picture of participants’ health.” The All of Us Research Program is now gathering this data in addition to surveys, electronic health record information, physical measurements, and blood and urine samples, working to make the All of Us resource one of the largest and most diverse data sets of its kind for health research,” NIH officials said.

“Collecting real-world, real-time data through digital technologies will become a fundamental part of the program,” Eric Dishman, director of the All of Us Research Program, said in a statement. “This information, in combination with many other data types, will give us an unprecedented ability to better understand the impact of lifestyle and environment on health outcomes and, ultimately, develop better strategies for keeping people healthy in a very precise, individualized way.”

All of Us participants with any Fitbit device who wish to share Fitbit data with the program may log on to the All of Us participant portal at and visit the Sync Apps & Devices tab. Participants without Fitbit devices may also take part if they choose, by creating a free Fitbit account online and manually adding information to share with the program.

All of Us is developing additional plans to incorporate digital health technologies. A second project with Fitbit is expected to launch later in the year, NIH officials said, and this project will include providing devices to a limited number of All of Us participants who will be randomly invited to take part, to enable them to share wearable data with the program.

The All of Us research program plans to add connections to other devices and apps in the future to further expand data collection efforts and engage participants in new ways.

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NorthShore to Lead “Largest Primary Care-Based Genomics Program in U.S.”

January 14, 2019
by Rajiv Leventhal, Managing Editor
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The Chicago-based NorthShore University HealthSystem and genomics technology company Color are partnering on a new initiative that will aim to deliver the power of genomics to routine primary care at population scale.

Known as "DNA10K," the initiative will engage more than 10,000 patients and will be the largest known primary care-based genomics program in the U.S., according to officials who made an announcement last week.

The approach will build on NorthShore's years of experience in genomics and actionable electronic medical records (EMR) information, while providing access to Color's clinical-grade genetic testing and whole genome sequencing to inform patients about their risk for certain hereditary conditions, according to company executives.

“The knowledge will help patients learn about their genetic makeup, including risk factors for certain disease types such as common hereditary cancers and heart diseases. This insight will help NorthShore personalize care for each patient to support improved outcomes, prevention and overall health,” officials noted.

The announcement comes on the heels of a recent pilot between NorthShore and Color that looked to unlock the benefits of genetic information in routine care.

As officials explained, in less than two months, more than 1,000 patients signed up for the Color population health program as a part of their primary care visit, an adoption rate of more than 40 percent of those eligible and significantly beating expectations of the pilot program. “This is a strong indicator of patients' interest in understanding genetic factors that can influence health and the opportunity to work with NorthShore care providers to make more informed treatment or prevention decisions,” they attested.

Overall, the DNA10K initiative supports NorthShore's efforts to improve patients' health outcomes at a population level, with genomics as a foundation for informing individualized healthcare.

Patients who take advantage of the "DNA10K" offering will provide a blood sample, which is then analyzed in Color's CLIA-certified, CAP-accredited lab, and results are returned to healthcare providers and their patients. In addition to their NorthShore primary care provider, patients will also have access to board-certified genetic counselors and clinical pharmacists from Color and NorthShore, officials explained.

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