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Roadmap to a Connected Digital Healthcare Future

October 9, 2017
by Bill Tribe and Erik Blazic, A.T. Kearney
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Medical technology is triggering profound changes in patient health diagnosis and treatment. What’s missing is an ecosystem to integrate the individual parts into one cohesive whole.

Imagine a team of healthcare providers taking full advantage of a patient’s genetic makeup, body imagery, electronic health records (EHRs), wearable devices, and real-time medical research and population health data. This vision has existed before—think about the press around the human genome project in the early 2000’s—but by 2030, predictive analytics and artificial intelligence will genuinely support this vision, bringing more accurate, timely identification and management for a range of health concerns.

Despite the wealth of available information, the variety of sources have not been integrated. Harnessing the power of these elements will bring immeasurable benefits—from predicting the likelihood of ailments based on a network of electronic health records to diagnosing diseases based on predisposition, the latest clinical research, and real-time population health trends.

Digital healthcare will also improve the system’s transparency and productivity, reducing costs. In this new ecosystem, patients can ensure they receive the best care at the lowest cost, and providers can deliver the best outcomes (see figure 1). Imagine how the economics will change.

Figure 1

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Early disease predictions will lead to behavioral changes that prevent and eliminate system costs. Patients will be able to compare provider quality and prices and make informed choices based on value, which will improve productivity. More accurate and timelier identification of diseases will enhance treatment and reduce waste. Telemedicine and remote monitoring, coupled with new and lower-cost care settings such as home care will improve patients’ health and ensure use of the most efficient level of care. Additional and more accurate information regarding the clinical and economic performance of products and services will improve innovation.

Along almost every dimension, the 2030 healthcare vision is vastly different and improved. Although many components already exist, what’s missing is a cohesive ecosystem.

A Digital Evolution

Healthcare is accelerating toward a patient-centric, value-based model. In fact, many companies are creating innovative business models to improve profitability and create a competitive advantage. However, the way the industry is moving toward this model is chaotic—a bit like the Wild West and like nothing the industry has seen before. Apps now track data from diabetics’ glucose meters to smart devices that provide a wealth of medical information but may be vulnerable to hacking. The digital environment comes with an array of implications, and evolving will require a bit of a balancing act. For example, products will need to be “patient differentiated” while delivering both value and best-in-class quality, and solutions will need to cover a broader part of the patient pathway supporting the full continuum of care. Apps and devices must be secure yet provide seamless interoperability, and the value proposition must be transparent while driving improvements across the value chain.

Four factors are driving this evolution:

Consumer expectations

Until recently, patients were relatively agnostic about their healthcare choices.  For example, a large portion of the population has insurance, which reduces a patient’s price sensitivity. Many people believe that physicians and hospitals offer similar capabilities for the same price, and there is a lack of transparency about quality and pricing.

However, as payments skyrocket and patients become more aware that they can—and should—make informed choices about their healthcare, behaviors are changing. As with the evolution of other industries, people have come to expect more comprehensive information. In retail, for example, consumers can quickly find products and browse reviews on Amazon and compare restaurants and make reservations on Yelp. The US healthcare system is beginning to support similar services. However, research shows there is still a long way to go (see figure 2).

Figure 2

In this evolving healthcare environment, consumers are seeing an array of benefits. People can use a variety of reputable online sources to do their own symptom and disease research—this may not always help physicians, but it is leading to empowerment of patients and more ownership of their care. Those with similar diagnoses can engage with their peers for advice and support. Services such as CareOperative’s Healthcare Bluebook help consumers compare prices for services in their area, and insurance company apps are helping people find the most effective networks and treatments.

New care models

Pharmacies, hospitals, and other industry stakeholders are establishing new care models to reduce costs, address new coordinated-care reimbursement regulations, and more optimally treat and monitor patient compliance. This comes at a time when new product innovation has dried up, costs are climbing, regulations are tightening, and the time to market is lengthy. By contrast, digital technologies allow for efficiency, create patient centricity, demand shorter timelines and less investment, and often evade government regulations. Given the landscape, the rise of new care models is driving a need for new digital technologies and practices. For example, Vidyo’s telehealth solution enables in-home, ambulatory, and acute care services, requiring seamless interoperability of connected, digital devices. In New York, Montefiore Medical Center opened a $152 million, 280,000 square-foot “bedless” hospital.  Since 2000, CVS Minute Clinics have treated more than 25 million patients, helping pharmacies boost traffic and create a captive market for prescription and over-the-counter product sales.

Digital technologies

Digital technologies have been developing and maturing for many years. Smartphones, for example, have become a gateway to almost all aspects of our lives. As a result, healthcare does not need to reinvent the digital wheel. However, the industry will need to integrate these platforms into the new models for patient care. A network of connected devices, cloud-based solutions, analytical applications, and electronic medical records are needed to create an efficient and effective digital ecosystem. The market for these services and applications is rapidly growing and is expected to be worth more than $600 billion by 2023. Driving this growth is a global connected health and wellness device market, valued at $120 billion in 2015 and expected to grow at 22 percent CAGR through 2023, primarily because of the rise of the Internet of Things and wearable medical devices.

With the growing popularity of wireless devices and services, the healthcare industry is exploring new business models. At a Chicago-area roundtable last year, executives from leading medical technology companies discussed digital strategy, stressing that they are seeking new ways to monetize and integrate data, make the system more productive, and provide more value-added services and products. They recognized nontraditional companies are experimenting in ways that reward speed and are unafraid of failing fast—a stark contrast to the approach of most traditional medical technology companies. Executives agreed that partnering traditional and nontraditional entities can unlock the full value.

Across the industry, companies are taking a variety of approaches in choosing areas of focus, ensuring their return on investment, pinpointing their ideal degree of risk, and finding ways to coordinate with ecosystem partners. Many are challenging the status quo. For example, Boehringer Ingelheim, a traditional pharmaceutical company, is working with Qualcomm Life to develop a wireless inhaler for chronic obstructive pulmonary disease. Medtronic and IBM Watson Health are developing new ways to tackle diabetes, and Philips has a handheld ultrasound device that connects to a smartphone or other handheld device.

Reimbursement and regulatory reform

For medical technology companies, the reimbursement and regulatory reform landscape is evolving. The provisions that insurance companies, Medicare/Medicaid, and other payers are introducing will improve manufacturers’ ability to create and get reimbursed for digital innovations. Many executives believe reimbursement is the biggest hurdle to unleashing innovation, with interoperability standards being a close second. The Centers for Medicare and Medicaid Services (CMS) has introduced changes to address some of these concerns. For example, the Medicare Access and CHIP Reauthorization Act (MACRA) has expanded the use of data, creating a framework to reward providers for quality of care rather than volume. The 2017 Medicare Physician Fee Schedule adds several telehealth codes to the eligibility list, and Centers for Disease Control and Prevention (CDC) program entities are required to submit claims electronically.

Other agencies have also been advancing legislative reform. In 2015, the Food and Drug Administration (FDA) clarified which apps it will not regulate as medical devices, including apps that provide wellness information and tracking. Recognizing the growing number of health apps, the Federal Trade Commission released a tool to help developers navigate federal laws.

A Path Forward

The future is bright for medical technology companies that aim to operate in this connected, digital environment. However, many of the largest firms are pursuing innovation that evolves around their existing product offerings—and they are struggling to transform their businesses (see figure 3).

Figure 3

Industry leaders ensure they have an end-to-end business model innovation framework that encompasses all products and services. Having a robust framework, they are integrating solutions by understanding when to develop, acquire, or partner.

Successful companies build capabilities to strategize, develop, and scale new business models (see figure 4). Although this begins with leadership and strategy, their operating model has a role in determining the degree of the transformation and the resulting market success. Companies must have an integrated approach - the supporting organizational structure, talent, culture, tools, and techniques all need to be aligned.

Figure 4

However, what worked for one company may no longer be relevant. Are you prepared for the future of connected digital healthcare?

Bill Tribe is a partner in the health practice at global management consulting firm A.T. Kearney. Based in Chicago, he serves a broad range of global clients in the medical devices, pharmaceuticals, biologics, and consumer healthcare sectors.

Erik Blazic is a principal in the health practice at A.T. Kearney. Based in Michigan, Erik leads globally focused operations-related engagements for clients in the pharmaceutical, medical device and nutraceutical segments.


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Survey: Physicians Sour on Value-Based Care Metrics, EHRs

September 19, 2018
by Rajiv Leventhal, Managing Editor
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They new research has several key findings related to value-based care, health IT and burnout

More than 50 percent of U.S. physicians who receive value-based care compensation said they do not believe that the metrics the reimbursement is tied to improve the quality of care or reduce costs, according to a new survey.

The research comes from The Physicians Foundation, an organization seeking to advance the work of practicing physicians and helps them facilitate the delivery of healthcare to patients. The Foundation’s 2018 survey of U.S. physicians, administered by Merritt Hawkins and inclusive of responses from almost 9,000 physicians across the country, reveals the impact of several factors driving physicians to reassess their careers.

Specifically, the new survey underscores the overall impact of excessive regulatory/insurer requirements, loss of clinical autonomy and challenges with electronic health record (EHR) design/interoperability on physician attitudes toward their medical practice environment and overall dissatisfaction—all of which have led to professional burnout.

The research revealed several key findings, including that value-based compensation is directly connected to the overall dissatisfaction problem, which is tied to metrics such as EHR use, cost controls and readmission rates, etc. Forty-seven percent (compared to 43 percent in the 2016 survey) of physicians have their compensation tied to quality/value, but when physicians were asked if they believe that value-based payments are likely to improve quality of care and reduce costs, 57 percent either disagreed or strongly disagreed that this is the case, while only 18 percent either agreed or strongly agreed that it is.

As one responding physician put it: “We are no longer in the business of healthcare delivery, we are in the business of ‘measures’ delivery.” More than 13 percent of physicians are not sure if they are paid on value.

What’s more, the research found that 88 percent of physicians have reported that some, many or all of their patients are affected by social determinants. Conditions such as poverty, unemployment, lack of education, and addictions all pose a serious impediment to their health, well-being and eventual health outcomes. Only one percent of physicians reported that none of their patients had such conditions.

Additional notable findings from the research included:

  • 18.5 percent of physicians now practice some form of telemedicine
  • 80 percent of physicians report being at full capacity or being overextended
  • 40 percent of physicians plan to either retire in the next one to three years or cut back on hours—up from 36 percent in 2016
  • 32 percent of physicians do not see Medicaid patients or limit the number they see, while 22 percent of physicians do not see Medicare patients or limit the number they see
  • 46 percent of physicians indicate relations between physicians and hospitals are somewhat or mostly negative

Coupled altogether, 78 percent of physicians said they have experienced burnout in their medical practices, according to the survey’s findings. And the results show that one of the chief culprits contributing to physician burnout is indeed the frustration physicians feel with the inefficiency of EHRs.

“The perceptions of thousands of physicians in The Physicians Foundation’s latest survey reflect front-line observations of our healthcare system and its impact on all of us, and it’s sobering,” Gary Price, M.D., president of the Foundation, said in a statement. “Their responses provide important insights into many critical issues. The career plans and practice pattern trends revealed in this survey—some of which are a result of burnoutwill likely have a significant effect on our physician workforce, and ultimately, everyone’s access to care.”

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Brigham Health’s 3-Pronged Approach to Reducing EHR’s Contribution to Burnout

September 18, 2018
by David Raths, Contributing Editor
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Focus is on individualized training, reducing unnecessary clicks, voice recognition tools

Research studies have found that “burnout” is nearly twice as prevalent among physicians as among people in other professions.  Physician surveys have found that 30 to 60 percent report symptoms of burnout, which can threaten patient safety and physician health. With EHR documentation ranked high among aspects of their work physicians are dissatisfied with, Brigham Health in Boston has taken a three-pronged approach to reducing the pain.

Brigham Health, which is the parent organization that includes Brigham and Women’s Hospital, Brigham and Women’s Faulkner Hospital and the Brigham and Women’s Physicians Organization, rolled out its implementation of Epic in 2015. In a Sept. 18 presentation that was part of the Harvard Clinical Informatics Lecture Series, Brigham Chief Information Officer Adam Landman, M.D., said the organization’s initial EHR physician training was eight hours of classroom training on where to find things in the EHR instead of focusing on workflows and how to use the EHR to support it.  “Our experience was not the best,” Landman admitted.  They followed up with tip sheets, a help desk and a swat team to do service calls, but providers only rated those interventions as somewhat helpful, so Brigham informaticists re-doubled their efforts to:

• Improve the EHR;

• Provide one-on-one training in the clinical setting; and

• Offer voice recognition software and training.

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Landman said IT teams at Brigham feel a sense of urgency about reducing the burden of EHR documentation. “Burnout is an epidemic, and the EHR is a component of this,” he said, adding that the changes are not just a one-year cycle but must involve continual iterative improvements. “We need to be more aggressive about making changes,” he said.

He described some efforts to reduce notifications and remove clicks from the medication refill process. They also removed a hard stop when discontinuing a medication. Those three changes alone reduced the number of clicks per month by 950,000 across the health system.

They also worked to reduce clinical decision support alerts with very low acceptance rates by turning them off. Three alerts with very low acceptance rates were turned off. “If we thought they were important, we would fine tune them to increase the acceptance rate,” Landman stressed. “That is part of clinical decision support lifecycle management. But we will continue to iterate to reduce the number of unnecessary clicks.”

A year and a half ago, Brigham also created a one-to-one support program, in which an expert trainer would meet the physicians in their practice and help them with their work flow. A pilot project involved four specialties, including general surgery. Each session was 90 minutes to two hours long, and providers were offered one or more follow-up sessions, as well as optional training on speech recognition. After seeing some negative feedback on their initial classroom training, the one-to-one sessions were met with a very positive response. Almost 95 percent said it was valuable, and 95 percent said they thought their efficiency with the EHR would improve following the training. Based on that early success, the training effort is now being rolled out to much larger groups of physicians at Brigham and across the Partners HealthCare network.

In another attempt to improve documentation turnaround time, Brigham has made voice recognition tools and training available to physicians. They made two-hour training sessions mandatory for those interested in adoption, with additional personalization sessions also available. Informaticists partnered with departments to build department-specific order sets. (Brigham also started offering 15-minute e-learning sessions for residents.) More than 90 percent of surveyed physicians said the training met expectations, and 70 percent said they would be willing to have additional training, Landman said. Currently 5,000 physicians across Partners are trained to use voice recognition tools with the EHR.

Landman also cited a study that compared U.S. and international use of Epic that saw a huge disparity in length of documentation notes. The U.S.-based users’ notes were nearly four times longer on average than those of their international counterparts. Epic users overseas tend not to complain about the burden of documentation, he noted. This has to do with how the provider notes are used in billing, he said, adding that CMS is working on proposals to change billing requirements that may alleviate some of the documentation burden for physicians.

In closing, Landman urged informatics colleagues to think about working on EHR optimization research and studying the impact of policy and technology changes. “New technology tools can seem fun and exciting, but for physicians who see up to 100 patients per day, they can be quite overwhelming,” he said. “We don’t want physicians spending half their time doing administrative work.”

 

 

 

 

 


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