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Optum Acquires DaVita Medical Group for $4.9B

December 6, 2017
by Rajiv Leventhal
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Minneapolis-based Optum, UnitedHealth’s health services segment, has acquired independent physician group DaVita Medical Group for $4.9 billion in cash, officials announced today.

DaVita Medical Group, with clinics in Florida, California, Colorado, Nevada, New Mexico and Washington, serves approximately 1.7 million patients per year through nearly 300 medical clinics featuring primary and specialist care. DaVita Medical Group also operates 35 urgent-care centers and six outpatient surgery centers.

DaVita will join with Optum’s physician-led primary, specialty, in-home, urgent- and surgery-care delivery services business.  The combination will aim to “improve care quality, cost and patient satisfaction through integrated ambulatory care delivery systems enabled by information technology and supportive clinical services. Optum’s data, analytics, technologies and clinical expertise will help DaVita Medical Group physicians deliver even higher quality care more effectively to the patients they serve,” according to Optum officials in a press release announcement.

Following the transaction, DaVita Medical Group will become part of Optum’s OptumCare division, which today works with more than 80 health plans to serve millions of consumers annually through 30,000 affiliated physicians and hundreds of care facilities. Joe Mello, chief operating officer of DaVita Medical Group, will continue in a leadership role in the combined entity, as will the DaVita Medical Group leadership team.

“Combining DaVita Medical Group and Optum advances our shared goal of supporting physicians in delivering exceptional patient care in innovative and efficient ways while working with more than 300 healthcare payers across Optum in ways that better meet the needs of their members,” Larry C. Renfro, CEO of Optum, said in a statement.

Earlier this year, Optum merged with The Advisory Board’s healthcare business in a $1.3 billion deal. Optum was also named a Healthcare Informatics Most Interesting Vendor this year, after finishing first on the Healthcare Informatics 100 list of health IT vendors ranked by revenue for the third straight year. Optum self-reported a health IT revenue of $7.3 billion in 2016.

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National Library of Medicine Creating Scientific Director Position

January 23, 2019
by David Raths, Contributing Editor
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New position will oversee Lister Hill National Center for Biomedical Communications and National Center for Biotechnology Information

As part of a reorganization of its intramural research activities, the U.S. National Library of Medicine (NLM) has launched a search for a scientific director. The scientific director will oversee a group of 150 scientific personnel, developing new approaches to data science, biomedical informatics, and computational biology.

In a blog post on the library’s website, director Patti Brennan, R.N., Ph.D., called the move a big step in revving up its intramural research operation.

One of the 27 Institutes and Centers of the National Institutes of Health (NIH), NLM creates and hosts major digital resources, tools, and services for biomedical and health literature, data, and standards, sending 115 terabytes of data to five million users and receiving 15 terabytes of data from 3,000 users every weekday.

NLM’s strategic plan for 2017-2027 positions it to become a platform for biomedical discovery and data-powered health. NLM anticipates continued expansion of its intramural research program to keep pace with growing demand for innovative data science and informatics approaches that can be applied to biomedical research and health and growing interest in data science across the NIH.

A Blue Ribbon Panel recently reviewed NLM’s intramural research programs and recommended, among other things, unifying the programs under a single scientific director. That shift also aligns the library with NIH’s other institutes and centers, most of which are guided by one scientific director.

NLM’s  intramural research program includes activities housed in both the Lister Hill National Center for Biomedical Communications (LHC) and the National Center for Biotechnology Information (NCBI). The researchers in these two centers develop and apply computational approaches to a broad range of problems in biomedicine, molecular biology, and health, but LHC focuses on medical and clinical data, while NCBI focuses on biological and genomic data.

But the Blue Ribbon Panel noted that the boundaries between clinical and biological data are dissolving, and the analytical and computational strategies for each are increasingly shared. “As a result, the current research environment calls for a more holistic view of biomedical data, one best served by shared approaches and ongoing collaborations while preserving the two centers’ unique identities, wrote Brennan, who came to NIH in 2016 from the University of Wisconsin-Madison, where she was the Lillian L. Moehlman Bascom Professor at the School of Nursing and College of Engineering.

She added that having a single scientific director should lead to a sharper focus on research priorities, fewer barriers to collaboration, the cross-fertilization of ideas and the optimization of scarce resources.

The new scientific director will be asked to craft a long-range plan that identifies research areas where the NLM can best leverage its unique position and resources. We’ll also look for ways to allocate more resources to fundamental research while streamlining operational support. “Down the road, we’ll expand our research agenda to include high-risk, high-reward endeavors, the kinds of things that raise profound questions and have the potential to yield tremendous impact,” she wrote.

Besides the scientific director, the NLM is also recruiting three investigators to complement its strengths in machine learning and natural language processing.

 

 

 

 

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Survey: Digital, AI Top Priorities in 2019, but EHRs Will Dominate IT Spend

January 22, 2019
by Heather Landi, Associate Editor
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Digital, advanced analytics, and artificial intelligence (AI) are top spending priorities for healthcare executives in 2019, but electronic health record (EHR) systems will dominate technology spending budgets, according to a recent technology-focused healthcare survey.

Damo Consulting, a Chicago-based healthcare growth and digital transformation advisory firm, surveyed technology and service provider executives and healthcare enterprise executives about how the demand environment for healthcare IT is changing and will impact the industry in the coming year. Damo Consulting’s third annual Healthcare IT Demand Survey also analyzes the challenges for healthcare organizations and the perceived impact of macro-level changes.

The report indicates technology vendors will continue to struggle with long sales cycles as they aggressively market digital and AI. For the second year in a row, the rise of non-traditional players such as Amazon and Google will have a strong impact on the competitive environment among technology vendors while EHR vendors grow in dominance.

Among the key findings from the survey, IT budgets are expected to grow by 20 percent or more, with healthcare executives indicating they are more upbeat about IT spend growth than vendors. All the healthcare executives who participated in the survey said digital transformation initiatives are gaining momentum in their enterprises.

However, the majority (75 percent) agree that rapid change in the healthcare IT landscape makes technology decisions harder and only 58 percent believe there are plenty of viable and ready-to-deploy solutions available today in emerging technologies such as AI and digital health solutions. Seventy-one percent agree that federal government policies have provided a boost to healthcare IT spend this past year.

Top IT priorities for healthcare enterprise executives in 2019 are digital, advanced analytics and AI. Of the survey respondents, 79 percent said accelerating digital health initiatives was a top priority and 58 percent cited investing in advanced analytics and AI capabilities as top priorities. However, modernizing IT infrastructure (25 percent) and optimizing EHRs (21 percent) are also significant priorities.

Technology vendors also see AI, advanced analytics and digital transformation as top areas of focus for next year, as those areas were cited by 75 percent and 70 percent of technology and service provider executives, respectively. Thirty-three percent of those respondents cited EHR optimization and 25 percent cited cybersecurity and ransomware. Thirteen percent cited M&A integration as a top area of focus in 2019.

However, EHR systems will dominate technology spending budgets, even as the focus turns to digital analytics, the survey found. Technology and service provider executives who participated in the survey identified EHR system optimization and cybersecurity as significant drivers of technology spend in 2019. Sixty percent of respondents said enterprise digital transformation and advanced analytics and AI would drive technology spend this year, but 38 percent also cited EHR optimization and cybersecurity/ransomware. One executive survey respondent said, “For best of breed solutions, (the challenge is) attracting enough mindshare and budget vs. EHR spends.”

When asked what digital transformation means, close to half of healthcare executives cited reimaging patient and caregiver experiences, while one quarter cited analytics and AI and 17 percent cited automation. As one executive said, “The biggest challenge for healthcare in 2019 will be navigating tightening margins and limited incentives to invest in care design.”

Healthcare executives are divided on whether digital is primarily an IT-led initiative, and are also divided on whether technology-led innovation is dependent on the startup ecosystem.

The CIO remains the most important buyer for technology vendors, however IT budgets are now sitting with multiple stakeholders, the survey found, as respondents also cited the CFO, the CTO, the CMIO and the chief digital officer.

“Digital and AI are emerging as critical areas for technology spend among healthcare enterprises in 2019. However, healthcare executives are realistic around their technology needs vs. their need to improve care delivery. They find the currently available digital health solutions in the market are not very mature,” Paddy Padmanabhan, CEO of Damo Consulting, said in a statement. “However, they are also more upbeat about the overall IT spend growth than their technology vendors.”

Looking at the technology market, healthcare executives perceive a lack of maturity in technology solution choices for digital initiatives, as well as a lack of internal capabilities for managing digital transformation. In the survey report, one executive said, “HIT architecture needs to substantially change from large monolithic code sets to an API-driven environment with multiple competing apps.”

A majority of healthcare enterprise executives view data silos and lack of interoperability as the biggest challenges to digital transformation. And, 63 percent believe the fee-for-service reimbursement model will remain the dominant payment model for the foreseeable future.

In addition, cybersecurity issues will continue to be a challenge for the healthcare sector in 2019, but not the biggest driver of technology spending or the top area of focus for health systems in the coming year, according to the survey.

Healthcare executives continue to be confused by the buzz around AI and digital and struggle to make sense of the changing landscape of who is playing what role and the blurred lines of capabilities and competition, according to the survey report. When asked who their primary choice is when looking for potential partners to help with digital transformation, 46 percent of healthcare executives cited their own internal IT and innovation teams, 17 percent cited their EHR vendor and 8 percent cited boutique consulting firms. A quarter of respondents cited “other.”

For technology vendors, the biggest challenge is long cycles, along with product/service differentiation and brand visibility.

The rise of non-traditional players, such as Amazon, Apple, and Google, will have a strong impact on the competitive healthcare technology environment, the survey responses indicated. At the same time, deeply entrenched EHR vendors such as Epic and Cerner will grow in dominance.

 

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AMIA Charts Course to Learning Health System

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Initiative seeks to create virtuous cycle where clinical practice is not distinct from research

In September 2015, at AcademyHealth’s Concordium 2015 meeting in Washington, D.C., I saw a great presentation by Peter Embi, M.D., who was then an associate professor and vice chair of biomedical informatics as well as associate dean for research informatics and the chief research information officer at the Wexner Medical Center at Ohio State University. 

That day Dr. Embi outlined some of the limitations of the traditional approach to evidence-based medicine —  that it is a research/practice paradigm where the information flow is unidirectional, and clinical practice and research are distinct activities, with the research design as an afterthought. “We want to leverage information at the point of care and in engagements with patients so we can systematically learn. That is what the learning health system is all about,” Embi said.

But in the current model, he noted, there is little consideration of research during planning of health systems. That limits the ability to invest in and leverage clinical resources to advance research. Also, there are no financial incentives for non-researchers to engage in research. Research as an afterthought also leads to regulatory problems and wasted investments.

Embi argued for moving from “evidence-based medicine” to an “evidence-generating medicine” approach, which he defined as the systematic incorporation of research and quality improvement into the organization. Rather than findings flowing only from research done looking back at historical data, this approach creates a virtuous cycle where clinical practice is not distinct from research.

Flash forward to 2019 and Dr. Embi is now president & CEO of Regenstrief Institute Inc., vice president for learning health systems at IU Health, and chairman of the Board of Directors of the American Medical Informatics Association (AMIA). And he is still advocating for a shift to evidence-generating medicine. He and AMIA colleagues recently published a paper in JAMIA offering more than a dozen recommendations for public policy to facilitate the generation of evidence across physician offices and hospitals now that the adoption of EHRs is widespread.

The paper cites several examples of current high-visibility research initiatives that depend on the EGM approach: the All of Us Research Program and Cancer Moonshot initiative, the Health Care Systems Research Collaboratory, and the development of a national system of real-world evidence generation system as pursued by such groups as the US Food & Drug Administration (FDA), Patient-Centered Outcomes Research Institute (PCORI), National Institutes of Health (NIH), and other federal agencies.

The paper makes several recommendations for policy changes, including that the Trump administration should faithfully implement 2018 Revisions to the Common Rule as well as establish the 21st Century Cures-mandated Research Policy Board. The administration must implement this provision to better calibrate and harmonize our sprawling and incoherent federal research regulations.

Another recommendation is that the HHS Office of Civil Rights (OCR) should refine the definition of a HIPAA Designated Record Set (DRS) and ONC should explore ways to allow patients to have a full digital export of their structured and unstructured data within a Covered Entity’s DRS in order to share their data for research. In addtion, regulators should work with stakeholders to develop granular data specifications, including metadata, and standards to support research for use in the federal health IT certification program.

The AMIA authors also suggest that CMS leverage its Quality Payment Program to reward clinical practice Improvement Activities that involve research components. This would encourage office-based physicians to invest time and resources needed to realize EGM, they say.

Based on the paper’s findings, AMIA is launching a new initiative focused on advancing informatics-enabled improvements for the U.S. healthcare system. The organization says that a multidisciplinary group of AMIA members will develop a national informatics strategy, policy recommendations, and research agenda to improve:

• how evidence is generated through clinical practice;

• how that evidence is delivered back into the care continuum; and

• how our national workforce and organizational structures are best positioned to facilitate informatics-driven transformation in care delivery, clinical research, and population health.

A report detailing this strategy will be unveiled at a December 2019 conference in Washington, D.C.

 

 

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