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New Blockchain Project Sets to Tackle Provider Credentialing

November 12, 2018
by Rajiv Leventhal, Managing Editor
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A group of five healthcare enterprises—National Government Services, Spectrum Health, WellCare Health Plans, Inc., Accenture, and The Hardenbergh Group—are linking up to participate in a distributed ledger program aimed at resolving administrative inefficiencies related to professional credentialing.

The project, Professional Credentials Exchange, is being developed by ProCredEx and Hashed Health, a blockchain innovation consortium. The exchange leverages “advanced data science, artificial intelligence, and blockchain technologies to greatly simplify the acquisition and verification of information related to professional credentialing and identity,” according to officials.

In an announcement, officials noted that credentialing healthcare professionals “is a universally problematic process for any industry member that delivers or pays for patient care.  The process often requires four to six months to complete and directly impedes the ability for a healthcare professional to deliver care and be reimbursed for their work.”

They added, “Hospitals alone forfeit an average of $7,500 in daily net revenues waiting for credentialing and payer enrollment processes to complete.  Further, nearly every organization required to perform this work does so independently—creating a significant administrative burden for practitioners.”

As such, the groups, via the exchange, will aim to address the time, cost, and complexity associated with these processes by facilitating the secure, trusted exchange of verified credentials information between exchange members.

Included in the collaboration are WellCare Health Plans, which serves about 5.5 million members, and Spectrum Health, a 12-hospital health system in western Michigan. National Government Services is a Medicare contractor for the Centers for Medicare & Medicaid Services (CMS), and processes more than 230 million Medicare claims annually.

"A fundamental component of developing the exchange lays in building a network of members that bring significant verified credential datasets to the marketplace," Anthony Begando, ProCredEx's co-founder and CEO, said in a statement.  "These are the leading participants in a growing group of collaborators who bring data and implementation capabilities to accelerate the deployment and scaling of the exchange."

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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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Medicaid Transformation Project Expands to 24 Health Systems

December 6, 2018
by Heather Landi, Associate Editor
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Seven new health systems have joined the Medicaid Transformation Project, a national effort to transform healthcare and related social needs for the nearly 75 million Americans who rely on Medicaid.

In total, the project now includes 24 health systems that comprise 342 hospitals, more than 65,000 beds, in 25 states with over $121 billion in combined annual revenue.

The Medicaid Transformation Project, which was announced August 28, was formed with the vision that healthcare organizations can work collaboratively to enable better health and outcomes for vulnerable populations, while also reducing costs, through the adoption of digitally-enabled care models. The project is led by AVIA, a network of healthcare organizations committed to digital transformation, and Andy Slavitt, former Acting Administrator of the Centers for Medicare & Medicaid Services (CMS).

The project initially began with 17 health systems, with five health systems anchoring the work—Advocate Aurora Health in Chicago and Wisconsin; Baylor Scott & White Health in Dallas; Dignity Health in San Francisco; Geisinger in Danville, Pa.; and Providence St. Joseph Health in Renton, Wash.

The project worked with health systems to target four critical challenges over the next two years to better meet the needs of vulnerable, low-income populations: behavioral health, women and infant care, substance use disorder, and coordinating community care to reduce avoidable emergency department (ED) visits.

The seven new health systems joining the Medicaid Transformation Project span distinct geographic and socioeconomic markets: BayCare Health System in Clearwater, Fla.; Boston Medical Center in Boston; Cedars-Sinai in Los Angeles; Carilion Clinic in Roanoke, Va.; Children’s Hospital Colorado in Aurora, CO; Jefferson Health in Philadelphia; and University Hospitals, in Cleveland.

According to Medicaid Transformation Project leaders, underpinning this action is an acknowledgement of the current health disparities seen in communities across the country. A leading indicator of such disparity is life expectancy, which is highly correlated with ZIP code, income, and race because care delivery varies greatly based on those factors. Insufficient healthcare access, patient engagement, and social determinants create variations in life expectancy that can be as great as 16 years between communities that are just a mile or two apart. The Medicaid Transformation Project’s commitment is to close the gap in care and outcomes in communities in need through a renewed focus on innovation and investment, leaders say.

“The current healthcare delivery system needs to be disrupted to dismantle health inequities. At Jefferson Health, we believe that collaboration and creativity will drive this necessary transformation,” Stephen Klasko, president and CEO of Jefferson Health, said in a statement. “We’re joining the Medicaid Transformation Project to learn from others across the country and to find the best innovations that improve care and outcomes for the most vulnerable among us.”

The 24 participating health systems have decided to initially focus on transforming the role of the emergency department, and leaders recently convened in Chicago to discuss how to better position EDs for sustainability and care coordination.

To do this, project participants are seeking to improve linkages from the ED to other critical parts of the delivery system, namely primary care, behavioral health, specialty care, and social services and supports. The underlying goals are reducing unnecessary ED visits, reducing avoidable ED visits, and improving patient disposition and sustainable transitions at the moment of discharge, project leaders say.

“By bringing together the nation’s leading health systems, we have a unique opportunity to improve the health of underserved populations in a way that hasn’t been done before. We’re committed to sustainable, durable solutions that improve care and outcomes for people. We must consider the best existing and new ideas and invest in the right ones,” Andy Slavitt, Medicaid Transformation Project Chair, says.

At the Action Forum, Medicaid Transformation Project participants discussed care models that had shown success—but had been previously limited by barriers in labor, cost, or technology. They viewed 10 on-site demonstrations of scalable solutions and engaged directly with company founders to explore relevant care models, ranging from community health worker (CHW) programs to virtual triage. They gathered insights from one other and from leading Medicaid experts, including Molly Coye, M.D., former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, and Vikki Wachino, former Director of the Center for Medicaid and CHIP Services.

“The collaborative model of the Medicaid Transformation Project is providing us with a new and necessary lens to view a long-standing challenge, which is improving access and coordination to community care,” Thomas M. Priselac, president and CEO of Cedars-Sinai, said in a statement. “Our team is excited to share what we’ve learned working with our community partners, and to scale new digital solutions that lower long-standing barriers to care.”

The health systems in the Medicaid Transformation Project will next select scalable solutions to extend care models and begin early implementation. “These 24 health systems have put a stake in the ground around transforming the function of the Emergency Department in communities with heightened vulnerability. By acting locally and collaborating nationally, we can create a force-multiplier effect that will inspire ripples across the country. We’re honored to help lead this work,” AVIA President Linda Finkel said in a statement.

The Medicaid Transformation Project will launch its next body of work on behavioral health in January 2019.

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