Health Information Technology (HIT) – Hype or Promise of a Better Healthcare System?

Salim Kizaraly, Founder & SVP of Business Development at Stella Technology, a healthcare information technology start-up, talked about the promise of  Health Information Technology in solving care coordination, physician collaboration, and system integration challenges to improve healthcare, at a recent http://www.bio2devicegroup.org event.

Kizaraly began by sharing the known fact that the mounting and huge healthcare costs in the US, that do not result in significant improvement in health, are not sustainable.  According to some estimates, almost 18.3% of GDP in the US, goes towards healthcare expenditure.  If the cost of healthcare continues to rise at historical rates, the share of GDP going towards healthcare in the US, is projected to reach 34%, by 2040.  While the costs continue to rise, gains on health improvement do not keep pace.  For instance, life expectancy in the US is only 78.4 years and US ranks 27^th out of 34 industrialized nations.  In this study of industrialized nations, US had highest to near highest infant mortality rates.

Kizaraly discussed the three defining historical events that got the ball rolling on healthcare transformation.  In 2004, President Bush announced that in the next 10 years, by 2014, every American would have an access to electronic health records. We have a long way to go, but certainly we are moving in that direction.  In 2009, HITECH (Health Information Technology for Economic & Clinical Health) Act, enacted as part of the ARRA (American Recovery & Reinvestment) Act, was signed into law, to promote the adoption and meaningful use of HIT and included incentives for faster adoption of EMR (Electronic Medical Records).  In 2010, the Affordable Care Act or Obamacare, with its mandate to expand coverage, cemented the case regarding the need towards transformation.

Barack Obama signing the Patient Protection and Affordable Care Act at the White House (Photo credit: Wikipedia)

The Affordable Care Act’s most significant contribution is to creating ACOs or Accountable Care Organizations.  An ACO can be defined “as a set of health care providers, including primary care physicians, specialists, and hospitals that work together collaboratively and accept collective accountability for the cost and quality of care delivered to a population of patients”. There are incentives to keep patients out of the extreme settings of care, including hospitals and nursing homes.  Different models are emerging of how these organizations put this into practice.  Underlying issue is that hospitals have to get better at treating patients.  Hospitals are bracing for lower revenues as they get better at keeping patients out of hospitals.  Different models of care are emerging.  Technology will be a big enabler to change workflow, rethink care, as homes emerge as places of care.  Here is link to my article on Keynote by Dr. Toby Cosgrove, CEO of Cleveland Clinic, at 2014 J P Morgan Healthcare Conference in San Francisco –http://bit.ly/1c3EyBB .  Cosgrove also said, that hospitals will not longer be epicenters of care, and while a few hospitals (e.g Cleveland Clinic) will be super high tech, they will partner and share resources with other care providers, to offset costs.  The disruptions will eventually enable us to “build a healthcare system that is humane, high quality, and sustainable”, said Cosgrove.

Kizraly discussed several national initiatives that are implemented or partially implemented to enhance collaboration among care providers and integration of information.  For instance, if a person experiences an emergency visiting New York, then eHealth Exchange will make it easy to get their health records from the state of their residence. Similarly, Blue Button makes it easy for Americans to get easy, secure, online access to their health records, with a single click.

Stella Technology is a self-funded health information technology services and product development company that focuses on care coordination, patient access, and information exchange projects.  Kizraly shared use cases and information on how Stella is helping providers, with great success, in integrating care.  Through aggregating data from a variety of sources, through identifying gaps in care, and with real-time, proactive analytics, Stella’s technology identifies care opportunities that can be improved and accordingly targets interventions.  In the long term these kinds of strategic technological interventions will enable care providers to curtail expenditure, while improving care. In the interim, we still have a long way to go and there are many opportunities for entrepreneurs to use technological advancements in big data, cloud, machine learning, (IOT) internet of things, and enable US healthcare system to become more efficient, with lower costs and improved outcomes.  Kizraly’s talk was followed by Q&A.

Women’s Health in a Digital World

At www.healthtechnologyforum.com annual conference in San Francisco, a group of eminent panel members, discussed opportunities and challenges in women’s health.  Not only healthcare in general is undergoing a major transformation, but the panelists highlighted how the world of women’s health might also transform in the coming decade, as technology is increasingly used to address and bridge the gap that currently exists in women’s health and wellness.

Intel Health Guide remote monitoring system (Photo credit: connectologist)

Christina Resasco, Founder of Mobilize for Cure and Leukemia & Lymphoma Society’s 2013 “Woman of the Year” award winner, moderated the panel, and asked insightful questions.  Below are some highlights.

Robin Farmanfarmaian is a serial entrepreneur.  Hear early diagnosis and battling an auto immune disease, later gave her the inspiration and passion for health and wellness.  Farmanfarmaian has been a driving force behindSingularityUniversity’s highly successful FutureMed conferences.  Farmanfarmaian said, the practice of medicine will be completely disrupted in 2-5 years and will involve POC devices that will enable consumer to be a key decision maker; devices that will help in early diagnoses of several diseases taking the doctor out of it.

Fiona Ma http://bit.ly/1pK4k5R, incumbent democratic candidate for State Board of Equalization, a reputed politician, and a former member of the San Francisco Board of Supervisors, California State Assembly.  She has long a standing interest in health and wellness and is a tireless campaigner and spokesperson for “San Francisco Hepatitis B Free” campaign.  Ma herself has battled Hepatitis virus.  According to Ma, technologies that help the efficient and seamless transition to EMR or electronic medical records, will be very important.  She also talked about how the government needs to find creative ways to work with the private sector, and not work in functional silos.  Her advice to women seeking to compete in the men’s world was to be proactive in taking on greater responsibilities and self selecting when required, rather than waiting for others to appoint them.

Panelist Danielle Posa was diagnosed with stage 3 Non-Hodgkins Lymphoma http://bit.ly/QIKSHn, at the age of 5 and learned early about the value and limitations of human life.  She campaigns and consults on health and wellness, and helps in fund raising efforts for Leukemia and Lymphoma societies.  Posa has been interviewed by Deepak Chopra on his show “One World” and has also spoken alongside him.  According to Posa, we need to integrate both the science and the art in implementing healthcare in the workplace.  She seeks to connect the public and the private sector leaders and help them broaden their focus from traditional metrics like GDP to more wholistic measures that reflect the quality of life.

Anne DeGheest (http://bit.ly/176Ij4j ) founded Healthtech Capital and MedStars Venture Partners several years ago, with a mission to save lives, through utilization of technology.  She believes, we need to think outside the box to influence positive change in consumer behaviors, in order to disrupt healthcare.  She firmly believes that data for the sake of data does not do anything; instead technology focus will have to be on solving pain points.  She said entrepreneurs often neglect the market and focus on building prototypes or products.  She advised that instead the entrepreneurs focus on understanding the market and the value proposition they are offering, in to solve the pain points.  She said historically healthcare has been sold to men, but in many households, the “chief medical officer” at home, are moms.  One of the disruptions will occur on account of the wider role that pharmacy chains will likely play in healthcare, in future.  Most of the Americans live within 3 mile radius of pharmacy chains and these chains will step in to provide basic care.

Vanessa Mason serves as Senior Manager with eHealth and ZeroDivide.  She manages the project portfolio, contributing to design, development, and adoption of products and services that promote health equity.   With a strong focus on healthcare disparity and how that negatively impacts women,  Mason has sought to bridge the gap through efficient use of technology.  By some estimates, in certain geographical areas in the US, about 4 in 10 women, do not receive healthcare.  Rates of women without health insurance have been higher among African American women.  Some recent projects “text for wellness” and “mobilize”, focused on cardivascular health prevention for African-American women.  This was a great example of efficient use of technology that did not add to the costs, but effectively connected people to keep them informed and focused on meeting their wellness goals.  Often these women are pursuing career opportunities while single handedly taking care of families and have to navigate multiple worlds.  Technology can only help if it is easily accessible and affordable.  She advised entrepreneurs that they focus on enhancing quality of life of the 80% of population towards the bottom of the pyramid, where there are many gaps that also represent huge opportunities.

 

 

 

Evidence Based Medicine – Aligning Labs, Clinicians & Payers for Better Diagnostic Decisions

Mark Zubiller, VP of Decision Management at McKesson, talked about value based medicine by driving better diagnostic decisions through collaborative model, aligning labs, clinicians, and payers, at www.bio2devicegroup.org event.

Molecular diagnostic tests identify molecular and genetic markers for an individual patients that help determine potential benefit from a specific, targeted therapy.  Molecular diagnostic tests have become a big buzz word but the area is fraught with challenges.  There isn’t a lot of clinical evidence that support many of these tests which are often based on extreme of a diagnostic marker, so there needs to be more data churning to demonstrate clinical utility of the data.  Second, there is limited point of service information.  Only 20% of molecular diagnostic tests on the market have evidence based guidelines today, although 75% of the providers believe that patients in their practice would benefit from having a genetic test.  As new tests continue to emerge, physicians cannot keep up with information about newer tests and their efficacy.  Third, many of the tests are unidentifiable.  There is no catalogue for identifying the tests, coding information is nonspecific, and payers do not have consistent way to code and pay for these.  Payers require clinical utility for coverage.  This often leads to denials and reapplications and generates a lot of frustration for everyone involved.  Finally, this results in increased paperwork and payer scrutiny.

Currently, market does not have a way to address this challenge and it is stuck between innovation and execution.  There is a great deal of system fatigue, on account of increasing administrative burden, reform compliance etc. but while innovation is greatly needed, it would bring reimbursement shifts, additional administrative challenges, and a need for collaboration among the stakeholders.  Payers, labs, and providers essentially share the same challenge of ensuring that patients get the right care at the right cost, without increased administrative burden.  Existing traditional payer programs operate in silos and do not have a way of engaging providers.  They require expensive manual resources and are struggling with administration, transparency, and consistency.  Lack of collaboration exerts a huge financial burden on both the providers and the payers.  Providers spend $31 billion annually and payers spend $74 billion annually that could be saved, with greater collaboration.

Explaining the McKesson value based care model, Zubiller said, it means “balancing value-based reimbursement with value-based care delivery at the point of care.  As the patient care progresses from care selection to care plan to network selection to reimbursement, point of care decisions happen at each stage that impact cost, care, and value.  Earlier and better decisions would greatly reduce cost, improve care, and provide better value, said Zubiller.  A value based diagnostics strategy has to be based upon collaboration between labs, payers, and providers for identification of tests, for determination of cataloging and coverage, for consistent evidence based payer and lab policies, for decision support rules integrated into EMR, and for sophisticated performance data analytics for payment.

The talk was followed by Q&A.  Explaining the strategy, Zubiller said, McKesson is a business that works with health care stakeholders in every setting and is therefore taking the lead to chart the course towards a stronger more sustainable future, for the entire industry.  McKesson is a leading provider of enterprise information technology solutions, including software, services, automation, and consulting to hospitals, physician offices, imaging centers, home health care agencies, and payers.  With strategic use of IT solutions to bring greater connectivity in the healthcare ecosystem and by leveraging its credibility to bring the stakeholders to the table for collaborative dialog, McKesson hopes to lead implementation of value based care model that would be a win-win solution for payers, providers, labs and for patients.

English: The logo of Mckesson Corporation (Photo credit: Wikipedia)