The 2018 U.S. HIMSS Leadership and Workforce Survey provides some insights about the state of health IT today and where its efforts will be focused for the next 12 months. With input from 369 hospital/health system and vendor respondents, the survey revealed that privacy and security, process improvement and workflow as well as data analytics and business intelligence to inform clinical decision-making remain top of mind.

For a glimpse of the 2018 priorities of the HIMSS respondents, this chart shows the Top 10 concerns of hospital leaders and the correlating priorities of the vendors who serve them. While there tends to be agreement about the top 10 issues facing health IT today, vendors and their customers do not always have alignment about their relative importance.

TOP 10 HEALTH IT PRIORITIES FOR HOSPITALS AND VENDOR CORRELATION (click to enlarge)

A Saturation Point

One of the most telling discrepancies between hospital and vendor respondents was the fact that hospitals overwhelmingly either anticipated stagnation or reduction in hiring in 2018 while vendors are still showing aggressive hiring practices. Vendors may be responding to last year’s demand and this survey indicates a need for them to adjust their projections to align with their customers.

CURRENT WORKFORCE VACANCY (click to enlarge)

This trend may show a saturation point for hospitals regarding how much more change and expense they are currently willing to incur to play the expanding health information technology game to the level that the government, innovators and vendors would like to push them.

Willingness is only part of the equation. The next generation of health information products in development will move information and technology to further integration and greater utility for patients, providers and payers. This trend is a juggernaut that will take both hospital and vendors with it in the next few years. Guaranteed.

So join Joe Paduda this week for Pre-election Pundit Ponderings! at Managed Care Matters for some pre-game festivities.

I am excited to announce that I will be hosting the last pre-election Health Wonk Review blog confab before the main event here at Health System Ed in two weeks. After Joe’s edition, what’s left to be said? Stay tuned…

“At Lemonade…their hope is to remake insurance as a social good, rather than a necessary evil.” – Dr. Peter H. Diamandis

The structure of ObamaCare® requires people who don’t have health insurance to purchase it; if you can’t afford it, the government will subsidize your payments. If you don’t sign up, you pay a penalty. If you wait until you are sick, you can sign up and your bills get paid. This system turns traditional actuarial science on its head because the insurer can’t reject applicants – all comers are in – so the insurer has no control over its insured pool.

Insurance of all sorts is based on predictive analytics derived from retrospective data. Experience would suggest that if you have run a bunch of red lights and have a drawer full of speeding tickets, that you are a higher risk to insure for a car accident than someone who drives the speed limit and obeys all the laws. Based on retrospective data, the car insurance company can make predictions about your future behavior and the amount of risk that it is assuming by issuing you a policy.

But what if a car insurer – or health insurer – could track your behavior in real time, perform some predictive analytics based on the collected data, and generate a premium based on that real-time data?

Ah, the Joy of Data

Our man at Singularity University  and Human Longevity Inc., Peter H. Diamandis, MD, is exploring what he describes as the “demonetization of insurance.” In an email last week, he described a new insurance model that is already in practice in homeowner’s insurance and the effect it will have on health insurance in the future.

The future of healthcare is about real-time data collection, analysis and informed action.  His concept takes the value of informed decision making to its logical conclusion.

Where Health System Ed imagined just a few years ago that the collection of health data from the universal set of all patients – and the resultant best practice clinical protocols – would reside in a big electronic patient record database to determine the best course of action during a single encounter, technology galloped ahead of that concept. The proliferation of personalized health information and tracking devices appears to allow patients to go straight to self-management of disease. It also goes straight to self-determining your health insurance risk to create your own risk pool.

Whaaattt???

Here are excerpts from Dr. Diamandis’ September 26 email where he describes Lemonade Insurance Company   in New York State – a peer-to-peer homeowners’ insurance company that is making the traditional insurance model obsolete. Lemonade isn’t just an insurance company; it is a non-profit organization with a humanitarian mission.  It’s worth reading through his description of the homeowners’ and car insurance concepts because when you get to the upshot, the application to health insurance will be obvious.

Dr. Diamandis:

…I have been advising and am a proud board member of a new company called Lemonade Insurance Company that is rebuilding the insurance model from the bottom up — it is the world’s first “peer-to-peer” (P2P) insurance company.

Imagine just 90 seconds to get insured, 3 minutes to get paid. Zero paperwork.

P2P reverses the traditional insurance model. They treat the premiums you pay as if it’s your money. With P2P, everything becomes simple and transparent. Lemonade takes a flat fee, pays claims really fast, and gives back what’s left to causes you care about.

This week Lemonade launched their service and announced that they’ve been licensed as a full-stack insurance carrier by New York State for homeowner and renter’s insurance…

Fraud consumes as much as 38% of all the money in the traditional insurance system, inflating premiums by $1,300 and making the claims process protracted and unpleasant.

This happens because there is a lack of transparency in a largely analog (rather than digital) system with many humans in the loop.

If you could digitize the entire process – from signing up to submitting a claim – and give the insured individual full transparency over the status of their request, adding in automation and machine learning, you can dramatically reduce processing time and costs.

This is what Lemonade does at its core. “Technology drives everything at Lemonade,” said Shai Wininger, president and cofounder. “From signing up to submitting a claim, the entire experience is mobile, simple and remarkably fast. What used to take weeks or months now happens in minutes or seconds. It’s what you get when you replace brokers and paperwork with bots and machine learning. Zero paperwork and instant everything. . .

Imagine finding a group of peers, who you trust and can vouch for, and coming together as a group to self-insure.

You skip the centralized, expensive middleman insurance carrier – instead, a technology stack (app, database, AI-bot) manages a decentralized network of people who pay premiums and file claims that the group approves.

This takes out an enormous percentage of the cost structure of traditional insurance. Instead of paying fees and insurance company salaries, your peer group will be able to decide what to do with the extra cash that wasn’t paid out.

At Lemonade, you actually have the option to donate underwriting profits to nonprofit organizations of your choosing. Their hope is to remake insurance as a social good, rather than a necessary evil. . .

When talking about life insurance, it’s going to be difficult to ignore genomic data. Your DNA is your medical future. It’s predictive of what’s likely to inflict or kill you…It’s in their best interest to do so. [Click here to see Health System Ed blog on Human Longevity Inc.] You’ll be able to upload your genomics data and find others in your peer group that have similar or better risk profiles than you do…

For life insurance companies, I believe there is a beautiful alignment of incentives coming soon. These life insurance companies will use genomics information to help their clients stay alive longer.

Why? Because the longer they are alive, the more premiums they can pay…

Sensors will allow insurance policies to be based on actual data (e.g. usage, health), rather than general heuristics and rules. As an analogy, check out Progressive Insurance’s SNAPSHOT Automotive Sensor package – it’s a sensor you put in your car that tracks how well you drive. (Do you brake hard? Speed? Take high-speed turns?)

When your insurance policy is based on how you actually drive, rather than just your age, gender and what kind of car you own, safer drivers win.

Sensors will have the biggest impact on health insurance, as hundreds of new health sensors are coming to market in the next 5-10 years.

Sensors tracking healthy behavior such as how much you exercise and what you eat, will get you low insurance costs…

In the near future, with the peer-to-peer model, you’ll soon upload everything from what you eat to the number of steps you take per day, and find a group with similar health profiles and self-insure.

Thus spake Dr. Diamandis. The pace of innovation just may outrun our problems.

What do you think?

You can know and affect your health future now. Human Longevity Institute is launching Human Nucleus, a place where you can have your genome completely analyzed into its millions of component pieces of information. That information is actionable immediately, and remains as part of a learning database from which you continue to benefit.

The first cohort of 200 participants is through the pilot phase, and the program is now opening to a wider audience on his email list, explained Peter Diamandis MD, co-founder of Human Longevity Institute  and the force behind this transformation of the way we think about healthcare. Dr. Diamandis is a leading futurist, Chairman and CEO of the XPRIZE Foundation and the co-founder of Singularity University.

To participate, you can fill out an application for the team to determine if you fit the criteria. If you make  the cut, you spend a day in LaJolla, CA with some of the sharpest and most forward-looking healthcare minds on the planet for a new level of a full medical workup. The cost? $25,000 buys you the chance to be part of a massive initiative to move healthcare into a future.

Manage Your Health Portfolio

Dr. Diamandis envisions that patients in the future will be able to “manage your health information the way that you currently manage your wealth portfolio,” he said during a Google Hangout  on Saturday afternoon with HLI’s Chief Medical Officer Clay Perkins. HLI’s stated goal to help move healthcare from Sick Care to a true healthcare system.

“Over time, we’ll see more emphasis on this time of care and less hospital beds,” Dr. Perkins said.

Exciting? Just a little. And by the way, if you wait a few years, the price of the genome sequencing is expected to drop to about $3,000. What is the price of waiting? You may save $22,000 by waiting for the commercial rollout or, like at least one participant in the first 200, if you spend the $25,000 today you may save your life by finding something that would not have been discovered until it was much more advanced and fatal.

If they find something amiss, they work with your physician to immediately find a top specialist to take action. Already, the team has found serious issues in about one-third of participants – issues that were able to be proactively addressed – and now the team is already getting thank you notes from a few people whose lives have been saved.

Population Health In Extremis

The idea of medicine being this personalized almost runs counter to the notion of population health, but actually it is population health in extremis.  Your highly secure information is first analyzed for your personalized health risk assessment and individual care plan around the assessment. Then you data is aggregated and analyzed along with all the other de-identified data resulting in ongoing machine learning insights. “The more data we have, the more we learn about you.” Participants are learning more about themselves as Human Nucleus learns more about the pool of participants.

The studies are being conducted in tightly controlled experiments that will be published in peer-reviewed journals.

“It’s a fundamental concept. If we can determine based on your genomics, [we can determine] what you are likely to die from. . .Your genome is your health future and it give you the probabilities, mixed in with nurture and your style…it tells us what to look for early on. . . it’s as fundamental as it gets,” Dr. Diamandis said.

The long view on the project is to find the secret to aging well by studying people who are healthy into their 90s and beyond. For details, check out Human Longevity Institute here and click on the Health Nucleus video on the home page.

“This is an early prototype of what human health will look like,” Dr. Perkins said.

Clearly, there is more grand thinking about the future and emphasis on the promise of digital health at this point than in the celebration of successes. But that isn’t to say there aren’t a few current successes and some projects underway that will start to bear fruit even as I write this.

The most important aspect of digital health that I learned at the Summit was that patients are truly at the center of any advances in the use of healthcare technology to achieve lower cost, higher quality and improved outcomes. After all, it’s the patients who need answers who are behind the rapid uptake  of any promising health or wellness application that might offer hope, support, and solid answers.

Stupid Cancer Show founder Matthew Zachary said emphatically he has legions of Millennials with cancer using apps and participating in peer support who freely offer their information for healthcare professionals who can use it to advance a cure. It’s there for the taking, and it is being offered enthusiastically.

Another informational session featured the developers and founders of GI Health, an app that helps diagnose and support patients who have GI symptoms so they can provide accurate and potentially life-saving information to their gastroenterologists.

On the marketing side, another app tracks physician online interactions to help pharmaceutical companies get product information to prescribers at the point of making treatment decisions.

The bottom line here is that there are plenty of players from the patient, provider and payer worlds who already have their heads in the game. Expect any moment that this 24/7 interactivity with health information will reach critical mass and change the whole game of caring for patients.

This is the eighth entry in a series of blogs for ePharma Summit 2016 to explore ways the pharmaceutical industry can maximize the promise of digital health.

A report put out by the California Health Care Foundation  last week chronicled the promise of digital health holding the key to holding down costs for low-income patients with chronic conditions. After all, it is the poor, those with poor literacy and health literacy, who are often the ones with the highest rate of chronic disease – and the highest cost – to the healthcare system.

Who pays? For patients who fit this description, it is often the states and federal government who end up footing the bill for medications, emergency department care (because they sometimes don’t have a home at all, let alone a medical home) and inpatient stays. The study states:

Some 90 million Americans have multiple chronic conditions (MCCs), with the prevalence of MCCs highest among people with the lowest incomes. Each additional chronic disease increases a person’s risk of adverse drug events, higher out-of-pocket expenses, impaired functional status, hospitalization, and mortality. Two-thirds of health spending is associated with patients managing MCCs. (p.3)

A series of pilot programs have shown that even the poorest of the poor in unstable living situations often have a cell phone or even a smart phone, and Internet access at a computer. With just those tools, a few low-cost, high-touch digital outreach programs have moved the needle with medication compliance, attending appointments and maintaining health regimens recommended by their providers.

Here are a few highlights from this February 2016 CHCF study which surveyed global healthcare leaders:

• Digital solutions use texting, customize language and communication style to the audience, uses portals, kiosks, video, telephone and cable, combines medical and social services, leverages a trusted human and collects data passively.
• One-half of low-income adults own a smartphone and 84% own a cell phone. Customized text messaging bolstered appointment adherence by 40% and medication adherence by 12%. One successful test program has been expanded to Medicaid care management programs in New York.
• Text4baby is a program in both English and Spanish that messages labor signs and symptoms, birth-defect prevention, prenatal care, urgent alerts, developmental milestones, immunizations, nutrition, safety and more. It also connects users to Medicaid and the CHIP program.
• Meducation targets community health centers and translates medication and discharge instructions into 18 languages as well as provides visual instructions.
• Kaiser Permanente implemented KP HealthConnect by mining retrospective data in the EHR and using HEDIS data sets to use electronic messaging to bolster outcomes for black patients managing diabetes and heart disease.
• In a North Philadelphia grocery store in a low-income area of the city, one kiosk with behavioral health information encourages people to get “a check-up from the neck up”.

Some programs leverage relationships with faith-based initiatives, federally qualified health centers and university programs. The promise of digital health to help, diagnose, treat and manage diseases and common conditions (like pregnancy!) are only limited to our imagination.

With the desire to serve those who cannot afford and do not have regular access to healthcare, and the limitations of state and federal budgets to do so, digital health solutions can bridge the gap between poor health outcomes and managing high-risk populations.

Whether it is data collection in the electronic patient record, information in the claims data base or monitoring of patient biometrics, data analysis and interpretation will be the lifeblood of healthcare organizations.

That lifeblood represents two critical elements 1) treatment delivered to the patient based on best practices and 2) quality care that supports value-based payment.

Simply put, for money to change hands in the future, you will need to show you’ve earned it using data. With public attention on drug costs, particularly after the Turing Pharmaceutical debacle where it took the price of a a toxoplasmosis drug from $13.50 to $750 a pill, biopharmaceuticals are under just as much pressure as anyone else to prove they are worth the price.

Novartis has stepped out in front of this parade by cutting outcomes-based pricing deals with Cigna and Aetna. The industry has been having discussion about outcomes-based pricing for a long time, but it is notoriously hard to determine exactly what to measure, and under what circumstances, to prove your – case. With better data and patient monitoring, pharma believes it has the tools – or soon will – to begin making these deals real.

The title of an article in mobihealthnews last week toplines the terms: Norvartis signs Aetna, Cigna for pay-for-performance drug deal, but not remote monitoring yet.

According to mobihealthnews.com, last fall when Novartis first mentioned how the deal would be structured, it told the Wall Street Journal that is was looking into remote monitoring and other digital health monitoring avenues to measure the drug’s performance, including possibly bundling devices with the drug, to support pricing. For now, it appears that part of the plan is on hold.

But the fact that the plan was well developed means that patient data – not just data in the patient record but biometric monitoring – is going to be part of pay-for-performance initiatives in the future.

So, if you think that exchanging digital information among patients, providers and payers, and the resultant data collection and tracking, is just nice to have for the cutting-edginess of it, do think again. The day is closer than it appears in your mirror when a mix of the digital assets available to healthcare will figure prominently in payment and reimbursement of all sorts.

Got value? Prove it.

This is the sixth entry in a series of blogs for ePharma Summit 2016 to explore ways the pharmaceutical industry can maximize the promise of digital health.

How many times have you heard the term “silo” in reference to your organization? I’m going to bet your answer is: More than once. No matter whether your organization is hanging on to its outdated org chart or not, those days are in the rearview mirror. The walls are coming down not just inside your organization. They are coming down among industry sectors and geographic areas, as well.

The interconnectivity and connection among healthcare payers, providers, industry and patients are organic. Simply, individuals are hyperconnected, and so the environments where they live, work, play and heal are, by extension, hyperconnected, too.

What Hyperconnectivity Means to Health Care

• Within Provider Organizations: Work groups and teams throughout an organization can literally always be on the same page, because that page is electronic. Ideally, entries and updates in documentation of all types are instantaneous across teams and within them. For patient care, providers are working off the latest information across the organization whether that information is clinical or claims related. We aren’t there yet, but we can see it from here.
• Among Provider Organizations: When interoperability is in place, providers will be working off the latest information across health systems, across the country and eventually around the world. We aren’t there yet, either. The barriers will be more regulatory and legal than technological, but it’s possible.
• Outside Provider Organizations: Patients and the industries that support them are rapidly becoming integrated into provider health systems via their digital imprint. Eventually, when the walls come down and the proper security is in place, patient connectivity to their record through their biometric device(s) provides real time feedback and recommendations to maintain wellness and manage illness. Industries that support the health system, including biopharmaceuticals, are beginning to understand and develop ways to leverage the connectivity advantage and provide support to providers and patients as 24/7 patient management approaches.

The pace of change is exponential. Just because it took us 30 years to get here from the birth of the Internet, does not mean change will continue at that pace. The mere fact of hyperconnectivity accelerates progress at a mind-boggling rate. If you can imagine it, it is happening somewhere already.

Sales, marketing, product research and development, patient care, provider access to patient and clinical information and payment systems are mutually supportive in a hyperconnected environment. When the health system is integrated into the fabric of an individual’s daily life and into the fabric of society, it erodes silos that interfere with optimal care.

The harbingers are already in place.