Seasons come and seasons go. Yes, in healthcare, too. We’ll open this week’s HOT Health Wonk Review looking at an enduring issue as Roy Poses of Health Care Renewal very nicely summarizes pharmaceutical marketing tactics and their effect on physicians and patients as it pertains to opiates. Some practices just keep coming around again.

Hope in a Bottle: Components of Purdue Pharma Stealth Marketing Campaign for Oxycontin Revealed by Legal Documents from Tennessee

The return of the good old days, sort of: a legal filing from the Tennessee Attorney General’s lawsuit against Purdue Pharma revealed multiple internal Purdue documents showing elements of the company’s stealth marketing campaign for Oxycontin.  These included: implied psychological manipulation of vulnerable physicians; perverse incentives for sales representatives; and use of third-party strategies (including creation of “astroturf” organizations) and miscellaneous deceptions.  More awareness and better understanding of such integrated, but deceptive marketing campaigns enables better resistance to them, and hence hopefully better professional decision making leading to better patient outcomes.  Previous stealth marketing campaigns have been revealed through litigation by the US government.  The Trump administration seems uninterested in pursuing corporate health care’s bad actors, but at least the baton has now been picked up by some state law enforcers.  Read more from Roy here.

While We’re Talking about Opioids…

Louise Norris of HealthInsurance.org tells us this year there has been an abundance of discussion about our national opioid abuse crisis and about strategies for addressing that challenge. But was the Affordable Care Act already helping address that crisis? Louise looks at how that ACA improved mental health coverage – including dramatically expanded access to additional treatment in some of the states hardest hit by the opioid crisis.

#CareTalk Podcast: Wry Healthcare Commentary with David Williams and John Driscoll

Podcast time, today our hosts David Williams and John Driscoll opine about the Right to Try law. “A great impulse and a dumb law,” says Carecentrix CEO John Driscoll. David Williams of Health Business Group agrees, “Right to try…who could argue with it, but it is a pretty cynical law.” It is redundant with compassionate use, and just removes the FDA to “take the smartest people out of the way,” says John. Lots of good stuff here as they look at a few other ways politics uses healthcare as a football. Watch, listen, learn right here.

High Deductible Health Plans: A Blunt Instrument that Doesn’t Work

High deductible health plans don’t work, so says Joe Paduda of Health Strategy Associates. Hear about why Joe calls high deductible plans “the bluntest of instruments” that has lots of nasty side effects and doesn’t reduce costs or improve care. Joe wonders “why the health plan industry is still selling these crappy plans.” Read more at Managed Care Matters where Joe talks about the ill effects of this health plan variant.

Much Ado About a Rounding Error? Looking at Sharing Ministries

Henry Stern of Insureblog channels Shakespeare while he questions if the faith-based ACA-compliant alternatives to ObamaPlans – now topping 1 million members – are such a good idea for people who need the assurance and reassurance of insurance or reinsurance. He’ll explain it all at this link.

Exploring Ethics: Is the Cost of Dying Worth It? Research Says Yes

Jason Shafrin at the Healthcare Economist asks if we are spending too much on end of life care and puts a new spin on the answer backed by research. He says we recognize that end of life care is expensive.  Conventional wisdom holds that we are spending too much on end of life care and we should just let people die at home in peace with hospice.  If only things were so simple.  The Healthcare Economist reviews new research that shows that end of life healthcare interventions may, in fact, by worthwhile. Paddle over to Jason’s blog at this link for a good discussion on an important topic.

Brush Up on Your Latin: Quo Vadis, Kentucky?

Tom Lynch of Workers’ Comp Insider recently attended a forum where he heard a presentation on the work requirements for Medicaid beneficiaries, a program called Kentucky HEALTH. Tom offers his perspective on the plan. It should be noted that a federal judge subsequently ruled the plan unlawful, but three other states are still developing plans for work requirements and other states are waiting in the wings. And this entire issue begs the question, where are we going, America? Is healthcare a right for all or privilege for those who can afford it? Tom kicks this football around a bit – on his private beach right here.

So now it’s time, dear Wonkers, to kick back, read the healthcare blogs and enjoy this summer day.

Photo by Anton Karatkevich on Unsplash

Here’s Joe:

“Blog posts!

Health Wonk Review returns to the inter-webs after a holiday hiatus. Refreshed, renewed, and revitalized, we bring you the best from the brightest!”

Thanks much for kicking off the new year, Joe!

Say, for example, you decided to run for President of the United States but you pulled a really stupid college-style prank, like plagiarizing someone else’s work, that makes you ethically ineligible for the presidency when the story gets out.  If you’re lucky, voters and even journalists who investigate the backgrounds of candidates might well forget your indiscretion a few decades later and you could end up, say, in the  White House a heartbeat away from the Oval Office.  You just never know in politics. Yesterday’s bum steer could end up today’s political sacred cow.

Take Obamacare. Please.

Way back in 2010, the public furor over the passage of the Affordable Care Act meant that some legislators were afraid to go home on break. Representatives’ offices were picketed, windows  broken, personal safety threatened. Citizens were very unhappy with the ACA’s mandatory coverage and legislated benefits packages that didn’t suit their needs and cost more than their current policies that allowed them to keep their plans and their doctors.

How unhappy were they?

As the October 2013 rollout approached, one health insurance company required training for their call center employees to teach them how to calm down member subscribers. The insurer ordered the training because it knew that it would be sending out letters terminating current policies and replacing them with more expensive, government-mandated ones. They anticipated the tears and anger, and put call center employees through sensitivity training to handle distraught customers.  That company knew well before the ACA launched that people could not keep their plans or their doctors, and that their rates would skyrocket to make up for it. The people who wrote the law, promoted it and voted for it probably knew, too. If they didn’t, they should have been fired.

Oh, wait! They were.

And here we are, in the land of Repeal and Replace.

In an administration where each new regulation requires that two are de-commissioned, we can expect a flurry of confusion from an industry that operates on auto-respond to commands from DC. While healthcare doesn’t like having to zig and zag to expensive orders from DC, providers, insurers, patients, drug and device manufacturers and even IT companies are used to reacting to dicta from federal regulatory agencies.

The most widely, publicly discussed aspects of the ACA pertain to patient coverage. The public is concerned, and understandably so, about the fate of mandatory coverage for pre-existing conditions and the 26-year-old dependent coverage clause. Everyone is required to have coverage so those who flat-out can’t afford it get subsidized. Those who flat-out can’t afford it and don’t meet the income thresholds for a subsidy pay a penalty.  Part of Repeal-and-Replace is figuring out how to address the grievances of those who haven’t fared as well under ObamaCare as they did under their former policies, and assuage those who have benefitted. It’s a job fit for a politician. Other normal humans would not want to find themselves between that particular rock and hard place.

On to the other aspects of Repeal and Replace, those aspects that affect the way the healthcare industry operates and gets paid. What happens to an industry when the regulatory bonds are loosed?

Under the ACA and other related legislation that support various facets the healthcare industry overhaul, doctors face new reimbursement models starting this year based on certain performance targets with rules so arcane that most did not even know late last year that they were subject to the new payment system called MACRA. Other laws resulted in providers and hospitals installing electronic record systems trying to catch the Meaningful Use stagecoach to reach reimbursement targets. Meanwhile, many doctors complained those same mandated electronic records systems were detracting from patient care.

On other fronts, providers are wondering what will happen to accountable care organizations, a concept best achieved with great data capture and analytics that rely on the integrity of the aforementioned electronic health record. Speculation abounds about the fate of other ACA spawn, such as bundled care payments, care coordination and value-based payment models that attempt to support population health in an effort to control costs.  

Finally, when President Trump told a joint session of Congress this week that he wants to loosen the reins on the FDA approval process, you could almost hear a little cheer go up from the pharmaceutical industry. But in the next breath, when he mentioned cutting price deals with drug companies, you got murmuring from the same quarter.

Certainly, many ACA and ACA-spawn initiatives have philosophical merit, as well as their defenders and detractors. The question before the healthcare industry now asks whether an affordable healthcare system can best be reached with less government over-reach?

The answer lies in whether initiatives that are rolled out naturally as a consequence of their merit will lower costs, improve outcomes and increase access, and can do so without adding a regulatory timeline or requiring an outlay of billions of dollars on the part of the government or the health systems that have to dance to the piper’s tune.

An educated populace is the bedrock of a sober and productive small “d” democratic society. Our Health Wonk Review contributors are doing their part to keep democracy alive. Let’s start by reading this positive post by our friends at Health Affairs about  opportunities for continued progress in the U.S. health care system that are not necessarily dependent on the outcome of the election.

Health Affairs Blog this week discusses What Bipartisan Opportunities Will the Next Congress and President Have to Improve Health Policy? by Anand Parekh, Ashley Ridlon, Katherine Hayes, Janet Marchibroda, Lisel Loy and William Hoagland of the Bipartisan Policy Center. In it, we learn that while larger ideological questions divide the two major parties regarding whether the Affordable Care Act should stand and how payments for programs should be structured, voters across party lines may still look forward to progress on issues that directly affect the quality of patient care such as the move to value-based care, the steady advance of technology, and the emergence of care coordination. The article’s introduction tells us that “there will be several potential opportunities for bipartisan agreement to further advance the health of the American public” and concludes, “Whether the political will exists to reach across the aisle and work together remains to be seen. If so, bipartisanship may very well contribute to having a positive impact on the nation’s health.”

Technology: The Promise and the Dark Side

Julie Ferguson at Workers Comp Insider also brings some heartening news on the potential for catastrophically injured workers to be enabled with new functionality via exciting new assistive technologies. See her post Cyborgs and Workers Comp where she defines the term “cyborg” to orient her readers to the promise of technology: A cyborg (short for “cybernetic organism”) is a being with both organic and biomechatronic body parts.

More on the promise of technology as David Williams asks Is Radiology Doomed? In this article, David explains that captured radiologic images may be delivered directly to the patient record completely bypassing a human radiologist. That prediction begs the question: Is machine learning going to replace radiologists? He says, “Eventually yes, unless radiologists figure out how to be diagnostic quarterbacks.”

Next, Roy Poses tells us that not all wonder drugs are all that wonderful. In his entry at Health Care Renewal, Not So Wondrous Drugs: New Warnings about Severe Adverse Effects of New, Heavily Marketed Drugs for Hepatitis C, Roy digs down into the clinical trial data of recently approved Hepatitis C cures. Roy discusses whether trial results really support claims for pricey and highly-touted Sovaldi. He concludes saying, “The skepticism [evidence-based medicine] should engender could lead to health care that is more about patients and their outcomes, and less about hype ideology, hype, and hucksterism. If only such skepticism were easier to find.”

Speaking of Evidence-Based Medicine

Another blogger this week is also questioning the evidence, or lack of same, from another quarter, and that is the legitimacy of a 30-day readmission rate as a quality benchmark for hospitals. In The Hospital Leader, Brad Flansbaum shows us data that reveals a hospital’s influence on a patient’s post-discharge condition falls off a cliff after about a week, at which point the readmission rate is influenced far more by factors outside the hospital’s control. Read more as The Hospital Leader considers ways this issue can be handled to the advantage of patient outcomes and a hospital’s liability for them.

Paying for Care – Proven and Unproven

You’ll never know whether a treatment works if you can’t pay for it. Several bloggers this week turn their attention to whether the nation’s Affordable Care Act is, indeed, affordable.

Hank Stern at Insure Blog submitted a blog written by his colleague Patrick Paule that looks at a shell game where taxpayers funded a non-profit health plan to participate as an Obamacare co-op in the state health exchange to the tune of $65 million under the condition that it remain a non-profit. However, as one of the few co-ops that have remained standing – albeit on wobbly legs – it just announced its acquisition by a private equity group and conversion to a for-profit entity – moves that create a dilemma for the Obama administration. Read details here about this political sticky wicket that catches 38,000 patients in its grip.

Another blogging HWR regular, Louise Norris, also digs into a detail of the ACA that snags another small subset of patients. In this two-part series at Healthinsurance.org , Louise analyzes the data on who is actually impacted by rising insurance rates. She concludes that while rates are going up, only a small sliver of the U.S. population are “being crushed by rate increases”. For those who are part of the non-subsidized, median-income crushed, she offers advice for dealing with premium hikes.

In a separate blog at Health Insurance Colorado , Louise Norris tells readers that while Colorado rates are rising an average of 20 percent for the combined subsidized and unsubsidized individual markets, the people of Colorado will be getting more for their Obamacare premiums. Specifically, benchmark plans for 2017 will include chiropractic care, bariatric surgery and fertility treatments.

Back to the Voting Booth

We will wrap up this edition of Health Wonk Review by revisiting the voting booth. Our contributor, Shalvi Prasad, writes for Health Access: California’s Health Consumer Advocacy Coalition asking readers in California to push the lever for Proposition 56 that would add $2 to each pack of cigarettes to fund smoking cessation programs and boost funding for Medi-Cal. Find details on Prop 56 in Health Advocates Protest Big Tobacco’s Lies at Health Access.

And don’t forget to eat your peas!

1. The escalating cost of drugs is an election year favorite
2. Then there are several reports this week that electronic health records are a PITA to doctors, and I don’t mean the kind wrapped in flatbread
3. Let’s not forget the fact that the Affordable Care Act is anything but – for patients who have to pay the rates (as opposed to those who get government subsidies) and for the health insurance companies trying to provide them

I thought about posting a request for a vote and then expound on the most popular topic. Each one, however, is so rich with possibility. Let’s not let any of them lie fallow.

The Escalating Cost of Drugs

Pharmaceutical companies are under public scrutiny for raising prices. We’ve had the Shkreli scandal and now another company is in the news for increases from about $100 to $600 over the course of about 8 years, give or take. Ouch. If you are a patient paying full price out of pocket, or even some copay that amounts to about 25% of the full cost, you feel that. Not seen in this diagram, however, is that much of this product finds its way into schools for free to save the lives of children.

After the public outcry, this particular manufacturer immediately cut the cost of its drug by half, then introduced a generic version.

There is the potential for a trend here. If the manufacturer releases its own generic, it wins whether it’s playing on the swings or the sliding board. And I am sure that this manufacturer’s price hike will remain political fodder for the next few months because hating on the pharmaceutical industry is such an easy win for a politician pandering to public opinion.

Beware the legislation that arises from this controversy.

Electronic Health Records

I would say it myself, except this writer said it so much better:

Electronic health records slow doctors down and distract them from meaningful face time caring for patients.

That is the sad but unsurprising finding of a time and motion study published in Tuesday’s Annals of Internal Medicine. A team of researchers determined that physicians are spending almost half of their time in the office on electronic health records (EHRs) and desk work and just 27 percent on face time with patients — which is what the vast majority of doctors went into medicine to do. Once they get home, they average another one to two hours completing EHRs…

…This is a shared problem with more than enough culpability to go around. Vendors like my company, athenahealth, and others have been required to develop EHRs that satisfy government regulations rather than the needs of providers and patients.

With limited authority and the best of intentions to oversee EHR certification and adoption, the Office of the National Coordinator for Health Information Technology continues to inflict enormous pain on our nation’s providers and care teams, turning caregivers into box-checkers and inadvertently limiting the private sector from innovating.

Motivated by more than $30 billion in incentives, vendors have lined up happily to ride the wave, building EHRs that satisfy government requirements but make it increasingly difficult and less rewarding to care for patients.

[end of excerpt]

I’ve been saying this for years, but writer Jonathan Bush just boiled it down so nicely. We’ve made progress on implementing electronic patient records throughout the system, certainly, and will continue to do so. However, so much greater progress will be made with physicians, patients and computer programmers working together in harmony rather than working against the constraints and deadlines of government regulations wending their way through a serpentine lawmaking process that can’t keep up with the pace of technological progress.

Technology should make our lives easier, don’t you think?

About the Cost of the ACA and Aetna’s Problem

I wrote about this when the ACA first passed, and it continues to be an obvious issue. The Affordable Care Act defies actuarial science. Under the ACA, rates are not set according to mortality charts, but are government-subsidized and the products are structured under regulations. In a rational health insurance scheme, healthy people pay into the plan and help fund sick people. Health insurance companies structure benefits considering the amount of risk they are willing to take on an individual given the amount of care the patient/member chooses to insure when they select a plan. Since the ACA, this concept is out the window. If someone shows up at the hospital without health insurance, the patient applies for health insurance and, at least in theory, the bill gets paid. Aetna is losing so much money on its ACA products that it is pulling out of most health exchanges.

If you are a provider, the ACA works because health insurance pays your invoice whether the patient was insured or not when they walked in the door. In fact, one hospital came up with the bright idea that they would even pay the premium of uninsured patients to make sure the bill got paid. That little scheme looks like it won’t pass court scrutiny.

Democrats need the ObamaCare plan to appear to work, even when the evidence is glaringly against it. Again, this New York Times writer was much more eloquent and succinct on this issue:

Premiums in many areas are expected to go up by double digits and some insurers are bailing out or scaling back after having lost hundreds of millions of dollars. Going into their fourth year, the law’s health insurance markets don’t seem to be on a stable footing yet. But they are also unlikely to implode, because subsidies will cushion the impact of premium increases for most customers.

[end of excerpt]

In election years, the cost and availability of healthcare have become perennially favorite scapegoats. If I were a politician, I’d promise free drugs, free health insurance, free exams, free everything because, after all, the government can just print more money and pay the bills.

What could possibly go wrong?

Nota bene: The opinions expressed are my own and reflect disillusionment with the politically-motivated solutions to our healthcare crisis. My opinions do not reflect lack of care for those who can’t afford to see a doctor or pay for a drug. Quite the opposite. My opinions reflect frustration, and I join with others looking for reasonable, rational, workable, affordable answers so people can get the healthcare they need, when they need it with the promise of technology providing part of the answer.

In the spirit of innovation, the entries this week are organized according to the order in which they arrived in my inbox. This relieves me, as the host, of the awesome responsibility of finding a compelling theme. First in, Dr. Bradley Flansbaum.

The Early Bird

 Dr. Bradley Flansbaum offers a birds-eye view of the physician relationship with the pharmaceutical industry at The Hospital Leader: the Official blog of the Society of Hospital Medicine. Dr. Flansbaum details his interactions with the pharmaceutical industry – from a young hospitalist receiving speaker’s honoraria to a pharma-sponsored researcher. If you want to know about the relationship between the pharmaceutical industry and the medical profession, this is a good primer. Dr. Flansbaum has chosen to opt out of all relationships with pharma, and he is eloquent in explaining his professional position. At the risk of taking the suspense out of his story, in part, here is his conclusion:

“Remember why we call industry, industry. It’s a business. They sell, and we buy. That’s my message so do with it what you will.”

Healthcare Economist Asks “Is P4P doomed to fail?”

 The way pay-for-performance and quality incentive programs are currently structured, the conclusion one draws from Jason Shafrin’s question is, “Yes, P4P is doomed to fail.”  Jason bases his discussion on a referenced article in Health Economics that calls out a “fundamental design flaw in P4P design” which is, simply, a provider chasing too many quality metrics that result in rewarding competing measures. For providers and health care organizations looking to be reimbursed based on this model, the ensuing confusion can be hazardous to your patients’ health and the health of your bonus payment. Read the detail at Healthcare Economist.

Tracking ACA Enrollments: Figuring Out How Many Grandfathered/Grandmothered Plan Are Still Around

In this week’s entry, Charles Gaba of ACASignups.net gives us a breakdown of a tally of Grandfathered and Grandmothered plans in the individual market. He did, in his own words, a “back of the envelope” calculation and, with input from Louise Norris of healthinsurance.org, came up with an estimate of those old plans still hanging around. Charles says, “My Conclusion? There should be roughly 1 million people still enrolled in Grandfathered policies and perhaps 1.5 million in Transitional/Grandmothered plans today.” If you want to know the difference between Grandfathered and Grandmothered health care plans and the detail, click here.

Dare Roy Poses Suggest: Healthcare Leaders Should Come From Healthcare

Roy discusses a New England Journal of Medicine article describing “Immersion Day” during which members of the board of a non-profit hospital system who had no healthcare background were given a one-day exposure to life in the hospital. Roy Poses poses (sorry, I couldn’t help myself) an interesting hypothesis: “True health care reform would put more health care professionals back in control of health care, or failing that, would at least promote leadership by people with some knowledge of health care who would support health care values and would be willing to be accountable for doing so.” Read the detail about the NEJM article here.

 ObamaCare Wear: Gasoline Pants

Hank Stern’s InsureBlog is on top of the dish on ObamaCare. Blogger Mike Feehan writes this week that we have more bad news about the ACA. ObamaCare Co-ops are going the way of the dodo bird, according to Mike. In fact, I can’t improve on Mike’s description of the status quo, so here it is, in his own words: “As Nipsy Russell might have observed, the Obama administration’s health policy is running thru Hell in gasoline pants.” Read More Bad News About ObamaCare Co-Ops – Part CCIX – at InsureBlog.

 Health Plans Need to Consider the UX

Just as Apple figured out that computer users needed an intuitive interface to finally integrate computing into their daily lives, Joe Paduda of Health Strategy Associates says that the health plans that figure out how to give their members a good user experience will be winners. “Members do NOT want to wade thru fine print stuffed with SAT-test words and jargon that’s murky at best. Blaming the consumer for misunderstanding a benefit plan is just nuts; write the plan so it’s understandable for everyone” Read more at JoePaduda.com.

California Is the Harbinger of Things to Come

California often leads the way in trends that work their way across the country. Anthony Wright at Health Access Blog writes out of the state capitol in Sacramento from Health Access California where he and co-blogger Bethany Snyder tell us “Covered California produced a report about potential 1332 waivers, and gave a greenlight to one proposal to allow undocumented Californians to buy into the exchange with their own money.” Yes, insurance is governed at the state level, but keep your eye on California’s move to allow undocumented people to buy into the healthcare system and the implications it could have for the future of health insurance. Read Opening Up Covered California here.

The CMS Innovation Center and Next Generation ACOs

Writing for Health Affairs, Chris Dawe, Nico Lewine and Mike Miesen discuss the recent CMS Innovation Center announcement saying ACOs can share in 100 percent of the savings they create for the payer’s largest book of business, theNext Generation ACO. In Today’s Most Attractive National ACO Model is Offered By…CMS, the authors write, “Would-be Next Gen ACO participants must grapple with two primary hurdles: risk exposure and a closing decision window.” Read more about the tension created by being exposed for full risk for spending in excess of targets and opportunities to enjoy capturing savings at the Health Affairs blog.

Another Medicare Pilot: Medicare Comprehensive Primary Care

If you’ve read this far, you know that Dr. Jaan Sidorov is not the only HWR contributor this week who wonders if government should get out of the way and let healthcare do its job of caring for patients. In this entry at Disease Management Care Blog , Dr. Sidorov explains that Medicare has just launched a multi-year primary care initiative aimed at improving care, but that might not be as good as it sounds. Dr. Sidorov tells us that it is based on a two-year-old pilot that hasn’t shown improvement in costs or quality. He asks, “Should CMS get out of the care management game and let others handle the work of caring for populations with chronic conditions?”

Lack of Transparency or Just Plain Greed?

David Williams at Health Business Blog writes about healthcare’s version of the military’s $10,000 toilet seat: in this case, a $427 hospital charge is reimbursed at $22. He wonders what could be wrong. Is the hospital overbilling to begin with? Is the health insurance company underpaying? Or both? In Urgent Care Billing: Eyebrows Raised , David discusses the implications of this type of billing/reimbursement discrepancy.

And Finally, A Little Education from Worker’s Comp Insider

Julie Ferguson takes time to educate about occupational medicine and its unique place in healthcare. At Workers’ Comp Insider, Julie writes about how occupational medicine differs from other specialties, and she offers an informative video, “Introduction to Occupational and Environmental Medicine (OEM)”. Check out this training at Workers’ Comp Insider here.

Blabbin’ with the Wonkers at Health Wonk Review On Air with David Harlow

If our biweekly dose of health policy leaves you wanting even more detail about things like QALYs and risk corridors, please join us live, online, every other Tuesday for Health Wonk Review On Air with David Harlow. David is joined by other HWR contributors to discuss details of the most recent edition and whatever else is on their minds health policy-wise.

Blab is interactive, so it is a good place to ask questions and join the discussion. If you miss the session, you will be able to view the recording later. David posts the link at HealthBlawg.com.

 The next edition of Health Wonk Review On Air Blab is Tuesday, April 26 from 1 to 1:30 p.m. Eastern.  

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 one of a series of blogs posted out of the ePharma Summit 2016 where pharmaceutical marketing folks talked tech for three days.

The future is here. We just need to recognize it and start using it for the good of patients. The technology available today allows the healthcare industry to stop talking at patients, or talking past patients, and engage them in meaningful conversations.

It is at the intersection of patients, the providers who care for them and the payers who have to manage the finances to pay for it all where technology will integrate these powerful forces. There was a fundamental frustration you could feel from the futurists at ePharma Summit 2016 that they are dragging a reluctant healthcare sector along to make this future that is now, actually fulfill its promise now.

Vendors had exciting innovations. More on a few of those in the next blog. The issue that calls out for immediate attention, though, is the nexus of and reason for all the efforts and stakeholders at the table – the patients we need to engage. Those patients are us.

Co-founder and CEO of StartUp Health Steven Krein said, “We are all part of this in a way no other industry is. If we aren’t personally, somebody in our family is a patient.”

As an industry, how quickly those of us in pharma can get caught up in the sales numbers, the marketing strategy and the fun techie gadgets and forget that the patient is the whole point of why we are in this industry. When you scratch a healthcare professional – no matter whether a doctor, nurse, marketing executive or pharma sales rep – they will tell you they are in it because they care about a disease, a patient, a cure.

As founder of The Stupid Cancer Show, Matthew Zacchary, said in his powerful presentation to the industry, “The humanity you stand for can’t get lost in this. You guys and your kids get cancer too. We’re all patients, we’re all humans.”

Yes, we’re all human and we’re all patients. And technology can help us make those personal connections that drive our industry and our reason for being.

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.