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A New Platform for Women in Healthcare IT – Doyenne Connections

Posted on December 2, 2016 I Written By

The following is a guest blog post by Janae Sharp (@coherencemed).
janae-sharp
Every day, healthcare loses potential profit from a lack of representation of women in technology. Healthcare IT takes a larger hit than some other technology areas. Taking the problems of gender pay disparity and lack of representation for women in healthcare to a dinner party was the beginning of Doyenne Connections. Founded by Max Stroud, a lead consultant at Galen Healthcare, this group of women in leadership roles in Health IT is about creating real life connections for women in technology.

Max had a vision of forward thinking women in health IT meeting together to enhance their careers and develop ideas together. A sort of “un-conference” emerged and the first weekend was a huge success. Organizations that would be an ideal match for Doyenne connections are companies that are concerned about gender equality. Organizations that believe in the value of a human connection can get involved from the corporate level. The founders club invites women leaders in healthcare IT to mentor and meet up with other women.

In healthcare technology there is so much interest in the next innovation and how technology connects us. Employees can telecommute. Patients can see a doctor over the internet. Providers can collaborate about patients and companies to improve systems via video call. While technology and social media connects us in person meetings are still invaluable.

Healthcarescene.com is proud to partner with Doyenne connections to help promote women in Health IT and how companies can increase their profitability through improving the workplace for women. Investing in the individual women and mentorships and meetups will help improve Health IT innovation and profitability. The costs of gender inequality in the workforce are high and the loss of women in technology and healthcare is an economic problem for our companies and a social problem. Women are underrepresented in leadership roles and average 78 cents for every dollar their male counterparts make.

Want to invest in your company’s gender equality? The Founders club is looking for current and future leaders in Healthcare and Doyenne Connections has spots for corporate sponsorships.

Are Providers Using Effective Patient Communication Methods?

Posted on December 1, 2016 I Written By

The following is a guest blog post by Cristina Dafonte, Marketing Associate of Stericycle Communication Solutions as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter:@StericycleComms
cristina-dafonte
This year at MGMA 2016, the Stericycle Communication Solutions team had the opportunity to survey over 800 providers about their patient communication strategy. Getting to collect our own data, rather than relying on facts and figures from scholarly articles, was truly invaluable. But what was even more exciting was sitting down and analyzing the results.

Many of the statistics weren’t surprising – nearly 100% of providers are sending appointment reminders, 60% of providers are using technology to send these reminders, and 2/3 of providers surveyed love the idea of online self-scheduling. These statistics all made sense to me… it’s almost 2017, of course providers would prefer to use technology when it comes to their patient communications.

But as I dug more into the numbers, I saw a startling trend:

  • Only 1 out of 3 providers who “love” online self-scheduling offer it to their patients
  • While almost all providers are sending appointment reminders, 1/3 are still manually calling their patients
  • Over 60% of providers are only sending appointment reminders via ONE modality

I started to think about other parts of my life where I booked appointments or used technology to interact with a vendor– did these healthcare numbers match their non-healthcare counterparts?

First I looked to my hair salon. When I go to their website, I have the ability to book an appointment with my current hair dresser directly on their home screen. I get an email reminder the day that I book the appointment with a calendar attachment. The day before the appointment, I get a text reminding me what time my appointment is and whom it is with. Four months after the appointment, I get an email reminding me that it’s time to come in for my next appointment… with a link to book an appointment online. Surprisingly, this didn’t match what I was seeing in my survey data analysis. When I looked at scheduling an appointment to get my car serviced, I saw the same trend – booking was conveniently online, the communications were all automated, and I received more than one reminder.

So why does there seem to be such a difference when it comes to healthcare communication? Our survey shows that providers like the idea of technology, so, I wonder, why are most providers only going halfway? What is it that is holding them back from fully investing in automated patient communications? According to TIME, the average person looks at his or her phone 46 times per day. As we near 2017, shouldn’t we reach and capture patients where they are engaged and spend most of their time – on their mobile devices and computers?

For more MGMA survey results and a sneak peak into how Stericycle Communication Solutions can help you adopt an automated patient communication strategy, download the infographic here.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality call center & telephone answering servicespatient access services and automated communication technology. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services.  Connect with Stericycle Communication Solutions on social media:  @StericycleComms

Vendor Study Says Wearables Can Promote Healthy Behavior Change

Posted on November 28, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study backed by a company that makes an enterprise health benefits platform has concluded that wearables can encourage healthy behavior change, and also, serve as an effective tool to engage employees in their health.

The data from the study, which was sponsored by Mountain View, CA-based Jiff, comes from a two-year research project on employer-sponsored wearables. Rajiv Leventhal, who wrote about the study for Healthcare Informatics, argues that these findings challenge common employer beliefs about these type of programs, including that participation is typically limited to young and healthy employees, and that engagement with these rules can’t be sustained over time.

The data, which was drawn from 14 large employers with 240,000 employees, apparently suggests that wearable adoption and long-term engagement is possible for employees of all ages. The company reported that among the employers offered the wearables program via its enterprise health platform, 53% of employees under 40 years old participated, and 36% of employees over 50 years participated as well.

Jiff researchers also found that employee engagement had not measurably fallen for more than nine months following the program rollout, and that for one employer, levels of engagement have been progressively increasing for more than 18 months, the company reported.

According to Jiff, they have helped sustain employee engagement by employing three tactics:  Using “challenges,” time-bound immersive and social games that encourage healthy actions, “device credits,” subsidies that offset the cost of purchasing wearables and “behavioral incentives,” rewards for taking healthy actions such as walking a minimum number of steps per day.

The thing is, as interesting as these numbers might be — and they do, if nothing else, underscore the role of engaging consumers rather than waiting for them to engage with healthier behaviors on their own — the story doesn’t address one absolutely crucial issue, to wit, what concrete health impact are companies seeing from employee use of these devices.

I don’t think I’m asking for too much here when I demand some quantitative data suggesting that the setup can actually achieve measurable health results. Everything I’ve read about employee wellness initiatives to date suggests that they’ve been a giant bust, with few if any accomplishing anything measurable.

And here we have Jiff, a venture-backed hotshot company, which I’m guessing had the resources to report on results if it found any. After all, if I understand the study right, with their researchers had access to 540,000 employees for significant amount of time.  So where are the health conclusions that can be drawn from this population?

And by the way, no, I don’t accept that patient engagement (no matter how genuine) can be used as a proxy or predictive factor for health improvement. It’s a promising step in the right direction but it isn’t the real thing yet.

So, I shared the study with you because I thought you might find it interesting. I did. But I wouldn’t take it too seriously when it comes to signs of real change — either for wearables used for employee wellness initiatives. At this point both are more smoke than substance.

Are Healthcare Data Streams Rich Enough To Support AI?

Posted on November 21, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As I’ve noted previously, artificial intelligence and machine learning applications are playing an increasingly important role in healthcare. The two technologies are central to some intriguing new data analytics approaches, many of which are designed to predict which patients will suffer from a particular ailment (or progress in that illness), allowing doctors to intervene.

For example, at New York-based Mount Sinai Hospital, executives are kicking off a predictive analytics project designed to predict which patients might develop congestive heart failure, as well as to care for those who’ve are done so more effectively. The hospital is working with AI vendor CloudMedx to make the predictions, which will generate predictions by mining the organization’s EMR for clinical clues, as well as analyzing data from implantable medical devices, health tracking bands and smartwatches to predict the patient’s future status.

However, I recently read an article questioning whether all health IT infrastructures are capable of handling the influx of data that are part and parcel with using AI and machine learning — and it gave me pause.

Artificial intelligence, the article notes, functions on collected data, and the more data AI solution has access to, the more successful the implementation will be, contends Elizabeth O’Dowd in HIT Infrastructure. And there are some questions as to whether healthcare IT departments can integrate this data, especially Internet of Things datapoints such as wearables and other personal devices.

After all, O’Dowd notes, for the AI solution to crawl data from IoT wearables, mobile apps and other connected devices, the data must be integrated into the patient’s medical record in a format which is compatible with the organization’s EMR technology. Otherwise, the organization’s data analytics solution won’t be able to process the data, and in turn, the AI solution won’t be able to evaluate it, she writes.

Without a doubt, O’Dowd has raised some important issues here. But the real question, as I see it, is whether such data integration is really the biggest bottleneck AI and machine learning must pass through before becoming accessible to a wide range of users. For example, healthcare AI-based Lumiata offers a FHIR-compliant API to help organizations integrate such data, which is certainly relevant to this discussion.

It seems to me that giving the AI every possible scrap of data to feed on isn’t the be all and end all, and may even actually less important than the clinical rationale developers uses to back up its work. In other words, in the case of Lumiata and its competitors, it appears that creating a firm foundation for the predictions is still as much the work of clinicians as much is AI.

I guess what I’m getting to here is that while AI is doubtless more effective at predicting events as it has access to more data, using what data we have with and letting skilled clinicians manage it is still quite valuable. So let’s not back off on harvesting the promise of AI just because we don’t have all the data in hand yet.

Quality Reporting: A Drain on Practice Resources, New Study Shows

Posted on November 17, 2016 I Written By

The following is a guest blog post by Steven Marco, CISA, ITIL, HP SA and President of HIPAA One®.
Steven Marco - HIPAA expert
If time is money, medical practices are sure losing a lot of both based on the findings in a new study published in Health Affairs. The key take-a-way, practices spend an average of 785 hours per physician and $15.4 billion per year reporting quality measures to Medicare, Medicaid and private payers.

The study, conducted by researchers from Weill Cornell Medical College, assessed the quality reporting of 1,000 practices, including primary care, cardiology, orthopedic and multi-specialty and the findings are staggering.

Practices reported spending on average 15.1 hours per week per physician on quality measures. Of that 15.1 hours per week, physicians account for 2.6 hours with the rest of the administrative work divided between nurses and medical assistants. About 12 of those 15.1 hours are spent logging data into medical records solely for quality reporting purposes. Additionally, despite a wealth of software tools on the market today, about 80 percent of practices spend more time managing quality measures than they did three years ago and half call it a “significant burden.”

Aside from the major drain on administrative resources, there are heavy financial ramifications for such lengthy and cumbersome reporting as well. The report found practices spend an average of $40,069 per physician for an annual national total of $15.4 billion.

The findings of this study clearly demonstrate the need for greater reporting automation in the healthcare industry. By embracing technology to manage labor-intensive, error-prone and mundane tasks; practices free up their staff to focus on patient care. In the past few years, we have watched electronic medical record (EMR) companies do just that by embracing cloud-based software solutions.
physician-and-administrator-growth-over-time
This overwhelming administrative bloat and financial burden can be addressed by implementing software tools and solutions designed to streamline reporting and compliance management. For example, if your practice or organization is still conducting your annual risk analysis through spreadsheets and other manual methods, it is time to embrace automation and a Security Risk Analysis software solution. Designed to control costs, a cloud based Security Risk Analysis solution automates 78% of the manual labor needed to calculate risk for organizations of all size.

There’s no time like the present to embrace best practices for your quality reporting. Allow technology to do the heavy lifting and free up your resources.

About Steven Marco
Steven Marco is the President of HIPAA One®, leading provider of HIPAA Risk Assessment software for practices of all sizes.  HIPAA One is a proud sponsor of EMR and HIPAA and the effort to make HIPAA compliance more accessible for all practices.  Are you HIPAA Compliant?  Take HIPAA One’s 5 minute HIPAA security and compliance quiz to see if your organization is risk or learn more at HIPAAOne.com.

What Would A Community Care Plan Look Like?

Posted on November 16, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Recently, I wrote an article about the benefits of a longitudinal patient record and community care plan to patient care. I picked up the idea from a piece by an Orion Health exec touting the benefits of these models. Interestingly, I couldn’t find a specific definition for a community care plan in the article — nor could I dig anything up after doing a Google search — but I think the idea is worth exploring nonetheless.

Presumably, if we had a community care plan in place for each patient, it would have interlocking patient-specific and population health-level elements to it. (To my knowledge, current population health models don’t do this.) Rather than simply handing patients off from one provider to another, in the hope that the rare patient-centered medical home could manage their care effectively on its own, it might set care goals for each patient as part of the larger community strategy.

With such a community care strategy, groups of providers would have a better idea where to allocate resources. It would simultaneously meet the goals of traditional medical referral patterns, in which clinicians consult with one another on strategy, and help them decide who to hire (such as a nurse-practitioner to serve patient clusters with higher levels of need).

As I envision it, a community care plan would raise the stakes for everyone involved in the care process. Right now, for example, if a primary care doctor refers a patient to a podiatrist, on a practical level the issue of whether the patient can walk pain-free is not the PCP’s problem. But in a community-based care plan, which help all of the individual actors be accountable, that podiatrist couldn’t just examine the patient, do whatever they did and punt. They might even be held to quantitative goals, if the they were appropriate to the situation.

I also envision a community care plan as involving a higher level of direct collaboration between providers. Sure, providers and specialists coordinate care across the community, minimally, but they rarely talk to each other, and unless they work for the same practice or health system virtually never collaborate beyond sharing care documentation. And to be fair, why should they? As the system exists today, they have little practical or even clinical incentive to get in the weeds with complex individual patients and look at their future. But if they had the right kind of community care plan in place for the population, this would become more necessary.

Of course, I’ve left the trickiest part of this for last. This system I’ve outlined, basically a slight twist on existing population health models, won’t work unless we develop new methods for sharing data collaboratively — and for reasons I be glad to go into elsewhere, I’m not bullish about anything I’ve seen. But as our understanding of what we need to get done evolves, perhaps the technology will follow. A girl can hope.

The Teeter Totter of Security and Usability – Tony Scott, US CIO at #CHIME16

Posted on November 15, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently at the CHIME Fall Forum and had the privilege of hearing a keynote presentation by Tony Scott, US Federal CIO, that was made possible by Infinite Computer Solutions. Tony Scott has a fascinating background at VM Ware, Microsoft, Disney and GM which gives him a pretty unique perspective on technology and his topic of cybersecurity.

During Tony’s keynote, he made a great plea for all of us working in healthcare IT when he said:

Cybersecurity is important and there’s something that each one of us can do about it!

When it comes to Cybersecurity I think that many people throw up their arms and think that there’s not much they can do. However, if we all do our small part in improving cybersecurity, then the aggregate result would be powerful. That’s something each of us in healthcare should take seriously as we think of how cybersecurity issues could literally impact the care patients receive going forward.

Along these same lines, Tony Scott also suggested that members of CHIME (largely healthcare CIOs) should work to share with peers. Cybersecurity is such a challenging problem, we have to share and learn from each other. I saw this happening first hand in a few of the cybersecurity sessions I attended at the conference. Healthcare CIOs were happily sharing security best practices with each other. The reality is that everyone in healthcare suffers when healthcare organizations suffer a breach and erode the confidence of patients. So, we all benefit by sharing our experience and knowledge about cybersecurity with each other.

Tony Scott also framed the cybersecurity challenge when he said, “Every time we have a breach, we could think of it as a quality issue.” No doubt this was calling back to his days at GM when quality issues were a major challenge, but what a great way to frame a breach. When there’s a breach, there’s something wrong with the quality of the product we provide our healthcare organizations and ultimately patients. With that mindset, we can go about making sure that the health IT product we provide is of the highest quality.

While I enjoyed each of these insights from Tony Scott’s keynote, I had the unique opportunity to be able to head backstage to the green room to talk privately with Tony Scott and the team from Infinite Computer Solutions that was hosting him as keynote. We had a brief but interesting discussion about his keynote and the challenges of cybersecurity in healthcare.

During our discussion, Tony Scott offered an important insight about the balance of cybersecurity and usability when he compared it to a teeter totter. Far too many organizations treat cybersecurity and usability like a teeter totter. If you make something more secure, then that makes things less usable. If you make things more usable, then they’re going to be less secure. Or at least that’s how many people look at cybersecurity.

In my discussion with Tony, he argued that we need to look at ways to raise the teeter totter up so that there’s not this give and take between security and usability. We should look for ways to make things extremely usable, but also secure. I’d suggest that this is the challenge we must face head on in healthcare over the next decade. Let’s not just settle ourselves with the teeter totter effect of security and usability, but let’s strive to raise the teeter totter up so we preserve both.

HealthTap Announces a Comprehensive Health App Platform

Posted on November 10, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

For the past five years, HealthTap has been building a network of doctors and patients who exchange information and advice through information forums, messaging, video teleconferencing, and other integrated services. According to CEO Ron Gutman, all that platform building has taught them a lot about what health app developers need–knowledge that they’ve expanded by listening to hospitals and third-party app developers over the years. On Tuesday, November 1, HealthTap announced a comprehensive cloud platform pulling together all these ideas. The features in the press release read like a wish list from health app developers:

  • Text, voice, and video messaging

  • Telemedicine

  • Population health

  • Predictive modeling

  • Device input and other patient-generated data

  • Handling clinical data from electronic health records

  • Aggregated data on patient groups, such as the frequency of concepts in the population

  • The ability to view timelines on patients

  • Searchable content from the huge library of clinical advice posted to HealthTap by its roster of more than 100,000 doctors

  • Identity management, so that patients and clinicians can verify who they are and connect securely

  • Customer relationship management through messaging

Many of the APIs covering these topics are covered in the developer documentation, and others are available by application from qualified developers.

Gutman told me that three to four years of work went into this platform, and that he hopes it can reduce the multi-year developments efforts his team had to deal with to just weeks for other developers hoping to innovate in the health care field. Transparency is promoted as a key value, because the developer terms required developers to “Clearly inform users what data you collect (with their consent) as well as and how you use the data you collect or that we (HealthTap) provides to you.” Even so, some items are restricted even more, such as adherence data and health goals.

In addition to RESTful APIs, the platform has SDKs for iOS, Android, and JavasScript. CTO Sastry Nanduri says that these SDKs permit apps to incorporate some workflows, such as making virtual appointments. His philosophy is that, “We do the work and make it easy for the developers.”

HealthTap has created its own formats and APIs instead of using existing standards such as the Open mHealth defined for medical devices (described in another article). A diversity of formats may make adoption harder. But the platform does harmonize diverse data from different sources into predictable formats, so that things such as blood glucose and body weight are shown in fixed units. Nanduri points out that most of their work has not been done by other organizations in an open, API format.

In any case, central to HealthTap’s goals and efforts is the sharing of data among organizations. If Partners Healthcare or Kaiser Permanente can open their data through HealthTap’s APIs, it can all be combined with the aggregated data from millions of records HealthTap has built up over time.

Offering this platform in HealthTap’s cloud gives it many advantages. Foremost is the enormous data repository of both patients and content served up by the platform. Second, identity management is automatically provided through the secure and robust platform HealthTap has always used for signing up patients and clinicians. Clinicians are carefully validated. Theoretically, a developer could also use an independent means of authenticating patients, so that someone can use apps built on the platform without a HealthTap account.

They are also exploring a blockchain solution for tracking permissions and contracts.

The proof of this huge undertaking will be in its adoption. I’m sure HealthTap’s partners and many other organizations will play with the platform and try to bring apps to life through it, either for internal use or for widespread distribution. Nanduri says that they are ramping up carefully, reviewing applications one by one, and will talk to each of their early developers to find out their goals and offer guidance to creating a successful app. Time will tell whether HealthTap has, as Gutman says, created the platform their developers wish they had when they started the company.

The Impact of the 2016 Election on Healthcare IT

Posted on November 9, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today it’s pretty obvious that the Presidential is on everyone’s mind. While I don’t plan to discuss the details of the election and the specific results, it’s worth thinking about what Donald Trump in the white house will mean for healthcare IT.

Let’s start off with the easy one: Meaningful Use/MACRA. One doctor tweeted me that now that Trump is President, MACRA will be gone. I don’t think that’s further from the truth. In fact, I really can’t imagine any scenario where the EHR Incentive program (Meaningful Use, which still applies to hospitals and Medicaid) and the MACRA program would be gone. I think they’re here to stay and won’t be altered at all by this election.

The biggest reason for this belief is that Trump is going to have so many other things on the agenda. Not the least of which is ACA (Obamacare), which we’ll get to later in this post, but also a whole suite of other things that he’ll make a priority. Why would Trump want to take on a relatively bipartisan thing like healthcare IT, EHR and MACRA? I don’t think he’ll waste a second on the subject.

Plus, even if Trump wanted to go after the MACRA and EHR incentive legislation, I can’t imagine the Senate and House passing something to replace those programs either. Remember that Trump can propose all he wants, but the Senate and House have to pass it too and both of those groups seem to be firmly behind both efforts. Add this to the previous point and why would Trump go after health IT when it’s unlikely to pass and isn’t a strategic goal of his? Short Answer: He won’t.

My opinion: we’re unlikely to see any change to MACRA and other healthcare IT initiatives.

The trickier part to assess is the impact a Trump presidency will have on the Affordable Care Act (ACA or Obamacare). I live in Vegas and I wouldn’t even want to offer odds on what’s going to happen there. The rhetoric out there is to “repeal and replace Obamacare.” What’s not clear to me is if this concept is even practical and possible. There are so many issues with the idea of repealing Obamacare, that I can’t imagine it ever happening. I could see parts of it being repealed, but not the whole thing.

I also think it would be seen as very unfavorable for Trump to roll back things like the pre-existing condition exemption that allows those with pre-existing conditions to get insurance. There are probably a dozen other things like this that would likely be hard to take back without some major backlash and so I think they’ll have to preserve many of these things in whatever they do with Obamacare. Maybe that means a full repeal, but then rolling back in some of the popular pieces of the legislation so they can say they repealed it.

All of this said, I think that Trump will evaluate all options to undermine many of the things that were implemented by Obamacare including the insurance mandate and the insurance exchanges. Most people don’t realize that there’s so much more to Obamacare than just the mandate and exchanges. How he’ll undermine Obamacare and the impact it will have is anybody’s guess. I’m not sure anyone really knows and it’s certainly beyond my political punditry.

Long story short on Obamacare, I have no idea. I know that something’s going to happen because of the strict “Rip and Replace” rhetoric. I just think it’s really hard to predict which parts they’ll be able to rip out at this point and what they’ll replace it with going forward.

No doubt this will keep many in healthcare on edge. Unknowns are always a challenge. While I think the Trump Presidency will likely have a big impact on healthcare, I don’t see it having a big impact for good or bad on healthcare IT. I think the path to healthcare IT is happening and he won’t do anything to really stop it.

Side Note: Check out this interesting lessons learned post by Mr. H at Histalk which talks about the challenge of relying on data. As healthcare enters the world of data in a big way, it’s important to make sure we have a good understanding of what the data really tells us and what it doesn’t.

Health Plans Need Big Data Smarts To Prove Their Value

Posted on November 2, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Recently, Aetna cut a deal which suggests a new role for health insurers in big data analytics and population health management. In partnership with Merck, the health insurer is launching a new program using predictive analytics to identify target populations and provide them with health and wellness services. AetnaCare will start by targeting patients with diabetes and hypertension in the mid-Atlantic U.S., but it seems likely to go national soon.

In its press release on the matter, Aetna says the goal of the program is to “proactively curate various health and wellness services… to support treatment adherence, ensure that critical social support needs are met, and reinforce healthy lifestyle behaviors.” That in and of itself isn’t a big deal. We all know that these are goals shared by providers, employers and health plans, and that most of the efforts health plans make on this front are pie in the sky, half-baked initiatives featuring cutesy graphics and little substance.

But then, Aetna’s chief medical officer gives away the real goal here — to power this effort by analyzing patient data being spun out by patients in varied care settings.  In the release, Dr. Harold Paz notes that patients are getting care in a wide variety of settings, including retail clinics, healthcare devices, pharmaceutical services, behavioral health, and social services, and that these services are seldom coordinated well, and implies that this is the real problem Aetna must solve.

If you listen to this with the ears of a health IT chick like myself, you hear Aetna (and Merck, actually) admitting that they must engage in predictive analytics across all of these encounters – and eventually, use these insights to help patients make good healthcare choices. In other words, they have to think like providers and even offer provider-like services fulfill their mission. And that means competing with or even beating providers at the big data game.

The truth is, health plans are in the same boat as providers, in that they’re at the center of a hailstorm of data and struggling with how to make use of it. Also, like providers they’re facing pressure from health purchasers to slow healthcare cost growth and boost patient wellness. But I’d argue that they’re even less prepared, technically and culturally, to improve health or coordinate care. So jumping in now is critically important.

In fact, I’d argue that health insurers are under greater pressure to improve population health than even sophisticated health systems or ACOs. Why? Because while health systems and ACOs can point to what they do – they make people better, for heaven’s sake — insurance companies are the eternal middleman who must continue to prove that they add value to the healthcare equation.

It remains to be seen whether programs like AetnaCare succeed at helping patients find the resources they need to improve and maintain their health. But even if this concept doesn’t work out, others will follow. Health plans need to leverage their unique data set to boost quality and reduce costs. Otherwise, as providers learn to work under value-based payments and accept risk, employers will have increasingly good reasons to contract directly — and leave the insurance industry out of the game entirely.