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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.

Obsolete Office Visits, Tracking Customer Behavior, and More — #HITsm Chat Highlights

Posted on June 22, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

John did a full writeup on these topics before the #HITsm chat. Be sure to read his thoughts on Healthcare Unbound.

Topic One: So how long will it be before office visits are no longer the norm? (via Mark Blatt, MD, CMIO Intel)

Topic Two: What technologies will lead the way?

Topic Three: How will these at-home and mobile technologies integrate with existing systems?

 

Topic Four: Aetna’s CarePass will track customer behavior. Will this become the norm, is it a good thing?

Working with United Healthcare, Aetna, Humana and Walgreens

Posted on May 31, 2013 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 I had a unique experience attending the Life At 50+ event that AARP puts on. It turns out that life at 50+ revolves around healthcare and wellness in many ways. Plus, they put together the AARP Live Pitch event for healthcare companies to pitch their companies to a board of judges and then to the AARP members. The later was quite interesting to watch and who doesn’t love hearing from real customers.

After lunch, they also had a panel with executives from United Healthcare, Aetna, Humana and Walgreens to talk about what they look for when it comes to working with healthcare startup companies. There were some predictable things like “we focus on the team” and also some off the cuff remarks like the tweet embedded above about “stuff that actually works.”

One thing was clear that these companies were all in an evolution from their core business to something else. As one panel member said they were moving from a claims processing company to a wellness company. Another panel member said they didn’t see themselves as providing healthcare as much as enabling healthcare.

I was most interested to hear these executives talk about what they looked for in a company. The general consensus seemed to be that they wanted companies that understood their gaps and could fill their gaps. Although, when they were asked to talk about their gaps, the executives seemed to have a hard time describing their gaps. I think this is the core challenge. If they really knew their gaps, they’d be filling it themselves.

With that said, I did pull out a couple areas that seemed of great interest to the panel. Those two areas were medication compliance and getting patients to the right doctor. If you can help with either of those things, then your company would likely be of interest to these companies. Although, as the tweet at the top says, you better make sure it works before you think they’re going to work with you.

I also found it ironic that some on the panel wanted an end to end solution while another described them as looking for point solutions. At the end of the day, I don’t think they’d mind either solution if that solution provided value and had seen some traction. For example, one panelist talked about coordinated care, but they also said they wanted to see proof of the coordinated care in action and implemented in a hospital system.

I guess none of these things are too surprising. Find something where you have traction and provide value and you’ll have lots of opportunities.

Big Health IT News Flowing – ICD-10 Delayed, Meaningful Use Stage 2 Imminent, and More

Posted on February 17, 2012 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.

If you live and love the EMR, EHR and Healthcare IT world like I do, then you’re enjoying all the big news that’s coming out right now. A part of me thinks that the big news is coming out because HIMSS is so close, but some of the news seems like it might not necessarily be timed directly to HIMSS. (To see company news coming out at HIMSS, check out our EMR, EHR and Healthcare IT News site.)

For those not keeping track, here’s a quick run down of some of the major news pieces I’ve seen that really point to larger trends in healthcare IT:

Meaningful Use Stage 2
We know that meaningful use stage 2 is imminent. It’s just a question of when we’re going to hear it. In fact, it might be announced as I’m writing this post. Neil Versel first queued us into the Meaningful Use Stage 2 Announcement prior to HIMSS, but the Twittersphere is also full of rumors about the announcement. Brian Ahier commented on my Facebook message about it:

Nothing is official until it’s released, but since Monday is a holiday it is very unlikely they will wait until next week. My understanding is that the review at the OMB is complete and the proposed rule is ready to be published…

For those who want a sneak preview on what to expect in meaningful use stage 2, check out Jennifer Dennard’s meaningful use stage 2 post.

ICD-10 Delayed
Many have wondered if ICD-10 would be delayed with most arguing that 5010, meaningful use and ICD-10 was a lot to change all at once. Two days ago I got an email from someone saying they thought ICD-10 wouldn’t be delayed. I replied that I wasn’t sure either way, but it seemed like there was movement that could make a delay quite possible. Although, I must admit that I didn’t even think the ICD-10 delay announcement would happen so quickly.

Regardless of prognostication, ICD-10 is going to be delayed. You can read my thoughts on the ICD-10 Delay on EMR Thoughts.

HIMSS Acquires mHealth Summit
Maybe this feels like bigger news since it’s so close to HIMSS and I can see how powerful this conference has become. You can read the press release on the acquisition here. This isn’t that surprising since HIMSS had partnered with the mHealth Summit last year. I think this spells really good things for the growth of the mHealth Summit. I’m not sure I’d want to be another mHealth conference, but there’s a niche for the right event.

I still have a hard time distinguishing mHealth from healthcare IT in general. There could be some differentiation, but I still believe that over time the dividing line between the two is going to be hard to see. Richard Scarfo, HIMSS’ vice president of vendor events (previously mHealth Summit director) is right to be concerned that it will be HIMSS 2.0.

Navinet Acquired by Blues Plans and Lumeris
Read more about the acquisition here. I must admit that I’m still trying to process exactly what this means. Although, one thing I’m sure it means we’re moving the tectonic ACO plates that will be necessary to change how we pay for healthcare.

Vince Kuraitis and Leonard Kish provide some interesting insight in this Google+ thread asking whether this is a shift from institution (enterprise) centered IT to patient centric IT or if it’s becoming payer centric IT. They also mention United’s restructuring of payments and Aetna’s acquisition spree as indicators of the shifting plates of healthcare reimbursement.

Aneesh Chopra as Senior Advisor to the Advisory Board Company
This isn’t as big of news, but it just came out so I thought I’d throw it in. For those that don’t know Aneesh Chopra is now former CTO of the US. Everyone just wondered what he’d do next. Brian Ahier posted that Aneesh Chopra landed at The Advisory Board Company where he worked previously for about 10 years. Looks like Aneesh and his energy and enthusiasm will still be around healthcare. I think that’s a very good thing.

Private Payers Need to Join Humana, CMS With EHR Subsidies

Posted on June 30, 2011 I Written By

Ever since the American Recovery and Reinvestment Act became law in February 2009, giving birth to the phrase “meaningful use,” I’ve wondered when private insurers would follow the federal government’s lead and start offering financial carrots and sticks for using and not using EHRs. After all, one of the purposes of the Medicare and Medicaid incentive program was to address the fact that payers tend to reap the greatest financial gains from hospitals and physicians adopting EHRs, even though most if not all of the cost of acquiring the technology falls on the provider.

Federal officials have made it clear all along that “meaningful use” is just that, the meaningful use of the technology. The government was not simply going to write checks so providers could go out and buy technology. As the country’s largest purchaser of  healthcare services, CMS wanted some value for its money (not exactly something you hear every day when it comes to government spending).

I’d been hearing for years that major commercial health insurers also were willing to share some of the savings from EHR adoption, but not until the largest payer of them all, Medicare, did so first. The private sector usually does follow Medicare’s lead when it comes to major policy shifts. Medicare now has done so, but private payers have been mostly silent. Mostly.

This month, as InformationWeek reports, Humana teamed up with Allscripts Healthcare Solutions to offer physician practices financial incentives for purchasing Allscripts EHR systems. The deal is similar to one Humana cut last year with Athenahealth. A few Blue Cross and Blue Shield plans, notably in Massachusetts and Rhode Island, have led similar programs at the state level, with eClinicalWorks the main partner.

But unless I’m forgetting something, Humana is the only big payer that has jumped into the game. Where are the UnitedHealthcares, Aetnas, Cignas and WellPoints of the world?

Payers, it’s time to make good on the lip service you gave years ago and start passing on some of the savings you will realize from Medicare, Medicaid and hundreds of thousands of providers spending billions of dollars on EHR technology and health information exchange efforts.

 

Commercial Insurance Implementing Meaningful Use

Posted on August 17, 2010 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.

The HITECH Law Blog had a post recently titled “Commercial Payors Implementing EHR Meaningful Use Criteria in P4P Programs.” Here’s a short excerpt:

On August 5, 2010, four major commercial health insurance payors participated in the Health Industry Forum in Washington, D.C., to discuss private industry collaboration with the United States Health & Human Services Department (HHS) to support providers in the adoption of certified electronic health records (EHRs). Leading the Forum’s panel discussion was David Blumenthal, M.D., Chief of the Office of National Coordinator of HIT. All four payors will include the Meaningful Use criteria in their pay for performance (P4P) programs.

The 4 insurance groups identified are Aetna, Inc and its subsidiary, ActiveHealth Managent, United Health Group (UHG), Wellpoint, Inc, and Highmark, Inc. (Blue Cross Blue Shield).

The author of the blog also asserts that now that the government has created the final meaningful use rule, it will clear the way for the commercial payors to implement it as well. The press releases from the 4 companies about this change are really vague and so it’s hard to say exactly how these companies will implement the meaningful use criteria.

In fact, this almost feels like it’s a little warning shot from the commercial payors. It seems like they’re testing the waters to see how doctors and practices will react to this type of announcement. Plus, I’ll be surprised if we see any major implementation of meaningful use by commercial payors until we see the first physicians showing meaningful use to the government. That way the commercial payors can sit back and watch the impact on physicians of having to show meaningful use to the government. If it goes poorly (like the bad PQRI incentives), then I can see commercial payors backing off the meaningful use bandwagon.

The theme I did read in all the press releases is that it’s valuable for commercial payors to have information from an EHR. Now I think the payors are just trying to figure out the best way to achieve that outcome. Will it be meaningful use? Will it be some other method? They don’t really care. They’re just concerned with their outcomes.

If commercial payors do require meaningful use, I think it’s going to be a really ugly outcome.