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Is Innovation Missing at MGMA 2016?

Posted on November 2, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week I’ve been at the MGMA Annual Conference in San Francisco. It’s been a very interesting event with a ton of people that really want to improve healthcare. I’m always impressed by these practice administrators passion for their work and their desire to do what’s right for patients.

While I love their passion, I can’t help but feel that there’s a clear lack of innovation at MGMA. More specifically the practice executives and not the MGMA organizations itself. Instead of trying to figure out and participate in new business models that will take their practice to the next level, most healthcare practices seem focused on optimizing their existing practice.

Sure, many of them are focused on various government regulations like MACRA. In fact, I’d suggest that most of them are too focused on government regulations. No doubt that’s part of why healthcare executives at MGMA aren’t focused on innovation. They’re too busy dealing with government regulation to be able to have time to sit down and think how they could take patient care to the next level or create new business models.

The two places I do think we see some interest in innovation is the shift to value based reimbursement and the change to direct primary care. The problem with value based care is that people don’t really know what that’s going to be. Most are in wait and see mode to see where it’s all going to go. Direct primary care is quite interesting to many, but that largely only applies to primary care and many feel it’s limited in which primary care practices can and should participate (I know that many people firmly disagree with this idea).

I guess that means that MGMA stands in somewhat stark contrast to many of the other healthcare conferences out there. Maybe that’s not such a bad thing. We need to optimize our current processes as well. I just think that many of these medical practice executives would benefit from more effort talking about where healthcare is heading in the future.

It’s great that patients can now schedule an appointment on a physician website. However, are practices ready for appointments to be auto scheduled based on personal device data or through a simple request through Amazon’s echo? I know that’s ahead of the curve, but it’s not that far off either.

Health Plans Need Big Data Smarts To Prove Their Value

Posted on 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.