2020 predictions from Luma Health chief medical officer and co-founder, Dr. Tashfeen Ekram.
Dr. Tashfeen Ekram
As a country we’re expected to spend about $1.3 trillion for hospital care this year. With an average profit margin of 8%, hospitals have higher margins than the pharmacy or insurance industries. Patients are bearing the brunt of these rising costs and as a result, crowdsourcing sites have seen an influx of patients requiring help to pay their medical bills. Some patients are even avoiding the U.S. medical system all together as demonstrated by higher numbers of medical tourism to countries that provide cheaper access to surgeries and other procedures.
To mitigate inflated costs and retain patients, providers in the year to come will implement savvier solutions to reach patients, such as telehealth visits or new ways of engaging with patients across their care journey to help them stay on top of their health and wellbeing. We will also see an increasing variety of innovative payment and business models to balance cost and outcomes.
Amazon will help build the lingua franca for healthcare, unless CMS does it first
The pursuit to democratize access to health data across providers and patients alike remains a critical one. Only by breaking down the data silos that providers, devices and wearables build can EHR systems be gleaned for the treasure troves of insight and help provide increasingly personalized medicine for better clinical outcomes.
Amazon, Google, IBM, Microsoft, Oracle and Salesforce have pledged to open up interoperability via their involvement in FHIR, but this past year, CMS might have made the biggest move in interoperability by opening up an API for access to patient billing data. And when CMS decides on something, history shows that most will follow.
Retail clinics will improve access to care for patients, but quality remains uncertain
The thousands of retail clinics now providing patient care as a result of players like CVS, Walgreens and Walmart entering the healthcare market will improve care for millions of patients, who can now go across the street for easy access to basic healthcare services. To keep up with higher patient expectations around speed of access and convenience that consumerized access to care brings with it, providers across the board will turn to new solutions and partnerships to increase access and convenience, upping their game and retain the patients they risk losing to consumerized care.
By Khurram Mahmood, chief technology officer, Vineti.
Personalized cell and gene therapies are expanding the frontiers of medicine. In the past two years, the FDA approved two autologous cell and gene therapies, Kymriah and Yescarta. These made history as the first commercialized therapies developed for individual patients using genetic material from the patients themselves.
This specific type of cell and gene therapy (autologous) has a unique manufacturing process that varies from that of allogeneic or traditional treatments, which can both be produced in bulk.
Alongside inspiring hope for patients, the cell and gene therapies have introduced a slew of new logistical and manufacturing challenges. The logistics around manufacturing and transporting these therapies are so new and unique, the industry is still trying to grapple with the sheer complexity of the process. Manufacturing is still very manual as automated manufacturing systems are just beginning to emerge. See Cocoon Platform from Lonza as an example on such automated platform. For therapies in pre-commercial phases, clinical trial teams are adopting agile methodologies where they build continuous feedback loops and tweak their processes based on the results from different batches of patients.
When a therapy is launched commercially, manufacturers have to on-board hundreds of hospital sites located across the globe, all with diverse IT systems and IT maturity, technology requirements, internal workflows, and national and regional regulations (which are constantly evolving). Many manufacturers are building geographically distributed facilities in an effort to more efficiently serve different regions, adding pressure to capacity management and routing capabilities.
As depicted in the diagram above, the autologous process must begin at a GMP-certified collection site (most often a hospital or lab) to collect raw material (e.g. blood or tumor sample) from the patient. That is then transported to an external site to undergo a multi-step manufacturing process, creating the therapy that is then sent to an infusion site for administration to the original patient. Furthermore, the entire process is subject to timing and condition requirements.
In the paragraphs below, we describe a few key tenants that a platform must possess to be able to successfully orchestrate the personalized medicine supply chain. We focus primarily on the autologous cell and gene therapy but the general principles apply to all personalized medicine.
1. Common codebase and flexibility through configuration
A platform that uses the same code base among all customers and provides flexibility through configuration is by its very nature higher quality, more feature rich, flexible and faster to change than a bespoke application built specifically for one customer.
Higher quality because the same codebase processes all transactions and thus is rigorously pressure tested – a codebase that has processed hundreds of thousands of patients is always going to be more robust than the one processing its first patient.
Flexible because such a platform has to, by necessity, enable patterns and then allow for those patterns to be configured for several different use cases. As such it is not tied to one use case and can easily and quickly be re-configured to support other use cases as the market needs change.
By Justin Hunt, MD, MS, head of psychiatry, Ginger.
Justin Hunt
From banking to healthcare to grocery delivery—businesses and organizations across multiple industries are pivoting to leverage text messaging as a way to reach consumers. And in behavioral healthcare, text-based coaching is paving the way for increased access to support. Traditionally, mental healthcare providers have only offered in-person appointments for individuals seeking care. Today, virtual services like teletherapy and telepsychiatry are gradually growing in popularity among an increasingly tech-savvy population. Now, services like text-based behavioral health coaching offer another meaningful way for individuals to get in-the-moment care.
Consumer Expectations Have Shifted
Consumers today expect instant access to mobile-first, on-demand services. A recent survey by the Harris Poll on behalf of Ginger revealed that Americans–especially Millennials–are more comfortable with the idea of being able to text for mental health support as a way to get access to care. Two-thirds of Americans (66%) say that if they were struggling with stress or life challenges, they would prefer to text immediately with a certified mental health coach who is trained to provide support if given the choice, while 34 percent would choose to wait three weeks to meet with a licensed therapist in person. This trend is strongest with the Millennial population: 69 percent would prefer to text immediately with a professional rather than wait to meet in-person.
For many consumers, a chat-based solution may be less intimidating as a first step than going in-person to see a licensed professional. Coaching is emerging as a way for individuals to access support in overcoming day-to-day challenges, reach goals, and learn skills to reduce stress. While not licensed like a traditional provider, coaches do have credentials like coaching certifications or master’s- and doctoral-level backgrounds in mental and behavioral health. And just this year, the American Medical Association approved new codes for health and well-being coaching. Individuals can work with coaches alongside a therapist and psychiatrist to receive support between appointments and sustain the progress they’re making toward personal growth. Coaching is also effective as a preventative layer of mental healthcare. At Ginger, 68 percent of our members are non-severe and don’t require intensive therapy or medication management.
Text-based Chat is the New Normal
The younger generations that are digital natives have grown up with texting and chatting online as a regular, highly expressive form of communication. It comes as no surprise that they would be comfortable expressing themselves in this way to mental healthcare providers. For them, text-based chat with a coach can help them find meaning and healing. Additionally, both therapy and psychiatry are episodic in nature—with clinicians meeting clients bi-weekly or monthly. But as I’ve found in my work as a psychiatrist, life does not operate on that schedule.
While clients might demonstrate an overall trajectory of improvement, unexpected mini-crises in between appointments can slow down improvement. Immediate coaching intervention at the exact time of need helps to address these natural setbacks that occur between therapy or psychiatry visits. In addition to handling acute issues, coaching can offer a helpful longitudinal approach to goal setting. For example, coaches can check in with clients between clinical visits and remind them of healthy sleep hygiene techniques or provide light motivational interviewing to help an individual reduce alcohol consumption.
Scaling Care to Meet Demand
As mental health stigma decreases, more people are actively seeking services. Earlier this year, in partnership with Dimensional Research, Ginger surveyed more than 1,200 U.S. workers and found that a growing number of workers are proactively seeking out mental healthcare. Fifty percent of workers said they are more likely to seek help now than they were five years ago and 85 percent reported that behavioral health benefits are important when evaluating a new job.
There’s no getting around it: prescription drugs are expensive. In fact, if you have a lousy insurance policy, you could end up paying thousands of dollars out-of-pocket just to get your hands on the medications that you need.
Are you in this position? Wondering how to soften the blow? There are a few different ways to save on prescription costs, all of which we’ll discuss in this article.
Opt for Generics
In general, there are two types of prescription drugs: Name-brand drugs and generic drugs. When it comes to cost, it’s not even close: generic drugs are substantially cheaper than name-brand drugs. In fact, in most cases, generic versions are around 80% to 85% cheaper than name-brand versions.
Of course, this means that generic drugs are of lower quality than name-brand drugs, right? Not at all, actually.
In fact, in the vast majority of cases, name-brand drugs and their generic equivalents share exact ingredients. As such, there’s really no reason to ever opt for name-brands.
So, when your doctor is writing you up a prescription, be sure to ask if there’s a generic version available. If there is, your doctor will be glad to write it up for you.
Make Use of Assistance Programs
Another way to save money on prescriptions is to make use of assistance programs. There are quite a few assistance programs available in the United States, some of which can help you save as much as hundreds of dollars a month.
First, look to your state and local governments. Most states provide specialized assistance programs, as well as a program called Medicare Extra Help. The latter is beneficial to those on Medicare.
Next, you should look for non-profit assistance programs. Some popular ones include Partnership for Prescription Assistance and Needy Meds. You might be able to find others by searching for “non-profit prescription assistance” in Google or another search engine.
Data center infrastructure management (DCIM) tools gather control, monitoring and allocation of assets, space, power, cabling, cooling and downtime in one place. This makes it much simpler to get and keep your arms around your facility. That is, assuming you know what functionalities are important for DCIM solutions when you acquire yours.
The right software will make it easier to trace and resolve cable and circuit outages. Integration of new equipment and maximization of old equipment can be accomplished more readily — even while power capacity is being optimized. And, best of all, you’ll have a clear picture of all of your center’s assets.
Given the proliferation of hackers taking control of systems and ransoming it back, one of your first concerns should always be access control. Keep in mind this applies to physical access to your server room as well. However, on the software side, you want a solution that gives you strict access control, including the ability to update access lists in real time. You want a system that keeps records of every transaction, including who performed it and from where it was enacted.
Robust Bandwidth and Power Monitoring
The ability to track and chart these two elements can help you determine when to expand your system as well as clue you in when things are about to go sideways. You’ll also be better positioned to determine the amount of bandwidth you’ll need to ensure smooth operation. The best software can be set to alert when certain power and bandwidth thresholds are approached. A spike in either of those parameters usually signals traffic is higher for some reason. It could mean you need to add equipment, the equipment you have is being used inefficiently, or you’re being hacked.
Precise Assets Tracking
Your network infrastructure is crucial to the operation of your facility. RFID technology, in conjunction with the right DCIM solution, makes monitoring assets possible 24/7-365. This enables it to be performed automatically and provide notifications when an asset is being used or moved.
Each day in the U.S., about 10,000 seniors turn 65. By 2050, there will be 83.7 million seniors in the country, representing about one-fifth of its population. Even with the growing awareness of health and fitness, it’s a hard reality that about three-quarters of these older Americans live with multiple chronic health conditions, ranging from diabetes to dementia, meaning that ongoing care and monitoring is simply a fact of life.
The way we deliver senior care has been evolving, and more patients are seeking to “age in place,” which means that they opt to remain in their own homes for as long as possible while receiving any necessary medical care.
This desire to remain at home is driven by many factors including a desire for comfort, access to friends and family, familiarity and privacy. Not to mention the economic benefits – with the cost of nursing homes easily topping $70,000 a year.
Because of this, home healthcare services have been growing in popularity, despite the fact that patients who receive care at home are more likely to experience a higher 30-day readmission rate after leaving the hospital, compared to those in nursing homes. Still, the lower costs and comfort make home care an attractive option.
Your Doctor is Only as Good as the Information They Have
One challenge that home healthcare providers face is consistency in tracking and communicating information to the patient’s primary doctor. Not only information from care at home, but also information from clinics or hospital visits. This lack of insight into patient data can significantly increase the cost of care for patients because without access to the full history of the patient, unnecessary tests may be run, wasting both money and the doctor’s time. It is reported that a whopping $210 billion is spent annually on unnecessary medical care each year in America. Put in perspective, this is almost twice the U.S. 2019 federal education budget.
Further, there can be even more serious consequences to this lack of information and tracking. Without access to accurate patient records, medical errors are more likely because, for example, the patient may have an allergy unknown by the care provider. Medical errors are in fact the third leading cause of death in the U.S. Each year, approximately 250,000 patients in the U.S. die due to such errors.
To prevent these tragedies, an up-to-date, accurate patient file that is updated at each point of care is crucial. This can be most efficiently accomplished via electronic records that are patient-centric and follow a patient wherever they go to receive care, keeping specialists informed throughout an individual patient’s journey. This bridges the gap when a patient switches providers or sees a new physician because each professional has a patient’s detailed medical history, already available to them.
The HITECH Act and Where Electronic Health Records (EHR) Can Go Wrong
Despite the obvious benefits to the implementation of Electronic Health Records (EHR) – it alone is not the answer. The HITECH Act – or Health Information Technology for Economic and Clinical Health Act was signed into law by President Barack Obama in February of 2009. A key aspect of the Act was to promote and expand the adoption of health information technology, specifically, the use of EHRs by healthcare providers. Prior to this, only 10% of hospitals had adopted EHRs.
Unfortunately, after more than $36 billion was spent on the project, and most doctors have indeed moved to electronic health records – the solutions were implemented in such a way that they are not interoperable with one another. So while one hospital may have impeccable electronic patient records – there was no way to efficiently transfer that information to another care provider, blocking the effectiveness of the initiative.
Further, some of the independent EHR systems were difficult for doctors to use and could cause dangerous mistakes, such as recording a child’s weight by default in kilograms rather than pounds, leading to the prescription of incorrect doses of medication.
Although electronic health records (EHR) are firmly established in the medical landscape, ongoing progress necessitates that providers keep up with emerging trends. Here are five of them.
1. Combining Artificial Intelligence and Voice Recognition with EHR
Artificial intelligence (AI) has already shown promise for assisting doctors with making diagnoses or recognizing historical trends about a patient’s condition. However, several companies are investigating bringing AI to EHR via voice recognition capabilities.
At Vanderbilt University Medical Center, providers can query the tools by posing questions in natural language. For example, a physician could ask a voice-enabled EHR system for details about a patient’s last recorded iron levels from blood tests. The system would inform the doctor of those levels, plus tell them whether they’re in a healthy range.
Allscripts and Northwell Health also recently struck a deal for a platform that blends AI with EHR and collects data from clinicians. Using voice commands within patient care could be especially useful for providers who have their hands full.
2. An Increased Emphasis on Mitigating EHR Errors
When the ECRI Institute released its 2020 report containing the top 10 health technology errors to be aware of in the coming year, EHR issues were mentioned multiple times. The first instance related to providers potentially being overwhelmed with notifications from EHR platforms, ignoring some of them and perhaps overlooking a genuine issue with a patient as a result.
The report also brought up the risk of medical data not including information about implants in patients that are sent for medical imaging. The study recommended providing a single place to enter or check for the presence of implant data in an EHR. Finally, the ECRI Institute cautioned that EHR mistakes could happen when a medication administration order sent by an EHR platform does not match the dosage time the provider intended.
This coverage of such mistakes will likely cause health care facilities to assess their systems and see if the issues exist there. If so, they’ll look for ways to reduce those problems.
The big data revolution has made today’s healthcare industry a vibrant hub of innovation in data, analytics, and artificial intelligence. Recent decades have brought tremendous advances in not only the science of clinical and medical services, but also in the business strategy powering those services.
Across the industry, digital pioneers are leveraging data to create new efficiencies, solutions, and breakthrough treatments. However, just as the industry offers endless examples of incredible transformation, so too does it offer endless case studies in untapped potential.
Some roadblocks to healthcare data innovation in the healthcare industry are unavoidable: Decades’ worth of legacy and proprietary systems have made modernization and integration efforts enormously challenging. Strict regulations mean that the barrier to entry for new technologies and processes are much higher than in other industries. Additionally, many healthcare organizations face governance challenges spurred by years of continuous disruption—making it even harder to bring innovative ideas to fruition.
However, these obstacles have not stopped healthcare data innovation; they’ve merely slowed the pace of change. Generally, when an organization has the resources, competencies, and will to innovate, the only thing that can thwart those intentions is an inability to build effective business data strategy.
Often, that lack of ability stems from a fundamental misconception about innovation itself—a case of mistaken identity that confuses innovation for inspiration. When this misconception flourishes, organizations can fall into a state of institutional inertia, forever waiting for the next big idea to appear out of thin air.
These organizations fail to understand that innovation is a process, not some mysterious phenomenon, and that they can build concrete business strategies with repeatable procedures designed to continually drive the formulation of breakthrough ideas. Fortunately, organizations need only three core ingredients to build an effective business data strategy that fosters innovation.
Fast Iteration
It’s been said, but it bears repeating: Innovation is a process. And when it comes to business innovation, an iterative process allows for the greatest amount of flexibility and experimentation in concepting and product development. Healthcare organizations who wish to develop new applications and revenue streams leveraging their data must create internal systems that allow for fresh ideas to be iterated upon at pace and at scale.
To do so, it is vital that these organizations drastically lower the cost to try. If, over the course of a year, the “cost to try” is 10 months of submissions, review, and approvals, then your organization will try one thing that year. If the cost to try is shortened to one week, then your organization will likely try 52 things that year. The more your organization is able to try new ideas, and iterate upon those ideas, the faster your organization will innovate.
One powerful tool helping organizations build fast iteration into their processes is the use of digital twins—detailed digital models of physical objects and processes that allow for big ideas to be tested at low cost.
Researchers at Oklahoma State University’s Computational Biofluidics and Biomechanics Laboratory have used digital twin models to optimize the delivery efficiency of aerosol medications. At the systems level, consultancy GE Healthcare recently teamed with Tampa General Hospital to launch the CareComm clinical command center, which leverages a digital twin of the hospital to predict patient needs and lower costs. Models like these significantly reduce the cost to try for innovative ideas leveraging patient data.
