By Juan Pablo Segura, president and co-founder, Babyscripts.
In a crisis, finding the “right” solution is much less important than finding the “right now” solution. During the COVID-19 pandemic, clinical practices scrambled to quickly transition care out of the office, with some practices fully turning over to virtual strategies in the course of a single weekend — and they used whatever means available to do so.
Relaxed HIPAA restrictions and expanded CPT codes made it easier for practices to leverage the tools at hand to help with remote delivery of care — whether it was using the EMR to patch together messaging or collect vitals or Facetime and Zoom to get video visits off the ground — the boomerang went out to the market to capture a solution simply to plug the hole in the dike.
But now that the crisis has abated, leaders are turning their attention away from quick fixes to think about the long-term sustainability of pandemic solutions.
Physician buy-in is no longer the challenge that it was — the urgency for virtual solutions in the face of the pandemic leapt that barrier, and the success of remote care for managing patients through the crisis proved its value. Covid-19 has accelerated a massive behavioral change around digital health — providers are more willing to prescribe it, and patients even more receptive to using it.
In order not to lose these massive gains in digital adoption and changing mindsets, though, leaders need to think more holistically about digital health and virtual care. They need to consider and address questions of scale and ease of use. Makeshift solutions like drive-through blood pressure measurements worked in a pinch, but how do they function when the weather changes? When people can’t take off work?
Leaders know that efficiency and optimization is crucial to clawing back margin and to transition away from massive losses. So, in response to these changes, a few thoughts:
A major subject of concern amidst the ongoing coronavirus pandemic spread and related financial crisis is- could this situation be the trigger for a new era of technology and emergence of widespread acclamation of digital health platforms and applications?
The massive outbreak of dreaded coronavirus has brought about a radical change in what is usually perceived as “normal.” With over more than million cases worldwide, COVID-19 has sent a wave of fear across the masses, causing an upheaval not only in their lives but also across various economies and businesses, given the stringent lockdown policies.
Major industry verticals have been touted to be severely affected by the pandemic explosion. However, one of the industries that has been successful in keeping its business alive amid the ongoing financial crisis is the digital health market. The corona pandemic has demonstrated the pivotal role of digital health in the medical fraternity. Although digital health was already on the rise before the humongous pandemic spread, in the wake of the virus, it will become an integral part of the routine medical treatment in the years ahead.
At this time, digital health stands as an ideal solution for both the healthcare professionals and patients as it completely reduces the risk of infection spread while offering complete and accurate healthcare expertise. While the global scientific community is racing towards development of effective vaccines or therapeutics, digital health remains the most essential defense.
The proliferation of artificial intelligence, cutting-edge technologies, and big-data have been majorly responsible for advancing digital health and are expected to drive the demand for the same over the next few years. COVID-19 undeniably, is anticipated to stay for a longer period of time due to delay in proper treatment methods and vaccines.
In this scenario, numerous tech firms are trying to get involved in digital health while undertaking various distinctive measures. For instance, IBM, a tech giant, in March, announced the launch of coronavirus map and application for keeping a track of COVID-19 infections.
According to official sources, the company’s The Weather Channel has introduced new tools for tracking coronavirus infection. The app would showcase estimated COVID-19 cases on the map that would further help individuals and business establishments to keep a track on the spread of virus around them. Above that, the free tools are likely to run on the IBM public cloud and implement IBM Watson with an intent of scrutinizing data from the WHO in tandem with state and national government bodies.
Even before the outbreak, digital technology was at peak in China and was extensively used to accelerate, optimize, and complement health care services, which enabled the region to make use of these in difficult times like the ongoing health crisis.
By Matt Henry, senior manager consultant, Denver, Point B; Talia Avci, managing consultant, Chicago, Point B; and Ashley Fagerlie, managing consultant, Phoenix, Point B.
As the COVID-19 crisis disrupts traditional care delivery, digital tools such as telehealth are making it possible to deliver care outside your facility’s walls. Here’s how to prepare your organization both now and in the future.
Amidst the COVID-19 pandemic, healthcare has literally left the building. With millions of Americans under orders to stay home, in-person care delivery and elective procedures have been effectively shut down, elevating the need for alternative care delivery options.
Health systems are in a crisis, balancing heroic action to ramp up and support their communities through the COVID pandemic with existential threats to established service line revenue and cost structures. The importance of using technology to extend reach and effectiveness of your mission has never been greater.
While other industries have spent years disrupting traditional operating models to deliver online engagement to meet customer needs, healthcare has lagged due to many practical, economic, regulatory, cultural and quality of care reasons.
As health systems prepared for a surge in infectious patients, many have leveraged their digital front door as a way to deliver credible information, guide care, and deliver safe and effective services to patients.
Taking lessons learned, the time is now to plan for your post-COVID plans and how your digital front door can extend your mission as you intentionally re-open your care facilities.
Re-imagine access: As you build your strategy, consider how new front door solutions are being offered by non-traditional ‘providers’, like Anthem, Walgreens and CVS/Aetna, to address gaps in the primary care landscape.
These gaps include inaccurate online health information, lack of access to personal health information, long wait times for appointments, lack of price transparency and other issues that impact patients along their care journey.
Barriers can be addressed by tools that assist in triaging, medication adherence, capacity management as well as two-way patient communication via websites, patient portals and apps.
Anthem has partnered with a digital health start-up, K Health, to offer symptom triaging to their 40 million members to provide care guidance and access. Members provide their symptoms to an AI-enabled algorithm and can text directly with providers for advice. Walgreens, with locations that are accessible by 78% of the U.S. population, has launched Find Care, which offers everything from lab tests to virtual consults.
CVS/Aetna has spent nearly 10 years building out digital health tools, focusing on medication adherence, with the power to leverage data as a pharmacy, payer and retail clinic to connect with their patients. Other organizations are launching chat bots for assessments and triage or more deeply leveraging remote patient monitoring for care. Each of these digital front door tools is changing how patients access care.
Mental health affects everyone at some point in our lives. A commonly quoted statistic in the UK is that one in four people suffer the impact of mental ill health. In the U.S., 80 percent of workers experience stress at some point every day, and anxiety and depression cost the world $1 trillion in lost productivity annually.
Once taboo, mental health is talked about more frequently and openly than ever before. From Hollywood celebrities to the British royal family, the impact and treatment for the global mental health crisis we are currently living through is rarely out of the news.
Young men, in particular, are being encouraged to talk more openly. Poor mental health, when it goes unchecked, can have a serious impact on overall well-being, physical health, relationships, work, productivity, absenteeism, money, and it can result in suicide. In the UK, suicide is the biggest killer of men under 45.
As a result, governments and healthcare providers need to find new ways to deliver mental health services. Digital healthcare solutions, including smartphone apps, are some of the most common ways to support those who need and want to access more help and support.
Damo Consulting, a healthcare growth and digital transformation advisory firm based in Chicago, recently released its third annual Healthcare IT Demand Survey report. The report indicates technology vendors will continue to struggle with long sales cycles as they aggressively market digital and AI. For the second year in a row, the rise of non-traditional players, such as Amazon and Google, will have a strong impact on the competitive environment among technology vendors while EHR vendors grow in dominance.
Top spending priorities for healthcare executives are digital, advanced analytics and AI. However, spending on EHR systems will dominate technology spending budget in 2019. Healthcare executives continue to be confused by the buzz around AI and digital and struggle to make sense of the changing landscape of who is playing what role and the blurred lines of capabilities and competition.
“Digital and AI are emerging as critical areas for technology spend among healthcare enterprises in 2019. However, healthcare executives are realistic around their technology needs vs. their need to improve care delivery. They find the currently available digital health solutions in the market are not very mature,” says Paddy Padmanabhan, CEO Damo Consulting. “However, they are also more upbeat about the overall IT spend growth than their technology vendors.”
The top spending priorities for healthcare executives are digital, advanced analytics, and AI. EHR systems will dominate technology spending budgets, even as the focus turns to digital analytics.
IT budgets are expected to grow by 20% or more. Healthcare executives are more upbeat about IT spend growth than vendors.
Healthcare executives say they are confused by the buzz around AI and digital. They are also struggling to make sense of the changing landscape of who is playing what role and the blurred lines of capabilities and competition.
Cybersecurity issues are a challenge for 2019 in the healthcare sector, but not the biggest driver of technology spending or the top area of focus for health systems in 2019.
The CIO remains the most important buyer for technology vendors, however IT budgets are now sitting with multiple stakeholders.
The biggest challenge for technology vendors is long cycles, along with product/service differentiation and brand visibility.
The rise of non-traditional players, such as Amazon, Apple, and Google will have a strong impact on the competitive healthcare technology environment. Deeply entrenched EHR vendors such as Epic and Cerner will grow in dominance.
In his keynote session at the DreamIt conference in Tampa, November 6, 2018, Sumit Kimar Nagpal, global lead of digital health strategy at Accenture, says the future of healthcare is about a few simple things: Keeping people safe, providing for their well-being and improving care via information and technology.
Sounds simple, but guess what? Traditional players in healthcare are simply not ready, he said. Before explaining why, he painted a portrait of the current landscape and what he expects to come.
First, the current marketplace is all about cost then “innovation,” “agility,” “convenience,” and even the supposed “patient experience.” Cost, however, is likely the single most important issue in healthcare, he said, citing its 18 percent of the US GDP. There a lot of talk about convenience and collaboration, but what’s the outcomes? he asked.
Cost is the biggest driver. It’s a “cost takeout” marketplace, which is dominated by back office optimization. In other words, reduce costs through back office efficiency controls and strategies to save health systems money.
However, there are three important mega trends in healthcare related to the individual consumer. We are aging as a population; we are living longer; and we are facing more long-term conditions. All of this is surrounded by consumerism or the consumer experience and what that means to their health.
Another major transformation is that care is shifting in its location. There is a shift of care to the retail setting, for example, out of the four walls traditionally known in healthcare, for earlier engagement of care in the areas where people live, work and play. This even means that experiences are moving online, into the home and into the community setting.
Those who give us care is changing, too, he said. We’re used to seeing a doctor or a family care provider in an office at a practice, but that is quickly shifting. Care teams are extending well beyond the doctor into retail pharmacists, friends and family, teleconsultations, visiting nurses and social workers and “Dr. AI” and “Dr. Google.
“We’re building a very different relationship with technology to help us decide what’s next and what we have as a condition. This is all about taking down the silos and the four walls, and includes deep, mass personalization,” he said.
In the U.S., more than a third of patients are referred to a specialist each year, and specialist visits constitute more than half of outpatient visits. Referrals are the link that make this connection between primary and specialty care. From 1999 through 2009 alone, the absolute number of visits resulting in a physician referral increased 159 percent nationally, from 41 million to 105 million. This volume and the frequency of specialty referrals has steadily increased over the years and will only continue. Yet despite this rise in frequency, the referral process itself has been a great frustration for years.
Specialty referrals are a complicated business. There are many moving parts and players that all have a crucial role to play within the process. By breaking it down and looking at exactly what a referral is, who is involved, and the challenges they face, we can then look to fix what is broken. What needs to be improved? And could there be a digital solution?
Let’s start from the very beginning by looking at the stakeholders and their unique interests and concerns.
Patient – The patient experiences a health concern and needs care to get it resolved. The primary physician doesn’t provide the full solution and refers them to a specialist with more expertise about the patient’s condition. This is where the referral occurs. Currently, the extent of the referral is the physician handing a phone number to the patient to call and schedule the appointment. It’s up to the patient to contact the specialist and follow through with the next step, which explains why 20 percent of patients never even schedule the referral appointment.
Provider –There is more than one provider involved in the referral process. First is the referring (or sending) provider and then the target (or receiving) provider. The referring physician is the provider recommending (referring) them to a specialist. The target provider is the specialist that has been recommended. For a health system or physician group, there are obvious financial and quality of care benefits associated when a patient is sent to a trusted provider within network. When patients don’t go to their referral appointment, the health system or physician group loses in several ways. First of all, they have lost control over providing comprehensive care to the patient. If a patient gets readmitted to a hospital because of their negligence to follow through on a referral appointment, the health system gets penalized for the readmission. The penalty could result in CMS withholding up to 3 percent of the funding provided to the health system. The system also suffers in terms of the perception of their quality of care. If a patient is not secured with a provider within network, they may go to a competing system.
Plan – Health plans have several important considerations when a referral happens with a vested interest on three fronts to ensure the patient goes to the target provider:
1) The health plan benefits if the patient goes to a target provider within their network. Not only will patients be directed to providers that best meet their needs, but the plan also benefits when patients are referred to the providers in their Smart Network. These providers are trusted for superior care for the patient and reduced costs for the plan.
2) When a plan member doesn’t get the care they need to maintain good health, their likelihood of having major adverse events rises dramatically. This means they will end up in the ER or needing other expensive care, which represents big costs for the health plan.
3) The current approach to referrals often results in long lead times, which makes for a poor patient experience and can increase costs.
Guest post by Todd Greenwood, PhD, MPH, director of digital strategy, and Benjamin Dean, digital and business strategist, Medullan.
Once upon a time, all that pharmaceutical companies had to do to get their drugs on formulary was to package their clinical data and convince payers that their products performed better (or better enough) in clinical trials. Contracts were struck and the revenues flowed. For most new specialty drugs, those days are now history.
With the average retail price of a specialty drug used on a chronic basis exceeding $53,000 (according to an AARP study), nearly 200 times the average price of generics, payers are demanding that pharmaceutical companies make data-driven, value-based cases before access is granted. Even when payers are convinced , they build stipulations into value-based contracts that require manufacturers to prove that outcomes are being met with their covered lives, or else the pharmaceutical company will face additional penalties or further restrictions.
This all means that the data that manufacturers have used to drive regulatory approval are insufficient for garnering payer formulary access. Companies are being required to prove that their drugs work in the real world – not just within the carefully controlled environment of a clinical study. Across therapeutic areas from osteoporosis to oncology, payers have and are currently using real world evidence studies to define their formularies. Payers want to know how expensive specialty drugs will perform as patients adhere to (or in most cases don’t adhere to) their medications, and outside of the rarified air of a traditional clinical trial.
Equally importantly, payers want to know how drugs affect the most important (and most expensive) health outcomes. Clinical data showing that a drug performed some percentage better than either a category leader or a placebo is now insufficient for new specialty drugs. Instead, payers need to know how health outcomes improved and how effective the drugs were at keeping patients out of the hospital and away from the catastrophic costs.
While it may sound easy, providing this kind of data is far from simple. Clinical trial data is controlled, clean and contained. Surveillance data (AKA real-world data) is a different beast, because patients are complicated. We have multiple conditions, take multiple medications, and we are inconsistent, rarely complying with our doctors’ orders. Moreover, the outcomes that payers care about – hospitalization, disability and death – can be difficult to distill. The data needs to be compiled from a variety of sources: medical and prescription drug claims, electronic health records, the lab (genomic and pathology data) and directly from the patient. Compounded with this, different populations of patients have different risks, and comparing one to another is fraught with difficulty. Finally, real world data can take time to accumulate. In order to know if a drug is working “in the wild”, researchers need to follow enough patients, for long enough, to observe negative health events of interest.
Take, for example, the new class of hyperlipidemia drugs, PCSK9-inhibitors. These injection drugs have been shown to cut LDL cholesterol levels in half, compared with about a 20 percent reduction for statin-class drugs like Zetia. But given the high price of these drugs ($14,000 per year in the US) plus their potential to be prescribed to a significant percentage of the population, payers have largely refused an access foothold. Payer organizations in the US and around the world are asking the same question: how well do these drugs work in real patient populations and to what end? Given that these drugs will be sanctioned for high-risk patients (many of whom will continue to use statin class drugs as combination therapy), payers are concerned about adherence, and ultimately if there is lower cardiac risk and fewer related cardiac events in patient populations. Many economists are asking: can’t we achieve the same ends for far less money by getting patients to adhere more faithfully to their statins?
The need is clear: pharma companies who have invested significantly to develop and launch new specialty drugs have to prove their worth with real world data. But in markets like the US, where providers are typically siloed and disconnected, it’s challenging to capture patient-level condition and drug utilization data, and effectively append it with hospitalizations, other outcomes evidence and costs in order to develop a complete picture.
But there’s hope. As the specialty drug market begins to shift to a value-based model, new ways of tracking real-world usage and connecting it to outcomes are emerging. This is where digital health is poised to play a critical role.
The image provides a pretty concise view on some of the prevailing thoughts on the use of consumer’s mobile technology and how perceptions of the technology might potentially improve patient outcomes.
Not surprising, one third of smart phone users look up health information on their devices via the web. Most surprising to me, though, is that according to the graphic, 25 percent of low-income adults own a smartphone; I shouldn’t be surprised given people’s passion for the latest devices. Hopefully, though, this will help improve their care and outcomes, individuals who, of course, would likely fall into the class of people most likely needing care but not receiving it or receiving it through non-traditional means.
If nothing else, as Aetna suggests through the image is that technology and personal devices may allow greater access to care and to information to improve care.
Such technology, and its use, is clearly the future of individual care and actionable outcomes for individuals. I only wonder what it will take to harness and implement real programs that help real people received sustainable care and guidance at the individual level, and how long it will take to become wide spread