Archives for April 2015

Quotable: Healthloop Founder Jordan Shlain’s Advice for Entrepreneurs & More

who-we-help-hero-2xDr. Jordan Shlain founded Healthloop, a cloud-based platform that automates follow-up care so doctors can check in on patients in-between visits. In a new LinkedIn post, he shares the transcript  of an interview he completed with the Health Data Consortium out of Washington, DC. The wide-ranging post “Nuance. Health. Digital. Language. Innovation. Humanity. Data” brings together all these different topics into a thought-provoking piece on the intersection of language and health, data response curves, and more. Below, an excerpt featuring his advice for entrepreneurs:

With HealthLoop, it was an inside-out solution. I’m a doctor, and I solved a problem for myself and other doctors – on the inside of the healthcare system. The advice I would give to entrepreneurs is to make sure you talk to clinicians before you build something and that, if they agree it’s a good idea, they’ll also test it for you. Many smart, talented entrepreneurs start with ‘I see a problem, it happened to me (or my mother) and I’m going to fix it.’ The problem here is that they don’t appreciate how complex and intertwined healthcare is. John Muir once said, “When you tug on a single thing in nature, you realize it’s connected with everything else”. The same is true for health IT. Many of the outsiders trying the outside-in approach run into the issue that, when they try solve one problem in healthcare, that creates four more.

Also, with a healthcare system that is overwhelmed by meaningful use, ACOs, penalties and regulations, doctors don’t want to juggle something new if it’s one more thing to do. It’s not that your product isn’t great, but changing healthcare is like trying to change a tire on a moving car. Unless if you have a champion internally, it will be hard to get anything going. If you choose to go into an incubator or accelerator program, make sure they have a proven track record of getting products into a clinical practice in some meaningful way. However, once you get in and you break into a health system, your product is automatically legacy, and once you’re legacy, people don’t want to get rid of you because they’ve already made the investment in the switch. Nothing goes viral in healthcare. Things go super slowly, and you have to have a realistic time horizon. Things don’t go viral in healthcare like they do in the rest of the internet, they go bacterial. Slow and steady.

Read the full post here.

CEB Field Report: The Employers’ Role in Healthcare Transformation

This morning, San Francisco-based Oliver Wyman partner and former high-tech entrepreneur Sam Glick presented at the 69th Annual Council on Employee Benefits Conference, where more than 100 of the largest US employers were represented. The assembled crowd of senior benefits professionals are on the front lines of health benefits, overseeing $30B+ in healthcare spending every year. Glick shares highlights from his presentation above and what he gleaned from the room’s engaged audience below:

For better or for worse, despite all of the transformation happening in healthcare, employers remain the primary patrons of the US healthcare industry.  Nearly 50% of Americans receive healthcare through an employer.  Health insurers compete aggressively to woo employer groups away from the competition, and wellness innovators see employers as their ticket to success.  Most healthcare providers operate a Robin Hood business model, where employers fill the coffers, Medicare fills the beds, and Medicaid serves the mission.

Yet (with a few notable exceptions), historically employers have viewed themselves as passive recipients of what the market has to offer.  They tweaked their plan designs every year, ran RFP processes to make sure they were getting competitive pricing, and did their best to keep up with the competition in terms of the benefits they provided.  This is changing rapidly.  The group of senior benefits leaders I met today are under too much cost pressure, are in too tight of talent markets, and care too much about their employees to sit by idly and wait for the market to transform around them.

This morning, I asked how many organizations knew what their population pyramids looked like, and about a quarter of the hands in the room were raised.  This is far too low – but it’s double the number of hands I saw when I asked the same question last year.  I asked how many executives felt they got a positive ROI on the money they spent on wellness services, employee engagement tools, and the like.  Not a single hand was raised.  How much longer do you think they’ll be willing to put up with spending money on services that don’t generate a return for them?

The time for everyone in the industry – from insurers to healthcare systems to startup innovators – to begin engaging employers in a more strategic way is now.  They’re ready to take a more active role in the transformation, and they need real partners – not vendors – to help them do it.  If you don’t have an employer strategy based around meaningful partnership, now is the time to build one.

ACO Buzz: Program Reforms Needed to Encourage Expansion

NYC-MKT08001-066_exhibit-5-mapOliver Wyman’s latest ACO Update report found that almost 70 percent of Americans now have access to accountable care organizations. The next step in the evolution of the model, says report author Niyum Gandhi, are program reforms that allow the best ACOs to invest in expanding. More on his take on accountable care trends below:

  • How do you interpret the latest ACO figures?
    The slowdown we’re seeing in the growth of ACOs was almost inevitable, given the pace of change of the past two years. I expect the next advance will be characterized more by increased sophistication than by increased numbers. A handful of the best ACOs are likely to find themselves with the data to prove that they really do deliver superior, lower-cost care—and will have the capital to invest in expansion. Traditional healthcare doesn’t provide very good value. It’ll be interesting to see what happens when patients have a compelling alternative.
  • Isn’t this taking longer than it was supposed to?
    Not really. People often fail to understand that payment reform only takes you so far. There are organizations out there that are trying to hit their cost reduction targets entirely by shifting sites of service or limiting expensive diagnostics. While that is important in the short run, in the long run, you need more. You need care models designed to meet the needs of specific patient populations—diabetics, frail elders, patients with multiple chronic diseases—and it takes time and money to build them.
  • Medicare has announced that it wants to change the rules for ACOs. How does that fit in?
    CMS has been learning along the way, much as ACOs themselves have been. Many people—including the most effective ACOs—believe CMS erred too much on the side of rewarding improvement rather than efficiency, while simultaneously structuring the program in a way that made knowing your improvement target difficult. The new rules make the program more sustainable and add some balance so strong ACOs can realize shared savings.

A handful of the best ACOs are likely to find themselves with the data to prove that they really do deliver superior, lower-cost care—and will have the capital to invest in expansion. – Oliver Wyman’s Niyum Gandhi

In the News: CMO Bruce Hamory on Healthcare Staffing Shortage

employee-health-planThe Society for Human Resource Management (SHRM), the world’s largest HR membership organization, featured interviews with Oliver Wyman’s Chief Medical Officer Bruce Hamory and Mercer colleague Tom Flannery in the article “Health Care Staffing Shortage Predicted to Get Worse Under ACA.”

The Association of American Medical Colleges has projected a shortage of 30,000 primary care doctors in the coming years, Hamory noted. “There has been a relative shortage of regular care physicians for a long time and it’s anticipated to get worse, with or without the ACA,” he said, explaining that an influx of new patients, doctor burnout, and a need for new IT skills are contributing to the challenging staffing environment.

“There are new skill sets as part of all the changes going on, which are needed for all of the people in healthcare, not just physicians,” Hamory told SHRM. “There’s a huge sea change in the way healthcare is delivered, both at a primary care level and a specialty level.”

Flannery, a partner specializing in healthcare at HR consulting firm Mercer, pointed out that another challenge is an economic one: “One of the reasons primary care does not have sufficient numbers of practitioners are primary care physicians are not paid as well as specialists.”

Read the full article here.

By the Tweets: #integrationpioneers Gather in London for International Care Models Conference

CDRRtoHWMAAC49rInternational healthcare experts gathered in London earlier today to share on-the-ground experiences of leading care model transformation. The International Care Models Conference was facilitated by Oliver Wyman in association with the UK’s Integrated Care Pioneer Programme, which develops innovative ways to coordinate care around people’s needs. An introduction to patient-centered care and reflections on the journey so far were shared by Martin McShane, National Director for Patients with Long Term Conditions (LTCs), NHS England; Oliver Wyman’s Andrew Chadwick-Jones and Craig Samitt; and Jonathan Higman, Director of Urgent Care and LTCs, Yeovil District Hospital.

The fundamental building blocks of integrated care models were presented by innovators in the midst of scaling new approaches across the globe. Iora Health CEO Dr. Rushika Fernandopulle described his team’s enhanced primary care model, while CareMore CMO Dr. Sachin Jain explained how the Extensivist care model can effectively respond to the needs of the “sickest of the sick.” Cornerstone Health Care CEO Dr. Grace Terrell addressed leadership challenges and embedding new care models, noting that “a strategy without leadership will fail.” Southcentral Foundation’s CEO Dr. Katherine Gottlieb offered a number of out-of-the-box solutions for system level evolution, with a focus on incorporating the unique values of its native Alaskan community. And David Meates, CEO of the Canterbury District Health Board, showed how his New Zealand team is driving change from the ground up by emphasizing care at home and timely community service input.

Highlights from the active Twitter conversation below:

[Read more…]

Slide Show: Accountable Care Within Reach of 15-17% of Americans

NYC-MKT08001-066_exhibit-5-map

Despite well-publicized departures from Medicare’s Pioneer ACO Program, the number of accountable care organizations (ACOs) continued to rise in the past year, though at a slower pace than in 2013. Almost 70 percent of the U.S. population now lives in localities served by accountable care organizations, and 44 percent live in areas served by two or more.

The figures come from a new Oliver Wyman report “ACO Update: A Slower Pace of Growth,” based on the Department of Health and Human Services’ announcement of the latest class of ACOs approved to participate in Medicare’s ACO programs. The latest round of approvals in January brings the total of Medicare ACOs to 426, up from 368 in January 2014 and 134 in 2013. Oliver Wyman has identified an additional 159 ACOs, bringing the estimated total to 585, up 12 percent from previous year.

As the above slide shows, access to ACOs differs considerably by state—and within states—but in the most recent analysis, a majority of the population in more than half of the U.S. could receive their care from an ACO.

“The slowdown we’re seeing in the growth of ACOs was almost inevitable, given the pace of change of the past two years,” says report author Niyum Gandhi, one of the firm’s experts on ACOs. “The next big spurt will be more in effectiveness and sophistication than it will be in growth in numbers of ACOs.” Gandhi also cites that the changes to the rules that CMS proposed this past winter, especially the Next Generation ACO model, could give ACOs the boost they need to compete more aggressively.

Read the full report here.

Experience Innovation: Solving Consumer Hassles in Healthcare

Helen Leis, a Health & Life Sciences partner at Oliver Wyman, says her understanding of health innovation is grounded in a deep understanding of consumers. Through visits with consumers in their homes and discussions with them about their health and healthcare concerns, she has found that people’s conditions are far more complex than their apparent symptoms often are.

“Many people do not recognize the patterns in their lives, do not understand the cause and effect relationships between nutrition, physical activity, and health,” she observes, adding that many also “do not believe they need to change and do not believe they have the resources (time and/or money) and support available to achieve their goals, or make a new lifestyle a reality.” Above, she shares a summary of her recent findings on consumer hassles and the best approaches to solving them.

For more on experience innovation, read her earlier post “Creating Transformative Consumer Experiences: Make It Magnetic.”

In the News: Dr. Marty Makary on Whether Hospital Monopolies Are Good for Healthcare

Dr. Marty Makary – author of “Unaccountable,” a surgeon at Johns Hopkins Hospital, and professor of health policy at the Johns Hopkins Bloomberg School of Public Health – argues in an opinion piece for the Wall Street Journal that a record number of hospital mergers and acquisitions is likely to lead to higher prices. In “The ObamaCare Effect: Hospital Monopolies,” he lays out the threats and opportunities that an active hospital consolidation market presents. An excerpt below:

As a busy surgeon, I have serious concerns about the race to consolidate America’s hospitals because of the risk that very large organizations may govern without valuing the wisdom of their front-line employees. Already many doctors are frustrated by the electronic medical records, strategic planning and hospital processes that they feel have marginalized their medical insights into their own patients.

We can encourage the good work of hospitals to create networks of coordinated care, while at the same time insist that hospitals compete on price and quality outcomes. Achieving this balance in the wake of the Affordable Care Act is critical to ensure that one-fifth of the U.S. economy functions in a competitive and competent market.

Read the full opinion piece here. Above, view Makary speaking on healthcare’s transparency revolution at the 2014 Oliver Wyman Health Innovation Summit.

#HIMSS15: Harbinger of HIT Bubble or of Boundless Innovation?

Source: HIMSS

Source: HIMSS

Oliver Wyman’s Charlie Hoban and Steve Filler were among the more than 38,000 healthcare IT professionals, clinicians, and executives from around the world who converged in Chicago this week for the 2015 Annual HIMSS Conference & Exhibition. Keynote speakers included Walgreens President Alex Gourlay, Humana CEO Bruce Broussard, and National Coordinator for Health Information Technology Karen DeSalvo. More than 1,200 health IT vendors lined the McCormick Place Convention Center, prompting speculation from Hoban that either a tech bubble is about to burst or a ton of innovation is on the verge of adoption, with many more waves to come. “Maybe both,” he concluded. More takeaways from our team plus some social media highlights below:

  • Consumer engagement as discussed at HIMSS is still mostly from the provider out. The solutions typically begin with the idea of the patient portal and then extend communication and touchpoints around that. Very few ideas were presented that really are focused on engaging the consumer in their broader set of needs, motivations, and behaviors in the 95% of their lives spent when they are not accessing healthcare. The big consumer companies weren’t really as present as they need to be.
  • Analytics and population health management are becoming meaningless phrases. The IT industry isn’t helping customers sort this out, instead it is confusing and conflating the issues by throwing everything into a big messy soup. Industry associations haven’t really stepped up in this regard either. Was also hard to find solutions that connect the dots between the big-picture transformation change agendas and the health IT tools needed to accompany and facilitate them.
  • The large electronic medical record (EMR) play is officially slowing down significantly. Each of the big players mentioned a major slowdown in the large system transformations. Notably, not all of the EMR vendors can meet the Stage 2 meaningful use standards. Those that can really pushed this as integrated into the clinical workflows.

ICYMI: StartUp Health Now Features Lisa Suennen on State of Digital Health Accelerators

Venture capitalist and digital health expert Lisa Suennen shares the highlights from her report on the state of digital health accelerators published by the California HealthCare Foundation. Read the full report here. Access the full StartUp Health Now video podcast series here.