Growing where you are already planted

Kristin Rodriguez, Health Plan Alliance, June 24, 2019

 

Dan Michelson, CEO of Strata Decision believes integrated delivery systems need to shift their focus from buying and building hospitals to leveraging their existing platforms to generate growth and often more profitable streams of revenue.  This creates the ability for delivery systems to become a hub for health and healthcare in the future.

What needs to occur for this transformation to take place? 

In an article published in Becker's Hospital Review recapping the 2019 JP Morgan Healthcare Conference, Michelson outlines six ideas for integrated delivery systems to get started on leveraging their existing platform.  Each represents a formidable challenge, but if we work together and take advantage of resources available to us, we can start moving in the right direction.

1. Embrace the digital front door: Healthcare providers have long excelled at building relationships and trust once consumers walk into our hospitals and clinics.  We need to harness the ability to create that same meaningful relationship, without limiting ourselves to a physical location.  
   
   Benjamin Isgur, Health Research Institute Leader at PwC Health Research Institute, echoes this advice.  At the recent Alliance Spring Leadership Forum, he underscored that Private Equity investors are particularly interested in anything that gets closer to the consumer.  And consumers themselves are eager for a new era of care delivery, with new venues and new menu options.  If we don't offer consumers a more convenient alternative, someone else will. 
2. Get serious about affordability: This isn’t just about transparency or about reallocating resources more thoughtfully.  It is bigger than combining clinical and financial data.  The healthcare cost problem is huge and policymakers, drug manufacturers, insurers, delivery providers and consumers all play a role.
   
   It's important we avoid the danger that is “everyone’s problem” becoming “no one’s problem.”  As part of integrated systems, Alliance members are particularly well positioned to get a strong line of sight on this challenge.
3. Don't just provide, prevent: Michelson points to the “strong strategic rationale associated with taking on a broader role of driving health versus only providing healthcare” in the communities we serve.  Policymakers understand this too; Medicaid and Medicare Advantage plans are encouraged more and more toward payment models and benefit design approaches that take on more than just clinical care.
   
   Just a few themes in the government-sponsored care space include VBID, telehealth, benefit flexibility, and behavioral health integration, all of which present unique opportunities to leverage the network, venues of care, community partnerships, and more to reimagine the system’s role in the local healthcare landscape.
4. Partner to innovate, or miss out: Becoming a hub isn’t just about the digital front door or food farmacies. It also means creating a space for innovators to gather, where research and education can occur so that ongoing evolution becomes a core competency of the system.
5. Target chronic conditions and specific services: This builds on the center of excellence model in profound ways.  Systems that craft a powerful experience for specific chronic conditions or targeted services stand a better chance of maintaining a relationship with those consumers.  Michelson notes that this is both an opportunity and a threat for integrated systems, as we compete more and more with new platforms gaining competency in serving chronic conditions, like those of CVS Health and Walgreens. 
6. Don’t just aggregate data – use it:  An Alliance member and informatics leader said that he envisions the day when his informatics teams can stop being data archeologists and can instead be data analysts.  The truth is that integrated systems are still solidifying their competency as data aggregators.  But it’s not enough.  It’s time to turn our attention to applied analytics: practical data sets that provide decision support so that we can gain better insights and pivot our platforms even faster.

With payers big and small across the country, the Alliance member network is a veritable think tank for executives wrestling these questions and challenges.  Join us and work elbow to elbow with your peers at our upcoming events designed exclusively for Alliance organization leaders. You can also meet and hear from Dan Michelson at the Fall Leadership Forum 2019.

The Health Tech Our Toddlers Should Never Know

by Kim Bellard, May 23, 2019

Joanna Stern wrote a fun article for The Wall Street Journal: "The Tech My Toddler Will Never Know: Six Gadgets Headed for the Graveyard."  My immediate thought was about health tech's equivalent list.  There certainly is a lot of health tech that should be headed to the graveyard, but, knowing healthcare's propensity to hang on to its technology way too long, I had to modify her more optimistic headline to say "should" instead of "will."

One can always hope.  Here's my healthcare tech list:

1.  Faxes:  You knew it had to be at the top of the list.  Anyone under thirty who knows how to work a fax machine probably works in healthcare.  The reason faxes persist is because they supposedly offer some security advantages, but one suspects inertia plays at least a big a role. There are other options that can be equally "secure," while making the information digital. 

2.  Phone Trees:  We've all had to call healthcare organizations -- doctors' offices, testing facility, health plans, etc.  Most times, you first have to navigate a series of prompts to help specify why you are calling, presumably to get you closer to the right person.  There are probably studies that show it saves money for the companies that use them, and perhaps some that even claim its saves customers time, but this is not a technology most people like. By 2030 I want my AI -- Alexa, Siri, etc. -- to deal directly with the companies' AI to spare me from phone trees. 

3.  Multiple health records: I have at least five distinct health records that I know of, only two of which communicate to the other at all.  For people with more doctors and/or more complex health issues, I'm sure the situation is even worse.  EHRs are old technology, the cable of healthcare.  By 2030, we should each have a single health record that reflects the broad range of our health.

4.  Stethoscopes:   You've seen them. Your doctor probably has one.  Find the oldest photographs of doctors that exist and you might find them with stethoscopes; they are that old.” It's not that they are useless, but as it is that there are better alternatives, such as handheld ultrasounds or even smartphone apps.  For Pete's sake, people are working on real-life tricorders.   By 2030, seriously, can we be using its 21st century alternatives?  

5.  Endoscopes: Perhaps you've had a colonoscopy or other endoscopic procedure; not much fun, right?  We do a lot of them, they cost a lot of money (at least, in the U.S.), and they involve some impressive technology, but they're outdated. By 2030, we should be using things like ingestible pill cameras, with ingestible robots to take any needed samples or even conduct any microsurgery. 

6.  Chemotherapy: Chemotherapy is literally a lifesaver for many cancer patients, and a life-extender for many others.  We're constantly getting new breakthroughs in it, allowing more remissions or more months of life.  But it can pose a terrible burden -- physically, emotionally, and financially -- on the people getting it.  Chemotherapy has been likened to carpet bombing, with significant collateral damage.  Increasingly, there are alternatives that are more like "smart bombing" -- precision strikes that target only cancer cells, either killing or inhibiting them.  By 2030, perhaps cancer patients won't fear the treatments almost as much as the cancer.

Healthcare certainly has no shortage of technology that we should hope today's toddlers will never have to use or experience.  The above are just six suggestions, and you may have your own examples.  We can make these happen, by 2030; the question is, will we?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting.

Robots Need DNA Too

by Kim Bellard, April 22, 2019 

DNA, it seems, never ceases to amaze. Now scientists are using it to create new kinds of "lifelike" mechanisms.   Pandora, we may have found your box. 

Researchers from Cornell recently reported on their advances.  They used something called DASH -- DNA-based Assembly and Synthesis of Hierarchical -- to create "a DNA material with capabilities of metabolism, in addition to self-assembly and organization – three key traits of life."

That sends chills up my spine, and not necessarily in a good way. 

Lead author Shogo Hamada elaborated:

The designs are still primitive, but they showed a new route to create dynamic machines from biomolecules. We are at a first step of building lifelike robots by artificial metabolism.  Even from a simple design, we were able to create sophisticated behaviors like racing. Artificial metabolism could open a new frontier in robotics.

The reference to racing in his quote refers to the fact their mechanisms were capable to motion -- likened to how slime mold moves -- and they literally had their "lifelike materials" racing each other.  If I'm reading the research paper correctly, the mechanisms were even capable of hindering their competitor."

Well, that's lifelike, all right.

It wasn't all days at the race track; oh-by-the-way, they also demonstrated its potential for pathogen detection, which sounds like it could prove pretty useful.

These mechanisms eat, grow, move, replicate, evolve,and die.  Dr. Luo says: "More excitingly, the use of DNA gives the whole system a self-evolutionary possibility.  That is huge."  Dr. Hamada adds: "Ultimately, the system may lead to lifelike self-reproducing machines."

Those chills are back.

There has been a lot of attention on engineering advances that will allow for nanobots, including uses with our bodies and so-called "soft robots," but we should be given equal attention to what is called synthetic biology.

Synthetic biology isn't necessarily or even predominately about creating new kinds of biology, as the researchers at Cornell are doing, but reprogramming existing forms of life. They're being programmed to eat CO2 (thus helping with global warming), help with recycling, get rid of toxic wastes, even make medicines. 

A Columbia researcher believes that new techniques for programming bacteria, for example, "will help us personalize medical treatments by creating a patient’s cancer in a dish, and rapidly identify the best therapy for the specific individual."

In the not-too-distant future, we're going to be programming lifeforms and "lifelike materials" to do our bidding at the molecular or cellular level.  We've been debating and worrying about when A.I. might become truly intelligent, even self-aware, but the Cornell research is giving us something equally profound to debate: how to draw the line between "life" and "things"?

Medicine, healthcare, and health are going to have to develop more 21st century versions.  What we've been doing will look like brute force, human-centric approaches.  Synthetic biology and molecular engineering open up new and exciting possibilities, and some of those possibilities will upend the status quo in healthcare in ways we can barely even imagine now.  

It's not going to be enough to think of new approaches.  We're going to have to find new ways to even think about those new approaches.  
  
In the meantime, let's go watch some DASH dashes!

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting. 

Do Unto Robots As You…

by Kim Bellard, January 23, 2019

It was very clever of The New York Times to feature two diametrically different perspectives on robots on the same day: Do You Take This Robot… and Why Do We Hurt Robots? They help illustrate that, as robots become more like humans in their abilities and even appearance, we’re capable of treating them just as well, and as badly, as we do each other. 

We’re going to have robots in our healthcare system (Global Market Insights forecasts assistive healthcare robots could be a $1.2b market by 2024), in our workplaces, and in our homes. How to treat them is something we’re going to have to figure out. 

Written by Alex Williams, Do You Take This Robot… focuses on people actually falling in love with (or at least prefering to be involved with) robots. The term for it is “digisexual.” 

As Professor Neil McArthur, who studies such things, explained toDiscover last year: We use the term ‘digisexuals’ to describe people who, mostly as a result of these more intense and immersive new technologies, come to prefer sexual experiences that use them, who don’t necessarily feel the need to involve a human partner, and who define their sexual identity in terms of their use of these technologies.

And it’s not just about sex. There are a number of companion robots available or in the pipeline, such as: 

• Ubtech’s Walker. The company describes it as: “Walker is your agile smart companion — an intelligent, bipedal humanoid robot that aims to one day be an indispensable part of your family.”
• Washington State University’s more prosaically named Robot Activity Support System (RAS), aimed at helping people age in place.
• Toyota’s T-HR3, part of Toyota’s drive to put a robot in every home, which sounds like Bill Gates’ 1980’s vision for PCs. 
• Intuition Robot’s “social robot” ElliQ. 
• A number of cute robot pets., such as Zoetic’s Kiki or Sony’s Aibo.

All that sounds very helpful, so why, as Jonah Engel Bromwich describes in Why Do We Hurt Robots?, do we have situations like: A hitchhiking robot was beheaded in Philadelphia. A security robot was punched to the ground in Silicon Valley. Another security bot, in San Francisco, was covered in a tarp and smeared with barbecue sauce…In a mall in Osaka, Japan, three boys beat a humanoid robot with all their strength. In Moscow, a man attacked a teaching robot named Alantim with a baseball bat, kicking it to the ground, while the robot pleaded for help.

Cognitive psychologist Agnieszka Wykowska told Mr. Bromwich that we hurt robots in much the same way we hurt each other. She noted: “So you probably very easily engage in this psychological mechanism of social ostracism because it’s an out-group member. That’s something to discuss: the dehumanization of robots even though they’re not humans.”

Robots have already gotten married, been granted citizenship, and may be granted civil rights sooner than we expect. If corporations can be “people,” we better expect that robots will be as well.

We seem to think of robots as necessarily obeying Asimov’s Three Laws of Robotics, designed to ensure that robots could cause no harm to humans, but we often forget that even in the Asimov universe in which the laws applied, humans weren’t always “safe” from robots. More importantly, that was a fictional universe.

In our universe, though, self-driving cars can kill people, factory robots can spray people with bear repellent, and robots can learn to defend themselves. So if we think we can treat robots however we like, we may find ourselves on the other end of that same treatment.

Increasingly, our health is going to depend on how well robots (and other AI) treat us. It would be nice (and, not to mention, in our best interests) if we could treat them at least considerately in return.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

In China, It’s the 21st Century

by Kim Bellard, September 21, 2018

It is 2018 everywhere, but not every country is treating being in the 21st century equally. China is rushing into it, even in healthcare, while the United States is tip-toeing its way towards the future. Especially in healthcare: Let’s look at a few examples:

5G: You may just be getting used to 4G, but 5G is right around the corner, with U.S. carriers expected to start offering networks in a few cities by the end of this year. Meanwhile, China has committed to having national 5G coverage by 2020, and the government is working closely with its private sector to spur development. U.S. wireless trade association CTIA believes China is leading the 5G race. Deloitte agrees; in a recent report, they cite reasons why China is leading, and warn that countries that adopt 5G first “are expected to experience disproportionate and compounding gains in macroeconomic benefits caused by “network effect.”’

Artificial Intelligence: Yes, the U.S. has been the leader in A.I., with some of the leading universities and tech companies working on it. That may not be enough. A year ago China announced that it intended to be the world leader in A.I. by 2025. China is far outspending the U.S. on A.I. research and infrastructure, coordinating efforts between government, research institutes, universities, and private companies. Dr. Steven White, a professor at China’s Tsinghua University, “likens the country’s succeed at all costs AI program to Russia’s Sputnik moment.” We have yet to have that wake-up call.

Quantum computing: Don’t worry if you don’t understand quantum computing; no one does. What matters is that quantum computing is literally a quantum leap above what current computing, so the first to deploy it will have unimaginable advantages. Take a guess what country is leading. Paul Stimers, the founder of the U.S. Quantum Industry Coalition, told CNN: “They [China] have a quantum satellite no one else has done, a communications network no one else has done, and workforce development program to bring new Chinese quantum engineers online. You start to say, that’s worrisome.”

Genetic research: The U.S. has been the leader in genetic research, but — you guessed it — that lead has been rapidly diminishing. Earlier this year, Eric Green, the head of the National Human Genome Research Institute told Asia Times: I do know that if you look in the last 15 years, the investment in genomics, in particular, have been more substantial in countries like China, South Korea, Singapore, and even places like Brazil. For example, the U.S. is still doing research on techniques like CRISPR, but The Wall Street Journal found that China is “racing ahead” in gene editing trials, in large part due to a more relaxed attitude towards regulation and possible ethical considerations.

When it comes to healthcare, China recognizes shortcomings of its existing system, and is rapidly trying to deploy 21st century solutions to it. China adopted a universal healthcare system in 2011 (about the same time the U.S. adopted ACA.)

Last year Fortune reported on China’s healthcare “boom,” spurred in part due to direct government investments and favorable regulatory processes. Similarly, earlier this year The New York Times noted U.S. tech companies’ interest in healthcare, but pointed out that their Chinese counterparts had already jumped in.

I don’t want to live in China, nor would I want to get my health care there. Yet. But if we don’t soon have our own “Sputnik moment” (or moments), we’re going to see the 21st century of healthcare happen in China, not here.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Consumers and Digital Technology: What’s the Deal With Healthcare?

by Clive Riddle, July 20, 2018 

The Deloitte Center for Health Solutions has just released some preliminary findings from their 2018 Survey of U.S. Health Care Consumers, which will be published in August, on the heels of their recently released Deloitte 2018 Survey of U.S. Physicians. Deloitte shares that “consumers and physicians typically agree that virtual health care holds great promise for transforming care delivery. Yet many physicians remain reluctant to embrace the technologies, worried about reimbursement, privacy and other issues.”

Thus Deloitte found consumers are well ahead of providers on the technology acceptance curve, and many providers are dragging their feet in meeting rising consumer demand in this arena. Dr. Ken Abrams, managing director, Deloitte Consulting tells us "Changes in health care reimbursement models, combined with growing consumer demand, are driving health systems to embrace virtual care, but they are struggling to get physicians on board."

The Deloitte surveys found:

• 64% of consumers and 66% physicians “cite improved patient access as the top benefit of virtual care.”
• “About half of physicians surveyed agree that virtual care supports the goals of patient-centricity, including improved patient satisfaction (52% agree) and staying connected with patients and their caregivers (45%  agree)
• “While 57% of consumers favor video-based visits, only 14% of physicians surveyed have the capability today, and just 18% of the remainder plan to add this capability.”
• “Clinicians worry about medical errors (36%) and data security and privacy (33%) associated with virtual care.”
• “Email/patient portal consultations are the most prevalent virtual care technology used by responding physicians (38%), followed by physician-to-physician consultations (17%) and virtual/video visits (14%).”

Moving beyond just virtual care, and examining the healthcare digital experience as a whole, the global brand and marketing consultancy Prophet has just released a two part report: Making the Shift, Part I Healthcare’s Transformation to Consumer-Centricity (25 pages) and Part II  A Culture Change Playbook for Healthcare Transformation (also 25 pages.) They found that “ healthcare providers, payers and pharma companies are not making significant strides toward consumer centricity despite increasing demands and competition for healthcare dollars.”

Jeff Gourdji, a partner at Prophet, tells us  “consumers want to be treated as powerful participants in their own health.  Increasingly healthcare organizations’ own bottom lines require meeting consumers halfway or more. So, it is increasingly in everyone’s best interests to make sure consumers are empowered, engaged, equipped and enabled so they become what we call the ‘e-consumer.’”

Prophet paints the picture at the start of their report like this: “With the rise of digital technology, consumers have unprecedented power. Consumers expect business categories like retail and consumer goods to provide individual experiences across both the physical and digital worlds. While other businesses are shifting their focus toward delivering meaningful and valuable consumer experiences, healthcare has largely stayed the same. And, until recently, it hasn’t had the imperative to change. However, pressures from governments and employers to lower costs and pressures from consumers to meet ever rising expectations means that driving consumer engagement and redefining how healthcare organizations interact with people is no longer a luxury, but a necessity. While healthcare organizations are feeling pressure to upgrade their consumer experience, with a focus on how to engage and empower consumers, the path to accomplishing this is unclear.”

Immediately below this intro, the next section header asks “What’s the Deal with Healthcare?” They share survey results that “81 percent of consumers are dissatisfied with their healthcare experiences, and the happiest are those who interact with the system the least.”

Some of Prophet's other survey findings include:       

• “Fewer than 10% of all healthcare organizations say they are “most willing” to partner with digital companies     
• Only 21% of respondents believe that ‘practical and important innovation is coming from digital startups’ compared to over 50% of respondents who believe this innovation is coming from providers and medical device companies         
• "Only about a quarter (27%) of surveyed companies measure relationship metrics like Net Promoter Score despite evidence that consumer metrics are critical to driving a commitment to consumer centricity.”
• "Only 15% of respondents reported a willingness to consider adding leadership from outside the industry, even when those leaders would be supported by a healthcare-savvy team.

Prophet goes on to share on elaborate on “five shifts that organizations must prioritize to reshape into more consumer-centric businesses:

1. Moving from tactical fixes to a holistic experience strategy
2. Moving from fragmented care to connected ecosystems
3. Moving from population-centric to person-centered
4. Moving from incremental improvements to extensive innovation
5. Moving from insights as a department to a culture of consumer obsession

Healthcare Organization Mobile Device Use: Check That Pager

By Clive Riddle, June 15, 2018

The list of benefits derived from mobile device use by clinicians and staff at healthcare organizations is a long one. But the challenges exacted comprise a worrisome list topped by privacy and cybersecurity concerns. Organizations who promote or allow BYOD (Bring your own device) of course have significantly enhanced concerns.

So in this context its worthwhile to take a gander at the eighth annual Spok survey report: Mobile Strategies in Healthcare Results Revealed. The good news is that 57% of healthcare organizations surveyed have developed a documented mobile device strategy. The bad news is 43% have not.

They respondents say these are the challenges they are facing

• Wifi coverage – 51%
• Cellular coverage – 40%
• Data security – 34%
• Compliance with BYOD policies – 34%
• IT support – 29%
• Mobile adoption rates – 28%

For those with a strategy, here’s the top seven components included:

1. Mobile management and security - 56%
2. Mobile device selection - 51%
3. Integration with the EHR - 48%
4. Infrastructure assessment (wireless and mobile) - 45%
5. Clinical workflow evaluation - 43%
6. Device ownership strategy (such as BYOD) - 34%
7. Mobile app strategy (in-house, third-party, hybrid) - 29%

How well are these policies enforced? 39% said extremely well, 33% said well. 24% weren’t sure and an honest 4% said poorly. With respect to validating compliance, 48% use education, 42% gather data from the devices, 37% seek feedback from the end user, 23% take surveys, and an honest 21% said they aren’t doing any validation.

With respect to devices they organization supports, 74% said smart phones, 69% wifi phones, 56% onsite pagers, 54% tablets, 45% wide area pagers, 22% encrypted pagers, 12% voice badges and 6% wearables.  

Perhaps the biggest surprise I found in the report was this passage: “Pagers are still a mainstay in healthcare. Despite the growth of other communication tools, they remain at a relatively high level of use as other mobile devices complement them (without necessarily replacing them altogether). In fact, onsite pagers are the most popular communication option for non-clinical care team members such as housekeepers, transport techs, and phlebotomists.” For non-clinical staff 54% listed some type of pager as their primary communication device (onsite 40%, wide area 10% or encrypted 4%/) Wifi phones came in at 15% and smartphones at 14%.

Medication Nonadherence: Data and Analytics Can Make an Impact

By Claire Thayer, May 16, 2018

Over two-thirds of hospital readmissions are directly due to medication nonadherence.  Many factors contribute to patients not taking their medications, including fear of side effects, out-of-pocket costs, and misunderstanding intended use.  Interventions targeted at understanding the underlying causes on nonadherence are critical to improving chronic disease outcomes.  Successful interventions include: educating patients on purpose and benefits of treatment regimen, reducing barriers to obtain medication, as well as use of health IT tools to improve decision making and communication during and after office visits. 

This weeks’ edition of the MCOL infoGraphoid, co-sponsored by DST Health, explores how data and analytics can provide insight to drive behavior change to improve adherence.

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Five Questions for Erin Benson and Rich Morino with LexisNexis Health Care: Post-Webinar Interview

Last week, Erin Benson, Director Marketing Planning and Rich Morino, Director, Strategic Solutions, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on opportunities for health plans to leverage social determinants of health data to attain quality goals while managing cost and enhancing member experience.  If you missed this engaging webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Erin and Rich on five key takeaways from the webinar: 1. What are some of the ways that member health is impacted on a daily basis by social, economic and environmental factors? Erin Benson and Rich Morino: The environment in which a person lives impacts their likelihood to develop health conditions as well as their likelihood to effectively manage those conditions. Care recommendations need to be a good fit for a member’s environment, not just their medical condition. If recommendations won’t work within the person’s physical environment, aren’t affordable or conveniently located, and are provided in a way that is hard for the member to understand, they won’t be effective at improving health. Studies support this fact. For example, 75-90% of primary care visits are the result of stress-related factors (JAOA Evaluating the Impact of Stress on Systemic Disease: The MOST Protocol in Primary Care). Money, work and family responsibilities – all reflective of social determinants of health -- are cited as the top three causes of stress (APA 2015). 2. We've heard reference to aggregating data at the zip code level for use in personalizing care for members. However, this is one of your top five myths about socio determinants of health. Can you tell us more? Erin Benson and Rich Morino: While aggregate data can be useful in certain capacities, it isn’t recommended as a best practice for personalizing care. Within a single zip code, it is not unusual to see variance in income levels, crime rates and other factors impacting an individual’s neighborhood and built environment, so we recommend looking at an individual’s neighborhood from the perspective of their specific address. Focusing on zip code alone also ignores the influences of education, economic stability and social and community context so we recommend incorporating these other social determinants of health into decision-making in order to view the member holistically and create a more comprehensive plan of care outreach.   3. Can you briefly explain why previous generations of SDOH have failed to improve health outcomes? Erin Benson and Rich Morino: There are two primary reasons why previous generations of SDOH have failed to improve health outcomes, data and workflow.   In order to get sufficient value, the data needs to address all 5 categories of SDOH to properly draw useful insights.  The data should also be at the member level, and address who the member’s family and close associations.  Without that information, we cannot tell if someone is socially isolated or living with caregivers, for instance. The second reason why previous generations of SDOH have failed is how they are deployed in the workflow.  An example would be a plan simply adding them to an existing claims-based model to achieve an increase in lift.  The lift is nice, but no changes in process are filtering down to the Care Management team interacting with the members.   In this scenario, a lot of value was ignored. A better method would be if the plan also built models identifying members with barriers to improved health outcomes.  If you now apply this to your chronic or at-risk population you can determine not just who is sick and in need of help, but how to most likely achieve success in an intervention program.  Care Managers would immediately know the challenges to success, and what type of intervention program the member should be in enrolled in from the start. 4. One of the SDOH models to uncover health barriers referenced during your webinar was social isolation. Can you provide more context for us here? Erin Benson and Rich Morino: Studies have shown that social isolation can increase risk of heart disease by 29% and stroke by 32% (New York Times How Social Isolation Is Killing Us). By understanding factors about an individual such as who else is living in the household with them, their predicted marital status, and how close their nearest relatives and associates live to them, healthcare organizations can identify who may be socially isolated. This allows care providers to ask the right questions to determine if that person needs access to social support systems such as support groups or community resources to improve their health outcomes. 5. What are some ways social determinants can help health plans enhance predictions and improve care management? Erin Benson and Rich Morino: The most common way of utilizing SDOH data so far has been to incorporate it into existing claims-based predictive models to improve predictive accuracy or to use it to create new predictive models. The second use is for care management purposes and this is where social determinants of health can be truly transformational. We recommend as a best practice to use social determinants of health insights to also build models that identify health barriers. The combination of models allows healthcare organizations to better stratify the risk of their members and then better tailor care to their medical and social needs.

Perhaps Accenture’s Surveyed Consumers So Willing To Share Healthcare Data Should Read Accenture’s CyberSecurity Survey Report

By Clive Riddle, March 9, 2018 Accenture has just released a 12-page report with findings from their 2018 Consumer Survey on Digital Health in which they conclude that “Growing consumer demand for digital-based health services is ushering in a new model for care in which patients and machines are joining doctors as part of the healthcare delivery team, and that  “consumers are becoming more accepting of machines — ranging from artificial intelligence (AI), to virtual clinicians and home-based diagnostics — having a significantly greater role in their overall medical care. “ Here’s some survey response highlights shared in the report: ·         19% have already used AI-powered healthcare services, with 66% of these consumers likely to use AI-enabled clinical services ·         Consumer use of mobile and tablet health apps has increased from 16% in 2014 to 48% currently. ·         44% have accessed their electronic health records in patient portals over the past year, with 67% of these consumers seeking information on lab and blood-test results; 55% viewing physician notes regarding medical visits, and 41% looking up their prescription history ·         The use of wearable devices by consumers has increased from 9% in 2014 to 33%t currently. ·         75% view wearables  as beneficial to understanding their health condition; while 73% cite them helping engage with their health, and 73% also cite monitoring the health of a loved one ·         90% are willing to share personal data with their doctor, and 88% are willing to share personal data with a nurse or other healthcare professional. ·         72% are willing today to share with their insurance carrier personal data collected from their wearable devices has increased over the past year, compared to from 63% in 2016. ·         47% are willing so share such data and with online communities or other app users today, compared with 38% in 2016. ·         38% are willing to share data with their employer  and 41% with a government agency Interestingly while consumers seem to trust sharing their data most with their doctor and clinical professionals much more than their health plan, another Accenture survey recently released on healthcare cybersecurity found that while overall 18% of healthcare organization employees were willing to sell confidential data to unauthorized parties for as little as between $500 and $1,000; there was considerable disparity between plans and provider offices: 21% from provider organizations would sell confidential data compared to 12% from payer organizations.

Five Questions for Patrick Horine, CEO DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, March 2, 2018

This week, Patrick Horine, CEO DNV GL Healthcare, participated in a Healthcare Web Summit webinar panel discussion on Leveraging Hospital Accreditation for Continuous Quality Improvement webinar. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Patrick on five key takeaways from the webinar:

1. What is ISO 9001 and how is this closely related to strategic goals for hospitals?

Patrick Horine: Goals are just goals unless there are objectives in place to be measured and met to achieve them.   The ISO 9001 quality management system (QMS) is the means for managing the objective to determine the needs of and desires for customers.    The ISO 9001 QMS is customer focused and to ultimately enhance patient satisfaction.    Engaged employees means more patient satisfaction.   Enhance patient satisfaction increase HCAHPS scores.   Increased HCAHPS scores are what provide the financial and reputational incentives for hospitals.    Given the current challenges with reimbursement and the competitive climate it is imperative for hospitals to ensure the patient experience and satisfaction is best as it can be.  Quality objectives are at every level of the organization.  They may apply broadly across the organization or more narrowly.   The goal may be the result but there are a lot of contributors to ensure the goal is attained.    Quality objectives are specified and aligned with the goals to enable the measuring and monitor of progress to evaluate progress.

2. What are some of the benefits and challenges associated with implementing ISO 9001?

Patrick Horine: In short, I would note the following:

• Improving consistency
• Added accountability
• Increasing efficiency
• Engagement of Staff

What drove us to consider integrating this within the accreditation process was because the hospitals we were working with could make improvements or address compliance but they had a more difficult time sustaining what they put in place.    ISO 9001 requires such things as internal auditing and management review are two of the most impactful aspects for the ISO 9001 requirements.  

Through these internal audits and then reflecting the success of the actions taken with the management reviews will lead to more consistent practices through the organization.   It is not uncommon see multiple versions of similar policies all throughout the hospital.  Are they really different?   Likely not, so reducing these to one practice will improve consistency.    I often ask groups “How many of you think you follow your policies and procedures exactly as they are written?”   Rarely, if ever, would you see anyone state they did.   So, if we don’t then why do we have them?   If we need to have them, as we really do, then they should be written, communicate, implemented and measured to ensure they are being consistently followed.   Without fail, doing so will lead to better results in some manner.

Simplification and consistent processes lead to more efficient operations of the hospital.   Hospitals or any organization for that matter that considers the quality management to be an integral part of their business operations will commonly achieve more efficiency than those that do not.

Gaining this understanding of the processes and getting to the efficiency is not possible without the involvement of those closest to them.    As an organization, if we strive to improve every day, it is imperative that the staff are engaged so they can be directly involved to improve their work to be more satisfied with what they do and their contribution to the success of the organization.   

Happy wife = Happy life, the same holds true with Happy employees = Happier patients.    Those who are more involved with improving of the processes they work with are happier and more engaged employees. Engaged employees are more productive when they are identifying improvements to be made and how to go about making them.  

Challenges

• Culture not conducive to change
• Making it more complicated than it needs to be
• Too many details

Can an organization implement ISO 9001 overnight?  No.   This is something that will leadership commitment, engagement of staff, willingness to be self-critical, ability to break with traditional thinking.    More easily described, the culture of the organization must be such that you are open to change, making improvements and have patience to know the quality management system will mature over time.   

What seems to be more universal thinking among us healthcare people, if it is not difficult then we will find a way to make it so somehow.    In my opinion, I think the ISO 9001 standard has evolved with each revision to be more and more befitting to healthcare than other industry sectors.    Process thinking, sequence and interactions, risk-based, competence of staff, customer expectations and satisfaction.   It fits.   We have much of what ISO requires already in place but still some work to be done.   This does not require wholesale changes so we don’t have to make it more difficult.   What is working and what is not working is a critical step because we must understand where improvements or change need to be made.  

Like I mentioned, policies and procedures are rarely followed exactly as they are written, but some are written as works of literature with elaborate detail.   Simplify, a 30-page policy is more effective when adapted to a 2-page work instruction.   More likely that one would read it, better opportunity for it to be consistently applied.    That is not to say that some we rid ourselves of all policies and procedures but rather don’t add complexity to what we already have and ask what we need to really keep.   

3. How does ISO 9001 hold hospitals accountable for meeting CMS requirements?

Patrick Horine: ISO 9001 itself does not address the CMS Conditions of Participation (CoPs).    All hospitals are accountable for compliance if they want to bill and be reimbursed under Medicare & Medicaid.   All CMS approved accreditation organizations must develop standards that meet or exceed the CMS CoPs.  Some choose to have more extraneous requirements, others apply the minimum.   DNV GL Healthcare wanted to have a standard that would meet the CoPs but we have integrated the ISO 9001 to the accreditation process and made this a requirement for hospitals under our program.  Compliance to the CMS requirements should be the by-product of a good quality management system and this is where ISO 9001 can be most effective. 

The ISO 9001 helps organizations have a more robust quality management system in place where compliance should be more of a by-product then the end goal.   Our thinking was that hospitals are often not complying with the minimum requirements to be met and these are what are fundamental to the organization to have provide safe and effective care.    To be more consistent meeting the fundamental requirements is the first challenge.   Going beyond, rather than more prescriptive requirements, the CoPs can be the parameters and the organization can me innovative to put practices in place.  We can still hold the hospital accountable meeting the CoP and then see how they demonstrate the effectiveness and outcomes of what they have in place.  

4. While the accreditation process for hospitals is part of Medicare / CMS program requirements, are there any plans to accredit hospital labs, physician clinics, or long term care organizations?

Patrick Horine: We currently have CMS deeming authority for acute care and critical access hospitals.   Next, we will complete the process for securing deeming authority for Psychiatric Hospitals and then Ambulatory Surgery Centers.   Most likely will not purse approval under CLIA for laboratories, but always possible.   There is desire to be more certification programs with physician/medical clinics and other providers.   Presently these would be self-governed as there is no deeming authority for such medical offices nor long term care.   I believe additional quality measures and oversight would make an impact in these environments.

5. How is DNV GL different from the Joint Commission and are there other accrediting organizations?

Patrick Horine: The more evident differences would be:

• Annual surveys vs. once every 3 years
• Less prescriptive standard more closely aligned to the CoPs – but inclusive of some additional requirements as well as maintaining compliance with ISO 9001
• Demeanor of our surveyors
• No types of accreditation; preliminary denial, conditional accreditation, double secret probation

It is better to describe those differences as told to us by those we have accredited, so I will use some of their quotes;

 “With DNV GL the surveys have been more meaningful and more consistent”

• “It is nice get away from an inspection oriented approach but still be thorough”
• “DNV GL is not easy but is easier to get along with”
• “We have appreciated more of a collaborative process rather disciplinary one”
• “We want to learn from the surveyors and how we can do better”
• “The annual surveys help keep us focused on compliance and we do less getting ready for surveys”

“Doing things for the right reason not because of … have to”

Elon, Do We Have a Disaster for You!

By Kim Bellard, October 18, 2017

One of the most interesting twists resulting from Hurricane Maria striking Puerto Rico was Elon Musk's offer that Tesla could help Puerto Rico solve its energy crisis, with a long-term, 21st century fix. 
It is telling that we don't have similar offers to rebuild the Puerto Rico's health care system, which is similarly devastated.  Or, for that matter, our system, which is its own kind of disaster.

Mr. Musk was asked on Twitter if Tesla could help Puerto Rico using solar and battery power, and he responded in the affirmative, saying it had done so on smaller islands but faced no scalablity issues.  Next thing we knew the Governor of Puerto Rico and he were talking.  Now Tesla is starting to deliver their battery systems to the island, so we'll see.

Maybe it is a marketing stunt on Mr. Musk's part -- if so, you have to give him credit for it -- but the idea has merit.  A disaster like Maria is a once-in-a-lifetime opportunity to try bold new ideas instead of blithely rebuilding what was there before.

Still, even Elon Musk isn't bold enough to offer to rebuild their health care system, much less ours.

Sometimes disasters do make us rethink our health care system.  Katrina, for example, has often been credited with creating the impetus for electronic health records (EHRs), since it destroyed countless paper records, wrecking havoc on care for thousands of patients.

But we didn't pay enough attention to even that very visible crisis.  We do have a lot more EHRs now, but less than 30% of hospitals self-report being interoperable.

The records themselves remain largely physician-centered and exclusively medical, although Epic, the nation's largest EHR vendor, is finally saying they will move to a "comprehensive health record" (CHR). . 

I'm glad that in 2017 EHRs vendors are finally realizing there is health outside a medical facility.

It shouldn't take a hurricane -- or an earthquake, or a bickering Congress -- to realize that we have an in-progress disaster with our health care system. 

Let's say we were starting from scratch.  Let's reset what our health care system could be.  Let's say we didn't have all these hospitals, hadn't trained any physicians, hadn't deployed any medical devices or used any prescription drugs, although we could start with the knowledge of what each of those could accomplish.

Would we remake the system as it is, or would we design something new?

In a previous post I enumerated several things about our health care system I was dying to redesign, and in another I gave some specifics about how a re-engineered system might work.  Even those, though, didn't start from entirely scratch, still focusing more on the medical than on the broader health perspective.

We should be spending more on our health needs -- broadly defined -- than on our medical care.  We should be more worried about if people are going to the park than if they are going to the doctor's office.  And when we do get medical care, we should make sure it is care that has solid evidence of working, rather than too often accepting care that might work.

Elon Musk has his hands full saving humanity, not to mention helping Puerto Rico, so we probably can't count on him to offer to reinvent our health care system too.  So who will it be?

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Provider Data Accuracy – Continued Challenges for Health Plans

By Claire Thayer, September 27, 2017

Inaccurate provider directories continue to pose challenges for health plans both in terms of removing barriers to patient care as well as the monumental task of keeping track of network providers and managing all data elements associated with a single provider record.  Not only is the data constantly changing, consider this: documenting this information takes time as a detailed record can track up to 380 distinct line items, including service locations, billing locations, payment locations, specialties, certifications, affiliations, office hours, and languages spoken.  Regulations have been enacted on both the federal and state level on required data elements and timeliness of maintenance requirements, with penalties for non-compliance and regulations that vary widely from state-to-state.

This weeks’ edition of the MCOL Infographic, co-sponsored by LexisNexis, focuses on increasing challenges for health plans with data reporting and maintenance of provider directories:

 

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

Health Care's Juicero Problem

by Kim Bellard, September 8, 2017 Bad news: if you were still hoping to get one of the $400 juicers from Juicero, you may be out of luck. Juicero announced that they were suspending sales while they seek an acquirer. They'd already dropped the juicer's price from its initial $700 earlier this year and had hoped to find ways to drop it further, but ran out of time.  Juicero once was the darling of investors. They weren't a juice company, or even an appliance company. They were a technology company! They had an Internet-of-Things product! They had an ongoing base of customers! The ridicule started almost as soon as the hype. $700 -- even $400 -- for a juicer? The negative publicity probably reached its nadir in April, when Bloomberg reported people could produce almost as much juice almost as fast just by squeezing the Produce Packs directly. Moral of the story: if you want to introduce products that have minimal incremental value but at substantially higher prices, you're better off sticking to health care. Take everyone's favorite target, prescription drugs. As Donald W. Light charged in Health Affairs, "Flooding the market with hundreds of minor variations on existing drugs and technically innovative but clinically inconsequential new drugs, appears to be the de facto hidden business model of drug companies." As with prescription drugs, we regulate medical devices looking for effectiveness but not cost effectiveness -- and we don't even do a very good job evaluating effectiveness in many cases, according to a recent JAMA study.  Take robotic surgery, hailed as a technological breakthrough that was the future of surgery. A robotic surgical system, such as da Vinci, can cost as much as $2 million, but, so far, evidence that they produce better outcomes is woefully scarce.  Proton beam therapy? It's one of the latest things in cancer treatment, an alternative to more traditional forms of radiation therapy, and is predicted to be a $3b market within ten years. The units can easily cost over $100 million to buy and install, cost patients significantly much more than other alternatives, yet -- guess what? -- not produce measurably better results.  Last year Vox used 11 charts to illustrate how much more we pay for drugs, imaging, hospital days, child birth, and surgeries than other countries. Their conclusion, which echoes conclusions reached by numerous other analyses: "Americans spend more for health care largely because of the prices." We not only don't get a nifty new juicer from all of our health care spending, we don't even get better health outcomes from it.    Health care's "best" Juicero example, though, may be electronic health records (EHRs). Most agree on their theoretical value to improve care, increase efficiency, and even reduce costs. But after tens of billions of federal spending and probably at least an equal amount of private spending, we have products that, for the most part, frustrate users, add time to documentation, and don't "talk" to each other or easily lend themselves to the hoped-for Big Data analyses.  Many physicians might, on a bad day, be willing to trade their EHR for a Juicero.  Jonathon S. Skinner, a professor of economics at Dartmouth, pointed out the problem several years ago: "In every industry but one, technology makes things better and cheaper. Why is it that innovation increases the cost of health care?"  So we can make fun of Juicero all we want, but when it comes to overpriced, under-performing services and devices: health care system, heal thyself first. This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Health Care's Kodak Moment

by Kim Bellard, July 26, 2017

For those of us of a certain age, a "Kodak moment" connotes a special event that should be captured by a photo.  For younger generations, the term probably doesn't mean anything, because they don't know what Kodak is.  That's why, for some, "Kodak moment" has come to suggest a turning point when big companies and even entire industries can become obsolete. 

Health care could soon be at such a point.

Anthony Jenkins, a former CEO of Barclay's, recently warned that banks could face a Kodak moment soon.  He said they're already seeing a "Uber-moment," where smartphones and contractless cards are transforming the industry.  "The Kodak moment is completely different," Mr. Jenkins explained.  "That’s where customers realize there’s a totally better and different way of doing what they want to do, and the incumbent becomes obsolete."

In a separate speech, Mr. Jenkins elaborated that, due to new technologies, "we can imagine total transformation of the banking system."  He predicted banks have 5 to 15 years to face these challenges, or become irrelevant to their customers.

The "good" news, he added, is that: "Banks can avoid that, but they have to act now, and what they really need to do is think about innovation, but also transformation, doing something radically different."

For "bank" or "banking system" feel free to substitute "doctor/hospital" or "health care system"

Incumbents all-too-often grow protective and/or fail to take advantage of new opportunities.  The irony of disruption, Mr. Jenkins noted, is that it is "actually a great growth opportunity," and that "incumbents are best positioned to seize disruptive opportunities."  

Health care has a number of legacy problems that make it ripe for disruption.  Innovators look at these problems and see opportunities.

The opportunities -- or, threats, depending on one's point-of-view -- on health care's horizon are numerous.  They include:

• Digital health makes real-time information and communication feasible, such as with wearables and telehealth.
• Big Data will help us finally understand what is happening with patients and predict with better accuracy how we can manage our health.
• Robots will take over health care tasks/jobs that humans either don't want to do or lack the required precision to do.
• Artificial intelligence (AI) will be able to make sense of all that Big Data and all the various research studies, and can serve to either augment or, at least in some cases, replace physicians.
• 3D printing will allow us to replace an ever-increasing number of body parts, even systems, and do so with unprecedented speed and affordable cost.
• Nanotechnology will allow us to monitor and maintain us down to a cellular level.

Meanwhile, traditional health care companies -- from providers to middlemen to manufacturers to insurers -- are waiting with some trepidation to see what 21st century behemoths like Amazon or Apple are going to do in their space.  

Disruption might come from innovators within the health care industry, but it might also come from unexpected sources -- and in unexpected ways.  Kodak didn't take digital photography seriously enough, and it certainly wasn't expecting smartphones as the new camera.  

Health should have a number of the old-fashioned Kodak moments -- the birth of a child, a miraculous recovery, achievement of a health goal, and so on.  Whether health care organizations or even the entire health care system suffer the other kind of Kodak moment depends on how (and when) they respond to the disruptive opportunities now available to them.  

Rise of the Drones

By Kim Bellard, May 24, 2017

For those of us of a certain age, we expected to be living in a Jetsons-type world, complete with flying cars.  That hasn't happened, but it is starting to appear as though the skies may, indeed, soon be full of flying vehicles.  It's just that they may not have people in them. 

Welcome to the brave new world of drones.

Many people may have viewed drones as a toy akin to radio-controlled airplanes. We're beyond that now.  Last summer PwC asked "Are commercial drones ready for take-off?"  They thought so, estimating the total available market for drone-enabled services at $127b

This is not going to all be about getting your books, or your socks, or even your new HD television faster.  It is going to impact many industries -- including health care.

And that impact has already started to happen.

Zipline International, for example, is already delivering medical supplies by drone in Rwanda.  They deliver directly to isolated clinics despite any intervening "challenging terrain and gaps in infrastructure."  They plan to limit themselves to medical supplies, but not only in developing countries; they see rural areas in the U.S. as potential opportunities as well.  Last fall they raised $25 million in Series B funding.  

Drones are also being considered for medical supply delivery in Guyana, Haiti, and the Philippines.   

And drone delivery is already being tested in more urban areas.  The Verge reported that Swiss Post, its national postal service, is working with two hospitals in Lugano to ferry lab samples between them. 

Similarly, Johns Hopkins has been testing drone transport of blood supplies, concluding that it is "an effective, safe, and timely way to get blood products to remote accident or natural catastrophe sites, or other time-sensitive destinations."

Airbus is developing the A-180 drone specifically to deliver medical supplies, especially for emergencies.  Its cargo capsule is "capable of transporting everything from medicine and antivenin to supplemental blood and even organs." A company called Otherlab is going a different direction.  Wired reports that their drone will deliver its package -- then decompose, making it ideal for deliveries to humanitarian crises (or to battle sites, since Darpa helped fund them).  

Lest we focus too narrowly on the concept of drones delivering medical supplies, argodesign has proposed a flying ambulance, which could be operated as a drone or by a pilot.  If you've ever seen ambulances stuck in traffic and felt sorry for the patients relying on them, such ambulances could be the solution -- arriving faster and to locations regular ambulances could not reach.  

But for real impact, let's go back to Amazon.  CNBC's Christina Farr broke the news last week that Amazon was considering getting into the pharmacy business. Put rapid delivery -- especially with drones -- together with lower and more transparent prices, and it is no wonder that the stocks of CVS and Walgreens took a hit when the news broke about Amazon's new interest.

Health care has been all-too-much a story of waiting.  That's quickly changing, with telemedicine, WebMD, retail clinics, and -- soon -- 3D printing and health care robots.  We can add health care drones to the list, allowing 30-minutes-or-less kinds of promises that we haven't even begun to tease out yet.

Bring on the drones!

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

Inaccurate Provider Directories Have a Direct Impact on Patients

By Claire Thayer, March 8, 2017

Provider directories are important tool for consumer engagement with health plans and provider networks. And in many instances, the provider directory is the vehicle for the patients’ first impressions of providers and the network they represent.  The consequences of directory inaccuracies create barriers to care as well as impact patient satisfaction. And while state and regulatory agencies are imposing stiff fines for non-compliance, a new report from the California Department of Managed Care finds that most insurers still have a ways to go in this regard as many have directories that contained “data inaccuracies significant enough to render them unusable.”

A recent special edition of the MCOL Infographic, co-sponsored by LexisNexis Risk Solutions, highlights the impact of directory inaccuracies on patients:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

How Health Plans Impact Revenue Performance and Improve Quality Outcomes

By Claire Thayer, March 2, 2017

The Healthcare Effectiveness Data and Information Set (HEDIS) measures developed by the National Committee for Quality Assurance (NCQA) are now used by over 90% of health plans to measure quality performance.  HEDIS consists of 81 measures across 5 domains of care and address a broad range of important health issues, including:     

• Asthma Medication Use
• Persistence of Beta-Blocker Treatment after a Heart Attack
• Controlling High Blood Pressure
• Comprehensive Diabetes Care
• Breast Cancer Screening
• Antidepressant Medication Management
• Childhood and Adolescent Immunization Status
• Childhood and Adult Weight/BMI Assessment

Many health plans report HEDIS data to employers or use their results to make improvements in their quality of care and service.  Each year, NCQA publishes The State of Health Care Quality Report to raise awareness on key quality issues and drive improvement in the delivery of evidence-based medicine. This report documents performance trends over time, tracks variation in care and recommends quality improvements.  Additionally, HEDIS data is also incorporated into many health plan ‘report cards’ and increasingly used by consumers and purchasers to track and compare health plan performance.

This week, a special edition of the MCOL Infographic, co-sponsored by DST Health Solutions, focused on strategic trends and key elements of performance improvement for health plans: 

 

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.

The Good, the Bad, and the Ugly in Health Care

By Kim Bellard, February 22, 2017

I hate being a patient.

My exposure to the health care system has mostly been through my professional life or through the experiences of friends and family.  The last few days, though, I unexpectedly had an up-close-and-personal experience as a hospital inpatient.

I offer what I consider the Good, the Bad, and the Ugly of the experience.

The Good:  The People
The various people involved in my care, from the most highly trained physician to the person who delivered meals, were great. I loved my nurses.  I liked my doctors a lot.  The aides, the lab techs, the imaging tech, the transportation specialists -- all of them doing jobs that I wouldn't be able to do -- were each friendly and helpful, taking pride in what they did and how it helped my care. 

The Bad: The Processes
On the other hand, on the lists of criticisms about our health care system, many of its rules and processes truly do deserve a place.  They're like part of an arcane game no one really understands. 

I'll offer three examples:

• ·         Check-in
• ·         NPO
• ·         Discharge

The Ugly: The Technology

Oh, health care technology.  It is equally capable of delighting as it is of frustrating.  It is truly remarkable that the doctor could go up my arm to perform a procedure in my chest, just as the detail an MRI provides is simply astonishing.  

Let's start with the perennial whipping boy, EHRs.  On many occasions, EHRs did not mean that people did not still often have to drag in other electronic equipment or even paper in order for them to do their job.

MRIs are a wonderful technology, but as I was laying in that claustrophobic tube getting imaged, I kept thinking: what the heck are all those clanging noises?  

I was on various forms of monitoring devices, the smallest of which was the size of a 1980's cell phone and still required countless wires attached to numerous leads.  I kept wondering, hmm, have these people heard of Bluetooth?  Do they know about wearables?

My favorite example of ugly technology, though, came when I had to fill out a form, so that it could be faxed to the appropriate department.  

No health care system is perfect.  Every system has its own version of the Good, the Bad, and the Ugly. Our system can do better.  Let's give all those great people working in health care a better chance to help us.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting

The Scourge of Healthcare Ransomware to Loom Larger in 2017

By Clive Riddle, February 17, 2017

CynergisTek has just released Redspin’s annual cybersecurity Breach Report:  2016: Protected Health Information (PHI). Their 21-page seventh annual report “provides in-depth analysis of the causes of PHI breaches reported to the Department of Health and Human Services and the overall state of cybersecurity in healthcare.”

 

The report cites that in 2016 there were:

• ·         325 large breaches of PHI, compromising 16,612,985 individual patient records
• ·         3,620,000 breached patient records in the year’s single largest incident
• ·         40 percent of large breach incidents involved unauthorized access/disclosure
• ·         over a dozen providers reported in media as having been victims of ransomware attacks with PHI breaches

The report lists the largest 2016 hacking attack on providers as affecting Banner Health with 3.62 million patient records breached, followed by 21st Century Oncology with 2.2 million records breached. Of large breaches, they state 78% involved providers, 16% health plans and 6% healthcare vendors.

The report makes particular note of “the scourge of Ransomware” and cite that in 2016 there was $1 billion overall in ransomware payments worldwide impacting all types of businesses and consumers The report cautions this will get worse in 2017, as “late last year, disturbing reports surfaced regarding the rise of ‘ransomware as a service’ (RaaS) – a business model in which malware authors enlist ‘distributors’ to launch the initial attacks (likely weaponized phishing emails) and then share in any profits. The potential accomplices do not need much technical expertise or capital to get started. Some ransomware kits cost as little as $100 dollars.”

Becker's Health IT & CIO Review featured an article: Get ready for hospital ransomware attacks 2.0 also cautions about a growing ransomware threat this year, stating "here are three tactics we've seen in the wild that are likely to become more widespread in 2017. Beyond encryption: 3 ways criminals are making their attacks more disruptive," and they go on to list and describe:

1) Developing ransomware strains that spread like a virus

2) Creating new versions of ransomware that disable the victim systems

3) Turning ransomware attacks into data breach events

The Department of Health and Human Services has weighed in, offering an eight page FACT SHEET: Ransomware and HIPAA, in which they cite “a recent U.S. Government interagency report indicates that, on average, there have been 4,000 daily ransomware attacks since early 2016 (a 300% increase over the 1,000 daily ransomware attacks reported in 2015).

The healthcare ransomware threat certainly isn't focused just on the U.S., and is a global issue. New research based on a Freedom of Information (FOI) request has revealed that 34% of NHS trusts in the UK have suffered a ransomware attack in the last 18 months.