e-CareManagement blog

by David C. Kibbe MD, MBA and Vince Kuraitis JD, MBA

Everywhere we turn these days it seems “Big Data” is being touted as a solution for physicians and physician groups who want to participate in Accountable Care Organizations, (ACOs) and/or accountable care-like contracts with payers. We disagree, and think the accumulated experience about what works and what doesn’t work for care management suggests that a “Small Data” approach might be good enough for many medical groups, while being more immediately implementable and a lot less costly. We’re not convinced, in other words, that the problem for ACOs is a scarcity of data or second rate analytics. Rather, the problem is that we are not taking advantage of, and using more intelligently, the data and analytics already in place, or nearly in place.

For those of you who are interested in the concept of Big Data, Steve Lohr recently wrote a good overview in his column in the New York Times, in which he said:

“Big Data is a shorthand label that typically means applying the tools of artificial intelligence, like machine learning, to vast new troves of data beyond that captured in standard databases. The new data sources include Web-browsing data trails, social network communications, sensor data and surveillance data.”

Applied to health care and ACOs, the proponents of Big Data suggest that some version of IBM’s now-famous Watson, teamed up with arrays of sensors and a very large clinical data repository containing virtually every known fact about all of the patients seen by the medical group, is a needed investment. Of course, many of these data are not currently available in structured, that is computable, format. So one of the costly requirements that Big Data may impose on us results from the need to convert large amounts of unstructured or poorly structured data to structured data. But when that is accomplished, so advocates tell us, Big Data is not only good for quality care, but is “absolutely essential” for attaining the cost efficiency needed by doctors and nurses to have a positive and money-making experience with accountable care shared-savings, gain-share, or risk contracts. The promotional literature for Big Data is peppered with jargon and catch phrases — “close to the point of care,” “synthesizing large amounts of information,” “transformational analytics,” and so on — that promise to “de-fragment” the current health care environment and offer predictive insights that the doctors, nurses, and patients do not now possess.

This all may be true. But why wait for Big Data to be put in place, when what we’ll call “Small Data” is already available and can offer information and analytical insights sufficient to get a good start on care management programs capable of improving quality and reducing some unnecessary costs?

Continue reading “Physicians Shouldn’t Wait for Big Data: “Small Data” Can Jumpstart Your Care Management Program”

Greg Masters reports on a recent Kaiser Health News article: Hospitals Look to Become Insurers, As Well as Providers of Care”.

This is the dumbest idea I’ve heard since “I’m going to invest all my money in Facebook’s IPO and get rich!”

Here are six reasons why:

Continue reading “Hospitals…Thinking About Getting Into Health Insurance? 6 Reasons To Lie Down Until the Urge Goes Away.”

by Vince Kuraitis and Shahid Shah

We are pleased to offer you our updated perspectives on the future of platforms in healthcare.

Click here for a copy of our joint presentation at the 9^th Annual Healthcare Unbound Conference. This is an update from our earlier joint presentation at the eCollaboration Forum as part of HIMSS 12.

What’s different in the marketplace over the past few months? Three key observations:

1) The trend toward platform adoption is accelerating and becoming more clearly understood. The requirements of Stage 2 Meaningful Use are a major catalyst, and in turn platforms are a critical enabler of health information exchange (the verb).

2) We are learning that “data platform” adoption is occurring more rapidly than the adoption of other types of platforms. While there are may elements to platform openness, we have long believed that data portability (separating data from applications) is an essential first step.

Why is there more rapid uptake on data platforms? We’ll speculate on a couple of reasons. First, the Federal promotion of “Government as Platform” generally and specifically CMS’ recent proposals relating to platforms for Knowledge Discovery Infrastructure (see slides 47-61).

Second, application platforms are more likely to involve shared workflow among care providers, not just shared data. Not unexpectedly, we are learning that sharing workflow is much tougher, but we believe in the long run will provide dramatic new levels of value.

3) Expect to see continuing marketplace battles among walled garden (semi-open) and open platforms. As one example, several recent market analyses (e.g., Chilmark, IDC) document more rapid adoption of private, walled garden HIEs (health information exchanges — the noun) than for more open state or regional HIEs.

There are good arguments for both walled garden and more open platforms. More on this topic later.

Again, you can click here for a copy of our presentation.

Guest post by Patrick Gordon, Director, Colorado Beacon Consortium

Early pioneers to Colorado did not have the luxury of waiting for railway or infrastructure to be in place before taming a new frontier. Their vision and determination laid the foundation for the settlers who followed. They used the tools and talents they had to develop an infrastructure and ultimately build viable, productive communities. Had they waited for the perfect conditions, they’d still be back east.

It’s a lesson we’ve applied to health care transformation. At the Colorado Beacon Consortium (CBC), we resisted the temptation to delay good learning opportunities and wait for perfect solutions. We embraced the ONC/HHS’ challenge to demonstrate how costs can be reduced and patient health improved by integrating health information technology (HIT) into a transformed clinical workflow. This pioneering effort requires new competencies with patient and population data, more sophisticated technology, and a supporting workforce. So far, we’ve offered technical assistance to more than 50 primary care practices in western Colorado. We are laying a foundation. Continue reading “Good or perfect: Cutting the fastest path forward”

Over the past decade, I’ve seen a number of studies asking people whom they trust among various health care stakeholders. Nurses, pharmacists, and doctors always come out at the top.  Beyond that:

• Trust of hospitals tends to be high (60–80%)
• Trust of health plans is at the bottom of the heap (10–20%)

Is this written in stone for the future? I don’t think so…and the dynamics for change are in motion.  Please read on.

Here’s the emerging picture I’m seeing:

• Hospitals are dragging their feet in connecting you with your electronic health information.
• Health plans are highly motivated to connect you with your health information. Continue reading “Hospitals or Health Plans: Who Do You Trust to “Connect” You with Your Health Records?”

One of the biggest concerns about ACOs has been their potential to enable market consolidation— that by uniting health care providers the ACO gains market clout and ability to charge higher prices.

While this is a legitimate concern about ACOs, so far it’s not playing out.

Why?

Continue reading “The ACO Antitrust Police — Nothing to Do”

I’m surprised and intrigued by Medicare’s announcement of 27 new Shared Savings model ACOs.

Surprised

I had been anticipating this announcement as a defining moment for Medicare’s thrust into accountable care. My expectations had been that we would see either:

Boom — a big splash of new Medicare shared savings ACOs announced, including big name hospitals and medical groups that were starting large scale ACOs, perhaps with hundreds of thousands of patients.

Bust — no one showed up at the party. Providers would have concluded that Medicare ACOs were too risky, bureaucratic, and high effort.

Intrigued

What we got is something in the middle: Continue reading “Medicare Announces 27 ACOs. A New Species?”

On the Perficient Health IT blog, Christel Kellogg writes:

I am hearing that carriers are staying away from ACOs and are not planning on partnering.  What have you heard?

This is one of those blip-on-the-radar-screen comments that jarred my attention — and it raises very important questions about industry dynamics.

First, let me expand on the issue.  As I’ve written before, there are at least two broad categories of “accountable care initiatives”:

1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare

2) Informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans.

The list of accountable care animals in the forest is likely to keep growing. For example, just this week Oregon announced details for CCOs (Coordinated Care Organizations) for Medicaid.

So how are different stakeholders likely to react to the opportunity of a formal ACO contracting with commercial health plans? Let’s look at this from a couple of different angles.

Continue reading “Will Health Plans Want to Contract with ACOs? Maybe, Maybe Not.”

Last week I wrote about five key differences between formal ACOs (mainly care providers contracting with Medicare)  and informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans.

1. Transaction costs
2. Timing
3. Incrementalism
4. Flexibility
5. Capital cost

There’s an important  6^th  difference worth noting:

Visibility

Formal ACOs will be visible from miles away — think elephants on the Serengeti.

An ACO that wants to contract with Medicare must establish itself as a corporation. The Medicare ACO models have substantial disclosure and reporting requirements. We won’t know everything about formal ACOs, but we will know a lot. ACOs cannot hide.

AC-Like arrangements between care providers and commercial payers could be much more difficult to spot and categorize — think chameleons in the jungle.  

Continue reading “A 6th Difference Between ACOs and “AC-Like” Arrangements”