List of Top 10 Health Plan Issues — Out of Whack!

Healthcare IT News just published its list of top issues for health plans in 2011:

1. Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.).
2. Care Management, Data Analytics, and Informatics.
3. Health Insurance Exchanges and Individual Markets.
4. New Provider Payment & Delivery Systems (ACOs, PCMHs, etc.).
5. Bend the Cost Trend.
6. Medicare and Medicaid.
7. Health Information Exchanges and EMRs.
8. Consumer’s Role in the Modernization of Healthcare.
9. Reform Uncertainties.
10. Payer/Provider Interoperability.

Dear health plan colleagues,

Wake up! The order of this list is totally out of whack.

#2: Care Management, Data Analytics, Informatics. Good…sounds about right.

However,

#2 can’t happen before you address:

#7: HIEs and EMRs

#10: Payer/Provider Interoperability

Health plans can’t analyze the data and assist in care management unless they first have access to it. Payers need access to clinical data, and they are at risk of being cut out of the loop.

P.S.

Please also take a look at priority #1: Administrative Mandates (Compliance HIPAA 5010, ICD-10, etc.). This is completely reactive!

In these times of great change, is this how health plans want to posture themselves in the community?

Comments to ONC: PCAST HIT Report Becomes a Political Piñata

The PCAST Report on Health IT has become a political piñata. 

Early Feedback on PCAST 

Like many of my colleagues, I was taken aback by the release of the Report in early December 2010 — I didn’t know quite what to make of it. Response in the first week of release was: 
  • Limited. The first commentaries were primarily by technical and/or clinical bloggers. The mainstream HIT world had remarkably little initial reaction to the Report. 
  • Respectful of the imprimatur of “The President’s” Report and noting some of the big names associated with the report (e.g., Google’s Eric Schmidt and Microsoft’s Craig Mundie.)
  • Focused on technical and/or clinical perspectives around two broad themes.
    • The vision is on target:  “extraordinary”, “breathtakingly innovative”.
    • These guys didn’t do all their technical homework. The range varies, but the message is consistent. 

Today’s POV on PCAST 

What  a difference a six weeks makes. 

Six First-Take Reactions to Surescripts Network Expansion

Yesterday Surescripts announced their new Clinical Interoperability Services:

  • Extended Network Connectivity – As a network of networks, Surescripts will support and enable the exchange of all types of clinical messages between EHRs, HIEs and health systems that, today, are not connected with each other.
  • Net2Net Connect – Allows health systems and technology vendors that already support clinical information sharing within their network to connect to Surescripts in order to receive and send clinical information outside their network (December 2010).
  • Message Stream – Secure messaging tools for health systems and technology vendors to enable their physicians to electronically exchange clinical information (December 2010).
  • Clinical Message Portal – Simple connectivity tools intended for providers that, today, do not have an EHR system to send and receive clinical messages. (January 2011).

Many others have recapped the new Surescripts network, so I’ll simply point you to a few of these resources:

Here are my 6 first-take reactions.

Healthcare IT News Highlights Mobile Health Expo Presentation

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Mike Miliard did a great job in capturing highlights and key points of my presentation at the Mobile Health Expo conference earlier this week. You can read his story here.

Please write me at vincek@bhtinfo.com in you’d like a copy of the PowerPoint presentation.

Update:  Neil Versel of FierceEMR also wrote up the presentation.  Here’s a link to his concise, on-target article “HIE, mobility, open platforms start to knock down ‘walled gardens’ of proprietary EMRs.”

Verizon Abandoning Walled Garden Network & Business Model: Implications for Healthcare

Wha…?  why are we talking about Verizon…isn’t is a healthcare blog?

When a major, multinational company does a complete turnaround on its operating and business model, it’s worth noting and examining the reasons behind the switch.

Wireless Week reported on a presentation made at the CTIA conference this week by Verizon COO, Lowell McAdam:

In a nod to the future, McAdam also said Verizon Wireless will scratch its “walled garden” approach because “in a 4G world, we need to turn that guarded model inside out.” The operator will transform its business model, he said, because it realizes that innovation in applications and use will come from outside the company.  Verizon will open its network, applications and location technologies to outside developers…[emphasis added].

Ars Technica reported further on McAdam’s commentary: 

I think collaboration and openness will be the operating platform for the future if we’re to bring the full promise of what 4G LTE brings. That’s really the new paradigm, the new model for operating in the entire wireless industry.

“Now I know that some of you in the audience are saying, ‘C’mon Lowell, you guys are the poster child for walled garden.’ What I’d say is that for the first 25 years that garden approach of closed systems served the industry pretty well. But in a 4G I think we need to turn that garden model inside out.”

How big a deal is this? Here’s an imaginary comparable statement that might be made by Judy Faulkner, CEO of Epic:

Megatrend Spotting: Health Plan Role of Having “Best Data About YOUR Medical Conditions” is Up for Grabs

Who has the most comprehensive data about YOUR clinical conditions?

For most people, the answer today is “your health plan”, but it’s not at all clear that health plans will continue to have this role in the future.

As physicians and hospitals adopt EHRs, it’s foreseeable that clinical data about patients will be far more available and accessible.

Will patient data become:

  • A jockeying point for control and business advantage between health plans and care providers,
  • A collaborative opportunity to optimize clinical care and care coordination, or
  • Both?

Overview: Here Come Stages 2 and 3 of HITECH!

 

We’ve spent the past year creating the MU (meaningful use) requirements for Stage 1 of the HITECH act.  As shown by the diagram above, Stage 1 focuses on Data Capture and Sharing. Now it’s time to begin to focus on Stage 2 (Advanced Clinical Processes) and Stage 3 (Improved Outcomes).

The current generation of EMRs (electronic medical records) were designed primarily to assist care providers with clinical documentation, billing, and maximizing revenues. They were not designed to enable care coordination and optimize population health.  

This essay is the first in a new, ongoing series that will highlight:

  • Design and metrics for Stages 2 and 3 of the HITECH act
  • Companies and care providers developing and using applications targeting Stage 2 and 3 MU objectives

This first essay will provide an overview of what we’ve seen in Stage 1 and what we might expect in Stages 2 and 3.

Digital Medical Office of the Future Conference. Las Vegas, Sept. 9-10

CLICK HERE FOR THE CONFERENCE WEBSITE

Healthcare providers face critical choices in selecting and implementing Electronic Health Records (EHRs). In addition, physicians and hospitals will need to develop the capacity to exchange clinical information in order to meet Meaningful Use requirements. This program will offer detailed and practical information on EHR selection and implementation, as well as strategies for creating a sustainable health information exchange (HIE). The program also features sessions on legal/regulatory issues, clinical platforms and applications as well as strategies for optimizing workflow in order to accelerate clinical transformation.

Distinguished Speakers Include:

Steve Adams, Executive Vice President, Collaborative Care, Alere & President, Clinical Groupware Collaborative
Mark R. Anderson, FHIMSS, CPHIMS, CEO & Healthcare IT Futurist, AC Group, Inc.
Beverly Bell, RN, MHA, CPHIMS, FHIMSS, Partner, Clinical Implementation Practice Director, CSC Healthcare Group
Soma Bulusu, MS, CIO, Marin General Hospital
Proteus Duxbury, Managing Consultant, PA Consulting Group
Andrew Ganti, MSIE, Principal, Workflow IT Solutions
Kennedy Ganti, MD, Virtua Lumberton Family Physicians & Chair, New Jersey Health Information Technology Commission
Arthur Gasch, Founder, Medical Strategic Planning, Inc. & Author of Successfully Choosing Your EMR: 15 Crucial Decisions (Wiley Press)
David C. Kibbe, MD MBA, Senior Advisor, American Academy of Family Physicians & Principal, The Kibbe Group LLC
Vince Kuraitis, JD, MBA, Principal, Better Health Technologies, LLC
Arien Malec, Coordinator, NHIN Direct, Office of the National Coordinator for Health Information Technology
Debbie Newman, MBA, CPHIMS, Director of Process Improvement, Licking Memorial Health Systems
Gordon Norman, MD, MBA, EVP & Chief Innovation Officer, Alere
Keith Parker, Regional Extension Center, Nevada
Deborah Smith, PhD, Chief Strategic Planning and Quality Officer, Alaska Native Tribal Health Consortium
Carlos Vigil, DO, Internal Medicine Physician & CEO, United Hospitalist Group

Platinum Sponsor: Ingenix
Silver Sponsors: AC Group, Inc., Medical Strategic Planning, Inc., NextGen Healthcare
Bronze Sponsors: Cerner Ambulatory, EHS

CLICK HERE FOR THE CONFERENCE WEBSITE

For additional information, please contact TCBI:
Ph: 310-265-2570               Email: info@tcbi.org

Is HITECH Working? #7: Where’s Plan B? Congress and ONC need to address major flaws in HITECH.

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

Pop quiz: Among early-stage companies that are successful, what percentage are successful with the initial business model with which they started (Plan A) vs. a secondary business model (Plan B)?

Harvard Business School Professor Clay Christensen studied this issue.  He found that among successful companies, only 7% succeeded with their initial business model, while 93% evolved into a different business model.

So let’s take this finding and reexamine our human nature. In light of these statistics, what makes more sense:

  • Defending Plan A to your dying breath?
  • Assuming Plan A is probably flawed, and anticipating the need for Plan B without getting defensive?

We question many of the assumptions underlying HITECH Plan A. We also want to talk about the need and content for Plan B in a constructive way.

In this essay we’ll discuss:

1) The Need for HITECH Plan B

2) Questioning Assumptions — Issues to Reconsider in Plan B

a) Rewarding Incremental Progress
b) Addressing Root Causes for Non-adoption of EHR Technology
c) Questioning Health Information Exchanges (HIEs) as Building Blocks for the Nationwide Health Information Network (NHIN)
d) Catalyzing Movement Toward Modular EHR Technology
e) Focusing Incentives on High Leverage Physicians
f) Recalibrating Expectations for EHR Technology Adoption
g) Getting Bang-for-the-Buck in Achieving Meaningful Use Objectives
h) Comprehensively Revamping Privacy/Security Laws vs. Tweaking HIPAA
i) Maximizing Sync Between HITECH and PPACA
j) Leveraging Potential for Patient-Driven Disruptive Innovation
k) Promoting EHR Adoption Beyond Hospitals and Physicians, e.g., long-term care, home health, behavioral health, etc.
l) Dumping Certification

3) Summing Up

Nuggets

The Emerging Market in Health Care Innovation
Tilman Ehrbeck, Nicolaus Henke, and Thomas Kibasi
McKinsey Quarterly May 2010
McKinsey conducted research in partnership with the World Economic Forum to study the most promising novel forms of health care delivery and, in particular, to understand how these innovations changed its economics.

The Delineation of Home Healthcare: The Natural Evolution of a Healthy Industry
Wyatt Matas & Associates (investment bankers), April 2010
This whitepaper discusses the opportunity for home healthcare to become the center of chronic care disease management and identifies a particular business model that some more advanced companies are implementing.

EHR Software Market Share Analysis
Chris Thorman
Software Advice; May 14, 2010
A substantive analysis of a tricky market – physician EHRs.

Disease Management: Does it Work?
Jill Bernstein, Deborah Chollet, and G. Gregory Peterson
Mathematica Issue Brief; May 17, 2010
Mathematica revisits a debate that’s raged for over a decade:

  • Not yet consensus that DM works
  • Relatively effective disease management programs have some characteristics in common:
    • They use individualized case management.
    • They contact patients in person, not just by phone.
    • They focus on hospital discharges as key opportunities to improve health outcomes.
    • They encourage patients to use effective treatments by reducing cost-sharing for these treatments.