Tag Archives: BigData

Healthcare Companies Sitting On Lots Of Cash…What Will They Do With It?

In the September 8-15 edition of Time Magazine, they have a whole article about data and numbers.  One of the pages is on which companies have the most cash.  Apple is number one and the one you always hear about.  As we’ve all seen, there are lots of rumors about Apple, Google, and Amazon and what they’re doing that is health related. 

At the same time, I was intrigued to see all the health related companies on the list:

  • Medtronic – $13.7B
  • Abbott Labs – $8.1B
  • Merck – $27.3B
  • Pfizer – $48.8B
  • Johnson & Johnson – $29.2B
  • Abbvie – $9.9B
  • Eli Lilly – $12.7B
  • Amgen – $23.1B
  • Bristol-Myers Squibb – $8.3B

You have several other non-healthcare companies which are doing things in healthcare that are also on the list:

  • Walmart – $8.7B
  • GE – $14B
  • Procter & Gamble – $8.5B
  • Qualcomm – $31.6B

If you look at the Rock Health recent report, you can imagine how these companies could leverage all this money to really change healthcare.  They could fund companies.  They could buy companies.  They could invest in orphan drugs.  They could create new technology standards.  They could educate consumers.  They could push technologies like the Internet of Things. 

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Dynamic Journey Mapping and P2P

I’ve talked several times about what P2P (peer-to-peer) healthcare is.  We have examples of PatientsLikeMe and CureTogether.  This is something that Pew has talked about several times over the years.  Additionally, here’s a blog post by Susannah Fox on this.  The point is that people turn to Dr. Google and social media often before they talk to a healthcare professional.  That’s critical to understand. 

Interestingly, as I was reading the IMS whitepaper on Journey Mapping, it really got me thinking about how all this social listening and patient content can influence and shape the Patient Journey (see example).  We’ve already heard about the influence this channel is having on clinical trials.  And, we know that Big Data trends are driving lots of new data sources for analysis and insights.  I think this JAMA list is a good starting point.  But, as Jane Sarasohn-Kahn points out, we can’t forget about the Open Notes initiative and the power that it will bring with it. 

The question of course is how this will all be reflected in the way we think about the consumer in all the “patient experience” and “consumer engagement” hype in healthcare.  For example, this image from a Deloitte whitepaper shows some of the ways a health plan can influence the consumer experience.

Consumer Experience Payer

We all know this is tricky, and it’s critical to establish trust between the consumer and the entity influencing the journey.  Health plans and pharmaceutical companies are usually not high on the trust scale. 

That being said, the IMS whitepaper does a good job of pointing out the need to expand beyond the traditional effort of focusing on key influencers.  It’s important to understand the payer view and the patient view in new ways.  It’s also important to understand what matters to each group.  While adherence may seem like the right metric, I would argue that it’s simply the easy metric.  It’s important to really understand the overall health of the patient.  They care about their experience.  They care about their quality of life.  These all need to be factored into the patient journey

Book: My Healthcare Is Killing Me

“A hospital bed is a parked taxi with the meter running.”  Groucho Marx

While I was flying last week, I had the chance to read My Healthcare Is Killing Me.  I could probably think of a few other titles for the book like:

  • Don’t let healthcare bankrupt you
  • Navigating the healthcare billing maze
  • Negotiating to better health
  • The $20 disenfranchisement fee

Those should give you a hint about the topic of the book.  It’s written by Chris Parks, Katrina Welty, and Robert Hendrick who are all part of the founding team at Change Healthcare.  If you’re not familiar with Change Healthcare, you should look at them and others in the transparency space.  (You can look at Jane Sarasohn-Kahn’s series on cost transparency for more information.)

Here’s a few of my notes from the book:

  • Hospitals and doctors view their patient’s bills as Days Sales Outstanding (which is why you can negotiate for prompt payment).
  • 22% of people have been contacted by a collection service for a medical bill
  • 60% of consumers that asked for discount on a medical bill were successful
  • The bill is NOT what the provider will (or expects) to get paid…It is the most that they will get paid
  • The chance of getting the right diagnosis and treatment on the first visit is 50% (scary)

The book has an interesting analogy from Patsy Kelly comparing healthcare to a restaurant:

“In healthcare, the patient does not order the service or have the primary responsibility for payment.  Additionally, the person who pays for the service does not order it or consume it, and the person who orders it does not pay for it or consume it.”

Another quote from Unity Stoakes was:

“We must arm ourselves with knowledge, wisdom and information.  Demand transparency in pricing by researching alternatives.  Negotiate!  Take control of your own healthcare now.  The more you know, the more power you have.”

The authors do a good job of simplifying down some of the complexities of the healthcare payment system.  Some things have changed with health reform, but the fundamentals are the same.  For someone taking on a large, complex condition which is likely to result in lots of costs, its worth reading.  For someone trying to change healthcare and understand the fundamentals, it’s also a great quick read which you can then follow-up on to see how this became the foundation for Change Healthcare. 

 

Great #BigData JAMA Image Missing Some Data Sources

JAMA image data

When I saw this article and image in JAMA, I was really excited.  It’s a good collection of structured and unstructured data sources.  It reminded me of Dr. Harry Greenspun’s tweet from earlier today which points out why this new thinking is important.

 

But, it also made me think about this image and what was missing.  The chart shows all the obvious data sources:

  • Pharmacy
  • Medical
  • Lab
  • Demographic
  • EMR / PHR

It even points out some of the newer sources of data:

  • Facebook
  • Twitter
  • Online communities
  • Genetics

But, I think they missed several that I think are important and relevant:

  1. Structured assessments like the PHQ-9 for depression screening or the Patient Activation Measure.
  2. Communications data like:
    • How often do they call the call center?
    • What types of questions do they have?
    • Do they respond to calls, e-mails, SMS, letters, etc?
    • Have they identified any barriers to adherence or other actions (e.g., vaccines)?  Is that stored at the pharmacy, call center, MD notes?
  3. Browser / Internet data:
    • This could be mobile data from my phone.
    • What searches I’ve done to find health information.  What have I read?  Was it a reliable source?
  4. Device data (e.g., FitBit):
    • What’s my sleep pattern?
    • What am I eating?
    • How many steps do I walk a day?
  5. Income information or even credit score type data

These things seem more relevant to me than fitness club memberships (which doesn’t actually mean you go to the fitness club) or ancestry.com data which isn’t very personalized (to the best of my knowledge).

In some cases, just simply understanding how consumers are using the healthcare system might be revealing and provide a perspective on their health literacy.

  • Do they call the Nurseline?
  • Do they go to the ER?
  • Do they have a PCP?
  • Do they use the EAP?

We’d like to think this was all coordinated (and sometimes scared into believing that it is), but the reality is that these data silos exist with limited ability to track a patient longitudinally and be sure that the patient is the same across data sources without a common, unique identifier.

Why Healthcare Needs A “Google Health”

Most people know that Google tried to jump into the healthcare space with Google Health a few years ago.  Google Health was (from Wikipedia):

Google Health was a personal health information centralization service (sometimes known as personal health record services) by Google introduced in 2008 and cancelled in 2011.  The service allowed Google users to volunteer their health records – either manually or by logging into their accounts at partnered health services providers – into the Google Health system, thereby merging potentially separate health records into one centralized Google Health profile.

Personally, if they wanted to build that, they should just go buy Dossia, and they would be there.  Looking backwards, you can read the announcement to cancel Google Health here, and there’s lots of articles out there about why it failed.

While they haven’t had a dedicated health team officially, they continue to have several health related projects:

  1. Helpouts is a video service that is HIPAA compliant meaning it could eventually compete with Teladoc, MDLive, and American Well.
  2. Calico is a newer company focused on aging which has lots of people wondering as they add well known executives to the core team.  
  3. They just came out with their smart contact lens to help diabetics test their blood sugar.
  4. Google has an app called My Tracks and an API to tap into some of the sensors in the phone that could be used for fitness apps.  
  5. Google X staff recently met with the FDA leading to some speculation.  
  6. Of course, there is also lots of discussion about how Google Glass could be used in healthcare.  (I personally think about the Checklist Manifesto as a perfect opportunity.)
  7. And, I would also point to the intelligent home (per their acquisition of Nest) as a venture which will lead them down the path of health at some point.

You could also look at the companies that Google Ventures is investing in from the health space:

I could have easily seen them investing in something like Theranos which stands to change the biometrics space.  

So…it’s not like they’re ignoring the space which isn’t unusual for many companies outside of healthcare.  Healthcare is hard.  Healthcare has lots of regulatory constraints.  In general, many companies want to avoid having to deal with some of those issues which can constrain the rest of their businesses.

But, let’s look at the critical and hot topics in healthcare right now:

  • BigData – how to use data; how to build predictive models
  • Engagement – how to personalize communications and engage consumers to take action from mass customization to segmentation to even gamification
  • Mobile and devices – how to use technology to track your steps, monitor your health, and collect data (see post about why your underwriter wants your mobile data)
  • Social – how to use social pressures and peers to create better health
  • Connectivity – how to connect devices, caregivers, pharmacies, providers, and others into a shared platform for care
  • Security – how to securely manage data
  • Transparency – collecting and aggregating pricing data to help consumers make intelligent decisions
  • User experience – creating user journeys and user interfaces to improve the overall consumer experience (perhaps changing the model like Uber (a Google Ventures investment))

Do those things sound like the competencies of any one company?  To me, they all sound like things that Google is good maybe even great at.  Additionally, the founders of Google have the big, picture and long-term vision that’s critical in healthcare.  Driving change in healthcare isn’t about meeting specific quarterly numbers.  It’s about seeing the world in a new light where you want to drive change and improve things like childhood obesity.  It doesn’t happen overnight.  

I wish I knew more about Google.  Someday, I’d love to work with them on some of these opportunities.  If so, I could see this being a perfect fit in the Google X world.  I could see them making a change as a core focus, as investors, or simply by creating enabling tools.  But, at the end of the day, this is why I think health needs Google to have a focus here.  It’s almost 20% of our GDP and something that impacts most people on a daily basis.  

Listing of Medication Adherence Solutions

It’s been a few years since I’ve worked on medication adherence solutions.  It seems to have become a big focus again in the industry both with the Medicare Star Ratings program and with all the emphasis on waste.

As I started thinking about adherence, I thought it would be good to create a list of solutions and vendors.  I couldn’t find one anywhere on the web.  So, here’s my initial list of almost 100 companies.

I’ll make this a dynamic list so please comment or send me suggestions to add.

Here’s some old posts on adherence that I think are still relevant here:

I’ve divided the list of solutions and vendors into the following:

Devices

  • Adherence Solutions LLC – develop programs to create alliances between different players, sell Dose-Alert which is a smart pill bottle cap, and provide a mobile tool
  • AdhereTech – smart pill bottles
  • Automated Security Alert – medication dispensers to complement their medical alert system
  • Biodose – electronic tray for monitoring time and day of use
  • CleverCap – smart cap for pill bottle
  • Didit – manual tracking device that attaches to a pill bottle
  • DoseCue – smart pill bottle
  • eCap – electronic compliance monitor
  • ePill – medication reminder devices
  • eTect – biocompatible tag on the pill with connectivity and a mobile solution focused on clinical trial adherence
  • iRemember – smart pill bottle cap with voice reminder and smart phone synching
  • MedCenter – monthly organizer and reminder system
  • Med-E-Lert – automated pill dispenser
  • MedMinder – automated pill dispenser
  • MedVantx – medication sampling at the physician’s office
  • Proteus – smart pill technology
  • Quand Medical – uses Near Field Communications and mobile to do medication management and reminders
  • SMRxT – smart pill bottle
  • TalkingRx – audio device attached to pill bottle
  • uBox – smart pillbox
  • Vitality GlowCap – smart pill bottle with communication programs

Mobile / Digital

  • 2Comply – patient portal with web coaching
  • ActualMeds – online medication management for consumers, caregivers, and providers
  • AI Cure Technologies – digital health solution
  • AssistMed – web and mobile based adherence solutions
  • Ayogo – social games and apps to improve engagement and adherence
  • CareSpeak – mobile solution
  • Care4Today – two-way messaging platform, app, and website
  • CellepathicRx – mobile solution
  • CloudMetRx – cloud based solution to help caregivers with medication management
  • Dosecast – mobile medication management and pill reminder
  • GenieMD – mobile medication management and reminders as part of broader solution
  • iPharmacy – mobile pill identifier, medication guide, and reminder app
  • Mango Health – mobile medication management with gamification and incentives
  • Medacheck – mobile reminder system that incorporates caregivers
  • MedCoach – mobile medication management and pill reminder
  • MedHelper – medication compliance and tracking app
  • mHealthCoach – reminder based solution creating a digital support system
  • Mscripts – mobile solution
  • MyMeds – mobile and web medication management and pill reminder solution
  • MyMedSchedule – mobile Rx management tool with reminder service
  • Nightingale – mobile solutions for reminders, engaging your physician, and notifying your caregivers
  • PillBoxie – mobile medication management and reminder app
  • PillManager – mobile medication management and pill reminder
  • PillMonitor – mobile medication reminders and logs
  • PillPhone – mobile phone solution with biometric authentication
  • Prescribe Wellness – automated, digital interventions
  • RightScript – platform to manage prescriptions through mobile reminders that connect patients, caretakers, practitioners, and health plans
  • RxCase Minder – mobile medication management
  • RxNetwork – mobile medication management and reminders with rewards
  • Quintiles – building digitally, connected communities
  • Virtusa – multi-dimensional interventions across the patient’s journey

Platform

  • Adheris – adherence suite and advanced analytics (just acquired Catalina Health) [note: they are owned by inVentiv Health who I work for]
  • Avanter – an adherence program for pharmacies in Argentina
  • Capzule – pill reminders as part of PHR
  • Dr. First – embedded tools into EHR
  • HealthPrize – platform with gamification, incentives, education, and communications
  • LDM Group – suite of compliance products
  • McKesson – sampling, coaching, coupons, and messaging
  • MediSafe – mobile medication management app and adherence platform
  • MedPal Health Solutions – platform for medication adherence solutions
  • MedSimple – medication management, pill reminders, coupons, and PAP programs
  • mHealthCoach – care collaboration platform using machine learning to personalize communications
  • Tavie – virtual nurse for improving adherence focused on several conditions

Communications

  • Ateb – multi-channel communication programs for pharmacies
  • Atlantis Healthcare – custom adherence solutions
  • Eliza – multi-channel communication programs
  • Intelecare – multi-channel adherence communications
  • MemoText – messaging platform
  • Patient Empowerment Program – medication adherence program for pharmacies
  • Pleio – adherence solutions for the first 100-days (when most people stop taking medications)
  • Silverlink – multi-channel communication programs [note: this is the company that I used to work for and still use]
  • Varolii (now Nuance) – multi-channel communication programs
  • Voxiva – web and text messaging solution
  • West – multi-channel communication programs

Big Data

Tools / Enablers

  • 5th Finger – assessment and personalization tools
  • GNS Healthcare – using data and predictive models to identify targets and fuel intervention programs
  • HumanCare Systems – creating patient and caregiver support solutions
  • Insignia (PAM) – measure of patient activation for segmentation and scoring
  • MedMonk – help pharmacists obtain funding for patients who can’t afford their out-of-pocket pharmaceutical expenses
  • MedSked – low tech, high impact labeling solution
  • Merck Adherence Estimator – screening tool available as a widget or online at Merck Engage
  • NaviNet – communications network to enable adherence
  • NCPA – toolkit and ROI calculator for pharmacies
  • ScriptYourFuture – tools and text reminders
  • Walgreens API – an application programming interface for developers to use to connect their adherence solutions to Walgreens

Medicare focused

  • Dovetail – pharmacist led programs including MTM, in-home visits, and telephonic coaching (focused on Star Ratings)
  • Mirixa – incorporated into the MTM program
  • Outcomes – data and tools as part of their MTM solution
  • Pharm MD – Medicare STARS program

Condition specific

  • GeckoCap – adherence offering for kids with asthma
  • MyRefillRx – mobile adherence app focused on high blood pressure

Packaging

Pharma

  • 90Ten Healthcare – providing adherence programs in 23 countries
  • TrialCard – voucher and co-pay programs for consumers to stop Rx abandonment
  • Triplefin – customized programs for pharma brand managers
  • Adherence Engagement Platform – a Pfizer program of adherence materials and tools (I couldn’t find it online only in hard copy)
  • RS Associate – a company working with manufacturers in India
  • Rx.com – MTM, pre-edit messaging at the POS, and print-on-demand messaging at the pharmacy

International (recommendations send to me without English sites)

What other companies am I missing?  Send them to me directly or add them in the comments section here.  Thanks.

How Do The Big PBMs Grow?

By now, the idea of a PBM and who they are is much more of a household item than it was a decade ago.  We’ve seen massive consolidation in the industry.  We’ve seen PBMs grow in the specialty PBM space.  The question I often ponder is what’s next.  Here’s some of my thoughts.

  1. Do Nothing.  Obviously, there’s a lot to be said for ongoing momentum.  The PBMs have shown growth for many years.  While the generic opportunity and the mail opportunity has slowed down, there are still opportunities in the specialty space.  
  2. Distribution. This seems like an obvious possibility.  Why not buy Cardinal, AmerisourceBergen, or someone else?  Procurement and distribution are core competencies so I think this makes some sense.  But, will that create issues in the current client list and retail pharmacies and PBMs haven’t always had the best relationships.  (E.g., Express Scripts GPO with Kroger)
  3. Pharma.  This has been debated by a few PBMs, but getting into the R&D space is risky and doesn’t build on their core competencies.  What could be more interesting would be them getting into the services space by acquiring a company like IMS or Quintiles.  
  4. International.  Several PBMs have tried this model.  In general, it hasn’t gone anywhere.  I think the international collaboration of Walgreens and Boots is really interesting and other retailers have gone international.  I don’t see this happening anytime soon with any material impact.  
  5. Physician.  Having a greater impact in the prescribing process could make a lot of sense.  I could see some interesting targets in terms of Allscripts, Cerner, or athenahealth.  This has been a challenge for years with a few ventures into the space.  (e.g., CVS Caremark and iScribe)
  6. Technology.  At the end of the day, the PBMs are large technology companies.  Could they see their way into the mHealth space?  This space is growing like crazy, and you’re seeing established players get into the remote patient monitoring space (e.g., AT&T and Qualcomm).  I could see an acquisition in this area of a telehealth company (e.g., Teladoc) or a device company (e.g., Welldoc).  Or, they could build something more organically.  On the flipside, they could look at technology platforms to open doors to care management or ACOs (e.g., Lumeris).  Alternative, I could see SoloHealth as a really interesting asset.    
  7. Retail.  With a few exceptions, I think this strategy is off the table.  I’ve loved the CVS Caremark integration for years, and I think it’s showing dividends.  Rite-Aid is probably the only big acquisition target out there.  In this space, you probably have to look at it the other way.  Would any retailers (e.g., Walmart, Walgreens, Target) buy a PBM?  Walgreens got rid of their PBM, and Walmart has said they don’t want to be in that market so I’m not sure that would go anywhere.  
  8. Insurer.  I think this one has some interesting opportunities from a Medicare perspective and from a commercial perspective.  Could PBMs create an underwritten product and take on risk?  I think yes, BUT I think that could impact their need for reserves and the way the market sees them.  That makes me think this is less likely, but possible.  
  9. Device Benefit Management.  I think several ex-PBM executives have gone out to try to build the “benefit management” concept into the healthcare marketplace in other areas (e.g., IPG).  Could an existing PBM do it and cross-sell into their base?  Perhaps.  But, a stretch.  They’re getting big so they want to buy meaningful revenue, create synergies, and then grow it.  
  10. Navigation.  The most used benefit is pharmacy.  Today, consumers touch the healthcare system most frequently through retail and their daily prescriptions.  With the ongoing complication of the health benefits, there is a huge need for navigators (and not just in the healthcare.gov use of the term).  Think about companies like Health Advocate or Accolade.
  11. Data.  With the RxAnte acquisition, it has to make you wonder about PBMs and their data assets.  How can they use them differently?  Can they create apps?  Can they create algorithms to license?  What would this look like?  What about companies like Proteus?  Perhaps, a PBM could consolidate several unique assets along the device, smart bottle, data path.
  12. Condition specific.  I could see some PBMs going deep on particular areas like oncology to really build out an oncology practice that did everything from second opinions to case management to end-of-life counseling.  Those could all wrap around the drugs.  Or, imagine them going into the chronic kidney care space by acquiring a company like DaVita.  
  13. Providers.  While there could be some interesting synergies here with a large hospital group (e.g., HCA) or some ACO/PCMH players, I see that more of a managed care play for rolling up companies.  The ROIC (Return on Invested Capital) is too different in these physical operations that I see that being a struggle.  And, I think there’s lots of concerns about the hospital needs over time.  

Which path plays out…I don’t know, but I think it’s getting close to time that you’ll see another shift in the market as they try to secure their next 10 years of growth by expanding into something that builds on their core competencies.  

I think the other question would be if they focus on differentiation by really showing material differences in outcomes and engagement rates and look at how they show an overall health ROI not just Rx specific.  That would be where I would place my bets and look at which of these options support that.  Maybe we’ll see a PBM X (like Google X) doing some strategic long-term deals to change the overall healthcare roadmap.  

2014 Healthcare Predictions and Trends

Happy New Year!  2013 has been an interesting year in healthcare with 2014 promising many more exciting developments.  A few of the biggest stories from 2013 include:

  • Healthcare.gov – the politics, the drama, and the missteps
  • Healthcare transparency and costs – new companies, new revelations, and an entire Time magazine focused on it
  • Healthcare engagement – ongoing focus on how to get consumers to engage
  • mHealth and QuantifiedSelf – apps and devices proliferate
  • Investment – a huge jump in VC and angel funding for healthcare
  • ACOs – do they work or not
  • Big Data – so much data…so many opportunities

Here’s my predictions for 2014:

  1. Transparency – The race to bring cost data to the forefront of the consumer mindset will move from a radical concept to an expectation.  With increased out-of-pocket costs and HDHPs, consumers will expect access and information to cost data.  They will look for systems that can predict what they need and push data to them in a timely fashion using location based services and predictive algorithms. 
  2. Exchanges – With big companies trying the private exchanges and moving their employees to the federal exchange, we’ll see the market holding its breadth to see what happens.  If this drives success on both sides of the equation – employers and payers, you can expect a large jump in this direction later in the year.   
  3. Mobile – The traditional member website will continue to die a slow death without mobile optimization in place.  More and more consumers will access the healthcare system through a smart phone or device like an iPad.  This will drive healthcare companies to figure out how to embrace user design and member experience in new ways as they strive to provide the sustainable app that consumers use more than a few times. 
  4. Providers – Providers will continue to cautiously embrace pay-for-performance, value-based healthcare, and models like ACOs and PCMHs.  They will want them to work, but they will continue to look for the Tipping Point in which their overall panel is part of these programs.  Providers will also begin to modify their workflows using technology based on Meaningful Use and the ubiquity of technology. 
  5. Engagement – Consumer engagement in healthcare will continue to be the elusive Holy Grail.  Companies will try behavioral economics, incentives, and mass personalization to try and get consumers to understand healthcare and take actions to improve their health.  There will be more shifting to include caregivers and embrace social media (e.g., Facebook) and peer-to-peer networks.  We will start to see documented case studies and results in terms of improved outcomes. 
  6. Devices – While 2013 was the year of device proliferation, we will see the number of people (early adopters and QuantifiedSelf groupies) maxing out.  I expect some further consolidation and a dip in adoption rate as we move into the period of disillusionment.  Devices will be less about a standalone solution and look at how they integrate with the smart phone and existing systems (at work and home).  Like smart pills and smart clothes, this will lead to increased data and integration into daily life.  This will require collaboration with providers and employers to figure out how to come through this period.
  7. Value-based – CMS will continue to be a big driver in pushing new payment models around healthcare as they struggle to figure out how to slow the tidal wave of costs coming in Medicare and Medicaid.  This will meet up with some of the progress in the commercial space with ACO and PCMH models leading to an evolving path in terms of how drive value.  This won’t be the breakthrough year, but we’ll see meaningful progress. 
  8. Investments – I don’t see any slowdown in healthcare investments.  Our health issues aren’t going away in the US or abroad.  China is just emerging with a long list of health issues and technology is creating new solutions in 3rd World countries. 
  9. Pills Plus – With pharma struggling with how to reinvent itself, they are going to look at new solutions like Merck is doing with Vree Health.  This will cause them to look at many of these trends and how they wrap services, technology, and incentives around their medications.  
  10. Specialty Care – Specialty pharmacy will continue to be a big growth driver with novel innovations coming down the pipe.  But, these pharmacies will realize that they can’t work in a vacuum.  They have to do a better job at integrating care management into their services and partnering with Case Management companies to holistically treat the patient. 
  11. Metabolic Syndrome – The overall global issues of obesity and diabetes will become a huge weight around the shoulders of the healthcare system.  While the focus will continue to be on the complex cases requiring massive dollars, the majority of people will be struggling with a chronic disease.  Metabolic Syndrome will become a big focus for payers, employers, and health services companies as they try to find ways to prevent further complications. 
  12. Prevention – While I don’t expect a huge shift here, I think we’ll start to hear more voices on the perimeter yelling about why we only spend 5% of our dollars on prevention.  They’ll point out other models outside the US spending more with better outcomes.  Health Reform will begin to enable some change here, but it will be slow. 
  13. Community Based Care – With more people coming back into the healthcare system with Health Reform, there will be a greater need for location based access to healthcare.  This will involve clinics but will be much broader.  Companies will need to look at how they embrace community resources like churches to engage the disengaged and poor who don’t trust the system and have limited access to the traditional channels.  

The 15 Year Old Technology Missing From Healthcare.gov

I talked about my experience trying to use the site day one. I honestly hoped it was an anomaly but it doesn’t seem to be.

But, as I think about Healthcare.gov and the general benefits selection process, I see two huge gaps.

Back in 1999, I was working with a company called Firepond. The had what was called a product configurator. At the time, I was at E&Y and Empire BCBS and several other Blues hired them to build a tool for brokers. The tool sat behind a really slick web interface which allowed the broker to ask a consumer less than 10 questions. They would move a sliding bar across the screen and it would dynamically rank their plan options to tell them what was the best option for them to buy. It seems like that wold be great for Medicare.gov and Healthcare.gov.

What we were missing then which Big Data might actually help us solve now is individual claims data. This is what drives me crazy when you have to pick your benefits at work. Why can’t I upload my benefits information and have a tool actually tell me what to buy? If I had my claims history plus a predictive model, I could make smarter decisions about how to select my benefits.

The Connected Pharmacy of 2020

At the conference last week, I was talking about the opportunity for retail pharmacy to play a broader role as the patient’s medical home.  As part of that discussion, I tried to create a vision of a digitally connected location.  Here’s my summary of that…

Imagine that the pill bottle you use is now a smart object (expanding on the RxVitality concept).  It now knows when you are running low on pills.  Since it’s connected to your WiFi signal and to your smart phone, as soon as you’re low, it does the following:

  • Send a new refill request to the pharmacy (or to your physician if you’re out of refills)
  • Puts a reminder in your phone for you to pick up the prescription (action item list, calendar) and updates that once it gets confirmation on time from the pharmacy

As you’re driving by the pharmacy, your smart phone reminds you to pick up the Rx as it knows where you are based on GPS.

When you enter the pharmacy, it has a system to capture information from your devices or phone about your sleeping habits, what you’ve been eating, and your exercise.  All of this information is important for them to actively manage your health.  Additionally, as you enter the pharmacy, they use a technology like FaceDeals to recognize you and do several things:

  • Alert the pharmacy that you’re in the store so they can pull your prescription
  • Pull up your CRM (customer relationship management) profile so they pharmacist and tech can great you by name and link back to other information (i.e., Hi George.  Are you here to pick up your prescription?  By the way, how did those crutches work out?)
  • Offer you a coupon on some new OTCs or medical supplies based on your chronic disease(s)

While you’re shopping (at a grocery or big box pharmacy), you’re linking your smart phone to the smart cart which is helping you navigate the store.  As it confirms your identify via fingerprint or facial recognition, it opens up a link to your medical data.  This allows the cart to help you navigate the store and scans everything you put into the cart to look for drug-food interactions (e.g., grapefruit juice).  It also helps to steer you to better food options (eat this not that) based on your diagnoses (i.e., for a diabetic, I would suggest this other cereal).  All of this is happening on your screen to protect your privacy.

By the time you get to the pharmacy, you stand in front of the register which has a scale embedded in the floor so they can instantly know your weight and compare that to your last measurement.  Since they are now tied into your medical data, the Point of Sale technology also gets relevant alerts that they can talk with you about (e.g., Did you know that your health coverage has changed?  Did you know that you have access to a health coach to discuss your condition?).

As you leave, all of the data they collected is integrated and pushed out to both your personal health record (PHR) along with the electronic medical record (EHR) that your physician uses.  Any new risks identified are also shared with your caregiver or others in your social circle that you’ve identified and opted-in to receive information.  This social connectivity helps to create the village necessary to drive change.

Scary or fascinating?  I prefer to think about this as a fascinating way of leveraging technology and data to make my experience better and improve my outcomes, but I know not everyone will feel that way.

Key Topics At #WHCC13 In DC

I’m at the World Healthcare Congress (WHCC13) in Washington DC this week.  This has always been one of the top 5 events for me to try to come to every year (admitting that there are a few like TED that I haven’t attended due to budget yet).

It’s interesting  how trends start to flow within a conference and how the trends change year to year.  This year, the key themes that I continue to hear are (in no order):

  • Engagement is critical.  Between MD and Patient.  Between social network / influencers and member.  Between employee and employer.
  • We have to get past the barriers to health enablement (i.e., legacy IT systems) and make change happen.
  • Game theory can help improve engagement.
  • Mobile tools are important.
  • Data integration has to happen and employers are doing it themselves.
  • Biometrics are critical path.
  • We can’t solve healthcare if we don’t solve health.  The community.  Our food choices.  Work / life balance.  (I would add sleep and stress.)
  • Rapid innovation.
  • Reform isn’t going to be easy on the employer or the employee.

But, since Twitter is my new note taker…here’s a few sets of tweets for you.

#whcc13 tweets whcc13 tweets3 whcc13 tweets2 whcc13 tweets1

Less Than 1/3rd Of Health Insurers Very Confident In Their Big Data Value To Consumers

With all the discussions these days on Big Data and how to use information to create insights and wisdom, I was really shocked when I looked back at this PWC survey from 2011.  In it, less than 1/3rd of health insurers were very confident in their use of informatics to add value around case management, disease management, wellness, and consumer health tools.  WHAT???

This seems crazy to me.  In this interconnected world where everyone is talking about connected devices, mHealth, and ENGAGEMENT, health insurers are in the optimal position to leverage their data to provide insights, to provide transparency, to create algorithms, to be preventative in their actions, etc.  Maybe their technology platforms are too old?  Maybe they’re too silo’d?  I’m not sure.  But, I find this an interesting arbitrage opportunity.

With a system that integrates data from claims, labs, patient reported sources, HRAs, and biometrics, you can add value by creating a personalized patient experience that adapts with their needs.

Clinical Informations for Care Mgmt


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