Healthcare transformation

Archive for Healthcare transformation

But Will It Fly? What Airlines and Healthcare Organizations Have In Common

What do airlines and healthcare systems have in common? Quite a lot it turns out, from a recent power breakfast featuring Rod Hochman, CEO of Providence St. Joseph Hoag Health system, and Brad Tilden, CEO of Alaska Airlines. In addition to the Pacific Northwest roots of both organizations, both have also undertaken mergers to gain market share and increase physical territory. Both serve a large cross-section of the population, and both are in highly-regulated industries that are not necessarily known for customer service that are grappling with new always connected user experiences and expectations.

The wide-ranging discussion included early inspiration for Hochman and Tilden’s early careers, how to motivate and engage a wide range of employees, and how to deal with competition and lead change. Both leaders had early influences on their career direction. Hochman knew he wanted to be a doctor at 16 when assisting on surgeries (!), and Tilden grew up beside Seatac airport watching planes while his peers were watching girls. Tilden grew his career at Alaska, while Hochman is a practicing rheumatologist, who has worked his way from small clinic to major system. Hochman joked that a rheumatology specialty is much more suited to success in administration than say surgery, equating running a hospital to the patient required in managing chronic diseases.

Airlines and health systems have similar challenges with employee experience. Both types of organizations have highly skilled staff, pilots and physicians, who demand a lot of autonomy. Mistakes in both professions can cause loss of life. The difference is that aviation has moved a lot faster in instituting standard procedures and checklists to improve safety and outcomes. Tilden frequently referenced an Alaska Air crash 17 years ago that impacted their approach to safety, and talked about the ways pilots and co-pilots double check settings. Hochman talked about his hope for quality improvements and better collaboration from the younger generation of physicians who have grown up in a world of checklists and standardization, and said that the ones who only care about being left alone to make decisions will retire.

They also have large teams of people who “get stuff done.” Hochman has banned the term ‘middle management’ since he sees those people as the ones who are making things happen, instead he calls them “core team”, a term that Tilden quipped he’d also start using.Rod Hochman & Brad Tilden

Customer experience was also top of mind for both execs. Tilden talked about Alaska adopting Virgin’s mission of being the airline people love. While he seemed to find some of Virgin’s approach to be a bit edgy compared to Alaska, he said you couldn’t find a better mission. Both grappled with the ease of sharing bad experiences on social media, and indicated that social media monitoring has become a key tool in managing consumer expectations. Hochman, also noted that it all comes back to the individual experience when he described that his staff hate when he has his own annual physical, because his expectations as a patient are much higher than what he experiences, especially with respect to convenience and information flow.

Both are optimistic and passionate leaders who genuinely care about the consumer and employee experience, and had as good a time interviewing each other as the audience did listening to them. This event was sold out, so if an opportunity like this comes up again, sign up early.

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, M-health

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Introducing Sugarpod by Wellpepper, a comprehensive diabetes care plan

We’re both honored and excited to be one of five finalists in the Alexa Diabetes Challenge. We’re honored to be in such great company, and excited about the novel device our team is building. You may wonder how a team of software folks ends up with an entry with a hardware component. We did too, until we thought more about the convergence happening in technology.

We were early fans of the power of voice, and we previewed a prototype of Alexa integration with Wellpepper digital treatment plans for total joint replacement at HIMSS in February 2017. Voice is a great interface for people who are mobility or vision challenged, and the design of Amazon Echo makes it an unobtrusive home device. While a mobile treatment plan is always with you, the Amazon Echo is central in the home. At one point, we thought television would be the next logical screen to support patients with their home treatment plans, but it seems like the Echo Show is going to be more powerful and still quite accessible to a large number of people.

Since our platform supports all types of patient interventions, including diabetes, this challenge was a natural fit for our team, which is made up of Wellpepper staff and Dr Soma Mandal, who joined us this spring for a rotation from the University of Georgia. However, when we brainstormed 20 possible ideas for the challenge (admittedly over beer at Fremont Brewing), the two that rose to the top involved hardware solutions in addition to voice interactions with a treatment plan. And that’s how we found ourselves with Sugarpod by Wellpepper which includes a comprehensive diabetes care plan for someone newly diagnosed, and a novel Alexa-enabled device to check for foot problems, a common complication of diabetes mellitus.

Currently in healthcare, there are some big efforts to connect device data to the EMR. While we think device data is extremely interesting, connecting it directly to the EMR is missing a key component: what’s actually happening with the patient. Having real-time device data without real-time patient experience as well, is only solving one piece of the puzzle. Patients don’t think about the devices to manage their health – whether glucometer, blood pressure monitor, or foot scanner – separately from their entire care plan. In fact, looking at both together, and understanding the interplay between their actions, and the readings from these devices, is key for patient self-management.

And that’s how we found ourselves, a mostly SaaS company, entering a challenge with a device. It’s not the first time we’ve thought about how to better integrate devices with our care plans, but is the first time we’ve gone as far as prototyping one ourselves, which got us wondering which way the market will go. It doesn’t make sense for every device to have their own corresponding app. That app is not integrated with the physician’s instructions or the rest of the patient’s care plan. It may not be feasible for every interactive treatment plan to integrate with every device, so are vertically integrated solutions the future? If you look at the bets that Google and Apple are making in this space, you might say yes. It will be fascinating to see where this Alexa challenge takes Amazon, and us too.

We’ve got a lot of work cut out for us before the final pitch on September 25th in New York. If you’re interested in our progress, subscribe to our Wellpepper newsletter, and we’ll have a few updates. If you’re interested in this overall hardware and software solution for Type 2 diabetes care, either for deploying in your organization or bringing a new device to market, please get in touch.

Read more about the process, the pitch, and how we developed the solution:

Ready When You Are: Voice Interfaces for Patient Engagement

Alexa Voice Challenge for Type 2 Diabetes: Evolving a Solution

 

Posted in: Behavior Change, chronic disease, Healthcare Disruption, Healthcare Technology, Healthcare transformation, M-health, Managing Chronic Disease, patient-generated data

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In Defense of Patient-Generated Data

There’s a lot of activity going on with large technology companies and others trying to get access to EMR data to mine it for insights. They’re using machine learning and artificial intelligence to crawl notes and diagnosis to try to find patterns that may predict disease. At the same time, equal amounts of energy are being spent figuring out how to get data from the myriad of medical and consumer devices into the EMR, considered the system of record.

There are a few flaws in this plan:

  • A significant amount of data in the EMR is copied and pasted. While it may be true that physicians and especially specialists see the same problems repeatedly, it’s also true that lack of specificity and even mistakes are introduced by this practice.
  • As well, the same ICD-10 codes are reused. Doctors admit to reusing codes that they know will be reimbursed. While they are not mis-diagnosing patients, this is another area where there is a lack of specificity. Search for “frequently used ICD-10 codes”, you’ll find a myriad of cheat sheets listing the most common codes for primary care and specialties.
  • Historically clinical research, on which recommendations and standard ranges are created, has been lacking in ethnic and sometimes gender diversity, which means that a patient whose tests are within standard range may have a different experience because that patient is different than the archetype on which the standard is based.
  • Data without context is meaningless, which is physicians initially balked about having device data in the EMR. Understanding how much a healthy person is active is interesting but you don’t need FitBit data for that, there are other indicators like BMI and resting heart rate. Understanding how much someone recovering from knee surgery is interesting, but only if you understand other things about that person’s situation and care.

There’s a pretty simple and often overlooked solution to this problem: get data and information directly from the patient. This data, of a patient’s own experience, will often answer the questions of why a patient is or isn’t getting better. It’s one thing to look at data points and see whether a patient is in or out of accepted ranges. It’s another to consider how the patient feels and what he or she is doing that may improve or exacerbate a condition. In ignoring the patient experience, decisions are being made with only some of the data. In Kleiner-Perkin’s State of the Internet Report, Mary Meeker estimates that the EMR collects a mere 26 data points per year on each patient. That’s not enough to make decisions about a single patient, let alone expect that AI will auto-magically find insights.

We’ve seen the value of patient engagement in our own research and data collected, for example in identifying side effects that are predictors of post-surgical readmission. If you’re interested, in these insights, we publish them through our newsletter.  In interviewing patients and providers, we’ve heard so many examples where physicians were puzzled between the patient’s experience in-clinic or in-patient versus at home. One pulmonary specialist we met told us he had a COPD patient who was not responding to medication. The obvious solution was to change the medication. The not-so-obvious solution was to ask the patient to demonstrate how he was using his inhaler. He was spraying it in the air and walking through the mist, which was how a discharge nurse had shown him how to use the inhaler.

By providing patients with useable and personalized instructions and then tracking the patient experience in following instructions and managing their health, you can close the loop. Combining this information with device data and physician observations and diagnosis, will provide the insight that we can use to scale and personalize care.

Posted in: Adherence, big data, Clinical Research, Healthcare Disruption, Healthcare Research, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient engagement, patient-generated data

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Consumerization Is Not A Bad Word

When you say consumerization, especially with respect to healthcare, people often jump to conclusions about valuing service over substance. There’s a lot of confusion over the meaning of consumerization, whether it’s possible in healthcare, and whether it’s happening. I recently had the privilege of speaking at the Washington State Health Exchange’s Annual Board Retreat on this topic. (Perhaps you saw it, the event was live-streamed to the public. 😉 ). The Health Exchange is pondering questions of how to attract new users, how to better serve their needs, and how to make the experience more useful and engaging. And, this my friends is consumerism, or at least one facet of it: user focus, better service, understanding needs. Doesn’t sound bad at all, does it? In fact, it sounds like something any good service or organization should be doing for its customers.

Consumer-centered pain scale. Baymax from Disney's Big Hero Six

Consumer-centered pain scale. Baymax from Disney’s Big Hero Six

And there’s that word, customers. That’s the debate. Are patients really customers? Not really, often they don’t have a choice, either because of their insurance coverage or from the necessity of an emergency where decisions are often made for patients. However, patients, and everyone else for that matter (except people in North Korea), are consumers, and they judge healthcare experiences both service delivery and technology as consumers. Think of it like this, your patients will judge your experiences through the lens of any other service they’ve interacted with. Fair or not, they will do that. Why do they do this? It’s human nature to remember positive experiences and try to seek them out. Although there’s another reason: high-deductibles are also driving people to examine where they are spending their healthcare dollars, and they evaluate based on outcomes, convenience, and the overall experience.

Since healthcare technology is my area of expertise, let’s stick to that rather than critiquing hospital parking, food, or beds. (Although these are often things that impact HCAHPS scores.) Consumerization when applied to health IT means that patients have an expectation that any technology you ask them to engage with, and especially technology you ask them to install on their own devices, will be as usable as any other app they’ve installed.

Consumerization also impacts internal health IT. Doctors were the first wave, when they pushed using their own devices to text with other providers within the hospital setting. (In IT this is often referred to as “bring your own device.”) The pager became obsolete and replaced with our own always on, always connected mobile devices. (Sadly, the fax machine, like a cockroach, keeps hanging in there.)

Patients are also bringing their own devices, and using them in waiting rooms and hospital beds. We’ve had patients reporting their own symptoms using Wellpepper interactive care plans from their hospital beds. This presents an opportunity to engage, and at a low cost: they are supplying the hardware. The final wave of consumerism will happen when clinicians and other hospital staff also demand convenient, usable, and well-designed tools for clinical care.

Consumerization is late to arrive in healthcare IT. Other industries have already reached tail end of this wave, and have already realized that technology needs to be easy to use, accessible, interoperable, and designed with the end-user foremost. However, consumerization is coming, both from internal staff demands and patients. Technology, healthcare IT, and the people that build and support it are facing scrutiny, being held to higher standards, and becoming part of the strategic decision-making healthcare organizations. This is a great thing, as it will result in better clinician and patient experiences overall, because at its core consumerism is about expecting value, and ease and getting it, and who doesn’t want that?

Posted in: Healthcare Disruption, Healthcare Technology, Healthcare transformation, Interoperability, M-health, Outcomes, Patient Satisfaction

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Trends That Survive Healthcare Reform

While many aspects of the Affordable Care Act drove significant new opportunities, innovation and change in healthcare, this recent article from Harvard Business Review points out that there are trends that are not dependent on the system. In particular they identify three trends that are not dependent on the act in its current form:

  1. Aging population
  2. Technology adoption
  3. Discoveries in life sciences

However, we think there are at least three more that will mean that the momentum in technology innovation and a patient-centered approach will continue.

  1. Consumer focus: High deductibles are driving two types of behavior. Patients are acting more like consumers and are shopping with their healthcare dollars. Healthcare organizations are trying to attract patients and better understand their experiences and pathways through the organization. The expectation of good and real-time service is high.
  2. People are getting less healthy: While we would like to see this change on its own, through diet and exercise, the fact is that people are not eating well or active enough, and the rates of diabetes and pre-diabetes are increasing. By 2030, it’s estimated that over 470M people world-wide will have pre-diabetes.
    Leading causes of death

    Leading Causes of Death from http://www.independent.co.uk/news/health/the-things-most-likely-to-kill-you-in-one-infographic-a7747386.html

  3. Value stays top of mind: Our healthcare costs cannot keep rising indefinitely, and experiments in value-based payments have shown to work. Payer/provider organizations are looking to deliver better outcomes at lower costs, and patient self-management and self activation can help with that.

While patient engagement is not the only solution, we believe activated people and patients are an under-utilized source of positive health outcomes. Regardless in of changes in the healthcare act, that will remain true.

Patient engagement has been a mantra for those seeking to reform health care, as it’s widely accepted that patients who are engaged in their own health care have better outcomes. Frank Baitman & Kenneth Karpay

 

Posted in: Healthcare Policy, Healthcare transformation, Outcomes, patient engagement, Uncategorized

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Mary Meeker’s 2017 Healthcare Trends Report Shows Opportunity

An annual highlight of Recode’s CodeConf is Mary Meeker’s internet trends report. Last year, I had the pleasure of hearing her in person, and I’m not sure I’ve ever heard a presentation with so much good data, presented so quickly. This year, I wasn’t able to attend, but she also ran out of time for some of the most important slides for a healthcare entrepreneur like me. Based on a quick run-through of the deck, these three slides struck me. (If you want to see the full section on healthcare, it starts at Slide 288.)

Not surprising that consumers expect digital health services, or that Millenials lead in most categories. It’s also not surprising that Boomers have sought the most remote care–they have probably sought the most care overall. It might be interesting to see this pro-rated by care usage. That Boomers are not looking at online reviews is very interesting given how much attention the surgeons we work with give to them.

 

 

 

 

 

 

 

 

 

 

 

 

Even with all their consumer device troubles, Samsung squeaks above Apple, and Facebook and Amazon both with a tremendous amount of data about you, are still reasonably well trusted. Both Microsoft and Google have tried and failed previously to own your personal health record, but they are well positioned to do so. What would also be interesting is to see these trust levels against traditional healthcare companies like GE or Johnson & Johnson.

 

 

 

 

 

 

 

 

 

 

 

 

EHR adoption is not surprising since it was mandated through meaningful use. It’s a bit depressing to look at the 2004 stats, and think back to which parts of your life weren’t digital in 2004, and compare that to your medical records. However, the biggest opportunity we see in this slide is dramatically expanding the data points available by tracking patients outside the clinic. Physicians are making decisions with only a few data points when there is so much richer information available through patient-entered and patient generated data.

Posted in: Healthcare Research, Healthcare Technology, Healthcare transformation

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Patient engagement and design in the art of medicine

Patient engagement is controversial for many physicians because it interferes with the traditional values that arise from the several hundred-year old guild of medicine. Per the NEJM Catalyst Insights Council, patient engagement is characterized as patients interested in participating in choices about their health care, taking ownership of those choices, and having an active role in improving their outcomes. Given the current epidemiology of chronic diseases, it is not surprising that many patients have low levels of engagement as well as health literacy. As someone who is preoccupied with the diagnosis and treatment of diseases, it is difficult for me to view any problem solving from the patient’s lens; yet, I know through the literature and intuitively that how patients feel impacts their outcomes. The following are a few of the things I have learned and will work on as I improve my ability to deliver care:

  • Time = effectiveness Opinions of clinicians and leaders in patient care have determined that increased patient time with a health care team lends to increased engagement. A basic concept in human dynamics is that the mere exposure to someone over time is enough to start an unlikely relationship. Tack onto that high quality communication and understanding nuances of healthcare literacy, and you have a more engaged patient. In modern medicine, this would be accomplished through a multidisciplinary team effort. This task is challenging given the constraints of our current healthcare system. Could I increase time with patients through mobile technology? If there was an automated way for me or another care team provider to connect with patients via text or a quick phone call at specific intervals, I would be able to increase exposure and augment time.
  • Shared decision making is key Another finding of the NEJM Catalyst is that shared decision making is one of the most effective strategies in improving engagement. We learn about this academically through the interpretative model (as opposed to paternalistic, etc.) of provider-patient relations; but this is also just common sense. I like to think this gives patients a sense of control, a sense of choice in a matter, where frankly, a lot make be out of your control. We are also better able to accept the consequences of the decisions we make, rather than the ones that are placed upon us. One of the reasons that UNICEF has been effective in helping children around the world is from the core guiding principle that children inherently have rights. American political views are reflected in the current model of access, but I would like to practice medicine with the belief that patients have inherent rights. It is a slippery slope because patients’ actions can be counterproductive to their health – but my preference is still to protect patient autonomy.
  • Technology alone cannot solve the problem The concept of remote monitoring with wireless devices doesn’t appear to improve chronic disease management or outcomes. Technology alone cannot solve a dilemma in a people’s “business”. I would opt to use adaptive technologies that improve my relationship and sense of connectedness to the patient over technology that would offer mostly education or content to the patient. The idea of people taking ownership for a difficult problem is non-trivial. It requires motivation at a level that is primarily internal. How do you access that in people? In the self-help world, the most effective motivational coaches tend to elicit a hyper-emotional state in people along with placing a high premium on discipline. I think it’s logical to work on building a relationship, connecting, allowing a safe space for vulnerability, and witnessing the struggle to achieve begin from that foundation. While patient engagement is primarily a patient responsibility, I think providers have a responsibility to elicit patient activation as this directly affects outcomes.
  • Design-thinking can help When Indra Nooyi became the CEO of Pepsi, one of her top priorities was to explore her staff’s beliefs on the concept of design. She asked business executives to take photographs of anything that they believed constituted design. After such an abstract request, she noticed that not only did people not care to complete the assignment, that some had even hired professional photographers to complete the task. My interpretation of this story is that she believes that there is an artistic aspect in the most unsuspecting of transactions. According to IDEO, human-centered-design is about building a deep empathy with the people you are designing for. In the process of being inspired, ideating, and implementing, a design researcher explores the texture and what matters most to a person before execution of a solution. How is this any different from delivering empathetic, tailored care to a patient? What we do well in medicine, some of the time, is already done at a higher level of sophistication in the real world outside of our clinics and hospitals. While design-centric thinking may lead to innovations in healthcare, for the provider I think the greatest advantage is that you amplify the relationship you have with the patient and increase overall engagement.

Whether it’s the creation of something that didn’t exist before or making decisions that are influenced by intuition, everyone is at one level involved in artwork. Improving patient engagement particularly with design-centric thinking would bring more value and meaning to the art of medicine, a skill I look forward to building throughout my career.

Posted in: Behavior Change, Healthcare transformation, patient engagement

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T2 Telehealth aka ATA 2017 aka ATA 23: Part 1, The Eye of the Hurricane

While there is a focus on transformation, value, and outcomes going on, if the keynotes are any indication it may be a rough road ahead for telemedicine.

“It’s the 23rd year for the American Telemedicine Association conference, why are we still talking about how to get paid?”, admonished Pamela Peele, PhD economist and Chief Analytics Officer of UPMC during the opening keynote of the annual conference of the American Telemedicine Association.

Pamela Peele at ATA2017

Pamela Peele at ATA2017

“Especially since, as this audience knows, telemedicine is the best thing since sliced bread?

Why indeed? Well, it’s complicated. The problem is that each person in the value chain, the payer, the physician, the healthcare organization, the patient, and the patient’s closest adult daughter (aka primary caregiver), only see the value of one slice of that loaf of bread, and we collectively as purveyors of telemedicine have to sell the entire loaf. There’s no clear solution to this problem. However, with unsustainable costs of healthcare, and increasing consumerization we have got to figure it out. The taxpayer is bearing the brunt of the costs right now, and Peele characterized the shift of baby boomers to skilled nursing facilities as a hurricane we are unprepared for. One way out is to keep people at home, and for that we need Medicare to fund a cross-state multi-facility study to determine efficacy, value, and best practices. Fragmentation of trials is keeping us from wide scale adoption.

The Adaptation Curve

The Adaptation Curve

“We have got to figure it out” was also the theme of best-selling author and New York Times columnist Tom Friedman’s keynote promoting his new book “Thank-You For Being Late.” Friedman claimed to be more right than the rightest Republican and suggested abolishing corporate taxes and at the same time more left than the leftist Bernie Sander’s supporter suggesting we need an adaptable safety net. His major thesis is that we are undergoing 3 climate changes right now: globalization, climate, and technological. To survive and thrive in this new world, we need to adapt and evolve, and take our cues from Mother Nature, not from some sort of top-down regulation. Like Peele on the previous day, Friedman also sees a hurricane coming and suggests that the only way to survive is to find the eye of the storm not by building a wall.

Adapting and evolving will come in handy with the harder times for healthcare investment ahead predicted by the venture investing panel in the day 3 keynote. Tom Rodgers of McKesson Ventures, and Rob Coppedge of the newly formed Echo Health Ventures pulled no punches, as they tossed of tweet worthy statements like “Don’t tell me you’re the SnapChat of healthcare” and “it seems like there are only 3 business models for telemedicine.” The later was Coppedge’s comment on walking the tradeshow floor. (The models are direct to consumer, platform, and as a combined technology and service.) Rodgers had no love for direct to consumer models or anything that targeted millennials who he deemed low and inconsistent users of services. Platform vendors were advised to surround themselves with services: video was seen as a commodity.

So where does that leave us? Value, value, value. The challenge is that the value is different depending on the intervention, the patient, the payer, and the provider. Preventing readmissions, aging at home, decreasing travel costs, all provide benefits to one or more of the key stake holders. Can we figure out how to reimburse based on slices of value? How do we get together to realize that value? And how do we do it before the hurricane hits?

Posted in: Behavior Change, Healthcare Disruption, Healthcare Policy, Healthcare Research, Healthcare transformation, Telemedicine

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Wellpepper attends Episodes of Care Summit at Cambia Grove

Last week, Wellpepper CEO, Anne Weiler and I attended a half-day Episodes of Care Summit put on by Cambia Grove. It was great to see payers, providers and technologists come together to focus on initiatives that directly impact the patient experience. Here are some of our takeaways:

Horizon BCBS of New Jersey is an episodes of care pioneer

Focus on retroactive bundles before proactive. Episodes of care and bundled payments are often used interchangeably. An episode of care typically refers to a payment made retrospectively while a bundled payment typically refers to a payment made prospectively. Horizon BCBS of New Jersey first launched retrospective pilots in 2010 (total hip and total knee replacements). In this model, savings are shared with the physician or practice once quality benchmarks and patient experience thresholds are met and costs come in below budget. After 7 years of scale and success, Horizon is now launching more immediate, risk-based, prospective initiatives in 2017.

Drive success through quality. Horizon piloted with over 200 quality metrics with member-specific, risk-adjusted financial targets. Metrics are key in driving success. Identify 3-5 standard quality metrics and 2-4 episode-specific metrics.

Community involvement is imperative

It’s great to see continued focus on community involvement in innovation and healthcare. The Bree Collaborative is an excellent example of bringing together community and industry leaders to identify and promote strategies that directly impact patient outcomes, quality and affordability. Wellpepper firmly believes in the work that the Bree Collaborative is doing. In fact, our total joint and lumbar fusion care plans follow Bree recommendations.

The Episodes of Care Summit held breakout sessions that mapped out the ideal episode of care/bundle experience through the lens of people, process and technology. Think of people, process and technology as a three-legged table. Remove one leg and the table falls. If the three legs are not the same size, the table does not function properly. Effort needs to be allocated equally across people, processes and technology to drive behavior change. Reimbursement seemed to take a precedence in every conversation rather than the patient’s needs or the provider’s care. Until this mindset is fixed, it’s hard to focus on what healthcare is really about. Dr. Hugh Stanley, from the Bree Collaborative did an excellent job bringing the focus of the conversation back to the patient.

Memorable quotes from breakout sessions:

  • “Patients need to be at the center of episodes of care.”
  • “We need to capture patient satisfaction in real time.”
  • “I’m blown away I can get more info on a dog bed than a provider.”
  • “We need to rebuild the patient deductible and copay mindset.”
  • “The payer community has a responsibility to share information to publicize data that drives provider readiness.”
  • “Creating episodes vs bundles benefits providers and ultimately patients.”

Posted in: Healthcare Policy, Healthcare Technology, Healthcare transformation, patient engagement, Patient Satisfaction, Uncategorized

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Wellpepper Receives Seattle Business Magazine’s 2017 Leaders in Healthcare Gold Award for Achievement in Digital Health

We are honored to have been named the Gold Award winner for outstanding achievement in digital health from Seattle Business Magazine’s 2017 Leaders in Health Care!

Thank you to our amazing team and partners!

 

Posted in: Healthcare Technology, Healthcare transformation, M-health, patient engagement, Press Release, Seattle, Uncategorized

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Population Health and Patient Engagement: A Reckoning Is Coming

Population health and patient engagement should be best friends. To draw conclusions for population health, you need a lot of data, and patient engagement that is, patients interacting digitally with treatment plans and healthcare providers, generates a ton of data. Population health tries to analyze the general to get to the specific and identify patients at risk. Patient engagement starts with the specific patient, and with enough data recorded by those patients, can find general trends.

With patient engagement, the information is real-time. With population health it is backwards-looking. Population health has the richness of the medical teams notes and diagnosis but it is missing the patient perspective. Patient-generated data will have diagnosis if it’s part of a treatment plan prescribed by a physician, but it won’t have the full notes. A blurring of the boundaries between population health and patient engagement presents a way forward to greater insights about both individuals and groups, and can make population health actionable at the individual patient level by providing personalized instructions (with or without care managers).

However, to get to this desired end-state, we need to clear some obstacles, first of which is the idea that patient engagement generates too much data for physicians.

Yes, an individual physician does not want to see or review each data point that a true patient engagement solution generates. However, this information can be extremely interesting to the patient, especially when looking for trends to help self-manage a chronic condition so it is worth enabling patients to collect it. For example, looking at whether certain foods trigger arthritis, or whether certain activities trigger headaches. However, to draw conclusions like this, you must record a lot of data points and in real-time, and this makes physicians nervous. They have enough to do, and not enough time to do it in, so this data cannot add to that workload.

As well, patient-generated data is messy, which can be intimidating, especially in an industry that is looking for deviations from norms. The challenge with patient-generated data is that it can uncover that the long-tail is actually longer than previously thought, that there are sub-groups within previously thought to be homogeneous groups of patients with a similar condition. In the long run, this will result in medical breakthroughs and personalized medicine. In the short run this can be difficult to deal with in the current systems.

the long-tail is actually longer than previously thought

Does that mean that we shouldn’t collect patient-generated data? Not at all. Helping patients track their experiences is a great first step to self-management. Knowing whether they are following a treatment plan, and what their experiences are with that treatment plan can help healthcare systems determine the impact of their instructions outside the clinic.

Although physicians don’t want all this data, healthcare organizations both providers and payers, should want it. Other industries would kill for this type of data. Data scientists and population health managers at health systems should be clamoring for this valuable patient-generated data.

Patient-generated data is usually collected in real-time so it may be more representative of the actual current population. The benefit of real-time collection is that further exploration of the actual patient experience is possible and can be used to prevent issues from escalating. With backwards looking data whatever was going to happen has happened, so you can only use it to impact new groups of patients not current groups.Patient-Generated Data

Finally, patient-generated data is less likely to be siloed, like clinical data often is, because the patient experience is broad and often messy and crosses clinical department thresholds (or more simply, patients are usually treated for more than one issue at a time.) Being relatively new to market, patient-engagement systems are built on modern and interoperable technology which also makes accessing data for analysis easier.

So where will we end up? To our team at Wellpepper, it seems inevitable that influencing and understanding patient experience outside the clinic. If you are making decisions for an individual patient with only a few clinical touch points, this is a very thin slice, often with a specific clinician’s specialty lenses on the actual situation. While healthcare systems are currently dipping their toes in the water on collecting and analyzing this data, if they don’t embrace the whole patient, patients will vote with their feet and pocket books towards organizations that are data and technology driven.

Posted in: Adherence, big data, Healthcare Technology, Healthcare transformation, Interoperability, M-health, patient engagement, population health

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Wellpepper Top Healthcare Blog Posts of 2016

We had a terrific year at Wellpepper and are anticipating great things in 2017. We’re looking forward to further improvement in the efficacy and effectiveness of mobile health and telehealth as well as advancement of new business models, value-based care, and interoperability between EMRs.

As we move forward, we’d like to take a moment to reflect and recap some of our most popular blog posts of 2016. In order of popularity they are:

Wellpepper Healthcare Christmas Wish List

Given the rush of the holiday season, it was a pleasant surprise to have gotten so many viewers (other than Santa) looking over our healthcare wish list, making it our most popular post of the year.

Not Patient Engagement with Jan Oldenburg

Unsurprisingly, our second most popular blog post happens to discuss a variety of topics ranging from shifting the healthcare mindset to utilizing digital tools to assist physicians, with nationally recognized consumer health information strategy leader Jan Oldenburg in this lively podcast that has listeners eagerly tuning in.

What’s True Now

With the uneasy condition of health systems and polices following the recent changes in leadership after the election, we are glad to see many turning to our blog post for some clarity. Will these factors remain true for the following years to come? We certainly hope so.

Better Living Through Big Data

We love sharing with our readers what we’ve gathered from panels and talks. This summary of our CEO discussing the benefits of collecting big data with the Seattle Health Innovator’s panel made this blog post our fourth most popular.

What Keeps Healthcare CEOs Up at Night

Last but not least, this recap of MATTER’s study about Accenture made our Top 5 by addressing the important values and actions that need to be implemented by healthcare CEOs in order to take a more patient-centered approach.

This next year, we are looking forward to sharing our new discoveries as we continue to tackle the challenges in healthcare and find more ways to improve mobile health and patient-centered technology.

Posted in: Healthcare motivation, Healthcare transformation

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Wellpepper’s Healthcare Christmas Wish List

santa

Dear Santa,

This year for Christmas we would like:

  • Real interoperability between EMRs and other systems so that data flows smoothly from patient to provider applications and between organizations. Make sure it comes with APIs and real reference architectures.
  • Modern, scalable, and reliable healthcare technology so CIOs and IT teams can spend more time innovating and bringing new ideas for patients and providers, and less time keeping systems up and running.
  • Patient-centered care where the goals of the patient are the most important outcomes considered. Make sure patients and providers can communicate about these goals and consider their impact on care.
  • Value-based care where cost and outcomes are evaluated to determine the right course of action. Let’s lower costs of care AND improve outcomes.
  • All people to have affordable healthcare regardless of pre-existing conditions. No one should go without healthcare.
  • When you deliver all the presents, please take away all the fax machines!

 

Thanks, Santa!

Good luck on your travels around the world on Christmas Eve.

 

Love, Wellpepper

 

PS We care about your health, so we’re leaving you an apple and some carrots for the reindeer rather than cookies this year.

Posted in: Healthcare motivation, Healthcare transformation, patient engagement

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What Keeps Healthcare CEOs Up At Night?

This week I had a double whammy of healthcare value from the comfort of my desk when MATTER Chicago live-streamed their event “What Keeps Healthcare CEOs Up At Night.” In addition to participating online with 40 others and engaging on Twitter on the topic, I’m pretty sure that Accenture charges big bucks to healthcare organizations to present these findings from interviews with over 50 healthcare CEOs. I got great info, some online networking, and no traffic!

So what does keep healthcare CEOs up at night? It seems that there are differing levels of awareness regarding the health of one’s own organization, changes in population health, as well as changes in healthcare in general. Perhaps the only thing keeping them all up at night is the delicate balance in shifting to outcome and value based payments without disrupting today’s revenue streams. It’s a classic innovator’s dilemma, but nonetheless, interviews and research with over 50 healthcare CEOs have shown that only some are effectively straddling these two worlds. Michael Main, managing director at Accenture Strategy, walked the full-house crowd at Matter and 40 of us on the live stream through the research, looking at winners and losers as well as making a few predictions for how the change would happen.

According to presenter Michael Main and the Accenture team’s analysis, only 5 out of these 50 CEOs were actually successfully making the shift to value based care, and of the rest, only 15 were capable of making that shift.

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See full report on Accenture here

To make the shift, Main identified some key criteria:

  • The CEO must have a strong passion for what healthcare can be, not what it is today. He or she must have vision and be motivated to make his or her system the #1 or #2 in their area.
  • The shift from volume to value needs to also include a shift back to volume but with the volume being serving a larger population base, not doing more to each patient. The only way to do this is to really understand a health system’s catchment area and the population. Main used the example of the 1,500 data points that Experian, the credit check company, has on each person and compared that to how few data points health systems have.
  • Care must move from being physician-centered to patient centered, but there must be strong physician leaders on board.

Main also identified barriers to change today:

  • Perverse incentives that reward for doing more to a patient rather than what’s actually best for the patient. Here, Main provided a couple of personal examples, including his father who was admitted to the hospital for 48 hours because of protocol when he would have been better at home waiting for test results.
  • People being worried about their own jobs. Main mentioned working with a nurse’s union on a patient-centered medical home project. Everything was positive until they realized the model would require fewer nurses than first expected. Demonstrating the basic adage that you can’t get someone to believe in something if their own livelihood depends on them not believing it.
  • Too much gray hair in the C-suite. Main believes that many hospital CEOs are too close to retirement to want to tackle the risk. They are looking to ride out the current fee for service world, and hand over the reins when the real change needs to be implemented. Most CEOs estimated the change will take another 7-10 years so they had time to wrap up their retirement packages. (Shades of physicians retiring around the deadlines for implementing electronic medical records.)

As you can imagine, there will be winners and losers in this new world of capitated and value-based payments. Basically, aside from the 20 CEOs that Main identified as either already changing or capable of it, the rest he felt were in the loser category. As care is pushed to the lowest cost delivery, hospitals could lose out if they don’t build integrated networks with primary care and urgent care in addition to emergency and inpatient. Smart CEOs are looking at consolidation by buying the best systems or smaller organizations instead of looking for bargains. They know that those bargain competitors will end up out of business. Winners will figure out how to incubate models that will cannibalize their own business rather that fending off upstarts who are looking to do it to them.

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Winners will have the right leaders who can take a patient-centered approach: both in aggregate and for individuals. In aggregate, they will better understand the patient base they serve in their geography and they will look at treatments that are outcome-driven and patient centered as well as looking at treatments that will impact each individual rather than the standard protocols like what Main described with his father’s treatment.

The Accenture research definitely pointed to answers in the transformation. Unfortunately, it seems like a number of CEOs today aren’t even asking the right questions. And of course, as with every healthcare event for the next while, with the looming threat to repeal the ACA, there are even more questions we need to be asking.

Posted in: Healthcare motivation, Healthcare transformation, Patient Advocacy

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Finding Change and Honesty at Mayo Transform Conference 2016

mayo-clinic-logoAlthough the theme of this year’s Mayo Transform conference was “Change,” it might as well have been dubbed “Honesty.”

From keynotes to breakout sessions, there was a raw sense of honesty and acceptance of the fact that change is hard, and we’ve reached a point where the evolution in healthcare doesn’t seem to be happening fast enough.

When you’re as successful as Mayo, it might be easy to brush failure under the rug – which made this session, “We Made This Thing, But It Didn’t Go as Planned. Now What?” unique. Now that some of the initial hype for digital health has died down, we are in a phase of realistic optimism where sharing both wins and misses represents a realistic way forward.

This interactive session in three parts by Steve Ommen, MD, Kelli Walvatne, and Amy Wicks unfolded a bit like a mystery. Questions were posed to the audience at each phase for our input on what might have gone right and wrong. Not surprisingly, the attentive audience proved as capable as the presenters, and some of the most valuable insights came from the audience questions.

The case study in this session was a three-year process to develop a new interface and workflow for the cardiology clinic. Dr. Ommen and the other presenters did not tip their hands to whether the project was successful or not, and we had to tease out the wins and losses that occurred during each phase.

The presenters shared stories, but did not show any artifacts of the process such as flow diagrams, screenshots, or personas. This methodology was effective because, instead of getting bogged down in critique of particular elements, we were able to see the bigger picture of challenges that could apply to any innovation or clinical change.

At the end of the session, the presenters summarized their top takeaways as:

  • Not having enough credibility and evidence

Much of the Transformation team were experts in design, but not necessarily the clinical experience for this service line. There were some misunderstandings between what could work in theory and in practice, although the team did identify areas of workflow improvement that saved time regardless of whether the technology was implemented.

  • Change fatigue (or “Agile shouldn’t be rigid”)

The team tried to use a lean or agile methodology with two-week product sprints: iterating on the design and introducing new features as well as interface changes biweekly. This pace was more than what the clinical users – especially the physicians – could handle, but the design aimed to stay true to the agile process. In this situation, the process was not flexible to the needs of the end users and possibly exacerbated the first point of lack of credibility.

  • Cultural resistance

The team lost champions because of the process. It also seemed like they may have spent too much effort convincing skeptics rather than listening to their champions. One physician in the audience wondered aloud whether the way physicians were included in the process had an outsized impact on the feedback the team received about what was working and wasn’t working. From his own experience, he noticed that a physician’s authority is often a barrier to collaboration and brainstorming.

From audience observations, it seemed like there may have been some other challenges such as:

  • Scope/Success Definition

There wasn’t a clear definition of success for the project. While the problem was identified that the current process was clunky and the technology was not adaptive and usable, not all parties had a clear understanding of what constituted success for the project.

Looking back, Dr. Ommen suggested that rather than trying to build a solution that addressed all co-morbidities, they should have chosen one that worked for the most common or “happy path” scenario. The too-broad scope and lack of alignment on goals made it challenging to conclude success.

  • Getting EPIC’ed

When the project started, the team was largely solving for usability problems created by having two instances of Cerner and one of GE used in the clinical workflow. During the course of this three-year project, Mayo made the decision to ink a deal with Epic, rendering the current problem they were solving for obsolete.

Going for a smaller win early on might have delivered value to end users before this massive shift in the underlying medical records software.

So what happened?

You can probably tell from the recap that the project was shelved. However, the team did have some wins, certainly in their understanding of how to better run a project like this in the future as well as in helping the clinical team optimize their workflow.

What should you take away?

Know your users, iterate, and move quickly to deploy quick wins – but not so quickly as to alienate your stakeholders.

Finally, ask your peers: we’re facing similar problems and can learn together.

Posted in: Clinical Research, Healthcare motivation, Healthcare Research, Healthcare transformation, Outcomes, Research, Uncategorized

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Health Care Innovators’ Uphill Climb

The Healthcare Innovators Collaborative and Cambia Grove have joined forces to present a series of talks on our evolving healthcare challenges.

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This series was run out of University of Washington last year, and this year’s sessions, subtitled “Under the Boughs” are held at Cambia Grove – where a new Sasquatch In Residence (SIR) ensures that the patient voice is present in the conversations.

September’s session took off with Dr. Carlos A. Pellegrini, Chief Medical Officer of UW Medicine, discussing the shift to value-based care. Pellegrini defined UW’s transformation as a process with 6 key goals:

  1.  Standardization

Standardization improves efficiency and is key to reducing cost and improving outcomes. Today, surgeons performing surgery at different hospitals may have varying tasks per hospital. Patients may receive different instructions depending on which physician or department they interact with. As a result, it is difficult to compare outcomes or optimize clinical workflow without a form of standardization.

      2. Population Health Management

Using system data to anticipate patient needs before they become major problems can both improve care and lower costs.

       3. Medical Home 

Implementing the medical home model can allow providers to be more aware of all of their patients and manage them proactively in measurable groups.

       4. Clinical Technology

Better use of clinical technical systems and of technology generally will enable more efficient and proactive patient care.

Dr. Pellegrini suggested they need to identify which patient was calling and suggesting the care they needed. For example “It’s Linda Smith, and she’s due for a mammogram.”

       5. Risk Management

“The Healthy You” – Sending better information to clinicians can help keep patients healthy, such as regarding activity level for obese patients.

        6. Smart Innovation

In contrast to standardization, consider opportunities to   customize experience/treatment for patients to deliver personalized and targeted care.

Understanding and measuring outcomes is also seen as key to approaching this evolution. Still, it was pointed out that providers, payers, and patients all understand a positive outcome differently. For example, for a provider the outcome is usually functional, for a payer or employer the outcome is financial, and for the patient it is often quality of life.

Only when these three outcomes are considered at once can we have true value-based experiences.

While Dr. Pellegrini and interview Lee Huntsman lamented the fact that US healthcare is ten times as expensive as other models, like the UK’s system, at present only 3% of UW Medicine’s revenue comes from value-based models, and it costs them $200M per year to maintain EPIC.

With numbers like this, the shift to value-based care has some big uphill battles. Keep fighting the good fight everyone, we know that the burgeoning health community in Seattle and the Cambia Sasquatch will!

Posted in: Healthcare Research, Healthcare transformation, Meaningful Use, Outcomes, Patient Advocacy, Seattle

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Mayo Transform 2016: Change

There was method to the madness, but the feedback for John Hockenberry, host and moderator of this year’s Mayo Clinic Center for Innovation Transform Conference at the first night reception was that the keynote was a bummer.

And it was. This year’s theme was change, and the keynote highlighted three key areas where we need fast and effective change: climate, diet, and early childhood education.Mayo Transform logo

Will Steger, a lifetime adventure and outdoorsperson and founder of Climate Generation, kicked things off with a dire warning that it was no longer possible to make a living running sled dog tours because the Arctic is melting. This was followed by Karen Watson who talked about the successful DrinkUp campaign to combat the challenge that 75% of Americans are chronically dehydrated from consuming sugared beverages instead of water. The campaign was focused on driving people to reach for bottled water instead of soda, and while this seemed counter to the first session on climate change, she cited that 22 million Americans have no access to potable water so bottled water is a good choice for them. Next up George Halvorson from First 5 California and former CEO of Kaiser Permanente talked about programs the state of California and KP have created for early childhood health and education, noting that the years from 0-3 were crucial for childhood development, and that a child of a working mother is read to for 1,500 hours during this period while the child of a typical Medicaid mother (who could be working) is read to for 30 hours during this period. This year 51% of children will be born to Medicaid mothers.

DrinkUpWhile both DrinkUp and First 5 provided solutions to the problems they raised, the overall impact of the keynote was depressing. While the intention was to catalyze people to change the schedule left us had the tools for making change delivered in sessions on days 2 and 3, which left us to drink our sorrows at the opening night reception (and not with bottled water).

Moving into days 2 and 3 of the conference, we did get tools for thinking differently, and the first session on day 2 provided richly in this area with Roger Martin, former dean of the Rotman School making the case for using both scientific method and rhetoric, and in particularly pointing out the short comings of scientific method if you want to innovate, in particular that it only looks at past data and does not imagine a future. Denny Royal of Azul 7 asked us to get out in nature for creativity, inspiration, pattern matching, by using biomimicry to use nature’s solutions for pressing problems, like how Sharklet used the natural antibiotic properties of sharkskin as inspiration to create a substance that naturally repels bacteria, or considering how to create adhesives that work better when wet, like the silk of the Cadis Fly, and could be used internally during surgery instead of our crude methods today like stiches or stapling. Teri Pipe, of ASU led us on a meditative path by asking us to notice what was happening in this moment, and apply these skills to build compassion and reduce stress in delivering care.img_0055

The day 2 keynote provided us with tools for imagining things that don’t exist, have the courage to quiet our own cleverness and learn from nature, and be resilient and empathetic. Given the day 1 keynote, this was just the antidote to embark on the rest of the conference.

Posted in: Healthcare Disruption, Healthcare motivation, Healthcare Research, Healthcare Technology, Healthcare transformation, M-health

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