Four Diverse Research Notes in Jan Monthly Update

As Chilmark has grown, so has our areas of research which is best represented in the following four research notes that our analysts put together for Chilmark Advisory Service (CAS) clients. The following four abstracts provide you perspective on some of the most critical and pertinent developments int his market sector.

We will be at HIMSS this year and likely have a few copies of this Monthly Update in our bags. If you want to get together to discuss the CAS service, just let us know, but be quick as our calendars for this event are rapidly filling up.

Fair Warning For Healthcare CFOs
The office, duties, and functions of healthcare CFOs will begin a major upgrade this year. Such changes have been a long time coming, but with only three years to take on Risk Assumption ACOs (RAAs), time is short. The difference between what is coming in, in fees for service, or capitation fees, has become dangerously close to what it costs to “keep the lights on.” Something has to be done. Fortunately there is plenty of mature software and a number of best practices CFOs can borrow from other industries to insure the solvency of our healthcare system. The four primary domains where CFOs should begin are:

  1. Formalized Budget & Planning
  2. Activity-based Costing
  3. Performance Monitoring and Measurement
  4. Contract Management

EHR Data is More Untrustworthy Than You Think
The healthcare industry, in its rush to adopt medical records and fervor to keep medical records HIPAA-compliant, has completely underinvested in ensuring the quality of the data that is entered into those medical records. Poor data quality stemming from human error and a pervasive lack of validation has enormous consequences for treatment decisions at the point of care and for secondary uses of patient data, particularly analytics. This research note takes a close look at the problem of data quality and what other industries have done to address it.

Keeping Track of Wearable Health Tech
Up until now, the $2 billion wearable tech market has focused primarily on wellness and fitness, and barely skittered around the edges of the broader healthcare market. In the past, devices such as quantified-self tools, fitness peripherals, movement trackers, and the like were not up to the task of tracking complex healthcare data but this is rapidly changing. Thanks to a confluence of growing interest, increasing market maturity, more robust, multi-dimensional devices and good timing, Chilmark Research believes wearable tech stands ready to make significant inroads into a value-driven healthcare market.

Learning to Like Direct
Despite a strong market and federal incentives, this is an uneasy time for HIE vendors, and Direct (Direct Secure Messaging) tops the list of HIE headaches. Direct doesn’t just sequester data in silos. In many HIE vendors’ view, it sends clinical information to some bunker underneath the silos of healthcare data. Add to this the fact that the legion of EHR-enabled providers is growing and these providers want information from their HIEs, including secure messages sent through Direct, integrated into existing EHRs. From a workflow perspective, this makes sense, but established EHR vendors have little to no incentive to make things easy for the new HIE kids. This article looks at Direct and what its rise portends for the future of HIE vendors and their product development and go to market strategies.

 Each month, subscribers to the Chilmark Advisory Services (CAS) receive an update of our research on the most transformative trends in the healthcare IT sector. Exclusive to CAS subscribers, monthly updates are part of the continuous feed of information and analysis we generate to keep subscribers on top of the rapid-fire changes in this market.

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2013 – A Year of Surprises

In the blink of an eye, a New Year has appeared and with it the need to look into our crystal ball (or is it a magic 8 ball) to make our annual predictions for the healthcare IT sector. Personally, I find this to be one of the more interesting and seriously fun parts of being an analyst.

Be forewarned, we’ve seen enough mealy-mouth, water-downed predictions as of late that simply state the obvious to last a lifetime. So let’s crack a few eggs and make some stretch predictions shall we. (Note: each analyst has contributed a prediction or two, which is noted).

1) Structured Data will Remain Gold Standard in 2013 – Cora
Despite Watson and all the buzz about mining unstructured data, the only data that will be analyzed in volume in 2013 will remain structured data. Forget about the 80% of health data that is unstructured. Simple key-value matching will continue but robust, rigorous pattern matching, NLP, etc, will have to wait.

2) The Need to Address Data Quality Moves to Forefront - Cora
Data quality issues (DQ) will become increasingly visible as more providers wonder why their clinical data is such garbage. Providers will be shocked they need to invest in DQ specialists/departments/processes (along with the security to support them).

3) Many ACOs Come to an “OMG, What Have We Done” Moment - Rob
For the first half of the year healthcare organizations (HCOs) will be all buzzy implementing, on paper, gain-sharing ACOs. By Independence Day these same HCOs will begin figuring out it is hard and expensive to set up an ACO and that their back office financial management tools are inadequate. By the end of 2013, just two years away from Risk Assumption ACOs (RAACOs) HCOs will take one of three paths: 1) realize ACOs carry all the risk and more of HMOs and bow-out; or 2) scramble to purchase and implement complex financial management software; or 3) cash-out and sell themselves to a payer.

4) Several HIE Vendors Pack Bags & Leave – John
Virtually all of the federal funds distributed to States to stand-up their statewide HIEs has been allocated. Without that federal largess we will begin seeing some vendors exit the HIE market. Who will they be? Think large companies with lots of brand equity and close ties to lobbyists but with only modest healthcare experience. Those vendors that remain must now contend with upping their value proposition beyond simple information  exchange (Direct Secure Messaging will take over that task). Some of the weaker HIE players with limited resources will be looking for a buyer.

5) HIE Market Growth Begins to Slow -John
Over the last several years the HIE market has been growing at a blistering pace well in excess of 30%. That growth will begin to taper off ever so slightly in 2013, say 18-22% CAGR as all who have adopted a solution continue down the arduous path deployment and on-ramping ambulatory providers to extract value from their HIE platform.

6) Despite Strong Growth in Direct Secure Messaging (DSM), Fax Isn’t Dead Yet - Brian
Volume growth in use of DSM sent via health information service providers (HISPs) in 2013 will exceed 100% driven primarily by integrated delivery networks (IDNs) seeking efficiencies and referrals. Despite this impressive sounding growth, far less than 5% of all care transitions will use DSM by end of 2013. And don’t forget, numbers lie. Much will be reported in 2013 on the growth in absolute number of secure email IDs issued by HISPs, but the majority of those accounts will remain inactive.

7) EHR Source Code Subpoenaed -Rob
We will see our first EHR software source code subpoenaed in a malpractice lawsuit this year – the developer will be named as a co-defendant.

8) Chorus Grows Louder, Politicians Weigh-in and MU Program is Put in Stasis – John
HITECH & meaningful use (MU) have done their job, by and large as EHR adoption and use has swelled dramatically throughout the healthcare sector. But there is also a dark-side. Deploying software so that it is effectively used takes time. Unfortunately, the provisions of ARRA do not allow for time to be taken, which is leading to a rapid cram-down of EHRs and associated MU requirements on clinicians. Early signs of a backlash began appearing in 2012. That backlash will come into full bloom in 2013 leading to Congressional hearings and ultimately someone in the White House being forced to hit the pause button on MU requirements.

9) Quantified Self (QS) Crosses Over into Healthcare – Naveen
The peripheral, biometric, consumer market is starting to bloom. In addition to completely new products and companies, we will see development of more flexible platforms driven by a focus on open APIs. Employers will start to incentivize the QS movement as part of their benefits programs. There will also be a shift from wellness-only into light medical use of these devices for such things as physical therapy/rehabilitation programs, mood tracking, sleep tracking and simple pain reporting.

10) Providers Take Interest in Health & Wellness Solutions – John 3
Payers and employers are the traditional markets for health and wellness solutions. But in 2013, those healthcare organizations (HCOs) that are moving towards capitated care models will markedly step up their interest in and adoption of these solutions. This will also result in new hires (health coaches, nutritionists, etc.) as clinicians balk at taking on added responsibility.

11) Emerging Conflicts Over Patient Generated Health Data - Cora
Conflicts will emerge between EHR data and user-generated health data.  Early adopting QS-type patients (see prediction 10) will be bringing in their mobile-app-generated data to their doctors. Majority of doctor(s) will declare that the data doesn’t match up to their records and will not accept it. Resulting conflicts over how/if to get this data into the medical record will ensue.

12) Patient Experience Begins Being Factored In to Treatment – John 3
With increasing attention on patient/customer satisfaction and need to improve adherence to treatment plans, innovative HCOs will begin adopting mHealth solutions that enable patients to track, in real-time, their treatment experience. Treatment plans will be modified “on-the-fly” based on these “experiences” to improve adherence.

Of course there were many other predictions that we mulled over that ultimately landed on the cutting room floor. What remains are predictions that we felt will create the greatest disturbances or ripples in the industry. Predictions that are generally not all that obvious or maybe it is just that there are not many who wish to state such in writing (we’re not shy).

Whatever the case may be, these are our predictions. we’ll stick by them unless someone has some incredibly brilliant argument as to why we have it completely wrong (that’s what comments are for).

So have at it everyone, are we on target, or will we completely miss the mark in 2013?

 

 

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Big Data Clarified, Providers, HIT & Obesity and ACA’s Impact on HIE Market

With the ramp up to healthcare reform, Chilmark Research sees signs of a potential slow down in HIE innovation. This is but one research note of three that were provided as part of our latest monthly update for Chilmark Advisory Service subscribers in the December Monthly Update. Below are abstracts of the three topics covered in this issue.

Provider Risk Will Drive Vendor Caution on HIEs
As the Accountable Care Act goes into effect, financial concerns and a host of unanswered questions will play a decisive role in how HIEs are developed and implemented. HIE innovation could slow in the coming year based on what providers are willing and able to pay for. Although Stage 2 meaningful use requires that providers include a summary of patient care records with any referral to an outside setting, most providers will take Direct as the path of least resistance to this end. Meanwhile, questions such as which entities within large IDNs will have final decision-making power on spending, and whether HIEs should have any role in sharing claims data, remain unresolved.

Big Data for the Rest of Us
Big data has become a hot buzz word in health IT, mainly because it remains largely undefined and can be molded to fit individual needs and circumstances. In the absence of a clear definition, big data has been used to disparage existing database technologies, especially SQL. Nonetheless, leveraging existing end-user tools is the clearest path to gaining broad appeal for a new technology, and the existing tools in analytics rely on SQL. This update looks at the efforts of vendors like Teradata, Oracle, and IBM to develop big data solutions, and what that could mean for HIT.

New HIT Markets for Tackling Obesity 
Payers have taken the lead in using health IT to turn the tide on rising health costs related to obesity and overweight. Innovative health insurers are using social media, mobile apps, and gamification to engage members and promote healthy behaviors. So far at least, providers have not joined payers on the new frontier of technology-based weight loss programs. Considering who currently bears the cost of weight-related health issues, this is not terribly surprising. Fee for service remains a disincentive to providers taking an ongoing role in patient behavior change, but healthcare reform could change that. One ACO quality measure, for instance, requires physicians to follow up with patients who have abnormal BMI. This update takes a look at the problem of obesity, where things stand with consumer engagement technologies, and how those technologies might develop.

Each month, subscribers to the Chilmark Advisory Services (CAS) receive an update of our research on the most transformative trends in the healthcare IT sector. Exclusive to CAS subscribers, monthly updates are part of the continuous feed of information and analysis we generate to keep subscribers on top of the rapid-fire changes in this market.

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Humana Jumps into HIE Market, Claims Analytics Turn Sights of Clinical, Med Adherence

CR_brandWebNovember saw the acquisition of yet another HIE vendor by a payer (Humana). An in-depth analysis of this acquisition and its implications was provided to Chilmark Advisory Service (CAS) clients at the end of November. Following are abstracts of the three research notes in our latest Monthly Update.

Humana Leaps Into the HIE Market
The health insurance industry is undergoing massive upheaval. Payers don’t need a crystal ball to see that in the near future, providers will sell services directly to employers, and that insurers need to get creative in order to stay competitive. With its acquisition of HIE vendor, Certify Data Systems, Humana joined two other payers in the HIE market: Aetna and UnitedHealth Group. Yet Humana’s strategy sets it apart from the other payers. On a single day in November, Humana announced not one but three acquisitions: Certify plus two Florida-based managed care service organizations. Humana has clearly articulated its plan to become the preferred Integrated Delivery Provider to Medicare Advantage members and dual eligibles. By adding Certify’s strong HIE capabilities to its bag of tricks, along with the ability to deliver primary care directly to a large Medicare population, Humana has positioned itself to do just that. Continue reading

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Will Surescripts Become De facto NwHIN?

Just as Healtheway looks to ween itself off the federal gravy train, Surescripts comes along and in a couple of quick strokes looks ready to drive a stake into the heart of Healtheway or at least any desire Healtheway may have to become the Nationwide Health Information Network (NwHIN).

It all started when Surescripts acquired collaborative HIE messaging vendor Kryptiq in late August. This was quickly followed a week later with Surescripts’ announcement that it would become Epic’s vendor of choice for cross-EHR connectivity. It appears that Epic has finally succumbed to the inevitable; that it will need to open up its system (Epic’s purported Epic Elsewhere, to address cross EHR connectivity was in reality Epic Nowhere – just vaporware) to communicate in a heterogeneous EHR environment. The Surescripts Clinical Interoperability (CI) network solution will become an “Epic Unit” and on Epic’s price sheet. The details of this story were covered in our September Monthly Update for CAS subscribers. Continue reading

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Another HIE Purchase by a Payer

Today, national health insurer, Humana, announced that it has acquired Certify Data Systems (CDS). This marks the third HIE vendor (UHG acquired Axolotl & Aetna acquired Medicity) that has been acquired by a payer in the last couple of years. Not that surprising when one looks at how aggressively payers are moving into the accountable care arena and seeking to form tighter links with physicians in their network, particularly those in the ambulatory sector, where CDS has done particularly well.

A key part of CDS’s success in the market was through its partnership with Cerner where it provided the technology stack for connecting ambulatory practices. The Certify HealthLogix is a well architected platform that has seen strong adoption. While terms of the deal were not disclosed, it is our guess that Humana paid a pretty penny for CDS, likely all cash deal at about 6-8x estimated 2012 sales.

While it is good to see that CDS leadership will stay in place, at least for now – serial entrepreneurs, such as CDS founder Marc Willard, typically do not last too long in large corporate entities such as Humana- we do have some concerns with Humana’s ability to actually manage a software company. This is way outside their core competency and hopefully they know well enough to provide CDS the resources to scale but also the wisdom to let CDS call most of the shots.

We will be providing Chilmark Advisory Service (CAS) clients with a more detailed breakdown of this deal later in the week after we have had a chance to speak with some key contacts/stakeholders of this acquisition. This will be pushed to subscribers via an Alert.

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