Assessing the Growing Market for Condition Management Solutions

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Watch lead analyst Brian Eastwood’s webinar that accompanied the release of this report:

Increasing pressure to control rising healthcare costs related to chronic conditions has led the industry to begin exploring the use of mobile apps, devices, and other digital interventions that help patients manage the symptoms of these conditions. Interest is understandably higher among the stakeholders responsible for paying for care than it is among those who deliver care, but the growth of value-based care (VBC) models is expected to drive greater adoption among provider organizations.

Selling to these stakeholders forces vendors to prove both clinical efficacy and return on investment (ROI) for their solutions. It also forces vendors to demonstrate ease of use and improved efficiency, as user adoption evaporates in the absence of these qualities. While this has presented hurdles, it has also forced the condition management market to mature quickly, with dozens of clinically proven solutions on the market:

 

This report examines the market forces driving current adoption of these technologies, looks at what we expect the future to bring, and provides profiles for a select set of market leaders (listed below). As the march to VBC continues, convergence between payers and providers will shift these solutions closer to the point of care. Learn what has made these companies stand out from the pack and what to think about when planning to implement your own condition management programs.

Vendors Profiled: AbleTo, Canary Health, Glooko, Lark, Livongo Health, Noom, Omada Health, Propeller Health, Twine Health, Wildflower Health

 

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Stay up to the minute.

“As biometric data becomes cheaper and easier to collect through smart sensors, devices, and mobile apps, expect to see more innovations in consumer health.”

-Alicia Vergaras

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Thanks to generous support from one of the organizations that performed well in our analysis, this report is now free to the public.
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Watch the corresponding webinar summarizing some of the report’s key findings below:

Building on the 2014 and 2016 editions of this report, Chilmark returned to the market this year to assess critical changes in vendor solutions and how well they map to provider needs. Notably, analytics solutions and care management applications are more tightly linked now and show promise for moving analytics-derived insights closer to the point of care. Analytics applications are also becoming more user friendly — an opportunity for differentiation previously identified in the 2016 edition.

What remains the most important driver underlying the strong growth in data analytics is the move to alternative payment models, commonly referred to as value-based reimbursement (VBR). Future financial success in the VBR realm requires healthcare organizations (HCOs) to effectively manage risks, utilization and costs while concurrently improving quality and optimizing outcomes.

This year’s report provides in-depth profiles on 17 of the leading analytics vendors in the market today. All solutions profiled have the capability to co-mingle claims and clinical data. While Chilmark noted last year that EHR vendors are well positioned to incorporate analytics into their EHR solutions, vendors of all types have promising analytics solutions both in terms of product vision and capabilities. The report also includes major changes in vendor solutions compared to those from last year’s report.

Vendors Profiled: The Advisory Board Company, Allscripts, Arcadia Healthcare Solutions, athenahealth, Inc., Caradigm, CareEvolution, Cerner Corporation, Conifer Health Solutions, eClinicalWorks, Epic Systems Corporation, Forward Health Group, Geneia LLC, Health Catalyst, HealthEC, IBM Watson Health, MCIS, Inc., Optum, Philips Wellcentive.

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Tackling Prior Auth: New Solutions to Address Provider-Payer Friction

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Watch lead analyst Jennifer Rogers’ webinar that accompanied the release of this report:

PA solutions are on the cusp of a breakout moment, partially driven by both the growing adoption of value-based care (VBC) arrangements, as well as sophistication of new enabling technologies, including APIs, NLP, and AI. A new PA model is emerging that promises to deliver mutually beneficial results for providers and payers with far less pain, better integrating CDS, claims, and order workflows at the point of care.

With the dubious honor of being one of the thorniest pain points in provider-payer collaboration, and sitting at the start of the revenue cycle, PA is a logical starting point to establish greater provider-payer convergence. Chilmark Research projects that this new evolution in PA technology will serve as a petri dish for greater forms of convergence that will then spread to other VBC strategies.

This report answers the following questions:

  • How is PA evolving for providers and payers alike, given the growing expansion of VBC adoption?
  • What is the current state of pharmacy and medical PA technology and process?
  • Who is innovating in this space to improve the provider-payer experience and clinical and cost outcomes?
  • What should healthcare organizations (HCOs) consider as they decide on a solution?
  • Where do significant gaps remain that HCOs will struggle to fill?

Vendors Profiled: Accenture, athenahealth, Availity, Change Healthcare, Cognizant, CoverMyMeds, eviCore, MCG, Partners Healthcare, Surescripts, ZipRad

Cost: $2,750 (Discounts for qualified provider organizations. Email John for details.)

 

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Driving Speed to Value: Three Approaches to Population Health Management

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Watch Jennifer Rogers’ free webinar on this report, reviewing the specific example of the Marshfield Clinic Health System and their subsidiary, MCIS:

This report delves into three case studies of different population health management strategies, examining the clinical and technology models. This research project is intended to increase PHM speed to value, helping to identify optimal health IT (HIT) enablement. This report combines the findings from these case studies with additional primary and secondary research to distill common themes and provide recommendations for other HCOs considering or already deploying a PHM strategy of their own.

The approaches taken by our three case study HCOs to PHM highlight a stark contrast in PHM strategies and technology models.

  • Trenton Health Team: Community collaborative and health information exchange that relies on a single-sourced HIT vendor;
  • Partners Healthcare: Large regional health system that has taken an extremely broad build-and-buy HIT portfolio approach;
  • Marshfield Clinical Health System: Vertically integrated health system that has developed and deployed a proprietary electronic health record and PHM integrated technology platform.

Recognizing there will never be a one-size-fits-all model that generates positive outcomes across all metrics, there is much to be learned from these early adopters that have been implementing PHM strategies for five or more years.

Report Length: 30 pages

Report Cost: $795 (Discounts for qualified provider organizations. Email John for details.)

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Watch Matt Guldin’s free webinar on this report, sharing some of the research highlights:

As healthcare in the United States has evolved toward a model of value-based care (VBC), so, too, has the concept of care management evolved. No longer is care management limited to the high-risk patients who require high-touch care interventions. Healthcare organizations (HCOs) are increasingly broadening the reach of care management to include the rising-risk population: Those in danger of developing a preventable chronic condition such as Type 2 diabetes or hypertension due to any number of health, lifestyle, genetic, or environmental factors.

Care management vendors are now starting to align around a core care management process: Identify patients, create care plans, communicate care plan goals and tasks to patients, monitor patient progress, and alter care plans as needed. Across the market, vendors are differentiating in the more nuanced parts of the process: How patients are identified, where care plans come from, how well patients are engaged, and how much of the care management process can be automated.

In last year’s seminal report on this market, vendors were focused on comprehensive and longitudinal care coordination. This has fallen out of favor with provider organizations due to costs and evasive return on investment. Providers are now focusing more directly on episodic programs directly tied to Medicare reimbursements, such as 30-day readmission penalties or 90-day bundled payment programs.

This report provides a comprehensive review of more than 25 solutions available today to meet the various needs of provider organizations pursuing care management strategies. It also examines for the first time the potential for patient relation management (PRM) and condition-specific solutions to help HCOs engage with patients and achieve ROI in their care management programs. Reflecting the market’s emphasis on episodic care, the report’s vendor rankings focuses on core care management functionality and places less emphasis on a solution’s care coordination features.

Current and prospective vendors of care management solutions will find this report valuable, as will providers and payers looking to buy or replace a care management solution. Consultants, investors, patient advocates, conveners, and others will all benefit from this in-depth report.

Vendors Profiled: Allscripts, athenahealth, Caradigm, CareEvolution, Cerner Corporation, Conifer Health Solutions, eClinicalWorks, Enli Health Intelligence, Epic Systems Corporation, Evolent Health, Geneia LLC, GSI Health LLC, Health Catalyst, HealthEC, IBM Watson Health, Lightbeam Health Solutions, Medecision, Optum, Philips Wellcentive, Inc., Salesforce.com

Report Length: 118 pages

Report Cost: $6,000 (Discounts for qualified provider organizations. Email John for details.)

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The Patient Will See You Now

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This month’s Domain Monitor is a little bit different. We recently read through Dr. Eric Topol’s latest book, The Patient Will See You Now. Over the past few years, Topol has become a “crossover” figure between our insular world of health IT and the more mainstream media. Today he is a widely respected thought leader in the area of digital medicine. In his latest book, he explores the myriad of changes happening to the traditional delivery of medical care, fueled by advances in consumerism, technology, science, regulation…and the list goes on.

While Topol is certainly a visionary, his thesis leaves out some obvious real world considerations about tractability, adoption, usability, health literacy, and more, which ultimately amounts to a sort of a prophetic evangelization of a high-tech future rather than a field guide to the present.

This book is not a roadmap for health executives, nor is it a blueprint for technologists or scientists. That being said, Topol does serve up a complete (if at times off-topic and/or esoteric) survey of the new consumer landscape in healthcare and medicine, along with the market drivers, roadblocks, technologies, and other factors involved. All in all, Topol’s overview of these complex topics is comprehensive, rife with detailed examples of companies, technologies, and concepts throughout.

What follows here is a high level summary of some of the major issues in this book, along with our overall take on Topol’s findings. We have also provided a quick “Executive’s Guide” for those interested in Topol’s work but without the time to pore through the entire book.

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Making the Most of the CCM Code

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One of the most buzzworthy topics at the recent HIMSS conference was CMS’ new CPT code for chronic care management (CCM). The code will pay providers and care teams $43 PMPM for the non-face-to-face time they spend managing complex, chronically ill patients’ health. Scaled across patient panels and office practices, this represents no small amount of potential new revenue. Yet, the billing requirements accompanying the new payments are complex and comprehensive, with considerable implications for workflow, documentation, IT customization,patient engagement, and more. This month’s domain monitor provides a high level outline of the new CCM code, a breakdown of the major challenges practices face in billing for it, and some early signs of how the health IT industry is responding to the opportunity with new solution capabilities.

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Watch Brian Murphy’s webinar on this report sharing some of the research highlights:

In the past, messaging-based and document-centric models of health information exchange helped healthcare organizations (HCO) coordinate resources across networked communities of clinicians to enhance care delivery. This report concludes that such approaches have reached the limits of their effectiveness. The advent of value-based care is driving the need to assess risk for a population and effectively manage that risk across a distributed clinical care delivery network. This requires far richer, diverse information flows across a greater diversity of market participants.

In early 2014, Chilmark Research’s groundbreaking research on CNM (Free Report: Migration to Clinician Network Management) uncovered an industry undergoing massive transformation at a rate that outpaced the vendor community’s ability to deliver solutions. This gap between industry needs and vendor products has widened since then, in part because most products are tied to an approach and a technology stack that does not take advantage of modern development and integration ideas.

The vendors profiled are deeply committed to making healthcare data more broadly available and useful around the healthcare system. Since our last CNM Market Trends Report these vendors have evolved their offerings to include more data types supplying a wider range of applications. Social and behavioral data is being incorporated and supplied to the point of care and for risk profile development and predictive analytics. Patient-reported data from wearables and devices is also being gradually incorporated into product plans. Most vendors also want to make this data available for new computing capabilities such as predictive modeling, machine learning, and cognitive computing.

The technical approach advocated in this report involves leaving health data closer to where it was created and making it available to a range of diverse applications and users via APIs. Organizations should also be able to provision data based on application need. This approach, widespread outside healthcare, represents a more effective way to supply and consume data. It also offers a better way to accomplish development and integration goals. Such an approach will better support value-based healthcare and simplify what has evolved into notoriously complex implementation and maintenance efforts.

Vendors Profiled: Allscripts Healthcare Solutions, Inc; CareEvolution; Cerner Corporation; Epic Systems Corporation; InterSystems Corporation; Medicity (Aetna); Orion Health; RelayHealth.

Report Length: 60 pages

Price: $6,000 (Discounts for qualified provider organizations. Email John for details.)

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Reducing the Risk of Risk-Based Arrangements: Vendors Enabling the ACO

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Watch Jennifer Rogers’ webinar sharing highlights from the research:

Despite the complexity of the ACO model, ACO growth has climbed steadily since 2012, with over 1,300 ACO contracts now executed in the U.S. Yet, this VBC model is by no means mainstream, covering only 10% of the U.S. population. Despite this relatively small number, our in-depth research uncovered a market that is far from plateauing and will see accelerated growth as both commercial and government payers look to ACO models of care as key to their efforts to rein in costs while improving quality and access to care.

Based on briefings with 10 ACO Enabler vendors as well as extensive secondary research, this Market Scan Report from Chilmark Research investigates the market and technology challenges of setting up an ACO and answers the following questions:

  • What technology gaps do ACOs most need to fill in order to be successful?
  • What are the challenges to filling those gaps? Are they able to be filled with current technology and legacy vendors or not?
  • What partners, if any, does the vendor rely on to provide technology solutions to ACOs?
  • Where are ACOs overcomplicating their technology infrastructure and need to simplify solutions and vendors?
  • Where do significant gaps remain that HCOs struggle to fill?

The report opens by identifying key components and requirements of at-risk providers and ACOs, including a discussion of ACO market growth and historical challenges encountered. The report discusses assessment criteria and guidance on the technology requirements and hurdles faced by ACOs then takes a detailed look at the 10 specific vendors selling full ACO enablement solutions. It concludes with projections of the future market trajectory, as well as recommendations for both ACOs and the Enabler vendor niche.

Anyone interested in better understanding the ACO model, its growth pattern and projected trajectory, as well as the vendors who support this market segment and their projected market evolution, will gain strategic insight from reading this report. This includes, but is by no means limited to: HCOs, payers, healthcare IT vendors, consultants, investors, patient advocates. Direct inquiries regarding non-profit and academic discounts to Sean Campbell.

Vendors Profiled: Aledade, Caravan Health, CHESS, Cognizant, Conifer Health Solutions, Evolent, McKesson, Optum, Premier Inc, and TMA PracticeEdge

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[FREE REPORT] APIs for a Healthcare App Economy: Paths to Market Success

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A critical element of business success across industries has been the surge in use of open application programming interfaces (API) that provide data for applications that did not create or originate the data. APIs are the technical foundation of engaging interfaces and high-value interactions between different applications. Application ecosystems such as Google Play and the Apple App Store would not exist without open APIs that enable data access across multiple sources and organizations. Open APIs in healthcare promise a HIPAA-compliant way to enhance a digital portfolio with an ecosystem of third party applications and services.

To understand what it will take to build an API program in healthcare and deliver on this promise, we conducted a broad survey of the healthcare market to solicit ideas and opinions about the opportunities and challenges represented by APIs. These interviews indicate significant enthusiasm for wider availability of APIs to make it easier to develop more accessible systems of record and more responsive and innovative systems of engagement.

You can watch the webinar we conducted to lead into the release below and download the slides here.

The API Opportunity in Healthcare

Big Potential – HCO C-suites, IT organizations, and clinical leadership need no convincing about the potential that APIs offer. Most expect API programs to deliver functional enhancements, improvements to user interfaces, and broader dissemination of digital assets across their connected communities.

HCOs Are Building New Care Models – HCOs are actively exploring process changes that can drive better care coordination, higher quality, and healthier patients. Many see APIs as a way to extend and improve applications to support the change needed to implement successful new care models.

Only Large HCOs Can Invest – The largest HCOs are currently expending time and resources on APIs. Other HCOs are waiting for their HIT vendors to show the way.

Smaller HCOs Will Follow – Small HCOs, dealing with the “tyranny of the moment,” will wait for tangible results from leaders who demonstrate the utility and efficacy of an API-based infrastructure.

HCOs Want to Spread Expertise – API-based development, together with advanced analytics, can increase the effectiveness of existing applications by enhancing the expertise of individual clinicians.

This report was sponsored by leading, innovative health IT companies who share Chilmark Research’s vision to educate the industry on transformational technologies that will improve the care delivery process and ultimately the patient experience. We extend a sincere thank you to Cerner, InterSystems, Orion Health and PokitDok for their support.


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Beyond the Portal: Technology for Improved Consumer Engagement

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Today, there is no all-in-one solution that provides the functionality required for the next generation of consumer engagement in healthcare. This new report clearly articulates how HCOs and other key stakeholders in the healthcare industry must work together to bring those features into a single platform that benefits all consumers regardless of age, health status, technological proficiency, or socioeconomic status.

Features such as bidirectional messaging with members of an extended care team, multimedia educational resources, interactive health coaching, and integration with community and other non-clinical resources remain in silos today, creating complexity for the consumer. Overcoming this will require a broader, more open framework and technology architecture than what patient portals today can provide.

Based on briefings with more than 20 solution providers across a number of domains as well as extensive secondary research, this Insight Report from Chilmark Research will:

  • Investigate why the patient portal needs to be replaced.
  • Address the challenges in replacing the portal.
  • Describe the architecture of the “new” portal.
  • Discuss which stakeholders in the healthcare industry will drive its development.
  • Provide a five-year market outlook and model for healthcare organizations (HCOs) investing in this new technology.

The report provides several important frameworks for HCOs and vendors, including: 

  • A Next-Generation Engagement Model that spans modalities of care for all types of consumers, regardless of age, socioeconomic status, level of health, type of insurance, or familiarity with technology.  
  • An Engagement Solution Maturity Model that describes how next-generation solutions will evolve through 2018, 2020, and beyond. 
  • An Investment Model for Engagement Solutions that identifies how HCOs that are leading the way, following, and waiting for guidance will approach their engagement strategies in the next three to five years. 

Above all, this report will explain the main reasons why a replacement for today’s patient portal, no matter how inadequate, won’t come quickly or easily.

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Making Healthcare Affordable: Implementing True Continuous Costing

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Despite changes to how we pay for care, the real costs of providing care remain hidden. One way or another, though, everybody pays for it, in the form of higher taxes, fewer jobs, lower net wages, increased debt, and reduced global competitiveness. That’s something many people don’t realize, including those in the business of providing healthcare.

This Chilmark Research Insight Report takes an unvarnished look at how much we pay for healthcare, where the money goes, the various approaches being taken to reduce spending, and, most importantly, the simple things that are not being done to dramatically reduce the cost of providing care.

The report will review the following: 

  1. Strategies and programs to reduce the volume of healthcare services delivered in order to reduce the aggregate healthcare bill.
  2. Impact of shifting patients to less costly facilities and providers – surgery centers vs. acute hospital operating rooms, advanced registered nurse practitioners (ARNPs) vs. MDs, freestanding imaging centers vs. in-hospital imaging centers, and so on.
  3. The use of modern analytics combined with data that providers are already capturing to monitor and manage their costs of providing care on an encounter-by-encounter, patient-by-patient, and minute-by-minute basis to assure they deliver services at the lowest possible cost.

Few providers can tell you with precision how much cost variability they have in similar admissions, procedures, tests, or anything else. This is unfortunate given the widespread availability of technology, the ubiquity of true cost data at every provider, and the very nature of the healthcare business. The goal of this report is twofold: to fundamentally change how providers think about costs, and demonstrate how they can use the data they have to lower costs using a concept Chilmark Research calls True Continuous Costing.

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The Evolution to Total Active Risk

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Healthcare organizations are under growing pressure to provide effective preventive care for the entire population they treat and their financial success will be predicated on their ability to improve outcomes at lower costs. Risk stratification is a foundational element of care management and population health management (PHM) and will need to evolve in step with value-based care objectives. The days of clinicians viewing what happens beyond the clinical walls as none of their business are soon to be over and risk stratification methodologies are an important window into the changes to come and how clinical teams and care managers will need to partner to offer better preventive care.

Total Active Risk Framework

Total Active Risk Framework for Next Generation Predictive Analytics

In this report we examine where risk models are now and where major vendors and new entrants into this space are headed with risk stratification efforts in the coming years. Current reliance on claims data and more static models that arose out of payer-led efforts will shift dramatically over the next several years. There is growing demand for better care coordination, identification of high value care gaps, and customization of interventions to individual contexts and risk stratification will be asked to do the heavy lifting in providing the analytics to accomplish these objectives. Risk management will move from a focus on identifying high risk patients to identifying the interventions with the highest probability of impact on outcomes.

The report provides a five-year roadmap for the adoption of Total Active Risk and presents case studies highlighting four vendors leading the transition away from traditional risk models – Forecast Health, Health Catalyst, SCIO Health Analytics, and Verisk Health.

Providing strategic insight, this report will be valuable to anyone interested in the role that risk stratification and patient activation can play in helping the healthcare industry achieve the goals of VBC. HCOs, payers, healthcare IT vendors, consultants, investors, and others will all benefit from this in-depth report.

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The Necessity of a Value Chain Model for Health Analytics

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The industry’s ongoing shift away from its fee-for-service (FFS) business model requires HCOs to provide high-value and not high-volume healthcare services for the communities they serve. Concurrent with this shift is the further digitization of care processes to improve the patient experience and optimize services. This requires a heavy reliance on data analytics to garner a deep understanding of how the HCO operates and the patients it serves.

Compounding this challenge is that the analytics platforms in place in today’s HCOs focus largely if not entirely on clinical data when social, environmental, and behavioral factors comprise up to 90 percent of a patient’s determinants of health. Leading HCOs are only just beginning to incorporate these datasets into their analysis of patient/population health but will need to move aggressively forward to truly capture the complete determinants of health for their patients to guide care coordination and patient activation across the entire care delivery chain – from preventive services to diagnosis and treatment to ongoing self-care in the home.

In many cases, this process is easier said than done, as data resides in disparate clinical, claims, laboratory, pharma, public health and patient-generated systems. Integrating these data sources is complicated and costly, but doing so gives HCOs greater insight into the services that patients have already received and still need – which helps avoid the duplicate tests, unnecessary services, and readmissions that the VBC model punishes.

The Chilmark Research Value Chain Model will help HCOs adopt a step-by-step process to identifying the stakeholders, processes, and outcomes that are key to a 360-degree analytics strategy in a VBC model. The report provides strategic insight and guidance to anyone interested in the role that a defined analytics strategy and robust analytics platform can play in accelerating an HCO’s ability achieve the goals of VBC. HCOs, payers, healthcare IT vendors, consultants, investors, and others will all benefit from this in-depth report.

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“One of the best reports Chilmark Research has ever produced.”
– Long Term Chilmark Research Client and CAS Subscriber

At its core, care management is about delivering the right care in the right setting at the right time, all in the name of closing the care gaps that lead to unnecessary hospitalizations, readmissions, duplicated treatments, and the onset of comorbidities. This aligns with the Triple Aim – improving the care experience, improving population health, and reducing overall care costs – as well as the emerging Quadruple Aim, which adds the goal of improving the experience for those who deliver care.

This sounds simple – and is the backbone of many a sales pitch – but the reality of care management is a series of interconnected workflows. As patients move through the care management life cycle, case managers must coordinate risk scores, assessments, treatment goals, care plans, interventions and, if necessary, care transitions, all while coordinating with medical professionals within and outside the hospital, community organizations, and the patients themselves.

The Vision for Care Management's Future

The Vision for Care Management’s Future

HIT vendors are responding to these needs with products that let multi-disciplinary clinical care teams from different HCOs build and execute evidence-based care plans. The report points to an important, ongoing challenge — incorporating cross-organizational and handoff considerations into existing workflows. For most of these solutions, clinicians toggle from their electronic health record (EHR) to a clinical portal to access care management functionality. EHR vendors have incorporated care management functionality into their products and are building on existing customer relationships to see good initial uptake of their offerings, but again, these solutions fall short of engaging the extended community.

This report is the result of Chilmark’s comprehensive review of over 100 solutions currently available in the market, for which a subset of leading vendors have been comprehensively reviewed (20 in-depth profiles, 9 additional discussed). These solutions will be critical to enable an HCOs population health management strategy.

Vendors Profiled: The Advisory Board Company, Aetna ActiveHealth, Allscripts, athenahealth, Caradigm, CareEvolution, Cerner Corporation, Conifer Health Solutions, eClinicalWorks, Enli Health Intelligence, Epic Systems Corporation, eTransX, Geneia LLC, HealthEC, IBM Watson Health, Influence Health, InterComponentWare AG, Medecision, Optum, Orion Health, Wellcentive, Inc., ZeOmega. Other vendors discussed: ACTmd, Blueprint Healthcare IT, Conversa Health, Cureatr, Forward Health Group, HealthLoop, Patient IO, Rounding Well, Wellframe, Zynx Health

Report Length: 128 pages

Cost: $6,000.00

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Please feel free to watch this HISTalk-hosted webinar we held post-report release:

While vendors continue to make progress in the functional evolution of their analytics solutions, healthcare organizations (HCOs) struggle with the complexity of their data management requirements and embedding analytical insights into clinical workflows in support of strategic initiatives. This extensive update to the 2014 edition builds on Chilmark’s comprehensive review of available solutions to serve the analytics needs of HCOs to enable their Population Health Management (PHM) strategies. The report also presents a new model for understanding the value chain for clinical analytics across the enterprise.

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The most important driver underlying strong growth in data analytics is the move to alternative payment models, often referred to as value-based reimbursement (VBR). Future financial success in the VBR realm requires HCOs to effectively manage risks, utilization and costs while concurrently improving quality and optimizing outcomes. Today, however, HCOs must straddle the two different payment regimes of fee-for-service (FFS) and VBR.

The report points to an important, ongoing challenge — incorporating analytics into existing workflows. While vendors have made progress with analytics functionality, workflow integration ultimately keeps analytics out of the hands of clinicians who could benefit most from insights at the point of care. Today, clinicians typically exit their EHR, toggling to a clinical portal for analytically-derived insights – proving how far we still have to go before these solutions reach their potential.

Vendors Profiled (25): The Advisory Board Company, Aetna ActiveHealth, Aetna HDMS, Arcadia Healthcare Solutions, Caradigm, CareEvolution, Cerner Corporation, Conifer Health Solutions, eClinicalWorks, Epic Systems Corporation, Geneia LLC, Health Catalyst, HealthEC, IBM Watson Health, McKesson, Optum, Oracle, Orion Health, Premier Inc., SAP, Tableau, Transcend Insights, Truven Health Analytics, Verisk Health, Wellcentive, Inc.

Report Length: 120 pages

Cost: $6,000.00

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Bridging the Genomics – Health IT Gap for Precision Medicine

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Since the White House launched its Precision Medicine initiative in January 2015 there has been a great deal of buzz about personalized or precision medicine and the future of healthcare. “Personalized medicine” is an older term and is gradually falling by the wayside as critics think that it denotes a focus on the individual whereas precision medicine is more focused on which treatments work best for patients with a specific genetic, lifestyle or environmental context. The latter is more appropriate in the context of digital health where the growth in wearables, mHealth and even Population Health Management have become part of precision medicine initiatives. But once we settle upon a definition, what are the real challenges to making precision medicine a reality? Given the significant challenges associated with EHR implementations as well as interoperability challenges across a given community, how will healthcare begin to address an additional stakeholder whose datasets are much larger and bring these insights into the clinic in an actionable way? There are very few, if any, EHR examples today that have the capability of integrating, in a systematic way, genetic data in a format that can be readily used for treatment and therapeutic practice. This raises a number of important questions on when precision medicine can become reality in the clinic and what kind of strategic roadmap can be put into place to address the health IT issues.



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Migration to Connected Health: Opportunities and Challenges in Remote Patient Monitoring

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While remote patient monitoring (RPM) may be a simple concept to understand, the research we conducted for this report revealed a complex landscape with different technology models and business cases. Carefully dissecting the approaches taken by a wide array of industries – medical device manufacturers, enterprise software vendors, pharmaceutical companies, health insurers, and several startups – this research report presents an underlying, multi-stage model for turning patient sensors into an actionable, real-time data feedback loop.

A Model for Remote Patient Monitoring

A Model for Remote Patient Monitoring

In compiling this report, Chilmark Research spoke with over a dozen organizations from across the healthcare landscape – payers, providers, and vendors. The resulting analysis features specific examples from best-in-class vendors and delivery systems, as well as insight into how connected health is evolving in the face of shifting technology and payment landscapes.

The report uncovers a set of wide-ranging market trends, including but not limited to the commoditization of the sensor and hardware landscape, the evolution of pricing models as vendors pivot from payer-driven pilots towards enterprise-level deployments, the emergence of cloud-based platforms and their influence on virtual care, and an analysis of recent industry partnerships and acquisitions and their implications.

Providers have their work cut out for them, both in understanding their own needs, assets, and business objectives when it comes to RPM, and making sense of a fragmented vendor landscape. To this end, the report offers a concrete set of insights to health system executives, vendors, consultants, and others interested in building a connected health model.

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Longitudinal Care Plans: Delivering on the Promise of Patient-Centered Care

This report is included with a Chilmark Advisory Service subscription. If you are a seatholder, please login here. Report can also be purchased a la carte for $995.

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Care plans from clinical content vendors and professional physician societies are available on the current market, but few go beyond the basics of coordinated care, and many remain paper-based. This leaves HCOs of all sizes with the unenviable task of having to creating longitudinal care plans and processes to distribute largely on their own. Chilmark forecasts that it will be two to three years, before more robust solutions from vendors will enter the market at scale. To create a true longitudinal care plan, HCOs must break down data and operational silos, automating communication processes and other workflows across disparate provider organizations, and provide patients and their caregivers access to the care plan. Some HCOs today use electronic health record (EHR) systems to attempt to accomplish this goal, while others use bare-bones care management systems or even paper-based records. Chilmark believes that HCOs will need far more comprehensive tools for documenting, developing, distributing, and monitoring the types of longitudinal care plans that will truly bend the cost curve in healthcare.

Overview of a Coordinated Care Plan

Overview of a Coordinated Care Plan

To compile this report, Chilmark evaluated care plan offerings available in the United States and several other countries. The report draws on this information to identify the most important elements of a longitudinal care plan, describe the steps that HCOs should take to facilitate coordinated care, indicate which data elements should go into a care plan, and provide best practices for using care plans in inpatient, post-acute, and behavioral health settings. In addition, the report evaluates off-the-shelf care plans from evidence-based clinical content vendors as well as physician specialty societies. The report will provide strategic insight to anyone interested in understanding how longitudinal care plans will evolve over the next several years in an increasingly value-based healthcare system. HCOs, healthcare IT vendors, consultants, investors, and others will all benefit from this in-depth report. Length of Report: 52 pages Cost: $2,000

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Health Plan Shopping Must Evolve

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The functionality of Healthcare.gov and the state insurance exchanges has improved markedly since their near-disastrous rollouts in October 2013, but many companies nonetheless believe they can make the process of buying health insurance as consumer-friendly as other online shopping experiences. With the third year of open enrollment underway, startups as well as established vendors look to lure shoppers away from the public exchanges with additional insurance offerings and better customer service.

This Domain Monitor describes the growing market for consumer-facing health insurance shopping tools and examines to what extent these services have been able to distinguish themselves from the public insurance exchanges.

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Health IT for Behavioral and Mental Healthcare Today

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While the landmark health reform laws enacted in 2009 (HITECH Act) and 2010 (Affordable Care Act, or ACA) have begun transforming certain aspects of the US healthcare system, they have not had a meaningful impact on behavioral and mental health care delivery. Patients in need of these services already face an uphill battle in terms of social stigma and making a decision to seek out care, yet our system compounds such challenges through poor benefit design, uneven IT adoption, and lack of care coordination. An emerging fleet of technology solutions focused on behavioral health care has the potential to improve care, though they are not without their own set of challenges.

 

  • Providers lack adequate incentives to adopt patient-facing digital mental health care tools. This is due both to omission of non-psychiatric mental health specialists in the Meaningful Use program as well as the slow adoption of value-based contracts.
  • Vendors of new technology have not placed a premium on making their platforms interoperable with legacy software. New startups have focused most of their efforts on developing self-contained tools geared towards the employer market rather than emphasizing document exchange, shared care plans, or tools for the population health manager to manage mental health needs.
  • Given the fragmented nature of the delivery system for mental health care, the market for mental health care IT is quite immature. While there are ample opportunities for one-off improvements (primary care, substance abuse facilities, Veterans Affairs, higher education, employee programs, etc) – only those health systems who can underwrite their own reforms will be the ones taking action.

 

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Data Lakes and Data Swamps

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Traditional approaches to data warehouses often imposed data models on large datasets up-front that had implications downstream for more advanced analytics. Early-binding approaches mean less flexibility in the choice of data models downstream. The concept of the Data Lake can both enable a more flexible approach to analytics and enables integration without losing the native format of data. For HCOs this has the added benefit of not forcing data clean-up and data schema development until later business cases are developed. In a rapidly changing environment, as we see in today’s transition from FFS to VBR, this is a major advantage over traditional relational database strategies.

The new Data Lake approaches also help with data governance and provenance issues as well. HCOs are increasingly building networks with disparate systems that increase the complexity of data sources and databases. Building Hadoop-based data lakes, for example, can become a tool for enabling effective data partnerships by enabling later development of data models to be built within the Hadoop framework as business needs emerge rather than forcing critical decisions up front. Traditional relational databases are also more expensive and integration of disparate data sets in a data lake is easier due to the lack of a rigid metadata schema. As PwC notes, this puts critical data science decisions into the hands of data scientists closer to the actual business enterprise layer rather than in the IT or database administrators several layers removed from the business intelligence function.

An important part of data lakes and downstream data analytics is the notion of binding, or early-binding vs. late-binding strategies. Binding means the linking of datasets to algorithms or calculations that act upon the dataset according to specific business rules.iii The business rules of concern can include provider attribution, length of stay, resource allocation to a specific physician, disease states, as well as vocabularies such as gender, patient identifiers, physician identifiers, diagnosis codes, etc. If you bind data to specific rules to soon it can inhibit the ability to run analytics later if the business rules change. This is a critical issue in today’s rapidly changing healthcare environment, particularly in the time of transition from ICD-9 to ICD-10 for example.

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Cerner’s HealtheIntent Gaining Significant Traction

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Several years ago, at a similar CHC event in 2012, we had our first glimpse at Cerner’s HealtheIntent strategy. HealtheRegistries (previously known as SmartRegistries), a solution they co-developed with Advocate Physician Partners, was the first solution, which went GA in December 2013.

Initial impressions were positive. Cerner correctly recognized that the path to future success did not lie in an ever expanding closed system, but accepting that the market will always be heterogeneous and subsequently, so too would be the sources of data to drive population health management (PHM) strategies. Today, HealtheIn- tent supports over 160 unique data connections that encompass 76 disparate systems. These disparate systems cross multiple domains including ambulatory, acute, claims, PBM, eMPI, various portals, patient satisfaction and other open data sources (e.g., census data).

Cerner also correctly recognized that for its clients to be successful in addressing PHM, it would need to be agile in solutions delivery. HealtheIntent was built from the start as a multi-tenant, cloud-based platform. This allows Cerner to provide a highly scalable platform that delivers rapid, iterative updates of the solutions within HealtheIntent, that reflect changing client needs.

While we applauded the technical and philosophical approaches Cerner was taking, it was not without its faults. HealtheRegistries was new and broader market acceptance uncertain. Cerner’s analytic and care management capabilities were non-existent. Most importantly, while Cerner touted openness, reality was otherwise. HealtheIntent was still by and large a closed system despite being open to accept other data sources outside Cerner and its EHR, Millennium. In 2013, Cerner’s CEO may have touted them as being the most open EHR vendor in the market, but that ‘openness’ had yet to materialize.

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Combating the Cadillac Tax with Wellness

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The Affordable Care Act’s so-called “Cadillac tax” of high-priced employer insurance plans has drawn the ire of Presidential candidates, members of Congress, and the general public. All fear that the intentions of the tax – penalizing generous plans that let members receive costly healthcare services they don’t always need – will instead cause employers to cut the benefits that Americans workers have come to count on.

If the Cadillac tax does go into effect on Jan. 1, 2018, employers face a 40 percent tax on all health plans that exceed $10,200 in annual costs for individuals and $27,400 for families. Up to half of all companies may hit that threshold in 2018 – and with healthcare costs outpacing inflation, more than 80 percent of firms may be subject to the tax by 2023. All told, the government expects to receive $87 billion in revenue from the tax in the next decade.

In anticipation of the tax, employers have taken a variety of cost-sharing actions:

  • Capping or outright eliminating flexible spending accounts (FSAs), health savings accounts (HSAs), or health reimbursement arrangements (HRAs)
  • Moving employees to tiered or narrow-network plans, which include fewer providers and can have the un-intended consequence of substantial out-of-network costs
  • Using reference-based pricing or other incentives to steer employers toward less-expensive providers or services
  • Introducing high-premium and high-deductible health plans (HDHPs)

This month’s Domain Monitor will examine how employers can use another provision of the ACA – tying 30 percent of the cost of healthcare coverage to wellness programs – to trim healthcare spending without adversely affecting employee benefits.

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Is the Clash of Cultures Slowing Adoption of Clinician Use of Analytics?

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A common storyline we are hearing these days is that physician adoption of clinical decision support tools and analytics in general is slow, often taking years to fully engage with new clinical decision support (CDS) systems. The concerns over clinician adoption are growing as data analytics become more commonplace with value-based care. The usual explanation for lagging adoption rates is blamed on the technology and the failure to integrate these tools and interfaces into clinical workflows in an efficient manner. This is certainly a major challenge, but there may be more to this than appears on the surface. Scan some of the editorial pages of medical journals in recent years and you can find numerous debates over the relevance of evidence-based medicine to clinical practice hashed out in terms resembling the classic science vs. art of medicine debates. What we may be seeing is a deeper philosophical agreement between the use of statistics to guide clinical guidelines based on statistical means versus the n=1 challenge a physician faces when meeting an individual patient and understanding the context of the patient’s life. This Domain Monitor digs deeper into this debate to see if there are other ways to frame the discussion and could open up ways for data science to uncover local patterns beyond global means that could provide physicians with the data they need to practice the art of medicine while also being scientifically based and evaluated. The timeliness of this debate is important; as interest in precision medicine and personalized approaches to therapy grows, we will need to manage the tensions that could possibly emerge between Population Health Management and the world of n=1.

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Provider Directories: An Opportunity Fraught with Challenges

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A primary goal of insurance expansion under the Affordable Care Act was to improve access to healthcare. Yet as thousands of people are finding, simply having insurance coverage does not guarantee that ‘the doctor will see them now.’

Due to poorly managed provider directories, a significant percentage of clinicians who are listed on a health plan’s website may not be operating at a given facility, accepting new patients, accepting certain insurance plans, or even actively practicing.

The Center for Medicare and Medicaid Services (CMS) has taken matters into their own hands with a series of regulations and reforms aimed to improve consumers’ experiences and protect them from out-of-network charges. These looming requirements around the creation and upkeep of accurate, up-to-date provider directories offer an opportunity for technology companies – though not without a fair set of challenges for vendors as well as health plans themselves.

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Salesforce Enters the Fray: Will they Succeed Where Others Have Failed?

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Salesforce formally entered the HIT market with Salesforce Health Cloud, a cloud-based “patient relationship management” (PRM) solution centered around a complete view of the patient with integrated data from electronic medical records (EMRs), wearables and more. The offering consists of a longitudinal patient record with software to support care coordination, care team and patient communications. Simply, Salesforce now sells provider and patient portals, a sector with countless competing solutions. Salesforce – a household name in enterprise computing — provides cloud-based marketing, sales, and service applications across all industries. It is the number one CRM company on the planet because it focused on the needs of front-line salespeople and service representatives rather than the C-suite’s perception of those needs. It is also the most successful platform company in IT with a vast network of developers and partners delivering applications built on the application ecosystem of its core CRM offering. But despite its well-deserved reputation as an enterprise software innovator, can it make an impact in the convoluted healthcare sector where numerous megalithic software vendors before it (e.g., Google, Microsoft, Oracle, GE, etc.) have flailed? We have our doubts.

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Current Applications of Health Assessments in Provider-led Care Management

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Conducting periodic health assessments on patients provides an opportunity for provider care teams to get a snapshot on the health status and the health risks of a panel or cohort of patients. Health assessment is a process involving systematic collection and analysis of health-related information on patients for use by patients, clinicians, and care teams to identify and support beneficial health behaviors and mutually work to direct changes in potentially harmful health behaviors. Health assessments are not intended to be diagnostic tools and they are not complete health histories; instead, they aim to be one method to engage patients in their own health, leading to better health choices and improved health outcomes in the long term.

The upcoming Care Management and Care Coordination study that Chilmark Research is undertaking this summer will provide more clarity as to how vendors are utilizing health assessments in their solutions to optimize care processes. This will include such issues as:

  • How to ensure non-redundant data is being captured and how it is being coupled with existing data including clinical data to drive workflow,
  • What approaches are being utilized to capture data via assessments including self-reported data, and
  • How responses are translated back into some type of risk quantification driving both risk segmentation and possible interventions.

    The following Monitor shares some of our early insights uncovered via conversations with care management stakeholders regarding the topic of health assessments.

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Emergence of Medicine-as-a-Service (Beyond the Pill)

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The move to Value Based Care (VBC) is changing the relationships that pharma has historically had with both payers and providers. The growing chronic disease burden, rise of digital health and commoditization of many drug-disease areas is forcing a rethinking of the underlying pharmaceutical (pharma) business model. The Medicine-as-a-Service or “Beyond the Pill” paradigm is likely to play a major part in future pharma business models and one of the key differentiators in the marketplace will be the analytics offerings that pharma companies develop with their partners in “owning the disease” across the value chain including drugs, disease/care management platforms, and both patient and clinician engagement. One of the key drivers shaping the future of pharma analytics is the growing emphasis on cost-effectiveness data for pharma products. The days are gone where minor modifications to molecules will pass muster for providers and payers without demonstration of substantial therapeutic gains. In the future, providers and payers will increasingly demand pharma to provide data to support their needs to contain costs while improving outcomes.

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Consumer-Driven Forces Disrupting Primary Care

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The traditional model of consuming healthcare services is changing. Frustrated consumers – accustomed to the technological advances that have improved air travel, retail, and a host of other industries – increasingly eschew the doctor’s office for newer, more convenient care delivery models. They’re even willing to pay more for these services.

This ongoing shift forces all healthcare organizations, from solo practices to sprawling academic medical centers, to reconsider how they treat low-acuity conditions now and plan to address chronic care management in the future. This month’s Domain Monitor will examine how retail health, telehealth, and direct primary care continue to threaten the traditional model of primary care, identify the challenges that these types of “convenient care” pose, and explain how prudent healthcare IT vendors can address these challenges.

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FHIR — The Healthcare Platform Enabler

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FHIR is the new, open way to represent clinical, financial, and administrative data about patients. It is being positioned as a comprehensive solution to many of the interoperability issues in healthcare. It provides a simple way for programmers to read or write data at its source rather than through extracted message streams or files. Programmers are provided simple REST-style commands to FHIR APIs. It works with existing security technology to help ensure HIPAA compliance. The major EHR vendors are currently working on providing some level of FHIR support. Most other HIT vendors are following this lead, although with varying levels of enthusiasm. Over the next few years, we expect to see a significant rise in both the availability and consumption of data via FHIR on the part of providers, payers, and others in healthcare.

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The Promise and Challenges of Analytics Marketplaces in Healthcare

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Plug-and-play data analytics or finding ways to more efficiently export algorithmic models to use with large datasets has been steadily entering fields outside healthcare over the past two years. Data markets have been around for several years with offerings such as data.com (Salesforce), the Azure Marketplace, Factual, Socrata’sOpenData, Infochimps.com and DataMarket.com to name a few. These markets exist so that companies have the option of outsourcing parts of the data value chain to third parties who can extract insights.

Algorithmia.com is one example of a general marketplace for building and sharing algorithms and for making them available as a web service. We’ve seen over the years a number of data markets emerge and the next step in their evolution could also be in the direction of these new algorithmic markets. LexisNexis Health Market Science has another type of health data market with claims data in a national level warehouse containing data from all of the major payers totaling nearly 1.2 billion claims that have been scrubbed and anonymized. Clients have the ability to obtain market insights on referrals – market dynamics for facilities.

These early experiments in data markets helped organizations outside of healthcare realize that the monetization of data could mean sharing data outside of the organization had the potential to realize even greater return on investment. The logical progression of this trend is towards simpler ways of doing analytics and running a growing number of analytics on top of data to optimize algorithmic insights in a less expensive manner, as well as gaining access to best of class algorithms for solving particular problems. We are now just beginning to see this happen in health analytics with the rise of new analytics or algorithm markets that enable plug-and-play and curation of algorithms for use by third parties.

It has been noted that healthcare is beginning to enter the algorithmic revolution and a new, higher value-added set of services will be the next phase in the trajectory of health IT. Algorithms rather than data alone are the currency in the algorithmic revolution. Analytics-as-a-Service (AaaS) is the next wave.

We are already seeing this outside of healthcare as Amazon enters the fray with one of the dominant AaaS offerings that is also relevant to healthcare. This leverages the cloud and a flexible platform that can pull data from APIs into the platform and offer a more rapid way to enable companies to build analytics products or services.

The underlying business model for AaaS is also designed to scale as organizations in the early stages of using analytics have datasets that may run a small number of algorithms. Over time, the needs of these organizations will naturally increase, driving a need to scale their algorithmic capacity by one or two orders of magnitude. This is where healthcare is headed in the coming years, but not without many challenges, namely trust in the cloud. In this Monitor we’ll be taking a look at two approaches to markets in algorithms or plug-and-play analytics services.

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2015 Platforms in Healthcare: EHR Vendors’ Capabilities for Interoperability

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Publication Date: July 2015

Demand for interoperable technologies and platforms is increasing and enterprise technology vendors are responding. Cloud computing, composite applications, and open-source software with publicly available application programming interfaces (APIs) are liberating data to catalyze rapid innovation in nearly every sector of the economy. Vendors such as Amazon, Cisco, EMC, Google, HP, IBM, Microsoft, Salesforce and VMWare have adopted this Platform-as-a-Service (PaaS) approach to help their customers increase their pace of development and deployment, take advantage of more widely available development skills, broaden product and service portfolios, and achieve greater customer satisfaction.

 

PaaS in Healthcare

This report provides a broad overview of the current macroeconomic drivers that will foster the growth of PaaS deployment and use in the healthcare sector. Recent advances in interoperability trends that will help to support the transition to a PaaS model are also addressed. The report surveys current EHR vendor strategies to enable PaaS with profiles of leading vendors including ratings on core PaaS functionality.

Vendors profiled: Allscripts, Athenahealth, Cerner Corporation, Epic Systems, Greenway Health, Practice Fusion

Pages: 40

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Current Applications of Risk Identification and Stratification in Provider-led Care Management

Historically, risk identification and stratification of patients is something that payers or other third-party companies such as disease management vendors have done exclusively. It is something they continue to do and is often a key service offering part of any provider-payer ACO or VBR collaboration today, including where the payer will offer to do this for all of the HCO’s patients defined in the shared risk contract if the relevant de-identified claims data is available and accessible.

What has changed in the last 2 or 3 years is that now providers are undertaking their own provider-led care management initiatives and are also beginning to comb through their patients’ data, increasingly using clinical data for risk identification and stratification for several purposes including: possible enrollment in a care management program, identification of the proper resource intensity for a patient (e.g., health coach vs a nurse care manager), discharged patients who may need additional support, etc.

As a part of the upcoming Care Management and Care Coordination study that Chilmark Research is undertaking this summer, we will provide more clarity as to how vendors are utilizing risk identification and stratification in their solutions to optimize care processes. This will include such issues as:

  • Where and how this data is being presented in their solutions to users,
  • What types of external methodologies they might be employing, and
  • Insights into the proprietary methodologies that vendors are utilizing.

In the interim, we want to discuss some of the early findings we have had in our conversations with care management stakeholders to date regarding their care management activities.

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Connected Care: Are We There Yet?

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Healthcare organizations (HCOs) are acknowledging the need for next generation tools to realize the promise of newer models of cost-effective, outcomes-driven population health management. As reimbursement changes and business challenges put pressure on the current model of one-to-one, episode-based treatment, the need has emerged for continuous data collection on high-risk patients, in a one-to-many management framework. Yet the reality on the ground is less clear. While the general value proposition of connected care is well understood at this stage, the specific business case remains murky: which use cases, disease states, and patient populations provide the best starting point? To what extent can existing investments be leveraged to enable new models? How much do these solutions cost, and what is the anticipated ROI? With so many vendors angling to serve this market, which approaches rise to the top?

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The Co-Morbidities Challenge in Population Health Management Analytics

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One of the most difficult patient populations to manage is the growing number of individuals with multiple chronic conditions (MCC). Many of the current predictive models for preventing readmissions are not having a major impact on outcomes for this population cohort. Currently 66% of the total healthcare expenditure in the US is directed toward the 27% with MCC.

Very few evaluations of PHM platforms exist at the moment but value propositions in this space will soon need to demonstrate significant results. Early generation digital health platforms typically tout their PHM capabilities around diabetes or other chronic diseases in a specific disease-focused manner not heeding the cautions raised in the 2001 “Crossing the Quality Chasm” report by the Institute of Medicine. The report warned against designing care around single diseases or conditions. Disease-specific approaches, the report warned, could be ineffective when dealing with the complex interactions of behaviors, medications, and disease progressions in the growing share of patients having MCC. Addressing this challenge is more than a simple problem of better algorithms. The issues are multi-dimensional, from the underlying science, data sources and best clinical practices, to change management at the organizational level.

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Stage 3 and Patient Engagement: VDT, API, PGHD, Oh My! As Industry Goes, So Goes CMS

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Patient engagement requirements outlined in CMS’ Stage 3 regulations have drawn attention for two reasons. First is the aggressive increase in the percentage thresholds from Stage 2. Second is the addition of two major components into the program: the use of an API to enable patient access to their records, and the much-anticipated incorporation of patient generated health data (PGHD) into reported measures. It can be argued that these amount to a bold step forward. We won’t make that argument here. Squabbles over percentages aside, the additions of both API-enabled access and PGHD functionality struck us as largely reactive to the broader progress that is being made by today’s leading vendors.

That being said, MU has never been about pushing the pace. These new rules will aim to operationalize an important set of use cases that are undeniably a good thing for patient engagement – an area that has to date been underappreciated, underfunded, and under-innovated in the Meaningful Use program. While success will be tough to measure and even tougher to predict, this month’s Domain Monitor offers up specific analysis and reaction to the proposed approaches outlined by CMS in their latest rule.

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INSIGHT REPORT: 2015 Population Health Management – Aligning IT Solutions to Strategy

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Population health management (PHM) is at the forefront of strategic initiatives being undertaken across the healthcare industry. Prompting these strategic initiatives is the massive shift in risk, via payment reform, from payers to providers. This shift is likely to completely redefine the healthcare delivery system in the U.S. However, the healthcare sector today is ill prepared to make the transition to a PHM model of care delivery. There are a number of challenges that stand in the way of healthcare organizations’ (HCOs) adoption of PHM-centric strategies. Few HCOs have the requisite expertise in PHM and the technology infrastructure to support this transition. The dynamic shift from fee for service (FFS) to value-based reimbursement (VBR) models leaves providers in the difficult situation of having to invest in PHM for the future with little if any near-term returns on investment (ROI). Lastly, the IT solutions that will be needed to support PHM initiatives remain immature and require HCOs to take a portfolio approach to investing in a range of best-of-breed solutions to support their PHM strategy. No single vendor today can offer a comprehensive PHM solution suite, though countless vendors will try to convince HCOs otherwise.

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The Future Evolution of the HIT Market

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The healthcare IT market is not much different than other software markets. It has its own particular nuances such as regulatory oversight and a recent, massive infusion of federal funds to drive adoption of EHRs. Beyond that, however, the basic mechanics of how this market will evolve in the next five years will reflect what has occurred in other software markets, particularly the enterprise ERP market.

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Payers Accelerating the Move Towards Value-Based Reimbursement

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Recently, HHS Secretary Sylvia Burwell announced plans to accelerate the transitions in Medicare reimbursement models that have already been under way since 2011. Following suit, the Health Care Transformation Task Force, a private-sector alliance, announced their intentions to accelerate the healthcare industry’s transformation to value-based reimbursement (VBR).

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Platform-as-a-Service: Old Idea but New to Healthcare

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Technology companies often open up their products to create an ecosystem for third party developers. This concept extends back to original desktop operating systems to Apple and its AppStore, Salesforce.com with its AppExchange, Google’s Gmail with its various extensions. Partners, ISVs, or customers who build enhancements to a core technology product are seen as enhancing the “stickiness” of the core platform. Accordingly, IT vendors for other non-healthcare industries have striven to grow the number and intensity of developer advocates in partner and customer organizations. Microsoft, Salesforce, and Apple exemplify the successful use of this strategy. Apple recently had the most profitable quarter in the history of human economic activity in large part because of the iOS ecosystem the company has cultivated.

Contrast this with the conventions of healthcare IT vendors where the prevailing view is that opening up their products increases the risk that its customers could more readily migrate to a competitor. Many fear that the data in their applications, if made liquid, will flow more readily to a competing solution thereby lowering barriers to migration.

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Clinical Patient Engagement Emerging Market, Converging Solutions

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  • Key Market Drivers
  • Technology Overview: Features & Use Cases
  • Provider Market: Mixed Maturity
  • Industry Dynamics: Proliferation of Offerings

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Engagement Goals

Patient Engagement Goals Across All Stakeholders

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Publish Date: February 2015

The clarion call for better patient engagement is not a new one. Leading healthcare organizations and reform advocates have long held that elements of “patient-centered care” can produce improved scores on quality and satisfaction measures. They may even impact total cost of care by improving adherence to medication protocols or preventing avoidable admissions. Yet as the two massive health reform laws of the era — the HITECH Act and the Affordable Care Act — continue to unfold, it is becoming clear that these government programs will not be enough to create a new culture of patient engagement without the active involvement of other stakeholders. Depending on the health status of a particular individual, as well as their particular constellation of provider, insurer, employer, and so on, engagement can take many different forms. As new models of care are built to manage complex populations with multi-faceted needs, HCOs’ engagement strategies will need to be flexible.

Focusing on the clinical applications of engagement technology, this report found that the basic patient portal, often tethered to their electronic health record (EHR), still serves as the foundation for a majority of digital patient interactions. After interviewing several healthcare executives, clinicians, and over a dozen technology suppliers with established footprints in the provider space, Chilmark found a mixed market for new approaches to clinical patient engagement, where some provider organizations have yet to adopt even these basic patient portals, while others have begun piloting advanced, “smart” tools. It is clear that patient engagement is taking a backseat to other enterprise priorities, such as defining clinician networks, building analytics capabilities, mastering risk-based contracting, and making other preparations for effective population-based health management.

The report outlines both the advanced use cases that will play a pivotal role in enabling value-based models of care, as well as the specific technical and organizational challenges that vendors and HCOs are navigating when it comes to developing and implementing a modern patient engagement strategy. In addition to the market research, this report profiles 14 market-leading vendors* of clinical patient engagement solutions, rating them on both the completeness and sophistication of their product offering as well as their performance in serving the provider segment of the healthcare industry.

Vendors Profiled: Aetna/iTriage, Allscripts, Axial Exchange, Cerner, Dossia, Emmi Solutions, Get Real Health, GetWellNetwork, Influence Health (MedSeek), McKesson/ RelayHealth, MedFusion, Microsoft HealthVault, NoMoreClipboard, and WebMD.

Report Size: 100 pages

Vendors Profiled: 14

Cost: $3,000.00

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This report is free with a Chilmark Advisory Service subscription. To learn more, please contact our Director of Sales, Sean Campbell. If you are a CAS Subscriber, you can access this report directly by clicking here (you will need to log in with CAS Portal credentials).

athenahealth Acquires RazorInsights: Can athenahealth Succeed Where Others Have Failed?

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On Wednesday, January 14, athenahealth announced it will acquire the cloud-based EHR & RCM company, RazorInsights. RazorInsights’ target market is rural, critical access, and community hospitals (25-50 beds), which aligns well with athenahealth’s strategy to move upstream into the inpatient market. As a part of the acquisition, athenahealth gains ~25 hospital clients currently running RazorInsights’ ONE EHR solution. athenahealth did not disclose any transaction details although early estimates are for a $40 to $50 million purchase price.

Even though athenahealth is already working on developing additional services for the inpatient market, the RazorInsights acquisition represents an effort to fast forward this process. The acquisition opens up a new segment of the market, albeit one that has modest growth prospects that are far below athenahealth’s targeted 30% bookings growth goal. This market also has some well-entrenched competitors e.g., CPSI and Meditech, and others targeting this sector – Cerner with its own cloud-based solution, CommunityWorks. If athenahealth/RazorInsights is successful though in continuing to add additional small hospital clients at a steady clip and additional sales of their population health and care coordination solution (athenaCoordinator), it will present a compelling blueprint for other ambulatory EHR vendors and validates some of Jonathan Bush’s broader vision of what athenahealth represents.

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Chilmark Bight: Inside Health Catalyst’s Partnership with Allina Health

Today, Health Catalyst and Minnesota-based Allina Health announced a deep, ten-year partnership to further respective goals in healthcare analytics. Health Catalyst will gain rights to Allina-developed intellectual property (IP) and add to its ranks roughly eighty Allina employees. Allina will gain access to the full solution suite of Health Catalyst platform and modules and together these two partners will co-develop new solutions/modules for the broader healthcare market.

Last week, we were briefed on this partnership by Health Catalyst’s CEO, Dan Burton. If you would like to read our assessment of the deal, please enter your information below to download this Chilmark Bight, a category of content we produce that is normally reserved exclusively for CAS Clients. To learn more about CAS Membership, please contact Sean Campbell via email: sean@chilmarkresearch.com

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Consumer-Driven Models of Care: Healthcare’s New Front Door

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One of the trending topics in healthcare right now is that of the “consumer revolution.” With so many changes happening – the way care is being delivered, who is paying for it, how technology is influencing decision making from doctors to insurers to individuals – the time is ripe for a rethinking of the traditional model of “the doctor will see you now.”

Over the course of 2014, it’s become clear that this trend is here to stay. What’s not yet clear is how exactly these new models will impact the industry. This month’s domain monitor, offers a high level look at some of the specific models and enabling technologies that are slated for a big year of growth in 2015. We will also outline some of the major implications for industry incumbents and break down how various segments of the healthcare market are (or are not) preparing for this sea change.

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Inside Health Catalyst ‘s Partnership with Allina Health

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Today, Health Catalyst and Minnesota-based Allina Health announced a deep, ten-year partnership to further respective goals in healthcare analytics. Health Catalyst will gain rights to Allina developed intellectual property (IP) and add to its ranks roughly eighty Allina employees. Allina will gain access to the full solution suite of Health Catalyst platform and modules and together these two partners will co-develop new solutions/modules for the broader healthcare market.

Last week, we were briefed on this partnership by Health Catalyst’s CEO, Dan Burton. Following is what we learned and our assessment.

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Valued-Based Payments Leading to Value-Based Supplier Pricing?

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Healthcare organizations (HCOs) are undergoing strategic shifts as they move from volume to value-based reimbursement models. Not only do they have to think about different metrics on how they track their own revenue and finances but also on how they negotiate prices with their various suppliers including the possibility of some value-based pricing arrangements from health IT vendors.

While HCOs are undertaking value-based pricing agreements with other HCO suppliers including pharma/biotech firms and medical device manufacturers, it is still a foreign concept to HCOs and health IT vendors with the exception of one vendor we spoke to. Instead, HCOs are taking a ‘staged deployment’ approach and instead of engaging in actual value-based pricing agreements are limiting their upfront financial exposure by enrolling select patient populations and often deploying a minimal set of solutions from a health IT vendor. If the HCO is achieving acceptable results, they will look to add additional lives, payer types, and deploy additional IT solutions/modules over time.

Public payers who are looking to add ‘accountable care’ elements and expand beyond traditional payer-led population health efforts are not looking to enter into value-based pricing agreements either for the solutions themselves. Instead, public payers are also looking to limit their initial financial exposure by demonstrating a ‘proof of concept’ with improved outcomes upfront over a certain trial period. If the outcomes are acceptable, the public payer will increase both the population covered under the arrangement and expanded additional solution deployment.  

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Published Date: December 2014

In early 2014, Chilmark Research’s groundbreaking research on Clinician Network Management (Migration to CNM) presented the findings of in-depth interviews with a wide range of HCOs. The research uncovered an industry undergoing massive transformation at a pace often outstripping the vendor community’s ability to deliver solutions to meet these HCOs’ needs. As HCOs increasingly take on risk for the community of patients they serve, their need to better manage care across all care venues rises significantly. This was once the domain of HIE vendors, and largely still is, but with HIE soon to be a legacy term, vendors must invest significant resources to remain relevant by providing solutions that the industry will need tomorrow.

Chilmark Research’s CNM framework, on which the latest Market Trends report is based and vendors are evaluated, seeks to advance the industry beyond simple document-centric, clinician-to-clinician exchange of information to a model of network services that support care, quality, and performance management. These network-centric services can provide a better understanding of the health risk of patient panels, ongoing visibility into quality of care delivered across community, as well as an ability to provide guidance at the point of care. One key cost that CNM can also help alleviate is variability in care delivery processes by enabling better care management through shared care plans across all stakeholders.

This report reviews the services being offered by CNM vendors to address provider requirements for enabling information exchange, analytics, care management, and population health management. It also highlights functionality largely missing from today’s vendor solutions, including contract management, discrete access to EHRs and other data sources, and cross-organization application integration.

The report examines how organizations can effectively marshal the data and services needed to successfully share risk with other provider organizations across a community. It provides a clear, concise framework to assist HCOs in evaluating the solution capabilities of vendors serving this market providing in-depth profiles of sixteen key vendors of CNM solutions. Leveraging the proven Chilmark Research methodology, vendors are rated on their ability to meet diverse requirements in three core categories of CNM functionality: Data Management and Standards, Essential CNM Applications, and Workflow & Integration. No vendor excels in all categories, but vendors are continuing to make progress on data management and standards while most need to redouble their efforts to develop essential CNM applications and workflow and integration capabilities.

Vendors Profiled: Alere Accountable Care Solutions, CareEvolution, Cerner, Certify Data Systems, dbMotion, Harris, HealthUnity, ICA, ICW, InterSystems, Medicity, Mirth, Orion Health, RelayHealth, Sandlot Solutions, and Surescripts.

Report Size: 134 pages

Vendors Profiled: 16

Cost: $6,000.00

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The report is available to subscribers of the Chilmark Advisory Service or may be purchased separately. To see if your organization is already a client, or if you have any inquiries regarding purchase, please address correspondence to Sean Campbell at sean@chilmarkresearch.com.

Home Is Where the Health Is: The Current State of Connected Health

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2014 has served as a coming out party for all things Connected Health. The buzz around telemedicine, virtual visits, and device-based monitoring solutions is rising to a fever pitch. For clinically oriented healthcare stakeholders, this has been a welcome shift away from the noise around wearables and the limitations of patient portals.

Skeptics may comment that we’ve heard this song before, but even they should take heed that the traditional barriers to telemedicine – reimbursement and need for better proof of outcomes/ROI – are steadily diminishing. The million (or billion) dollar question remains – is the market ready to start buying into these advanced tools and models of care?

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