Our industry was in state of unrest going into HIMSS17. Some would call it panic. This year’s HIMSS was as much a REALLY large group therapy session as it was a trade show. Seemed as if everyone was reassuring each other again and again, “Value-based care (VBC) has left the station, the new administration can’t turn us back now.” This consensus was echoed by prior HHS Secretary Mike Leavitt, former House Speaker John Boehner, former CMS Administrators Mark McClellan and Andy Slavitt, as well as all providers and vendors of all stripes.
The entire Chilmark Research team made the journey to Orlando. This post represents our general observations and some specific VBC and PHM IT trends we uncovered at HIMSS17.
We are officially in the post-Meaningful Use (MU) era and a much-needed reassessment is taking place — a top-to-bottom realignment of all that is needed to be successful in the transition to VBC. Large healthcare organizations (HCOs) have approximately 25 to 35 percent of revenue coming from VBC. This appears to be the tipping point at which HCOs begin making significant transformations to how they operate and what they measure. We discuss this further in our upcoming report, Vendors Enabling the ACO: Reducing the Risk of Risk-Based Arrangements.
Besides political uncertainty, there is nothing quite like old-fashioned competition to give vendors heartburn. They seem to be finding it in the EHR community, with leaders Epic and Cerner likely generating the highest volume of antacid sales. How much PHM market share will EHR vendors be able to capture is the $100,000 question. Early signs are that larger HCOs appear to be migrating to their incumbent EHR vendor to enable their PHM/VBC strategy.
Less clear is to whom ambulatory practices will turn to enable their PHM/VBC strategy. While they have viable EHR vendor options to enable such in Allscripts, athenahealth and eCW, there remain a wide range of vendors including Caradigm, Forward Health, Geneia, i2i, IBM Watson Health (Phytel), Lightbeam, Orion Health, and ZeOmega, all of whom continue to grow. Forward-thinking non-EHR vendors are enacting strategic plans to ensure longevity, focusing not only on developing differentiating features but also on selling into the payer and employer markets as an end run around the foothold EHR vendors have in the provider market.
Provider-payer convergence was top of mind for most conference attendees (PHM and analytics firms, industry ERP giants, EHR vendors, payers, and providers), with a growing recognition that we desperately need to establish a common platform between providers and payers to eliminate duplicative processes and technologies and enable a mutually-beneficial value-based health model.
Approximately 70 percent of the vendors we met with have some initiative in place around this convergence theme. Drill down beyond vendors’ ability to repackage and provide payer capabilities into the provider community, though, and there’s not much substance regarding shared technology or processes. We were pleased to learn Epic intends to leverage its market scale and negotiate with payers on behalf of providers for a common format for payer claims submissions, a step in the right direction.
HIMSS17 provided ample evidence of a variety of specific IT trends and themes as well:
High Interest and Chatter, But Little Evidence
- Yes, there was the expected much ado about predictive analytics, AI, machine learning and cognitive computing, though booth staff had a hard time articulating use cases.
- Social determinants of health (SDoH) came across as an unexpectedly strong conference theme — though, again, we saw only random application of functional use cases.
High Interest Matched by Mounting Evidence
- Network management tools are improving; athenahealth and Health Catalyst demonstrated their easy-to-use and informative leakage analysis, while Cerner is developing enhanced network management tools in early 2017.
- Having moved beyond the lip service we experienced at prior year’s HIMSS conferences, patient engagement is finally becoming real this year with operational use cases. We saw a hospital-based, in-room PHR (OneView) that lets patient and family know what will be happening that day — and when — based on EHR-derived data. It not only makes hospitalization less traumatic for patients but also lessens the load on busy clinicians.
- Traditional software vendors realize they also need a growing portfolio of services to help providers optimize the technology. Services appear to be the optimization “Band-Aid” when there isn’t an easy technology fix for pressing VBC challenges, particularly, change management.
- We saw a plethora of other innovations, though you had to work the exhibitors’ floor to find it. These include voice-enabled home health aides (Orbita Voice and Lenovo Health), coordinating transportation (RoundTrip), patient decision tools (WiserCare), multi-language video interpreter services (Stratus Video), as well as chatbot that automates routine physician office tasks (SimplifiMed).
Somewhere in the Middle
- Interoperability continues to garner attention. We found less discussion than last year, though still keen interest. CommonWell substantially increased its live sites compared to prior year. The session conducted by Indiana HIE’s Jon Kansky and Keith Kelley was standing room only in a very large hall, with people craning to hear about the state of nationwide information exchange. Boston Children’s Dan Gottlieb gave a well-received presentation on SMART-on-FHIR. HCO interest in this topic is still high. One thing that people seemed split on: The likely effect of the data blocking provisions of the 21st Century Cures Act. We have projected that enforcing this legislation gets lost in the shuffle of the new administration. But a sizable number of vendors think it will only take one or two big penalties to cause the biggest HIT vendors and their customers to turn over a new leaf.
- A heavier emphasis on outcomes-focused solutions including Outcomes as a Service is also gaining momentum, though capabilities vary by vendor (athenahealth, Cerner, Epic, Health Catalyst)
- The rise of at-risk pricing wherein a vendor (e.g., athenahealth, Cerner, Evolent, Lumeris) goes at risk with the HCO on a VBC initiative
- Clinical Decision Support use cases include tools for physician ordering (e.g., National Decision Support Company, Stanson Health), preauthorization requirements, and verified third-party content embedded in PHM software to better support care plans.
Besides the group therapy, we enjoyed HIMSS17 as an opportunity to rekindle relationships and forge new ones. This conference also enables us as an analyst firm to frame our ongoing and future research to ensure it is highly relevant in moving the market ever forward. Our collective experiences at HIMSS17 underscore that this industry has enough sense of purpose and passion to charge ahead even in the absence of reassuring each other. Either way, the hope is we are all now sufficiently renewed to meet the challenges ahead.