HIMSS18: Care Management and Engagement

HIMSS18 Review 2 of 4

By Matt Guldin and Brian Eastwood

Having returned and (mostly) recovered from HIMSS18 in Las Vegas, the Chilmark Research team wanted to share our thoughts on what we saw in presentations and heard in conversations. This post includes our analysis and insights on Care Management and Engagement; additional posts will consider Analytics/AI and Interoperability as well as Population Health Management and Convergence.

Overall, we were pleased to see progress on telehealth, as well as a broader understanding that healthcare organizations (HCOs) will get patient engagement right only when they assemble a comprehensive collaborative health record (CHR). On the other hand, we were disappointed in slow progress toward addressing two prominent public health issues — the opioid crisis and behavioral health — as we didn’t see many large-scale use cases for engagement in general or episodic payments in particular.

There certainly was an increased awareness and discussion of integrating behavioral health into primary care and care coordination at HIMSS18. However, this shift is still in its very early stages.

Care Management Themes

Lack of focus on the opioid crisis: Last week, the CDC released a Vital Signs report that showed a 30% increase in emergency department visits due to suspected opioid overdoses from July 2016 to September 2017. Despite this continued public health crisis, there was a general lack of targeted solutions or marketing focused on this topic at HIMSS18.

Instead of vendors helping providers to help address this problem at the point of care or service, though, there is a “top-down” approach at the state level emphasizing tighter prescription regulations, inventory control, and tracking. There were some specific examples we did find though. One vendor, Venebio, has created a predictive analytics solution to identify and predict the specific overdose risk over the next 12 months for a particular patient; Venebio is selling to state Medicaid agencies, payers, and providers. Collective Medical, through their EDIE report, is helping to provide a list of current medications for ER patients which facilitates identifying drug-seeking patients.

Integrating behavioral health is in its early stages. There certainly was an increased awareness and discussion of integrating behavioral health into primary care and care coordination, including several educational sessions on the topic. However, this shift is still in its very early stages. To be determined: What types of models by the work best in varied primary care settings; how IT solutions such as telemedicine and digital health might help to address various challenges, including a lack of sufficient behavioral health providers and lengthy behavioral health service queues; and the role of self-support tools, which have high levels of engagement and effectiveness.

Scaling episodic payments remains a huge challenge. While a number of HCOs have already engaged in an episodic payment for a particular procedure or two in a service line (such as cardiology or orthopedics), scaling these efforts across several service lines for an HCO remains a challenge as solutions remain immature and most HCOs are in the early stages of forming post-acute networks. Some of the biggest challenges include the timely notification of when a patient enters into an episode, an inability to track patients across and outside the HCO, and an effective patient engagement strategy that is customizable to meets the needs of a patient in a particular episode.

Engagement Themes

Data matters. If there was a unifying theme to the preconference Patient Engagement & Experience Summit, it was the need to begin patient engagement efforts with a CHR – one combining clinical, claims, consumer, financial, and patient-generated health data to provide a comprehensive view of a patient’s diagnoses, social determinants of health (SDoH), and barriers to receiving care. Record in hand, healthcare organizations (HCOs) can shift away from generic patient outreach – think portal message, email, or even snail mail flier – toward outreach that better meets patients’ individualized needs.

If there’s a theme to my patient engagement conversations so far at #HIMSS18, it’s a clear shift to more personalized and targeted outreach.

— Brian Eastwood (@Brian_Eastwood) March 6, 2018

Use cases remain simple. The operative word above is can, as HCOs aren’t yet meeting individualized needs. Many use cases at the preconference summit highlighted a single condition: Asthma, colon cancer, sepsis, substance abuse, outpatient physical therapy, etc. Two factors seem to cause this. The first reflects the adage that you can’t manage or improve what you cannot measure. Since HCOs are measuring readmission rates, HCAPHS scores, and joint replacement bundled payment performance as if their financial lives depended on it (and they do), patient engagement and experience efforts are frequently tied to these metrics.

Behavior change is hard. The second factor is the challenge of personalization. It’s fairly easy to use a CHR to identify what makes a patient unique (thanks to advances in AI and machine learning that colleagues Ken Kleinberg, Brian Edwards, and Brian Murphy covered in a separate HIMSS recap). It’s much harder to align those unique characteristics to specific actions that will improve clinical outcomes. As noted by Dr. Heather Cole-Lewis, Johnson & Johnson’s Director of Behavior Science, such alignment requires context, and today’s engagement solutions have not been designed to handle the complexity that comes with that context. For example, to accomplish a care plan goal of lowering blood pressure to 140/90, Cole-Lewis said, a patient may need to do one (or more) of at least seven things:

• Start doing something.
• Stop doing something.
• Keep doing something.
• Learn about doing something.
• Do something once.
• Do something for a year.
• Do something forever.

Telehealth is maturing. If there was a bright spot for the engagement domain at HIMSS, it was the level of activity in the telehealth market. (Full disclosure: I wrote my first “telehealth is ready to take off” article in 2013.) Nathaniel Lacktman, chair of the law firm Foley & Lardner’s telehealth industry team, pointed out that the recently passed federal budget includes several extensions of telehealth reimbursement under Medicare, particularly for kidney dialysis, telestroke, and the patient-centered medical home. This should provide HCOs with the impetus to initiate or expand telehealth efforts that have otherwise stalled.

Plus, as John Moore pointed out in his HIMSS18 recap, telehealth vendors are pushing to cover the vast area between low-acuity DTC services and inpatient services through a variety of strategies. These include offering chronic condition management, supporting outpatient care settings, or unifying their inpatient and at-home UX. Stay tuned for Chilmark’s forthcoming report, Telehealth Beyond the Hospital, which will examine these strategies in much greater detail and identify which vendors are best positioned to execute in this market.