HIMSS’19: Real Value in Telehealth and Virtual Care

This is the second in a series of blog posts recapping HIMSS’19; you can read all our coverage here.  

My primary purpose at HIMSS’19 was gathering information and ideas for our upcoming report on the front door to care. This report will take a close look at the evolving ways patients first enter the healthcare system. Whether from retail health, telehealth, remote patient monitoring, or remote care apps, HIMSS was full of changing ideas and approaches. The conference had a utilitarian focus, looking less at generic or abstract buzzwords to get people excited, and more at what can be done right now to engage providers, payers, and ultimately patients.

My biggest takeaways:

Telehealth, Remote Monitoring, and Virtual Care can significantly erode established HCO business models, or complement them.

Health systems have invested a lot into controlling referrals and leakage. While the PCP remains the central organizing hub of most healthcare, the growth of retail and remote health could lessen the PCP’s centrality in traditional referrals networks.

Unlike the Teladoc model, which employs contracted providers to provide a turnkey outsourced telehealth service, newer entrants offer operational platforms and back-end systems so HCOs can staff and run their own telehealth programs. This allows them to retain control of the patient experience. It’s an easier model for an HCO to understand and use, but whether they adopt such solutions before their competition is an open question.

Behavioral health might finally get its due through Virtual Care apps.

Between shrinking reimbursements and scarce providers, behavioral and mental health care have been the first service line on the chopping block for a while now. PCPs have become the go-to provider for too many behavioral health needs, occupying increasing amounts of time and stretching their expertise thin.

Several of the telehealth and remote health platforms I saw last week had behavioral health components. There were a few well-executed apps dedicated to mental health and wellness, mainly with a CBT/DBT focus and some with solid clinical results. Helping PCPs manage this care and mitigating the effects of comorbidities on patients is an important part of addressing PCP workload and job satisfaction, as well as patient engagement. These virtual care offerings can help struggling PCPs get their patients the help they need, while still working within tight budgetary and scheduling restrictions.

Telehealth, Remote Monitoring, and Virtual Care can significantly erode established HCO business models, or complement them. The question is whether health care systems will recognize that in time.

Performance improvement services are becoming a core component of analytics products

With my background in healthcare performance analysis and improvement, I wanted to see how analytics is evolving to become more effective and efficient.

The future of analytics platforms looks less like pre-built dashboards or reports and a lot more like what Visiquate offers. Its embedded employees work directly with customer end-users to execute Agile-inspired improvement sprints supported by their analytics and reporting. Vendors are coming to grips with the challenge of operationalizing analytics for value and performance improvement. The value proposition behind both improved reporting software and process improvement is pretty well understood. Figuring out how to fit it all into an annual budget in an era of shrinking margins is the real hard part here.

Leveraging data to produce specific, actionable recommendations remains a challenge.

A fascinating conversation about AI at the Geneia booth on Tuesday afternoon summed up the current state of AI and machine learning in the clinical world. While access to existing and new kinds of data is increasing and the ability to integrate it is getting more sophisticated, AI and ML still aren’t the clinical tools many expected them to be. Only imaging, an area where the datasets are complete and the challenges are well understood, has really begun to heavily leverage AI/ML. Everywhere else, the barriers to gathering appropriate context and rendering predictive clinical recommendations have yet to be overcome.

Stay up to the minute.

Did You Know?

HIMSS’19: Maturing Market Drives Pragmatism

Even the exhibit hall was calmer with vendors focused on solving specific problems instead of the latest buzzword

Frankly, I was dreading attending HIMSS this year. I’ve grown tired of the hype, the noise and just how little we have accomplished as an industry in the past few years. We have not contained costs, but have increased clinician burnout. We have made only a modest impact on quality, but the lack of interoperability has hampered care coordination. I had become increasingly cynical every year as we approached the big event, dreading more of the same, which is never a good thing.

Yet at the outset, while waiting to board my flight to Orlando, I started meeting many a compatriot in healthcare IT. This did not stop until I landed back in Boston five days later. Those brief meetings always included a hug, checking in with how each other is doing personally and then proceeding to talk about the industry – in that order. I have worked in a wide range of industries over the course of my career, only in healthcare have I experienced such genuine warmth and caring. These brief encounters renew my spirit pushing that cynicism back for this industry is more than just a business, it is about health, and it is about life.

HIMSS’19 Reflections

For the last eleven HIMSS conferences I have attended, there has always been one buzzword or acronym that virtually all vendors on the exhibit floor would latch onto, whether they could deliver those capabilities or not. There was no such word or acronym this year. The hype, the buzz may be behind us, which is welcomed by this analyst and I’m sure most in attendance.

I also noticed that conversations were less about whiz-bang features. Instead, conversations focused on specific problems that can be solved and value delivered to an organization. The industry is quickly moving beyond being strictly regulatory-driven (albeit CMS’s NPRM dropped Monday at HIMSS goes against that) to a more pragmatic market, which is a healthy sign of a maturing industry.

It was clear this year that the EHR war for buyers is over. Those EHR vendors offering a fairly limited, EHR-centric product with few extensions (e.g. analytics, RCM, PHM, etc.) were eerily quiet. EHR vendors with broad capabilities had their fair share of visitors, but the discussions focused on the extension apps and equally important, how to extract value from those significant EHR investments.

In speaking to one of the largest EHR vendors, they were surprised by the interest in PHM among their clients, which has been tepid in recent years. Clearly, CMS’s recent moves to get provider organizations to get serious and start taking on downside risk are being felt. But this vendor went on to say that most prospects simply want someone to tell them what to do to be successful. For companies like Aledade and Evolent this must sound like mana from heaven.

Some quick outtakes from HIMSS’19

  • Acute and ambulatory have been by and large taken care of, yet we still do a very poor job as an industry addressing the “community of health.” Good opportunity for a truly visual, intuitive platform.
  • Ada Health, a Berlin-based small company using AI for self-triage is just entering the US market and has landed Sutter Health as its lighthouse customer. Keep an eye on them – they are interesting.
  • Significant shift among provider-centric vendors who are now signing large deals with payers. Still plenty of mistrust between providers and payers, but if incentives are aligned – it can work.
  • Collective Medical out of Utah has been operating in stealth mode and racked up several payer and provider clients. Compelling value-prop but they will have to move fast as several much larger vendors are looking to do something similar.
  • Many a large health IT vendor does a poor job at data aggregation and digestion (normalization) and are seeking partnerships with a number of small innovative companies that focus on this problem.
  • Apervita, a company that has been around for several years with a business model I never was fond of has completely changed direction. I like what I saw at HIMSS this year. Their work with NCQA is pretty impressive.

The Wrap

HIMSS this year reflects a maturing market. With any maturing market, conferences like HIMSS begin to lose their luster, despite their own self-promotional hype. But what HIMSS does well is to bring together a broad cross-section of the industry and remains a fabulous place to reconnect and network. Does it need to be three and a half days (plus!), I do not believe so. In five years, HIMSS will still be here, but the high water mark was likely last year (barring any major federal incentives a la HITECH). The tide is going out.

HIMSS’19: What to Expect, What I Hope to Find

Next week, most of the healthcare IT industry will descend on Orlando to attend HIMSS’19. This is my 12th year attending HIMSS, an event for me that is more about networking and confirming assumptions than actually learning anything new.

For years now, HIMSS and the multitude of vendors exhibiting there have feasted at the trough of federal largesse ($35B plus), via the HITECH Act passed in 2008 to foster adoption of EHRs. The HITECH Act was successful, driving EHR adoption from the low teens to over 90% today. Though some may question the value of that investment, I personally believe that over time (another 7-10 years) we will reap benefits that far exceed that initial investment.

However, now that we’ve reached that level of adoption, the market has plateaued. Sure, there were hopes of a robust EHR replacement market, but that never materialized. Then there was the hope for huge gains (profits) to be made on the shift from volume to value through the sale of PHM solution suites. That didn’t pan out too well either as the fate of the ACA was left in the lurch with a change in administrations. Also, quite frankly, PHM is a complex sell, requiring significant change management that few healthcare organizations were ready to commit to and few vendors had the services to support.

The provider health IT market is going through a significant transition and it’s not going to be pretty. Clearly, the party is over and one has to wonder: Why does HIMSS continue to exist? Why are all these vendors here? Are we on the Titanic, seemingly blind to the economic icebergs that surround us?

But I digress.

What is important is that the EHR has become the central nervous system to provider organizations. Secondly, this market will continue to consolidate rapidly with few independent EHRs surviving the shakeout. Those left standing will attempt a number of different strategies to drive continued growth in a plateauing market.

  • Acquire other EHR vendors to gain market share (Allscripts, Cerner, CPSI, Harris)
  • All major EHR vendors are pursuing an extension strategy moving from EHR to supporting PHM, RCM, analytics, etc, though their capabilities in these adjacent areas vary wildly.
  • Expansion into new markets. Epic is looking to dentistry and insurance. Allscripts, life sciences and payers with Veradigm. Cerner, government and payers. All large acute/ambulatory EHR vendors are actively pursuing overseas markets, with Meditech particularly strong in Canada.

It remains to be seen how successful these strategies will be but rest assured, even if successful, no EHR vendor is completely safe from a future acquisition.

This sets the stage for what to expect at HIMSS’19:

  • All vendors will continue to tout the momentum they have in the market as if this market will remain forever on a hockey stick trajectory, but very few can back it up.
  • AI/ML will be just as pervasive this year as last, permeating all aspects of health IT, but likely very little demonstrable proof of scale.
  • A multitude of disease-specific, chronic management solutions but no vendor with a true portfolio of best-in-class solutions on a single platform. Resmed appears close to enabling such a platform for respiratory ailments.
  • More FHIR use cases.
  • Plenty of patient-centric this, consumer-centric that but all a head fake as it is really about capturing patient revenue via online bill pay and filling vacant appointment slots.

And what I hope to find at HIMSS’19:

  • An AI/ML company that has truly scaled its solution across an enterprise in at least two customer deployments.
  • Clear metrics from EHR vendors on the level of adoption and use of FHIR across their client base.
  • An engagement solution that is looking beyond the near-term volume/revenue needs of a healthcare organization to how to truly engage patients/consumers in their health e.g. Aetna/Apple’s Attain app.
  • How vendors are assisting their customers in achieving demonstrable, defendable ROI from their solutions. Health Catalyst stands out here.

May your trip to HIMSS’19 be a success, however you define it. And if you see us in the halls, do not hesitate to stop and say hello – maybe we’ll have a few quick on-the-fly notes to share.

Once again, it is that time of the year for our annual pilgrimage to HIMSS. While many attendees focus on the sheer size of the exhibit hall or packing their schedule full of meetings, we wanted to highlight the other major part of the event: education sessions. Below are this year’s recommendations from the Chilmark analyst team, organized according to our domains of research.

We plan to attend many of these sessions, so if you would like to meet up afterward, please feel free to email anyone on the team to coordinate meeting at the session to discuss the topic further.

Analytics

Communicate Value and Build Support for Enterprise Analytics

Tuesday, Feb. 12, 4:15pm – 5:15pm, Convention Center W304E

Speakers:

  • Chris J. Donovan, Executive Director, Enterprise Analytics, Divisions of Finance, Cleveland Clinic
  • Andrew Proctor, Senior Director, Business Intelligence, Medical Operations Division, Cleveland Clinic

Why AttendDescribes the experience that Cleveland Clinic has had since they embarked on an enterprise analytics endeavor since 2014. This session will provide insights into how to achieve strategic leader buy-in and the ‘why’ of particular use cases vs. focusing on the technological ‘how.’

Leveraging Data Analytics to Complement Value-Based Approaches

Wednesday, Feb. 13, 8:30am – 9:30am, Convention Center W308A

Speaker:

  • Nathan Riggle, Director of Analytics, Mercy ACO

Why AttendACOs are investing in various advanced analytics solutions with mixed results. This session will explain how to use data to develop the right growth strategy and clinical pathways to truly realize the benefits of these investments in valued-based contracts.

Interoperability

Five Best Practices for Improving Transitions in Care with HIE

Tuesday, Feb. 12, 10:30 – 11:30am, Convention Center W315A

Speakers:

  • Andrea Gelzer, SVP and Corporate CMO, AmeriHealth Caritas Family of Companies
  • Joe Miller, Director, Strategy and Innovation, AmeriHealth Caritas

Why Attend: This session should provide ideas about the value of HIE from a payer perspective.

Improving Care Coordination with Nationwide Data Exchange

Tuesday, Feb. 12, 1:30pm – 2:30pm, Convention Center W230A

Speakers:

  • Arthur M. Lauretano, CMO, Circle Health
  • Jitin Asnaani, Executive Director, Commonwell Health Alliance

Why AttendThis should be a good update on CommonWell, including its integration with Carequality. Hopefully, they will also talk about how TEFCA will affect both CommonWell and Carequality.

Care Management

Empowering Consumers with Data to Improve Chronic Disease Conditions

Tuesday, Feb. 12, 1:30pm – 2:30pm, Convention Center, W315A

Speakers:

  • Joshua Riff, CEO, Onduo
  • Mark Talluto, VP of Strategy and Analytics, Blue Cross Blue Shield Association

Why Attend: Self-directed care management utilizing digital health apps to address chronic conditions is still in its earliest stages. This session will talk about some of the new technologies that payers are using and the strategic partnerships they are forming help payers meet the needs of their members.

Bending the Cost Curve with Whole-Person Care

Tuesday, Feb. 12, 4:15pm – 5:15pm, Convention Center W300

Speakers:

  • Teddy Shah, VP, Advisory Services, Optum
  • Jeffery Arnold, Medical Director, Santa Clara Valley Health and Hospital System

Why Attend: Safety-net providers have a large number of Medicaid patients that often have unique requirements. This session will address how Santa Clara Valley Health and Hospital System in CA has implemented specific strategies to address the social, clinical and behavioral needs of their high-risk Medi-Cal beneficiaries.

Population Health Management

Public Health Extension of the Primary Care EHR

Tuesday, Feb. 12,  1:30pm – 2:30pm,  Convention Center W311E

Speakers:

  • Nivedita Mohanty, Chief Research Officer, AllianceChicago 
  • Fred D. Rachman, Chief Executive Officer, Alliance of Chicago Community Health Services

Why AttendVarious public health systems have not been linked to primary care EHRs limiting the efforts of broader population health efforts. This session will examine some of these issues and the progress that is being made by an organization in the greater Chicago area.

Population Health As Ecosystem Engineering

Tuesday, Feb. 12, 10:30am – 11:30am, Convention Center, W204A

Speaker:

  • Richard Biehl, MS-HSE Program Director, UCF College of Engineering & Computer Science

Why AttendBuilding a population health infrastructure is a complicated endeavor that requires a different approach than provider organizations are used to since there is a focus beyond the ‘four walls’ of their facilities. This session will examine how a new ‘ecosystem’ approach for population health contrasts with the traditional ‘system of system’ approaches.

Patient Engagement

Opening Keynote: Will Consumer-Directed Exchange Disrupt the Healthcare Marketplace?

Tuesday, Feb. 12, 8:30am – 10:00am, Convention Center, Valencia Ballroom

Speakers:

  • Aneesh Chopra, President, CareJourney
  • Seema Verma, Administrator, Centers For Medicare and Medicaid Services

Why Attend: Seema Verma, Aneesh Chopra, and Hal Wolf (moderator) will discuss how consumer-directed efforts are impacting healthcare delivery. If CMS is going to make any big announcements at HIMSS, it will be during this session.

Elevating the Patient’s Digital Experience

Tuesday, Feb. 12, 12:00pm – 1:00pm, Convention Center W311A

Speaker:

  • Aditya Bhasin, VP Software Design & Development, Digital Solutions, Stanford Health Care

Why Attend: This session will take a look at Stanford Health Care’s efforts to use digital health to transform the patient experience across their organization. It will provide a review of what has and hasn’t worked so far as well as recommendations on how other provider organizations might learn from their experience.

Payer-Provider Convergence

Providing Payer Insights to Clinicians at the Point of Care

Tuesday, Feb. 12, 12:00pm – 1:00pm, Convention Center W315A

Speakers:

  • Nancy Beavin, Interoperability Leader, Humana Inc

Why Attend: Basic primer and update on how payers are trying to delivering insights into EHRs at the point-of-care. This session will address some of the most pertinent challenges to this topic including bidirectional information exchange and provide an overview of how Humana has tried to tackle this issue to date.  

Unifying Provider and Payer Data to Propel Value-Based Care

Thursday, Feb. 14, 8:30am – 9:30am, Convention Center W208C

Speakers:

  • Claudia Williams, CEO, Manifest Medex
  • David Kates, CTO, Manifest Medex
  • Erica Galvez. Chief of Staff and VP of Programs and Partnerships, Manifest Medex

Why Attend: This will provide a good update on how Manifest Medex is working through the challenges of trying to create a unified patient record across a large geographic region (CA) with multiple payers and numerous providers organizations. It will also provide some insights into how this HIE is being used to support various value-based payment initiatives across California.

Other Session Topics:

If You Build It, Build It Well: User-Centered Design and Agile Development Provides User-Delight

Wednesday, Feb. 13, 4:00pm – 5:00pm, Convention Center W307A

Speaker:

  • Subha Airan-Javia, Associate Professor of Medicine, UPenn; Chief Medical Officer, TrekIT Health, University of Pennsylvania Health System

Why Attend: The chronic usability problems of healthcare applications must be addressed. This session is about one organization that is trying to incorporated mainstream ideas for healthcare users.

Leveraging Technology to Improve Prior Authorization

Wednesday, Feb. 13, 2:30pm – 3:30pm, Convention Center W204A

Speakers:

  • Heather McComas, Director, American Medical Association
  • Tyler Scheid, Senior Policy Analyst, American Medical Association

Why Attend: This session will provide highlights on the growing problem and specific challenges that physicians face with prior authorizations. Beyond just identifying specific challenges, this session will also provide an overview of the technology solutions to achieve higher rates of automated prior authorization.

What other sessions and events are you looking forward to? Tell us in the comments below and maybe we can see you there!

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