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eHealth Initiative’s Annual Conference: moneyball and big data

As eHealth Initiative’s Annual Conference kicked off last Tuesday in Orlando, Fla., it was clear that the two-day event would offer a candid forum for health care leaders, state representatives and vendors to share the highs and lows, as well as what lies ahead in the ever-shifting world of health information technology.
eHealth Initiative Chief Executive Officer Jennifer Bordenick’s welcome address focused heavily on the perseverance the health care industry must have to achieve meaningful, lasting results. Despite major breakthroughs in innovation over the last several years, she said the industry is “starting to see some cracks around the edges.” Bordenick emphasized the uncertainty that surrounds health IT as well as the frustration felt by the private and public sector struggling to implement health care reform, ICD-10 and meaningful use amid strapped budgets and failed projects. She didn’t sugarcoat the introduction; the conference would be a place to discuss successes and pitfalls with “brutal honesty and humility.”
Still, Bordenick’s ultimate message was one of hope and encouragement. She took a few minutes to highlight a renowned group of political and cultural icons, all who experienced major defeats before breaking ground – Abraham Lincoln, Steve Jobs, Steven Spielberg, Michael Jordan and Jerry Seinfeld.
“It’s not about just getting it right,” said Bordenick. “It’s about perseverance – taking the time to get it right.”
In his keynote address, Optum’s Group Executive Vice President Andrew Slavitt discussed the opportunities and challenges of technology and big data. He said the good news is that the next generation of providers expects to use technology in their jobs instead avoiding it. The challenge is that geographic adoption of technology could get worse as more technologies are introduced, due to limited resources.
Slavitt said current health technologies are being built to fulfill the needs of the old world instead of the new, and emphasized the importance of understanding the needs of the dual eligible population – about 10 million Americans who qualify for both Medicare and Medicaid, and “whose health and social needs are at the root of almost everyone’s health care costs.”
According to Slavitt, the health care industry would benefit from adopting a moneyball approach to data analytics. For those unfamiliar with Michael Lewis’ book or the 2011 motion picture starring Brad Pitt, moneyball refers to how baseball’s Oakland Athletics used heavy analytics to assemble a team who went on to win a majority of games in 2001 on a limited budget. Instead of relying on typical batting averages and game statistics, the A’s professionalized data and analytics, and developed a data strategy.
Slavitt also noted that adoption and implementation of technology will accelerate once data speaks the language of margin and marketshare. He said with a moneyball approach and investment in health IT, keeping one in five dual eligible individuals in their homes instead of health institutions is an achievable goal, and one that would drastically reduce the $360 billion spent on their care.
In closing his address, Slavitt asked the crowd if big data was hype (more promise than will be realized), a fad (gone in five years), or a trend (true, lasting change). While the majority of the attendees believed big data to be a trend, Slavitt leaned toward hype. He said at this time, big data has a major lack of interoperability, standards, severity data, and linked data, all of which “hurts patient care” and “drains the usefulness out of data.” He said until a solution achieves these needed components, the risks of big data can be compared to “playing with fire.”
To read more about the eHealth Initiative Annual Conference, please read the full analyst recap.

Look to the States for IT Opportunities in the Supreme Court’s Ruling on Health Care Reform

After three months of grueling debate in the hearing on the controversial Patient Protection and Affordable Care Act (ACA), the Supreme Court upheld the law, including the individual mandate for citizens to have health insurance. However, the court made it clear that the penalty for not having health insurance coverage is a tax—a mechanism Congress has power to exercise. Under this language, Americans are not necessarily being “forced” to purchase health insurance; rather, they are incented to in order to avoid being taxed. The ruling means that virtually every program created by the controversial law will move forward. 
The ACA won’t have much of a direct impact on technology spending and the contracting market over the next few years in the federal IT market. Under the Obama administration, impacted federal agencies have already been moving ahead in implementing many of the provisions of the law. For example, the oversight offices mandated in the law, such as the Center for Consumer Information and Insurance Oversight (CCIIO), have been established and the technology for those offices to function has been installed and, most importantly, building the IT infrastructure needed to implement the provisions in the law has begun.
The two most critical federal IT investments, the federal Health Insurance Exchange (HIX) and IRS projects for tax collection, are already underway. The Department of Health and Human Services’ Centers for Medicare & Medicaid Services (CMS) spent an almost $134 million in FY2011 and $57 million in FY2012 on CMS’ CCIIO Healthcare Insurance Exchange IT Investment program, which is planned to cost $516 million in total. Part of that included contracting the building of a federally-run HIX to CGI. 
The HIX is a platform for organizing the health insurance marketplace to help consumers and small businesses shop for coverage in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. 
For FY2013, CMS and IRS investments have been consolidated and the joint funding request for FY2013 totals $427 million. Various projects at IRS, some of which are minor, total $303 million in FY2013 and are likely to go to exiting IRS tax system contractors. The Supreme Court’s ruling merely means that these projects continue as planned, so don’t expect an IT boom in the federal IT market based on the ruling.  Rather look to the states.
Look for Opportunities at the State Level
Each state is required to set up its own health insurance exchange online marketplace and HHS has awarded hundreds of millions of dollars to states to help them and will continue to do so through 2014. However, expect to see most procurements come between now and the end of 2013 because states are required to have their exchanges up and running by January 2014.  
Procurements may be for insurance exchange components, including Web portal services, call centers, system integration services, quality assurance services, eligibility system enhancement services, and marketing and outreach services.
The Supreme Court’s ruling creates an urgent time-crunch for many states that will compel them to move quickly, especially for those that did not get started on their HIX or made slow progress because they either opposed the law or were betting that the Supreme Court would strike it down.  And this creates immediate opportunities for IT vendors.
Under the law, by November 16, 2012 states have to submit letters of intent, or blueprints, to the Center for Consumer Information and Insurance Oversight (CCIIO) that confirm the state’s plan to have a state-based or partnership exchange up and running by January 1, 2014.  Many states that delayed will be scrambling to put together implementation plans for their exchange.  States that fail to meet federal deadlines will be forced to have the federal government step in and set up its own version of the exchange, which is being developed by CGI under the aforementioned HHS contract. 
To expedite the process states may look to different procurement strategies. For instance, some are adding insurance exchange components onto existing contracts, such as for eligibility systems. Much of the information stored in these systems overlaps, which may make existing system contractors the most knowledgeable regarding what infrastructure will allow for optimal interoperability. Another technique states may choose to use is procuring for multiple components of the exchange under the same contract, such as call center and program integration services.
In the short term, vendors can expect to see an influx of consultative opportunities released by states that have made minimal progress on insurance exchange implementation. These states that have been rather sluggish will need assistance in performing gap analyses of their as-is and to-be technology environment. Vendors can also expect states that were waiting on the ruling to move forward with releasing solicitations for actual system implementation.  States will continue to release procurement to enhance or completely replace their eligibility systems.  States will also be looking to contract for consumer assistance-related services, such as call centers.
In 2014 and beyond, vendors can expect to see more solicitations for marketing, outreach and education-related initiatives, since this will be the time consumers are actually signing up for health plans. 
Note: This blog was co-authored by Amanda White who covers state and local healthIT at Deltek.

Fast Forward: Integrated Telehealth—Better Care with a Kickin’ ROI

In this recent “Fast Forward” blog series, I’ve been noting industry advancements and events that will fast forward healthIT and its transformational benefits of enabling better patient care while lowering costs. And I’m noting how that relates to the federal health care environment and healthIT market and what vendors need to do. This week the focus is on telehealth happenings.
Several articles and announcements this week drove home the value proposition of telehealth—if done right.  Healthcare IT News reported that industry executive panelists at the recent American Telemedicine Association 2012 Conference made the point that a significant impact on improving the quality of care in the healthcare system can be made using telehealth, if existing healthIT solution silos are broken down.  However, they lamented the fact that it isn't happening, and noted the poor conference attendance by EHR and other healthIT providers.
Today in a blog in Computerworld, Ravi Krishnan, executive director of Kaiser Permanent’s IT PMO, states that “care interactions are happening in an increasingly wide range of locations: hospitals, rural clinics, mobile health vans, homes, or even during the course of a person’s daily activities.”  He advises fellow IT strategists in the healthcare industry that “the most effective way to frame a mobile strategy is as an ecosystem comprised of multiple components that work together to enable mobile behavior and to envision a health care environment “where physical boundaries are immaterial—even irrelevant.”
One of the major value propositions of the combination of EHRs, mobility, and telehealth solutions is that it can be a force multiplier enabling, on average, physicians to see one more patient per day. This makes them more efficient and expands their reach without compromising the quality of the care provided.  The combination can produce a fantastic ROI—if done correctly—and nowhere is that more evident than in mental health where most of the cost is healthcare personnel.
VA Case In Point
Treating post traumatic stress syndrome at MHS and VA has been rising dramatically for the last 10 years or more and the increasing suicide rate of soldiers returning from the war is alarming.  According to the VA, since 2007, it has experienced a 35% increase in the number of Veterans receiving mental health services.  This portends to be a massive problem for individuals, families, and US society for some time to come and a costly one for taxpayers. Moreover, VA reports that since 2009 the VA has increased the mental health care budget by 39%! 
Most of that increase is surely attributable to the professionals needed to address mental health, which has also been increasing inVA. Since 2007, VA reports experiencing a 41% increase in mental health staff! And in April, Shinseki announced VA would add approximately 1,600 mental health clinicians and nearly 300 support staff to its existing workforce of 20,590 to meet the increased demand for mental health services.
To address this multitude of issues, just today VA Secretary Shinseki stated in a press release posted on the VA site a goal to increase telehealth services 30% in FY12 by conduct more than 200,000 clinic-based, telemental health consultations in fiscal year 2012, up from 140,000 in fiscal 2011.  Complementing this, few weeks ago, Shenski did a great thing for vets (and to boost the telehealth adoption rate) when he announced that VA would no longer charge Veterans a copayment when they receive care in their homes from VA health professionals using video conferencing.  Clearly, he gets it—telehealth works for all.
In the statement, Shenseki said, “telemental health provides veterans quicker and more efficient access to the types of care they seek.  We are expanding the reach of our mental health services beyond our major medical centers and treating veterans closer to their homes.  We are leveraging technology to reduce the distance they have to travel, increase the flexibility of the system they use, and improve their overall quality of life.” 
Vendor Recommendations
Vendors can also benefit from the trend if they have a healthcare process perspective rather than a technology approach to their solution strategy and build out their suite to make “seamless multi-modal care anywhere” their value proposition.
  • Partner or acquire companies that expand and compliment your offering;
  • Integrate components by building interfaces and, if tightly integrated even same-look-and-feel GUIs for ease of use by healthcare practitioners;
  • Get involved in industry associations that enable dialogue with other vendors and don’t shy away from co-opetition;
  • Use all means (customer visits and surveys, focus groups, “birds of a feather” sharing groups, conference speaking engagements) to listen to healthcare practitioners to understand their processes, pain associated with current HIT solutions, and especially their wish-lists. They are anxious to help you develop solutions to help them and are proving to be innovative in that.
  • Same tried and true mantra: Talk benefits to providers customers and prospects rather than modules, feature, and functions.
If vendors take such an approach, with market adoption mobility and telehealth becomes a win-win proposition, not just for federal agencies, health care providers, and patients, but for vendors as well.