HIMSS 2016 - "What Happened In Vegas"
It was fitting that HIMSS returned to Las Vegas because like Vegas, in a word, HIMSS16 was consistent. There were many of the same old problems: out of control costs, a far-from retail-like consumer experience, providers struggling to adapt to changing care delivery and reimbursement models, and siloed data creating challenges to the flow of data and clinical health information. There was also the same HCIT vendor panache purporting to have the panacea for these problems on the showroom floor and inconclusive results from practitioners as to hard dollar progress being made to solve these problems The Consumer and Patient Engagement: Consumers act like consumers everywhere except (you guessed it!) in the world of healthcare. Huge gaps exist between how consumers want to interact with the healthcare system and the methods of which healthcare systems are actually providing. This is a HUGE problem and creates a barrier to true patient and consumer engagement in healthcare. The good news is that recent surveys suggest both sides are trying to change this paradigm. Like any consumer-driven industry, patients have high interest in comparison shopping along cost and quality lines, as well as interacting and communicating with their providers online. However, very few consumers are doing so and thus remains a huge problem for both the provider and the consumer. For example, interest in communicating electronically with doctors is high (at nearly 72%), but only one in five care recipients has done so. Furthermore, consumer interest in paying a medical bill online is electronically with doctors is high (at 70%), but only one in three people who have received care has actually done so. Though disappointing, these gaps in service provision represent enormous opportunity! Another huge problem is that many providers are in the dark about what is important to the healthcare consumer. In a recent survey of a major Tier 1 Health System survey, patients reported that the most important quality when choosing a healthcare provider was the availability of parking at the facility. Providers need to encourage consumers to make favorable choices by making the first clinical encounter a positive one. Providers can do this by bringing what is important to consumers to the table at these critical decision points. In order to create a truly engaged provider-consumer relationship, providers also need to adopt solutions to close the service provision gaps mentioned above. This will likely mean that technology systems for providers to manage consumer preferences will be needed. These solutions will hypothetically resemble CRM’s – only on steroids! Salesforce.com, a leading customer relationship management (CRM) tool, recognizes this open opportunity and was a significant presence at HIMSS. In sum, it seems that there are solutions to the troubled healthcare provider-consumer relationships and it is likely that technology from outside the healthcare industry will be sought to address them. Population Health Management – Still in its Early Innings but Providing Difficult in Practice There are two big impediments to effective population health: a lack of clinical data exchange and, perhaps the larger of the two, care coordination. Care coordination is defined as directing patient care by developing care plans, synchronizing multiple care providers’ efforts, engaging patients, and managing all facets of well-being. Managing well-being appears to be the biggest challenge for health systems in achieving population health management. Population health is defined by Kindig and Stoddart (2003) as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group,” and “includes health outcomes, patterns of health determinants, and policies and interventions that link these two.” The good news is that traditionally, providers more so than payers are better positioned to deliver on the promise of better population health. This largely because people generally trust their healthcare providers. The bad news is that population health practitioners have yielded inconclusive results - or so it seems to investors. A panel session from large Tier 1 healthcare provider (and an early advocate of population health management) reported challenges to truly engaging patients in meaningful cost reducing behaviors. Although practitioners claimed that the population health program (and the over $20 million of technology spent to support the new model) was wildly successful, they failed to report improved outcomes and hard dollar cost savings. Instead, success was measured in terms of workflow improvements and greater staff efficiency. This lack of hard ROI to indicates that one of two things is happening: either we are simply still in early days of implementing population health management effectively, or this new model is in fact failing to illustrate hard dollar costs savings (which is perhaps the more likely of the two). Value-Based Reimbursement: Payment Models are Changing and Forcing a Transformation in Technology Systems Across the Provider Landscape Despite the struggle healthcare providers and technology service providers are facing to define what a shift to value-based care means to them, one thing remains clear: value-based reimbursement is happening. According to Brown and Crapo (2014), value-based reimbursement shifts the traditional focus of healthcare billing away from the number of patients they see, procedures they perform, and tests they order and towards the quality and value of care delivered (Brown & Crapo, 2014). Healthcare systems and practitioners would like to be able to take on greater risk and be rewarded for doing so, but often lack the business and technology infrastructure to do so. This phenomenon creates a market hungry for technology and business processes to support new payment models, which would require that all systems be augmented or replaced altogether in order to meet emerging needs. There is not a single facet of the healthcare delivery system that will be unaffected by the shift to value-based reimbursement. External patient facing technologies, internal clinical applications, and even business, administrative, and accounting systems will be hot areas of innovation and growth going forward! Interoperability – The Lack of Free Exchange of Patient Clinical Data Lags Behind Requirements for Population Health and Value-Based Reimbursement Here, the big problem is that electronic medical records (EMRs) don’t talk to each other, creating a HUGE mess for healthcare providers and consumers alike. This short-coming is a far-reaching barrier to successful population health and value-based reimbursement. Physicians are frustrated by the lack of interoperability and hungry for tools to improve it, yet big EMR players (like EPIC and Cerner’s) loathe the thought of creating this openness. So clinical data remains in siloes. Hard copies of records and faxing are still among the primary methods of recording and managing patient information. Yet without adequate data exchange technologies, there is no way for physicians to know what is happening to their patients outside of their care. Ultimately, clinical data needs to be free flowing across health care facilities, providers, and the continuum of care. It is important for practitioners and patients to have a longitudinal perspective of their healthcare in order to engage consumers and manage care effectively. Enhancing the exchange of patient health data needs to be a new focus for technology providers. View of Private Capital Markets in HCIT Recently, public healthcare information technology (HCIT) companies have been facing a slow (but significant) pullback, which is slowly trickling down to the private markets. Though the private market remains hot and attractive as a capital raising and seller-friendly market, investors are acting with more skepticism and caution. There are fewer big multiple 6x+ revenue capital raising deals closing in the HCIT industry and even fewer have been “priced to perfection.” Investors and strategic buyers seem to be favoring scale and EBITDA over rapid growth and burn, with 2016 holding the potential to be the year of revised expectations for both sellers and buyers.