States are pursuing new policy avenues. Managed care is evolving. And providers need to help clients find access to a system with ever-shrinking resources.
This webinar will examine the various ways states are addressing their Medicaid challenges…and how those changes could impact you.
In this recorded webinar, Ronald W. Lanton III, Esq., Executive Director & Senior Counsel at Frier Levitt Government Affairs gives an insider’s take on potential changes coming to Medicaid. He works with clients throughout the Care Continuum, helping them navigate both government and market issues, including:
Greater state scrutiny of managed care and reimbursement
State responses to the opioid crisis and their effect on providers
Increased demand for behavioral health and how to pay for it
Congressional policy and what to expect after the mid-terms
If you need assistance with government/market issues or reviewing how 2019’s potential Medicaid changes will impact your business, contact Frier Levitt Government Affairs.
This webinar is presented through a partnership with Mediware.
The recent hurricanes, Harvey and Irma, have left thousands of people without power, homes, and the necessities of life. Hospitals and doctor’s offices have also experienced devastation with many closing their doors. This leaves patients vulnerable and without proper care.
Recently, several companies have offered a new type of patient care service to those affected by the hurricanes in the form of telehealth. Telehealth allows patients to receive long-distance clinical care as well as health education, and consultations from virtually anywhere an internet or phone connection is present.
The Florida based company MDLive recently offered free telehealth consultations for those affected by the recent storms. Other companies such as DoctorOnDemand, HealthTap, and Teledoc are offering similar services. Telehealth companies aren’t restricted to physical care. Many offer mental health services as well such as American Well, a Boston company, which has offered free telehealth counseling.
The free services from most telehealth companies are on a limited time basis. However, some companies are giving extended free trials specifically for storm victims. LiveHealth will be offering non-emergency telehealth services, including services for mental health, through December 31st. As with most other telehealth services, LiveHealth is available 24/7 at the need and convenience of the patient.
Electricity and internet are still down for many in the storm ridden areas, but luckily most telehealth companies offer cell phone apps that can be accessed if the patient has service and data on their phone.
Cuts, bruises, and common ailments as well as prescription refills and mental health care are some of the more general needs patients seek on telehealth services and considering the widespread damage of the recent hurricanes, telehealth may be the quickest and most efficient way for patients to seek care.
Unfortunately, natural disasters will continue to take place. It seems telehealth companies are realizing how important their services can be in times of turmoil. The next step for these companies will likely consist of expanding the awareness of their existence as well as the services they offer to better assist those in need.
Companies offering discounts and free services are offering further information on their respective websites with details on terms and conditions.
Contact us today to find out more about telehealth.
Originally published in Mediware’s Home Care Blog. Re-posted with permission.
MoonShot 2020, the official name of which is the National Immunotherapy Coalition, is “one of the most comprehensive cancer collaborative initiatives launched to date, seeking to accelerate the potential of combination immunotherapy as the next generation standard of care in cancer patients. This initiative aims to explore a new paradigm in cancer care by initiating randomized Phase II trials in patients at all stages of disease in 20 tumor types in 20,000 patients within the next 36 months. These findings will inform Phase III trials and the aspirational moonshot to develop an effective vaccine-based immunotherapy to combat cancer by 2020.” [1] The goal is to get oncology to the point where it is manageable, like today’s chronic diseases. However; with so much data surrounding this effort, it can be as overwhelming as finding a needle in a haystack.
Three companies are showing us how information technology could be the key in helping us decode possible solutions. Recently, IBM launched Watson Health Cloud to provide a secure and open platform for physicians, researchers, insurers, and companies that are focused on improving health outcomes. Specifically regarding oncology, Watson has teamed up with Memorial Sloan Kettering to “take information about a specific patient and match it to a huge knowledge base incorporating published literature and the treatment history of similar patients. Watson’s ability to mine massive quantities of data means that it can also keep up—at record speeds—with the latest medical breakthroughs reported in scientific journals and medical meetings. Additionally, because it utilizes cognitive computing, Watson continually ‘learns,’ thereby improving its accuracy and confidence in the treatment options it suggests.”
Microsoft is also entering the cancer research arena with its recently announced artificial-intelligence-powered solutions aimed at the disease. Although the company has several teams of researchers tasked with “solving” cancer, Microsoft says its overall efforts will take two basic approaches.
The first is “rooted in the idea that cancer and other biological processes are information processing systems.” Therefore, based on that assessment, Microsoft suggests that “the tools that are used to model and reason about computational processes—such as programming languages, compilers, and model checkers—[can be] used to model and reason about biological processes.”
Microsoft says its second approach is data driven and revolves around the concept that “researchers can apply techniques such as machine learning to the plethora of biological data that has suddenly become available and [can] use those sophisticated analysis tools to better understand and treat cancer.”
Lastly, computer graphic chip manufacturer Nvidia has announced its partnership with the National Cancer Institute, the U.S. Department of Energy, and several national laboratories in order to build an artificial intelligence framework. The framework, called CANDLE—or the Cancer Distributed Learning Environment—seeks to advance oncology research.
Nvidia says CANDLE will be used to “help discover the underlying genetic signatures present in DNA and RNA of common cancers that are predictive of treatment response from the mass of molecular data collected by the NCI genomic data commons.” CANDLE will also “accelerate the molecular dynamic simulations of key protein interactions to understand the underlying biological mechanisms creating conditions for cancer.” In addition, through “semi-supervised learning, CANDLE will automate information extraction and analysis of millions of clinical patient records to build a comprehensive cancer surveillance database of disease metastasis and recurrence.”
It’s exciting to see so many diverse groups working together toward a solution for cancer. Finding one, or possibly even several different options, will not only save the healthcare system millions but will also provide priceless benefits. While it remains to be seen how much funding will be allocated to projects such as Cancer MoonShot 2020 as well as other private investment, the life-altering effects of cancer can be felt regardless of political affiliation. Hopefully, the time is soon that we all can celebrate major breakthroughs through communication, cooperation, and persistence.
This shows that the specialty market continues to evolve. Staying ahead of both your competition and information will be key to an organization’s future success. Contact us for our unique solutions that will help you get an edge.
According to the Treasury Department, Health Savings Accounts or HSAs were created in 2003 so that individuals covered by high-deductible health plans could receive tax-preferred treatment of money saved for medical expenses. This new vehicle was part of the Medicare Modernization Act, which gave seniors and disabled Americans a new prescription drug benefit under Medicare.
“A Health Savings Account is a tax exempt trust or custodial account you set up with a qualified HSA trustee to pay or reimburse certain medical expenses you incur. You must be an eligible individual to qualify for an HSA. No permission or authorization from the IRS is necessary to establish an HSA. You set up HSA with a trustee. A qualified HSA trustee can be a bank, an insurance company, or anyone approved by the IRS to be a trustee of individual retirement arrangements (IRAs) or Archer MSAs. The HSA can be established through a trustee that is different from your health plan provider.” Employers may also have additional information on HSAs.
To qualify for an HSA, one must meet the following requirements:
You are covered under a high deductible health plan on the first day of the month
You have no other health coverage except what is permitted under other health coverage by the IRS
You aren’t enrolled in Medicare
You can’t be claimed as a dependent on someone else’s 2016 tax return
The IRS has laid out a few benefits that one more enjoy from establishing an HSA:
You can claim a tax deduction for contributions you, or someone other than your employer, may make to your HSA even if you don’t itemize your deductions on a Schedule A (Form 1040)
Contributions to your HSA made by your employer may be excluded from your gross income
The contributions remain in your account until you use them
The interest or other earnings on the assets in the account are tax free
Distributions may be tax free if you pay qualified medical expenses
An HSA is “portable.” It stays with you if you change employers or leave the workforce.
While there are many benefits to an HSA, the question is whether this is a helpful tool for consumers to use? “Prescription drug costs for Americans under 65 years old are projected to jump 11.6 percent in 2017, or at a quicker pace than the 11.3 percent price increase in 2016, according to consulting firm Segal Consulting. Older Americans won’t get much of a break: Their drug costs are projected to rise 9.9 percent next year, compared with 10.9 percent in 2016. By comparison, wages are expected to rise just 2.5 percent in 2017.” With the combined factors of higher drug prices for improved patient outcomes, along with the increased amount of FDA approvals, this trend shows no signs of slowing down.
A recent survey below conducted by Devenir showed that since inception, HSAs have grown to an estimated $34.7 billion in assets and 18.2 million accounts for the period ending June 30, 2016.
At Frier Levitt Government Affairs, our focus is to show companies trends and their options for overcoming adverse priorities via our solutions. For the time period that we are currently in, it seems that the trend favoring consumer driven healthcare has returned with the Republican controlled Congress and Administration. As long as the Republican Party maintains control, we expect to hear this message resonate, especially with the debate surrounding the legislation designed to replace the Affordable Care Act (ACA). While health savings accounts are still in the early stages of adoption, it may be safe to assume that HSAs will see greater use, even though this vehicle may not provide total complete relief in a world that is witnessing faster prescription drug price increases. Contact us today for more information.
On July 25, 2016, the Department of Health and Human Services (HHS) released its proposed new models that demonstrate the Administration’s continued transition from quantity into quality of care. In this case, HHS was proposing incentives for hospitals to improve patient outcomes at a reduced cost to the healthcare system. The proposal, titled Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR), seeks to have hospitals collaborate with other providers in order to prevent hospital patient readmissions and avoid costly complications. On May 19, 2017, CMS announced that it is delaying the start date of this program to January 1, 2018 to allow additional time to prepare. For those that are wondering what this rule is, we figured we would outline what was previously proposed.
When it comes to the cardiac rehabilitation services of the proposal, CMS seeks to accomplish a few things. First, this will be geared toward patients that have been “hospitalized for a heart attack or bypass surgery, which would be based on beneficiary utilization of cardiac rehabilitation and intensive cardiac rehabilitation services in the 90-day care period following hospital discharge.” Secondly, CMS discussed model specifics. Hospitals may use this incentive payment to coordinate cardiac rehabilitation and support beneficiary adherence to the cardiac rehabilitation treatment plan to improve cardiovascular fitness. These payments would be available to hospital participants in 45 geographic areas that were not selected for the cardiac care bundled payment models as well as 45 geographic areas that were selected for the cardiac care bundled payment models. This test will cover the same five-year period as the cardiac care bundled payment models. Standard Medicare payments for cardiac rehabilitation services to all providers of these services for model beneficiaries would continue to be made directly to those providers throughout the model.
CMS proposes establishing a two-part cardiac rehabilitation incentive payment that would be paid retrospectively based on the total cardiac rehabilitation use of beneficiaries attributable to participant hospitals
The initial payment would be $25 per cardiac rehabilitation service for each of the first 11 services paid for by Medicare during the care period for a heart attack or bypass surgery
After 11 services are paid for by Medicare for a beneficiary, the payment would increase to $175 per service paid for by Medicare during the care period for a heart attack or bypass surgery
Based on Medicare coverage, the number of cardiac rehabilitation program sessions would be limited to a maximum of two one-hour sessions per day for up to 36 sessions for as many as to 36 weeks, with the option for an additional 36 sessions over an extended period of time if approved by the Medicare Administrative Contractor. Intensive cardiac rehabilitation program sessions would be limited to 72 one-hour sessions, up to six sessions per day, over a period of up to 18 weeks.
According to HHS, cardiac care should be a great target for cost containment. In 2014, more than 200,000 Medicare beneficiaries were hospitalized for heart attack treatment or underwent bypass surgery, costing Medicare over $6 billion. But the cost of treating patients for bypass surgery, hospitalization, and recovery varied by 50% across hospitals, and the share of heart attack patients readmitted to the hospital within 30 days varied by more than 50 percent. And, while harder to quantify, patient experience also varies.
Note: The chart below shows the first nationwide prevalence study of hip and knee arthroplasty shows 7.2 million Americans living with implants
Source: Mayo Clinic
While this proposal is geared toward hospitals, specialty providers should take notice for three reasons.
Since this rule was put into place by the Obama Administration, there is undoubtedly uncertainty with the Trump Administration as far as whether this rule will survive intact. One certainty is that cost in this sector must be controlled and specialty has tools to help.
Proposals such as these represent an opportunity for specialty. Since your business model is about helping patients improve outcomes, your unique position in the supply chain places you at the center of payer, provider, and manufacturer strategies
Because many of the patients you treat may have underlying chronic conditions, cardiac issues may be among those you have to combat and knowing how HHS plans to reimburse this particular disease state will be key for your profitability.
Gone are the days in which providers can operate in a fee-for-service reimbursement silo. Now providers must adapt to working with each other in order to demonstrate value and maintain network viability. If you are looking for assistance in realizing how your firm can capitalize on policy and marketplace changes either by lobbying and advocacy or by simply needing to know how to advance your priorities regardless of what is happening, contact us.
The uncertainty in health coverage continues to grow, so does the spotlight on mental health care. 1 in 5 Americans have a mental health disorder. Mental health conditions are the most expensive medical condition in the U.S., costing over $200 billion a year. Adding to the concern of mental health is its correlation with substance abuse.
The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that Americans with mental health disorders are twice as likely to report a substance abuse issue compared to the general population, with a total of 8.9 million Americans living with co-occurring disorders.
Depending on the person, mental health may pre-date the substance abuse or the other way around, making it imperative that each person seek specialized treatment to determine how both mental health and substance abuse affect one another.
There is no generalized prescription or plan of care that can be labeled as a “cure” for those who suffer with mental health and substance abuse. Each person’s methods of treatment and ongoing care is different. While one plan of care may lead to recovery for one person, it may worsen another’s condition. For instance, a psychiatrist treating a patient’s anxiety disorder may prescribe anti-anxiety medication. If the patient has been known to suffer from substance abuse or an addictive disorder, there is a risk of abusing the same drug prescribed for the anxiety which would only create further mental health and substance abuse issues.
The unique circumstances surrounding those with both mental health and substance abuse disorders requires comprehensive rehabilitation. The sad reality is that only 7.5% of Americans with co-occurring disorders obtain treatment.
For those that do seek treatment, some of the most effective methods to recovery are cognitive and behavioral therapy, dialectical behavior therapy, interpersonal and family therapy, prescription medication, and ongoing counseling and psychiatric care. These methods require a variety of professionals including but not limited to psychiatrists, counselors, general physicians, specialized physicians, nutritionists, and life coaches.
Treatment for the co-occurring issues can become complex and expensive. Currently the Affordable Care Act (ACA) requires most health insurances, including all of those sold on the Marketplace, to provide coverage for 10 essential benefits, including mental health and substance abuse disorders. In addition, it requires compliance with the Mental Health Parity and Addiction Equity Act (MHPAEA) where mental and substance abuse coverage cannot be more restrictive than medical and surgical coverage. Medicare and Medicaid also currently provide a variety of covered services for mental health and substance abuse disorders. While the ACA began a journey towards expansion of these services, the future of the ACA is unstable.
The passing of the American Health Care Act (AHCA) by the House has raised concerns regarding continued coverage. The AHCA would eliminate the federal requirement to cover the 10 essential benefits including mental health and substance abuse services and instead would refer to the states to make the determination of what is required in health care coverage. The AHCA would also cut $839 billion of funding to Medicaid over the next 10 years. These changes create concern over the future of treatment. However, nothing is finalized at this point. The AHCA still has hurdles to jump before becoming law. The AHCA will head to the Senate where any changes made will then send it back to the House and then back to the Senate before heading to the President.
The provisions in the AHCA, and/or any other health care legislation, will determine if and how Americans receive treatment. While the future is unclear we can assume the need for mental health and substance abuse treatment will continue as will the concern over coverage. Contact us today for more information.
Studies show that as much as 80% of healthcare data is going unused. However, with IBM Watson unstructured and underutilized data may be a thing of the past with the help of health analytics. Many companies have trouble finding the right consultants to help them with heath analytics.
The amount of healthcare data is astronomical and beyond the scope of what the human eye can read and decipher. In fact, the volume of healthcare data is estimated to be around 150 extrabytes. IBM puts it in perspective: If the data was placed on CDs the tower of discs would reach Mars.
Unlike humans, Watson can analyze data at a rate that makes the extraordinary amount of data manageable. In fact, Watson can read 200 million pages of text in only 3 seconds. The abilities of Watson is everchanging and continues to expand. Watson’s fluency in 9 languages allows the technology to extend borders and encourage collaboration between physicians.
Unlike other systems, Watson can compare patient data with medical research and compute words beyond simple data collecting and processing. Watson can take weeks of research and compile results in minutes, producing crucial patient treatment suggestions. In time-sensitive health matters, Watson can be a lifesaver.
Watson has already been making an impact in Oncology. Watson teamed up with Quest Diagnostics regarding cancer gene sequencing. Watson takes the information of the sequenced patient tumor provided by Quest Diagnostics and analyzes the data to identify mutations that may be treatable. Watson compares the DNA from healthy tissue with cancer cells to determine what treatment would be appropriate and what treatment should be avoided.
In addition, the New York genome center has teamed up with IBM to create a national cancer tumor database which would document how patients react to treatment. As of now it includes data from roughly 200 New York patients but hopes to grow in the near future. Gathering this type of data can lead to advances in how to properly fight cancer, especially for patients who have failed to respond to more conventional treatment.
IBM Watson has also tackled diabetes by joining the American Diabetes Association in designing apps that would aid in prevention and management of diabetes. The Medtronic and Watson app would help patients track and control their diabetes on a daily basis. The app can monitor nutrition and insulin levels to gather information in real time. This information can lead to additional discoveries in the correlation between lifestyle and diabetes as well as assist patients with being more aware of their diabetic condition.
Watson isn’t the final solution to fighting diseases but rather a valuable tool that can aid physicians and patients in choosing the appropriate treatment. It will also continue to evolve as information is added. For instance, when Watson analyzes information from specific genes and provides connections between that mutated gene and potential treatments, the physician can relay back to Watson what treatment did in fact work. This information is saved in Watson’s system and allows for a more accurate and comprehensive Watson analysis the next time a similar gene is sequenced.
Watson is expected to continue expanding and encompass other areas of healthcare by bringing crucial data and information to patients and doctors. Healthcare data will no longer be wasted or go unanalyzed but will fulfill a purpose of helping current and future patients obtain optimal treatment. Contact us today for more information regarding health analytics.
Mobile health is an emerging area where we hear about the increasing possibilities of reducing costs and achieving greater patient engagement. Right now, there are over 97,000 health and wellness mHealth apps, as the projected revenue for mHealth in 2017 is $26 billion. Additionally, 93% of physicians believe mHealth apps can improve patient health. However, with fitness apps, electronic health records and the of greater utilization of telemedicine, the question that many are asking is what is mobile health?
To date, there is no standardized definition of mobile health or mHealth as its generally referred to. Organizations like the World Health Organization (WHO) has previously referenced mHealth “as an area of electronic health and it is the provision of health services and information via mobile technologies such as mobile phones and Personal Digital Assistants,” while the NIH Consensus Group referred to mHealth as “the use of mobile and wireless devices to improve health outcomes, healthcare services and health research.”” Having no clear definition usually creates a wild west regulatory scheme.
Currently mobile health is overseen by three regulatory agencies:
FDA: The FDA’s position on mobile health is that is it “taking a tailored, risk-based approach that focuses on the small subset of mobile apps that meet the regulatory definition of ‘device’ and that: are intended to be used as an accessory to a regulated medical devices, or transform a mobile platform into a regulated medical device. For many mobile apps that meet the regulatory definition of a ‘device’ but pose minimal risk to patients and consumers, the FDA will exercise enforcement discretions and will not expect manufacturers to submit premarket review applications or to register and list their apps with the FDA. The FDA’s mobile medical apps policy does not regulate the sale or general consumer use of smartphones or tablets.”
FCC: “The Federal Communications Commission (FCC) regulates interstate and international communications by radio, television, wire, satellite and cable. The agency’s jurisdiction extends to non-Federal users of spectrum in the 50 states, the District of Columbia and U.S. possessions. The FCC manages Radio Frequency (RF) communications to ensure that RF devices operate efficiently and without interference. In the healthcare area, the FCC authorizes a wide variety of RF-based medical devices including both implanted devices and patient monitoring devices. It also authorizes carriers whose networks are used by a wide variety of mobile devices to access, store or transmit health information, and it establishes technical rules used by Wi-Fi and other similar networks.”
FTC: The Federal Trade Commission (FTC) protects consumers from fraudulent, unfair or deceptive acts or business practices. “The Federal Trade Commission has created a new web based tool for developers of health related mobile apps, which is designed to help the developers understand what federal laws and regulations might apply to their apps. The FTC developed the tool in conjunction with the Department of Health and Human Services’ Office of National Coordinator for Health Information Technology (ONC), Office for Civil Rights (OCR) and the Food and Drug Administration (FDA).
The guidance tool asks developers a series of high-level questions about the nature of their app, including about its function, the data it collects, and the services it provides to users. Based on the developer’s answers to those questions, the guidance will point the app developer toward detailed information about certain federal laws that might apply to the app. These include the FTC Act, the FTC’s Health Breach Notification Rule, the Health Insurance Portability and Accountability Act (HIPAA) and the Federal Food, Drug and Cosmetics Act (FD&C Act).
The guidance, which is maintained on the FTC’s website, links directly to each agency’s information about applicable laws. In addition, the FTC simultaneously released its own best practices guidance for compliance with the FTC Act, by building privacy and security into their apps.”
Where mHealth is concerned, it has focused on the claims companies have made about the effectiveness of their devices or apps. In late 2015 the FTC showed it becoming more aggressive in its oversight of mobile health that may cause confusion on who the lead regulator is in this field. The FTC settled with a California based app developer named Carrot Neurotechnology for $150,000. The company pledged that their Ultimeyes app improved visual acuity, but the FTC stated that the company’s “promoters did not have the scientific evidence to support their claims that the app could improve users’ vision. Health-related apps can offer benefits to consumers, but the FTC will not hesitate to act when health-related claims are not based on sound science.”
Why the FTC? This shows how there is a “wild west environment” that exists with no lead regulatory agency. There are many questions around why the FDA has remained silent. Some theories are that the FDA’s current regulatory structure has not caught up with a 21st century issue such as mobile health. Additionally, the FDA may not want to give the perception that it could stifle innovation. Whatever the case, we could get further clarity on who regulates mobile health with a new Administration.
On the legislative policy front Congress currently has a few bills on point.
S. 1101 titled the Medical Electronic Data Technology Enhancement for Consumers’ Health Act or the MEDTECH Act wants to exempt certain software that promotes healthy lifestyles from being classified as a medical device subject to FDA oversight.
H.R. 2396 titled the SOFTWARE Act sponsored by Congresswoman Blackburn (R-TN) is now part of the 21st Century CURES legislation. This bill seeks to define health software as software that does not acquire, process, or analyze data from an in vitro diagnostic device or signal acquisition system, is not an accessory or part of a medical device, is not used to prevent disease in the transfusion of blood and blood components. Health software is exempted from FDA oversight except for software that provides patient-specific recommendations and poses a significant risk to patient safety.
H.R. 5906 titled the Wi-Fi Capable Mobile Devices Act of 2016 directs the FCC to issue rules to ensure that providers of mobile broadband Internet access service supported through the Lifeline Assistance Program offer mobile devices that are capable of: (1) receiving Wi-Fi or other wireless broadband signals using unlicensed spectrum, and (2) sharing a mobile service connection with other compatible hardware or devices.
So, is mHealth something that specialty pharmacy can take advantage of? I believe so. First it would be best to be aware of some of the emerging mHealth technology to tell your patients as some approved products can have an immediate impact on their outcomes. For example, the Mount Sinai Health System in New York has launched an enterprise-wide platform for doctors to prescribe mobile health apps directly to patients. The platform called RxUniverse features a curated list of apps – pulled from the thousands of health apps available to consumers today – that have already been evaluated for their efficacy based on published literature. Israel-based medical device maker TytoCare has received FDA 510(k) clearance for its digital stethoscope, which pairs with a smartphone and allows users to examine the ears, throat, skin, heart, lungs and temperature. Data will be captured, stored and shared via a cloud-based telehealth platform with video conferencing. Examinations can be done in real time or in advance of a telehealth visit.
A second suggestion is to be aware of the continued emergence of telemedicine. Telemedicine is an area that has been grouped in with mobile health and has shown strong signs of momentum on both the state and federal level as policymakers recognize that telemedicine will help rural patients achieve greater access. Besides expanding the benefits of telemedicine to patients outside of rural areas and the eventual sorting out of licensure concerns, the only major roadblock that exists here is how are providers that engage in telemedicine going to be reimbursed?
Lastly, mobile health can help specialty pharmacies increase medication adherence. Per the Network for Excellence in Health Innovation, medication non-adherence costs our system $290 billion annually. We have seen patients today that are not only more tech savvy in that they own smartphones, tablets and other connected devices, but these patients are the more engaged than ever in trying to improve their own outcomes. By developing or utilizing apps, adherence tools or how to videos, you can help your patients achieve their personal goals but they key is to make sure that these digital resources are simple to use and provides the necessary incentives to keep your patients engaged long term. Contact us today for more information.
The biggest problem the United States healthcare system faces is preventable disease. We don’t have enough doctors, nurses, and health coaches to fix it. Yes, we have a doctor and nurse shortage. But the larger issue is that the treatment or prevention of these types of diseases requires significant behavior and lifestyle changes, which are achieved through extensive coaching, carefully timed intervention, and constant monitoring – all very hands-on, human activities. Even the best, most attentive healthcare providers simply can’t be there for a patient around the clock to catch every bad habit or reinforce every positive behavior.
Many make the argument that we need to increase federal funds and train more nurses, license more physicians, and/or deploy more health coaches. Yes, we need to do these things, but it’s not going to be enough, and increasingly people are becoming more comfortable interacting with machines than they are with humans. Traditional approaches, even if they are wildly successful, only ensure that more people get to see their doctor in a timely fashion. They don’t do anything to help doctors spend more time with each patient. It’s time to turn to technology to help us do what it does best – scale.
Artificial Intelligence (AI) has evolved to the point that it can significantly augment the work done by physicians, pharmacists, and health coaches. AI-powered technologies can fill in the gaps between appointments by reminding patients to take their medications according to their schedule, influencing and rewarding behavior change at exactly the right moment, and even intervening when something in the treatment plan is off. AI is capable of learning and growing with a patient too, so it can adapt and adjust based on the patient’s individual needs, schedule, and disease.
The preventable disease problem we’re facing in healthcare today can be solved by a deepening relationship between humans and AI.
If this sounds futuristic, it is… sort of. The technology already exists and is deployed in other arenas like finance and business intelligence. But in healthcare, there’s a human and psychological barrier – can we trust AI with our health? Our health data?
In a recent study conducted by Next IT Healthcare and Kaiser Permanente, researchers found that patients are increasingly comfortable with and trusting of AI-driven virtual health coaches. In fact, many patients who interacted with artificial intelligence-driven technology in a doctor’s office were inclined to disclose more information than they would otherwise tell their doctors.
What does this new human-to-machine bond make possible for our healthcare system? The implications for healthcare are profound.
Better data. When patients interact with a virtual health coach on their phone, desktop or tablet, human caregivers get new context that has heretofore been very difficult to obtain, particularly in real-time. Virtual health coaches are perhaps the best collection mechanism for data addressing patient medication questions, treatment plan adherence, and accessing how patients are feeling day to day. Consider what happens when we can correlate this data with other patient-generated data, like that from wearables, home monitors, scales, and environmental sensors.
Healthcare providers can use this data to better understand when to intervene, to predict and prevent relapses, and to create a custom treatment plan specific to a patient’s routine that also evolves with the patient. The value of high-fidelity and real-time patient generated data is immense and will be transformative.
System-wide cost benefits. 24/7 access to what is essentially a nurse-less hotline can reduce the burden on doctors and other care providers. They can ensure that when human interactions are needed, they are as impactful as possible.
Imagine a patient needs help understanding the side effects of a drug she is taking. A virtual health coach can walk a patient through the known side effects and identify if the patient is experiencing any of those effects. If she is, the virtual health coach can determine the severity of the side effects by asking a series of questions. The technology can then triage and rout the resulting information to a live healthcare provider, who can intervene immediately if needed, and help the patient determine if she needs a trip to the emergency room, or can treat the symptoms at home.
Early detection prevents potentially costly complications while patients would otherwise be waiting for an office visit. But the technology can also reduce the occurrence of unnecessary office visits. Whether there’s a problem or not, this technology can drive efficiency.
Personalized treatment. “Doctor’s orders,” treatment plans and standards of care are rooted in sound science and studies involving hundreds and thousands of subjects, but are rarely tailored to the individual – eat vegetables 3-4 times a day, exercise 3-5 days a week, take your pills twice a day for 2 weeks. Yet adherence to these kinds of recommendations is dismal because there is no guidance on how a patient can achieve those goals and why, particularly given their existing lifestyle and behaviors.
A virtual health assistant is able to spend more time with patients than even the best and most attentive healthcare providers, and using motivational interviewing it can collect valuable information and insights passively and proactively. It can therefore learn a patient’s preferences, habits, and routines, and adapt treatment plans to match.
For example, instead of prescribing a medication and saying a patient needs to take it twice a day, 12 hours apart with food, a virtual health coach can learn when you generally eat breakfast and dinner, and when you wake up and go to bed and help you determine a specific schedule that fits your lifestyle and improves the outcome.
Regulation & Policy Implications
The human benefits that virtual health assistants can bestow on the patient population are clear. But are there relevant policy issues that VHAs can help address too? First it should come as no surprise that the debate around healthcare has centered on its fiscal impact. For example:
According to the Centers for Disease Control and Prevention, the World Health Organization has estimated that by 2020 the number of Americans affected by at least one chronic condition requiring medication therapy will grow to 157 million. Additionally, the direct economic cost associated with non-adherence to medication is estimated at $100 billion to $289 billion.
Chronic diseases are responsible for 7 of 10 deaths each year, and treating people with chronic disease accounts for 86% of our nation’s healthcare costs.
From 2015-2025, health spending is projected to grow at an average rate of 5.8% per year and will grow 1.3 percentage points faster than the Gross Domestic Product per year over this period.
Only recently have policymakers begun to examine the benefits of how integrating healthcare professional services can create an improved outlook on cost containment and patient outcomes.
Prior to the enactment of the Affordable Care Act (ACA), patients would receive siloed treatment as there would be no coordination of care for a patient that transitioned from acute to post-acute care settings. It is during this vital time that patient questions go unanswered and the risk of non-adherence rises thus driving up healthcare cost. However; to tackle this problem, the ACA has created alternative payment models such as bundled payments that are forcing providers to share more risks in an effort to receive a greater piece of now “shared” reimbursement. Now providers must work together to demonstrate how they have affected a patient’s positive outcome and thus created value for the healthcare system. The best way to do this is through data sharing. That is one area where virtual health coaches have the greatest opportunity.
The origins of data sharing as a way to tame healthcare spending can be seen through the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The law’s enactment in 2009 along with the solidification of the importance of electronic health records in the ACA, set the stage for physicians and hospital providers to receive a reimbursement incentive from the Centers for Medicare and Medicaid Services (CMS) for those who are successful in becoming “meaningful users” of electronic health records. If providers have not found a way to do this by 2015, they would soon find themselves subjected to penalties under Medicare.
As providers continue to struggle with how to implement electronic health records into their practices, perhaps they are overlooking the simplicity of AI-powered solutions. More than ever consumers are becoming more involved with maintaining a healthy lifestyle using technology such as fitness apps and telehealth. Interestingly, about 35% of U.S. adults say they have used the Internet to figure out what medical condition they or someone else might have, demonstrating a need for on-demand convenience. Utilizing a virtual health coach can not only give healthcare providers a better look into what works for a patient, but also satisfies policymaker goals. First, healthcare costs can be reduced since a virtual health coach serves as another powerful tool a provider can use in monitoring a patient; records created by the VHA could be shown by the provider community that they are meeting the “meaningful use” requirements set the by HITECH Act, and by putting patients in control of their own outcomes by utilizing a tool that can adapt to their lifestyle would more likely than not create a potent recipe for cost containment success.
Integrating AI into everyday chronic disease management has the potential to solve some of the most burdensome problems facing the U.S. healthcare system. AI-powered solutions improve engagement with patients, earn their trust in the process, and offer a comprehensive holistic one-stop-shop ecosystem from which the patient can manage their health, something the previous generation of health technologies could not accomplish. The human-to-machine bond makes it possible for this new generation of technologies to directly address rising costs while improving quality of life and patient outcomes.
Though we’re still in the early stages, and we certainly don’t have all of the answers, we need to pursue this area of innovation with urgency. Imagine a healthcare system aided by artificial intelligence that is a trusted partner in a patient’s lifelong healthcare journey.
That day, we believe, is just around the corner. Contact us for more information.
