Tag: Health iT
ClearData, IBM, PureStorage and others are positioning themselves for an environment where providers rely on a mix of public and private secure clouds for their data.
Recent announcements from three major healthcare cloud vendors offer an interesting perspective on where the technology is trending.
ClearDATA, which focuses on security in the healthcare cloud, scooped up $26 million this week in a new round of financing to help it innovate its products and fuel growth. The funding comes from a diverse group of strategic investors, including Humana and Health Care Service Corporation, and points to a confidence in and reliance on secure health data – even as the cloud environment grows in complexity – that would have been hard to imagine in healthcare even a few years ago.
That same day, Pure Storage, the flash storage vendor, launched its new Cloud Data Services, a suite of new tools to run on Amazon Web Services, that enable healthcare customers and others to leverage a single architecture to unifies application deployments, on-premises and on the cloud, for their analytics, AI and machine learning needs.
Meanwhile, a new report in ZDNet points to further evolution in the market as the types of cloud hosting available to healthcare continues to shift and expand. Specifically, it examines IBM, which looks to be positioning itself to help the many organizations who depend on multiple clouds – some 90 percent of them, according to one report. Adding to the complexity, thost clouds often run in a complex mix of environments: public, private, firewalled, etc.
WHY IT MATTERS
As cloud options have multiplied so too have the uses healthcare systems have had to adapt the technology for. So-called hybrid clouds incorporate a mix of public and private clouds, both on- and off-site.
Multi-cloud use is getting to be the norm and now large players are getting involved. Consider IBM, with a long history of helping manage complex IT systems, is positioning itself not just as a cloud provider but as a way to “clean up the mess” of the modern hybrid cloud world, according to ZDNet.
ClearDATA has recently been broadening its business model to focus multi-cloud solutions, it notes in its new funding release, working to better integrate healthcare organizations with the mix of cloud options while at the same time ensuring security and compliance.
Pure Storage, for its part, touts a single storage architecture that unifies application deployments, enabling health systems to run multiple clouds while avoiding some of the infrastructure problems that arise between industrial enterprise systems and more user-friendly clouds.
THE LARGER TREND
Successful healthcare organizations scale and deliver improved outcomes by leveraging advances in data sharing and interoperability, as ClearDATA claims. But it’s reality that health systems rely on multiple different clouds, and that variety necessarily muddies the waters for a streamlined experience across all of them.
While cloud-based solutions are more user-friendly, more secure and more in-demand by consumers, they don’t always provide the enterprise-level assurances and security that providers need. Pure Storage notes that “organizations are too often forced to choose between on-premises or cloud,” while in reality a better option is a hybrid approach with both onsite and cloud applications where necessary.
Not surprisingly, there is no single solution to hosting apps, accessing data and sharing services. Different clouds exist for different use cases. Most healthcare systems probably depend on a few different cloud solutions, so finding a way to integrate the data to make it more valuable while protecting its security are big musts.
IBM is positioning itself as a solution to that headache, while ClearDATA and Pure Storage are both working in the hybrid cloud space as well to help healthcare providers make their data more valuable, accessible, and safe.
ON THE RECORD
“Today, there exists a cloud divide – the cloud is not purpose-built for enterprise applications, and enterprise infrastructure isn’t as user-friendly as the cloud,” said Pure Storage CEO Charles Giancarlo, in a statement. “Customers should be able to make infrastructure choices based on what’s best for their environment, not constrained by what the technology can do or where it lives.”
Meanwhile, Humana CIO Brian LeClaire explained that the insurer, in partnering with ClearData to advance its integrated care delivery model, is more and more using the “computing and analytic power and scalability of the public cloud to accelerate our ability to deliver better outcomes and experiences to our members and providers.”
The number of reported data breaches in 2018 is at a consistent pace with this same time period in 2017, according to new research from Risk Based Security, but there’s a catch: mega-breaches and hacking persist as top cybersecurity concerns across all industries.
WHY IT MATTERS
So far there have been 3,676 publicly disclosed data breaches across all industries exposing approximately 3.6 billion records.
Seven of the breaches through the third quarter of this year exposed 100 million or more records, with the 10 largest accounting for 84.5 percent of the records exposed, the report said.
Hacking continues to be the leading cause of data breaches, accounting for 57.1 percent and fraud was the cause of the most records being exposed, accounting for 35.7 percent.
THE BIGGER TREND
“Despite the decrease from 2017, the overall trend continues to be more breaches and more ‘mega breaches’ impacting tens of millions, if not hundreds of millions, of records at once,” said Inga Goddijn, executive vice president for Risk Based Security.
Threats continue. For example, a new Symantec report found that the notorious, highly targeted SamSam ransomware virus is primarily hitting the U.S. – especially the healthcare sector, where hackers may believe organizations are more likely to pay. SamSam breaks into networks and encrypts multiple computers across an organization. The clean-up costs can run in the double digit millions, according to Symantec.
While healthcare organizations are better at understanding and investing in cybersecurity needs, hackers are keeping pace — and then some, according to a panel of CISOs at the HIMSS Healthcare Security Forum in Boston late last month. When asked to rank the cybersecurity posture of the healthcare sector, four healthcare infosec leaders found that while the industry has improved, there’s still a long way to go.
Anahi Santiago, chief information security offier of Christiana Care Health System, said larger organizations are much more secure — but small to mid-size hospitals are struggling.
In the next five years, healthcare will be the biggest target, information security experts say, and hackers will be able to quantify how they can monetize the data. As the use of healthcare data matures, the hackers will keep pace. In the end, healthcare will only be successful when infosec leaders have a seat at the table when it comes to strategy,
ON THE RECORD
“The number of reported breaches shows some improvement compared to 2017 and the number of records exposed has dropped dramatically,” said Inga Goddijn, executive vice president for Risk Based Security. “However, an improvement from 2017 is only part of the story, since 2018 is on track to have the second most reported breaches and the third most records exposed since 2005.
- New business models are disrupting medical care, putting pressure on companies to rethink their strategies or risk being left behind, according to a new PwC Health Research Institute report.
- HRI points to four new archetypes of deals that are transforming healthcare economics and how patient get care: vertical integrators, employer activists, technology invaders and health retailers.
- Retail clinics have a particular strength, with their convenience and knowledge of consumer behavior. With features like online scheduling and bill paying and digital product support, they can draw patients away from traditional providers provided the price is right. About a fifth of consumers surveyed had visited a retail clinic in the past several years, according to the report.
The research comes as the CVS-Aetna vertical integration deal is poised to close by Thanksgiving. The two companies have trumpeted the merger as a cost saver by using CVS pharmacies and Minute Clinics to better serve Aetna’s members. According to HRI, 19% of consumers have little or no idea what a prescription will cost when they pick it up at the pharmacy, and only about a fourth believe their insurance company is doing enough to keep drugs affordable.
Other vertical integrators include UnitedHealth Group’s Optum and DaVita Medical Group and Cigna’s $67 billion bid for Express Scripts.
Cost is a big factor driving people to health retailers, along with convenient hours and shorter wait times. More than half of respondents said they would go to a clinic in a retail store or pharmacy to have stitches or staples removed or a wound treated if doing so would save them money.
As more healthcare services move to the retail space, payment models such as reward points or subscription services will follow. Companies can attract consumers to clinics and keep them coming back by offering incentives or subscription-type services. Among consumers who were surveyed, 85% said they would be very or somewhat likely to use a service that helped them to finance large medical expenses.
Amazon, J.P. Morgan Chase and Berkshire Hathaway exemplify the employer activist model, with their joint company to manage the healthcare needs of a combined 1.2 million U.S. employees. But while these companies have the technology and capital to redesign how care is purchased and delivered, price negotiations could be a challenge as employees are spread throughout the country, the report says.
Tech giants — including Google, Apple, Amazon, Uber and Lyft — are also vying for a piece of the healthcare pie. According to the report, 61% of consumers are open to using a digital tool that brings all their health information together in one place, and 47% are comfortable with a virtual visit offered by a telehealth vendor.
To succeed, tech companies should consider partnering with established healthcare companies that know the industry and what patients need, the report adds.
Athenahealth has agreed to be acquired by a Veritas Capital and Evergreen Coast Capital affiliate for $5.7 billion, the companies announced Monday morning.
Athenahealth will continue to be its own brand, but Veritas and Evergreen will merge it with Virence Health, the analytics and software firm formerly known as the Value-Based Care Solutions Group, which GE Healthcare acquired earlier in 2018.
Virence Chairman and CEO Bob Segert will lead the newly combined company.
“Combining with Virence will create new opportunities for collaboration and growth,” Athenahealth Executive Chairman Jeff Immelt said in a statement.
Athenahealth has been facing takeover attempts since at least 2017, when Elliott Management first tried to buy the company. Elliott Management supports the Veritas-Evergreen acquisition. The transaction “represents an outstanding, value-maximizing outcome for Athenahealth shareholders,” Elliott partner Jesse Cohn said in a statement.
Athenahealth will hold an earnings call later Monday. In a third-quarter earnings report released Friday, the company reported it booked less business compared to the same period of 2017. Revenue for the quarter was $329.5 million, according to the company’s new accounting standards, and $331.4 million according to the old standards, up 9% over the year-before quarter.
Athenahealth’s stock was up nearly 10% between market close on Friday and the middle of the trading day Monday.
- From large hospitals to small clinics, providers are pursuing different functionalities in the secure communications they purchase, and the industry is responding to those demands. But wide variation exists in what vendors are currently offering to meet various needs, a new KLAS Research report finds.
- Acute care organizations tend to want broad communication platforms that facilitate communication enterprise-wide, while ambulatory facilities more often opt for HIPAA-compliant messaging.
- After functionality, cost is the most important factor behind lost sales. Vendors that offer enterprise pricing, such as Cerner and Epic, are more likely to clinch new deals, since customers know what they will get for the price and don’t feel they’re being nickle-and-dimed, according to KLAS.
KLAS surveyed 100 acute care, ambulatory and post-acute care organizations to see which vendors they considered, what drove their decisions and how they rated the vendors they chose. As EHRs become ubiquitous in healthcare, such questions will shape how the sector evolves.
When it comes to consideration, retention and performance, Epic, Voalte and TigerConnect all do well. Epic’s broad EHR market imprint, enterprise pricing and reputation for quality products and services makes it a dependable choice for many acute care organizations, KLAS says. Customers also appear confident the product will improve over time.
Voalte’s broad communication platform is also viewed as above average in meeting acute care facilities’ needs. Secure messaging vendor TigerConnect, formerly TigerText, has wide name recognition as a cross-industry vendor, but less scores due to immaturity of its broader platform.
The top two reasons organizations consider and settle on one vendor over another are product functionality and having a standing relationship with the company. Voalte and Vocera rank highly here because both have communication platforms offering a range of functionalities, such as VoIP, alarm routing, nurse call tools, mass notifications and labs, according to the report.
EHR integration is the next most important factor, and Epic and Cerner both score marks here, though their platforms are less optimal than some others, according to the authors.
Organizations are also looking for vendors that offer continued development of their platforms. Spok and Imprivata have lost potential customers because they have been slow to develop new functionalities and improve integration, the report says.
The report points to possible disrupters in the mix as well. A good share of acute care hospitals that consider Telmediq and PatientSafe Solutions are choosing to go with the vendors, citing high quality and confidence the companies can deliver on communication platform needs. Providers are drawn to Telmediq’s robust physician scheduling and PatientSafe Solutions’ BPOC and nurse documentation. Moreover, both companies offer enterprise pricing.
However, it remains to be seen whether these vendors can scale up to meet growing demand, KLAS says.
Alternative payment models have been en vogue in American healthcare for some time now. Payers and providers are increasingly being asked to take on greater financial risk instead of shared savings alone.
The latest data out this week shows that 34% of total U.S. healthcare payments were tied to APMs in 2017, up 12% from two years ago as value-based care marches onward.
But the road to new payment models is rife with many hurdles, experts say.
Though many groups feel ready to join the movement, some aren’t comfortable taking on more financial downside. Evolent Health CEO Frank Williams reiterated earlier this year that switching to alternative payment models can be tricky due to risk alone.
“You can lose a lot of money quickly, so in larger risk arrangements or full health plans, you could lose $20 to $30 million a year,” he told Healthcare Dive. “For an organization that’s been relatively stable, those are pretty daunting numbers and they’re scary for health systems’ boards and physician groups that don’t have a lot of capital.”
CMS is thinking about forcing the healthcare industry’s hand. In August, the agency proposed an overhaul of the Medicare Shared Savings Program (MSSP) that would require participating accountable care organizations to take on financial risk more quickly.
But the 82% of Medicare ACOs currently in the upside-only MSSP track (shared savings alone) — or any other organizations stressed about assuming risk — can make it work, a group of high-level experts said this week.
A panel this week at the Health Care Payment Learning and Action Network (LAN) 2018 Summit focused on provider strategies for thriving in risk-sharing payment models. Here are five takeaways from Monday’s event to stack the odds that providers stay in the black while taking a gamble with downside risk.
1. Invest in data and technology.
Heritage Provider Network is one of the largest physician-led value-based care organizations in the country. It has grown largely due to its founder and CEO Richard Merkin, who has helped expand the integrated delivery system to more than 50 related healthcare companies over four decades.
One important facet of the group’s sustained success, according to Merkin, is that Heritage has invested in leveraging technology such as data analytics that connects physicians with each other and with the patient.
Along with a traditional slew of enterprise-level products, HPN uses EZ-CAP, a HIPAA-approved, scalable management system with an accessible web portal for participating medical practices and NextGen Health Information Systems, a comprehensive and open EHR that includes electronic prescribing.
HPM also uses the q Suite of products, seven systems that help doctors profile and stratify patients to provide preventive care, allocate resources and individualize care plans, according to its website.
The group is particularly bullish on such algorithms.
In 2013, Merkin and the HPN shelled out $3 million to the winners of the Heritage Health Prize, a worldwide predictive modeling contest. Entrants were challenged to create an algorithm that could predict how many days a patient would spend in a hospital with the goal of cutting down on unnecessary hospitalizations.
The company now employs close to 50 computer scientists and software engineers seeking to eliminate a lot of the common administrative burdens faced by provider networks.
“Make it as simple as possible,” Merkin said, and share the computer systems. HPM sometimes licenses (and sometimes gives away) its technology to new groups taking on full risk to help them shoulder the load.
2. Don’t rely on the status quo.
As CMS has proved in recent weeks, provider groups can’t trust that regulations and laws will stay the same.
“Over time, regulations change,” Merkin said at the panel, noting administrative burden as one example. “You have to adjust. If you embrace the status quo, you’re dead.”
Richard Snyder, senior VP and chief medical officer of Independence Blue Cross, agreed. Snyder focuses on speeding the switch to patient-centered care through patient-centered medical homes, the Comprehensive Primary Care Plus program and a facilitated health network approach to value-based care delivery in Pennsylvania.
The state used to be risk-averse because “they lived through the 80s,” Snyder said, where “some systems went bankrupt or virtually bankrupt.”
Although healthcare organizations in Pennsylvania may be recalcitrant, Snyder believes in starting them off with low downside risk and increasing it year by year.
‘There’s a tremendous amount of inertia in the system and you’ve got to convince people that change is the new norm,” Snyder said.
3. Recruit the best people you can — especially at the top.
Along with a strong data infrastructure, it’s important that a network relying on an APM have a culture that’s not afraid of change. That starts with its people.
“There is no substitute” for this strategy, according to Merkin, who has grown HPM to about 5,000 team members over 40 years.
This is most important at the top of the food chain, Snyder added. “Culture needs to start from the top down” as someone needs to be accountable for making the decision to move forward with APM adoption, he said.
“Certainly you have to have leadership at the top” that’s bullish on value-based care, agreed David Buchanan, a primary care physician and executive medical director for Oak Street Health. The primary care collaborative has 42 centers across five states, managing the health of about 50,000 Medicare patients.
4. Solidify your vision and support it with value-based infrastructure.
But what to do if your company wasn’t founded with that clear purpose in mind?
Oak Street supplies free transportation to and from visits to help low-income seniors. They have behavioral health specialists on site, nurse practitioners who do house calls, employees who go to hospitals to assist site-of-care transitions, longer visits and scribes sitting in on appointments so doctors can focus all their attention on the patient.
Oak Street’s financial model has caught up with its invested care model and it’s sustainable, Buchanan said.
Organizations can’t be afraid of hard work, cautioned Merkin, who brought up the example of working on the weekends. Those two days are 29% of the week so “if you work hard on the weekends, you can lower your costs by 29%.”
Assuming risk forces people to think systematically about care delivery, said Snyder, who ended up in the Blues system after it bought his HMO. For about a decade it had an upside risk only program for hospitals, which meant no one was worrying about cost.
Now, Independence Blue Cross contracts with a number of providers by bringing their unit cost down and giving them an opportunity to earn those dollars back if they take on downside risk, Snyder said.
He believes it’s successful by engaging with the providers to look at their costs over time and set reasonable targets, sharing the payer’s actionable data with participating health systems and receiving patient data in return and collaborating across the board.
5. Community engagement is key.
The last suggestion is bringing the community into care to foster good relations with patients.
HPN will sometimes vertically integrate in communities if it doesn’t have a surgery center, urgent care facilities or hospice, for example. But if it does, Northridge, California-based HPN always outsources to local businesses, Merkin said.
Chicago-based Oak Street Health has community rooms in its centers open to anyone, not just members. Occasionally, it hosts bingo games, which are “probably the most popular thing” that happens at Oak Street, Buchanan said.
The community rooms and the events there build a greater sense of trust in the care team and the staff, along with a sense of community and purpose for sick patients. They’re a “positive spiral that connects all these pieces together,” Buchanan said.
And they boast results. Although it’s hard to separate what Buchanan called the “bingo effect” from the rest of Oak Street’s services, the primary care group has reduced hospitalizations by roughly 45% for all of its patients compared to the average for risk-adjusted Medicare recipients.
Taking on more risk is daunting, but it’s not a death knell. It can be a business opportunity, especially for primary care practices that are on the bottom of the food chain.
“If you’re starting from where you are now, what do you have to lose?” Buchanan said, noting that Oak Street doesn’t usually put the PCPs themselves under the yoke of downside risk and if there are problems it will work with them to find solutions.
HPN’s model is paid for by comprehensive prospective payment, wherein health plans share the risk with their provider network. “We don’t believe that you can put a PCP at risk,” Merkin said. Each group is accountable for what it can manage.