Ensuring that a conference discussing health did indeed practice what it preached, day two of this year’s Health Datapalooza got off to an early start with a Stride Health-sponsored 3 and 5 mile fun run. Back at the conference venue, the day’s content began on the main stage with Dr. Mark McClellan, Director of the Duke Margolis Center for Health Policy and Former Administrator at the Centers for Medicare and Medicaid Services (CMS). Mark’s opening comments characterized the politics of healthcare as one of consistent bipartisan stories, since healthcare spending has historically been prioritized over much of everything else. To put that into perspective, the healthcare budget for CMS this year is on the order of $1T. The national defense and homeland security budgets together represent approximately $600B. However, while healthcare spending has remained stable, education, social service, and infrastructure programs have shrunk over time. It was always assumed that health outcomes improved when progress in medical care occurred. However, as Mark showed, the US is becoming an outlier as health outcomes have leveled off and sometimes decreased in certain sub-groups of the population. Mark argues that while progress has been made on coverage, that alone is not enough. Some of the programs being shrunk in favor of the healthcare budget could in fact be more effective at moving the needle for many struggling sub-groups of the overall population.
Following the opening session, attendees jumped right into a set of back-to-back breakout sessions. The topics of these sessions ranged from leveraging digital health tools to benefit underserved communities, to transforming care delivery. One breakout session titled “Using Advanced Analytics and Interactive Visualization in Value Based Payment Reform” covered work by a team at the New York State Department of Health developing an analytics platform to measure the results and track the pulse of care being provided in the state.
The session was moderated by Greg Allen, Director at the New York State Department of Health, whose team, also speaking on the panel, included Marc Berg, Principal Advisory at KPMG, Jeff Wendth, VP at CMA Consulting, and John Amisano, Principal Consultant at Salient. Part of the impetus behind the project was the weak performance of the state on avoidable hospital use and cost and in most metrics related to good care coordination. For example, New York was listed dead last at #50 on the Commonwealth Score Card. As a result, the state set the goal to reduce avoidable hospitalizations (emergency department and inpatient visits) by 25% over 5 years through the multi-pronged Delivery System Reform Incentive Payment (DSRIP) program. The program used pay-for-performance incentives to encourage providers to form networks of Performing Provider Systems (PPSs) who would collaborate towards achieving improved care coordination goals while capturing and reporting on a number of different data points throughout the process. To support DSRIP, the project team developed Performance Dashboards which provided meaningful analytics to both the state and to providers. The goal was to create a platform that was not just documentary but directional, interpretive, easily consumable, and actionable to providers tracking towards performance benchmarks and stretch goals tied to pay-for-performance equations that determine a provider’s bonus. A couple use cases highlighted involved diving into performance metrics to identify which provides are driving cost and comparing the value of care across all state payers and providers.
Another session on “Consumer Technology Ecosystems” brought together panelists to talk about the role of consumer technologies, such as mobile health platforms, in achieving better consumer satisfaction, engagement, and integration with their care. Margo Edmunds from AcademyHealth moderated the panel. First to speak was Erin Mackay, Associate Director of Health Information Technology programs at the National Partnership for Women & Families. Erin spoke about GetMyHealthData, an initiative to make it easier for consumers to have access to their electronic medical records and other health data. The most recent iteration of the initiative expanded to also support providers in redesigning their information sharing processes. Erin shared a number of examples highlighting the effort required to access one’s records which today can reside in various, unintegrated patient portals, profiles, and physical records. While new ways of transmitting information, such as email, are allowed under Meaningful Use, many providers are still not taking advantage of easier ways to provide patients with their medical information. Second, Chris Fierer, Director of Innovation at Medfusion, spoke about his company’s patient experience platform built on top of a data network centered around the patient. Echoing a mantra from earlier in the conference, Chris stressed the point that consumer technologies in health should not be built with the expectation that patients will come to them, but should rather aim to meet patients where they are already. To that end, Chris believes that opportunities for these types of experiences take place when solutions bring together data, including medical, financial, and other sources of information, workflow of the target user, and context that makes the information collected meaningful. Next, Gillian Christie, Health Innovation Manager at Vitality, spoke about a set of guidelines for personalized health technology outlined in Vitality’s Guidelines for Personalized Health Technology Final Report published in March 2016. The five guidelines are:
- Build health technologies informed by science
- Scale affordable health technologies
- Guide interpretation of health data
- Protect and secure health data
- Govern the responsible use of health technology and data
Last up was Valerie Monet, Health Insurance Practice Leader at J.D. Power, who shared a wide range of data giving evidence to the fact that while consumer technologies designed to engage patients still have a long way to go in terms of adoption, those that are in use can have a significant impact on patient satisfaction and access to care. J.D. Power’s data showed that the satisfaction scores of patients who accessed their health plan through a website were significantly higher than patients who did not. Importantly, the improvement in satisfaction, or difference in the two scores, was even higher when patients accessed their health plan through a mobile app. Mobile apps also resulted in a higher percentage of patients understanding how to receive preventative services and knowing their health plan offers prescription drug adherence programs, behavioral health or stress management programs, and health assessment or risk screenings compared to patients who had no mobile app contact. Finally, while there is only a slight improvement in a patient’s perception of their overall health when engaging through a mobile app (56% vs. 48%), use of a mobile app does significantly increase the percentage of patients engaging in at least one health management activity (92% vs. 62%).
After the breakout sessions, attendees reconvened for the lunch presentations kicked off by Dr. Patrick Conway, Director and Deputy Administrator for Innovation and Quality at CMS. Following Patrick’s opening remarks, Colin Hill, Chairman and CEO of GNS Healthcare led an Innovation Showcase beginning with David Vinson, Founder and Chairman of Xcertia. David spoke about Xcertia, a collaboration between the AHA, AMA, DHX, and HIMSS, to create a comprehensive set of requirements and recommendations for the development, selection, and usage of mobile health apps. The guidelines provided by Xcertia, still in creation, will broadly touch on five areas: content, usability, privacy, security, and operability.
Following David were co-presenters from the Office of the National Coordinator for Health Information Technology (ONCHIT) Steve Posnack, Director of the Office of Standards and Technology, and Adam Culbertson, HIMSS Innovator in Residence, to talk about the Patient Matching Algorithm Challenge. While the typical data matching process includes data pre-processing, indexing, comparison, and classification, there is currently a gap in what should be the fifth step in the process: evaluation. There is no set of criteria today to evaluate patient matching algorithms. This is what the Patient Matching Algorithm Challenge is asking the data community to solve. The competition will be launching in early June with more information to come at HealthIT.gov.
The latter half of the Innovation Showcase included presentations from Umer Mujeeb, Director of Software Engineering at Softheon, Kim Klupenger, Chief Experience Officer, and Laurie Coleman, Business Development Executive, from OCHIN, and Dr. Jason Gerson, Senior Program Officer at PCORI. Kim and Laurie shared OCHIN’s latest product Acuere, a medical data aggregation tool differentiated by its ability to provide real-time data generated through seamless integration with existing record systems and accessed through easy-to-use reporting tools backed by dedicated consulting and support personnel. Features of the tool include provider report cards, care gap reporting, patient risk stratification, and cost of care analysis taking into account patient risk scores. Jason spoke about PCORI’s Open Science Initiatives wherein PCORI-funded studies and findings are already made publicly available through PCORI’s website and other resources such as ClinicalTrials.gov. PCORI’s next step is to make the underlying data and data documentation of these studies available as well. At this point, PCORI has created a Draft Policy on Data Access and Data Sharing to soon be followed by a Data Sharing Pilot Project.
Dr. Katherine Hempstead, Senior Adviser to the Executive Vice President of the Robert Wood Johnson Foundation (RWJF), took the stage next with two announcements. The first was a new RWJF call for proposals: Health Data for Action. With a goal to generate actionable insight from “hard-to-access” health data, RWJF is bringing together two partners in the Health Care Cost Institute and athenahealth who will be making their data available to successful applicants at no cost. Three to five successful applicants will receive $150,000 to complete 12 month projects utilizing this data; applications are due May 24. The second announcement was the release of a new dataset: HIX Compare. The dataset, developed by Vericred with support form RWJF, is a 50-date health insurance database of every individual and small group marketplace plan offered from 2014 to 2017. While there are some gaps, Katherine believes that the database and its documentation is now at a point where the public can begin to take advantage of the potential insights the dataset can provide.
Joining by videoconference, Founder and Chairman of Leavitt Partners, Former Governor of Utah, and Former Secretary of HHS Michael Leavitt gave his observations regarding transitions and transformations in healthcare today with questions prompted by President and CEO of Leavitt Partners and Former Chief of Staff of HHS Rich McKeown. Former Governor Leavitt called the current activity in DC a “grand negotiation” that is an iteration in the 40 year transition towards value-based, which he believes will ultimately keep the healthcare system in the US sustainable. One of the challenges the former governor highlighted is that the payers and the government are moving more quickly to a new model than providers are willing or ready to go. He elaborated how this is the same challenge that occurred during the shift from paper to electronic medical records (EMRs) and that many of the same mistakes are again being made with the lack of standard definitions and competencies which initially plagued EMRs. Ending with a charge, Former Governor Leavitt claimed that every US generation faces a major challenge that they must overcome and that healthcare is that challenge for the current generation which, in the former governor’s opinion, can be solved.
After a short update on the modernization of the Department of Veterans Affairs by the current Secretary, The Honorable David J. Shulkin, Bob Kocher, Partner at Venrock, moderated the last main stage session of the event on “How Data Drives Business Transformations”. Panelists for this final session included Len D’Avoilio, CEO and Co-founder of Cyft, Tim Kelsey, Chief Executive of the Australian Digital Health Agency, and Donald Trigg, President of Cerner Health Ventures.
Len believes that data is creating an environment where personalization of healthcare is possible and where doctors can have a better understanding of which of their patients are the sickest and need to be prioritized for care and support. That kind of specificity is something Len has seen in other industries but which is only now possible in healthcare. Donald also pointed to other industries, commenting that indicators of disruption in other sectors such as increased levels of choice and decreased levels of cost are now being seen in healthcare and should ultimately converge in an appetite for patients to take advantage of data and make it part of their strategy around care.
Tim brought an interesting perspective to the conversation, given than in Australia use of personal health records to access medical information from a smartphone is a centerpiece of healthcare policy. One program that Tim is part of to make this a reality in Australia is My Health Record, which already has over 5 million patients signed up. My Health Record gives patients complete control over their medical information, even going as far as to allow patients to prevent a doctor from accessing a specific part of their medical record. This represents a level of buy-in, access, and control that the US is still working to achieve.
One final series of breakout sessions covering topics from integrated data systems for population health to international technology ecosystems closed yet another successful Health Datapalooza. With a great range of content around healthcare data access, usage, and security, attendees will be sure to continue internalizing many of the innovative ideas and opportunities shared at this year’s event for days to come. The challenges and competitions announced over the two days of the event provide avenues to dig even deeper into some of the more poignant topics discussed. We look forward to seeing what comes out of these opportunities and will be on the lookout for any news and updates until next year’s Health Datapalooza.