healthcarereimagined

The amount averages about $1 billion a year, less than the projected $16 billion for the Cerner platform — which Congressional members say doesn’t encompass the whole price tag.

By Jessica Davis

The blockchain revolution has made its way to the healthcare industry, and it’s only the beginning of what’s possible. Healthcare Rallies for Blockchain, a study from IBM, found that 16% of surveyed healthcare executives had solid plans to implement a commercial blockchain solution this year, while 56% expected to by 2020. Healthcare companies, tech innovators and the rest of the healthcare industry are grappling with what’s possible now and what blockchain could solve in the future.

The overall vision for blockchain to disrupt healthcare in the future would be to solve many issues that plague the industry today to create a common database of health information that doctors and providers could access no matter what electronic medical system they used, higher security and privacy, less admin time for doctors so there’s more time to spend on patient care, and even better sharing of research results to facilitate new drug and treatment therapies for disease.

What is blockchain?

While blockchain principles were first applied in the financial world as the technology that allowed Bitcoin to operate, it has applications for many industries including healthcare. Blockchains are distributed systems that log transaction records on linked blocks and store them on an encrypted digital ledger. There is no one central administrator, but it has unprecedented security benefits because records are spread across a network of replicated databases that are always in sync. Users can only update the block they have access to, and those updates get replicated across the network. All entries are time and date stamped.

What are potential uses of blockchains in healthcare?

Although there are some incredibly exciting ways blockchains can enhance healthcare operations, it won’t be a cure-all for the industry today, but it would certainly be a step in the right direction. The healthcare industry is drowning in data—clinical trials, patient medical records, complex billing, medical research and more. Adoption and implementation of blockchains will be an evolution over time as blockchains applications are vetted and adopted as well as the industry coming together to determine collaboration and governance issues. As it always is with new technology, the full possibilities of what may transpire in the future is unknown at this time. However, as quoted in a Wired article, “Now is probably the right time in our history to take a fresh approach to data sharing in health care,” says John Halamka, chief information officer at Boston-based Beth Israel Deaconess Medical Center.

Here are the most likely applications:

Medical Data Management

MedRec, one prototype using blockchains, is intended to improve electronical medical records and allow patients’ records to be accessed securely by any provider who needs it solving the waste of time, money and duplication in procedures, confusion and sometimes even life-threatening issue of records being distributed across many different facilities and providers. The goal with MedRec is to give patients and their providers one-stop access to their entire medical history across all providers they have ever seen. Additionally, if patients wish to grant access to their personal medical records to researchers, their data would be provided anonymously to be used in research which could make medical breakthroughs possible faster than they are now. This pioneer in the field shows the potential for how dramatically things could change in healthcare by deploying blockchains.

Drug Development and Supply Chain Integrity

Not only could blockchains facilitate new drug development by making patient results more widely accessible (if the patients give their permission), it could help reduce the counterfeit drug implications that currently cost pharmaceutical companies an estimated $200 billion in losses annually.

Claims and Billing Management

Medicare fraud caused more than $30 million in losses in the United States in 2016, and blockchain-based systems could help minimize it. In addition, it could reduce admin costs for billing by eliminating the need for intermediaries with automated activities and more efficient processing.

Survey shows only about half of Americans would have money to pay for an unexpected medical bill of $1000.

While Intel, Beth Israel Deaconess and others threw their support behind the CMS proposed plan to make interoperability mandatory for Medicaid and Medicare billing, AHA and other stakeholders slammed the proposal as “premature” and “duplicative.”

By Jessica Davis

By David Blumenthal

January 4, 2018

The economy may be growing and the stock market booming, but Americans are dying younger — living shorter lives than previous generations and dying earlier than their counterparts around the world.

It is easy to place the blame squarely on our nation’s opioid epidemic, but if we do that we miss seeing the abysmal new life expectancy data from the Centers for Disease Control and Prevention for what they are — an indictment of the American health care system.

According to the CDC, the average life expectancy at birth in the U.S. fell by 0.1 years, to 78.6, in 2016, following a similar drop in 2015. This is the first time in 50 years that life expectancy has fallen for two years running. In 25 other developed countries, life expectancy in 2015 averaged 81.8 years.

There’s no question that a big culprit is the opioid epidemic, which contributed significantly to an increase in death rates for Americans aged 15 to 64 years. At first glance, substance abuse would seem more a social and economic problem than one of health care, and there is no question that socioeconomics are a major player in causing the so-called deaths of despair associated with substance abuse.

But, we cannot let our health care system off too easily.

The epidemic of drug abuse and overdose deaths has not affected other developed countries the way it has ours. With 4 percent of the world’s population, the U.S. accounts for 27 percent of the world’s overdose deaths. The European Union, with a population of 507 million, reported 6,800 overdose deaths in 2014, compared to 47,055 in the U.S. That disparity exists even though many other developed countries have faced even greater economic challenges than we have. In 2016, France and Spain had unemployment rates of 10.1 and 19.6 percent, respectively, compared to 4.9 percent in the U.S.

Why has it been it so much worse here? One reason is that the U.S. doesn’t have strong social safety nets that buffer the effects of recessions and job loss as other nations do. Another reason is the way the U.S. health care system functions.

The profitability of drugs in the United States, a result of sky-high and skyrocketing drug prices, has made the aggressive marketing and sale of new prescription opioids an almost irresistible temptation for American pharmaceutical companies. Bombarded by clever advertising, U.S. physicians have, in turn, become quicker on the draw in prescribing opioids than physicians in other developed nations. The role of pharma is most clearly illustrated in the case of Purdue Pharma, which has been sued thousands of times over OxyContin, a prescription painkiller. The company settled one case for $600 million after the federal government accused it of making false claims about the drug’s risk of addiction and denying its potential to be abused. A raft of new suits by cities and states claiming that drug companies have profited from a product they knew to be dangerous are now pending.

The opioid epidemic is not the only area in which the U.S. health system lags. In 2015, life expectancy at age 65 in the U.S. ranked 26th among the 37 members of the Organization for Economic Cooperation and Development, which includes most developed nations. It is widely accepted that the accessibility and quality of medical services strongly affect life expectancy among the elderly and elderly Americans fall behind their counterparts overseas when it comes to being able to get and afford the health care they need.

This may seem surprising given that Americans over 65 enjoy universal health insurance coverage under Medicare. But as valuable as Medicare is, it provides far less protection against the cost of illness, and far less access to services, than do most other Western countries. In a recent cross-national survey, U.S. seniors were more likely to report having three or more chronic illnesses than their counterparts in 10 other high-income countries. At the same time, they were four times more likely than seniors in countries such as Norway and England to skip care because of costs. Medicare, it turns out, is not very good insurance compared to what’s available in most of the western world.

We are the wealthiest nation on earth, but far from the healthiest, and things are getting worse, not better. The CDC report is yet another call to action for fundamental health system change that should include, among other things, reforming our pharmaceutical markets and making good health insurance available to all Americans. These need to be urgent priorities in 2018 for a government that should care as much about the health of Americans as their wealth.

Article link: https://www.statnews.com/2018/01/04/life-expectancy-us-health-care/

David Blumenthal, M.D., is president of the Commonwealth Fund.

Veterans Health Affairs’ director of standards and interoperability warns that FHIR is not a cure all, just one valuable asset in a tech toolbox.

By Jessica Davis

June 19, 2018

Toplines

by Evan Sweeney | Jun 25, 2018

The American Hospital Association (AHA) has come out against a policy floated by the Centers for Medicare & Medicaid Services (CMS) to make interoperability a requirement to bill Medicare and Medicaid.

In a proposed hospital payment rule issued in April, CMS included a request for information regarding a revision to hospital Conditions of Participation (CoP) and Medicaid Conditions for Coverage (CfC) that would require hospitals to share data electronically with other hospitals, community providers and patients “if possible.”

In comments (PDF) submitted to CMS, the AHA said it “strongly opposes creating additional CoPs/CfCs to promote interoperability of health information.”

“The AHA strongly supports the creation of an efficient and effective infrastructure for health information exchange,” the nation’s largest hospital advocacy grout wrote in their letter. “This is central to the efforts of hospitals and health systems to provide high-quality coordinated care, support new models of care and engage patients in their health.

“However, we do not believe a new mandate tied to CoPs is the right mechanism to advance health information exchange,” the group added.

RELATED: CMS floats proposal tying medical records sharing to Medicare participation

CoPs are viewed as a far heftier regulatory stick, and hospitals are resistant to additional requirements that have huge repercussions for noncompliance. CMS Administrator Seema Verma has made interoperability one of her primary objectives, rolling out new initiatives this year aimed at getting data in front of patients.

AHA said the rule unfairly targets one set of actors in the healthcare ecosystem and that new requirements could have “unfortunate consequences for some hospitals and communities.”

RELATED: CMS launches new initiatives to expand patient access to health data, plans ‘complete overhaul’ of Meaningful Use

The group argued that it’s premature to consider building interoperability into CoPs or Medicaid’s CfCs until the barriers to data sharing have been fully addressed, noting that post-acute care providers, in particular, are often behind the curve with EHR implementation.

AHA also argued that compliance would be difficult for surveyors to measure, and providers can deliver care safely without interoperability.

“Instead, the AHA urges CMS to focus its attention on resolving problems created by the lack of a fully implemented exchange framework, adoption of common standards and incentives for EHR and other IT vendors to adhere to standards,” AHA said, pointing to the Trusted Exchange Framework and Common Agreement (TEFCA) release by the Office of the National Coordinator for Health IT earlier this year.

AHA also said it opposes the use of Stage 3 requirements in fiscal year 2019, a transition included in the proposed rule that would require hospitals to upgrade their EHR systems. The group was largely supportive of the agency’s proposal to rebrand the Meaningful Use program as “Promoting Interoperability” and altered its scoring system.

AHA wasn’t the only organization opposed to building interoperability into CoPs. The College of Health Information Management Executives (CHIME) said in a letter to CMS that new regulations are unnecessary, and that CMS should let existing policies such as data blocking and TEFCA to “take root” before implementing more stringent requirements.

Likewise, the American Medical Informatics Association (AMIA) said the data blocking rules “will be sufficient in stemming the nefarious aspects of information blocking, especially for provider-to-provider exchange” and recommended CMS implement those policies before moving on to Medicare and Medicaid requirements.

Comments were still filtering in on Monday ahead of the midnight deadline.

Article link: https://www.fiercehealthcare.com/tech/aha-cms-conditions-participation-interoperability-medicare-medicaid

Beyond HCAHPS: CXOs are looking for technology to offer better patient experience as a competitive differentiator.

By Mike Miliard

June 22, 2018

https://www.bloomberg.com/news/videos/2018-06-24/amazon-berkshire-jpmorgan-health-venture-takes-aim-at-middlemen-video

• Venture seeks to improve care and cost efficiency for workers
• CEO’s goal: ‘Take some of the middlemen out of the system’

he health venture established by Amazon.com Inc., Berkshire Hathaway Inc. and JPMorgan Chase & Co. will take aim at intermediaries in the health-care system as a part of a broad effort to reduce wasteful spending, the venture’s newly named chief executive officer said.

The still-unnamed business will initially seek to develop ways to improve care for the more than 1 million individuals who get health insurance from the three firms. Over time, the venture will make those innovations available freely to other companies, meaning that if it’s successful, its effects could be felt more broadly among the more than 150 million people in the U.S. who get their health insurance through work.

“My job for them is to figure out ways that we’re going to drive better outcomes, better satisfaction with care and better cost efficiency with new models that can be incubated for all,” Atul Gawande, the Harvard surgeon and journalist who was named last week to run the initiative, said Saturday at an Aspen Institute event.

Gawande, 52, starts July 9 at the Boston-based business, which is independent of the three firms that established it and not intended to generate profits. The companies have collectively said little about what the venture will do since announcing it in January, prompting broad speculation about its plans for upending health care.

Gawande said the venture will seek to target three kinds of waste in the health-care system: administrative costs, high prices, and improper health-care usage. He didn’t say which intermediaries the venture might target, or what its plans are.

Attacking Costs

“One source of waste is our very high administrative costs,” he said during a conversation with journalist Judy Woodruff at the Spotlight Health event. “There are a lot of middlemen in the system, and there have to be solutions that simplify that, take some of the middlemen out of the system.”

When the venture was announced, investors sent shares of health insurers, pharmacy-benefits managers and distributors lower, worried that the initiative would pressure their profits. Gawande’s remarks at the event are the most detailed to date about his plans and may confirm some of those concerns.

The biggest U.S. pharmacy-benefits managers are CVS Health Corp., Express Scripts Holding Co. and UnitedHealth Group Inc.’s OptumRx unit. UnitedHealth is the biggest U.S. health insurer, and other large carriers include Cigna Corp., Aetna Inc. and Anthem Inc.

The health industry has been reconfiguring itself, too. CVS late last year announced a deal to acquire Aetna, and Cigna in March agreed to buy Express Scripts.

Gawande also said the venture has a long time horizon, echoing past remarks from Berkshire CEO Warren Buffett and JPMorgan CEO Jamie Dimon. He raised questions about the future role of employers in the U.S. health-care system, as workers increasingly move between jobs or work in many smaller roles that don’t provide insurance in the gig economy.

“Tying how you get your health to your place of employment is going to become less and less tenable as fewer and fewer people are getting coverage through their employment,” he said. Gawande supports government-guaranteed health insurance for all.

“Even though I’m going to work for a bunch of employers, employer-based care is broken,” Gawande said

Article link: https://www.bloomberg.com/news/articles/2018-06-24/amazon-berkshire-jpmorgan-health-venture-takes-aim-at-middlemen