healthcarereimagined

Envisioning healthcare for the 21st century

  • About
  • Economics

Strengthening health care’s supply chain: A five-step plan – McKinsey&Company

Posted by timmreardon on 05/07/2015
Posted in: Uncategorized. Leave a comment

Strengthening health care’s supply chain: A five-step plan

Dramatically changing the sector’s inefficient supply chain may eliminate the dangers posed by counterfeiting and medication errors.

September 2013 | byThomas Ebel, Erik Larsen, and Ketan Shah

The manufacturing of pharmaceuticals and medical devices is becoming increasingly complex. Companies are expanding their product portfolios to meet rapidly changing markets and lengthening product life cycles. Emerging economies want more affordable products. Quality and compliance issues are rising because products are more complex and regulatory scrutiny is stricter. And the number of drug recalls is increasing. Yet the supply chain remains fragmented and incomplete, with weaknesses that put patients at risk, cost billions in value, and lessen the health-care sector’s ability to take on the challenges it faces. (For more, see our video interview with McKinsey director Katy George on how improving the health-care supply chain will benefit companies across the industry.)

Video – click to view

Rethinking health-care supply chains 

Rethinking health-care supply chains

The good news is that models do exist to strengthen and improve the health-care supply chain. We believe that by learning from the experience of industries such as fast-moving consumer goods (FMCG), the health-care sector could cut production lead times and obsolescence, while manufacturers, distributors, hospitals, and pharmacies could carry significantly smaller inventories (Exhibit 1). Improving the health-care supply chain also could give millions of people around the world access to safer and more affordable health care, reduce costs, and provide new revenue sources for manufacturers.

Exhibit 1

Operational metrics suggest huge opportunities

SVG_HealthcareSupplyChains_ex1

 Our research identified five specific capabilities that can have a dramatic impact on performance and bottom lines:
  • better segmentation of products, markets, and customers
  • greater agility, to reduce costs and increase flexibility
  • measurement and benchmarking
  • alignment with global standards
  • collaboration across the health-care value chain

Now, we recognize that transforming supply chains isn’t easy. In our experience, limited improvement efforts yield poor results, while comprehensive, integrated efforts are complex. But the payoff can be significant. Supply chains now account for nearly 25 percent of pharmaceutical costs and more than 40 percent of medical-device costs. The annual spending is so vast—about $230 billion on pharmaceuticals and $122 billion on devices—that even minor efficiency gains could free up billions of dollars for investments elsewhere. In fact, if the sector adopted straightforward advances well established in other industries, we estimate that total costs (from the supply chain and external areas, such as patient care) could fall by $130 billion.

Industry research, together with our own experience serving clients, has revealed opportunities to boost profitability throughout the value chain. The improvement from better-performing supply chains would range from about 6 percent for retailers to 20 percent for hospitals and producers of devices and medical supplies (Exhibit 2).

Exhibit 2

Opportunities from the transformation of supply chains can be found across the whole value chain

SVG_HealthcareSupplyChains_ex2

Easing shortages, improving safety

The cost of the shortcomings of today’s supply chain is substantial. Since 2005, drug shortages have nearly tripled in the United States and added more than half a billion dollars in costs for hospitals worldwide. Supply issues also create opportunities for counterfeiters and gray-market vendors, threatening patient safety and cutting into the revenues of legitimate companies. Supply-chain security breaches are increasing by an average of more than 33 percent every year, rising not only in emerging markets such as China, India, and Brazil but also in the developed world.

In addition, medication errors in the developed world occur in roughly 10 to 20 percent of all inpatient hospital admissions. About 1 in 10,000 patients admitted dies from adverse drug events, which, we estimate, add $20 billion to $90 billion in costs to the health-care system globally. Better supply-chain processes are central to increasing patient safety. We estimate that adopting a common global data standard and upgrading supply-chain processes could slash counterfeiting in half, returning $15 billion to $30 billion in revenue (by 2016) to legitimate companies for reinvestment in further improvements to patient care.

Building a new health-care supply chain

A typical Asian laptop manufacturer can accept an order on a Monday and deliver a pallet of freshly assembled customized computers to a European customer little more than a week later. In contrast, a typical pharmaceutical manufacturer has a lead time of about 75 days. How can medical-device and pharmaceutical manufacturers close the gap? Of the five comprehensive transformations we have identified, three can be accomplished internally. Two others—alignment and collaboration—are potentially the most powerful but require a company to work together with its customers, suppliers, and even competitors. Here’s what must be done.

Internal factors

1. Segmentation. Many pharmaceutical and medical-device companies come close to running one-size-fits-all supply chains. In practice, however, there can be significant differences in profitability, value per unit of weight, demand, the importance of a drug or device to patients, a customer’s cost to serve, and service expectations. Forcing products with such varied characteristics through a single set of supply-chain processes creates multiple inefficiencies, such as high inventories for some products while others are in short supply, the use of expensive air freight when slower surface modes would do, or a need to reschedule production campaigns hastily to meet urgent delivery requirements. Leading companies tackle these problems by intelligently segmenting their supply chains according to the characteristics of products and the requirements of customers. They then develop forecasting, production, and distribution strategies for each category.

2. Agility. This means more than just being fast when there’s an emergency; it means building an operating model that can better respond to demand shifts and customer wishes—at the same or even reduced cost. As we mentioned, the replenishment lead time from pharmaceutical plants to distribution centers is 75 days, on average. But leading companies in sectors such as fast-moving consumer goods take a fraction of that time, often without additional investments. Companies must better align the production cycle with the patterns of patient demand and increase the low frequency of their manufacturing processes. The average stock-keeping unit (SKU) is packaged every two to three months; only about 10 percent are packaged every two weeks or less.

An agile supply-chain model also requires stability in production, replenishment, and visibility. Many health-care companies need to make deliveries from third parties and in-house plants more reliable and to upgrade their sales- and operations-planning capabilities to the standards of the fast-moving-consumer-goods industry. The necessary improvements include a more disciplined cross-functional process, a better understanding of demand-and-supply scenarios and of underlying assumptions, more effective communication, and transparency on potential supply issues and bottlenecks.

3. Measurement. Health-care companies need to increase the transparency of their costs, including manufacturing, transport, warehousing, inventory holding, staff, and obsolescence—moves that could cut operational costs and optimize route-to-market approaches and product portfolios. Improvements are also needed in structural drivers or capabilities: responsiveness, manufacturing frequency, reliability of supply, and stability are mostly not systematically measured or managed across the network. Consumer-goods companies are clearly more advanced: they watch metrics such as the manufacturing-frequency index to measure the share of SKUs that are produced with high frequency. Finally, companies must standardize metrics across countries and plants. Commercially available benchmarking tools and approaches provide rough guidance for high-level opportunities in services, costs, and inventories, but not fully comparable results or tangible recommendations on how to capture value.

External factors

While internal optimization can deliver better service at lower cost, companies have even more to gain from optimizing externally. To do so, they must align processes and improve collaboration.

4. Alignment. Manufacturers of fast-moving consumer goods use point-of-sale information from retail customers to build production plans. The grocery industry, for example, has created billions of dollars in value by adopting standard barcodes. To build a cost-effective supply chain, the health-care sector could align around a single set of global standards that support data interchange, processes, and capabilities. Doing so may increase efficiency and patient safety by making it harder for counterfeiters to operate, by reducing medication errors, and by improving recall processes.

5. Collaboration. While the use of common standards is part of the challenge, supply-chain partners must find ways to collaborate more effectively to reap the full benefit. Barriers to improvement are often cultural rather than technical—transactional relationships must be transformed into something more ambitious. In our experience observing successful collaboration projects, six essential steps can make the difference between a productive collaboration and a frustrating one: companies must collaborate in areas where they have a solid footing; agree on sophisticated benefit-sharing models; select partners for the potential value of the collaboration, as well as their capabilities and willingness to act as a team; dedicate resources to the collaboration and involve senior leadership in it; jointly manage performance and measure impact; and start out with a long-term perspective.

At a recent meeting of senior supply-chain executives in the pharmaceutical and medical-device industries, we asked attendees which of these five supply-chain changes offered the greatest opportunity. More than 70 percent specified improved collaboration.

Transforming the health-care supply chain can do much more than improve the bottom line. By embracing the challenge of supply-chain leadership, pharmaceutical and medical-device companies can provide safer, more affordable access to products that enhance or even save the lives of people across the world.

For more on this research, download the full report, Building new strengths in the health-care supply chain (PDF–871KB). You can find further information on the topic of standardization by downloading the related report Strength in unity: The promise of global standards in health care (PDF–3.3MB).

About the authors

Thomas Ebel is a principal in McKinsey’s Düsseldorf office; Erik Larsen is an associate principal in the Chicago office, where Ketan Shah is a principal.

The authors would like to acknowledge the contributions of Katy George and Drew Ungerman to this article.

Article link: http://www.mckinsey.com/insights/health_systems_and_services/strengthening_health_cares_supply_chain_a_five_step_plan?p=1

IBM’s Watson computer can now do in a matter of minutes what it takes cancer doctors weeks to perform – Business Insider

Posted by timmreardon on 05/07/2015
Posted in: Accountable Care Organizations, ACOs, Big Data, Cancer Treatment, Data Science, Global Standards, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Healthcare Informatics, Innovation, Integrated Electronic Health Records, Oncology, Precision Medicine, Uncategorized. Tagged: Cancer, Cancer Treatment. Leave a comment

Fourteen US and Canadian cancer institutes will use International Business Machines Corp.’s Watson computer system to choose therapies based on a tumor’s genetic fingerprints, the company said on Tuesday, the latest step toward bringing personalized cancer treatments to more patients.

Oncology is the first specialty where matching therapy to DNA has improved outcomes for some patients, inspiring the “precision medicine initiative” President Barack Obama announced in January.

But it can take weeks to identify drugs targeting cancer-causing mutations. Watson can do it in minutes and has in its database the findings of scientific papers and clinical trials on particular cancers and potential therapies.

Faced with such a data deluge, “the solution is going to be Watson or something like it,” said oncologist Norman Sharpless of the University of North Carolina Lineberger Cancer Center. “Humans alone can’t do it.”

IBM is positioning Watson for exactly this task: an area of medicine where humans can see the vast potential, but can’t begin to wrangle the data needed to achieve it. “Genomics is the secret to unlocking personalized medicine,” said Steve Gold, a Vice President of the IBM Watson Group, at a press conference on Tuesday.

Yet it is unclear how many patients will be helped by such a “big data” approach. For one thing, in many common cancers old-line chemotherapy and radiation will remain the standard of care, and genomic analysis may not make a difference.

The scientists directly involved with Watson aren’t making any promises, but they’re hopeful they can slowly begin to make a difference in the world of cancer treatment, which today leaves a great number of patients without many good options.

“Traditional cancer treatments are moderately effective, associated with moderate toxicity, and many patients still succumb to the disease,” said Lukas Wartman, assistant director of Cancer Genomics at Washington University and a leukemia survivor, at Tuesday’s press conference. “There’s been a lot of pessimism among those [fighting] cancer, and Watson offers an opportunity to fight back against that pessimism.”

Watson

Cloud-based Watson will be used at the centers – including Cleveland Clinic, Fred & Pamela Buffett Cancer Center in Omaha and Yale Cancer Center – by late 2015, said Steve Harvey, vice president of IBM Watson Health. The centers pay a subscription fee, which IBM did not disclose.

Oncologists will upload the DNA fingerprint of a patient’s tumor, which indicates which genes are mutated and possibly driving the malignancy. Watson, recognized broadly for beating two champions of the game show Jeopardy! in 2011, will sift through thousands of mutations and try to identify which is driving the tumor, and therefore what a drug must target.

Distinguishing driver mutations from others is a huge challenge. IBM spent more than a year developing a scoring system so Watson can do that, since targeting non-driver mutations would not help.

“Watson will look for actionable targets,” Harvey said, matching them to approved and experimental cancer drugs and even non-cancer drugs (if Watson decides the latter interfere with a biological pathway driving a malignancy).

But Watson has trouble identifying actionable targets in cancers with many mutations. Although genetic profiling is standard in melanoma and some lung cancers, where drugs such as Zelboraf from the Genentech unit of Roche Holding AG target the driver mutation, in most common tumors traditional chemotherapy and radiation remain the standard of care.

“When institutions do genetic sequencing, only about half the cases come back with something actionable,” Harvey said, often because it is impossible to identify the driver mutation or no targeted therapy exists.

The other collaborating centers are Ann & Robert H. Lurie Children’s Hospital of Chicago; BC Cancer Agency in British Columbia; City of Hope, in Duarte, California; Duke Cancer Institute in North Carolina; McDonnell Genome Institute at Washington University in St. Louis; New York Genome Center, Sanford Health in South Dakota; University of Kansas Cancer Center; University of Southern California Norris Comprehensive Cancer Center, and University of Washington Medical Center.

(Reuters reporting by Sharon Begley; Editing by Dan Grebler)

Read more: http://uk.businessinsider.com/r-ibms-watson-to-guide-cancer-therapies-at-14-centers-2015-5?r=US#ixzz3ZULVAlP8Read more: http://uk.businessinsider.com/r-ibms-watson-to-guide-cancer-therapies-at-14-centers-2015-5?r=US#ixzz3ZULALTFU

Lawmakers form working group to find ways to improve EHRs – FierceEMR

Posted by timmreardon on 05/01/2015
Posted in: Accountable Care Organizations, Blue Button, Data Science, EHR Interoperability, EHR Usability, Emergency Medicine, Genetic Data, Genomic Data, Global Standards, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Healthcare Informatics, Healthcare Security, Innovation, Integrated Electronic Health Records, Military Health System Reform, Mobile Healthcare, National Health IT System, Open Data, Patient Portals, PCMH, Precision Medicine, Primary Care, Public Health, Quadruple Aim, Quality Measures, U.S. Air Force Medicine, U.S. Army Medicine, U.S. Navy Medicine, U.S. Surgeon General, Uncategorized, Veterans Affairs, Warrior Transistion Units. Leave a comment

April 30, 2015 | By Katie Dvorak

A new bipartisan committee’s working group will gather on Capitol Hill throughout the coming months to find ways to improve electronic health records, according to Senate health committee chairman Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.).

The group will work to find five or six ways to “make the failed promise of electronic health records something that physicians and providers look forward to instead of something they endure,” Murray said in an announcement.

While adoption of EHRs has grown, many physicians aren’t satisfied with the technology. In a recent survey by Accenture of 600 U.S. physicians, only 46 percent believe EHRs improve treatment decisions and 64 percent believe they reduce medical errors. EHR adoption also appears to have leveled off, FierceEMR previously reported.

All members of the Senate health committee are invited to be a part of the working group. Staff meetings begin this week, with participation from health IT professionals, industry experts and government agencies.

The working group’s goals include the following:

  • Help providers improve quality of care and patient safety.
  • Facilitate interoperability between EHR vendors.
  • Empower patients to engage in their own care through access to their health data.
  • Protect privacy and security of health information.

The working group isn’t the only way Alexander and Murray are pushing for change when it comes to EHRs.

Both spoke at a recent Senate appropriations subcommittee hearing of the Health Education, Labor and Pensions Committee regarding the Health and Human Services Department’s budget. The senators told Department of Health and Human Services Secretary Sylvia Mathews Burwell that, despite $28 billion in subsidies pursuant to the Meaningful Use program, physicians are not adopting EHRs as hoped.

To learn more:
– here’s the announcement

Article link: http://www.fierceemr.com/story/lawmakers-form-working-group-find-ways-improve-ehrs/2015-04-30

Related Articles:
Despite increased use, docs still not embracing EHRs
HHS, Congress plan collaboration to fix doc EHR problems
Survey: Doc EHR adoption leveling off
To err is human; EHRs must account for that, panelists say

VA slammed by GAO and IG for inability to effectively oversee veterans’ healthcare systems – FierceGovernment

Posted by timmreardon on 05/01/2015
Posted in: Accountable Care Organizations, ACOs, GAO Reports, Health Care Costs, Health Care Economics, Health IT adoption, Health Outcomes, Healthcare Delivery, Healthcare Informatics, Healthcare Security, Integrated Electronic Health Records, Public Health, Quadruple Aim, Quality Measures, Uncategorized, Veterans Affairs. Leave a comment

The Government Accountability Office placed the Veterans Affairs Department’s healthcare system on a list of high-risk programs for 2015, saying at an April 29 Senate Veterans’ Affairs Committee hearing that the agency needs to address inadequate oversight and ambiguous policies.

“Risks to the timeliness, costeffectiveness, quality and safety of veterans’ healthcare, along with other persistent weaknesses GAO and others have identified in recent years, raised serious concerns about VA’s management and oversight of its healthcare system,” said GAO Healthcare Director Debra Draper at the hearing.

GAO prepared testimony (pdf) says VA operates one of the largest healthcare delivery systems in the nation, including 150 medical centers and more than 800 community-based outpatient clinics.

Enrollment in the VA healthcare system has grown significantly, increasing from 6.8 to 8.9 million veterans between fiscal years 2002 and 2013, GAO says.

Over this same period, Congress has provided steady increases in VA’s healthcare budget, increasing from $23.0 billion to $55.5 billion.

At the hearing Draper outlined five major areas that put the VA at risk of failing to provide adequate healthcare to veterans including ambiguous policies and inconsistent processes, inadequate oversight and accountability, information technology challenges, inadequate training for VA staff and unclear resource needs and allocation priorities.

John Daigh, the VA’s assistant inspector general, agreed with Draper’s assessment of the Veterans Health Administration.

“VHA is at risk of not performing its mission as the result of several intersecting factors,” Deigh said. “VHA has several missions, and too often management decisions compromise the most important mission of providing veterans with quality healthcare.”

Daigh focused on the Veterans Integrated Service Networks – regional offices that are set up to oversees VA medical centers in certain areas – saying the current VISN structure has not worked effectively to support and solve problems facing hospitals.

One role of the VISNs is to make sure medical providers at each facility are doing their job properly with periodic reviews.

Daigh said in prepared testimony (pdf) that a forthcoming VA OIG report found that in hospitals where there are specialty units with small numbers of providers, it is difficult to obtain unbiased peer reviews of clinical cases and assessments of clinical performance by peers.

That lack of data makes it difficult for VISN’ to accurately assess medical care providers. But medical centers shouldn’t be shouldering all of the blame, Daigh said.

“The VISN structure has been inconsistently effective in addressing this issue,” he said.

Each VISN has a different internal organization and each medical facility has a different internal structure.

“This lack of standardization makes the dissemination of information and policy to facilities challenging and the acquisition of critical data from facilities more difficult,” Daigh said.

For more:
– go to the hearing page (webcast and prepared testimony available)

Article link: http://www.fiercegovernment.com/story/va-slammed-gao-and-ig-inability-effectively-oversee-veterans-healthcare-sys/2015-04-30?utm_medium=nl&utm_source=internal

Related Articles:
OSC: VA hospital switched out antipsychotic drugs to save money
VA cedes control of bloated Denver medical facility construction to Army Corps of Engineers
VA construction costs and delays substantially increased at four largest sites, GAO report says

U.S. Medical School Enrollment Soars – Forbes

Posted by timmreardon on 05/01/2015
Posted in: Uncategorized. Leave a comment

by Bruce Japsen, Contributor

Enrollment in U.S. medical schools is on track to jump by 30% within five years after universities opened more programs and made other changes, according to the Association of American Medical Colleges.

The association, which represents all 141 accredited U.S. medical schools and nearly 400 teaching hospitals, said first-year medical school enrollment will reach 21,304 in the 2019-20 school year. It’s just 130 positions short of a goal the association, known as the AAMC, called for in 2006 as one of the nation’s leading advocates to address a doctor shortage.

AAMC said more medical schools have opened while existing universities have expanded programs or tweaked curricula to get students interested in certain medical disciplines. For example, 72% of medical schools told AAMC they were planning “at least one initiative” to increase interest in primary care specialties.

Primary care professions of all kinds are needed as insurance companies and government health programs like Medicare and Medicaid emphasize paying for value over reimbursing doctors for volume of tests and procedures in the traditional fee-for-service medicine.  Insurers like Aetna (AET), Anthem (ANTM), Cigna (CI), Humana (HUM) and UnitedHealth Group (UNH) reported in their first quarter earnings that they are ramping up payments for care coordination, which emphasizes primary care and outreach to patients.

Though the interest in becoming a doctor somewhat addresses a physician shortage, it doesn’t solve the problem. After medical school, these potential future graduates still have to enter a residency program.

And with residencies funded by the Medicare health insurance program for the elderly, it would take an act of Congress to increase the number of slots.

“Without an increase in federally funded residency training positions, all these new medical school graduates may not be able to complete their training and become practicing physicians,” said Dr. Darrell Kirch, AAMC’s president and chief executive said in a statement accompanying the report.

Article link: http://www.forbes.com/sites/brucejapsen/2015/04/30/u-s-medical-school-enrollment-soars/?utm_campaign=Forbes&utm_source=TWITTER&utm_medium=social&utm_channel=Business&linkId=13888632

Angry Over Drug Prices, More States Push Bills for Pharma to Disclose Costs – WSJ

Posted by timmreardon on 05/01/2015
Posted in: Accountable Care Organizations, Data Science, Health Care Costs, Health Care Economics, Open Data, Public Health, Quadruple Aim, Uncategorized. Leave a comment

By Ed Silverman

WSJ 9

Should drug makers be required to disclose their costs to justify rising prices?

This is what a growing number of state legislatures are considering. Over the past several weeks, lawmakers in a handful of states stretching from California to Massachusetts have introduced bills in a bid to force the pharmaceutical industry to conduct an economic striptease.

“We need to have some transparency,” says Tony DeLuca, a Democrat who chairs the Pennsylvania House Insurance Committee and who introduced one such bill earlier this week. “Some of the sticker prices are outrageous. I’m hoping it achieves lower health care costs.”

The bills are not wholly identical. Some would require drug makers to report profits and various operational costs for any medicine that has a price tag of more than $10,000 a year, while others seek this information for all medicines, regardless of price. A bill was also introduced in North Carolina.

The effort comes as a national debate intensifies over prices for prescription medicines. Over the past year, payers – both public and private – have remonstrated over the cost of new specialty drugs for hard-to-treat ailments and for older generic drugs that were supposed to offer low-cost alternatives.

A new poll by the Kaiser Family Foundation found that 76% of Americans overall – and across party lines – say their top health care priority is ensuring that high-cost drugs for chronic conditions, such as HIV, hepatitis, mental illness and cancer, are affordable.

The issue is placing drug makers on the defensive, even as they argue pricey new medicines – notably, those for combating hepatitis C and certain rare diseases – represent good value for illnesses that would, otherwise, cost more to treat in the long run.

These bills represent a new front, though, in trying to blunt escalating price tags. And the legislation is winning enthusiastic backing from business groups, consumers advocates and health insurers, which some legislators say have helped craft language.

“This is about starting a conversation,” says Charles Bacchi, chief executive at the California Association Plans, which worked with a California legislator on one bill. “We need real answers about why these drugs are priced so high. Yes, there are limits to what a state can do, but it’s a debate we need to have.”

To what extent these bills may succeed is uncertain, at best.

Drug makers, not surprisingly, are pushing back and recently helped defeat legislation in Oregon. Earlier this week, the pharmaceutical industry trade group testified against the bill in California, where a vote was postponed until next week in light of opposition, according to a legislative aide.

As far as drug makers are concerned, the bills are not only onerous, but make demands they maintain cannot be met. For instance, an industry trade group argues that providing development costs for some drugs may be impossible when research was simultaneously conducted on other medicines that failed. The bottom line, says the California Healthcare Institute, is that the bill would “stifle innovation.”

“The price charged for an individual drug is not a reflection of development costs,” says Ken Kaitin, director of the Tufts Center for the Study of Drug Development, which receives pharmaceutical industry backing. “Pricing strategies are based on therapeutic value, market size, usage, patent life, competition and other factors.”

Even if one or more bills were to become law, there is no certain path toward lowering prices. But the effort may resonate around the country, especially with the 2016 presidential campaign under way. “This may be a model that other governments may want to build upon,” says Jamie Love of Knowledge Ecology International, a non-profit group that tracks access to medicines issues.

“While it is too soon to know if this prescription transparency legislation will continue to expand this year,” says Richard Cauchi, the program director for health insurance, financing and pharmaceuticals at the National Conference of State Legislatures, “state legislators often do look at what their colleagues in other states are doing.”

Article link: http://blogs.wsj.com/pharmalot/2015/04/24/angry-over-drug-prices-more-states-push-bills-for-pharma-to-disclose-costs/?KEYWORDS=health+insurance&utm_campaign=KHN:+First+Edition&utm_source=hs_email&utm_medium=email&utm_content=17307123&_hsenc=p2ANqtz-9hfIIzG3Y6DHON-qcvxxtxqFNnECpucjcrmaIQx-saUBvzfV9yFqH8nIK8-oWvhkYoB41pKK2MH-l8xMCmC0E2aO6GKw&_hsmi=17307123

US Hospitals Could Save Billions If They Took This Lesson from the VA – Defense One

Posted by timmreardon on 04/17/2015
Posted in: Accountable Care Organizations, Data Science, Emergency Medicine, Health Care Costs, Health Care Economics, Health Outcomes, Healthcare Delivery, National Health IT System, Patient Centered Medical Home, Primary Care, Public Health, Quality Measures. Leave a comment

defense-large-1

April 13, 2015 By Kathleen Carey Quartz

Most hospitals don’t have good ways of measuring the complex costs associated with an individual patient’s stay in the hospital. The VA is one surprising exception.

The success of health reform in the US depends on finding ways to control the growth of costs. Hospital care is expensive. And when patients have to be readmitted unexpectedly after discharge, it can really crank up spending.

As we strive to keep health care costs in line, reducing hospital readmissions is drawing a lot of attention. Reducing preventable readmissions could reduce health care spending and improve quality of care at the same time.

But very little research on readmission costs has been done. An exception is a study that found that one in five elderly Medicare patients is readmitted to the hospital within 30 days of being discharged, at an estimated cost of $17.4 billion in 2004.

Most hospitals don’t have good ways of measuring the complex costs associated with an individual patient’s stay in the hospital.

But there is, however, a hospital system that does a very good of job of tracking these costs: the Veterans Health Administration.

Veterans Affairs could provide a blueprint

The Veterans Health Administration (the VA) operates 119 acute care hospitals across the US, and has created an unparalleled comprehensive patient-cost accounting system, its Decision Support System (DSS).

The DSS works from the bottom up by summing the individual resources and costs each individual patients winds up needing during their hospital stay. Unlike most other hospital accounting systems, the VA DSS also can separate costs that are fixed regardless of the volume of services provided, such as administrative overhead, from costs that vary with service volume, such as lab tests or imaging. All of this means that the VA can track patients’ costs with greater precision than most hospitals, and can more easily see the cost of readmissions.

There are other reasons why VA is a good setting for studying readmission costs. VA hospitals have a simpler set of incentives around readmitting patients. Under Medicare, hospitals face a trade-off between receiving payments for readmitting Medicare patients and avoiding payment penalties for not readmitting patients under the new ACA regulations.

But in the VA system, budgets are set annually, so there is no financial incentive to readmit patients. It will not increase the amount of money VA hospitals get. And physicians who work in VA hospitals are salaried VA employees. They do not gain financially when they readmit patients, so they have no incentive to provide unnecessary care.

How much money does preventing readmission save?

In a recent study, Theodore Stefos and I used 2011 Decision Support System data to examine the component of cost that varies with a readmission, to provide hospital managers with a more realistic estimate of how much they could save by reducing readmissions.

We found that managers could expect to save $2,140 for the average 30-day readmission prevented. For heart attack, heart failure, and pneumonia patients, expected readmission cost estimates were higher: $3,432, $2,488 and $2,278 respectively.

We also found that patients’ risk of illness was the main driver of expected readmission cost. This is an important finding for managers. Even though this is a factor they cannot control, they can expect that patients with a greater risk of illness might be at greater risk after controlling for other factors such as age. Men also were much more likely to be readmitted than women, as were lower income and unmarried vets. Understanding this information can help hospital managers better predict which patients are at risk for readmission, and to take steps to address this proactively.

(Related: Despite Scandal, the VA Has Actually Fired Very Few for Misconduct)

While the VA has some processes of care that differ from other health care systems, its experience has important lessons for private sector hospitals, especially for those that treat a high share of chronically ill or low-income patients.

Why it is important to know what readmissions cost

Today hospitals are under increasing pressure to curb readmissions. For instance in 2013 Centers for Medicare & Medicaid Services (CMS) started to financially penalize hospitals for 30-day readmissions that exceed national averages for heart attack, heart failure and pneumonia. As of October 2014, chronic obstructive pulmonary disorder and elective knee and hip replacements are also being targeted and the penalty has increased up to 3% of the total Medicare reimbursement to the hospital.

Hospital managers would like to know what actual cost savings are when a readmission is avoided, so they can understand how readmissions affect their overall budgets.

Article link: http://www.defenseone.com/technology/2015/04/us-hospitals-could-save-billions-if-they-took-lesson-va/110029/?oref=defenseone_today_nl

This post originally appeared at The Conversation. Follow@US_conversation on Twitter. 

IBM Creates Watson Health to Analyze Medical Data – NY Times

Posted by timmreardon on 04/17/2015
Posted in: Data Science, EHR Interoperability, EHR Usability, Genetic Data, Genetic Research, Genomic Data, Global Standards, Health Care Costs. Leave a comment

By Steve Lohr13bits-kelly-blog480

Credit Ángel Franco/The New York Times

April 13, 2015 6:00 pm

John Kelly oversees IBM’s research labs and new initiatives.

IBM is taking its Watson artificial-intelligence technology into health care in a big way with industry partners, a pair of acquisitions and an ambitious agenda.

The initial three industry partners are Apple, Johnson & Johnson and Medtronic. On Monday afternoon, after the close of stock trading, IBM also announced it would buy two start-ups: Explorys, a spin-off from the Cleveland Clinic whose data on 50 million patients is used to spot patterns in diseases, treatments and outcomes; and Phytel, a Dallas maker of software to manage patient care and reduce readmission rates to hospitals.

The IBM plan, put simply, is that its Watson technology will be a cloud-based service that taps vast stores of health data and delivers tailored insights to hospitals, physicians, insurers, researchers and potentially even individual patients.

“We’re going to enable personalized health care on a huge scale,” said John E. Kelly, a senior vice president who oversees IBM’s research labs and new initiatives.

To date, IBM has done some individual projects using Watson technology with leading medical centers, including Memorial Sloan Kettering Cancer Center in New York, the University of Texas MD Anderson Cancer Center in Houston and the Cleveland Clinic. But the creation of the Watson Health unit, Mr. Kelly said, is an effort to apply the technology to the mainstream of health care.

And while IBM has been commercializing Watson technology with tools for mining Twitter, weather and Internet of Things data, Mr. Kelly said Watson Health was the first move into a specific industry.

The Watson Health announcement is also the latest in flurry of initiatives IBM has announced this year that include new corporate partnerships as well as moves in cloud computing, data analytics and Watson. They are evidence that IBM is intent on investing for future growth, and showing it is doing so, in a year when its financial performance is likely to lag.

IBM has reported disappointing earnings recently, and Virginia M. Rometty, IBM’s chief executive, has told industry analysts and investors that 2015 would be a transition year in which new growth businesses like Watson did not yet overcome the profit erosion in some of its traditional hardware and software products.

IBM’s broad vision of combining and analyzing health data from varied sources to improve care has been around for decades. But the company and its partners say that technology, economics and policy changes are coming together to improve the odds of making the IBM venture a workable reality. They point to improvements in artificial intelligence, low-cost cloud computing and health policy that will reward keeping patients healthy instead of the fee-for-service model in which more treatments and procedures mean more revenue.

“Forces in health care are aligning as never before,” said Sandra E. Peterson, a group worldwide chairman at Johnson & Johnson in charge of information technology and new wellness programs. “It could be a unique moment and something like this could have real legs.”

A focus of the Johnson & Johnson partnership with IBM will be improving patient care before and after knee and hip replacements. The company will apply Watson technology to data sources ranging from patient records to digital fitness devices and smartphone applications, which can monitor movement and vital signs. “It will allow us to do much more integrated, personalized care,” Ms. Peterson said.

Medtronic, a large medical equipment maker, wants to use data intelligently to treat diabetes patients beyond providing them with its glucose monitors and insulin pumps. Medtronic devices are already digital and produce a lot of data, but the company plans to use the Watson software to spot patients trending toward trouble and automatically adjust insulin doses and send alerts to care providers and the patients themselves.

“The goal is dynamic, personalized care plans so you can delay or stop the progression of diabetes,” said Hooman Hakami, executive vice president in charge of Medtronic’s diabetes group.

Apple is increasingly a major supplier of health sensors, from iPhone apps to the Apple Watch. Its recently introduced HealthKit and ResearchKit software make it easier for applications and researchers to harvest health information from millions of owners of Apple products, with their permission. That data can now be plugged into Watson. “We want to be the analytics brains behind HealthKit and ResearchKit,” Mr. Kelly said.

The IBM initiative raises questions on how data is handled and about privacy. Mr. Kelly said the data scrutinized by Watson will typically be anonymized and often be read by Watson but not removed from hospital or health company data centers. “There will be no big, centralized database in the sky,” Mr. Kelly said.

Even critics of health information technology say the IBM effort holds promise. “If that future when all this stuff works is going to become real, then having some of the key players come together is the only way it’s going to happen,” said Dr. Robert M. Wachter, a professor at the University of California, San Francisco medical school and author of “The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age.” “This could be a pretty important step along the way.”

Article link: http://bits.blogs.nytimes.com/2015/04/13/ibm-creates-watson-health-to-analyze-medical-data/?hpw=&rref=technology&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well&smid=tw-nytimes

Roadblocks to Sharing Medical Records – NY Times

Posted by timmreardon on 04/17/2015
Posted in: Uncategorized. Leave a comment
17fri3web-articleLarge
Getty Images
By THE EDITORIAL BOARD
April 16, 2015

The ability to transfer electronic medical records from one doctor or hospital to another is essential to the smooth functioning of the health care system and to providing the best possible care to patients. Yet all too often these transfers are being blocked by developers of health information technology or greedy medical centers that refuse to send records to rival providers.

This will not be an easy problem to fix, but some possible approaches were detailed in a report to Congress last week from the Office of the National Coordinator for Health Information Technology, a unit of the Department of Health and Human Services.

The full extent of the problem is difficult to assess, according to the report, mainly because of contractual restrictions imposed by software developers on their customers. Even so, the office deduced from various sources — including customer complaints and interviews — that some software developers and medical centers have deliberately blocked the sharing of information. It did not name the parties because it could not determine with any certainty whether some of the information was blocked for legitimate reasons, like concern for patient privacy.

The motivations for hoarding or restricting data appear to be mostly business-related; for instance, companies lock customers into costly proprietary technology and often charge exorbitant fees for sending or receiving information. Some hospitals, critics say, won’t share information with doctors outside their own networks, lest they lose control of the patient and erode their dominance of a local market. Larger hospital systems that share health information internally sometimes won’t do so with competing hospitals and unaffiliated providers.

The report suggests some ways to combat information blocking, including new transparency requirements (already in the pipeline) for developers to disclose the restrictions and costs associated with buying their systems. There are additional steps the federal government could take on its own. For example, it could name the suspected wrongdoers and let them explain the reasons behind their actions. Congress could go still further and pass a new law providing criminal penalties and stiff fines for vendors and providers who deliberately block information sharing with no valid excuse.

The federal government has invested some $28 billion to convert hospitals and health care professionals to electronic health records, with gratifying results. More than half of the nation’s doctors have adopted electronic health records. It would be a shame if limitations on their ability to send and receive digital records undercut national efforts to improve the quality of care.

Article link: http://mobile.nytimes.com/2015/04/17/opinion/roadblocks-to-sharing-medical-records.html?referrer=

2015 is already the year of the health-care hack — and it’s only going to get worse – Washington Post

Posted by timmreardon on 03/27/2015
Posted in: Big Data, Data Science, Health IT adoption, Healthcare Security, Integrated Electronic Health Records, National Health IT System, Open Data, Precision Medicine. Leave a comment

Vista1Last year, the fallout from a string of breaches at major retailers like Target and Home Depot had consumers on edge. But 2015 is shaping up to be the year consumers should be taking a closer look at who is guarding their health information.

Data about more than 120 million people has been compromised in more than 1,100 separate breaches at organizations handling protected health data since 2009, according to Department of Health and Human Services data reviewed by The Washington Post.

“That’s a third of the U.S. population — this really should be a wake-up call,” said Deborah Peel, the executive director of Patient Privacy Rights.

The data may double-count some individuals if they had their information compromised in more than incident, but it still reflects a staggering number of times Americans have been affected by breaches at organizations trusted with sensitive health information. And the data does not yet reflect the hack of Premera, which announced this week that hackers may have accessed information, including medical data, on up to 11 million people.

[Read: Premera Blue Cross says data breach could affect 11 million people]

Most breaches of data from health organizations are small and don’t involve hackers breaking into a company’s computer system. Some involve a stolen laptop or the inappropriate disposal of paper records, for example — and not all necessarily involve medical information. But hacking-related incidents disclosed this year have dramatically driven up the number of people exposed by breaches in this sector.

When Anthem, the nation’s second-largest health insurer, announced in February that hackers broke into a database containing the personal information of nearly 80 million records related to consumers, that one incident more than doubled the number of people affected by breaches in the health industry since the agency started publicly reporting on the issue in 2009.

“We are certainly seeing a rise in the number of individuals affected by hacking/IT incidents,” Rachel Seeger, a spokesperson for HHS’s Office for Civil Rights, said in a statement. “These incidents have the potential to affect very large numbers of health care consumers, as evidenced by the recent Anthem and Premera breaches.”

And some cybersecurity experts warn this may only be the beginning. “We’re probably going to see a lot more of these happening in the coming few months,” said Dave Kennedy, the chief executive of TrustedSEC.

Health organizations are targets because they maintain troves of data with significant resale value in black markets, Kennedy said, and their security practices are often less sophisticated than other industries. Now that some major players in the market have come forward as victims of cyberattacks other organizations are likely to take a close look at their own networks — potentially uncovering other compromises, he said.

“The information that companies like Anthem and Premera had is more valuable than just payment card information held by retailers or financial institutions,” said Scott Vernick, who heads up the data security and privacy practice at law firm Fox Rothschild. Credit card information has a relatively short shelf life, with new cards issued on a regular basis, he explained. But a health organizations often have complete profiles of people including Social Security numbers and medical health information that is much more difficult if not impossible to change.

[Related: Yes, we’re still using dumb passwords. But not nearly as much as before.]

Some of the data can be used to pursue traditional financial crimes — like setting up fraudulent lines of credit, Kennedy said. But it can also be used for medical insurance fraud, like purchasing medical equipment for resale or obtaining pricey medical care for another person.

This type of scheme is often not caught as quickly as financial fraud, experts said, and could have a lasting affect if it results in a person’s medical history containing false information. “In theory you could end up in an emergency situation, and if your records are contaminated by someone else’s information that could cause serious problems — like medical professionals believing you have a different blood type,” said Peel.

If a hacker is able to obtain information about a person’s medical condition, as it appears may have happened in the Premera breach but not the Anthem breach, there are additional risks. Information about mental health or HIV treatments could be made public, and there’s no way to truly make the information private again. “There’s almost no way to remedy this; there’s no recourse,” said Peel.

Health care providers already have to comply with government rules on protecting patient privacy, including HIPAA, which are enforced by HHS.

“Health care organizations need to make data security central to how they manage their information systems and to be vigilant in assessing and addressing the risks to data on a regular basis,” said Seeger, the HHS official. “In addition, organizations need to ensure they are able to identify and respond appropriately to security incidents when they do happen to mitigate harm to affected individuals and prevent future similar incidents from occurring.”

State-level officials are also increasingly involved in enforcement in this area, said Vernick, and consumers may have additional legal avenues depending on state laws.

But privacy and cybersecurity advocates say the industry and the government still aren’t doing enough to protect consumers.

“HIPAA required security be addressed, but it wasn’t spelled it out exactly how, so there was no culture of using ironclad security,” said Peel. “We have systems that are engineered as though this data is not sensitive and valuable.”

Health organizations sometimes rely on legacy systems, and some have not invested in cybersecurity at a rate that matches the urgency of the threats they face, Kennedy said. “The medical industry is years and years behind other industries when it comes to security.”

Even before the Anthem breach, major health insurers had become aware of the rising risk of cyberattacks. Aetna and United Health Group both cited the risks of hackers and breaches in their respective 2013 financial reports.

And the industry is already taking steps to coordinate how it responds to such incidents through groups designed to share information about digital threats — like the National Health Information Sharing and Analysis Center, or NHISAC. The organization is one of several efforts related to critical infrastructure that works with the Department of Homeland Security to share data about current threats, such as what sort of tactics are used and forensic information about attackers.

Members are able to share details about security incidents in “machine time” using an automated system, according to NHISAC executive director Deborah Kobza, and the group sends out daily threat updates. When a major cyberattack is disclosed, NHISAC erupts into a flurry of activity — trying to find out as much as possible so its members have information that can make it easier to see if they’ve been the victims of a similar attack.

And 2015 has already kept NHISAC busy: “We just caught our breath from the Anthem hack, and here we go again,” said Kobza about responding to the Premera breach.

Article link: http://www.washingtonpost.com/blogs/the-switch/wp/2015/03/20/2015-is-already-the-year-of-the-health-care-hack-and-its-only-going-to-get-worse/

Read more:

China suspected in major hacking of health insurer Anthem

How tax sites like TurboTax can better protect customers

Target data breach victims could get up to $10,000 each from court settlement

Posts navigation

← Older Entries
Newer Entries →
  • Search site

  • Follow healthcarereimagined on WordPress.com
  • Recent Posts

    • By Barring Profits on Basic Coverage, Switzerland Keeps Insurers from Denying Care – Commonwealth Fund 10/19/2026
    • Patients’ Perspectives on AI in Primary Care – Commonwealth Fund 09/11/2026
    • Bitcoin Mining Energy Footprint 08/06/2026
    • Closing the AI Hype Gap 08/05/2026
    • Why Artificial Intelligence is Neither Artificial, Nor Intelligent 07/31/2026
    • Agentic AI, explained 07/05/2026
    • Heeding the pope’s call to ensure AI protects human dignity – MIT Sloan Management 06/01/2026
    • Association between Wealth and Mortality in the United States and Europe – New England Journal of Medicine 05/30/2026
    • U.S. Health Care from a Global Perspective, 2026 – The Commonwealth Fund 05/30/2026
    • Anthropic co-founder Chris Olah’s remarks on Pope Leo XIV’s encyclical “Magnifica humanitas” 05/28/2026
  • Categories

    • Accountable Care Organizations
    • ACOs
    • AHRQ
    • American Board of Internal Medicine
    • Big Data
    • Blue Button
    • Board Certification
    • Cancer Treatment
    • Data Science
    • Digital Services Playbook
    • DoD
    • EHR Interoperability
    • EHR Usability
    • Emergency Medicine
    • FDA
    • FDASIA
    • GAO Reports
    • Genetic Data
    • Genetic Research
    • Genomic Data
    • Global Standards
    • Health Care Costs
    • Health Care Economics
    • Health IT adoption
    • Health Outcomes
    • Healthcare Delivery
    • Healthcare Informatics
    • Healthcare Outcomes
    • Healthcare Security
    • Helathcare Delivery
    • HHS
    • HIPAA
    • ICD-10
    • Innovation
    • Integrated Electronic Health Records
    • IT Acquisition
    • JASONS
    • Lab Report Access
    • Military Health System Reform
    • Mobile Health
    • Mobile Healthcare
    • National Health IT System
    • NSF
    • ONC Reports to Congress
    • Oncology
    • Open Data
    • Patient Centered Medical Home
    • Patient Portals
    • PCMH
    • Precision Medicine
    • Primary Care
    • Public Health
    • Quadruple Aim
    • Quality Measures
    • Rehab Medicine
    • TechFAR Handbook
    • Triple Aim
    • U.S. Air Force Medicine
    • U.S. Army
    • U.S. Army Medicine
    • U.S. Navy Medicine
    • U.S. Surgeon General
    • Uncategorized
    • Value-based Care
    • Veterans Affairs
    • Warrior Transistion Units
    • XPRIZE
  • Archives

    • October 2026 (1)
    • September 2026 (1)
    • August 2026 (2)
    • July 2026 (2)
    • June 2026 (1)
    • May 2026 (12)
    • April 2026 (4)
    • March 2026 (9)
    • February 2026 (6)
    • January 2026 (8)
    • December 2025 (11)
    • November 2025 (9)
    • October 2025 (10)
    • September 2025 (4)
    • August 2025 (7)
    • July 2025 (2)
    • June 2025 (9)
    • May 2025 (4)
    • April 2025 (11)
    • March 2025 (11)
    • February 2025 (10)
    • January 2025 (12)
    • December 2024 (12)
    • November 2024 (7)
    • October 2024 (5)
    • September 2024 (9)
    • August 2024 (10)
    • July 2024 (13)
    • June 2024 (18)
    • May 2024 (10)
    • April 2024 (19)
    • March 2024 (35)
    • February 2024 (23)
    • January 2024 (16)
    • December 2023 (22)
    • November 2023 (38)
    • October 2023 (24)
    • September 2023 (24)
    • August 2023 (34)
    • July 2023 (33)
    • June 2023 (30)
    • May 2023 (35)
    • April 2023 (30)
    • March 2023 (30)
    • February 2023 (15)
    • January 2023 (17)
    • December 2022 (10)
    • November 2022 (7)
    • October 2022 (22)
    • September 2022 (16)
    • August 2022 (33)
    • July 2022 (28)
    • June 2022 (42)
    • May 2022 (53)
    • April 2022 (35)
    • March 2022 (37)
    • February 2022 (21)
    • January 2022 (28)
    • December 2021 (23)
    • November 2021 (12)
    • October 2021 (10)
    • September 2021 (4)
    • August 2021 (4)
    • July 2021 (4)
    • May 2021 (3)
    • April 2021 (1)
    • March 2021 (2)
    • February 2021 (1)
    • January 2021 (4)
    • December 2020 (7)
    • November 2020 (2)
    • October 2020 (4)
    • September 2020 (7)
    • August 2020 (11)
    • July 2020 (3)
    • June 2020 (5)
    • April 2020 (3)
    • March 2020 (1)
    • February 2020 (1)
    • January 2020 (2)
    • December 2019 (2)
    • November 2019 (1)
    • September 2019 (4)
    • August 2019 (3)
    • July 2019 (5)
    • June 2019 (10)
    • May 2019 (8)
    • April 2019 (6)
    • March 2019 (7)
    • February 2019 (17)
    • January 2019 (14)
    • December 2018 (10)
    • November 2018 (20)
    • October 2018 (14)
    • September 2018 (27)
    • August 2018 (19)
    • July 2018 (16)
    • June 2018 (18)
    • May 2018 (28)
    • April 2018 (3)
    • March 2018 (11)
    • February 2018 (5)
    • January 2018 (10)
    • December 2017 (20)
    • November 2017 (30)
    • October 2017 (33)
    • September 2017 (11)
    • August 2017 (13)
    • July 2017 (9)
    • June 2017 (8)
    • May 2017 (9)
    • April 2017 (4)
    • March 2017 (12)
    • December 2016 (3)
    • September 2016 (4)
    • August 2016 (1)
    • July 2016 (7)
    • June 2016 (7)
    • April 2016 (4)
    • March 2016 (7)
    • February 2016 (1)
    • January 2016 (3)
    • November 2015 (3)
    • October 2015 (2)
    • September 2015 (9)
    • August 2015 (6)
    • June 2015 (5)
    • May 2015 (6)
    • April 2015 (3)
    • March 2015 (16)
    • February 2015 (10)
    • January 2015 (16)
    • December 2014 (9)
    • November 2014 (7)
    • October 2014 (21)
    • September 2014 (8)
    • August 2014 (9)
    • July 2014 (7)
    • June 2014 (5)
    • May 2014 (8)
    • April 2014 (19)
    • March 2014 (8)
    • February 2014 (9)
    • January 2014 (31)
    • December 2013 (23)
    • November 2013 (48)
    • October 2013 (25)
  • Tags

    Business Defense Department Department of Veterans Affairs EHealth EHR Electronic health record Food and Drug Administration Health Health informatics Health Information Exchange Health information technology Health system HIE Hospital IBM Mayo Clinic Medicare Medicine Military Health System Patient Patient portal Patient Protection and Affordable Care Act United States United States Department of Defense United States Department of Veterans Affairs
  • Upcoming Events

Blog at WordPress.com.
healthcarereimagined
Blog at WordPress.com.
  • Subscribe Subscribed
    healthcarereimagined
    Join 149 other subscribers

    Have a WordPress.com account? Log in now.

  • healthcarereimagined
    View site in Reader
    Manage subscriptionsSign upLog in
    Report this content
    Collapse this bar
Loading Comments...