Category: digital health

Affordable Care Act, digital health, telemedicine

Must listen JP Morgan Healthcare Conference Webcasts: Teladoc

Admin

by Gregg A. Masters MPH

NOTE: This is one in a series of ‘Must listen’ webcasts produced at JP Morgan’s 34th Annual Healthcare Conference; for background and details, see ‘If It’s January, It’s JP Morgan Healthcare Conference‘. Remaining companies to detail as they represent important ‘bell weather’ insights relative to their respective sectors, include: Aetna, AthenaHealth, Centene, Genomic Health, Molina Health, Universal American, Tenet Health, as well as several from the ‘non-profit’ (tax exempt) sector including Baylor Scott and White. 

While telemedicine has been around since the 1980s via traditional ‘pipe to pipe‘ bi-directional points of presence typically found in hospital or academic medical centers, today’s more ubiquitous web enabled presence further leveraged by smart phones and tablets, is an entirely different and new experience and opportunity.

Whether one focuses on telemedicine or the wider swath of ‘telehealth services‘, both the technology and the cast of characters advancing the scope and range of practice opportunities or the body of work establishing use cases and modeling best practices, this remains a fast moving and rapidly iterating ecosystem.

One of the trophy and arguably best-in-class players in the space with both market and mindshare that dwarfs the aggregate total of the remaining three (3) out of the top four (4) players is Teladoc, which according to it’s website is:

…the first and largest telehealth provider in the nation, founded in 2002.

With it’s 2015 IPO we are afforded certain insights enabled by the regulatory reporting process as well as the sometimes behaviorally ‘nuanced’ though strategically insightful ‘management reports of operations’ of publicly traded companies.

As the sole telemedicine or telehealth play with this public standing, this is Teladoc’s first year to report out their experience as well as the issues, obstacles and opportunities it’s management sees for 2016 and beyond.

For context from Teledoc’s Chief Medical Officer Henry DePhillips, MD recorded at the American Telemedicine Association in Los Angeles in 2015, click here.

For direct link to the JP Morgan Healthcare Conference, click here. For the associated Teladoc deck and report narrative, click here.

Meanwhile, here are some slides which paint the picture both company and industry:

Teladoc highlights

 

Teladoc role of smart phone in telehealth

Teladoc growth strategies

Teladoc Comp Model

Screen Shot 2016-01-25 at 10.40.39 AM

Advertisements
Accountable Care, ACO, Affordable Care Act, digital health

Mark (I’m Not a Doctor but So What) Cuban’s Bold Vision or Big Ego?

Admin

By Gregg A. Masters, MPH

Mark Cuban CigarLast week witnessed a rather spirited discussion stimulated by a series of tweets from Billionaire owner of the Dallas Mavericks (and anointed judge of entrepreneurial insight on CNBC’s ‘Shark Tank‘) Mark Cuban.

What’s perhaps most poignant in this energetic public exchange is it comes at a time when ‘health’, ‘healthcare’ [and the emerging promise of ‘precision medicine’] including it’s increasing share of GDP (albeit at a decelerating rate of increase) are top of mind for many.

Considering the long, labored and ‘the jury is still out’ nature of whether the Affordable Care Act is necessary and sufficient to cure the ills of volume incentivized but silo-ed U.S. healthcare Mark Cuban aka @mcuban tweeted:

‘If you can afford to have your blood tested for everything available, do it quarterly so you have a baseline of your own personal health’ 

Followed by:

‘create your own personal health profile and history. It will help you and create a base of knowledge for your children,their children, etc.’

‘A big failing of medicine = we wait till we are sick to have our blood tested and compare the results to “comparable demographics”..’

To wit the veteran and respected investigative healthcare journalist and @ProPubica reporter Charles Ornstein aka @charlesornstein replied:

Please don’t listen to @mcuban for medical advice. Paging all doctors. https://t.co/gxV1UMMxUU

If you’re tempted to listen to @mcuban, read/listen to this: Is Preventive Medicine Actually Overtreatment? http://t.co/6H0HSFh5dr

Then many health-wonks, clinicians, patient advocates and those aligned with responsible healthcare social media stewardship chimed in with their ‘take’ on this exchange including yours truly:

Gregg Masters @2healthguru Timely and good read! via @ddiamond @mcuban Doesn’t Understand Health Care’ onforb.es/1yGBrY3 c @charlesornstein http://t.co/cIjQ1DqCKe

Dr. Florence Comite @ComiteMD @mcuban Comparing results to so-called normal range is not ideal. Preferable to use own data. @JCVenter @2healthguru #PrecisionMedicine

Ryan Lucas @dz45tr I’d just assumed he had invested in @theranos. lol. @2healthguru @ddiamond @mcuban @charlesornstein

Michael Tomasson @MTomasson @fqure @2healthguru @mcuban @ethanjweiss @johnpharmd My take: https://michaeltomasson.wordpress.com/2015/04/02/mark-cuban-understands-the-future-of-health-care/

Gary Wolf @agaricus @2healthguru @lsmarr @mcuban @charlesornstein Don’t think of these tests as entries in a lookup table, but as a basis for learning.

Perhaps the tweet that best framed and unfortunately may prevail in the ‘take-away’ narrative associated with Mark Cuban’s foray into health, healthcare and unwittingly so health-economics was posted by patient advocate and e-health expert Sherry Reynolds aka @cascadia:

Disconnect in medical testing thread @charlesornstein + et al are giving facts @mcuban is building a brand – guess who will win?

While I completely disagree with Mark Cuban and attribute his presumptive perhaps ‘intuitive ‘insights’ to the privileged perch he occupies (I doubt he concerns himself with the cost, systemic impact or health consequences of his recommendations, let alone co-payments, deductibles or co-insurance of his health plan), his argument may align with the broader movement into ‘digital health’ and patient empowerment as most recently expressed by Eric Topol, MD‘s new book ‘The Patient Will See You Now’ which aligns with the likely future of medicine or ‘Medicine 2.0’ – if you will. In this vision clinical medicine is ‘informed by’ genomics and manifests the promise of ‘precision medicine’ to better understand and thus target the fundamental mechanisms of underlying disease pathology and thus prevention.

My net take away from this exchange is reflected below:

Gregg Masters @2healthguru Well if nothing else @mcuban has sure stimulated debate on the value prop of ‘medicine 2.0’. This one via @RogueRad http://bit.ly/1GafTL8

Meanwhile at The Healthcare Blog Radiologist Saurabh Jha MD further opines in ‘Radiologists vs. Mark Cuban on Don’t Ask / Don’t Tell’ an itemized series of responses to additional queries posed by Mark Cuban.

So back to the ‘bold vision’ or BIG ego’ question: some of this ‘brashness’ may be attributed to what I’ll call the ‘Dallas Effect’ where everything is BIG especially mega-churches, football stadiums, ‘non-profit hospital systems’ and heck even the egos’ of their principal cheerleaders?

Only time will tell who’s on the right side of this narrative. Meanwhile, Mark thank you for your willingness to engage in an important conversation via this democratized medium known as twitter!

 

 

Accountable Care, ACO, digital health, HealthIT

Accountable Care, mhealth and the Triple Aim

Admin

By Gregg A. Masters, MPH

For those of you following this blog you know I write about ACOs and the emerging accountable care zeitgeist. My lens has been forged by decades of experience in the ‘managed competition’ experiment. For an earlier piece see: ‘Some Context and Perspective on Standing Up the ACO.’ HCFA masthead

The managed competition industry – perhaps more widely known as ‘managed [though more accurately mangled] care’ – can be traced back to it’s regulatory oversight origins via an office in the predecessor agency to CMS, the Health Care Financing Administration (HCFA) titled the ‘Office of Alternative Delivery Systems’ (OADS).

The mission of the OADS was to monitor the then emerging (‘disruptive’) players in the HMO domain but also this little known but ‘HMO lite’ mutation dubbed ‘preferred provider organizations’ (PPOs). The alternative delivery system domain was typically populated by those operators who compensated their contracted network of physicians, hospitals and ancillary providers via other than routine fee for services based payment. Alternative compensation ranged from mere discounts of standard fee schedules to full or partial capitation for physician or even hospital services, thus ADS operators could be arrayed across a continuum of risk assumption.

It is interesting to note that what was then considered ‘alternative’ to prevailing or normalized healthcare financing and delivery is now the new ‘normal’. Yet, we hear more reference to ‘alternative delivery systems’ today as representative by such new age/zeigeist disruptors the likes of certain ACOs, medical homes or even the tapestry of direct, membership, retainer or even ‘concierge’ models of delivery – including hybrids (OneMedical).

So in a way, the first phase of the ‘integration 1.0’ cycle is complete and we’re now embarking on ‘integration 2.0’ using the same terms albeit applied to different vehicles. Instead of HMOs or PPOs, we’re talking about ACOs, medical homes or other care delivery innovations.

Clearly technology – both enterprise and consumer facing – are central to the complex deliverable of the sustainable healthcare ecosystem, yet the preferred ‘chassis’ onto which to stitch if not graft the organizational, governance and operational best practices remain somewhat elusive.  To many digital or mhealth enabled solutions seems to represent a fair amount of rational promise to emerging ACOs.

At the 5th Annual mhealth Summit in a session titled: ‘Mobile Enabling the ACO‘ we’ll here from:

…on the state of the merger between promising digital health technologies and ACO operational fulfillment of certain ACA performance requirements .

The session description and schedule is pasted below:

mobile enabling of ACO

Accountable Care, ACO, Affordable Care Act, digital health

ACA, Accountable Care and the @HealthcareGov Fiasco

Admin

By Gregg A. Masters, MPH

With the quiet time afforded this ‘Thanks Giving-Kah’, I feel called to express some ‘dis-ease’ with the progress towards our pursuit of the triple aim or sustainable healthcare ecosystem.

healthcareGov cartoon

As if the health reform battle hasn’t been a power partisan exchange from day one. Think again…

If you weren’t paying attention during the run up to the Act’s passage in March of 2010, be reminded that the process was NOT imbued with the goodwill and fair consideration of grounded health policy arguments – both pro and con – to vet what might emerge from our bi-cameral legislative process and stand in the marketplace of ‘workable reform’.

But who among us could have predicted that health information technology performance or more accurately the lack of said ‘e-commerce performance’ might emerge as the likely candidate fulfilling the oppositions’ intent to stand in the way of ‘real’ health insurance for some 75 millions Americans?

Seriously HealthIT as the tipping point in the demise of the Act? Who saw that? As noted by a colleague on twitter:

Margalit Gur-Arie ‏@margalitgurarie 20 Nov
@2healthguru Oh yeah If someone said a year ago that Obamacare will fail on account of technology, I would have laughed them out of the room

In the midst of 46 attempts by the Republican controlled House to defund or repeal the ACA, a tapestry of lawsuits filed by AGs in ‘red states’, an unexpected SCOTUS affirmation of the law coupled with ‘discretionary’ state participation in the Medicaid expansion provision, and relentless Tea Party backed efforts to tag the Act as the end of freedom itself and the institutional permanence of ‘big government’ in the lives of all Americans – what most failed to appreciate is the market based nature of the effort. Health reform and the provisions in the Act express macro trends deeply rooted in the connective tissue of provider/payor/patient/consumer marketplace experience, wholly independent of the exquisitely orchestrated though faux political narrative – the crown jewel in the playbook of ‘weapons of mass deception’.

I have been in the ‘managed competition’ side of this business for 3+ decades and often can’t understand the nature of the beast we’ve created. The ‘healthcare conundrum‘ so aptly coined by Atul Gawande quite some time ago is a complex and unwieldy beast I have affectionately tagged the ‘healthcare borg‘ as a reference to the ‘resistance [as in change] is futile’ reference in Star Trek. Yet, many who lack even an undergraduate grasp on the nature of the American sick-care economy are unreasonably certain in their opinions on the nature of the malady and what might pass as proper remedies. Unfortunately, this certainty seems to be rooted in cheerleaders who might be characterized as ‘frequently wrong, but never confused.’

In this absence of anchorage to facts and contextual truths where is one to start in an ideological fueled echolalia of lies, misrepresentations, partial truths architected by armies of K-street funded special interests and their partner PR machines? Unfortunately for the rest of us K-street and the balance of the often morally bankrupt (chase the buck) beltway bandits find gold in them their hills of fueling ‘conflict’ as a contractual or ‘annuity solution’ to their recurrent ‘bill-ability’ concerns.

Let’s be clear. If the ACA were repealed do you think any of the macro trends would slow or reverse? Would Accountable Care be set aside for an ‘unaccountable care’ status quo? How about the movement into value based or performance based payment? Might this be moved to the quicksand of failed ideas while the return to fee for services ‘happy days’ plays on and on? Will selective movement into direct or retainer based medicine somehow disappear as well (note the return to direct practice is merely the reinvention of the HMO only in more micro practice terms)? Or will care management and coordinated care be seen as merely a passing fad with an immediate return to silo based episodic care and unit revenue or pricing maximization? I don’t think so…

None of these granular market tectonics would reverse if the Act were to be defunded, repealed or somehow re-litigated in the court of public opinion or elsewhere.

So let’s place the change or transformational energy impulse where it can best serve us. Since we’ve just recognized the 50th anniversary of the tragic JFK assassination I’m reminded of this bit of timeless wisdom:

‘if you’re NOT part of the solution, you are [part  of] the problem.’

Have you looked in the mirror lately?

Accountable Care, ACO, Affordable Care Act, digital health

From FutureMed to ACO Congress and Health Insurance Exchange West Summits

Admin

By Gregg A. Masters, MPH

Today I drove north some 150 miles or so from San Diego to the Century City Plaza Hotel complex in Los Angeles on the suitably named ‘avenue of the stars’ adjacent to the Fox entertainment empire. The Sunday session at FutureMed hosted at the Hotel Del Coronado was infectious and upbeat with as usual forward thinking and doing entrepreneurs, scientists and the people who love, follow or aspire to be one of them. BYQPw7vCUAAVaWr.jpg-large

The day was packed with inspirational speakers and concluded with a keynote than none other than San Diego’s digital health superstar and agitator for the creative destruction of medicine – Eric Topol, MD.

For a tweetchat dashboard of the action at FutureMed – the event runs through this Wednesday – click here. For the program agenda and schedule click here, while the transcript to date can be accessed here and the digital dashboard chronicling reach of the footprint is here.

Meanwhile here we are at the current sessions of the 4th National ACO Congress and the 1st ‘Health Insurance Exchange Summit West’ which will no doubt be a annual affair for the near term – given the disastrous rollout of HealthCare.gov and the contrasted ‘successful’ reviews of those state administered exchanges in California aka Covered California and Kentucky aka Kynect.

As I sat in the audience at FutureMed hearing the passion of the presentors I regularly kept asking myself, ok this is all awesome stuff – from 3D printing/manufacturing of just about everything from organs to guitars, but how does it assimilate and disrupt our house of cards if not ‘calcified hairball’ (per Esther Dyson) of a healthcare financing and delivery system? And coincident as it turns out, the session I am attending for the next two days represent the best and brightest – if you will, of the aggregators if not orchestrators of the sustainable healthcare ecosystem envisioned by the triple aim?

We shall see! I will be monitoring both event hashtags via #ACOcongress and #FutureMed – and so can you.

ACO, Affordable Care Act, digital health, health reform, HealthIT, Triple Aim

Time for a New ‘IPA’? The Independent Patient Association

Admin

By Gregg A. Masters, MPH

India Pale AleFor some ‘IPA‘ is about conversation and spirit enabled conviviality often in micro-breweries scanning the daily options for consumption. While for others IPA conjures up images and memories of labored if not painful efforts to steward the phased transformation of the American healthcare [non]system from a production oriented fee-for-services silo culture to one that is patient centric, team based and ‘what’s best for the patient’ value driven.

FPA Medical ManagementWe were first introduced to the ‘I/P/A’ (independent practice association) acronym in the mid 70s when the HMO Act greased the skids to reach out to mainstream medical staff communities vs. remain domiciled in it’s limited albeit more centrally managed ‘staff model’ (employed physicians) iteration.

Mullikin MedipartnersSeveral decades later, the track record of the IPA to assume, embrace, administer, and ultimately thrive under a prepaid, capitated or otherwise value based compensation system has been a dismal failure. The idea the IPA would seed group practice culture while constituting an increasing share of the individual physician’s practice would ultimately result in ‘urge to merge’ integration of individual practices into a ‘medical group without walls’ if not a fully integrated bricks and sticks merger. Clearly some instances of both have materialized, and there are some IPAs today that remain active and vibrant in the resurrected ACO conversation (Monarch Healthcare and Advocate Health Partners are two such examples).

Yet the cold facts are these, healthcare costs remain out of control and out of reach of many (50+ million uninsured, and 75+ [and growing]  million ‘under-insured), while there is no more ‘there, there to health insurance’ (witness the prevalence of cost shifting, benefit reductions and growth of so called ‘consumer directed [high deductible] health plans’, as the fundamental drivers of medical and healthcare cost inflation remain largely immune to industry efforts to reign them in.

Resistance is futileSo might it be the right time to entertain a new IPA? Where the I/P/A stands for ‘independent patient association’?

Between the power of the crowd to leverage ‘most favored nations pricing’ via massive, ‘club based’ group purchasing, and the potential to empower informed patient choices via the emergence of increasingly friendly, smart phone or tablet enabled devices, might we be on final approach to a truly patient engagement inspired revolution as envisioned in Eric Topol’s ‘Creative Destruction of Medicine‘ to select indicia of Patient Engagement reflected in the Affordable Care Act?

So is this a tech enabled ‘power to the people’ moment which taps into, harnesses and drives the granular re-engineering of our house of cards sickcare [non]system from paternalism to patient centricity? Or might this ‘convergence’ qualify as an @Adbusters scenario of:

When the moment is ripe, all it takes is a spark

Can an army of device or otherwise web enabled empowered patients and/or consumers supported by an association that contractually negotiates the lowest possible price points (hospital, physician and ancillary) via large scale, wholesale group purchasing of ‘most favored nations‘ rates be that spark?

Or otherwise put, can this quantum ‘super-positioning’  be the elusive elixir that finally levels the playing field of an otherwise insatiable fee-for-services supply driven demand economy coupled with opaque pricing that disproportionately favors its hierarchical [‘resistance is futile’] inertia?

Might this be the moment for a ‘new IPA?’