Tag Archives: HIMSS

The Triple Aim, Well Two Out of Three… Really is Bad

One of the Triple Aim‘s has gotten lost. Will anyone in the healthcare sector publicly declare that they are in fact working on the Double Aim?

The Triple Aim, that lofty set of goals that the healthcare system claims to have embraced:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and.
  • Reducing the per capita cost of health care.

I agree with them and believe they are appropriate and necessary.

Everyone it seems, says they are working towards the Triple Aim, and many have taken to adding Provider Satisfaction and saying we in fact need a Quadruple Aim. Well, before we go there, let’s see what we are actually doing on the initial three.

After attending a number of conferences and seeing what the system is in fact doing,  I’m fairly certain, that healthcare is not actually going after the Triple Aim. In fact, it appears that almost everyone has quietly agreed on the “Double Aim” in an effort to short-circuit any true progress and continue on the path we have been on.

What do I mean by the Double Aim? Here are some examples of things I saw, heard or didn’t hear at HIMSS 2018:

After listening to an excellent panel on innovation, by three leading health system executives who oversee their systems innovation area or department, I just had to ask a question:

“At what point does this innovation actually lower costs?” A murmur arose in the room.

Response one:

“Well we could spend a whole day on that one”

The next answer? Well, there wasn’t one.

At the conclusion of the session, Gregg Masters spoke with one of the panelists and asked if as part of their innovation center they were tasked with lowering costs.  Their response “no, that’s not part of our charge.”

Why wouldn’t an innovation center also be looking for innovation that reduces costs?

At a dinner panel one evening, a health plan association executive when asked if health plans were really lowering costs, pointed to the Medical Loss Ratio (MLR) Rule (which I have written about here) as a key contributor to holding costs down.  When I explained my belief that the MLR rule ensures costs go up because “who would want 15% of a lower number next year” there were audible chuckles of agreement in the room, a shocked look on the panelists face and the panel quickly switched to another topic. While the person who asked the original cost question, looked at me, raised his eyebrows and laughed.

I do not recall any booth or individual discussing programs that save money, in fact most were talking about revenue enhancement.

Only Kaveh Safavi of Accenture and one other presentation discussed the elephant in the room; that healthcare is the only industry where as it adds technology, the workforce gets less efficient.  I would call the behavior we exhibit in this regard, an addiction.  We continue to do it, even though the outcomes will be bad for us.

Do we not hear the clamor associated with the Amazon, Berkshire-Hathaway, JP Morgan?

“Healthcare is the Tapeworm of the American economy”

 

Or the announcement by Wal-Mart regarding their narrow network, in which they said that about 40% of people referred to their center of excellence for back surgery were told they don’t need it. How about the growing relevance of Dave Chase and the Health Rosetta and books like Dan Munro’s Casino Healthcare, or the Health Value Awards.

Even the esteemed Dr. David Nash of the Jefferson College of Population Health saying there are too many medical errors and too many tests being ordered and it was “time for doctors to look in the mirror”.  But not just doctors, all sectors of healthcare, especially hospital systems, health plans, device and pharmaceutical manufacturers and vendors. You may be thinking you can slip by with the Double Aim, but others are AIMing to knock the inappropriate costs out of the system, and if you don’t get involved it might be you.

And now when CMS announces their Pathways to Success, a new ACO requirement that pushes ACOs which have been living off of one-sided risk in the MSSP program, and showing no savings, to two-sided risk, the industry goes bonkers.

Avalere_Health_MSSP_Performance_Results_Versus_CBO_Projections

We know there are excesses in the system, everyone talks about that, everyone talks about the Triple Aim, but it seems in the case of doing things versus talking about the Triple Aim, we are truly only interested in the Double Aim.

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Me and My Apple Watch

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So as you know from my earlier posts, I have used and blogged on FitBit, Garmin, Moov, Basis Watch (2nd post on Basis Watch), Google Glass and apps like BodBot as well as posted on issues with wearable trackers in general.  At the recent HiMSS conference I was given an Apple Watch for participating in a 20 minute meeting with a vendor.  Great gift by the way.  Anyhow, I have now worn this watch daily for about two months and have come to a few early conclusions.  So here we go:

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Validic, an Interview with Chris Edwards, Chief Marketing Officer

As the world continues its push to mobile health and monitoring, Validic has been getting a lot of attention.   Validic provide’s a digital health platform linking a broad array of mobile devices to companies looking to use this data. Their services’ are being used by  hospitals, doctors, insurers, health and wellness companies, pharmaceutical companies and other health care entities.

The revolution going on in healthcare to truly understand the person, how they live, its impact on their health, the creation of a two-way stream of data and impactable information is being fueled by companies like Validic.

Join Chris Edwards, their Chief Marketing Officer as I learn more about Validic, their services and growth brought to you by Health Innovation Media.

 

 

 

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Heading to HiMSS: What I’m Looking for in Population Health – Can you wow me?

I have been to the last few HiMSS conferences and each year population health is a big topic.  It seems everyone is talking about population health. From booth to booth, the vendors discuss how they are doing population health; when in fact each of these vendors brings a potential solution to some segment of the population health ecosystem. Population health is so broad that to do it completely requires collaboration between the person, family, providers, vendors, non-profit organizations, communities and the government.

But there are unique features I’ll be looking for from vendors in this space.  I base these features off the Population Health Alliance Framework for Population Health from the Outcome Guidelines Version 6. The framework is at the bottom of this post.

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Thinking About Patient Engagement and Meaningful Use – What’s Missing

A few months ago I was presenting as part of a panel at a Central and North Florida HIMSS Chapter event entitled Meaningful Use / Patient Engagement / HIE: Experiences from the Trenches… and tying it all Together for the Benefit of the Patient!.  (Slides Here)

My excellent co-panelists were all hospital executives, IT staff or consultants discussing the various meaningful use rules, where their organization’s were in the implementation process,  how they got there and lessons learned. When it was my turn to present, having been asked to focus on engagement, I offered the audience a few questions before beginning:

  • How many of you use email as your primary form of communication?  A large number of hands went up
  • How many of you use telephone calls as your primary form of communication? Another group of hands went up
  • How many of you use text messages? Still another group of hands went up

This was followed by the comment, if you all use different forms of communication, how many of you have a patient portal that shows more than one page to a patient about any given topic? Is there any difference in language, literacy, video versus print versus audio based upon the patients unique needs?   Not a hand went up.

A fellow panelist then said, “you know I have a very large Hispanic population, they can’t do anything with my portal.” Bingo!

Suddenly attendees understood that when one of the executives from a large health system had earlier stated they had  11,000 hits to their patient portal since implementation, that this was a start but more was needed given the tens of thousands of patient interactions the hospital and its physicians had every month. And on the discussion went as the presenters and participants began to analyze what they had done and what is needed to truly engage and make their systems meaningful to their patients.

Rules such as Meaningful Use are okay, they are a step on the road to creating something useful for the patient, but they don’t get to the heart of the problem.   If patients go to your site and have a very low literacy, they probably can’t comprehend your site, or perhaps they  learn better via videos instead of text, or perhaps they don’t use the web at all. All of these issues and many more must be factored in to the systems we are building to communicate with and engage patients. We must provide services to the person in the unique way and level that they need and respond to.

Meeting the Federal requirements allows us to check the governments standards box, but probably not the patients. We as an industry need to go beyond the requirements and develop systems that are truly meaningful if we plan on  “tying it all Together for the Benefit of Patient!”

 

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