Lenovo Health

The third gathering of the Health Innovation Think Tank brought together a diverse group of leaders, innovators and policymakers to identify best practices that can move the industry toward key clinical models associated with value-based care, connected health and virtual care.

Technology is ubiquitous in today’s healthcare environment. Yet hospital and healthcare organizations’ struggle to make the most of their technology investment is equally pervasive.

As the population ages, the demand for clinical care is rising rapidly. At the same time, the healthcare industry is dealing with a shortage of physicians and nurses. It’s a difficult equation, at best. “How can healthcare organizations provide the right clinical resources to a larger patient population while maintaining or improving the quality of care? It’s not easy to bend the cost curve when there are so many challenges in the healthcare delivery environment,” said Tom Foley, director, global health solutions strategy at LenovoHealth. Thought leaders gathered at The Health Innovation Think Tank, Adoption and Policy at a Crossroads, held at the UPMC Center for Connected Medicine in Pittsburgh on October 10th, pointed to the fact that virtual care just might be the factor that can help to solve healthcare’s current conundrum. Co-hosted by Lenovo Health, Justin Barnes Advisors, Center for Connected Medicine (CCM), Inventiv Health and HIMSS Media, the event brought some 50 healthcare delivery system, payer organization and healthcare IT vendor thought leaders together to offer their insights on myriad industry issues. Indeed, virtual health solutions can help to extend provider’s reach and close the care gap that is currently making it difficult to meet value-based care’s call to improve outcomes while simultaneously reducing costs. For example, as part of its Re-engineered Discharge (RED) program, Boston Medical Center is using “Louise,” a virtual patient advocate to deliver discharge instructions and education at the bedside. Louise communicates directly with patients, teaching them about components of their care, such as their prescribed medications, follow-up appointments and diagnoses.  “We know that nurses don’t really want or have a lot of time to do patient discharge,” said Brian Jack, MD, professor and chair of the Department of Family Medicine at Boston University School of Medicine and Boston Medical Center. Yet, properly conducting thorough patient discharge sessions can significantly help to improve quality and reduce costs. In fact, some 20 percent of patients experience post-discharge adverse events and about 20 percent of Medicare patients are readmitted to the hospital, according to Jack. A virtual solution could help providers offer a better discharge experience and, in turn, improve quality and reduce costs. “Peter Drucker would have said that this is an enormous problem with billions of dollars on the table and the solution is to just teach the patients what to do when they come home from the hospital,” he pointed out. Through the RED program, Boston Medical is doing just that and, as a result, has experienced a 20-percent reduction in readmissions and 25-percent reduction in emergency department (ED) visits, according to Jack. Considering the fact that 75 percent of homes are expected to have smart speakers by 2020, the potential for virtual solutions to close the care gap in a variety of scenarios is great, according to Bill Rogers, CEO of Orbita. Because everyone is accustomed to using voice, virtual assistants can engage patients in a natural way and “lower the friction” when used to teach patients about diseases such as diabetes; act as a personal assistant to help patients book appointments or record symptoms; or serve as a lifestyle coach to help people track fitness goals and stick to diet plans, Rogers said. While virtual solutions can be used in many ways, Sylvan Waller, MD, principal at Waller MD, pointed out that healthcare organizations must rely on virtual care and telehealth best practices that “have been developed over the past 30 years. This is not just an overnight success,” he said. For example, telehealth solutions work best when they are integrated into the “fabric of care delivery,” not when they are used as a stand-alone solution. In addition, organizations must implement change management programs that secure the physician and care team buy-in needed to support virtual health initiatives. While interest in virtual care is on the rise and its potential is great, Jack suggested that more widespread adoption might not be realized until value-based care actually becomes the dominant payment model. In fact, despite the fact that value-based care is gaining ground, many health organizations are still operating under predominantly fee-for-service models. As such, Jack noted, some leaders want to learn how to use virtual technologies to improve care and reduce readmissions but don’t want to “actually flip the switch” until they have stronger value-based incentives to do so.

While it’s difficult to predict what will happen next in Washington, there is certainty around one thing. The industry needs to “move from volume to value-based care. Everyone is on the same page about that,” said Jeff Coughlin, senior director of federal and state affairs at HIMSS. Coughlin led a discussion at The Health Innovation Think Tank, Adoption and Policy at a Crossroads, a one-day event held at the UPMC Center for Connected Medicine in Pittsburgh, and co-hosted by Lenovo Health, Justin Barnes Advisors, Center for Connected Medicine (CCM), Inventiv Health and HIMSS Media. The Think Tank brought some 50 healthcare delivery system, payer organization and healthcare IT vendor thought leaders together to offer their insights on a variety of issues. Under the emerging value-based care model, which clearly centers on improving clinical care outcomes, what happens outside of the traditional care setting is becoming more important than ever before. As a result, HIMSS is supporting initiatives such as the “Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2016” and the “Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017.” CONNECT is specifically designed to remove barriers to the use of telehealth and other healthcare technologies such as remote patient monitoring, resulting in greater access to high-quality care, improved continuity of care and better value for patients and the Medicare program. The pending legislation could help to accelerate  delivery of care organizations’ connected health efforts, as they continue to focus on finding ways to “increase patient empowerment,” which will help to traverse the existing care gap, said Tom Foley, director, global health solutions strategy at LenovoHealth. “Sometimes, it’s not what happens in front of a physician or while on the phone with a care coach, it’s what happens during the time when patients are on their own – and that’s where connected health technologies come into play,” he pointed out. Indeed, the goal for health systems and hospitals should be to “keep patients away from the hospitals and sustain them in the trajectory toward wellness as opposed to only curing illness,” said Rasu Shrestha, MD, chief innovation officer at UPMC and executive vice president at UPMC Enterprises. As such, the healthcare industry should move toward the “bedless hospital,” a model that focuses on delivering more care in the patients’ homes and less care in the hospital setting. The easier-said-than-done proposition, however, requires a strategic approach that moves beyond simply uttering “buzz words.”  To start, the key to successfully sustaining a bedless hospital lies in “incentivizing the behavior changes that will sustain the residents of the community toward wellness,” Shrestha said.  To do so requires “leveraging some of the principles of design thinking and engaging end-users. It is really important to engage them in the design of the solution before a single line of code is even written,” he added.   Such efforts could help to more precisely meet consumers’ needs. For example, by working closely with chronic care patients, leaders at Livongo have discovered these patients actually “hate dealing with their diseases” and don’t necessarily want to engage more. Instead, they want to “engage less and experience better health,” said Jim Pursley, chief commercial officer at Livongo. To this end, the company is re-engineering chronic condition management to elegantly integrate everything patients need into an experience they will love – which requires providing patients with the optimal level of engagement.  Such efforts could mean providing patients with the opportunity to pass data via a variety of devices to care providers in an effort to “liberate data in the intelligent home environment,” according to Chris Fickle, director of sales at Qualcomm Life. “When we talk about the connected experience we look at anything and everything being connected – disposable devices, patches, smart phones, tablets, personal assistants. Things that we don’t necessarily think about being connected today could be connected tomorrow,” Fickle said. To truly enable intelligent care, however, organizations need to adopt variety of best practices to ensure that data is connected, continuous, (near) real-time, secure, highly reliable and liquid. By adopting these and other best practices that were uncovered during the Think Tank, the healthcare industry can truly move toward the successful realization of value-based models and can “create a connected ecosystem that supports a virtual care environment and ultimately brings value to all constituents – providers, payers, and most importantly patients,” Foley concluded. 

The Health Innovation Think Tank, Adoption and Policy at a Crossroads, held at the UPMC Center for Connected Medicine in Pittsburgh, on October 10th, discussed how healthcare organizations can truly embrace value-based care.

The Health Innovation ThinkTank, Adoption and Policy at a Crossroads brought together more than 50 healthcare thought leaders across the industry including care delivery systems, payer organizations and health IT innovators, to examine best practices.

Currently, the typical patient waits 29 days to see a physician, according to a recently released survey from Merritt Hawkins. And, it could get worse. The country is expected to experience a shortage of about 90,000 physicians by the year 2025, according to the American Academy of Medical Colleges.  As a result, patients are apt to seek primary care for minor ailments such as a cold of flu through emergency departments – or to simply go without any treatment whatsoever.  Delivering care under such conditions could become virtually impossible.  “Access is a huge problem in American healthcare,” said Sylvan Waller, MD, a physician executive. Waller served as one of the catalysts during The Health Innovation Think Tank:  A Collaboration of Global Health Industry Thought Leaders, an event that was co-hosted by Lenovo Health, Justin Barnes Advisors, University of Pittsburgh Medical Center/Critical Care Medicine , Inventiv Health and HIMSS Media. The good news is that virtual care could solve this access dilemma. Indeed, remote monitoring, secure communication and telehealth solutions can connect doctors to patients directly while also addressing healthcare’s triple aim and reducing the need to seek care in inappropriate, high-cost settings. “When all of these virtual technologies are leveraged, a virtual connected health eco-system is created. Consumers can then engage with providers through these virtual systems – and the home becomes the primary care setting.  Technologies such as the Alexa app, with applied health skills, becomes every consumer’s trusted health assistant,” said Tom Foley, director, global health solution strategy at Lenovo Health. The big question: Are healthcare organizations ready to migrate to virtual care delivery? “The technology is there. Consumerism is there. People expect services on demand and they want concierge care,” Waller said. “It is coming. However, [virtual care] is just not quite there yet as barriers to adopting it are much harder than we thought about.”   Steve Aylward, senior vice president of partner enablement at Change Healthcare, agreed.  He explained how he sees both strong demand and challenges on the horizon for virtual health. “Reader’s Digest recently ran an article telling its readers that they have to have three popular telehealth apps. So, when Reader’s Digest starts telling its readers they need something, it is definitely becoming mainstream,” he said. To optimize virtual health’s potential, however, organizations need to overcome a variety of challenges associated with: Regulatory and legal requirements. “In the U.S., prescribing regulations are huge,” Waller said. Many states limit clinicians to providing treatment only to patients who are located in the state where the caregiver is licensed to practice. In addition, clinicians need to establish patient doctor-patient relationships, assess the patient and come up with a treatment plan. Consumers, however, should not be restricted by such constraints, according to Foley.. “This is where we lose patient engagement,” he said. “We should have the choice and the option to work with doctors in other states to get advice. This state barrier should not be an inhibitor. The legislative policies that restrict this need to change.” Trust in virtual health services. “Consumers don’t know the difference between telehealth providers. There is no brand recognition,” Waller said. “When a health system lends their brand, however, those patients have much more trust and adoption is much better.”  Understanding payment rules. According to Jeff Coughlin, senior director of federal and state affairs at HIMSS, Medicare beneficiaries may receive telehealth services in a variety of settings. Current Medicare law (SSA Section 1834(m)), however, restricts telehealth payments by the type of services provided; the geographic location where the services are delivered; the type of institution delivering the services; and the type of health provider. The good news is that payment concerns are becoming less onerous. Indeed, a 2016 Consumer Telehealth Benchmark Survey where just 34 percent of respondents cited reimbursement as an adoption barrier, compared to 72 percent in 2015. Recognizing the sweet spot. Organizations are beginning to realize that virtual care needs to expand to be financially feasible. “Everyone in the 1.0 version of virtual care is realizing that just treating cough, cold, congestion is a losing business model,” Waller said. “So, as they move to the 2.0 version, they are realizing that they need to get into chronic care management.”

The average patient with five chronic conditions typically will sit in front of a doctor for only 15 out of the 8,760 hours in a year.

There’s plenty of discourse and dissent about the future of healthcare in the United States. Value-based care, however, seems to be eliciting support from all corners, according to Jeff Coughlin, senior director of federal and state affairs, HIMSS. “Everyone is on board with value-based care” as there is both economic and clinical quality justification for the model, Coughlin said during The Health Innovation Think Tank: A Collaboration of Global Health Industry Thought Leaders held on June 22nd at Lenovo headquarters in Durham, N.C. The challenge, however, rests in overcoming obstacles that stand in the value-based care path, according to some of the approximately 50 healthcare delivery system and healthcare IT vendor thought leaders gathered at the symposium, which was co-hosted by Lenovo Health, Justin Barnes Advisors, University of Pittsburgh Center for Connected Medicine, Inventiv Health and HIMSS Media. Holly Miller, MD, CMO at MedAllies, Fishkill, N.Y., for example, pointed out that innovative technology only accounts for about 20 percent of the transformation equation with the other 80 percent hinging on process and workflow redesign.  “In the United States, we have spent 30 billion on the adoption and implementation of digitized healthcare information. We have made progress but we have not really leveraged that investment,” said Miller, who was serving as one of the thought leader “catalysts” at the event.  Consider the following: One in five patients experience an adverse event after being discharged from the hospital, despite the fact that technology is capable of performing real-time document transfers to primary care physicians. The problem is that such electronic communication only accounts for 20 percent of the critical components of the discharge process. To truly experience value, organizations must heed the other “80 percent,” which includes processes such as discharge medication reconciliation, clinician-to-clinician hand-offs, scheduling an appointment with a primary care provider within three days of discharge and placement of a phone call to the patient within 24 hours of discharge. Patient identification is another challenge that organizations must address as they share health records across the continuum of care – regardless of EHR. Tom Foley, director of global health solution strategy at Lenovo Health, reflected on the fact that he, like many other consumers, sees various providers and “all of my data is in different locations and they all know me differently.” As such, when transitioning from one care setting to another, organizations are often besieged with problems such as duplicate medical records, medical identity theft and payment fraud. Unique patient safety identifiers can eliminate these problems by enabling organizations to match patients with records. A unique patient safety identifier is not an alphanumeric value someone can view, but it is an encrypted token that can also be leveraged in a deterministic-matching algorithm that allows healthcare organizations to know with 100-percent confidence they have the right person. These identifiers can outperform other methods such as the enterprise master patient index, which employs probabilistic matching and is only accurate about 80 percent of the time. While leaders must address issues such as process redesign and patient identification, they also simply need to make the move to value-based care. The fact of the matter, however, is that the majority of care is still delivered via fee-for-service models and many healthcare organizations are not quite ready to make the change. The situation reminds Leigh Williams, administrator, business systems at the University of Virginia Health System, of an old fishing theory that says a fisherman can catch a large bounty of fish while a storm is coming in, but “you have to do a risk/reward analysis to know when to bring the ship in from the storm.” Indeed, although organizations know that they will need to come in and adopt a value-based model, it is difficult to “pivot because [they] are still catching fish in the fee-for-service model,” she concluded.

HIThinkTank is a dynamic group of health industry leaders dedicated to leveraging their collective wisdom in an effort to share best practices and positively affect public policy.