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Number Of Healthcare AI Investments Climbing Rapidly

Posted on August 31, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I’ve written frequently about the growing influence of artificial intelligence tools on healthcare delivery. These include not only support for advanced analytics and adaptive processes but also a growing number of clinically-oriented chatbots.

As far as I knew, these trends were early in their lifecycle, and ventures dipping their toes into healthcare AI were still just dots on a map. Apparently, I was way off on this one.

According to a recent article from CB Insights, healthcare has been, and continues to be, the top industry for AI investment deals. According to the company, there were 29 venture capital investments in healthcare AI last quarter, and from what analysts are saying, that number may rise substantially over the next few quarters. In fact, analysts noted that as of late August, it looked like this quarter’s level of healthcare AI deals would beat the previous quarter’s results.

Just to be clear, CB Insights’ definition of “healthcare AI” covers a lot of ground. The firm defines AI in healthcare as occurring when startups leverage machine learning algorithms to reduce drug discovery times, provide virtual assistance to patients or improve the accuracy of medical imaging and diagnostic procedures – plus some additional unspecified additional applications. (Its list does exclude hardware-focused robotics startups and health-related AR/VR ventures.)

Still, even if you peel away the drug discovery, research and diagnostics investments, there’s plenty of VC deals to track. For example, UK-based Babylon Health raised $60 million in funding the past quarter, the largest funding round tracked by CB Insights. Perhaps this is less surprising given that Babylon Health’s first VC deal included money from Alphabet’s DeepMind Technologies, a nice pedigree for any startup, but it’s still a huge deal. (As you’ll see if you click the link, DeepMind has plenty of healthcare IT development of its own going on.)

Other interesting funding deals included investments in mental health startup Spring Health and risk analytics company OM1, which snagged $15 million in Series A funding. Also, CB Insights found that while most deals involved US companies, four healthcare AI investments went to companies in India and three to companies in China.

Having absorbed this data, I’m eager to see whether my pet interest makes it onto CB Insights’ radar for Q3 of this year. You may already have a general idea about how AI is being deployed in predictive analytics for use in clinical care improvement, or to increase researchers’ ability to pinpoint genes for precision medicine projects, but you may not be aware that another hot application for AI use in healthcare is to provide counseling (and perhaps, in the future, psychiatric services) via chatbot.

I find these services particularly interesting because psychotherapy via AI has some characteristics which differentiate it from many other forms of AI-driven clinical options. One standout is that people may actually tell a chatbot more than they will a live person in some cases, which makes such bots helpful in supporting populations (such as soldiers with PTSD) which might be unlikely to open up otherwise. Let’s see if such applications attract big VC investors anytime soon.

Positive Patient Experience with an EHR is Possible

Posted on August 30, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Last week I had a rare healthcare experience – something that I had only read about in blogs and on Twitter – a physician showed me what he was entering into him EHR while I sat beside him in the exam room! I’m not ashamed to admit that my first thought was “I can’t believe this is really happening”.

The doctor must have noticed how I quickly moved my seat closer to the large monitors because he chuckled and asked me: “How long have you been in healthcare?”. After sharing a laugh he went on to say “It’s rare that patients take a keen interest in what I’m keying into the system. It’s usually other healthcare people that want to see what’s going on. Are you a nurse or a physician?”

When I told him I was in Healthcare IT field he smiled and said “Ah that would have been my third guess.”

For the next 20 min he would type a line of notes, point to the screen and then share his reasoning with me. I asked him questions on clinical terms that I did not understand, at which point he would bring up a resource that had a definition. If he didn’t have a ready resource, he explained it as best he could and then encouraged me to look it up on a trusted site like Mayo Clinic’s.

Near the end of the appointment, the doctor asked me if I was involved with EHRs. When I asked him why, he said the most intriguing thing – “because it’s clear to me that the people who design EHRs (a) have never actually seen a patient in an exam room – it’s ridiculous how awful the screens are and (b) never thought that one day doctors would sit beside patients to let them see what they are entering.”

The latter statement has been churning through my mind ever since.

There is little doubt that the majority of EHRs are less-than-well-designed. Physicians everywhere complain about the amount of clicking required to navigate their EHRs and the number of fields they have to enter. The prevailing opinion is to improve EHRs by getting closer to physicians and actually studying how they really conduct a patient visit. This will certainly yield positive results.

But what if we designed an EHR that was meant to be displayed on a big screen? One that had screens that the patients would see as the doctor entered his or her notes? I believe that designing for this type of usage would result in a more significant improvement in usability and have a more positive impact on patient experience than building EHRs based on better observation of physician workflow.

Consider the phenomenon of open kitchens in the restaurant industry. For diners, being able to watch the kitchen staff prepare meals helps to pass the time while waiting for your order. It also allows the diner to see how talented the chefs are – because they can see them working. For staff, an open kitchen often means that the restaurant has put a lot of thought into optimizing food prep workflow. After all, no one would choose a layout that had staff constantly bumping into each other in full view of diners.

If a company designed an EHR that could be shared with patients, they would not only improve the interface for physicians, but they would also provide a means for that physician to improve the overall patient experience.

I hope that more physicians adopt the practice of sharing their EHR screens with patients during a visit. Doing so will immediately improve patient experience and will push vendors to improve their solutions at a far greater pace.

Fear, Loathing, and Documentation. Why Do Doctors Still Say They Hate EHR?

Posted on August 29, 2017 I Written By

The following is a guest blog post by Daniel Sabido, Director of Product Marketing at CareCloud.

It’s been 10 years since the start of the modern EHR era. Why do doctors still report hating the technology so much? Electronic health records (EHR) have been fairly universally villainized in surveys of physicians. Here’s a recent sampler for you:

  • 54% of physicians reported being unhappy with their EHR system in 2014, according to an American EHR survey.

  • 82% of users in a survey by Peer 60 said they would actively discourage other medical professionals from using one particularly hated EHR vendor.

  • Physicians blame EHR for lost productivity — spending more time on documentation (85%) and seeing fewer patients (66%) in an IDC report on tech dissatisfaction.

What’s happening in healthcare? Is EHR really the most universally despised technology in America? Or is it a scapegoat for other changes in medicine? Let’s take a closer look at a couple of key trends:

A higher standard for EHR

Crucially, not all EHRs have been created equal. For years, the health technology market was swamped with expensive, server-based systems. These antiquated platforms were easily 20 years behind your average first-generation iPhone and looked more like Windows 95 than Mac iOS 10. When Meaningful Use incentives were prescribed under the 2008 economic stimulus plan, it created a surge in adoption for a technology landscape that frankly was not ready for primetime. Medical practices and physicians were right to complain about this rushed technology.

In recent years, we’ve seen a readjustment with a hot rip-and-replace market for EHR technology. Software Advice found that the number of clinicians replacing their EHRs increased 59% between 2014 and 2015. They’re not just upgrading to better systems; these medical groups are seeing the huge advances made in other industries and moving to the cloud. Black Book Rankings reported in 2015 that 7 out of 10 small medical practices were using a cloud-based EHR.

Changing health economics

At the same time that healthcare technology has been getting better, the economic pressure on medical practices and physicians has been getting more intense. The shift to value-based care and other policy changes have increased administrative burden. “About 80% of physician burnout is really due to workflow issues…the electronic medical record has contributed to burnout as one component,” said Steven Strongwater, a rheumatologist and CEO at Atrius Health in a New England Journal of Medicine interview.

It’s not just the recording process, but how much physicians are being asked to record that is interfering with the clinical workflow. There’s an epidemic of “just one more thing” creep in regulatory policy. Asking physicians to record a relatively simple new health marker, such as smoking status, can quickly compound into an extra hour a week of work. EHR systems don’t need to just keep up, they also need to speed ahead of increasing efficiency drag in the practice of medicine.

Perception vs. reality

Health technology has undoubtedly created stress on physicians in the past decade. Research also shows tremendous benefit. Contrary to the common belief that EHR gets in the way of patient experience, research shows that patients prefer it when their physician uses a computer. A whopping 76% of patients said they prefer their doctor to use EHR over paper charts, according to a survey by the Office of the National Coordinator (ONC).

In our 2017 Practice Performance Index, we found that high-performing medical practices were twice as likely to be adopting new health technology compared to practices that were falling behind. In our upcoming Patient Experience Index, a full 85% of patients said that it was important for medical practices they visit to be “modern and up to date.”

What comes next for EHR?

I believe we’re entering a new era of EHR in healthcare. Thanks to the shift to cloud-based systems, there is a faster pace of innovation in the sector. Cloud-based systems can roll out upgrades in a few hours, instead of a few months of costly consultant-driven updates. We’re seeing a new focus on tools that intelligently streamline administrative tasks and that connect what happens inside the exam room with the patient experience outside it. The same kind of technology that helps recommend movies on Netflix and send friendly timely reminders on Runkeeper are coming to healthcare, helping physicians provide a better patient experience and improve overall outcomes.

There are also new risks emerging to this rosy future. Meaningful Use created bad behaviors in the EHR market — the kinds of rote, administrative bulk that led to physicians despising their systems. MACRA could be heading down the same path. Can health technology companies stop history from repeating this time?

At the end of the day, patients want their doctors to be using modern technology, and patient satisfaction is a crucial part of the shift to value-based care economics. Physicians who want to be successful in their practice will need to find a way to love their EHR — or look for one that can keep up with new demands. It’s up to those of us in the health technology sector to meet them halfway.

About Daniel Sabido
Daniel Sabido is CareCloud’s Director of Product Marketing, where his responsibilities span the entire portfolio of products, and is particularly focused on identifying trends that will affect the performance of medical groups across the country. Previous to joining CareCloud, he was an Engagement Manager at OC&C, a global management consultancy, based in their London HQ where he focused on B2B clients. Daniel has also held strategic planning roles at McCann Worldgroup in New York and at the Monitor Group as a consulting analyst.

Daniel holds an MBA with Distinction from the London Business School and completed his undergraduate at the University of Pennsylvania’s Wharton School with majors in Finance and Operations.

MACRA Monday: MIPS Imposes A Major Burden

Posted on August 28, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

A new study by the Medical Group Management Association has concluded that most practices find participating in the MACRA Quality Payment Program to be very challenging. The study, which focuses on regulatory burdens affecting group practices, also identifies several other rule-related challenges practices face.

In its press release, the MGMA notes that almost half of practices surveyed said they spent more than $40,000 per FTE physician each year to comply with various regulations. Nonetheless, they continue to participate in programs that reward them despite the hassles involved.

According to the research, the vast majority of respondents are participating in the Merit-Based Incentive Payment System (MIPS) this year, and 72% said they expected to exceed the minimum reporting requirements.

That being said, their success clearly hasn’t come easily, with 82% of practices rated MIPS as either “very” or “extremely” burdensome. Within MIPS, groups cite clinical relevance (80%) as their top challenge. Seventy-three percent of survey respondents said MIPS doesn’t support their practice’s clinical quality priorities.

In fact, many respondents said that complying with MIPS was like pulling teeth. Over 70% reported that they found the MIPS scoring system to be very or extremely complex, and 69% said they are very or extremely concerned that unclear program guidance will impact their ability to participate in MIPS successfully.

Eighty-four percent of respondents agreed or strongly agreed that if Medicare’s regulatory complexity were reduced, they could shift more resources to providing patient care. Their frustration is palpable, as the following anonymous comment illustrates: “The regulatory and administrative burdens have dramatically increased over the past two years. However, the biggest problem isn’t the increase itself, [it’s] that the increase is for no good purpose.”

Other programs respondents named as very/extremely taxing included national electronic attachment standards (74%), audits and appeals (69%) and lack of EHR interoperability, followed by payer use of virtual credit cards (59%).

It’s interesting to note the disconnect between the number of practices participating in MIPS (and seemingly, crushing it) and the complaints most are making about participation. Clearly, given how painful it can be to comply with the rules, most practices see their involvement as necessary from a financial perspective.

It’s unlikely that this participation it will get much easier in the near future, though. Eventually, as regulators keep taking feedback and streamlining the MIPS program, they may be able to streamline its requirements, but I wouldn’t hold my breath waiting for that to happen.

3 CEO Perspectives on Medication Adherence – Part 3 of 3

Posted on August 25, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on medication adherence.

This is part 3 in a 3 part interview on medication adherence. Be sure to read part 1 and part 2 as well.

Q: How can technology be harnessed to collect patient-reported outcomes such as real-time symptoms and perceptions of medications?

DVS: Propeller sensors passively collect information about use of inhaled medications and transmit that information through a smartphone to Propeller. Then, the system tries to make sense of how the person is doing, to estimate their level of risk and impairment, and to report back its impression and suggestions through digital apps and interfaces.

We ask people to add details about their symptoms, tell us what they perceived to have triggered their episode, and to answer periodic questionnaires that provide other kinds of information, such as whether they are waking up at night. Altogether, this information teaches us a lot about how asthma is affecting that individual in their daily life and how they are responding to treatment.

With this combination of self-reported information and medication use data, Propeller is able to inform physicians about which of their patients need more attention, to help them better understand what might need adjustment to gain control of the symptoms, and to encourage collaborative efforts to improve its care and treatment.

JB: I think this concept has a lot of merit in managing adherence, because if we can get people to communicate with us about how they’re using their medicine and how their medicines are making them feel in real-time, then we can more actively detect and overcome those barriers to nonadherence before they become a decision to stop the medicine.

Phone calls and mobile apps alike can be used to collect information from patients, assess how the medication is working, and tailor the intervention program.  For example, we use our live pharmacist call center to collect patient-reported outcomes and potential reasons why patients may have trouble using their medications as prescribed.  Response rates to digital approaches are typically lower, but they are also less costly.

CH: This is a critical issue because most technologies today, especially electronic health record systems, aren’t really set up to store anything beyond basic patient clinical factors. We need a lot more technology today that can go beyond these basic factors.  We need to think about socioeconomic, patient-reported outcome measures, and other factors to really improve our understanding of medication adherence. How effective a medication is, what outcome it’s really delivering for certain types of patients, and really looking at technologies that are sophisticated decision support systems that capture all this at the point of care, similar to what we’re doing at RxREVU, with our prescription decision support platform, and capturing those key socioeconomic factors.

If we know the patient has a poor adherence, why is that happening and is it a side effect? Is it a socioeconomic factor? What are those patient-reported outcome measures we can capture and store and then longitudinally feed that data across a whole host of patients to better understand how those factors are affecting adherence?

At the patient level, we’re looking at really simple technologies today, Even text messaging is a great solution, especially for many low-income patients that may not have a smartphone, to engage with them and capture that information.

We don’t need sophisticated apps yet. We’re not there at all, in terms of capturing these types of measurements. It’s really about these simple technologies that can engage a patient with a simple question, allow them to answer that through a technology like SMS, and then obviously store that information and make it available to stakeholders to evaluate and better understand adherence issues. Those are definitely some things I think about, as we start to get better at capturing patient-reported outcomes measures that directly affect adherence.

Additional Comments

JB: There’s an exciting tidal wave of interest in the topic of medication adherence across the healthcare system. Fifteen years ago, pharmaceutical companies were the only ones investing heavily in medication adherence. But this has changed dramatically, especially over the past six to seven years.

It’s changed because of new evidence that helped us better understand the consequences of non-adherence as a population health management problem. This stimulated the development of consensus-based quality measures for medication use.

Today, health plans, providers, pharmacies and pharmacy benefit management companies are increasingly being compensated based on the quality of care they deliver—and that is an incentive to improve adherence to critical medications. RxAnte’s products and services are used by all of these stakeholders—and in the years ahead, we want to facilitate unprecedented collaboration among these parties to help patients get more from medicines.

CH: In terms of adherence, we at RxREVU really take a different point of view. Many companies are focused clearly on the patient’s experience and around adherence and how they improve that. But ultimately, all these decisions start at the point of care. We are solely focused on helping the provider at the point of care make the most informed decision that’s going to drive an appropriate prescription to the patient, that they can afford, and they can adhere to.

As we look to the future, I think this is a critical piece that we need more and more technologies at the point of care supporting clinician’s decisions, because ultimately, you as the patient aren’t making the decision; your provider is. That’s sometimes missed, and providers are a key component to the decision-making. It is really is a shared decision-making and technologies that can sit alongside those patients and providers in the exam room and support those decisions are really going to be critical in the coming years.

This was part 3 in a 3 part interview on medication adherence. Be sure to read part 1 and part 2 to read the full interview.

About David Van Sickle

David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.

About Josh Benner

A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it.  He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.

Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.

Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.

About Carm Huntress

Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001.  After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations.  He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.

After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world.  He managed the transition of the core technology platform and team for growth.  In 2013 he moved to Denver where he founded RxREVU.

3 CEO Perspectives on Medication Adherence – Part 2 of 3

Posted on August 24, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on medication adherence.

This is part 2 in a 3 part interview on medication adherence. Be sure to read part 1 and part 3 as well.

Q: A recent study by the Journal of the American Board of Family Medicine underscores the emotional and behavioral barriers faced by patients with chronic illnesses. How do we leverage technology to reduce the impact of social and economic factors such as poverty, transportation challenges, and medication costs?

DVS: We know that, in some cases, people avoid taking their daily medicines for asthma because they’re costly and they can’t afford the required co-pay or co-insurance amounts. But without those medications, people are more likely to develop symptoms, and may have to spend quite a lot of their discretionary income dealing with the costs of uncontrolled asthma, whether it’s because they’re forced to miss a day of work or school, or because they need to seek medical attention. The faster we’re able to help bring someone’s disease under control, the sooner they can avoid unnecessary costs and suffering.

We know that a lot of things in the environment, such as workplace exposures or air pollution in the community, can have a material effect on a person with chronic respiratory disease. By learning about the locations where people have symptoms, Propeller aims to help them avoid or mitigate those exposures.

For the past few years, Propeller has been part of program in Louisville to help residents better manage their asthma and to collect information about where, when and among whom asthma is happening across the metro. Aggregate data from thousands of participants has highlighted how socioeconomic context contributes to poor respiratory health. At the same time, by making these patterns visible, we’ve also opened new opportunities for municipal discussion, policy decisions, and applied public health interventions to try to address these risk factors, and to increase the respiratory health of the entire community.

JB: These are really important barriers. The cost of medications is going up. That makes them unaffordable for some patients, and those are often the patients that are also most vulnerable to the consequences of non-adherence—like low-income and older Americans for whom these medications are really important to them staying out of the hospital, keeping a job, or otherwise living independently. So, we are increasingly doing work in the Medicare, Medicaid and dual-eligible populations. We use advanced predictive analytics to identify members of those populations who are at risk, which means we predict whether they’ll be able to be adherent to the medications that have been prescribed for them.

More than that, we also predict the consequences of their expected adherence. For example, we’ll predict what their non-adherence is likely to cost over the next year or two. That score enables us to prioritize members of those populations tailor programs to the patients who are most likely to benefit.  Another technology we developed, RxEffect, allows us to deliver this information in prioritized workflows to physician offices or care managers, so they always know in real time which of their patients need their attention and what problems to focus on.

Different interventions can solve for different barriers. We use telephone outreach with interactive voice response, because that’s an effective way to facilitate a refill for a patient. On the more intensive end of the spectrum, we use live pharmacist care managers to make sure that they understand the importance and the benefits of remaining adherent and to troubleshoot drug therapy problems that the patient might report.  If they say, “I’m having a side effect with this med,” or, “I can’t afford this med,” the pharmacist is able to go back to the patient’s prescriber, get it changed to something that the patient might find more tolerable or more affordable, and call the patient back to offer to help get that prescription filled.

A third approach is to use so-called “digital therapeutics” or a combination of digital devices and communication tools to maintain long-term engagement with the patient. These services can be delivered through mobile phones like secure text messaging and secure chat to create an ongoing dialogue with the individual.  That provides a conduit to deliver things like a video on how to use your asthma inhaler correctly, so that you and your asthmatic child can use that medicine correctly and stay out of the hospital. Or to deliver a co-pay assistance coupon or some other patient assistance tool provided by the manufacturer to overcome the cost barriers for that particular patient. This is potentially cost-effective and scalable because of the growing mobile and smartphone adoption among these populations.

CH: First and foremost, socioeconomic factors need to be brought into the equation in terms of determining what medication is right for a patient, which will ultimately lead to their adherence. Things we specifically look at are concepts around, for instance, pharmacy deserts, and the challenge for patients, because of public transportation combined with the location of specific pharmacies can lead many patients, especially low-income ones, into situations where they don’t have access to a supermarket or pharmacy within a reasonable distance, that has a pharmacy where they can get their medication.

Another issue is cost and understanding of patients’ income and what they’re ultimately going to be able to afford. Patients won’t take medications or won’t be adherent to medications they can’t afford, period. There’s really no way around that and I think that’s something that is directly tied to socioeconomic factors.

Technologies that can bring those concepts forward and identify those socioeconomic factors up-front and address them in both the exam room as well as the patient’s in a process of getting their medication filled or refilled are going to be critical, because there are a lot of programs that can support patients’ costs. Obviously identify these patients and help support them. There’s a lot of data out there that’s just not being collected and brought together cohesively and made easily accessible to patients to find and access this type of information. I think those are some critical things that really relate to the socioeconomic pieces of adherence.

This was part 2 in a 3 part interview on medication adherence. Be sure to read part 1 and part 3 to read the full interview.

About David Van Sickle

David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.

About Josh Benner

A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it.  He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.

Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.

Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.

About Carm Huntress

Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001.  After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations.  He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.

After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world.  He managed the transition of the core technology platform and team for growth.  In 2013 he moved to Denver where he founded RxREVU.

3 CEO Perspectives on Medication Adherence – Part 1 of 3

Posted on August 23, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Medication adherence has been called the least-appreciated aspect of medicine but its impact is certainly noteworthy.

A recent report, “Adherence and Health Care Cost,” characterized it as “an important public health consideration, affecting health outcomes and overall health care costs” and estimated between 20 and 50 percent of patients are non-compliant with drug therapy.

Additionally, poor medication adherence following hospitalization costs the U.S. healthcare system roughly $100 billion annually, according to a New England Journal of Medicine study.

As our healthcare system moves to value-based reimbursement, technology will help improve medication adherence rates. With this in mind, KNB Communications recently interviewed three leaders in healthcare technology – Propeller Health Co-founder and CEO David Van Sickle, RxAnte Founder and CEO Dr. Josh Benner, and RxREVU Founder and CEO Carm Huntress – to get their insights on this important topic.

This is part 1 in a 3 part interview on medication adherence. Be sure to check back and read part 2 and part 3 once they’re published.

Q: What are some solutions for addressing the top reasons for medication adherence failure:

  • Medications never getting to the patient
  • Medications not being taken correctly
  • Medications not being refilled

DVS: At Propeller, we focus on respiratory disease. We spend all of our time and attention trying to figure out ways to help people with asthma and COPD better and more effectively use the medicines that they take to prevent symptoms from occurring.

These are daily medicines that are subject to factors such as: people forgetting to take them; people not understanding them; people thinking that they’re taking them correctly but not, in fact, doing so; or people trying to negotiate or even intelligently adjust their regimens in one way or another, to benefit their life or for their own understanding of medicine.

Propeller builds devices that capture information about the day-to-day use of those medications and attempts to understand the patterns with which people are taking them or not. Then, we’re able make use of that information through digital interfaces and experiences, to try to encourage, educate, coach, and remind people about how to better manage their condition.

Across the market we’re seeing the creation of digital interfaces and experiences that are tightly coupled to medications that aim to make them more personal, more accessible, and more convenient. These start from thinking about medications from the patient’s perspective, and asking the question: How can you simplify and strengthen these regimens in ways that makes them easier for people to understand and use?

JB:  The adherence failures you identified are an all-too-common cascade of risks for anyone prescribed a medication.  If the patient never fills a new prescription, we call it “primary non-adherence.”  This happens for 20-30% of new prescriptions written.  Of those who fill a prescription, about 50% don’t take it correctly, or stop prematurely.  Effective solutions need to understand why these failures occur, and prevent them from happening.  Our perspectives on this are informed by decades of research and our direct experience managing 8 million people’s medication adherence for health plans around the country.

Some of the reasons people don’t take medications are because they’ve decided, for what they think are good reasons, not to take the medication. This is actually most of the non-adherence that we observe in our work managing population-level adherence.  People either think that the medication didn’t work for them, that they experienced a side effect or fear a side effect that someone else told them about, or they made a choice not to pay for it because of its cost. Essentially, they considered the risks, the benefit, the convenience and the cost, and made a conscious decision not to take the medication.

Other patients want to be adherent but may be forgetful, have complex regimens they don’t understand, are inadvertently taking a drug incorrectly, can’t get access to the pharmacy or the product, or they want to take it but can’t afford it. That’s a different set of barriers.

Our approach is generally to predict who is at risk of these failures, determine the likely barriers, and then deliver an appropriate intervention that can overcome the barriers.

For patients who may choose not to adhere to their therapy, the answer is education and close follow-up, to make sure that they understand why they’re taking the medicine, how to take the medicine, what to expect from the medicine, so that they know it’s working or know it’s not working.  Close monitoring of lab values or clinical signs and symptoms can show them whether the medication is having the intended effect for them, and help them put that benefit in perspective relative to any side effects they may be feeling.  The goal here is to prevent non-adherence.

We published some work several years ago showing that in patients starting a cholesterol medicine, if you get them back into the doctor’s office within the first three months for a cholesterol test – their likelihood of being adherent over the subsequent year is far higher than if they don’t return for another lab test in that time period.  This notion of demonstrating the benefit of treatment early in therapy is really important because it balances against what they might perceive to be as the expense or the inconvenience or the side effects.  And it prevents non-adherence.

For the patient who is already receptive to therapy and wants to be adherent, we use interventions that address different barriers. This is where things like reminders, pillboxes, special unit-dose packaging, financial assistance programs, and home delivery can be helpful.  We’re trying to make it possible for the patient to be adherent to the regimen.

CH: I think when it comes to the refill issue and even first-fill challenges; the thing we really looked at is cost.

Our data indicates about a third of abandonment issues are usually due to cost concerns for an individual patient. A lot of that has come down to transparency. Any technology that can help bring that transparency, not only to the patient but also to the provider at the point of care, is going to be critical in creating a successful engagement and encouraging the patient to fill that medication and continue to take it.

Sadly, in many cases, there are alternatives that are less expensive that would still be clinically effective for the patient. But the provider and the patient are just unaware of what’s covered, what it would cost, and any programs that may enable the patient to get that medication at a lower cost. And so, I think that addresses that third point. In terms of the first point, what we look at is the friction from the point of prescribing to the pharmacy, to that fulfillment.

Today, there’s a huge amount of friction that really needs to be removed from the process, leading to abandonment and poor adherence. Many times, there’s a prior authorization on a drug and there is another drug that doesn’t have a prior authorization, so the patient gets to the pharmacy, can’t get it filled, and has to go through the prior authorization process, which can take days or weeks to complete.

We think that situation leads to poor adherence and has to be solved. Technology that can not only support that process and speed it up for the patient but ultimately solve it at the point of care, dealing with the PA immediately and not burdening the provider and the patient afterwards will be critical to the success of increasing that patient’s adherence. I also think about site of fulfillment, which can make a huge difference if that pharmacy a patient’s using is in network or out-of-network. Where is it on their plan?

Many times, the patient’s unaware or their provider is unaware of that. And so, technologies that can bring that information forward and help guide that patient to the right site of fulfillment are critical. It can be an actual physical pharmacy or even mail order. Anything from a technology standpoint that can address those issues is really going to have a massive impact on adherence.

To learn more about medication adherence, check out part 2 and part 3 of this medication adherence interview.

About David Van Sickle

David Van Sickle is co-founder and CEO of Propeller Health – the leader in respiratory digital health. David received his PhD in medical anthropology. His dissertation research, funded by the National Science Foundation, examined the rising prevalence of asthma and allergy in India. He was then an Epidemic Intelligence Service officer at the Centers for Disease Control and Prevention in Atlanta, where he was assigned to the Air Pollution and Respiratory Health Branch. During this time, he provided epidemiological support to the National Asthma Control Program, and investigated the health effects of a variety of environmental exposures. In addition, he helped establish emergency illness and injury surveillance in coastal Mississippi after Hurricane Katrina. David was also named a Champion of Change by the White House for his work on innovation.

About Josh Benner

A leading voice on medication adherence, Dr. Benner’s award-winning research and numerous publications have shed new light on the problem of nonadherence and identified promising approaches to improving it.  He is the founder and CEO of RxAnte, the leading provider of predictive analytics and targeted clinical programs for improving medication use.

Before joining RxAnte, Dr. Benner was Fellow and Managing Director at the Brookings Institution’s Center for Health Care Reform, where he focused on medical technology policy.

Prior to Brookings, Dr. Benner was principal at ValueMedics Research, an analytic and consulting services firm. Following the acquisition of ValueMedics by IMS Health in 2007, he served as senior principal in health economics and outcomes research and global lead for medication adherence at IMS. Dr. Benner received his Doctor of Pharmacy degree from Drake University and his Doctor of Science in health policy and management from the Harvard University School of Public Health.

About Carm Huntress

Carm Huntress is an entrepreneur and strategic leader with over 20 years of experience in startups focused around consumer and enterprise technology. His first web development and hosting company he started while in high school was eventually acquired in 2001.  After finishing his degree in electrical engineering at Northeastern University in 2004, he went on to work for PlumVoice, an IVR and voice technology startup, where he ran their network operations.  He later was asked to run product development at My Perfect Gig, a Northbridge and Commonwealth Venture start-up.

After two years as CTO at Reef Partners, where he ran the technology for a number of portfolio companies, he became CTO at Audiogon.com, the largest high end audio site in the world.  He managed the transition of the core technology platform and team for growth.  In 2013 he moved to Denver where he founded RxREVU.

Intelligent Analytics, Clinical Decision Support, and EMR As a Skill

Posted on August 22, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s time for a quick Twitter round up where I highlight a few tweets from around the Twittersphere and add some of my own commentaries. I hope you’ll join in the comments and share your perspectives on these tweets.


I agree with Lalit that it’s clear that the patient owns the clinical data. The real problem is that many healthcare organizations don’t act like patients own it. We need that culture change to occur in many parts of healthcare. However, Lalit is aso correct that the data needs to be married to intelligent analytics if we want the data to be extremely useful for both patients and their care providers. We’re starting to see this happen.


I’ve often thought that CDS (Clinical Decision Support) is the oft forgotten feature of an EMR and that it likely should get a lot more attention than it does. Dr. Harvey is correct that the CDS inside an EMR is the largest feature that contributes to the intelligence of the EMR system. However, the CDS gets so little attention. I know that’s not true in many EMR implementations where vast committees scour the CDS to ensure that it satisfies the care requirements and guidelines they want to follow in their organization. However, CDS doesn’t get nearly enough press. I think that needs to change since much of what can be accomplished to improve care in the EHR is going to be CDS.


This was great to see Dr. Stewart acknowledge and highlight how learning to use an EMR is a skill that needs to be developed just like deliveriers and sutures are a skill to be developed. I’ve seen so many doctors who complain about their EHR, but they also chose not to spend the time learning how to develop the EMR skill. They just thought that they could start using it with no training, no real workflow evaluation, etc. Skills have to be developed and learned and that’s true with the EMR as well.

Leveraging New Age Technology to Overcome MACRA Challenges – MACRA Monday

Posted on August 21, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Dr. David A. Goldman, CEO and founder, Goldman Eye and Ophthalmology Team Lead, Anterior Segment at Modernizing Medicine.  This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program (QPP) and related topics.

MACRA and the Quality Payment Program (QPP) were implemented by the Centers for Medicare & Medicaid Services (CMS) to improve healthcare by focusing on the quality of care provided to patients. There are two paths under the QPP: the Merit-based Incentive Payment System (MIPS) track which covers most clinicians, and the Advanced Alternate Payment Models (APMs) track which applies to providers who have taken on some risk related to patient outcomes (Medicare Shared Savings 2,3 and Next Gen ACO participants for example).

MACRA and MIPS are intended to advance quality based care by implementing outcome-based payment adjustments. Providers will be measured across a number of different performance categories and will be paid on a curve. By 2022, physicians who outperform their peers may receive up to a 9 percent positive payment adjustment on their Medicare reimbursements based on their performance in 2020. Those who report poor performance may receive up to a 9 percent negative payment adjustment on their Medicare reimbursements in 2022.

Specialtyspecific Measures & Bonus Points

As previously mentioned, if you perform better than your peers when it comes to MIPS, you can substantially increase your Medicare reimbursements. Conversely, reporting a score below the performance threshold could prevent you from receiving a positive payment adjustment on your Medicare reimbursements, and not reporting on MIPS could cause you to be penalized.

Some MIPS categories will be the same across all specialties such as Advancing Care Information and Improvement Activities, whereas others can be geared towards a specialty, like Quality. Quality accounts for 60 percent of your total MIPS score in 2017. As an Eligible Clinician (EC), you should select six measures, including one Outcome Measure or if an Outcome Measure is not available, a High Priority Measure. After your first Outcome or High Priority Measure, any additional ones you report will count towards your bonus points (up to six points). In addition, an EC can earn another six points by doing end-to-end reporting. More information on the measure specifications can be found here.

Under the Advancing Care Information (ACI) category, ECs have the option to earn 5 bonus points by being in active engagement with a specialized registry, which are typically specialty-specific. The third category of MIPS is called Improvement Activities (IAs) which has over 90 activities to choose from. ECs, regardless of specialty, can choose activities that apply to their practice size and way of practicing like expanded practice access and closing the referral loop. Depending on the IA selected, ECs can also earn a 10 point bonus under the ACI category.

How can we turn this change into an opportunity?

A major factor in succeeding in MIPS is the use of today’s latest technology. Innovative electronic health record (EHR) systems, which can collect and organize clinical data in a structured format, empower doctors to extract meaningful insights at the patient and population levels. Instead of relying on any one physician’s narrative assessment or unstructured data for a diagnosis or treatment, physicians who have access to an interoperable platform can reference relative findings from their peers while eliminating redundancies, automating communications and improving patient outcomes.

How Do You Track Your Performance

The answer is certainly not using pen and paper. Look for a certified EHR vendor that has technology which provides services and products that can track data in real time and provide analytics to show your progress and outcomes. You want MIPS intelligence directly built-in to your EHR system.

Modernizing Medicine offers a specialty-specific suite of products and services that gives physicians added support. modmed Ophthalmology™ helps ophthalmologists transition to MIPS by providing them with quality data and reporting capabilities with the products and services they provide. Included within the suite is the company’s flagship EHR system, EMA™. EMA provides functionality for automated quality data capture, population health registries, real patient engagement and analytical tools, plus the ability to submit MIPS right to CMS.

I have been utilizing EMA for the past few years and am also a team lead on Modernizing Medicine’s ophthalmology team. As a practicing ophthalmologist, I have gone through the process of spending countless hours documenting patient reporting following a long day in the office. Couple that with ensuring my compliance measures are in check – it adds up. Now, my measures are completed efficiently, accurately and securely, ready to be submitted to CMS at the end of my reporting period. I even led a webinar on the topic of MIPS, if you want to see it in action.

EHR System Checklist for MIPS

From my unique perspective of working for an EHR vendor and utilizing the certified technology in my practice, I’ve shared a few qualities to look for in an EHR to support your reporting needs:

  • 2014 / 2015 ONC Certified
  • Integrated MIPS intelligence
  • Built in Improvement Activities
  • Qualified MIPS Registry
  • Automated data capturing and reporting
  • Built-in, real-time analytics reporting for Quality, Resource Use, Advancing Care Information and Improvement Activities
  • A vendor with an all-in on solution, including the ability to submit MIPS right to CMS
  • Advisory services and consultation during MIPS transition and reporting

While there is much work to be done in terms of keeping up with and understanding today’s fast-paced healthcare landscape, one thing is for certain – the proper use of specialty-specific technology can help alleviate hours of extra work, stress and physician burnout. As noted above, there are certain aspects of MACRA that apply across all specialties, whereas others are specialty-specific and working with a vendor that can guide you along this MIPS journey can be crucial to your financial success.

David A. Goldman, M.D. is the Ophthalmology Team Lead, Anterior Segment at Modernizing Medicine and founder of Goldman Eye in Palm Beach Gardens, Fla.

Medical Groups Struggling To Collect Payments Promptly

Posted on August 18, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Particularly as patients assume responsibility for more of the costs of care, it’s getting harder for providers to collect on outstanding bills.

My recent look at a dashboard created by the Medical Group Management Association certainly underscores the point. The story it tells is a grim one. Despite their best efforts, few practices are succeeding at meeting RCM challenges.

The MGMA intends the dashboard, which focuses on the number of days bills spend in Accounts Receivable, to give medical groups some benchmark RCM data. It relies on data from the group’s 2016 DataDive Cost and Revenue study, and allows users to view (at no cost):

  • Mean percentages of accounts receivable aged 0-30 days, 31-60 days, 61-90 days, 91-120 days and over 120 days
  • Mean days gross fee-for-service charges in A/R
  • Meeting days adjusted fee-for-service charges in A/R

It also allows users to select a specialty group type, including primary care, nonsurgical, surgical and multispecialty practices and look at their specific profile.

For example, the dashboard reveals that roughly 50% of accounts held by primary care practices spent a mean of 0-30 days in A/R, 11.2% of accounts were aged 31-60 days, 6.9% were at 61-90 days, 6.2% stayed in A/R for 91-120 days and 25.4% for 120+ days in A/R.

The MGMA page also stated that primary-care groups had an overall average of 61.86 adjusted days in A/R and 35.60 gross days in A/R.

Does that sound depressing? Well, it should. What’s more, other specialties’ performance was nearly as bad in some categories and even worse in others.

Look at the performance of nonsurgical groups. Only 44.7% of nonsurgical groups’ revenue came in within 30 days in A/R or less, almost 13% of accounts averaged 31-60 days before being paid, and almost 15% of accounts spent between 61 and 120 days in A/R. Twenty-eight percent of accounts had a mean 120+ days in A/R before being satisfied.

The other stats were even worse. For example, nonsurgical groups’ accounts spent a mean of 88 days in A/R and 46.2 gross days in A/R. Not very encouraging.

Even well-paid surgeons weren’t exempt from this problem. Most of the account aging stats were distributed similarly to the other specialty areas, and only 28.2% of accounts in this area spent more than 120 days in A/R. However, adjusted days in A/R came in at 136.7 and gross days in A/R at 54.

Meanwhile, the tally for multispecialty groups was a bit better, but not much. Account aging benchmarks were very similar to primary care practices, and adjusted days in A/R came in at 69.4.

Most of you probably had an idea that medical groups were facing these kind of collection problems, even if you didn’t have these benchmark numbers in hand. The thing is, they were even worse than I feared. (An acquaintance working in medical billing called the results “comical.”)

I don’t know what percentage of the accounts in question were self-pay, but given that self-pay is becoming a steadily higher proportion of medical practice revenue, these stats are pretty bad news. Something’s gotta give eventually. Plus, we’ll have to keep tracking how this data trends over time.