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Telehealth and Its Contribution to Healthcare

Posted on December 6, 2017 I Written By

The following is a guest blog post by Juan Pablo Segura, Co-founder & President of Babyscripts.

In 2016, Americans spent roughly 18% of GDP on healthcare. Abetted by an aging population and continuously rising costs of care, CMS projects that this number will only grow over the next decade, increasing at an average of 5.6% annually. A crisis seems unavoidable: yet a huge fraction of this sum is lost to inefficient spending, which, when compared to other factors like an aging population, socio-economic challenges, or expensive new treatments, seems completely within the industry’s control to control and eliminate. A new OECD report calculates that approximately 20 cents out of every dollar spent on healthcare are considered unnecessary.

Could a simple reallocation of time and resources be enough to check the seemingly inevitable? The potential cost-savings of such a reallocation has policymakers and health professionals poised to revolutionize healthcare, as an industry that has long been resistant to innovation rejects antiquated models of care for more efficient methods that prioritize patient and provider alike.

A simple resolution that is already allowing more patients to receive necessary and important primary care is the extension of care teams through mid-level providers that cost a fraction of the salary of a full time physician. Physician’s Assistants and nurse practitioners are being granted more autonomy, as State governments remove restrictions while enacting legislation that grants PAs and other personnel full prescriptive authority. Allowing these lower cost health professionals to perform routine, primary care instead of more expensive, specialized physicians, immediately eliminates inefficiencies in the system and increases access to care to patients in the midst of a physician shortage.

These changes in personnel are necessary, but not enough to respond to the changing face of care. The answer to more affordable care is in leveraging existing technologies.

The rapid adoption of synchronous, video visits between patients and providers across the country is an exciting example of how technology can eliminate waste and help the system reallocate its resources. Recognizing its potential to decrease the administrative demands on providers and facilitate access to patients in remote areas, the industry has placed great emphasis on this aspect of telemedicine, even to the extent of providing incentives to providers for facilitating care through video.

But far from being the solution, video visits just scratch the surface of technology’s potential contributions to affordable healthcare, and in fact are the least beneficial of the efficiencies that technology is poised to provide. Some studies have indicated that when video visits are included in a medical plan, patients tend to treat them as an add-on, rather than a replacement for traditional in-person care. Furthermore, without integrated systems, video visits function much as if a patient were receiving all medical care at the ER, producing a fractured and incomplete medical record.

The dialogue must be centered on those innovations that revolutionize the way we approach healthcare, not simply attempt to translate an outdated system into a world that has evolved past it.

The conversation needs to focus on the most relevant, effective and impactful technology tools to affect the ultimate cost of care. Already, forward thinking providers like Greenville Health are creating end to end “virtual strategies” that rely heavily on remote monitoring apps and asynchronous visits that have the capacity to identify the problems before they begin. Beyond the immediate benefit of proper allocation of time and resources, the ultimate goal of technological innovation in healthcare has always been the opportunity to identify potential problems and create the necessary infrastructure to allow our healthcare system to focus on preventative health.

Of the healthcare apps currently in the digital marketplace, some have been shown not only to decrease costs but to be as successful as medication in preventing complications, anticipating a future of decreased prescription costs. Remote monitoring programs that use IOT devices like blood pressure cuffs and weight scales have reduced the cost of prenatal care by 40% while detecting problems like preeclampsia and other high-risk illnesses. Yet there is very little coding or direct payer incentive for deploying preventative technologies like that provided for video visits.

And why not? Video visits are a move in the right direction, but the decrease to cost of care does not have to come at the expense of the client/physician relationship or integrated care. Instead, effective technology should cut costs while assuring patient and provider of the continuity and efficacy of care.

The conversation amongst policymakers needs to expand to include these more revolutionary aspects of digital health, rewarding those who are effectively reducing costs without compromising care. Digital health will not be confined to a narrow vision, but it is up to the government and the industry to expedite the future of healthcare.

About Juan Pablo Segura
Juan Pablo Segura is Co-founder & President of Babyscripts, a Washington, DC-based technology company that builds mobile and digital tools to empower women to have better pregnancies. Juan Pablo was named a Wireless Life Saver by CTIA and a health care Transformer by the Startup Health Academy in New York City.

Telemedicine Becoming Popular, But Seldom Profitable

Posted on October 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.

New research suggests that while most physicians are supportive of telemedicine, others have grave reservations about providing this type of care, and that more than half of organizations aren’t making money delivering telemedicine services.

In an effort to learn more about attitudes toward telemedicine, Reaction Data surveyed 386 physicians, physician leaders, IT leaders and nurse leaders as well as differences in adoption levels between different types of organizations.,

Some of the top benefits of telemedicine cited by respondents included that it helped providers to meet demand for simpler and more cost-effective care delivery (28%), allowed them to treat more patients (23%) and that it was easing demands on staff (19%). Interestingly, just 10% said that telemedicine was proving to be a viable source of revenue, and elsewhere in the survey, 14% reported that telemedicine was revenue-negative.

The majority of physicians (68%) reported that they were in favor of telemedicine, while another 15% took a neutral position. Only 17% didn’t support widespread telemedicine use.

Their responses varied more, however, when it came to how much of care could be effectively delivered via telemedicine.

Thirty-two percent felt that 0 to 20% of care could be delivered this way; 33% of physician respondents felt that 30 to 40% care could be delivered digitally; 19% of respondents said 50 to 60% of care could be provided via telemedicine; 14% felt that 70 to 80% of care could be provided digitally. Just 2% felt that 90 to 100% of care could be delivered via this channel.

When it came to actually delivering the care themselves — rather than a hypothetical situation — respondents seemed less flexible. For example, 33% said that they would never contract with an outsourced telemedicine company to provide patient consults.

On the other hand, 50% said they’d considered moonlighting as a telemedicine consultant, 7% said they’d already done so frequently, 8% said they delivered such consults occasionally 2% said that was all they did for a living.

Regardless, many healthcare organizations are adopting this approach on a corporate level. Sixty-one percent of hospitals in a health system said they adopted telemedicine: 40% of standalone hospitals had done so; 58% practices owned by a health system has that this technology. Only 17% of physician-owned practices had done so, which could reflect cultural issues, costs or technology adoption concerns.

Physicians that were delivering telemedicine services most often used them to reach patients in rural areas (24%), provide follow-up care (24%) and manage specific patient populations (23%).

Among organizations that haven’t adopted telemedicine, many are scarcely getting their feet wet. While one in three providers are evaluating telemedicine options currently, 20% are two years or more away from adoption and 26% said they would never move in this direction.

Meanwhile, roughly one-third of physician-owned practices reported that they would never adopt telemedicine. One responding physician called it “inherent malpractice,” and another called it a “blatant attempt to circumvent the physical examination.” It seems unlikely that these clinicians will change their views on this topic.

Is Healthcare Delivery Not ‘Sexy’ Enough for Investment?

Posted on September 1, 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.

On the latest #hcldr tweetchat, guest hosts Pam Ressler @pamressler and Pippa Shulman @drpippa posed an interesting question – why hasn’t the delivery of healthcare been an area of innovation? or put another way – is healthcare delivery not sexy enough to warrant investment?

Ressler and Shulman used the example of online retail giant Amazon. Among its many innovations, Amazon came up with a new way to deliver the retail experience. They found a way to deliver goods to people where and when they wanted it. Their approach to delivery was so good that it has since become the expected norm for anything purchased online.

Ressler and Shulman wanted to know why healthcare delivery wasn’t getting the attention it needed.

Shulman’s comment makes for an interesting thought exercise. Instead of just asking what it would be like if Disney ran your hospital. What if we asked what would happen if FedEx, Dominos or Amazon did. It would be fun to see uniformed “delivery agents” speed-walking through the hospital carrying meals and oxygen tanks.

Deanne Kasim @DKasim agreed with Shulman and Ressler:

Kasim’s “need it, want it” statement really struck a chord with the #hcldr community. It’s not just a case of delivering care in the way that patients want it (ie: Telehealth), we need to think about delivering it in when and where patients need it. Telehealth during regular business hours is helpful, but imagine how much more successful it would be if it were available after-hours when most people are home from work. The same with text messaging and email communication.

Kat McDavitt @katmcdavitt tweeted her frustration with this timing mismatch:

Dr. David Tom Cooke @DavidCookeMD went further and provided a great example of how appointment-booking could use an Amazon-upgrade.

Later in the chat, Dr. Cooke provided an compelling idea. Instead of trying to make healthcare delivery attractive for investment by making it “sexy” (which many believed would be very hard), why don’t we just present it as it is – a difficult and challenging problem.

I believe one of the best ways to spur investment is to have a bold pioneer show the world how successful they can be. Amazon showed the world how shopping online could be as-good-as (and now even better than) shopping in-person. FedEx showed us that next-day delivery could be done affordably and reliably. I believe it will take a healthcare pioneer to help blaze the trail for innovation in healthcare delivery.

For a time, Turntable Health in Las Vegas was one such pioneer. Zubin Damania MD, better known as @ZDoggMD, created a wholistic practice – one that made health a relationship rather than a transaction. They used technologies to engage patients in their care and they helped their patients with prevention as much as treatment.

James Legan MD, who practices in Montana, is another pioneer who projects his EHR so that patients can see what he is entering. He has also linked his EHR to a cloud-based customer-relationship-management (CRM) system so that his practice can be more efficient in the way they serve the community.

There are also practices like Access Healthcare in North Carolina and Izbicki Family Medicine in Pennsylvania that are demonstrating the benefits of direct primary care for both patients and physicians.

Hopefully there is a physician practice pioneer out there today that will become the beacon that will attract more investment in healthcare delivery. If you know of one, please email me or put their name in the comments section.

Amazon Attacking Health IT Opportunities

Posted on August 17, 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.

Getting a footing in the health IT industry is more challenging than it looks. After all, even tech giants like Microsoft, Apple, and Google haven’t managed to take over despite their evident interest in the field.

Apparently, that hasn’t daunted Amazon. The retail giant has pulled together a secret team dedicated to exploring new healthcare technology opportunities, according to a CNBC report. And unlike other companies attacking the space from outside, Amazon has a history of sliding its way into unexpected markets successfully.

According to CNBC the new team, which is named 1492, is working to find an easier way to extract data from EMRs as well as push data into them. In doing so, Amazon is going up against a very wide field of competitors ranging from small startups to the healthcare arms of giant tech vendors and consulting firms.

What distinguishes Amazon’s approach from its competitors is that the online retailer hopes to aggregate that data and make it available to consumers and their doctors, sources told CNBC. The story doesn’t say whether Amazon plans to sell this data, and I don’t know what’s legal and what isn’t here, but my bet is that if it can, Amazon will pitch the data to pharmaceutical companies. And where there’s a will there’s a way.

In addition to looking at data management opportunities, 1492 members are scouting out ways of repurposing Amazon’s existing technology for use in healthcare. As another article notes, some healthcare organizations have already begun experimenting with delivering routine medical information and even coaching surgeons on safety protocols using Amazon voice-based assistant Alexa.  The new group, for its part, will be looking for healthcare applications for existing Amazon products like the Echo and Dash Wand.

The 1492 group is also preparing to build a telemedicine platform. Your first thought might be that the industry doesn’t need another telemedicine platform, and generally speaking, you would probably be right.  But if Amazon can get its healthcare IT bona fides in order, and manages to attract enough doctors to its platform, it could be in a strong position to market those services to consumers.

Make no mistake: We should take Amazon’s health IT effort seriously. At first glance, healthcare may seem like an odd arena for a company best known for selling frying pans and socks and discount beauty supplies. But Amazon has expanded its focus many times over the years and has typically done better than people expected. It may do so this time as well.

By the way, the retailer is apparently still hiring people for the 1492 initiative. I doubt it’s easy to find the hiring manager in question, but if I were you I’d inquire. These jobs could pose some interesting challenges.

Everything Old is New Again at Lenovo #HIThinkTank Event

Posted on June 28, 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 in Durham NC, 35 healthcare innovators gathered at the Lenovo offices to discuss three trendy topics: Value-base care, connected health and virtual care. Dubbed the Health Innovation Think Tank #HIThinkTank, it was the first summit-style event hosted by Lenovo Health.

#HIThinkTank was designed to be an opportunity for audience members to learn about the latest innovations from leading academics, technology companies and healthcare organizations. I went into the event expecting to hear about the latest in artificial intelligence, big data, predictive analytics and genomic medicine. It did not turn out to be that kind of event…and it was all the better for it.

I would say that the overall theme of #HIThinkTank was innovation through the application of old ideas in new ways. In other words, everything old is new again in healthcare.

The day started with Rasu Shrestha MD, Chief Innovation Officer at UMPC Enterprises, emphatically stating that we are “in a time of tremendous opportunity in healthcare” and that it was “time for us to move from ‘doing digital’ to truly ‘being digital’”. Shrestha went on to explain that our challenge now was to reimagine clinical processes/workflows in light of modern technologies and methodologies. Like the re-engineering wave that swept through manufacturing in the 1980s, Shrestha believes it’s time to engage all stakeholders and collaborate on reworking healthcare.

Shrestha was followed by Juliet Silver of Perficient who gave us all a dose of reality by telling her personal healthcare story. The day Silver’s husband was diagnosed with cancer was the day she became an advocate – “Google searching and academic research quickly became my constant companions as we struggled to make sense of his disease.” Silver made specific mention of how she had to manually obtain paper copies of her husband’s medical records in order to share them with members of his care team and what a difference that made in his care. She hinted that patients may be the key to truly solving healthcare’s interoperability problem as they are the one stakeholder with the most to lose/gain.

After Silver, several speakers made their case for a return to a more community-based approach to healthcare – one that harkens back to the days of early pioneers when physicians, nurses and members of the community worked together to keep each other healthy.

Holly Miller MD of MedAllies presented the results of a local implementation of CMS’s Comprehensive Primary Care Plus (CPC+) program – a program that stressed simple post-discharge follow-up as a way to reduce readmissions and keep overall healthcare spending to a minimum. Miller specifically mentioned how community doctors do this all the time.

This was echoed by Marty Fattig, CEO of Nemaha County Hospital, a 16-bed facility 60 miles south of Omaha NE. Fattig spoke at length about the successful EHR, HIE data sharing and population health initiatives by his staff. Particularly noteworthy was his repeated statement: “We may not have the financial or technical resources of the large networks, but we get stuff done because we are all driven to improve the health of our community peers. It makes a big difference that we see our patients at church, at the grocery store and at the post office.” Ironically this old fashioned community approach to delivering healthcare is now the goal of many healthcare organizations.

In the afternoon Steve Aylward of Change Healthcare and Dr Sylvan Waller led the discussion on virtual care by first reminding the audience that over 90% of virtual visits still happen via the phone. Video consults is the fastest growing area of virtual care, but it has a long way to go to catch up to the telephone. Dr Waller said it best “In 30 years #telehealth will finally become the overnight success everyone expects it to be”. Both Aylward and Waller stressed that we cannot lose sight of these “older technologies” that work for patients when we think about innovation.

For me, what drove home this theme of old-is-new-again was the afternoon tour of the Lenovo model data center. This new highly efficient and “green” room prominently featured Lenovo’s latest innovation – direct water-cooled servers. The new NeXtScale WCT server series boasts high pressure water lines that physically run through the server and draw heat directly away from the quad CPUs. Back in the early 90’s I remember getting a tour of an IBM facility (not far from Lenovo’s facility in Durham) that still had a functioning 308X mainframe that featured…you guessed it…water cooling technology.

All in all, I walked away from #HIThinkTank feeling encouraged about the future of healthcare. It was refreshing to be at an innovation event and hear about actual successful implementations rather than pie-in-the-sky promises. The event reaffirmed my belief that technology alone is insufficient to fix healthcare. Those of us in HealthIT need to do more than just create cool products, we need to help clients re-engineer their internal processes to better utilize those products to improve community health.

As Dr Shrestha said – It’s time for us to stop doing digital and truly be digital.

Retail Clinics Are Not the Enemy, Inconvenience Is!

Posted on June 16, 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.

Check out this incredible insight that Gabriel Perna shared on Twitter:

What a great insight and something that most of the entrenched healthcare people don’t understand. Retail clinics are not the enemy, inconvenience is.

In many ways, it reminds me of the approach that taxi cabs took to Uber and Lyft. Taxis described them as evil as opposed to understanding why consumers wanted to use Uber and Lyft instead of a taxi cab. If the taxi cab industry would have understood the conveniences that Uber and Lyft provided customers, they could have replicated it and made Uber and Lyft disappear (or at least they could have battled them more effective than they’ve done to date).

Gabriel Perna further describes the issues of retail clinics and AMA’s approach to retail clinics in his article and this excerpt:

There are many reasons for this phenomenon [growth of retail clinics], but more than anything though, retail clinics are convenient and many physician offices are not. Because of this, the AMA shouldn’t be trying to treat the retail clinics as some kind of foreign invader, but rather use their rise to prominence as a way to guide physician practices forward. For instance, getting in to see a doctor shouldn’t be a three-week endeavor, especially when the patient is sick and needs attention immediately. However, that’s what has happened. Personally, I’ve been told “the doctor doesn’t have anything open for at least a month” more times than I can count.

It’s simple supply and demand. If you or your child needs to see someone immediately because of an illness and your doctor’s office can’t take in you for a week, and there happens to be a retail clinic down the street, guess where you’re going? Any hesitations you may have over your care being fragmented, the limited ability of your retail clinic physician, or anything else will go out the window pretty quickly.

I agree completely with the idea that convenience is key. However, what Gabriel doesn’t point out is that the fact that doctors have a 3 week waiting list for patients is why they don’t care about offering convenience to their patients. They have enough patients and so they don’t see why they should change.

You can imagine the taxi cab industry was in a similar position. They had plenty of people using their taxi service. They didn’t see how this new entrant could cause them trouble because they were unsafe and whatever other reasons they rationalized why the new entrant wouldn’t be accepted by the masses. Are we seeing the same thing with retail clinics vs traditional healthcare? I think so. Will it eventually catch up to them? I think so.

What’s even more interesting in healthcare is that retail clinics are just one thing that’s attacking the status quo. Telemedicine is as well. Home health apps and sensors are. AI is. etc etc etc. All of these have the potential to really disrupt the way we consume healthcare.

The question remains: Will traditional healthcare system be disrupted or will they embrace these changes and make them new tools in how they offer care? It took the taxi cab industry years to adapt and build an app that worked like Uber and Lyft. However, it was too late for them. I don’t think it’s too late for healthcare, but it’s getting close.

Women Executives in Telehealth American Telemedicine Association ATA2017

Posted on May 18, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor.
Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare.
twitter: @coherencemed

Susan Dentzer, Charlotte Yeh, Janet McIntyre, and Janae Sharp at the American Telemed Women Executives in Telehealth Panel

One of the highlights of the American Telemedicine conference in Orlando Florida was excellent coverage of women in telemedicine and leadership.  They had a panel of women in leadership which focused on promoting women in telemedicine and had the best moderation of a panel I’ve seen at a conference.  Highlights of great advice for women in HealthIT were from that panel, and from speaking with women that were tasked with going to the conference as buyers in the telemedicine space.

Charlotte Yeh acted as moderator of the panel. She framed what the panel would cover and what they were not concerned with. She mentioned that we would not cover work life balance since that also applies to men and has been covered on many platforms.  Framing a conversation within the conference and healthcare setting made a huge impact.  Promoting women in telemedicine and HealthIT needs to have a specific framework.

Susan Dentzer, President and CEO of the Network for Excellence in Healthcare innovation suggested making an award for advancing women in leadership in Telehealth.  I’m a huge fan of medals for participation. Every day I get up and when I work out I suspect that I deserve a medal.  The medals for best contribution for advancing women next year should be an amazing ceremony at ATA.

Susan quoted Madeline Albright that “there’s a special place in hell for women who don’t support other women.” Think deliberately about creating something you want to be a part of. This year I’ve personally seen Max Stroud of Doyenne Connections simply create something she wanted to be a part of.

Julie Hall-Barrow invited leaders to find a young woman and become their mentor. Some of the women in leadership in healthcare are happy to promote other women but the promotion seems more strategic than like actual concern. Leaders should purposefully craft their ideal mentor relationship. ATA discussed creating a group dedicated to what women and companies in the telemedicine space would like to do with collaboration.

Paula Guy, when asked what she would tell a younger self, said “first of all I would tell myself not to get married so many times.” Her advice was hilarious and focused on not letting people tell you no. There is a power in knowing what you are capable of and surrounding yourself with other women who are also in that space. Paula’s advice was also to be part of a group that promotes mentors and other women working together.

Kristi Henderson spoke about not being afraid to push boundaries. Never settle until you get where you want to go. The advice and positive belief that women are capable of breaking through boundaries and leveraging their social connecting makes women poised for success despite being underrepresented.

Janet McIntyre, The Vice President of Professional services of the Colorado Hospital association, decided to approach Patrick Kennedy about coming to Colorado to help with the opioid epidemic there. He shared his family story and personal conviction about making a difference and Janet decided to invite him to help with her state.  Women need to be fearless in their ask and expect that people will want to help them succeed.

Rachel Dixon, director of Telehealth for AccessCare services, pointed out that women should have a safe space to discuss gender issues in their work. We can create a place to discuss which companies are working well with women in the telemedicine space and which ask about an older man partner or lack professionalism. I shared a story with her about a potential employer asking if he should consider my job only a work proposition.  Gender issues for a younger woman in leadership can be complex in navigating personal relationship. A soft intelligence network about how a company treats women is valuable for investors and employees.

I was impressed with the positive planning of women in healthcare leadership in telehealth. The thought leadership at this conference was one of the best organized in terms of giving organizations and individuals actionable plans for increasing female technology talent in leadership positions.

Various Medical Practice Model Types

Posted on May 3, 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 EHR vendor (and many other services), Kareo, has put out a practice model guide which they call “Practice Models: The ABCs from ACOs to Concierge and Everything in Between.” With this guide they shared this picture that includes various practice models:

When I see an image like this I’m torn on if this is an extremely exciting time for physicians or if it’s a miserable time to be a physician. One thing is clear, times are a changing. The medical practice models of the past are going to be blown up by new models.

Take for example Telemedicine. Can you imagine any healthcare future where telemedicine is not part of that future? I can’t.

I’m still personally torn on concierge practices. I can see why they’re appealing to so many. I love the idea of unlimited primary care and getting insurance out of primary care. However, it’s not clear to me that this idea can scale across the entire healthcare system. Certainly the rich can do it no problem. Can the concierge model work for the middle and lower class? Many fans of concierge tell me it can. I’m still not so sure.

I know a lot of doctors that are part of ACOs. I don’t know very many that are excited by the work ACOs are doing. Most of them just feel like they need to be part of it to understand the future of medicine. They’re not joining ACOs because they think it’s something that shows a lot of promise for their patients.

I’m probably coming off a little more cynical than I am about these shifts. A number of these changes are really exciting to see happening. However, I’m also not blind to the challenges that many of these medical practice models face.

Needless to say, it’s an exciting and challenging time to be in medicine. The structure of how we pay for healthcare is being questioned and new models are being explored. This can be really exciting if you find yourself tracking the right wave. However, if you miss the wave, then you can be stuck out in the middle of the ocean wondering how you missed out.

E-Patient Update: Hey Government, Train Patients Too!

Posted on February 10, 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.

Recently I got a most interesting email from the ONC and A-list healthcare educator Columbia University. In the message, it offered me a free online course taught by Columbia’s Department of Biomedical Informatics, apparently paid for by ONC funding. (Unfortunately, they aren’t giving away free toasters to students, or I definitely would have signed up. No wait, I’m sorry, I did register, but I would have done it faster for the toaster.)

The course, which is named Health Informatics For Innovation, Value and Enrichment) or HI-FIVE, is designed to serve just about anyone in healthcare, including administrators, managers, physicians, nurses, social workers an care coordinators. Subjects covered by the course include all of the usual favorites, including healthcare data analytics, population health, care coordination and interoperability, value-based care and patient-centered care.

If I seem somewhat flippant, it’s just because the marketing material seemed a little…uh…breathlessly cheery and cute given the subject. I can certainly see the benefits of offering such a course at no cost, especially for those professionals (such as social workers) unlikely to be offered a broader look at health IT issues.

On the other hand, I’d argue that there’s another group which needs this kind of training more – and that’s consumers like myself. While I might be well-informed on these subjects, due to my geeky HIT obsession, my friends and family aren’t. And while most of the professionals served by the course will get at least some exposure to these topics on the job, my mother, my sister and my best girlfriend have essentially zero chance of finding consumer-friendly information on using health IT.

Go where the need is

As those who follow this column know, I’ve previously argued hard for hospitals and medical groups to offer patients training on health IT basics, particularly on how to take advantage of their portal. But given that my advice seems to be falling on deaf ears – imagine that! – it occurs to me that a government agency like ONC should step in and help. If closing important knowledge gaps is important to our industry, why not this particular gap. Hey, go where the need is greatest.

After all, as I’ve noted time and again, we do want patients to understand consumer health IT and how to reap its benefits, as this may help them improve their health. But if you want engagement, folks, people have to understand what you’re talking about and why it matters. As things stand, my sense is that few people outside the #healthit bubble have the faintest idea of what we’re talking about (and wouldn’t really want to know either).

What would a consumer-oriented ONC course cover? Well, I’m sure the authorities can figure that out, but I’m sure education on portal use, reading medical data, telemedicine, remote monitoring, mobile apps and wearables wouldn’t come amiss. Honestly, it almost doesn’t matter how much the course would cover – the key here would be to get people interested and comfortable.

The biggest problem I can see here is getting consumers to actually show up for these courses, which will probably seem threatening to some. It may not be easy to provoke their interest, particularly if they’re technophobic generally. But there’s plenty of consumer marketing techniques that course creators could use to get the job done, particularly if you’re giving your product away. (If all else fails, the toaster giveaway might work.)

If providers don’t feel equipped to educate patients, I hope that someone does, sometime soon, preferably a neutral body like ONC rather than a self-interested vendor. It’s more than time.

 E-Patient Update:  The Impact Of Telehealth Confusion

Posted on January 27, 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 am a huge fan of telemedicine consults. As far as I can tell, all of the chronic conditions I currently cope with can be addressed effectively by a virtual visit unless I’m in a medical crisis.

My reasons are not unusual. Like most people, I hate having to drive to a doctor’s office if I’m already feeling yucky, particularly if it’s not necessary. And since time is money – particularly when you work for yourself like me – there’s some material benefits to telehealth too. Not only that, since I’m a tech fan who lives online, these contacts “feel” as real as face-to-face visits, so I don’t have lingering doubts that I’m not getting much for my money.

Getting a quick visit in regarding an acute medical issue (like, say, a sinus infection) has been pretty easy and relatively affordable as well. But reaching out to a new specialist – or even connecting with my existing providers — is another story. Over the last several months, I’ve encountered a number of barriers which seem to be fairly entrenched in the system.

Garbage contact info

Over the last year, I’ve been with two major health insurers (CIGNA and United Healthcare) whose databases included a list of specialists which were allegedly willing to do telehealth consults. But as it turns out, actually moving ahead with such visits has been impossible.

At one point, I decided to go all out and see if I could actually schedule a telehealth visit with one type of specialist I need. Armed with a list of providers who were supposedly up for it, I called perhaps 15 or 20 offices to see how I could schedule my first virtual visit. But I got nowhere. Most of the physicians simply never returned my calls, and in the rare cases where I got a live person, they had no idea what I was talking about.

I’m assuming that this happened because the doctors had the option to check a “telemedicine” box if they were generally interested in implementing it, and that few if any had actually gone ahead with their plans. But I’m still very annoyed with the whole thing. Sure, insurers don’t have perfect information on hand at any given moment, but isn’t in their interests to steer patients to less-expensive telehealth services if they’re available?

Coverage confusion

Another thing that astonishes me is that while I allegedly have telemedicine coverage via my current insurer (CIGNA) I can’t find anyone who has the slightest idea of how I should use it!  I have called CIGNA’s call center four or five times in an attempt to straighten this out, but none of the reps I spoke with had a clue as to which providers were covered by my policy, if any, and under what circumstances.

At some point, telemedicine coverage will be known as “coverage,” of course. There’s really no reason to segment it out into a separate category if you’re going to pay for it anyway. But at present, if CIGNA is any indication, there’s still some confusion around how and when coverage is even applicable. I can’t understand it, but I can attest to you that such foolishness is a Real Thing.

Launch fears

The other problem I’ve encountered is that while medical practices may have the technical capability to deploy telemedicine, they seem afraid to do so. I’ve asked many of my doctors (and their staff) what it will take for them to begin offering virtual visits, and I’ve gotten a mix of confusion and concern. None, even for example the fairly large and seemingly well-funded PCP office I visit, appears to be anywhere close to rolling out such services.

I can’t prove it, but my sense is that two things are going on here. First, I sense that practice leaders don’t feel ready to take on the technical challenges involved in supporting virtual visits. Though my guess is that security is the only real issue — which can be addressed by using the right vendor — they seem quite timid about even experimenting with this approach. Second, I am pretty sure they’re not sure how to handle billing, or alternatively, what to charge if they don’t bill insurance.

I admit their concerns are reality-based. But I’d argue that the benefits of offering telehealth far outweigh these concerns. Apparently, my doctors don’t agree just yet.

Ultimately, I think we’d all agree that telemedicine uptake will grow by leaps and bounds over the next several years. But it seems we’ll have to deal with a lot of administrivia before that can happen.