Dr. Mike Cantor grew up in a healthcare home. His dad was a solo practice family physician and his mom worked in the practice. He developed an interest in healthcare policy from an early age, as he heard his dad describe the challenges serving his patients and dealing with insurance companies. As a geriatrician and an attorney, Mike focused on care for the elderly.
I met Mike years when he was chief medical officer at NEQCA and have stayed in touch with him over the years. He’s an expert on the healthcare system, so I decided to tap into his thoughts about the last year of the pandemic.
In this episode of the HealthBiz podcast, Mike and I talk about the impact of digital technologies in bringing healthcare closer to patients, how payment systems are changing to support telehealth and home care, what’s new in nursing homes, and how disparities are baked into the system.
Mark Frank has a great sense of timing. He graduated from West Point just in time for 9/11 and had a summer job at Lehman soon before its collapse. Then a few years ago, he had an insight that a mental health wave was coming as stigma fell, mental health parity rules took effect, and as stresses increased. He co-founded SonderMind where as CEO he’s helping make behavioral health more accessible, approachable and utilized.
In this episode of the HealthBiz podcast, Mark describes how his upbringing in Atlanta, Japan and Germany shaped his outlook and how family members have influenced his enlistment in the military and his path with SonderMind.
At Health Business Group, we have two decades of experience in developing robust strategies for telehealth and remote patient monitoring companies whose strategic opportunities and challenges are similar to SonderMind’s. If you need strategy consulting help, please reach out.
Weight loss is a top New Year’s resolution. Noom is a great app with human coaching to help people lose weight and keep it off. Noom can be expensive, but can you get Noom for free? Does health insurance pay for Noom? In my case the answer was yes.
At Blue Cross Blue Shield of Massachusetts, weight loss reimbursement is offered alongside fitness reimbursement. They’ve made it much easier to understand since I requested reimbursement last year.
Here’s the FAQ for “What qualifies for weight loss reimbursement?”
Participation fees for hospital-based programs and in-person Weight Watchers sessions
Participation fees for Weight Watchers and other non-hospital programs (in-person or online) that combine healthy eating, exercise, and coaching sessions with certified health professionals such as nutritionists, registered dietitians, or exercise physiologists.
Notice, Noom isn’t officially named on the list even though Weight Watchers (not nearly as good as Noom) is. But I called Blue Cross and they told me Noom was reimbursed. When I submitted my request for reimbursement online it was paid right away.
This is the best of all benefits because there’s no co-pay, no co-insurance, no prior authorization and it doesn’t come out of my deductible.
Here’s the simple form I filled out online in 2020:
Does your plan pay for Noom? I don’t know, but it might. And it should. Losing weight and keeping it off is a win-win. It makes you healthier and saves the health plan money on medical costs.
With the digitization of health care records, you’d kind of expect that electronic medical records could talk to one another. Alas, the US healthcare system is still a veritable tower of Babel. It’s a real mess for patients, doctors, hospitals, labs, etc. trying to share information. And the pandemic has made things worse as people get testing and care in different places than they’re used to. Thanks to healthcare, the fax machine is still alive and well in the third decade of the 21st century.
But people like Drew Ivan haven’t given up. They’re working nonstop to turn the promise of healthcare interoperability into reality. As Chief Product and Strategy Officer of Lyniate, Drew is building digital connections throughout the healthcare ecosystem.
If interoperability seemed like a vague concept a year ago, the COVID-19 pandemic has made it concrete for many people trying to share healthcare information across practice settings. I asked Matthew Michela to comment from his vantage point as CEO of Life Image, which bills itself as the largest medical evidence and image exchange network.
What has the pandemic revealed about data-sharing infrastructure in healthcare? Is the answer different for other industries like financial services?
Healthcare is decades behind financial services when it comes to customer-centric, protected data sharing. The pandemic has magnified the many clinical, operational, and infection risks associated with the outdated data-sharing infrastructure in healthcare, which relies heavily on faxes, paper, and CDs. However, the problem isn’t a lack of technology. The problem has been the business, financial, behavioral, and cultural resistance to data interoperability. This pandemic demonstrated that data interoperability isn’t an existential threat.
In radiology, nearly 80% of the transactions that Life Image sees are the processing of images that are sent on a compact disc (CD) into a digitally shareable format online. During a pandemic, the last thing any clinician wants is for a patient to show up in the ER clutching a CD that has touched multiple points in its workflow. Nor is it in the best interest of patient treatment to lack access to critical data such as a lung x-ray for treatment decisions.
What are the implications for healthcare interoperability?
In recent years, interoperability between large, tertiary hospitals, and their primary referral sites have made gains, but connections with smaller community referral sites and patients remain virtually nonexistent. This has a detrimental impact on care coordination and the risk of disease spread. Complex data is notoriously difficult to access. Locked in proprietary silos, this critical information is not accessible in a timely and efficient manner or requires manual intervention. Faxes, PDFs, CDs, and thumb drives are unreliable, especially during a massive emergency, and having no clinical information available happens way too often. It is imperative, during this public health crisis, that there is a flow of data through digital connections for attending healthcare workers to have as much relevant clinical data in advance as possible. A lesson learned the hard way, data interoperability must be a priority and resources should be reallocated to break down data silos and turn data into information. Frictionless data sharing is no longer an existential threat. All of a sudden, because of the pandemic, the hazards of no interoperability are tangible.
How do the ONC and CMS interoperability rules interact with the pandemic?
COVID-19 has manifested a critical need for exactly what the rules require: the advancement of interoperability and digital online access to clinical data and imaging, at scale, for care coordination and infection control. For decades, accessible healthcare data has been limited to structured data typically found in claims systems and, more recently, electronic health records (EHR). While this information identifies procedure type and cost, it has very limited clinical value. Now, more than ever, it is imperative that healthcare workers have as much relevant clinical data in advance as possible. Access to data for post-acute care monitoring is equally as important, as much of it will be done virtually. Patient data needs to be digitally accessible and analyzed by geographically dispersed care teams. The pandemic demonstrated why the rules were needed long ago and have helped fast-track interoperability even as ONC delayed compliance with the information blocking rules a second time.
What role does the cloud play for healthcare data? What are the advantages and disadvantages? Does the pandemic change anything?
Think out a decade or so. All the data silos are gone, and there will be better access to all sorts of clinical data. This will be because of the cloud. Cloud-based solutions support the availability and scalability of health data. Providers will have access to valuable patient data from numerous sources, enabling better care coordination and treatment decisions. Research teams will be able to access diverse sets of patient data to advance understandings in medicine and drug development. AI developers will be able to more effectively train algorithms on diverse datasets and increase the validity of machine learning. Standardized data in the cloud will accelerate innovation. The cloud is often viewed as a threat by providers or facilities because it means giving up control of data, but it’s not their data to control. Or there tend to be unsubstantiated concerns surrounding the privacy and security of the cloud. In the shadows of big tech, this is where healthcare is heading.
What role is Life Image playing in the pandemic? What adjustments have you made from a year ago?
With nearly 15 years of experience building interoperable tools and a mature digital network, Life Image has a number of established tools to assist during this public health crisis. Patients’ lives can depend on data running across the Life Image network. Our customers depend on our network to provide uninterrupted ability to care, coordinate with other physicians, and to minimize health risks to their own employees. Exacerbated by the pandemic, we launched two new solutions to help alleviate these needs:
Patient Connect Portal (PCP): Given the fact that Covid-19 is a respiratory illness with significant secondary impacts on other organs such as the brain, liver and kidney, the ability to collaborate around medical imaging data and bring that information to the point of care is critical. We launched a comprehensive portal called Patient Connect Portal that gives patients the ability to collect, own and share their health data with their care team. Most patient portals do not give patients ownership of data nor do they have the ability to collect diagnostic images due to the complexity of that type of data. The patient portal combines both diagnostic images with their medical data for a more meaningful clinical picture of a patient’s history.
Life Image Network Connector (LINC): As I previously mentioned, the larger AMCs and urban centers have pretty good connectivity. The severe gaps occur in more remote, rural regions and with smaller healthcare institutions. To alleviate this gap, we created a solution specifically designed for this segment of healthcare innovators, community hospitals, imaging centers and physician groups who don’t have a large IT staff or budgets. LINC provides the ability to quickly get up and running with a solution that enables bi-directional exchange of diagnostic images and reports with other facilities or patients electronically.