Real World Evidence (RWE) is becoming more important in US healthcare, but the fragmented system and lack of interoperability makes it hard to collect and analyze. In this podcast, Life Image CTO Janak Joshi discusses the state of the field and how it’s evolving.
(0:12) How would you describe the evolution of medical data?
(2:36) Real world evidence and real world data are becoming more prominent in healthcare –and for good reason. What are some of the challenges in assembling RWD and RWE? How can they be overcome?
(6:36) Is it really true that unstructured notes are becoming quantifiable and useful?
(9:46) There are major efforts by the US government and private sector to improve interoperability and end data blocking. You have groups like CommonWell and Carequality –now working together. What’s the current state of play and how are things changing?
(13:56) You talk about data brokers like Datavant and HealthVerity. How much of their success is because the US system is so broken? Do you see them having the same success elsewhere?
(17:31) Promoters of AI and Machine Learning –including Life Image—tout the opportunity to revolution healthcare with these new techniques. Is it for real or overhyped? And how does interoperability tie in?
(22:20) What are you most excited about over the next few years?
For the past 14 years, Massachusetts Health Quality Partners (MHQP) has published results of its primary care patient experience survey. The information is useful to the practices themselves as they seek to improve, and to health plans looking to evaluate their networks, improve member service, and pay bonuses to the best practices.
This year MHQP added an analysis of free text feedback to its analysis, to give practices more color on the scores.
The consumer-facing site, Healthcare Compass lets users view ratings for individual practices and compare up to three at a time. Users can click on the individual categories to learn what each one means, what patients can do, what doctors can do, and where to find additional resources. For example, the “what you can do” tab in the communications section includes suggestions to speak up if you want your doctor to make eye contact and to ask the doctor to repeat back what you just said.
I used the site to compare three practices I am familiar with and the results match up well with my perceptions.
There is a lot to like about MHQP’s patient experience reporting including:
It provides validated information on key elements of practices, for both adult and pediatric
The site is easy to navigate. The information is communicated in plain English and with simple, intuitive graphics. For even more detail, you can click on the Harvey balls (I didn’t realize this at first) to get the detail behind the score.
Providers have responded to the feedback by improving performance in key areas over the years, including communications and care coordination
The bottom line “willingness to recommend” percentage provides a useful benchmark for comparing practices
For the first time this year, MHQP issued awards for the highest performing practices for adults and pediatrics and for each domain of care. You have to go to the MHQP site itself to see it, but you can bet the doctors know it’s there!
MHQP has built trust with providers and payers by working collaboratively with them and taking their sensitivities into account when publishing the performance data. Here’s how public reporting of survey results could expand, subject to the consent of providers and payers and additional funding:
Provide more prominence to the actual scores for the measures, rather than just a three-level Harvey ball (full, half full, empty) showing relative performance. The current approach obscures the fact that median scores for certain categories are much higher than others. For example, the mean score for pediatric practices on patient-provider communications is 97.3% compared with 50.3% for empowering patient self care. While we’re at it, it might also be nice to see the range of scores. Does everyone cluster around 50% for self care or do some practices get into the 70s or 80s?
Provide reporting at the level of the individual MD for measures where that’s relevant, e.g., “how well doctors communicate with their patients” and “how well doctors know their patients,” while keeping practice-level reporting for measures such as, “getting timely appointments, care, and information.” The challenge here is that it would require a much bigger budget to reach the needed sample size
Provide a synthesis of the qualitative comments
Provide ratings of specialists as well as primary care
The pushback will be that there are valid reasons to present the information as it is and that expanding will be cost prohibitive, but on the other hand it would make this reliable and validated information more likely to be used.
Congratulations to MHQP for its continued success in shining a light on patient experience and making useful information available to all the stakeholders in the Massachusetts healthcare system.
For many years Massachusetts Health Quality Partners (MHQP) has collected and published information on the patient experience of care in Massachusetts. The outputs have been revealing and very helpful for physician groups seeking to improve and for patients trying to identify the best places to receive care.
But Medicaid (aka MassHealth) patients have never been included. Considering that Medicaid serves more than one million patients and is the biggest item in the state budget, it’s about time to at least understand what’s going on.
MassHealth has contracted with MHQP to conduct a large-scale patient experience survey of Medicaid patients. It was a big enough deal to merit front page, lead article placement in yesterday’s Boston Globe (edging out stories about the shutdown and the Patriots) so it has people’s attention.
The state government will have access to the full results and promises to make some of the findings public. Frankly I hope they’ll publish everything so the general public, physicians and MassHealth patients can learn as much as possible. The more widely the information is publicized, the more likely it will be to have an impact.
I’m looking forward to reviewing and writing about the results of the first survey, which should be available around the start of next year.
What’s worse than needing help with gait, mobility and balance? Being told you need a walker. No wonder, when the typical walker basically screams “frail elderly,” and is difficult to use as well.
Neurologist Patricia Kavanagh was struggling to get her patients with Parkinson’s and other movement disorders to use a walker. So she teamed up with a design and production team to found Foray and create the Spring, a modern device that is more functional and stylish.
In this podcast interview we discuss:
(0:13) Dr. Kavanagh’s clinical practice and the types of patients she treats
(1:19) Key challenges she faces working with patients with movement disorders
(3:24) Problems with current assistive devices like canes and walkers
(6:11) Whether walkers are unique in their poor design
(7:26) The story behind the birth of Foray and the development of the Spring
(8:42) The target audience
(12:04) Price point for the new device
(12:50) The thinking behind the branding of Spring and Foray
(13:31) Potential line extensions
(15:20) Impact of burden of chronic disease on mobility and exercise tolerance
Patient payments are a real friction point in the US healthcare system. Patients don’t understand what they owe, and doctors usually can’t help them figure it out. HealthiPASS is doing its best to solve these problems with a consumer-friendly approach that pays off financially for providers.
In this podcast interview, HealthiPASS CEO, Rajesh Voddiraju answers my questions about how it all works.
(0:17 )What are the problems with patient payments today?
(2:40) What have physician offices been doing about it about it? How successful are those efforts?
(6:30) How does HealthiPASS work?
(11:50) With the four steps it sounds like you are allowing the physician office to educate the patient about the extent of their financial obligations under high deductible plans. Is that right?
(13:09) How does the system interact with existing practice management systems? What is the impact on the office workflow?
(18:51)The value proposition for physician offices is pretty clear, but what about for patients? Is it in a patient’s interest to use this system?