Category: Policy and politics

Future of Health Data –the Big Brains convene!

published date
October 22nd, 2019 by
Datavant summit katyal panel
Katyal, von Eschenbach, Shulkin and Siddiqui

A quiet revolution is underway in healthcare data. A decade after the HITECH Act spurred the rapid adoption of electronic medical records, we are seeing the resulting data being integrated with other sources such as insurance claims, clinical registries and social determinants of health to produce richer data sets for analysis and action.

As we’ve noted in our own consulting work, Datavant has emerged as a key player in connecting disparate data sources at the patient level while protecting privacy. The company’s methodology anonymizes patient identifiers with a unique patient key, matches records across data sets, and enables data exchange.

So I was excited to attend Datavant’s Future of Health Data Summit in Washington, DC earlier this month. As one would expect from a company that strives to organize and present data efficiently, accurately, and clearly, it was a quality event. The day featured 40-minute panels with strong moderators and 3-4 expert panelists along with keynotes from luminaries such as former FDA Commissioner Robert Califf, CDER Director Janet Woodcock, and former Senate Majority Leader Tom Daschle.

The closing panel, Healthcare Policy, Value-Based Care and Data Sharing was typical of the program. Moderator Neal Katyal (former Acting US Solicitor General) made the most of the expertise of panelists David Shulkin (Former VA Secretary), Mona Siddiqui (Chief Data Officer, HHS) and Andrew von Eschenbach (former FDA Commissioner).

They were all passionate about the ability to finally leverage healthcare data at scale. Shulkin talked about using data to prevent suicides of veterans. The highest incidence is in the first year after discharge, when they risk falling between the cracks as they transition from the DoD to VA system. Siddiqui bemoaned the difficulties of confronting the opioid crisis with 2-year old data, and von Eschenbach spoke of the potential to transform the whole healthcare system by improving care and reducing costs.

Shulkin seemed the most skeptical about where things are headed in the near term, predicting incremental change in the healthcare system as the most likely outcome of the fight between Medicare-for-All Democrats and Republicans who want to crush federal involvement. When Siddiqui gushed about the potential to use the planet’s largest healthcare data set (from CMS) in hackathons and challenges and system redesigns, Shulkin interjected that working with the government was, “not for the feint of heart,” and “,not a great strategy for a young company.”

There was an interesting back and forth about how to get the public comfortable with data sharing, how to overcome the decline of public trust in general, and how to address privacy from a policy and technological standpoint.

The panelists generally agreed that patients would be on board if they saw how use of data could help with their own care, and that even spectacular data breaches wouldn’t completely erode patients’ trust in the system. We have become accustomed to such breaches with our financial data, after all.

Shulkin thought people would get really upset if they learned that their data was for sale. I disagree -I think consumers are already coming to terms with their data being sold throughout the rest of the information economy; it’s by no means unique to healthcare.

In closing, von Eschenbach said he was “incredibly optimistic” due to the tremendous energy coming into the process right now. It’s a chaotic environment, he said, but we’ll look back in five years and be grateful for today’s chaos.

Shulkin pointed to the large number of healthcare data companies formed over the past three years, using that as an indicator of the level of optimism in the field. It wasn’t evident to me that he fully shares this optimism.

And Siddiqui presented herself as a realist but also a bit of a visionary and optimist, who is thinking about the healthcare system that we want to have. For her –and many of us– it’s one that’s more technology enabled, virtual care enabled, and homecare centric.

I’m heading to the HLTH conference in Las Vegas next week. I hope it’s as worthwhile as the Datavant event!


By healthcare business consultant David E. Williams, president of Health Business Group.

What gets measured gets done. So be careful what you measure!

published date
October 21st, 2019 by

When I read ‘Fear of Falling’: How Hospitals Do Even More Harm By Keeping Patients in Bed I was reminded of the old adage, ‘What gets measured gets done.’

In this video I lay out three solutions to the problem of overzealous pursuit of fall reduction:

  1. Keep the measure but change the target so we’re not aiming for zero falls
  2. Add a new measure of how much patients are getting up and walking
  3. Reduce the penalties for excessive falls

What do you think?

By healthcare business consultant David E. Williams, president of Health Business Group.

Blockbuster Medicare Innovations: AHIP panel recap

published date
September 27th, 2019 by

I enjoyed moderating the Blockbuster Medicare Innovations panel at the AHIP conference on Medicare, Medicaid and Dual Eligibles. In this video recap, I summarize the panelists’ key takeaways on supplemental benefits, home dialysis, and telemedicine.

Thanks to Dr. Michael Cantor of CareCentrix, Bruce Greenstein of LHC Group and Mary Hsieh PharmD MPH of Health Management Associates for doing a great job with it.


By healthcare business consultant David E. Williams, president of Health Business Group.

How Trump can win on healthcare

published date
September 18th, 2019 by

It should be easy for the Democrats to beat President Trump on healthcare. After all, he never followed through on his promise to “take care of everyone” or to unveil a “phenomenal” plan. Moreover, his sabotage of Obamacare, attacks on Planned Parenthood, and stress introduced by his tweets have caused additional damage.

However, leading Democrats including Bernie Sanders and Elizabeth Warren insist on shooting themselves in the foot by touting Medicare for All. The critics are right: it would be expensive, complex, disruptive and represent a government takeover of the healthcare system. A new Kaiser Family Foundation poll shows that most people don’t even believe their wages will rise if employers save a bundle on health care, as they would under Medicare for All.

Meanwhile, Trump has competent people in his administration in healthcare (unlike other areas) and they’ve worked hard on productive areas such as Medicare Advantage, kidney care, transparency, and vaping.

As a result, Trump can win on healthcare even without a signature TrumpCare program.

Democrats would be wise to nominate someone who espouses building on Obamacare, not replacing it with Medicare for All. Michael Bennet is my pick, but he isn’t getting traction. Joe Biden is the best of the current frontrunners and as Obama’s Vice President is best placed to cement the Obamacare legacy.


By healthcare business consultant David E. Williams, president of Health Business Group.

 

Air ambulance reality warp in Wyoming

published date
September 3rd, 2019 by
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How much for a ride?

From reading (Why Red Wyoming Seeks The Regulatory Approach To Air Ambulance Costs) it appears that the laws of economics have been repealed and that the state’s rugged individuals have gone soft on us. But really, it’s just another take on the absurdity of the air ambulance business.

I had to laugh at this passage:

The air ambulance industry has grown steadily in the U.S. from about 1,100 aircraft in 2007 to more than 1,400 in 2018. During that same time, the fleet in Wyoming has grown from three aircraft to 14. [A]n oversupply of helicopters and planes is driving up prices because air bases have high fixed overhead costs. [C]ompanies must pay for aircraft, staffing and technology… before they fly a single patient.

But with the supply of aircraft outpacing demand, each air ambulance is flying fewer patients… So, companies have raised their prices to cover their fixed costs and to seek healthy returns for their investors.

Imagine if there were three gas stations in a town and then there were 14. Would prices go up or down? [Hint: Down.]

But healthcare doesn’t work like that, somehow. Ambulances in general and air ambulances in particular are great examples of why not. In particular, you can’t really refuse to be transported by ambulance and if you have private insurance the ambulance companies can stay out of network and stick you –the consumer– with the bill.

In this case, Wyoming is doing the right thing in trying to socialize the industry by pushing everything into Medicaid.  The legislature would be wise to use this as an opportunity to reconsider its opposition to Medicaid expansion, which it has rejected in the past, even it added a hard hearted and counterproductive work requirement.

I first covered the topic in March 2005, the first week I started writing this blog. What I wrote then (Air ambulances: costly, dangerous, slow?) is still worth recalling:

According to today’s Wall St. Journal, not only are air ambulances liable to crash (a crew member who worked 20 hours/week for 20 years would have a 40% chance of being killed), they are often slower than ground ambulances, and are used to transport patients who aren’t that sick.

Of course, there are situations where air ambulances make sense, such as in rural areas. On the other hand, even speedy air ambulances can’t do much about the 10-20 hours waits I mentioned in yesterday’s post on Mass General.

  • After 9-year-old Tyler Herman fell and broke his jaw in the wilds of Arizona, doctors at a community hospital decided the boy should fly to Phoenix to undergo plastic surgery for a gash on his face. During the flight he was well enough to sit up and remark on the scenery. Upon arriving in Phoenix, he waited nearly 20 hours to undergo surgery. “We could have driven him there in four hours,” says Sharon Herman, the boy’s mother. Her insurance didn’t cover air transport, leaving the Hermans with a bill for $25,000.

Wyoming is a rural state, and the picture that air ambulances conjure up is people being rescued from car crashes or heart attacks in remote areas. Of course that’s the story the owners of air ambulance services want you to believe.  Here’s what the lobbyist in Wyoming says about it:

“How many of these 4,000 people a year [flown by air ambulance] are you willing to tell, ‘Sorry, we decided as a legislature you’re going to have to take ground ambulance?’” Mincer said during a June hearing on the proposal.

Sure enough, in Wyoming the situation now is like it was in Arizona a decade and a half ago. “On-scene trauma responses,” represent just a small portion of the flights. In this case, supply creates its own demand and in many cases a ground ambulance would be a better option.

It’s tempting –but too easy– to place all the blame on private equity investors for the problem. State and federal government, health plans, physicians and even consumers have the power to make it stop.


By healthcare business consultant David E. Williams, president of Health Business Group.