Category: Technology

Scaling up bundled payments: Interview with Loopback Analytics CEO Neil Smiley

published date
July 6th, 2016 by
Neil
Neil Smiley, Loopback Analytics CEO and Founder

Neil Smiley is CEO and Founder of Loopback Analytics, which supplies tools to providers to manage bundled payments. I asked him to comment on the growth of bundled payments and the role of analytics.

Why are hospitals hesitant to adopt bundled payment options?  What strategies can long-term care providers take to encourage bundled payment adoption on a large scale?

In most cases, a hospital’s financial responsibility ends upon patient discharge.  Bundled payments significantly lengthen the care episode, making hospitals responsible for the costs of downstream care partners.  The shift to value-based reimbursement from our current environment of fee-for-service represents a sea-change for the industry.  Decades of business practices, clinical relationships, payment structures and core competencies are being reevaluated in light of this new payment model.  Such evaluation and reflection takes time, and we are starting to see leading organizations embrace this challenge as an opportunity to develop differentiating capabilities.

Long-term care providers can help accelerate this process through proactive engagement with their hospital colleagues.  Hospitals will need better data from their post-acute care partners to have confidence that they can consistently deliver efficient care and strong clinical outcomes.  The long-term care providers that can demonstrate these capabilities pave the way for hospitals to better understand, trust and rely on the broader care delivery pathway they must manage with bundled payments.

What are the main benefits patients will reap from bundled payments?  

Bundled payments have the potential to significantly improve patient outcomes through better care coordination across providers and care settings.

Under a fee-for-service payment model, there is little financial incentive to help ensure a patient makes a successful transition to skilled nursing after an acute care stay, or ensuring that patient successfully transitions home after leaving a skilled nursing facility.

Under bundled payments, there is now an aligned incentive with providers across care settings to ensure transitions are clinically successful and financially efficient.  Patients are likely to get more help in navigating multiple silos of care, when participating providers are financially responsible for the cost of poor outcomes.

What factors are holding back scalability of bundled payments options?

Broader scalability of bundled payment options will be paced by the availability of accurate and timely data from network participants and workable frameworks for sharing risks and rewards among bundled payment partners.

At the national level, CMS has relayed its intention to aggressively advance pay-for-value reimbursement models, with bundles being a prominent example.  Ready or not, the expectation is that bundles will quickly expand to include additional conditions and broader mandated participation.

At a health system level, first movers that have invested in the tools, competencies and partnerships needed to succeed in bundle configurations will be courting more bundle opportunities to take advantage of their lead in the market.

What is the role of analytics in bundled payment? Can you provide an example?

Advanced analytics are absolutely essential to success in bundled payments.

Bundled payments require that different providers across the care continuum come together to consistently deliver a clinically successful and financially efficient episode of care.  Without deep knowledge of potential partners’ strengths and weaknesses, a bundled payment manager stands a poor chance in creating a winning network.

CMS provides data to healthcare systems, ranging from high-level quality ratings to detailed, individual claims records.  With effective application of data analytics, these sources of information, combined with data from network partners can be used to create the most effective care delivery network possible.

How will analytics advance over the next 5 years? 10 years? How do you measure progress?

Looking towards the future, we expect a pronounced shift from retrospective, historical analytics to prospective, predictive analytics.  The former allows healthcare systems to accurately assess their current and historical states, and is an essential component for improving operations.  The latter allows healthcare systems to avoid costs and adverse clinical events before they even occur.  The availability of real-time health data will continue to grow with the proliferation of digital monitoring devices. Machine learning and predictive algorithms are already establishing themselves in matching patients with appropriate resources based on a diverse set of data markers.  We foresee significant expansion on this front in the coming years.

With so many analytics solutions vendors out there how do you distinguish yourself?

Loopback Analytics puts analytics into action.  Loopback has an integrated technology platform that allows our clients to move from investigatory analytics to data-driven interventions, through a platform  that provides a closed loop feedback system to ensure executed actions achieve the expected impact.

It is only through such an integrated solution that healthcare organizations can be assured that the problem is understood, the appropriate actions executed and impact quantified.

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

In the future, will every job be a healthcare job?

published date
June 6th, 2016 by
ID-100404750
I’m here for your job

The US added 38,000 jobs in May, including 46,000 in healthcare. In other words, healthcare added more than 100 percent of the new jobs in the economy. That won’t happen every month, but it’s a pretty striking statistic.

What’s going on here?

I recently read The Second Machine Age: Work, Progress, and Prosperity in a Time of Brilliant Technologies, which basically argues that almost all jobs –including highly skilled ones– will be wiped out by automation, robots and artificial intelligence. Case in point: truck drivers and taxi drivers, who will be replaced by self-driving vehicles.

Job destruction is happening today on a large scale. Manual laborers have been vulnerable for a long time, but professionals are now under threat as well. There’s little opportunity in previously safe jobs like bookkeeper and paralegal. I firmly believe that a big driver of Donald Trump’s popularity is the alienation felt by many workers –including skilled ones– whom the economy no longer really needs or won’t need soon. It’s easy to blame free trade pacts, Chinese, Mexicans, and our feckless political leadership, but technology is actually the root cause.

The two big exceptions to job loss are healthcare and education, sectors that have been very slow to match the innovation pace established by the rest of the economy. That’s kept costs high and rising. As a result, Americans are getting killed by healthcare and education expenses at a time that incomes are stagnant.

Healthcare is always 10-20 years behind the rest of the economy (I’ll let someone else speak for education) so we can expect continued robust healthcare hiring for some time.

If the jobless future described in The Second Machine Age really comes to pass, society will be in serious trouble. I really don’t like the author’s idea of addressing joblessness by paying everyone a guaranteed minimum income. Sure people need an income, but they also need purpose in life, which often comes from having something productive to do on the job.

As I’ve been saying for years –for example Welcoming immigrants and robots to fill the nursing shortage and Robots are coming and they plan to treat you like a moron –I do think healthcare will eventually catch up with the rest of the economy and healthcare jobs will go by the wayside. But maybe there will be enough lag time that we will in fact preserve and invent meaningful jobs in healthcare, and that the healthcare field will lead the next wave for the re-humanization of the economy.

Image courtesy of Geerati at FreeDigitalPhotos.net

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

 

Amazon Echo for healthcare

published date
June 2nd, 2016 by
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Alexa, what can you do for healthcare?

I bought an Amazon Echo this week and have been enjoying using it in the kitchen. I can ask, “Alexa, what time is it in Germany?” and it will tell me. Or I can say, “Alexa, play music by the Beatles,” or ask, “Alexa, how many ounces in a cup?” and it will let me know. It’s remarkably easy –and not at all frustrating– to use. The whole family is enjoying it.

Naturally I started almost immediately to think of healthcare uses, so I wasn’t at all surprised to pick up the Boston Globe yesterday and see that my friends from Boston Children’s Hospital are a step or two ahead. Chief Innovation Officer John Brownstein, PhD and clinical innovation director Michael Docktor, MD have launched a KidsMD app for the platform and are testing out uses for Echo in the OR, ICU and bedroom.

Although the article lays out some of the potential for Echo, overall I find it too dismissive, highlighting a software glitch, voice recognition problem, and asserting that “another layer of technology might frustrate staff.” The article ends with a quote from a Children’s engineer whose own kids aren’t interested in speaking with Alexa. None of this reflects my family’s experience.

What the article misses is that Echo represents the latest example of physicians bringing cutting edge consumer technology into the hospital and running circles around the standard tools offered by the IT department. In the real world, physicians are early and enthusiastic adopters of tools like the iPad and iPhone, and through the bring your own device (BYOD) movement they have upended the traditional, clunky hospital IT environment.

Here are some thoughts about what could make Echo so useful for healthcare:

  • It’s the rare tool that can be used equally well by doctors and patients
  • It’s a handsfree device, which makes it easy to use when one’s hands are occupied, dirty, or injured
  • The voice recognition is really good, and works just fine in a noisy environment
  • It enables continuity of care because a patient could use the same device at home that was used at the hospital
  • It gets smarter all the time as new intelligence and apps are added to the cloud
  • It can entertain as well as inform

I can foresee apps that help patients remember their customized care instructions, “Alexa, how often am I supposed to change my dressing?” or “Alexa, am I supposed to take my medication with food?”

I also think it will be useful for hospitalized patients who are trying to remember questions they want answered the next time their doctor or nurse comes around. There is a built in ability to say, “Alexa, add butter to my shopping list.” So there’s no reason it couldn’t compile a list of doctor questions as well.

These are the veritable tip of the iceberg, and I look forward to seeing a thousand (or more) flowers bloom as the healthcare field embraces Echo. “Alexa, I love you.”

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

 

Uber the ambulance chaser

published date
April 8th, 2016 by

ID-100263676

Uber and to a lesser degree Lyft have decimated the taxi industry with a disruptive model that lowers costs, improves service, and identifies the few bad apples among drivers and passengers. Now both companies are venturing into a niche market that’s in need of serious reform: medical transportation.

Some patients need help to get to their medical appointments and Medicaid and Medicare step in as needed to pay for transportation. However, too often a patient is transported in an expensive limo or even an ambulance when a regular car would have been fine. The government recognizes the problem and has taken some steps to clean up the business, but it’s tough going.

I’m not exactly sure how Uber and Lyft will tackle the intricacies of the business, but they are diving in:

  • Boston Children’s John Brownstein has helped form Circulation, which will use the Uber network to provide rides to medical visits to seniors and those with disabilities. Medicaid will provide coverage
  • In New York, Lyft has been working with the National Medtrans Network on a pilot program

These services will be valuable in their own right because they are likely to reduce costs and improve service. But the downstream value to the healthcare system is even greater: if patients can get to and from appointments more reliably it may well reduce overall medical costs and improve outcomes.

Finally, it’s helpful for patients to have their medical appointments bracketed by state-of-the-art service experiences, since it will encourage patients and maybe medical offices to strive for the same service levels in their medical care. Kind of like how Disney pulls up all customer service in the Orlando area.

Image courtesy of vectorolie at FreeDigitalPhotos.net

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

 

ICH endorses a faster, less expensive approach to cardiac safety testing

published date
December 22nd, 2015 by
iCardiac CEO Alex Zapesochny
iCardiac CEO Alex Zapesochny

Drug developers must demonstrate that new medications are safe and effective in order to win regulatory approval. The gold standard in cardiac safety testing has been the Thorough QT study, a separate, expensive trial that is typically conducted late in the clinical development process.

The international body that informs drug development standards has just revised its stance to support definitive QT testing based on ECGs collected during existing early-stage trials. iCardiac Technologies, where I’m a board member, pioneered this approach in conjunction with the FDA. I asked iCardiac’s CEO Alex Zapesochny to explain what is happening.

  1. What is the ICH and why does it matter for clinical trials?

The International Council for Harmonisation is an international forum for regulators to harmonize drug approval practices. The group includes pharmaceutical industry representatives and regulators from the United States, Canada, the European Union, Japan and Switzerland.

As for the clinical trials process, the ICH aims to make recommendations toward achieving greater harmonization in the interpretation and application of technical guidelines and requirements related to research and development of new drugs. These guidelines can assist with pharmaceutical product registration and help reduce or avoid duplication of testing carried out during R&D.

  1. ICH has issued a regulatory revision for cardiac safety testing. What specifically has it done?

Currently, the FDA and other regulators expect nearly all new drugs to be tested using a costly, stand-alone Thorough QT (TQT) study to assess a drug’s effect on the QT interval before market approval. This is an important step, since a prolonged QT interval is associated with a heightened risk for arrhythmias and possible sudden cardiac death. The latest revision adopted by the ICH states that data from ECGs collected during routine Phase I or other early clinical trials may be used to conclusively demonstrate a drug’s QT effect. This approach relies on intensive, high quality ECG analysis and the use of exposure response modeling.

  1. What led to the change?

Regulators around the world want to make the drug development process as safe, precise and efficient as possible. The ICH revision emerged a year after the U.S. Food and Drug Administration helped to organize a meeting of thought leaders to discuss the results of a successful prospective validation study demonstrating the ability to determine cardiac safety much earlier in the development process. This revision is likely the most significant regulatory shift in cardiac safety since the original E14 guidance was adopted by the ICH in 2005.

  1. What role did iCardiac play? The FDA?

iCardiac has been championing this alternative approach for several years, including collaborating with thought leaders from the FDA and from industry to help organize a prospective validation study to definitively test this new approach. Ultimately iCardiac sponsored that definitive validation study, and it was overseen by iCardiac personnel and used our proprietary High Precision QT methodology to perform the critical data analysis. Leaders from the FDA have been involved in multiple key ways, including decisions around the validation study design and co-authoring publications about the validation study and its implications. Of course, the FDA is also a participant in the ICH and played a direct role in the new regulatory revision.

  1. What will be the practical implications?

This development provides an alternative path for sponsors with regard to demonstrating the effect of their drug on QT, which is a critical part of gaining market approval for a new drug. By analyzing ECG data from a Phase I or other early clinical study, sponsors can choose to seek a waiver from regulators from having to do a TQT study. The FDA granted the first TQT waiver based on this alternative approach earlier in 2015. So apart from saving time and money, this approach gives drug developers insight into their compound’s QT liability much earlier in the clinical trials process.

  1. What are you doing to let people know more about the implications?

iCardiac will conduct two free public webinars to explain the new ICH guidance and the standards it establishes for receiving a waiver from the Through QT study. Dr. Borje Darpo, a cardiologist and chief scientific officer at iCardiac, will discuss the impact of this regulatory revision on the clinical development process. The webinars will be held on January 12th and January 20th, 2016. You can follow the links below to register for one of iCardiac’s webinars:

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