Scary Monsters, Take 3: one week later, JPMorgan Chase takes heat, Amazon speculation, industry skepticism

It’s the Week After the Amazon/Berkshire Hathaway/JPMorgan Chase announcement of their partnership in a non-profit joint venture to lower healthcare costs for their 1.1 million employees, and there’s a bit of a hangover. Other than a few articles, there’s been relative quiet on this front. This could be attributed to the financial markets’ roller coaster over the past few days, at least in part due to this as healthcare stocks were hardest hit. In the US, healthcare is estimated to be 18 percent of the economy based on Centers for Medicare and Medicaid Services (CMS) actuarial statistics for 2015…and growing. 

Jamie Dimon, CEO of JPMC, had some ‘splainin’ to do with some of the bank’s healthcare clients, according to a report in the Wall Street Journal (paywalled) summarized on MarketWatch. He assured them that the JV would be to serve only the employees of the three companies. JPMC bankers handling the healthcare sector also needed some reassuring as they are “paid handsomely to help clients with mergers and other deals and worry the move could cost them business.”

Speculation on Amazon’s doings in healthcare remains feverish. A more sober look is provided by the Harvard Business Review which extrapolates how healthcare fits into Amazon’s established strength in delivery systems. Amazon could deliver routine healthcare via retail locations (Whole Foods, Amazon Go), same day prescription delivery, passive data capture developed for Amazon Go sold as a service to healthcare providers (on the model of Web Services), and data analytics.

Headlines may have trumpeted that the three-way partnership would ‘disrupt healthcare’, but our Readers in the business have heard this song before. While agreeing with their intent, this Editor differed almost immediately with the initial media cheering [TTA 31 Jan]. The Twitterverse Healthcare FlashMob in short order took it down and apart. STAT racks up some select tweets: in the ACO model, savings come when providers avoid low-value care; the contradiction of profitable companies avoiding profit; that the removal of healthy employees from existing plans will increase inequity and the actuarial burden upon the less insurable; the huge regulatory hurdle; and the dim view of investment advisory firm Piper Jaffray that it will not be a ‘meaningful disruptor’. 

In this Editor’s view, there will be considerable internal politicking, more unease from JPMC customers, and a long time before we find out what these three will be doing.

Disrupting the pathways of Social Determinants of Health: the transportation solution

Guest Editor Sarianne Gruber (@subtleimpact) and MovedbyMetrics examines one aspect of social determinants of health, transportation. Social factors have been called the missing links in population health: others are housing, food, finances, and employment. This is not only affordable ‘a to b’ transportation, but also clean, safe and tailored to the patient’s needs. Sarianne interviewed Todd Thomas, then of Veyo and now of Zendrive, a company developing data analytics to make roads safer and to save lives through measuring driver behavior and coaching. Other companies in Veyo’s area are Uber Health and Circulation [TTA 10 Nov].

More and more people are starting to have conversations around the Social Determinants of Health.  And for the first time, the c-suite within healthcare companies are talking about transportation.  People haven’t talked about transportation before because there haven’t been good choices, only poor and expensive service levels. Transportation has always been a low budget item and a cost center. Now people are talking about transportation as a key link in the complete continuum of care. If we are talking about treating the complete person, a huge part of that is making sure they are getting to their treatments on time every time, picking up their pharmaceuticals and shopping to get fresh, clean food. These things make a huge impact in the lives of patients and the members.  It is great that people are becoming aware of transportation and talking about it.Todd Thomas, VP Strategic Business Development at Veyo

Social Determinants of Health, as recognized by the World Health Organization, are the conditions in which people are born, grow up, live, work and age, together with “the systems” that are put in place to deal with illness. Transportation is one of those systems.  In a conversation with Todd Thomas, VP of Strategic Business Development at Veyo, he chronicled how the digitization of this sector broke barriers in Non-Emergency Medical Transportation.  The medical transportation, as Thomas described, was very challenged for decades with the same nationwide providers, all delivering the same levels of service and at the same price.  None had any initiative to adapt to new technologies or evolve their business models.  Medical professionals and companies across the US had come to expect poor service as the norm.  It wasn’t until a couple of years ago when the transportation network companies, the TNCs such as Uber and Lyft, came onboard into the market and really changed transportation in the US and in the world. Thomas contends that what the TNCs did for the transportation world has really turned things upside down, and absolutely raised the level of customer expectations and raised standard of what transportation was going to be.  And ultimately closed a huge care gap for transportation-dependent patients. (more…)

Health execs’ wish list for 2017: security, analytics, pop health…and telehealth (US)

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/01/2017-upgrade-HITN-survey.jpg” thumb_width=”200″ /]Healthcare IT News published the results of their October survey of 95 healthcare executives as to their forward plans (resolutions?) for 2017. It’s unsurprisingly centered on upgrades to the following areas:

  • Data security (52 percent)–definitely making up for lost time and spending due to the obvious threats from hacking and data breaches. In November alone, nearly two incidents a day (57) and over 458,000 records were reported by healthcare entities to HHS. (Protenus Breach Barometer)
  • Data analytics (51 percent)–figuring out what to do with all that patient data generated by….
  • Patient engagement and population health (44 percent each)–demanded by quality standards in CMS’ MACRA Quality Payment Program (QPP), including the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs)
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2017/01/2017-introduce-investigate-HITN-survey.jpg” thumb_width=”200″ /]The surprises come here–the technologies they expect to introduce or investigate. Analytics and workflow correspond to the last two points above, but what is compelling is an apparent tipping point for technology which links the patient to care monitoring and access: telehealth (44 percent), smart medical devices (41 percent) and remote patient monitoring (34 percent). These overlap (as in telehealth and RPM require smart medical devices), yet these are strong numbers if they accurately reflect these execs’ actual (or eventual) spending. (Does it point to more clinically validated use of trackers like Fitbit? The Magic 8 Ball does not tell here….)

The presence of 2016-17’s ‘It Girl’, precision medicine (21 percent), which applies both data analytics and genomics to improve patient outcomes, isn’t surprising with the emphasis on quality care.

One can quibble that the sample size is small N, and the report doesn’t confirm the selection details like title, location, and type of organization, but the direction has to be cheering on many fronts. HITN’s overview, survey results (16 slides)

Personal health ‘big data’ exchange is all good, right? Perhaps wrong.

Many of our recent stories have touched on ‘big (health) data’ as Achieving the Holy Grail–how it can be shared, how it can work with the Internet of Things and how poorly implemented personal health record (PHI) databases can derail national health systems (and careers) [TTA 22 Sep]. They are, after all, 1) extremely difficult to design to preserve privacy and 2) must satisfy patients’ requirements for easy use as well as privacy including opting out. But when despite all good intentions, data goes awry, the consequences can be severe.

  • A daughter applies for health insurance from Aetna, and her mother’s medications, about which she had no knowledge, are attributed to her. How? Data mining off Milliman’s IntelliScript data service which mixed up the records.
  • EHR exchange can spread errors such as a dropped critical health or medication record. One led to the death of an 84 year old woman. VA also had a problem with its EHR (not cited but likely VistA) slotting medication histories into the wrong patients’ files. An Australian hospital mixed up discharge files in electronically sending them to doctors. The more records are exchanged, the more possibility there is for propagation of errors.
  • More information is shared with third-party suppliers; survey companies are increasingly tapping into these databases to send annoying, potentially privacy-invading treatment questionnaires to individuals.

Bloomberg Business’ conclusion is that this could be a problem, but much beyond the tut-tutting doesn’t get into solutions. The Pitfalls of Health-Care Companies’ Addiction to Big Data

Unicorns to Series A–health tech funding gained in (perhaps) the nick of time

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/08/1107_unicorn_head_mask_inuse.jpg” thumb_width=”150″ /]Money, money everywhere–unicorns get the headlines, but the companies are still (largely) small

Up until early August, this Editor would have assumed that our Readers would look at this funding roundup as a bracing windup to a largely positive eight months and a veritable Corvette Summer for healthcare technology funding. We may have to give back the keys a little sooner than we imagined. Will the dropping market affect digital health as 2008-9 did–‘out of gas’ for years? Or will it barely affect our motoring onward? Despite the Dow Jones average hitting an 18 month low today, we hope it’s closer to the latter than the former. though the new and big entrant to digital health investing is the country most affected, China.

Our roundup of the August Action includes ZocDoc, Fitbit, Alphabet, PillPack, Owlet and more, along with a few comments:

**ZocDoc, a NYC-based online medical care appointment service that matches patients with doctors by location and schedule, had the most sensational round with last week’s Series D funding of $130 million, giving it a valuation of $1.8 bn. It took over a year after the filing (June 2014) and was led by two foreign funds (London-based Atomico and Edinburgh-based Baillie Gifford) with additional funding from Founders Fund, which previously participated in raises of $95 million.

Though it claims 60 percent coverage in the US  and ‘millions of users’ (numbers which have been quoted for some years), ZocDoc won’t disclose profitability nor volume–metrics that would be part of any IPO.

Direction? Points given for deciphering this windy statement (quoted from Mobihealthnews): (more…)

mHealth Summit now HIMSS Connected Health Conference

Another sign that mHealth is now in our rear view mirrors [TTA 24 July] is that one of the main conferences on the US and international conference calendar is changing its name. Since 2009, the mHealth Summit has closed the year. Its organizing groups have changed and it’s gone international to Europe (the recent summit in Riga). Now it has been renamed (though not on the website yet) the HIMSS Connected Health Conference-an umbrella event comprising the mHealth Summit (including the Global mHealth Forum), and two new conferences:  the Cyber Security Summit and Population Health Summit.

The shift in the industry and new concerns are clearly reflected in this reorganization. Transitions were visible last year to this Editor in covering the sessions, speaking with exhibitors and attendees. It’s not about the tech anymore, but how it fits into care models, saves money/avoids costs, improves care, improves the experience–all population health metrics–and fits with other technology and analytics. (It’s also how it fits into government payment models, an endlessly changing equation.) What is surprising is the lifting of cybersecurity to equal status, given the Hackers’ Holiday that healthcare is now (see TTA here). (Also this Editor notes that last year’s Big Buzzwords, Big Data and Analytics, has faded into where it should be–into facilitating population health and we should expect, inform data security. We also note that HIMSS has stepped forward as the organizer. HIMSS release  Telehealth & Telecare Aware has been a media partner of the mHealth Summit for most years since 2009. 

Health Datapalooza 2015: more data, better health

Guest columnist and data analytics whiz Sarianne Gruber (@subtleimpact) sat in on the Health Data Consortium’s 2015 edition of Health Datapalooza last week in Washington, DC. It was all about the data that Medicare has been diligently harvesting. Also see the US-UK connection on obesity.

Health Datapalooza 2015, now in its sixth year, welcomed more than 2,000 innovators, healthcare industry executives, policymakers, venture capitalists, startups, developers, researchers, providers, consumers and patient advocates. Health Datapalooza brings together stakeholders to discuss how best to work the advance health and healthcare,” said Susan Dentzer, senior policy adviser to the Robert Wood Johnson Foundation and a member of the Health Data Consortium. The Consortium promotes health data best practices and information sharing; and works with businesses, entrepreneurs, and academia to help them understand how to use data to develop new products, services, apps and research insights. This year’s conference was held on May 31 through June 3 in Washington, DC. And how best to celebrate is with the gift of more data!

New Medicare Data Means More Transparency
The Centers of Medicare and Medicaid Services (CMS) released its third annual update to the Medicare hospital inpatient and outpatient charge data on June 1, 2013. (more…)

Really big data analytics enlisted to fight soldier suicide (US)

Suicides by US active duty soldiers have more than doubled since 2001, according to a January Pentagon report, and current prevention programs have not been that effective in reducing the over 200 reported suicides per year. Enter a huge database program called STARRS–Army Study to Assess Risk and Resilience in Service–to identify risk factors for soldiers’ mental health. The US Army not only likes acronyms, but also never does anything small–a five-year, $65 million program analyzing 1.1 billion data records from 1.6 million soldiers drawn from 39 Army and Defense Department databases. Researchers are looking at tens of thousands of neuro-cognitive assessments, 43,000 blood samples, more than 100,000 surveys, hospital records, criminal records, previous risk studies, family and job histories plus combat logs. The study, also using resources from the National Institute of Mental Health, the University of Michigan and other educational institutions, will conclude this June–and researchers are now wrestling with the privacy and moral consequences of responsibly using this data for health and in leadership. NextGov

IBM Watson Health adds 2 companies, three partners, moves to Boston and into the cloud

[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/IBM-Watson-Announcement.jpg” thumb_width=”200″ /]A Day with a Big Exclamation Point for Healthcare Data and Analytics. In a series of press releases late NY time on Monday and a spectacular announcement at HIMSS (photo hat tip to Sandeep Pulim via Twitter), the recently quiet-on-the-healthcare-front IBM Watson has announced multiple major moves that re-position it squarely into the healthcare arena as the 90,000 lb. Elephant.

  • IBM Watson Health is now a separate business unit headquartered in Boston. The Watson New York headquarters will be expanded, but that may be for their other businesses: travel, retail, veterinary care, cognitive computing, and IT security and support. IBM claims that Watson Health will be hiring up to 2,000 healthcare consultants, clinicians and researchers, folding in existing units such as Smarter Care and Social Programs.
  • The IBM Watson Health Cloud is now their secure, open and HIPAA compliant platform for health-related data: physicians, researchers, insurers and health and wellness companies.
  • Three new partnerships were announced, designed to bolster IBM in different aspects of what is to be done with All That Data being generated from health and fitness devices. IBM Watson Health Cloud will be the secure platform, storage and analytics for Apple’s HealthKit and ResearchKitJohnson & Johnson will be working with Watson on pre/post-operative coaching and education and Medtronic on diabetes management using data from Medtronic devices. (more…)

“Data moves at the speed of trust”–RWJF report

The report issued today by the influential Robert Wood Johnson Foundation (RWJF), ‘Data for Health: Learning What Works’ advocates a fresh approach to health data through greater education on the value/importance of sharing PHI, improved security and privacy safeguards and investing in community data infrastructure. If the above quote and the first two items sound contradictory, perhaps they are, but current ‘strict’ privacy regulations (that’s you, HIPAA), data siloing and the current state of the art in security aren’t stemming Hackermania (or sheer bad data hygiene and security procedures). Based on three key themes, the RWJF is recommending a suite of actions (see below) to build what they term a ‘Culture of Health. All of which, from the 10,000 foot view, seem achievable. The need–and importantly, the perception of need–to integrate the rising quantity of data from all these devices, pry it out of its silos (elaborated upon earlier this week in ‘Set that disease data free!), analyze it and make it meaningful plus shareable to people and their doctors/clinicians keeps building. (‘Meaningful’ here is not to be confused with the HITECH Act’s Meaningful Use.)

But who will take the lead? Who will do the work? Will the HIT structure, infrastructure and very importantly, the legal framework follow? We wonder if there is enough demand and bandwidth in the current challenged system. Release. RWJF ‘Data for Health’ page with links to study PDF, executive summary which adds details to the recommendations below, more.[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/04/Data-For-Health-Advisory-Committee-RWJF.png” thumb_width=”400″ /]

Another Xerox healthcare move: reducing readmissions

About two months ago [TTA 13 Nov 14], we noted Xerox’s interesting investment in telehealth/virtual consult kiosk HealthSpot Station. We thought at that time that Xerox was not active in healthcare services and thus found the HealthSpot Station investment unusual. Right on the diagnostics, wrong on the data crunching. Notably, their Midas+ subsidiary concentrates on healthcare quality management, analytics and benchmarking solutions. Midas+ has entered into the readmissions fray by combining its proprietary database, compiled over 1,900 Xerox hospital clients, with five years of Medicare and claims data to help hospitals better predict 30-day same-cause readmissions. The Midas+ Readmission Penalty Forecaster uses the data to project in “near real-time” both patient patterns and reimbursement rates. Commenting to MedCityNews, Justin Lanning, SVP and managing director of Xerox Healthcare Provider Solutions, said the Forecaster has a 1.5 percent margin of error within the predictive model, with quarterly updates provided to participating hospitals. Midas+ also offers, beyond the model, onsite consulting. HealthSpot Station theoretically could throw off a lot of data on outpatient disease and treatment. Midas+ Forecaster white paper, eWeek.

We also note that MedCityNews, one of the livelier publications that covers a wide swath of the US healthcare scene,  is being acquired by Breaking Media, a New York City-based digital publisher. CEO Chris Seper will remain with the publication. Article.

Data streams of the future analyzed at NYeC Digital Health

Guest columnist Sarianne Gruber (@subtleimpact) also attended the NYeC Digital Health Conference and reflects on what to do with all that data patients and devices are generating–a natural for her as she is a consultant in data analytics for Encore Health Resources. 

The New York eHealth Collaborative hosted its fourth annual Digital Health Conference at New York City’s Chelsea Piers on November 17 and 18. There I was joined by 850 health-related professionals to listen, engage and see how life science meets digital technology. No doubt we have become a digital culture. Even seated on an airplane, I noticed the gentleman next to me wearing a Fitbit, and we strike up a conversation on step and sleep data and our dislike of the new dashboard. At the conference, Keynote Speaker Dr. Eric Topol, a Cleveland Clinic cardiologist and a leading practitioner of digital medicine, shared with us his thoughts on what it means be a part of this digital revolution as a patient and a doctor. Technology changes the scope of individual care. Advances in genomics now gives us answers based on our DNA that will genetically determine the success of medications and treatments. Epigenomics, a molecular diagnostics company, can prescreen an unborn baby of a mother with cancer with a simple blood test, sequencing the DNA, to manage her therapy. I was fascinated to hear that a genomic signal sensor can detect heart attacks and warn you of this possibly fatal event, and that necklace for heart failure patients can monitor fluid status averting repeated readmissions for these patients. Dr. Topol believes that digitized 24/7 patient health data will shift the patient–doctor relationship. Bringing in your self-monitored data, eliminates “the how are you feeling questions” and instead the doctor can confirm diagnosis and start treating the patient. “Patient owning data is a foreign concept and the digital revolution ushered this in.“ (more…)

IBM Watson decision tools expand, lands at NYC HQ

Confirming that New York metro’s once-devastated (post-dot.com bust) ‘Silicon Alley’ is increasingly attractive to healthcare and tech firms, IBM this past Monday opened its new NYC downtown headquarters at Astor Place for the IBM Watson Group. Our readers have been following the development of Watson in the healthcare decision-making process since 2012 [TTA’s article index here], primarily in oncology (breast and lung cancer), in the UK (via the RSM’s 5 June ‘Big Data’ conference) as well as the US. IBM Watson has smartly created Ecosystem Partners where third parties integrate Watson. The spread is fairly wide: travel (your Editor’s former industry), retail, veterinary care, IT security and support, cognitive computing and of course healthcare. Spotlighted were three companies: @PointofCare, Welltok and GenieMD. (more…)

Data mining health records: the good, bad and ugly

Take your time this weekend and read this article from the Washington Post on the ‘brave new world’ of data mining health records. While those with experience analyzing real-world health data snicker at Larry Page of Google’s inflated claims of ‘saving 10,000 lives in the first year’ if only he could get his hands on that identified data (of course, then there’s the opportunity to make $£€¥, which is what Larry and Sergey are really interested in–count your Editor as a cynic!), the Health Data Analytics Express rolls on. The promise lies in more precision in treatment areas such as brain tumor radiology where sizing is critical (BraTumIA) and individualized genomics for disease. Yet the author does not touch on healthcare decision support systems best exemplified by IBM Watson, (more…)

Pilot Health Tech NYC winners announced (US)

Last Thursday, the 11 winners of the second annual Pilot Health Tech NYC program were announced at Alexandria Center, NYC. A joint initiative of the New York City Economic Development Corporation (NYCEDC) and Health 2.0, it provides early-stage health tech companies based in NYC a ‘test bed’ in partnership with many of the most prestigious metro area healthcare organizations, and another platform to keep health tech growing in the city. Each project represents a distinct need in the spectrum and a common theme is integration of care into workflow. Some needs are obvious: senior care, pediatrics, rehabilitation, cardiac disease and diabetes management. Others are less so: vision, medication adherence, data analytics, blood donation and social support.

The winners are supported by $1 million in funding to operate and report results from the individual pilots which will take place starting in late summer through end of year. An interesting fact from the announcement release is that the Pilot Health Tech inaugural class companies [TTA 1 July 2013] have raised over $150 million in private investment since their win: AdhereTech, eCaring, Rip Road, Vital Care Services, BioDigital, Flatiron Health, Sense Health, Bio-Signal Group, Opticology and StarlingHealth (acquired by Hill-Rom).

The winners (some of which we’ve been following like GeriJoy, NonnaTech and eCaring) and their partners are:

  • Smart Vision Labs / SUNY College of Optometry
  • GeriJoy / Pace University
  • QoL Devices, Inc. / Montefiore Medical Center
  • Urgent Software, LLC / Mount Sinai Health System
  • Nonnatech / ElderServe
  • Fit4D/ HealthFirst
  • AllazoHealth / Accountable Care Coalition of Greater New York
  • Canopy Apps / Visiting Nurse Service of New York (VNSNY)
  • Healthify / VillageCare
  • Tactonic Technologies / NYU Langone, Rusk Rehab Center
  • Hindsait, Inc. / NY Blood Center

More information in their release. Many thanks to NYCEDC and Eric Vieira of ELabNYC (another NYCEDC initiative) and CUNY.

Related reading: ELabNYC Pitch Day in March

A ‘before the alarm’ approach to the soundtrack of ICU data

ICUs–and indeed, any acute care setting–have a soundtrack of boops and beeps that accompany regular telemetry of data from multiple devices. Alarms which indicate emergencies shatter the rhythm, eventually inducing ‘alarm fatigue’. What if ICUs could get a step or two ahead and use the torrent of data to predict a downturn in a patient’s condition and warn clinicians before that alarm goes off? That is the idea behind the system being developed at Boston Children’s Hospital with a local data analytics startup, Etiometry.  The latter’s Risk Analytics model is designed to transform data into clinically actionable information and to predict decompensation–a worsening or emergency status for the patient. For the cardiac intensive unit at BCH, the Stability Index pops up on the vital signs screen. “Doctors choose different parameters to measure, then the Etiometry system renders its risk assessment on a simple numerical scale, with 0 being most stable and 4 the least.” Not the first innovation for Boston Children’s either; with another software provider, they developed a single view of vital signs interface dubbed T3.  Boston Globe, FierceMobileHealthcare