TECHNOLOGY’S FUTURE · 2018-04-25 · We’re turning data into informa-tion that delivers better, person-alized outcomes for customers, providers, and clients. And by using artifi

Managed Care TECHNOLOGY SURVEYFINDINGS

February 2018 VOL. 28 NO. 2

EXECUTIVEManagedHealthcareExecutive.com The C-Suite Advisor

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MANAGED HEALTHCARE EXECUTIVE ❚ FEBRUARY 2018 ManagedHealthcareExecutive.com6

OPINIONFROM MARK BOXER, PHD

As the amount of informa-

tion in the world nearly

doubles each year, detect-

ing relevant signals through

the noise is becoming even

more diffi cult. However,

it can be a tremendous

value creator, especially in

healthcare.

For decades, the industry has been

chasing the goal of evidence-based

medicine, where proven science and

published literature guides therapies.

Th e application of machine learning

algorithms to diverse big data sets

means we can deliver the evidence at

the point of care. As we combine ge-

nomic data, published literature, and

other clinical data to guide therapies,

we can radically and dramatically

transform the patient experience and

clinical outcomes.

Th e promise of data science goes

way beyond better clinical outcomes;

it creates a better customer experi-

ence. Our customers expect seam-

less and simple interactions with

any enterprise they’re working with,

including their health plan.

Customers want us to translate

their interactions across all channels

into a more personalized experi-

ence and help improve their clinical

outcomes. At Cigna, we’re focused on

turning massive amounts of raw data

and often, unstructured data, into

actionable information in real-time to

help them get the solutions they need

with the outcomes they deserve.

We’re turning data into informa-

tion that delivers better, person-

alized outcomes for customers,

providers, and clients. And by using

artifi cial intelligence and machine

learning techniques, we’re success-

fully leveraging big data to save lives

through earlier interventions, with

the right care, in the right setting.

We also recognize that safeguarding

confi dentiality and gaining consent

on if, when, and how information

can be used is essential.

Th is is not a future vision; we are

making this real today. For example,

we can identify when a customer is

likely to have an emergency room visit;

have an inpatient admission in the

next six months for chronic obstructive

pulmonary disease or coronary artery

disease; be diagnosed with depression

(three months prior to antidepres-

sant prescription); or have a hip/knee

replacement/repair within the next six

months.

Another example is how we’re

leveraging machine learning coupled

with analytics to proactively engage

customers in our new, integrated cus-

tomer decision support and service

program, One Guide. We’ve already

seen a reduction of total medical cost

for a number of conditions in the fi rst

year for customers supported by the

program.

A fi nal example is as relevant as

today’s headlines: the opioid epidem-

ic. As an organization, we’re thinking

diff erently about how to address this

pervasive and nondiscriminating kill-

er. In fact, we’re reducing opioid use

among our customers by 25%, though

there is still more to do. In addition to

our collaboration with our network

of doctors, technology is playing a

critical role. One way is through our

Opioid Likely Overdose Risk Model,

which uses machine learning with

integrated claims data and analytics

to detect opioid use patterns that sug-

gest possible misuse that may lead to

overdose or even death.

Looking ahead we see even more

opportunities to use sophisticated AI

and machine learning techniques—

from predicting and preventing chronic

diseases, to mining data to reduce

payment and claims fraud, to using

the data from wearables to optimize

health. Th ese advances will allow us

to build even better models to answer

more complex questions; the ones that

will lead to better healthcare outcomes.

We’re hearing the big data signals.

Th ose signals show that the promise

of evidence-based medicine is here

today and it is helping us deliver on

our mission: to improve the health,

well-being, and sense of security for

the people we serve.

Mark Boxer, PhD, Managed Healthcare

Executive editorial advisor, is executive

vice president and global chief

information offi cer for CIGNA, where he

is responsible for driving the company’s

worldwide technology strategy.

AI transforms big data pools into useful information

Signal through the noise

“We can radically and dramatically transform the patient experience and clinical outcomes.”


ManagedHealthcareExecutive.com MANAGED HEALTHCARE EXECUTIVE ❚ FEBRUARY 2018 7

EXECUTIVEEditorial Advisory Board

Must-have apps PAGE 19INSIDE

CONTENT

SARA MICHAELVP, Content & Strategy

AUBREY WESTGATEExecutive Editor(203) 523-7116, [email protected]

TRACEY L. WALKER Content Manager(440) 891-2732, [email protected]

ROBERT MCGARRArt Director

PUBLISHING & SALES

GEORGIANN DECENZOExecutive Vice President, Managing Director

KEN SYLVIAVice President, Group Publisher

WILLIAM MULDERRYGroup Publisher(732) 346-3071, [email protected]

DAN GALLODirector, National Accounts(203) 523-7037, [email protected]

PATRICK CARMODYAccount Manager Print/Digital(440) 891-2621, [email protected]

TOD MCCLOSKEYSales Manager Classifi ed/Display Adv(440) 891-2739, [email protected]

JOANNA SHIPPOLIAccount Manager, Recruitment Advertising(440) 891-2615, [email protected]

TERRY TETZLAFFDigital Traffi c Coordinator(218) 740-6585, [email protected]

DAVID DONOVANVP, Digital Products

MEG BENSONSpecial Projects Director

AMY ERDMANVP, Marketing

JILLYN FROMMERPermissions and International License(732) 346-3007, [email protected]

PRODUCTION

KAREN LENZENProduction Director(218) 740-6371, [email protected]

AUDIENCE DEVELOPMENT

JOY PUZZOVP, Marketing & Audience Development

CHRISTINE SHAPPELLDirector, Audience Development

JESSICA STARIHAAudience Development Manager

Mission Managed Healthcare Executive provides healthcare

executives at health plans and provider organizations with analysis,

insights, and strategies to pursue value-driven solutions.

Mark Boxer, PhD, is executive vice president and global

chief information offi cer for CIGNA, where he is responsible for

driving the company’s worldwide technology strategy.

Roy Beveridge, MD, is senior vice president and chief

medical offi cer for Humana, where he’s responsible for developing

and implementing Humana’s clinical strategy with an emphasis on

advancing the company’s integrated care delivery model.

Darnell Dent is president and CEO of FirstCare Health Plans, a

provider-sponsored health plan serving local communities in West

Texas with offi ces in Abilene, Amarillo, and Lubbock; and, corporate

offi ces in Austin, Texas.

David Calabrese, RPh, MHP, is senior vice president

and chief pharmacy offi cer at OptumRx, a pharmacy benefi ts fi rm

that provides pharmacy care services for more than 65 million lives

nationally.

Joel V. Brill, MD, is the chief medical offi cer for Predictive

Health, LLC, which partners with stakeholders to improve coverage

of value-driven care that optimizes health for people.

Douglas L. Chaet, FACHE is chief managed care offi cer,

Sentara Healthcare, and chairman, American Association of

Integrated Healthcare Delivery Systems.

Perry Cohen, PharmD, is chief executive offi cer of The

Pharmacy Group and the TPG family of companies, which provides

services to associations, healthcare and information technology

organizations, payers and pharmaceutical companies.

Don Hall, MPH, is principal of DeltaSigma LLC, a consulting

practice specializing in strategic problem solving for managed

care organizations. He most recently served as president and chief

executive offi cer of a nonprofi t, provider-sponsored health plan.

Cynthia Hundorfean is president and CEO of Allegheny

Health Network (AHN), an integrated healthcare delivery

system that serves Western Pennsylvania. AHN is part of the

Highmark Health family of companies.

David Schmidt is president of the TPG International Health

Academy, which hosts trade/study missions around the world for

U.S. healthcare executives. He also provides strategic consulting to

health plans and health systems.

John Mathewson, MHSA, is interim president and CEO

for the DC Primary Care Association, an advocacy and infrastructure

organization for Washington, D.C., and Maryland area community

primary care providers. He has held C-suite roles for managed care,

hospital, and home care companies.

Kevin Ronneberg, MD, is vice president and associate

medical director for health initiatives at HealthPartners, an

integrated, nonprofi t healthcare provider and health insurance

company located in Bloomington, Minnesota.

Daniel J. Hilferty, MPA, is president and CEO,

Independence Health Group, a leading health insurance

organization headquartered in Southeastern Pennsylvania with

nearly 8.5 million members in 24 states and Washington, D.C.

Margaret A. Murray, MPA, is the founding chief

executive offi cer of the Association for Community Affi liated Plans,

which represents 54 nonprofi t safety net health plans in 26 states.

Dennis Schmuland, MD, is chief health strategy offi cer,

U.S. Health & Life Sciences division of Microsoft Corp., where he

is responsible for setting the company’s strategy and overseeing

solutions for the managed care industry.

Paul J. Setlak, PharmD, MBA, is director of fi eld health

outcomes at AstraZeneca, where he is responsible for leading

fi eld-based clinical and health outcomes activities with payers,

integrated delivery networks, health systems, and other groups.

Amy Shin is the CEO of Health Plan of San Joaquin, a not-for-profi t

plan serving 350,000 Medicaid members in San Joaquin and Stanislaus

counties of California. Amy has 20 years of progressive Medicare,

Medicaid and commercial managed care leadership experience.


mailto:[email protected]










EXECUTIVE

MANAGED HEALTHCARE EXECUTIVE��]��FEBRUARY 2018 Managed Healthcare Executive.com8

Volume 28 Issue 2

FEBRUARY 2018

COVER STORY

REPRINTS: 877-652-5295 ext. 121, [email protected]. Outside US, UK, direct dial: (281) 419-5725. Ext. 121 SUBSCRIPTION SERVICES: 8885277008

36 TECHNOLOGY SURVEY FINDINGS Is your organization on pace with the

biggest technology trends?

42 WILL BIOSIMILARS DELIVER?

Storm clouds raise savings questions

45 TALKING POINTS

COMMENTARY

6 SIGNAL THROUGH THE NOISE AI transforms big data pools into useful

information

by Mark Boxer, PhD

44 TECH SPENDING Why health orgs will invest more this year

by Dennis Schmuland, MD, FAAFP

DEPARTMENTS

7 EDITORIAL ADVISORS

ESSENTIALS

9 STAFFING UP Four essential players for your data

analytics team

11 HEMOPHILIA Ground-breaking gene therapies in store

17 END-OF-LIFE DECISIONS Is it the place for big data?

19 MUST-HAVE APPS For work and for play

20 INDUSTRY ANALYSIS Health systems start generic drug

company

35 THREE QUESTIONS FOR . . . Human’s chief medical offi cer

Five tools coming in the next 10 years 22

Healthcare technology’s future

Co

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Shut

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.com

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TRANSFORMING CARE THROUGH HEALTH IT

TechnologyTRANSFORMING CARE THROUGH HEALTH IT

Technology

Four essential players for your data analytics team by DONNA MARBURY

How will your IT staff numbers change in 2018?Q:

66%

Decrease

Stay the same

Increase

8%

26%

Staffi ng upChief analytics offi cer (CAO)

Putting together the right team of data specialists is an important part of the future success of healthcare organiza-tions. Healthcare data is growing at 48% per

year since 2013, according to a report by EMC Digital Universe. By the year 2020, healthcare data will be about 2,314 exabytes (one exabyte equates to about 1 bil-lion gigabytes).

Experts says analyzing all that data can’t be an additional re-sponsibility of the IT department. “Healthcare organizations will need to recognize that the skills required for data analytics are not merely an extension of exist-ing personnel but will require additional training or acquisition of staff ,” says John Zaleski, chief analytics offi cer at Bernoulli, which develops medical device integration and clinical surveil-lance solutions for hospitals and health systems. “Data are becom-ing more and more the part of day-to-day clinical care. As such, the need for those individuals trained in the acquisition, clean-ing, interpretation, and identifi -cation of value will be required.”

To help ensure you have the right team in place, we asked tech experts to weigh in, and we researched health IT job open-ings. Based on that information, here are some of the most impor-tant players, with job descrip-tions and skills required.

Skills required: This senior manager who heads data analysis should have an

education background in applied science, physics, engineering or engineer-

ing mathematics, or applied mathematics and statistics. Should have hands-on

experience in domain of application and experience in participating and leading

a clinical trial involving data reduction and analysis. Should also have experience

with tools associated with the domain for data reduction, programming, simulation

modeling and the various languages, including of Python, R, Matlab, Excel and

VBA. Should have experience managing scientists, applied mathematicians, or

researchers including medical doctors and researchers with PhDs.

Why this position matters: Unlike a chief information manager (CIO), the CAO’s sole responsibil-ity is leading a team whose goal is to make sense of all types of data that inhabits an organization, says Zaleski. Th is includes claims and fi nancial data, clinical data, and patient-generated data from wearables and remote monitoring devices. He says the CAO should be able to dissect problems into their components and guide team members.

“Th e role is distinct from the CIO’s offi ce as the focus is not on the selection and implementation of software and technology, but rather on the assessment of clini-

cal data and the impact of these data in terms of infl uencing the clinical work fl ow, patient safety, and quality of healthcare within the enterprise,” Zaleski says.

Having this independent analytics leader is paramount as data becomes a standard part of clinical care and complex business decisions for healthcare organiza-tions, Zaleski says. “As healthcare organizations begin relying more on data, the analytics will play a substantial role in clinical patient management, identifi cation and support for best practices in guidelines, and supporting the end-user in making better deci-sions on patients,” he says.

Source: Managed Care Technology Survey 2018. See full results, pg. 36.



Technology

Source: Managed Care Technology

Survey 2018. See full results, pg. 36.

Does your organization employ data scientists whose sole job is to analyze and interpret data, spot trends, and provide feedback to your organization?

Q:

YES

36%

NO

64%

Skills required: This individual should have experience collecting various data

and making it usable. Experience in “soft skills,” such as working with a team

and various levels of management and staff, is also key. “It is crucial for our data

scientists to have strong problem-solving skills, a keen sense of process analysis

to translate business problems to data problems, a collaborative mindset, and the

ability to bring data to life through storytelling,” says Ang Sun, chief artifi cial intel-

ligence offi cer at Cambia Health Solutions, a nonprofi t health insurance corpora-

tion based in Portland, Oregon. Expertise in data visualization and preparation,

pattern recognition, and text analytics is required. May have experience as a data

statistician or programmer. Many have a master’s degree or doctor of philosophy

degree in mathematics and statistics, computer science, or engineering.

Business intelligence manager

Nursing informatics specialist/nurse analyst

Skills required: This individual collaborates with business and data teams to con-

ceptualize, design, and deliver actionable insights. Must have experience in the

architecture and design of processes that answer data questions for both business

and clinical teams, including reports, dashboards, and other reporting tools. This

individual becomes a subject matter expert on best practices that blend data and

business, and creates methodologies and standards used for training throughout

the organization. Education requirements include a bachelor’s degree in computer

information systems, health information management, or mathematics.

Why this position matters: Being able to leverage technology and data to make it actionable across the organization is key to improv-ing and simplifying patient experi-ence and outcomes, Sun says. “From the proactive identifi cation of individuals for specifi c clinical interventions, to optimizing the

consumer experience, to saving our consumers money by detect-ing and stopping incorrect or anomalous claims, data scientists strive to improve healthcare for all,” Sun says. “Th e team collabo-rates with a wide range of busi-ness partners to operationalize data-driven personalization.”

Why this position matters: As the industry shifts to value-based care, organizations must be able to combine data and create scenarios to predict the best outcomes. Busi-ness intelligence managers work with multiple stakeholders to summarize data and experiences, which can make decision making easier. A 2014 report by Gartner suggests that the top need for healthcare informatics is to create a business manager role who can create and manage a clinical data warehouse as a foundation for complex population health and

business strategies.“(Th is role) recognizes the

importance of persistent market-ing and communication about information management and analytics architecture use cases, as well as about current value achieved, as a primary focal point,” the report’s authors state. “Use all the education and infl uence you can muster with top execu-tives to make the case for a strong top-executive commitment to high-value use, strong information governance, and data quality.”

Skills required: This individual oversees the

integration/sharing of information to sup-

port decision making by patients and their

providers through the perspective of nursing.

This individual should make documentation

of data, voice-enabled notes, and mobile

or patient-generated data easy to analyze

and interpret. Education background should

include a bachelor’s degree in nursing with

experience with EHRs and a master’s degree

in health informatics, healthcare manage-

ment, or quality management.

Why this position matters: Keeping the needs of patients in the forefront as big data continues to increase makes nurse analysts important team members, says Asha Gaines, nurse analyst and popula-tion health coordinator for value-based clinical care at Northside Hospital healthcare system in Atlanta.

“I use the term nurse analyst because I use my nursing lens to note trends and patterns in data,” Gaines says, adding that her team of nurses collaborates with payer partners and clinicians to coordinate care. “Th e system solutions are embedded in the data. Healthcare is sitting on goldmines of unused data. Healthcare organizations need folks who understand how to extract information out of data to optimize outcomes.”

Donna Marbury is a writer in Columbus, Ohio.

Data scientist


Managed Healthcare Executive.com MANAGED HEALTHCARE EXECUTIVE ❚ FEBRUARY 2018 11

Drugs In The Pipeline

Hemophilia is an inherited bleeding disorder that prevents a person’s blood from clotting properly and is caused by a muta-tion in the genes. Th e most common types are hemophilia A (lack of clot-

ting factor VIII) and hemophilia B (lack of clotting factor IX). Hemo-philia predominantly aff ects males and according to the CDC, 20,000 Americans have it.

“Although the population of patients with hemophilia is small, cost of treatment for an individual patient can be extremely high, from tens of thousands of dollars for each monthly prescription to over a million dollars per year,” says Crystal Blankenship, PharmD, se-nior clinical consultant for Accredo specialty pharmacy’s bleeding dis-orders therapeutic resource center.

Th e CDC estimates that about 15% to 20% of patients with he-mophilia develop inhibitors that prevent treatments from working, further complicating therapy.

Current treatments Current treatments include recombinant and plasma-derived direct factor replacements that re-quire intravenous administration, says Blankenship. Market leaders for hemophiliaA include:

❚ Advate (antihemophilic factor

[recombinant])

❚ Eloctate (Antihemophilic factor

[recombinant], Fc fusion protein)

❚ Humate-P (antihemophilic

factor/von Willebrand factor

complex [human])

❚ Adynovate (antihemophilic factor

[recombinant], PEGylated)

❚ Novoeight (antihemophilic factor

[recombinant])

❚ Kovaltry (antihemophilic factor

[recombinant])

BeneFix, a recombinant factor IX treatment, is the market leader in the hemophilia B space. Other commonly used products include:

❚ Idelvion (coagulation factor IX

[recombinant], albumin fusion

protein [rFIX-FP])

❚ Alprolix (coagulation factor IX

[recombinant], FC fusion protein)

❚ Mononine (coagulation factor IX)

❚ Ixinity (coagulation factor IX

[recombinant])

For patients who develop in-hibitors, expensive clotting factor bypassing agents such as Feiba (anti-inhibitor coagulant complex) or NovoSeven RT (coagulation factor VIIa [recombinant]), may be needed, says Haita Makanji, vice president, clinical specialty solu-tions at Magellan Rx Management.

Th e newest market entry, Hem-libra (emicizumab-kxwh), used to prophylactically manage patients with inhibitors, marks the fi rst weekly subcutaneous option. It is indicated for patients who have

hemophilia A with inhibitors.“Due to the highly precise calcu-

lations, signifi cant prescriber time is required to evaluate the patient’s current clinical state and the sever-ity of their defi ciency,” says Jennifer Seagle, PharmD, area clinical manager for CompleteRx. “When you add in ongoing lab monitoring, pharmacy and infusion clinic time, the current treatments in place result in signifi cant direct medical costs, with approximately 80% of those costs covering the medica-tion alone.”

Emerging therapiesHemophilia has had an extremely active pipeline, with nine new drugs approved since 2014, says Makanji. Th e immediate pipeline includes additional extended half-life prod-ucts and products for patients who develop inhibitors. Specifi c agents include damoctocog alfa pegol and eptacog beta, says Makanji. Both drugs are administered via intrave-nous infusion.

Damoctocog alfa pegol is an ex-tended half-life factor VIII product that uses site-specifi c PEGylation technology. “Once approved, it will be the fi rst factor VIII product that may be dosed up to once every seven days,” says Makanji.

Th e main benefi ts could be few-er infusions and potentially fewer bleeding episodes, says Seagle, add-ing that it may be more costly.

Eptacog beta is an innovative recombinant form of human factor VIIa.

New gene therapy products are expected in the future, enabling patients to produce their own clot-ting factors, and to maintain the factors they already have.

Erin Bastick, PharmD, RPh, is a staff pharmacist

at Southwest General Health Center, Middleburg

Heights, Ohio.

HemophiliaGroundbreaking gene therapies in store

by ERIN BASTICK, PHARMD, RPH



BEST PRACTICES FOR OPTIMAL OUTCOMES

Health Management

There’s no easy way to discuss end-of-life care. And there’s no easy way for patients and families to make decisions related to it. But there are advances in technol-ogy that could help

providers frame the discussion to help patients and families better understand their situation and gain confi dence in the choices.

“I do believe that we’re really at a point when we’re starting to see data analytics and predictive mod-eling for individuals, especially as we start to look at population health,” says Michael L. Munger, MD, a family physician in Overland Park, Kansas, and president of the American Academy of Family

Physicians. “Th ese tools help you not only with your end-of-life dis-cussion, but they are also going to lead to more and better utilization of palliative care services.”

Predictive modeling Providers sometimes recognize that there aren’t many options left for patients to experience clinical improvement or mean-ingful quality of life, but with the high level of medical intervention that is possible, some patients’ families fi nd this diffi cult to ac-cept. Other times, providers may want to continue with interven-tions at the request of families, without a clear picture of how those actions might actually help patients.

In these cases, predictive analytics may prove useful. It can off er providers risk stratifi cation scores based on a patient’s condi-tions, medications, hospitaliza-tions, and age. Th at information can then be shared with families and patients. “To me that’s almost like the next frontier,” Munger says. “It allows every-one to really focus on what they want and what is reasonable. It addresses the question of how do you want to live the rest of your life in the best manner and what’s important to you. Hope-fully we can shift the conversa-tion from having to do everything

possible to one of having great quality of life.”

Predictive modeling can be used even when end-of-life isn’t imminent. For example, in primary care offi ces providers can discuss end-of-life care plans with patients using data about their age, co-morbidities, functional level, and more. “It’s then a lot easier when you’re sitting down with Mom and adult children to say, ‘Th is is what we see based on all of the previous information and studies together,” Munger says.

Th ese discussions, while dif-fi cult, can lead to higher quality of life and fewer hospitalizations, he says. “Th ere is peer-reviewed re-search that shows that if you have that true advanced care planning earlier, it leads to better care and much higher patient satisfaction. Families no longer feel like they are making the decision to withdraw care,” Munger says. “You have to have these discussions sooner. You can’t wait until it’s time; we have to have it ahead of time.”

Time for full-fl edged use?Some experts think predictive analytics tools are too new and untested to take the chance of using at such a sensitive time. “I think we are some distance from the use of data analytics in end-of-life discussions,” says Linda Harrington, RN-BC, PhD, an independent consultant on health informatics and digital strategy; professor at Baylor College of Medicine; past chair of the American Association of Critical-Care Nurses (AACN) Cer-tifi cation Corporation National Board of Directors; and technol-ogy department editor for AACN

Advanced Critical Care. “Leading

End-of-life decisions

“Hopefully we can shift the conversation from having to do everything possible to one of having great

quality of life.”MICHAEL L. MUNGER, MD, AMERICAN ACADEMY OF FAMILY PHYSICIANS

Is it the place for big data?by RACHAEL ZIMLICH, RN


MANAGED HEALTHCARE EXECUTIVE ❚ FEBRUARY 2018 Managed Healthcare Executive.com18

Health Management

healthcare organizations grap-pling with the use of data analyt-ics to solve issues are confronting challenges largely surrounding data quality, analytic tools, and talent to do the work.”

Today, data analytics alone is insuffi cient to counsel patients and families about chances of recovery or survival, she says. “End-of-life decisions are very individual and complex, requiring data that may not be currently available and not held in one database, such as an electronic health record. In addition to the patient’s medical and psychoso-cial data, an analysis of data in related research, family history, genetics, resource availability, and more can impact survivabil-ity. Data analytics that create a holistic view may one day enable better support for patients and families.”

More than 40,000 studies have been published over the last decade on end-of-life care, and 10,000 on data analytics, according to Teresa Rincon, RN, enterprise critical care cham-pion for the EHR design team at UMassMemorial Health Care. Still, she says, fewer than 100 of these studies have specifi cally investigated the use of analytics in end-of-life care. While EHRs contain an enormous amount of data, she cautions that this data varies in its completeness and de-

tail. She adds that EHRs are used primarily for clinical and fi nancial functions, and may not contain the data elements and formatting necessary to use in data analyt-ics for the purposes of end-of-life care.

When data fall short Rincon says data analytics also lacks the ability to take into ac-count the emotional and physi-cal aspects of death and dying. Harrington agrees, adding that it is an interesting time to discuss tech-nology in end-of-life care because she is seeing a growth in narrative medicine in response to the short-comings of the digital world.

“Th e focus is on the experience of illness, in this case end of life, the meaning of which can be lost in hard data stores,” Harrington says. “Th e lesson here is to balance

technology and data analytics with the larger picture of the patient and family experience.”

How patients process end-of-life discussions is also infl uenced by emotional, psychosocial, and spiritual aspects, Rincon says. Although survival rates and statistics may help some in the decision making process, the same information may create false hope for others. “Th ere are also those that seem to defy statistics, living much longer than predicted. Th ese outliers may cause caregivers, patients, and families to lose trust in predictive models derived from data analytics,” she says.

Data analytics may provide individualized care and interven-tions in end-of-life care, Har-rington says, but research is also conducted in controlled environ-ments and doesn’t often take into account the human element. To truly apply data analytics to sensitive end-of-life care discus-sions and planning, there has to be a full understanding of the source of the data and how it was compiled, and the unique needs of the patient and their family, she says.

Th ese concerns underscore Munger’s advice that end-of-life discussions should happen sooner, and with a familiar provider. “Th is is where having a relationship with a patient and family really pays off because when I take care of a family, I’ve had other challenging conversations that are delicate,” he says. “If you have someone that’s trusted and that you’ve shared things with before, now we can sit down with good data and statistics and have that relationship because I’ve become a trusted voice.”

Rachael Zimlich, RN, is a writer in Columbia Station,

Ohio.

“The lesson here is to balance technology and data analytics with the larger picture of the patient and family experience.” LINDA HARRINGTON, BAYLOR COLLEGE OF MEDICINE

What is predictive analytics?Predictive analytics involves extracting

information from data and using it to

forecast the future based on existing

patterns and associations. It has been

used to optimize existing processes,

better understand customer behavior,

identify unexpected opportunities,

and anticipate problems before they

happen.


THE LIST


MANAGED HEALTHCARE EXECUTIVE BOARD MEMBERS WEIGH IN

Must-have appsASCVD Risk Estimator +Th is app, by the American College of Cardiology, provides an estimate of your initial 10-year atherosclerotic cardiovascular disease (ASCVD) risk. For providers, it helps guide patient discussions around customizing intervention plans.

FlipboardTh is app aggregates content from social media, news feeds, and other websites based on your preferences and prior selections. “Given time constraints and the need for real-time news,

Flipboard as a news aggregation and social network

aggregation platform meets my needs. I really like the

interface, and the artifi cial intelligence and predictive

analytics creates a true personalized experience for the

busy executive.” —Mark Boxer

EvernoteTh is app helps you quickly document ideas, make check lists, and save things you fi nd online. You can also use it to share notes with friends and colleagues and sync information between your phone and computer.

Life360Th is app allows you to share location information with other users.“It helps me keep track of my teenagers and I like the

app’s functionality—it integrates with my car.”

—Douglas L. Chaet

LumosityWhen you’re in a slump, this app can help you recharge. It’s fi lled with games that challenge your mind and train your memory.

Audible.Th is app allows you to download and listen to your favorite books anywhere. “It allows me to ‘read’ more books during my long

commute and catch up on all my podcasts to keep me

better informed.” —Amy Shin

DoctorOnDemandTh is app allows you to connect with board-certifi ed physicians and therapists over live video. “I like the fact that the app also has psychologists and lactation

consultants available and that it can help with getting refi lls for

prescriptions. Th is app could be a gamechanger. —Don Hall

TripItTh is app is great for frequent travelers. It automatically transforms your emails into a trip itinerary.

WAZETh is community-based navigation app allows you to view and share real-time traffi c information with other drivers in your area.“I never know where I am going, I’m always in a hurry to get there,

and I like to share my Boston traffi c miseries with all the other

Wazers around me.” —David Calabrese

MyChartTh is app allows users whose providers use MyChart to view health information, communicate with doctors, manage appointments, pay bills, and more. “Patients want to have personal information at their fi ngertips

and take control of their healthcare experience, and MyChart

allows them to do so, securely and effi ciently.” —Cynthia Hundorfean

CamScannerTh is app helps users scan, store, sync, and collaborate on various contents across smartphones, tablets, and computers. You can use it to scan receipts, notes, and business cards, and share documents.

DirectTVGreat for anyone who spends lots of time on trains and planes, this app allows users with DirectTV accounts to watch live and recorded shows on-the-go. “Being able to access news, sports, and TV shows on my

smartphone is great.” - Perry Cohen

Here are some to check out—for work and for play by AUBREY WESTGATE

IN CASE YOU MISSED ITTo learn more about these board members, see PAGE 7



INDUSTRY ANALYSIS

Four large health systems have joined together over frustrations about drug prices and shortages to form a nonprofi t company to make generic drugs.

Th e hospital systems are Intermoun-tain Healthcare, Ascension, SSM Health, and Trinity Health. Combined, they own more than 280 hospitals in the United States, with Ascension being the coun-try’s largest nonprofi t hospital group.

Th e organizations have been working on this idea for a year and a half, says Dan Liljenquist, vice president of the Enter-prise Initiative Offi ce at Intermountain. “We focused on fi xing a life-or-death situ-ation,” he says, noting that drug shortag-es and price hikes are an increasing prob-lem. “Th e objective is to keep essential generic drugs available and aff ordable.”

Liljenquist says the company pro-vides an opportunity to work with part-

ners in stabilizing some of the market failures. Th e company will be competi-tive, he says, and other hospital groups are welcome to join in. “We want every hospital in this.”

Many of the well-publicized problems in the U.S. generic drug market can be at-tributed to a reduction in the number of suppliers, consolidation of production volumes, and a concentration of mar-ket pricing power, according to a group statement about the initiative. “Th ese market factors are particularly problem-atic with older generic medications that hospitals rely on every day to take care of desperately ill patients.”

HOW IT WILL WORK

Th e company is expected to start with products—including injectables, patch-es, and oral medications—that are usu-ally administered in hospitals, Liljen-quist says. However, he says it may eventually cross over into the retail space with its products. It will contract out the actual manufacturing for most products, but may develop its own man-ufacturing capacity for some.

During the year and a half since the project started, the four hospital sys-tems have been vetting the idea and creating an advisory committee to help guide it, says Liljenquist. Two members of that committee are former Senator and Nebraska Governor Bob Kerrey and Don Berwick, MD, former administra-tor of CMS.

Valerie DeBenedette is managing editor of Drug Topics, Managed Healthcare Executive’s sister publication.

Health systems start generic drug company

How biosimilars could impact drug prices http://bit.ly/Expert-analysis MORE ONLINE:

V A L E R I E D E B E N E D E T T E

“We felt that this was an opportunity for us to work with partners in stabilizing some of

the market failures.”—DAN LILJENQUIST

Here’s why and how it could affect the industry

Expert analysisOverall generic prices have

not been increasing, but prices

for certain generic drugs have

skyrocketed, in some cases,

over 5,000%, says Joe Fuhr,

professor emeritus of economics,

Widener University, Chester,

Pennsylvania; adjunct faculty,

Thomas Jefferson University

College of Population Health

in Philadelphia. While this

does not greatly affect the

overall drug budget, it can have

considerable adverse effects on

those consumers who need these

drugs, which can result in higher

copayments and sometimes

make the drug unaffordable even

to those with insurance.

Various factors can cause

price increases, but the major

one is lack of competition for

a particular product, says Fuhr.

This is due to low generic prices

and low profi t margins in some

markets so that generic fi rms

leave and only one fi rm is left.

This creates a monopoly in

the market and the fi rm now

lacks competition and has the

ability to signifi cantly raise

prices. Some other reasons for

only one fi rm remaining are

consolidation through mergers

and low-revenue markets where

fi rms leave and other fi rms do

not enter.


http://bit.ly/Expert-analysis

http://asembiasummit.com

http://asembiasummit.com


In the next decade, many of the concepts

aiming to streamline the healthcare in-

dustry could be reality. Technology such

as artifi cial intelligence, blockchain, and

virtual reality will make interoperability

and automation possible, as tech giants

and startups partner with hospitals

and health systems to prevent medical

episodes and lower costs.

“We are entering an era of massive in-

novation in healthcare to combat the rising

costs of the last decade,” says Jay Samit,

independent vice chair of digital reality for

Deloitte consulting fi rm. He says as patients

begin to get more involved in their health-

care, providers will have even more data to

make better decisions.

“Right now, we use smartphones to track

our vitals and our steps, but when artifi cial

intelligence is tied into the phone, it could

tell you that you might have a heart attack

in 30 days. You would take that seriously,”

Samit says. “Healthcare currently happens

after the event, and new technology will

make it more preventive.”

Here are fi ve technologies that experts

say will be commonplace in the next

decade:

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abbi

t/Sh

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Five tools coming in the next 10 years

HEALTHCARE TECHNOLOGY’S

FUTUREby DONNA MARBURY




1/BLOCKCHAIN TECHNOLOGYFinding secure and reliable ways to transmit sensitive data between stakeholders has been an issue in healthcare for years. But many ex-perts are confi dent that blockchain technology applied to clinical and claims data will result in huge cost savings in the next decade.

“Everyone talks about big data, but there needs to be a longitudinal view of the data that sits in diff erent silos. Blockchain enables that,” says Shahram Ebadollahi, chief science offi cer for IBM Watson Health technology solution fi rm.

In a blockchain, patient health records could include clinical, behavioral health, and payer information, and can be reviewed, stored and exchanged in a peer-to-peer transaction ledger. Because information is stored in blocks rather than one fi le, information can be used in clinical decision making or population health manage-ment. Patients can give unilateral permission to

use portions of the data, and past information can be stored without being changed. Th is also allows for patient information to be used more widely for clinical trials without researchers having to get multiple layers of permissions.

Many big players in healthcare technology have been making headway into blockchain. IBM Watson Health is currently working with the CDC to identify uses for it and barriers for adoption. Th eir goal is to exchange diff erent types of information including clinical trial data, genomic data, and patient generated data, making it available to several stakeholders in a secure way. Deloitte has also submitted a whitepaper to the HHS Offi ce of the National Coordinator for Health Information Technology detailing how blockchain can be used to make health information exchanges more secure and interoperable. Gem, a startup blockchain pro-vider, has also partnered with CDC to explore population health solutions.

Ebadollahi says the various uses for block-chain technology would impact supply chain sectors of healthcare, clinical trials, business, and clinical fi elds.

“We see an increase in the number of risk-shared, gain-shared contracts and there are penalties for those that don’t make their out-comes. Th ere are diff erent outcomes produced by various players, and blockchain is a way to keep track of the outcomes of various players. It

What is blockchain? It is a digital ledger that allows for data to be stored in chronological

order. The data can be interconnected, but cannot be changed once

entered into the ledger. Key information can be stored without identifi -

able factors that can be a security risk. The technology is promising for

healthcare because it allows for less paperwork and easier methods

of capturing permissions to use across healthcare silos, says Shahram

Ebadollahi, chief science offi cer for IBM Watson Health.

Who is using it? 47% of healthcare organizations are “trailblazers,” meaning they

expect to begin investments and usage of blockchain

technology in 2017, but only 8% of North American healthcare

organizations fall into this category.

56% of healthcare organizations are “mass adopters,” meaning

they plan on investing in blockchain between 2018 and

2020.

29% of healthcare organizations are “followers,” meaning they

are waiting to see what problems and roadblocks may be

involved in adopting blockchain. They plan to invest in the technology

after 2020.

60% of trailblazers anticipate blockchains will help them access

new markets, and new and trusted information they can

keep secure.

70% of trailblazers expect the greatest blockchain benefi ts to be

in clinical trial records, regulatory compliance, and medical/

health records.

56% of healthcare organizations expect to encounter inaccurate,

misleading, or incomplete information when fi rst adopting

blockchain technology

Source: 2017 IBM survey of 200 healthcare payer and provider executives in 16 countries on the adoption of

blockchain technology

“We are entering an era of massive innovation in healthcare.”JAY SAMIT, DELOITTE



will be a huge cost savings once it is adopted on a wide scale,” Ebadollahi says.

2/INTELLIGENT INTEROPERABILITYTh e industry is focusing on improving interop-erability in eff orts to use technology to break down silos between payers, providers and patients. But in the next fi ve to 10 years, the concept of interoperability could become less about the transmission of data and more about how actionable it is.

Dave Lareau, CEO of Medicomp Systems, a medical information technology company, says “intelligent” interoperability will help identify and interpret disorganized and complex data from multiple sources. High-value information can then be fi ltered as part of a provider’s work fl ow to support clinical decision making in the exam room.

“With intelligent interoperability, providers don’t just have data, but actionable information that is structured and organized in a way that facilitates viewing across clinical settings and domains,” Lareau says. “Clinicians can access the precise information they need when they need it, during patient encounters and within their normal work fl ows across the continuum of care.”

Th e large amount of data generated by EHR systems is often disorganized, redundant, in multiple formats, and therefore, unusable, Lar-eau says. “To achieve intelligent interoperabil-ity, providers need solutions that sift through

this wealth of data, eliminate all the other clini-cal static, and make the right information avail-able at the right time in the care process,” he says. “Unless organizations have the ability to contextually fi lter data, physicians will struggle to identify the precise information that is rel-evant to each specifi c patient and their known or suspected clinical issues.”

Lareau predicts healthcare organizations will not have to replace their current EHR sys-tems to achieve intelligent interoperability. In-stead, interoperability standards including Fast Health Interoperability Resources and Clini-cal Document Architecture will require more seamless data exchange.

“For example, data that comes from another provider must be coded to a usable standard. One way to achieve this is by leveraging tech-nology that intelligently identifi es, interprets, and links medical concepts and maps them to standard nomenclature, such as ICD-10, SNOMED, RxNorm, or LOINC,” he says. “Th e data can then be easily merged with existing information and made actionable at the point of care. In addition, when clinicians create new data through the documentation process, they need tools that facilitate the capture of high quality data in structured formats that are eas-ily exchanged and interpreted with minimal manual intervention.”

3/ARTIFICIAL INTELLIGENCETh ough artifi cial intelligence (AI) is being used in administrative and clinical functions, experts believe that the next decade could see the tech-nology taking a more direct role in clinical deci-sion making.

Th e use of AI to design treatment plans, man-


The percentage of healthcare organizations who say their most pressing Health IT problem is exchanging claims/patient data with other entities.

Source: Managed Care Technology Survey 2018. For full survey fi ndings, see page 36.

19%

“Clinicians can access the precise information they need when they need it.”DAVE LAREAU, MEDICOMP SYSTEMS

The role of artifi cial intelligence is to help practitioners sift through knowledge, publications, and hard to analyze data.” EBADOLLAHI



age medications, assist with repetitive adminis-trative tasks, and promote predictive medicine could grow the AI technology market to more than $10 billion by 2024, according to a report by Accenture.

Th e growth in AI in the next decade could also ease workforce defi cits. Projected physi-cian shortages have many healthcare organi-zations beefi ng up care teams with physician assistants and nurses, and AI could help those care teams with decision making.

Technology that enables AI can also make genomics more accessible to care teams, and assist with chronic care management, Ebadol-lahi says. “Th e role of artifi cial intelligence is to help practitioners sift through knowledge, pub-lications, and hard to analyze data.”

Ebadollahi adds that AI already has diff er-ent adoption rates depending on the healthcare sector, but in the next fi ve years the technology will be more common in the hands of physi-cians and nurses as they diagnose and create treatment plans.

Th e use of more AI, and data in general, will also lead to new roles, says Ebadollahi. “On a healthcare team of physicians, nurses, and physician assistants, it won’t be a remote idea to have a data scientist as a part of the team.”

4/INCREASED AUTOMATIONStreamlining claims and administrative pro-cesses would be a game changer to the industry. Billing and insurance-related administrative expenses cost more than $375 billion, account-ing for about 15% of total healthcare costs in the United States, according to a 2015 report by BMC Health Services Research. A simplifi ed billing system would save money, and push the industry toward being more in step with other

automated consumer experiences.Craig Kasten, cofounder of Skygen USA, a

claims management technology and outsourc-ing solutions company, says in the next decade, healthcare organizations that aren’t able to process claims and authorizations in the same day will be obsolete. “During the next fi ve to 10 years, healthcare payers will either adopt new technologies and automated processes, or they will be replaced by competitors with lower costs that off er innovative services and deliver a much better experience for both providers and patients,” Kasten says.

Reliance on paper and outdated technology can be tedious, slow, and increase vulnerabili-ties to data breeches, he says. Health plans need technology solutions built with electronic com-munications and process automation as the foundation of the architectural design, rather than technology centered on paper forms and manual processes.

“Many hospitals and health systems in par-ticular are making investments in revenue cycle management technology in an eff ort to create


“During the next fi ve to 10 years, healthcare payers will either adopt new technologies and automated

processes, or they will be replaced by competitors.”CRAIG KASTEN, SKYGEN USA

The savings expected to be realized by 2026 if the healthcare industry uses artifi cial intelligence to assist

with administrative tasks.

$18 BILLIO

N

Source: Accenture analysis, July 2017

The percentage of healthcare organizations who employ a data scientist whose sole job is to analyze and interpret data,

spot trends, and provide feedback.

Source: Managed Care Technology Survey 2018. For full survey fi ndings, see pg. 36.

36%



greater effi ciencies, reduce waste, and improve the member/provider experience,” says Kasten. “Incorporating automated claims submission, remittance advice, payments, etc., into those technologies will greatly increase the value of those investments and help them manage their cash fl ow more eff ectively—an important con-sideration given the challenges that come with the transition to value-based care coupled with ever-shrinking margins.”

Kasten says that real-time automated deter-minations and claims adjudication will result in more accurate and reliable claims payment, lower accounts receivable balances, more con-sistent revenue streams with faster and easier daily reconciliation, and reduced reliance on collection agencies to pursue unpaid bills and unpaid claims from insurers.

Health plans will benefi t from signifi cantly fewer calls from providers seeking claims sta-tus and payment information, fewer duplicate claims submissions, fewer denied and resub-mitted claims, higher provider satisfaction, a better experience for patients, and higher productivity and lower administrative costs, Kasten says, noting that same-day account-ing and reimbursement encourages provid-ers to abandon paper and engage in electronic relationships.

“To achieve the best outcomes with the low-est costs, health plans must invest in modern technologies that seamlessly automate routine administrative functions, while streamlining

processes that do require human judgement, such as instantly providing a full, online view into patient treatment history, allowing clini-cians to make medical necessity determina-tions effi ciently and accurately.”

5/VIRTUAL REALITYTh e daily use of virtual and augmented reality with practitioners is coming within the next 10 years, says Samit. “If the engine is artifi cial intel-ligence and blockchain, augmented and virtual reality are the interfaces that make the technol-ogy accessible.”

So what will this look like? He predicts physi-cians will use more virtual reality, for example, wearing a pair of glasses that captures a patient encounter and ensures compliance, record keeping, and patient privacy. “Augmented real-ity glasses can be worn by doctors and some-one can listen in on their meetings and take notes,” Samit says. “At the end of their rounds, everything is typed up, medications are noted, confl icts have been researched, questions have been answered. Everyone on the care team will have the latest and greatest knowledge, and it helps the doctor be more educated.”

Augmented and virtual reality technology can also be used in operations where the sur-geon is in another location guiding robotics to perform surgeries. It can also be used in the operating room as surgeons wear headgear and glasses that can show 3D images of a patient’s tumor to be removed, says Samit. “Today we are seeing great imaging, but it is useless to see 2-dimensional images when you can see 3-di-mensional images hovering above your patient in the operating room.”

Another use for virtual reality: combatting the opioid epidemic. Samit calls this use for it “mechanized medication,” citing studies that assert that patients who are distracted from their pain using virtual reality leave hospitals sooner and have less use for pain medication. A 2016 study conducted at Cedars-Sinai Medi-cal Center found that patients experience 24% less pain within 10 minutes of viewing virtual reality experiences including ocean exploration, Cirque du Soleil, and tours of Iceland.

Samit predicts that virtual reality glasses and holographic technology will fl ood the health-care market within the next two years, due to its effi ciency and the better health outcomes produced.

Donna Marbury is a writer in Columbus, Ohio


MONEY MATTERSBilling and insurance-related administrative expenses cost more

than $375 billion annually, accounting for about 15% of total

healthcare costs in the United States.

Source: BMC Health Services Research.

“Today we are seeing great imaging, but it is useless to see 2-dimensional images when you can see 3-dimensional images hovering above your patient in the operating room,” SAMIT



INDUSTRY EXPERTS WEIGH IN

Q&A

More family physi-cians are moving into value-based payment models, according to an American Academy of Family Physicians

study. But the study, sponsored by Humana, also found that physi-cians still face similar value-based

payment barriers as they faced two years ago, when a similar study was conducted. Nearly 400 physicians responded to the study.

Here’s more from Roy Beveridge, MD, Managed Healthcare Executive

editorial advisor and Humana’s chief medical of cer.

Q:MHE: Is pay for value becoming more common?

Beveridge: T e study showed slightly more than half of the physicians (54%) indicated their practices participate in value-based pay-ments. I believe we’re seeing more adoption for two primary reasons:

First, the industry is demanding it. T ose who are paying for healthcare—the government, employers, patients, commercial health plans—want more value for their healthcare dollar. Second, physicians are tired of being limited to treating patients 15 minutes at a time.

Another important factor: Physicians who practice in value-based models are seeing results. At Humana, we’re distributing more payments to value-based family physicians than the national average. T at’s because their Humana Medicare Advantage patients have more screenings and better health outcomes. T ese value-based physicians also have higher HEDIS scores, fewer inpatient admits, and fewer emergency department visits when compared to traditional fee for service.

Q:MHE: What are some of the issues the survey identifi ed?

Beveridge: T ere were many com-mon barriers but some that really caught my attention were value-based payment implementation like:

❚ Lack of staff time: 90%

❚ Unpredictability of revenue stream:

77%

❚ Lack of resources to report,

validate, and use data: 74%

When you consider more than one-third of physicians receive payment from more than 10 payers, you start to understand the complexity with not only payments and revenue, but data, reporting, and quality targets/goals.

Q:MHE: How should executives address the barriers?

Beveridge: Executives from both care providers and health plans can begin to think beyond what has normally been a contractual relationship between the two. It’s a relationship that historically has not been collaborative and stems from negotiated rates and fee schedules. In a value-based environment, there are overarch-ing, common goals between a care provider and health plan. It makes sense to work together.

A good starting point is with the sharing of data and insights, and that begins with the health plan. Certainly transparent,

accurate, and timely data allows for enhanced decision making when treating patients. But it also improves practice performance, especially when a physician knows what actions and levers af ect revenue and payment.

T e fact that signif cantly fewer family physicians today believe value-based payments lead to better patient outcomes or more time with their patients means that we—as a healthcare industry—need to provide them with more research and real-world data to support the promise of value-based care.

Tracey Walker is content manager for Managed Healthcare Executive.

Humana’s chief medical offi cer by TRACEY WALKER

Roy A. Beveridge, MDThree questions for …

¥ Forty-three percent of family physicians are

hiring/hired care managers, up from 33% in 2015.

¥ Fifty-four percent of family physicians are

updating/adding health IT infrastructure for data

analysis.

Noteworthy stats

BEVERIDGE

Source: 2017 AAFP Value-based Payment Study, sponsored by Humana.

ES1018846_MHE0218_035.pgs 02.09.2018 01:29 ADV blackyellowmagentacyan



“I am not surprised that the most pressing information technol-ogy issue is turning data into actionable

information. Most health plans are ‘data rich’ and ‘information

poor.’ These plans will need to begin to use outside vendors more to address this

need.”

Perry Cohen, PharmD, editorial advisor and CEO,

The Pharmacy Group and the TPG family of companies

TECHNOLOGYSURVEY

Is your organization on pace with the biggest healthcare technology trends? Here’s your chance

to fi nd out. During the fourth quarter of 2017, nearly 120 executives from provider organizations,

benefi t management organizations, health plans, long-term care organizations, and more

took Managed Healthcare Executive’s annual Technology Survey. Th eir responses reveal the top

technology trends and challenges you should be watching.

2018

Which of the following represents your most pressing information technology problem?

Q:

Keeping patient data secure

Securing funding for IT initiatives

Difficulty exchanging claims/patient data with other entities

Difficulty turning data into actionable information

Training staff and/or physicians on new technology

Other

9%

9%

19%

30%

22%

11%



Respond to the following statement: “The federal government should mandate that payers pay for telemedicine services.”

Q:

How would you grade your organization’s use of big data to reduce costs and improve quality?

Q:

Technology Survey

“Commercial payers are certainly moving in this direction, so I’m not sure a mandate is required.

Provider adoption is also picking up speed, particularly with those

telehealth models that support established patient/physician

relationships.”

Douglas L. Chaet, FACHE, editorial advisor, chief managed care offi cer, Sentara

Healthcare, chairman, American Association of Integrated Healthcare Delivery Systems

“The growing trend is to meet the patient where and when they want

healthcare. The ability to grow telemedicine opportunities as such becomes a win for patient experi-

ence. Our experience has been that millennials want and seek this

type of healthcare. Additionally, growing a strategy to use tele-

health platforms between caregiv-ers is needed just as much.”

Cynthia Hundorfean, editorial advisor, president and CEO, Allegheny Health Network

“While I would agree with challenges noted, there are two foundational issues that must be resolved: the inte-

gration and reconciliation of clinical and fi nancial data, and the lack of uniformity

with respect to methodology and reporting. Until this is

resolved, the industry will be unable to effectively evalu-ate comparative health plan and provider performance in

a meaningful way.”

Chaet

What is your organization’s biggest challenge related to big data?

Q:

Difficulty gathering information6%

Difficulty exchanging information between systems30%

Difficulty turning data into actionable information32%

Not having enough staff members with adequate expertise in data analytics32%

68%Agree

Disagree 32%

4%

4%

40%

36%

16%

A

B

C

D

E



Technology Survey

Which of the following technology tools does your organization use? (select all that apply)

Q:

Has your organization successfully used remote monitoring devices to improve patient care?

Does your organization provide patients with tools to help them estimate the cost of healthcare services?

Q: Q:

Patient registries

Business intelligence and analytics

Health information exchanges to share data with other organizations

Remote health monitoring/telemedicine/wearable devices

Organization-specific apps for patients

Cost/quality transparency tools for patients/members

50%

60%

54%

26%

21%

24%

33% 35%Yes Yes

No 67% No 65%



Does your organization use social media to communicate about your business?

Do you believe the time/effort invested in social media is worth it for your business?

Q: Q:

67%Yes

No 33%

Technology Survey

73%Yes

No 27%

How much do you expect to invest in technology in 2018?

What technology has had the most positive impact on your organization in the past year?

Q:

Q:

The same amount we invested in 2017

Data analytics tools

More than we invested in 2017

EHRs

Less than we invested in 2017

Clinical decision support tools

Not sure

E-prescribing

Remote monitoring tools/wearable devices

Other

27%

29%

43%

35%

9%

11%

21%

17%

4%

4%

Dennis Schmuland, MD, editorial

advisor and Microsoft Corporation’s chief

health strategy offi cer reacts. See page 44



Technology Survey

How is your organization doing when it comes to exchanging information with other plans/providers?

Q:

We are exchanging very little information

in real time

We are exchanging some information in

real time

We are exchanging most information in

real time

We are exchanging all information in real

time.

41%

41%

14%4%

40%

44%

15%

1%

How will your IT staff numbers change in 2018?

Q: Does your organization employ data scientists whose sole job is to analyze and interpret data, spot trends, and provide feedback to your organization?

Q:

8%Decrease

Stay the same 66%

36%YES

NO 64%

Increase 26%

“Providers do not have the money to

spend on improving their IT systems so

they cannot interface well with health

plans. As ACOs grow and providers take on

more fi nancial risk, the need for improved

IT systems will increase and you will see more spending in

this area.”

Perry Cohen

“One culprit here that might explain why information exchange has stalled is the paradox that data discovery in EHRs is becoming more diffi cult and time consuming, not less, for clinicians on the receiving

end of EHR information exchange transactions. The sheer volume of data stockpiled in EHRs over the last few years, including copied and pasted misinformation, has made it diffi cult for clinicians to justify spending the time to sift through digital reams of data to fi nd the few nuggets of knowledge they need.”

Dennis Schmuland

2017 2016


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Pharmacy Best PracticesINNOVATIVE IDEAS FOR DRUG UTILIZATION AND MANAGEMENT

The biosimilars market picked up in 2017 as federal agencies off ered more clarity about the regulatory landscape and the FDA issued draft guidance on nam-ing and interchangeabil-

ity. Th ose developments will help bring the United States into the biosimilars era—if manufacturers can seize suffi cient market share, according to experts.

Until November 2017, Medicare Part B payment policy for biosimi-lars left manufacturers unclear as to how they would compete with reference biologics, says Amanda Forys, MSPH, senior director at Xcenda, a part of Amerisource-Bergen.

CMS had indicated in 2016 that biosimilar products for a given reference biologic would all share a single billing code separate from the reference product, meaning Medicare Part B would reim-burse each biosimilar at the same

rate—the average sales price for all products sharing that billing code plus 6% of the reference product’s average sales price, Forys says.

Th at would have caused un-certainty in biosimilar pricing for providers compared to reference products and could have created challenges for pharmacovigilance, as biosimilars are not interchange-able with one another. Together, these challenges could have sig-nifi cantly slowed provider uptake, she says.

But in November 2017, CMS issued fi nal rules for the Physician Fee Schedule and the Hospital Outpatient Prospective Payment System that established unique billing codes for each biosimilar. Th e rules will take eff ect this year.

Th is will encourage competi-tion in the biosimilars market and ultimately hasten patient access to less-expensive drugs, Forys says. “Where we still have a problem and need to think about the next step is Medicare Part D. Biosimilars do not count as branded products under the Medicare Part D program, which means manufacturers cannot participate in the coverage gap discount program, which provides patients discounts in the ‘donut hole’ [coverage gap].”

Th e FDA also released in 2017 draft guidance for interchange-ability, says Gary H. Lyman, MD, MPH, codirector of the Hutchinson

Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, and professor of medicine at the University of Washington School of Medicine, in Seattle.

To be deemed interchangeable with reference biologics, bi-osimilars have to meet additional regulatory requirements, including evidence that they are expected to produce the same clinical results and that the safety and effi cacy eff ects of switching between the products has been evaluated.

No biosimilars have been ap-proved as interchangeable and that’s unlikely to change in 2018, Lyman says. But state govern-ments will become bigger players in implementing biosimilar interchangeability, as more state legislatures weigh in on implemen-tation of interchangeability for biosimilars prescribing.

“Th irty fi ve states already—and more to come—have preempted forthcoming federal rules on interchangeability, switching, and notifi cation,” Lyman says.

Landmark year for cancer biosimilars Biosimilars began to move into clinical oncology in 2017, with the FDA’s approval of an anti-cancer biosimilar for Avastin (bevacizumab). Th e biosimilar, Mvasi (bevacizumab-awwb), is approved for treating meta-static colorectal and renal cell carcinoma, cervical cancer, glioblastoma, and non-squamous non-small-cell lung cancer, and will likely be available in 2018, says Lyman.

In May 2017, the FDA Onco-logic Drugs Advisory Committee also recommended approval of an epoetin alfa biosimilar across all

Storm clouds raise savings questions

by BRYANT FURLOW

Will biosimilars deliver?

Behind the curveThe European Union is ahead of the

U.S. on biosimilar development and

approvals. That’s largely because the

U.S. didn’t establish a pathway for FDA

biosimilar approvals until the ACA was

passed in 2010.



Pharmacy Best Practices

indications of reference biologics for treatment of anemia. Lyman says this will likely gain approval in 2018 or early 2019.

Th e FDA also approved biosimilars in 2017 for the tumor necrosis factor-alpha (TNF-alpha) inhibitors Renfl exis (infl iximab) and Cyltelzo (adalimumab) for Crohn’s disease, ulcerative colitis, rheumatoid arthritis, plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis, Lyman says. Th e Cyltelzo biosimilar, adalimumab-adbm, was also approved for juvenile idiopathic arthritis. Th e Renfl exis biosimilar (infl iximab-dyyb) was introduced in October 2016.

Th is will be another landmark year for oncology biosimilars, Ly-man says. Biosimilar trastuzumab, rituximab, cetuximab, and other versions of bevacizumab are likely to gain approval in 2018 or early 2019.

“For the fi rst time we will have biosimilar anticancer drugs and not just biosimilar supportive care agents like fi lgrastim,” he says. “Pa-tients who are currently doing well on an originator biologic are likely to continue on that per patient and provider preference. However, changes may be forced based on reimbursement or formulary restrictions even in the absence of an interchangeable label.”

Cost questionsUltimately, insurers and health sys-tems will likely “drive the uptake” of biosimilars by restricting use of biologics via negotiated pricing, Lyman says. Biosimilars will likely enter the market priced at a 20% to 40% discount to their reference competitors, predicts Forys.

“I anticipate that the uptake of biosimilars in the U.S. will be more gradual than in Europe,” Lyman says of oncolytic biosimilars. “Th e U.S. healthcare system is far more independent, with the majority of cancer patients treated in the community.”

Some clinicians will be uneasy with newly-approved biosimilars compared to the original reference biologics.

And, as anticancer biosimilars launch, patients and oncolo-gists are going to be “very, very concerned” about substituting branded oncolytics, considering the life-and-death stakes, says Ambrose Carrejo, PharmD, na-tional pharmaceutical contracting leader at Kaiser Permanente. Many branded biologics have strong patient copay assistance programs in place, he says.

Lyman agrees. “Th ere will likely be concern about switching from previously approved biologics of known safety and effi cacy to new biosimilars approved with much less clinical data support-ing effi cacy and safety along with extrapolation of approval to other indications with little or no data provided,” he says. Th ere will be concerns about possible rare or delayed toxicities, so postmarket-ing surveillance will be “critical” for clinical acceptance.

“We need to be able to identify and track diff erent forms of biolog-ics [and] biosimilars in practice and identify unusual or delayed toxicity or loss of effi cacy,” Lyman says. “It is also critical that provid-ers be notifi ed when a patient is switched from a reference product

to a biosimilar, or between biosimi-lars.”

If biosimilars do become well-accepted, the savings could be profound. A recent analysis by the Rand Corporation suggests that biosimilars could cut healthcare spending in the United States by more than $50 billion over the coming decade.

Not everybody is as optimistic, however. “How will biosimilars aff ect costs overall? Th ey may not, is my concern,” Carrejo says.

He points to the recent Remicade (infl iximab, Johnson & Johnson) biosimilar Infl ectra (infl iximab-dyyb, Pfi zer) as one sign of potential trouble ahead.

Pfi zer has fi led suit against Johnson & Johnson in federal court over allegedly using exclusionary contracts to suppress price compe-tition from biosimilars.

Pfi zer launched Infl ectra in 2016 at a 15% discount compared to Remicade’s price. But a year later, Infl ectra had captured only 2.3% of infl iximab volume, ac-cording to a second quarter 2017 investors’ call.

If that’s the market share manufacturers can look forward to, Carrejo says, “one can imagine that they are going to take their football and go home—that, you know, there’s just no money in biosimilars. Th at would be cata-strophic. How else are we to cre-ate competition in this branded arena and prevent or mitigate some of the pricing actions that have been going on year over year over year in the form of multiple price increases, double-digit, with no added innovation or added value in that product? In my mind, that would just be a shame if the robust biosimilars market that we dreamt of came and went before prices were af-fected.”

Bryant Furlow is an award-winning medical

journalist, reporting on clinical research, oncology, and

healthcare.

FDA approves cancer biosimilar #2The FDA recently approved the

fi rst Herceptin (trastuzumab)

biosimilar for treating HER2-posi-

tive breast and stomach cancers.

The agency approved Ogivri

(trastuzumab-dkst, Mylan GmbH)

for treating patients with HER2+

breast cancer, gastric cancer,

and gastroesophageal junction

adenocarcinoma.



MANAGED CARE OUTLOOK

One of the more interesting fi ndings in the 2018

Managed Care Technology Survey that caught my

eye relates to health IT investment predictions.

In the 2017 survey (which took place dur-

ing the fourth quarter of 2016), nearly 50% of

respondents said they planned to invest more

in 2017 than in 2016. In the 2018 survey (which

took place during the fourth quarter of 2017),

more than 40% of respondents predicted they’d invest more

in 2018 than in 2017. So why are healthcare organizations

continuing to heavily invest in tech?

Chief information offi cers and chief transformation offi -

cers looking to drive digital transformation in their organiza-

tions are no longer asking, “How do we drive EHR adoption

and show an ROI on our EHR investment?” but rather, “How

can we create new value and business designs by blurring the

digital and physical worlds of business, people, and things

with exponential technologies, alongside our existing EHR

investment?”

A December 2017 Deloitte Insights report predicts the

manifestation of exponential technologies within the next 36

to 60 months. It references, for example, artifi cial general in-

telligence, defi ned as an advanced version of artifi cial intelli-

gence that would have capabilities similar to what we call “gut

instinct,” which allows us to perceive and interpret information

on the spot. What’s unique about exponential technologies

and most exciting is that they’ll empower, not burden, orga-

nizations and clinicians who have been protesting that they’re

serving their EHRs more than their EHRs are serving them.

Th is is very good news because True North for value cre-

ation is now the quadruple aim: better heath, better experi-

ence, lower costs, and improving the productivity and work

experience of clinicians. Technology must now do more than

improve experiences, outcomes, or even safety at any cost; it

has to accomplish these at the same or lower cost.

Th is will require health systems to deploy three exponential

technology platforms that I like to refer to as “human empow-

erment platforms”: intelligence, engagement, and collabora-

tion platforms that will pick-up where EHRs have left off and

drive real-life experience and cost structure transformation for

consumers, payer, and providers. By design, they’ll amplify hu-

man eff ort and ingenuity.

❚ An intelligence empowerment platform will

empower organizations to redesign their business and

clinical processes and help clinicians scale their productivity,

expertise, reach, and leadership.

❚ An engagement empowerment platform will

empower organizations to deliver unobtrusive interactions

to consumers during the 5,000 hours between offi ce visits

to improve care outcomes, promote healthier living, and

accelerate recovery.

❚ A collaboration empowerment platform will

empower organizations to digitize care teamwork and extend

care coordination efforts into the medical neighborhood to

reduce the need for care and improve population health.

What’s particularly exciting is that, for the fi rst time in his-

tory, every sector in the healthcare industry—provider, payer,

and pharma—now has a business imperative to deliver servic-

es or products that achieve the quadruple aim. When innova-

tive health systems begin to harness exponential technologies

to empower their organizations, clinicians, and consumers to

amplify human eff ort and transform their experience and cost

structures, we will see the kind of real life digital transforma-

tion that’s been long overdue.

ABOUT THE AUTHOR ❚

Dennis Schmuland, MD, FAAFP, is a Managed Healthcare

Executive editorial advisor and chief health strategy offi cer, U.S.

health and life sciences, Microsoft Corporation.

Why health orgs will invest more

this year by DENNIS SCHMULAND, MD, FAAFP

Tech spending

The same amount we invested in

2017

More than we invested

in 2017

Less than we invested

in 2017

Not sure

2017 2016

27%43%

9%

21%26%

51%

3%

20%

How much do you expect to invest in tech in 2018?


51%


THE BOTTOM LINE

• Old age

• Male gender

• Longer hospital stay

• Previous ED visits

• A more severe comorbidity

• Low socioeconomic status

30-day COPD hospital readmission risk factors include:

Source: Population-based longitudinal cohort study con-ducted in Ontario, Canada, on all COPD hospitalizations between 2004 and 2014 in 130,137 patients.

Praisaeng/Shutterstock.com

of Americans have taken opioids at some point in their lives.

Only one in four have talked with a medical professional about opioid addiction.

Source: KRC Research survey on behalf of Prime Therapeutics

Why senior leaders struggle to take time off

Source: Project: Time Off

52%

47%

46%

DON’T TAKE TIME OFF BECAUSE OF WORKLOAD

FEEL IT IS HARDER TO TAKE TIME OFF AT HIGHER LEVELS OF THE COMPANY

FEEL NO ONE CAN DO THE JOB WHILE THEY ARE AWAY


Documents

TECHNOLOGY’S FUTURE · 2018-04-25 · We’re turning data into informa-tion that delivers better, person-alized outcomes for customers, providers, and clients. And by using artifi