- “Give me a lever long enough and a firm place to stand, and I shall move the world,” declared Archimedes in defense of the notion that with the right tools in place, the targeted application of a little force could shift a mass that seems far beyond its ability to impact.
The healthcare industry is no stranger to weighty problems, including skyrocketing costs, slumping provider productivity, and the near-universal lack of big data liquidity – and it has certainly tried to implement its fair share of forceful solutions.
Top-down regulatory solutions backed by financial penalties, such as the EHR Incentive Programs, have been a mainstay of the laborious healthcare reform process, requiring providers to meet a laundry list of regulatory demands without giving them much guidance about how to actually achieve their ultimate goals.
The result has been less than overwhelming for many. While 96 percent of hospitals and 78 percent of physicians now use electronic health records, not all of them do so happily.
Through the first two stages of meaningful use, the government has poured out more than $37.3 billion in incentive payments to produce a healthcare ecosystem that has simply traded many of its paper-based problems for electronic ones.
Health 2047, the Silicon Valley “innovation enterprise” that boasts the American Medical Association (AMA) as its biggest investor, thinks that it is time to take a different approach – and that a paltry $10 billion could be all it takes to tip the scales in favor of truly impactful improvements.
The AMA as a catalyst for “exponential improvement”
Instead of trying to tweak regulations or redirect incentive payments, Health2047 is hoping to use a relatively small amount of money and the powerful fulcrum of the AMA to completely – and collaboratively – revolutionize the way the healthcare industry turns big data into meaningful actions.
“We think that if you deployed $10 billion in the right ways with the right partners, you could actually make a huge dent in the issues that affect all of us,” said Jack Stockert, MD, Managing Director of Strategy and Business Development.
“The money wouldn’t be for investing in incentives to marginally improve the current state of the industry. It’s for strategically investing in the right partners that can help us scale the best ideas out there. We want to move past the incremental steps that we’ve seen in healthcare so far. We want exponential improvement instead.”
The AMA is the anchor investor in the visionary organization, which plans to use the professional society’s extensive industry influence to build relationships between its more than 200,000 member physicians, the health IT vendor community, and other key players in the space.
“There are very few entities with a similar involvement in every core area of the industry or a similar commitment to addressing concerns that matter to physicians, to patients, and to everyone in between without the competitive tensions of a business or a vendor,” said Stockert.
“I don’t think people are as concerned about an organization like the AMA facilitating these initiatives as they would be about a for-profit entity getting involved in their data and trying to make changes to the way they do business. The AMA is a trusted organization, which really helps to craft a collaborative narrative.”
Health2047’s ultimate goal, reflected in its unique moniker, is to create a seamless pipeline for innovation that will transform the way providers practice and patients seek care by the middle of the century.
“The 200th anniversary of the AMA is in 2047. And besides that, the URL was available," he said jokingly.
The four pillars of effective healthcare reform
Exactly how to fix the ailing industry is a topic of contention among stakeholders, each of which has its own ideas about which levers are most effective to pull.
For Stockert, the industry’s most pressing needs can be broken down into four main component parts: data liquidity, chronic disease reduction, productivity enhancements, and revenue flow reform.
Creating a strategy to address these concerns, all of which feed into and off of each other, will require long-term planning that keeps comprehensive goals in mind.
“At the root of the problem is the fact that we spend a ton of money as a society and a system on chronic disease management, but the rates just keep climbing year after year,” he said.
“We can try to pat ourselves on the back and say, ‘Well, thank goodness we’re slowing the growth curve,’ but that’s not the ultimate goal. We need to shatter the curve entirely by changing our thinking about how we motivate patients to stay healthy.”
Reducing barriers to good health, including socioeconomic challenges, care access issues, and the difficulties of communicating easily with providers, will be key for designing and deploying effective interventions that actually stick with patients.
“We need to make it delightful to be healthy and stay healthy, because we can pretty much all agree that it’s delightful to eat donuts,” Stockert said. “What technologies and strategies are going to transform our motivations and improve communications and convenience in such a way that it is easy – really easy – to live a healthy life?
The question doesn’t have the perfect answer yet, but part of the solution will no doubt be making it simpler for providers to access the data and insights they need to ensure that their patients are receiving the right services at the right time.
The lack of data liquidity, or interoperability, has become one of the industry’s most well-known sticking points.
The EHR Incentive Programs have often been criticized for focusing more on getting something – anything – digital into the majority of healthcare organizations without focusing sufficiently on whether or not those systems could communicate effectively.
This has left providers without many of the technical capabilities that have quickly become essential for success with population health management, business intelligence, and risk-based reimbursement contracting.
While there have been plenty of proposed solutions, Stockert again believes that stakeholders may be thinking on too small of a scale.
“People have tried to solve data liquidity by thinking of it as a one-to-one normalization problem,” he said. “Epic could talk to Epic, but couldn’t talk to Cerner – so clearly we needed to layer standards on top of those disparate systems that could normalize the data moving between the two.”
“That would make communication happen, and then we could move on to Cerner and MEDITECH, then Epic and Allscripts, then MEDITECH and Allscripts, and on and on until every permutation was finally connected.”
The obvious inefficiency of such a system quickly gave rise to health information exchanges (HIEs), Direct secure messaging, and then to private industry-led consortiums such as CommonWell and Carequality, which have allowed vendors to tackle their interoperability issues together.
Collaborative problem-solving is a step in the right direction, Stockert said, and the unique privacy and security constraints of data exchange in the healthcare industry do require a sensitive and careful approach. But the big picture answer is already out there, waiting for healthcare to copy.
“We need to mimic the internet,” he said. “A distributed approach is the best way to go. I think we aren’t quite sure what we could do in a fully connected universe like that.”
“Machine learning and artificial intelligence are better when they can access aggregated information. If we let the data siloes continue and fail to transcend those boundaries, none of those technologies are going to flourish the way that they could.”
Breaking down barriers to data access and the emerging technologies that can extract actionable insights from big data will naturally lead to improvements in productivity, he continued.
Artificial intelligence and clinical decision support tools backed by sophisticated machine learning will help physicians start thinking about their roles in an entirely different way.
“Better access to data will empower physicians to practice at the top of their license. It will give them the time and the tools to be more productive. Hopefully, they will also be happier and feel more fulfilled so that we can start to address the enormous toll that burnout is taking.”
“Physicians – all providers of any qualification, really – should be practicing at the intellectual peak of their training. Getting there will definitely require a mix of approaches, including virtual and digital engagement, AI-driven support tools – whatever they might end up looking like in the future.”
Freeing up healthcare’s big data assets will also contribute to improvements to the fourth pillar: payment reform.
“Right now, there is a fundamental assumption that care should be funneled through a specific series of providers: from primary care to specialty to the hospital and back again,” Stockert explained.
“It’s a very centralized model with the acute care hospital in the middle. But there are two things that are going to decentralize healthcare, which are better access to data and more reimbursements based on outcomes.”
The two are inextricably linked. “EHR data has to be enriched with more data sources if it is to be used for outcomes-based reimbursement,” he continued.
“So if you think about EHR data, it’s got a gravitational pull of – let’s say 100. That’s how much we use it for clinical care. And even though socioeconomic data and lifestyle data is much, much bigger, at the moment it only has a pull of about 10. We barely use it.”
EHR data isn’t likely to grow much in size, or even in its value to clinical care. Instead, innovative data sets including genomic, environmental, and lifestyle data, Internet of Things device data, and patient-reported outcomes, are going to exert a much bigger influence on clinical care.
“When we start putting EHR data into context within that broader ecosystem of health and health data, we can start transforming how we think about the way payments are allocated for the care that is being delivered,” said Stockert.
“That decentralized, multi-faceted, data-rich model is going to create a whole new set of winners when it comes to the payment environment. The tricky part for organizations today is figuring out how to position themselves to be among those winners.”
The evolving role of the EHR vendor
EHR vendors, most of whom are quickly transitioning to becoming holistic health IT ecosystem vendors, will continue to play an important role in determining who those winners may be.
While Stockert still sees vast opportunities for improvement, he is also quick to praise health IT companies for their contributions to this ongoing technical evolution.
“Vendors have done an extraordinary job so far,” he said. “Just think about where we were in the year 2000 compared to where we are now in the digitization process. There has been a remarkable change over that time period, and vendors should be congratulated for that.”
“Health IT companies should be congratulated for the remarkable changes they’ve helped create, and for setting us on a path towards digital healthcare. But I don’t think we have even conceived of where that path leads yet, and that is where we want to come in.”
It is difficult for anyone to think outside of their current reference points, and perhaps even more so for vendors and organizations trying to juggle the frenetic demands of day-to-day business.
“If I had told you in 2004 that you would have a computer in your pocket that could access the internet with a personalized voice recognition assistant, provide live GPS, and give you millions of applications that can do everything from monitor your health to augment your reality, you’d have a hard time conceptualizing that,” Stockert said.
“Because your frame of reference at the time was limited to something that could make calls, maybe do text messages, and maybe play a few games – if you spent a lot of money, you could even take some grainy photos or get something with a tiny little keyboard. It’s the same with EHRs. We have no idea what they could look like ten years from now. And that’s actually very, very exciting.”
However, vendors have to make some big changes if they want to continue leading the way towards a promising future, he warned.
“The days of the protectionist enterprise sales model are numbered,” Stockert says. “The question is whether or not they will be able to evolve into a more open, collaborative ecosystem.”
“EHR vendors have a lot of insights in their pocket about workflow and interoperability. They could be a real asset for the industry, but not if they’re going to keep playing ‘hide the ball’ and lock things up to protect their business interests.”
Over the past two years or so, the zeitgeist has shifted towards a much more open approach to data sharing and interoperability, which is an encouraging sign for providers and their patients. That has to continue, said Stockert, and he thinks it will.
“The vendor community is certainly chock full of wonderful leaders and very, very smart people who can add so much to this process. These companies will have to evolve quickly so that we can unlock the data and let it move,” he said.
“The true winners will be the people who can innovate on top of that liquid data ecosystem, not the people who hoard data and hope someone will pay them for it.”
Slicing off $10 billion of the $3.2 trillion pie
Making such a fundamental change to the business model is likely to be painful for EHR vendors, not to mention the providers who have become very familiar with the ongoing agony of remaking themselves over and over with each new tweak to the rule book.
Every member of the care continuum is fighting for any little scrap of relief, financial or otherwise, that might make their jobs just a little bit easier, said Stockert, and no one wants to give up even a morsel of the $3.2 trillion pie that is the nation’s annual spending on healthcare.
“At the moment, we’re in a situation where everyone has already eaten their piece of the pie,” he said. “We can all say, ‘well, you need to eat less pie,’ but no one likes to eat less pie. They will always eat everything that’s put in front of them, because that’s human nature. And in healthcare, what they get is never really enough.”
“But the thing about this industry is that the pie is actually much, much bigger than we think it is. This isn’t a $3.2 trillion healthcare spending problem. This is an $18 trillion public productivity problem. But before we start trying to gobble up all of that, we need to think about to divide that pie in innovative ways so that everyone really does get everything that they need – and that includes patients, who are at the heart of all these decisions that we’re making.”
The key to brining that enormous opportunity to stakeholders is Stockert’s $10 billion, which would act like seed money to start growing partnerships and collaborations that could bring a laser-sharp focus to the industry’s improvement efforts.
“I really believe that all we need is $150 million apiece for those four pillars,” he said. “If we can find the right partners to provide the leverage, and get critical stakeholders to invest in these foundational changes, we will unlock innovations that can scale up and out and produce entirely new business opportunities for providers, payers, and vendors.”
“My hope is to transform the way physicians practice and make it a joy for them to do the work that they are so dedicated to doing. We can make that happen – and hopefully long before 2047 – if we put in the hard work now to scale up the best ideas available from an industry that is really crying out for some major, major change.”