We are overdue, for a fresh new view in Healthcare

Rama Juturu, 17 Nov 2017

The continual chasms of:  cost & quality, an individual’s last 3rd’ of life health expenses, chronic disease excessiveness, misalignment of incentives amongst payers and providers, and our governments fickle nature in regard to health economic direction, has moved us away from the one sentinel component that will, indeed, move the system opportunistically forward. See: The consumer.

 The New Norm will be led by Consumers and Their Disruptive Appetites

 There will be three players:

1) Consumer (one who is attracted to a healthier existence, and in search)

2) Patient (currently in need of actual care)

3) Caregiver (those individual’s giving care to growing populations of need & improved health)

Let’s respect the National, Community and Family Goal: Keep All Healthy

 In doing so

  • It is time to redefine EHRs as transactional systems for compliance, regulatory requirements & billing. This being said, let’s effectively surround this clinical practice with third party apps of varying consumer demand.
  • We should redirect our energies to create “person-centered data records “ essentially enabling a “personal chart on a smart phone” delivering efficiencies across the care continuum and ensuring outcomes by empowering, engaging, and enhancing that consumer’s experience.
  • The technology sector in healthcare is now carrying a torch not only disrupting the current volume-based reimbursement model, but, the siloed delivery model as well, setting the trend for: Prediction, Detection and Prevention, thus, enabling next generation care delivery and reimbursement.
  • IoMT, AI, Digital Platforms, Apps will continue to drive the disruption in the coming years.
  • Clinical care is “just a small component” in terms of Healthcare. Healthcare is a narrow definition of health. Now, health is moving to digital environments empowering patients, consumers, and caregivers, leading to and creating, a “new healthcare economy” that will have implications, synergies, opportunities and threats.
  • Digital Health will enable creating an ecosystem ensuring holistic approaches for care delivery by capturing patient generated health data (PGHD) as well as social determinants of health (SDOH) seamlessly and efficiently.
  • Our home will become the first care management center interfacing with the rest of the community and world for managing health.
  • We will be seen spending our healthcare dollars wisely, benefiting hard working families, finally.
  • We will have a transparent environment reflecting diversity of population and diversity of stakeholders, helping each other.

We will all become “Next Generation Stakeholders” by leveraging various data points, algorithms and insights, but just as importantly, we will all deliver value to our communities in achieving respectable health outcomes.

Machine Learning, and applying it to the National, Community and Family Goal of Keeping People Healthy

Rama Juturu, 27 Oct 2017

What is Machine Learning?
First, and quite important, what it is not.  It is not a magic bag of pixie dust, nor an artificial intelligence. What it is, rather, a sophisticated-comprehensive math + computation. Likewise, it is cutting edge pattern identification’s and fruitful correlations for successful outcomes.  Unlike traditional statistics, Machine Learning is an iterative testing of many millions of combinations of varied data points. Also, Machine Learning can learn many pathways accounting for variance that exists in human health, rather than, mapping to average outcomes. We expose lots of relevant information to various machine learning models by pre-processing clinical notes using NLP technologies. Machine learning will be a team sport requiring the integration of data science and medicine. With such, new players, and the training of doctors in data science, statistics, and behavioral science will be necessary.

Where does Machine Learning Fit In?
Data access and its relationships; content sourcing and context creation; algorithms building; and lastly, insights for decision making

Healthcare industry challenges and implications for machine learning, training and teaching:
(unlike in other industries where ML is becoming a reality, e.g. Retail, Airlines, Banking, Logistics)

In healthcare, we don’t measure outcomes because we don’t get paid, while machine learning relies on outcomes to ‘learn’ correlations to them.  This means machine learning is likely to be limited to helping schedule more services, more effectively, versus, keeping people out of hospitals. 

Challenges: Machine Learning for Healthcare Industry

  • The healthcare delivery system remains very complicated, fragmented, thereby, difficult to navigate and understand. The system, likewise, lacks transparency, collaboration and accountability. Most people don’t have any sense of how the system works “at large” and continue to get lost in its process. Unfortunately, we, as patient-consumers, only grasp the mechanics of this delivery on a “piece by piece” basis. Getting to a holistic, convenient, and consumer “valued” experience, remains a big challenge.
  • With diversity in populations, various stakeholder engagement’s, differential motives and desires, our health systems have great difficulty around alignment and true coordination in achieving the necessary goal of cost control & quality care.
  • Healthcare regulations continue to not only take on a spirit of gradualness, but, remain cumbersome and difficult to track, thus, act on.
  • Clinical care is “just a small component” in terms of Healthcare. Healthcare is a narrow definition of health. Now, health is moving to digital environments empowering patients, consumers and caregivers, leading to and creating, a “new healthcare economy” that will have implications, synergies, opportunities and threats.
  • 90% of health data is generated outside the physician office environment; the clinical component substantiates the other 10 to 20% of this capture.  Clinical data, the core for innovation, is fragmented, unstructured, hidden at times, and not interoperable. Likewise, and critically important, often untrusted.
  • Clinical care delivery is siloed, volume driven, and care coordination is not yet fully incentivized.
  • While basic EMR implementation is complete in most care delivery settings, it remains frustrating and unsatisfactory, causing physician burnout and confusions, by not delivering quality information at the point of care. The access to multiple “patient portals” for a consumer with varying degrees of chronic illness, isn’t a reality in terms of centralizing this complex data, nor, normalizing the content into an understandable context.
  • The one definitive accomplishment of the past decade is that we have standardized clinical terminology with RxNorm, LOINC and SNOMED-CT. However, this being said, it is fair to say that we don’t have a national patient matching strategy, a national provider directory, nor a standardized consent/privacy policy.
  • Healthcare reimbursement based on clinical documentation from ICD and CPT codes continues to be very complex.
  • We don’t have a healthcare “costing” system.  Employers and patients don’t have access to pricing info (i.e. transparency) nor how their dollars are being spent by payers and providers.
  • Individual health risk assessment, quality measurement, while burdensome, remains essential for ensuring outcomes and performance.

A Fix for Healthcare? “Consumerism-Disruption” through Innovation is the answer

Rama Juturu, 20 May 2017

We are on a 10-year healthcare transformation journey enabling “Consumerism-Disruption” through Innovation defining a series of stages, steps, iterations driving market maturity benefiting the community finally.

Health will be digital empowering patient-consumer-caregiver and medicine will be data science driven by – smart data, smart algorithms and smart insights.

We will be experiencing immense challenges resulting in – implications, synergies, opportunities and threats in the coming years.

A less expensive, broader-based healthcare system?

Here’s What Your Future Doctor Visits Could Look Like

We conduct business and live in the new era (smart machine age) where the content is digitized. We can develop a framework on the lines of C5 (content, consume, converge, collaborate, context) and HIaaS (Healthcare Insights as a Service) innovating for the healthcare stakeholders.

Curated Content is a compelling solution for today’s immense challenges

In the historic fee-for-service payment model and siloed delivery model the MDs/ Providers control/ influence 80% of healthcare costs of $3T healthcare industry causing 1,000 preventable deaths daily.

Where Does Your Premium Dollar Go?

A Brief Analysis of the 2015 Medical Loss Ratio and Rebates Results

Medical mistakes still kill 1,000 patients a day, Leapfrog says

The 4-year MD program is a century old, MDs are trained and practice medicine in a massively broken system.

The Value Proposition for Medical Education is Under Stress

Medical education is in an era of transformation | Discover why

AMA advances initiative to create the medical school of the future

Obamacare, Trumpcare are the catalysts igniting the torch and the private sector is carrying the torch making investments, innovating aligning “Consumerism-Disruption” needs.

Digital health funding remains strong in 2017 Q1

Clinical Care isn’t Healthcare  

How CVS is taking on more acute and chronic care

Value Based Care, MACRA (Clinical Care) ≠ Healthcare

A less expensive, broader-based healthcare system?

Rama Juturu, 23 Mar 2017

New care delivery model that has a big potential: It’s going to be an excitingly different healthcare system in 15 years. It’s up to us to try to make sure that it goes in the right direction and gets there quickly enough. A less expensive, broader-based healthcare system?

I believe we can have an easy fix for healthcare costs and medical errors that is alarming: Simplicity with convenience is the ultimate sophistication.

Major Issues:

  1. The US Healthcare system is historically designed and medicine is practiced with an emphasis on:
  • Institutional care
  • Fragmented care
  • Sick care
  1. The coding system (ICD and CPT) for reimbursement of services by multiple commercial and government health plans is complex and unique to US that the citizens barley understand it.
  1. The citizens have been incurring exorbitant cost that isn’t sustainable.
  1. Diagnostic errors are a top concern in the patient safety field.
  1. The EMR that is now in place in most of the care settings are foundationally designed for billing services, this added further complexity and frustration across the care continuum that is disconnected.

Physician market dynamics empowering patient-consumer in the coming years:

  1. The control is moving from physician to patient positioning as a consumer – the millennials will crack it, baby boomers will get assistance from caregivers.
  2. Regulations are igniting a torch, the private sector will carry the torch promoting innovation benefiting the community offering: SIMPLICITY, CONVENIENCE, ACCESSIBILITY, AFFORDABILITY.
  3. Independent vs employed physician make a difference in care management.
  4. Health management requires patient-centric, holistic, nonclinical as well as clinical, data driven approach as opposed to current clinical (say 20% of health) approach promoting fragmented care.
  5. There will be a very tight integrated system among: payer, provider, patient ensuring information sharing across the care continuum by leveraging smart data, smart algorithms, smart insights at the point of care and the moment of decision.
  6. There will be emphasis on leveraging patient generated data (say 90% of whole health data) for managing health by patient-consumer.

Recommended Solution:

It is time to place an emphasis on: leveraging retail industry experience, retail convenience and data-driven algorithms.

It’s going to be an excitingly different healthcare system in 15 years. It’s up to us to try to make sure that it goes in the right direction and gets there quickly enough.

Supported by artificial intelligence-based algorithms, CVS’s pharmacists and nurse practitioners are working at the top of their licenses to provide acute and chronic care management. In the transition to value-based care, has CVS found a path to a less expensive, broader-based healthcare system?

Curated Content is a compelling solution for today’s immense challenges

Rama Juturu, 23 Feb 2017

We had an opportunity to meet with several healthcare executives at HIMSS17 (Feb 20-22, Orlando). We presented the following framing, the context and the feedback we have received is excellent. We would like to hear your thoughts and comments, please email us at  insights@ramaonhealthcare.com

  1. C3 (Content, Consumerism, Consolidation) are the strategic drivers for healthcare/digital transformation in the coming 5 to 10 years.  Curated Content is a compelling solution for today’s immense challenges in most business areas.
  2. RQC (Risk, Quality, Cost) are essential elements for any value-based model (ACO, MSSP, MACRA, Medicare Advantage, Medicaid managed care/ ACO, Commercial) for managing Population Care/Health involving clinical, non-clinical determinants: social, economic, geographic, environmental.
  3. There are currently multiple ecosystems evolving from Apple, EMR/PHM/ Virtual care vendors, it will be driven by patient-consumer-community in the coming years.
  4. The healthcare will be: retail, cloud, social, mobile interacting with: emerging technologies, and smart data, algorithms, insights in a real-time environment.
  5. There will be a key role for value-added services/ consulting companies focusing on performance measurements beyond typical Health IT, Digital Health product vendors.  It is a marriage between products and services for varied population needs ensuring health outcomes.

To position in ever-changing, rapidly-changing healthcare markets “actionable thought leadership” skills are essential for survival and success.

Year 2017 – EMP (Empowering Patient First) is the NEW NORM

Rama Juturu, 16 Dec 2016

“EMP (Empowering Patient First) is the NEW NORM” in the Healthcare Transformation domain creating opportunities in “PCDI (Patient Care Disruptive Innovation)” space demanding convergence of “Doctor, Data, Device (D3)” in delivering value to the community.

Doctor education, training, skillsets, and a revolutionized practice of medicine will comprise of: Engineering, Health System Science, Data Science, Cognitive Clinical Computing, Community Partnerships aligning with Digital Health, Population Health Management and Precision Medicine needs.

Data will take the form of “Smart Data, Smart Algorithms and Smart Insights” at the point of care/ the moment of decision ensuring patient (consumer)-doctor collaboration.

Device innovation will advance Healthcare IoT, Interoperability, Workflows ensuring outcomes.

We should recognize that current health systems focus is on clinical care meeting a portion (11%) of a person’s health needs. However, we should view health as a holistic measure of an individual’s entire living situation and life experience. The future delivery system will be redefined on the lines of Prediction, Prevention, Detection repositioning patient-consumer-community as the primary stakeholder.

As healthcare evolves we (those who work in healthcare) will be experiencing gradual disruptions in our organizations improving our day-to-day working lives as professionals that requires altogether new talent focusing on design skills pertaining to: Behavior, Innovation and Thinking.

It is time to prepare ourselves as we will be conceptualizing and executing a series of stages, steps, iterations in the coming decade with metrics and measurements pertaining to: new ways of addressing Risk, Quality, Cost, Efficiency, Safety and Revenue benefiting the community and stakeholders in the healthcare space.

CC-AI-IoT PLATFORM FOR HEALTHCARE TRANSFORMATION

Rama Juturu, 22 Nov 2016

Healthcare consumers are becoming more digital. Siloed approaches are not sustainable in a seamless digital world. We CAN Fix Healthcare!

The US Healthcare System remains broken requiring continued disruption of current practices of medicine, care delivery and payment models. The CC-AI-IoT platform (Clinical Computing- Artificial Intelligence-Internet of Things) will be the disruptor empowering and engaging patient-consumer by enhancing experience across the care continuum resulting in: simplicity, convenience, accessibility and affordability, the unique solution for today’s healthcare problems.

The healthcare will be “social and retail based led by millennials” requiring a new thinking thereby our competencies have to be more related to data and science than experience, hence it is essential preparing for success 10 years down the line for us to survive.

Following are the key points to remember and pursue for leading better lives by keeping people healthy.

Determinants of Health: medical care determines only about 11 percent of health-far less than individual behavior (38 percent), social circumstances (23 percent), and genetics and biology (21 percent).

* Three focus areas: Population health management, Digital health, Precision medicine

* CC: library of computerized calculations, or algorithms, that will be combined with EHR data in an effort to more quickly help develop patient care plans, precise diagnosis and treatment methods.

* AI: Artificial intelligence and machine learning can – and will be a large part of everyday life.

* IoT: Billions of new IoT devices, apps and services could transform our lives in ways we can only begin to imagine.

PATIENT CARE DISRUPTIVE INNOVATION (PCDI) – PATIENT INDEPENDENCE

Rama Juturu, 17 Aug 2016

Triple Aim Goals: Better Health, Better Care, Better Cost

The overabundance of healthcare laws and regulations “HITECH, ACA, ICD-10, and MACRA”, CMS Innovation Center’s experimentations and learnings on new care delivery and new payment models from “Volume to Value” had ignited several market forces driving towards consumerism leading to “Patient Independence”, the ultimate solution for today’s healthcare crisis. We have a responsibility to do better and make an impact on the community by changing the way we think about the healthcare problems.

* Health IT Vendors’ offerings: EMR, HIE, RCM, PHM will require a new thinking from the start so as to align with patient-consumers demands to “manage individualized health by owning medical records and having access to their lifetime’s worth of data”.

* SMAC (Social, Mobile, Analytics/ AI, and Cloud) and  IoT (Internet of Things) technologies resulting in: SMART DATA, SMART ALGORITHMS, SMART INSIGHTS will enable decision making at home as well as at the point of care.

* Medical schools will launch altogether new programs from the ground up aligning health care towards value creation focusing on community partnerships.

* The Academic medical centers/ Health systems/ Hospitals will change fundamentally as Technology will allow care at home that is convenient, accessible, affordable, better and safer.

* The Insurers and Employers will manage healthcare dollars by rewarding outcomes.

* Retail and Healthcare are at cross roads. Healthcare and Technology are intersecting. We will see retailer mentality in healthcare aligning with: individual behavior, emotions and mindset.

* The doctor-patient relationship will flip the relationship to a patient-doctor relationship.

Each stakeholder will have a role to play by placing the patient-consumers at the center of healthcare transformation and achieving the Triple Aim Goals: Better Health, Better Care, Better Cost. By engaging patient-consumers we’ll have a healthier population that will use less care.

Yes, We as a community will solve today’s healthcare problems.