HIMSS21 Interviews: Castell Health's Andrew Sorenson on Analytics for PHM During a Pandemic

I recently spoke with Micky Tripathi, National Coordinator for Health Information Technology, about assessing value in digital health / healthcare IT investments and how federal action can help  coordinate progress in healthcare technology. We discussed the role of federal policy, highlights from recent ONC legislation, and opportunities ahead. 

Join us on a journey through Micky's unconventional path from political science to spearheading health data interoperability initiatives, and glean insights into the transformative impact of federal regulations like the 21st Century Cures Act on the adoption of healthcare IT.

In our candid exchange, we scrutinize the evolution of health information exchange networks and the essential role of governance in safeguarding data integrity and trust. With the ONC's craftsmanship of the SDOH playbook under the Biden-Harris administration, we break down the quest for health equity through data integration initiatives like USCDI and TEFCA. 

Having established a digital baseline, the industry now looks to innovate upon that core to truly begin unlocking value from these assets. There is still so much untapped potential to utilize health data for major initiatives, such as the Cancer Moonshot program or solving for the maternal health divide. 

For those passionate about influencing healthcare policy, we close with Micky's advice on how to wield your voice through public comment opportunities. Tune in for this  opportunity to hear from a vaunted pillar of healthcare IT policymaking, and learn about his future vision for digital health.

In this episode of the Chilcast, John Moore interviews Keith Figlioli, Managing Partner at LRVHealth and host of the Health Care is Hard podcast. Continuing the theme of the Health Impact Project series, the two discuss current market conditions in healthcare and how various stakeholders are assessing the value of digital health implementations today.

Keith shares insights from his experiences at Explorys and Premier, as well as what he learns from the conversations he has with other industry leaders in his current role. He notes we are entering the "second wave" of digital health focused on fundamentally transforming how and where care is delivered, largely driven by the macro force of ongoing clinical scarcity. 

Figlioli emphasizes that healthcare organizations must keep innovating despite economic challenges. Successful technologies will demonstrate clear cost reductions or revenue growth. He believes priorities include automating administrative tasks, improving patient scheduling, integrating medical evidence into EHRs, and streamlining prior authorizations.

Looking ahead over the next decade, Figlioli sees major changes coming in specialty care similar to recent disruption in primary care, with private equity becoming more involved. He advises health systems to carefully define their competitive differentiation and not spread themselves too thin. Partnerships will become increasingly important.

Moore and Figlioli agree the market is resetting to more realistic dynamics after a period of excessive hype and overvalued companies. But substantial venture funding continues to flow into digital health focused on true transformation.

In our third guest episode for the Health Impact Project, we invited our friend Grace Cordovano, PhD, BCPA, to discuss the value of healthcare technology from her perspective as a patient advocate. In addition to running her advocacy practice, Enlightening Results, and her startup, Unblock Health, Grace is also involved with the Cancer X Initiative, the Sequoia Project, and the National Academy of Medicine's AI Code of Conduct Project. She also happens to be one of our favorite people to follow on LinkedIn.

During this conversation, Dr. Cordovano speaks to her experiences working with patients, noting the toll of patient administrative work, the impact of financial toxicity, and the role of technology in improving access to care – in particular clinical trials for cancer treatment.

We talk about the value of healthcare organizations from the patients' perspective, where the most important outcomes are focused on reducing suffering and appropriately aligning with each individual's values – making sure to see them as a person and not as just a statistic or their diagnosis. This brought remote patient monitoring, palliative care, and digital tools into the conversation, as these have all been shown to greatly improve quality of life in the right situations.

Most of our discussion can be summarized in one particularly compelling statement that Grace made, and which underlies much of her policy-focused work: anything in healthcare that touches the patient should be aligned with giving that individual a competitive advantage against their diagnosis. This perspective is so compelling and easy to grasp, but not one we hear anywhere near often enough.

Key Takeaways:

• The patient administrative burden continues to worsen and it's clear that only proper regulation will be effective in curtailing this. Just like with provider-facing solutions, this is an area where information technology can be particularly effective in supporting users' needs.
• Better access to clinical trials, and greater diversity in these trials is essential to creating healthy populations – particularly in cancer care and rare disease treatment.
• Remote monitoring and home care are [re-]emerging as particularly effective models of care that improve quality of life, but there are many considerations to take into account in each case when deciding if its appropriate.
• It is crucial for any company or organization touching patient lives to incorporate the perspective of actual patients in the development of their solutions and services, otherwise "patient-centric" is merely lip-service to a current buzzword.

In the second Chilcast episode featuring the Health Impact Project team, we go deeper with our exploration into the challenges of assessing the value of digital health and health IT implementations. This conversation explores the history of recent legislation and regulation that impact the healthcare sector, specifically the interplay between technology regulation pushed via HHS and care model innovation pushed by CMS. We also introduce the idea of a healthcare innovation version of Generally Accepted Accounting Principles (GAAP), with a brief exploration of why nothing like this exists already. As with most of these episodes, we conclude with a call for a collaborative conversation to drive industry maturity and improve patient outcomes.

The conversation captured on this episode, as well as the next group one, both tie into our recently published article, "When world's collide: How two decades of regulation both advanced and hindered our transformative vision of healthcare innovation."

Takeaways

• Legislation has played a significant role in shaping the adoption of IT in the healthcare industry, but has come up against care model reform legislation that often doesn't neatly align with IT maturity. This has created extra burden on decision makers who must balance these prerogatives.
• Challenges remain in assessing the value of technology, especially due to the complexity of current shifts in the economics of care.
• Our industry needs to develop its own equivalent of generally accepted accounting principles (GAAP) for evaluating the impact and return on investment (ROI) of health technologies. This is complicated by the moral mandate of the healthcare industry, where the outcomes of "free market forces" are not always best for the population being served. Any calculation of ROI needs to account for this double bottom line.
• Collaboration and a shared understanding of value are essential for driving industry success with technology use cases, which in turn should improve  outcomes and experiences.

In this episode of the Chilcast, John Moore interviews Steve Kraus (Partner) and Sofia Guerra (Vice President) at Bessemer Venture Partners' (BVP) Cambridge, MA, office, about how venture capital firms perceive the value and impact of health technologies.

Key topics discussed:

• BVP takes a "bilingual" approach with expertise in both healthcare and technology to identify innovative opportunities. With healthcare being far behind other industries in digitization and consumerization, they're able to apply expertise and insights from other enterprise technology adoption to healthcare.
• Major challenges facing healthcare technology companies include long sales cycles, fragmentation into niche solutions, and financing risk. However, there is strong talent for building cutting-edge health products now.
• To drive adoption, developers need to first create end user love. Know who your users are going to be, what they really want from a solution, and then deliver on that.  
• In healthcare, it's critical to show both clinical outcomes and financial ROI. Appeal to key decision makers - CTOs, CMIOs, CIOs.  
• Major societal healthcare challenge is marginal outcomes at too high costs, largely due to the fee-for-service payment system. Value-based care helps address this, but we're still figuring out what this means from both an economic and regulatory standpoint.
• Consumer engagement remains a huge unmet need. Giving consumers choice drives efficiency and quality as it has in other industries.
• Disruptors like Amazon and Microsoft will have impact by focusing on their core competencies in areas like consumer experience and AI automation.
• The market downturn will persist through 2023 into 2024 but strong companies will emerge from the noise during this period as the broader markets rebound. Continued innovation opportunities will also arise from new regulations and the evolving needs of a changing market.

On this episode of the Chilcast, host John Moore III interviews John Glaser, Executive in Residence at Harvard Medical School and healthcare [technology] industry veteran. The conversation delves into the factors that determine whether a transformation strategy will be successful, and how to think about assessing the value of healthcare IT implementations, highlighting the need for organizations to have a customized, agreed-upon approach based on their specific goals.

Key Takeaways:

• Assessing the value of digital health and health IT implementations in the healthcare industry requires a tailored approach based on the specific needs of each organization.
• Financial return on investment (ROI) should not be the sole metric for assessing the value of technology, as it can overlook other important factors such as patient experience and clinical outcomes.
• There are 5 specific factors required for any organizational transformation strategy to succeed.
• Collaboration among multiple stakeholders is crucial for driving value and reducing costs in healthcare. Technology needs to be seen as an enabler of strategic initiatives, not as the initiative itself.

More from John Glaser, PhD:

• Recent Harvard Business Review articles:
  • Using Data to Improve Employee Health and Wellness
  • It's Time to Cement Telehealth's Place in US Health Care
• Learn more about John's courses at Harvard Medical School:
  • Leading Digital Transformation in Health Care
  • Global Health Care Leaders Program

In the world of healthcare, where patient experience / quality of life and physician’s ability to feel fulfilled in their work are key drivers of success, defining ROI with a sole focus on finance just didn’t match what we were hearing from colleagues and seeing in the headlines.

Nearing the 15 year anniversary of HITECH, and 20th of the founding of the ONC, it seems like the industry is having a reckoning with the fact that it is still exceedingly difficult to quantify the impact of the billions of dollars of investment that have been made in IT.

After intentionally interrogating this observation with dozens of discussions validating that gut feeling, a few brilliant, deeply experienced, and like-minded folx came together to work on developing a path forward that better aligns with the actual goals of various technology investments across the sector. The team that has come together around this effort are:

• John Moore, Chilmark Research
• Curtis Peterson, Kingfisher Advising
• Marie Copoulos, Horta Health
• Susan Irby and Pam Arlotto, Maestro Strategies

After months of working on how to approach this, we’re thrilled to introduce our effort to the world, the Health Impact Project. We officially soft-launched the effort last week with the initial installment of our five-part manifesto, Assessing Health Tech Value in the Next Decade. In addition to the written word, we will be producing a series of podcasts under the Chilcast banner. 

For our first podcast, get to know the team as we dive into what motivated each of us to come together for this work, the values we each bring to the table, why this has been hard for the industry to date, and what makes this work so mission-critical today.


Key Discussion Points:

• 1:24 - Our motivation to come together to work on this
• 4:54 - The values we each bring
• 9:46 - Why is this so dang hard in [US] healthcare?
• 17:35 - What makes this work so critical *now*?

On this episode of the Chilcast, we tackle the main topic of 2023 with three of the leading voices in the industry – the responsible development of AI for healthcare use cases with John Halamka, Suchi Saria, and moderator Jody Ranck.

Key takeaways from this episode:
- Our experts highlight the need for a balanced approach to regulation and innovation – need to ensure safety and ethical development, but don't want to stifle new advancements either.
- It is proven to be critical that diverse perspectives and voices are included in both the regulatory and development processes.
- Collaboration and continuous learning are crucial for responsible AI implementation in healthcare.

Chapters:
0:00 Introductions
4:25  Mayo Clinic Platform
7:02  Overview of The Coalition for Health AI (CHAI)
8:31  Bayesian Health Overview
11:12  Current Regulatory Discourse
23:24  Managing Tradeoffs and Social Impact
30:19  Accelerating Evidence-Based Medicine
34:30  Who Gets a Seat at the Table?
40:41  Can "Hallucinations" be Valid Hypotheses?
42:25  Evaluation as Part of the Innovation Cycle
50:41  What is the Threshold for AI Accuracy to be Implemented in Care Decisions?
54:25  Regulation Impact on Innovation
56:39  Regulation of Applications vs Models

In this episode of the Chilcast, Managing Partner John Moore is joined by Carrie Kozlowski, COO and co-founder of Upfront Healthcare, and Ed Marx, CEO and Founder of Marx Advisory, to discuss the importance of engagement, trust, and technology as part of community outreach in the context of the ongoing post-PHE Medicaid redetermination process.

The episode opens with an introduction to the problem: the concerning number of individuals who have lost Medicaid coverage so far – approximately 38% of those evaluated, largely due to trivial administrative issues – and the significant impact to children when health access is denied during key developmental years. This is also a significant financial hit to already struggling disproportionate share hospitals (DSH means high Medicare / Medicaid populations), creating significant uncertainty around ongoing access to care in some of these communities if margins are eroded any further, possibly resulting in closures or reduction in services provided. 

The three then get into a discussion about some of the social factors contributing to this issue, how technology can address aspects of the problem when applied appropriately, and the importance of recognizing that everyone is different so you really need to meet people where they are to have a meaningful impact. A lot of ground is covered, so it’s best to just go and listen. 

Key Takeaways:

1. Focus on the patient: The guests emphasize the need for a patient-centric approach, understanding patients' unique needs and preferences, and delivering culturally sensitive content in multiple languages and literacy levels.

2. Utilize technology effectively: Technology plays a crucial role in patient engagement – but keep in mind that the right people and processes are critical to achieve the intended outcomes of any tool. Leveraging the right data and adopting an omnichannel care approach can improve both communication and outcomes.

3. Collaborative system redesign: Collaboration and system redesign are essential in driving change. Leaders should work together across departments and with community representatives to implement innovative outreach and activation campaigns. Education and buy-in from local leaders is a must to establish trust.

4. Experimentation and adaptation: Healthcare systems must be willing to adapt quickly and experiment with new approaches, as seen during the COVID-19 pandemic. Learning from companies outside of healthcare and incorporating community awareness can lead to more consumer-friendly care experiences. 

5. Prioritize the patient and equity: The guests stress the importance of prioritizing what is best for the patient as a whole person and taking steps towards equity. Providing a hyper-personalized experience and focusing on the wellbeing of entire communities are some of the best ways to drive better outcomes.

On this episode of the Chilcast, John Moore III, Managing Partner of Chilmark Research, sits with Joshua McHale, a consulting analyst at Chilmark who was the lead author for the recent report, Getting Real with Healthcare Data: RWD/RWE Enabling New Models of Research and Care Delivery. They discuss the importance of RWD/RWE in healthcare delivery and research today, notable findings from the report, and advice for folks starting or getting deeper into their RWD strategy.

Questions? Comments? Feel free to reach out at podcasts@chilmarkresearch.com. We'd love to hear from you.

Audio editing and production handled by Colin Kingfisher.