By Frank Ingari of NaviNet, Inc.
Two weeks ago, I attended the terrific Health Evolution Summit in Laguna, CA. These are the themes that struck me personally:
- Disruption Now. All healthcare sectors are vulnerable to significant disruption, are already experiencing such disruption, and are seeking strategies to make the best of the change.
- No Plan B. The shift to value-based reimbursement (VBR) is under way: there is no turning back. Steve Helmsley, Chief Executive Officer of UnitedHealth Group (UHG), said that $40 billion of UHG’s business is in some level of VBR today and is slated to go to $65 billion by the end of 2017 ( >50%). Andy Slavitt, Acting Administrator for the Centers for Medicare & Medicaid Services (CMS), echoed this theme and restated the government’s goal to move more than half of its spend to VBR in the next few years.
- MA is the Way. Consensus has emerged that Medicare Advantage (MA) represents an important model for the future. Slavitt said, “We are big believers in MA…it’s giving us good care outcomes and engaged clinical communities.” The MA Risk Adjustment system has enabled great change, but needs modernization, perhaps by indexing to the MA population (as opposed to fee-for-service) and by adjusting to recognize the variable impact of state-defined Medicaid strategies.
- The Unstated Triple Aim. While the phrase rarely comes up anymore, the goal remains the same, and the combination of VBR and consumer power is emerging as the best path to the Triple Aim.
- Buddy Up. Partnership—never a strength of the U.S. healthcare system—is now seen as the key to survival and success. The window of disruption is open, and it is more important to learn through alliances than to wait for in-house perfection. APIs are embraced both as technical strategy and as the core of business models; the “walled garden” is seen as a dangerous strategy for even the most aggressive vendor.
- Consumers Rule. The rapid growth of high-deductible plans in exchanges and commercial plans is creating a wave of consumer dissatisfaction and sticker shock; physicians and hospitals face growing bad debt and must now focus on cash collection from patients; and disruptors like ZoomCare and CVS are offering cash-pay basic services in new consumer-friendly formats. Consumer outrage is feared, but many believe consumers have more potential to drive interoperability and transparency than regulators do.
- Connect the Consumer. A “parallel universe” of self-directed consumer healthcare has blossomed—from the $50-billion vitamin market to a handful of highly successful websites and the personal device business. Connecting this universe to the traditional healthcare establishment is a challenge and a priority.
- Walls Come Tumblin’ Down. The silos that have characterized healthcare (such as behavioral health versus “medical” health) are breaking down. Medicaid expansion and the boomer boom are forcing behavioral health into the mainstream conversation at last.
- Unmentionable. The industry is getting better, but very slowly, at talking about unmentionables such as end-of-life. Alexandra Drane, Co-Founder, Chief Visionary Officer & Chair of the Board of Eliza Corporation, drove this discussion throughout the conference. Lisa Suennen’s post on this topic is excellent. Lisa is Managing Partner at Venture Valkyrie.
- EMR Backlash. Several senior executives offered the blunt opinion that EMRs are no more than “transactional” systems meant to document the patient’s situation; do more harm than good without accompaniment by what Glenn Steele, President and Chief Executive Officer of Geisinger Health System, called “functional” applications; and will not succeed as the “ERP” platform for healthcare. All this struck me as somewhat extreme, but then I don’t have to run a modern hospital system.
- Big Data Stranded. Concern exists that the investment in big data systems will not provide a return without “adoption achieved by weaving high-quality information into the workflow,” or what Dan Hilferty, President and Chief Executive Officer of Independence Blue Cross, called “bringing the power of big data to the individual patient encounter.”
- Rising Optimism. Industry leaders share a widespread and surprising optimism that we have begun a successful journey of reform. While there will be winners and losers in the transition, many believe we will emerge as a worldwide model in a decade or so. The globalization of HIT is coming.
The Summit reminded me of the seminal conferences led by Esther Dyson and Stewart Alsop in the early days of the PC and the Internet—it catalyzes the industry that it convenes. Thanks to David Brailer and Julie Murchinson for including me again this year.