The Alluring Mirage Of Digital Health

Improving our population health and reducing our healthcare spending requires that we make hard political and personal choices. Historically, we have not been receptive to doing either. We should employ and leverage information technology tools. But digital health is not a panacea. We should be leery of placing too much faith on government edicts, data analytics and logarithms to avoid doing the hard work and making the hard choices necessary to improve the health of all Americans.

The full Forbes article can be viewed at this link.  

Rural Hospital Sustainability: New Analysis Shows Worsening Situation for Rural Hospitals, Residents

While the potential for a rural hospital crisis has been known for years, this predictive data sheds light on just how dire the situation could become. Now, by being able to accurately assess the economic health of all rural hospitals in America, there is no choice but to pay attention. Local, state, and federal political leaders, as well as hospital administrators, must act to protect the well-being of rural hospitals nationwide and the communities they serve.

The full analysis can be downloaded below.  

Opioid Prescribing and Physician Autonomy: A Quality of Care Perspective

The public health and social harms resulting from misuse of opioids, particularly substance use disorders related to prescription opioids, have been under intense scrutiny in recent years. Some individuals who receive prescription opioids also use heroin, which has additional risks due to unknown potency and adulteration. Center for Disease Control and Prevention (CDC) statistics indicate that 115 Americans die of an opioid overdose each day. Although the dominant media narrative assigns much of the blame to overprescribing or misprescribing by physicians, the news media less than 20 years ago frequently castigated physicians for failing to provide sufficient pain control and dismissed or ignored the possibility that inappropriate deployment of opioids could lead to addiction. As one article published in American Family Physician in 2000 stated: “Despite recent advances in the understanding of pain management, patients continue to suffer needlessly, primarily because of improper management and inadequate pain medication”. In 2001, a story appeared in the Chicago Tribune reporting that “[a] jury awarded $1.5 million to the family of an 85-year-old man who accused his doctor of not prescribing enough pain medication during his final days”.

Since then, the narrative has changed. Headlines such as “Who Is Responsible for the Pain-Pill Epidemic?” and “Doctors Increasingly Face Charges for Patient Overdoses” have led physicians in many cases to be extremely cautious in prescribing opioids and lawmakers to impose highly specific restrictions on treatment use of opioids. Legal actions seeking to impose liability on opioid manufacturers for their marketing practices have focused on the alleged effects of those marketing efforts on physician prescribing. Yet, nothing can relieve the responsibility of the physician as the party ultimately responsible for the decision to prescribe a controlled substance. That responsibility is grounded in professional obligations to treat patients appropriately and according to accepted standards of care, violation of which can lead to professional discipline, peer review actions, and quality-assurance measures. This article evaluates the effectiveness of recent legislative mandates and restrictions on opioid prescribing and proposes alternative frameworks for combatting and preventing harms caused by the misuse of prescribed opioids.

The full article can be downloaded below.  

2019 HEALTHCARE TRENDS FORECAST: THE BEGINNING OF A CONSUMER-DRIVEN REFORMATION 

The well-known proverb “may you live in interesting times” is considered by many to be a blessing, yet others believe it is actually an ancient curse. People’s interpretation tends to correspond with their own appetite for change, as well as their comfort (or lack of) in the face of ambiguity. Regardless of the adage’s origin and intent, many would agree that these are interesting times for healthcare. In fact, at HIMSS we believe healthcare is currently undergoing a period of reformation on a scope and scale that is unmatched.

A perfect storm of factors – including the shift toward value-based care, rising costs, health system consolidation, the approaching silver tsunami, regulatory pressures, increased consumerization, major technology players entering the market and the ever-expanding potential of digital health tools – are coalescing and fundamentally disrupting business models. Traditional healthcare institutions are in reactive mode. Upstarts are finding that healthcare is not as easily disrupted as industries like retail. For nearly everyone, there are more questions than answers.

At HIMSS, we believe it is our responsibility to help the industry make sense of these changes and tap into the promise and potential of information and technology. With that premise, we are introducing an annual forecast report. Bringing together insights from leadership across HIMSS and our subsidiaries, we’re aiming to shine a light around the corner and help illuminate the path to clinical and financial health.

Read on for our predictions for the industry in 2019.

The full article can be downloaded below.  

Integrating Clinical and Mental Health: Challenges and Opportunities

Nearly 45 million American adults suffered from some form of mental illness in 2016. Although there is little change in the estimates of those with mental illness over the last few years, rates of death due to drugs, alcohol, and suicide are increasing. In 2016, about 45,000 Americans age 10 and over died by suicide. Twenty-five states experienced at least a 30 percent increase in suicide rates between 2014 and 2016.

The national opioid crisis has resulted in significant attention to federal policy associated with substance use disorder (SUD). Mental illness along with SUD comprise a broad category of illness commonly referred to as “behavioral health.” In 2016, 44.7 million American adults experienced a mental illness, 20.1 million experienced a SUD, and 8.2 million experienced both—and these numbers are likely underestimated due to lack of identification and issues of stigma. Collectively, more than 1 million people have died from drugs, alcohol, and suicide over the past decade. If these trends continue, the death rate could grow to claim 2 million more lives by 2025.

The purpose of this paper is to examine the barriers to the integration of clinical health care and mental health services, and to identify policy options for consideration in advancing integration of services. In 2018, the Bipartisan Policy Center hosted a series of public and private discussions on this topic. As part of this research, BPC consulted patient advocates; clinical and behavioral health care providers; federal, state, and county agency officials and staff; insurers; academics; and other experts. The goal was to identify barriers to integration caused by federal policy, to identify policy options to mitigate or remove those barriers, and, through policy changes, to advance evidence-based treatment for mental health in the United States.

The full paper can be downloaded below.  

What would happen if hospitals openly shared their prices?

Hospitals have resisted disclosing prices, leading policymakers to consider laws requiring price transparency. This issue has taken on increasing urgency, as patients face increasing out-of-pocket costs. In addition, prices vary widely across hospitals. The same lower limb MRI can cost US$700 at one hospital and $2,100 at another. This means that there are large potential savings if patients switched to less expensive options.

There was a tiny step in this direction on Jan. 1, when all hospitals in the U.S. were required to post their charge prices. However, the list of over 15,000 procedures is notoriously incomprehensible, even for medical professionals. What exactly is a “HC PTC CLOS PAT DUCT ART,” a procedure listed by one Tennessee hospital? Perhaps more importantly, patients’ out-of-pocket costs often depend on the specifics of their insurance plan and the prices that are negotiated by their insurer, meaning the listed prices do not reflect what they actually pay.

For these reasons, many researchers and commentators, including myself, believe that this approach is unlikely to have a meaningful effect on health care costs.

That does not mean that price transparency is hopeless. Recent research shows that price transparency tools that actually have useful, easy-to-use information can benefit patients and reduce health care costs.

The full The Conversation article can be viewed at this link.  

Assessing the Unintended Consequences of Health Policy on Rural Populations and Places 

Because of the complexity of the U.S. health care system, thoughtfully designed health policies carry a risk of having unintended consequences, particularly for health systems in rural places that have place-based fundamentals that deviate substantially from urban and suburban areas. Policies developed without consideration of rural contexts are likely to create unanticipated and negative consequences for rural residents, providers, and communities.

When health policies are being developed, a number of themes that emerge are useful to keep in mind. Specifically, how will this policy impact the ability of a rural health system to offer essential, affordable, and high-quality services to rural populations? How might this policy result in disparate outcomes and widen health inequities, such as threatening access, slowing quality improvement, or creating financial barriers to obtaining health insurance or buying health care services?

The rural-proofing framework presented in this paper is a policy analysis tool for thinking about what the unintended consequences of a policy may be on rural populations and places vis-à-vis the objectives of a high-performance rural health system. Policy analysis must be applied to all sources of authoritative actions given that policies are produced not just in the legislative context, but also through judicial, administrative, and rulemaking actions.

The full report can be downloaded below.  

You can now look up charges at your local hospital. Good luck understanding them.

The Trump administration rang in 2019 by enacting a seemingly great health care policy: requiring all hospitals to list the price of their most common procedures on their websites.

The whole idea was to make the American health care system more transparent, allowing patients to research the cost of care at thousands of hospitals across the country.

All in all, it seemed like a common-sense and well-intentioned policy to liberalize health care data. And, on January 1, the policy rolled out into the real world. We’ve quickly seen some big shortcomings in this effort to increase price transparency — ones that tell us a lot about how hard it is to give patients good cost estimates in a health care system rife with secretive prices.

One of the biggest shortcomings? The data that hospitals are posting can be hard to find, and difficult to parse. I looked up the prices at some of my local hospitals in DC.

It usually took me about five to 10 minutes of searching around their websites to locate the price data — not great, but not terrible either. Once I did find it. ... That’s where things got interesting.

The full Vox article can be viewed at this link.  

Digital Healthcare Growth Drivers In 2019

The digital transformation of healthcare will see significant growth in the next 12 months fueled by institutional interest in driving down costs and improving patient engagement. Expect increased pharma investment, improving regulatory status, payer engagement with digital tools and better telemedicine connectivity through consolidation.

Digital health will build on the major events of the past year. Amazon made headlines at the beginning of 2018 with its announcement of collaborating with Berkshire Hathaway and JP Morgan to create a new entity to improve care options for their employees. Towards the end of the year Amazon got attention again with its expansion into software to digitize and mine patient medical records to improve treatment and cut costs. It joins the ranks of IBM and UnitedHealthcare’s Optum, as well as Apple and Google’s efforts to mobilize, organize and analyze health records. The anticipated buyer for all these services are health systems that have historically lagged in fully embracing the potential of electronic record analytics.

The full Forbes article can be viewed at this link.  

Laws Requiring the E-Prescribing of Opioids Have Gained Momentum, but Prescriber Adoption is Playing Catch Up

The SUPPORT for Patients and Communities Act, which Congress passed and President Trump signed into law in October, mandates the use of electronic prescribing of controlled substances (EPCS) for all controlled substances under Medicare Part D by January 1, 2021.

EPCS is a critical tool in the nation's response to the epidemic. It eliminates paper prescriptions, which can be stolen, forged or altered, and gives prescribers electronic access to a patient’s prescription history to help identify potential overuse or abuse. In addition, there are other benefits, including enhanced security, privacy and prescribing flexibility, as well as improved workflow efficiency for prescribers and pharmacists alike.

Policymakers clearly see the need to leverage EPCS in the fight against opioid abuse, as the continued acceleration of EPCS legislation at the state level demonstrates. In 2018, eight more states passed mandates--Arizona, California, Iowa, Massachusetts, New Jersey, Oklahoma, Pennsylvania and Tennessee—bringing the total number of states with EPCS mandates to 15. Of that total, the mandates in Arizona, New Jersey and Pennsylvania become effective in 2019—with Arizona’s beginning the very first day of the new year. Michigan and Illinois have now introduced EPCS bills, and industry experts expect nearly twenty more states to pursue similar legislation in 2019.

The full Surescripts article can be found at this link.