The Rise of the Data-Driven Physician

Since its inception, the Stanford Medicine Health Trends Report has examined the most consequential developments and technologies that are changing health care delivery. Our 2020 report describes a health care sector that is undergoing seismic shifts, fueled by a maturing digital health market, new health laws that accelerate data sharing, and regulatory traction for artificial intelligence in medicine.

The full report can be downloaded below.  

‘Accountable Care’ And You: Better Care Delivery, Reduced Costs

Accountable care organizations (ACOs), a byproduct of the Affordable Care Act (ACA), were designed and deployed to better coordinate and manage the delivery of care and reduce healthcare costs to the system. Theoretically ACOs are “built” to manage patients on the care continuum to ensure that care is coordinated to deliver quality outcomes and better, lower-cost care. The care continuum would include, but is not limited to, multiple different players in healthcare, such as family practice/internal medicine clinicians, cardiologists, orthopods, hospitals, and skilled nursing facilities (SNFs).  

The full Forbes article can be viewed at this link.  

Cancer Statistics, 2020

Each year, the American Cancer Society estimates the numbers of new cancer cases and deaths that will occur in the United States and compiles the most recent data on population-based cancer occurrence. Incidence data (through 2016) were collected by the Surveillance, Epidemiology, and End Results Program; the National Program of Cancer Registries; and the North American Association of Central Cancer Registries. Mortality data (through 2017) were collected by the National Center for Health Statistics. In 2020, 1,806,590 new cancer cases and 606,520 cancer deaths are projected to occur in the United States. The cancer death rate rose until 1991, then fell continuously through 2017, resulting in an overall decline of 29% that translates into an estimated 2.9 million fewer cancer deaths than would have occurred if peak rates had persisted. This progress is driven by long-term declines in death rates for the 4 leading cancers (lung, colorectal, breast, prostate); however, over the past decade (2008-2017), reductions slowed for female breast and colorectal cancers, and halted for prostate cancer. In contrast, declines accelerated for lung cancer, from 3% annually during 2008 through 2013 to 5% during 2013 through 2017 in men and from 2% to almost 4% in women, spurring the largest ever single-year drop in overall cancer mortality of 2.2% from 2016 to 2017. Yet lung cancer still caused more deaths in 2017 than breast, prostate, colorectal, and brain cancers combined. Recent mortality declines were also dramatic for melanoma of the skin in the wake of US Food and Drug Administration approval of new therapies for metastatic disease, escalating to 7% annually during 2013 through 2017 from 1% during 2006 through 2010 in men and women aged 50 to 64 years and from 2% to 3% in those aged 20 to 49 years; annual declines of 5% to 6% in individuals aged 65 years and older are particularly striking because rates in this age group were increasing prior to 2013. It is also notable that long-term rapid increases in liver cancer mortality have attenuated in women and stabilized in men. In summary, slowing momentum for some cancers amenable to early detection is juxtaposed with notable gains for other common cancers. 

The full report can be downloaded below.  

From Leather Bags to Webcams, the Emerging Tools of Tele-primary Care

For many years, the physician’s leather bag has been an essential component of the primary care physician’s armamentarium—used for holding everything needed for house calls and symbolizing the physician’s craft. As the availability and technology of telemedicine increases, the leather bag is expanding to include a laptop and webcam. Currently, 79 million Americans live in Health Professional Shortage Areas (HPSAs), and healthcare costs the USA $3.5 trillion annually. Therefore, innovations, such as telehealth, with the potential to deliver high-quality care to greater numbers at lower cost must be further explored. While optimal scope and structure are yet to be determined, high-quality telemedicine care is an opportunity to reach more patients and should stretch beyond urgent care to become an important tool for primary care providers.

The full article can be downloaded below.  

Prescription Opioids, Time to Rethink How We Assess Risk

While the opioid epidemic was officially declared a public health emergency in 2017, the USA has grappled with this problem for much longer. After 2017, the response to the crisis came at every level, from individual practices and healthcare establishments to state and national organizations and the government. The result was an influx of policies and laws aimed at reversing the epidemic, primarily by restricting the initial prescription of opioids. The CDC report from 2019 noted a decrease in the prescribing rates of opioids; however, opioid-related deaths have not followed suit. This discrepancy is without a clear explanation but raises numerous issues.

The full article can be downloaded below.  

2020 Predictions: The Health IT Year Ahead​

When I started my career almost 40 years ago, I had no idea just how gratifying it would be to work in an industry devoted to helping people get, feel and stay better. Focusing on the IT side of healthcare has been nothing short of inspiring, always pushing forward, proactively paving the way to safer, more secure patient care.

I’ve learned a lot along the way, and look forward to what’s next. My bet is that safety and security will be at the wheel in 2020. I recently shared my top predictions of what we can expect in the year ahead with MedCity News. Check them out below:

1. Trust emerges as a major competitive differentiator
2. Information blocking rules will matter
3. The real-world impact of price transparency becomes evident
4. Time to therapy for specialty medications decreases with better information flow
5. Artificial intelligence chips away at the cognitive burden on physicians
6. Opioid prescribing becomes smarter
7. Pharmacies become sites of care delivery
8. Consumer-oriented digital health services are challenged to mature

The full Surescripts article can be viewed at this link.  

Deep Learning in Medical Imaging

The artificial neural network (ANN), one of the machine learning (ML) algorithms, inspired by the human brain system, was developed by connecting layers with artificial neurons. However, due to the low computing power and insufficient learnable data, ANN has suffered from overfitting and vanishing gradient problems for training deep networks. The advancement of computing power with graphics processing units and the availability of large data acquisition, deep neural network outperforms human or other ML capabilities in computer vision and speech recognition tasks. These potentials are recently applied to healthcare problems, including computer-aided detection/diagnosis, disease prediction, image segmentation, image generation, etc. In this review article, we will explain the history, development, and applications in medical imaging.

The full article can be downloaded below.  

Cigna: Uniting Medical, Drug And Mental Health Saves $850 Per Enrollee

Cigna said efforts to combine medical, pharmacy and behavioral benefits saves more than “$850 per customer,” according to the insurer’s internal analysis.

Cigna, which owns the large pharmacy benefit manager (PBM) Express Scripts, released its fourth annual “value of integration” study documenting various savings for employer clients that have a “connected set of medical, pharmacy, and behavioral benefits.” The insurer looked at more than 2.3 million customer claims during a two-year period.

Though an internal report that would seem to favor a developing Cigna strategy, the analysis captures a broader effort by the health insurance industry to integrate more than just medical benefits into offerings they sell to employers and government clients.

Health insurers see a value-based approach that better coordinates care for the “whole person” as a way to improve health outcomes and ultimately save money. That contrasts with fee-for-service medicine that pays doctors and hospitals based on volume of care delivered.

The full Forbes article can be viewed at this link.  

Impact of Community Pharmacist Interventions With Managed Care to Improve Medication Adherence

The consortium successfully designed, implemented, and analyzed community pharmacist-led adherence interventions in collaboration with a third-party provider and academia. Community pharmacists were able to increase interactions with patients and in some cases improve adherence measures. Most community pharmacies face workflow implementation barriers when instituting new interventions into practice. However, the opportunity to improve adherence outcomes is a valued intervention and can be administered through a third party looking to target certain members. Interventional data from the pharmacy to the third party are valued and should be streamlined for completeness, accuracy, and clinical content. The need for efficient electronic exchange of information will be key to the expansion of set services. Academia plays a key role in the study design, effectiveness of clinical output, and integration of the collaboration into didactic and experiential aspects of student training. Future research must include implementation outcomes (eg, acceptance, adoption, fidelity, sustainability) in order to better understand how community pharmacists can effectively implement these interventions. A focus on implementation would help to address the barriers that most community pharmacies face when instituting new interventions into practice.

The full article can be downloaded below.  

A novel use of telemedicine during a hospital mass casualty drill

During a mass casualty disaster drill at NewYork-Presbyterian’s Lower Manhattan Hospital in April 2019, the Emergency Department (ED) used telemedicine to see low-acuity ‘walking wounded’ patients. This telemedicine service is provided every day as ED Express Care Service and staffed by off-site, board-certified Emergency Medicine attending physicians. This novel use of the ED Express Care Service allowed the ED to provide timely, safe, quality care while expanding resources and ED capacity through rapid assessment, treatment and discharge of the low-acuity patients.

The full article can be downloaded below.