Six niches in need of medtech innovation
“MACRA” sounds big: Medicare Access & CHIP Reauthorization Act of 2015. And it is big. The final rule, published in November, runs 2,100 pages. MACRA is complex, a lot to digest and boil down to infographics or to explain to the physicians and admin staff who will have to wrestle with it beginning in a few months.
MACRA formalizes a tidal shift in paradigm that demands a commensurate shift in how health care providers are reimbursed: moving from paying for services rendered to paying for outcomes realized.
An idea whose time has come
Jennifer Anderson, executive director of NCHICA, the North Carolina Healthcare Information and Communications Alliance, says MACRA is a good thing “because every year we’d have this big sustainable growth-rate-formula change to deal with, like a 30- to 35-percent reduction, and Congress would rescue it. Costs were too high, so physician payments were being cut, and Congress would rescue it. We can’t rescue the system any more.”
Physicians for years have been pelted with payment-policy changes, and Anderson is sympathetic to their plight. Now, MACRA seeks to “tie physician payments to outcomes through the new Merit-based Incentive Payment System, or MIPS, and to encourage adoption of ‘alternative payment models’ (APMs)” By 2019, some 95 percent of physicians will fall into the MIPS side of the house and the remaining five percent into APMs like medicare shared savings programs and accountable care organizations.
At its core, Anderson says, MACRA’s value-based-care paradigm, which is “disrupting the health care system at every level”, will demand laser-like focus on three things: patient engagement, care coordination, and reducing costs.
“That’s were a lot of the medtech innovation and advancement will focus,” she says. “That’s the name of the game.”
While MACRA’s emphasis is reflected in the payment reform now under way, Mike Rhoades, founder and CEO of health-care consulting firm Blaze Advisers, says “Payment reform is not a technology problem at its source. Technology has to enable us to work more efficiently.”
Here are six areas that stand out as niches inviting innovation:
“Telehealth is huge,” Anderson says. She calls remote monitoring “one of the keystones” to reducing cost and raising quality. Checking in on patients using technology such as a Bluetooth-enabled monitoring device or secure video conferencing is something providers are all looking at.
For example, with heart patients, weight gain is a big challenge and a good indicator of the patient’s status. With an internet-connected scale, a nurse with access to the back-end data could monitor her patients’ weight daily and re-admit if needed.
What can we do to make the hospital experience better? Anderson says, give patients iPads so they can see what tests or procedures are scheduled each day; so they can see when the specialist will be making rounds and the family can be there to ask questions; or so that the patients can message their care teams.
“Having a better experience means improved patient-satisfaction scores, which in turn feed into reimbursement rates,” Anderson says.
Anderson notes plenty of improvement being made regarding interoperability, adding that it’s not where it needs to be for providing an integrated look at patient health.
She cites a large provider, an NCHICA member, that is making great strides with interoperability. On a therapist’s schedule, for example, this provider can see all of a patient’s hospital admissions, all pharmacy fulfillments, and can see at a glance how many times the patient has been admitted, no matter where; whether the patient is buying opioids more often than she should, or not buying enough. Gathering and integrating data from many sources, “That’s what makes the difference.”
For Mike Rhoades, “It’s all about workflow, workflow, workflow” — the sequence of steps & resources necessary to deliver care. If a caregiver must switch from one clinical EHR system to another, or to several others, to make a treatment query, everything and everyone along the way suffers. “How do you integrate [your product] into the physician workflow?” Rhoades asks. Providers are working on a two-percent margin. “If you throw them new technology that damages their workflow, you can break system,” he warns.
Mike Rhoades has a simple analogy to illustrate inferential analytics. For most people, buying a new car could spur an elevation in one’s mood. A foreclosure on your house, in contrast, likely results in lowering one’s mood, and if one were a heart patient, a lowered mood could be stressful, even dangerous. We can make inferences about a patient’s behavior from certain bits of data.
Rhoades is working on a project that leverages lab data, which is pretty easy to get at a macro scale. For example, knowing which direction one’s cholesterol is headed over time in the context of a specific chronic condition, he says, “allows us to benchmark your performance to a similar condition and acuity peer group to see if your trajectory is an outlier. What if I also knew that you had a chronic cardiac condition or congestive heart failure? Now I know a lot about your health conditions, your LDL cholesterol trajectory, and, compared to your peer group, I can infer whether you are compliant with best-practice nutrition protocols. That patient’s doctor doesn’t have to wait for him to call with a complication; the doctor can contact him first to potentially divert an ED or in-patient visit, thus saving money and improving the quality of care.
The proliferation of wearable medical devices is all about detecting health issues before they happen.
Consider your mobile phone. Without touching an app, without talking, Rhoades says, “Your phone is the biggest tattletale you own.” It reports your location, your movement, your speed which tells whether you’re walking or driving. It can track your social activity: “Do you text? Have you logged onto Facebook? Social activity is a huge indicator of depression” and so, too, the likelihood of noncompliance to treatment plans. “People who are noncompliant with treatment plans tend to be self-isolating.”
Rhoades asks the next logical question, “What tools can we develop that are engaging, fun and helpful while generating meaningful data about you that can improve your treatment?”
Inferential analytics? Meet patient engagement.
A great example is the game, The Amazings. What appears to be an exciting runner-style game for kids is really a tool for teaching pediatric asthma patients about their illness while collecting data about their asthma triggers — triggers such as local pollen count, airborne particulates, and whether the user has taken an inhaler at the right time. A Bluetooth-connected pressure sensor in the inhaler tracks such behavior, and the “game” can send alerts to parents. Developed by the Carolinas HealthCare System, the Amazings is designed to keep kids fully engaged; otherwise, they delete it from their phones.
The next question that occurs to Rhoades: “Why can’t we develop something like that for dementia, or Alzheimer’s?”
Social-determinant analytics & surveillance
Taken together, inferential analytics, patient engagement and portable data-collecting devices equate to powerful remote monitoring, predictive analytics, better patient health and reduced costs. Ultimately . . .
It boils down to this
Big data. As Dr. Richard Gliklich has written, “All organizations hoping to succeed in value-based arrangements need access to actionable data for timely decision-making. […] Large data sets enable highly accurate predictive analytics for personalizing decisions. For example, in bundled payment programs, the data can identify patients who are most likely to experience high-cost events before they occur, allowing organizations to target resources to avoid problems.”
Another perspective to consider, Rhoades says, is this: “Sometimes small data, understood in a larger context, can be powerful and is a lot easier to access while waiting for Big Data connections. The big-data library, in this situation, can simply be a static reference library through which we test our hypotheses for correlations.”
Tips for innovators
- Medtech can be a complex and expensive space for innovators to break into, but there is opportunity even for upstart innovators working, for instance, on new APIs and mobile apps. You have to know healthcare, but you can be a small, independent innovator and come up with something innovative. In April 2015, NCHICA partnered with Northwestern AHEC, Wake Forest School of Medicine, and Quintiles to sponsor a hackathon focused on caregiver support. It drew all kinds of people with all types of interests, and they came up with some great ideas, including an Uber-style service for caregiver support and a way to feed music into patients’ homes.
- Designers: Design with a mission. Look for opportunities, for the field that hasn’t been plowed much yet.
- Be laser focused. Don’t try to boil the ocean. Keep your overarching sales pitch focused on one thing. When that works, then pivot to another.
- Workflow needs to be addressed at the front end. Get some workflow-operations experts or advisers. Pilot your product. Continue to make it invisible behind the scenes. Work with existing technology so that your product will not be noticed in the workflow. If it’s noticed, it’s probably causing a problem.
- Winners in the mobile-app space will explore the potential of mobile phones by creating the next must-have app that can inferentially track my behavior. There’s a three-month drop-off rate for apps. The winners in this space must provide meaningful value, a means of connecting and solving a problem.
- Data will always win. Show me your shiny project, and I say, “Show me the data.” People will build better joints, better pharmaceuticals, better mouse traps, but the opportunities I see in devices and pharmaceuticals is that they are all trying to build a data system. How about tracking information on how a person responds to medication even as the medication passes through body? The Holy Grail is to understand all your health-care history.
We at tekMountain recognize the broad range of tight integration necessary for a vibrant, results-oriented medtech ecosystem. Speak with us today about your ideas for innovation. Our mentors and cowork space await you.