Pictured from left: (moderator) Chitra Nawbatt, Global Head of Health Assurance Partnerships at General Catalyst; Aaron Martin, EVP Chief Digital Officer, Providence; Snezana Mahon, COO, Transcarent; Neal Patel, Chief Informatics Officer, Vanderbilt University Medical Center; Tressa Springmann, Senior VP and Chief Information and Digital Officer, LifeBridge Health
This article is part of a series powered by HLTH and CHIME to highlight key insights and perspectives from leading executives speaking at ViVE.
The first full day of the inaugural ViVE conference at the Miami Beach Convention Center offered multiple perspectives on how to balance risk and reward through the prism of strategic investors and health systems working with startups, ROI, and improving health equity. A keynote talk from Micky Tripathi, who heads up the Office of National Coordinator for Health IT, highlighted new developments towards improving interoperability and functionality of EHRs.
Startup tourism
One bittersweet observation that came out of a panel discussion on strategic partnerships, To buy, to build or to partner? That’s the strategic question, was that hospitals and health systems love learning about new technologies, and how different companies approach it, but that interest could be misinterpreted by startups who take that as a sign they’re interested in their company in particular. Hashed Health Founder and CEO John Bass warned, half jokingly, that “selling to hospitals will take years off of your life.”
Aimee Quirk, Oschner Ventures CEO, observed that it’s critical for startups to be clear about the “give-get” both for their business and the investment firm they pitch. Panelists, which also included McKesson Ventures Partner Michelle Snyder and KP Ventures Managing Director Liz Rockett, shared that there needs to be alignment between the startup and investors on what the goals are for the business.
Hospitals need to do better on evaluating business model risk
Providence EVP and Digital Officer Aaron Martin noted that hospitals needed to do a better job on business model risk as part of the panel discussion, Forget the money, show me the ROI!.
“They evaluate risk based on technical or operational risk, but they don’t really do a good job on business model risk. So I run into this more times than I can count where we brought in a company that’s going to do something kind of transformational from a partnership standpoint. And the organization will say ‘Well, that’s cannibalistic; that may compete with our existing business.’ And my response is, ‘OK, great. Show me the fully funded plan to compete against that.’ And it’s crickets. They’re like, ‘Well, what do you mean? We did our job and we said no, right?’
“I said, ‘Well, you’re going to compete, because they’re going to go partner with that health system across the way, and you’re going to compete against them. And they’ve got a better model than you do. So how are you going to take them on? Show me the budget to take them on.’ Because we had the budget to do this. It was a really controversial discussion, as you can probably imagine. Not very fun. I don’t think health systems do a good job of fully evaluating the 360 [degree] risk of ‘What if I don’t do it?’
Pregnancy isn’t a disease
Maternal care came up a few times at the conference, particularly in the context of health equity but also in a panel discussion on realizing ROI in healthcare.
In a fireside chat, Dr. Margaret-Mary Wilson, Chief Medical Officer and EVP with UnitedHealth Group, talked about how the payer was working to address social determinants of health, particularly for African-American women. In an effort to address the relatively high rate of mortality among pregnant black women, dying at 4 times the rate of women of other demographics. The payer is building up an infrastructure of maternity care which includes training doulas, who provide emotional and physical support to pregnant women.
“Women shouldn’t be dying of pregnancy,” Wilson said. “It’s not a disease.”
In the panel discussion, , Martin also touched on how the health system is working with startups to improve pregnancy outcomes through its work with health tech company Wildflower.
“We built a platform that really did a great job of engaging with patients during the pregnancy journey, and then, you know, t + three years postpartum into pediatrics. If you get that high level of engagement, then you can wrap a risk model around it, and start to actually lower costs. So that’s the next phase of Wildflower. We get super excited about businesses that help us create new businesses or help us transform. Those tend to be very, very high ROI investments.”
Applying real world evidence to supporting patients
A discussion on applications for real world evidence gathered through wearables and devices used by patients to generate meaningful insights into their condition, The data nexus: Unshackling real-world evidence, generated compelling insights from panelists, particularly around Parkinson’s disease.
“One of the research initiatives that we have at AbbVie is in Parkinson’s disease and it has a wearable that’s part of this study,” said Dr. Michael Eaddy, VP of the Real-World Evidence Center of Expertise at AbbVie. “It was so important, because during a lot of the on and off time for these patients, they would track it based on what the patient highlighted back to the physician. So the physician is now trying to make changes to the dose based on trying to maximize the time that the patients haven’t moved around, but now you have a wearable that specifically tracks that information and what’s important in the patient.”
John Doyle, Group VP and principal scientist with Exponent, also shared his experience working with Parkinson’s disease patients: “There’s so much residual unmet clinical need for Parkinson’s disease patients and I was just reflecting on work I’d done for the Michael J. Fox Foundation at one point where we were trying to capture the patient experience in a way that insurance companies, payers, and PBMs… would value. But it was difficult. It was almost like a bridge too far to measure a real world experience with some type of walking test or some type of patient reported outcome. But now linking all of your responses about being passive and creating the metrics that surround that patient with the right sensor and wearable to truly capture what’s meaningful to the patient for movement should be quite a breakthrough for all stakeholders to appreciate.”
Improving access to health records through enforcement and API functionality across EHRs
In a keynote by Tripathi, he highlighted some of the provisions of the 21st Century Cures Act that come into play this year including the enforcement structure for the “information blocking” rule and API functionality.
“The law specifically says that entities that are holders of information being with providers, technology developers and public information networks are prohibited from interfering with the exchange of information with the availability of information for authorized purposes as authorized by state and federal law.”
He noted that the rule complements HIPAA, which permits organizations to share information for treatment and payment but doesn’t require them to. The information blocking provision says HIPAA-regulated organizations are actually obligated to in order to avoid being fined.
Tripathi said that it recently began sharing data on the type of complaints it received about information blocking. He pointed out that since last year, it received an average of one complaint a day, that 75% of those complaints were from patients, and the majority of them were allegations against providers and provider organizations that they claimed were preventing them from accessing their information.
He added that this is the first year that ONC will require a technical specification to enable APIs to scale across EHR platforms by the end of the year, also as part of the 21st Century Cures Act. Developers won’t have to deal with proprietary APIs, which impose costs and create friction, according to Tripathi.
