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A unified app platform helps gastroenterologists achieve a digital transformation
CHICAGO – A gastroenterologist-founded tech firm is making big waves in digital health care as Rx.Health, a spinoff from Mount Sinai Hospitals, New York, partners with the American Gastroenterological Association and other professional societies to deliver health solutions to the palms of patients’ hands.
“I would make the argument that disruption doesn’t have to come from the West Coast. It can come from savvy East Coasters, as well as Midwesterners, as well as Southerners,” said Ashish Atreja, MD, MPH, chief innovation officer of medicine at Mount Sinai Hospitals, New York.
At his home institution, where Dr. Atreja also serves on the gastroenterology faculty at the Icahn School of Medicine, the discussion about digital health began as Mount Sinai experienced rapid expansion. “So that has been a learning ground for us – to say, ‘What is happening across different hospitals? How are we going to standardize care?’ ” he said, speaking at the AGA Partners in Value Meeting.
“We’re looking at digital health to do it,” and the digital initiative dovetails perfectly with the strong value-based health mission of Mount Sinai, he added. “We say that, if our hospital beds are filled, then we are failing,” although the institution’s biggest revenue stream is from inpatient care. “We really have to look beyond the four walls of the hospital to provide care.”
The digital innovation laboratory at Mount Sinai was set up about 6 years ago, making it one of the first such centers in the country. It took about a year to build a team that had the technical skills to build apps in house, but once the ball got rolling, “it has been a fascinating journey,” said Dr. Atreja.
Innovation doesn’t always mean adoption
When Dr. Atreja and his colleagues took apps that were powerful data collection tools and put them out for general patient use, “We only saw 6% adoption ... because the patients forgot the names. They mistyped the names. They got lost in 60,000 apps. They forgot the activation code.
“And even if they got all of this, 20% of patients didn’t have space in their smartphones anyway.”
That’s when Dr. Atreja and his collaborators realized they didn’t really have an innovation problem, but rather a transformation problem – they needed to change the existing digital patchwork into a clinically meaningful intervention.
At this turning point, the Mount Sinai digital innovation team realized physicians could use evidence-based apps “and actually prescribe them – much the same way that you prescribe medication. ... So this was our ‘aha’ moment 3 years ago,” said Dr. Atreja.
Now, at Mount Sinai, apps are integrated with the electronic health record and can be prescribed with a few clicks. With the integrated digital prescription platform, patient activation of the apps has increased to 92%, said Dr. Atreja.
Currently, about 25 projects using this integrated system are being initiated within the Mount Sinai health system, and 35-50 external projects are underway in association with Rx.Health, a spin-off of the Mount Sinai efforts. Dr. Atreja serves as chief strategy officer for Rx.Health.
In all, 22 health systems are using the app platform at present, which bundles many facets of digital health – health education, remote monitoring, telehealth, secure messaging, to name a few.
The unified platform, said Dr. Atreja, “allows all of us – clinicians, business drivers, tech, researchers – to become creators and digital practitioners.”
Case study: Colonoscopy
After a particularly discouraging day in the endoscopy suite in which six of seven patients had inadequate bowel preparation for colonoscopy, Dr. Atreja dug a little further into Mount Sinai’s endoscopy data. “I realized we were losing one million dollars a year because of no-shows and inadequate bowel preparation,” he said.
A higher success rate could be achieved with bowel preparation if enough staff time is dedicated to repeat phone calls, he conceded. “But you are spending $300,000 just on a brute force solution” of massive staff resources, he said.
In the Mount Sinai example, when all missed opportunities are considered, “you’re looking at 4 to 5 million dollars that we’re leaking because we are not able to engage patients at the right time.”
Gastrointestinal procedures are a major source for revenue leaks, he said. Patients may miss procedures or be late; up to 1 in 4 patients may have poor bowel preparation, and sometimes patients arrive without a plan for a ride home after a procedure that requires sedation.
Other care gaps include the 30%-70% of patients who don’t return at recommended screening intervals, and patients who have positive fecal immunohistochemical testing but don’t receive a colonoscopy. Some patients have colonoscopies ordered, but never scheduled, and still others are never offered any colorectal cancer surveillance testing at all.
It’s no wonder patients are confused, said Dr. Atreja, providing an example of one center’s colonoscopy preparation instructions for split-dose polyethylene glycol bowel preparation. Patients must closely follow a full page of bullet points to be completed at precise time intervals. “One in four patients actually loses the paper by the time they need it before the procedure,” he said. Another 40% don’t look at instructions until it’s too late to prepare adequately or to line up an escort to bring them home post procedure.
This scenario, he said, shows that “it’s not in the science of medicine, but in the practice of medicine, that we are failing. ... So how about we completely change the game and create a real-time digital navigation for the patient?”
The digital alternative to the slip of paper is a real-time patient navigation tool that guides patients through the entire colonoscopy preparation process. “Based on where the patient is at that point in time, and the procedure, and the bowel prep,” the app gives the patient timely and relevant information: what the procedure is like, why bowel preparation is important, and how preparation is correctly performed, explained Dr. Atreja.
A reminder to arrange an escort arrives on the patient’s phone a full 10 days before the procedure, with subsequent nudges. Patients even receive driving and parking directions. The day before the procedure, a last-minute query checks on transportation. “So we’re working with Uber to actually make an ... integration with Uber so they can pick up the patient if they have transportation issues.”
Post procedure, patients are asked about their experiences, and a plan for appropriate patient recall is integrated into the app as well. “The best part is, this has not been designed by anyone [other] than those in the health system. Because we already know the recommended guidelines, we know the best practices.” This, he said, is where the value of digital apps is truly created.
Early evidence gleaned from a dashboard that’s part of the digital health solution from one site using the app shows a 24% improvement in bowel preparation. Importantly, the rate of aborted procedures has been cut in half, and patient satisfaction rates are at 93%.
The endoscopy suite as digital transformation center
Now, in partnership with AGA, Dr. Atreja and his collaborators are planning a roll-out to multiple sites to see whether the savings and return on investment are replicated at other endoscopy sites. The vision expands beyond reducing revenue leaks to creating “digital transformation centers,” he said.
Digital health solutions such as this afford powerful opportunity for data collection, not only for practice optimization but also for research, said Dr. Atreja. He cited the example of endoscopic retrograde cholangiopancreatography, where procedural details could be linked to postprocedural admission rates in the service of fine-tuning one of the endoscopist’s greatest procedural challenges.
“You can create all of those clinical trial networks for devices right on the fly,” he said. In devising a clinical trial for an app-based intervention for anxiety – prevalent in those with irritable bowel disease – Dr. Atreja and his colleagues opened trial enrollment at 8 a.m., hoping to enroll 20 patients. By the end of the day, over 200 had enrolled. “We over-subscribed our trial by 10 times” in 1 day using the digital platform, he said.
Dr. Atreja is currently working with the American College of Cardiology on digital solutions for home monitoring of heart failure patients. “Partnerships with other health systems and societies are key for learning and rapid transformation – a rising tide lifts all boats,” said Dr. Atreja. “Digital medicine is not digital medicine. It is medicine. Because the practice of medicine is medicine.”
Dr. Atreja reported receiving funding from AbbVie, Janssen, Pfizer, Takeda, Astrazeneca, UCB, and Roche; the RxUniverse app has been licensed from the Icahn School of Medicine at Mount Sinai to Rx.Health.
AGA has partnered with RxHealth to support gastroenterologists’ ability to provide patient care and improve patient adherence by creating up-to-date, evidenced-based digital tools that can be prescribed at point of care. Dr. John I. Allen, the Editor in Chief of GI & Hepatology News, is on the advisory board of RxHealth and recused himself from review and approval of this story. Learn more about the program and how to become a pioneer site at https://rx.health/GI or [email protected] .
CHICAGO – A gastroenterologist-founded tech firm is making big waves in digital health care as Rx.Health, a spinoff from Mount Sinai Hospitals, New York, partners with the American Gastroenterological Association and other professional societies to deliver health solutions to the palms of patients’ hands.
“I would make the argument that disruption doesn’t have to come from the West Coast. It can come from savvy East Coasters, as well as Midwesterners, as well as Southerners,” said Ashish Atreja, MD, MPH, chief innovation officer of medicine at Mount Sinai Hospitals, New York.
At his home institution, where Dr. Atreja also serves on the gastroenterology faculty at the Icahn School of Medicine, the discussion about digital health began as Mount Sinai experienced rapid expansion. “So that has been a learning ground for us – to say, ‘What is happening across different hospitals? How are we going to standardize care?’ ” he said, speaking at the AGA Partners in Value Meeting.
“We’re looking at digital health to do it,” and the digital initiative dovetails perfectly with the strong value-based health mission of Mount Sinai, he added. “We say that, if our hospital beds are filled, then we are failing,” although the institution’s biggest revenue stream is from inpatient care. “We really have to look beyond the four walls of the hospital to provide care.”
The digital innovation laboratory at Mount Sinai was set up about 6 years ago, making it one of the first such centers in the country. It took about a year to build a team that had the technical skills to build apps in house, but once the ball got rolling, “it has been a fascinating journey,” said Dr. Atreja.
Innovation doesn’t always mean adoption
When Dr. Atreja and his colleagues took apps that were powerful data collection tools and put them out for general patient use, “We only saw 6% adoption ... because the patients forgot the names. They mistyped the names. They got lost in 60,000 apps. They forgot the activation code.
“And even if they got all of this, 20% of patients didn’t have space in their smartphones anyway.”
That’s when Dr. Atreja and his collaborators realized they didn’t really have an innovation problem, but rather a transformation problem – they needed to change the existing digital patchwork into a clinically meaningful intervention.
At this turning point, the Mount Sinai digital innovation team realized physicians could use evidence-based apps “and actually prescribe them – much the same way that you prescribe medication. ... So this was our ‘aha’ moment 3 years ago,” said Dr. Atreja.
Now, at Mount Sinai, apps are integrated with the electronic health record and can be prescribed with a few clicks. With the integrated digital prescription platform, patient activation of the apps has increased to 92%, said Dr. Atreja.
Currently, about 25 projects using this integrated system are being initiated within the Mount Sinai health system, and 35-50 external projects are underway in association with Rx.Health, a spin-off of the Mount Sinai efforts. Dr. Atreja serves as chief strategy officer for Rx.Health.
In all, 22 health systems are using the app platform at present, which bundles many facets of digital health – health education, remote monitoring, telehealth, secure messaging, to name a few.
The unified platform, said Dr. Atreja, “allows all of us – clinicians, business drivers, tech, researchers – to become creators and digital practitioners.”
Case study: Colonoscopy
After a particularly discouraging day in the endoscopy suite in which six of seven patients had inadequate bowel preparation for colonoscopy, Dr. Atreja dug a little further into Mount Sinai’s endoscopy data. “I realized we were losing one million dollars a year because of no-shows and inadequate bowel preparation,” he said.
A higher success rate could be achieved with bowel preparation if enough staff time is dedicated to repeat phone calls, he conceded. “But you are spending $300,000 just on a brute force solution” of massive staff resources, he said.
In the Mount Sinai example, when all missed opportunities are considered, “you’re looking at 4 to 5 million dollars that we’re leaking because we are not able to engage patients at the right time.”
Gastrointestinal procedures are a major source for revenue leaks, he said. Patients may miss procedures or be late; up to 1 in 4 patients may have poor bowel preparation, and sometimes patients arrive without a plan for a ride home after a procedure that requires sedation.
Other care gaps include the 30%-70% of patients who don’t return at recommended screening intervals, and patients who have positive fecal immunohistochemical testing but don’t receive a colonoscopy. Some patients have colonoscopies ordered, but never scheduled, and still others are never offered any colorectal cancer surveillance testing at all.
It’s no wonder patients are confused, said Dr. Atreja, providing an example of one center’s colonoscopy preparation instructions for split-dose polyethylene glycol bowel preparation. Patients must closely follow a full page of bullet points to be completed at precise time intervals. “One in four patients actually loses the paper by the time they need it before the procedure,” he said. Another 40% don’t look at instructions until it’s too late to prepare adequately or to line up an escort to bring them home post procedure.
This scenario, he said, shows that “it’s not in the science of medicine, but in the practice of medicine, that we are failing. ... So how about we completely change the game and create a real-time digital navigation for the patient?”
The digital alternative to the slip of paper is a real-time patient navigation tool that guides patients through the entire colonoscopy preparation process. “Based on where the patient is at that point in time, and the procedure, and the bowel prep,” the app gives the patient timely and relevant information: what the procedure is like, why bowel preparation is important, and how preparation is correctly performed, explained Dr. Atreja.
A reminder to arrange an escort arrives on the patient’s phone a full 10 days before the procedure, with subsequent nudges. Patients even receive driving and parking directions. The day before the procedure, a last-minute query checks on transportation. “So we’re working with Uber to actually make an ... integration with Uber so they can pick up the patient if they have transportation issues.”
Post procedure, patients are asked about their experiences, and a plan for appropriate patient recall is integrated into the app as well. “The best part is, this has not been designed by anyone [other] than those in the health system. Because we already know the recommended guidelines, we know the best practices.” This, he said, is where the value of digital apps is truly created.
Early evidence gleaned from a dashboard that’s part of the digital health solution from one site using the app shows a 24% improvement in bowel preparation. Importantly, the rate of aborted procedures has been cut in half, and patient satisfaction rates are at 93%.
The endoscopy suite as digital transformation center
Now, in partnership with AGA, Dr. Atreja and his collaborators are planning a roll-out to multiple sites to see whether the savings and return on investment are replicated at other endoscopy sites. The vision expands beyond reducing revenue leaks to creating “digital transformation centers,” he said.
Digital health solutions such as this afford powerful opportunity for data collection, not only for practice optimization but also for research, said Dr. Atreja. He cited the example of endoscopic retrograde cholangiopancreatography, where procedural details could be linked to postprocedural admission rates in the service of fine-tuning one of the endoscopist’s greatest procedural challenges.
“You can create all of those clinical trial networks for devices right on the fly,” he said. In devising a clinical trial for an app-based intervention for anxiety – prevalent in those with irritable bowel disease – Dr. Atreja and his colleagues opened trial enrollment at 8 a.m., hoping to enroll 20 patients. By the end of the day, over 200 had enrolled. “We over-subscribed our trial by 10 times” in 1 day using the digital platform, he said.
Dr. Atreja is currently working with the American College of Cardiology on digital solutions for home monitoring of heart failure patients. “Partnerships with other health systems and societies are key for learning and rapid transformation – a rising tide lifts all boats,” said Dr. Atreja. “Digital medicine is not digital medicine. It is medicine. Because the practice of medicine is medicine.”
Dr. Atreja reported receiving funding from AbbVie, Janssen, Pfizer, Takeda, Astrazeneca, UCB, and Roche; the RxUniverse app has been licensed from the Icahn School of Medicine at Mount Sinai to Rx.Health.
AGA has partnered with RxHealth to support gastroenterologists’ ability to provide patient care and improve patient adherence by creating up-to-date, evidenced-based digital tools that can be prescribed at point of care. Dr. John I. Allen, the Editor in Chief of GI & Hepatology News, is on the advisory board of RxHealth and recused himself from review and approval of this story. Learn more about the program and how to become a pioneer site at https://rx.health/GI or [email protected] .
CHICAGO – A gastroenterologist-founded tech firm is making big waves in digital health care as Rx.Health, a spinoff from Mount Sinai Hospitals, New York, partners with the American Gastroenterological Association and other professional societies to deliver health solutions to the palms of patients’ hands.
“I would make the argument that disruption doesn’t have to come from the West Coast. It can come from savvy East Coasters, as well as Midwesterners, as well as Southerners,” said Ashish Atreja, MD, MPH, chief innovation officer of medicine at Mount Sinai Hospitals, New York.
At his home institution, where Dr. Atreja also serves on the gastroenterology faculty at the Icahn School of Medicine, the discussion about digital health began as Mount Sinai experienced rapid expansion. “So that has been a learning ground for us – to say, ‘What is happening across different hospitals? How are we going to standardize care?’ ” he said, speaking at the AGA Partners in Value Meeting.
“We’re looking at digital health to do it,” and the digital initiative dovetails perfectly with the strong value-based health mission of Mount Sinai, he added. “We say that, if our hospital beds are filled, then we are failing,” although the institution’s biggest revenue stream is from inpatient care. “We really have to look beyond the four walls of the hospital to provide care.”
The digital innovation laboratory at Mount Sinai was set up about 6 years ago, making it one of the first such centers in the country. It took about a year to build a team that had the technical skills to build apps in house, but once the ball got rolling, “it has been a fascinating journey,” said Dr. Atreja.
Innovation doesn’t always mean adoption
When Dr. Atreja and his colleagues took apps that were powerful data collection tools and put them out for general patient use, “We only saw 6% adoption ... because the patients forgot the names. They mistyped the names. They got lost in 60,000 apps. They forgot the activation code.
“And even if they got all of this, 20% of patients didn’t have space in their smartphones anyway.”
That’s when Dr. Atreja and his collaborators realized they didn’t really have an innovation problem, but rather a transformation problem – they needed to change the existing digital patchwork into a clinically meaningful intervention.
At this turning point, the Mount Sinai digital innovation team realized physicians could use evidence-based apps “and actually prescribe them – much the same way that you prescribe medication. ... So this was our ‘aha’ moment 3 years ago,” said Dr. Atreja.
Now, at Mount Sinai, apps are integrated with the electronic health record and can be prescribed with a few clicks. With the integrated digital prescription platform, patient activation of the apps has increased to 92%, said Dr. Atreja.
Currently, about 25 projects using this integrated system are being initiated within the Mount Sinai health system, and 35-50 external projects are underway in association with Rx.Health, a spin-off of the Mount Sinai efforts. Dr. Atreja serves as chief strategy officer for Rx.Health.
In all, 22 health systems are using the app platform at present, which bundles many facets of digital health – health education, remote monitoring, telehealth, secure messaging, to name a few.
The unified platform, said Dr. Atreja, “allows all of us – clinicians, business drivers, tech, researchers – to become creators and digital practitioners.”
Case study: Colonoscopy
After a particularly discouraging day in the endoscopy suite in which six of seven patients had inadequate bowel preparation for colonoscopy, Dr. Atreja dug a little further into Mount Sinai’s endoscopy data. “I realized we were losing one million dollars a year because of no-shows and inadequate bowel preparation,” he said.
A higher success rate could be achieved with bowel preparation if enough staff time is dedicated to repeat phone calls, he conceded. “But you are spending $300,000 just on a brute force solution” of massive staff resources, he said.
In the Mount Sinai example, when all missed opportunities are considered, “you’re looking at 4 to 5 million dollars that we’re leaking because we are not able to engage patients at the right time.”
Gastrointestinal procedures are a major source for revenue leaks, he said. Patients may miss procedures or be late; up to 1 in 4 patients may have poor bowel preparation, and sometimes patients arrive without a plan for a ride home after a procedure that requires sedation.
Other care gaps include the 30%-70% of patients who don’t return at recommended screening intervals, and patients who have positive fecal immunohistochemical testing but don’t receive a colonoscopy. Some patients have colonoscopies ordered, but never scheduled, and still others are never offered any colorectal cancer surveillance testing at all.
It’s no wonder patients are confused, said Dr. Atreja, providing an example of one center’s colonoscopy preparation instructions for split-dose polyethylene glycol bowel preparation. Patients must closely follow a full page of bullet points to be completed at precise time intervals. “One in four patients actually loses the paper by the time they need it before the procedure,” he said. Another 40% don’t look at instructions until it’s too late to prepare adequately or to line up an escort to bring them home post procedure.
This scenario, he said, shows that “it’s not in the science of medicine, but in the practice of medicine, that we are failing. ... So how about we completely change the game and create a real-time digital navigation for the patient?”
The digital alternative to the slip of paper is a real-time patient navigation tool that guides patients through the entire colonoscopy preparation process. “Based on where the patient is at that point in time, and the procedure, and the bowel prep,” the app gives the patient timely and relevant information: what the procedure is like, why bowel preparation is important, and how preparation is correctly performed, explained Dr. Atreja.
A reminder to arrange an escort arrives on the patient’s phone a full 10 days before the procedure, with subsequent nudges. Patients even receive driving and parking directions. The day before the procedure, a last-minute query checks on transportation. “So we’re working with Uber to actually make an ... integration with Uber so they can pick up the patient if they have transportation issues.”
Post procedure, patients are asked about their experiences, and a plan for appropriate patient recall is integrated into the app as well. “The best part is, this has not been designed by anyone [other] than those in the health system. Because we already know the recommended guidelines, we know the best practices.” This, he said, is where the value of digital apps is truly created.
Early evidence gleaned from a dashboard that’s part of the digital health solution from one site using the app shows a 24% improvement in bowel preparation. Importantly, the rate of aborted procedures has been cut in half, and patient satisfaction rates are at 93%.
The endoscopy suite as digital transformation center
Now, in partnership with AGA, Dr. Atreja and his collaborators are planning a roll-out to multiple sites to see whether the savings and return on investment are replicated at other endoscopy sites. The vision expands beyond reducing revenue leaks to creating “digital transformation centers,” he said.
Digital health solutions such as this afford powerful opportunity for data collection, not only for practice optimization but also for research, said Dr. Atreja. He cited the example of endoscopic retrograde cholangiopancreatography, where procedural details could be linked to postprocedural admission rates in the service of fine-tuning one of the endoscopist’s greatest procedural challenges.
“You can create all of those clinical trial networks for devices right on the fly,” he said. In devising a clinical trial for an app-based intervention for anxiety – prevalent in those with irritable bowel disease – Dr. Atreja and his colleagues opened trial enrollment at 8 a.m., hoping to enroll 20 patients. By the end of the day, over 200 had enrolled. “We over-subscribed our trial by 10 times” in 1 day using the digital platform, he said.
Dr. Atreja is currently working with the American College of Cardiology on digital solutions for home monitoring of heart failure patients. “Partnerships with other health systems and societies are key for learning and rapid transformation – a rising tide lifts all boats,” said Dr. Atreja. “Digital medicine is not digital medicine. It is medicine. Because the practice of medicine is medicine.”
Dr. Atreja reported receiving funding from AbbVie, Janssen, Pfizer, Takeda, Astrazeneca, UCB, and Roche; the RxUniverse app has been licensed from the Icahn School of Medicine at Mount Sinai to Rx.Health.
AGA has partnered with RxHealth to support gastroenterologists’ ability to provide patient care and improve patient adherence by creating up-to-date, evidenced-based digital tools that can be prescribed at point of care. Dr. John I. Allen, the Editor in Chief of GI & Hepatology News, is on the advisory board of RxHealth and recused himself from review and approval of this story. Learn more about the program and how to become a pioneer site at https://rx.health/GI or [email protected] .
EXPERT ANALYSIS FROM AGA PARTNERS IN VALUE 2019
How to bring telemedicine to your GI practice
CHICAGO – Is your practice ready for telemedicine – and should you dive in?
Once you and your practice managers work through regulatory, legal, and technical details, said Theresa Lee, MD, a gastroenterologist in private practice in Lone Tree, Colorado, speaking at the 2019 AGA Partners in Value meeting.
The general field of telehealth – in which images might be shared or patients might message their care team for medication refills – is a broad term, said Dr. Lee. She explained that telemedicine is narrowly defined for Medicare and Medicaid reimbursement purposes as “two-way, real-time interactive communication between the patient and the physician or practitioner at [a] distant site ... that includes, at a minimum, audio and video equipment.” This is the video visit that many people think of when they imagine telemedicine, she said.
There’s increasing acceptance of telehealth services, said Dr. Lee, with a recent online poll showing that two-thirds of those surveyed would be willing to use telehealth; this would translate to about 24 million Americans who would be potential telehealth patients. And a 2019 survey of internal medicine physicians showed that more than half are working in practices in which telehealth is used in some capacity. Both patients and clinicians can benefit in a telehealth relationship, said Dr. Lee. The lack of physical travel and the potential for access after normal clinic hours can be a real boon for patients; “So how does this help us? How does it improve practice and make our lives easier?” she asked. Telehealth services can lead to improved efficiency, patient satisfaction and retention, and the ability to stand out in a market, especially if a practice can initiate telehealth services now, during the rapid growth and adoption phase for this newer technology.
“You want to make sure you really understand what some of the legal issues are surrounding telehealth and telemedicine,” said Dr. Lee, to ensure compliance with state and federal laws. There can be barriers to practicing across state lines; some states require an initial in-person visit, or the signing of a consent form, before initiating telemedicine; others may limit controlled substance prescribing via telemedicine.
And the mode of communication matters, said Dr. Lee: “Why can’t we just use Facetime to call our patients? The first thing to think about is privacy, and unauthorized access to data,” so it’s critical to do your research and use fully HIPAA-compliant communications technology.
Technology – and pricing plans – can vary widely, she added. “There’s some benefit to including technology that integrates with other clinical programs;” the platform Dr. Lee’s group chose communicates with their EHR for such functions as scheduling.
Pricing models can vary; a common scheme charges a per-user monthly fee, though blanket-fee plans also exist. Some telemedicine platforms use a hybrid pricing model that charges a flat fee up to a certain number of users and then adds a per-user fee after that.
Best practices to manage liability include continuing to maintain high standards of compliance after attorney consultation and notifying your practice’s malpractice insurance carrier, said Dr. Lee.
Reimbursement is on the upswing, as insurers see the benefits of telemedicine, and employers see their patients needing less time off work for appointments, and there are fewer emergency department visits for after-hours problems. Medicaid reimbursement is fairly straightforward, but Medicare is more restrictive and requires the beneficiary to be in a rural originating site.
Coding for a telemedicine visit is strictly based on face-to-face time spent in video conference, said Dr. Lee, at levels on par with time-based coding for office visits. “But you’re not including that time you spend doing chart review and not including the time you spend coordinating care.”
Dr. Lee’s own experience with telemedicine began in late 2016, when the 22-physician general gastroenterology group looked into it as a way to increase growth.
During the first half of the next year, the gastroenterology group’s administrative leaders and an engaged physician proponent vetted a number of telemedicine companies, and the group tried the leading candidates’ technologies.
By mid-2017, the comprehensive gastroenterology group, which also employs six advanced-practice clinicians, was piloting video visits with a group of four physicians. “One of those physicians was actually one of my partners who had sustained an Achilles tendon injury, so wasn’t really coming to the office post surgery. He was starting to use this at home, to do video visits, and everything went pretty smoothly with that,” said Dr. Lee.
When this trial was successful, the group went all in, with on-boarding of clinicians accomplished by the end of the year, site visits and 1:1 training provided by the telemedicine platform providers.
The practice is seeing video visits continue to grow in popularity, among both patients and clinicians, said Dr. Lee. She shared some tips and lessons learned from her practice.
There’s currently no formal protocol that selects patients for participation in the telemedicine program at Dr. Lee’s clinic. Providers may offer video visits to patients, and triage nurses also can suggest that patients ask their provider about them; flyers in waiting rooms and exam rooms encourage patients to ask about the possibility.
The practice maintains a telehealth committee that includes the practice’s president and administrator, about three core physicians who are strong telehealth champions, and additional physicians who are high telehealth users. The committee also folds in the office and information technology managers to make sure issues of workflow, billing, and technology are addressed.
Some practical considerations can pose challenges to a successful telemedicine program, said Dr. Lee. Connectivity problems on the patient end are fairly frequent, and no-shows also can be a problem. On the clinic side, not all clinicians have embraced video visits. For these low users, telemedicine may not represent a good value proposition. However, she said, they are seeing more and more clinicians come on board with video visits as word gets out of the generally positive experiences others are having.
Dr. Lee suggested several ways to up telemedicine utilization and make it work within your practice. “Identify which patient would benefit most,” she said – this might be patients with inflammatory bowel disease who mostly need medication management, or patients with limited mobility or who live far away. Staff can also help a patient get a same-day visit by scheduling a video visit with an available clinician. By mentioning video visits as an option for uncomplicated issues or a way to get a rapid read on a new concern, clinicians can get patients thinking about telemedicine as an appealing option.
In some clinics, exam room space can limit clinician productivity, and scheduling a block of video visits when space is tight can be a great solution. Clinicians can optimize their schedules if they incorporate video visits, said Dr. Lee, citing the example of a physician assistant in her practice who stacks video visits in the evening hours, so she’s able to be with her preschool-aged children during the day. After-hours video visits have been popular among patients too, said Dr. Lee, so the scheduling flexibility may help with both patient and provider retention, and be a practice differentiator.
“There’s great potential for value through improved patient satisfaction, provider efficiency, improved health care outcomes, and cost efficiency,” she said.
Dr. Lee reported that she had no relevant disclosures.
AGA has partnered with SupportedPatientTM, a HIPAA-secure telemedicine platform. It allows you to expand your practice and connect your patients with additional specialists. Learn more at https://www.gastro.org/practice-guidance/practice-updates/supportedpatient .
CHICAGO – Is your practice ready for telemedicine – and should you dive in?
Once you and your practice managers work through regulatory, legal, and technical details, said Theresa Lee, MD, a gastroenterologist in private practice in Lone Tree, Colorado, speaking at the 2019 AGA Partners in Value meeting.
The general field of telehealth – in which images might be shared or patients might message their care team for medication refills – is a broad term, said Dr. Lee. She explained that telemedicine is narrowly defined for Medicare and Medicaid reimbursement purposes as “two-way, real-time interactive communication between the patient and the physician or practitioner at [a] distant site ... that includes, at a minimum, audio and video equipment.” This is the video visit that many people think of when they imagine telemedicine, she said.
There’s increasing acceptance of telehealth services, said Dr. Lee, with a recent online poll showing that two-thirds of those surveyed would be willing to use telehealth; this would translate to about 24 million Americans who would be potential telehealth patients. And a 2019 survey of internal medicine physicians showed that more than half are working in practices in which telehealth is used in some capacity. Both patients and clinicians can benefit in a telehealth relationship, said Dr. Lee. The lack of physical travel and the potential for access after normal clinic hours can be a real boon for patients; “So how does this help us? How does it improve practice and make our lives easier?” she asked. Telehealth services can lead to improved efficiency, patient satisfaction and retention, and the ability to stand out in a market, especially if a practice can initiate telehealth services now, during the rapid growth and adoption phase for this newer technology.
“You want to make sure you really understand what some of the legal issues are surrounding telehealth and telemedicine,” said Dr. Lee, to ensure compliance with state and federal laws. There can be barriers to practicing across state lines; some states require an initial in-person visit, or the signing of a consent form, before initiating telemedicine; others may limit controlled substance prescribing via telemedicine.
And the mode of communication matters, said Dr. Lee: “Why can’t we just use Facetime to call our patients? The first thing to think about is privacy, and unauthorized access to data,” so it’s critical to do your research and use fully HIPAA-compliant communications technology.
Technology – and pricing plans – can vary widely, she added. “There’s some benefit to including technology that integrates with other clinical programs;” the platform Dr. Lee’s group chose communicates with their EHR for such functions as scheduling.
Pricing models can vary; a common scheme charges a per-user monthly fee, though blanket-fee plans also exist. Some telemedicine platforms use a hybrid pricing model that charges a flat fee up to a certain number of users and then adds a per-user fee after that.
Best practices to manage liability include continuing to maintain high standards of compliance after attorney consultation and notifying your practice’s malpractice insurance carrier, said Dr. Lee.
Reimbursement is on the upswing, as insurers see the benefits of telemedicine, and employers see their patients needing less time off work for appointments, and there are fewer emergency department visits for after-hours problems. Medicaid reimbursement is fairly straightforward, but Medicare is more restrictive and requires the beneficiary to be in a rural originating site.
Coding for a telemedicine visit is strictly based on face-to-face time spent in video conference, said Dr. Lee, at levels on par with time-based coding for office visits. “But you’re not including that time you spend doing chart review and not including the time you spend coordinating care.”
Dr. Lee’s own experience with telemedicine began in late 2016, when the 22-physician general gastroenterology group looked into it as a way to increase growth.
During the first half of the next year, the gastroenterology group’s administrative leaders and an engaged physician proponent vetted a number of telemedicine companies, and the group tried the leading candidates’ technologies.
By mid-2017, the comprehensive gastroenterology group, which also employs six advanced-practice clinicians, was piloting video visits with a group of four physicians. “One of those physicians was actually one of my partners who had sustained an Achilles tendon injury, so wasn’t really coming to the office post surgery. He was starting to use this at home, to do video visits, and everything went pretty smoothly with that,” said Dr. Lee.
When this trial was successful, the group went all in, with on-boarding of clinicians accomplished by the end of the year, site visits and 1:1 training provided by the telemedicine platform providers.
The practice is seeing video visits continue to grow in popularity, among both patients and clinicians, said Dr. Lee. She shared some tips and lessons learned from her practice.
There’s currently no formal protocol that selects patients for participation in the telemedicine program at Dr. Lee’s clinic. Providers may offer video visits to patients, and triage nurses also can suggest that patients ask their provider about them; flyers in waiting rooms and exam rooms encourage patients to ask about the possibility.
The practice maintains a telehealth committee that includes the practice’s president and administrator, about three core physicians who are strong telehealth champions, and additional physicians who are high telehealth users. The committee also folds in the office and information technology managers to make sure issues of workflow, billing, and technology are addressed.
Some practical considerations can pose challenges to a successful telemedicine program, said Dr. Lee. Connectivity problems on the patient end are fairly frequent, and no-shows also can be a problem. On the clinic side, not all clinicians have embraced video visits. For these low users, telemedicine may not represent a good value proposition. However, she said, they are seeing more and more clinicians come on board with video visits as word gets out of the generally positive experiences others are having.
Dr. Lee suggested several ways to up telemedicine utilization and make it work within your practice. “Identify which patient would benefit most,” she said – this might be patients with inflammatory bowel disease who mostly need medication management, or patients with limited mobility or who live far away. Staff can also help a patient get a same-day visit by scheduling a video visit with an available clinician. By mentioning video visits as an option for uncomplicated issues or a way to get a rapid read on a new concern, clinicians can get patients thinking about telemedicine as an appealing option.
In some clinics, exam room space can limit clinician productivity, and scheduling a block of video visits when space is tight can be a great solution. Clinicians can optimize their schedules if they incorporate video visits, said Dr. Lee, citing the example of a physician assistant in her practice who stacks video visits in the evening hours, so she’s able to be with her preschool-aged children during the day. After-hours video visits have been popular among patients too, said Dr. Lee, so the scheduling flexibility may help with both patient and provider retention, and be a practice differentiator.
“There’s great potential for value through improved patient satisfaction, provider efficiency, improved health care outcomes, and cost efficiency,” she said.
Dr. Lee reported that she had no relevant disclosures.
AGA has partnered with SupportedPatientTM, a HIPAA-secure telemedicine platform. It allows you to expand your practice and connect your patients with additional specialists. Learn more at https://www.gastro.org/practice-guidance/practice-updates/supportedpatient .
CHICAGO – Is your practice ready for telemedicine – and should you dive in?
Once you and your practice managers work through regulatory, legal, and technical details, said Theresa Lee, MD, a gastroenterologist in private practice in Lone Tree, Colorado, speaking at the 2019 AGA Partners in Value meeting.
The general field of telehealth – in which images might be shared or patients might message their care team for medication refills – is a broad term, said Dr. Lee. She explained that telemedicine is narrowly defined for Medicare and Medicaid reimbursement purposes as “two-way, real-time interactive communication between the patient and the physician or practitioner at [a] distant site ... that includes, at a minimum, audio and video equipment.” This is the video visit that many people think of when they imagine telemedicine, she said.
There’s increasing acceptance of telehealth services, said Dr. Lee, with a recent online poll showing that two-thirds of those surveyed would be willing to use telehealth; this would translate to about 24 million Americans who would be potential telehealth patients. And a 2019 survey of internal medicine physicians showed that more than half are working in practices in which telehealth is used in some capacity. Both patients and clinicians can benefit in a telehealth relationship, said Dr. Lee. The lack of physical travel and the potential for access after normal clinic hours can be a real boon for patients; “So how does this help us? How does it improve practice and make our lives easier?” she asked. Telehealth services can lead to improved efficiency, patient satisfaction and retention, and the ability to stand out in a market, especially if a practice can initiate telehealth services now, during the rapid growth and adoption phase for this newer technology.
“You want to make sure you really understand what some of the legal issues are surrounding telehealth and telemedicine,” said Dr. Lee, to ensure compliance with state and federal laws. There can be barriers to practicing across state lines; some states require an initial in-person visit, or the signing of a consent form, before initiating telemedicine; others may limit controlled substance prescribing via telemedicine.
And the mode of communication matters, said Dr. Lee: “Why can’t we just use Facetime to call our patients? The first thing to think about is privacy, and unauthorized access to data,” so it’s critical to do your research and use fully HIPAA-compliant communications technology.
Technology – and pricing plans – can vary widely, she added. “There’s some benefit to including technology that integrates with other clinical programs;” the platform Dr. Lee’s group chose communicates with their EHR for such functions as scheduling.
Pricing models can vary; a common scheme charges a per-user monthly fee, though blanket-fee plans also exist. Some telemedicine platforms use a hybrid pricing model that charges a flat fee up to a certain number of users and then adds a per-user fee after that.
Best practices to manage liability include continuing to maintain high standards of compliance after attorney consultation and notifying your practice’s malpractice insurance carrier, said Dr. Lee.
Reimbursement is on the upswing, as insurers see the benefits of telemedicine, and employers see their patients needing less time off work for appointments, and there are fewer emergency department visits for after-hours problems. Medicaid reimbursement is fairly straightforward, but Medicare is more restrictive and requires the beneficiary to be in a rural originating site.
Coding for a telemedicine visit is strictly based on face-to-face time spent in video conference, said Dr. Lee, at levels on par with time-based coding for office visits. “But you’re not including that time you spend doing chart review and not including the time you spend coordinating care.”
Dr. Lee’s own experience with telemedicine began in late 2016, when the 22-physician general gastroenterology group looked into it as a way to increase growth.
During the first half of the next year, the gastroenterology group’s administrative leaders and an engaged physician proponent vetted a number of telemedicine companies, and the group tried the leading candidates’ technologies.
By mid-2017, the comprehensive gastroenterology group, which also employs six advanced-practice clinicians, was piloting video visits with a group of four physicians. “One of those physicians was actually one of my partners who had sustained an Achilles tendon injury, so wasn’t really coming to the office post surgery. He was starting to use this at home, to do video visits, and everything went pretty smoothly with that,” said Dr. Lee.
When this trial was successful, the group went all in, with on-boarding of clinicians accomplished by the end of the year, site visits and 1:1 training provided by the telemedicine platform providers.
The practice is seeing video visits continue to grow in popularity, among both patients and clinicians, said Dr. Lee. She shared some tips and lessons learned from her practice.
There’s currently no formal protocol that selects patients for participation in the telemedicine program at Dr. Lee’s clinic. Providers may offer video visits to patients, and triage nurses also can suggest that patients ask their provider about them; flyers in waiting rooms and exam rooms encourage patients to ask about the possibility.
The practice maintains a telehealth committee that includes the practice’s president and administrator, about three core physicians who are strong telehealth champions, and additional physicians who are high telehealth users. The committee also folds in the office and information technology managers to make sure issues of workflow, billing, and technology are addressed.
Some practical considerations can pose challenges to a successful telemedicine program, said Dr. Lee. Connectivity problems on the patient end are fairly frequent, and no-shows also can be a problem. On the clinic side, not all clinicians have embraced video visits. For these low users, telemedicine may not represent a good value proposition. However, she said, they are seeing more and more clinicians come on board with video visits as word gets out of the generally positive experiences others are having.
Dr. Lee suggested several ways to up telemedicine utilization and make it work within your practice. “Identify which patient would benefit most,” she said – this might be patients with inflammatory bowel disease who mostly need medication management, or patients with limited mobility or who live far away. Staff can also help a patient get a same-day visit by scheduling a video visit with an available clinician. By mentioning video visits as an option for uncomplicated issues or a way to get a rapid read on a new concern, clinicians can get patients thinking about telemedicine as an appealing option.
In some clinics, exam room space can limit clinician productivity, and scheduling a block of video visits when space is tight can be a great solution. Clinicians can optimize their schedules if they incorporate video visits, said Dr. Lee, citing the example of a physician assistant in her practice who stacks video visits in the evening hours, so she’s able to be with her preschool-aged children during the day. After-hours video visits have been popular among patients too, said Dr. Lee, so the scheduling flexibility may help with both patient and provider retention, and be a practice differentiator.
“There’s great potential for value through improved patient satisfaction, provider efficiency, improved health care outcomes, and cost efficiency,” she said.
Dr. Lee reported that she had no relevant disclosures.
AGA has partnered with SupportedPatientTM, a HIPAA-secure telemedicine platform. It allows you to expand your practice and connect your patients with additional specialists. Learn more at https://www.gastro.org/practice-guidance/practice-updates/supportedpatient .
EXPERT ANALYSIS FROM AGA PARTNERS IN VALUE MEETING
The time is now for physicians to ride the digital disruption wave
CHICAGO – “The health care milieu is ripe for digital disruption,” said Anton Decker, MD. Speaking at the American Gastroenterological Association Partners in Value meeting, which was developed in partnership with the Digestive Health Physicians Association, he said that physicians need to become part of the disruption before it’s too late.
There’s no sign of improvement in worrisome trends in reimbursement, said Dr. Decker, president, international, at the Mayo Clinic, Rochester, Minn. The megamerger trend that is bringing together ever-larger payers, pharmacy benefit managers, and hospital groups is just one manifestation of the trend toward consolidation that’s also seen in the airline industry, in financial services, and in telecommunications, he said.
“The math is not good on the payer and health systems side,” but for physicians, “There are ways to survive trends like this if we can move ourselves higher in the food chain.”
Other players in the health care space are figuring it out, he said. For example, the state of Ohio has five Medicaid plans; in 2018, aggregate profits for these plans were approximately 400 million dollars. Laying this profit figure against the backdrop of Medicare reimbursement rates for physician services makes it clear that “we have to figure out ways to survive this game,” he said.
“Health systems keep their lights on because of the hospital reimbursements – that pays for everything else,” said Dr. Decker, adding that payments from commercial insurers fill the coffers that, in turn, pay physicians who are employed by health systems. However, there’s a sea change underway in the sites in which care is delivered: “There’s enormous pressure to get people out of the hospital and out of the emergency rooms,” said Dr. Decker, “And that’s not always better for patients.”
That shift to delivering care outside of the four walls of the hospital represents an opportunity for digitally savvy companies, many of whom may actually have little experience with health care delivery.
“Digital disruption is a sleeping giant that is easy to ignore, but you do that at your own peril. It’s happening in front of your eyes. My message today is: Figure out how you can move yourself further down the line.”
Chronic diseases, said Dr. Decker, “represent an opportunity for providers and health systems to leverage digital disruption.”
Overall, health care services contribute only to 10% of a patient’s health, said Dr. Decker, and are far overshadowed by individual health behaviors and social determinants of health. Is there a role for physicians to move beyond the clinic and hospital as partners in the digital disruption of health care? Yes, said Dr. Decker: “We’re not part of that aspect of a person’s life, and we need to be. ... I believe that providers have the right to be involved in other aspects of peoples’ lives to make them better, and yes, also to survive financially.”
said Dr. Decker. “Sixty percent of this country has a chronic disease. We as health care providers need to think differently about that.”
Changes are already well underway, with score upon score of startup companies developing apps that utilize smartphones and wearable devices to offer coaching, health education, and remote monitoring to consumers. “The barrier to entry is really low,” said Dr. Decker, with Silicon Valley already partnering with patients and payers to achieve digital monitoring and care delivery. But relatively few of these partnerships have actually involved physicians in building and executing the solutions they offer. “And that’s our fault, for not making sure we are part of this disruption,” he said.
Further, the evidence base for much of this monitoring and intervention is low. “There are some scathing articles on the level of evidence that these apps have – or don’t have,” said Dr. Becker. Physicians who get on board at the early stages of technology development could make a real difference, he said. “We could help them build the real evidence.”
Looping back to the current payer model, Dr. Decker asked, “Which pool of money is this coming from?” From the same pool of money that pays physicians, he said: “It’s coming off our backs.”
This isn’t a time when physicians can afford to wait and see how the digital health care landscape evolves, stressed Dr. Decker, making the subtle but important point that it’s hard to discern when you’re in the middle of disruptive change. Though the curve may appear relatively flat at the moment, he assured attendees that exponential growth in digital health care is already well underway.
Here is where early entry and user adoption are key: “Why do you think Facebook bought WhatsApp?” he asked. Though the messaging app, which has more than a billion users worldwide, is free now, eventual plans to charge WhatsApp users a dollar – or even less – per year will net Facebook staggering sums in the end, he said. Companies like Facebook “have figured out...the strength of exponential growth in a digital world,” he said.
All the building blocks are in place for physicians to begin contributing to health care’s digital disruption, said Dr. Decker. The Centers for Medicare and Medicaid already have reimbursement codes for remote patient monitoring, for example. “Providers are being left out, and I think it’s our own fault.”
Dr. Decker reported that he had no relevant conflicts of interest.
CHICAGO – “The health care milieu is ripe for digital disruption,” said Anton Decker, MD. Speaking at the American Gastroenterological Association Partners in Value meeting, which was developed in partnership with the Digestive Health Physicians Association, he said that physicians need to become part of the disruption before it’s too late.
There’s no sign of improvement in worrisome trends in reimbursement, said Dr. Decker, president, international, at the Mayo Clinic, Rochester, Minn. The megamerger trend that is bringing together ever-larger payers, pharmacy benefit managers, and hospital groups is just one manifestation of the trend toward consolidation that’s also seen in the airline industry, in financial services, and in telecommunications, he said.
“The math is not good on the payer and health systems side,” but for physicians, “There are ways to survive trends like this if we can move ourselves higher in the food chain.”
Other players in the health care space are figuring it out, he said. For example, the state of Ohio has five Medicaid plans; in 2018, aggregate profits for these plans were approximately 400 million dollars. Laying this profit figure against the backdrop of Medicare reimbursement rates for physician services makes it clear that “we have to figure out ways to survive this game,” he said.
“Health systems keep their lights on because of the hospital reimbursements – that pays for everything else,” said Dr. Decker, adding that payments from commercial insurers fill the coffers that, in turn, pay physicians who are employed by health systems. However, there’s a sea change underway in the sites in which care is delivered: “There’s enormous pressure to get people out of the hospital and out of the emergency rooms,” said Dr. Decker, “And that’s not always better for patients.”
That shift to delivering care outside of the four walls of the hospital represents an opportunity for digitally savvy companies, many of whom may actually have little experience with health care delivery.
“Digital disruption is a sleeping giant that is easy to ignore, but you do that at your own peril. It’s happening in front of your eyes. My message today is: Figure out how you can move yourself further down the line.”
Chronic diseases, said Dr. Decker, “represent an opportunity for providers and health systems to leverage digital disruption.”
Overall, health care services contribute only to 10% of a patient’s health, said Dr. Decker, and are far overshadowed by individual health behaviors and social determinants of health. Is there a role for physicians to move beyond the clinic and hospital as partners in the digital disruption of health care? Yes, said Dr. Decker: “We’re not part of that aspect of a person’s life, and we need to be. ... I believe that providers have the right to be involved in other aspects of peoples’ lives to make them better, and yes, also to survive financially.”
said Dr. Decker. “Sixty percent of this country has a chronic disease. We as health care providers need to think differently about that.”
Changes are already well underway, with score upon score of startup companies developing apps that utilize smartphones and wearable devices to offer coaching, health education, and remote monitoring to consumers. “The barrier to entry is really low,” said Dr. Decker, with Silicon Valley already partnering with patients and payers to achieve digital monitoring and care delivery. But relatively few of these partnerships have actually involved physicians in building and executing the solutions they offer. “And that’s our fault, for not making sure we are part of this disruption,” he said.
Further, the evidence base for much of this monitoring and intervention is low. “There are some scathing articles on the level of evidence that these apps have – or don’t have,” said Dr. Becker. Physicians who get on board at the early stages of technology development could make a real difference, he said. “We could help them build the real evidence.”
Looping back to the current payer model, Dr. Decker asked, “Which pool of money is this coming from?” From the same pool of money that pays physicians, he said: “It’s coming off our backs.”
This isn’t a time when physicians can afford to wait and see how the digital health care landscape evolves, stressed Dr. Decker, making the subtle but important point that it’s hard to discern when you’re in the middle of disruptive change. Though the curve may appear relatively flat at the moment, he assured attendees that exponential growth in digital health care is already well underway.
Here is where early entry and user adoption are key: “Why do you think Facebook bought WhatsApp?” he asked. Though the messaging app, which has more than a billion users worldwide, is free now, eventual plans to charge WhatsApp users a dollar – or even less – per year will net Facebook staggering sums in the end, he said. Companies like Facebook “have figured out...the strength of exponential growth in a digital world,” he said.
All the building blocks are in place for physicians to begin contributing to health care’s digital disruption, said Dr. Decker. The Centers for Medicare and Medicaid already have reimbursement codes for remote patient monitoring, for example. “Providers are being left out, and I think it’s our own fault.”
Dr. Decker reported that he had no relevant conflicts of interest.
CHICAGO – “The health care milieu is ripe for digital disruption,” said Anton Decker, MD. Speaking at the American Gastroenterological Association Partners in Value meeting, which was developed in partnership with the Digestive Health Physicians Association, he said that physicians need to become part of the disruption before it’s too late.
There’s no sign of improvement in worrisome trends in reimbursement, said Dr. Decker, president, international, at the Mayo Clinic, Rochester, Minn. The megamerger trend that is bringing together ever-larger payers, pharmacy benefit managers, and hospital groups is just one manifestation of the trend toward consolidation that’s also seen in the airline industry, in financial services, and in telecommunications, he said.
“The math is not good on the payer and health systems side,” but for physicians, “There are ways to survive trends like this if we can move ourselves higher in the food chain.”
Other players in the health care space are figuring it out, he said. For example, the state of Ohio has five Medicaid plans; in 2018, aggregate profits for these plans were approximately 400 million dollars. Laying this profit figure against the backdrop of Medicare reimbursement rates for physician services makes it clear that “we have to figure out ways to survive this game,” he said.
“Health systems keep their lights on because of the hospital reimbursements – that pays for everything else,” said Dr. Decker, adding that payments from commercial insurers fill the coffers that, in turn, pay physicians who are employed by health systems. However, there’s a sea change underway in the sites in which care is delivered: “There’s enormous pressure to get people out of the hospital and out of the emergency rooms,” said Dr. Decker, “And that’s not always better for patients.”
That shift to delivering care outside of the four walls of the hospital represents an opportunity for digitally savvy companies, many of whom may actually have little experience with health care delivery.
“Digital disruption is a sleeping giant that is easy to ignore, but you do that at your own peril. It’s happening in front of your eyes. My message today is: Figure out how you can move yourself further down the line.”
Chronic diseases, said Dr. Decker, “represent an opportunity for providers and health systems to leverage digital disruption.”
Overall, health care services contribute only to 10% of a patient’s health, said Dr. Decker, and are far overshadowed by individual health behaviors and social determinants of health. Is there a role for physicians to move beyond the clinic and hospital as partners in the digital disruption of health care? Yes, said Dr. Decker: “We’re not part of that aspect of a person’s life, and we need to be. ... I believe that providers have the right to be involved in other aspects of peoples’ lives to make them better, and yes, also to survive financially.”
said Dr. Decker. “Sixty percent of this country has a chronic disease. We as health care providers need to think differently about that.”
Changes are already well underway, with score upon score of startup companies developing apps that utilize smartphones and wearable devices to offer coaching, health education, and remote monitoring to consumers. “The barrier to entry is really low,” said Dr. Decker, with Silicon Valley already partnering with patients and payers to achieve digital monitoring and care delivery. But relatively few of these partnerships have actually involved physicians in building and executing the solutions they offer. “And that’s our fault, for not making sure we are part of this disruption,” he said.
Further, the evidence base for much of this monitoring and intervention is low. “There are some scathing articles on the level of evidence that these apps have – or don’t have,” said Dr. Becker. Physicians who get on board at the early stages of technology development could make a real difference, he said. “We could help them build the real evidence.”
Looping back to the current payer model, Dr. Decker asked, “Which pool of money is this coming from?” From the same pool of money that pays physicians, he said: “It’s coming off our backs.”
This isn’t a time when physicians can afford to wait and see how the digital health care landscape evolves, stressed Dr. Decker, making the subtle but important point that it’s hard to discern when you’re in the middle of disruptive change. Though the curve may appear relatively flat at the moment, he assured attendees that exponential growth in digital health care is already well underway.
Here is where early entry and user adoption are key: “Why do you think Facebook bought WhatsApp?” he asked. Though the messaging app, which has more than a billion users worldwide, is free now, eventual plans to charge WhatsApp users a dollar – or even less – per year will net Facebook staggering sums in the end, he said. Companies like Facebook “have figured out...the strength of exponential growth in a digital world,” he said.
All the building blocks are in place for physicians to begin contributing to health care’s digital disruption, said Dr. Decker. The Centers for Medicare and Medicaid already have reimbursement codes for remote patient monitoring, for example. “Providers are being left out, and I think it’s our own fault.”
Dr. Decker reported that he had no relevant conflicts of interest.
EXPERT ANALYSIS FROM AGA PARTNERS IN VALUE MEETING