4/16/21 Weekly Update

Summarizing the week that was in the business of healthcare

Apr 17, 2021

Welcome to The Donut Hole’s weekly summary. The news doesn’t stop. Lucky for you, we are here to help you take in the week that was in the business of healthcare.

What's on the horizon for healthcare beyond COVID-19? Cerner, Epic and Meditech executives share their takes

Here’s a good write up on an interesting roundtable discussion with leader of three major EHR companies. The panel included the CEOs of Epic and Meditech and the President of Cerner. In particular, the conversation focused on digital adoption, creating consumer experiences in healthcare delivery, and value-based models and innovation. Below are a few notable quotes.

"We need to think about the digital-physical mix, the relationship between providers and patients and how you meet and exceed expectations of consumers within your market," Trigg [Cerner President] said. "Understanding communication preferences is a critical dimension as far as engagement." He added, "We're going to see more engaged consumers and that's going to take some real art from provider organizations to develop strategies around that."
As health systems look to build out "digital front doors" for patients and expand healthcare services outside the four walls of the hospital, these organizations will look to health IT companies to provide software to help tackle those challenges.
"The problems that provider organizations are asking us to solve are pretty simple. There’s a heavy appetite to look at the EHR and figure out how to drive service-line growth, create efficiencies, make money at Medicare and Medicaid rates, drive care outside the hospital and make provider health networks operate effectively against that strategy," Trigg said.
Faulkner [Epic CEO] also foresees continued efforts to "mesh together" EHR and genomic data to help clinicians gain a better understanding of patients. "There will be more research on that data and then feeding that research back to the clinicians so that evidence-based medicine can go from 10% available to 90% available at the moment the doctor needs it," she said.

Potential impact on you: We’ll have to wait and see how forward-looking these EMR vendors turn out to be. They all benefit from the status quo of data silos and information blocking, but if providers and patients really push perhaps they would release additional interoperability features that go beyond the CMS’ interoperability rules to truly allow patients to bring their medical records anywhere in an immediately usable format. It is likely that EMR vendors keep innovating on the other workstreams the panel discussed, including digital front doors for virtual visits, care coordination and data aggregation across sites of care (including the home), and integration of clinical evidence at the point of care. After all, health systems will pay for these features!

Omada Health Launches Physician-Guided Care Program, the First Virtual Cardiometabolic Clinic

Continued innovation from the emerging digital chronic disease management sector! Omada, which provides high touch programs (connected devices, coaches, and self-management content) for individuals enrolled in diabetes, hypertension, weight loss, MSK, and behavioral health programs, announced the roll out of virtual consultations with physicians for members who need more help controlling their condition. The visits are initially available within the diabetes and hypertension programs but will expand to all covered conditions over time. This is big news as the offering adds medication prescription, medication management, and lab orders and results into the programs, providing the support an enrolled member needs between visits with their primary care physician.

Potential impact on you: While there has been an explosion of digital chronic disease management companies focused on the employer and health plan markets (Livongo / Teladoc, Virta, Hinge, and many, many others), most have positioned themselves as extensions of the patients’ current providers and have stuck to comparatively basic coaching services, behavior change, biomarker monitoring, and self-management capabilities. This announcement from Omada is significant as it signals a major move by a digital care company into the traditional physician’s territory. If successful, it’s not hard to see Omada and others further disintermediate and in some ways replace traditional providers, particularly if legacy providers fail to adopt digital front doors and remote monitoring solutions of their own.

Can independent primary care doctors survive dominance of hospital health systems?

This is an excellent view into the trade-offs of running independent primary care practices vs. working at health system-owned groups. The article goes into a lot of detail but the core of the debate is the increased autonomy independent providers enjoy against the significant back office capabilities (EMR infrastructure, revenue cycle management, insurance network negotiation, regulatory reporting requirements, etc.) provided by health systems. Per the article:

Regulatory and insurance requirements necessitate “an amount of staffing, technical expertise and capital that independent practices just can’t raise by themselves for the most part, or it’s very difficult,” said Kastenbaum, whose organization provides loans and technical assistance to primary care providers.
Financial losses and costs connected to practicing medicine during the COVID-19 pandemic has exacerbated pressures on private practitioners, said Dr. Gary Price, president of the national Physicians Foundation and a Clinton plastic surgeon. “COVID made a bad situation much, much worse,” he said.
Independent practices are also threatened because young physicians don’t want to run businesses. They want to be employees focused on practicing medicine and having a balanced lifestyle, said Victoria Veltri, OHS executive director.

American Medical Association statistics show just 46% of physicians owned their own practices in 2018, down from 75% in 1983.

Potential impact on you: For those of you looking to start or join independent practices, you’ll unfortunately face a tough road. With the focus on value-based care models that require robust care coordination and analytics capabilities, it’s likely more and more care will flow into hospital-owned groups. That said, it still is possible to be a successful independent physician if you can establish the proper infrastructure for the practice. As Dr. Ghumman, a champion of the independent model, notes in the article, “If you have systems in place that are working for you and your patients, you can still do without having to be a part of a large corporate system.”

Canvas Medical raises $17M to rebuild health records for primary care

Here’s some start-up news that ties together many of our recurring themes, including in this issue! Expensive, cumbersome EMRs, frustrating workflows, and poor coordination with payors drive up the costs of practicing medicine and increase provider burnout. One way to go to address these problems is to build an intelligent, intuitive technology layer on top of the EMR, which is the approach taken by Google’s Care Studio (discussed in a previous Donut Hole issue). The other, which is what Canvas is up to, is to rebuild the EMR. Canvas was founded in 2015 and claims its software can reduce the number of clicks by 80% by auto-completing some fields in the medical record and dropping in billing codes automatically as physicians chart. Interestingly, Canvas’ EMR also integrates with payors directly to better enable value-based care payment models and other quality initiatives.

Potential impact on you: Hopefully these two themes - EMR usability and payor / provider alignment - remain focus areas for the vendor community. Both should improve provider workflows and help address burnout while advancing value-based initiatives that improve care quality.

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