“Some of the biggest and most famous brands in America are making big bets on health care. The blue chips of Silicon Valley — Amazon, Apple, Google, Uber — have announced in the past few weeks they’re interested in disrupting an industry that has bedeviled us with rising costs and inefficiencies for decades.
Amazon is setting up a mysterious new partnership with JPMorgan Chase and Warren Buffett. Apple is planning a line of (surely sleek and minimalist) medical clinics. Google’s sibling under the umbrella company Alphabet, Verily, is looking at the Medicaid market. Uber wants to disrupt ambulances.
It is way, way, way too early to start imagining a world where health care is truly owned by Big Tech — you order prescription drugs with your Amazon Prime account, see a nurse at the Apple Clinic, get your benefits statements from Google, and call an Uber instead of an ambulance when you need to go to the hospital.
But something is happening here. The most proven, forward-thinking, and, dare I say, disruptive companies in our country have decided health care should be their next big move. They see a system rife with administrative inefficiencies, opaque prices, and customer dissatisfaction. In other words, a huge opportunity.” (A)
“Out of the gate, the new health care venture from Amazon, Berkshire Hathaway and JPMorgan Chase seems to be headed in the right direction — using new technology to provide their employees better value and health outcomes. That’s where things will start, but this could be a laboratory for a more sweeping transformation.
The big picture: To bring lower costs and better care to their employees and others, these companies will need to do more than deploy a modern technology overlay. They will have to better align payments and outcomes in health care across the board. If they accelerate this process, we will all benefit.
The problems: Our health care system is afraid of new technology, partially because of outdated ideas about how to pay for care that are layered into government programs. Consider the example of Type 1 diabetes — a chronic condition that affects more than 1.2 million Americans.
New technology called continuous glucose monitoring, or CGM, uses a digital sensor to monitor patients’ blood-sugar levels throughout the day, without requiring them to draw blood.
CGM is even more effective when it pairs with analytic algorithms and a smartphone. Patients can share readings with a doctor in real time, or automatically alert loved ones in the case of an emergency. These are precisely the kind of technologies a company like Amazon should know how to leverage.
Because of old and often inflexible rules, Medicare won’t have anything to do with CGM if a smartphone is involved. The government doesn’t want to be in the business of paying for smartphones.” (B)
“All journeys begin with a single step. The journey to value-based care is no different. One foot in front of the other. The steady accumulation of those steps and one finds oneself a thousand miles from the starting point. The same will be the story of artificial intelligence in healthcare.
For AI in healthcare, there is more focus on the high-profile failures than the small successes — the incremental steps. Yet those small wins offer a vibrant story of transformation, re-invention, and improved patient experience.
It is these small wins, in concert with each other that will alter the trajectory of healthcare in the U.S. and beyond. Let’s take a look at the range of some of these wins and consider the collective implications if adopted broadly across a major U.S. system.” (C)
“Alphabet, Microsoft and Apple have filed more than 300 healthcare patents between 2013 and 2017 — revealing the tech giants’ increasing desire to disrupt the healthcare space, according to a new report by Ernst & Young.
Between 2013 and 2017, Google’s parent company Alphabet filed 186 patents, Microsoft filed 73 and Apple filed 54.” (D)
“EY’s analysis of the US health patents filed by major technology players, including Alphabet, Apple and Microsoft, shows the investment technology giants are making in health care (see Figure 1). Alphabet, for instance, has a range of initiatives that span DeepMind and Verily Life Sciences, including joint ventures in diabetes (Onduo), bioelectronics (Galvani Bioelectronics) and smart operating rooms (Verb Surgical). Apple, meanwhile, has filed patents to turn its phones into medical devices capturing biometric data such as blood pressure and body fat levels; it has also partnered with Stanford University to develop algorithms to predict abnormal heart rhythms. Based on its filed patents, Microsoft has focused on expanding its AI capabilities and developing monitoring devices for chronic conditions.” (E)
“Patients and physicians both are ready to engage with one another using digital tools, according to a new Ernst & Young national survey released at HIMSS18 this week.
The survey found 54 percent of consumers said they are comfortable contacting their physician digitally and further expressed interest in using technology such as at-home diagnostic testing (36 percent), using a smartphone or connected device for information sharing (33 percent) and video consultations (21 percent).
There is widespread agreement among physicians that digital technologies and data sharing will contribute effectively to the overall well-being of the population, the survey found. And 83 percent of physicians believe that increased patient-generated data from connected devices would benefit the overall quality of care and enable more personalized care plans.
Further, 66 percent of physicians said that increased use of digital technologies would reduce the burden on the healthcare system and its associated costs, and 64 percent think it would help reduce the burden on doctors and nurses and have a positive impact on the critical issue of burnout, the survey said.
“The health sector today is ripe for disruption, and these findings reinforce the need for organizations to rethink how and where care is delivered to consumers,” said Jacques Mulder, U.S. health leader at Ernst & Young. “Both consumers and physicians are empowered by emerging technology and are hungry for better, more connected experiences. This demand paves the way for nontraditional players to make an impact on the industry, and is another indicator that health in entering an era of convergence.” (F)
“For the better part of a decade, the drive to adopt health information technology was focused on just that, adopting technology. Now, the push seems to be twofold: actually finding value in the billions spent on health IT and, equally as significant, trying to keep pace with consumer demand.
That means an increased focus on telehealth and virtual care; deploying consumer-friendly apps; experimenting with artificial intelligence; and collecting, analyzing and pushing out actionable data. Hospital executives, vendors and others gathered here last week at the Healthcare Information and Management Systems Society’s annual meeting were adamant in their belief that healthcare organizations need to stop nibbling at the edges and pick up the pace of embracing consumerism.
That push, however, has to be balanced with the reality that provider revenue streams are tightening, as well as the fact that payers, employers, consumers and the government are clamoring for more preventive and population health-based care.” (G)
“Interoperability” isn’t a word most people hear every day. But when it comes to the future of patient-centered healthcare in the United States, few technological developments may prove to be more important.
Interoperability is essentially the ability of different computer systems to communicate with each other quickly and effectively. For healthcare specifically, that means being able to share patient data in an instant regardless of what hospital, pharmacy, laboratory, or clinic houses the information—and being able to do so with complete reliability and privacy protection.
The Trump Administration views interoperability as a top priority for the Federal government. This week, White House Senior Adviser Jared Kushner laid out President Donald J. Trump’s plan at HIMSS18, a leading conference focusing on health information and technology transformation.
“Interoperability is about our shared bottom line: saving lives,” Kushner said. “There is overwhelming consensus: America needs better access to patient data and interoperability now.” (H)
“Amazon.com Inc said on Wednesday it was expanding its discounted Prime membership offer to Medicaid members, the U.S. government’s health insurance program for the poor.
The move from the e-commerce giant comes nine months after it said it would offer a discount on its popular Prime subscription service for shoppers who receive U.S. government aid.
To qualify for the discounted $5.99 monthly Prime membership, customers must have a valid Electronic Benefits Transfer or Medicaid card and can renew it annually for up to four years, the company said.
The $12.99-per month or $99-per-year prime service offers users added perks like low prices and faster delivery for certain purchases and shipped over 5 billion items worldwide last year.
Any push by Amazon into poorer demographics comes at a time when traditional brick-and-mortar suppliers like Walmart Inc have been fighting the online shopping giant’s arrival by seeking to attract more high-spending shoppers.
The Medicaid connection may also stir more nerves among healthcare companies worried about tentative moves by Amazon to sell and distribute some medical supplies and drugs. (I)
“The program has earned Amazon praise for “doing well by doing good” but also draws attention to product offerings that will likely come in handy specifically for customers on Medicaid, such as over-the-counter medications and eyewear. Healthcare consultant Lyndean Brick of the Advis Group noted to the Indianapolis Star that the move is also aligned with the company’s larger strategy to expand into the healthcare marketplace. Amazon recently announced a plan to partner with Berkshire Hathaway and JPMorgan Chase to launch their own employee healthcare company.
“They have a strategy to enter into the healthcare market and it’s clearly well thought out, and they are going to enter the industry from all sides simultaneously,” Brick said.” (J)
“If you’re in the pharmacy business, Amazon’s roster of employees is starting to look ominous. In the past 18 months, the e-commerce giant has poached more than 20 employees from industry heavyweights such as CVS Health, Express Scripts, and UnitedHealth Group, according to a STAT review of available LinkedIn data. The new hires include software engineers, data analysts, business strategists, and others with years of experience in the prescription drug and health care” (K)
“Walmart Inc., the largest private employer in the U.S., has been buying health care for its workers directly from providers in six different regions — bypassing insurers who usually negotiate with doctors and hospitals. The retailer is trying to find out if its formidable purchasing power can squeeze out middlemen and drive down costs in the same way that its tough bargaining has brought down prices for shoppers.
“We wanted to see what was more effective — what works, and what doesn’t work,” said Lisa Woods, the company’s senior director of U.S. health care. “If we can’t impact and influence cost or how cost trends are increasing, then we need to change or do something different.”
Companies are the largest providers of health insurance in the U.S., giving more than 150 million people access to coverage. While premiums have soared 55 percent over the past decade, according to the Kaiser Family Foundation, most firms have done little tinkering with their health plans beyond asking employees to pay higher contributions and out-of-pocket costs.” (L)
“Uber launched Uber Health on March 1, a new form of non-emergency medical transportation. The new service allows patients to schedule rides to and from medical appointments hours before or up to 30 days in advance. Providers who order the rides do so through an online dashboard, and patients receive a text message or phone call for information about their trip, making rides accessible to those without smartphones.
Lyft Concierge, which launched in 2016, allows businesses to schedule rides on behalf of individuals, and Lyft has already partnered with health-care providers such as Blue Cross Blue Shield with this platform. On March 5, Lyft announced it is expanding its medical transportation service after partnering with Allscripts, one of the largest electronic health-care service companies.
Uber and Lyft have touted their services as solutions for the 3.6 million people who miss appointments due to a lack of accessible medical transportation. Although their services should be great ways to modernize medical transportation, Uber Health and Lyft Concierge come with concerns.
Unlike Medicaid’s non-emergency transportation program, for which a transportation provider’s staff must receive patient privacy and safety training, neither ridesharing company requires drivers to have any special training for escorting patients to and from their appointments. This poses a serious health risk for passengers who may be dealing with severe, chronic illnesses and, in the event of an emergency, will not have proper assistance.” (M)
“So, then why such a big buzz?…
In other words, whether or not these three companies will deliver true transformation in the future is still TBD, but they are absolutely providing motivation right now. And this is huge.
Why is this outside influence so critical in this industry? The simple truth is that healthcare delivery systems are incredibly complex multibillion dollar operations with tens of thousands of employees. All businesses of this size and scale, both inside and outside of healthcare, have an extremely hard time being nimble and are always at risk for innovation happening on the edge of their business model. So, while group purchasing, employer clinics and transportation are not burning platforms for any executive team in a hospital today, when they see the names Amazon, Apple and Uber playing in those spaces, these areas immediately become board level agenda items and initiatives…
There is a great line from a Tracy Chapman song All That You Have is Your Soul that goes “don’t get tempted by the shiny apple.” While it is easy to be attracted to simple ideas, healthcare is an incredibly complex industry with an overwhelming number of problems that need to be solved. And truly solving these problems is incredibly challenging work.
With that said, for too long it is has been too easy to accept healthcare’s shortcomings. And that is exactly why Amazon, Apple and Uber can be incredibly helpful — not just in producing ideas, but in providing the inspiration for us to truly take action to help heal healthcare, not in the future but right now.
And if they can do that it would truly be an, “OH MY!” (N)
“Health 2.0 looked at five drivers that could advance healthcare; the new interoperability and the increased use in FHIR and SMART system; novel modalities, such as voice assistants and virtual reality; new market entrances like Amazon and JP Morgan; business model disruptions, and new environments for health systems like schools.
But Subaiya said that no one system can solve healthcare a crisis alone. Partnering is key to solving some of the most pressing issues in healthcare, Subaiya said. However, some healthcare providers are still reluctant to embrace the change, citing little resources, difficulty in integration and a lack of domain experience.
Subaiya urged providers to go beyond their walls. She gave the example of the opioid epidemic. The condition isn’t limited to one type of doctor or care. Treating addiction includes mental health services, physician referrals, Pharma regulations, and emergency care.
“These problems are complex, the solution sets are starting to aggregate into small clusters that make sense for a large problem. Now they need the mechanism and the infrastructure with the care delivery system to have true impact,” she said.
For example, in solving the opioid epidemic innovation around the opioid epidemic is clustering into care coordination, digital therapeutics, identifying and monitoring, social determinant side.
“I think you’ll see incredibly powerful platforms that are consolidating units of innovations. We are going to be seeing people putting pieces of innovation together,” said Subaiya.” (O)
“Given that government intervention a la the “Affordable Care Act” failed to drive efficiencies or bend the cost curve in health care, now Amazon, Berkshire Hathaway and JPMorgan will have the opportunity to try their hand at modernizing the health care system.
While time will tell whether (and how) Amazon, et al. can make an impact on the market, their potential entrance thereto is already driving change in the industry as existing market players are having to re-think their strategies related to innovation, efficiency, and transparency in preparation for new competitive entrants.
And, as anyone with experience dealing with the health care system will quickly acknowledge, change to the status quo is sorely needed given that the current byzantine nature of the American health care system has over the course of several decades created barriers to entry for new competitors while also reinforcing perverse incentives among and between various players in the space.
In addition to stock price movements, 2017’s health care merger activity is an indication that change may be apace.
From horizontal mergers of hospitals and insurers to vertical mergers involving players in historically isolated segments of the industry, such as the proposed merger of pharmacy giant CVS Health and insurer Aetna, it appears that the market is positioning to improve integration and efficiency.” (P)
“Eric Schmidt delivered a hearty dose of optimism Monday evening in the HIMSS18 opening keynote.
“A revolution has been happening in my industry. Scale changes the rules, scale changes everything,” said Schmidt, who is the former Executive Chairman of Alphabet and today serves as a Technical Advisor to Google’s parent company. “The combination of cloud, deep neural networks, the explosion of data will give you a model.”..
Schmidt pointed as example to a theoretical technology product he called Dr. Liz — named in honor of the first woman to earn a medical degree, Elizabeth Blackwell — a scenario wherein a voice assistant in patient rooms interacts with consumers, makes evidence-based recommendations to doctors and handles all the administrative burden of working in an EHR.
“Everything I just described is buildable today or in the next few years,” Schmidt added. “All it takes is for all of us to figure out how.”
That’s not to say it will be here tomorrow, but Schmidt laid down a clear path toward just such an innovation akin to email, the Internet or smartphones that will be the proverbial killer app that causes all sorts of interactions and connections.
Here’s what Schmidt said that will take: A clinical data warehouse packed with diverse data sets that are curated and normalized such that sophisticated analytics can be run against the data and accessed with a rich API. Hospitals then need a second tier of data to supplement EHRs…
Reinforcement learning requires those powerful networks. Schmidt described the concept of consisting of a simulator, training data, real-time experience to that looks at forwarding outcomes.
“We believe we can build reinforcement solutions to significantly improve pathways of care,” Schmidt said.” (Q)
“Artificial intelligence is all the rage in Silicon Valley, but it has so far not made much of a dent in health care. That’s largely because the technology just isn’t good enough yet, according to a report in VentureBeat.
The most interesting applications so far have focused on diagnostics — using algorithms to process and distill published medical research at a volume humans simply couldn’t handle, or having them read patient data and look for abnormalities, the report says.
Key quote: “I have no doubt that sophisticated learning and AI algorithms will find a place in health care over the coming years,” data scientist Andy Schuetz tells VentureBeat. “I don’t know if it’s two years or 10 — but it’s coming.”” (R)
“Dan Patterson: Can you forecast the future for us? Some advice and insight on what technologies may be most disruptive, and what technologies may be most helpful in the next 18-36 months?
Ted Smith: I’ll leave you with something controversial that will be memorable. But my money is on the toilet, just to be clear, based on biometrics, considering all that can be done by sampling by what’s going on with someone, believe it or not, we can learn a lot about your health with a smart toilet.
It’s kind of a gross thought, but it’s something we all use multiple times a day. It’s probably the gateway to always knowing about your health.” (S)
““What if we told you we could back up your mind?”
So yeah. Nectome is a preserve-your-brain-and-upload-it company. Its chemical solution can keep a body intact for hundreds of years, maybe thousands, as a statue of frozen glass. The idea is that someday in the future scientists will scan your bricked brain and turn it into a computer simulation. That way, someone a lot like you, though not exactly you, will smell the flowers again in a data server somewhere.
This story has a grisly twist, though. For Nectome’s procedure to work, it’s essential that the brain be fresh. The company says its plan is to connect people with terminal illnesses to a heart-lung machine in order to pump its mix of scientific embalming chemicals into the big carotid arteries in their necks while they are still alive (though under general anesthesia).” (T)
(A) Why Apple, Amazon, and Google are making big health care moves, by Dylan Scott, https://www.vox.com/technology/2018/3/6/17071750/amazon-health-care-apple-google-uber
(B) How Amazon & Co. can revolutionize the health care system, by Dan Mendelson,https://www.axios.com/mendelson-on-amzbhjpmc-health-1517524125-2f8d2447-c121-4f02-a902-5b9d1eb128dc.html
(C) Small wins vs. big losses: AI in healthcare, by JONATHAN MUISE, https://medcitynews.com/2018/03/small-wins-vs-big-losses-ai-healthcare/
(D) Google’s parent Alphabet, Microsoft and Apple have filed 300+ healthcare patents: 5 things to know, by Alia Paavola, https://www.beckershospitalreview.com/healthcare-information-technology/google-s-parent-alphabet-microsoft-and-apple-have-filed-300-healthcare-patents-5-things-to-know.html
(E) When the human body is the biggest data platform, who will capture value, http://www.ey.com/Publication/vwLUAssets/ey-when-the-human-body-is-the-biggest-data-platform-who-will-capture-value/$FILE/ey-when-the-human-body-is-the-biggest-data-platform-who-will-capture-value.pdf
(F) Survey: Patients are comfortable engaging doctors digitally, but not with sharing data, by Bill Siwicki, http://www.healthcareitnews.com/news/survey-patients-are-comfortable-engaging-doctors-digitally-not-sharing-data
(G) Drive to embrace consumerism forcing change in health IT strategies, by Matthew Weinstock and Rachel Z. Arndt, http://www.modernhealthcare.com/article/20180310/NEWS/180319989
(H) The Trump Administration’s Plan to Put You in Charge of Your Health Information, https://www.whitehouse.gov/articles/trump-administrations-plan-put-charge-health-information/
(I) Amazon offers discount Prime membership to Medicaid recipients, by Tamara Mathias, by Sarah Young, https://www.reuters.com/article/us-britain-facebook-far-right/facebook-bans-far-right-group-britain-first-for-inciting-hatred-idUSKCN1GQ1JS
(J) MEMBERSHIP TAKEAWAYS FROM AMAZON’S MEDICAID DISCOUNT, by ERNIE SMITH, https://associationsnow.com/2018/03/membership-takeaways-amazons-medicaid-discount/
(K) Amazon’s pharmacy hires hint of ambitions to upend a $360 billion market, by By CASEY ROSS, https://www.statnews.com/2018/03/09/amazon-pharmacy-hires/
(L) Amazon Isn’t the Only Retail Giant Trying to Remake Health Care, by Zachary Tracer, https://www.bloomberg.com/news/articles/2018-03-08/amazon-isn-t-the-only-retail-giant-trying-to-remake-health-care
(M) Corporations struggle to do what health-care system won’t, http://www.columbiachronicle.com/opinion/article_877679c4-23f2-11e8-ab72-ffbfd0590f7e.html
(N) The No. 1 takeaway from HIMSS 2018: ‘Amazon and Apple and Uber, oh my!’ by Dan Michelson, https://www.beckershospitalreview.com/healthcare-information-technology/the-no-1-takeaway-from-himss-2018-amazon-and-apple-and-uber-oh-my.html
(O) Health 2.0 sees the future of healthcare innovation in collaboration, by Laura Lovett, http://www.mobihealthnews.com/content/health-20-sees-future-healthcare-innovation-collaboration
(P) Amazon’s early impact on health care, by David Bottoms, http://www.mdjonline.com/cobb_business_journal/amazon-s-early-impact-on-health-care/article_06e8141a-1d81-11e8-85c8-5b11d94855e4.html
(Q) Eric Schmidt lays out formula for healthcare innovation, by Tom Sullivan, http://www.healthcareitnews.com/news/eric-schmidt-lays-out-formula-healthcare-innovation
(R) When AI will start to disrupt health care, by Sam Baker, https://www.axios.com/artificial-intelligence-disrupt-health-care-b879abb2-af8c-45c8-a65c-ef5d82471850.html
(S) A smart toilet may be the future of IoT healthcare, by Dan Patterson, https://www.techrepublic.com/article/a-smart-toilet-may-be-the-future-of-iot-healthcare/
(T) A startup is pitching a mind-uploading service that is “100 percent fatal”, by Antonio Regalado, https://www.technologyreview.com/s/610456/a-startup-is-pitching-a-mind-uploading-service-that-is-100-percent-fatal/