The power of artificial intelligence in disrupting health care

“Speaking at the Federation of American Hospitals convention in D.C., Health and Human Services (HHS) Secretary Alex Azar laid out a series of actions the administration will take that are aimed at lowering health care costs, and warned that it wouldn’t be deterred by powerful special interests.
“Today is an opportunity to let everyone know that we take these shifts seriously, and they’re going to happen — one way or another,” Azar said. “The administration and this president are not interested in incremental steps. We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests.”
The administration will make it easier for patients to access their health records, encourage health providers to be more transparent about costs of procedures and services and remove regulations that “impede” innovation. HHS will also “experiment” with payment models in Medicare and Medicaid to “drive value and quality,” he said…
“But there is no turning back to an unsustainable system that pays for procedures rather than value,” Azar said. “In fact, the only option is to charge forward — for HHS to take bolder action and for providers and payers to join with us.” (A)

“In his keynote, Webb first noted the importance of taking disparate data sets in healthcare and turning them into actionable insights that can be used to improve patient care or the patient experience. Webb, who also is the author of The Innovation Playbook, The Digital Innovation Playbook and the best-seller What Customers Crave, contended that there are four pillars of disruption in healthcare: consumerization; disruptive innovation; connection architecture; and economic models. “These pillars will impact everything about your business in the next six years. We used to believe that change was a linear curve, and we are [misled] in believing that change is linear. But it’s not; change is explosive,” said Webb, adding that the depth and speed of change could “sink” some healthcare organizations.
To this end, Webb said that his firm recently interviewed some 130 healthcare executives, asking them on a scale of 1 to 10, how important disruption is to their organization. Amazingly, Webb reported, every single person who was interviewed responded that disruption ranked a “10 out of 10” in importance.
But perhaps just as noteworthy, the executives were then asked to explain what disruption meant—and not a single person was able to do so clearly, Webb said. “Disruption is like a unicorn in [the sense] that nothing too weird has happened yet,” he said. Explaining further, Webb attested that breakthrough innovations are certainly occurring right now in healthcare, but he feels that isn’t the same as disruption. “Disruption means destruction. We are destroying clinical models and patient relationships and replacing it with betterness ran by three things: connection architecture, consumerization and disruption,” he said.” (B)

“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.” (C)

“The challenge inherent in building a system that involves healthcare stakeholders—care providers, payers and healthcare consumers—is deciding which areas should be influenced. A unified healthcare ecosystem, however, has but one purpose—to deliver the best, most effective and appropriate care in a cost-effective way to the patient.
Even with today’s many technologies, getting there won’t happen in a day, a month or even a year. It won’t occur by using a single methodology or solitary technology. Interoperability is needed across all healthcare stakeholders to effectively plan, execute and pay for services. The ability to view clinical data internally is deemed extremely important by 70 percent of healthcare executives, and 50 percent of those executives say it’s extremely important to view clinical data externally, according to a new HFMA report. Today, unfortunately, most systems don’t have the ability to talk to one another, which is why it’s so important to support the digital transformation of healthcare.
An effective way to accomplish this imposing task is by converting medical practices to fully digital organizations with the ability to accept and manage financial risk, integrate disparate software systems to improve efficiencies, build value-based care programs and optimize the entire revenue cycle.”…
Making the digital transformation won’t be easy, and most providers will benefit from outside assistance. Organizations that make the successful transitions will be well-positioned after they achieve digital transformation.” (D)

“Organizations need to understand what the umbrella term of AI includes and what to look for in different infrastructure tools that include AI technology. Some tools may contain different AI methods to achieve a certain goal…
IA was created to emulate the human mind and working processes, and can independently solve problems without needing to be programmed to do so. AI can accept new information and learn from it without human intervention.
The computing power behind AI allows it to process information exponentially faster than a human could, fixing problems or drawing conclusions that the human mind would never be able to achieve.
Gartner described AI as applications including autonomous vehicles, automatic speech recognition and generation, and detecting novel concepts and abstractions. Detecting concepts and abstractions is useful for detecting potential new risks and aiding humans to quickly understand very large bodies of ever-changing information.
The potential for AI in healthcare is vast and the technology can be applied from the infrastructure level all the way through treating patients.
“This radical transformation is already underway and is occurring as a response to the increasingly menacing nature of unknown threats and multiplicity of threat agents,”
“Analytics is another example of a patient facing use of AI in healthcare, especially when it comes to using images for diagnostics.
A computer with AI can look at an image of a healthy brain scan and an image of a brain scan with tumors. The device could then recognize the difference between the two images by breaking them down into machine-readable patterns.
The machine can remember and reference these patterns then apply them to future images to determine which patterns indicate that a brain tumor is present.” (E)

“In an environment where consumers are constantly expanding the use of technology in all areas of their lives, healthcare providers are also shifting their services to meet these customer needs. One such way has been virtual care, which has proven effective as a means to expand access and bring greater convenience, while providing quality care and reducing costs.
Virtual care helps increase the efficacy of both in-home and facility-provided management of acute and chronic diseases, promoting efficiency in clinical decision making and treatment recommendations. Technology is not a substitute for excellent clinical care; rather it is a tool which serves to enhance communication and collaboration, ultimately benefiting patients, particularly those in rural and underserved areas.
Virtual care services range from a patient at home interacting with a distant provider for a medical consultation, to the remote monitoring of a patient at home with chronic disease in order to prevent exacerbations, to patients in a hospital or at other facility, who require a specialty clinical consult. Patients can connect via their devices – smartphones, laptops, desktops, etc. – for “on-demand” medical consultation services in areas including urgent care, behavioral and mental health, and other cases with real-time clinical video interaction, often decreasing time and travel for patients.” (F)

“The term innovation loses so much meaning, and one of the meanings that it gets is ‘It’s innovation if it uses products designed by Apple,’” David Asch, MD, executive director at the Penn Medicine Center for Health Care Innovation, said in his keynote address. “Many of us love Apple products because of the design, but I’ve heard too many people say ‘We’re doing innovation because we’re using iPads.’”
Even outside of Apple, the assumption that all innovation needs to be technological is a problematic one.
“I think technology for technology’s sake is a mistake,” Luis Castillo, president and CEO of Ensocare, said on a leadership panel. “If you’re automating a bad process it’s still a bad process.”
Instead, Asch said, innovation needs to be undertaken the way hospitals take on research.
“Innovation is like research,” he said. “It’s hypothesis-driven, it’s falsifiable and it’s highly disciplined.”
One problem that many organizations have innovating is they don’t recognize that step one is to identify the problem.
“Often we are solving for the wrong problem, and if we solved for the right problem we might be in a better position to address our customers’ needs,” Asch said. “Until you identify the problem you fundamentally want to solve, you can innovate in the wrong direction.” (G)

“Regarding recent reports on plans for Amazon, JPMorgan Chase, and Berkshire Hathaway to create a new health care company: Kudos to Jeff Bezos, Jamie Dimon, and Warren Buffett for stepping forward to take on the bloated US health care system.
The challenges are clear: administrative waste, unnecessary treatment, monopoly pricing, inequitable access, and often lousy quality. Less obvious is how to address them.
A good start would be to question widely held assumptions: that current treatments — including drugs — all have been proven safe and effective (safe, maybe; effective, no); that physicians can tell you what’s best for you (they can, but only if they know what is important to you); or that more medical care is always better (it’s not).”
The system is ripe for disruption and new thinking. But it will take a fearless commitment to keeping patients at the center and the profiteers at bay.” (H)

“Organizations with existing innovation centers, and those considering developing them, should consider the following actions which can head off or, at least, reduce the drag on innovation these challenges pose:
– Identify a specific purpose that unifies efforts and engage only in activities which forward it.
– Create forums for project contributors to learn about varying approaches to problem-solving.
– Develop stakeholder co-creation methods and tools which ensure maximum engagement amidst resource constraints.
– Enlist project managers and ensure clear roles and responsibilities for all center employees.
– Set project budgets and scope design projects at the outset to align with funding size and horizons.
– Establish clear initial operational and performance metrics such as percent of innovation concepts expected to be implemented, number of clinicians and patients involved in co-creation processes, types of IP generated, and stage-gated timelines.
– Be prepared to revise metrics as the center evolves and celebrate small wins.” (I)

BIG TECH HAS a lot of problems: fake news, sexual harassment, Russian interference, privacy concerns, and growing fears that too much screen time rots your brain. But even as they struggle to solve these day-to-day problems, the industry’s biggest players are putting more resources into another notoriously hard problem: health care….
Tech companies like Apple are known for creating products that people love. It’s easy to picture the industry creating a better health care experience for patients, and Apple is already hard at work designing new health products and finding new applications for its existing products. It’s researching ways to monitor blood sugar non-invasively and is working with Stanford University to test whether the Apple Watch could screen for irregular heart rhythms. This week, CNBC reported that the company will use new on-campus clinics for employees to test new health products…
The problem is that it’s not enough to just make products that patients love. The products also need to be used by doctors, nurses, and administrators. For example, a company could create a great app for letting patients share their medical data with their doctors. But if the doctor can’t access the data through software approved by her clinic, it won’t help patients. Another problem: if doctors can’t easily track or bill for their time, they may not want to use an innovative app.” (J)

“The odds: Bezos, Buffett and Dimon are big names — big as they come — but the history of health care is littered with business titans who have declared war on health care costs. Amazon, Berkshire Hathaway and JPMorgan Chase may be able to get their own costs down, but that doesn’t mean they can do it for anyone else…
The big picture: Health care costs are not one problem but many: national health care spending, federal health care spending, employer premiums, out-of-pocket costs, and the value of the dollars spent. Each has different constituencies who care about them, requiring different solutions presenting different challenges…
Reducing national health spending is a different goal. What distinguishes the level of GDP we spend on health from other countries is primarily the prices we pay for everything in health care, not the volume or intensity of services we provide. These companies might make a small dent in the prices they pay, but as big as they are, they will not have the leverage to do much beyond that…
What to watch: Perhaps other employers will try to emulate them or buy into whatever they do, but they could be successful and still have almost no impact on national health spending, federal spending, or consumer out of pocket costs.
Nor will they be immune from the forces that have hampered previous efforts. Health coverage is a popular benefit and an important part of any employer’s wage structure; they will go only so far to “disrupt” it…
As intriguing as the recent announcement is, experience suggests keeping it in perspective. (K)

“According to a recent report from Moody’s Investors Services, both for-profit and nonprofit hospitals will face a new threat in the form of greater competition, volume losses and weakened margins as commercial health insurers aggressively continue pursuing growth strategies to reduce cost and increase efficiency.
The ratings agency cites a rise in the acquisition and expansion of outpatient and post-acute services by insurance companies as examples of the increased competition. The result of this trend will be a shifting of patients away from hospital settings and toward lower-cost outpatient settings, reducing hospital volumes and placing future margins at risk.
Moody’s discussed several of the large insurance industry deals announced in recent months, including the plan to merge Aetna (the nation’s third-largest health insurer) and CVS (the biggest drugstore chain). If successful, the new entity will be able to direct members to its own provider sites and shift more care away from hospitals. Further, the new entity would expand on its services. CVS already operates clinics within its retail pharmacies that provide blood drawing and diabetes care.
The report also referenced transactions such as plans by UnitedHealth Group’s Optum to acquire DaVita Medical Group, one of the nation’s largest independent physician groups. Optum has a legitimate presence in six states and owns physician groups in six other states, including New Jersey.
“As Optum and health insurers attempt to move to value-based payment models that emphasize quality over quantity of care, hospitals will see even less volume,” a Moody’s executive stated.
The agency believes that Optum is in a good position to adopt full-risk, value-based contracts since it has many contracts with managed care clients. A physician-centric, full-risk model would give physicians control of the full premium dollar and expenses, instead of hospitals.
“Beyond being vulnerable to losing market share because of potentially being carved out of contract provider networks, hospitals face the risk that insurers will move more quickly to population-based, full-risk contracts.” (L)

“Regarding “The Future of Hospitals” (Journal Report, Feb. 26), hospitals of the future must move health care from the expensive, inefficient and inequitable model we have now to one that truly empowers consumers to manage their own health, wherever they are. We also need to reimagine the roles clinicians will play in the future. While health systems focus on bringing care to patients, instead of patients to care, we must also select and foster doctors to embrace technology, collaborate across disciplines and deliver care with empathy rather than automaticity. Artificial intelligence will provide an opportunity to let the robots be robots. Meanwhile, doctors must be the humans in the room, regardless of where that room is located, or even if it’s virtual.” (M)

“A dentist office for employees in 1919 at the Lord & Taylor store on Fifth Avenue in Manhattan. In the 19th century, many department stores started providing worker benefits that included health clinics, exercise rooms and libraries.
Who knew? But yes, The New York Times reported in 1904 that “small hospital wards are the latest features among the comforts and conveniences of the shops in a big city.”
Long before the announcement in January of a new employee health care partnership among Amazon, Berkshire Hathaway and JPMorgan Chase & Company, America’s department stores, led by John Wanamaker, were introducing an array of free worker welfare benefits — innovations that were sometimes called Industrial Paternalism. Ill or injured patrons were also accommodated.
The initiatives quickly spread to Lord & Taylor, Macy’s, Saks & Company, Bloomingdale’s, B. Altman & Co., Jordan Marsh and other shopping emporiums whose names have passed into mercantile heaven.
The long-forgotten history emerges from articles in newspapers, journals and trade publications and photo archives at the Museum of the City of New York.
Common store services for employees, according to The Times, included pharmacies and emergency rooms to set broken limbs, perform surgery and deliver babies, employee-only lunchrooms, academic and vocational classrooms, sun lounges, vacation camps, libraries, parlors stocked with fine stationery and maid-attended bathrooms with combs and brushes, curling irons, weighing machines and “shoe-blacking damsels.
So Jeff Bezos, Warren Buffett and Jamie Dimon may be onto something with plans for an independent health care company for the U.S. employees of Amazon, Berkshire Hathaway and JPMorgan Chase. Welcome, gentlemen, to the 19th century.” (N)

“Health care is incredibly backward in its use of information and consumer technologies, so it seems ripe for disruption. And, there’s just a lot of damn money in health care,” Levitt said. “There is a potential convergence going on now. Electronic medical records, mobile phones, and wearables have achieved widespread adoption, creating new opportunities.”
It’s way too soon to know where any of this is going. It could be nowhere: Google and Microsoft have talked for years about breaking into health care, with little to show for it so far. Some of these ventures are more theories than concrete plans at this point.
But it’s still worth watching. Because if any industry is in dire need of disruption, it’s American health care.” (C)

(A) Trump’s health chief warns hospital execs about health care costs: ‘Change is coming’, by JESSIE HELLMANN,
(B) Healthcare Innovators Dig Deep on Disruption, Digital Medicine at HIMSS18, by Rajiv Leventhal,
(C) Why Apple, Amazon, and Google are making big health care moves, by Dylan Scott,
(D) HIT Think Why digital transformation is crucial for healthcare providers, by Joel Gleason,
(E) How Artificial Intelligence Can Shape Health IT Infrastructure, by Elizabeth O’Dowd,
(F) Virtual care is transforming our healthcare system one visit at a time, by Anthony R. Tersigni,
(G) Innovation is much more than just using new tech, by Jonah Comstock,
(H) Disrupting health care? Check your assumptions at the door, by Michael A. Cohen,
(I) Putting Humans at the Center of Health Care Innovation, by Yasser Bhatti,Jacqueline del Castillo, Kristian, and OlsonAra Darzi,
(K) Don’t overhype the new health care venture, by Drew Altman,
(L) Moody’s: Insurers’ Disruptive Growth Strategies Pose Threat to Hospitals, NJHA Newslink, March 5, 2018
(M) Prescriptions for the Hospitals of the Future, Stephen K. Klasko,
(N) Attention 1916 Shoppers: The Doctor Is In, by RALPH BLUMENTHAL and SANDRA ROFF,

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