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CYBERSECURITY IS TOP ISSUE FOR HOSPITAL IT PROFESSIONALS, CREATING NEW WORKFORCE DYNAMICS
HIMSS survey suggests focus on other IT priorities may lag; influence of security leaders may cause tension.
Cybersecurity, privacy, and security are creating such pressing issues for hospitals, other technology projects may be waylaid and discord among IT leadership could occur if the emerging influence of security professionals is not handled properly, according to the 2019 HIMSS U.S. Leadership and Workforce Survey.
The annual study included feedback from 269 U.S. health information and technology leaders between November 2018‒January 2019. The 30th edition of the survey examines trends and provides insights into the rapidly changing market for healthcare and IT professionals.
Among the key takeaways for hospitals:
- The emergence of information security leaders as the third influential member of hospital IT leadership teams—following CIOs and senior clinical IT leaders—may create tensions for some organizations.
- The top issue for hospital IT leaders is cybersecurity, privacy, and security.
- The focus on security is so predominant, authors of the study suggest that other technological priorities may be put on the back burner.
Information about trends and issues for vendors and non-acute care facilities are also addressed in the full report.
ROLE OF SECURITY LEADERS EXPANDS
The study examines employment trends for specific job titles and, in some cases, compares rates to the prior year. Information security leaders continue to expand their presence in hospitals.
While employment of CIOs and senior clinical IT leaders remains fairly steady; employment of senior information security leaders at hospitals rose by 14% between 2018 and 2019. The study also documents how many hospitals employ professionals for other emerging technology leadership roles, such as chief technology, innovation, and transformation officers, but does not provide comparisons to previous years.
Hospital employment of IT leaders in the following positions for 2019 includes:
- Chief Information Officer 84% (-3% compared to 2018)
- A senior clinical IT leader (CMIO, CNIO, CHIO) 68% (+1% compared to 2018)
- A senior information security leader (CISO) 56% (+14% compared to 2018)
- Chief Technology Officer 36%*
- Chief Innovation Officer 19%*
- Chief Transformation Officer 7%*
- None of the above 9%*
“The emergence of a third leader overseeing a hospital’s information and technology efforts is bound to result in internal tensions as competing interests and overlapping jurisdictions present themselves,” says Lorren Pettit, MS, MBA, vice president at HIMSS in a news release. “These challenges have the potential to stymy a hospital’s progression if hospital leaders are not careful to manage these hurdles effectively.”
The report further elaborates that unless roles and responsibilities are clearly delineated, the influence of security professionals could impede a hospital’s progression on information and technology priorities as leaders “work through internal territorial challenges.”
INFORMATION TECHNOLOGY PRIORITIES
The survey gauges interest from IT professionals about 24 topics. While cybersecurity outranked all other responses, “improving quality outcomes” and “clinical informatics and clinician engagement” also was highly rated for hospital respondents. Telehealth ranked ninth; innovation took the twenty-first spot.
Survey participants ranked these topics on a scale of one (not a priority) to seven (essential priority). Following are the ranking and mean scores for hospital respondents:
- Cybersecurity, Privacy, and Security 5.81
- Improving Quality Outcomes Through Health Information and Technology 5.28
- Clinical Informatics and Clinician Engagement 5.24
- Process Improvement, Workflow, Change Management 5.03
- Culture of Care and Care Coordination 4.92
- Data Science/Analytics/Clinical and Business Intelligence 4.91
- Leadership, Governance, Strategic Planning 4.90
- User Experience, Usability and User-Centered Design 4.86
- Telehealth 4.82
- Consumer/Patient Engagement & Digital/Connected Health 4.80
- Population Health Management and Public Health 4.77
- Safe Info and Tech Practices for Patient Care 4.62
- HIE, Interoperability, Data Integration and Standards 4.62
- Public Policy, Reporting, and Risk Management 4.31
- Healthcare App and Tech Enabling Care Delivery 4.20
- Social, Psychosocial & Behavioral Determinants of Health 4.06
- Consumerization of Health 3.75
- Clinically Integrated Supply Chain 3.66
- Healthy Aging and Technology 3.60
- Health Informatics Education, Career Development & Diversity 3.53
- Innovation, Entrepreneurship and Venture Investment 3.47
- Precision Medicine/Genomics 3.47
- Disruptive Care Models 3.39
- Grand Societal Challenges 2.88
SECURITY NEEDS MAY SLOW DOWN FOCUS ON OTHER IT PRIORITIES
Study authors characterized the prioritization of cybersecurity, privacy, and security by providers as “remarkably higher” than the next highest priority. The focus is so predominant, the authors suggest that other technological priories may be put on the back burner.
“Of the array of priorities presented respondents, ‘cybersecurity, privacy, and security’ was one of the only ‘defensive’ business tactics respondents were asked to consider,” states the report. “That providers (especially hospital respondents) responded so passionately to this priority suggests a growing number of provider organizations realize the need to protect existing business practices before aggressively pursuing other information and technology issues. If true, then there are potential downstream implications for the market as other information and technology priorities considered in this study may be put on hold or ‘slow walked’ until the security concerns of organizations are settled.”
In addition to this survey, HIMSS also released a related report last week, the 2019 HIMSS Cybersecurity Survey, which sheds additional light on some of these issues. Among the highlights:
- A pattern of cybersecurity threats and experiences is discernable across U.S. healthcare organizations. Significant security incidents are a near universal experience with many of the initiated by bad actors, leveraging e-mail as a means to compromise the integrity of their targets.
- Many positive advances are occurring in healthcare cybersecurity practices and healthcare organizations appear to be allocating more of their IT budgets to cybersecurity.
- Complacency with cybersecurity practices can put cybersecurity programs at risk.
- Notable cybersecurity gaps exist in key areas of the healthcare ecosystem. The lack of phishing tests in certain organizations and the pervasiveness provides insight into what healthcare organizations are doing to protect their information and assets, in light of increasing cyber-attacks and compromises impacting the healthcare and public health sector.
ANA CRITICIZES ‘CRIMINALIZATION OF MEDICAL ERRORS’ AS VANDERBILT NURSE ARRAIGNED
The statement expresses support for handling medical errors with ‘a full and confidential peer review process.’
KEY TAKEAWAYS
The fatal error was made in December 2017, but it didn’t become public until November 2018, with a CMS report.
Vanderbilt was threatened with a loss of its Medicare status over the incident.
The nurse was indicted this month and scheduled for an arraignment Wednesday.
As a former nurse for Vanderbilt University Medical Center in Nashville, Tennessee, was scheduled to appear in court Wednesday morning for an arraignment on felony charges of reckless homicide and impaired adult abuse, the American Nurses Association raised concerns about the precedent the case could set.
Radonda Vaught administered a fatal dose of the wrong medication to a 75-year-old woman in late 2017, after overriding system safeguards, as The Tennessean’s Brett Kelman reported, citing an investigation report by the Centers for Medicare & Medicaid Services. That incident, which VUMC reportedly failed to convey to the medical examiner, prompted CMS to threaten VUMC’s Medicare status last November.
Vaught was indicted earlier this month, prompting the ANA to voice some concerns.
“Health care is highly complex and ever-changing resulting in a high risk and error-prone system,” the ANA said in a statement Tuesday. “However, the criminalization of medical errors could have a chilling effect on reporting and process improvement.”
Related: How DeKalb Medical Fixed Drug Safety Problems After Fatal Error
The statement, which specifically mentions Vaught’s case, expresses support for handling medical errors with “a full and confidential peer review process.”
The ANA also offered its condolences to the those who have suffered as a result of this error.
“This tragic incident should serve as reminder to all nurses, other health care professionals, and administrators that we must be constantly vigilant at the patient and system level,” the ANA added.
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New nurses work overtime, long shifts, and sometimes a second job, research shows
Overtime in particular has been negatively associated with patient care, and a good proportion of nurses are required to work extra hours.
New nurses are predominantly working 12-hour shifts and nearly half work overtime, trends that have remained relatively stable over the past decade, finds a new study by researchers at NYU Rory Meyers College of Nursing. And 13 percent hold a second job.
Changes in health policy in recent years — from the passage of the Affordable Care Act and increased access to healthcare, to the recession — which delayed some nurses’ retirements — have had implications for nurses and the hours they work, while overtime has been linked to patient safety and nurse well-being.
IMPACT
The research team analyzed surveys from more than 4,500 newly licensed nurses in 13 states and Washington D.C., collecting information on nurse demographics, education, work attributes and attitudes. Specifically, nurses were asked about their work schedule, daily shift length, weekly work hours, overtime, and whether they worked a second job.
In addition to the 12-hour shifts and second jobs, it was found that new nurses prefer working the day shift and 12 hours is the preferred shift length.
Twelve percent of nurses report working mandatory overtime (an average of less than an hour in a typical week), and nearly half, 45.6 percent, work voluntary overtime (an average of three hours in a typical week).
There were nuanced changes in overtime hours during the decade studied: There was a decline in both mandatory and voluntary overtime during the economic recession by about an hour per week, but overtime hours rose in the most recent cohort.
There’s good news and bad news in the results. The good news is that new nurses seem to be working a similar proportion of 12-hour shifts as more experienced nurses, and most are working the shift and schedule they prefer. There also weren’t statistically significant increases in weekly work hours or overtime hours.
But the findings on overtime were troubling given that previous research has established associations between working overtime and patient outcomes (such as medication errors), occupational injury among nurses, and factors like burnout and job dissatisfaction.
While voluntarily working overtime can be a welcome source of income for some nurses, mandatory overtime — which is restricted by law in 18 states — was found to be a practice norm, occurring for 12 percent of new nurses.
THE TREND
Nurses operate within a highly competitive job market, and as is the case in other high-stress fields, there’s a fatigue starting to set in. Burnout is a very real danger, and much like physicians, nurses are prone to leaving when they’ve finally had enough — and that turnover can have detrimental effects on everything from a hospital’s financial strength to the quality of patient care.
UPMC fires back at state AG, seeks to join BCBS antitrust lawsuit
University of Pittsburgh Medical Center filed a counter lawsuit on Thursday against the Pennsylvania attorney general, who is seeking to force the healthcare giant into contracting with rival Highmark. The system is also seeking to insert itself in a broader lawsuit over the ways Blues operate.
The flurry of filings taps into big questions over payer competition and underscores tensions seen throughout the country between insurance companies and providers as they negotiate contracts, particularly in highly concentrated markets. States have stepped up their enforcement of consumer protections against rising healthcare costs — but UPMC is saying its regulators have greatly overstepped their bounds.
Earlier this month, Shapiro alleged Pittsburgh’s dominant medical provider wasn’t living up to its charitable mission as a nonprofit, accusing the health system of “forsaking its charitable obligations” in exchange for “corporate greed.”
The legal duel stems from a contract dispute between UPMC and its rival Highmark. Until June 30, the two have a legal agreement protecting consumer access to the other’s network through a consent decree. UPMC refuses to modify the decree and contract with Highmark, which risks in-network access to UPMC hospitals for Highmark members.
In response to the attorney general’s initial complaint, UPMC alleges that Shapiro’s attempt to renew and modify an expiring agreement between the Pittsburgh health system and Highmark is “unprecedented and unwarranted.” The modification would, among other things, remove the majority of UPMC’s board of directors and force the integrated system to contract with any payer.
The state AG responded on Friday, accusing UPMC of ignoring its mission and noting it would not be intimated by the healthcare behemoth.
“With their filings today, UPMC has shown they intend to spend countless hours and untold resources on a legal battle instead of focusing on their stated mission as a non-profit charity — promoting the public interest and providing patient access to affordable health care,” said Attorney General’s Office spokesman Joe Grace.
In its notice to the AG, UPMC lays out five examples it calls frivolous enough to get Shapiro’s motion dismissed — including previous testimony delivered by Deputy Attorney General Jim Donahue in 2014, when he told state representatives there is “no statutory basis” to make the two companies contract with each other without setting a dangerous economic precedent.
“If we force the resolution in this case, we really could not avoid trying to force a similar resolution in all those other situations, and that is simply and unworkable method of dealing with these problems,” Donahue said at the time. “We’d be putting our finger on the scale, so to speak … and we’re not sure what those effects would be.”
One effect is a class action lawsuit, which UPMC filed separately Thursday. It alleges Shapiro has violated at least four federal laws: Medicare Advantage statutes protecting competition, the Affordable Care Act’s nonprofit payer regulations and the Sherman Act and the Employee Retirement Income Security Act of 1974.
“Purporting to act in his official capacity, General Shapiro has illegally taken over nonprofit healthcare in the Commonwealth of Pennsylvania,” UPMC’s class action states. “Without rulemaking, legislation or public comment, General Shapiro has announced new ‘principles’ that radically (and often in direct contravention of existing federal and state law) change how nonprofit health insurers and providers operate, now rendering the Attorney General the arbiter of how nonprofit health organizations should envision and achieve their mission.”
UPMC says Blues system bad for business
Separate from its battle with the state attorney general, UPMC is attempting to jump in the middle of a legal antitrust battle over how Blue Cross Blue Shield plans operate. UPMC is seeking both a preliminary injunction and a motion to intervene in the years-long federal case in Alabama.
UPMC is asking the Alabama court to stop the Blues plans from enforcing their own market allocation agreements that prevent UPMC from contracting with other Blues plans, according to the filing. UPMC says a significant chunk of its patients have a Blue Cross Blue Shield plan from a different provider other than Highmark.
Joe Whatley, co-lead counsel for provider plaintiffs in the Alabama case, told Healthcare Dive UPMC “presents a good example of how the Blues are abusing their illegal agreement for their benefit and to harm healthcare providers throughout the country.”
UPMC argues that it would contract with other Blue Cross Blue Shield plans, separate from Highmark, but cannot due to the way Blues operate — or limit how they compete with one another. BCBS plans tend to stake out their own geographic areas and avoid competition with one another, a practice the Alabama court has already found is in violation of antitrust laws. A BCBS appeal to the Alabama judge’s opinion was already struck down by the 11th U.S. Circuit Court of Appeals late last year.
UPMC is asking the Alabama court for an injunction, or to step in and stop the Blues plans from enforcing or complying with their own market allocation agreements that are preventing UPMC from contracting with other Blues plans, according to the filing. And because the hometown plan, Highmark, does not have a contract with UPMC after June 30, it means that other Blues plan members that have enjoyed in-network access to UPMC will soon lose access after the consent decree expires.
About 24% of UPMC’s hospital patients have a Blue Cross Blue Shield plan other than Highmark.
UPMC contends that it has tried to contract with other Blues but was turned down. “The average non-Highmark Blues patient does not know that UPMC has offered contracts to each of these plans and been turned down because the Blues’ illegal market allocation prevents them entering into such an agreement with UPMC,” according to the filing.
Without an injunction, UPMC alleges it will suffer irreparable harm to its reputation and will lose a significant number of patients who have a non-Highmark Blues plans.
The Pennsylvania attorney general’s office has not responded to Healthcare Dive’s request for comment and UPMC declined to discuss the case further.
Coping with Serious Illness in America
http://features.commonwealthfund.org/coping-with-serious-illness-in-america
Relying on Family and Friends
Focus groups and in-depth interviews conducted by the Commonwealth Fund since 2016 revealed that while taking care of a seriously ill family member or friend can bring meaning and satisfaction to caregivers, it also can become a complex and serious responsibility that burdens them.
Below we describe the many functions caregivers — defined as family and friends who provide care to the seriously ill — serve, as well as the financial, physical, and emotional challenges they face. We offer policy solutions, such as financial protections, employment flexibility, and training to prepare an “invisible workforce” for this deeply meaningful but sometimes overwhelming role.
Any one of us could find ourselves in the role of caregiver if we haven’t already. And our country and economy are likely to benefit when we help ensure caregivers are able to maintain their mental and physical health and stay in the workforce.
Learn more about the Health Care in America: The Experience of People with Serious Illness survey, including methodology and additional findings.
Many Caregivers Say They “Do Everything” for a Family Member or Friend with Serious Illness
Approximately 40 million Americans provide 37 billion hours of care and help each year to family members and friends. Most of the people with serious illness we surveyed (86%) reported that in recent years family and friends helped them deal with their medical or health condition at home.
Illness can make the simple activities of daily living, like cooking, cleaning, and bathing, nearly impossible, especially without assistance. Caregivers reported that helping with these routine tasks can become a huge commitment, and that the demand for care can escalate unexpectedly. “It started out as doing his laundry, getting groceries, but [my uncle’s] problems continued to get worse,” one caregiver explained. “There was really no other family in the area and now basically I do everything for him. I take him to his appointments. I cook his meals. When I leave him it almost feels like I’m leaving a child alone. It’s very scary.”
Even when a nurse or aide provides in-home help to the sick family member or friend, caregivers still need to organize the logistics of care, from scheduling doctors’ visits to taking time off work to provide transportation to the appointments and participate in the visits. Among people with serious illness we surveyed, more than half (55%) reported bringing a family member or friend to every medical appointment they had in recent years.
Our survey respondents also reported that they often relied on their family or friends who were health professionals (34%) for health care advice. These caregivers take on a number of important responsibilities for family members and friends with serious illness, such as helping to find qualified doctors, talking directly to the supervising clinician, and arranging appointments.
The Benefits and Tolls of Caregiving
People who care for a seriously ill family member or friend can benefit psychologically, emotionally, and socially from the experience. Previous studies have found caregiving increases self-confidence, makes caregivers feel closer to their ill family member or friend, and gives them the peace of mind that their family member or friend is well cared for. A daughter who cared for her mother with cancer described the fulfillment it brought her: “It meant a lot that I was able to be there for the person that was always there for me — who raised me and sacrificed for me.”
Despite the fulfillment caregiving can bring, it also can be incredibly burdensome and disruptive. The seriously ill adults we surveyed worry about the challenges their caregivers face. One seriously ill adult we spoke with said the following about her children: “Not only for my sake, but for the sake of my kids and my grandkids, I hope they are able to enjoy their later years and not worry about having to take care of me. I know they’d be glad to do it, but it has an impact on their lives, both short and long term.”
One-third (36%) of the seriously ill we surveyed reported that caregiving created problems for their family member or friend. These include emotional, physical, and financial strains.
Emotional strain
About one in three (31%) seriously ill adults in our survey reported their caregivers experienced emotional stress from caring for them. This is consistent with other studies that find caregivers experience significantly more stress than noncaregivers and have mental health issues like depression at twice the national rate. Caregivers who lack support from friends and family themselves are particularly affected by mental health issues and emotional strain.
Physical health issues
A quarter (25%) of the seriously ill adults we surveyed reported that their family or friend caregiver experienced physical strain from having to bathe, dress, and even lift them, to name a few issues. Other studies have shown just how powerful the physical toll of caregiving can be. Caregivers, compared to noncaregivers, are twice as likely to report chronic conditions like heart disease or diabetes, are more likely to view their health as fair or poor, and are even more likely to die. These physical consequences seem to be in part because of caregivers having limited time and resources to spend on their own health. They also may engage in unhealthy behaviors like drinking, eating poorly, and postponing their own doctors’ visits.
Financial problems
Nearly one in four (23%) seriously ill adults reported their caregiver experienced financial problems because of caregiving. Moreover, more than half (57%) of the seriously ill adults we surveyed said the costs of their medical care were a direct burden to their family. As seriously ill adults themselves face financial strain because of their condition, family members and friends may be left to pick up unpaid medical bills. Beyond paying directly for medical care, a study by AARP found that family caregivers spend on average close to $7,000 a year taking care of their family member, or about 20 percent of their annual income.
Employment disruption
Compounding the financial burden, caregiving can get in the way of work; 15 percent of the seriously ill we surveyed said their caregivers lost or had to change jobs because of their caregiving responsibilities. A recent study found that nearly half of working caregivers said caregiving interfered with their job, and another 40 percent of those who were not working at the time of the study had quit their jobs or retired early because of caregiving. As one caregiver from our focus groups said, “My mother with Alzheimer’s lives with me. I manage all her affairs. I pretty much shut my life down to stop working and take care of her.” This need to drop out of the workforce is particularly concerning because the primary protection for working caregivers, the federal Family and Medical Leave Act (FMLA), offers only three months of unpaid leave. Moreover, it means the U.S. has fewer productive workers than it would if services were in place to support caregivers.
Support for “The Invisible Workforce”
There are several ways in which we as a nation could support this “invisible workforce” of caregivers — a group unseen, yet critical to the provision of care.
- Education, training, and mental health support.Education and training on effective caregiving could help to improve both caregiver and patient outcomes. A recent study found that reviewing how to take care of their family member or friend before discharge from an inpatient hospital stay lowered the cost of postdischarge care and reduced readmissions. In addition, mental health support from behavioral health providers and others could offset the emotional and physical challenges caregivers experience. For example, a managed care plan in New Jersey, Amerigroup, hosts caregiver events where they provide educational workshops on illnesses and offer relaxation exercises to help caregivers cope.
- Redesign health care for the seriously ill to make it less burdensome for patients and caregivers. Expanding the availability and affordability of respite care — which gives caregivers a temporary break — along with home care services, transportation, and care coordinators, would mean less responsibility for family and friends. AmeriHealth Caritas, for example, covers additional respite care beyond the state minimum to improve quality of life for enrollees and tackle caregiver burnout.
- Financial support. Policies requiring paid leave for those working and taking care of sick family could protect them from some financial consequences and help keep them in the workforce longer term. In addition, federal and state policymakers could offer tax benefits, provide direct compensation, or allow family and friend caregivers to claim Social Security benefits for the time they spend caring for the seriously ill to offset financial costs. Lastly, payers can directly compensate caregivers for their time. For example, Medicaid long-term-care plans offer payment to caregivers for direct care, but the specific benefits and criteria vary from state to state. Paying informal caregivers could even save the health care system money long term by preventing more costly care later on.
Caregiving in America is not easy for the friends and family who provide this undervalued, unpaid, and even unrecognized service for both the person with serious illness and our society. To keep family and friend caregivers healthy and in the workforce, health systems, payers, and policymakers could expand training, increase insurance coverage for home-based services, and implement policies to financially protect caregivers.
Analysis Shows One-in-Five U.S. Rural Hospitals at High Risk of Closing Unless Financial Situation Improves
https://www.navigant.com/news/corporate-news/2019/rural-hospitals-analysis
Twenty-one percent of U.S. rural hospitals are at high risk of closing unless their finances improve, according to an analysis from management consultancy firm Navigant.
The study also found 64 percent, or 277, of high financial risk rural hospitals are considered essential to their communities.
The analysis — which examined the financial viability (operating margin, days cash on hand and debt-to-capitalization ratio) and community essentiality of more than 2,000 of the nation’s rural hospitals — suggests 21 percent or 430 rural hospitals in 43 states are at high risk of closing. These hospitals represent 21,547 staffed beds, 707,000 annual discharges, 150,000 employees and $21.2 billion total patient revenue, according to Navigant.
Of the 43 states, 34 have five or more rural hospitals at risk.
Navigant cited payer mix degradation; declining inpatient care driving excess capacity; and inability to leverage innovation as factors putting the hospitals at risk. Medicare payment reductions, the age of many rural facilities and a lack of capital to invest in updated, innovative technology were specifically cited.
“While the potential for a rural hospital crisis has been known for years, this predictive data sheds light on just how dire the situation could become,” the study authors concluded. “Now, by being able to accurately assess the economic health of all rural hospitals in America, there is no choice but to pay attention. Local, state and federal political leaders, as well as hospital administrators, must act to protect the well-being of rural hospitals nationwide and the communities they serve.”
Read more about the analysis here.
The Biggest Growth Opportunities in Healthcare
Healthcare growth opportunities for 2019 should pivot around the three big themes: digital transformation, value-based care, and patient-centricity, according to a new report.
According to Frost & Sullivan’s report, “Global Healthcare Market Outlook, 2019,” digitization of products, services, and commerce models are democratizing current healthcare systems, manifesting a new era of healthcare consumerism.
“Now the new vision for healthcare is not just about access, quality, and affordability but also about predictive, preventive, and outcomes-based care models promoting social and financial inclusion,” says Kamaljit Behera, transformational health industry analyst at Frost & Sullivan, and author of the report. “This makes digital transformation and realization of long-pending policies reform a key growth priority for healthcare executives and major health systems during 2019 globally.”
According to Behera, increasing pricing pressure and shifting the focus of the healthcare industry from a volume- to value-based care model demands that drug and device manufacturers elevate their business models beyond products to customer-centric intelligent platforms and solutions.
“In 2019, the healthcare market will continue to transit and stick into the value-based model,” Behera says. “More sophisticated outcomes-based models will get deployed in developed markets, and emerging nations will start following the best practices suited to their local needs.”
Despite the promise of digital transformation, the potential promise and actual commercial application still remain the poles apart from some of the most touted technologies like AI and blockchain, according to Behera.
“Current technology is often perceived to increase the barriers between patient and providers,” he says. “In order to bridge these gaps, healthcare executives need to change the debate around digital transformation and start look beyond the mirage of technology novelty and really focus on the outcomes.”
Behera predicts that these five areas will be the biggest areas of growth for healthcare in 2019:
1. Meaningful small data
Healthcare data analytics focus will shift from ‘big data’ to ‘meaningful small data’ by hospital specialty, according to Behera. “Increasing digitization of healthcare workflows is leading us to a data explosion along the care cycle, globally,” he says. “This makes insights generation from existing healthcare data for targeted use cases a relatively low-hanging opportunity relative to other emerging technologies. Additionally, health data being the ‘holy grail,’ the analytics solutions are considered the first foundational step to catalyze complementing technology promises leveraging healthcare data (e.g., artificial intelligence, cloud computing, and blockchain).”
Entailing this, Frost & Sullivan research projects the healthcare analytics market revenue to cross $7.4 billion in the United States by the end of 2020.
“The key pivotal theme driving this growth opportunity includes population health management, financial performance improvement, and operational automation by patients, payers, physicians, and procedures,” Behera says. “Also, the rise of value-based care and outcomes-based reimbursement programs will continue to boost the demand for specialized analytics solutions.”
In 2019, payers and providers will continue to prioritize and leverage the potential of specialty-specific analytics solutions to investigate drug utilization, treatment variability, clinical trial eligibility, billing discrepancy, and self-care program attribution specific to major chronic conditions, according to Beherea.
2. Digital health coming of age with increased focus on individual care
“During 2019, we project application of digital health will continue to go far beyond the traditional systems and empower individuals to be able to manage their own health,” Behera says.
Favorable reimbursement policies (e.g., toward clinically relevant digital health applications) will expand care delivery models beyond physical medicine to include behavioral health, digital wellness therapies, dentistry, nutrition, and prescription management, according to Behera.
“For example, major insurance bodies are already using digital health services to communicate with patients,” he says. “Traditionally, lack of formal reimbursement processes is actually a deterrent to the uptake of these—wearables, telehealth etc. The next 12 months will see a relaxation of reimbursement rules for digital health solutions.”
The global aging population and an expanding middle class are major contributors to the chronic disease epidemic and surging healthcare costs, Behera says. “This year will be a pivotal year for defining value for healthcare innovation and technology for digital health solutions catering to aged care and chronic conditions management to bending healthcare cost curve,” he says.
“Telemedicine in emerging markets will become more mainstream and will aim to become a managed services provider [rather] than being just a telemedicine platform,” he says. “Telemedicine will move into the public health space as well, with countries like Singapore is testing the platforms in a regulatory sandbox. Finally, as the lines between retail, IT, and healthcare continue to blur, non-traditional players such as Amazon, Apple, Google, Ali Health, Microsoft, and IBM, among others, will continue to make further headway into the individual care space— providing the required impetus to public health systems to ensure accessibility and affordability of care-leveraging, patient-centric digital health tools and solutions.”
Healthcare executives should prioritize their roadmap for growing IoMT and connected health ecosystems (device-, wearables-, and mHealth-generated individual health data) in order to monetize these new sources of innovation and service-oriented future revenue streams, according to Behera. “The future focus should shift from drug and device mind-set to intelligent solutions/services, demonstrating outcomes-based health benefits to individuals and their caregivers,” he says.
3. AI
In next 12 to 18 months, the priority will be to bring AI/cognitive platform technology use cases closer to clinical care to augment the physicians and even patients with actionable decision-making ability, according to Behera. “In next two to three years, AI will become a common theme across all digital initiative and platforms.”
AI-based work flow optimization use cases will represent more than 80% of the workflow market contribution. These include:
- The elimination of unnecessary procedures and costs
- In-patient care and hospital management
- Patient data and risk analytics
- Claim processing
- Optimizing the drug discovery process
“For example, Google is already at work to use machine learning for predicting patients’ deaths, and the results boast a flattering figure of 95% accuracy, which is better than hospitals’ in-house warning systems,” says Behera. “AI application across clinical and non-clinical use cases will continue to show hard results and further bolster the growth in the healthcare space in 2019.”
AI-powered IT tools that manage payers’ and providers’ business risks (including clinical, operational, financial, and regulatory) continue to be important for the market, according to Behera. “Across all regions in the world, AI-based cognitive technologies are proving to be the most useful for medical imaging and clinical diagnostics—as a decision-support tool—followed by AI application to derive intelligence on remote patient monitoring data to promote outcomes-based personalized care.”
4. Regenerative medicine
Cell-gene therapy combinations are rapidly gaining momentum, which make use of gene-editing tools and vector delivery systems to devise innovative curative therapies, according to Behera.
“There is also a pipeline of induced pluripotent stem cells (IPSCs), mesenchymal stem cells (MSCs), and adipose-derived stem cells (ADSCs) for novel therapeutic treatments for neurological, musculoskeletal, and dermatological conditions, among others,” he says.
These are poised for growth because rising pressures to decrease healthcare cost globally, the emergence of value-based reimbursement models, and healthcare digitization trends are transitioning the treatment model from “one-size-fits-all” to stratified and outcomes-based targeted therapies, according to Behera.
“Many factors determine the rate at which the stem cell therapy market advances,” he says. “It is driven by the success of stem cell treatments in curing life-threatening diseases such as cancer, heart diseases and neuromuscular diseases in the world’s aging populations. Emerging gene-editing techniques such as CRISPR/Cas9 that offer high precision, accessibility, and scalability, compared to other genome editing methods, such as ZFNs and TALENs for cell and gene therapy applications will continue to attract high investment both from venture capital and pharma companies.”
As regenerative medicine is redefining medical technology synergies by combining stem cell technology with tissue engineering, market participants should be investing in innovative models such as risk sharing, in-licensing/out-licensing deals, fast-to-market models, and in-house expansions, according to Behera.
“With cell-therapy manufacturing being time sensitive, biopharma companies should implement IT-based solutions for improved manufacturing capabilities,” he says. “Despite the promises with novel cell and gene therapies such as CRISPR/Cas9, questions around ethical application challenge its future potential. This makes it necessary for the life science research executives to work closely with regulators in developing guidelines and regulations [that will] guide ethical and real-word unmet needs of the healthcare industry.”
5. Digital therapeutics
“Digital therapeutics are about to become a true medical alternative that will utilize communication-based technologies, apps, and software to improve patient outcomes and help to lower the cost of healthcare,” Behera says. “Digital therapeutics offer the benefit to improve patient outcomes and reduce treatment cost by replacing the need for a drug or augmenting a standard of care, but they are not endorsed by a regulatory body, such as the FDA.”
Frost & Sullivan projects that the overall digital therapeutics market is to grow at a CAGR of 30.7% from 2017 to 2023.
“Digital therapeutics will become an exciting healthcare option that adds a curative dimension to technology,” he says. “As care for these chronic diseases expands in scope, prevention and recovery are becoming the new focus areas—apart from diagnosis and treatment. This demands a holistic view of individual health, lifestyle, and environmental data beyond the clinical health records to efficiently stratify at-risk patients for a preventive and targeted treatment paradigm.”
Defining digital therapeutics appears at first glance to be a simple task, but challenges develop when attempting to define digital therapeutics as a market opportunity, according to Behera.
“Healthcare executives exploring the growth opportunities should prioritize their market positioning, which is often dictated by focused use cases (e.g., condition management vs. behavior management) rather than the technology novelty,” he says. “At present, many companies are either claiming to be or cited in the media as digital therapeutics, but only a small number of early-stage participants are seeking FDA certification based on randomized clinical trials. They make it critical for healthcare executives to keep a close watch on progressing regulatory developments, such as the FDA precertification program.”
The 4 Biggest New Areas to Focus on in 2019
https://www.managedhealthcareexecutive.com/health-management/4-biggest-new-areas-focus-2019
If you ignore the Sword of Damocles hanging over the industry in the form of a Texas federal judge’s ruling the entire ACA unconstitutional, 2019 could shape up as a relatively chaos-free year with little chance of legislative or regulatory upheaval. Despite the fact that the number one issue on voters’ minds during the 2018 election was healthcare, it’s unlikely that the extremely divided Congress will be able to address it in any meaningful way. Cue the 2020 election.
The biggest issues healthcare industry leaders foresee include:
1. Addressing social drivers of health
Although it’s become clear that a person’s zip code has more impact on their health than their DNA, dealing with the social determinants (or social drivers) of health that relate to where a person lives are often far outside of the scope of most health plans’ operations. That’s rapidly changing. Whether it’s food or housing insecurity, economic stability, social or environmental safety or literacy, the impacts these social drivers have on health outcomes and costs are significant. Spurred by state Medicaid agencies and CMS, finding and deploying tools to measure and address the underlying issues that drive much of the cost and utilization in healthcare will be a focus during the year.
2. Provider consolidation
As hospital systems extend their reach with acquisitions, mergers and alliances (for example the $28 billion Catholic Health Initiatives and Dignity Health merger), health plans will be faced with much less leverage in rate negotiation and greater challenges in establishing competitive product differentiation as providers will have more power to dictate terms for products and rates. On the other hand, plans aligned with providers will face a more favorable environment and may see significant growth over their unaligned competition.
3. Medicaid work requirements
Adding work requirements for “able-bodied adults” to Medicaid expansion waivers has allowed Republican states that opted out of this ACA option (and the significant federal dollars that go with it) to find a way to participate that aligns with their stated conservative values.
Unfortunately, work requirements are much easier to put in place than to administer as some of the early-implementing states like Arkansas are finding out. Expect more non-expansion states to use this mechanism to expand their Medicaid coverage and for the health plans involved to be inundated with a whole new set of administrative requirements and challenging enrollment issues.
4. Personal healthcare technologies
The Dick Tracy watches are here and are way more than cool communication devices. Measuring pulse and blood sugar, breathing rate, simple ECGs, and providing emergency alerts for falls are only the beginning of what appears to be a host of clinical monitoring and alerts coming from these personal technologies. Whether and how health plans address and incorporate the application of these new capabilities to their membership will make a significant difference in the MCO’s market presence and competitive stance.
While these were a some of the more frequently mentioned challenges, obviously other issues resonated a higher level for some execs based on their geography and product lines. Here’s hoping that 2019 sees the industry better serve the diverse healthcare needs of the country by meeting consumers’ demands for quality, affordability, and access.
HENRY KOTULA 