It’s not about what blockchain can do in healthcare, but what it’s already doing

It’s not about what blockchain can do in healthcare, but what it’s already doing

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A panel discussion at the upcoming MedCity INVEST meeting in Chicago will look at real-world applications of blockchain technology in healthcare and biopharma.

Much of the focus on blockchain in healthcare and biopharma has been on the theoretical – what the technology could potentially do and where it could potentially be applied. But increasingly, that focus is shifting from potential to reality.

Real-world applications of blockchain in healthcare – not just what it can do, but what it is doing – will be the topic of a panel discussion at the upcoming MedCity INVEST conference, taking place April 23 in Chicago, with KKH Advisors CEO Kimberly Ha as moderator. The panel will bring together Health2047 Managing Director Charles Aunger, vice president for medical and regulatory affairs at drugmaker Boehringer Ingelheim’s Canadian division Uli Broedl, Embleema head of blockchain consortium Alexis Normand and Medable vice president for life sciences Tyler Pugsley.

A timely example of blockchain’s implementation came last week when Embleema, based in New York, announced it would work with the government of Armenia for an effort to use blockchain to modernize digital healthcare in the country. The aim is to offer physicians there better access to health data while connecting Armenia to international research, particularly in areas like oncology, immunotherapy and molecular medicine.

“I think it’s the first proof-of-concept of using blockchain at the national level,” Ha said in a phone interview.

But numerous efforts have taken place in the private sector as well. At the annual Healthcare Information and Management Systems Society conference in February, Boehringer Ingelheim and IBM announced a partnership that they said would mark blockchain’s first use in clinical trials in Canada. In particular, the US technology giant and German drugmaker said they would test whether blockchain can provide a decentralized framework to enable data integrity, provenance, transparency and patient empowerment, along with automation of processes for clinical trials. The partnership’s aim is to improve trial quality and patient safety, given that current processes are often seen as inadequate, leading to erroneous trial records that threaten safety and interpretability.

Realistically, for now blockchain’s application in clinical trials will likely be in postmarketing Phase IV studies, as opposed to earlier trials used for proof-of-concept or regulatory approval, Ha added.

For the time being, a number of questions remain that Ha and Aunger said they would like to see brought up in the panel. One, Aunger said, is what are the benefits people are seeing from using blockchain. “Everybody asks that question all the time – nobody gives a really good answer,” he said in a phone interview. Additional questions include whether the blockchain platform is being built for the betterment of the patient or organization; whether it truly has privacy; and how to get past the marketing hype, he said. “The other question is who regulates it – should it be government, or should it be someone else,” he said.

Ha said she would like to talk about incentivizing in terms of how blockchain facilitates the creation of a marketplace type of platform enabling patients to provide data and control what is done with it. “After I join a clinical trial, I don’t know where my data is being sold,” she said. “Lack of security around patient data is a massive vulnerability.”

 

 

 

Advocating for evolution, not disruption, in healthcare

https://medcitynews.com/2019/04/advocating-for-evolution-not-disruption-in-healthcare/?utm_campaign=MCN%20Daily%20Top%20Stories&utm_source=hs_email&utm_medium=email&utm_content=71446469&_hsenc=p2ANqtz–34bi05gJtda54hwonqyCB9rxFgJoCujD6XqJVlAXN-4zFSD8Z-UjONzK_dzDDHx1pG_jCZPZSiwrDtx_-6cOwrzj3_Q&_hsmi=71446469

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Healthcare doesn’t shatter and reanimate as the terms “disruption” and “disruptive innovation” suggest. It evolves. Even groundbreaking technologies in history show the transformation happening over time and with continuous building upon prior advances.

Late last year, the Christensen Institute’s Rebecca Fogg wrote about disruption accelerating in healthcare, priming of the pump for new capitated health plans and new delivery models. It is certain that leading consultancies have expressed a surging desire to disrupt in their business intelligence work and their analysis holds some insight for business leaders. But the truth about what our healthcare system will look like over the next 20 years is far from determined — and “disruption” will certainly not be the optimal path.

Disruption is, well, disruptive. It leaves in its wake complicating debris that trend towards more disorder. Consider that disruption’s synonyms include breakdown, collapse, disarrangement, disturbance, havoc, upset,… Is this what we actually want or need? Healthcare doesn’t shatter and reanimate, it evolves. Over 200 years ago, for example, the invention of the stethoscope ushered in a series of generational discoveries that transformed public health, general health, and overall life expectancy through the enhancement of insight into pathophysiology underlying human symptoms.  The new technology was groundbreaking, but the transformation happened over time and with continuous building upon prior advances. This evolutionary system works remarkably well. To disrupt it, to disarrange it, does not make sense.

At the center of Fogg’s argument is interest in different models that seem to be on the increase. The data does not fully support this view or serve as evidence of a pending wave of disruption. What we see instead are repeated ripples.

Take the “wave” of HMOs initiated in the 1970s. The ramp was supposed to be significant — combining financing and care delivery would be genuinely transformative. And yet the model’s penetration over 20 years only reached about 15 percent nationwide, and even now (data as of 2016) has only increased to 31.6 percent.

Further, in 2014 and again in 2018, Rand Corporation explored health payment constructs. Its most recent report on this work is a great representation of both our progress and stagnation: Findings suggest that in the window between initial engagement around alternative payment models (such as value-based care in 2014) and follow up (in 2018) little in the way of significant change has occurred. While we have seen plenty of perceived “disruptive models” emerge, we’ve also witnessed models championed as “disruptive” fall away.

The rise, plateau, and sometimes decline of various broad modernization initiatives is common and should be expected. The whole effort is hard.  We do not have any magical ability to foretell the future.  And we do a poor job of grasping the evolutionary nature of healthcare and the timelines of its change. Sure, we see pockets of capitated plan models that work, locations where the ACO makes sense, incidences where bundles show promise. But we are not primed for disruption that will change everything, or even most things, tomorrow. Rather, we are primed for a series of experiments, discoveries, and adaptive evolution. This is OK.

Three points stand out significantly in charting the realistic course of healthcare change moving forward:.

  1. The road is long.
    Understanding that healthcare evolution is a journey and not a rapid-shift prospect is important. There are a variety of considerations, one of which is contemplating the measures of success in the future state. Part of the failure of using payment models as a measurement for transformation is rooted to how blunt a tool payment structures are in producing desired outcomes. Consider recent disruption in payment models on the music industry. Whether you pay per song or via subscription has little bearing on the quality or appeal of the music itself. And with music, we can at least gauge direct feedback from users of the delivery systems to determine perceived value, effectiveness, and overall adoption. The feedback loops for what is working in healthcare are more complicated and difficult to master, and a great challenge to the value-based care revolution has been a lack of good measures. This is due, in part, to the framing of systematic structural levers as the core issue. That we cannot measure what holds value has little to do with whether a service is paid for through a capitated structure or through FFS. That’s not to say that payment structures do not alter incentives and change care behaviors, but whether one option is better than another is not the right question. This shouldn’t be discouraging. Evolution requires contemplation and development and new measures addressing different disease needs, delivery models, and technological capabilities. But all this takes time. It’s no use oversimplifying the nature of the beast.
  2. The substrate matters.
    It is essential to consider what is working and where. Solution sets for physicians and individuals, as well as the healthcare system as a whole, must be a mix of scaled capabilities and regional deployments. The recent study by Jha, et. al. in JAMA showed how breaking down traditional arguments about our health system is important to ensure we are understanding its problems and potential precisely. Among other things, the study shed light on the point that we have 50 different systems within our system from which to learn. The sheer variety state to state — not only in demographic and disease needs, but also in how treatment and services are paid for — enables enormous opportunity for innovation and testing. A relatively untapped resource lies in exploring what is working and why within these individual substrates. Breaking down the national system to a function of its parts would be a productive exercise for creating an adaptive mechanism for a “learning” healthcare system that evolves and advances more productively.
  3. The status quo is a threat to be managed.
    If healthcare innovators want to be “disruptive,” they need to take on the entirety of a complex, multi-faceted, multi-trillion-dollar industry. Clay Christenson writes of the velocity of history in his Innovators Dilemma. Being caught unawares is a great risk, akin to missing the new train when it leaves the station and you stuck on your old platform. That’s a powerful motivator. But in healthcare, the profits (and there are significant profits) create a ruthless resistance to any alteration of the status quo. So new trains don’t get to run on the current system’s tracks, rendering them irrelevant. Or they seem impactful, but run on the same schedule and under the same power, making them more or less lipstick on the proverbial pig. The introduction of change to the system must aim to be holistic, and include the critical voices of all stakeholders — predominant businesses, physicians, patients, investors, government and upstarts alike.

Amid the flurry of articles and analysis expounding the grandiosity of ever-imminent healthcare disruption (just around the corner), a nod to Darwin and the observable nature of our actual healthcare system and a scientifically based understanding of evolution seems appropriate.

 

 

 

WHAT’S TO KEEP AMAZON FROM COMPETING IN BRICK-AND-MORTAR HEALTHCARE? NOT MUCH

https://www.healthleadersmedia.com/strategy/whats-keep-amazon-competing-brick-and-mortar-healthcare-not-much

Amazon could join retail clinics already competing with hospitals and health systems to provide outpatient healthcare services.


KEY TAKEAWAYS

Amazon’s launch of new ‘urban grocery stores’ could serve as a possible beachhead for expansion into outpatient medical care services.

Amazon plans to offer goods besides food in the grocery stores, creating a potential entry point for it to get into brick-and-mortar retail healthcare.

Even in a digital age where more services are headed online, e-commerce retail giant Amazon could be poised, alongside retail healthcare clinics, to compete with hospitals and health systems on their brick-and-mortar playing fields.

And there’s little preventing Amazon from doing this, especially after news the company is looking to launch new “urban grocery stores,” which could serve as a possible beachhead for expansion into outpatient medical care services. Amazon would join retail providers Walgreens, CVS Health, and Walmart, which are competing already with hospitals and health systems to provide outpatient services in their communities.

This potential competition to hospital outpatient business comes as CVS is testing a “HealthHub” store concept in Houston following its acquisition of health insurer Aetna, and as Walgreens is dedicating armies of Microsoft scientists to a “store of the future.” Analysts expect these retail clinics to change the way U.S. healthcare is delivered, which includes efforts to give patients less need to use the hospital and its ancillary outpatient services.

And why not Amazon as well?

“Amazon’s basic approach has been to create a transactional platform that supports an ecosystem of interrelated products and services,” says Ken Kaufman, managing director and chair of consulting firm Kaufman Hall. “Adding brick-and-mortar stores to its online platform will support Amazon’s grocery business and its competition with Walmart but could be applied to other products and services, including healthcare, which is very much on Amazon’s radar.”

Amazon last year acquired the online pharmacy PillPack and formed a new venture recently named Haven with Berkshire Hathaway and JPMorgan Chase to examine ways to lessen the cost of care and improve health outcomes for the three corporate giants’ 1.2 million employees. Amazon’s announcements don’t directly impact hospitals and health systems, though analysts say Amazon, like Walmart, has a laboratory in its large workforce to test what works.

For now, Amazon “plans to launch urban grocery stores that could offer a spectrum of goods that include beauty products alongside food,” as The Wall Street Journal reported. Amazon declined HealthLeaders‘ request for comment on its plans.

But Kaufman sees this as a potential entry point for Amazon to get into brick-and-mortar retail healthcare, given its history to add on services over time from the successful platforms.

For example, Amazon in recent years has opened brick-and-mortar bookstores in New York, Chicago, and Washington, D.C. Earlier this month, Amazon said it is closing 87 of the pop-up kiosk variety stores in malls and Kohl’s stores, but it is maintaining Amazon Books and Amazon “4-star” stores that are largely stand-alone sites.

Amazon is looking at a grocery store model that includes leases with more flexibility than traditional commercial leases, as the Journal reported. That could allow Amazon to jump into healthcare services more quickly.

Though it’s unclear what kind of healthcare services and products Amazon could offer, Kaufman thinks that there’s not much keeping Amazon from exploring brick-and-mortar healthcare delivery in the future.

“It is always difficult to predict the long-term intentions behind Jeff Bezos’ short-term moves,” Kaufman said.

“The more comfortable Amazon gets with physical commerce, the easier it will be to pivot toward healthcare,” he added.

 

 

 

Former Aetna CEO on being a “radical capitalist” and the current state of health care

https://finance.yahoo.com/video/former-aetna-ceo-being-radical-164919638.html?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202019-03-20%20Healthcare%20Dive%20%5Bissue:19979%5D&utm_term=Healthcare%20Dive

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Former Aetna CEO Mark Bertolini spent 8 years as company head until 2018 when the insurance giant was sold to CVS. He joins Yahoo Finance’s Adam Shapiro, Julie Hyman, and Julia La Roche to discuss his new memoir “Mission-Driving Leadership: My Journey As A Radical Capitalist.”

 

 

 

 

POPULATION HEALTH TRENDS TO WATCH, TRENDS TO QUESTION IN 2019

https://www.healthleadersmedia.com/clinical-care/population-health-trends-watch-trends-question-2019?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_190319_LDR_BRIEFING_resend%20(1)&spMailingID=15320844&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1601503618&spReportId=MTYwMTUwMzYxOAS2

Healthcare organizations cannot afford to ignore consumers in 2019, as a number of major trends shape the future of care delivery (and a number of other trends warrant more critical thinking).

This article was first published March 18, 2019, by MedPage Today.

By Joyce Frieden, news editor, MedPage Today

PHILADELPHIA — The consumer will be where it’s at for population health in 2019, David Nash, MD, MBA, said here Monday at a Population Health Colloquium sponsored by Thomas Jefferson University.

“Whatever business model empowers the consumer, wherever she is,” including at home, will spell success, according to Nash, who is dean of Jefferson’s School of Population Health. “That’s where population health must go.”

Nash noted that back in 1990, Kodak, Sears, and General Electric were the most important companies in the Dow Jones Industrial Average; all those companies have disappeared or almost disappeared today.

“If we ignore the consumer, it will be at our peril,” Nash said, citing home healthcare, telehealth, and the use of wearables among the trends to watch in the coming year.

Nash, who is a columnist for MedPage Today, also cited these other trends to watch:

  • The growth of Medicare Advantage and managed Medicaid. “These are two programs that are working,” he said. “They’re working because they deliver value — high-quality care with fewer errors — and they follow our mantra: no outcome, no income.”
  • Tax reform. “Whatever your politics are [on this issue], park it at the door,” he said. “The sugar high is over, and now we’re in a carbohydrate coma. We’ve got the biggest deficits in American history; if we continue to spend money we don’t have, what will that do to healthcare? I think it will bite us in the butt when [it] comes to the Medicare trust fund.”
  • Precision medicine and population health. “[There is a notion] that precision medicine and population health are actually kissing cousins,” said Nash. “They are inexorably linked.”
  • Continued deal-making. The CVS/Aetna, UnitedHealth Group/DaVita, and Humana’s deals with Kindred Healthcare and Curo Health Services are just some of the more recent examples, he said. And he noted, the healthcare company formed by Amazon, Berkshire Hathaway, and JPMorgan Chase now has a name: Haven. “It’s a place where they’re going to figure it all out and they’ll let us know when they do.”
  • Continued delivery system consolidation. “Big surprise there,” he said sarcastically. “The real question is will they deliver value? Will they deliver synergies?” Nash noted that his own institution is a good example of this trend, having gone from one or two hospitals 5 years ago to 16 today with another two in the works.
  • Population health technology. “The gravy train of public money into this sector will [soon] be over; now the real challenge is for the IT [information technology] systems on top of those legacy companies; can they create the patient registry information and close the feedback loop, and give doctors, nurses, and pharmacists the information they need to improve care?”
  • The rise of “population health intelligence.” “That’s our term for predictive analytics, big data, artificial intelligence, and augmented intelligence … It says we don’t want to create software writers — we want doctors, nurses, pharmacists, and others who can glean the usable information from the terabyte of information coming our way, to [know how to interpret it].”
  • Pharmaceutical industry disruption. “This is really under the thumb of consumers … It’s all about price, price, price,” Nash said. “We’ve got to find a way to rationalize the pricing system. If we don’t, we’re going to end up with price controls, and as everybody in this room with a background in this area knows, those don’t work either.”
  • More venture capital money. Nash described his recent experience at the JPMorgan Chase annual healthcare conference, where people were paying $1,000 a night for hotel rooms that would normally cost $250, and being charged $20 just to sit in the lobby of one hotel. “What was going on there? It was more private-sector venture money coming into our industry than ever before. [These investors] know that when there’s $1 trillion of waste in an industry, it’s ripe for disruption.”
  • Workforce development. This is needed for the entire industry, said Nash. “More folks know a lot more [now] about population health, quality measurement and management, Lean 6 Sigma, and improving processes and reducing waste. The only way we’re going to reduce that waste of $1 trillion is to have the right kind of workforce ready to go.”

Lawton Burns, PhD, MBA, director of the Wharton Center of Health Management and Economics at the University of Pennsylvania here, urged the audience to look critically at some of these possible trends.

“You need to look for evidence for everything you hear,” said Burns, who coauthored an article with his colleague Mark Pauly, PhD, about the need to question some of the commonly accepted principles of the healthcare business.

Some of the ideas that merit more critical thinking, said Burns and Pauly, are as follows:

  • Economies of scale
     
  • Synergy
     
  • Consolidation
     
  • Big data
     
  • Platforms
     
  • One-stop shops
     
  • Disruption
     
  • Killer apps
     
  • Consumer engagement

“I’m not saying there’s anything wrong with those 10 things, but we ought to seriously consider” whether they’re real trends, Burns said. As for moving “from volume to value” in healthcare reimbursement, that idea “is more aspiration than reality” at this point, he said. “This is a slow-moving train.”

Burns also questioned the motives behind some recent healthcare consolidations. In reality, “most providers are positioning themselves to dominate local markets and stick it to the payers — let’s be honest,” he said. “You have to think when you hear about providers doing a merger, you have to think what’s the public rationale and what’s the private rationale? The private one is [often] more sinister than you realize.”

“IF WE IGNORE THE CONSUMER, IT WILL BE AT OUR PERIL.”

 

 

 

 

The Biggest Growth Opportunities in Healthcare

https://www.managedhealthcareexecutive.com/healthcare-leadership/biggest-growth-opportunities-healthcare?rememberme=1&elq_mid=5658&elq_cid=876742&GUID=A13E56ED-9529-4BD1-98E9-318F5373C18F

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.”

 

 

 

Here’s How Microsoft Plans To Modernize Healthcare

http://fortune.com/2019/02/07/microsoft-healthcare-artificial-intelligence/

Image result for microsoft healthcare bot service

Microsoft announced its new service to help healthcare companies store patient data in the cloud and a Healthcare Bot service that will be integrated with Electronic Health Records.

The tool will be based on Microsoft’s Azure cloud platform, which it describes as a secure end-to-end platform that organizations can use to store and analyze sensitive data.

“Healthcare leaders are thinking about how they bring their data into the cloud while increasing opportunities to use and learn from that data,” Microsoft wrote in a blog.

With its new healthcare push, Microsoft aims to create a system that makes health records more easily accessible and sharable between clinicians, researchers, and patients, Bloomberg reports.The corporation also sees its integrated healthcare storage as a way to attract companies to Microsoft, over its competitor Amazon Web Services.

 

Top Six Healthcare Executive Challenges in 2019

http://www.managedhealthcareexecutive.com/executive-express/top-six-healthcare-executive-challenges-2019

The pace of change in healthcare is not slowing down; in fact, it is accelerating. Healthcare organizations that are most successful in 2019 will know what challenges and changes are coming down the pipeline, and they will prepare accordingly.

To help ensure you don’t get left behind, we’ve assembled the top six challenges the industry will face in 2019.

1. Shifting the focus from payment reform to delivery reform. For the past few years, C-suite leaders at healthcare organizations have been focused on navigating healthcare payment reform—attempting to preserve, improve, and maintain revenue. Amidst those efforts, delivery reform has sometimes taken a back seat.

That will need to change in 2019. Organizations that are the most successful will focus more on patient care than revenue, and they will see improved outcomes and reduced costs as a result.

Many organizations are already exploring delivery reform with initiatives that focus on:

  • Remote health monitoring and telemedicine;
  • Population health management;
  • Patient engagement;
  • Social determinants of health; and
  • Primary care.

In 2019, however, they will need to bring all of these initiatives together to implement sustainable improvements in how healthcare is delivered.

An added bonus? Organizations that accomplish this will see enhanced revenue streams as value-based reimbursement accelerates.

2. Wrestling with the evolving healthcare consumer. Healthcare consumers are demanding more convenient and more affordable care options. They expect the same level of customer service they receive from other retailers—from cost-estimation tools and online appointment booking to personalized interactions and fast and easy communication options such as text messaging and live chats.

Organizations that don’t deliver on these expectations will have a difficult time retaining patients and attracting new ones.

That’s not the only consumer-related challenge healthcare organizations will face. In 2019, millennials (between the ages of 23 and 38), will make up nearly a quarter of the U.S. population.

This generation doesn’t value physician-patient relationships as highly as previous generations. In fact, nearly half of them  do not have a personal relationship with their physician, according to a 2015 report by Salesforce.

Finding ways to maintain or increase the level of humanity and interaction with millennials will be a key challenge in 2019. Patient navigator solutions and other engagement tools will be critical to an organization’s success.

3. Clinician shortages. Physician and nurse shortages will continue to intensify in 2019, creating significant operational and financial challenges for healthcare organizations.

The most recent numbers from the Association of American Medical Colleges predict a shortage of up to 120,000 physicians by 2030. On the nursing side, the Bureau of Labor Statistics projects a need for 649,100 replacement nurses by 2024.

The implications of the shortages, combined with the fact that healthcare organizations face a number of new challenges in the coming years, are many. Fewer clinicians can lead to burnout, medical errors, poorer quality, and lower patient satisfaction.

Healthcare organizations that thrive amidst the shortages will find new ways to scale and leverage technology to streamline work flows and improve efficiencies.

4. Living with EHR choices. Despite the hype and hopes surrounding EHRs, many organizations have found that they are failing to deliver on their expectations.

recent Sage Growth Partners survey found that 64 percent of healthcare executives say EHRs have failed to deliver better population health management tools, and a large majority of providers are seeking third-party solutions outside their EHR for value-based care.

The survey of 100 executives also found that less than 25% believe their EHRs can deliver on core KLAS criteria for value.

As we recently told Managed Healthcare Executive, that statistic is striking, considering how important value-based care is and will continue to be to the industry.

Despite the dissatisfaction surrounding EHRs, switching EHRs may be a big mistake for healthcare organizations. A recent Black Book survey found 47% of all health systems who replaced their EHRs are in the red over their replacements. A whopping 95% said they regret the decision to change systems.

Hospitals and physician may not be entirely happy with their EHR choices, but the best course may be to stick with their system. Highly successful hospitals and health systems will find ways to optimize workflow and patient care which may involve additional IT investments and best of breed investment approaches, rather than keeping all of the proverbial eggs in the EHR basket.

5. Dealing with nontraditional entrants and disruptors. In 2018, several new entrants entered and/or broadened their reach into healthcare.

Amazon acquired online pharmacy retailer PillPack, and partnered with JPMorgan Chase and Berkshire Hathaway to create a new healthcare partnership for their employees. Early in 2018, Apple announced it was integrating EHRs onto the iPhone and Apple watch, and recently, Google hired Geisinger Health CEO David Feinberg for a newly created role, head of the company’s many healthcare initiatives.

New partnerships have also arisen between traditional healthcare entities that could result in significant healthcare delivery changes. Cigna and Express Scripts received the go-ahead from the DOJ for their merger in September, and CVS and Aetna formally announced the completion of their $70 billion merger November 28.

Read more about the top two ways the CVS-Aetna merger could change healthcare.

All of these new industry disruptors and mergers will impact healthcare organizations, likely creating new competition, disrupting traditional healthcare delivery mechanisms, creating price transparency and pressures, and fostering higher expectations from consumers in 2019. Keeping an eye on these potential disrupters will be important to ensuring sustained success in the long term.

6. Turning innovation into an opportunity. From new diagnostic tests and machines to new devices and drug therapies—the past few years in healthcare have seen exciting and lifesaving developments for many patients. But these new devices and treatment approaches come with a cost.

One of biggest 2018 developments that best exemplifies the challenge between innovation and cost is CAR T-cell therapy. This new cancer treatment is already saving lives, but it racks up to between $373,000 and $475,000 per treatment. When potential side effects and adverse events are accounted for, costs can reach more than $1 million per patient.

Finding the best way to incorporate new treatments like this one, while balancing outcomes, cost, and healthcare consumer demands, will be a top challenge for healthcare organizations in 2019.

 

 

 

10 Notable Health Care Events of 2018

https://www.commonwealthfund.org/blog/2018/10-notable-health-care-events-2018?omnicid=CFC%25%25jobid%25%25&mid=%25%25emailaddr%25%25

2018

Between the fiercely competitive midterm elections and ongoing upheaval over the Trump administration’s immigration policies, 2018 was no less politically tumultuous than 2017. The same was true for the world of health care. Republicans gave up on overt attempts to repeal and replace the Affordable Care Act (ACA) through legislation, but the administration’s executive actions on health policy accelerated. Several states took decisive action on Medicaid and some of the struggles over the ACA made their way to the courts. Drug prices remain astronomically high, but public outrage prompted some announcements to help control them. At the same time, corporate behemoths made deeper inroads into health care delivery, including some new overtures from Silicon Valley. Here’s a refresher on some of the most notable events of the year.

1. The ACA under renewed judicial assault

Texas v. Azar, a suit brought by Texas and 19 other Republican-led states, asked the courts to rule the entire ACA unconstitutional because Congress repealed the financial penalty associated with the individual mandate to obtain health insurance that was part of the original law. District Judge Reed O’Connor ruled in favor of the plaintiffs, creating confusion at the end of the ACA’s open enrollment period, and setting up what may be a years-long judicial contest (yet again) over the constitutionality of the ACA. To learn more about the legal issues at stake, see Timothy S. Jost’s recent To the Point post.

2. Turnout for open enrollment in health insurance marketplaces surged at the end of the sign-up period

The federal and state-based marketplaces launched their sixth enrollment season on November 1 for individuals seeking to buy health coverage in the ACA’s individual markets for 2019. Insurer participation remained strong and premiums fell on average. While some states have extended enrollment periods, HealthCare.gov, the federal marketplace, closed on December 15. After lagging in the early weeks, enrollment ended just 4 percent lower this year than in 2017.

3. The administration continues efforts to hobble ACA marketplaces

While the reasons behind lower enrollment cannot be decisively determined, executive action in 2018 may have contributed. The Trump administration dramatically cut back federal investments in marketplace advertising and consumer assistance for the second year in a row. The federal government spent $10 million on advertising for the 34 federally facilitated marketplaces this year (the same as last year but an 85 percent cut from 2016) and $10 million on the navigator program (down from $100 million in 2016), which provides direct assistance to hard-to-reach populations.

4. Insurers encouraged to sell health plans that don’t comply with the ACA

Another tactic the Trump administration is using to undercut the ACA is increasing the availability of health insurance products, such as short-term health plans, that don’t comply with ACA standards. Short-term plans, previously available for just three months, can now provide coverage for just under 12 months and be renewed for up to 36 months in many states. These plans may have gaps in coverage and lead to costs that consumers may not anticipate when they sign up. By siphoning off healthy purchasers, short-term plans and other noncompliant products segment the individual market and increase premiums for individuals who want to — or need to — purchase ACA-complaint insurance that won’t discriminate against people with preexisting conditions, for example.

5. Medicaid expansion in conservative states

Few states have expanded Medicaid since 2016, but in 2018, a new trend toward expansion through ballot initiatives emerged. Following Maine’s citizen-initiated referendum last year, Idaho, Nebraska, and Utah passed ballot initiatives in November to expand Medicaid. Other red states may follow in 2019. Medicaid expansion not only improves access to care for low-income Americans, but also makes fiscal sense for states, because the federal government subsidizes the costs of newly eligible Medicaid enrollees (94 percent of the state costs at present, dropping to 90 percent in 2020).

6. Red states impose work requirements for Medicaid

A number of states submitted federal waivers to make employment a requirement for Medicaid eligibility. Such waivers were approved in five states — Arkansas, Kentucky, Wisconsin, New Hampshire, and Indiana — and 10 other states are awaiting approval. At the end of 2018, lawsuits are pending in Arkansas and Kentucky challenging the lawfulness of work requirements for Medicaid eligibility. About 17,000 people have lost Medicaid in Arkansas as a result of work requirements.

7. Regulatory announcements respond to public outrage over drug prices

Public outrage over prescription drug prices — which are higher in the U.S. than in other industrialized countries — provided fodder for significant regulatory action in 2018 to help bring costs under control. Of note, the Food and Drug Administration announced a series of steps to encourage competition from generic manufacturers as well as greater price transparency. The U.S. Department of Health and Human Services in October announced a proposed rule to test a new payment model to substantially lower the cost of prescription drugs and biologics covered under Part B of the Medicare program.

8. Corporations and Silicon Valley make deeper inroads into health care

Far from Washington, D.C., corporations and technology companies made their own attempts to alter the way health care is delivered in the U.S. Amazon, Berkshire Hathaway, and J.P. Morgan Chase kicked 2018 off with an announcement that they would form an independent nonprofit health care company that would seek to revolutionize health care for their U.S. employees. Not to be outdone, Apple teamed up with over 100 health care systems and practices to disrupt the way patients access their electronic health records. And CVS Health and Aetna closed their $69 billion merger in November, after spending the better part of the year seeking approval from state insurance regulators. In a surprise move, a federal district judge then announced that he was reviewing the merger to explore the potential competitive harm in the deal.

9. Growth in health spending slows

The annual report on National Health Expenditures from the Centers for Medicare and Medicaid Services estimates that in 2017, health care spending in the U.S. grew 3.9 percent to $3.5 trillion, or $10,739 per person. After higher growth rates in 2016 (4.8%) and 2015 (5.8%) following expanded insurance coverage and increased spending on prescription drugs, health spending growth has returned to the same level as between 2008 to 2013, the average predating ACA coverage expansions.

10. Drug overdose rates hit a record high

Continuing a tragic trend, drug overdose deaths are still on the rise. The Centers for Disease Control and Prevention reported 70,237 fatalities in 2017. Overdose deaths are higher than deaths from H.I.V., car crashes, or gun violence, and seem to reflect a growing number of deaths from synthetic drugs, most notably fentanyl. 2018 was the first year after President Trump declared the opioid crisis a public health emergency. National policy solutions have so far failed to stem the epidemic, though particular states have made progress.

As we slip into 2019, expect health care issues to remain front and center on the policy agenda, with the administration continuing its regulatory assault on many key ACA provisions, Democrats harassing the executive branch with House oversight hearings, both parties demanding relief from escalating pharmaceutical prices, and the launch of health care as a 2020 presidential campaign issue.

 

 

8 things for healthcare executives to note in 2019

https://www.beckershospitalreview.com/hospital-management-administration/2018-the-year-that-was-8-things-for-healthcare-executives-to-note-in-2019.html?origin=bhre&utm_source=bhre

Image result for 2019 healthcare trends

Hospital executives quit on the spot. Corporate giants took healthcare into their own hands. Flu hit the country hard. Nurses wanted to cut ties with Facebook. These and four other events and trends shaped the year in healthcare — and the lessons executives can take from them into 2019.

Flu-related deaths hit 40-year high

Roughly 80,000 Americans died of flu and related complications last winter, according to the CDC, along with a record-breaking estimate of 900,000 hospitalizations. That made 2017-18 the deadliest flu season since 1976, the date of the first published paper reporting total seasonal flu deaths, according to the CDC’s Kristen Nordlund.

The milestone flu season reflected a couple of trends. No. 1: Fee-for-service remains the dominant payment model in healthcare. Flu-related hospitalizations triggered financial gains for health systems and hospital networks. No. 2: A deadly flu season gave more weight to concerns about a flu pandemic, which weighs heavily on the minds of CDC Director Robert Redfield, MD, and Bill Gates, among others.

JP Morgan-Berkshire Hathaway-Amazon rocks healthcare

Not even one month into 2018, three corporate giants combined forces to lower healthcare costs for 1.2 million workers. Since the Jan. 30 announcement, Amazon, Berkshire Hathaway and JPMorgan Chase made several important hires: Surgeon, writer and policy wonk Atul Gawande, MD, started work as CEO of the health venture July 9. Soon after, Jack Stoddard, general manager for digital health at Comcast Corp., was appointed COO. More questions than answers remain about this corporate healthcare disruption, including how extensively the new entrants will redesign healthcare for their employees and how much they will collaborate with traditional healthcare providers.

While Dr. Gawande and Mr. Stoddard continue to build their healthcare-centric team to pursue an ambitious mission, remarks from a member of the old guard illustrate the frustration fueling these corporate giants’ foray into healthcare. “A lot of the medical care we do deliver is wrong — so expensive and wrong,” Charlie Munger, vice chairman of Berkshire Hathaway, said in a May interview with CNBC. “It’s ridiculous. A lot of our medical providers are artificially prolonging death so they can make more money.”

While someone briefed on the undertaking said the alliance does not plan to replace existing health insurers or hospitals, it will be fascinating to see how this partnership forces legacy providers to behave differently. Chief executives Jamie Dimon, Warren Buffett and Jeff Bezos are clearly dissatisfied with the way their employees’ healthcare has been accessed, delivered and priced to date.

Sudden executive resignations

The practice of two-week notice became less standard for hospital and health system leaders this year — especially CEOs. Becker’s covers roughly 100 executive moves per month, and the rate at which we wrote about executives abruptly leaving their hospitals in 2018 stood out from the norm. Executives normally provide ample notice of their departure from an organization, much more than the baseline of two weeks that’s expected for any industry or occupation. But in 2018 many more executives resigned immediately, withholding explanation for their sudden departure or bound by non-disclosures to keep it confidential. For the first time, we began publishing round-ups of executives who departed with little notice. Two months into the year, we had nearly a dozen to report.

Healthcare consistently has a high executive turnover rate — 18 percent in 2017. But 2018 was a year in which leadership churn became even more volatile with the swift and mysterious nature of executive exits. The uptick in unexplained resignations occurred during the #MeToo movement, but we don’t have the right information to draw any correlation between them. The frequency of “effective immediately” resignations will normalize this practice if it persists in 2019, which could prove detrimental to hospitals for a host of reasons. Transparency is important in healthcare; highly paid executives quietly walking away from their posts does not bode well for community affairs or physician engagement. It goes back to a lesson from media relations 101: “No comment” is the worst comment.

Health system-backed drug company receives warm welcome

Several leading health systems kicked off 2018 by uniting to create a nonprofit, independent, generic drug company named Civica Rx to fight high drug prices and chronic shortages. The pharmaceutical entrant — backed by Intermountain Healthcare, HCA Healthcare, Mayo Clinic, Catholic Health Initiatives, Providence St. Joseph Health, SSM Health and Trinity Health — is led by CEO Martin Van Trieste, former chief quality officer for biotech giant Amgen. The company’s focus will be a group of 14 generic drugs, administered to patients in hospitals, that have been in short supply and increasingly expensive in recent years. The consortium has declined to name the drugs in development, but said it expects to have its first products on the market as early as 2019.

Intermountain CEO Marc Harrison, MD, exercised measure when describing the new drug company’s mission, noting that responsible pharmaceutical companies will fair fine, but those that have been unprincipled in the past with price increases or supply issues should watch out. Civica Rx may be starting with 14 drugs, but it has noted that there are nearly 200 generics it considers essential that have experienced shortages and price hikes.

Based on reactions from providers and on The Hill, the potential for Civica Rx to quickly gain participants and policy advocates seems rich. For instance, even before Civica Rx applied to the FDA for permission to manufacture drugs, the idea of the company caught hospitals’ interest nationwide. Dr. Harrison said approximately 120 healthcare companies — representing about one-third of hospitals in the U.S. — contacted Civica Rx organizers with interest in participating. Furthermore, lawmakers and regulators were quick to throw support behind the venture even though Congress has done little to get drug pricing under control. Dr. Harrison noted to Modern Healthcare that, as of November 2018, the collaborative “received tremendous bipartisan encouragement from elected officials and from regulatory agencies to continue with our efforts.”

Guns and shootings cemented as a healthcare issue

Gun violence was never outside the realm of health and wellness, but in 2018 the medical community passionately declared the issue as one within their jurisdiction. When the National Rifle Association tweeted Nov. 7 that “Someone should tell self-important anti-gun doctors to stay in their lane,” physicians were quick to respond with detailed, graphic stories and images of their encounters treating the aftermath of gun violence. The #ThisIsOurLane social media movement coincided with tragedy Nov. 19, when a man fatally shot a physician, pharmacist and police officer in Mercy Hospital in Chicago.

With the right resources, clinicians can become ardent advocates to better patients’ social determinants of health, including responsible gun ownership and use. Leavitt Partners released poll findings in spring 2018 in which physicians said they see how social determinants influence patients’ well-being, but do not yet have the resources to help with things like housing, hunger, transportation and securing health insurance. If the fervor of #ThisIsOurLane — and attention paid to it — is any indication, physicians deeply care about nonmedical issues that affect patients’ health. With the right resources, the medical community stands to become a powerful catalyst for change for a broad range of issues.

If health systems are serious about success under value-based payment models, they will empower clinicians with the support, partnerships and tools needed to intervene and improve social determinants of health for the good of their patients.

Media coverage of surprise billing

In late 2017, the American Hospital Association released an advisory notice encouraging members to prepare for a yearlong media investigation into healthcare pricing, conducted by Vox Media Senior Correspondent Sarah Kliff. The AHA’s memo illustrated how poorly prepared hospital executives and media teams are in fielding questions about pricing, especially facility fees.

“When I have tried to conduct interviews with hospital executives about how they set their prices, I find that many are reluctant to comment,” Ms. Kliff wrote. By the end of her 15-month project, Ms. Kliff had read 1,182 ER bills from every state and wrote a dozen articles about individual patient’s financial experiences with hospitals (she was also on maternity leave from June through September). Her work produced some effective headlines. Case in point: “A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill.” In that case, the hospital reversed the family’s $15,666 trauma fee after Ms. Kliff published her report.

As of Jan. 1, Medicare requires hospitals to disclose prices publicly — but this change is unlikely to greatly benefit patients and consumers since list prices don’t reflect what insurers, government programs and patients pay. Furthermore, price transparency is but one of the problems Ms. Kliff encountered in her extensive reporting. Others include high prices for generic drug store items ($238 for eye drops that run $15 to $50 in a retail pharmacy), out-of-network physicians tending to patients who are visiting in-network hospitals, and ER facility fees. Hospitals reversed $45,107 in medical bills as a result of Ms. Kliff’s reporting. Based on the change spearheaded by her work and the Congressional attention paid to medical billing practices, hospitals and health systems shouldn’t quit their AHA-advised preparation on their own billing practices just yet. They also shouldn’t chalk much progress up to CMS-mandated price postings, because that information does not answer the questions Ms. Kliff set out to answer, including how hospital set their prices. There will only be more questions like this — from journalists, patients and lawmakers.

Optum scaring the crap out of hospitals

Which business is keeping hospital leaders up at night? Many executives will tell you it’s not Amazon, not CVS, not One Medical — but Optum, the provider services arm of UnitedHealth Group. Optum was a key driver of the 11.7 percent gain UnitedHealth Group’s stock saw in 2018, which made it one of the top performers in the Dow Jones Industrial Average, according to Barron’s. Through its OptumCare branch, Optum employs or is affiliated with more than 30,000 physicians — roughly 8,000 more than Oakland, Calif.-based Kaiser Permanente.

Aside from directly competing for patients, Optum wants to hire or affiliate with the same MD-certified talent. It offers physicians three ways to do so: direct employment, network affiliation or practice acquisition. “OptumCare Medical Group offers recent medical school graduates the opportunity to practice medicine and become a valuable partner in their local community minus the hassles associated with the ever-changing business side of healthcare,” the company writes on its employment website.

It’s not just the physician force that makes Optum a serious concern for hospitals. Part of the challenge is that the $91 billion business has a hand in several healthcare buckets, expanding its presence as either a serious competitor/threat or a potential collaborator in multiple arenas since it is not easily categorized. For instance, consider the mountain of data Optum sits upon, with valuable insights related to utilization, costs and patient behaviors. “Because they are connected to UnitedHealth, they probably have more healthcare data than anyone on the planet,” the CEO of a $2.5 billion health system said.

Mark Zuckerberg lost face with nurses

For as much as we talk about the collision of Silicon Valley and healthcare, one of the year’s most vivid clashes came down to a dozen California nurses and Mark Zuckerberg, the chairman and CEO of Facebook and world’s third-richest person. San Francisco General Hospital and Trauma Center was renamed the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital and Trauma Center in 2015 after Mr. Zuckerberg and his wife, Priscilla Chan, MD, gave $75 million to the organization.

Soon after the Facebook-Cambridge Analytica ordeal came to light, a dozen nurses protested and demanded Mr. Zuckerberg’s name be stripped from their hospital. His name is hardly synonymous with the protection of privacy, they argued. But philanthropy proves to be more of an art than a science. By November, even as a San Francisco politician pressed for the removal of the name, hospital CEO Susan Ehrlich, MD, said: “We are honored that Dr. Chan and Mr. Zuckerberg thought highly enough of our hospital and staff, and the health of San Franciscans, to donate their resources to our mission.”

The dispute illustrates the tension hospital and health system executives must deal with as cash-rich tech giants and venture capitalists make more high-profile forays into healthcare. Hospitals can use the cash, sure, but the alignment of value systems may present some challenges. 2018 was a year in which several tech companies faced problems with transparency, holding leaders publicly accountable, and diversity in hiring, among other issues. A dozen nurses protesting their hospital sharing a name with Mark Zuckerberg? That’s not the last time we’ll see clinicians urging wealthy but problematic tech icons to back off. Hospital executives will need to be adept in handling that tension and exercise urgency in their response.