February 24, 2010

“You Ugly”: Creating 8 cow software

Ugly (ŭg’lē) adj.

  1. Displeasing to the eye; unsightly.
  2. Repulsive or offensive; objectionable
  3. Likely to cause embarrassment or trouble

UPDATE: I was able to talk with several senior executives, including Jonathan Bush (CEO) and Rob Cosinuke (Chief Marketing Officer) about my concerns. The great news is that athena is finally getting serious about design and hired their first UX folks last fall. They have begun their work and I look forward to hearing about their progress. I also was given some insight into athena’s plan to leverage their new Communicator platform (functional PHR) as a first foray into creating virality (as in viral) to their software. The approach is still a “push” and I believe they will find that their design efforts will create more of a viral “pull” than anything else they can do on their side. As one of the best UX people I know recently said, ” UX design is business strategy, not just making something look pretty.”

One of my favorite stories from my childhood was the quaint but profound story of Johnny Lingo. As you recall, Johnny was a young man who was the original Bachelor on his sleepy south Pacific island. The village was abuzz as Johnny prepared to make an offer on his future wife. All the village girls primped and pranced in an effort to win his heart as they heard that Johnny was preparing to offer a significant sum for his wife. However, one young woman, did not participate in the festivities. Mohanna was different than the other girls and was treated very poorly by the other villagers as well as her own family for her plainness and painful shyness (the cutting words of her father, “Mohanna, you UGLY!” became a familiar epithet used around our home and on the playground).

But the noble Johnny Lingo saw something that no one else did. On the set aside day, Johnny gathered his friends and began the processional march into town. To everyone’s amazement, Johnny was followed by eight cows – more than had ever been offered in the entire history of the island. He passed house after house of eligible bachlorettes to both their deep disappointment and obvious dismay. Finally he came to the humble house of Mohanna’s father and offered his 8 cow dowry for his daughter. The shocked father questioned Johnny’s sanity, but ultimately agreed to the gifts in exchange for his daughter. Mohanna, affected deeply not only by the amount that was paid for her hand in marriage, but also by Johnny’s ongoing devotion and deep love for her, rapidly blossomed into an amazing beauty. For the first time ever, people were able to see the incredible beauty that had always been there.

Athena is the most powerful software “solution” I have seen in the market to date. I have highlighted the solution repeatedly because I believe so profoundly in the underlying principles (dang, there is some funny stuff in there):

The important concept to understand is that athena is promoting “service enabled software” meaning that an entire service organization is built up around the software platform. The software is a tool that is highly leveraged and works synergistically with the service organization to create an unprecedented practice performance level. Having implemented the software now for three months, I can see the real, tangible, and immediate benefits of athenNet services. It has lived up to its promise and we are pleased with our results to date.

HOWEVER, “athenaHealth you UGLY”!

It has a 1999 interface, with way too much content and information, too many clicks between screens, not enough help in creating templates, and not enough attention being paid to overall presentation and functional utility for the user. Athena simplifies my life in so many ways but it still reflects the complexity of the insurance world in which it lives and is optimized. This needs to be abstracted out for me just like they abstract out the other difficulties in my practice life.

Given the robustness of the platform, I remain shocked that athena only has about 1% of the overall market. I often heard Jonathan bemoan this fact as well. I would argue that if Jonathan Bush and his team would drop the 8 cows dowry to improve the UI, more people would be able to see and appreciate the inherent beauty of the platform. If you want viral growth, you have to have a viral interface that can be rapidly adopted. You can’t just push it out either, it has to get “pulled” out by the users because of its inherent “awesomeness” and the subsequent referral communities that build up around it.

I believe that athenaNet is 8 cow software, but its going to require to an 8 cow dowry to help others see it as well.

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Filed under 10422713, EHR, Innovation

February 23, 2010

The next 15%: The Software Enabled Services Concept

Software Enabled Services

  1. Professional service offerings that leverage software to synergistically deliver higher levels of performance than obtainable from either alone.
  2. A next generation construct which builds upon the concept of Software as a Service (SaaS) but involves the actual human delivery of the services.

I am here in Las Vegas at the athenahealth user conference. Jonathan Bush is on the MIC regaling the crowd with his usual unique style of charismatic evangelism (“um…this is a pie chart, lots of lines, lots of things, yada yada yada”). The crowd is a typical demographic of office management set as seen across America – a middle aged office staff crew, mostly women, and mostly worried about the day to day activities of running a practice. They are here, I assume, because they want to learn how to leverage a very powerful practice management and electronic health record software. However, I wonder how many of them understand that what they really have is the most powerful software enabled service (SeS) offering in the industry.

We implemented athenaHealth (both Collector and Clinicals) in December 2009 at a traditional medical practice that Crossover Health manages.  We noted an immediate 5% bump in our revenue through better documentation, we accelerated our collections 5%, and because of new capabilities we were able to modify our staffing which reduced our costs by another 5%. This 15% uptick in revenue is real, noticeable, and has had an immediate impact on our practice.

All these advantages could be had by implementing probably most any reasonable EHR/PM software system. However, the reason I am attending the conference isn’t for this first 15% efficiency gain, its the next 15%. This next 15% is much harder and where I believe our partnership with athena will pay big dividends.  I am attending the conference not to optimize “points and clicks”, but rather to better understand the “nodes and grids”. I am here to learn how to plug in and play up the network effect and power grid that is athenahealth.

Think about it. Our little practice is one outpost in a networked grid of practices “fighting the man” every day. We are all working off the same software, sharing our collective knowledge we gain every day, wearing down the inefficiencies of each practice, measuring and monitoring our improvements, and taking advantage of nearly 2,000 athenistas who work around the clock to ensure that my practice gets Paid More, Paid Faster and with Less Work every single day. I get a monthly Practice Performance Report which compares my little clinic to the best benchmarking in the network, that clearly delineates areas of improvement, and provides a support infrastructure to help me get there. The financial controls on my practice are unprecedented; and only made possible through the network effect of my colleague clinics and the centralized efficiencies inherent in athena’s business model.

The software enabled service approach is well on its way to closing the second 15% gap, and best positioned to initiate the hunt for the third 15%  – the uncharted and untapped area of clinical process and outcome improvement. I can’t wait to see athena apply their patented approach to the measurement, monitoring, and continual improvement of the clinical side of medicine. This will only happen as financial incentives become aligned with excellent clinical outcomes, and no one is in a better position to do that than athenahealth.

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Filed under Conferences, Innovation, Leadership

February 22, 2010

Career Walkabout: Going On and Off the Grid

Walkabout (wôk’ə-bout’) n.

  1. A temporary return to traditional Aboriginal life, taken especially between periods of work or residence in modern society and usually involving a period of travel through the bush.
  2. A public stroll taken by an important person, such as a monarch, among a group of people for greeting and conversation.

I have been off the grid for the last several months heads down on a project which is the cumulative result of my last three year walkabout. Each of the experiences I had along the way provided a stepping stone and preparation for the path that I have recently embarked on.

After a couple of years of talking about health deliver reform (starting with Redefining Health Care), health care financing (Health Equity), health plan innovation (Lemhi Ventures), new practice models (Current Health), and health care reform (X PRIZE), I was left feeling like I was nibbling around the edges without having anything to sink my teeth into. The X Prize proved to be the catalyst, as I had to think about which side of a competition I wanted to be on (Administration vs. Competition). As a former collegiate athlete, there was never a question that I would choose to compete. As my contribution to that project wound down late in the fall, my decision was made – it was time to hang up the Blue Blazer and Khakis and put the stethoscope back on.

I used to think that I had moved on beyond being “just” a physician. I always respected and appreciated the work that went into becoming a doctor. But along my journey, I somehow lost the appreciation for what it means to be a physician – a trusted heath advisor, a healer, and someone who people turned to with confidence during some of the most difficult times in life. Perhaps the shift work in the ER, the patient population I dealt with on a daily basis, and certainly the shiny objects flashing on the always greener side of the fence were contributors to the reasons I chose to pursue other interests outside of the practice setting.

Ironically, those same interests have led me on a walkabout journey that has come full circle. When we founded Medsphere, the market was at a tipping point for implementing EHR’s. Those were the days we had to convince people that EHR’s were a good idea, that the VA was a benchmark for automation, and that open source was actually a viable development and business model. Our thought was always that the implementation of the EHR was the first step, that you absolutely needed to get an information gathering infrastructure in place in order to even consider improving health care delivery. We often talked about our second company, which would be a data analytics powerhouse that could create actionable work plans to turn the data into information and ultimately knowledge about health care performance. Health care delivery is where the action is, because that is where the monetary and resource allocation decisions are made. Its also where the rubber truly hits the road. I have since become convinced that no matter how fast your rev your RPM’s (health care hype), it is in the friction, heat, grime, and gristle of contact (physicians “touching” patients) that true progress can be made.

Its also where we need the most help with innovation.

Health care delivery is woefully behind most other professional service industries in nearly every measurable criteria. Our customer service is atrocious, our efficiency metrics don’t even register, and we certainly can’t provide very good guidance to our patients when we practice in a data free environment. Beyond just being a typically conservative industry, our cottage nature is confounding and for a profession that highly leverages the peer review process in sharing knowledge, we take a parochial perspective when sharing best practices. As a result of these and many other factors, the way our profession is compensated has morphed in negative ways to the exclusion of some, the short term gain of others, and ultimately to the demise of all.

I think we can do better; I know we can do better; and I look forward to being a contributor to the required change. Given my cumulative experiences, I believe the way that I can have the most impact is in the actual “rubber meets the road” delivery of care. As a physician, it is my privilege to touch patients through practice delivery innovation that incorporates the best thinking, technology, and talent that can achieve the best outcomes. All that I have learned, experienced, and seen during the last several years is going to be leveraged in the creation and implementation of Crossover Health.

I look forward to having you join me for the journey.

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Filed under Change Agents, Crossover, Entrepreneurship, Innovation

September 25, 2009

Customer Disservice: Health Care #FAILs again and again

Disservice (dĭs-sûr’vĭs)

  1. A harmful action; an injury
  2. An act that is not just

Our health care system is completely devoid of customer service. It is pathetic.

I took my son to have a simple tympanostomy (ear tubes) procedure this morning. I show up, sign in and take my seat amidsts the throngs of people in the surgical center waiting room. I brought my laptop and some reading materials to bunker down for the long wait ahead.

20 minutes later I get called up front to sign some additional paperwork. Instead of being greeted, 15 documents each complete with a full page of legalese is shoved my way regarding various aspects of responsibility, payment, agreement, arbitration, and host of other information. The grumpy lady has clearly done this a thousand times and she has absolutely no tolerance for any of my questions. She paries my first few skillfully, but I don’t let her blunt my questions regarding the finances.

She shows me that the facility is charging me $5,600 but that fee has been reduced by the insurance to $1,799. This is an all in fee for the facility only (includes staff, equipment, monitoring, etc) and does not include fees charged by the physician and the anesthesiologist. I ask what those charges will be (I already knew ahead of time), but she says she is not responsible for their charges and that I would have to speak with those providers about that. I start asking her why they don’t bundle everything into one price so I can compare across various combinations of facilities and providers. She has no idea what I am talking about and ends the conversation by giving me their phone numbers. Take your seat Mister, how dare you ask a question about pricing comes across clearly as she stares me down to my seat.

I immediately pick up the phone and talk to the physician office. After about 10 minutes, I finally get the billing person who is able to provide me the CPT code (69436) and Zip Code (92691) as well as what they charge for procedure ($345). I tell here I am not interested in her price because it is irrelevant and that Blue Cross has already dictated the price that you are going to get. A little defensive, she then relays to me the the administratively set Blue Cross reimbursement that has been dictated to this particular physician ($208.08).  I then ask her about bundling of services and created an Ear Tube product that would include all the components so that I can compare across facilities and providers. She has no idea what I am talking about. I give her the hamburger example (I don’t get separate receipts for tomoatoes, buns, and burger – I get a single price for the thing I want – the complete hamburger). I refer her to Carol.com as an example and she thinks this sounds like a good idea.  When I ask why they don’t do it now that she understands, she says that she doesn’t think the physicians would ever agree to work in that way. She tells me she will pass this along to the physicians, and with a laugh that indicates that will never happen, we end the call.

Next, I call the anesthesiologist group. First the lady attempts to tell me she can’t give the pricing because it is a HIPAA violation. I quickly disabuse her of her ignorance and get her manager on the phone. Anesthesia is unique in all of medicine because anesthesiologist charge for their time in increments called units (typically 15 minutes). So they get a “set up” fee and a “time-based” fee for their services, both in terms of units. So I ask them what their per unit charge is and the manager tells me that it is proprietary information. I call him out on it and say that pricing information is not proprietary, perhaps his costs structure is, but he has a duty to tell me the cost of the service I am about to engage him in. I am pretty frothy at this point and really lay into this guy. He still refuses to tell me his proprietary, negotiated per unit rate with Blue Cross but relents on giving me the overall price. He then passes me along to someone else who looks up in their database and tells me the cost will be either $300 or $360 for the procedure for either a 15 minute or 30 minute anesthesia time. So, knowing they go in 15 minute unit increments, I can tell that there is either 5 or 6 units involved, and therefore a $60 / unit price. So, full pricing is 4 units “setup” and either 1 or 2 units for their time. So much for your proprietary formula and negotiated pricing. $60 bucks every 15 minutes or $240/hour for anesthesiologist time. Thats mid-tier lawyer rates for South Orange County but interesting in how at least this type of physician’s time might be valued by insurance companies.

So finally, after about 45 minutes of phone time, by someone who knows the ins and outs, all the secret handshakes and covert codes, and most aspects of healthcare financing, I am able to arrive at an all in price for a very simple surgical procedures:

Tympanostomy
CPT Code: 69436
Zip Code: 92691
Facility Fee: $1,699.00
Surgeon Fee:  $208.08
Anesethsiologist Fee: $360.00
TOTAL:  $2,267.08

This is great to know the price information for my selected combination of facility and physicians. However, I have no information on outcomes achieved, safety rates, customer satisfaction, or other metrics to determine if I would not be better off with a different combination of facilities and physicians. What do you think the response was when I attempted to ask about health outcomes for my physician?

Pin drop, anyone?

This is not just another rant, but meant to highlight that the very basic, fundamental courtesies expected during a consumer transaction are all but non-existent in health care. Simple things like getting pricing information, like getting helpful customer service, like understanding what you are buying, and the quality features that attract you to purchase something in the first place. Health care should be one area where customer service is impeccable. I believe you begin to see “brands” emerge that get this, invest in it, and deliver it consistently over time. Looking forward to the ongoing retailization of health care – it truly needs it.

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Filed under Consumerism, Rational Choice, Transparency

September 25, 2009

Sermo makes the connection: Health Reform leads to Cash-based Practices

Connection (kə-nĕk’shən) n.

  1. The act of connecting.
  2. The state of being connected
  3. An association or relationship
Sermo finally makes the connection between all the health insurance reform conversations and the inevitable consequence of pushing a large percentage of providers toward a cash based practice. I have highlighted the rise of direct practice multiple times, and believe enough in the model that I am currently creating a direct practice network for Southern California. There are multiple emerging tools that will make this much easier and I believe the inevitable financial reimbursement fallout will result in a dramatic rise in the number of physicians moving to this model.

The comments below are only available once you log into Sermo:

The past two weeks have seen polls come out that would appear to portray physicians with diametrically opposite positions in the current healthcare debate. A September 14th poll of 5,157 physicians in New England Journal of Med… indicates that:

  • 63% of physicians support a combined public/private approach to coverage (i.e. the healthcare reform approach currently proposed)

A poll two days later by IBD/TIPP of 1,376, also randomly selected physicians, indicated that [LINK]:

  • 65% say they oppose the proposed healthcare plan
  • 45% of the respondents stated that they would consider leaving medicine if the reforms were in fact enacted

In parallel, there has been a dramatic acceleration in the number of discussions around cash-on… While fee-for-service or “cash only” practices have long been a popular topic on Sermo, there appears to be increasing interest in this as the healthcare debate has progressed.  Given the growing impact of this trend, the media is asking the Sermo physician community to help asses this trend and the possible impact on the physician-patient relationship.

Sincerely,

Daniel Palestrant, MD
CEO & Founder, Sermo

P.S. Get your colleagues involved. And help us make a big statement to the media. Cut and paste this link into your outgoing email: https://md.sermo.com/medical/ticket/details?id=41104

3 Comments

Filed under Consumerism, Crossover, Innovation, Insurance

September 5, 2009

Open Letter to Athena: Open Up the Afterburners!

Afterburner (af·tər′bər·nər) n.

  1. A device for augmenting the thrust of a jet engine by burning additional fuel in the uncombined oxygen in the gases from the turbine
  2. The augmentation of thrust obtained by afterburning may be well over 40% of the normal thrust and at supersonic flight can exceed 100% of normal thrust

athenahealth is one of my favorite companies anywhere. I believe they have a great vision, a highly capable team, an incredible business model, and an unprecedented business opportunity before them. However, for all the amor, I have been disappointed that even with all their blistering success (Bam, Bam, and Kabam!) they have captured less than 2% of the target market since the IPO. I am not just disappointed for them but for the entire ambulatory care space which doesn’t seem to readily get the value of the collective intelligence inherent in the network.

In November 2007, I attended a technology conference with Jonathon Bush in the LA area. Jonathon was in rare form that day (probably trying to get psyched for his WFC battle with Allscripts CEO Glen Tullman which never materialized – Glenn was a no show) and I challenged him to get serious about getting his software in the hands of as many physicians as possible. We had an animated 45 minute banter on how this could actually happen. He asked me to write up the proposal I drafted on the back of a napkins that were doubling as our ad hoc whiteboard.  I think he briefly considered it, but the business focus and the upcoming IPO made it just a passing interest. Now, nearly two years later, I still think what I wrote is highly relevant and could be highly very useful in helping athenahealth rapidly expand their current book of business.

My pitch to athenahealth, then as now, is to turn on the AFTERBURNERS by opening up the platform:

November 6, 2007

Provocative Quotes

Business Case

AthenaHealth is the hottest health care information technology on the planet as I write this. The recent oversubscribed IPO has been sequentially followed by exceptional national press coverage, impressive recent customer wins, and an ongoing run up in the stock price.

This unprecedented public launch is another confirmation of Athena’s compelling business model. Athena provides back office automation software that leverages a proprietary claims database and workflow engine that dramatically reduces the inefficiencies of medical practice finances. As a result of this technology, Athena has been able to provide medical practices with real-time information on claims, cash flow, and financial optimization. By focusing on the revenue cycle management service, Athena knows first hand how relevant clinical information is the creation and management of financial information. In order to more effectively capture that information, Athena recently launched AthenaClinicals, their web based EMR which complements their web-based AthenaCollector software.

Because Athena’s business model is based on revenue cycle management, and the clinical software is a means to acquire better financial data, Athena does not have to charge money for the software itself and choose to sell it as a service. In fact, since the revenue model at AthenaHealth makes money off the increased collections, Athena is willing to go at risk on implementations.

This representats one of the new school business models and an evolution of the Software Value Chain evolution. Furthermore, due to its architecture of participation, each new practice becomes a contributing member of the Athena Network. This Network effectively creates a natural “collective intelligence” and collective experience around best practices, insurance rules, and financial optimization. 

Because Athena was conceived as a “Software as a Service” company and because the revenue model does not involve software licenses, the value of AthenaClinicals does not reside in the features/functions, but in its ability to gather bits and bytes. The greater the ability to gather bits and bytes, the greater the ability or opportunity to generate revenue streams. It therefore stands to reason that the more broadly your bits and bytes gathering ability is distributed, the more opportunity you will have to generate revenue. Why not have as many doctors as possible using AthenaClinicals by making if freely available for their use?

This decision would allow you to reap the whirlwind of innovation, while still protecting all your proprietary knowledge and intellectual property within Athena Collector and Athena Enterprise applications. Access to the Network would continue to be on a subscription basis but you would open up development and collaboration opportunities which you have not previously contemplated. The Athenista’s will be celebrated as hero’s, an appreciative community would form and become a veritable “army of messengers”, and I believe you would continue to force disruptive change within the industry.  Based on your successful business and your successful brand, I believe that you could accelerate the creation of a public good that you have previously discussed by engaging a worldwide public of developers, users, and potential customers.

Specific and tangible additional benefits would include:

  • Get the benefit of solidify your message that “Software is Dead” and the “Network is Nirvana”
  • Get the benefit of a huge branding and buzz opportunity
  • Get the benefit of expanding the number of potential developers of the software
  • Get the benefit of expanding the number of potential users of the software (decrease adoption impedance)
  • Get the benefit of having a larger installed user base to upsell your professional version and access to AthenaNetwork
  • Get the benefit of collaboration from partners, players, and payers that you have currently not contemplated
  • Get the benefit of co-announcing and co-branding with Red Hat and/or Ubuntu to leverage up on the ongoing buzz associated with Linux
  • Get the benefit of creating a community, neigh an entire nation of Athenista’s, who plug into the network effect which you have amplified.

I have struggled to find a compelling reason not to do it. Most companies struggle with the decision due to their business model reliance on software licensing. Not your problem. Others struggle because they are so conservative or do not want to disrupt current partners. Not your problem. Still others don’t make this decision because they do not have the corporate resolve or insight to see where the market is going. Not your problem.

Again, I realize this will have the flavor of a religious conversation, but I believe in there is a valid business proposition in this proposal. I honestly believe you guys can accelerate your current trajectory – opening up the afterburners by opening up your software.

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Filed under Innovation, Open Source, Value

August 24, 2009

Healthcare Pioneer: EHR Vendors start their outreach

Pioneer (pī‘ə-nîr’) adj.

  1. Of, relating to, or characteristic of early settlers
  2. Leading the way; trailblazing

When I worked shifts in the ER, I was trained and learned to be weary of people who were overly complimentary or attempted to become too familiar. It is a personality defect seen in those with borderline personality and often in drug seeking behavior. The appeal to the ego can provide a tug into the deep waters, but that natural hesitancy and wariness kept me in the safe shallows more than once. The often innovative ways these people appeal to the ego is almost as interesting as the sudden shift into the vicious when you don’t give them what they want.

So it is with that familiar wariness in which I review alot of incoming email I have been receiving as of late. The traditional EHR vendors are getting more and more innovative with their marketing approach. Take note of the interesting email from a company that I actually respect for a solid product – Greenway Technologies (see below). I evaluated them very thoroughly in late 2008 and noted that they have a very solid, traditional  system specifically tuned to the current quagmire in which physicians practice. They have a decent EMR, decent practice management, solid PHR, and an interesting twist on population management with their clinical research (glorified registry) functionality.

However, I couldn’t pull the trigger on them because they were tuned for the traditional. I didn’t see that they were leveraging the concept of the network, or their EHR as a platform, or that their UI technology was fluid or as modern as I wanted. I didn’t get a sense for the flexibility and freedom found in the notion of clinical groupware. And finally, I didn’t get the sense that they were going to take me to the next level. Please – don’t get me wrong,or  attempt to outKLAS me, or bang on their numbers which are impressive. They are a solid player who will do well – but it wasn’t for me or the network of primary care clinics that I am wanting to build.

Needless to say, I found their marketing approach to be quite pioneering:

Healthcare Pioneer,

You are probably wondering how you became designated as a Healthcare Pioneer by Greenway.  We define such an influencer as an organization or individual who is involved in leading the development of the Health IT community, implementing EHR’s at the point of care and optimizing the opportunity at hand presented to us by The American Recovery and Reinvestment Act of 2009/specifically the HITECH Act.  We polled our employee base and asked: “Who in your respective region/professional arena do you hold in high regards and value as it relates to our mutual $45+ Billion market place?” You were nominated for your leadership and dedication to creating the most efficient and effective healthcare transformation through Health IT.  As we grow our network of influential leaders, and jointly capitalize on the media driving our Health IT sector, we extend a gratuitous “Thank You” to you for being a part of our success.

In an effort to provide continued educational awareness, as well as provide mutually beneficial opportunities, we will begin disseminating periodic, customized Corporate Communications outlining current Industry news, industry achievements & milestones, Webinars, as well as pertinent Health IT Transformation and Healthcare Reform activity from Capitol Hill.

Did You Know?

  • 27,000 Healthcare Providers and Professionals call upon Greenway’s integrated EHR, Practice Management, Interoperability and Clinical Research solution everyday … denoted by the name PrimeSuite®.
  • 315 plus dedicated Greenway employees have driven over 30% annual revenue growth the past 3 years consecutively.
  • Over 19 Million Electronic Records are managed comprehensively and efficiently throughout 49 states (and the Nation’s Capitol) by highly satisfied Greenway customers.
  • Over 1,375 unique interfaces from 115 plus 3rd party vendor participants find themselves internally managed via Greenway’s PrimeExchange® interoperability engine producing hundreds of thousands of transactions monthly and creating a simplistic workflow for our thousands of customers.
  • Best in KLAS, our industry’s “Consumer Reports”, has ranked Greenway Best in KLAS three consecutive years in a row.  In 2008 Greenway was awarded Best in KLAS in 3 categories, including 2-5 Ambulatory EMR, 6-25 Ambulatory EMR and 2-5 Practice Management, making Greenway the only Ambulatory-focused organization to receive multiple Best in KLAS awards in 2008.
  • Greenway is a leading national speaker on how the current EHR “meaningful use” and Certification criteria are evolving. We have testified and/ or addressed Congress as well as both Presidential Administrations on twelve occasions regarding Health IT.

To Learn More:

Without question, there are some remarkable, opportunistic and exciting times before us and
Partnering with you will continue to be a Privilege. Thank you again for thinking Greenway!

Call today at 866.242.3805 or email us at info@greenwaymedical.com

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Filed under EHR, Entrepreneurship, Industry, Quality, Value

August 21, 2009

Microcapitation: Prometheus Catches Fire

Prometheus (prə-mē’thē-əs) n.

  1. A Titan who stole fire from Olympus and gave it to humankind, for which Zeus chained him to a rock and sent an eagle to eat his liver, which grew back daily.
  2. A personification of the unconquerable will opposing greater power, forever chained and suffering but confident of the ultimate triumph of his cause.

The second health financing innovation with relevance to the Healthcare XPRIZE was highlighted in the most recent New England Journal of Medicine article. The Prometheus Payment Model has been a longstanding project of Francoise De Brantes (of Bridges to Excellence fame) and folks like Doug Emery who have been beating the “episodes of care based” financing for years. I have had some great conversations with Francois and Doug over the years and I am pleased to see their ideas actually being implemented in some pilots sponsored by the Robert Woods Johnson Foundation.

Prometheus is a payment concept based on clearly defined episodes of care  wherein all the services provided can be bundled together in discrete “Care Packages” (not everything fits neatly into this construct as they note). These Care Packages are then assigned a global budget from which all care providers must deliver their services (technical term is Evidence Informed Case Rate). The Care Packages are further adjusted for patient severity as well as for Avoidable Patient Complications (APC). These are things like hospital acquired infections, exacerbation of chronic conditions, or other events that if optimally managed would not have occurred.  This payment model rewards providers for organizing along the entire episode of care. It clearly is a move away from independent, discrete payments for disconnected care to a new model of continuous view of all the events that make up the episode. The global budget for a clearly defineable event creates financial incentives toward high performance and quality outcomes.

I was the first to call this new payment model “Microcapitation“, and describe further in another post. The NEJM article is a good read, and highlights many of the talking points that I strongly believe in:

  • Rewards for value not volume
  • Rewards for quality not quantity
  • Rewards for the organization and coordination of care
  • Provides a financial integration mechanism for non-integrated providers to work together
  • Provides financial incentives to reward the above
  • Leaves plenty of room for innovation and improvements underneath the global budget.

I  hope to see the Prometheus model gain additional traction. A variation of this concept and much simpler to follow is the highly successful “Proven Care” model employed by Geisinger (see their excellent website describing the development process and the elements of their Angioplasty episode of care). I am encouraged to see these begin to flourish as part of the ongoing efforts of health care innovators.

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Filed under Health Finance, Healthcare, Innovation, Quality, Value

August 20, 2009

Utah leads out with new virtual health insurance exchange

Exchange (ĭks-chānj’) n.

  1. To give in return for something received; trade
  2. To give and receive reciprocally; interchange
  3. A place where things are exchanged, especially a center where securities or commodities are bought and sold

There have been several interesting health finance innovations that have been announced recently which have relevance to health reform in general and the some of my work at the Healthcare X PRIZE specifically. I wanted to first start with an announcement from the State of Utah that their version of a Health Insurance Exchange is now “open for business”. The Utah Health Exchange is based on a multi-year, multi-stage health reform effort in the very progressive but conservative state (is that possible?). The plan has three main components:

  • Defined Contribution
  • Virtual Health Insurance Exchange
  • Risk Adjustment

Each element is described in a detailed communication from Edmund Haisimaier, a Senior Fellow Research Fellow in the Center for Health Policy Studies at the Heritage Foundation. Before you dismiss this effort as some conservative schtick from the right, you should actually look at what they are doing and how they are doing it. It is actually a fascinating read.

My take: BRAVO! What Utah is doing in health financing is something we should be seeing alot more of in the future. Couple points of comment:

Defined Contribution. I also love the notion of a “defined contribution” coming from employers. This is also a no-brainer – let the employees both see how much you are contributing to their health as well as give them the flexibility to make their own choice. These ideas were made popular by Definity Health, and I love seeing this concept move forward. For me, this will be the “death knell” of employer based insurance if this concept takes off – which I see as a very positive outcome.  I have already ranted about Employer Based Insurance in the past and the sooner we decouple this unnatural relationship the better off our country will be.

Virtual Health Insurance Exchange. Leveraging a technology platform (eInsurance in this case) to bring together all the disparate information to make an apples to apples comparison of various health insurance options. This allows the consumer to make rational choices based on their own preference sensitivity of price, features, benefits, and other metrics. I love that insurers, and the brokers who push their products, will have to do more than convince an HR manager who makes a company wide decision, but rather have to compete consumer by consumer by offering the best value. The technology makes it possible to compare dozens of different plans based on age and family status simultaneously. The agent role turns much more into that of a value added advisor.

Risk Adjustment. This is actually much harder to follow. Essentially, Utah is laying the foundation to create a state wide pool with everyone who has insurance being a part of a single pool. On the “front end” when the consumer purchases the insurance there will be some variation in pricing based solely on age and family status. However, on the “back end” the insurer taking the diabetic will actually get a little bit more of the premium. Furthermore, any insurer who has an inordinate amount of large expenses or wide variations in claims will receive additional credits from the other insurers. This innovative wrinkle can actually entice other insurers to participate as these “adjustments” further minimizes the risk that their “pool” performs worse or costs more than others. Essentially, the Utah Health Exchange pools premiums from all the consumers, each insurer provides coverage during the year, and at the end of the year they redistribute a portion of their premiums to any insurer who took an excessive hit during the year. The details of how this will work in practice were not included but the concept is very interesting.

This is exactly the type of health financing innovation we need to be seeing. New ways to pay for insurance, new ways to acquire insurance, new ways to spread and pool risk, and new business models that will allow these concepts to flourish.

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Filed under Innovation, Insurance, Value

August 5, 2009

CLEAR! Shocking Google Health Back to Life

* This is the second part of my commentary on the June HealthVault Connected Care Conference in Seattle. I hope to use this post to motivate my good friends at Google Health into taking a much more public, visible, and proactive role in the health conversation. More importantly, it is a call to Google HQ to wake up to the opportunity within health care to leverage their current tools and technology to create a platform that others can use to enable the creation of a next generation health system.

The scene was familiar, but it didn’t take away the tragedy. A young motor vehicle accident victim was involved in a head on collision with a drunk driver. The blunt trauma to the chest had created a literal mish-mash of complex internal injuries. The ambulance crew had attempted multiple times enroute to obtain a pulse and the monitors were all flatlined from the field. They intubated the patient in the field, performed CPR enroute, and initiated a ATLS protocol which included shocking the patient en route. In the face of asystole (lack of heart movement) after blunt trauma to the chest, the indication is to literally crack the chest open (called a anterolateral thoracotomy), a serious medieval last ditch rescue effort to save a life.

My perception is that the Mack truck called Microsoft HealthVault has just run over a young upstart, Google Health, who had such a promising future. The blunt trauma has put the patient in a precarious fight for survival, and the only way out that this ER doctor can see is to crack the chest open.

I really like Missy, Roni, and crew and believe they are smart, capable, and well connected individuals who have really done some great work to get the product launched. However, I cannot for the life of me understand why Google as an organization cannot get serious about the Health care vertical. A couple of stats:

My most recent assessment of the Google Health vs. Microsoft Health Here is my most recent assessment of the Microsoft Health vs. Google Health

It is not like Google couldn’t do some amazing things very fast. I am not just talking about Google Wave style innovation, I mean just their current assets themselves could be reassembled in short order to produce a very useful health care communication platform. They already have gmail, calendering, photos, search, documents, video, chat, and a framework from which to store/retrieve their health information. I think you could build out a mashup in no time that is immediately competitive and would be the leading “groupware” tool available. They also have all their current relationships and the interest of any health care CEO in the country.

Ironically, the reference to iGoogle (platform w/ widgets of functionality) was mentioned more than once at the Microsoft HealthVault conference. I don’t remember hearing about this at the Google conference – oh, oops – Google doesn’t have a conference.

I guess my point is that I love the innovation machine that is Google. I am just profoundly disappointed at what appears to be a lack of commitment by the organization to truly invest and innovate in the health care space. Is it a strategy question? An opportunity cost situation? Why the paralysis?

Google! The patient is dying on the table. The only thing I can see doing at this point is getting out the rib cutters.

6 Comments

Filed under Conferences, Innovation, Irony

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