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Archive for the ‘Analytics’ Category

CR_brandWebNovember saw the acquisition of yet another HIE vendor by a payer (Humana). An in-depth analysis of this acquisition and its implications was provided to Chilmark Advisory Service (CAS) clients at the end of November. Following are abstracts of the three research notes in our latest Monthly Update.

Humana Leaps Into the HIE Market
The health insurance industry is undergoing massive upheaval. Payers don’t need a crystal ball to see that in the near future, providers will sell services directly to employers, and that insurers need to get creative in order to stay competitive. With its acquisition of HIE vendor, Certify Data Systems, Humana joined two other payers in the HIE market: Aetna and UnitedHealth Group. Yet Humana’s strategy sets it apart from the other payers. On a single day in November, Humana announced not one but three acquisitions: Certify plus two Florida-based managed care service organizations. Humana has clearly articulated its plan to become the preferred Integrated Delivery Provider to Medicare Advantage members and dual eligibles. By adding Certify’s strong HIE capabilities to its bag of tricks, along with the ability to deliver primary care directly to a large Medicare population, Humana has positioned itself to do just that.

Taking Population Health from Claims to Clinical
As you know from past updates, the burgeoning field of healthcare analytics is a top priority here at Chilmark Research. This month, we take a look at population health management and current efforts to adapt existing claims-based risk management to clinical settings. Population health and risk management have long been the purview of health insurers and public health departments. Yet as providers take on more risk, they will need to identify populations and sub-populations that could benefit from preventive health – and ultimately cost less in healthcare services. THis research note takes a look at some of the traditional, claims-based analytics vendors and their intentions to move into analysis of real-time clinical data sets.

From Med Lists to Meds Reconciliation to Meds Adherence
Ask any home-care provider, and you’ll hear stories of medicine cabinets chock full of old, unused medications. Chronic disease and frequent hospitalizations compound the problem, because patients end up with medications from before and after each hospital stay. It’s no wonder that medication maladherence is recognized as the most important driver of preventable readmissions. But understanding the problem is much different than finding a solution. Chilmark Research reports on the current fractured state of medication adherence, and argues that without deep provider engagement and interoperability across systems, true medication adherence programs will remain a pipe dream.

Each month, subscribers to the Chilmark Advisory Services (CAS) receive an update of our research on the most transformative trends in the healthcare IT sector. Exclusive to CAS subscribers, monthly updates are part of the continuous feed of information and analysis we generate to keep subscribers on top of the rapid-fire changes in this market. Below is a summary of what we covered in the latest update, which was distributed in November.

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Cerner is embarking on a journey of transformation. That transformation, if successful, will culminate in Cerner becoming more than a health IT company to becoming a health company. They’ve tested much of this strategy internally with onsite campus clinics, health and wellness challenges, the creation of rich consumer/patient engagement tools, heck, they have even created their own third party administrator (TPA) as Cerner is self-insured. The company wishes to take these lessons learned, these solutions that have been developed, to transform their company into a health company to address not only the patient experience in a clinical setting, but the patient/consumer health experience throughout the community.

This is all a part of Cerner’s Healthe Intent strategy, a strategy we received a deep dive in during our recent attendance to the Cerner User Conference in early October. Healthe Intent is a big, grand, bold vision in an industry where there seems to be a dearth of such visions. Whether or not Cerner is successful, Healthe Intent certainly has its fair share of challenges, rests more with Cerner than any other outside force.

In the October Monthly Update, which is exclusive to Chilmark Advisory Service (CAS) subscribers, we provided subscribers a deep dive into Cerner’s Healthe Intent strategy and what its implications are for both Cerner and more broadly, the healthcare industry. Each month, CAS subscribers  receive an update of our latest research findings on some of the most transformative trends in healthcare IT. This is all part of the CAS service, a service that provides a continuous feed of research findings and access to our analysts keeping CAS subscribers abreast of the rapid-fire changes in this market. Below are abstracts of the other two research notes we published in the October Monthly Update.

 With Readmission Penalties Looming, Can Care Get Coordinated?
CMS penalties for patient readmissions within 30 days of discharge went into effect October 1, posing a very real challenge that all hospitals must now address. Needless to say, better care coordination across various settings will be critical to cutting back on readmissions. Currently, patients are transferred from venue to venue with incomplete records, leaving providers to fill in the blanks in their care. Healthcare IT has long been promoted as a magic fix to this problem, but it will take more than technology to truly coordinate care, and different patient populations pose different technology needs. This is partially why our 2013 HIE Market Report will pay particular attention to what solutions vendors may be developing to ensure providers have complete patient data.

Clinical Analytics Gears Up for Second Wave
The second story continues to unwrap the analytics market. Though other sectors have used analytics to make business decisions for decades, all but the most innovative healthcare providers lagged behind under fee for service. With that reimbursement model on its way out, the second wave of healthcare providers are grappling to choose an analytics vendor, even as many work through the rocky early years of electronic health record adoption. These providers are in for a confusing procurement process, with a market awash in vendors claiming to offer a clinical analytics solutions. To say this market is getting heated is putting it mildly.

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Today, national health insurer, Humana, announced that it has acquired Certify Data Systems (CDS). This marks the third HIE vendor (UHG acquired Axolotl & Aetna acquired Medicity) that has been acquired by a payer in the last couple of years. Not that surprising when one looks at how aggressively payers are moving into the accountable care arena and seeking to form tighter links with physicians in their network, particularly those in the ambulatory sector, where CDS has done particularly well.

A key part of CDS’s success in the market was through its partnership with Cerner where it provided the technology stack for connecting ambulatory practices. The Certify HealthLogix is a well architected platform that has seen strong adoption. While terms of the deal were not disclosed, it is our guess that Humana paid a pretty penny for CDS, likely all cash deal at about 6-8x estimated 2012 sales.

While it is good to see that CDS leadership will stay in place, at least for now – serial entrepreneurs, such as CDS founder Marc Willard, typically do not last too long in large corporate entities such as Humana- we do have some concerns with Humana’s ability to actually manage a software company. This is way outside their core competency and hopefully they know well enough to provide CDS the resources to scale but also the wisdom to let CDS call most of the shots.

We will be providing Chilmark Advisory Service (CAS) clients with a more detailed breakdown of this deal later in the week after we have had a chance to speak with some key contacts/stakeholders of this acquisition. This will be pushed to subscribers via an Alert.

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Healthcare is awash in data but starved for information. Progress has been slow in adopting analytics within healthcare. A key ingredient that could speed up the development and adoption of analytic approaches appropriate for healthcare is clarity in both terminology and technical products.

The road ahead requires a classification of analytical needs. Healthcare analytics is all over the map at the present time. It is unclear if this problem is due to the fact that both vendors and healthcare organizations alike are unable to articulate the scope of analytical needs. Problem may also simply be a by-product of what is a rapidly changing market and the struggle that all stakeholders are facing in trying to position themselves for a future state that still remains undefined. Given the lack of clarity in defining analytical needs, vendors offer varied and sometimes random solutions hoping to address problems.

Fixing this problem will require clarity of thought – including a taxonomy and definitions. For simplicity, the bastion of big data—life sciences should be kept separate. My discussion of healthcare analytics relates to patient and population centric data, including data from numerous sources e.g., clinical, claims, etc.

Commonly touted claims from software vendors state that their analytical tools will help physicians make better decisions and improve quality at point of care. However, the claims are often not specific enough. My interviews with multiple healthcare providers and even some technology executives suggests that many are confused by the claims made by tech companies today. “I find this confusing,” is a common refrain. Conversations with numerous vendors in this emerging industry elicited disparate responses to any single problem.

It is hard for target customers to understand the differences among the various offerings in the market. Healthcare providers are under immense pressure to improve clinical outcomes while reducing costs. In this highly competitive arena, effective analysis and use of data (clinical, financial and operational) to improve quality and outcomes while reducing costs will give healthcare organizations a foothold for profitability and success.

Software vendors need to acknowledge openly that no single analytics solution can tackle all the needs of a given healthcare organization. Then, they should identify specific problems that their technology excels at addressing and equally importantly, problems that their technology does not solve well. By doing so, vendors will bring greater clarity to the market as to what their solutions are capable of performing.

In addition, standardizing clinical data entry and providing clarity around this data so that it is truly credible for analysis is going to be critical. Success of analytical tools is highly dependent on data integrity. A single erroneous data has the potential to have life threating consequences. It will be the responsibility of healthcare organizations and their chosen partners to provide this clarity of data for the analytics solutions chosen.

In this nascent industry, vendors should consider incorporating a ‘checks and balance’ tool to catch errors. Clinical data entry can vary due to human oversight. A simple example, an adult patient may see multiple doctors over a period of 6 to 8 weeks. Across all these appointments, it may not be surprising if this patient’s height has been entered incorrectly. As industry veteran, Larry Yuhasz, Director for Strategy and Business Development, Truven Health Analytics (formerly Thomson Reuters Healthcare) recently pointed out, “EMR data is all over the place. If analytics for clinical support has to be optimized, clinical data has to be standardized.”

It will take an unique group of thought leaders in healthcare organizations and vendors alike to intuitively and pragmatically understand the analytics’ challenges within healthcare. Classification of needs will help vendors build appropriate tools that can be nimbly customized as organizational needs change. The products developed by this unique group will own significant market share once the dust settles in this sphere.

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At this year’s HIMSS conference the big buzz was analytics. Seemed as if every vendor in attendance was promoting some sort of analytics capability. It was a tad overwhelming and if I was having a problem trying to separate out all these countless vendor offerings (this is exactly what I am trained to do as an industry analyst) I couldn’t imagine what it must have been like for those representatives of healthcare IT departments.

Then I had this deja vu moment – I had experienced this all before a few years earlier when the buzz at HIMSS was health information exchange (HIE). As with the HIE market back then, it was hard to make sense as to who was riding the latest marketing buzzword (e.g., ACO analytics) and who was actually solving problems for customers. There was also no easy way to differentiate one solution from the next. Clearly, the market needed someone to make order from the chaos.

Making order, applying structure to a market is one of the key roles of an analyst firm. As Chilmark Research has done for the HIE market, we intend to develop a similar structural framework for the analytics market.

We have recently embarked on a major research project to delve into the healthcare analytics market that will culminate in a report of similar length (~100pgs) and breadth to our 2012 HIE Market Report. Padmaja Raman, who recently joined Chilmark Research, will be the lead analyst for this research project.

In advance of formal research, we have had roughly a dozen casual conversations with various stakeholders in the healthcare analytics market. Here’s a few things we have learned so far:

Two dominant market vectors: 1) Changes in reimbursement and associated risk. 2) Regulatory requirements (MU attestation, quality reporting etc.)

Analytics using clinical data is in its infancy.

Clinical datasets are typically a mess and very difficult to work with.

For foreseeable future, most healthcare organizations will need to rely on claims data to ascertain risk.

We may be years away from doing true real-time analytics with clinical data.

Most healthcare providers do not have well-trained informatists on staff (particularly problematic for smaller healthcare organizations) and thus “analytic offerings” will have a high service component.

Business intelligence (BI) tools are not well-developed (either too simplistic or too complex for average clinician) and thus clinicians are unable to run their own reports. This has led to IT departments being completely overwhelmed with clinicians asking for various reports.

Those pretty dashboards that are based on clinical data which you see at trade shows and in PowerPoint presentations can rarely be replicated at a client site – lots of smoke and mirrors.

Most EHR vendors are just getting started in this area and their solutions are rudimentary.

This is a fascinating market and one where I am confident we can provide value. Without exception, every stakeholder we have spoken to has stated that this market is prime for in-depth analysis. Now it is our turn to provide such – Stay Tuned.

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This morning, as most of you already know, the Supreme Court ruled that the Privacy Protection and Affordable Care Act (commonly known as ACA) is constitutional and basically left the entire law intact. While it was no surprise that this was a close 5-4 decision, it was surprising that rather than rule that certain sections of the law were unconstitutional (e.g., the individual mandate), it was either an all-in or all-out dividing line (those in dissent would have thrown the entire law out the window). In fact, among our esteemed and we like to think highly knowledgeable readers, two-thirds voted in our prediction poll that ACA would be circumscribed by the Supreme Court while 17% felt the law would be upheld in its entirety.

Implications of Decision:
We are an analyst firm that is focused on the adoption and use of healthcare IT. Thus the implications of the Supreme Court decision which follow are focused on just that:

Healthcare systems will continue to aggressively move forward to form comprehensive care delivery systems (acquiring practices, long-term care facilities, etc.) to more effectively manage their patient populations across care settings. This will in turn require greater clinical connectivity and integration across these care settings. Expect to see very strong demand for health information exchanges.

Payers will continue to struggle with improving their operating margins. Some, such as United Health Group and Aetna, have ventured into the more lucrative and higher margin HIT market via acquisitions. Expect to see other payers make a move here as well jumping into the HIT market via acquisition(s).

Payers will also venture directly into care delivery via partnerships with large providers to stand-up ACO-like entities (e.g., Blue Cross of CA & Dignity Health) or acquire (e.g., Highmark and West Allegheny). We may also see some payers be quite innovative and begin providing more state-of-the-art, low cost concierge care services such as One Medical to serve the vast pool of some 30M+ new members nationwide.

To effectively and efficiently survive under future bundled care reimbursement models, hospital systems will finally have to get truly serious about patient engagement. No longer can they view this as just something for the marketing department to deal with (listen to yesterday’s podcast) but will need to actively engage with patients and aggressively encourage self-management of chronic diseases. This need will lead to a blossoming of innovation in new solutions, be they mobile, telehealth, whatever you want to call it to improve patient adherence outside of the clinical setting.

Got Analytics? Yes, analytics is going to be huge but today, most analytics solutions are not up to the task of serving all healthcare provider needs, or at least no single solution/vendor is. Providers will need to accept the fact that for the foreseeable future they’ll be purchasing best-of-breed solutions. But providers also need to do their homework as we predict that there will be a significant amount of consolidation, via acquisition, in this market over the next five years. And one last word of advice to providers, don’t count on your EHR vendor to deliver these solutions anytime soon.

Of course there is far more that we could delve into on the implications of this ruling to the HIT market but for now believe we have provided enough to get your collective  juices flowing. Is there anything we missed that you believe is screaming out loud in the HIT market due to this decision? If so, please let us know via a comment – we love comments!

In closing, hope all have a great July 4th week ahead and…

God Bless America

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Earlier this year Chilmark Research launched its latest service, the Chilmark Advisory Service (CAS). One of the benefits of CAS is that subscribers receive a continuous feed of our research, from major annual reports such as the recently released 2012 HIE Market Report, to Quarterly Reports (e.g., mHealth Adoption for Patient Engagement) and exclusive to subscribers, the Monthly Update. Of course, subscribers also get unfettered access to our analysts to answer any specific questions they may have.

For the merry month of May, the Monthly Report touched upon four topics that are abstracted below:

Social Games for Wellbeing, Courtesy of Your Health Insurer
Much of this story was pulled from the forthcoming report that Cora is authoring that takes a close look at how payers are adopting consumer technologies (social media, gamification, mobile apps, etc.) to more effectively engage their members in healthy behaviors. This story looked at the current initiatives of Aetna, Blue Cross of California, Cigna, and Humana, each of which is taking a slightly different approach to more actively engage their members.

When Behavioral Health Goes Mainstream Will Technology be Ready?
This year, five states received grants of $600K each to explore how they would integrate behavioral health data into their statewide HIEs.  Analyst Naveen interviewed several stakeholders about how they would actually address the technology and policy hurdles to incorporate such data into an HIE. One of his findings, which he details in this story, is that current technology offerings from HIE vendors are ill-prepared to address this growing need to fold in behavioral health data into the HIE. Secondly, there remain significant policy issues that need to be addressed as behavioral health data is some of the most sensitive and protected health data.

Filling Gaps Separating Behavioral Health from the Healthcare Continuum
We had another story on the relative state of technology adoption within the behavioral health community. Our interviews with several stakeholders uncovered a market that is even further behind (at least 10-15 years) the rest of the medical community in IT adoption and use. As public health officials, healthcare organizations and others come to the realization that a significant proportion of chronic disease patients have a co-morbidity with a behavioral health issue, they are also coming to the realization that more effective care coordination must also occur with behavioral health specialists. John (the younger) takes a close look at what may develop in this market to fill the current gap.

Feds Look to Tighten Privacy & Security of HIEs
This last story took provided subscribers an assessment of the current Request for Information (RFI) for the Nationwide Health Information Network (NwHIN). The RFI was released on May 10, 2012 and is the an attempt by the U.S. government to establish a clear set of governance rules for the sharing and use of patient data within an HIE, and of course more broadly across the U.S., via the NwHIN. While the objectives are noble and to some extent needed, our assessment is that in several areas the RFI goes too far and will significantly hinder HIE innovation, deployment and adoption.

If you wish to learn more about CAS, please head on over to the Research Services page and towards the bottom there is a slide deck that provides a prospectus on CAS. If that piques your interest, drop us a line and we’ll be more than happy to answer any further questions you may have regarding the service.

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