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Intel Healthcare IT

68 Posts authored by: Eric Dishman

 

Mobile apps are making a big impact on the health of patients worldwide. That’s why I sat down recently with Martha Wofford, vice president, head of CarePass at Aetna, Inc., to talk about consumer empowerment, healthcare apps, and what the future of patient engagement technology will look like.

 

Watch the above conversation and let me know what questions you have about personalized healthcare and apps.

 

Eric Dishman is General Manager of the Intel Health and Life Sciences Group.

 

Follow him on Twitter (@EricDishman)

Read his other healthcare and life sciences posts

 

Not too long ago I had the opportunity to sit down with Jack Andraka, the 2012 Intel International Science and Engineering Fair award winner, to discuss innovation, cancer research and diagnostics, and where personalized medicine is headed in the future.

 

You may have seen 15-year-old Jack and his story about discovering an early cancer detection test on 60 Minutes, the Colbert Report, or other numerous media outlets. He is a bright young man and shares a vision with me about the future of healthcare.

 

Watch the video above and let me know if you have any questions.

In the currently raging debates about healthcare, there’s little attention to population aging and the cost of care — two critical trends that I call the $4.6 trillion question.

 

By 2020, there will be 55 million Americans over age 65, reflecting a global population aging trend that could be as important to our future as global climate change.  Also by 2020, according to federal government projections, the nation’s healthcare costs will be $4.6 trillion, close to doubling in a decade.

 

One of the ways we must respond to these trends is to use technologies that enable a model I call “care anywhere.” Thanks to a range of personal health technologies available now—mobile health (mHealth) capabilities for smart phones and tablets, telehealth technologies for remote patient monitoring and virtual visits, intelligent software assistants for prompting and coaching, and social technologies for connecting patients, families, and providers in powerful new ways—we have the opportunity to move away from costly, institution-centric care delivery for the majority of needs.

 

The core necessity is this: care must occur at home as the default model, not in a hospital or a clinic. We need this to curb escalating costs, increase access and improve patient experience and outcomes.

 

Policy makers are paying attention. Last month, committees in both the House and Senate passed Medicare reform through Sustained Growth Rate (SGR) bills with bipartisan support, encouraging greater interoperability and data exchange for electronic health records (EHRs). And a discussion of telehealth measures led to an agreement between the Congressional Budget Office director and Senate to work together on how to estimate savings, an issue that has plagued telehealth and mHealth for years.

 

But even with all of the excitement, reforms and investment activity around mHealth, the promise of care anywhere – made possible by mobile technologies, data analytics and real-time connectivity – is far from being realized.

 

I think about the importance of care anywhere from three perspectives:

 

As a patient who tried to force in-home, mobile and virtual care models for myself while undergoing cancer and chronic kidney disease treatment for 24 years, my fight was not just against cancer but against a flawed healthcare system.

 

As a social scientist who has studied the cultures of healthcare innovation, I have seen the many challenges we must overcome to redefine the roles of patient, caregiver and provider.

 

And as a business executive responsible for health innovation opportunities globally, I have learned a lot from other parts of the world that are deploying social, political and technical infrastructure for care anywhere.

 

A new Intel study found that more and more people are feeling empowered through new technology tools to become fuller participants in their own care. More than half of the respondents globally believe the traditional hospital will become obsolete in the future.

 

Today, technology is reducing unnecessary emergency room trips using real-time video collaboration between patients, EMTs and doctors and reducing doctor office visits with innovations such as in-home blood pressure, ultrasound and eye tests that instantly send information from your smartphone to your doctor.

 

In Indianapolis, where cardiac patients were treated using remote care technology, St. Vincent’s Hospital saw a 75 percent decrease in hospital readmissions, proving that care anywhere can take costs out of the system and better support patient recovery.

 

In the future, doctors will be able to track patients’ health instantaneously through ingestible tracking devices in their bodies. More than 70 percent of respondents in our research are even receptive to using tools like toilet sensors, prescription bottle sensors and swallowed monitors.

 

But no amount of technology innovation investment alone can help us mainstream mHealth. We need a shared roadmap and strategy to create a movement around these care models. Remote care will never gain momentum without laws that allow doctors to be reimbursed for effective patient care no matter how it is delivered.

 

Medicare reform through the SGR includes telehealth as a method for physicians to transition to alternate payment models. Reform should provide incentives to use advanced technology innovation, when appropriate. As Congress makes needed changes in payment, let’s take this opportunity to make bold changes in the way people access care. By expanding telehealth reimbursement for all chronically ill patients in their homes, not only will patients benefit, but the United States will see a reduction in Medicare costs.

 

The Wyden-Isakson-Paulsen-Welch Better Care, Lower Cost Act of 2014, introduced last week, offers a targeted approach for providers to focus on chronic care management by offering preventive services through new technologies such as telehealth.  This bipartisan, bicameral legislation would encourage providers to coordinate care and reward them for achieving healthy outcomes rather than for the number of services they provide. It’s about time we change the formula for smart care and payment in the United States.

 

Our nation is aging and traditional healthcare costs are unsustainable. Technology advancement has outpaced our laws. Patients have told us that they are ready to embrace care anywhere. It is time for policy makers to help patients, their families and a broader range of health workers innovate answers to the $4.6 trillion dollar question.

 

Here’s your personal invitation to join me for the Intel Health & Life Sciences Innovation Summit webcast series next week on Oct. 23-24. Register today and reserve your spot for the online discussions.

 

Watch this sneak peek clip from the Intel Health & Life Sciences Innovation Summit webcast series on Oct. 23-24. Register for the online sessions to hear the full conversations between me and Dr. Brian Druker and Dr. Brent James.

It is beginning to feel to me like cancer has become as common as the common cold. Almost everyone I know—in every aspect of my life—is going through a cancer experience either directly themselves or via a friend or family member.

 

The grand challenge to end cancer has certainly brought significant improvements to treatment over the past few decades, but there is still much to learn about the underlying mechanisms that cause so many diverse kinds of cancer to emerge and how they might possibly be slowed or stopped. There is still too much painful experimentation and expensive guesswork involved in treating an individual patient based on what medicine can glean from randomized studies of large populations. Healthcare today really can't know the individual in his or her genetic and disease complexity, and thus, often fails to deliver a treatment protocol with precision or positive results.

 

From roulette to precision

As a cancer patient advocate for more than two decades, I have witnessed firsthand what the lack of precision brings us. It leads to a kind of "diagnosis and drug cocktail roulette," as one oncologist described it to me years ago, because physicians lack the tools to really understand an individual's case. Thus, the grand challenge for thousands of patients I have worked with has been to survive the experimentation, the trials, and the side effects from the treatment. We all laugh but also cringe at the all-too-common mantra: "It's not the disease you have to worry about, it's the cure!" We must give medicine the means to customize cancer care—and all care—for each and every one of us.


Given these challenges, I am excited about today’s announcement that Intel and Oregon Health & Science University (OHSU) have formed a multi-year strategic collaboration to explore this kind of individually targeted cancer therapy. We will deploy next-generation computing to help solve the data-intensive challenges that personalized medicine for cancer really requires. Very complex problems—like developing the ability to “turn off” the spread of cancer in a particular person—demand multidisciplinary teams of experts working side by side. Together, Intel’s engineers and OHSU’s biomedical experts are optimizing supercomputing clusters and software to isolate the genetic variations that contribute to the root causes of illness.

 

From weeks to hours

For more than a decade, Intel technologists and social scientists have worked with OHSU (my first clinical fieldwork for Intel was in several OHSU hospitals and clinics back in 1999!) to move toward a vision of what I call "Personal Health." Our prior work together has focused on two of the three pillars of Personal Health: care anywhere and care networking.  We have developed technologies and care models for helping to care for people—especially seniors—in their own homes through telehealth, remote patient monitoring, online coaching, intelligent prompting, and care coordination of virtual, networked teams.

 

Today's announcement continues our innovation partnership with OHSU and focuses on the third pillar of Personal Health: care customization. Scientists can now gather billions of data points on how a specific patient’s cells are malfunctioning. Genetic abnormalities that cause these tumors manifest differently in each of us. What’s more, even a healthy human body creates millions of these mutations.  So it’s an enormous scientific challenge to determine, for each individual, which mutations are relevant in creating "my" disease. But that's where medicine must go.

 

We're bringing together Intel’s strengths in developing energy-efficient, extreme-scale computing solutions with OHSU’s pioneering work in imaging an individual's complex biological information in four dimensions (three-dimensional space and time). The calculations required to advance in this field are mind-boggling. Today, it takes weeks to analyze this information for an individual, but through this collaboration, we hope to shorten the data-crunching from weeks to hours and bring the costs down to something that can be clinically viable for every patient.

 

Digging into the ‘circuitry’ of cancer

If we succeed, this would mean more tests can be performed in a given time, with hopefully quicker discoveries. Eventually, this all leads to the promise of highly precise diagnostic tests to customize care for someone going through cancer because we can now understand that person’s particular mutations in enormous detail. But our joint team plans to do research not only into the mutations but also the "circuitry" that enables malignant cells to spread. The ultimate hope here is to learn how, for a specific individual, this circuitry can be “turned off” to stop the spread of cancer cells!

 

I know well what these kinds of breakthroughs could mean for patients. I have experienced my own "roulette game" of trials and experimentation for kidney disease for almost 25 years. In fact, I write this blog about our new OHSU-Intel collaboration from a hospital bed, as I recover from a routine biopsy of my new kidney transplant to make sure that it continues to do well. One of the things that helped get me to this amazing state of normal kidney function and good health again was having my whole genome sequenced.  It, too, took weeks of computing and then months upon months of analysis to make sense of my own unique case. Today, these tools are too slow, too expensive, and too rare—I want to make sure everyone has access to the kind of customized care that I lucked into.

 

Of course, there are no guarantees in this type of grand endeavor. We cannot know now how successful such investigations will be, or how soon average patients will benefit. But we do know that it is high time time to end the dangerous roulette game of diagnoses and drug cocktails that cancer patients must endure. It is time to stop the guesswork by giving physicians the tools to deliver true care customization for an individual. It is time to end the war on cancer by ending cancer once and for all. I hope and believe that this pioneering collaboration between Intel and OHSU will make significant contributions to these ends. And that one day these kinds of efforts will help make "cancer" one of those historical diseases that future generations will have heard about but not really understand because they have never seen anyone go through it.

Health IT gets a lot of attention within physical locations like hospitals and clinics. But what about healthcare technology that helps those on the front lines, away from brick-and-mortar healthcare facilities?

 

In the below video, an American Medical Response (AMR) ambulance crew in Portland, Ore., shows how computers have improved their ability to care for people in an emergency. Intel-powered devices are used throughout their shift, from the dispatch center to monitoring equipment to ruggedized laptops. They explain that their ability transfer patient information wirelessly to the hospital before the patient arrives can save precious minutes in life-or-death situations.

 

What questions do you have?

 

Intel spent a day recently with nurse practitioner Ginger Harris as she went on home visits with a new Intel-inspired Ultrabook. As our population grows older, technology plays a significant role in providing home-based care for people who have trouble getting to the doctor's office. Critical for "on-the-go" clinicians is a reliable computer that is lighter, faster, and "instant-on."

 

Watch the video to see what Intel-inspired Ultrabooks can bring to mobile health workers. What questions do you have?

 

Draft of Speech for United Nations Rio + 20 Pre-Conference
Stanford University Campus, 2/3/2012
By Eric Dishman

I am very honored to be here today on behalf of Intel Corporation and our joint venture with GE, Care Innovations, to help celebrate the 20-year anniversary of the Rio conference and to help plan for the next 20 years of sustainable development and innovation. I realized as I prepared for today that my own career as a social scientist in high tech, focused on home health and independent living, has paralleled those 20 years. In fact, it was the summer of 1992 while working for Paul Allen, the co-founder of Microsoft, at his think-tank in Silicon Valley when I designed my first remote patient monitoring prototype to help monitor the heart rate and blood pressure of seniors who found it too challenging to get to a doctor’s office for a check-up.  What was vision back then is a much-needed reality today. If you take only one message away from my comments here this morning, it should be this: if we are to develop sustainable, worldwide healthcare systems, we must build a workforce, a business model, and a technology infrastructure to take healthcare home.

For a moment, I ask you to visualize in your imagination the oldest person you have ever known. It could be a parent, a grandparent, a neighbor, a former boss. Just capture their image in your mind, when they were at their oldest. What did they look like? Their clothes? Their hair? (Or lack thereof?) What surprised you about what they could still do at their age? And what depressed you that they had lost? Now look around this auditorium and imagine a fifth of the people here sharing the same looks, needs, and capabilities of that oldest person you can remember. Now you will begin to have a sense, thanks to so many advances in healthcare, agriculture, and technology, that we have a “longevity challenge” ahead of us. It is most striking when you realize that back in 1950, there were only 3000 centenarians on our planet but, by 2050, demographers believe there will be more than 6 million people over age 100! It is, indeed, a swiftly graying planet.

The Rio conference in 1992 served as a wake up call about Global Warming and helped to energize innovation and investment in climate change sciences and industries. But Global Aging, by comparison and with every bit as much impact on our global economy and lifestyle as Global Warming, has received inadequate attention and investment. Thus, Intel, a company whose history and heart is about trying to solve big, audacious societal challenges through computing, started about 12 years ago to study Global Aging. Over this time, our social scientists, engineers, and designers have observed over 1000 elderly households and 250 care facilities in 20 countries. This body of work has helped to fuel everything from new products and businesses like those in Care Innovations to policy work in the U.S. and the European Union to our current work with China on “Age Friendly Cities” as they strive to move 90% of their care for older people to the home by 2020.

As part of that fieldwork, almost a decade ago, I spent time studying rural villages throughout Europe to try to figure out how to deliver healthcare to those resource-limited communities. In one town in particular, the local leader—sort of the unofficial mayor—drove me out a few miles from the center of the town to show me an empty lot that he and others in the community were attempting to buy to build a hospital. He proclaimed to me: “If you have a hospital, then you have arrived as a community…you have made it!” They were doing everything from bake sale fund raisers to major capital campaigns to try to build a hospital for their isolated region.

About a year ago, I checked in on their “progress,” and it was a sad story. The unofficial mayor had died of emphysema, and the group of investors in that community had never been able to raise the money for such an expensive endeavor as a hospital. They had lost their down-payment money (and, in some cases, their retirement nest eggs) in the midst of the financial mayhem of the European debt crisis. And the lot, to this day, sits empty, with nothing but a gravel parking lot and bushes and trees poking up through a lone, crumbling sidewalk to nowhere.  Perhaps most tragic to me is the lost decade—two decades, really, from when they had first started—of having no care available for the local people of that town in the interim.

Herein lies some of the thinking about healthcare development that I want to try to “un-do” today. The notion of a hospital as a symbol of “having arrived”—of economic and technological progress—is not surprising, but also not very healthy in the long run. I ask you to consider the idea that real progress—truly successful innovation—would be to use hospitals only as a last resort and to build out a 21st century healthcare infrastructure that shifts care to the home and community, that focuses more on prevention and early detection, and that is accessible and affordable for everyone. As a global society, we need to accept the idea that the hospital as the end goal—as the marker of medical progress—no longer fits our needs. In the midst of Global Aging, a hospital-centric model must somehow begin to give way to a home-centric model for the future.

So how might we begin to get there—how do we begin to take healthcare home? I’m somewhat notorious at Intel for coming up with alliterative phrases, and today will be no different. As you break out into workgroups this afternoon at the conference—and as you prepare your national strategies back home for the Rio conference in June—I urge you to think about the following “3Cs”: Connectivity, Careforce, and Community.

By “connectivity,” I mean many of the connection technologies already discussed here at the conference today. In particular, how do we insure we build a broadband infrastructure that is ready for 21st century healthcare delivery all the way to the home? So many countries are rightfully investing in fiber or wireless of many types and flavors, but they have done little to define requirements for the kinds of healthcare needs we will have in a graying world. We can’t let digital movies and music be the only source for driving our requirements for broadband networks. Healthcare requirements—for a virtual visit with a doctor, vital signs capture from the home, a sensor network for helping to prevent falls, a security solution that protects patient data from the bedside to “the cloud” and all points between—should also be part of the mix. We must come to ask: Do we have the right speed, security, network redundancy, packet prioritization, and other capabilities to make the home a plausible, affordable, and safe node of care?

Connectivity technologies and innovations for a 21st century healthcare “grid” abound. For example, Intel has recently worked with doctors and officials in Mexico to build a solution called “Medicina a Distancia” to bring hospital quality expertise to remote and rural parts of the country. I know many of you here have been working on similar telehealth initiatives to bring the access and expertise of the city to rural areas, which is an amazing beginning. But we still treat such telehealth encounters as the exception to a face-to-face visit instead of the norm. We have to make the face-to-face visit the rare exception. And to do so, we have to carry the “last mile” of that connection all the way to the patient’s home, workplace, and community for some rather creative applications that drive prevention, wellness, behavior change, and adherence to a care plan.

For example, years ago, researchers in Intel Labs in Ireland took off-the-shelf GPS technologies and an internet connection to prototype an online service that allowed senior citizens who still could drive their cars to share their weekly routing information online with frail, home-bound seniors who could no longer drive. Pretty soon, they were carpooling and sharing rides all around town, getting people out of the house, and offloading the local healthcare authorities who didn’t have time or money to check in on each homebound elder. The connective power of the internet can unleash amazing social support systems that we have only begun to tap into as a society; we must leverage this connectivity if we are to give everyone access to high quality care.

The “second C” I ask you to think about is what I call “careforce.” That is, how do we use information and communication technologies to help skill-shift care to increasingly informed and empowered patients, friends, neighbors, and community health workers? In the era of Global Aging, we simply cannot train enough doctors and nurses to catch up with the demographic realities of the age wave, so we must come up with creative ways to better leverage the family caregivers and community workers who already provide the bulk of daily care anyway. Online training and time banking tools for volunteers, social support networks, decision support tools…all of these can be key enablers for a 21st century careforce that must learn to assist and complement the hard work of increasingly scarce doctors, nurses, and highly trained medical specialists.

To help achieve this end, we recently launched the “Intel Skoool Healthcare Education Platform” for multimedia content and assessment on mobile computers in Sri Lanka. (Intel World Ahead Program)  This program seeks to expand and to give technology training to 1 million healthcare workers in developing countries by 2015. This will also entail delivering basic electronic health records to children in 5000 schools by that same year. Furthermore, Intel social scientists have continued to study “team based care models” around the world to help figure out what new tools and workflow training is needed to do virtual, coordinated care between general practice doctors, nurses, medical assistants, volunteer community health workers, and patients themselves. We believe developing a tech-savvy careforce—and the coordination tools to support them—is crucial for a sustainable healthcare system in the long run.

The third and final “C” I ask you to consider is “community.” I opened this talk with the call to “take healthcare home.” While I sometimes mean specifically building care capacity in the actual homes of citizens—and that is certainly a focus for our Care Innovations joint venture—I also more broadly mean that we have to move beyond hospital-and-clinic-centric models to home-and-community-centric models. In short, we must learn how to place-shift care to these more inexpensive, accessible settings—for diagnosis, treatment, and prevention. And we must learn how to design buildings and neighborhoods where care-at-home is a priority, instead of an after-thought or a panicked, expensive retrofit for our parents’ homes after they have already become ill or injured.

This may involve putting a telehealth unit—like our Care Innovations “Guide” technology—into the actual homes of chronic disease patients, who can remotely collect their vital signs, get just-in-time video coaching or content, or hear reminders for medication and other behavioral supports. Or it may mean using a health kiosk at the workplace or library or grocery store for a quick checkup, instead of an often un-necessary, expensive pilgrimage to the clinic. Our social science team has been studying models like the Veteran’s Administration Home-Base Primary Care program in the U.S. and various “hospital at home” models in Europe to understand just how much care can safely and effectively be done in the home. As a result, we have come to believe that each nation should be exploring how to achieve the goal of shifting at least 50% of care done in hospitals or clinics today to the home or community by 2020, as a starting point for building a sustainable healthcare economy!

These 3Cs provoke us to ask questions—and to challenge long-standing assumptions—about who delivers care, where it gets done, and how it is funded. And they ignite possibilities for connectivity and computing technologies that we have only begun to explore. In no way do I mean to suggest that we should become “anti hospital” or that clinics and hospitals will go away completely. But we should build and use fewer of them—so that we reduce our dependency on those expensive settings that require more and more of society’s resources to maintain. And we should focus our energy and investment, instead, on building out this “healthcare grid” to the home and community, thus offloading our overburdened mainframe medical systems. At an individual level, these questions can also help us to think about how each of us might reduce our “clinical footprint”—much as we have our carbon footprint—by taking ownership of our own health, wellness, and prevention in a proactive way to reduce our impact on the medical system.

Thanks to the ripples of innovation and policy change coming out of Rio 20 years ago, all of us in this room now know “Global Warming” as a megatrend to contend with. We all now know that there is an international race to be at the front of the pack for developing “green technologies” and “green jobs.” And we now know that, in many cases, developing countries may well leap ahead of developed countries in innovating eco-technology because they do not have the “old way of doing things” to maintain and defend. Their historical lack becomes their potential future gain.

I suggest to you that Global Aging is no less urgent or impactful than Global Warming—it is the other inconvenient truth which has been too long ignored or glosses over. Longevity is a societal “success catastrophe” that requires new thinking and new investment by all of us. Thus, perhaps together, here today, we can move towards making Rio 2012 the beginning of the wake up call for Global Aging. So too, developing economies may well achieve a 21st century healthcare system faster than the developed world because there is no old, hospital-centric way of delivering care to protect. Many of you have the chance to move straight to a home-and-community-based care model. I hope these 3Cs help you to think about that possibility. I hope they help ignite your country’s efforts to develop “gray technologies” and “gray jobs” to address the global needs of the more than two billion people aged 60 and above who will share this planet—who will inhabit this room with us—in the not so distant future of 2050.

So, in closing…let’s have no more empty lots waiting for enough cash to build the mega hospital complex that says our community “has arrived.” Let’s use the widely available, increasingly affordable connection technologies that are already here in our midst to build a new kind of healthcare system—a 21st century healthcare grid—that is available and affordable for everyone….in their workplaces, their communities, and their homes. Let’s build a society in which aging-in-place—in which independence—is a reality, even for those who celebrate more than 100 birthdays.

Thank you. And I look forward to joining you in the breakout sessions and in this noble human endeavor!

To paraphrase Mark Twain, rumors of the demise of healthcare innovation at Intel are greatly exaggerated. Given that many of the world’s healthcare information systems run on Intel technologies, I would go so far as to say that it would be almost impossible for a company as large and as global as Intel not to be working on healthcare innovation, even if we wanted to stop. Yet, because of a birthday I will talk about in a second, there are sometimes perceptions out there that Intel has stopped all healthcare activities. We have changed how we are organized but have not stopped healthcare innovation!

And why would we?


Healthcare is poised to be one of the largest growth opportunities for computing over the next decade. It is already the largest sector of the global economy–and the largest percentage of GNP for almost every nation–even before Global Aging swells the ranks of retirees and reduces the rolls of doctors and nurses available to care for our swiftly aging planet. Globally, we spend more human capital on caring for our health than any other human endeavor. More than 25 countries have recently passed healthcare reform laws with many–like the U.S., China, and Australia to name a few–making massive investments in health IT to “future proof” their healthcare infrastructure for the 21st century. And as computing becomes more powerful, ubiquitous, affordable, connected, and secure, healthcare is finally becoming more automated and algorithmic, from medical devices and equipment to clinical systems running on desktops, laptops, tablets, and smart phones to cloud-based and “big data” servers that enable population analytics and genomics unimaginable even a couple of years ago. In short, the era of Personalized Medicine is upon us, and it will require a transformation of computing as we know it, even as we transform healthcare as we know it.


So why do I bring this up now?


This month marks the first birthday of Care Innovations, the Intel GE joint venture focused on personal health technologies and new care models for the home and community. It has been an amazing year watching Care Innovations launch new products, build its own culture, and move into great new offices near Sacramento, Portland, and New York City! As a small company that inherited great assets from our parent companies, Care Innovations also gained the freedom and responsibility to blaze our own trail. Led by former Intel VP, Louis Burns, Care Innovations is delivering telehealth, independent living, remote patient monitoring, and assistive technologies–and working with care providers around the country to transform their care models using these technologies. As the director of public policy for Care Innovations, I am proud to be part of this venture and will cover many policy issues about shifting care to the home in this blog in the coming months, particularly during this healthcare-contentious election year in the United States.


But I also serve as director of health innovation and policy for Intel, and I want to clear up any misconception about the status of other healthcare innovation efforts at Intel. A year into this, I sometimes am asked whether Intel has ended all other healthcare work and/or spun everything out with Care Innovations. While it is true that there is no longer a single, dedicated business unit at Intel focused on healthcare–what was formerly called the “Intel Digital Health Group” led by Louis Burns did spin out for the most part–there are still well over a dozen Intel teams globally driving a wide range of innovative projects. This website highlights many of the health IT related efforts we are focused on. And below is a sample of some of the activities currently happening at Intel–many of which I will be blogging about in the coming months:


- Intel sales and marketing experts continue to partner with healthcare organizations worldwide on the implementation of health IT, especially around cloud computing, security, and clinician mobility.
- Our Intelligent Systems Group continues to deliver Intel technologies into a wide range of medical customers and devices, from MRI machines to fitness equipment.
- The Intel “World Ahead” program just launched the “Skoool Healthcare Education” platform in Sri Lanka with a goal to help educate 1 million health workers by 2015.
- Various R&D groups inside Intel have explorations ranging from ubiquitous healthapplications on smart phones to the future of biosilicon and artificial organs.
- Intel architects and engineers have been invited in many countries to help design secure cloud architectures for EHRs, insurance exchanges, and regional health information networks.
- An Intel team is working on the challenge of delivering high performance computing to help usher in next generation genomics for personalized medicine.
- Our global public policy organization continues to work with governments worldwide on health innovation, from broadband plans to changing reimbursement models for virtual care.
- Our team of clinicians, social scientists, and engineers are working on next generation tablet designs for doctors and nurses, building upon the Mobile Clinical Assistant (MCA) reference design.
- Intel recently helped to pilot a telemedicine network in rural Mexico that may well expand to the entire country to help connect patients and medical experts.
- We began work in China–and other countries–on the development of a blueprint on how to build “Age Friendly Cities” that use technology to drive better healthcare quality, access, & costs.
- Our social science team has been conducting ethnographic studies to inform the future of primary care/general practice using coordinated care teams and collaboration technologies.

And the list above continues to grow, not surprisingly, as so many countries and companies invest in the healthcare sector. Each quarter, I bring together Intel teams who are working in some way, shape, or form on healthcare innovation, and I continue to be amazed to find out where Intel’s people and our technologies touch as our compute continuum meets the care continuum from hospital to home.


So, a “Happy Birthday” goes out to our partner and sister company, Care Innovations! And to all of our Intel collaborators, customers, and colleagues out there, I add: “Healthcare innovation is alive and well at Intel!” Please be sure to continue to reach out to your Intel contacts to find out about the many amazing ways in which we are working on the future of healthcare. After all, Intel’s audacious corporate vision reads: “This decade we will create and extend computing technology to connect and enrich the lives of every person on earth.” If this decade is also the beginning of the era of personalized medicine, it follows that these two visions are well intertwined. There are many of us still painted “Intel blue” who are determined to deliver upon that vision for healthcare. It’s hard to imagine a more exciting business opportunity for our company; it’s hard to imagine a more important calling for our world

To paraphrase Mark Twain, rumors of the demise of healthcare innovation at Intel are greatly exaggerated. Given that many of the world's healthcare information systems run on Intel technologies, I would go so far as to say that it would be almost impossible for a company as large and as global as Intel not to be working on healthcare innovation, even if we wanted to stop. Yet, because of a birthday I will talk about in a second, there are sometimes perceptions out there that Intel has stopped all healthcare activities. We have changed how we are organized but have not stopped healthcare innovation! And why would we?

Healthcare is poised to be one of the largest growth opportunities for computing over the next decade. It is already the largest sector of the global economy--and the largest percentage of GNP for almost every nation--even before Global Aging swells the ranks of retirees and reduces the rolls of doctors and nurses available to care for our swiftly aging planet. Globally, we spend more human capital on caring for our health than any other human endeavor. More than 25 countries have recently passed healthcare reform laws with many--like the U.S., China, and Australia to name a few--making massive investments in health IT to "future proof" their healthcare infrastructure for the 21st century. And as computing becomes more powerful, ubiquitous, affordable, connected, and secure, healthcare is finally becoming more automated and algorithmic, from medical devices and equipment to clinical systems running on desktops, laptops, tablets, and smart phones to cloud-based and "big data" servers that enable population analytics and genomics unimaginable even a couple of years ago. In short, the era of Personalized Medicine is upon us, and it will require a transformation of computing as we know it, even as we transform healthcare as we know it.

So why do I bring this up now?

This month marks the first birthday of Care Innovations, the Intel GE joint venture focused on personal health technologies and new care models for the home and community. It has been an amazing year watching Care Innovations launch new products, build its own culture, and move into great new offices near Sacramento, Portland, and New York City! As a small company that inherited great assets from our parent companies, Care Innovations also gained the freedom and responsibility to blaze our own trail. Led by former Intel VP, Louis Burns, Care Innovations is delivering telehealth, independent living, remote patient monitoring, and assistive technologies--and working with care providers around the country to transform their care models using these technologies. As the director of public policy for Care Innovations, I am proud to be part of this venture and will cover many policy issues about shifting care to the home in this blog in the coming months, particularly during this healthcare-contentious election year in the United States.

But I also serve as director of health innovation and policy for Intel, and I want to clear up any misconception about the status of other healthcare innovation efforts at Intel. A year into this, I sometimes am asked whether Intel has ended all other healthcare work and/or spun everything out with Care Innovations. While it is true that there is no longer a single, dedicated business unit at Intel focused on healthcare--what was formerly called the "Intel Digital Health Group" led by Louis Burns did spin out for the most part--there are still well over a dozen Intel teams globally driving a wide range of innovative projects. This website highlights many of the health IT related efforts we are focused on. And below is a sample of some of the activities currently happening at Intel--many of which I will be blogging about in the coming months:

- Intel sales and marketing experts continue to partner with healthcare organizations worldwide on the implementation of health IT, especially around cloud computing, security, and clinician mobility.

- Our Intelligent Systems Group continues to deliver Intel technologies into a wide range of medical customers and devices, from MRI machines to fitness equipment.

- The Intel "World Ahead" program just launched the "Skoool Healthcare Education" platform in Sri Lanka with a goal to help educate 1 million health workers by 2015.

- Various R&D groups inside Intel have explorations ranging from ubiquitous healthapplications on smart phones to the future of biosilicon and artificial organs.

- Intel architects and engineers have been invited in many countries to help design secure cloud architectures for EHRs, insurance exchanges, and regional health information networks.

- An Intel team is working on the challenge of delivering high performance computing to help usher in next generation genomics for personalized medicine.

- Our global public policy organization continues to work with governments worldwide on health innovation, from broadband plans to changing reimbursement models for virtual care.

- Our team of clinicians, social scientists, and engineers are working on next generation tablet designs for doctors and nurses, building upon the Mobile Clinical Assistant (MCA) reference design.

- Intel recently helped to pilot a telemedicine network in rural Mexico that may well expand to the entire country to help connect patients and medical experts.

- We began work in China--and other countries--on the development of a blueprint on how to build "Age Friendly Cities" that use technology to drive better healthcare quality, access, & costs.

- Our social science team has been conducting ethnographic studies to inform the future of primary care/general practice using coordinated care teams and collaboration technologies.

And the list above continues to grow, not surprisingly, as so many countries and companies invest in the healthcare sector. Each quarter, I bring together Intel teams who are working in some way, shape, or form on healthcare innovation, and I continue to be amazed to find out where Intel's people and our technologies touch as our compute continuum meets the care continuum from hospital to home.

So, a "Happy Birthday" goes out to our partner and sister company, Care Innovations! And to all of our Intel collaborators, customers, and colleagues out there, I add: "Healthcare innovation is alive and well at Intel!" Please be sure to continue to reach out to your Intel contacts to find out about the many amazing ways in which we are working on the future of healthcare. After all, Intel's audacious corporate vision reads: "This decade we will create and extend computing technology to connect and enrich the lives of every person on earth." If this decade is also the beginning of the era of personalized medicine, it follows that these two visions are well intertwined. There are many of us still painted "Intel blue" who are determined to deliver upon that vision for healthcare. It's hard to imagine a more exciting business opportunity for our company; it's hard to imagine a more important calling for our world.

A year ago, I blogged a new year's resolution that I would blog more in 2011 about what was happening in healthcare reform, innovation, and information technology efforts that Intel is involved in around the world. I knew then that I should have stuck to my prior decade-long resolution not to make new year's resolutions (or annual predictions, for that matter!) because I didn't get to blog as often as I had hoped.  You would think I would know better by now: best intentions are nice, but you shouldn't make promises that you can't keep. So I won't promise to blog more in 2012--only to do the best that I can.

 

I used to make these same impossible promises to myself each January about "getting in shape." Given the number of neon gym membership ads shoved under my windshield wiper while parked at the grocery store, I suspect it is the same for many people. January is about the “I-ate-so-much-over-the-holidays-but-am-now-going-to-eat-right-and-exercise” resolution—to promise ourselves to do better in the nutrition and fitness departments. Thus, we buy not only gym memberships but all kinds of diet “solutions” and home exercise equipment each new year. We buy into these grand promises to ourselves that we will lose 40 pounds or run a marathon. We sell everyone around us on the concept that this is the “new me.” And for most of us, the intent to do the right thing lasts through the first quarter, the energy to do so through mid February, and the commitment just until the stores have sold the last leftover holiday wrapping paper and candy that no one bought at full price.

 

About three years ago, I finally got off this endless cycle of unfulfilled, self-made promises and set a different course that has produced far better results in terms of my health. I achieved this (and other positive side effects like losing 35 pounds and preparing for a 10k run) first and foremost by firing my doctor. I also fired myself as a "passive patient"--and rehired myself as a key "owner" of my own health and wellness. Many people are shocked when I tell them this, as if they could never imagine switching to a new physician. But it is preposterous that the idea of firing your personal doctor is so preposterous! Many of us demand the best possible service, expertise, and attention when we get our cars repaired, our vacations planned, or the health of our children or parents dealt with, but we somehow will just keep going to the same doctor year after year for ourselves, even when we feel like the relationship is lackluster at best.

 

In my case, I had gone to the same primary care doc--the one I had sort of stumbled into because he was "accepting new patients" in the brochure I was given when enrolling in benefits at my "new" Intel job--for TEN years! It was not that he was a bad doctor. He routinely saw me once a year. He was friendly enough (though he could never remember that I go by my middle name "Eric," not my first name "James"). And he dolled out the obligatory drugs for my multiple chronic conditions, small injuries, and the occasional flu as required. The problem was that he was, well, just another passive primary care physician...and I was, well, just another passive patient...caught up in the typical treadmill of reactive medicine as we each waited for the next "problem" to warrant a clinic visit. Over the last five years that I saw him (and I know this because I tracked it in my journal), he literally did not physically touch me during any of my visits. It got so bad that I even joked with friends that "my doctor seems to be afraid of touching his patients" because he simply interviewed me and placed check-marks on a form. But, still, I tolerated and maintained this mediocrity for years: I got my prescriptions; he got his reimbursement from my insurer; our interaction was simply a transaction that neither of us paid much attention to.

 

I finally got tired of this treadmill going nowhere and decided to look for a physician I loved, not just one I tolerated. I started asking around for recommendations from friends and colleagues, and while most everyone thought their doctor was "fine," almost no one seemed to love their physician as much as they did their easy-to-recommend babysitter or mechanic or financial planner. Which was strange to me, because people seemed incredibly loyal to their primary care physician and loathe to change to a new one, but unwilling to recommend one. Finally, a colleague at work gave me a passionate recommendation--she said I had to join GreenField Health because she loved all of their doctors and staff whom she had interacted with. I got on its website where it described itself as "a completely different doctor's office." Three years into this relationship, I readily admit that GreenField lives up to the hype: it was a game-changing move for me, and I am someone who loves my doctor, the staff, and the entire setup.

 

Now, I happily write a $500 check to GreenField each January as an annual resolution and investment in myself and a contract with them that I am very happy to make. This money enables them to provide me with a service--a doctor patient relationship--that I really need. There is no waiting room. I can get an appointment any time. We interact online through secure email when appropriate. I have a physician champion who oversees the complexities of my care across all the specialists I see. They take the time to help me--whether it is a 5 minute call or two hour exam. But most importantly, my doctor there starts with a very different question when we meet. He starts each "visit" by asking, "What should we work on together this year?" instead of the ubiquitous "What's wrong?" or "What seems to be the problem [for me to fix] today?" This is such an important, radical act to begin with a different question. He immediately enlists me as a partner with him on whatever health and wellness project I want to embark on. In my case, it was getting off the New Year's diet fad and onto a more ongoing, proactive, preventive, healthy lifestyle. The GreenField philosophy--embodied in that opening question--moves beyond the fix-what-is-broken mentality that governs so much of reactive medicine today to a proactive partnership for better health (and better "cost, quality, and access" as today's health reform mantra goes). Each year--and I am looking forward to my upcoming January meeting with him--we work on a plan together for my health for the year, and because he can afford through such a financial arrangement to spend time to help me deliver upon that plan, we actually make it happen.

 

I realize full well that not everyone is in a position to be able to fire their doctor or to pay $500 a year for this kind of personalized service. But each of us can demand more from our doctor and can step up as a partner to own more responsibility for our health. We can begin to get off the reactive medicine treadmill that is premised upon (and financed around) pharmacological fix-its rather than tackling more fundamental health issues. What my GreenField experience has helped me to realize is that we, as patients, have to be active members of a coordinated team and that we need a physician champion to help oversee all the other meds we take, specialists we see, and complex health needs that we have. I’ve been fortunate enough through GreenField to have a taste of the future of healthcare now: a true partnership, a prevention orientation, and a care team who takes the appropriate time to teach and enlist me in my own care and behavior change.

 

All around the world these days, we hear healthcare experts abuzz with catch phrases like "medical homes" or "patient centered medical homes" or "next generation primary care" or "coordinated, collaborative care teams."  And against the backdrop of these many discussions of electronic health records, meaningful use criteria, quality measurement, telehealth, clinician workflow, change management, age friendly cities, payment reform, cloud computing for clinics, data security, predictive analytics, and personalized medicine--many of which are topics I will end up blogging about in 2012 to some degree--it is important to remember that, at the end of the day, real reform--real innovation in healthcare--has to be about building better relationships between patients and doctors. (Or perhaps there will be better words for these staid, traditional roles, such as "providers" and "partners.") If all our efforts in reform and healthcare IT come to fruition successfully, then this kind of care I fallen in love with at GreenField shouldn’t be the "boutique" or "concierge" exception for only a few….it should become the norm and standard in care for everyone.

What do you think?

A year ago, I blogged a new year's resolution that I would blog more in 2011 about what was happening in healthcare reform, innovation, and information technology efforts that Intel is involved in around the world. I knew then that I should have stuck to my prior decade-long resolution not to make new year's resolutions (or annual predictions, for that matter!) because I didn't get to blog as often as I had hoped. You would think I would know better by now: best intentions are nice, but you shouldn't make promises that you can't keep. So I won't promise to blog more in 2012--only to do the best that I can.

I used to make these same impossible promises to myself each January about "getting in shape." Given the number of neon gym membership ads shoved under my windshield wiper while parked at the grocery store, I suspect it is the same for many people. January is about the “I-ate-so-much-over-the-holidays-but-am-now-going-to-eat-right-and-exercise” resolution—to promise ourselves to do better in the nutrition and fitness departments. Thus, we buy not only gym memberships but all kinds of diet “solutions” and home exercise equipment each new year. We buy into these grand promises to ourselves that we will lose 40 pounds or run a marathon. We sell everyone around us on the concept that this is the “new me.” And for most of us, the intent to do the right thing lasts through the first quarter, the energy to do so through mid February, and the commitment just until the stores have sold the last leftover holiday wrapping paper and candy that no one bought at full price.

About three years ago, I finally got off this endless cycle of unfulfilled, self-made promises and set a different course that has produced far better results in terms of my health. I achieved this (and other positive side effects like losing 35 pounds and preparing for a 10k run) first and foremost by firing my doctor. I also fired myself as a "passive patient"--and rehired myself as a key "owner" of my own health and wellness. Many people are shocked when I tell them this, as if they could never imagine switching to a new physician. But it is preposterous that the idea of firing your personal doctor is so preposterous! Many of us demand the best possible service, expertise, and attention when we get our cars repaired, our vacations planned, or the health of our children or parents dealt with, but we somehow will just keep going to the same doctor year after year for ourselves, even when we feel like the relationship is lackluster at best.

In my case, I had gone to the same primary care doc--the one I had sort of stumbled into because he was "accepting new patients" in the brochure I was given when enrolling in benefits at my "new" Intel job--for TEN years! It was not that he was a bad doctor. He routinely saw me once a year. He was friendly enough (though he could never remember that I go by my middle name "Eric," not my first name "James"). And he doled out the obligatory drugs for my multiple chronic conditions, small injuries, and the occasional flu as required. The problem was that he was, well, just another passive primary care physician...and I was, well, just another passive patient...caught up in the typical treadmill of reactive medicine as we each waited for the next "problem" to warrant a clinic visit. Over the last five years that I saw him (and I know this because I tracked it in my journal), he literally did not physically touch me during any of my visits. It got so bad that I even joked with friends that "my doctor seems to be afraid of touching his patients" because he simply interviewed me and placed check-marks on a form. But, still, I tolerated and maintained this mediocrity for years: I got my prescriptions; he got his reimbursement from my insurer; our interaction was simply a transaction that neither of us paid much attention to.

I finally got tired of this treadmill going nowhere and decided to look for a physician I loved, not just one I tolerated. I started asking around for recommendations from friends and colleagues, and while most everyone thought their doctor was "fine," almost no one seemed to love their physician as much as they did their easy-to-recommend babysitter or mechanic or financial planner. Which was strange to me, because people seemed incredibly loyal to their primary care physician and loathe to change to a new one, but unwilling to recommend one. Finally, a colleague at work gave me a passionate recommendation--she said I had to join GreenField Health because she loved all of their doctors and staff whom she had interacted with. I got on their website where they described themselves as "a completely different doctor's office." Three years into this relationship, I readily admit that GreenField lives up to the hype: it was a game-changing move for me, and I am someone who loves my doctor, the staff, and the entire setup.

Now, I happily write a $500 check to GreenField each January as an annual resolution and investment in myself and a contract with them that I am very happy to make. This money enables them to provide me with a service--a doctor patient relationship--that I really need. There is no waiting room. I can get an appointment any time. We interact online through secure email when appropriate. I have a physician champion who oversees the complexities of my care across all the specialists I see. They take the time to help me--whether it is a 5 minute call or two hour exam. But most importantly, my doctor there starts with a very different question when we meet. He starts each "visit" by asking, "What should we work on together this year?" instead of the ubiquitous "What's wrong?" or "What seems to be the problem [for me to fix] today?" This is such an important, radical act to begin with a different question. He immediately enlists me as a partner with him on whatever health and wellness project I want to embark on. In my case, it was getting off the New Year's diet fad and onto a more ongoing, proactive, preventive, healthy lifestyle. The GreenField philosophy--embodied in that opening question--moves beyond the fix-what-is-broken mentality that governs so much of reactive medicine today to a proactive partnership for better health (and better "cost, quality, and access" as today's health reform mantra goes). Each year--and I am looking forward to my upcoming January meeting with him--we work on a plan together for my health for the year, and because he can afford through such a financial arrangement to spend time to help me deliver upon that plan, we actually make it happen.

I realize full well that not everyone is in a position to be able to fire their doctor or to pay $500 a year for this kind of personalized service. But each of us can demand more from our doctor and can step up as a partner to own more responsibility for our health. We can begin to get off the reactive medicine treadmill that is premised upon (and financed around) pharmacological fix-its rather than tackling more fundamental health issues. What my GreenField experience has helped me to realize is that we, as patients, have to be active members of a coordinated team and that we need a physician champion to help oversee all the other meds we take, specialists we see, and complex health needs that we have. I’ve been fortunate enough through GreenField to have a taste of the future of healthcare now: a true partnership, a prevention orientation, and a care team who takes the appropriate time to teach and enlist me in my own care and behavior change.

All around the world these days, we hear healthcare experts abuzz with catch phrases like "medical homes" or "patient centered medical homes" or "next generation primary care" or "coordinated, collaborative care teams." And against the backdrop of these many discussions of electronic health records, meaningful use criteria, quality measurement, telehealth, clinician workflow, change management, age friendly cities, payment reform, cloud computing for clinics, data security, predictive analytics, and personalized medicine--many of which are topics I will end up blogging about in 2012 to some degree--it is important to remember that, at the end of the day, real reform--real innovation in healthcare--has to be about building better relationships between patients and doctors. (Or perhaps there will be better words for these staid, traditional roles, such as "providers" and "partners.") If all our efforts in reform and healthcare IT come to fruition successfully, then this kind of care I fallen in love with at GreenField shouldn’t be the "boutique" or "concierge" exception for only a few….it should become the norm and standard in care for everyone.

Last week I had the honor of speaking to the American Academy of Home Care Physicians at their annual scientific meeting. I think of these clinicians as both the history and future of healthcare in the United States. They continue to make "house calls" to some of the sickest of the sick in our society--to those who are often too frail to send to a hospital where the stress of dislocation or the risk of infection could have deadly consequences. Thus, these doctors, nurses, and nurse practitioners maintain a tradition of personalized, in-home care that is centuries old. But these clinicians also may be a harbinger of what is to come. They represent what has to happen for healthcare reform to be effective: they deliver contextualized, personalized, compassionate, and collaborative care to individuals at home, often at lower costs and higher quality than institutional settings can afford.

 

 

 

What was most interesting to me is that the entire event was standing room only. It was so crowded that they had to remove the hotel room walls in the middle of the event to expand the venue so we didn't all pass out from heat stroke or lack of oxygen!  The AAHCP conference is held in association with the much larger American Geriatrics Society conference, and I don't think anyone ever imagined there would be so much sudden interest in home-based care. Let's be honest: home care has often been ignored or maligned while our national attention has focused so much on optimizing care in hospitals and clinics. But health reform--in the U.S. and around the world--is finally creating economic incentives to deliver care to people at home, at work, on-the-go, and electronically instead of just "filling beds," which has been the economic engine of reactive, volume-driven healthcare for a long, long time.

 

 

 

Perhaps equally revealing as to the importance of home-based care to our national economic interests was the fact that I came home with no less than a dozen business cards from venture capitalists, private equity investors, and other business leaders who attended the AAHCP conference because they believe home-based care is poised for significant investment and growth. This is a sea change from the past, where, because of reductions and changes to the ways in which home care has been reimbursed, many investors have treated this industry as an economic backwater. But suddenly, having a well-trained work force of clinicians who can deliver high-quality, highly-coordinated care to people in the community becomes a strategic and all-too-rare asset in a world of ACOs, bundled payments, and risk sharing.

 

 

 

As I prepared for my talk to AAHCP last week, I had an "ah hah" moment--at least for me. And I shared this thought with the audience there at our nation's capital. While it is hard to argue against one of the major quality goals of U.S. health reform being to reduce hospital readmission rates, why are we satisfied with that as an end goal? I mean, of course it makes sense to get rid of unnecessary suffering and expense by helping patients who leave the hospital to recover quickly and safely within their own homes instead of being rushed back to a hospital with complications after some surgery, accident, or major illness.

 

 

 

But something about hospital readmission rates becoming a major coin of the realm for health reform--an uber quality metric by which many hospitals and health plans will be measured in the future--really disappoints me. First off, why "readmissions"? Why not just focus on reducing hospital admissions in the first place--get rid of the "re"--through prevention, earlier detection of problems, or better triage and delegation to less invasive and expensive care settings? To some degree, focusing on hospital readmissions doesn't really solve the fundamental problem we face as a nation because it maintains a bed-filling economic incentive, even if we simply specify exactly how long we want to fill those beds to make the math work out.

 

 

 

Furthermore, why stop there? Let's measure the true quality of healthcare in America--and the true impact of reform--by tracking the reduction of the total number of hospitals in our country! I've written many times in this blog space that there will always be a time and place where hospitals are required, but not for every time and place that care is needed. Hospital-at-home models are flourishing in many parts of the world, and some of the Scandinavian countries have consciously and conscientiously reduced their number of hospitals to force themselves to invent other means to deliver high quality care to their citizens. If we aimed our reforms and innovations at bed-avoiding--and hospital avoidance--we'd end up in a very different place, quality-wise and economically.

 

 

 

I know, I know. This is "crazy talk" to almost any audience I could find. Yes, I realize that Americans are addicted to our hospitals. It is almost a rite of passage for a small community that they have "arrived" when they get their own hospital in town. But hospitals often become an economic albatross around a community's neck. The psychology of "sunk costs" sets in, and every dollar invested in hospital infrastructure becomes a requirement to invest many more in the future to maintain the facility, to be competitive,  and to "keep up with the Jones's" hospital. We need more and more dollars to maintain and accelerate our "hospital habit" once we become dependent on them. Or, I should say, this is crazy talk to almost any audience other than the American Academy of Home Care Physicians. Because they perform miracles every single day by delivering hospital quality care and intervention in the homes of patients with very limited resources. They already know it can be done.

 

 

 

So they didn't blink at my suggestion that the real measure of quality over the next couple of decades is not reducing hospital readmission rates, but decreasing hospital construction rates. Or put another way, let's drive a paradigm that is all about increasing "hospital reconstruction rates"....as we figure out new things to do with those shiny, expensive medical megaplexes we have built all around the country. These home-based doctors, nurses, and nurse practitioners may end up not only tearing down the walls of a conference room to make room for new ideas...they may literally tear down the walls of our medical institutions to show us a better way. They may just be the key to achieving our cost, quality, and access challenges by taking care home again. Or perhaps those investment bankers just ended up in the wrong conference room by accident.

Hear ye, hear ye, read all about it! For those of you who have been waiting with bated breath (you know who you are!), the U.S. Department of Health & Human Services has just published the proposed rules and guidelines for Accountable Care Organizations (ACOs) and the Medicare Shared Savings Program (SSP). You can download the 428-page document here and see the official press release here. Though, unless you are a policy or healthcare reform geek (which I guess I am becoming, frighteningly enough), you might want to wait for the inevitable summaries to be done by various consulting firms, non-profits, and individuals. I will post some of the good ones here when I see them.

These rule-makings around ACOs are a major component of the Affordable Care Act signed by President Obama last March, though most citizens and press outside of the healthcare industry have no clue what this is all about. ACOs are the primary mechanism for beginning to shift the American healthcare system from a volume-driven to a value-driven paradigm. In other words, today, the majority of healthcare is paid based on the volume of face-to-face visits, labwork, and prescriptions generated more than the value of the care provided. And these payments occur regardless of whether the treatments given (and charged for) are effective or helpful. The strategic intent of the health reform bill is to shift to a mode of payment that focuses much more on rewarding the quality of care over the volume of care.

There are three primary aims of these reform efforts (sometimes referred to as "the triple aims" or as "Berwick's triple aims" named for Don Berwick, the current Administrator for the Centers for Medicare and Medicaid Services). First, the goal is to provide better care for individuals. Second is to improve care for populations. And third is to lower the growth in healthcare costs and expenditures. ACOs are one of many tools to achieve these three aims, and healthcare providers and companies have been eager to see what the Secretary would propose as the specific requirements for becoming an ACO.

Basically, an ACO is a group of care providers--usually centered around primary care physicians--who commit, according to the proposed rules released today, for a minimum of three years to manage the overall care and costs of at least 5000 Medicare patients. And the ACO has to have a legal structure (though they are very flexible on the different kinds of structures permissible) that allows the organization to receive and distribute payments to all its care providers in the management of the care.

So imagine, for example, several physician practices, a hospital, and a home care agency within a particular town coming together to form an ACO to care for at least 5000 Medicare beneficiaries in that community. They would be paid what is often referred to as a "bundled" or "global payment" annually to care for all of the health needs of those patients, and they could participate in the Shared Savings Program by which they could get bonuses based on helping to reduce healthcare expenditures while boosting quality. Lest you think these providers would just ignore the needs of the sickest patients to keep their costs low and leave more shared savings in their pockets (and I should say that I have never met any clinicians in our 10+ years of fieldwork who would be so inclined--the majority are good people who went into medicine to help people), there are clear rules and data-driven quality measurement mechanisms that prevent that from happening.

I am particularly heartened to see some of the following language in the proposed rules:

  • The ACO shall define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies (p.17)
  • The ACO shall demonstrate to the Secretary that it meets patient-centeredness criteria specified by the Secretary, such as the use of patient and caregiver assessments or the use of individualized care plans (p.17)
  • An ACO will manage resources carefully and respectfully. It will ensure continual waste reduction, and that every step in care adds value to the beneficiary. An ACO will be able to make investments where investments count, and move resources to meet beneficiaries' needs. Because of its capabilities with respect to prevention and anticipation, especially for chronically ill people, an ACO will be able to continually reduce its dependence on inpatient care. Instead, its patients will more likely be able to be home, where they often want to be, and, during a hospital admission, they receive assurance that their discharges will be well coordinated, and that they will not return due to avoidable complications (p. 25)
  • An ACO will be proactive by reaching out to patients with reminders and advice that can help them stay healthy and let them know when it is time for a checkup or a test (p.25)
  • An ACO will collect, evaluate, and use data on health care processes and outcomes sufficiently to measure what it achieves for beneficiaries and communities over time and use such data to improve care delivery and patient outcomes (p. 25)
  • An ACO will be innovative in the service of the three-part aim of better care for individuals, better health for populations, and lower growth in expenditures. It will draw upon the best, most advanced models of care, using modern technologies, including telehealth and electronic health records, and other tools to continually reinvent care in the modern age. It will monitor and compare its performance to other ACOs, identify and examine new processes for care improvement, and adopt those approaches that are demonstrated to be effective (p.25)

While I have several hundred more pages to go, my initial read shows some very promising directions. The rules feel very innovation-friendly and leave lots of flexibility and experimentation for communities to try different approaches to setting up ACOs. The focus on "patient engagement" shows a much-needed momentum around providing tools and expectations for patients to be a more proactive and responsible party in our own care. The explicit references to the use of telehealth and remote patient monitoring and the calling out of the need to move care to the home shows that CMS "gets it" in terms of the need to "place-shift" (a topic I bring up frequently in this blog) where care occurs away from more expensive settings like hospitals. And the requirements for incorporating and using data-driven, evidence-based tools to drive best practice care and continuous innovation/improvement will help us finally achieve a 21st century healthcare infrastructure that is scalable and competitive, internationally.

I will post more of my own and other peoples' summaries over the next week. Meanwhile, what say ye?

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