Drew Borland, Manager at Wellcentive outlines the overarching trends among clinical quality programs and where you can expect them in the coming years.

A quality program (or Clinical Quality Improvement program) is a collection of healthcare quality measures/metrics grouped together and applied for a meaningful purpose, to evaluate and/or incentivize an entity to improve clinical and/or financial outcomes. These entities are typically providers, provider groups (IPAs, PHOs, ACOs), and payers.  The main purpose of a healthcare quality program is to assess performance as it relates to controlling costs, and to create an environment that incentivizes participants to adhere to the quality standards.

Over the past few years, healthcare professionals have gone from marginally understanding these quality programs, to now barely being able to keep up with them. Incentive-based payer-driven quality programs are quickly becoming the modern day ‘tax code’ for the healthcare industry.  Keeping that in mind, I will focus on identifying the overarching trends among the quality programs and shed some light on where you can expect them to be in the coming years.

The Clinical Quality Program Landscape

From a landscape perspective let’s take a look at the main quality programs that exist today (many of these were covered in previous blog entries, so descriptions will be abbreviated):

Physician Quality Reporting System (PQRS) — Incentive based program for healthcare professionals created by CMS. Multiple varieties include Claims-Based, Registry-Based, and EHR-Based.

Meaningful Use (MU) — Incentive based program for healthcare professionals created by CMS. There are currently two outstanding specifications; Stage 1 and Stage 2.

Medicare Shared Savings Program (MSSP) — Performance based program for provider groups created by CMS.

Healthcare Effectiveness Data and Information Set (HEDIS) – Benchmark based evaluation tool for comparing health plans created by NCQA.

Pay for Performance (P4P or PFP) — Payer-specific preventive care and chronic disease management programs with metrics often based on national standards, such as HEDIS.

A typical healthcare provider will most likely be involved with several concurrent quality programs, each with its own deadlines and year-to-year program specifications. While vendors, including Wellcentive, help insulate quality program participants from some of the intricate details, it is very important to understand that the programs are rapidly evolving. As a result, how providers are being measured as well as reimbursed is fundamentally changing. In the following sections, we’ll look at some of the main trends that we have noticed on the vendor side over the past few years.

Pay For Performance is replacing Pay-For-Reporting

In order to receive an incentive payment, several quality programs initially only required that the providers report their data. The actual numbers that they reported (their underlying quality scores/metrics) had no effect on their corresponding incentive payment. At the time, this was beneficial because this approach helped garner participation in the program and minimized the effect on a provider’s clinical workflow. Today, with quality reporting becoming more mainstream and refined, this model has largely been phased out. More modern quality programs like the MSSP are changing their models to pay based on performance (the quality scores). While some programs still only require reporting, soon all quality programs will force providers and eligible professionals to improve their quality, or leave a significant amount of money on the table.

More Measures

When Claims-Based PQRS (then known as PQRI) started in 2007, there were only 74 measures from which to choose. For the most recent 2012 program year, there are 210 measures from which to choose. This trend has increased the pool of eligible professionals that can participate in the program, expanding to even more specialists. It is extremely important that providers continue to track their eligibility for these quality programs, because programs they could not participate in yesterday may be available to them today.

More Types of Measures

One of the main reasons that the number of quality measures is growing is that the types of data that is accessible for measurement is expanding. Some of the early quality programs focused primarily on paper and electronic claims data. Today, almost any structured data that can be found in an EMR, EHR, PMS, Registry, or HIE is fair game for use in a quality measure. This expansion of available data has led to the creation of sub-groups (or types) of quality measures, including:

• Preventative Health Measures
• Patient Satisfaction Measures
• Care Coordination Measures
• Patient Safety Measures
• Chronic Disease Management Measures
• Meaningful Use ‘Best Practice’ Measures
• Cost and Utilization Measures

More Complicated Measures

Early quality measures (circa 2008) targeted ‘low hanging fruit’ and focused on specific quality actions on very simple and straightforward populations. For example, NQF 0056: Foot Exams in Diabetes Patients, concretely measures what percentage of an adult diabetes population has had a foot exam in the last 12 months. The numerators, denominators, and exclusions for these early measures were reasonably comprehensible. Over time, as the number of quality measures increased, so did the complexity. This led to more detailed measure specifications, which in turn added more challenges to healthcare organizations and vendors to support these measures. Below is a snippet for a newer measure, NQF 0659: Endoscopy/Poly Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps- Avoidance of Inappropriate Use (circa late 2011), which demonstrates the increase in complexity:

From the measure above, it is quite evident that the age of understanding and measuring simple clinical quality metrics has passed. More and more healthcare organizations are understanding that the expansion of data that is in the purview of clinical quality measures combined with the increased complexity is quickly exceeding their technical capabilities. From the Wellcentive perspective, every single customer is leveraging our abilities to aggregate and normalize the data that is spread over their entire organization to solve their data management needs. This is the essential first step in satisfying any quality or incentive program requirements.

Related: The Do’s & Dont’s of Successful Data Management for Population Health Management

Patient-Level Data Reporting is replacing Aggregate-Level Data Reporting

The emergence of advanced EHRs and EMRs empowered providers to calculate the aggregate totals of specific patient populations required by the early quality programs. As HIT has continued to improve, quality programs have begun to require more detailed patient-level data in favor of the aggregate data of yesteryear. This patient-level data is granular, much more precise, and allows for more advanced auditing capabilities (traceability). As quality programs evolve towards Pay for Performance, watch for them to similarly require patient-level data as a reporting and participation requirement.

Quality Results are going Public

Another growing trend among quality programs is the publishing of provider quality metrics. While most providers are not in favor of this concept, it is creating a much-needed non-financial incentive to help increase participation and adherence to the program. Originally pioneered by HEDIS to publicly compare health plans, other provider-centric quality programs are following suit and allowing consumers to perform an online ‘Physician Compare’-style provider evaluation, a term coined by CMS.

Group Reporting Replacing Individual Reporting

As mentioned in some of the trends thus far, quality programs are not only changing, but also changing quickly. As a result, they are getting increasingly complex. While PHOs and POs have been around for quite a while, there has been a huge uptick in the formation of Accountable Care Organizations (ACOs) to work on behalf of a group of providers. One of the main drivers here is that single providers and small clinics are realizing that they simply cannot sustain the burdensome requirements of all of these programs. This natural progression from individual to groups has its advantages and disadvantages, but we’ll leave that subject for another blog post.

Payment Model Experimentation

As we’ve seen from a myriad of P4P programs that are largely backed by payers, the models for reimbursement vary greatly. Each program is potentially different. While we know that most of them are focusing now on paying for ‘good’ performance, the payment mechanism and/or model is a mixed bag at best, with no clear progress towards any kind of standardization or trend. This trend (or lack thereof), however, is not only specific to private payers. CMS has created the Innovations Center, which is dedicated to researching and experimenting with various payment, and incentive models to ultimately identify the models that provide the highest clinical quality at the lowest cost.

Clinical Quality Program Evolution Trends

At a high level, improving clinical outcomes is a core tenet of Responsible Population Health Management (PHM). The financial implications of quality programs shape our industry more than any other external force. Therefore, tracking the evolutionary trends of such programs helps us design the tools and products of tomorrow to best meet our customers’ needs.

Related: 6 Pillars of Responsible Population Health Management

From a provider standpoint, understanding these trends is not simply academic. These programs have an influential impact on future clinical workflow. Knowing the predicted path clinical quality programs will take is also critical when choosing an effective PHM platform. Using a PHM system that is tuned for clinical quality improvement, manages your quality/incentive programs, and most importantly, does not impede core productivity are all important requirements. Understanding these trends in the evolution of clinical quality programs will help you to ask the right questions of your organization and empower you to plan accordingly to maximize any potential or unrealized future gains from these programs.

 Drew Borland is the Manager of Architecture and Research at Wellcentive where this article was first posted. 

Image credit: Lazy_Artist via cc

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Report identifies a confluence of challenges that make staying profitable increasingly difficult for physician practices today.

Physicians are almost two-thirds more likely to foresee a negative profitability trend, rather than a positive one, in the year ahead according to recent research report by cloud-based health technology provider, CareCloud and QuantiaMD, online and collaboration physician platform. The findings gathered through online surveys and related discussion groups report an overall downtrend in profitability among US physician practices with reform requirements as the leading source of financial burden.

Declining reimbursements, rising costs, ACA, coding/documentation changes including ICD-10, and EHR adoption were identified as having the most negative impact on practice profitability. Despite these challenges, the report concludes that most physician practice owners want to stay independent. Physicians also identified improved billing and technology as the greatest keys to improving the financial performance of their practices.

Background

 The Practice Profitability Index (PPI) was created to provide a voice to US physicians practices about issues that impact their financial performance and operational health. 5,012 physicians contributed their insights to the PPI during April of 2013 and, functions as a barometer for the operational and financial health of private practices in 2013. The 2013 report identified a confluence of challenges that make staying profitable increasingly difficult for physician practices today.

Key report findings include:

• 1-in-3 physicians see overall profitability trending downward in 2013
• 65% say declining reimbursements are the greatest threat to profitability
• 59% spend at least one day per week on paperwork instead of treating patients
• 48% say they lack the resources to accept any of the 30 million new patients from the ACA
• Only 9% are very confident in their current processes for getting paid
• Plus, profitability data is broken down by state, specialty and more…

Some of key data points in the report have been highlighted in the infographic visualization shown below:

Download the full report here

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The Healthcare Innovation Council, an independent group of healthcare experts  has urged Congress to re-examine the direction of the Meaningful Use program, stating that it is not improving patient care. The commentary entitled, “Lets Admit the Emperor has No Clothes-It’s Time to Redesign EHRs to Improve Patient Care” was submitted by six US Senators in response to a report released by six Republican senators on April 16th.

According to the council, the current breed of EHRs is causing a “massive disruption of providers’ patient care focus as they chase meaningful use dollars” leading to severe financial burdens on EHR hardware and software by healthcare providers. Thus far, CMS has spent over $12.7 billion of EHR stimulus incentives.

The commentary outlined 2 “root cause” reasons why EHRs are failing to deliver on their promises:

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Completely fed up with the current health care system, Joanthan Govette, Founder of Referral MD shares 11 reasons why our health care system is broken.

If you have met me personally, I have been known to cuss a few times in my life, not as much as Dave McClure from 500 startups though.   If you have been under a rock lately then you may have not read our PART 1 version of the “11 Reasons Why” article that went viral in the healthcare community.

So after a short break from the original article I decided to create my next opinion addressing another 11 reasons why healthcare is completely broken.

1. ICD-10

A code for everything!

All I can say is “Really?”,

The US Department of Health and Human Services (HHS) has mandated the replacement of the ICD-9-CM code sets used by medical coders and billers to report health care diagnoses and procedures with ICD-10 codes, effective Oct. 1, 2014. ICD-10 implementation will radically change the way coding is currently done and will require a significant effort to implement.

Now comes the funny part

There is literally a code for almost everything, don’t believe me?

SITUATION: You’ve been involved in a water-skiing accident where your skis have caught fire and now you are being rushed to the emergency room.

I really wish I was kidding, but I am not.

THE GOOD NEWS: There a code for that. ICD-10-CM, (“we have to pass the bill so that you can find out what is in it”) has anticipated this and your hospital will have no problem billing insurance for your treatment.

THE BAD NEWS: There are 6 different codes for this situation and you’ll be delayed as the medical administrator has to choose one.

More funny codes:
Z3754   Sextuplets, all liveborn
W5922xS Struck by turtle, sequela
Z62891  Sibling rivalry
Z631    Problems in relationship with in-laws
V9107xD Burn due to water-skis on fire, subsequent encounter
T505x6A Under-dosing of appetite depressants, initial encounter
V616xxD Passenger in heavy transport vehicle injured in collision with pedal cycle in traffic accident, subsequent encounter
V9733xD Sucked into jet engine, subsequent encounter
T63442S Toxic effect of venom of bees, intentional self-harm, sequela
Z621    Parental over-protection

2. Prescription drugs:

Over-prescribed and the side effects

Doctors are rewarded for prescribing drugs. Big pharmaceutical companies are known to hand out “consulting agreements” worth more than your annual salary to doctors who prescribe their drugs like candy. … This is one of the worst practices I can think of that drives a stake right through the heart of healthcare’s credibility

And unfortunately it seems people take accept it and take pills for everything.

Have a headache?  Take a pill.  A rash?  Take a pill.  Sore muscle?  Take a pill.  Tired?  Take a pill.  Overwhelmed?  Take a pill.  The list goes on and on.

• Why do people these days feel the need to take a pill for every ache and pain they have?
• What do they think people did before these medications were around?
• Why are doctors so easy to prescribe a pill for everything?
• Is it an easy way out?
• Are they getting paid from the drug companies to prescribe them?

Ugly (and disturbing) Truth to side-effects

Drug: Alli
Used For: Weight-loss/Weight-control.

Obesity has reached record-highs in this species of ours, and there are many who would quite literally do–or endure–almost anything, just to go down 1 dress-size. However, as many know, there is almost always a catch. And the catch for Alli takes the cake (no pun intended). Side effects range from uncontrollable bowel movements, to loose stools, to…”oily spotting”. Naturally, this “oily-spotting” is accompanied by flatulence. The website for Alli describes the “oily-spotting” as such:

“…You may recognize it as something that looks like the oil on top of a pizza…”

That sure is a lovely image. And the website states this side effect as a “minor” problem. However, this problem can be solved by limiting or entirely stopping your fat intake. Which raises the question:

Why even take Alli in the first place??  Why not just remove fat from your diet?

Drug: Accutane
Used For: Acne

Having pimples is no fun, we all have them from time to time, but to go to an extreme and take a pill that has the side effects that cause crying spells, rectal bleeding, and bone fractures (oh my!) is absurd.

I think I would rather have a few zits.

Somewhat less amusing, and well worth the description of “alarming” are side effects like hepatitis, psychosis and hirsutism. That last one is, in fact, an overabundance of hair. Finally, and we’re unsure of the logistics on this one, but according to Rxlist.com, you can also, somehow, end up with herpes.

Basically, in your quest to get rid of acne, it’s not outside the realm of possibility, slim though it may be, that you could end up as a psychotic wolfman with VD. One with anal bleeding.

3. Healthcare Lobbying:

AARP : A non-profit that is for profit.

A wolf in sheep’s clothing, drinking the blood of trusting souls that do not know any better.

This may be a strong statement but look at the facts.

• AARP’s haul from sponsoring insurance plans have nearly tripled in recent years to $657 million a year.
• Former CEO Bill Novelli got a raise of more than 80 percent from 2007 to 2009 even as the recession was taking hold. Novelli’s pay went from a little over $900,000 a year to more than $1.6 million.
• Some of the money also goes to lobbying — AARP is the fourth highest-spending lobbying group in Washington with other healthcare related companies following suite (AMA, Pharma, AHA, Blue Cross/ Blue Shield )

Making the Big Bucks!

As the facts set forth in this report reveal, AARP is not simply a non-profit entity claiming to advocate on behalf of America’s seniors. AARP is in fact a large, complex and sophisticated organization with over $2.2 billion in total assets and had revenues in excess of $1.4 billion in 2009 alone.

When measured by the products it endorses and profits it derives from those deals, AARP is one of the nation’s largest insurance companies and by far the largest provider of Medicare plans to seniors. AARP is also one of the most powerful and active lobbying groups (in terms of dollars spent) in the country.

Further clouding AARP’s image is a tangled relationship between the board members of its “for-profit” subsidiaries and the parent “non-profit” AARP which establishes AARP’s policy positions – often making it impossible to tell the two sides, and their competing agendas, apart.

Repeat Offender: Part 1, 2, 3 …

It should be noted that this report is not the first time AARP’s commercial activities have been the focus of federal government actions seeking to address a range of improprieties which appear to conflict with the organization’s 501(c)(4) tax-exempt status.

In 1994, AARP paid the Internal Revenue Service (IRS) a one-time settlement payment of $135 million in lieu of taxes, resolving an audit over tax returns for years 1985 through 1993 for failure to fully pay unrelated business income tax (UBIT) on its commercial activities.

Also in 1994, AARP agreed to pay the U.S. Postal Service $2.8 million to settle allegations that AARP improperly mailed health insurance solicitations at non-profit rates in 1991 and 1992. In 1999, the IRS and AARP once again reached a settlement to conclude an IRS audit of the organization covering tax years

1994 through 1998 with respect to the treatment of revenues AARP received from licensing and selling its name and logo to insurance companies. More than a decade later, AARP activities and business arrangements continue to raise concerns about which interests are being served at AARP – those of its 40 million members or the AARP business portfolio.

See full report:http://waysandmeans.house.gov/uploadedfiles/aarp_report_final_pdf_3_29_11.pdf

4. Tort Reform

To Sue or not to Sue… That is the question

”The first thing we do, let’s kill all the lawyers.” (Shakespeare in Henry VI, part 2, Act IV, Scene II). Shakespeare’s acknowledgment that the first thing any potential tyrant must do to eliminate freedom is to “kill all the lawyers” illustrates the central role lawyers have played in modern civilization, irrespective of weather that role is positive or negative.

The Positive

On the positive side, the legal profession has codified laws and drafted constitutions of many countries, giving recourse to the weak and oppressed against the powerful and privileged.

The Negative

On the negative side, the mercenary behavior of some lawyers has left the reputation of the field in tatters, with lawyers now occupying a status in society only a notch above bankers, stock market analysts and politicians (at least for the time being).

The Savings:  If we changed…

The Gallup Organization estimates $650 billion could be saved nationally from the health care system — more than one of every four dollars spent — if doctors, hospitals and other medical providers didn’t have to protect themselves from being taken to court by ordering unneeded tests.

The damage has been done…

Lawyers on the whole have done the most damage to the medical profession and ultimately to the supposed beneficiaries, the patients.  The litigation threat has affected trust between physician and patient.  Medical care should be driven by patient-physician respect, not by actions of lawyers.  How can this rapport be established if the physician wonders about every patient being a walking lawsuit?

Dragging a physician to court for every perceived mistake, however small or understandable, has led to defensive medicine wherein all kinds of tests are ordered to avoid the remotest possibility of overlooking something.  A physician should not have to conduct tests s/he does not think necessary but has to simply because it could be used against her or him in court.

A physician undertakes therapeutic interventions that s/he considers best for the patient.  However, every medication or procedure has side effects or interactions that can be unforeseen and serious.  A physician should explain the most likely and the rare but serious possible adverse outcomes.  But it is impossible to list every single reaction for every single intervention and the physician cannot be held accountable.

Mistakes do happen…

It cannot be denied that medical mistakes are made, some egregious, for which the victim or patient should be compensated.  However, there is no reason why that compensation should drive the average physician out of business by virtue of raising insurance premiums to ridiculous levels.

What can we do to fix the problem?

Tort reform has already been proposed to correct this anomalous situation, placing limits on payment for “pain and suffering”.  However, to redress the balance, here are some other remedies that could be applied

1. Lawyers should be liable for cases they lose by paying court cost and time spent by the defending physician.  This should decrease frivolous lawsuits.
2. Lawyers should not be paid a contingency of 30% – 50%, as is the case now.  That amount should be reduced to not more than 10% of final settlement as has been proposed in Florida.  Financial incentive should not be a driving force here, genuine concern for the litigant should.
3. Lawyers who file more than a pre-specified number/percentage of frivolous lawsuits should be barred, just as doctors who commit medical fraud are de-licensed.
4. Juries should be comprised of peers of physicians, nurses, and physical therapists, and physician’s assistants, under the supervision of judges.  Juries should not comprise of those not intimately familiar with medical profession since they do not have the required knowledge to judge the appropriateness of medical care.
5. Tort reform should also address a limit to malpractice claims, as is in Texas now.

Maybe when all the above changes are made, medical care will switch back to caring doctors and not sue-happy lawyers.

5. Healthcare Costs:

Medical related costs for almost every average American have grown so large that very few can actually afford coverage.  Over the last decade we have seen costs of healthcare rise faster then our average wage, leaving many in the dark.

Here is a short excerpt that we found in Time Magazine about a man that was diagnosed with cancer that ran up a bill of nearly a million dollars before  he died.

Something isn’t right here

• It has been estimated that hospitals overcharge Americans by about 10 billion dollars every single year.
• One trained medical billing advocate says that over 90 percent of the medical bills that she has audited contain “gross overcharges”.
• Quote from Aetna’s CEO Bertolini, “In some markets, increases in premiums could “go as high as 100 percent. And we’ve done all that math. We’ve shared it with all the regulators. We’ve shared it with all the people in Washington that need to see it. And I think it’s a big concern.”

Conflict?

The chairman of Aetna, the third largest health insurance company in the United States, brought in a staggering $68.7 million during 2010. Ron Williams exercised stock options that were worth approximately $50.3 million and he raked in an additional $18.4 million in wages and other forms of compensation.  The funny thing is that he left the company and didn’t even work the entire year.

So it is rather hard to listen to companies, when they say one thing about how healthcare will get more expensive but are in some ways contributing to the high costs by paying their C-levels absorbent salaries.

6. Medicare

It is America’s largest most likely to fail healthcare insurance programs.  Medicare helps pay for healthcare for over 43 million people.  But it is headed for disaster.  Spending is growing faster then revenue due to America’s aging population.

Medicare will not be able to pay for all the hospital bills that come in. Well before that year, Medicare beneficiaries will find that it is increasingly difficult to make appointments with specialists and gain access to high-tech care because of a squeeze on payments to providers. If trends continue, federal health spending (including the rising cost of Medicaid) will crowd out funding for the environment, defense, and other priorities from the budget.

How much does Medicare need to be saved?

Medicare will need about $10 trillion in new revenue (measured in today’s dollars) just to keep paying bills that will come in over the next 75 years for hospital care and other services under Part A. We will need about $20 trillion in tax revenue to pay for outpatient services under Part B and prescription drugs under Part D. Even in an economy as large as America’s (our GDP in 2006 was about $13 trillion), the tax increases required to raise such amounts would be formidable. Economic growth would suffer from the drain on the private sector and jobs would be lost. Although seniors might pay part of the needed costs, most of the burden of such a tax hike would be borne by our children and grandchildren.

Even if we raised the funds, much of the new money would be wasted without a fundamental reform of Medicare. Trying to maintain the program as it is today would mean preserving incentives for excessive and inappropriate care. While we need to ensure continued access to healthcare for Medicare beneficiaries, we should focus our efforts on creating a new Medicare program that works.

Thoughts on how to fix Medicare

1. Change payment incentives. Medicare should pay for better health outcomes, not just for services performed.
2. Enhance competition. As the Part D experience has shown, the best way to lower costs is through more competition, not more government management. Traditional Medicare should be permitted to adjust its benefits, premiums, and other features in response to changing consumer demand and evolving medical practice, rather than waiting for Congress to act.
3. Improve care delivery. Traditional Medicare is “à la carte” medicine, with a vast menu of treatments and health providers laid out before often-uncomprehending patients. By failing to coordinate the delivery of health services, we waste resources.
4. Keep track of which treatments work best. A flood of medical innovations promise improvements in our ability to diagnose and treat disease. Choosing a treatment can be complicated, however, and the knowledge of what really works is often lacking. Patient-level data from Medicare should be used to analyze the effectiveness of treatments for diseases.
5. Let beneficiaries be consumers. When people turn 65, they do not suddenly lose their ability to make decisions. Fears that Medicare beneficiaries would not be able to select a Part D plan proved unjustified. To the contrary, that experience illustrates the need for a consumer-oriented infrastructure in healthcare. Consumers need transparency plus clear financial incentives that promote prudent decision making.
6. Promote personal responsibility. Medicare should promote responsibility, such as better patient compliance with drug therapies for hypertension. The result will be better care and lower costs. But, again, the problem doesn’t begin with Medicare. Good health habits are developed well before age 65.

7. Doctors are going broke

While most doctors (50%) are employed by hospitals, the other 50% may not be doing so good.

“A lot of independent practices are starting to see serious financial issues,” said Marc Lion, CEO of Lion & Company CPAs, LLC, which advises independent doctor practices about their finances.

Do more with less, much less.

Doctors list shrinking insurance reimbursements, changing regulations, rising business and drug costs among the factors preventing them from keeping their practices afloat. But some experts counter that doctors’ lack of business acumen is also to blame.

Loans to make payroll: Dr. William Pentz, 47, a cardiologist with a Philadelphia private practice, and his partners had to tap into their personal assets to make payroll for employees last year. “And we still barely made payroll last paycheck,” he said. “Many of us are also skimping on our own pay.”

Great with patients, terrible at business

I have seen this 100′s of times personally, doctors love their patients, want to help as much as possible but know very little about business (i.e. websites, Google Places, PR, marketing, software, etc…) It is shocking to see that most do not hire a quality business consultant to help assist with these types of duties.  Most ask a staff, or family member to assist, and most are way under-qualified to help run an efficient practice.

Are you in this boat? not sure what to do with your marketing campaign?

Check out these articles we recently wrote, they should help.

1. Developing a Great Marketing Plan – Affordable Best Practices (free e-book)
2. 8 Quick Steps You Can Do Today to Set Your Healthcare Practice up for Gigantic Success

8. Meaningful Use

Source: HIPAA Cartoons

Unfortunately meaningful use and its incentives caused many problems that will be felt for years to come, it created a modern gold rush for new EMR vendors hoping to cash in.  With that, very many vendors have created very poor systems that will probably fail in a few short years due to being designed incorrectly and not supported mainstream.

The post Another 11 Reasons Why Our Health Care System Is Broken appeared first on HIT Consultant Media.

A comprehensive 10 step roadmap to a blockbuster health IT startup for aspiring HIT entrepreneurs. 

If you are tired of practicing medicine, or are compelled to be your own boss, or for whatever reason decide to try something new, you should consider becoming a Health Information Technology (HIT) entrepreneur, because health care is a $3 trillion industry undergoing great upheaval and widespread computerization, and as John D Rockefeller used to say, you should try to turn every disaster into an opportunity. As a physician, you have a significant head start when it comes to credibility, and if you are a tiny bit technically inclined, your value will easily quadruple. There are many ways to go about this, and you can follow your heart and try to “fix health care”, or relegate your entrepreneurship to hobbyist levels and work on some app for this or that, or you can judiciously research the market and pragmatically choose an endeavor most likely to yield quick and overreaching results. For the novice and uninitiated, below lays a semi-serious roadmap for hitting the elusive jackpot.

Step 1: Establish Thought Leadership

There is some foundational work to be done first and you should begin long before you actually quit your day job. Thought leadership today means that you have several thousands of followers on Twitter, Facebook, Google+ and LinkedIn. If you don’t have accounts for these social media sites, go ahead and create them, with your real name and credentials, and tie them all together to form a unified identity that can be leveraged across platforms. Start posting fast and furious. This sounds hard, but there are apps out there that will let you cross and schedule your posts. It is very important that you do not take any sides in any political or medical debates, and that you do not express any original thoughts at this early stage. Your messages (about half a dozen per day) should be just hyperlinks to articles and scant neutral commentary (e.g. “interesting study on medical errors”). With the right tools, this should take you about an hour per day. Once people start “following” your thoughtful stream of updates, make sure you eclectically follow the important ones back, but don’t start following a large number of famous people in advance. The sure sign of a thought leader is that he or she has many more followers than he or she is following. Keep this up and let it simmer while you move on to other steps.

Step 2: Educate Yourself

Although you can rise to thought leadership status without knowing much about anything, our long term goal is different, so this is the time to begin exploring issues in health care, most of which you are probably aware of, but you need a deeper level of understanding to initiate decent market research while enhancing your thought leadership. Don’t worry about identifying specific problems and don’t get hung up on possible solutions at this stage. Just read a lot and make Google your best friend. Start with simple searches (e.g. “medical errors”) and follow the links from quality mass consumption media (e.g. New York Times, Wall Street Journal, and Forbes), government sites (e.g. CMS, ONC), and reputable health care sites and blogs (e.g. kevinmd.com, AMA news, Health Affairs, etc.). As you become engaged in this activity, you will discover other publications that are useful, and don’t forget the big medical journals (e.g. JAMA, NEJM). This education phase will cross-pollinate your social media efforts in Step 1 quite nicely.

Step 3: Master the Language

This is the last step before you are ready to speak up in your own voice, and this may be the hardest part for a doctor. As you go through Steps 1 and 2, you will no doubt notice certain terms and phrases that are used frequently by current thought leaders, decision makers and others who recently completed all 10 Steps. Make these phrases your own. You must become conversational in this language to advance to Step 4. So for example, if someone wakes you up at 2 am asking you who the best cardiologist in town is, don’t just blurt out Dr. Heartfelt’s name and go back to sleep. Instead you should immediately state that this question in itself is an example of “lack of transparency in health care” and that “standardized measurement of provider performance is key to value-based decision making by consumers and purchasers”. If you are chaffing uncomfortably in your chair right now, remember that you chose to leave medicine and patients behind, because that too was very uncomfortable, and this Step is very much like learning a foreign language; you don’t have to think or dream in the new language, but you should be able to converse with the natives and eventually write a little too.

Step 4: Formulate a Problem

The first thing to note here is that you need not identify an existing problem, although it would be fine if you did, because many successful businesses provide solutions to problems people never knew they had. This is your opportunity to be creative and innovate. Remember that you are trying to build a business, and not just any business, but a blockbuster HIT business, so you are looking for rather quick and large returns on minimal investment, and there are three well-known strategies to accomplish this:

1. Find a Blue Ocean – a completely new product where there is no competition
2. Deploy a Christensen innovation – create a product that is much cheaper than what is currently available but still perceived as good enough by most people
3. Identify an insertion point in a transaction intensive market and create a very sticky product to fill the hole with

Unless you can create software to cure cancer, there are no Blue Oceans left in the shark infested waters of health IT, so #1 is out for most entrepreneurs. Christensen innovations are a-dime-a-dozen in health IT, and although some cheap innovations have worked better than others, health care is not a typical consumer market, and cheap stuff is considered almost sinful when life and death are on the balance. This leaves you with #3 which is particularly suitable for highly regulated markets, and ideal for chaotic ones. You may need to go through several iterations, but for illustration purposes, let’s pick one of the many possible roads you could take, and look at the exploding market of software for measuring physician performance.

Measuring quality of care provided by physicians is a government mandate. It is an excellent idea to hitch your business cart to funded federal mandates, particularly ones that are fuzzy, controversial and resented. The HIT market is flooded with EHRs that calculate quality measures and with dashboards and analytic tools that contend to do a better job. All these software tools cost small fortunes and when deployed on the same data, there is no guarantee that they will produce the same results. The raw numbers are rarely enough, and other sophisticated tools are needed to adjust results for comparison purposes. Major controversy exists regarding the quality of the measures themselves, the quality of the processing tools, the quality of interpretation, and to top it off, the measured are very unhappy with the entire affair. You may have your own hard feelings about the situation, which is a good thing, since being driven by a mission is infinitely better than a mercenary approach to entrepreneurship. What if you could step in at the point of purchase and provide assurance to both the measured and the measurers that the tools they are about to buy are reasonably fit for purpose? Not sure how to do this? That’s OK for right now, because first thing is first, and you need to create the need before you can ask people to pay you to satisfy it.

Step 5: Enhance Your Visibility

Now that you selected a business line, you will need an Internet presence and a platform to promote your innovation. You need a website and a blog. If you already have a personal blog or website that may be related to your practice, you will need to reevaluate the content and tone of your writing. More than likely you will be starting from scratch. Your website and your blog are your public image. It is imperative that you make a serious businesslike, yet innovative, impression. The current fashion dictates that your website is very white and very sparse, with very large high-quality dynamic graphics (please, no pictures of you sporting a stethoscope around your neck) and a small amount of tantalizing text in huge fonts. Your blog should also look Spartan and uncluttered. The favored color schemes are greyscale with small colorful accents, or the health care perennial favorite of smoky blue and ash grey with touches of faded neon green. Get this set up professionally and keep the website name on the generic side, just in case you come up with a better or somewhat different idea down the road. Start with a few awe inspiring sentences and build the content as you progress through the remaining stages.

Step 6: Build Public Awareness

Fear, uncertainty and doubt (FUD) is the synonym to “public awareness” in the world of sales, marketing and politics, as you should have learned in Step 2 and began practicing in Step 3 above. Continuing the quality measures example, and using the tools you developed in Steps 1 through 5, you should now launch a campaign to highlight the inability of any stakeholder to place trust in the hundreds of software tools employed to measure physicians’ performance. Don’t go overboard and discredit the shear notion of measuring performance, and do not alienate the software vendors (i.e. your future paying customers). At the same time, use your standing as a practicing physician (e.g. country doc, in the trenches, etc.) to elicit trust from your former peers, consumers and those who must privately (and begrudgingly) accept that when it comes to the actual practice of medicine doctors know better (e.g. payers, government, professional observers). You must use the language you learned in Step 3 and make sure that you are always perceived as an impartial, trustworthy and genuinely concerned visionary (it’s not as difficult as it sounds). Leverage whatever connections you managed to create so far, and those from your previous career, to make your voice heard. Publish, publish, publish…. However, do not let this Step drag out too long since there is always the possibility that a more expedient entrepreneur will help himself to the lunch you are preparing.

Step 7: Forge Relationships

The bad news is that you cannot do this alone. The good news is that if you did a good job in previous steps, and since you have an MD after your name, finding useful partners should be pretty straightforward, particularly if you set up your enterprise as a non-profit. You will need several types of partners and supporters. First and foremost, you will need a couple of big name public and/or private supporters (not necessarily financial supporters) to amplify whatever visibility you managed to create on your own, and to add credibility to your agenda. In our field of endeavor, ONC would be great, but decently sized technology companies with health care aspirations, such as IBM, AT&T or Microsoft may be even better. Large health IT vendors, maybe even sleeping giants like GE or Siemens are also good, and medical centers of excellence or reputable academic centers, like Kaiser, Mayo, Johns Hopkins, Intermountain or Duke, are a fantastic addition. In some cases, medical societies, private insurers and State organizations can add lots of value to your supporter list. If you are truly a country doc, you may need to dig up some old acquaintances from Medical school that chose a different path in life and renew some friendships that you may have discarded along the road. Expect to be buying lots of lunches and learn to not take rejection personally. Remember, you only need one good supporter to start the ball rolling. You will also need a couple of individuals (preferably somewhat known in the industry) with expertise in statistics, health IT standards and software testing, which will not be very difficult to find.

Step 8: Float Some Innovative Ideas

Once you have your infrastructure in place, it’s time to present your baby to the world. A word of advice here is in order. Health IT is a domain where intellectual property has no meaning; hence you better have your ducks in a row and ready to hop into the pond before you present anything specific. Going back to our example, after you, and your powerful sponsors, have convinced everybody that instilling some order in the chaotic market of quality measurement will save lives and money, you should now present your reasonably detailed plan to test and certify software that extracts and computes quality measures from clinical and administrative data. There are multiple methods you can utilize to make the case for the urgent need of a trusted and verified seal of approval for tools that affect the health of people and the revenues and expenditures of health care organizations. The nature of the partnerships you forged in previous Steps will dictate much of the marketing effort, but be prepared to help organize industry collaborative sessions and perhaps some conferences on the subject of quality and value-based payments (grind your teeth and keep your feet moving). Goes without saying that you will need to continue writing and speaking about quality and the pitfalls of disorganized and non-standard tools to measure performance, and hopefully by now you will be an invited keynote speaker at various industry venues.

Step 9: Deploy Your Innovation

Yes, Step 9 requires significant investment of funds. However, staying with our illustrative example, note that there really is no tangible product here, because there really is no problem that needs solving, so your only measure of success is going to be the number of vendors that voluntarily submit to your approval process. You will need a couple of market leaders to be early adopters (like anchor megastores in a mall), and if you picked your partners wisely in Step 7, you should be all set. From here on, you’re in maintenance mode with gradual expansion of value added services related to your original innovation.

Step 10: Enjoy the Ride

If all goes well with your startup venture, a liquidity event should become available to you in five years or so. Of course, every innovation is unique and your mileage may vary, but the principles are going to be very similar to those described here. You will have a few ups and many downs, long stretches of self-doubt, humiliation and borderline clinical depression, punctuated by the giddiness of a sudden breakthrough. The odds are overwhelmingly against you, and very few startups go beyond just starting up, but all in all, this is a most exhilarating journey.

Margalit writes regularly about intersection of healthcare & technology on her site: On Health Care Technology

Image credit: Flying Jenny via cc

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