Wednesday, June 22, 2016

Farzad Motashari Shares His Take on Healthcare at AHIP Institute

This interview of Farzad Motashari (@Farzad_MD), CEO of Aledade (@AledadeACO) by Kate Warnock (@mkatewarnock) of GuideWell (@_Guidewell) at the AHIP Institute last week is verrry interesting - and not stupid!

For your ease of reference and comprehensive pleasure, I’ve culled out the key information that Kate solicited from Farzad. Thank you Kate and Farzad!

Here We Go!

Kate: Can you recap your presentation here at AHIP Institute?

Farzad: “It was about data – turning data into insights. This time is different– the availability of digital infrastructure, digital information and what do you do with that data once you have it. It was about the Yin and Yang of payment reform and delivery transformation. And I believe data and information systems are going to play a critical role in helping us succeed”


Champion of the Small Practice


Kate: “Doctor, you are a champion of the provider. In regards to the ‘Small, independent practitioner’ – how do you help them?"

Farzad: “Good news is that we now have tools that are cloud-based, that the smallest practice can take advantage of. Tools and systems that were recently only available to large providers like Kaiser"

Farzad: “The Big Theme with MACRA. And the changes coming in healthcare is that there are greater and greater demands on healthcare: reporting, administration, compliance, and value-based payment. It’s going to be… VERY, VERY hard to stay autonomous. As a doctor I’ll have to figure out: do I become an employee, retire, check out or band together with other practices?”


Message of Hope

Farzad: 'There is a third way’ – small practices can band together with other practices into virtual groups – come together and get support you need to do the reporting, population health, do the ACO contracting, - but don’t change your independence."

Kate: "How do you see this independent practitioner competing against larger, consolidated practices that have the extended services, transportation, offer home-based monitoring that can impact quality scores and reimbursement?”


David vs. Goliath?


Farzad: "You might think that Goliath has the advantage here but they don’t! Small practices have lower readmission rates, lower costs, higher patient satisfaction and higher patient engagement. The one thing they lack is market power - in the FFS environment”

“Population health plays to the advantages of practices/groups that don’t have to worry about keeping their beds full, the procedure suite humming, and the operating suite going. If you don’t have to worry about ‘demand destruction’ (What health systems call it when patient's are healthy) then you have a mathematic advantage. Small practices can outperform large health systems"

Kate: "Virtual arrangement can be a way to scale."

Farzad plugged his company Aledade here. :)

Farzad: “Every time there are new payment rules issued there are significant impacts to infrastructure. CIO’s are becoming more and more strategic – they need to anticipate what the organization will need in the future.

What Should Healthcare CIO's Do With Their Data?

Farzad: There are few things CIO’s they need to do with their data: 

1. Generate insight of your data
2. Make that data accessible for insight.
3. Create a learning infrastructure (like I'm doing here) – experiment, instrument your interventions and outcomes. Learn from yourself.

“There’s nothing you can predict – like we’re going to need more of this or that – you can’t know that. But what you can know is that the future is going to be changing and the more you can learn the better your organization is going to be"

Farzad: "There is a commitment on the part of CMS to get it right –and their going to continue to work to get it right."

What Types of Care are There?

Farzad: There are three Types of Care: 

Managed Care – Lots of benefit design, who you can see, what you can get, what you can’t get

Totally Unmanaged Care - FFS, PPO – go wherever you want. The patient is the manager.

Something in the Middle – someone to accountable for you and make you accountable in a soft way, to nudge you.


That's it. Thanks to Kate Warnock and Farzad Motashari for sharing this great info. 



Key Info, Ideas & Considerations on Addressing Healthcare via Non-Medical, Community-Based Resources & Tools

source: www.health.state.mn.us
It’s been established that 70-80% of determinants of health outcomes can be attributed to socio-economic, environment influence and behavioral health challenges. Accordingly, support from the community, through local volunteers or trusted low–cost services, has a vital role to play in meeting one’s practical healthcare needs and improving ones quality of life.

On Friday, June 17, 2016, I hosted the weekly #HITsm tweetchat where topics on “Addressing Healthcare via Non-Medical, Community-Based Resources and Tools” were discussed.


This post summarizes the key points of information, ideas and considerations raised by participants of that tweetchat. For detailed information contained in individual tweets, see previous posts referenced at the end of this post.

Topic #1: How can individuals who may benefit from non-medical support services be identified?

Specific locations where individuals who might benefit from non-medical support services were identified

The use of assessments – at doctor’s offices and upon admission and/or discharge from the hospital

Mobile application, Smart Phones, various devices and the Internet of Things can supply key data points

Analytics (aka. ‘Big Data’) are an important means to identify those who may benefit

Funding and Reimbursement for identification, assessment and referral coordination must be addressed!

The individual must be the center of attention

Topic 2: What role, if any, do physicians have in connecting patients to specific, local, non-medical support programs and resources?

There’s disagreement about the role of the physician

There's a role for others both in the doctor's office and elsewhere

Your shopping receipts can reveal a lot about your health and potential health needs

Topic #3: How can technology be used to reach out to people who may not seek help or sign up to receive it?

Technology supports patients and their caregivers – in public and private venues

Technology makes helpful resources accessible, available and scaleable

Supports Communication between resources, patients and caregivers.

Analytics & personalization are key needs addressed by technology

Topic 4: How can technology tap the large supply of informal support from volunteers and resources provided by local service organizations?

Creating a repository of available resources is important

Attributes and tags to help identify opportunities & potential conflicts

Technology is needed to enable interoperability and share information

Topic 5: How can digital tools bridge care provided in clinical settings w/community-based, non-medical resources?

Supports inter-operability, sharing of information and messaging between patient and resources

Facilitates actionable information that's easy to consume

Analytics create insight by identifying need and matching resources to those needs

Topic 6: What are some ways technology can help support the ‘carers’ who provide support to others?

Helps fit information and support into caregiver’s daily routine and workflow

Can relieve caregivers of some of the burden of day to day administrative and care coordination overhead

Enables and supports Communities of Care

Provides support for caregiver needs

Where to Find Details on All of the Above
For more detailed information and ideas on the above, check out these previous blog posts for tweets providing additional details on the above:

Topic #1


Also, consider following me on Twitter where I share information on this and other healthcare data, technology and services topics on a regular basis.

Curated Tweets on Final Two Topics from Last Week's #HITsm Chat

source: healthstandards.com
Here are the final two topics #5 & #6 from the #HITsm tweetchat held on Friday, June 17, 2016: “Addressing Healthcare via Non-Medical, Community-Based Resources and Tools.” In previous posts I shared curated tweets from Topic #1, Topic #2, Topic #3 & Topic #4.

Topic #5: How can digital tools bridge care prov. in clinical settings w/community, non-medical resources?

Interoperability, Sharing & Messaging

@jwander14: First you have to have a way to get real-time #data from outside of four walls!  

@matt_r_fisher: Get the systems to talk with each other. Right now likely exist in completely different spheres.

@stuckonsw: Hospital / community service tech agreements??

@shimcode: Tech can be used to automatically share info between care coordinators and patient medical records

@ochotex: For provider-patient care, I think I agree. Would be nice if it was as easy to use as Slack.

@jimmie_vanagon: Yes and in small office IMHO the best tool for this is a #HealthCRM co-managed by 1 great employee who knows every pt, nurse

@jimmie_vanagon: Not all #portals or #CRM s the same, we commonly hear how easy our portal is to use think the #CRM space will grow

@mandibpro: ...and CCDA sent to more than 1 external #EHR (and THAT one could be a test #DirectProject address). 

@jwander14: Agree - SMART apps and plugins

@jimmie_vanagon: IMHO it is best to have messaging from pts coming in via password protected/archivable format like #CRM Portal

@jimmie_vanagon: Otherwise how do you keep the messaging organized and coupled with the #EHR too messy otherwise

@shivam_mundra: Setting up messaging infrastructure which allows providers communicate to such programs/community

@shereesepubhlth: Smart phones! And that's no joke. I think it says something that we get smart phones into hands of Srs but not preventive care

@jimmie_vanagon: Yes and make sure the #ptportal provided for your patients is #smartphone compatible

@shawnmyersrn: I think #FHIR Has a lot of promise here. New apps can help community organizations collaborate with medical. 

Actionable Information That's Easy to Consume

@shimcode: A list of resources that can be maintained by community organizations themselves (even crowd sourced) would be good.

@uiandme: Where consumable means multi-platform (including print) and accessible (findable, readable, etc.) https://t.co/WJGYD2WGer

@shimcode: Anything to decrease time difference between identification of need and receipt of benefits will help.

@shimcode: Make stuff easy to process and recall! Cognitive load of materials given out to help people is often enormous.

@scottyweitzman: Think and act at compute speeds as well deliver the resources info in a much more consumable manner to pts 

@cathysusk: the tech part of data sharing is easy but regulatory hurdles would be hard

@glhc_hie: You mean like w/ #HIE! We're working on it! Your check is in the mail Matt!

@glhc_hie: Please refer to my first answer to T1! I'm starting to feel a little like Chuck (@wareFLO) "All HIE, All the time!"

@glhc_hie: I give you the "Virtual Integrated Patient Record - REAL-TIME longitudinal patient data!: https://t.co/G5Qc6Cyfl4 #HIE

Analytics & Insight

@mandibpro: Data mine to identify local resources, business rules could be written to suggest correlation to #EHR data.  

@stuckonsw: How can care managers/nurses get involved in #FHIR & give "boots on the ground" perspective on these probs?

@shereesepubhlth: I do love all the protected tech emerging applications.  

@stuckonsw: Matt did you also see @CrisisTextLine got a huge funding boost and will be baked into FB messenger @sarahmlavoie @mloxton


Topic #6 - What are some ways tech can help support the ‘carers’ who provide support to others?

Administrative Assistance

@nxtstop1: A HUGE issue. Firstly, carers need to be empowered, as empowered as their "patients" wants them to be and have all data they need.

@nxtstop1: Carers, if baby boomers likely have a superb grasp of #technology and able to well handle tech outreach strategies.

@scottyweitzman: Constant availability. Could take down admin workloads, insurance issues, appts, etc.

@shimcode: Tech can be used to assist w/ “life care planning” based on currently available, local resources.

@mandibpro: Yes - but #FHIR currently-anointed cross-#EHR standard for ingesting data INTO system (not exporting).

Enable & Support Communities of Care

@stuckonsw: Any tech to educate, connect, and communicate as a team! Family, patient, providers, specialists... Make the world smaller

@ochotex: I think a lot of communities built networks post-9/11 for emergencies. Could they unite for health?

@shimcode: Tech can be used to support 'Virtual Patient Communities' to provide caregiver support

@jimmie_vanagon: There are some incredible apps available now, my nurse finds the #CRM containing #portal helpful

@uiandme: Concentrate on probs common to underserved 1st: hrt disease, cancer, liver disease, kidney disease, skin infections, pneumonia and TB

Fit into Caregivers Daily Routine/Workflow

@ochotex: Keep it simple so it actually helps, doesn't make them stop what they're doing to "make it work"

@shimcode: Tech can help track services provided/interventions and help measure health and well-being improvements. Assign 'value/savings'

@uiandme: Onboarding for a transient population? HC resources that can be accessed at library or HC facility.

@scottyweitzman: Taking down workloads may relieve stress, promote new studies, better care. IMO

@jimmie_vanagon: Share #EHR at point of care on wall mounted screen so pt has ability to view & edit together with doc #ProjectedEHR

Support the Caregiver Too

@nxtstop1: Carers deserve precisely same respect/attention as do those they care for - by the HCP team> to insure successful health outcome

@shawnmyersrn: We need to provide education to address care providers’ needs, as well as patients.

@ebukstel: Sometimes the caregivers in underserved areas are also need food stamps to get by / effect on HC

@shereesepubhlth: Caregivers need HIT options that address stress and socio-economic fears associated w/ providign care to loved-ones. Huge MH segment

Some Examples

@mandibpro: Platform like Ginger.io could be expanded to address other #SDoH needs (non-med, non-#mentalhealth). Guys! Enhancement request! ;)

@shawnmyersrn: Opennotes is a good model https://t.co/NiFVVJkqXS

@ebukstel: Well here's an app that helps the homeless shed unwanted calories https://t.co/PAP0UPRy6D

@ochotex: Look no further than Africa where smart phones are incredible tools. Less requirements allow loose PHI sharing.


@jimmie_vanagon: So the PHQ-9 questionnaire4depression can be shared on large screen, filled out together, results graphed over time helps

@jimmie_vanagon: Yes and one of the best new upgrades on my #EHR is having the PHQ-9 available and immediately saved to chart 2see response to Rx 

That's All Folks!

This post completes the sharing of curated tweets from the #HITsm tweetchat I hosted last week. for more information on this and similar topics related to healthcare data, technology and services, consider following me on Twitter.

What I Wanted to Share About #AHIPInstitute on #HCBiz blab today

Sorry about the technical difficulties in today’s #HCBiz blab – unfortunate when you never really know what causes these connectivity issues.

Here are some very quick (and dirty formatted) notes I took but didn’t really get a chance to share during the blab. And I have a lot more but not enough time to share right now...

1. What is AHIP (org and conference)?


a. Amer Health Insurance Plans
b. Lobbying organization
c. It's the 'HIMSS' for health plans/payers

2. Who attends the conference?

a. Mostly Health plan execs, those involved with risk-bearing provider organizations, lots of vendors trying to sell into that space.

b. Some associations like The Joint Commission, public health organizations

3. What were the major themes of the conference?

a. Value-based Reimbursement,
b. Social Determinants of Health,
c. Telemedicine,
d. Innovation, - Corporate Investments

e. Population Health

Major themes are dictated by fact that healthplans are changing.

Payers are collaborating with providers more. More direct to consumer health solutions firms

4. Did you find anything particularly new/exciting?


a. A couple of the sessions were good.

b. Many vendors and payers at the AHIP Institute didn’t seem to be as good with sharing and promoting their products and services information as vendors and providers at HIMSS

c. Some of the corporate investing – Mark Stryker of GuideWell and Rob Coppedge of Cambia

d. Guidewell (BCBS of FL) had an “Insights” stage where they interviewed a lot of speakers and others involved with the event

5. What disappointed you about the show? 

A lot of superficial information in some of the sessions and keynotes.

Keynotes where some of the keynoters plugged products they have interests in

Two of the sessions I attended were painful to experience: poor speakers, IMO, not a lot of good, real information or insight

Slides you couldn’t read

Presentation materials – no handouts!

Aggressive vendors – 3 or 4 people standing in line staring at you as you approach their booth - blocking their table – Facing Offensive line of the

6. You’ve been focusing on SDOH quite a bit lately. What did you see from payers/vendors in addressing those issues?

a. Lot of talk about the value of addressing sdoh and behavioral health issues, impact to risk assessment and management

b. It’s clear that now even more people besides payers and providers have to be involved with supporting positive patient health outcomes

c. Not a lot of specifics as far as programs and tools

So again, sorry about not being able to share. I'll try again with Blab someday - maybe. :( 

Monday, June 20, 2016

Curated Tweets from Recent #HITsm Tweetchat on Non-Medical Tools & Resources - Topic #4

source: healthstandards.com

The #HITsm tweetchat on Friday, June 17, 2016 discussed six topics related to “Addressing Healthcare via Non-Medical, Community-Based Resources and Tools.” In previous posts I shared curated tweets from Topic #1, Topic #2 & Topic #3. In this post I will share curated tweets from Topic #4.

Topic #4: How can tech tap large supply of informal support from volunteers and resources provided by local service organizations?

@mloxton: Well there's a good question. I haven't the foggiest

@mloxton: Maybe the question needs to be flipped over. What tech do the people in need use and access? #BusShelter

Create a Repository of Resources

@shimcode: It can point out specific services/resources to specific individuals based on caregiver defined needs. 

@mandibpro: Easy. #Datamining #tech can curate/categorize resources. If person OKs info-sharing, cross-ref participants.

@healthcora: Search results should plug you into these resources - super easy to parse what someone is looking for into what they need #SEO

@matt_r_fisher: Create communities and organize directories. Think this was said before. Tech great way to bring diverse info together.

@nxtstop1: Since libraries R go-to community resource areas w/computers, internet & training> Like centralized local social support website.

@matt_r_fisher: Think many are surprised at just how much libraries are still used. I go all the time and get odd looks.

@shereesepubhlth: They can be great resources and they would be a good place to reach out to public needing help

@mloxton: Isn't Ushahidi sort of that? Geospatial problem marker with ability to have volunteer orgs respond?

Identify Opportunities & Inconsistencies

@cathysusk: Lots of community resources seem to aim for the lowest common denominator though which is too bad 

@drsxr: Funding realities and legal framework tend to require a LCD approach

@2healthguru: Considering all public funding troughs into healthcare ecosystem, should be a standard, MJ.

@jimmie_vanagon: The struggle on a local level will be finding a resource that can individualize and meet needs

@mandibpro: If "in need" means homeless veteran panhandling on street corner and missing shoes, thinking tech not his.

@nxtstop1: Umm think most providers keenly aware of the awful lives of many of their patients....they can't cure but > #Election2016

@scottyweitzman: Maybe off base, but Cog Tech is NLP based understand EHR as a human would. Finding errors or missed ops

@fqure: Conflicted. Do we ask patients for even more data or is data we've captured already enough to determine

Support Sharing of Information

@shimcode: People and programs offering resources can be kept updated about individual needs. Many temporary programs underutilized. 

@shivam_mundra: Providing a platform where volunteers can share their ideas #socialmedia, creating specific groups/communities @HealthStandards

@2healthguru: General rule? Those who need it, don’t use. Those who don’t (need it) do?

@ochotex: Messaging apps can unite everyone... Getting those to agree to be united is the hurdle!

@shereesepubhlth: When I worked on my last project regarding this topic, we didn't have to collect additional data

@glhc_hie: EVERYONE talks about Patient Engagement, but it's hard, messy, and absolutely necessary! Tech is a means, NOT an end!

@stuckonsw: Big problem is healthIT and social service IT systems "don't talk" ... see @Open_Referral #interop

@jwander14: If using technology, need HIPAA compliant platform/portal for non HCP community-based team.

@uiandme: Platform is important too. Many still without mobile and internet access. Need low tech alts included in strategy

@jimmie_vanagon: Yes agree and in small office setting a #HealthCRM that ties the #Portal #EHR #efaxing 4 INFO flow in and out of office works well

@glhc_hie: With #mHealth apps and trackers, patient data can be auto-reported through passive or regular interaction.

@wareflo: Personally, think mistake 2 wait 4 #FHIR here, lots HC API companies create new APIs all the time (just IMHO)

Still More to Come!

The information shared on Topics #5 and #6 are coming soon. In the meantime, for more information on healthcare data, technology and services, consider following me on Twitter.