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"The Dish on Health IT"

Engaging discussion around Health IT with perspectives from across the healthcare landscape. This informative and entertaining rotating panel of senior health IT consultants and their guests will keep you in the know about the latest innovations, policies and industry shifts impacting healthcare and point out the opportunities that lie within.

The Dish on Health IT

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Episode 14: 2020 Year-end Review & 2021 Prognostications


On this year-end episode of The Dish on Health IT podcast, host Gary Austin and co-hosts Ken KleinbergPooja Babbrah and Jocelyn Keegan discuss prognostications on the year ahead in the areas of COVID-19, technology innovation, health data, and price transparency 

Gary begins the episode by addressing the elephant in the room: the ongoing impact of COVID-19. He asks Pooja to open the discussion by giving her thoughts on the impact of the healthcare vertical COVID-19 is going to have in 2021. Pooja says COVID-19 is going to impact a lot of things, starting off with the vaccine. For the vaccines that are beginning to roll out, two different doses are needed for it to be effective. Tracking immunizations will be tricky for HIEs. Who has received the first dose? The second? Adherence will be critical. We need to make sure those who received the first dose of the vaccine also receive the second dose. Even the payers and pharmacies are going to be impacted by COVID-19 not just with the vaccine, but with how people are seeing their doctors. Pooja references past The Dish on Health IT podcasts that covered telehealth, the expanding role of pharmacists such as giving vaccinations, and the opportunity to better include community pharmacists in efforts, which all will remain relevant moving into the new year. 

Jocelyn agrees with Pooja in saying we need to drive volume in this market to the most suitable place that can best serve a patient and have the right tools and connectivity to make sure that data is comprehensively gathered. Jocelyn does see two things we will have to grapple with when moving into the new year. The first is the impact of profits and loss from a provider organization standpoint. There is massive loss happening for those in the direct line of care. She thinks when we look at 2021, it will be about leveraging the tools in front of us and taking advantage of the new technology that is being laid down. The second issue at hand will be impacts of market readiness. We wanted these rules to be put in place and then the rules were put in place. Will delays on these rules slow us down when we were at a point in time when we could have had a perfect storm to push through a lot of technology change? How fast do we allow ourselves to move? How much do we acknowledge what our provider teams are dealing with? 

Ken believes the vaccine will be key. He recently read an article that correlated the degree of someone’s education with their willingness to take the vaccine. If you had an advanced degree, you would be most likely to want to take the vaccine. The less education a person had, the less likely they were willing to take it. There are big trust and education factors here that payers, providers, IT vendors – all of us really – need to take responsibility in helping with that.  

Gary moves the discussion to the next topic: health technology, specifically telehealth, FHIR APIs and health information exchanges (HIEs). What are your thoughts as to where these technologies are going in 2021? Ken notes that all three of these technologies have something in common and that is that they are connecting stakeholders together. We’ve experimented and piloted. We’ve had our successes and less so over the last two decades, but now we are seeing these technologies come together and become mainstream. This could be due to leadership, regulations, relaxation of regulations (in the case of telehealth), or simply the need to fight the pandemic. Once data starts to flow, we will be able to run advanced analytics with more varied data sources. This can inform decision support, risk stratification, analysis of social determinants of health, precision health and so forth. Ken is particularly excited about the promise of natural language processing and AI machine learning.  

Pooja agrees with Ken in saying these technologies are essentially connecting people together and sharing more information, which brings up trust. We are starting to open up more data. We have HIPAA which spans across our business entities. What will happen when we open up data to the patient? Patients having trust in applications will be critical for them in getting their information. Then comes the issue of who the patients are willing to share the information with. eConsent plays a huge role in this. Who are patients going to share the data with? Do they understand that when they share their record, it will essentially share their entire patient record? Is that something they want to do? Moving into 2021, trust and eConsent will be a huge focus.  

Jocelyn points out that if a problem is big enough, we can make the existing artificial barriers disappear. She goes on to explain that people have been leveraging tools that are available to them. When you’re in the middle of a pandemic, it is about what tools are there that are being underutilized such as the HIE. She goes on to address new technologies and the unleashing of data by using APIs predominantly through FHIR. The pandemic has clearly shown how important these projects are and will allow stakeholders to progress towards more real work in the upcoming quarters. Payer and provider rules continue to get dropped. Jocelyn feels the work around FHIR and APIs is truly a nonpartisan topic. We are seeing universal agreement and will continue to push forward.  

Gary moves to the next topic, which is health data. What do you see happening with health care data in 2021? Jocelyn sees a couple of things happening here. First, payers and EHRs, around the information blocking rule, are mastering their information in a way that they haven’t had to before; being able to comprehend where their clinical and claims data are. What’s most interesting is the scope of data that’s under regulation and having people meet those initial regulations. Secondly, we are realizing this is real. There are the people who are getting their house in order and then there are people who are trying to just check the box to get through this set of regulations.  

Ken notes that terminology and code set management have been important to providers and now to payers as well. Payers will need to get a handle on the clinical data they have and share it. Ken says some may only do the bare minimum while others will use this as a business advantage.   

Jocelyn hopes that the next round of USCDI addresses some of the deficits in the payer-based data.  

Pooja adds that while we often talk about clinical and claims data, we need to also be thinking about pharmacy data. With USCDI 2.0, we need to start thinking about those stakeholders who haven’t been involved like pharmacies. To have clinical, claims and pharmacy data together would be a very powerful thing. 

Gary asks Pooja to address price transparency. Pooja says that real time benefit check feels old hat now since it has been in the market for five years. With consumer-facing, there are implementation guides in place, and we are starting to see some PBMs pick those up and start to look at it. The biggest thing though is the final rules that dropped a couple weeks back for the payers and providers. Pooja thinks that’s where we’re going to see a lot of traction in 2021. Payers and providers need to be looking at this as a way to give themselves a market advantage. There is a long way to go, but it all comes down to freeing data and putting more opportunity in the consumers’ hands. To find the care they need at a price they can afford it.   

Ken says that consumers can play a very important role with price transparency. He wonders how we educate the consumers to operate in the proper vector. The more information you provide them, in an easily-digestible way, can make a difference. Ken believes these final rules can be used as a market differentiator that could lead to stronger consumer loyalty.  

Gary asks Jocelyn to discuss accelerators in terms of price transparency. Jocelyn says the name of the game with price transparency is that it needs to be patient-focused. It’s about information equityhaving the same information as my provider, which requires all the players to be involved. Jocelyn thinks that if we look across the board, that’s the sentiment of what’s happening. That’s the foreseeing function we see coming out of these rules is make the data available so that we can have the innovation we need to get to a well-educated consumer.  

 The final topic relates to the new administration. Gary first asks Jocelyn where she sees CMS and ONC going? She predicts that we can expect public health to get some money to actually do real work. Since this is a non-partisan topic, she also expects regulations to continue to come through. Jocelyn is confident that with the work coming out of the ONC and CMS teams around regulations and the work we are seeing come out of cross collaborations, we are making real meaningful progress in helping our consumers.  

Pooja adds that with CMS, we are still waiting on a final rule for the consumer-facing real time benefit check transaction. These topics seem to have bi-partisan support, so she does not see many changes in these focus areas.  

Ken gives his final thoughts. He thinks 2021 is going to be one of the most intense years in decades for health plans, providers, and IT vendors as they start to tackle all the game changing open API regulations that are going to require them to share data.  

Jocelyn thinks we have never been better positioned to impact change. We are in a unique situation with the move toward FHIR and APIs. It is rare to be able to fundamentally change how an industry works. That’s what we’re doing.  

Pooja closes by saying she thinks this pandemic has opened our eyes to everything that is wrong. The CMS and ONC rules were coming out just as we were going on lockdown. It makes you wonder, if we had these rules in place just on our own without being forced to do it, how much of this heartache and struggle we are going through now could have been avoided? Pooja was frustrated to see the rules get delayed. We are in the middle of a pandemic. We should not be slowing things down; we should be speeding them up.