For the sixth episode of our Monday Morning Healthcare IT Podcast Series, Tom takes a call with John McDaniel, our Senior Vice President of Innovation and Technology Solutions at The HCI Group. Tom and John will be discussing the future of healthcare, going over topics such as how the industry will look in the year 2025, the role of innovation in the future of healthcare, and how to develop innovative strategies.
In case you missed it, make sure to check out our episode from last week, where Chelsea Wyatt went over some key strategies and cost considerations that healthcare organizations should be keeping in mind during an Epic upgrade project.
Transcript
Definition of Healthcare 2025
Tom:
Hello and welcome, everyone. My name is Tom Letro of the HCI Group, and today I will be joined over the phone by John McDaniel, our Senior Vice President of Innovation and Technology Solutions here at the HCI Group. Our conversation today will focus on Healthcare 2025, a model that John has put together that gives a look into several different factors that will shape the way healthcare looks by the year 2025.
Now John, would you mind starting us off here today by giving an idea of what exactly you mean when you say “healthcare 2025?” As well as maybe why it is important to have the future of healthcare in mind?
John:
Well, healthcare, there is a number of changes that are occurring in healthcare that will mandate that the industry kind of restructure how care is delivered, driven primarily by reimbursement models. If you look at some of the models that are going into legislation, even this year the MACRA reimbursement module, and how it is going to address and focus on the quality issues associated with care as opposed to buy-in based reimbursement, will drive a lot more data collection and reporting regarding the services provided to the patient, ensuring that they are high quality and required, so that is one of them.
I think the next ones are – the industry is shifting through mega consolidations to where there’s roughly 5,400 hospitals, I think some industry pundits project around 1,000 in the next 5-10 years, so if that happens, you are going to see more at-risk taken by a number of these institutions, meaning the development of health plans, in essence becoming the payer, which will mandate that care focus on really preventing healthcare interaction versus treating a patient when they are sick. That is the second piece of it, and I think the third one is really customer patient expectations. There was a survey done not too long ago that looked at the requirements, or the expectations of an advanced population, we’ll say 16 over, and roughly 80% of those individuals wanted to interact with their care providers using technology, primarily Telehelp, or some form of visual consultation or virtual consultation, up over the internet, as opposed to showing up at their office. So I think customer expectations, reimbursements change around macro and quality based reimbursement, and the creation of large healthcare plans, owned and operated by the provider organizations will force healthcare to transform the way it’s delivered today.
Tom:
Ok, and I’m sure this is a question that you get asked a lot, but I’ll ask you one more time here, John. Why 2025?
John:
2025, I just really looked at it, it’s kind of a personal – I just looked at it and said “ok, I kind of have a roadmap that looks at where we are now, understanding what’s going to happen, understanding what technologies are available, oh and by the way, the technology to enable transformation is basically in place today, the real issue is cultural change and organizational restructure, and my assumption when I road-mapped that, not my assumption, my premise was, when I road-mapped that, it’s going to take 10 years, and I initially created this concept in 2015 to really address restructuring the industry, restructuring how care is delivered, and more importantly taking advantage of technology in changing our culture of care.
Tom:
Right, so obviously it sounds like a lot is going to be changing here in the coming years. What should organizations be doing now to prepare for this shift in how healthcare will look?
John: I think that’s a great question, I advise several clients to start to look at a number of different approaches to prepare. The first one is to really create or establish a chief innovation role, someone chartered with the responsibility to look outside, and think outside the box of how healthcare is traditionally delivered. Look at the new technologies that are being created and adopted. Look at very progressive, innovative organizations, and how they are starting to structure. If someone can be the internal champion at the executive level for innovation and change. So a lot of organizations have adopted the concept or role of a chief innovation officer.
Choosing a Chief Innovation Officer
Tom:
Ok, and are there any challenges maybe in choosing that chief innovation officer? And if so, how can you overcome those?
John:
Great question, there’s a number of challenges associated with finding the person or the individual with the right skill set for a chief innovation officer. There’s a number of attributes that I think are required for an individual to be successful. Obviously you’ve got the traditional ones like great communicator, somebody that can work in the team concept, but also someone who understands the process of healthcare today, and what it’s going to evolve into, a real thought leader, a progressive thinker, someone that understands the appropriate information technology, and the whole clinical process, and someone that could really establish a high level roadmap, and work with constituents to implement that roadmap. It’s very challenging to find that, however, having said that, there are a number of organizations that I have worked with that have found those resources and they are doing an outstanding job in helping that organization transform into a new model.
Tom:
Ok, and would you mind going a little bit more into the roles and responsibilities of this Chief Innovation Officer?
John:
It would really be, I would say they would share, one of the things I recommend is creating an innovation council. And that is usually comprised of a number of thought leaders within an organization, but I also encourage them to include patients into that council, and really kind of facilitate thinking in collaboration as they move forward.
So really, their primary responsibility is to look at where healthcare is going, create a roadmap in order to get there, working with that innovation council or governance council, and then really focusing on “what are the various steps required to get us to where we need to go,” and understand – I often tell chief innovation officers, or CIOs this, is expect to fail. You will make some mistakes, but have a process in place so you recognize very early that you’re headed down, I won’t call it a totally incorrect path, but a slightly incorrect path, that you can quickly modify so that the cost of failure is not significant. Don’t go into this thinking you are going to always be successful, you’re not. You are in somewhat uncharted waters, that’s why we need this kind of skillset that I alluded to earlier, and really drive innovation into an organization. That’s primarily the role that this person plays.
Challenges to Innovation
Tom:
Right, so it sounds like, like you said, you definitely need to make sure you pick the right candidate for that. But let’s say after you pick your chief innovation officer, they begin to accept some of the roles and really grow within themselves, are there any other challenges that organizations will face outside of that, with regards to innovation?
John:
A number of them. Obviously, budgetary concerns are one. This is not going to be an inexpensive endeavor, and most organizations don’t have an abundance of capital available to implement this, so there’s a number of very innovative ways to look at how to build these models out. So access to capital is a big one. However, the biggest one is really changing the culture of an organization, that says “we’ve always given care primarily at the hospital, that’s always been at the center of the healthcare universe, and then the model that a number of organizations are talking about, including us, is the focus really becomes the individual.”
So I manage the wellness stage of the individual, I manage the health stage of the individual, I manage, I do predictive kind of analytics to understand the individual may be trending in the wrong direction, and then ultimately, based on where I triage into, or where the healthcare codes or primary care physician triages them to, they might ultimately end up in the acute care center of the hospital. So it’s really changing the culture, and the way care is delivered in organizations in the United States.
Challenges after Innovation
Tom:
Ok, so we’ve gone over some of the challenges that are going to go into planning for this shift in the industry, but what challenges will these future healthcare providers face once they have reached that point? And once we get there, is there anything specifically that they should be looking out for?
John:
Patient education, patient engagement. That is absolutely an essential component for success in this model. At the end of the day, the only person that can really take accountability and responsibility for their health is the individual. So creating a very, creating a strategy that engages and encourages the individual to participate in all likelihood incurs success. It doesn’t guarantee, but it ensures that the opportunity for success becomes much greater. So it’s really focusing on models in all care, and the entire of stretch of engaging with that client or that individual or that patient, and why I think that is so important is going back to what I said earlier, we really want to engage with the individual in these kind of models that focus on predictive analytics, that focus on wellness management, so the individual might be reimbursed based on quality. I’m treating the right individual for the right thing at the right time and the right location.
More importantly, if I’m at risk, I want to keep that individual healthy, so ideally they never become a patient. But if they do, we understand well in advance what is going on, and we are prepared with our best protocols to address whatever illness the patient presents us with. Understanding we’re always going to have chronic-type care issues. We’re always going to have, well I won’t say always, hopefully we’ll find a cure, but we’ll have cancer, heart conditions, and other ailments that are chronic in nature, that need to be addressed in a medical care center. So there is always going to be a role for that, but primary focus is up front and doing a much better job of engaging and managing and coaching that patient.
The Role of Advancing Technology in Healthcare Innovation
Tom:
Ok, and, I’ve got to ask because, right now I’m using my computer and fancy microphone to talk with you, which is something I couldn’t have done 10 years ago from today. Obviously, technology is advancing rapidly, and has done so for the last 10 years. So, 10 years from now, we can only imagine. How profound do you think the role of this advancing technology is going to be in your model?
John:
Extremely profound. I think that is what is facilitating the transformation to occur. We’re talking about Telehealth, virtual health, telemedicine, whatever it is. The ability to interact with a patient in any site, from any site, with a care provider. So that is first and foremost, and you’re seeing huge in advancements in that, just imagine ten years ago, to your example, is my primary interaction. If I was doing anything, I was sending information over the phone from patient loading into a computer. Well, today I can actually look at that individual in a phone conversation using whatever technique I want to use, and recording and capturing the conversation I am having with that patient which can become part of the electronic medical record. So that’s a big piece of it.
The second piece is really around healthcare analytics. We’ve got to really be capturing information from all sources of the patient information. An example would be social media. There’s an abundance of, an aloft of medical information shared in social networks. The personal devices, FitBits, iWatches, whatever it may be, that are capturing real time data about me and my health status, needs to be aggregated and looked at on an ongoing basis. My electronic medical record needs to be inclusive in that, and probably the biggest component, I think, of that information that is going to be required in the future is around genomics. Being able to capture all my markers, and identify what I am predisposed to so I can build algorithms that will look at, well this patient is predisposed towards diabetes or whatever the marker might be, we build algorithms to start to look at what’s going on in a day in their life, what’s their electronic medical record say “you know what, John is kind of trending in the wrong direction, we need to engage now before something happens.” So let’s do a much better job of coaching that.
The big piece that the industry hasn’t started to look at in its entirety, with the exception of a few very progressive organizations, is a concept I call cognitive computing, which really is, it’s the Watson-esque type device. It’s intelligent, it’s a machine-learning device that allows capturing information from all of these types of sources, looking at the information, analyzing it very quickly, and giving information back to the primary care provider, based on how the patient’s trending. More importantly, it needs to be able to look at, on average there are 11,000 new publications a day on clinical trials, the result of clinical trials, new procedures, which might be relevant to an individual, that if I had that information, and I am treating someone with that specific disease, that falls within this category of DNA, and how they react to different things, I could change how I treat that patient in a much more effective way. So cognitive computing is a third component to take with technology.
Probably the most important is interoperability. In the model I am talking about, we have to have the ability to collect data, normalize and standardize that data in a real time manner, so that I can make an affective clinical decision about how I’m doing, how the patient’s doing, real time, and make coaching decisions, or triage decisions based on that information. And the last one really is around culture change.
Inevitable Change
Tom:
Ok, and last question here, John. So we have this model of how we think things are going to play out in the next decade. Would you say that this is inevitable, that this is going to happen? Or would it be possible for this to change?
John:
Well I learned a long time ago that you never say never. I’ll put it this way, the industry cannot continue to sustain the huge increases in dollars spent in healthcare, so we have to formulate strategies that will look at how we improve the quality of care, and reduce the costs associated with it. So the focus really becomes “well I’m doing a much better job up front in managing and coaching and working with that individual or patient before they ever become a true hospital-based patient.” So, if I put a percentage on the organizations I have talked to, and I’ve probably talked to more than 1,000 CIOs, CMIOs, and CEOs – everyone pretty much agrees that this is the model we need to progress towards, at least the framework of the model we need to progress towards in how we deliver care in the future. So if you were to ask me to put a percentage on whether it is this model or a model similar to this one based on this framework, I would say I am 90-95% confident that will happen.
Summary
Tom:
Ok, and it looks like the key is going to be innovation going into the future everyone. But thank you John we appreciate your time here today.
John:
You bet.
Tom:
Thank you for being here John, and thank you to everyone for listening. Make sure to subscribe to our blog and our podcast, as well as to follow us on social media. Also, make sure you comment below with anything that you feel we may have missed with regards to the future of healthcare, so that we can keep the conversation going.
For John McDaniel, this has been Tom Letro of the HCI Group. The HCI Group, offering a smarter approach to healthcare IT.