BLOG STARTUPS, VENTURE AND THE TECH BUSINESS

Big Ideas From The Forbes Healthcare Summit

[This post first appeared at blogs.forbes.com/toddhixon on October 12, 2013.]

 

Senate Passes Insurance Industry Aid Bill
(Photo credit: Mike Licht, NotionsCapital.com)

 

The Forbes Healthcare Summit in New York last week brought together very senior people across the U.S. healthcare spectrum: CEOs of big insurance companies, R&D heads of top pharma companies, CEOs of major medical centers, and CEOs of a few of the key upstarts: AthenaHeath, ASAP Urgent Care, Rothman Institute, MinuteClinic, etc. Here’s a summary of the big ideas that emerged.

No One Thinks Health Reform Is Going Away. Regardless of the drama in Washington, health reform is going ahead, and the major institutions are working to adapt to it. Beyond the ACA* the big driver for this is patient empowerment, which was the theme of the conference. Patients are being forced to pay more of the cost of their care, and because of this plus social change, they are taking more control and demanding more information and service.

Exchanges Are Happening On A Large Scale, And Volume Will Move To Value. McKinsey’s Shubham Singhal presented hot-off-the-press research on exchange sign ups. Consumers need a lot of help to navigate the exchanges, but they are trying in large numbers. Offerings are numerous. Some are less expensive, utilizing narrower provider networks to squeeze out further savings that offset expanded benefits and higher morbidity (sicker people buying insurance). McKinsey expects a big shift in volume to the lower priced offerings.

There Is Hope That Biotech May Finally Make Pharma Research More Efficient. This has been predicted for 30 years and not realized. The pharma R&D heads expect a major boost in the success rate to come from new technologies that make it possible to validate drug targets before development in human (versus mouse) biological models.

Healthcare Is Becoming A Consumer Business. Senior officer of a major hospital: “For a long time [we] thought care quality was all. Patient service and engagement has been a discovery. Care systems will need to provide understandable bills, and actual customer service.” Lives will move to the public exchanges (different views on how fast). Employers and insurers are offering private exchanges to stretch dollars and keep control: that puts them in the direct to consumer business. Consumers are doing a good job buying what they need on private exchanges: over-insured consumers tend to accept more risk; others spend more than the employer allowance to get what they need. New care modalities (drug store clinics, urgent care centers, surgi-centers) cater to consumer needs. Start-ups such as ZocDoc and Pokitdok facilitate transparency and consumer choice. Healthcare used to be primarily B2B, now it’s B2C**.

Integrating EMR*** And Claims Data Is The Next Frontier Of Healthcare IT. Several speakers said this will lead to insight into treatment cost-effectiveness and gaps: what patients need and are not getting, resulting in readmission.

Big Data Has Big Potential. There was some breathless discussion of linking everything seamlessly in the cloud. More specific areas of promise: integrating EMR with claims info (as above); creating large databases that enable correlations of therapies, outcomes, and bio-markers (patient traits that might predict which therapies are effective); and using “registry” data (data on what patients have received approved drugs) to short circuit parts of the drug approval process. The big problem with big data is HIPAA, however: the rules are tight and the penalties are big. It will be cumbersome to navigate the rules and motivate sharing of data. Several spoke of “health data donor” status: a person contributes his/her data anonymously to science, similar to organ donor status.

Everyone Speaks In Favor Of Transparency. Consumers need information if they are to take ownership of their health and the cost of their health care. All the players are promising to share data; United provides “pre-adjudicated claims data” (an estimate of the patient’s share of treatment cost) to its customers in advance of treatment, so they can know what to expect. However, as on audience member put it to a panel of insurance company CEO’s: “You’re talking very politely, but data is power. Are you really going to share?”

Patient Engagement Is The Key To Better Health At Lower Cost. Hospital CEO: “US health care was founded on dependence and authority. That is eroding. Patients now have access to technology and info: WebMD is the same info I got in medical school 30 years go, but it looks nicer”. Some see a new meme that makes healthiness a widely-held norm, similar to smoking cessation, seat belts, and sober driving. Insurance CEO: “It’s hard to get patient engagement without a provider in the mix.” The healthcare power players acknowledged a bit grudgingly that primary care needs to play a bigger role and have a seat at the table. As Gibbs would say, “Ya think?”

============================

*The “Patient Protection and Affordable Care Act” of 2010, commonly called the “ACA” or “Obamacare”.

**B2B is web-speak for business to business; B2C means business to consumer.

*** EMR = electronic medical record, the record of a patient’s diagnosis and treatment.

 

Comments are closed.

Top of the page