Post-HIMSS Interview with NaviNet

2014 NAVINET EXPERT INTERVIEW SERIES

Laura McCaughey’s Interview with Janice McCallum on 2014 Outlook for Health Insurance Exchanges, Health Start-ups, and Need for Price Transparency Tools

Janice McCallum, Managing Director of Health Content Advisors, is a leading blogger and contributor to healthcare IT conversations on social media. Last night, Janice graciously spent time with us after Hillary Clinton’s HIMSS14 keynote address to discuss what surprised her in 2013, her thoughts about the progress of health insurances exchanges (HIX) to date, the most interesting start-ups she’s seen in the past few months, and what applications she expects to have the biggest influence on healthcare in 2014.

(1) What event/nonevent or trend surprised you the most last year?
I’ve lived through several periods of rapid change where digital technology radically improved access to information and transformed how we purchase goods and services. So, it’s not easy to surprise me; I’ve seen a lot!

But, to answer your question, I’d have to single out the problems with the Massachusetts Health Connector as it transitioned to an ACA-compliant health exchange last fall as the biggest surprise. The HealthCare.gov problems didn’t surprise me as much, since I had an inkling of how complex the set of data extraction and matching algorithms had to be. However, within Massachusetts (my home state), where we had ample experience with an existing insurance marketplace that we call the “Connector,” it took me by surprise that the transition to the ACA HIX was—and still is—such a disaster. Perhaps it was due to overconfidence, or more likely, it was due to the fact that Mass chose the same IT contractor as the federal government used for the launch of Healthcare.gov: CGI Federal. I don’t place the entire blame for early problems with the Healthcare.gov site on CGI’s shoulders, but it does appear that they had insufficient resources to complete either job on time. Overall, I’d say there’s plenty of blame to go around, but for now the focus has to be on moving forward and fixing the problems.

(2) Uncertainty and painful reality around health insurance exchanges (HIX) are keeping payers, providers, and patients up at night—and demanding a lot of problem-solving during the day. What advice would you give to health plan CIOs as they strategize to leverage technology to insulate their companies from the reality of HIX versus the model?
I can only offer high-level strategic advice, since I’m not an expert in the technology underpinnings of the exchanges. My advice is to learn from the successes and failures on HealthCare.gov and the state exchanges, adopt best practices from the successes, and avoid duplicating the mistakes made by others.

(3) You are quite active in the world of innovation. What are some of the most interesting start-ups you’ve seen in your travels over the past few months?
I see a lot of well-intentioned start-ups that aim to help patients/consumers manage their health—whether their audience consists of consumers managing chronic diseases, trying to maintain wellness, or fitness enthusiasts who want to analyze data to gain a competitive edge – or just a better understanding of the effects of exercise. However, I think it will be a couple of years before these consumer apps really take off, because it will require more connectivity between consumers, researchers, providers, and payers. More important, business models that offer benefits to consumers are needed. I’m concerned that the business model that is gaining momentum involves sending data to providers and payers who will use the data to dictate to patients/consumers what they must do to stay compliant with their health plan. Personally, I want to see a more inclusive model where motivated patients have full access to the data and their observations and analyses are taken seriously by payers and providers. At present, we don’t have an evidence base that is solid enough to jump to a model where health plans make decisions based on device data without involving the consumers, whose observations about the data could reveal insights about interactions or other factors that affect the interpretation of data.

Apart from devices and sensor data start-ups, I’d point to investments by Google Ventures for early-stage companies that merit watching. Their investments include One Medical Group, Foundation Medicine (which recently went public), InformedDNA, and About.me. On February 20, 2014, Google Ventures announced investments in two enterprise/mobile security companies—Ionic Security and ThreatStream. These applications certainly play a big role in healthcare enterprises. Also, I think Rock Health does a very good job of tracking and categorizing healthcare start-ups.

(4) What application do you expect to have the biggest influence on healthcare in 2014?
Apps that help consumers track healthcare expenses and aid in price transparency will be in demand in 2014 as high-deductible and health savings account (HSA) plans expand. Castlight Health is a player in the price transparency space and is a darling of the investment community, but it is targeted to the employer, not consumer, segment. I am more interested in tools that help consumers understand what an encounter with a provider or an episode of healthcare will cost. To really make an impact, apps will have to provide information to consumers before they make a decision to visit their general practitioner, urgent care center, a specialist, or choose some other path.

Apple’s planned Healthbook platform may be a game-changer in this space if they can go beyond consolidating data from apps and patient health records (PHRs) and connect that data with information from a consumer’s health plan. I think Intuit had planned to focus on the financial tracking aspect when they acquired Medfusion in 2010 to grow the Quicken Health Expense Tracker. But, that goal was short-lived when Intuit’s corporate strategy shifted away from the consumer market, and they sold Medfusion back to its founder.

To succeed in achieving the price transparency and out-of-pocket expense tracking objectives, these consumer application developers—Apple, HealthVault, and others—will have to collaborate with health plans in order to have access to the cost-sharing structures of each health plan. Policymakers and health plan executives keep emphasizing how important it is for consumers to make wise healthcare decisions. In 2014, I’d really like to see significant movement toward giving consumers access to information that helps them make better decisions about their health and their utilization of healthcare services.

This interview was originally published at http://www.navinet.net/blog/2014-navinet-expert-interview-series-janice-mccallum on February 27, 2014.

Healthcare IT Predictions for 2014: Patient Engagement, Interoperability and the Value of Price Transparency

As 2013 comes to a close, we are excited to welcome the insights of top healthcare IT leaders in our Healthcare IT Predictions for 2014 blog series. So far we’ve heard from David Harlow, renowned healthcare lawyer, and John Lynn, prolific blogger on healthcare IT, EMR and HIPAA. Today, we welcome Janice McCallum, managing director of Health Content Advisors. Janice is a top authority on commercial applications across stakeholder groups and relevant sectors, including providers, clinicians, payers, life sciences, government and patients. At Health Content Advisors, Janice helps publishers and suppliers of healthcare information services develop effective marketing and business development strategies for reaching today’s clinicians and consumers.

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1)    What healthcare IT buzzwords will move to the center of conversation in 2014?

Patient engagement will continue to be a hot topic in 2014 because of the increased role that patients are playing in nearly every aspect of their healthcare. However, there’s not much clarity on the definition of “patient engagement”. Since the Meaningful Use program is a key driver of patient engagement initiatives; and since IT infrastructure is critical to Meaningful Use implementation, patient engagement is still very much a health IT issue. I’ve said many times that providing patients with access to their data is the most important element for providers that want to engage patients. But, patient engagement is just a first step in a process to rebalance the current information asymmetry between physicians and patients.

Leonard Kish coined the phrase: “Patient Engagement is the Blockbuster Drug of the Century” last year.  I agree, but due to the range of interpretations of what it encompasses, I expect “patient engagement” to be the most overused and least understood buzzword in 2014.

2)    Jacob Reider has taken over for Farzad Mostashari as Interim National Coordinator post at the ONC; what does the industry need most from the next leader?

Given the political environment, our next National Coordinator for Health IT will need have a rare mix of health IT knowledge, political savvy and management skills. To respond to concerns from provider organizations, I would recommend that the next ONC leader have some experience within a provider organization; ideally, someone who has dealt with implementing reporting systems for early stage Meaningful Use. Better yet, I’d like to see a new ONC leader who wants to put him or herself out of a job by helping to consolidate the various quality-reporting programs within HHS and encouraging industry associations to take over the leadership function for health IT standards.

3)    What is your top prediction for Healthcare IT in 2014?

My top prediction is that the topic of price transparency will be paramount. Even though price is a business rather than an IT issue, provider IT systems need to be capable of providing reliable price estimates to patients, since an increasing number of providers require patients to pre-pay their copay portion of medical bills at check-in. We can’t expect patients to approve an unknown charge to their credit card or their bank account without some reasonable estimates of costs, although I have heard of plans by some providers to do just that! Price transparency also helps inform consumer choices about where to seek care and what care plans to choose.

4)    What initiatives do healthcare stakeholders need to prioritize in order to reach true interoperability in 2014?

I’m not even sure how to define true interoperability. Common data standards are a huge part of facilitating data interoperability. But, different stakeholder groups will continue to have different data standards, especially when the different parties include research data, clinical data, patient-reported data and sensor data. Furthermore, a big part of the health information exchange problem stems from the incomplete nature of patient records in any single institution or network, errors in patient records, and the lack of unique IDs. The solution has to involve patient review and control of his/her own records.

This post was originally published at the Orion Health Blog on December 3, 2013.