https://www.ajmc.com/conferences/academyhealth-2019/embracing-innovation-in-healthcare-to-transform-delivery-of-care
Embracing Innovation in Healthcare to Transform Delivery of Care

Jaime Rosenberg

While the advent of new treatments, such as immunotherapy and targeted therapy in cancer, has brought systematic change to patient care, there are also innovations outside of medicine that are leading the charge in transforming healthcare. During a session at AcademyHealth National Health Policy Conference held February 4-5 in Washington, DC, healthcare stakeholders discussed 3 innovations that are changing the way we think about healthcare: social determinants of health, digital health, and data.

When you look at the root causes of health, you have to look at social determinants, which set the stage for a patient’s well-being, explained Bechara Choucair, senior vice president and chief community health officer, Kaiser Permanente.

“As health systems, how do we start thinking about our patients’ and our members’ social needs? Whether it’s housing, whether it’s food insecurity, transportation, or economic opportunity, or social isolation,” he said. “How do we think about those needs, how do we screen for those needs, how do we predict those needs, and how do we build solutions to support our members’ needs?”

Zoning in on housing, in particular, Bechara explained: “It’s not fair to expect patients to live healthy lives if they don’t have a stable, safe roof over their head.”

People who are homeless live, on average, 27 years less than those who are housed, according to Bechara. They are also at a much higher risk for readmissions, have hospital stays 2 to 3 days longer than those who are housed, and have an increased risk of infectious disease, chronic disease, addiction, and mental health.

To address this, last May, Kaiser Permanente announced a $200 million impact investment to improve housing instability and homelessness. In January, it announced 3 initiatives being taken through this investment, including investing in a multiunit building to preserve and expand affordable housing, anchoring an $100 million loan fund to protect affordable housing across the healthcare system, and identifying 515 people older than 50 years with at least 1 chronic condition in Oakland in an effort to get them housed.

According to Bechara, stakeholders should take a few more steps upstream and think about the policies, the systems, and the environmental changes that are needed to transform the healthcare system to effectively address these needs. To do this, and do it right, there’s a role for federal and state governments, as well as for cities, counties, and local governments.

But even when a patient has a roof over their head, they may still struggle with access to care, explained Naomi Fried, PhD, founder and chief executive officer, Health Innovation Strategies. This is where digital health comes in.

Originally designed to reach people in rural areas without access to clinicians, virtual health has expanded and allowed providers to virtually provide care to people in many situations who struggle with access to a provider.

And virtual health isn’t the only area providing improved access to and quality of care, said Fried. A large part of this innovation is coming from patient-facing digital health solutions, which span across several technologies outside of virtual health.

“Digital health leverages technology to deliver care and information to patients and providers that’s more convenient, cost-effective, and often more personalized,” she explained. “It has potential to decrease costs, improve quality, improve efficiency, and deliver care and information in ways that could not be done before.”

For example, clinical-grade digital information collects information from the patient that is actionable by their provider, who can then make a therapy decision or evaluate a condition. She gave the example of an algorithm created by Massachusetts Institute of Technology researchers that analyzes a person’s typing patterns and determines whether or not they have Parkinson disease. For those who have the disease, the algorithm can track the disease progression.

She also walked through BiliScreen, which uses the iPhone camera to detect pancreatic cancer by recognizing bilibrubin in the whites of the eye. When a person has pancreatic cancer, bilirubin is produced, turning the whites of the eye yellow. However, by the time it’s visible to the human eye, the cancer is typically in advanced stages, so the BiliScreen app allows for much earlier detection.

There is also technology that can change the course of disease after diagnosis, Fried explained. These digiceuticals are digital therapies that utilize software programs to affect clinical outcomes, including a computer program that has been clinically demonstrated to be as effective as drugs for treating multiple sclerosis–linked depression.

However, with promise of these technologies also comes caution, specifically with privacy and security concerns. “At the first level, privacy and security need to be addressed by the developer and they need to be able to assure patients that their information will be used appropriately,” said Fried.

She also pointed to challenges with increasing patient engagement and figuring out ways to reach all patients, as well as address the digital divide, with older generations being less willing to utilize the technology. Choucair added that it’s crucial to ensure these technologies benefit everyone in the community and help close inequities and disparities rather than expand them.

Expressing his excitement for how technology is entering the healthcare industry through analytics, electronic medical records, consumer engagement and more, Chris Coloian, MHA, executive vice president of Cotiviti, said that it’s helping fix a system that is siloed. 

Looking at the role of data on the payment side of things, he said, “How do we de-silo the system, pay for what we intend to create and the value we want, and remove the inefficiencies from the system so we can afford to do it?”

Currently, for payment models, there is a focus on whether care is being delivered for the right diagnosis at the right site of care by the right provider, explained Coloian. Analyzing data coming from CMS and commercial payers, he explained that there’s anywhere from 11% inaccuracy in Medicare to 19% inaccuracy in commercial plans.

Looking forward, he said that using these data will not just address payment accuracy, but also look at the quality of care the patient is receiving.
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