Perspectives

From diagnosing symptoms to assisting clinicians, digital assistants are plugging into health care

Health Care Current | September 11, 2018

This weekly series explores breaking news and developments in the US health care industry, examines key issues facing life sciences and health care companies, and provides updates and insights on policy, regulatory, and legislative changes.

My Take

From diagnosing symptoms to assisting clinicians, digital assistants are plugging into health care

By Steve Burrill, vice chairman, US health care leader, Deloitte LLP

Fifty years ago, five scientists set off for Jupiter aboard the Discovery One in Stanley Kubrick’s 1968 epic, 2001: A Space Odyssey. While humans haven’t yet embarked on interplanetary exploration, some of the predictions laid out in the movie turned out to be eerily accurate. Astronauts lived aboard an orbiting space station equipped with videoconferencing booths, used tablet-like computers, and relied on a voice-activated digital assistant. But after the HAL 9000 took control of the spaceship and turned against the crew, movie audiences (and the public) grew leery of talking devices equipped with artificial intelligence (AI).

That trepidation appears to have faded. AI-enabled, voice-activated digital assistants are now the fastest-growing consumer technology, according to Canalys.com, a technology market analyst firm. More than 38 million of these devices (e.g., Amazon Echo, Echo dot, Google Home) are expected to reach the US consumer market this year.1 In kitchens and bedrooms around the world, voice-activated digital assistants regularly recite grocery lists, play music and news, control lights, and adjust thermostats.

Digital assistants have also become popular tools for people who want to track their health and fitness, according to the results of our recent survey of health care consumers. In February and March 2018, the Deloitte Center for Health Solutions conducted an online survey of 4,530 American adults. The survey seeks to understand consumer interest, preferences, and attitudes around technology-enabled health.

Millennials are comfortable talking health with digital assistants

Among consumers who use technology for health care, 75 percent told us they rely on digital assistants for reminders or alerts about medications, while 72 percent of respondents in this group use digital assistants to monitor their health. Not surprisingly, millennials (i.e., people born between 1982 and 1997) are more comfortable with the AI-enabled technology when compared to older groups.

More than 80 percent of millennials say they use digital assistants to monitor health, and 74 percent use the technology to receive medical alerts. While fewer seniors use digital assistants, our survey results identified a segment of “tech-savvy seniors” who are comfortable going online to shop, book travel, and manage personal finances. They are more inclined than their contemporaries to be interested in using technology for their health care needs.

 

Twenty-five percent of tech-savvy seniors said they used technology to monitor health issues, compared to 3 percent of seniors who are not technologically savvy. We also found that more than 60 percent of tech-savvy seniors are interested in using technology for accessing, storing, or transmitting personal health information or records to clinicians, compared to only 19 percent of non tech-savvy seniors.

What role can digital assistants play in health care?

While digital assistants continue to get smarter, they are still in their infancy. The possibilities in health care are virtually limitless, according to our research on the digital hospital of the future. Integrating AI with digital assistants will likely become more advanced in the near future. In the home, for example, a person might say, “I’m in pain.” In response, an AI-enabled digital assistant might be able to access the patient’s electronic health record and check the patient’s recent history, evaluate vital signs, or even scan for environmental factors. It could also connect the person to a family member or nurse.2

Last spring, WebMD announced that certain Amazon devices would have access to WebMD’s digital library of health content, which patients and caregivers can use to answer questions about symptoms, conditions, and treatment options.

A growing number of hospitals and health systems are using voice-activated tools to assist patients and clinicians. Some hospitals are bringing the traditional nurse call button into the 21st century by asking patients to use a digital assistant to request assistance—or state their meal preferences. This use of technology can maximize the staff’s time and extend other resources as well, according to our research.

Four hospitals where digital assistants are booting up

Here are a few examples of how digital assistants are being used in hospitals and health systems:

  • Advocate Aurora Health: The health system—which operates 27 hospitals and has more than 500 outpatient locations in Illinois and Wisconsin—is piloting a “digital concierge” that uses natural language processing to answer patient questions about symptoms. Advocate Aurora’s digital division collaborated with an external vendor to develop the tool to understand natural language and process a patient’s answers to a set of questions. It can diagnose symptoms and suggest a treatment plan, including whether the patient should go to urgent care, make an appointment with a primary-care doctor, or stay home. It can also help schedule appointments.3 The digital concierge knows about 5,000 health conditions and will learn more as more people use it.
  • Boston Children’s Hospital: The hospital is piloting an app that could help physicians comply with pre-surgery protocols and procedures. The hospital also recently launched an app that answers questions about common illnesses and medication doses.4
  • The Mayo Clinic: The voice-activated Ask Mayo First Aid tool launched about a year ago at the Mayo Clinic’s home in Rochester, Minnesota. A new health-guidance “skill” added to the Amazon Alexa platform gives the device the ability to offer self-care instructions for dozens of health-related issues.5
  • Thomas Jefferson University Hospital: The Philadelphia health care system is working with IBM Watson to design hospital "smart rooms" where voice-activated commands can be used to dim or brighten lights, adjust the temperature, turn on music, or close blinds in a patient’s room.

Consumers have grown accustomed to getting information when, where, and how they want it—and this includes quick answers to their health care questions. Virtual assistants can already answer routine questions about diagnoses, expected recovery experiences and times, and daily medication schedules. At some point, virtual assistants could become data repositories for a patient’s medical history, test results, consultation times, appointment schedules, and even stories from other patients who have had similar diagnoses.

Five decades ago, the omnipresent (but fictional) HAL 9000 set certain expectations for a future inhabited by AI-enabled talking computers. But real digital assistants could become important tools for patients and clinicians. These devices of the 21st century aren’t malevolent—and would most certainly open the pod-bay doors if asked.

Email | LinkedIn

1 mHealth Intelligence, March 14, 2017, mHealth Takes a Closer Look at Digital Assistants
2 Healthcare IT News, February 6, 2018, Alexa, Call a Nurse: Special Report
3 Microsoft press release: https://www.microsoft.com/en-us/research/project/health-bot/

4 CNBC, June 6, 2017, hospitals are looking for the killer amazon alexa app
5 Mayo Clinic press release, September 15, 2017
6 Thomas Jefferson Hospital press release, October 5, 2016

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In the News

CMS to expand Part D formulary flexibility

Beginning in 2020, Medicare Part D plans will have flexibility to tailor their coverage of drugs for different indications, according to an August 29 memo from the US Centers for Medicare and Medicaid Services (CMS). This policy will help health plans negotiate drug prices, which could lower costs for beneficiaries, the agency explained. Additionally, the agency said that granting health plans the flexibility to include drugs for specific indications, rather than potentially excluding a drug altogether, will give beneficiaries access to therapies targeted to their health needs.

Under existing guidance, if a Part D plan formulary contains a particular drug, the plan is required to cover the drug for every patient condition, or “indication,” as approved for market.

Under the new policy, Part D plans that opt to assign their on-formulary drug coverage to specific indications must include another therapeutically-similar drug within their formularies for the non-covered indication, in accordance with anti-discrimination provisions of the Medicare law. Part D plan sponsors that choose this option must update their 2020 beneficiary materials accordingly.

(Source: CMS, CMS provides new flexibility to increase prescription drug choices and strengthen negotiation for Medicare enrollees, August 29, 2018)

CMS: Next Generation ACOs reduced Medicare spending without decreasing quality

On August 27, CMS released a report evaluating the Innovation Center’s Next Generation Accountable Care Organization (ACO) Model’s first performance year. According to the report, the Next Generation ACO Model reduced Medicare spending by $62 million in 2016, after adjusting for shared savings and loss payments. Most of the savings came from reduced hospital and skilled nursing facility (SNF) costs.

The Next Generation ACO Model began in January of 2016 with 18 ACOs, each with an average of 26,000 beneficiaries. Half of the savings came from four of the 18 ACOs.

According to the report, Next Generation ACO participants saw the following utilization reductions per every 1,000 beneficiaries:

  • 1.7 fewer monthly acute-care hospital days
  • 15.6 fewer monthly non-hospital evaluation and management visits
  • 20.4 more annual wellness visits

Among all of CMS’s ACO initiatives, the Next Generation Model requires the highest level of financial risk—most 2016 participants agreed to 80 percent risk. In exchange, Next-Generation participants have the flexibility to provide services such as telehealth and can offer incentives that encourage beneficiaries to maintain their health.

In a webinar held the day the report was released, CMS Administrator Seema Verma praised the Next Generation Model’s first-year performance and noted that other ACOs can mirror its success. Verma added that the results show ACOs can succeed under two-sided risk. CMS previously proposed incorporating some of the Next Generation Model’s principles, such as increased downside-risk, into the Medicare Shared Savings Program (MSSP), which will impact participating ACOs (see the August 14, 2018 Health Care Current).

The Next Generation ACO Model concludes on December 31, 2020.

(Source: CMS, ACOs taking risk in innovative payment model generate savings for patients and taxpayers, August 27, 2018)

Uninsured rates were stable in 2018, exchange participation dipped slightly

About 28.3 million people lacked health insurance during the first three months of 2018. While virtually unchanged from the same period a year ago, this is 20.3 million fewer than in 2010, according to a new federal report.

In 2010, the year the Affordable Care Act (ACA) was signed into law, 16 percent of the population lacked health insurance—nearly double the 8.8 percent of the population that was uninsured in the first quarter of 2018, according to the report. During the first quarter of 2018, about 19 percent of non-elderly adults were enrolled in a government program (mainly Medicaid and some Medicare), while 70 percent of the population had private health coverage. Of those who had private health insurance, about 3.6 percent (9.7 million) purchased their individual coverage through a state or federal exchange—down slightly from 4 percent (10.9 million) during the first quarter of 2017. High-deductible health plans (HDHPs) made up 47 percent of private health plan enrollment—up from 43.7 percent during the first quarter of 2017, according to the report.

The report also noted that non-elderly adults who live in states that expanded their Medicaid programs—as called for by the ACA—are less likely to be uninsured than those who live in states that did not expand Medicaid. In Medicaid-expansion states, the rate of uninsured adults stood at 8.7 percent in the first quarter of 2018. In non-expansion states, the percentage of uninsured adults during the same period was 18.4 percent, according to the report.

RELATED: Employers that offer fully insured health coverage to employees expect premiums for the 2019 plan year to increase by an average of 6.1 percent over 2018 rates, according to the results of Credit Suisse’s Annual Health Benefits Survey. Self-insured employers said they expect employee contributions will increase by an average of 3.2 percent for the 2019 plan year, compared to the prior year. Self-insured respondents anticipate medical costs will increase by an average of 5.1 percent in 2019, compared to the prior year. The findings are based on a survey of 737 large-group employers.

(Source: Credit Suisse, 2019 Annual Health Benefits Survey)

RELATED: After the one-year moratorium on the ACA’s so-called health insurance tax (HIT) ends this year, health plans that sell fully insured products will be required to pay $16 billion for the following year. Consulting firm Oliver Wyman estimates that paying the HIT next year will cause health plans to raise premiums by an average of 2.2 percent for the 2020 plan year. The amount of the HIT, which helps fund the public insurance exchanges, is tied to each health insurers’ market share in the fully-insured market. This year, Congress approved a one-year moratorium on the fee for the 2019 plan year. Health plans paid $8 billion in 2014, the first year of the HIT.

(Source: Oliver Wyman, How the ACA’s HIT Will Impact 2020 Premiums, August 28, 2018)

Hospital systems launch their own drug company to fight shortages, high prices

Seven hospital systems, along with three philanthropic groups, have launched a not-for-profit generic drug company, Civica Rx. The hospitals announced their intent to produce drugs last January and released the new company’s name and details about its structure on September 6. A Deloitte blog published March 29 looked into the idea of hospital-produced generic drugs.

In recent years, many hospitals have reported shortages—and price spikes—of common, generic drugs. The founding entities developed Civica Rx to encourage price transparency and generate a steady supply of 14 common generic drugs that hospitals use. Civica Rx members will pay the same price for each drug, and all members must commit to only purchasing these drugs from Civica Rx. Individual members are not allowed to purchase the entire supply of any drug, which could cause a shortage for other members.

(Source: National Public Radio, Inc., Hospitals Prepare To Launch Their Own Drug Company To Fight High Prices And Shortages, September 6, 2018)

Breaking Boundaries

PCORI funds telehealth programs to improve patient access to care

Last month, the Patient-Centered Outcomes Research Institute (PCORI) announced plans to provide more than $31 million in funding to study whether telehealth programs improve access and other outcomes.

PCORI—a nonprofit organization authorized by the ACA—opened its doors in 2011. The organization’s mission is to inform patients, clinicians, purchasers, and policymakers about the appropriateness, clinical effectiveness, and relative health outcomes of various medical treatments and services. Since 2012, PCORI has funded more than $1.6 billion in research and related projects. Some of that research has focused on methodology and capacity, as well as helping patients and other stakeholders get involved in research.

West Virginia University will receive $13.2 million from PCORI to examine whether clinicians who use remote web-based cognitive behavioral therapy can improve care management and outcomes among patients who have major depressive disorders. These patients are at high risk for suicide and opioid dependence, and often face long waiting lists for care.

Vanderbilt University Medical Center is getting almost $16 million to test a stroke-care Integrated Practice Unit (IPU). The program involves a nurse and a lay health educator who assess post-stroke patients at home or within a skilled nursing or rehabilitation facility. The PCORI grant will allow the program to expand to additional sites and will help the medical center compare this model against traditional stroke care.

Other funding will go diabetes studies. One will evaluate whether telehealth can help improve care management for Hispanic and Latino patients with type 2 diabetes. Another will study the effect of weekly telehealth visits for patients from lower-income communities, who might have limited access to health care.

PCORI previously funded telehealth research, such as a 2014 study that assessed the benefit of specialist telehealth appointments for Parkinson’s disease patients who have difficulty traveling. During a virtual house call, a specialist remotely checks the patient’s dexterity and gait. The patient and caregiver also discuss the symptoms, medications, side effects, and other concerns related to the disease. The first phase of this study highlighted the difficulty in recruiting patients who didn’t already have a specialist and were neither white nor college-educated. The next phase is addressing these barriers by recruiting patients from satellite clinics in remote rural areas and providing technical support to participating patients.

(Source: PCORI, PCORI Board approves $85 million to support new studies on opioids, cancer and other high-burden conditions, August 21, 2018)

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