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Health Care Current | September 13, 2016
A glimpse into the future: What technologies will allow consumers to get care at home?
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
- Implementation & Adoption
- On the Hill & In the Courts
- Around the Country
- Breaking Boundaries
By Sarah Thomas, managing director, Research, Deloitte Center for Health Solutions, Deloitte Services LP
Earlier this month, my husband and I went to see the new Star Trek movie. As usual, it was a lot of fun. It tells a great story that features moral dilemmas and heroism and presents a vision of the future. That future vision includes transportation, architecture, translation, space travel (of course), and even health care. But, technology can fail – in the movie, the ship’s doctor needs to provide health care to Spock. “Bones” is without his trusty tricorder for diagnosing and treating illness and has to rely on memory of Vulcan anatomy and old fashioned ways of preventing blood loss.
While this may not be what health care will really look like in the future, it is interesting to speculate. How fast do we expect change and adoption to happen? Technology-enabled care, telemedicine, sensors, remote patient monitoring (RPM), and the Internet of Things (IoT) are creating opportunities for more care to happen outside of traditional health care settings like doctors’ offices and hospitals, and instead take place where people live, work, and play.
Engaged consumers, value-based care payment models spurred by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), a growing aging population (that prefers to age in place), and increasing chronic disease prevalence are some of the things driving the development of technologies to support health care outside the traditional setting. Telemedicine, sensor technologies, and IoT hold promise to help improve and personalize care – and create new value for industry stakeholders. Importantly, these technologies have the potential to reduce costs by keeping patients out of the hospital, lowering readmission rates, and promoting adherence to care plans.
As more technology-enabled care is offered, will consumers want it? What will they like and not like about it? The Deloitte Center for Health Solutions 2016 Survey of US Health Care Consumers explored consumer expectations, preferences, and attitudes around technology-enabled care. Specifically, we explored consumer interest in technologies for health care services, barriers to adoption, and motivations and values around the use of health care services.
Some highlights include:
- Consumers have an appetite for using technology-enabled care. Seven in 10 of the respondents say they are likely to use telemedicine, RPM, robots or drones.
- Half of consumers are likely to use telemedicine – which makes it the most popular technology among consumers. In particular, they are interested in using it for post-surgical care and chronic disease monitoring.
- Particular subgroups are especially keen on these technologies. We saw this especially in those who have chronic diseases, Millennials using telemedicine, and seniors using RPM.
- Caregivers are a key population. More consumers say they are likely to use sensor technology when caring for others (caregivers) than on themselves. Current and previous caregivers are also more likely to say they would use telemedicine and RPM technology than non-caregivers.
- Consumers demand high quality, personalized care and want assurance that their personal information will be safe. About a third express concern about the security of their information or that it might be misused. Four in ten think that care quality could be lower than if they saw a provider in person (43 percent for telemedicine, 35 percent for RPM).
- While adoption levels are growing, the use of technology in self-health care is still in early days. Most commonly, consumers report using technology to fill prescriptions (58 percent). Use drops off from there, however, where one-third or less report using other types of health technologies (e.g., paying medical bills online, monitoring health issues).
In addition to telemedicine and RPM, we decided to push the envelope and ask about some technologies that are imaginable but not yet very common in health care consumers’ experience – robots and drones.
While drones and small robots are still a novelty to many, researchers say that in the next several decades, they may be able to assist older individuals with health risks who want to stay in their homes as long as possible.1 Some of the tasks that may be possible include getting medication from another room, household cleaning, and other tasks that could reduce the risk of falls in older adults who live alone.
We assessed consumer interest in using robotics and drones in five futuristic scenarios:
Interest among consumers is relatively high in using robots and drones in these scenarios. Forty percent of consumers are interested in using drones to help with self-care for a chronic disease (medication assistance). Interest is just as high in having robots assist their doctors diagnose a condition. Fewer are interested in using robots to diagnose conditions without a doctor (32 percent) or to monitor others (as a caregiver) (35 percent).
My take is that we likely will have technology in the future that we haven’t even dreamed of today and that consumers, whether patients or caregivers, and their clinicians may adopt technologies that both work as intended and show their value. To the extent we can harness new technology to help people remain in their homes as they age and improve the quality of their lives, I say bring it on!
1John Markoff, New York Times, “As Aging Population Grows, So Do Robotic Health Aides,” December 4, 2015
Implementation & Adoption
CMS provides clinicians new flexibility under MACRA
Last week, Andy Slavitt, Acting Administrator of the US Centers for Medicare and Medicaid Services (CMS) announced in a blog post that CMS will give clinicians two additional options for participating under MACRA. With this announcement, CMS appears to be responding to feedback from health care stakeholders, including clinicians, small and rural provider groups, and lawmakers that had asked for more time to prepare.
Clinicians will now have four options for participation in 2017:
As discussed in the September 9, 2016 Reg Pulse Blog Post, this announcement only gives clinicians flexibility on the reporting requirements and does not change the start date for the first performance period. Based on the CMS blog post, it appears that only clinicians who do not report any information under MIPS and do not meet the Advanced APM thresholds will receive negative payment adjustments. CMS did not give greater detail on the new options. However, Slavitt said in the announcement that stakeholders can expect the final rule by November 1, 2016, which will provide additional details.
Report: Nearly one-third of health systems are using precision medicine
A new HIMSS Analytics survey found that 29 percent of health care systems use precision medicine methods. Precision medicine is the use of targeted treatments based on a patient’s lifestyle, biological, and environmental influences. It is an emerging approach to focusing treatment on specific diseases or groups of diseases.
Of the health care organizations reporting that they currently employ precision-based care models:
- 35 percent are academic medical centers
- 25 percent are multi-hospital health care systems
- 41 percent have at least 500 beds
Precision medicine techniques can be used in many different therapeutic areas. Most (80 percent) health systems responding to the survey reported that they prioritize oncology in their precision medicine programs.
The high cost of developing personalized services and the financial burden of supporting precision medicine research programs and teams can be barriers to implementation for many organizations. However, 60 percent of respondents said that their most significant challenge in implementing precision medicine techniques was integrating clinical data systems with their clinical and genomic data collection systems. Respondents cited the lack of functional capabilities of their electronic health record (EHR) systems as a major challenge to be addressed.
Analysis: Several federal initiatives exist to support precision medicine. In the fiscal year (FY) 2016 budget, the administration included $130 million for the National Institutes of Health (NIH) and its Precision Medicine Initiative (PMI). It included an additional $70 million for the National Cancer Institute (NCI) and an oncology-focused PMI. According to HIMSS, this funding, along with additional grants from the Cancer Moonshot initiative (see the August 2, 2016 Health Care Current), could help direct precision medicine techniques to focus on cancer and oncology genomics.
(Source: HIMSS Analytics, “2016 Essentials Brief: Precision Medicine Study,” August 29, 2016)
CMS: Nearly all eligible hospitals have demonstrated stage 1 or stage 2 Meaningful Use
CMS recently published a fact sheet on the payment adjustments for eligible hospitals under the 2017 Meaningful Use (MU) program. In it, CMS said that 98 percent of eligible hospitals and critical access hospitals across the country have achieved either Stage 1 or Stage 2 MU for the 2017 payment adjustment year.
The 2 percent of eligible hospitals that did not successfully demonstrate MU will see Medicare payment reductions beginning on October 1, 2016. Their payment updates between 2016 and 2017 will be lower than those for hospitals who did demonstrate MU.
On the Hill & In the Courts
Proposed Notice of Benefit and Payment Parameters for 2018 would alter risk adjustment program and create a high-cost risk pool
In late August, the US Department of Health and Human Services (HHS) published the proposed Notice of Benefit and Payment Parameters for 2018. This annual rule outlines major changes and updates that CMS will make to the federally-facilitated and state-based public health insurance exchanges.
CMS proposes to incorporate several recommendations from a white paper published earlier this year on improving risk adjustment. CMS would include data on prescription drug use and data from enrollees who are not enrolled for a full year to calculate risk in the exchange population. CMS says that these changes will help the program more accurately capture health status and costs. CMS would also change the risk adjustment data validation process and recalibrate the model as needed to catch discrepancies early and allow for data to be collected and used in real time.
CMS also proposes to create a high-cost risk pool where health plans would only be responsible for 40 percent of beneficiaries’ costs above $2 million.
Other proposals in the payment notice include:
CMS would also change special enrollment periods (SEPs) to limit people’s ability to join plans only when they need services. Over the last year, CMS has issued several forms of guidance (see the May 17, 2016 Health Care Current and the June 14, 2016 Health Care Current) to tighten the parameters for SEP eligibility. The proposals found in the guidance and interim final rules would be codified through this payment notice. Additionally, CMS proposes to pilot a new pre-enrollment verification and confirmation process to better establish eligibility for a SEPs. CMS is seeking input on the pilot’s design, especially on its proposed scope and how to measure the program’s effect.
CMMI announces Track I funding for AHC program
Last week, Dr. Patrick Conway, principal deputy administrator and chief medical officer at CMS, announced that organizations can now apply for funding for Track 1 of the Accountable Health Communities (AHC) model. The AHC model, which the Center for Medicare & Medicaid Innovation (CMMI) announced in January 2016, focuses on health-related social needs, including housing instability, hunger, and interpersonal violence, for Medicare and Medicaid beneficiaries. Track 1 of the AHC model focuses on increasing providers’ capacity to respond to patients’ health-related social needs. Many health systems do not screen their patients for social needs or know how to identify community service providers who can help people with these needs.
The original announcement about the model outlined three tracks within the program. Based on stakeholder feedback, CMS decided to modify the Track 1 application requirements to make the AHC model more accessible to a larger range of applicants. The two key changes to Track 1 include:
- Reducing the annual number of beneficiaries applicants are required to screen from 75,000 to 53,000
- Increasing the maximum funding amount per award recipient from $1 million to $1.17 million over five years
Applicants can re-apply to Track 1 even if they applied to the original announcement earlier this year. CMS is accepting applications through November 3, 2016.
Commission on Care releases recommendations for transforming Veterans Affairs
The Commission on Care released a detailed report on how to redesign Veterans Affairs (VA) for the next 20 years. After a comprehensive independent report of the Veterans Health Administration (VHA) found several management and system issues, Congress formed the Commission on Care to evaluate and address the findings from the report. The Commission concluded that while VA provides quality health care, that quality varies between facilities. Moreover, veterans continue to face problems accessing care while the VHA struggles with service and operations.
The Commission’s recommendations for the VA and VHA to enhance services and care delivery include:
The VA Secretary noted in a letter that VA has been working toward or has already achieved 12 out of the 18 recommendations. The VA Secretary disagreed with the Commission’s recommendation to restructure VHA leadership.
(Source: Commission on Care, Final Report, June 30, 2016)
House Ways and Means subcommittee holds hearing on Medicare Part A quality and innovation
Last week, the House Ways and Means Health Subcommittee held a hearing with industry leaders to discuss innovation and quality in Medicare Part A. The panel of experts provided testimony on the future of value-based purchasing (VBP) and quality improvement initiatives and discussed whether existing policies encourage health care providers to furnish high-quality cost-efficient care. All of the witnesses testified to the value of APMs and support the health care delivery and payment transformations called for by MACRA.
The panelists discussed several areas for improvement:
- CMS should align quality metrics along patient-centered priorities instead of organization-centered priorities
- The pre-claims review for home health agencies (HHA) demonstration may inadvertently create a barrier to beneficiaries’ ability to access care. This demonstration requires HHAs to submit claims requests to a third party for review before they are paid (see the June 14, 2016, Health Care Current).
- Financial penalties should not be tied to measures that may be out of the control of a hospital or a health care provider.
- Improve risk adjustment of the quality measures. Readmission rates are not risk adjusted for the socio-economic status of the patients, and several panelists said the lack of risk adjustment leads to lower scores on readmissions, which disproportionately affect teaching hospitals and safety net providers.
Related: A recent report published in Health Affairs found that the Comprehensive Care for Joint Replacement (CCJR) program may disproportionately penalize hospitals that serve more medically complex patients. CCJR sets the target price for bundled payment through a formula that combines a hospital’s own spending on an episode with the average episodic spending from other hospitals in the same geographic region. This formula intends to reduce the effect that practice patterns can have on spending differences in different care settings.
However, the formula does not include risk adjustment for more medically complex patients. The authors modeled how risk adjustment could change the spending vs. target calculation and found that including risk adjustment in the formula could increase some hospital’s payments by as much as $114,184 per year. The authors recommend that CMS include risk adjustment in CCJR and all future bundled payment initiatives.
(Source: Health Affairs, “Medicare’s New Bundled Payment for Joint Replacement May Penalize Hospitals That Treat Medically Complex Patients,” September 2016)
Around the Country
Massachusetts appoints 23-member commission to study health care prices
Massachusetts Governor Charlie Baker recently announced that eight members will join a now 23-member commission assembled to study factors that contribute to price variation in physician, hospital, diagnostic testing, and ancillary services. The state legislature agreed to reform the commission to avoid a ballot initiative about health care pricing.
The commission will study variation in prices at providers across the state and provide a report with recommendations to reduce the variation. Pricing in Massachusetts is under scrutiny after reports found that large teaching hospitals in the state often get paid more than community hospitals for providing similar services.
The commission comprises eight gubernatorial appointees, the Secretaries for Administration and Finance and Health and Human Services, the Attorney General, and the Executive Director of the Group Insurance Commission (GIC) (or their designees), legislative appointees, and health care industry experts. State Senator James Welch and State Representative Jeffrey Sanchez will chair the commission.
Cancer Moonshot panel publishes draft report to advance the initiative forward
The Cancer Moonshot Blue Ribbon Panel (BRP) released its first draft report last week. The report lays out 10 recommendations for accelerating cancer research to achieve the Cancer Moonshot’s goal of making a decade’s worth of cancer research progress in five years. The recommendations were informed by public comment and include building broad patient networks, improving clinical trials for cancer research, enhancing data sharing, and increasing evidence-based cancer prevention measures. The panel considered ideas from the broader cancer community submitted online, via email, and other routes.
The BRP, formed this spring, is made up of cancer researchers, oncologists, patient advocates, and representatives from the private sector and government agencies. The BRP established seven working groups to assess the state of the science and call out research opportunities that could benefit from the support of the Cancer Moonshot to inform the recommendations.
The working groups focused on the following areas:
- Clinical trials
- Enhanced data sharing
- Cancer immunology
- Implementation science
- Pediatric cancer
- Precision prevention and early detection
- Tumor evolution and progression
The BRP’s recommendations focus heavily on establishing mechanisms for data sharing and engaging patients, including calling for the creation of a national cancer data system for sharing and analysis. It also calls for a federated network that offers patients tumor profiling. The report recommends more research to inform the development and clinical testing of new therapies, such as interdisciplinary studies to delineate the range of genetic, molecular, cellular, and physiologic mechanisms that lead cancer cells to become resistant to previously effective treatments.
Related: In the August 2, 2016 Health Care Current, Terri Cooper, principal and the Federal Health Sector leader, Deloitte Consulting LLP explained that there is not a community or family cancer has not impacted. As a result, when the White House announced the Cancer Moonshot initiative, communities across the country sprung to action to come up with plans to contribute to this challenge. One step Deloitte is taking is to design an XPRIZE Grand Challenge in cancer.*
Cancer research is incredibly specialized, which can result in research and data silos. Through Deloitte’s collaboration with XPRIZE, experts from across the industry will be engaged over the next several months to issue a challenge to cancer researchers to help meet the goals of the Cancer Moonshot initiative. The XPRIZE model has the potential to activate the crowd and unite traditional and non-conventional partners across this wide cancer ecosystem to address the most pressing challenges.
*XPRIZE is a nonprofit organization with the mission to bring about radical breakthroughs for the benefit of humanity, through large-scale, high-profile incentivized prize competitions.