Digital

Medicine’s administrative burdens create openings for innovation

The administrative burdens embedded in the U.S. health care system are so ripe for improvement that they have created a multitude of ways for innovators to make a positive difference.

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That’s the view of Marijka Grey, MD, MBA. She is executive leader for transformation implementation, physician enterprise, at Catholic Health Initiatives, which recently aligned with Dignity Health to form CommonSpirit Health.

“Instead of concentrating on the patient and what the patient needs at the moment, we’re concentrating on the data and the computer,” said Dr. Grey, who spoke at the HLTH conference in Las Vegas. The AMA, which is focused on making technology an asset in the delivery of care instead of a burden, was an innovation partner at HLTH and shared how it is helping to drive the future of digital health.

At an earlier presentation, James L. Madara, MD, the AMA’s executive vice president and CEO, told attendees that if tech companies want their digital health tools to gain market adoption, their products must work as intended. And for that to happen, physicians must be involved in their initial design, testing and prototype development.

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Physicians aren’t technophobic

Similarly, Dr. Grey sought to dispel the misconception that physicians are technology phobic.

“Physicians love technology—we are the No. 1 adopters of the newest tech,” she said. “We always have the greatest gadgets in our homes.

“But the difference is that the tech we have at home works for us—the tech we have at the office does not,” she added to applause from the crowd. “And if it doesn’t work for us, it doesn’t work for the patient.”

Another panelist was Vivek Garipalli, co-founder and CEO of Clover Health, a company originally built to work with Medicare Advantage (MA) plans to provide physician clinical-decision support. When the company was getting a cold reception, Garipalli and his partners decided to build their own MA plan and asked themselves, “How hard can that be?”

Lessons they learned included going easy on using terms such as “value-based care” and “pay-for-performance,” which he said “create a lot of paranoia” among physicians about potentially punitive payment policies.

Instead, Garipalli said physicians who use the Clover decision-support system get “gold card” treatment for “quick and easy” payment or prior authorization decisions. Also, rather than resulting in punitive action toward physicians, instances in which doctors overrule the decision-support system are considered educational. Data from such occasions is collected to inform future recommendations.

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Pain points lead to innovation

Other panelists shared their stories of a how a bad situation shaped the companies they founded.

Ali Diab, co-founder and CEO of Collective Health, said he formed his company that supports self-insured employers after he incurred a huge hospital bill and his previous employer’s health plan said it would only cover about half of it.

Meanwhile, Pranay Kapadia, acted on the words of his physician wife, who said she sometimes felt like a well-paid data collector. Kapadia launched his startup company, Notable, with a voice-powered Apple Watch app that records spoken data points and enters them into an electric health record.

Dr. Grey noted that she and other primary care physicians need solutions that apply to all their patients.

“I treat the sore knee, I treat the diabetes, I treat the possibility of cancer,” she said. “I take care of it all.”

If a solution doesn’t support all her patients, it could lead to a two-tier system where some patients receive the high-tech, high-touch treatment and others do not.