I had a wide-ranging conversation with Joe Kvedar, VP, Connected Health at Partners Healthcare in Boston, where he is leveraging personal health care technologies to improve health care delivery and help providers and patients manage chronic conditions, maintain health and wellness and improve adherence, engagement and clinical outcomes. Joe has a couple of books out, is an active blogger at The cHealth Blog, and chairs the Connected Health conference. You should follow him on Twitter: @jkvedar.
We started off by discussing the term “digital therapeutics” and Joe suggested that digital applications and wearables can be more cost-effective interventions than the traditional chemical compounds helping to manage health care, and yielding positive outcomes.
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He gave a couple of specific examples: First, a Partners-Samsung partnership that used machine learning to mash up data about each patient and about the patient’s environment in order provide a personalized daily message encouraging patients to increase their physical activity levels. After six months, the study group had significantly increased physical activity levels and the control group had not. Second, teenagers with asthma in a Facebook group had increased social connections, which correlated with improvements in their asthma without any changes in medication.
We talked about the different incentives in fee for service and value-based payment systems, and noted that even in most value-based systems, individual provider level activity is usually coded in the same manner as activity in fee for service systems, thus potentially skewing individual provider incentives. As Joe noted, some, but not all, provider organizations are able to insulate individual providers from the fee for service incentives even within a value based system, using payment models such as payment based on size of patient panel rather than number of patient encounters. (Some of these payment systems will work better for certain types of providers.)
Sometimes, the viability of different approaches to innovation depends not only on eing able to incorporate the innovation into existing clinical workflows, but also on the relationship between the provider and the payor, and the framework for that relationship.
Joe notes that digital health can’t really take off beyond its current penetration rate (20% of AMA members use virtual visits; under 10% use remote monitoring) unless these services are recognized in the way that all other health care services are recognized: they need their own billing codes. Joe sits on the digital payment advisory group at the AMA; Now in its second year, the group provides input to the procedure code development process. The first two codes to come out of committee – one for remote monitoring, and one for physician-to-physician consultation over an electronic medical record – have gone through the CPT editorial panel and are now at the point where the relevant committee needs to assign monetary values to them. Joe anticipates having a CMS decision on whether to adopt these codes for Medicare payment purposes in time for January 2019.
We need to integrate digital tools into medical practice in order to be able to address the needs of the silver tsunami. While Joe suggests that “we should all start by celebrating that we’ve added 25 years to our lifespan over the past century,” he notes that we need to shift the way we use technology in health care in order to maintain the healthspan of people enjoying a longer lifespan. (Interesting fact noted by Joe: When Social Security was first enacted, benefits started at 65, but the average life expectancy was 62. Now, average life expectancy is 78 or 80.)
We don’t tap into older people’s experience enough. If we did a better job, we could ensure that more older people retain a sense of purpose, which turns out to be a very good predictor of longevity. People with a sense of purpose keep themselves healthier – whether mentoring or advising someone in a business, or taking care of the grandkids. Social connection is key; social isolation is as bad for longevity as a fifteen-cigarette-a-day habit. In this day and age, technology can play a role in keeping people connected, and in keeping people physically active (e.g., through the use of wearable activity trackers and mobile applications that can help motivate users).
Older people will overwhelm the healthcare system unless we put into place “one-to-many” systems using technology.
I asked Joe what is one thing he would hope or predict would be different in five years, and while at first he demurred, noting that five years isn’t such a long time in a slow-to-change sector like health care, he suggested: “If we integrate technology in the right way, and we’re thoughtful about it, we’ll create the opportunity for your doctor to be more of a human being and to take better care of you.” Most health care providers are overwhelmed with non-caring tasks (data entry, etc.) to the point that “while we’re with you we have to do things like type.” Noting that in other settings, if you don’t need a real person you can use self-service technology, Joe suggests that we need to take that approach more universally in health care, and he expects that perhaps in the next five years a nontraditional player (e.g. a CVS or Walgreens) may be more likely than a traditional healthcare provider to bring to healthcare the equivalent of five self-service checkout lanes in a big box store, and one checkout lane with a live person. Most of the time, we don’t really need the live person – but when we do, we really do. If we can take the burden of the silver tsunami off the shoulders of that individual live person health care provider, then we can humanize healthcare through the adoption of technical tools.
I spoke with Joe as part of my ongoing series of fireside chats with healthcare innovation leaders – Harlow on Healthcare, on HealthcareNOW Radio. You can catch me live weekdays at 8:30 am, 4:30 pm and 12:30 am ET. As each new show goes live, the last one joins the archive, available via SoundCloud or your favorite podcast app (iTunes, Stitcher, iHeartRadio). Your comments are welcome here. Join the conversation on Twitter at #HarlowOnHC.