Health Datapalooza 2013: Jonathan Bush, athenahealth
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Health Datapalooza IV: June 3rd-4th, 2013 Keynote Address Jonathan Bush Co-Founder, athenahealth
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Health Datapalooza 2013: Jonathan Bush, athenahealth
- 3. Reduced C-sections from 24% to 10% 40% fewer NICU days than industry average Lost our shirts
- 6. 31.8% not recording vital signs 94.6% not providing clinical summaries 71.7% not collecting demographic info
- 10. Order TOTAL HIP ARTHROPLASTY Lopez, Richard S 5.1 miles 7.2 $36,903.30 6.9 Smith, Joanne C 11.6 miles 5.1 $28,886.22 4.3 White, Joseph L 11.9 miles 8.9 $27,217.46 7.0 Provider Name Distance Quality Score Cost Patient Sa… IN IN IN O’Malley, Timoth… 2.5 miles 6.9 $12,977.67 5.2 Jones, Elizabeth R 15.0 miles 2.1 $43,185.78 5.4 Fitz, Albert G 24.1 miles 9.1 $19,487.60 6.1 OUT OUT OUT
- 14. Flu rates at season- high in Nebraska. Only 13% of patients vaccinated.
Editor's Notes
- Big Data is very sexy these days and everyone wants a piece of the actionWhat I am hoping to convince you of today is that big data is fed and watered and nursed by the PROFIT MOTIVE; without the profit motive, big data will not exist on any meaningful scale and will never drive the many actions that will add up to real change.Success will depend on:Being ALLOWED to profitBeing able to convert DATA into MEANINGFUL ACTIONTo make my point, I’m going to share a few quick stories from my own data annals:One where the profit motive worked in a meaningful wayOne where it seems to be working but is too early to be certainOne live opportunity that could go either way depending on what WE doAnd one where success is still on a distant horizon
- But first…by way of unpacking this thesis, I’m hoping you’ll indulge me as I take you on a brief journey of my own love affair with big data, which began 15 years ago at Athena Women’s HealthVision was to make women’s health care work as it should but we weren’t just doing it out of the goodness of our hearts; we believed we could turn a profit by sharing in savingsThat drove us to reduce C-section rate, etc.We tracked our data obsessively…but in the end we lost our shirts because we couldn’t get our claims paid…Our failure at being profitable drove us to create a new business: athenaNet
- Over time, with athenaNet we found ourselves sitting on this massive stockpile of data but try as we might we couldn’t fix the bigger problems with payers and their inefficienciesWe wanted to change behavior of payers on a bigger scale so WE and our PROVIDERS could profit but also so the whole system operated more efficientlySo we launched PayerView to “out” payers, publicly shame them; We resorted to shamelessPR stunts, were going to take out a full page ad outing a payer but they agreed to work with us on improvement instead
- Then in 2010 CMS came out with Meaningful Use – we took up the challenge with a vengeance not because we’re good people or thought it was all that meaningful, frankly, but because we had skin in the game!In the middle of Year 1 our numbers sucked…everyone’s numbers sucked but we were the only vendor advertising our failure
- Again, we resorted to all ends…I even dressed up in a woman’s kimono with our failing numbers projected on my chest so our necks and the necks of the other vendors were on the lineNot because we were good people, but because there was real money on the line for our providers and for us.It ultimately paid off: we achieved 85% in 2011 and 96% in 2012 – this compares against the industry numbers in the low 40s% (and CMS has yet to release full 2012 numbers…and it’s’ June!)
- Next up is ACOs and the question of who’s going to have the data and the ability to manage risk
- CMS made a big splash releasing hospital charge data – of course it’s the wrong data since it’s not what anyone was paid for these procedures…and is two years old…So thanks CMS, great start…but this kind of data should be available all the time to ANY ENTITY that can make good use of it to manage risk and enable shopping
- With that claims data we could give providers a complete picture of cost and quality at the point of care, in their EMR, so they could SHOP for the best option and we’d all share in the savingsFor example, imagine being able to order a hip procedure and having this level of detail to guide a provider’s decision – this is totally doable…with the right data availableIn reality, though, the many rules around being qualified entity to get CMS data conspire to limit access and are unfairly, and unwisely, biased toward non-profits
- BTW, let’s talk for a minute about those “non-profits” we’re electing to guard the henhouse (sidebar on TedMed message)
- Brief TedMed vignette on Partners and colonoscopy cost
- Then off on the horizon, there is the vast realm of things we could do to improve health care and improve public health that currently have no market mechanism, no profit motive to drive them forwardLike FluView – tracked claims data to see the spread of flu across the country in more or less real-time – Dec 2012 to Jan 2013
- We could envision eventually pushing that data out to providers to alert them…but how many entrepreneurs in this room are going to take this on when there’s no money to be made?
- So here is my plea to our government colleagues in the room:Release CMS data to any entity that can use it to manage riskThis is why everyone is at Datapalooza—recognition of the power of gov data to transform delivery and cost of health careGov shouldn’t be in the business of picking winners and losers, and yet that’s exactly what happens when regulations are such that only a specific type of entity created in a specific kind of way gets the benefit of claims data.This data (deidentified at a patient level, of course!) should be available to any health care provider or entity working with a health care provider to manage risk. We know we need our system to transition toward risk and away from fee-for-service… we need big data to fuel that transition.2) Expand the ACO model Data liberation is important and will fuel the successful transition away from fee-for-service, but it’s not enough on its own. We also need to enable entities to be able to USE the data.Managing risk shouldn’t be limited to one form of entity. CMS is conducting a bunch of pilot and demo programs exploring various ways for providers to share and manage risk and that is GREAT. But we need to go further…Any entity that can help providers share and manage risk—whether provider owned/controlled/whatever—should be enabled to do so. This means we can’t be overly prescriptive in regulations, because that always inadvertently excludes a really good alternative option. Let’s open up the ACO shared-savings model and watch the innovation in managing risk flourish.3) Legalize an open market for health information exchangeSpeaking of data liberation, we have a real problem with this in health care that goes beyond CMS simply opening up their trove of data. We also have all the data that is completely silo-ed by health systems and different EHRs. Simple reason for this: it’s ILLEGAL to have a true market for information exchange like we have in so many other sectors of our economy (finance, auto parts, etc.)It’s econ 101. The specialist wants certain data to see a patient for an orthopod consult. The PCP has the data. In a functioning market demanders pay suppliers. But because Stark and Anti-kickback Statute call that an illegal payment connected to a patient referral, no payment happens. And the market breaks. And you know what happens then? The data simply never… gets… sent.
- If these 3 conditions are met, I believe some wonderful and necessary changes will take hold in health careFirst, we canbreak down the siloes that are currently holding data hostage and can create a truly open market for health information exchange
- Second, we can use that data to direct care and work to the right person, to the right place, at the right time – reducing costs and improving care
- And finally, we will have enabled health care to look like this, etc.