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Geisinger Partners With Pharmas To Improve Diabetes Outcomes

Posted on October 10, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Geisinger has struck a deal with Boehringer Ingelheim to develop a risk-prediction model for three of the most common adverse outcomes from type 2 diabetes. The agreement is on behalf of Boehringer’s diabetes alliance with Eli Lilly and Company.

What makes this partnership interesting is that the players involved in this kind of pharma relationship are usually health plans. For example:

  • In May, UnitedHealth Group’s Optum struck a deal to model reimbursement models in which payment for prescription drugs is better structured to improve outcomes.
  • Earlier this year, Aetna cut a deal with Merck in which the two will use predictive analytics to identify target populations and offer them specialized health and wellness services. The program started by focusing on patients with diabetes and hypertension in the mid-Atlantic US.
  • Another example is the 2015 agreement between Harvard Pilgrim health plan and Amgen, in which the pharma would pay rebates if its cholesterol-control medication Repatha didn’t meet agreed-upon thresholds.

As the two organizations note in their joint press statement, cardiovascular disease is the leading cause of death associated with diabetes, and diabetes is the top cause of kidney failure in the U.S. population. Cardiovascular complications alone cost the U.S. more than $23 billion per year, and roughly 68 percent of deaths in people with type 2 diabetes in the U.S. are caused by cardiovascular disease.

The two partners hope to improve the odds for diabetics by identifying their condition quickly and treating it effectively.

Under the Geisinger/Boehringer agreement, the partners will attempt to predict which adults with type 2 diabetes are most likely to develop kidney failure, undergo hospitalization for heart failure or die from cardiovascular causes.

To improve the health of diabetics, the partners will develop predictive risk models using de-identified EHR data from Geisinger. The goal is to develop more precise treatment pathways for people with type 2 diabetes, and see that the pathways align with quality guidelines.

Though this agreement itself doesn’t have a value-based component, it’s likely that health systems like Geisinger will take up health plans’ strategies for lowering spend on medications, as the systems will soon be on the hook for excess spending.

After all, according to a KPMG survey, value-based contracts are becoming a meaningful percentage of health system revenue. The survey found that while value-based agreements aren’t dominant, 36 percent of respondents generated some of their revenue from value-based payments and 14 percent said the majority of revenue is generated by value-based payments.

In the meantime, partnerships like this one may help to improve outcomes for expensive, prevalent conditions like diabetes, high blood pressure, arthritis and heart disease. Expect to see more health systems strike such agreements in the near future.

Wisconsin Prepares For Statewide HIE

Posted on September 3, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The state of Wisconsin is gearing up to kick off a statewide HIE network that would embrace hospitals, clinics, nursing homes and other care facilities, according to a piece appearing in the Milwaukee Journal Sentinel.

The network, known as the Wisconsin Statewide Health Information Network (WISHIN), is a private nonprofit organization. It expects to add several hospitals to its network this year, and most of the state’s major health systems have committed to participating over time. The health systems and other providers who participate in WISHIN will pay an annual subscription fee based on their size.

WISHIN expects to make a wide variety of information available securely to providers, including problem lists, prescriptions, radiology reports, physician notes and test results, the newspaper notes.

WISHIN will replace the Milwaukee area’s Wisconsin Health Information Exchange, a network which was formed in 2008 and included 13 hospitals in the area. The WHIE was shut down after the region’s health systems decided that being part of a statewide network would be more efficient than relying on a local organization.

WISHIN was created in December 2010, funded by the American Recovery and Reinvestment Act of 2009. Initial planning for the network was done by a body overseen by the state’s Department of Health.

Since then, WISHIN brought in Medicity Inc. to handle the design of the network. Medicity, which is owned by Aetna, is building HIEs in several states.

In kicking off its network, WISHIN is joining a rapidly-growing community of hospitals who have embraced HIEs. In fact, a recent study appearing in the journal Health Affairs concluded that health data exchanges between hospitals and other healthcare providers have climbed 41 percent between 2008 and 2012.

And WISHIN is one of a growing number of statewide efforts. For example, New Jersey’s State Department of Health just awarded $1.57 million to a coalition of HIE group to help them kick off a statewide HIE there.

What’s not clear, from the description of either HIE, is how they’re going to sustain their efforts over the medium and long term;  subscription-model based HIEs have failed in the past and, unless something new is afoot, are likely to fail again.  Let’s see if the ROI is enough to satisfy hospitals and providers this time around.

Reasons Hospitals Acquire Medical Practices

Posted on January 28, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Charlotte Observer did a great report on the shift to hospital owned medical practices. For those not familiar with the shift, here’s the numbers the article offers:

Last year, 47 percent of U.S. physicians were employed by hospitals – roughly twice the percentage in 2002, according to surveys by the Medical Group Management Association.

One health care recruiting company predicts that hospitals could employ as many as 75 percent of U.S. doctors within two years.

I still think that some of this shift is cyclical, and independent thinking doctors will eventually leave their hospital overlords and be back on their own again. However, considering the financial side of the equation, many doctors might not be able to go back to their own practice even if they want to do so.

Here’s an example from the article that explains one of the reasons that hospitals are acquiring medical practices.

Gary Ziomek can vouch for that. The Waxhaw resident began getting physical therapy in 2011, after undergoing an unsuccessful spinal fusion surgery. He went to a therapist at Carolinas Rehabilitation on the campus of Carolinas Medical Center-Pineville hospital.

Early this year, his bill was $148 for 30 minutes of massage. But starting in May, the charge for a 30-minute massage rose sharply, to $249.30 – even though he got the same therapy from the same therapist in the same building.

Ziomek said an employee told him the higher charge came about because the office, which is owned by Carolinas HealthCare, began billing as a hospital-based setting. He said he was told that patients could go to the Ballantyne office and pay the lower amount.

Ziomek’s Aetna insurance reimburses differently based on where a service is rendered. For an office visit, Ziomek was responsible for a $20 co-pay, no matter if he had met his $250 deductible. For a hospital visit, he pays 10 percent of the bill after paying the $250 deductible.

In this case, Ziomek’s out-of-pocket expense dropped, because he had already met his deductible for the year. But he’s concerned that the overall cost went up, with no change in service or quality.

“Somewhere along the line, they realized, ‘We can charge more to the insurance company even though the patient is getting exactly the same service,’ ” said Ziomek, 70, a retired investment banker. “They could have kept the lower rate, but they chose not to. Why? Because of greed.”

I think the last line about greed is a little bit of sensationalism. In our market, healthcare is driven by revenue and profits. Many hospitals say they’re non-profit, but they certainly act like for profit entities.

What’s surprising to me is that insurance companies are putting up with this shift. I expect the loophole will be reversed again, but that often takes time. Some policy will be put in place to stop hospital owned medical practices from charging at the hospital rate. However, until that happens you can be sure that hospitals will continue their acquisition of medical practices.

HIE and Other Interoperability Solutions for Healthcare

Posted on September 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was participating in a LinkedIn discussion a few months back about HIE solutions. Jeremy Bikman from Katalus Advisors offered this great list of HIE and other interoperability solutions for healthcare:

Orion. Love these guys. Top notch products. Great service. Great UIs and culture too.
dbMotion. Another great firm. Top R&D in Israel. To-die-for partnership with UPMC
Axolotl (United). One of the first to really do HIEs. Good number of clients. Access to a lot of stuff by being owned by a mega-Payer.
Medicity (Aetna). See comments on Axolotl. Bought Novo Innovations which makes them super good at Amb-to-Acute connections. I know several of their execs and they are good honest guys.
Microsoft/GE/Whatever the JV will be called [This commentary is a few months old. I’m sure Jeremy knows it’s called Caradigm now]. They have a few very large and advanced HIEs (WHIE being the foremost of its kind). Remains to be seen what will become of it with so many top leaders leaving.
ICA. John Tempesco from ICA described their offering this way, “With our new approach to HIE deployment, we’ve been experiencing very good success in deploying our CareConnect clinical communication capabilities to enable clinicians in rural settings to attach clinical documentation and have true conversations in a secure environment at very low entry points and high adoption. See more at www.icainformatics.com to review our solution page.”

There are dozens of other vendors that claim to do it (and have one or two psuedo-HIEs here and there) including many of the inpatient and outpatient EMR vendors (Greenway just landed a big chunk of the state of Idaho) but I won’t mention those like Epic that have a great HIE offering (so long as the other orgs in the HIE also have Epic).

I think this is a good way to look at the various vendors and how their customer bases match their company culture as Jeremy pointed out. Are there other HIE solutions that should be on this list?