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Five Accelerants to the Adoption of Connected Health

January 28, 2015

I’m often asked, ‘If you could snap your fingers and do some things to accelerate the adoption of connected health, what would they be?’  I’ve resisted responding, thinking that things are not so simple and reducing the keys to adoption to a list is unrealistic.  However, I have been thinking lately about the cultural and business phenomena that are currently shaping and accelerating the adoption of connected health and, in that context, came up with five accelerants.  The best part of the story is that four of the five are already going on and we can see their early-stage effects.

So, at the risk of ‘dumbing down’ adoption, here is my list of five accelerants.  If we could make these go faster, the adoption of connected health would accelerate too.

1. Increase value-based reimbursement for providers.

Virtual Visits_Homebase program

The more providers are financially rewarded for outcomes/quality and efficiency, the more they will be receptive to virtual care.  This is more acute in situations where providers take on downside risk, i.e., they lose money if they do not achieve the targets mentioned above.  Virtual care enables improved efficiency by allowing us to scale our human resources across more individuals/patients.  It enables improved quality by enhancing ‘just-in-time’ decision-making.  And, patients are almost universally in favor of it.  For instance, a recent survey showed that 64% of consumers were receptive to virtual visits with their doctor.

2. Create more mechanisms for provider reimbursement for non face-to-face care (like the new CMS CPT code that just took effect).

Reimbursement reform_cHealth Blog

This may seem counterintuitive given the first accelerant, but even when providers go at risk, they still need ways to document their effort.  We could just put everyone on a salary, but even then, it seems administrators need evidence of actual units of work.  The Centers for Medicare and Medicaid Services’ newest CPT code includes reimbursement for telemedicine services, which is exciting because it enables clinicians to envision a mechanism where they can be financially rewarded for providing chronic care management.  More codes like this would be a tremendous accelerant.

 3. Accelerate consumer choice in the marketplace as well as ‘consumer-driven health care’ (i.e., high deductible plans, health savings accounts (HSAs), etc.).

Supermarket interior, empty red shopping cart.

It’s been fun to watch how health insurance exchanges have affected the dynamic between insurers and consumers.  Insurers were used to selling to employers (human resource professionals) and having the employers do the work selling the plans.  Health plans must now go direct to consumer, forcing them to explain in plain English what health insurance means and how it works.  On the consumer side, it has put the cost of health care in the consciousness of consumers.  The cost-conscious consumer will likely prefer virtual care because it keeps care out of the high cost part of the system.  High deductible plans and health savings accounts (HSAs) draw consumers into the conversation of health care costs. If we offer a virtual service for two-thirds the cost of a face-to-face service, you can bet consumers will flock, if they have a deductible to spend down or if it’s coming out of their HSA.

4. Make the consumer-facing technology truly frictionless.

Frictionless technology_cHealth Blog_Kvedar

This includes a mix of wish-list items, all designed to make it effortless for consumers to participate in connected health.  We’ve found that even the effort to find an app in the app store, download it and create an account can impede adoption.  It seems that people will do it for Snapchat or Trivia Crack, but not to improve their health.  Likewise with all of the effort required to set up wearables and sensors so that their data flows to the right place.  This needs to be simplified. Standards have a role to play here. My favorite example of this is USB.  If you lived through the time where printers had one cable, your mouse/keyboard had another and other peripherals still another, you appreciate how powerful standards can be. USB allows us to easily connect and plug them in without extra effort.  Bluetooth Low Energy is becoming that important connection for wearables, but it has a ways to go.

 5. Create a universal privacy/security technology and make it a public good.

Man looking through keyhole

This is the most pie-in-the-sky idea.  I believe it is important to solve the problem of privacy and security within that same envelope of frictionless technology.  There are products on the market today that add layers of security in connected health, but they require the consumer to take extra steps and they are expensive.  The scandals with the NSA, the multiple credit card breaches and the periodic stories on how Facebook is secretly manipulating your data are all a big setback for the adoption of connected health.  We have to create a system in which consumers can share their health data with minimal extra effort, but also with minimal worry about whether it will be hacked.

I came up with these five accelerants in a moment of creativity. Do you agree? What did I miss?

20 Comments leave one →
  1. January 28, 2015 4:31 pm

    Increase value-based reimbursement for providers. …. I like it. It will solve the helath care cost problem head On

  2. January 28, 2015 5:50 pm

    Do you agree? What did I miss?

    1. I believe it’s time for a healthy change. If we are serious in reducing our healthcare cost, we must explore less pharmaceutical and alternative approaches, that works great without any side effects. This will provide consumers the best of both worlds.

    2. PCMH – moving care from hospital to ambulatory facility to doctors office to HOME

  3. January 28, 2015 6:27 pm

    both of these are consistent with my thinking, yes. thanks for commenting.

  4. TSmall permalink
    January 28, 2015 7:52 pm

    Universal acceptance of the CPT codes from all payers — CMS/Medicare is a HUGE first step, but now all the practices and health systems will have to negotiate inclusion with each of their local/private plans, one by one.
    Since the new chronic care management CPT codes are just a few months old, many healthcare systems are also in the very early stages of even interpreting how they can be leveraged within their org. Many are already stretched thin on clinical resources (who has 20 mins per patient per month?).
    Hopefully once they hear about the first health systems getting payment (possibly some of their competitors) in the coming months, they will jump in with both feet.

  5. January 28, 2015 7:56 pm

    well stated

  6. January 29, 2015 12:48 am

    Good list and I might add an additional point (as a 4B) centered around ensuring meaningful content / utility / value-add for patients and care partners since we often are asking more of them. A frictionless UX is important, but without sufficient personal motivation / drivers, I have experienced a lot of patient non-compliance in chronic self-care applications. Roadmaps are full of incremental capabilities for providers, but ample patient value needs to be enriched (alerts, new disease mgmt content/training, access to labs, opportunity to interact with a provider, etc). I am not talking about gamification either which may or may not be possible for a given UX. With ample patient teasers, the growing push towards behavior modification platforms need not solely tackle mHealth app adoption challenges.

    • January 29, 2015 7:03 am

      You are quite right in bringing this to the fore. I have written and talked about the importance of technologies engaging consumers/patients before, i.e. motivating them. It is an oversight to leave it out of this list.

  7. Janice Flahiff permalink
    February 1, 2015 6:06 am

    Reblogged this on Health and Medical News and Resources.

  8. Jeff Phillips permalink
    February 3, 2015 11:18 am

    The new codes are a good first step, but they don’t pay nearly enough and are fraught with red tape. For example, patients must sign-on to this type of care, which they will pay more for out of pocket. It might be a tough sell…”Sign here and we will charge you extra for much of what we are already doing”… Good first step, but let’s eliminate some of the red tape and get the private payers onboard.

    Totally agree with your point regarding regarding a solid, simple UI on the patient end. It needs to be similar on the provider end, or it will always be an enthusiast-only model of care and adoption will be limited.

    • February 3, 2015 5:03 pm

      Yes, Jeff. Not ideal. I’m just excited to see a nod to reimbursement for virtual care. it will help us move lots of conversations and financial analyses from the abstract to the concrete.

  9. February 11, 2015 10:36 am

    Fantastic post Joe!

    Number four you mentioned at summit in your talk and this is really the key factor, I believe. We have adopted this as one of our key mantra values of Personal Medicine Plus. I would add that for maximal cost savings, we need to create this frictionless mobile tech FOR our most vulnerable and at risk for diabetes and hypertension Medicaid Group, and furthermore the younger ones. This is a true prevention model. At PMP we believe that the 15 interventions of MU3 should not become another “check off the box” of the EMR, as we see with so much of meaningful use so far. Rather, the interventions of MU3 will be most effective if implemented as true user facing tech, with the mobile as the vessel.

  10. February 11, 2015 1:19 pm

    Thanks for taking the time to comment. Your thoughts are spot on and well stated.

  11. lbitter permalink
    February 12, 2015 5:48 pm

    This is a great post. Thank you. And I agree with your point of view. I would add that consumers (particularly older consumers) have a very vague notion of what “connected health” means and more than that, little has been communicated to make it relevant and valuable as a proposition. Until we get the interest level out of the “gadgetry” category and into a meaningful value proposition for consumers adoption will be slow.

  12. Tom Rhoads permalink
    April 1, 2015 11:01 pm

    Great insight. We must also remain focused on the 5-10% sickest and most expensive of the population and not be distracted by the 90%. This group needs quality care and can quickly bend the cost curve with impactful approaches.


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