[Vision2020] Obamacare’s Other Surprise

[Art Deco]

  [image: The New York Times] <http://www.nytimes.com/>

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May 25, 2013
Obamacare’s Other Surprise By THOMAS L.
FRIEDMAN<http://topics.nytimes.com/top/opinion/editorialsandoped/oped/columnists/thomaslfriedman/index.html>

LISTENING to the debate about President Obama’s health care plan, some
critics argue that Obamacare is going to need Obamacare — because it’s
going to be a “train wreck.” Obama officials insist they’re wrong. We’ll
just have to wait and see whether the Affordable Care Act, as the health
care law is officially known, surprises us on the downside. But there is
one area where the law already appears to be surprising on the upside. And
that is the number of health care information start-ups it’s spurring. This
is a big deal.

The combination of Obamacare regulations, incentives in the recovery act
for doctors and hospitals to shift to electronic records and the releasing
of mountains of data held by the Department of Health and Human Services is
creating a new marketplace and platform for innovation — a health care
Silicon Valley — that has the potential to create better outcomes at lower
costs by changing how health data are stored, shared and mined. It’s a new
industry.

Obamacare is based on the notion that a main reason we pay so much more
than any other industrial nation for health care, without better results,
is because the incentive structure in our system is wrong. Doctors and
hospitals are paid primarily for procedures and tests, not health outcomes.
The goal of the health care law is to flip this fee-for-services system
(which some insurance companies are emulating) to one where the government
pays doctors and hospitals to keep Medicare patients healthy and the
services they do render are reimbursed more for their value than volume.

To do this, though, doctors and hospitals need instant access to data about
patients — diagnoses, medications, test results, procedures and potential
gaps in care that need to be addressed. As long as this information was
stuffed into manila folders in doctors’ offices and hospitals, and not
turned into electronic records, it was difficult to execute these kinds of
analyses. That is changing. According to the Obama administration, thanks
to incentives in the recovery act there has been nearly a tripling since
2008 of electronic records installed by office-based physicians, and a
quadrupling by hospitals.

The Health and Human Services Department connected me with some start-ups
and doctors who’ve benefited from all this, including Dr. Jen Brull, a
family medicine specialist in Plainville, Kan., who said that she was
certain she had been alerting her relevant patients to have colorectal
cancer screening — until she looked at the data in her new electronic
health care system and discovered that only 43 percent of those who should
be getting the screening had done so. She improved it to 90 percent by
installing alerts in her electronic health records, and this led to the
early detection of cancer in three patients — and early surgery that saved
these patients’ lives and also substantial health care expense.

Todd Park, the White House’s chief technology officer, said many new apps
being developed have been further fueled by the decision by Health and
Human Services to make available massive amounts data that it had gathered
over the years but had largely not been accessible in computer readable
forms that could be used to improve health care.

It started in March 2010 when Health and Human Services met with “45 rather
skeptical entrepreneurs,” said Park, “and rather meekly put an initial pile
of H.H.S. data in front of them — aggregate data on hospital quality,
nursing home patient satisfaction and regional health care system
performance. We asked the entrepreneurs what, if anything, they might be
able to do with this data, if we made it supereasy to find, download and
use.” They were told that in 90 days the department would hold a “Health
Datapalooza,” — a public event to showcase innovators who harnessed the
power of this data to improve health and care.

Ninety days later, entrepreneurs showed up and demonstrated more than 20
new or upgraded apps they had built that leveraged open data to do
everything from helping patients find the best health care providers to
enabling health care leaders to better understand patterns of health care
system performance across communities, said Park. In 2012, another “Health
Datapalooza” was held, and this time, he added, “1,600 entrepreneurs and
innovators packed into rooms at the Washington Convention Center, hearing
presentations from about 100 companies who were selected from a field of
over 230 companies who had applied to present.” Most had been started in
the last 24 months.

Among the start-ups I met with are Eviti, which uses technology to help
cancer patients get the right combination of drugs or radiation from Day 1,
which can lower costs and improve outcomes; Teladoc, which takes unused
slices of doctors’ time and makes use of it by connecting them with remote
patients, reducing visits to emergency wards; Humedica, which helps health
care providers analyze their electronic patient records, tracking what was
done to a patient, and did they actually get better; and Lumeris, which
does health care analytics that uses real-time data about every aspect of a
patient’s care, to improve medical decision-making, collaboration and
cost-saving.

Obamacare will be a success only if it can deliver improved health care for
more people at affordable prices. That remains to be seen. But at least it
is already spurring the innovation necessary to make that happen.


-- 
Art Deco (Wayne A. Fox)
art.deco.studios at gmail.com
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