Healthcare opportunities for smart SIs and solution providers

Healthcare opportunities for smart SIs
and solution providers
Smart VAR Healthcare Summit
August 2015
Shahid N. Shah, CEO

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@ShahidNShah
www.netspective.com www.ShahidShah.com 3
Who is Shahid?
• 20+ years of software engineering and multi-site
healthcare system deployment experience in
Fortune 50 and Government sectors.
• 12+ years of healthcare IT and medical devices
experience (blog at http://healthcareguy.com)
• 15+ years of technology management experience
(government, non-profit, commercial)
• 10+ years as architect, engineer, and
implementation manager on various EMR and EHR
initiatives (commercial and non-profit)
Entrepreneur, contributing
author, blogger, engineer, and
healthcare futurist

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@ShahidNShah
www.netspective.com www.ShahidShah.com
What’s this talk about?
Questions answered
• What kinds of BS can
healthcare customers
detect?
• What innovations can you
help customers deploy?
• Where are the major
opportunities to grow your
business?
Key takeaways
• Go narrow, specialize, dive
deep – talk about what’s
important to your customers.
– Revenue, profit, and growth
matters to them too
• Understand PBU: Payer vs.
Benefiter vs. User
• Understand why healthcare
businesses buy stuff so you
can serve them in ways they
find you indispensable

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@ShahidNShah
What are the palpable opportunities?
Business / Clinical
• Condition-specific apps
• EHR aggregation
• Revenue cycle management
• Genomics integration
• Patient recruitment
• Telemedicine
• Remote medical monitoring
• Health information exchange
• Risk assessments and monitoring
Technology
• Analytics and tools
• Information assurance and
cybersecurity
• Cloud infrastructure growth
• Virtual desktops
• Network optimization (to support
larger images, genomics, etc.)
• IoT and monitoring tools
• Assets review and operational
portfolio management
• Unified communications

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@ShahidNShah
What you need to know these days
Consumer Health,
mHealth, eHealth
Health IT Product
Development
Wireless & Mobile
Strategies
Collaboration,
Social Technologies
Cloud Computing
Strategies
MedTech Product
Development
Content &
Document
Management
(CMS/DM)
Enterprise
Architecture, SOA
Regulated Product
Management
Trust Models &
Regulated Privacy,
Security Planning
Technology Due
Diligence

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@ShahidNShah
Problems you can solve for your customers
Patient Discovery
•Website
•Pre-Patient
Provider Search
•Patient Connect
•Patient
Scheduling
•Reminder call,
scheduling,
Ensuring Patient
show up
•Patient
Intake/Experience
Practice
Management
•Patient
Scheduling
•Charge Capture
•Practice
Management /
Billing Tools
•Revenue
Analytics
•Claims Scrubbing
•Billing Services
•Pricing
Management
(Aggregated
Billing Data
analytics)
•Reviews /
Feedback
Infrastructure
•DaaS
•Network
•Office
Automation
Clinical
Management
•MU2+ Compliant
EHR
•eRX
•Voice
Recognition
•Clinical Language
Understanding
Integration
•Patient Connect
integration to PM
•HIE
•Labs
•Device
Connectivity
•Image storage /
EMR Access
•Clearing Houses
•Gateways
Consulting
Services
•ICD
•HIPAA
•Practice
Consulting
•Revenue
Planning
•Legal and
Compliance
•Clinical Workflow
Optimization
•Billing to Clearing
House
Integration
•Records
Management /
Migration
Focus on jobs that customers need to be done, not what you want to build

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@ShahidNShah
Care Delivery Technologies
On the Rise
• FHIR
• Blue Button+
• Real-Time Healthcare System
• Voice User Interface
At the Peak
• Natural-Language Processing
(Clinical Enterprise)
• E-Prescribing of Controlled
Substances
• Logical Data Warehouse
• C-CDA
• Clinical Communications and
Collaboration
• Consent Management
• Enterprise File
Synchronization and Sharing
• Enterprise Fraud and Misuse
Management
• Secure Text Messaging
• Healthcare Master Data
Management
• IT GRCM
Sliding Into the Trough
• Continua
• Business Continuity
Management Planning
• Unified Communications
• Semantic
Interoperability/Healthcare
• Legacy Decommissioning
• End-User Experience
Monitoring
• ICD-10 (U.S.)
• Direct Messaging
• HIE
• GS1 Healthcare (GDSN)
• HL7 Infobutton
Climbing the Slope
• Desktop Virtualization
• Patient Self-Service Kiosks
• Positive Patient Identification
• Vendor-Neutral Archive
• Enterprise Mobility Services
• Information Life Cycle
Management
• IHE XDS.b
• Location- and Condition-
Sensing Technologies
• User
Administration/Provisioning
• Enterprise Content
Management
• Patient Portals
Entering the Plateau
• Strong Authentication for
Enterprise Access
• Medical Device Connectivity
Source: Gartner Hype Cycle for Healthcare Provider Technologies and Standards, 2015

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Healthcare customers have great BS
detectors
The opportunities are real and achievable but…

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@ShahidNShah
What does “disrupting healthcare” mean?
This is $1 Trillion and the
Healthcare Market is about
$3 Trillion
This is $1 Billion

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@ShahidNShah
Healthcare industry fallacies
• Healthcare folks are neither
technically challenged nor
simple techno-phobes (they’re
busy saving lives and trying to
stay in business)
• Most product decisions are not
made by clinical folks or CIOs in
silos, they are all consensus-
driven and require team selling
• Complex, full-featured, products
are not easier to sell than simple,
stand alone tools that have the
capability of interoperating with
other solutions
• Stakeholders deal with
consumers, members, and
patients differently.
– Payers, care delivery organizations
(enterprises, independents),
pharmacies, ancillaries
• Selling into even small
customers (e.g. doctors offices)
is not easy.

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www.netspective.com 12
Nothing you do matters to the
healthcare “industry”.
But a lot of what you do
could matter to specific
stakeholders

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No, your big data or mobile ideas
will not change healthcare.
But if you can use them to add or extract value
from the existing system, you’ll do just fine.

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No, your EHR/PHR or app will not
be used by enough doctors or
patients to matter.
But if you can get even a fraction of them
to use your software, you’ll do just fine.

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No, your tools and solutions will
not easily be accepted by
permissions-oriented institutions.
Find customers with a problem-solving culture
willing to accept risks and reward failures.

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No, your offerings will not be
easily integrated into regulated
device-focused clinical workflows.
Incumbent vendors will not entertain the potential of
new legal liabilities without someone to share it with or
new competition without direct compensation.

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@ShahidNShah
You have made the job of
identifying, diagnosing,
treating, or curing
diseases faster, better, or
cheaper for clinicians
through the use of
information technology
(IT) or business models.
You have made the job of
self-diagnosing, self-
treating, or preventing
diseases and improving
overall wellness of
patients through the use
of new incentives,
business models, or IT.
You must be selling “actionable innovation”
You can help your customers achieve practical, relevant, actionable solutions

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Understand shift from volume to value
To succeed in healthcare you need to…

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@ShahidNShah
Life expectancy is increasing…
…but the rate of growth is slowing

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@ShahidNShah
Bacteria used to kill us the most…
Per 100k population, Historical Statistics of the United States, Millennial Edition

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@ShahidNShah
We’ve got most infections beat…
…except the flu and pneumonia

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@ShahidNShah
Top killers today
Heart disease Cancer
Chronic lower
respiratory
diseases
Top killers in 1900
Pneumonia
and influenza
TB
Diarrhea and
enteritis
Infectious diseases used to kill us…
…but what’s left seem only to be “manageable” not easily “curable”

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@ShahidNShah
Death by age group, 1900 Death by age group, Today
From cures to management…
…young people don’t dye of diseases often now
http://siteresources.worldbank.org/INTHSD/Resources/topics/Health-Financing/HFRChap1.pdf

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Where’s the
opportunity?

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http://www.slideshare.net/RockHealth/the-affordable-care-act-for-dummies

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@ShahidNShah
Shift from Fees for Service (FFS) to Value (VBC)
The Shift
The clinical model is shifting
away from treatment of
chronic conditions and
focusing more on prevention,
wellness, obesity intervention,
behavior and lifestyle
modification.
Implications
Clinical operations are shifting to hospital and
physician ‘centered’ services that will rely heavily
on health information technologies to monitor,
coordinate, and manage care.
• Successful Transition in Care resulting in
Reduced Hospital Readmission Rates
• Proactive population management
• Patient engagement and collaboration
• Disease prevention through wellness and
obesity management
• Chronic disease management
• Care coordination and collaboration
• Metrics and analytics

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@ShahidNShah
How Digital Health helps in shift
Successful Transitions of
Care
Reduced Hospital
Readmissions
Innovative Practice
Models like Patient
Centered Medical
Homes
Prevention, Wellness,
Obesity intervention
Behavior adjustments
and modification
Physician Marketing
Personalized
Concierge-Like
Medicine
Total Population
Management

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@ShahidNShah
What kinds of users are your customers targeting?
Help your customers go narrow and deep not wide and shallow
• Obesity Management
• Wellness Management
• Assessment – HRA
• Stratification
• Dietary
• Physical Activity
• Physician Coordination
• Social Network
• Behavior Modification
• Education
• Health Promotions
• Healthy Lifestyle Choices
• Health Risk Assessment
• Diabetes
• COPD
• CHF
• Stratification & Enrollment
• Disease Management
• Care Coordination
• MD Pay-for-Performance
• Patient Coaching
• Physicians Office
• Hospital
• Other sites
• Pharmacology
• Catastrophic Case
Management
• Utilization Management
• Care Coordination
• Co-morbidities
Prevention Management
26% of Population
4% of Costs
35% of Population
22% of Costs
35% of Population
37% of Costs
4% of Population
36% of Costs
Source: Amir Jafri, PrescribeWell

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@ShahidNShah
How will you choose to compete?
Top-line
revenue
growth
Free cash flow
improvement
Bottom-line or
margins
enhancement
Cost
containment
Technology
Managed
services

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@ShahidNShah
Why healthcare businesses buy stuff
Revenue
Cycle
Maintain
capabilities
Enter new
markets
Attract new
patients
Increase staff
productivity
Find your
reason
Healthcare businesses have complex buying processes – figure out why and what they buy

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@ShahidNShah
The best ways to partner
1. Top-line revenue growth: companies
that help grow revenue for their clients
are always welcome. There are fewer
competitors when you’re selling solutions
that grow revenue.
2. Free cash flow improvement: if you can
help healthcare companies improve cash
flows, you’re going to have a much easier
time than companies that don’t.
3. Bottom-line or margins enhancement:
companies that can show how they can
grow their customers’ margins will skip to
the front of the line when setting
appointments with their clients.
4. Cost containment: if a solutions provider
can clearly show how they can help
contain costs, they will see many
competitors but will still have a good
story that can help differentiate them.
5. Managed services: taking over major
areas of your customers’ workloads
makes sense
6. Technology: being “just” a tech partner is
now table stakes, and it will be very
difficult to compete.

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@ShahidNShah
The business needs
• Quality and performance
metrics
• Patient stratification
• Care coordination
• Population management
• Surveys and other direct-
from-patient data collection
• Evidence-based surveillance
The technology strategy
• Aggregated patient registries
• Data warehouse / repository
• Rules engines
• Expert systems
• Reporting tools
• Dashboarding engines
• Remote monitoring
• Social engagement portal for
patient/family
Do you have ideas in payment design?
Payment models going fee for service to outcomes-driven care

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@ShahidNShah
How will your customers get paid for your stuff?
Direct Payment
• Your best option
• Very few truly disruptive
technologies can be
directly paid for by
providers within the USA
• Limited adoption of
‘traditional’ pay for service
reimbursement for next
generation technology
Direct Reimbursement
• Second best option
• Improvements in
technology are outpacing
payer adoption
• Reimbursement will come
but its time consuming and
difficult
Indirect Reimbursement
• Emerging option
• Payer requirements for
improved quality and
efficiency are creating
indirect incentives to adopt
innovative solutions
• Solutions targeting new
value-based
reimbursement incentives
are highly useful to medical
providers
If you haven’t figured it out for them, customers will not figure it out for themselves

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Act like a regulated entity, narrow your
focus, and concentrate on workflows
To succeed in healthcare you need to…

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@ShahidNShah
Your customers’ innovation fit determines your opportunities
Therapies
Therapeutic
Tools
Diagnostic
Tools
Patient
Administration
Patient
Education
Most Regulation
Least Regulation
Be aware of regulations, don’t fear them, use them as
a competitive advantage

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@ShahidNShah
Can you repurpose or enhance health data?
Proteomics
Genomics
Biochemical
Behavioral
Phenotypics
Economics
Can you help customers use data to create new diagnostics or therapeutic solutions
IOT sensors
Administrative

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Where’s
your
focus?
Why?

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“Small”
isn’t
easy to
define

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@ShahidNShah
If you’ve focused on tech, not customers…
Where are you in the hype cycle?
Source: Gartner; “Hype
Cycle for Consumer
Engagement With
Healthcare and Wellness,
2015”

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@ShahidNShah
PBU: Payer vs. Influencer vs. Benefiter vs. User
Payer
Benefiter
Influencer
User
If you don’t understand the exact interplay between PBU your sale will fail
The payer is the
person/entity
that writes the
check for your
product.
The person or group
that benefits most
from the use of the
product.
Or the person or
group who
influences the users.
The person or group that
actually uses the product.

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@ShahidNShah
Why selling into healthcare is hard
Easy sell (iPhones, tablets, pagers)
Physician Pays
Physician
Benefits
Physician
Uses
Hard sell (EHRs)
Institution
Pays
Gov’t
Benefits
Physician
Uses

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@ShahidNShah
How to best identify your buyers (not users)
FFS vs. VBC?
Target health
sector?
Number of
employees?
Annual sales
volume?
Geography?
Number of
hospital beds?
Number of
patients?
Type of
patients?
The list goes on
and on…be
specific!
Help them stay away from market segmentation, focus on identifying PBU particpants
Identifying your
customers will depend
on helping your
customers identify theirs

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@ShahidNShah
Problems your customers looking to solve
Improve
medical
science?
Improve access
to care?
Reduce costs?
Improve
therapies?
Improve
diagnostics?
Improve drug
design?
Improve drug
delivery?
Create better
payment
models?
Focus on jobs that customers need to be done, not what you want to build

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@ShahidNShah
Some stuff not to focus on
• Don’t go for simple incremental innovation if
you can be bold and “disruptive” but make it
look like you fit into the existing ecosystem
nicely
• Don’t look at mHealth, look at mobility in
healthcare
• Don’t look at apps, look at entire systems
Incremental innovation is easier, disruptive innovation is probably more useful

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@ShahidNShah
Forget mobile apps, focus on health IOT
• With all the attention being paid to mHealth
there’s been an useless focus on mobile apps
• For the mobile apps, instead focus on
mobility in healthcare through “health
internet of things (IOT)” and self-care
technologies

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What’s needed in the marketplace?
What are we doing wrong when it comes to health IT applications?

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@ShahidNShah
Patient collaboration begs integration
Independent
Care
Connected Care
Coordinated Care
Integrated Care
Accountable Care
Systems integration thinking (especially for
EHR and RCM integrations) are a big
opportunity

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@ShahidNShah
We’re in the integration age
Source: Geoffrey Raines, MITRE
We’re not in an
app-driven
future but an
integration-
driven future.
He who
integrates the
best, wins.

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@ShahidNShah
Application focus is biggest mistake
Application-focused IT instead of Data-focused IT is causing business problems.
Healthcare Provider Systems
Clinical
Apps
Patient
Apps
Billing
Apps
Lab
Apps
Other
Apps
Partner Systems
Silos of information exist across
groups (duplication, little sharing)
Poor data integration across
application bases

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@ShahidNShah
NCI
App
NEI
App NHLBI
App
Healthcare Provider Systems
Clinical
Apps
Patient
Apps
Billing
Apps Lab
Apps Other
Apps
Master Data Management, Entity Resolution, and Data Integration
Partner Systems
Improved integration by services
that can communicate between applications
Needed: Modernize Integration
Need to get existing applications to share data through modern integration
techniques

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@ShahidNShah
What’s being offered to users What users really want
Needed: Reimagined User Interactions
Data visualization requires integration and aggregation

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@ShahidNShah
Needed: self-service applications
Patient Scheduling
for Services
Secure Social Patient
Relationship
Management (PRM)
Patient
Communications,
SMS, IM, E-mail,
Voice, and Telehealth
Patient Education,
Calculators, Widgets,
Content
Management
Blue Button, HL7,
X.12, HIEs, EHR, and
HealthVault
Integration
E-commerce, Ads,
Subscriptions, and
Activity-based Billing
Accountable Care,
Patient Care
Continuity and
Coordination
Patient Family and
Community
Engagement
Patient Consent,
Permissions, and
Disclosure
Management

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@ShahidNShah
Needed: diagnostic quality mHealth

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@ShahidNShah
Needed: predictive analytics

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@ShahidNShah
Needed: care team integration
HEALTHCAR
E PROVIDER
PATIENT/
CONSUMER
HOSPITAL
FAMILY
CAREGIVER
ALTERNATE
SITE OF
CARE
Care Team
CALL CENTERS AND
REMOTE SUPPORT

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@ShahidNShah
Needed: automated diagnostics

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Thank You
Visit
http://www.netspective.com
http://www.healthcareguy.com
E-mail [email protected]ctive.com
Follow @ShahidNShah
Call 202-713-5409

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Healthcare opportunities for smart SIs and solution providers

Healthcare opportunities for smart SIs and solution providers

Shahid N. Shah

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