Healthcare opportunities for smart SIs and solution providers

This presentation was given at the Smart VAR Healthcare Summit. It was presented to managed services providers, solution providers, innovators, and systems integrators (SIs). Answering:

* What kinds of BS can healthcare customers detect?
* What innovations can you help customers deploy?
* Where are the major opportunities to grow your business?

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

Transcript

1. Healthcare opportunities for smart SIs and solution providers Smart VAR Healthcare Summit August 2015 Shahid N. Shah, CEO
2. @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
3. 4 @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
4. 5 @ShahidNShah www.netspective.com www.ShahidShah.com 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
5. @ShahidNShah www.netspective.com www.ShahidShah.com 6 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
6. 7 @ShahidNShah www.netspective.com www.ShahidShah.com 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
7. @ShahidNShah www.netspective.com www.ShahidShah.com 8 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
8. Healthcare customers have great BS detectors The opportunities are real and achievable but…
9. @ShahidNShah www.netspective.com www.ShahidShah.com 10 What does “disrupting healthcare” mean? This is $1 Trillion and the Healthcare Market is about $3 Trillion This is $1 Billion
10. 11 @ShahidNShah www.netspective.com www.ShahidShah.com 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.
11. www.netspective.com 12 Nothing you do matters to the healthcare “industry”. But a lot of what you do could matter to specific stakeholders
12. www.netspective.com 13 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.
13. www.netspective.com 14 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.
14. www.netspective.com 15 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.
15. www.netspective.com 16 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.
16. 17 @ShahidNShah www.netspective.com www.ShahidShah.com 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
17. Understand shift from volume to value To succeed in healthcare you need to…
18. 19 @ShahidNShah www.netspective.com www.ShahidShah.com Life expectancy is increasing… …but the rate of growth is slowing
19. @ShahidNShah www.netspective.com www.ShahidShah.com 20 Bacteria used to kill us the most… Per 100k population, Historical Statistics of the United States, Millennial Edition
20. 21 @ShahidNShah www.netspective.com www.ShahidShah.com We’ve got most infections beat… …except the flu and pneumonia Per 100k population, Historical Statistics of the United States, Millennial Edition
21. 22 @ShahidNShah www.netspective.com www.ShahidShah.com 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” Per 100k population, Historical Statistics of the United States, Millennial Edition
22. 23 @ShahidNShah www.netspective.com www.ShahidShah.com 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
23. www.netspective.com 24 Where’s the opportunity?
24. www.netspective.com 25 http://www.slideshare.net/RockHealth/the-affordable-care-act-for-dummies
25. 26 @ShahidNShah www.netspective.com www.ShahidShah.com 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
26. @ShahidNShah www.netspective.com www.ShahidShah.com 27 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
27. 28 @ShahidNShah www.netspective.com www.ShahidShah.com 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
28. @ShahidNShah www.netspective.com www.ShahidShah.com 29 How will you choose to compete? Top-line revenue growth Free cash flow improvement Bottom-line or margins enhancement Cost containment Technology Managed services
29. 30 @ShahidNShah www.netspective.com www.ShahidShah.com 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
30. 31 @ShahidNShah www.netspective.com www.ShahidShah.com 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.
31. 32 @ShahidNShah www.netspective.com www.ShahidShah.com 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
32. 33 @ShahidNShah www.netspective.com www.ShahidShah.com 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
33. Act like a regulated entity, narrow your focus, and concentrate on workflows To succeed in healthcare you need to…
34. @ShahidNShah www.netspective.com www.ShahidShah.com 35 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
35. 36 @ShahidNShah www.netspective.com www.ShahidShah.com 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
36. www.netspective.com 37 Where’s your focus? Why?
37. www.netspective.com 38 “Small” isn’t easy to define
38. 39 @ShahidNShah www.netspective.com www.ShahidShah.com 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”
39. 40 @ShahidNShah www.netspective.com www.ShahidShah.com 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.
40. 41 @ShahidNShah www.netspective.com www.ShahidShah.com 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
41. 42 @ShahidNShah www.netspective.com www.ShahidShah.com 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
42. 43 @ShahidNShah www.netspective.com www.ShahidShah.com 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
43. 44 @ShahidNShah www.netspective.com www.ShahidShah.com 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
44. @ShahidNShah www.netspective.com www.ShahidShah.com 45 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
45. What’s needed in the marketplace? What are we doing wrong when it comes to health IT applications?
46. @ShahidNShah www.netspective.com www.ShahidShah.com 47 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
47. 48 @ShahidNShah www.netspective.com www.ShahidShah.com 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.
48. 49 @ShahidNShah www.netspective.com www.ShahidShah.com 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
49. 50 @ShahidNShah www.netspective.com www.ShahidShah.com 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
50. 51 @ShahidNShah www.netspective.com www.ShahidShah.com What’s being offered to users What users really want Needed: Reimagined User Interactions Data visualization requires integration and aggregation
51. @ShahidNShah www.netspective.com www.ShahidShah.com 52 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
52. 53 @ShahidNShah www.netspective.com www.ShahidShah.com Needed: diagnostic quality mHealth
53. @ShahidNShah www.netspective.com www.ShahidShah.com 54 Needed: predictive analytics
54. @ShahidNShah www.netspective.com www.ShahidShah.com 55 Needed: care team integration HEALTHCAR E PROVIDER PATIENT/ CONSUMER HOSPITAL FAMILY CAREGIVER ALTERNATE SITE OF CARE Care Team CALL CENTERS AND REMOTE SUPPORT
55. @ShahidNShah www.netspective.com www.ShahidShah.com 56 Needed: automated diagnostics
56. Thank You Visit http://www.netspective.com http://www.healthcareguy.com E-mail shahid.shah@netspective.com Follow @ShahidNShah Call 202-713-5409