This week is a special week to celebrate the New Year and I am talking to some of my fellow show hosts to get their take on what to expect in the coming year in healthcare. In alphabetical order, I was joined by
Matt Fisher (@Matt_R_Fisher), General Counsel at Carium and Host of Healthcare de Jure
Tom Foley (@foleytom), Chief Growth Officer at GenieMD and host of The Virtual Shift
Beth Friedman (@HealthITPR), Senior Partner at FINN Partners, and host of FINN Voices
Fred Goldstein (@fsgoldstein), President Accountable Health, LLC, host of PopHealth Week
Daniel J. Marino (@DjmarinoHD), Managing Partner, Lumina Health Partners and host of Value Based Care Insights
Roberta Mullin (@mssoftware), Station Manager and Producer at Healthcare NOW Radio
Jim Tate, President, EMR Advocate, Inc., host of The Tate Chronicles
My guests offer some great insights into upcoming innovations and changes in our healthcare system and what you should be looking out for. Some of the things to listen out for
- The Looming Start-up Crash courtesy of the rising interest rates and higher capital costs
- Expanding Pharmacy services including newer provision of direct patient care
- Remote Patient Monitoring and innovation and more care in the home
- A belief the government will move at lightening speed and the new HIPAA regulation will be expedited
- Fast track Telehealth bills to continue pandemic era regulations easing Telehealth adoption
- TEFCA will start to get real traction
- A host of EHR vendors throwing in the Towel
- Population Health gaining ground and delivering on the Value-Based Care Promise
- Machine Learning and Automated Intelligence (AI) will deliver real wins
- Rethinking drug pricing in the face of high-cost therapies and perhaps the waning of PBMs
- Increasing focus on home, wearables, and lifestyle
- Consolidation pressures will abound
- More EHR integration thanks to improved interoperability
- Increase in Smart contracting and automation for approvals between payers and the clinicians
I see more home health technology and home monitoring that will bring real medical home capabilities with a special focus on passive monitoring capabilities. I am also a fan of AI, but in my reading of it, more automating intelligently with narrow implementations that will remove friction for patients, staff, and processes. My final prediction is more of a hope but is tied to the pharmaceutical pricing and the PBM black box exposed to appropriately increased scrutiny allowing for real solutions to the drug price problem in the US
Listen in to hear our take on the coming year, the highlights of what to expect and where we think you will see significant changes.
My thanks to all my co-hosts for joining me on the show – wishing everyone a Happy New Year.
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
Hi and today we are introducing a special show. This is our predictions for the coming year 2023. And I’m excited to be joined on this show by many of my fellow hosts on healthcare now radio, and we are going to share our predictions and have a discussion this year about how they might be implemented. So joining me today, I have Beth Freedman. She’s the senior partner at thin partners Jim Tate, president of EMR advocate, Matt Fisher, General Counsel of carrion Tom Foley. He’s the chief growth officer at Genie MD, Roberta Mullen, the station manager and producer at health care. Now radio, for those of you that don’t know, that’s what makes all of this stuff happen. Fred Goldstein, my good friend and partner for the whole of COVID-19. He’s the president at countable health. And Dan Marino, he’s the managing partner at Lumina, Health Partners. Welcome, everybody.
Tom Foley
And welcome. Thank you. Thank you for having me. Thank goodness, they
Nick van Terheyden
all replied, I really would be thinking there was nobody actually on this call for a second there. Right. So let’s kick off we saw, we talked a little bit about this ahead of time, we’re gonna give everybody an opportunity to share their thoughts. They’re at top three predictions for 2023. Tom, I’m going to kick off with you.
Tom Foley
All right, thank you. And thanks for having me on the program. So top three predictions for 2023 I’m predicting that we’ll have a similar.com crash of with startups considering the the the interest rate increases and some of the inabilities to generate real revenue will see significant impact in the in the startup arena, forcing them to either raise additional capital at unfavorable terms initiate layoffs, and we’ve already seen this with some of the startups and and we’re sell off the company. That’s Prediction number one. Prediction number two, I’m going to switch arenas here pharmacists, one of the most trusted resources in the delivery of care market will actually be given the ability to provide direct patient care, including er X. And remote patient monitoring coupled with chronic care management will reach its tipping point and become the new standard of care considering the financial woes of hospital systems and and providers in the reimbursement arena. So this is a an opportunity for additional cash flow, additional profitability. And as I always say, Mikey likes us patients like the idea of remote patient monitoring and care in the home.
Nick van Terheyden
Thanks, Tom, Matt Fisher.
Matt Fisher
It’s a one one part I think we’ve been waiting for for a while is getting the final HIPAA regulation from the proposed rule and the RFI that have come out I think, almost a year ago now. I think, coupled with that the Part Two regulation that was just proposed, I’m optimistic that we’ll finalize, maybe mid mid year next year, we’ll try to get that to move at an Lightspeed for the government. Second prediction, I think we will continue to see on the digital and virtual care front, a move away from point solutions to platforms where you can have kind of one stop shopping that you can build on top of. And then the final one, this kind of comes from having just been at a conference and hearing a couple of reporters from Politico, but I think there will be a telehealth bill that comes out of Congress that will help permanently enact some of the waivers. And if I had a hazard prediction on that front, I think that we’ll be ready by the fall. Because I feel like I read recently that there is a prediction that the public health emergency will finally end maybe sometime first quarter next year, which then with the 100, with 150 or so day trail period that came out of one of the bills this year, that takes it to the end of the fiscal year, the government’s fiscal year and allows for the renew everything to renew with the new fiscal year next fall.
Nick van Terheyden
So I told all of my guests that we would wait and we won’t have comments. So it’s unfair because I’m the host, so I get to sort of intervene and I’m just going to say commentary here. Matt Fisher thinks the government is going to move at lightspeed. Jim, take your three.
Jim Tate
Well, thank you. The first is Kafka. Kafka has been work Really, it’s the opposite of lightning speed, more glacial speed. But prediction, as well as a wishful hope is that Kafka will start actually getting some traction, a lot of work has been done over the years. But we still don’t have any qualified health information network. So that’s been delayed for a few quarters, certainly, hopefully, TEPCO will get off the ground and start gelling. Second is the fire API. That’s the requirement to promote interoperability EHRs have to meet that new certification criteria. So the function technical functionality has been worked out, but to work process behind it in the real world is going to cause confusion, because if Apple with their Apple Watches comes to a small EHR vendor, and says, We want to be authorized to be able to access your file server. The workflow and process of how the documentation occurs and, and even how large third parties try and contact those EHR vendors, is kind of up in the air and workflow has not been established. And it’s gonna be confusing. And the third thing is, I think in, I’ve actually heard of the last quarter lot, some of the smaller EHR vendors I work with, are going to throw in the towel, the towel this year, some of these folks been around 10 or 15 years. But the kind of referring back to the fire API, they say that’s about as far as we can stretch our capability from the development side. So I think that’s gonna happen.
Nick van Terheyden
All right, thanks, Jim. Roberta.
Roberta Mullin
I’ve got big, big retail, especially the pharmacy, I think that they’re going to continue to acquire and get bigger and they’re going to have a bigger footprint in care next year. I think that patient engagement experience platforms are going to do the jockeying around and see who who floats and who who’s going to who’s going to take over that be the dominant one, because I don’t think all 600 of them are going to be able to do anything. So we’ll see who floats to the surface on that. And then on the interoperability. I don’t believe that we’re gonna get anywhere with that. I think that Tuska is, it’s already it’s already 12 years now. It’s now they were supposed to have the queue hence, this quarter. They say it’s next quarters. I don’t believe that. But I think that they’ll move the needle very slightly, if anything, and I think that the same players are going to be in it. And the same players are going to be the naysayers.
Nick van Terheyden
Okay, fantastic. Roberta I just floor dropping 600 patient engagement. That’s extraordinary to me,
Roberta Mullin
aren’t there, at least that many I
Nick van Terheyden
could be? Right Goldstein,
Fred Goldstein
thanks so much pleasure to be on with this incredibly esteemed group here. My first one actually is an extra one that I’m going to throw in here, because of all the work we’ve done over the last couple of years, and that is that COVID is officially over as of January one, we can all just move on, it’ll not infect anybody anymore, and we can continue our lives without worrying about that disease anymore. So we’re going to start first 2023 is the year that population health finally does something about social determinants of health or social influences of health. They’ve talked about it forever. And now we’re beginning to see some early entrants, the question becomes, do they have to have a CPT code for everything one of them are we going to move to value based care and they can actually pay for it through what they save. The second is everybody talks AI and machine learning. And now it’s going to come the dawn is here, but it’s not in the cool areas of looking at X rays or some of these other health issues. It’s in improving system processes. It’s in document stuff, converting documents, setting up appointments and things like that there’ll be much more effective in improving the efficiency of the health care system. Whether that gets down to prices or not, is another point. And the final area is we just had a brand new gene therapy approved for haemophilia B $3.5 million. I think that’s going to be a wake up call to employers and payers. Because the only way to finance that is through some different mechanism. You can’t pay three and a half million dollars upfront and watch that individual go to another health plan or another group. And so it’s going to require some innovative thinking and I think we’ll finally get some movement towards some multi year types of contracts and outcomes based based on that one drug.
Nick van Terheyden
Another floor dropping.
Fred Goldstein
Excuse me, go ahead.
Nick van Terheyden
Another floor dropping number from Fred 3.5. And yes, exactly. Dan Marino.
Dan Marino
Thanks, Nick, happy to be here. My first prediction is that we’re going to continue to see a lot of advancement from retail from these non traditional healthcare providers advancing into healthcare. And I really believe that not only are they going to address a lot of the primary care needs that we’re seeing, especially with the younger population, but they’re going to start to integrate wearables and really create some influences around lifestyle, and almost taking social determinants of care and building a whole lifestyle component of that, I think there’s a there’s a good advancement occurring as it exists right now. The second thing is, given the financial pressures that we’re under, I believe there’s going to be some pretty considerate considerable consolidation that’s going to occur, potentially with some of these non traditional providers, merging with a healthcare system. It seems like we’re dabbling in that right now. And especially with where some of these large retail players are, even technology boy, if you know, somebody like an Amazon or Google wants to be able to consolidate with the healthcare system, man, what a disruptive change that would be. So that could be you know, I think something that would be interesting going down the road. And then the last one is really around reimbursement. I believe there is going to be some changes from reimbursement this year, continuing to advance Medicare Advantage. Providers are having to assume more and more risks. And I do believe with Fred that there’s going to be a lot of advancement in population health and share.
Nick van Terheyden
Fantastic Dan. Bet Friedman, last but not least,
Beth Friedman
Hey, Nick, thanks for having me on. Today’s has been such an informative panel and group, I really appreciate it. So I have three, I had the opportunity to sit in on several panel sessions that are conferences fall that were led by chief innovation officers at the big health systems and hospitals and really inspired by what they’re doing, I think we’re going to see to the point of digital health technologies and applications, I think we will see some success stories out of that, with specific use cases coming out of those innovation centers. What I was inspired by was I think that two things will change this year, we will see that had a return on investment, whether that’s financial or patient satisfaction or clinician burden burden. And I also think we’re going to see more integration of the with the EHRs with the legacy systems that are there. So I think those coming out of those innovation centers, I think we’ll see two new things, there’ll be refreshing. I think there’ll be more focus on that payer provider data exchange of information. There is so much administrative burden waste on both sides of that equation. I think we’ll see some of that AI machine learning RPA doing some automation between payers and providers, and that just trying to get that bill pay the claims, the audits, everything involved with that. And then the last thing I think several folks have mentioned pharmacists, you know, community, pharmacists now have the green lights and stuff to start prescribing medications for COVID. And I think that trend of the pharmacists being sort of a helpful adjunct clinician in the community. I’m really excited to see that continue.
Nick van Terheyden
Fantastic. Well, appreciate everybody’s thoughts, suggestions, we’re gonna have a discussion on this, just before we do, I’m going to throw down my top three, and I’ll start with Home Health Tech, and it sort of resonates with a couple of the folks that talked about remote patient monitoring, I think that’s going to really expand, we’re going to see more of the clinically valid versions. And specifically, I think the ones that will take off will be the passive ones. So everything that requires no input, no desire. So you we’ve seen some of these LIDAR capabilities, you literally just put them in and they’re sensing, I think they’re going to make big differences. I heard a couple of people talking about AI. And I’m gonna say automating intelligently, I think is going to be the key to this. This is not just hey, we’ve got aI this sort of narrow focus, but actually augmenting intelligently is a better version of AI in my view. And I think we’ll see that. Although I gotta be honest, I push back on this automation that Beth talked about, which says, Hey, we’re going to automate this exchange of, you know, contracts because I think the whole pre off process is not about technology. It’s about actually denying payments and its economic flow is my personal view. And then finally, I’ll round this out because I heard a number of people talk about pharma and the pharmacist. I hope that pharmacists are going to kill PBMs and toss them into the dust where they belong, because they provide essentially another middleman that is not delivering value. And we have to fix that drug pricing as Fred essentially identified with the 3.5 million. So that for me is my three. I’m gonna open it up to the floor, the piece that I heard a little bit of conflict on that I’d like to sort of start the discussion and, you know, feel free to jump in is interoperability. So on the one hand, you know, Matt ceases going at lightspeed with the government saying, Yeah, we’re gonna do this. But I heard Jim saying, yeah, it’s happening, Roberta, what are your thoughts? So we really go, how do we get to interoperability? Because if we’re going to get rid of all of those EHRs that are thrown in the towel, that was kind of surprising, Dan, thanks for letting us know, is, how do we get to it? Because I feel like we’ve been doing this for as long as I’d been in this business.
Tom Foley
Oh, I kicked that off, if you don’t mind. My fourth guest or my fourth prediction would have been the O and C, finally removes EHR certification from the requirements as well. I’ve worked where some EHRs, I was very involved in direct messaging when they first came out under me, too. I think that the interoperability model is is flawed in the context of, we are still working in a probabilistic record matching algorithm, as opposed to a deterministic model. And because of that, we are still injecting errors into the system and creating harm. And until we fix that problem, we can have interoperability.
Nick van Terheyden
I’ll say, Yeah, that’s true. But to me, that’s sort of a fundamental matching problem that we’ve been also trying to solve. And the government said, you can’t go and create a national patient identifier that’s in the regulations. I just, I’m sorry.
Tom Foley
When you do interoperability at a larger scale, and it kind of manifests the problem, right? If you keep interoperability or record matching flaws at a local level, it mitigates it doesn’t resolve the problem. It doesn’t make it right. But every EHR has this problem. And until we recognize that we’ll never have a good interoperability network, because we can’t match the record correctly. 100% of the time.
Roberta Mullin
This Roberta, did you say that? Oh, and C is going to you think that they will?
Tom Foley
was? That was my hope and prayer? I have no illusions.
Nick van Terheyden
There’s no hope and praying in healthcare. I’m sorry, that predictions don’t rely on hope and prayer, because God allow for that. What about farmer? Fred? I’m sorry.
Fred Goldstein
Yeah, I want to come in and come in and farm if you’d like, I love your PBM comment, because I think that’s a dream. And
Nick van Terheyden
so I’m, I’m hoping, as well,
Fred Goldstein
today that they’re going to disappear. But the the idea of primary care and retail is fascinating. And my issue with that is we keep sort of ignoring the fact that the largest employer of primary care doctors in the country today is united. And how many are going to be left after they acquire the rest? And so I think it may be a little bit late for some of that acquisition, the hospitals have done it and some of the others. And then the question becomes, is it really a retail deal with primary care? I mean, potentially, what they’re doing is most of them are is picking up a rnps, er, nurse practitioners. And those tend to be staffing more of those retail clinics, which is a good way to do it, particularly in rural areas. But I wonder if it might be a little a little bit late. When you talk about interoperability? Well, then creating those kinds of links is also an extremely difficult area, although a bunch of people are working on that now. And obviously, if you’ve got CVS, Aetna, you’ve got one company.
Roberta Mullin
Roberta again, remember though, that far, the pharmacies are one very local and two, they’ve had computer systems way before I was installing pharmacy computers in the 80s. They they have the inner ability within themselves. They have the big systems, they’ve they’ve figured it out. Nobody seems to want to ask them about it, but they have figured
Nick van Terheyden
it out. Well, what have they figured out?
Roberta Mullin
Well, you can go anywhere i i get my drugs at CVS, I can go when I’m up in New Jersey, I can go there, they can tell me what I haven’t and fill
Fred Goldstein
them. I mean, I think that’s that’s very true. Roberta is right again. But But the issue becomes E prescribing is now a requirement. You know, we’re seeing that come out. So all of the all of the healthcare systems can be prescribed. So whether the connection for that is because the CVS pharmacy or Rite Aid or any Has it or the provider has it, or the payer is watching it monitored through their systems? I think pharmaceutically we’re connected pretty heavily. But it’s talked about the interoperability and the rest of it. It’s a little bit more difficult. And so I wonder if, if maybe some of these pharmacies might be a little late to the game? And then the question becomes my going there for my primary care, because it’s better. Where am I going there? Because it’s just easy. But does it really overall improve my health? Because I did one visit an urgent care center or pharmacy. I just got part.
Nick van Terheyden
Yeah. So I feel you need to jump in, because I beat up on you right at the start. So
Matt Fisher
yeah, no, I mean, I think the retail question is interesting, because I think it’s just at the moment, just creating more fragmentation, because they’re, you know, they’re trying to draw people into a pharmacy, whether you’re talking about CVS, any minute clinics or village, colocating, and Walgreens like, it’s still all, by itself, I think until we create better continuums, where you can have cared seamlessly going across different locales in different places. But all the issues that we’ve all identified are going to remain, because we haven’t created we haven’t fostered a system where it encourages people working together, like whether you’re talking about interoperability, reimbursement, all of that, right now, you’re still incentivized to hold on jealously to whatever piece that you can get a part of, because that’s the only way you’re going to profit or that’s the only way you’re going to primarily profit, since value based care continues to lag behind.
Nick van Terheyden
Right. And, Dan, you talked about that the sort of, you know, the increase in the wearables, but for me, that requires that interoperability. And that’s the piece that misses in all of this. Oh, so great, show up. You’ve got the system, but it’s not all connected. I mean, I want to see that because as Roberta said, everything’s local, it’s easy to go to the pharmacy, because it’s right there, especially for the remote on underserved communities.
Dan Marino
Yeah, Nick, I agree, I think we’re going to see levels of interoperability that’s going to occur, I believe, you’re going to see it occurring first, very local, very localized, where you’re going to have the pharmaceuticals, you’re going to have the local healthcare providers, create some level of interoperability, and then I believe it’s going to be regional and then it’s going to be more national, they’re going to have to be able to do that one, because care is localized to you can’t boil the ocean, right. So you have to solve this problem incrementally, incrementally, rather, and then be able to really grow from there. So yeah, I think we’re gonna start to see a lot of good good waves occurring in the integration of retail with providers and the whole interoperability issues.
Nick van Terheyden
Of course, I’m gonna agree, because that’s incremental. And Beth, in fairness to you, I jumped on you as well. So you ought to be able to respond and push back. So go ahead.
Beth Friedman
No, I’m just actually going to concur about the community focus with the pharmacies, getting those community pharmacies integrated in their local health care delivery systems, whether it’s through, you know, sharing are being a part of that population health platform, having their data go back into the HR, being part of that care coordination team, I do think some of those smaller community pharmacies might make better strides than some of the big guys.
Nick van Terheyden
Interesting. Jim, we beat up on you a little bit with the whole and you were, you know, positive on API’s. And you talked about Apple, Apple just signed a deal with epic that sort of blew my mind a little bit. Well,
Jim Tate
you know, before we run out of time, like bring up something else here that I think it’s gonna be fascinating to watch this next year. And that is Amazon moving into primary care. And so, you know, they’ve acquired it one medical is that tonight, you know, and so, you know, they’ve been able to move into food distribution with whole foods, we’ll see what they can do with a primary care model. That’s gonna be fascinating to watch this year.
Nick van Terheyden
Yeah, I think that’s exactly right. I mean, there’s, there’s, you know, that’s how we all get things I realized that when I went into the store for a first you know, the first time into one of these sort of, you know, places that I used to shop, it was deserted and there was nothing there we’ve we’ve moved to this online sort of experience. So unfortunately, as we do each and every week we run out of time. I just want to make a call out these are all my colleagues and guests and I would encourage my listeners to go take a listen will have the links to each of their shows. You’ve heard a little bit of their insights, obviously slightly different perspective. You know, all credit to Dan for pulling out the incrementalist in his commentary. So yay for that just saying, and Newton, and hands down, you know, all of these folks showed up. I didn’t say when can you meet? I said this is the time and place so I’m very grateful. To all of you to birth, Jim, Matt, Tom, Roberta, Fred and Dan for making the time coming on the show, sharing your thoughts. I’m interested. I think it was helpful to me. Hopefully it’ll be interesting to our listeners. So thanks to everybody for joining me on the show.
Jim Tate
Happy holidays.
Roberta Mullin
Thank you.
Matt Fisher
Thank you. Appreciate it. Thank you
