This Week Health

News Day – Interoperability Headwinds and Behind Amazon’s Pill Pack

The stories we cover this week.

- Lawmakers call for a delay in implementing interoperability rules - FierceHealthcare.com

- Aetna’s Consumer Tech Bet: Why the Insurer is Teaming Up with Apple to Keep Patients Healthier - hcinnovationgroup.com

- The inside story of why Amazon bought PillPack - CNBC.com

- Why Google believes machine learning is its future - arstechnica.com

Transcript

 This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Welcome to this week in Health IT News, where we look at four stories in 20 minutes or less. That's gonna impact health It I. Today lawmakers look to delay interoperability rules. Apple Aetna Health app launches, uh, an inside look at the PillPack acquisition from by Amazon and Google's machine learning is advancing rapidly.

My name is Bill Russell, recovering healthcare, c i o, and creator of this week in Health. It is set of podcasts and videos dedicated to developing the next generation of health IT leaders. This podcast is brought to you by health lyrics. Have a struggling healthcare project. Do you need to go? Well, Let's talk.

Visit health lyrics.com to schedule your free consultation. We are the fastest growing podcast in the health IT space with news and interviews that are targeted to the application of technology and healthcare. We have two shows every week. We have this week influence a discussion with industry influencers and this week news where we explore the news impacting the professionals such as yourselves that are focused on the use of technology and the delivery of health.

If you enjoy the show, please share it with a peer. If you have a story you want us to cover, Please, uh, shoot me a note in email bill at this week in health it.com. And now onto the news lawmakers call for delay in implementing interoperability rules. This's an article by Heather Landy on fierce healthcare.com.

And, uh, what you're seeing here is that your, you know, H H S O N C uh, came out with rules around interoperability. And, um, now you're starting to see it sort of filter through the system. And now you have senators who are debating this on Capitol Hill, and you just see the powerful forces behind them, uh, as their words sort of, uh, Tell us what people are thinking.

So you have, uh, and this is both sides of the aisle. Uh, there's a fair amount of people calling for delay and their, um, their rationale is that it's unrealistic. Uh, the timeline's unrealistic, and that would pose a significant compliance burden on health insurers, providers, and other stakeholders. Um, but you know, there are people on both sides of this argument.

Uh, for example, Senator Mike Braun, Republican from Indiana says that, uh, this is a healthcare industry, is an industry that's dragging its feet. He called the healthcare industry dysfunctional and not consumer driven. Uh, he goes on to say that the healthcare industry is full of smart individuals and big corporations who have figured out how to take advantage of the rules.

Um, I Interesting debate that's going on in Capitol Hill. This is a little different, actually. It's a lot different than what we saw at the keynote. We saw officials from multiple administration. Across decades. Literally. You had Obama administration, you had Bush administration, you had the Elder Bush administration going back that far.

And uh, you know, they were telling us that the time was now we had learned a lot and that, um, you know, that, uh, Secretary Azar and, uh, Verma was on stage that the O N C and HSS were spot on in what they were talking about with regard to interoperability. The time was now to empower the consumer with their health data.

The technology's ready. We have the experience with fire. APIs are more common in the industry. APIs are just common in general. Uh, college kids are graduating today, know how to use them. Mobile applications have proliferated, uh, security models are there. We, we have all sorts of the, the, the timing is right to make this happen.

There was bipartisan agreement to take the next step. So just as a reminder, what, what we're talking about here, C M SS has proposed some, um, some rules for anyone who participates in programs like Medicare, Medicaid, uh, the exchanges, and it would, they would be required by January 1st to have the capability to give 125 million patients electronic access to their personal health information at no cost to the patients.

Okay, so that's what they're talking about. The, uh, Senator suggested that H H Ss should adopt a more phased in approach, um, instead of hard deadlines that it would be over time and it would be, it's, it's just a lot softer. Uh, I thought one of the more interesting comments, Senator Mitt Romney, Republican from.

Question whether trying to achieve NA nationwide interoperability was a bridge too far. At this stage, we might need to rethink how we approach this goal of interoperability and move to a more standard oriented process versus an implementation process. Wow. I would love to know what that means. Um, but, uh, I, uh, it's, it's interesting to ask the question of are we going about this incorrectly?

That's what I think is interesting about that comment. I'm not sure what the end of that comment really means, but to say, are we doing this correctly? Are we approaching this correctly? I think is what he is saying. So, um, lastly from this article, national Coordinator for Health, it, Dan Rucker. Um, MD pushed back on the changing of the timelines, noting that the majority of providers have access to health IT software that meets the interoperability standards.

Today. The risk of delaying this is that the American public is not in charge of their healthcare, are paying far more, uh, are paying more for their care and not getting as good a care as they could get. So you're starting to see this thing play out. Uh, I think the big takeaway from this is there's a potential delay in the.

Powerful forces are at work behind the scenes making this happen. Uh, the good news is no one's really arguing the need, just the speed. So it's, it's not about doing interoperability, it's just a ma matter of the pace at which we're bringing it about. So what, uh, we're gonna try to end each one of these stories with a so what?

So what? It still remains the right thing to do. The economics may not line up yet. Uh, the use cases. Or may not line up yet. Uh, it's still the right thing to do. People are still heading in this direction. Uh, so we should probably be heading in this direction one way or another. I don't hear any sound arguments for why we should not be sharing the data with the patient and empowering the patient, so no one's making that argument yet.

So all this is, is a delay, buys a little bit of time. So that's, you know, potentially a good thing for some, uh, for others like us. All of us who are patients, it may not be a good thing. So we will see, we'll see how this transpires. Second story, apple, Aetna Health app gets released. So let me tell you what I, what I see in this story.

So this story is from. Health, uh, HC innovation group.com. So Healthcare Innovation, uh, is a online journal and magazine that's out there titled the articles, Aetna's Consumer Tech Bet. Why the insurers teaming up with Apple to keep patients healthier. I. Uh, let me just break this one down. There's not a lot of quotes and things to really read about this, but c v s Aetna is releasing an app.

They've been piloting it, piloting it. Uh, they've grown the, uh, pilot to about 250 to 300,000 users. Of their 22 million members that they have. And the app is called Tain. Uh, I'm looking at some of the screens here. And to be honest with you, it looks an awful lot like a health wellness app for an employer program.

So you have, uh, the ability to track things, track your, uh, exercise goals, your weight loss goals, probably a couple others that I'm not seeing here. Uh, it's linked to your, uh, watch, so it's receiving that information directly. The, um, has some, uh, some health tips, I guess, if you will. It has some challenges.

I don't know if it has the ability to challenge others, but you get some challenges sort of delivered through the app itself. And then it has a rewards program. So as you, as I'm describing it, you can picture this from any one of the wellness organizations that has an app out there for, uh, for large organizations, uh, to utilize for their employees.

This, uh, it's interesting 'cause a large, uh, large part of this article talks about, um, Patient privacy. Privacy of the information, which I find interesting from this perspective. Privacy, it, it's not really talking, I mean, it's talking about privacy, like protecting the data, like my step data and all that other stuff.

I don't think it has data in there that I'm really worried about anyone getting hold of. Accept the insurer. To be honest with you, I'm afraid the insurer's gonna get it. Take a look at the number of steps and say, Hey, you don't take that many steps. We're gonna increase your rates. They're gonna look at my weight and say, Hey, you, you put on 10 pounds, we're gonna increase your rate.

So it's interesting. They're talking about privacy. Uh, it, it's, anyway. They, it, it just doesn't seem like they're, I, I, they're focused on the right thing. They should be more focused on the privacy of my data, going to the very people who created the app, which I think is one of the challenges. So I think there's three things here.

One is, uh, this is a, uh, consumer discerner mediation play. And all that means is Aetna c v s are clearly positioning themselves between the patient, uh, the consumer and the health system, because they want to direct where care goes. Um, the app looks very much like most employer engagement tools that are out there.

Uh, the third thing I, I would say is they talk about this. There's been a lot of failures in this space. I think that's all the more reason to have a strategy, not one of those things where you just throw up your hands and say, uh, we can't en engage consumers or we haven't been able to. So, uh, so what's the so what on this article?

I, I think the, so what is, we keep seeing these dis remediation plays. Healthcare systems cannot afford to be disin mediad from their consumer. So you have to figure it out. Listen to consumer, figure out what they want, build, buy, or partner, whatever it takes to get there. You have to have a play to keep from being disintermediated from the consumer.

So that's the so what on that article? Let's go on to the next one. Next one's interesting. Uh, cnbc.com. The inside story of why Amazon bought PillPack in its effort to crack the $500 billion. So on June 28th, Amazon bought PillPack for $753 million. Um, the reason they did that is the spending in US prescription medication is approaching about 500 billion a year with grow growth rate of about 7%.

And, uh, it goes on to say in more detail why they did it. Um, PillPack has spent years going through the hard work of getting licenses to ship to every state except Hawaii, and they've built a system that automatically manages refills and works with insurance, uh, insurers on behalf of customers. It provides dispensers to make everything as easy as possible.

So the two things about this acquisition, one is, uh, PillPack has a software called, uh, pharmacy oss, which was a big part of why Amazon bought this. And the second is they have a very consumer friendly way of delivering the, uh, medications, right? So you're used to getting the big pill with the Unop bottle.

Now you get these pill packs, which essentially are. Labeled Sunday, Monday, Tuesday, Wednesday. You just open Sunday, you take your pills and away you go. So why? Why did Amazon do it? Um, Uh, Fred Dustin, early PillPack investor, described it as a complicated and expensive space with a potentially big prize. In other words, it's the type of business that Amazon, C e o, Jeff Bezos loves huge do, huge dollars antiquated technology, and so many regulatory barriers that the smart money is running away.

So they did the hard work. They went out and they got the licenses in every state, which is not a small deal. They've created the software that's gonna help automate it, and now they're moving to scale. And that's what Amazon, uh, saw. Um, here's a, an interesting quote on this. Amazon bought the one company in the space that all the PBMs and other pharmacy businesses were threatened by, said, human choice, a health tech investor at Bain Capital Ventures.

So, uh, you know, it's interesting, this article. It, it's, it's, it's a good article. It's a good read. 'cause it talks a lot about how this sort of came about. It talks about the history of the founders and, and the acquisition itself. I think one of the more interesting aspects, it talks about how. Um, the PBMs actually went after them a little bit and how they, uh, combated that.

They hired a, uh, bunch of, uh, pretty powerful people from former administrations to help orchestrate a, uh, a defense, uh, against the PBMs and what they were doing, and they were successful. I think that's pretty interesting. Another, um, You know, another reason that Amazon bought it, and I think this is fascinating as well, uh, for Amazon, which recorded over 230 billion in sales last year, PillPack doesn't move the needle at its current size.

The value for Amazon is in the promise of plugging the delivery network into a giant e-commerce machine, especially when considering the average user in 2018 was worth $5,000 in revenue. Through insurance payments and patient copays. According to the slide presentation, that's far more than the average Prime member who spends about 1300 plus.

It's a completely different demographic. Uh, it's an older demographic which they, uh, are looking to attract and go after. Um, So, you know, what are the three takeaways here? The, uh, you know, Amazon loves these businesses. They, they go after high barrier of entry and, um, businesses that can benefit from automation and economies of scale.

And this is perfectly in that space. Uh, the sec second is, you can look at this and say, Amazon as a strategy has . At, its at, at part of its strategy is to replace the visit to the local pharmacy, right? So there's almost nothing that you get at a C V S that you cannot get on Amazon, uh, with the addition of medication, right?

So you could even get, um, You know, home goods and those kind of things. You can get whatever you want off of Amazon, get it delivered, uh, in a, in a much more automated and better form factor. They're looking to grow this, by the way, I, I missed talking about this in the story. They're looking to grow this by partnering with, uh, payers and going directly to payers, going directly to consumers.

And going directly to their prime, uh, prime customers. And so that's a way that they're looking to grow this. And it, it is seeing a pretty rapid growth pace. Um, the last thing I would say, uh, the last thing on this is the software pharmacy. OSS was a, a key component of the purchase and it also lends itself to the strategy that Amazon typically looks to, which is, uh, leveraging software and automation to, uh, take complexity out.

To, uh, remove friction of the transaction and to, uh, and to build just a better overall, uh, supply chain and experience for the, uh, consumer. Because it's Amazon, everything is about the consumer. So what, so if you're health it, why, why even cover this story? Uh, because it represents new business models and, uh, the, the new business models that are the most dangerous are the ones that are, uh, at scale.

And this one just immediately went to scale at 200. It was at 200 million already. It's well on billion. With Amazon's capabilities, uh, you're looking at a business model that is gonna be disruptive. So keep an eye on this one. I think it's really worth, uh, worth taking a look at potentially partnering with, who knows, who knows what your health system strategy are.

But that, uh, could be, could be something to, uh, take a look at. So our last story comes from, uh, ARS Technica. It's, uh, why Google believes machine learning is its future. Right. So, uh, Google io just happened and they did really cool stuff, uh, with Google's voice assistant and things that, you know, it was pretty basic stuff in terms of writing an email, but it was much more like natural language things like, you would have to say the subject to this email is going to be, they would just say, um, you know, they would just say, you know, subject, you know, set the subject to Yellowstone Adventures and it would set it.

Then they'd just go on. And continue to dictate or say things and it would immediately drop down to the body. So there's a bunch of things it did, and it, it really showcased the fact that they were able to really hear and match patterns for how I was dictating the email and putting it in play. So not a lot of new, um, let's say announcements at Google io around this, just showcasing some of the sophisticated features.

That, uh, Google is able to do with the technology. So, you know, so what are we looking at here? I, some of the things I thought were interesting from this story is that, uh, they talk about the three-legged stool of, uh, deep learning and they are better algorithms, more training data, and uh, much more computational power.

Right. So when I read those things, better algorithms, more training data, more computing power, I immediately think of healthcare. 'cause we have a ton of algorithms, we have a ton of data, and computing power is available to us. So however you get there, there's an opportunity to utilize machine learning and ai.

So the other thing I picked up from this article is, um, oh, uh, they are starting to move machine learning down to the phone itself, giving it a 10 x advantage in terms of performance. Now, I'm not entirely sure how they're doing this. I, I, they don't really go into details, but if they're able to move it down to the phone, uh, down to the mobile device without connectivity to the internet, Then you are looking at a significant change in the way that, um, voice assistants operate and potentially how we interoperate, uh, how we interact with things like our E H R.

And there's, there's definitely some opportunities to use mobile technologies and mobile phones to really transform the, uh, the clinician experience with some of those systems. So something to keep an eye on. So what are the three things on this? Um, You know, they just showed off their prowess for machine learning and AI basic tasks today, but it showed very sophisticated interaction.

They talked about the three-legged stool of deep learning, better algorithms, more training data, more computing power, and they talked about moving ML and AI to the mobile device for a 10 x improvement. So what, um, I would say the, so what is, what is your machine learning and AI strategy? If I were a board member today, I would pull the c i o in and I would say, tell me what we are.

How are, how am I supposed to be thinking about machine learning and ai? And, uh, I, I actually did speak to a C I O today and asked him that very question about machine learning and ai. And he had a very clear and well thought out AI and machine learning strategy and approach. It's not that he everywhere.

Um, it's not necessarily that your board is looking for answers on that. What your board's looking for is a co coherent strategy to coming up to speed on it, to, uh, where you're going to be implementing it. Uh, you know, maybe on the clinical side, maybe on the administrative side, but they, they're not really looking for answers at this point.

They're looking for a direction and so, That is the so what on that Google? Every time you read machine learning and ai, there are very few people that don't think it's going to really transform the industry, and so it's time to get ahead of it. So those are the four stories in 20 minutes or less. Uh, keep in mind we have an exciting lineup on this week in health It Influence.

That's the show every Friday. Uh, Jonathan Manis was on Manis, c i O for Christus was on last week. Andrew Rosenberg. Uh, Michigan Medicine, c i o, uh, is gonna be on in the coming weeks. Chad ine St. Luke's University Health Network, c i o, uh, is gonna be on as well. Charlie Low heed, former c e o of Explorers is now starting a company for applying, uh, blockchain.

Uh, So he is a blockchain health tech entrepreneur and I'm looking forward to talking to him about the state of the industry there. Eric Yolana is the c i o for Stan Stanford Medical Center. And, uh, all those people are scheduled to be on on Friday, on the Friday show. So you're gonna wanna check back every Friday and then every Tuesday we're gonna continue to do.

This new show where we try to do four stories in under 20 minutes. This show is a production of this week in Health It. For more great content, you can check out our website at this week in health it.com or the YouTube channel at this week in health it.com/video. Thanks for listening. That's all for now.

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