Bill Russell Parses Healthcare Predictions for 2020

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January 7, 2020: Are any of these predictions for healthcare really going to happen in 2020?  It’s Tuesday News Day and today we parse the vast ocean of predictions. With 2020 already here, we are using this episode to go through some of the predictions that have been made about healthcare for the year ahead. Bill has selected 10 different predictions from a range of articles and commentaries to discuss and he breaks them down, weighing in with his thoughts on each. At the end he drops in a few of his own and considers the next 12 months in the health field in general. The breakdown includes predictions around AI and machine learning, 5G, data stores and the American healthcare system. Bill also talks about energy efficiency, voice technology and mergers and acquisitions in the space. For all this, make sure to tune in and we look forward to another year of sharing great content with you!

Key Points From This Episode:

  • Looking back briefly over the important stories of 2019. 
  • Energy efficiency and healthcare centers that are more green. 
  • The rise of telehealth and a return to a home-based care models and house calls.  
  • Assessing the impact that 5G might have in the near future. 
  • The administrative capabilities of AI and machine learning for management. 
  • Utilizing the data stores in healthcare for analytics and intelligence. 
  • The unquestionable position of voice technology in the coming year.  
  • Free healthcare for all Americans — Is it a viable option? 
  • Self-funded employers’ increasing role in risk and care management.
  • The accelerated merging of social and medical care through value-based care.
  • Marketing in healthcare; changes that we will see in these areas in 2020.
  • The slowing down of mergers and acquisitions as healthcare wisens up.

Bill Russell Parses Healthcare Predictions for 2020.

Episode 172: Transcript – January 7, 2020

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

[0:00:04.5] BR: Welcome to This Week in Health IT news where we look into as many stories as we can in 23 minutes or less that is going to impact health IT. My name is Bill Russell, Healthcare CIO Coach and creator of This Week in Health IT, a set of podcasts, videos and collaboration events designed to develop the next generation of health leaders. 

It’s Tuesday news day and we’re going to ease into the new year by taking a look at the predictions for the upcoming year. Instead of, as you know, we normally take a look at the top 10 news stories and I give you my take on it and then circle back on a couple of them and go into a little more detail.

For this, we’re just going to take a look at 10 predictions that people are putting out there. I took a look at 10 stories and then I’m just going to – some of them are were the same predictions over and over again, we’re just going to look at 10 predictions from those very stories.

We want to thank our founding channel sponsors who make this content possible, Health Lyrics and VMWare, if you want to be a part of their mission to develop health leaders, go to thisweekhealth.com/sponsor for more information and you’re going to want to stay tuned on that front. We will be announcing three more channel sponsors here shortly. 

Thanks to, Drex DeFord who helps me with research with his new service, 3xDrex where you get three stories texted to you in three day – three stories, three days a week. To sign up you just text ‘drex’ to 484848. All right, again, for those of you who are watching this on the video, this is a bucket list item, we are renting a place for December, January February and this is in between us moving out of our old studio and into a new studio or you can take that as moving out of our old home and moving into a new home.

We decided to rent here at Sunset Beach and the views are breathtaking. Hopefully you’ll get some of that in the background.

 

[0:01:45.1] BR: All right, here we go. You know, here are the stories I’m pulling from. There was a Fierce Healthcare story editorial, advisory council, offers insights, it was a good story, Significant Advances in 5G AI and Edge Computing, CBS Interactive. What’s Next for Health, Five Predictions for 2020 that was Healthbox, good article.

 

Healthcare executives on topics to follow in 2020, Health Leaders Media. 2020 Will Bring Massive Change, Why Society Might Not be Ready, Barron’s. That’s a completely different story by the way. I read that, I’m not going to quote any of it in this episode, it is worth a read, it’s about, it’s really looking at the mega trends across society and just some things that really strecthed my thinking and I think it will for you as well.

 

Took a look at Peter Diamandis, In 2030 Amazon and Apple Will be our Doctors, Agree or Disagree, Fast Company article, Shift to Cloud, Renewable Energy, Top CIO Sustainability Agendas, Wall Street Journal. 20 in 2020 IT Leaders Dish Out Predictions, CIO.com and 10 Healthcare Trends to Watch in 2020 from Rod Hochman on LinkedIn. Definitely worth a read. 

 

Rod is a great thinker in our industry and a former guest of the show and then the last one was Doubling Down: HIT Leaders Discuss their 2020 Visions, Health Systems, CIO.com. Has some of my favorites in there, some former guest of the show and really like some things they were saying. You know, before we go to 2020, let’s take a look back.

 

[0:03:18.6] There is a really good article down here, probably in December if I thought about it. Healthcare IT News here it is. Healthcare IT News did an article, Healthcare IT Gains New Ground and they took a look at the main stories and just so you remember where we’ve come from, there’s a couple of stories here. 

 

In 2019, Social Determinants of Health Got Attention They Deserve. I think that’s really true 2019. We talked an awful lot about social determinants. VA Looks Back on 2019 Sees Year of Improvements and Continued Progress, VA is employing a new HR as well as doing it just —telehealth, a lot of really cool things. Look back at the past decade of UK health informatics. EHR’s in 2019 still the source of frustration but getting better bit by bit. Providers Innovated Patient Engagement and Experience in 2019. Healthcare security took the forefront. Forward looking providers made strides in AI in 2019.

 

We had this goofy thing about Apple buying Epic in the middle of the year and might as well put the story out there because we ended up talking about it a lot for some reason. People got all jazzed about it until people started to sit back and really think about it and it’s like, you know, apple’s never been an enterprise software company, per se. I know somebody will argue that but they are not buying Epic. 

 

[0:04:39.5] You had a bunch of stuff on AI or [inaudible] book that came out, you had Cris Ross, Mayo Clinic CIO, this artificial intelligence stuff is real, he announced at the Healthcare 2.0 conference. Don Rucker was interviewed state of the – state and next frontier of interoperability, talking about Fire version four and a bunch of other stuff around AI and other things that are out there.

 

North Well, all scripts North Well Health to co-develop new AI powered EHR.. Those are just some of the things that went on in the – in 2019 just to give you a feel. Actually, I think one of the things that’s interesting is what I’ve been telling people is, the most important article or most important story from last year and they didn’t even cover it. I think partially because I get looks because I think the most important health announcement of the year came from Cerner.

 

When I said this last time in a large group, people look at me like, “What? Cerner’s irrelevant.” Well, they’re not really, you know, they signed a significant partnership with Amazon AWS and for those wondering if big tech is going to get in to the EHR business, they did in 2019 with this announcement. The partnership, AWS is now really the engine that is going to fuel Cerner’s rapid progress and advancement and you know, there could be a potential purchase in the future but you know, if the partnership’s done right, it’s not really necessary.

 

It appears like they’ve driven a really good partnership between the two of them and so now you have the AWS rocket engine strapped to Cerner. I think it will be an interesting year from that perspective. Anyway, going beyond 2019, let’s take a look at what some of the things that people are saying for 2020.

 

[0:06:30.7] Some of these I agree with, some of them I disagree with. I’ll let you know which are which and I’ll throw in a couple at the end that I’m keeping an eye on. This is from Dick Daniels, CIO Kaiser Permanente said that his hospital in health insurance company is investing in making their data centers more energy efficient that some of the initiatives include wind power, natural gas without combustion byproducts too generate power for some of its datacenters. 

 

I think in 2019, I think the CIO’s are going to be asked to go green. Believe in global warming, don’t believe in global warming, it almost doesn’t matter at this point. A significant number of people in your community believe in it, they also expect health systems to be global citizens and healthcare and actually, what’s interesting to me is, there’s an awful lot of people who believe that global warming is a health issue.

 

It’s a lot of issues really when you think about it. It’s an energy issue, it’s an environment issue. Clearly, it can be a health issue and so, because of those expectations on the health system to be a good global citizen, I think the CEO’s are going to ask those kinds of questions in forums and I think eventually, the CIO is going to be asked – I think Dick Daniels is right, I think this is one of the things that we’re going to need to keep an eye on. 

 

The second one, you know, return to home base care models in earnest. Craig Samitt, President and CEO of Blue Cross and Blue Shield of Minnesota. He said, given the growing unaffordability of volume based and facility centered care delivery models, we’ll see a return to house calls and explosive growth and home based care models.

 

[0:08:08.4] 2020 will likely see health plans, technology companies and retail entering home-based care in earnest all with the desire to reinvent care delivery. Now, some of these have sort of a bent of, of course, somebody from other payer is going to say this but I think this is really a real trend that is going to happen. Really, it’s about time, you know, care is finally going out of the hospital itself and I think we would agree it’s about time, it’s very expensive and there’s a certain amount of risk to it.

 

Clinics of all shapes and sizes are popping up across the landscape, you know, some are run by health systems, some are you know, actually – they’re being run by a lot of different things. They’re being run by employers, they’re being run by venture backed groups. Some retailers, Walmart obviously is getting into it, Amazon Care, Amazon’s running, that’s an employer program.

 

You know, it’s a lower cost venue and it’s really becoming the preferred choice off many. But I agree with him that his is just a stepping stone to some more bold moves in tele health and home based care models. So yeah, I think this one’s going to accelerate a little bit, you always have to look at the financial models and where it makes sense because that really will determine the speed at which something moves.

 

This is gaining some traction and it’s a way for new entrance to compete and so keep an eye on that. A lot of predictions around tele health but quite frankly, we can go back to 2014 and just replay the same predictions, ’14, ’15, ’16, ’17, ’18, ’19 and now in 2020, we’re saying hey, tele health is going to set a new standard for care out there. I’m not knocking anybody who is making this prediction. 

 

[0:10:01.8] I would love this prediction to be true, I think it will make some serious progress in certain areas within healthcare. I think you know, visits that don’t make sense, we saw this in New York with orthopedic after surgery, people are doing tele health visits, you don’t want to drive in New York, it’s hard to drive into New York, it’s expensive to drive in New York. If you’re in Jersey and you have your surgery done in a  New York hospital, the follow up visit’s being done via tele health.

 

I think you know, there’s a whole bunch of use cases where it is expanding. As we heard from Dr. Klasko, doing this requires health systems to cannibalize their revenue, unless they are a payer, an insurance carrier and a provider, it requires them to cannibalize for revenue and it’s really hard to make that case to anyone, especially your board.

 

I think for that reason, it’s going to become a weapon of choice for people who are looking to be new entrants and competitors in those space and then eventually, it’s going to have to be a defensive strategy. In highly populated areas and in reaching out to rural areas, I still think it’s a very good strategy. If you take markets that are densely populated. 

 

Chicago, New York, LA, San Francisco and others. You can use tele health as an offensive strategy to take patients away by utilizing convenience. Will tele health take hold this year? I think health systems are going to move slowly because they have to cannibalize their revenue.

 

[0:11:35.6] I do think it will continue to make that progress, I think the VA announcement was huge last year and I hope to see more of those kind of things breaking down the barriers between states. Recently saw the – I think it was the AMA support the cross state, licensure, I forget what it’s called some pact or something. Again, I expect to see a lot of movement there.

 

A bunch of 5G announcements or 5G predictions, 5G will enable all sorts of new solutions. Color me a skeptic here a little bit and don’t get me wrong, keep an eye on 5G. When 5G is implemented correctly in earnest across the country, it will completely change the landscape of just about every industry. With that being said, we’re not there yet.

 

What you’re seeing right now is you know, you have T-Mobile saying hey, we’re doing 5G across the country, they’re doing 4G+ across the country, it’s just a slight improvement. Until we get the next level which is really building out the – requires a lot of infrastructure buildout and there’s some other things to overcome like the signal going through walls is not as good, you’re going to have to have carriers, this T-Mobile and Sprint merger is really important because Sprint has all this bandwidth.

 

They have the different layers of bandwidth so that they can do long haul and into buildings and all sorts of other things. That’s why that merger is so important for T-Mobile and for Sprint. T-Mobile has the cash to take Sprint’s bandwidth and really put it to use. But anyway, regardless, here’s the thing around healthcare around this. There’s a lot of solutions that we could be doing on 4G that we’re not doing today.

 

[0:13:33.0] I’m not sure why all of a sudden we think 5G is going to be available and we’re going to start doing a whole bunch of stuff that we could really be doing today across 4G. Yes, it is going to be transformative. No, it’s not going to be in 2020. Keep your eye on it, stay close to it, especially if you’re in a major market. They have implemented in some markets and so it might be something you are looking at this year if you’re in one of those markets. But very few markets have done it at the higher speeds.

 

The 5th thing, AI and machine learning. A lot of predictions around AI and machine learning. I’m sticking to my premise here which is, huge advancements in administrative and IT uses, using it around security, machines managing machines if you will. As your network becomes complex and you have to manage exfiltration and those kind of things.

 

Machine learning and AI used in those cases, RPA being used in the repetitive tasks, call centers, AR, you name it. I think you’re going to see it expand there. I think it’s going to be slow in the clinical side, although some people disagree with me, they say big push in clinical this year, I think we’re seeing it replace some of our analytics models from the past.

 

We’re not replacing some of our [inaudible] models replacing some other things but really, the promise of AI is real time culling of the information and providing support to the people who are delivering care in real time. I think that’s still a little ways away for a couple of reasons. 

 

[0:15:15.5] One is, we lack the credibility we need with physicians and we’re still earning that back with some poor EHR implementations over the years and some other systems. We can’t just walk in and say, “Hey, this is the future,” that argument just doesn’t cut it anymore. We have to truly implement this in a collaborative way and you know that takes time and it takes some savvy and sophistication in the form of the CIO leader. The second thing is some clinicians are calling for clinical trials around AI and there is some concerns around the black box of AI, both of which are probably valid in clinical. 

 

In a clinical setting, if we are doing a new drug, we would ask for clinical trials. AI machine learning has that same impact and we are going to be making decisions off of these things. We probably should put them through a low – with a little bit more significant rigorous testing before they get deployed. So I think it is going to slow down the clinical side. Not that we are not going to see progress or not that we are going to not – we should be investing that time right now. 

 

So that we see significant progress in ’21 and ’22. So again, AI machine learning is the future. I agree with Cris Ross. I agree with everyone who makes these predictions. I am just trying to fine tune the timing of it, if you will. Data, gosh the predictions around data are all over the place but the reality is we’re still using only about 10% of the stored data in health care for analytics or intelligence of any kind and that’s really unacceptable. 

 

And so from that perspective, everyone is predicting that we are going to start using the other 90% or really make in roads and there is a lot of different ways that that’s being said. You know we are going to see we have a lot of the stored in data lakes, we have a lot of it tied up in different silos and those kind of things and so there’s people predicting new tools that are going to come out. There is people predicting new methods that are going to come out. 

 

[0:17:19.0] And you know I am really a strong proponent that I believe two things that went out here. One is I think some people are just going to throw it over the fence and say, “Hey Google, Hey Health Catalyst, Hey…” fill in the blank, Amazon potentially, Microsoft, “Hey I am going to throw this over the wall, can you help me to implement these new tools? And I will bring the algorithms and the analytics and the health care knowledge to bear.” 

 

I just think we are going to see that thrown over the wall, kind of thing is going to be primary. The second thing I think you are going to see is service providers that are really good at this like you know health, if they have the tools and they have the people are really going to do well in this space. So I think you are going to see a lot of partnerships and a lot of vendors really focusing in on this data side. 

 

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[0:18:14.2] We’ll get back to our show in just a minute. As you know Health Catalyst is a new sponsor for our show and a company I am really excited to talk about. In the digital age, cloud computing is an essential part of an effective healthcare and precision medicine strategy and we’ve talked about it many times on the podcast but healthcare organizations themselves are still facing huge challenges in migrating to the cloud. 

 

Currently, only 8% of EHR data needed for precision medicine and population to health is being effectively captured and used. That is 8%. One of the things I like about Health Catalyst is that they are committed to making health care more effective through freely sharing what they have learned over the years. They published a free eBook on how to accelerate the use of data in the delivery of healthcare and precision medicine. 

 

You can get that eBook by visiting thisweekhealth.com/healthcatalyst and you know, this is a great opportunity to learn how a data platform brings health care organizations the benefits of a more flexible computing infrastructure in the cloud. I want to give a special thanks to Health Catalyst for investing in our show and more specifically, for investing and developing the next generation of health leaders. 

 

Now back to our show. 

 

[DISCUSSION CONTINUED]

 

[0:19:26.3] BR: All right, coming in at number seven, Rod Hochman again, a great thinker I have two of the things that he said in his article in his ten trends. The first being the race to bring voice activated technology to healthcare will heat up and be an essential feature in the hospital and clinic of the future. We have talked a lot about this on the show. We’ve had several guest, we have highlighted Orbita and others on the show as well. 

 

I absolutely agree with this, 100%. I think it is a given, I think 2020 is the year where you are going to see this just everywhere. You saw the partnership with Nuance and Microsoft. You see Orbita is making waves, you see Amazon doing partnerships. It is just you are going to see this be a major theme in 2020, no doubt. Number eight, new alternatives to Medicare for all will emerge in the Presidential Debate. One viable option should be taken seriously, free primary care for every American. 

 

Rod Hochman, well, I hate to disagree with Rod on this one but I understand where he is coming from. As a health system CEO, I would hope for free primary care for everyone because someone is going to pay for that and probably that is the Federal Government and the Federal Government pays for it that means that all of a sudden his health system and all of the other health systems just got a significant windfall of money since they have a majority of the primary care physicians in the country. 

 

I don’t think that is going to be a viable option and I don’t think that is going to get really any legs in the 2020 election cycle but I do think he is right in the fact that the Presidential Debate is going to kick up all sorts of new thoughts and ideas around this and one of them is we start to see ramblings of this. Medicare Advantage for some or Medicare Advantage for all I guess is a way of saying it. Medicare for some, Medicare Advantage for all. 

 

[0:21:23.4] I think we will start to become a talking point at some point as sort of a center for you on this and Medicare Advantage has been pretty good for health systems, pretty good for the people who have it. So I could see people starting to have this conversation. This isn’t a political show so I am not going to get into it in any way, shape or form but I think that is going to be the conversation for 2020 that we are going to hear the most of. 

 

And we will hear obviously you know both the other side, which is making a true market as you are doing capitalism and we’ll hear the other side, which is completely centralized health care and turned into Medicare for all. So yeah, I think we are going to have that conversation. You know one thought on the election cycle, I just want to throw it out there and I just want to keep saying this because you know Peter Diamandis says in his quote in his article. 

 

Where he says, “Heathcare is the biggest business in the world and it is phenomenally broken.” And you are going to hear a lot of this kind of stuff in spades in an election year. You may be convinced that our health system is so bad that you should go outside of the country and I know that any of the last two or three elections that may have been how you felt. I should go to Canada to be cared for. But the reality is, we continue to export our care around the world. 

 

You know people seek out our healthcare, our healthcare tourism business is thriving. We have the best healthcare in the world. We aren’t necessarily the healthiest country in the world and you can blame that on a lot of other things but we have some of the best healthcare in the world, period. So it is going to be a tough year. It is an election year, you know people win points on creating some fear, uncertainty and doubt around that. 

 

[0:23:15.8] Our healthcare might cost a lot. We have some things to fix for sure, absolutely but we still have great healthcare in the United States. Number nine, self-funded employers will play a larger more creative role in risk and care management. This is absolutely true and this is going to continue to make progress in 2020 and I like to say that we are going to see significant movement in 2020 but I think that again it is probably 18 to 24 months off. 

 

Amazon Care was a big announcement this year, I think that is interesting. I think Apple has their own program that they – you still have Amazon Care separate from the JPM Berkshire. Amazon Haven announcement and we really haven’t seen where that is going to take us. So I agree the cost of care for their employees is still a major concern for many employers and they are taking matters into their own hands. So that will continue to be a trend and a strong one in 2020. 

 

And then finally, value based care will accelerate the merging of social care and medical care systems. I hope so, I doubt it but I hope so and the reason I doubt it is because I don’t fit the financial models line up and then we are relying on the mission of health systems in the hope that they will act in the best interest of their communities and to be honest with you, not all of the incentives are aligned that way. Again, we had that conversation with Dr. Klasko. 

 

Where he said his incentive as a CEO did not align to that objective to taking care of the people in Philadelphia, it didn’t really align to that. It was really about the business and so he pushed them to make to align his incentives with improving the care of the people of Philadelphia and if more health systems and CEO’s do that I think that will make progress. I am not sure that that has happened yet so that is why I am a little skeptical on it. 

 

[0:25:25.6] All right, those were the 10. Let me give you a couple of more things that I am keeping my eye on. I think a major movement is going to be in marketing. Marketing healthcare is going to change in 2020. I think health systems will start requiring real measures and real results from marketing groups. I think they’re going to change how they function and how they operate. You know one of the things that we are hearing over and over again is the most important tool for healthcare is Google search. 

 

And I know that some of you just turned off your podcast but it is literally the frontlines of care. A billion health related searches are done a day on Google search. It is the front lines. It is where the people are going to find out where should I go, what do I have and if I were working for a health system marketing team and they were to tell me that they spend more money on sponsoring the baseball stadium then Google ads, I would tell them that they’ve missed the boat. 

 

They should be figuring out a way to insert themselves. They have been dis-intermediated already people are going to Google instead of to their primary care physician because it is just easier, right? It is on your phone, it is right in front of you, it is right in front of me. I could ask all sorts of questions right now. So that’s it, how do you insert yourself in that process? How do you get back in that process? You can pay to get back in with Google ads or you can try to work some way around that system. 

 

The other way Google search, the voice assistants have an all new search algorithm that you can insert yourself into and there is a whole new field to play out of there for positioning with in search on voice assistance and that should be being looked at. Marketing people much like IT people have got to be more sophisticated and I think that is going to start happening in 2020. I think it started to happen in ’19, 2020 I think is going to be the year that it’s going to make a move. 

 

[0:27:19.1] And then the last thing I would say is I think the mergers and acquisitions are going to slow down significantly. Now we will see going to the JP Morgan conference next week, we will see what people are talking about but you know healthcare continues to play monopoly but the regulators I think are starting to be onto this whole thing. They are looking at the research. The research does not supported that outcomes improve at all. 

 

And it does not support that cost go down at all or that access to care improves at all and so we have a problem and that’s what we are using to sell these mergers and that is not what’s really coming out as a result of it. Now, Rod Hochman in one of his points makes that this is the year that you are going to see that progress and I hope that’s the case. I hope it just takes a little longer than we think but to date, we have not seen that progress as quickly as we should see that progress. 

 

And so state regulators are now starting to look sideways and I think they are going to – now, what they are doing is asking for bigger concessions on these mergers but I think what you might see is they might start turning them down. We will have to see where it goes. Anyway, those are what people are looking at for 2020, the year of perfect vision. So hopefully, we have this right. Hopefully we focus on the right things. It is not as – 

 

To be honest with you, when these things came out every year as a CIO, I sort of glanced at them to see if what we are doing was right. What we did is we looked at those trends. We looked at the mega trends, we looked at society trends like around the aging population, the trends around our community, what type of people are moving in, what was the demographics, how were they consuming healthcare, where were they looking for their healthcare information. 

 

[0:29:13.5] And then we built out models over a five year timeframe to build out those continuum of cares and the continuum of care transitions of care and those kind of things and digital tools that we’re going to be required to serve that population. That is how we looked at it and then what I would do with these trends, to be honest with you is to say, “You know, are we still trending where we thought we were? Do we need to adjust those assumptions?”

 

So maybe you are doing the same thing, maybe you’re not, maybe you’re putting in an awful lot of stock in these things. It sells newspapers, which is why I think everybody came out with their trends for 2019-2020 and I am now part of that cabal, if you will, to sell newspapers by talking about predictions, I guess. So I am a hypocrite, I talked about them. 

 

Next week, we will get back to the news. We will look at 10 stories and I am looking forward to that. And then the following week, we will do our annual JP Morgan Conference rundown because next week on Tuesday I will actually be at the JP Morgan Conference. I am going to record probably on Sunday the new show for next week, so I am looking forward to that. 

 

Hey, that’s all for this week. This show is a production of This Week In Heath IT. For more great content, you can check our website at thisweekhealth.com or the YouTube channel. Special thanks to our sponsors, VMware and Health Lyrics for choosing to invest in developing the next generation of health leaders. Thanks for listening. That’s all for now. 

 

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