HLTH2019 – Tech Enabled Care Shines Under Neon Arches in Las Vegas

Las Vegas was not lost on the dialogue.  Every session at the 2019 HLTH conference had risk on the table.  Whether it was policy, product or the interplay of technology with a new breed of patient activism you got a strong sense that the people were sitting down with a stack of chips.  People that have fought through the early stages of this battle to bring definition to the clamor for lasting health solutions even turned to the Trump Administration and the new darlings of “policy meets progress” in other parts of Washington.  There were plenty of leaders rushing the hill with the flags of their own vision and ventures but amidst all the sponsorships and cardboard avatars you had a sense of underlying purpose that energized the show.

The Parnassus Group group is laser focused on equipping purposeful leaders in healthcare so it was great to see friends on the stage and meet with so many others in the hallways of this well produced conference. We were particularly interested in the story lines that are developing for 2020.  Our Analysts covered the full range of tech and provider/payor topics at the meeting with a goal of equipping our strategic intuition and bringing some of the content back to our community of leaders. Our vantage point is often unique so we will hit 5 high  notes of what we saw this year that we think will dial into the calculus of clinical, social and financial action:

  1. Behavioral and mental health are critical focus areas for technology and innovation investment in 2020
    • Oren Frank (CEO of Talkspace) Over 60% of the people within their care network have never had any kind of therapy previously due to the stigma. Invisible communities of connected treatment will break down barriers quickly and they are partnering with college student organizations and other segments to move the needle culturally.
    • David Sides (Teledoc) 82% of people will not talk about mental health issues at work (affects 1 in 4 people) which demonstrates the misconceptions around stigma and the isolation that naturally occurs.
    • Ben Miller  (Chief Strategy Officer for WellBeing Trust) 151,000 lives were lost in the US in 2017 to alcohol, suicide etc. These statistics further demonstrate what is at stake when the resources are available to fix the problem.  Ultimately it requires mental health to become a seamless part of policy which is the focus of WellBeing Trust.
  2. Social determinants of health are quickly moving from electives to core curriculum for value based care
    • Karen Murphy (Geisinger Chief Innovation Officer) Pointed out the success of their fresh food pharmacy where they are prescribing food as medicine and seeing significant impact.  They are moving to partner with community agencies to step into housing as well
    • Dan Trigub (Head of Uber Health) Points to sizable program with Bay Care in Tampa, FL. Now at discharge, staff can select an Uber option and it blends with the patient charges. They went from approximately 3,000 Uber rides in 2017 to and estimate of 22,000 in 2019.  Florida Blue Cross/Blue Shield awarded them $100,000 per year to advance the program which has significant behavioral health application as well. Uber Health just launched a major partnership with Cerner to expand their program with a different level of synergy.
    • Dr. Alisaha Cole (Chief Innovation Officer – Atrium Health) Atrium has prioritized food insecurity and housing as core to their success as a provider. They implemented Kids Eat Free in NC and so they worked as a hospital with food services providers to move it into action through two of their hospitals.  They are now kicking off a $2MM housing program as well.
  3. Public policy is moving choice and transparency toward consumers
    • Seema Verma (Administrator of CMS for the Trump Administration) Her reputation was initially built on her work to reform Indiana’s Medicaid program. Looking at the current situation nationally she points to lack of humility from government programs in healthcare as a leading problem preventing effectiveness. She expressed that “Medicare for all” puts an unwarranted confidence in government as a substitute for the power of the free market and innovation.  Today Ms. Verma controls a  $1.3 Trillion budget (more than 1/3 of the federal budget). Medicaid is now the first or second largest budget item for most states.  The financial burdens are un-sustainable. She sees government as a neutral entity, not the provider/payer if the system is to function in the future. Patients have also got to be empowered as consumers to see higher value and have price and quality information available to them.  She also highlighted th critical nature of having data that can travel with them, indicating that the Trump administration sees the critical need for completing the interoperability puzzle begun by previous administrations. She stated that reform is not possible without changing the status quo and criticized what she called “bad actors” who are sending patients bills that take them to court when they can’t pay. “They are pursuing a false agenda of reform that is actually pushing patients further into the corner.”
  4. Community care innovation will leverage technology and consumer science to rapidly evolve
    • Marcus Osborne (Walmart’s Vice president of Health Transformation) pointed to the advantages in access and experience that they can uniquely offer with their new health clinic offering (launched this fall in rural Georgia). You pay a flat fee whether you have insurance or not that is $40 for a primary care visit, $50 for dental checkups and $45 for ophthalmology services.   They are even debuting therapy services with a flat $1/minute fee structure.   They have the full spectrum of services and provide the clinical support that can animate care in with a high quality expectation.  Using their consumer expertise they are working to create a start to finish service platform that can deliver diagnosis and therapy and provide pathways for continued care management.
    • Rich Roth (SVP Common Spirit Health) Points to integrated community health as the core business challenge for the entire health ecosystem. If you are going to take risks you must have an integrated community health strategy to be effective and it has to include shared data just like we saw in the EMR world (aka CommonWell)
  5. Chronic conditions require a layered approach to reach needed outcomes with onsite and remote capability
    • Hank Schlissberg (President Vively Health) Spoke about their work providing primary care in the home as a full risk medical group with no physician offices.  They do not replace the PCP but act as an overlay that can prevent unseen/unknown factors that complicate care. Much of their current focus is fine tuning their approach to get to the right group of patients which may not be on the lists provided by the payors.  They see this as critical to demonstrating deeper value.
    • Julia Hu (CEO Lark Health) They provide care to approximately 1.6M people utilizing an AI diabetes nurse.  Health plans designate populations and patients can download the service and right away have access to the digital nurse.  They are providing day to day management that closes care gaps and are an overlay to primary care that can be distributed by health plans or employers.J
    • Jim Mault (CEO Biointellisense) Considering other modalities of remote care delivered through the home, he talked about the challenges of asynchronous virtual care.  Delivering care in the home is tough because if it is synchronous (same time care) you are still expending the time of the clinical provider but in a remote location.  MD’s are less likely to send people home because the wealth of data that they can keep on patients when they are in the acute care walls.  Currently there is not the same confidence interval around data they can reliably get from home monitoring.

The format of debate between leaders from Iora Health and Aledade was arguably one of the most productive formats used at HLTH2019 and we hope to see more of this kind of rigorous discussion (Nancy Brown was an outstanding moderator) in future HLTH events.  Organizers built a packed schedule of interesting topics and curated the event with apps/people that made for a user friendly environment from start to finish.  We will look forward to providing coverage of the 2020 event next fall.