Bringing HLTH 2019 to You: A Three-part Blog Series from EdjAnalytics (Part Three)
By Susan Olson, PhD (EdjAnalytics COO)
In a three-part blog series inspired by HLTH, Edj is sharing perspectives gained from the event. In part three of the series, we focus on advances in technology and new care models.
On display at HTLH was the massive impact technology is having on clinical modalities and delivery of care. This blog first covers examples of clinical advances in genomics, cancer treatments and advance predictions of health problems such as kidney disease. The second part of the blog talks about examples of how technology is impacting care delivery from the location (physical or digital) to the provider to the quality of care.
Genomic Sequencing and Other -Omics
On the mainstage at HLTH, Francis deSouza, CEO of Illumina, included the following topics in his message.
- Veritas has reduced to whole cost of sequencing a genome to $600.
- The NHS in U.K. is rolling out genomics as standard of care next year.
- The liquid biopsy is coming. Companies like GRAIL are showing success in detecting early stage cancer with a blood test.
- Efforts are ongoing to develop polygenic risk scores. deSouza mentioned gene-drug interactions as an easy win for genomics.
- Childhood diagnoses can be critically impacted with gene sequencing. There have been improvements in access – payers moved relatively quickly starting in 2014. Not as much progress has been made in utilization; deSouza mentioned that less than 1% of sick kids are getting these tests. A study with BCBS discovered genomic deserts where providers were not aware of these tests. Illumina has launched the iHope network to help.
Microsoft and Jackson Labs Partner to Accelerate Cures for Cancer
In the opening general session, Peter Lee from Microsoft described why it has a right to play in the healthcare space. With a 98% digitization rate of health records, Microsoft feels it has a role to play with all of that digital data. Lee spoke about interoperability, partnerships with organizations like Humana, and artificial intelligence. He said that by far the hottest topic in AI was natural language processing, a technology that Edj has used in its collaboration with a large hospital system. Specifically, Lee said, it’s about machines “reading” documents.
Lee shared the stage with Dr. Susan Mockus from Jackson Laboratory to talk about their work to accelerate cancer research with machine-assisted human curation in collaboration with Microsoft’s Project Hanover. Because of the monumental amount of literature published about biomedical research (some 200 papers about cancer alone per day), humans can’t keep up with all of the publications. The machine reading technology is being used to triage complex biomedical research literature and highlight relevant facts for researchers to review.
The technology is enabling faster updating of information for a Jackson Laboratory tool, called the Clinical Knowledgebase, or CKB, that is a searchable database where “subject matter experts store, sort and interpret complex genomic data to improve patient outcomes and share information about clinical trials and treatment options.” Once the trove of articles have been flagged using AI, human curators can then narrow their focus on the highlighted papers to validate or invalidate the accuracy of what AI has discovered.
The pair highlighted the importance of making the scope of their project manageable. With their measured efforts, they have now created a foundation to build on for the future.
Google Health and Clinical Support Algorithms
On the second day mainstage, David Feinberg from Google Health outlined the company’s direction. Feinberg pointed to Google’s algorithmic solutions such as DeepVariant for genome reconstruction for high throughput sequencing, prediction of future acute kidney injury, work to reduce false positives for breast cancer, and detection and grading algorithms for diabetic retinopathy. The speaker also alluded to research findings that other key health indicators, past and future, may be discovered from reviewing the human eye.
Looking forward to the
future, Feinberg said that Google wants to become the authoritative health
information resource for consumers, pointing out that it is already the number
one resource for consumers looking for health info.
Tech for Reducing Administrative Burden on Physicians
Pranay Kapadia, CEO of Notable, created a digital assistant for providers from the front desk to the back office for providers, focused on eliminating administrative burden. Kapadia said that he started company after his wife, a physician, said that she hated her job because of the administrative burden. He discussed that one in three dollars in the provider setting are spent on administration. The AI-powered platform integrates wearables and smartphones. Notable uses voice technology to document patient-physician discussions and translate information into patient electronic files.
Retail Health Centers
Transylvania graduate and Walmart VP Marcus Osborne presented a video showcasing the stunning new Walmart Health center in Dallas, Georgia, along with its fixed prices for care services. Osborne discussed a broad set of primary care services to serve a range of needs from acute to chronic and serving all ages from children to adults to seniors.
Osborne spoke of a cadre of offerings, including office visits, labs, imaging diagnostics, behavioral health, vision, hearing, dental and wellness classes. Walmart Health accepts insurance as well as cash. Osborne discussed a simple pricing approach, mentioning $40 for a primary care visit, $55 for an adult dental visit and therapy for $1/minute. The center also officers financing solutions. Online scheduling is available to create appointments for multiple services at once. In another tech application, Osborne said that dental crowns could be 3D printed on demand.
Osborne said that their research indicates consumers rank healthcare as their number one concern. He discussed that cost, convenience and care (as in “who cares?”) are the three drivers for these concerns. They found that half of consumers deferred or didn’t get care because of cost. He told of a story of a woman having to wait two years to get access to a primary care physician for her children. The Walmart Health center appears to be where the company landed to pilot solving these healthcare consumer challenges.
Comcast insures 200,000 people nationally and is using Crossover Health to transform its employee healthcare experience. The first problem they set out to solve was primary care, where the status was 29 days average time to see a PCP, 14% percent of ED visits happening due to doctor’s office being closed, and 50% of people dissatisfied with their last PCP visit. The solution to this problem in concentrated areas was using on-site/near-site facilities operated by Crossover. The next problem was to provide access for employees in less concentrated areas. Crossover emphasizes a digital-first approach and uses a predictive, proactive approach to connect with members using EHR, claims, and other sources of data.
Centers of Excellence and Focus on Quality Care
Walmart’s Lisa Woods and Grand Rounds’ Owen Tripp discussed their collaborative national pilot to focus on appropriateness of care and quality of care to drive efficiencies and cost reductions. Woods quoted that 30% of all care is not medically necessary. Walmart has over two million employees and over one million employees covered by their plans, which emphasizes the scale of the retail giant’s risk burden for its employer sponsored health plan. Woods pointed to an article published in Harvard Business Review about their first generation successes gained from creating centers of excellence (COE) with Mayo Clinics for treatment areas like transplants and spine care. The COEs realized better outcomes in readmissions, back-to-work time and surgical need.
In the pilot with Walmart, Grand Rounds provides a physician finder service for employees. This physician finder uses machine learning to find the highest quality physicians. Woods illustrated the high degree of variability in primary care physician quality across the nation. He discussed findings that low-quality PCPs are six times as likely to prescribe high-dose opioids.
Remember the blood pressure cuff station at your pharmacy retailer with its red LED numbers? Meet its tech-enabled revision on steroids. To create more accessible healthcare, higi has rolled out more than 10,000 smart health stations across the U.S. The stations live in Kroger, Publix, Walmart, Walgreens and many other consumer-oriented locations. Consumers can track their vitals, including blood pressure, pulse, weight, and BMI, and connect to a mobile device to track activity in a higi account.
For healthcare businesses, CEO Jeff Bennett described that higi provides an information sharing service for health plans and providers via consent mechanisms from the consumer. Data is the new oil, after all. The stations can also do fast consumer studies for business patrons. In one study, higi discovered that 50% of women that are pregnant don’t have an ObGyn. Bennett described that higi gets patients to take action through several channels, such as a recommended action coming through an email from a provider or a referral to a PCP if a consumer doesn’t have one. He mentioned that there’s a pharmacist nearby in 95% of the locations. For surveys, the surveyor must recommend a next step for the patient following the survey. In one case, a higi survey discovered that 30% of people missed a meal, and there had to be resource to send those people to.
 Corporate VP of Microsoft Healthcare
 Head of Google Health
 VP, Health & Wellness Transformation
 Senior Director, Strategy & Design U.S. Benefits, Walmart
 Co-founder and CEO, Grand Rounds Inc.