Reactive vs. Proactive Health Care: The Intersection of Payment Reform & Consumer Data Powering Clinical Insight

One of the greatest opportunities that exists in moving from “turnstile medicine” (or fee-for-service) to value-based payment models is the shift from reactive to proactive health care. The focus on accountability for population health forces providers to adopt a completely different mindset: Instead of waiting for sick patients to come knocking on your door, you need to figure out what they need, when they need it, and how to get it for them.

At the upcoming conference, Health 2.0 WinterTech: The New Consumer Health Landscape (January 15, San Francisco), I will moderate a panel on “Consumer Data Powering Clinical Insight.” The panel  features several different perspectives on how consumer-facing technologies can translate discrete consumer-generated data into useful information that providers and others can use to deliver more personalized and proactive support and care management.

The dramatic proliferation of electronic health records (EHRs) in the last five years means that much more clinical patient data exists in electronic form than ever before. True meaningful use of that data involves organizing it into meaningful and useful information by building algorithms, leveraging machine learning principles and delivering the right information to the right person at the right time. In addition, de-identified data in the cloud provides a scale for that kind of data analytics. Practice Fusion, a cloud-based EHR company uses patient-derived data—everything from booking an appointment to patient intake questionnaires—to drive proactive health management. CEO Ryan Howard will discuss how, in early 2015, they’ll begin incorporating qualitative and quantitative data from the patient and machine learning based on how physicians react to it to better target diagnosis, treatment and other support.

Taking machine learning even further, MIT engineers decided to apply that approach to better support people with mental health issues. Although validated survey instruments like the PHQ-9 can play an important role in diagnosing and managing depression, they’re not designed to be continuous assessment tools. In contrast, Ginger.io leverages passively collected data from people’s daily lives via smart phones to identify patients at risk and building proactive care management processes based on these naturally occurring data. Co-Founder Karan Singh will talk about the invaluable information that can be derived from seemingly mundane human behavior such as GPS data on a person’s mobility throughout the day or patterns of missed phone calls. Ginger.io is currently testing in multiple academic medical centers how these data can flow into algorithms to generate alerts in a web-based dashboard that care managers use.

The prevalence of incorporating data from activities of daily living into providers’ clinical information systems remains low, despite the fact that people spend a miniscule fraction of their annual 525,600 minutes within the confines of clinical settings. Meanwhile, although the tech industry seems to be buzzing about wearables that focus on wellness and fitness, many of these devices remain completely outside consumers’ interactions with their providers. Qualcomm Life has developed platform solutions around remote care monitoring with the goal of integrating daily-life data seamlessly into the care delivery process to drive consumer engagement. SVP & General Manager Rick Valencia is eager to share Qualcomm’s plans to integrate these data to tailor chronic care management and improve care transitions.

When we think about tailoring care management, it is sometimes hard to fathom the possibilities that genomic innovation has for personalizing treatment approaches. The growing efficiency of human genome sequencing – and its associated diminishing cost – raises the potential for more practical applications in the normal course of care delivery. The Illumina Accelerator hopes to drive personalized health care down to the genomic level by providing mentorship, financial support and access to scientific resources to start-up companies. Amanda Cashin, who heads the Accelerator program, will discuss how start-ups will leverage sequencing technology in diagnostics and therapeutics applications to support better care management in oncology, reproductive health and other clinical areas.

Meanwhile, FDA must figure out when these new tools cross a line that separates a care management support application from a new medical device. FDA’s Bakul Patel is right in the middle of these discussions and has to think through how broad or narrow to define “devices.” Patel will talk about what FDA has clarified thus far and how companies should think about these issues going forward.

This panel is sure to bring innovative, yet differing, views on the progression of consumer-based data sources. As moderator, I will particularly press them on how their solutions help consumers, clinicians and other stakeholders succeed under the demands of new payment models and the expectations of proactive care delivery models.

Joshua Seidman, PhD, is Vice President at Avalere Health, where he runs the Avalere Center for Payment & Delivery Innovation™. He also is the Immediate Past President of the Society for Participatory Medicine.

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