The future of Health is Mobile+ Kaiser Permanente now has a mobile optimized web site for 9M members.

This afternoon I am joining Kaiser Permanente to learn about their Mobile App for members. Kaiser Permanente is a major forward thinking health care provider. It is great to see them embracing Mobile.  I have being saying for a long time that the patient/member is often not at a computer when they are receiving service in the health care system. The device they do have to hand is typically their cell phone.  

What is needed is a Mobile+ solution. A desktop based solution doesn't work in isolation, neither does a Mobile only solution. You can see this when you look at the emerging consumer wellness sensor market. The Bodymedia device has a website and a mobile application. But the two platforms aren't connected.  The new Jawbone UP is a neat wristband but it only has an iOS app. That may be fine for on the go data entry but deeper analysis just cries out to work on a desktop browser. Fitbit remains my favorite tool for wellness. The immediacy of the on device readout is great. I don't need an app to get immediate feedback on my level of activity, the stairs I have climbed or the steps I have taken. However, the mobile app allows me to enter data and get a quick snapshot, as of the last sync event. If I go to the web browser on my laptop I can get an immediate update of anything entered in to the mobile app. It is this Mobile+ approach that health system developers need to embrace. 

Mobile is not the panacea. It is a part of a complex puzzle. Patients/Members/Consumers will choose the access method that works for them, and that may change based upon their situation.

Anyway.... time for me to get off that little soap box. Let's take a look at what Kaiser Permanente has been up to...

So KP is launching a mobile app to support 9M members. This is a massive roll-out of a mobile health platform.

The major components of the App:

- Medical Record

- Pharmacy Center

- Appointment Center

- Message Center

- Location Finder

KP.org is now mobile-aware. If you sign on with your smartphone or tablet it will present a mobile friendly format.

The authentication for the app leverages the same mechanisms used for the standard web app.

The Medical Record on mobile gives access to:

- Allergies

- Reminders

- Health Summary

- Immunizations

- Ongoing health conditions

- Past visit history

- Test Results

Some of the most popular features are therefore available from a smartphone such as:

- Message Center

- Appointments

- Test Results

KP promises a two day turn around for messages but the typical practice is to provide a same day response.

15% of traffic is currently coming from mobile devices. This helped drive KP to produce a mobile friendly site.

The Mobile App is available on Android and iOS.

Bill Marsh: The transition to mobile is positively transforming the trusted relationship between patient and physician. Mobile amplifies the relationship in real time.

in Colorado 40% of support is currently delivered virtually. Mobile will expand this further.

HealthConnect is being tested on tablets and mobile devices. They are heading in that direction but it is not widely deployed yet.

@healthyThinker asked about use of lab results. Everything that is accessible online is also available on mobile.

The vast majority of routine tests are auto-released. Only those that are sensitive or regulated by state regulations not autoreleased.

Per @epatientdave "This is what everything should be in health care"

The mobile platform allows more accessible access to care. People are shifting away from using their desktop/laptops and switching to mobile.

Expect to see geo-location and other mobile specific services to be incorporated as the mobile platform is developed. 

The truth is that the KP web site has always been accessible from a smartphone with a good browser (think iOS, Android or Palm). The latest development is to optimize the experience on mobile devices. This is obviously the first step to enhancing for mobile.

The plethora of standards for video are barriers to implementation. Then add in security to the mix. KP is already testing solutions. Facetime (form Apple) has already been identified as HIPAA compliant. Since Apple built Facetime using industry standard protocols we really need to see other developers producing cross platform versions of Facetime "clones". It would be great to have a Facetime on Windows and Linux devices.

KP is producing a family of mobile apps. The mobile optimized web site will launch the KP Locator app to help members find a local KP facility. Expect to see more apps join this family.

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Curing US HealthCare… Coding reform and payment reform go hand in hand

This week I took part in the Care Innovations Summit in Washington DC. On Wednesday I was at the Kaiser Permanente Center For Total Health for a pre-Summit networking day. It was great to work with Danielle Cass and Ted Eytan from Kaiser to facilitate a day long event that I heard people describe as "The Best Networking Day. Ever"

The day was a mix of networking exercises, fireside chats with people that are shaping the future of health care and panel discussions that really made people think. If you get chance to spend time with Jack Cochran, MD, Executive Director, The Permanente Federation, Kaiser Permanente grab the opportunity. He has a life history that would make a great movie and his views on the future of health care and how to improve health are worth listening to and he takes his energy and relentlessly applies it to achieving that aim of better care. 

Joe Smith, MD, PhD, Chief Medical and Science Officer, The West Wireless Health Institute is equally vocal about improving our health care system. While Joe didn't get on stage at the Summit itself, he was one various panel discussions at the pre-summit. You really need to listen to his ideas. West Wireless Health Institute is doing great things to promote new approaches to health care. Joe is one of the people shaping the future. 

The themes that kept surfacing at the pre-networking event where two fold: Coding Reform and Payment reform. The two need to go hand in hand. As the industry is about to go through a transition that multiplies the number of CPT codes in use complexity is going to try to drive another nail in the coffin of transparency. We can't let this complexity win.  If we are not careful we will become so focused on diagnosing exactly what is wrong with a patient that we will forget that it would have been better to have avoided the patient having to come in for a diagnosis in the first place. 

If CPT Coding stays focused on minutely identifying an action or condition it risks missing the big picture and enabling preventative actions by physicians. Yet prevention is the big win in healthcare. It is something that has been lost in the Pay for Volume model that is the lot of the vast majority of US Health Care - with certain notable exceptions - like Kaiser Permanente.

When I look back at this week I wish Daniel Palistrant (of Sermo and Par8o) had been at the pre-networking event. His would have been an interesting voice to add to the discussion. He has a provocative article on his blog this week that complimented the CPT and Payment reform discussion. Check out his latest blog post:

"I Know Cancer When I See It"

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Here is the full Tweet Reach report for #CISummit - Provided by HealthCamp as a service to Health Innovators everywhere

I was asked by someone at CMS if I could get a copy of the Tweets from the Care Innovations Summit (#CISummit). So here as a service to the Innovation Community is a copy of the report from TweetReach - both the old style report and the jazzy new version.

Old Style Report:

TweetReach_cisummit_or_hcidc_org-OldStyle.pdf Download this file

New Style Report:

TweetReach_cisummit_or_hcidc_org-NewStyle.pdf Download this file

If you want to show some love for this service you can always head over to HealthCa.mp and make a small token donation.

It was a great event and I am looking forward to a repeat next year. We should all thank West Wireless Health Institute and the Centers for Medicare & Medicaid Services for putting together a great event. Thanks should also go to Kaiser Permanente for working with West Wireless to host the pre-event networking day at the Kaiser Permanente Center For Total Health. The feedback we have had from that high energy event has been fantastic. I heard understated comments like: "Best Networking Event. Ever!" The only downside of the networking day was the complaint from people that they had heard great reports about the event but didn't hear about before hand so that they could take part.

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#CISummit Don Casey wraps up the summit

Don Casey:

CMS gets very little positive feedback. They took a risk and engaged with a passionate audience.
Let's thank CMS for all their efforts.

1200 people at the event.

2400 people listened to web cast for extended periods.

Invest in putting the patient at the center - this is the path to better outcomes at lower cost.

Can we engineer a jailbreak for HealthCare. The question is how quickly.

Talk is cheap - what are you doing?

We need to take action quickly.

Westhealth Policy Center working on a fellowship program to create research with actionable outcomes.

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#CISummit - Wrap up in the Innovation Hot Tub

5:15- 5:45pm

Fireside chat with Susan Dentzer Editor-in-Chief, Health Affairs  Jonathan Blum Deputy Administrator and Director for the Center of Medicare at the Centers for Medicare and Medicaid Services (CMS)  Cindy Mann Deputy Administrator Director Centers for Medicare & Medicaid Services  Rick Gilfillan, MD Director, Center for Medicare & Medicaid Innovation ("CMS Innovation Center")

Susan Dentzer suggests that a hot tub is a more appropriate metaphor since there is no fireplace.

Innovation is doing! Like cooking. 

Payment is an important part of the innovation soup.

Secret sauce is Culture Change

Scaling for Culture is hard to do.

Technology and Data is key.

Data is an enabler and the rocket fuel of innovation.

Evidence is key. 

We need to Share.

How do we move forward:

Jonathan Blum:  What does it take to be a high performing doctor or technician.

Best practice audits to review top performing plans and learn what the secret sauce is. Then communicate this information to others to apply.

[ED:]Scaling Positive Change is the same challenge as patient medication adherence. We can package it like a pill but medication is not the only part to a cure. People have to want to get better. If providers don't buy in to new processes they will not perform at the same level as the top performers.

Rick Gilfillan: We (the Feds) don't have to build a new delivery system. The care services in their local communities will build what works.

[ED: The challenge is to provide the payment systems that enable innovative methods of care to be implemented.

Looking in the upcoming CMS Challenge for ideas that engage people/patients in these new models.

Cindy Mann: our doors are open . Come forward with ideas.

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#CISummit Ignite Talks - Part 3

3:45- 4:00pm

Ignite Talks: Rapid Fire Innovation Pitches Facilitated by Joe McCannon Senior Advisor to the Administrator, Centers for Medicare and Medicaid Services (CMS)  Will Shrank, MD Director, Rapid Cycle Evaluation Group, Centers for Medicare & Medicaid Services (CMS)  David Eddy MD, PhD Co-Founder, Archimedes

Joe McCannon -  Asked the question:

- Who would you most like to meet?

- What innovation has captured your imagination?

I know I want to learn more about the Allscripts challenge. 

Will Shrank - Rapid Cycle Evaluation Group - CMS

Medication Non-Adherence - Americas other drug problem

$0.5T problem due to medication non-adherence.

No magic bullet.  But....

Better education and communication

Pharmacists are potent communicators

Benefit design to remove payment barrier.

Simple reminders

Better labeling and packaging

HIT is the backbone of any adherence initiative. Social Networks are powerful tools.

Engage family and friends.

Tom Lee - One Medical Group

Entrepreneur behind epocraties

Redesigned primary care service at lower cost. Same day appointments. More time with patients. 

Not a concierge model.

Ideas are cheap. It is putting them in to practice that takes effort.

There is waste in the system. First concentrate on internal waste.  Started looking at support staff. Typical practice has 4.5 FTE's per MD.

But that depends on handling many, many patients.

Dropped it to 1.5 FTE per MD

Classic People - Process - Technology challenge.

Instituted email. - what a concept! 

Simple systems. Email, web forms, simple EHR

Don't specialize

What was learned:

- The bar is low.

- Expectations are rising.

Creativity is thinking new things - Innovation is doing new things.

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#CISummit - Chronic Care Management - The discussion

Atul Gawande leads a discussion on Chronic Care Management.

2:00- 3:30pm Panel 2

Care Delivery/Chronic Disease Innovation Case Study Moderator: Atul Gawande, MD, MPH Surgeon, Writer, Public Health Researcher  Kenneth Coburn, MD, MPH Chief Executive Officer and Medical Director, Health Quality Partners (HQP)  Alan Hoops Chairman and Chief Executive Officer, WellPoint/CareMore  Debbie James Vice President, Healthways Fitness Division, Healthways  Mary Naylor, PhD, RN Professor in Gerontology, University of Pennsylvania School of Nursing

DJ: Complex model. Targeted messaging based on demographics. 

Mail campaigns (majority of activity), phone calls. some clients they work with physicians. (Healthways client is the health plan or employer)

Fitness centers are trained to deal with seniors. 

MN: Nurse "hold the family and patient's hand through the transition from hospital to home. This starts before release. Patients in hospital go from 24x7 care to 24x7 nothing upon release. 

AH: The component pieces of care are nothing new. What is new - for Health Plans to be accountable. CareMore focuses on the 10-20% of patients that exceeds the PCP's ability to care for them. 

So.... CareMore is an outsource model. 

50% of chronic condition seniors admitted to hospital are either dead or readmitted within 12 months.

MN:  Focus on medicare and dual eligibles, multiple chronic conditions, multiple acute service use. Work in hospital and with PCP's. Pick people up at a point of risk and support them to a point where they are no longer at risk.

DJ: beenfits seen in Year 1, benefits pay for all participants in Year 2.

KC:  High risk groups has ROI in first year. Wider beneftis in 4.5 yrs. Once people ar ein the program they stay in and continue to benefit.

MN: TCM has a continued investment needed in systems and training. Hospitalized patients show an ROI within months. 

AH: CareMore Model is a platform and patients are divided in to many sub-groups. Differing payback returns. CareMore looks for broken systems that enable 20-50% reduction in cost in a 6 month time frame.

Innovative models don't fit the regulations. Regulations are designed for the healthier 75% and not the sickest 25%.

MN: Our biggest barrier is us

KC: No part of health system can stand apart. We need collaborative models.

DJ: Short term risk is short term thinking about costs

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