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Healthcare Algebra, take a peek

Even if you are not oriented to kidney disease in your business or personal life, what’s happening in this sector is a good preview of the coming changes across all healthcare.
May 9, 2024

Want to get a really good glimpse into the future of healthcare?

Stay with me for a moment – just like you view that Netflix teaser clip to decide whether to select Play …

Short answer: it’s a value-based care program focusing on chronic kidney disease (CKD).

Even if you are not oriented to kidney disease in your business or personal life, what’s happening in this sector is a good preview of the coming changes across all of healthcare.

And who among us isn’t in need of or interested in health care?

BTW: ‘coming’ means January 2030 – 5 years and 7 months from now – when the CMS Innovation Center wants all CMS beneficiaries to benefit from accountable care.

Yes, primary care models are beyond the testing phase and ACO REACH is definitely here to stay but CKD is the go-to, ‘tip of the spear’ program for specialty value-based care (VBC).  And, you may not be aware, the current CKD VBC program, Kidney Care Choices (KCC) model, is a generation 2.0.  A precursor program was the ESRD-QIP program initiated back in 2012.

The nascent KCC program has momentum.  I recently stumbled across @Tim Fitzpatrick’s #signalsfromspace and he’s pumping out some cool data and opinions related to this CMMI value-based care program.

Tim’s topics and data orient to the business delivery of KCC but, if you squint just a little and look towards the horizon, one can see how it could apply to other chronic conditions as well as our own patient care.  And, well, sometimes it helps to follow the money … look at all the venture capital aimed at this space.

Disclaimer 1: While kidney disease is not the “tippy-top” condition affecting America’s health, it is consistently in the top few and does have a spiderweb effect on many other (resource-intensive) chronic diseases.

Disclaimer 2: I receive no remuneration of any kind from Tim (but would consider it…)

Disclaimer 3: I’m posting for the general public consumption and am not a chronic kidney wonk so my clinical-speak will stay rather rudimentary.

Circling back … consider applying what’s occurring TODAY with chronic kidney disease value-based care to your personal health as well as your business focus – if health care is your paycheck.

Why am I shouting TODAY?  Because everyone is talking about AI and the future.

AI this and AI that.  AI is coming! I don’t even need to spell it out – it’s just AI.

I think AI is like the ‘cool kids’ in high school; lots of promise but when, can, and how will it turn out?

In a swim lane next to the AI-is-coming promise and reality, Tim recently posted survey results from chronic kidney disease thought-leaders / executives / in-the-mix-type people that rated and prioritized the most ‘missing’ element or the ‘biggest opportunity’ or if-we-could-only fix-this-one-thing.

The results and opinions were pretty … long-term or complex.  Maybe it’s time to tag this with #moonshot.

Well, if you’re like me, you see there’s a lot we can be doing better TODAY to advance our own health and the health of a population like we’re seeing directed at chronic kidney disease.

Here’s what I’m hearing from my family and friends impacted by kidney disease, as well as my managed care clients who provide value-based kidney care …

… improve a patient’s TODAY care.  Not tomorrow’s care next month or next year’s.

Help the patient TODAY.

And what is the one constant suggestion to this that I hear from both the patients and the care teams?

It’s this: improve communication and coordinated action between the care team and patient, or, the patient and the care team.

H E double hockey sticks – let’s go so far as officially making the patient (and their caregiver) part of the care team!

Here’s the ubiquitous sports metaphor – get the patient and the care team working off the same playbook.  Call the play; run the play.  And be ready for an audible before the ball is snapped because, well, things change.

Patient engagement (aka when a patient and care team are aligned) is both a holy grail and the foundational aspect of all accountable care models and why CMMI says these are the three key aspects to achieving the 2030 goal:

  1. Patient and provider education
  2. Regulatory flexibility
  3. Data Sharing

 Let’s quickly unpack these three points:

  1. CMS programs are littered with decades of attempts to induce patient/care team contact (isn’t that what we all want when we are a patient?)
  2. CMS recognizes current regulations need to morph (and they want our feedback)
  3. CMS / HHS enacted legislation (and fines) related to ‘data blocking’ to promote ‘data sharing’.

The third point builds off two previous legislations:  privacy of patient information (HIPAA) and electronic patient records (HITECH).

As a patient, you know your [HIPAA enabled] data protections and you are aware of available technology [from $28B of HITECH incentives] to manage your health data.  Think EMR portal, eesh. So, 1990s.

But is your care team – or you – familiar with more recent [The Cures Act] legislation that ensures the flow of patient data?

Let’s do some HHS legislation algebra:

HIPAA + HITECH + Cures Act = Patient Engagement (i.e. holy grail)

Notice the sum does not reference a “provider”.  That’s because – and this is a big leap, get ready – the three legislations position the patient to engage with more than their care team.

More. We love more. Give us more. Super-size me, while you’re at it.

Engage more what or more who?

That would be… engage sources that complement and support their care team.

What source can complement the care team?  Here are a few: data collected from the patient’s own body, information from knowledge sources, a ‘condition community’ the patient engages, the patient’s clinical data from across the community – and more.

Want some TODAY proof?  Lean in and I’ll whisper it: Blue Button 2.0.  Few know about this CMS gem.  Even fewer technology vendors are pondering how to utilize Blue Button 2.0 APIs in Medicare claims data to streamline the clinical care process.

Other examples include harvesting relevant patient health metrics from Apple’s Health app or Google Health.  Or, publishing information videos and patient education from trusted sources (NIH, CDC, etc.).  Or, subscribing to a peer disease-specific health community (think Strava, Garmin Connect, etc. with a disease focus).

Doesn’t all this sound better than a … portal? You bet!

The delivery platform of all this “more” is mobile technology.  Apps, as they’re called; getting health apps to access other information and talking to one another following privacy guidelines.

Raise your hand if you have elder friends and relatives that are very comfortable with technology.  Right, close to but not everybody.

But do you see more use of mobile apps (e.g. people glued to their phones in the airport) than 5 years ago?  A lot more? As Tony Robbins says, “Yes and yes.”

And what’s going to happen in the next five years?  Yup, more mobile app users.  And then those 2030 CMMI goals arrive.  And people are living longer.  And health care costs/premiums rise. And taxes go up. And …

So, would you be interested in utilizing mobile apps to improve your health and be an active part of your care team?  I thought so.

Thank goodness for that CMS algebra.

HIPAA + HITECH + Cures Act = Patient Engagement

And take a peek at the KCC value-based care model.  It’s coming soon to a specialty program impacting you and those you care about.

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Information blocking impacts patient care every moment of the day. It once impacted my patient care (story at a later date); it affects your care, your family’s care, and everyone’s care.

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Value-Based Care
Accountable Care Organization
Accountable Care Model
Alternative Payment Models
AndrewRittler - Chief Executive Officer

Author

Andrew Rittler

Andrew Rittler, Chief Executive Officer, joined MITEM Corporation in 2013 to bring the eVigils platform to market and lead product direction. Andrew has a 35-year history in healthcare technology leading consulting, sales, and service operations.

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