Dr. Watson Will See You Now

I recently attended the annual Health IT Insight conference, which was very useful knowledge by the way, and one of the most interesting presentations was presented by IBM and how Watson can be applied within the Clinical Decision Support process.

You've probably all heard about Watson, the IBM computer that defeated two of the greatest champions on the game show Jeopardy! Jeopardy showed off the power and sophistication of Watson.  Watson is able to understand spoken natural language, decipher it and research highly probable answers.  Watson can process 200 Million pages of data (I actually think it can handle much more than that now) in three seconds.  So how can this technology be applied to healthcare?

IBM has a range of ideas but I think the most immediate application is as a decision support tool for clinicians where it can, in real-time, recommend treatment options or provide a second opinion for clinicians to consider as part of diagnosis and treatment planning.

Personally, I would love to see Watson applied to a high-tech minute clinic.  Minute clinics are those drop-in clinics popping up at your local drug store to treat simple problems (sore throats, rashes).  I know we're probably still centuries away from a high-tech unmanned minute clinic, but imagine if a patient can identify themselves using a portable health record on a smart card to a health kiosk running with Watson's intelligence.  After a minute of discussion, a vending machine dispenses a prescription drug for treatment.  It sounds cool!

Senator Scott Brown Visits Venture Café!

On June 10, 2011, Senator Scott Brown stopped by at Venture Café and Cambridge Innovation Center (CIC)!  There was a lot of excitement in the air for his arrival.

Senator Scott Brown encourages entrepreneurs.

All smiles around for Brian Wang, Venture Café Operations Manager; Senator Scott Brown; Renee Lin, Venture Café Acting Community Manager.

Senator Brown gave a talk to CIC clients about jobs, innovation and Massachusetts.  Afterwards, he stayed and mingled to hear about projects that CIC clients are working on.  Thanks to Senator Brown for the visit and inspiration!

How to Replace Health Plan Core Administration Systems

Health Plans spanning the entire United States from Rhode Island to Hawaii will at one point face the challenge of replacing their core administration systems.  These systems are the backbone of these health plans and manage key processes like Member Enrollment, Premium Billing and Claims Processing.  The reason why health plans look to replace these systems is because they no longer can easily support the continuous changing rules of the business, such as changes in plan design.  As Federal Healthcare Reform continues on and Payment Reform continues to evolve, these administration systems must be able to support payment changes too, like bundled payments.  Health plans in their search for a new solution, consider solutions not limited to TriZetto QXNT, TriZetto Facets, Perot Diamond and DST AMISYS.

The initiative to replace a core administration system is no easy task.  It takes a lot of brainpower, years and money.  It is such a hard task in fact, that many health plans have even scrapped the initiative after spending years on the project.

As health plans continue with replacing their core administration systems, here are some key points to consider:

Appoint Exceptional Leadership.  It really does matter who is leading the initiative.  The project team will become so large, that it’s important to make sure that the overall project leader and the leaders below can understand how the whole project ties together and what objectives their teams must meet to make the overall solution work.  All leaders must understand how to implement a replacement system, understand the importance of their team’s contribution to the solution and be able to direct the team to stay focused on the business goal.  It is important for the leaders to be able to recognize when the project has gone off course and to redirect efforts.  An exceptional leader that really understands both systems and business process is essential.

Put your Best Team on it.  The core system replacement will no doubt be one of the health plan’s most difficult tasks ever.  It will take the brightest and most committed team to give it the best chance for success.  There will be many challenges along the way that will require only the best problem solvers.  Commitment is also important because the project will go on for a long time.  There will be up’s and down’s and the team must be able to brave the storm. 

Break it up into Phases.  This means not to try to do everything all at once.  The Health plan is replacing the core systems that cover almost every process; it seems impossible to do it all at once.  Instead, break it up into phases either by grouping the customer accounts into phases or by separating business functions into phases.

Pick the Right Solution.  Make sure to understand what the business and technical requirements are for an ideal core administration system replacement before choosing the solution.  Remember to consider future needs too.  Take time to research which solution meets the needs of your requirements. 

Learn the Product.  Even after choosing a solution, take time to learn in-depth how the product works before configuring it.  An understanding of how the product works will allow you to visualize how to configure it best to work in the business environment.  After visualizing the overall configuration strategy, the detailed configurations can be filled in.

Health “Data Liberacion” – What do we do now?

This month, Todd Park CTO of Health and Human Services and co-founder of athenahealth spoke about what he calls “Data Liberacion”.  I attended this talk organized by Xconomy and witnessed his passion and enthusiasm for this initiative.

Pictured left to right: Chris Herot, CEO of SBR Health; Todd Park, CTO of Health and Human Services; Renee Lin, the “Health Plan Geek”

“Data Liberacion” makes tremendous amounts of health data metrics available to the Public and anyone that wants it, for the purposes of creating new and useful health applications.  Todd recommended reading “The Hot Spotters” in the New Yorker, as a related example of how data can be applied in valuable ways.  “The Hot Spotters” details one Physician who analyzed health data to map out the highest utilization and highest cost geographic points in his nearby city.  The Physician then focused his energy on these high utilization areas with the challenge to increase patient health and lower utilization.  This Physician’s story is admirable, useful and an example of how health data can be applied to add value to everyone in healthcare.

With all this data now available and more soon to be available, what should healthcare organizations do now?  I would suggest a couple of actions: implementing the use of some of the data now, exploring what is available in the data sets (listed below) and then monitoring what kind of applications spawn from it.  One example of something that Health Plans are doing now is to integrate data with their Provider Search tools, such as the Patient Hospital Survey (HCAHPS) and Hospital Compare data sets from Medicare which will help consumers choose a Hospital or Physician by reviews/quality.  Healthcare organizations should also explore what is available in the data sets and brainstorm how the data can add value to existing services already offered.  Also, it would be wise to monitor the applications that come to market as a result of this data availability and make available the helpful applications to consumers.  As we take a look at the data, we may see that some of it still needs some refinement.  Just as an example of the state of some of the data: when I searched for teenage births “Births to Mothers Under 18” on the Health Indicators Warehouse, I received back the metrics for non-teenage females “aged 15-54 years; Female”.  The data could still use some cleaning up, however, as the industry starts to use the data, we should see refinements in the data.

Here are some of the public health data sets to start (re)exploring:

• Consumer Assessment of Healthcare Providers and Systems
• Healthdata.gov
• Health Indicators Warehouse 
• HHS Open Data Sets
• Medicare Data Sets
• NPI Data 

10 Career Opportunities in Health Insurance

Two weeks ago, I wrote here on my blog about some implications of the potential merger of two local health insurance companies, Harvard Pilgrim and Tufts Health Plan.  In response to that post, I received some questions about layoffs due to a merger.  In an increasingly complex industry, the company faces the challenge to remain an attractive product while also doing "the right thing" for members and employees.  So can there be layoffs?  Sure.  Will there also be new career opportunities?  Sure.  I see the need to move employees into new roles to help the company succeed.  As we face a new horizon for what a new valuable Health Plan really can be, new roles must be considered to propel the Health Plan and make it efficient, competitive and grow.  So here is my forecast of ten upcoming career opportunities within any health plan that wants to be efficient, competitive and grow.

1)Re-engineering Process and Systems

As health consumers demand lower costs in healthcare, everyone must do a part to decrease the administrative cost wherever we can.  Now is the time to take a look at current processes and brainstorm how they can be made more efficient.  The optimized process will also identify new system solutions that will enable the new efficiencies.  If the re-engineering is done well, I believe it will be the key driver in lowering cost and create a dominant market appeal.  Employees with knowledge of current business process, current systems and who are forward thinking will be needed to achieve these efficiencies by defining the new processes and implementing the new systems.

2)Vendor Management

With the re-engineering effort, many new service vendors will be in consideration.  Employees will be needed to take a look at existing contracts, re-negotiate contracts and draft new contracts with existing/new vendors.

3)Growth Strategy

How aggressive does the company want to be in signing on new employer groups and members?  What is the best way to compete with competitors?  What will be the strategy?  Employees will be needed to help the company achieve membership goals through building the winning growth strategy.  In the case of Harvard Pilgrim and Tufts Health Plan, they together will be offering insurance in: Massachusetts, Maine, New Hampshire, Rhode Island and must strategize on membership growth starting in these four states.

4)Actuarial

Actuarial is a good role to get into within the industry because there always seems to be a shortage in Actuarial professionals that understand the risk factors in health insurance.  Due to many federal and state regulations now and in the future, Actuaries are needed to analyze the increasing number of new business scenarios, such as New Product Designs (for example, upcoming MA Division of Insurance select/tiered provider network product designs) and new provider reimbursement methods.

5)Healthcare Informatics
Healthcare Informatics is hot now and will continue to be for some time.  Employees will be needed to slice and dice the data to find ways to lower cost, measure results of new programs, monitor provider quality and segment members to offer personalized care.

6)Regulatory Projects

Now until 2016, there will be a focus on Regulatory Projects, such as ICD-10, Federal Health Reform and additional Federal and State Mandates.  Employees that understand the health insurance business and systems will be needed to make policy, process and system changes.

7)Social Media Management

Social Media Management is about protecting and extending the company brand.  Social Media Managers monitor what is being said about the company online, such as reviewing web posts, Twitter comments and Facebook comments.  If faced with a poor review/comment, the Social Media Manager performs damage control by offering to help and hear the situation (sometimes taking the follow-on conversations offline due to privacy).  The Social Media Manager will also perform some marketing and public relations activities to promote the company brand.  Social Media Management is a fairly new career opportunity in the health insurance industry.  Don’t forget that Social Media should be managed in the Member and Provider online mediums.

8)Multi-Lingual Services

In an increasingly diverse country, it is important to provide Multi-Lingual services via written and spoken mediums.  There is a push from consumer advocate groups to better engage, educate and support non-English speaking consumers to promote public health and better access to care.  Healthcare organizations have created units in order to better service the non-English speaking population.  Employees with capability to speak/write a foreign language, perform English translations and who possess good customer service skills are needed to fill these roles.

9)Leadership Development Program

With a growing number of health plan employees approaching and taking retirement, health plans must make investments to ensure that the health plan is able to carry forward a strong business into the future.  A Leadership Development Program can be a rotational, mentorship program to train promising staff to become the next leaders.  Participants in the Leadership Development Program must be offered incentives to stay with the company after the Program is over, otherwise, they may take their talent to other companies.  The desired skill set for candidate selection into a Leadership Development Program, should be: vision, social responsibility and integrity.

10)New Business Ventures

As the health plan recognizes that their core competency is offering insurance, they may begin to diversify into different States and other insurance products, like comprehensive dental insurance, stop loss insurance or worker's compensation.  Any of these would be a huge effort and would require experienced human resources with different skill sets in order to make this possible.