A Must Read: Article on Population Health and Health Care Consumerism

The latest issue of the Health Care Consumerism Outlook 2013 includes an article by members of the Care Continuum Alliance’s team discussing how population health management and health care consumerism have a symbiotic relationship.

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The Future for Population Health Relies on Three Key Consumer-Centric Features: Health Data, Care Coordination, and mHealth” is an excellent read, if we may say so ourselves.

Consumerism and its impact on health often move faster than the health care industry. At CCA we have worked to keep pace with this market movement and respond appropriately. In 2013 our research and advocacy priorities, which are driven by our members through their participation in our Quality and Research committees, focus on the understanding of how incentives work, not merely to move consumers into wellness programs, but to engage them in community wellness, that is, incentives that inspire the consumer to transcend the health of self to move into a community health mindset.

Improving the health of populations starts by building a healthy shield around one individual consumer at a time. CCA’s population health framework, an outcome of our committees’ work puts the consumer at its very center.  We use the term consumer, not patient, because the health continuum encompasses services beyond those of “health care” and being a “patient” to include wellness and prevention, and the engagement of the individual. Lifestyle issues such as exercise and diet have been one of the initial foci of consumerism as it entered the health care space.

Read the article the full article, “The Future for Population Health Relies on Three Key Consumer-Centric Features: Health Data, Care Coordination, and mHealth”, on the magazine HealthCare Consumerism Outlook 2013.

Notes from Congressional Hearing on Health Information Technology

The U.S. House of Representatives Energy & Commerce Committee’s Subcommittee on Communications and Technology held a hearing March 19 titled “Health Information Technologies: Harnessing Wireless Innovation.”

Stakeholders from the population health management industry testified in this important issue for our industry and wellness in general. Here is a brief summary of the testimony:

U.S. House of Representatives Hearing Summary

Energy & Commerce Subcommittee on Communications and Technology

 “HIT: Harnessing Wireless Innovation”

Representative Greg Walden (R-OR) – Chair

Representative Bob Latta (R-OH) – Vice Chair

Key Comments from Health Care Industry Stakeholders:

Overly broad application of FDA regulations and the medical device tax continue to be top concerns and potential hurdles to investment and growth for mobile health industry stakeholders. Stakeholders generally described uncertainty in the health care industry on how to best navigate the mobile medical regulatory environment and anticipate future regulatory actions. They emphasized the need for final FDA guidance on mobile medical devices and applications to bring clarity and assurance to the marketplace. The final guidance should delineate what would be considered low-risk devices and hence outside of the regulations. It should also assess manufacturing exemptions, classify devices by individual levels of risk, coordinate through a single office in the FDA and work in collaboration with app developers. Further, higher risk medical apps that purport to make clinical decisions should be required go through the FDA approval process. Stakeholders noted that the final guidance does not have to be all-encompassing. Rather, updates should be anticipated as technology advances the concept of a medical device and health care stakeholders continue to innovate.

Regarding the medical device tax, significant anxiety persists among health industry stakeholders over the tax’s potential to stifle innovation and marketplace investment. In response to the “retail exemption” to the medical device tax, stakeholders seemed aligned that most medical apps would qualify for the exemption and that smartphones and tablets are excluded from the tax.  Though, some stakeholder comments indicated that the tax could be a slippery slope to overregulation and wary of whether this retail exemption will alleviate burdens associated with the tax if a mobile medical device or application is deemed to be FDA regulated.

Finally, the Federal Communications Commission Incentive Auctions must be open and inclusive. There is significant underutilization of the wireless spectrum that needs to be resolved in order to pave the way for continued growth and innovation in the health industry.

Key Comments from Subcommittee Members:

Members of the Subcommittee broadly agreed and recognized that cloud, mobile and app technology is transforming health IT. Patient safety continues to be a paramount consideration for both Congress and industry stakeholders as innovation and corresponding regulatory actions progress. The Subcommittee’s objective was to understand stakeholder concerns and risks related to the medical device tax and pending FDA final guidance. They also expressly sought information from industry stakeholders on recommended next steps.

Additional Background Information:

Medical Device Tax

The Affordable Care Act amended Section 4191 of the Internal Revenue Code to create the medical device tax. The tax is 2.3% of the sale price of the taxable medical device and generally applies to manufacturers and importers of certain devices created after December 31, 2012. The “retail exemption” to the medical device tax states that the tax does not apply to the sale of any devices that are typically purchased at retail by the general public for individual use. The IRS issued final medical device tax regulations on December 7, 2012 and noted factors to consider in evaluating whether a particular device qualifies for the “retail exemption.” The regulations also identify several categories of exempt devices. For further details, view the final IRS regulations on taxable medical devices here: Federal Register- IRS Medical Device Tax. Also, view the IRS’s Frequently Asked Questions and Answers on this topic here: IRS-FAQ Medical Device Tax.

Federal Communications Commission Incentive Auctions

The Federal Communications Commission Incentive Auctions are a voluntary, market-based method of repurposing the wireless broadband spectrum. The auctions encourage current licensees to voluntarily relinquish spectrum usage rights in exchange for a share of proceeds from an auction of new licenses to use the repurposed spectrum. The first incentive auction is anticipated in 2014.

Love Letter to TEDMED

Wow. That’s all I can say after three unbelievable days attending the inaugural TEDMED DC event. My head is swelling with ideas and inspiration and innovative opportunities for population health. It was unlike any “event” I’ve ever attended and it sets a new standard for education and networking.

What’s it all about? TED stands for “technology,” “entertainment,” “design.” There were performance artist poetry slams about thinking outside the box that literally took my breath away. There were personal vignettes about surviving breast cancer by the President and CEO of the Red Cross. There were discussions about the technology of food, of fitness, of wellness, of illness. So much of this conference had a population health theme that is perfectly aligned with CCA’s goals and the work of our industry leaders. It was all just presented in a way that makes you think harder and better and more collaboratively.

A common thread through nearly every presentation, I found, was the importance of personal wellbeing and responsibility. Obesity was a key theme and presented from various perspectives. A huge takeaway for me: Obesity is directly linked to one-third of all cancers. Encouraging healthful behaviors at a community and social network level was another key issue and was the top choice of TEDMED delegates in the Great Challenges of health and medicine. Kudos to Challenge Advocate Rajiv Kumar, Founder and Chief Medical Officer, ShapeUp, for promoting the “Inventing Wellness Programs that Work” Challenge. Rest assured, you got several of my votes!

Finally, let me state emphatically: TEDMED, don’t change a thing for next year in DC. I ran into a few of my DC colleagues who work in other health industry organizations this week and, in the words of one, they just “didn’t get it.” Yes, it’s different. Yes, it’s all “West Coast-y.” It is NOT your same old, same old conference with a bunch of boring policy wonks and PowerPoints. Not all of the speakers were equally enthralling (although most of the ones I saw were) but there was certainly a nugget or grain of an idea in every single one that spurred a conversation and possibly another innovation down the road. This conference is about IDEAS and PEOPLE and NEW WAYS OF THINKING. It was also a great equalizer in that the vast cross section of delegates attended to meet and explore. There was no hierarchy, just idea sharing. It was, simply, awesome.

—Tracey Moorhead, President & CEO

IOM Report Reflects Expanding Role of Population Health Management

Over the past couple weeks, there’s certainly been no shortage of commentary on our industry and its evolution from the early days of siloed, call center-based disease management to today’s integrated, sophisticated population health management (PHM).

Certainly, the recent CBO report was a catalyst for some of these conversations—especially as the Care Continuum Alliance (CCA) and others highlighted the outdated design of the programs detailed in that report. But another catalyst is the increasing interest in PHM strategies from public and community health organizations, as well as primary care groups.

This was reinforced in my mind this week as I read the Institute of Medicine (IOM) report, Living Well with Chronic Illness: A Call for Public Health Action. At the request of the Centers for Disease Control and Prevention (CDC) and the Arthritis Foundation, the IOM developed the report to identify public health strategies that reduce disability and improve the function of and quality of life for people with chronic conditions.

As you’d expect, the report focuses on public health and its authors almost exclusively are public health leaders. The important point here, however, is that the report gives great attention to and identifies significant opportunities for the current and likely future iterations of population health management strategies and services. Specifically, the report includes several recommendations significantly relevant to our industry, including that:

  • the CDC increase demonstration programs for chronic disease control that cut across specific diseases or multiple chronic conditions and emphasize mitigating the secondary consequences of various chronic conditions;
  • the Department of Health and Human Services and state and local government public health agencies evaluate existing, emerging and new models of chronic disease care that promote cooperation among community-based organizations, the health care delivery system, employers and other stakeholders to support living well with chronic illness; and
  • HHS supports states in developing comprehensive, collaborative, population-based strategic plans with resources that focus on the management of chronic illness, including community-based efforts.

A key takeaway from the IOM report: Ultimately, successful health care is local. Current federal and state policy priorities seek to advance this concept through community-based, primary-care led models to improve health and health care quality and to constrain costs. Yet, all stakeholders recognize that this evolution in health care delivery will require the integration and coordination of numerous care providers and services in new ways. We’re seeing this happen throughout the industry in multiple collaborative projects. The IOM cites other challenges, including a lack of incentives for care coordination and the prevalence of fee-for-service payments.

This week’s IOM report asserts the potential for community-based care and collaborative models to improve the lives of people managing chronic conditions and to mitigate the impact of chronic disease. These models will benefit from the very strategies and tools in the wheelhouse of population health management as practiced today. It’s a particularly salient point in a week when so many were overly fixated on old approaches to chronic condition care.

—Tracey Moorhead, President & CEO

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