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// // Depression, Integrated Health, AI in medicine
Eric Topol makes the case for how artificial intelligence can improve health care, despite privacy concerns ILLUSTRATION: MICHAEL GLENWOOD By Sumathi Reddy March 4, 2019 9:39 a.m. ET There’s no doubt that artificial intelligence is transforming health care. But its use doesn’t come without controversy, as critics ask if AI could further dehumanize medicine and erode the doctor-patient relationship. Eric Topol, a cardiologist and director and founder of Scripps Research Translational Institute in San Diego, argues the opposite in his new book, “Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.” The book, coming out March 12, makes the case that not only will AI improve the accuracy of diagnosis and treatment of illnesses, but it will also restore compassion to medicine. Dr. Topol is a paid adviser to two AI health companies, Verily Life Sciences, a Silicon Valley-based company that used to be part of Google, and Voxel Cloud, a China-based company. Here are edited excerpts from a recent interview: A lot of consumers and even health-care professionals are wary of artificial intelligence. They see it as something that depersonalizes medicine. Obviously, you disagree. Why? I had the same kind of bias going into this field. I spent a few years of research to figure out where we could take AI. My major conclusion was this would be the ultimate objective: that we use technology to enhance humanity. There’s many different ways that this can be achieved. The theme is the gift of time, because every type of clinician can have augmented performance by having AI support. So not just reading scans or slides but getting rid of keyboards completely, using voice recognition. And getting rid of all the administrative tasks that are such a burden. What specialties and tasks is AI particularly useful for? It’s perfect for anything that’s a pattern, be it an image, like a medical scan, or speech. For both those areas of image and speech, we now have deep learning algorithms that are as good as humans, even expert humans, in interpreting and making the right classification. So that’s the strength and that’s where we can immediately in the years ahead start to harness that to improve health care. AI brings with it a lot of privacy concerns. Consumers are worried about their private medical data being shared. How do you allay these concerns? Privacy and security is a fundamental concern. If we can’t guard that and take it to the levels of priority that it deserves then all this is a bust. Axiomatic is people owning their data—all their data, from birth on. That’s sensor data, that’s genomic data, that’s traditional medical records, everything. And if they own it, then it would be available for inputs for AI algorithms. How do people own their data? It should be a civil right. In Estonia, everyone owns their data and it sits on a blockchain platform. Many other countries around the world are moving to the model of people owning their health data and sharing it or sharing parts of it as they need or sharing it for medical research if they would like to. But in the U.S., there hasn’t been any movement in that regard. In order to do this right, to really use the power of AI, the more of your data that goes into the algorithms, the better the output will be. So right now people can’t even get all their data because they go to a lot of different providers and move around in their life and have to pay for it a lot of times. It’s just ridiculous. Our country is way behind in people having their data. And as a privacy issue, if it sits only in health systems that get hacked left and right, that’s not exactly ensuring your privacy. All the cybersecurity gurus say that the best way to protect your data privacy security is in the smallest possible units, not sitting in massive servers. Dr. Eric Topol speaks in Philadelphia in this 2015 file photo. He advocates for using more AI in health care. PHOTO:NEILSON BARNARD/GETTY IMAGES One surprising chapter in your book talks about how arbitrary diagnoses are in the medical world. How can AI help doctors with diagnosis? Medical errors are pervasive. We have well over 10 million in the U.S. a year and this is also accompanied by a tremendous amount of waste and overtesting and overmedication. So what AI can do is bring in all the data of each patient and bring in the list of probable diagnoses, many of which aren’t even thought of by a doctor when they see a patient. So what’s great here is having all the data that no human being could assimilate. And that also includes all the medical literature, up to the moment. No doctors can integrate all that. They can’t keep up with the remarkable pace of medical literature. You talk about freeing up more time for doctors. But couldn’t AI create a tsunami of information that becomes too difficult for doctors to process? No, it’s just the opposite. AI takes the remarkable amount of data and crystallizes it, distills it quickly and accurately. So the currently overwhelmed doctor with data, that’s all diffused. You have a chapter on mental health that cites research showing that people are often more comfortable talking to virtual humans than a real one. Do you think there’s a role for virtual therapists in diagnosing and treating conditions like depression or anxiety and other mental-health disorders? Yes, it’s already happening. There are already AI tools, Dr. Woebot and many others, that are expanding to provide virtual support, taking advantage of the willingness for people to disclose their innermost secrets to an avatar. But also the fact that there is such a burden of depression and mental-health conditions and there’s already some small, randomized trials showing evidence that this can be of marked benefit. Another chapter talks about diets. How in the world can AI tell me what to eat? The reason we’ve never had an individualized diet is because we’ve never had AI to bring in all the data about each person. But when you start getting billions of pieces of data about your gut microbiome, everything you eat and drink, and your sleep, and your physical activity, and your genome, that can be integrated to predict what are the foods that cause glucose spikes. So it turns out if we all ate the exact same food at the exact same time and amount, we all have markedly variable responses to different constituents in our blood like glucose, like triglycerides and I’m sure many others. You talk about patients being monitored remotely in their homes rather than being treated in a hospital. Is this a real possibility? AI can decompress the need for hospital rooms and fix a lot of the economic woes we have today as far as the investment in human capital, because the large staff of doctors and nurses that would not be necessary in the future. We already have the tools of getting vital signs and monitoring people in their home, but it relies on developing the algorithms and proving that it’s at least as safe as having people in the hospital. But I’m confident that over time it will be proven that patients can be more safely monitored in their own bedroom at a fraction of the cost. What kind of role do you see virtual medical assistants playing in the future? Will Alexa soon start telling me when my blood pressure is too high or when I’ve gained a few too many pounds? I think that’s certainly one of the most exciting applications of AI, because here you have your constant coach helping you stay healthy. If you have all the data and it’s being fed back to you with all the medical literature and all your ongoing physiology from sensors, there’s so many things that are imminently preventable. It’s an opt-in thing—not everybody will like this—but for those who are willing to be coached, it might wind up being one of the most important advances in health-care history. Write to Sumathi Reddy at sumathi.reddy@wsj.com
// // Healthcare Payments, Patient Collections, Patient Financial Responsibility, Healthcare Costs, Consumerism in Healthcare
With healthcare starting to act like other industries, providers should be using data, healthcare price transparency, and convenient care to address healthcare consumerism. Source: Thinkstock January 14, 2019 - 2019 will be the year of healthcare consumerism, according to industry experts. As patient financial responsibility increases, revenue cycle and finance leaders are finding it high time to align their business practices with consumerism. Patient financial responsibility is up 11 percent, according to the most recent data from TransUnion Healthcare. The average person is now paying $1,813 in out-of-pocket costs a year for their healthcare services. The patient financial responsibility upswing spells trouble for healthcare revenue cycles. As out-of-pocket spending increases, the likelihood of collecting full payment from patients decreases, consulting firm Crowe found using data from over 170 hospitals in 2017. For most providers, accounting for the healthcare consumer in revenue collection strategies is a new way of thinking. Patient collection approaches are still largely paper-based and most providers are still developing consumer-oriented capabilities, like offering virtual access points and providing price transparency. “The US health industry has often lagged other industries—think tech, retail, hospitality— when it comes to modernizing. Once thought to operate outside the greater US economy, the industry—with its byzantine payment system, complicated regulatory barriers and reliance on face-to-face interactions—is being disrupted,” experts at PricewaterhouseCoopers (PwC) stated in a recent report. READ MORE: Preparing Providers for the Healthcare Consumerism Shift “The US health industry is looking less like a special case, an asterisk in the US economy, and is beginning to behave like other industries.” Providers should be addressing healthcare consumerism in 2019 to effectively collect payments and attract and retain patients. Gathering consumer data, addressing healthcare price transparency, and offering convenient, low-cost care options are major strategies providers should use to account for the consumer in the revenue cycle. USING DATA TO IMPROVE THE CONSUMER EXPERIENCE Delivering a high-quality, consistent consumer experience is key to increasing revenue in the new healthcare economy. “Health companies can strengthen their brand, increase revenue and manage cost by focusing on what matters most to their customers,” PwC’s Health Research Institute (HRI) stated in a recent report. “For example, provider executives from organizations that use customer feedback to inform their customer experience investments report realizing economic benefit from those investments, according to an analysis of HRI survey data.” Looking at consumer preferences by segment is vital to realizing the revenue benefits, researchers added. READ MORE: Value-Based Purchasing, Consumerism Top Healthcare Exec Challenges Consumer segmentation allows providers to identify the interventions worth trying and which will result in higher returns on investment. It allows providers to predict patient behavior and estimate the value of altering individual behaviors, such as improving patient adherence or switching providers. But to executive consumer segmentation, providers may need more data than they currently have access to. Patient and consumer data exists in silos across the healthcare industry. Each player has access to different information, and they are not sharing that data with other providers, the HRI found. Only one-quarter of provider executives surveyed by the institute felt they knew enough about their patient populations to engage with them outside of the clinical setting in their daily lives. Another 78 percent also said they lack the data to identify the social needs of their patients. However, forward-thinking providers should consider the following investments to access the data necessary for consumer segmentation: Create a data hub or contract with a data broker Work with a data aggregator Develop data partnerships with other healthcare stakeholders Commercialize insights READ MORE: Key Ways to Boost Collection of Patient Financial Responsibility “Gaining access to data and analyzing them will be critical for matching patients with the services they want and need,” the report stated. ADDRESSING HEALTHCARE PRICE TRANSPARENCY As patients act more like retail consumers, they are demanding increased healthcare price transparency to understand value. About 77 percent of consumers want more price transparency in healthcare, research shows. CMS is also pushing price transparency in an effort to empower patients to shop for lower-cost, higher-quality care. The federal agency recently required hospitals to post a list of their standard charges online. However, providers are not well-equipped to meet the demand of consumers. Approximately 63 percent of providers in a 2016 survey said they have trouble providing sufficient price transparency. Additionally,18 percent said they don’t have a patient-facing cost estimation tool, 13 percent lack the staff to address price transparency, and 12 don’t offer enough convenient payment options. A more recent study in JAMA Internal Medicine also found the percentage of hospitals that could not give consumers a complete price estimate actually increased from 14 percent in 2012 to 44 percent in 2018. Price transparency can be difficult for providers. What providers charge for services is not generally what patients end up paying. Insurance companies pay the bulk and depending on the patient’s plan, the patient pays the remainder directly to providers. Providing meaningful out-of-pocket cost estimates requires additional data and a patient-facing portal or tool to deliver the information to patients. Software and other health IT systems that rely on historical claims data can help hospitals and health systems boost price transparency, explained Sean Lundy, CMPE, of the Hand & Wrist Center of Houston. “It is critical for providers to use accurate estimates when collecting the patient responsibility, as inaccuracies can generate added follow-up expenses, such as refunds and bills, which may turn profitable procedures into losses,” he wrote. “Since obtaining current allowable amounts directly from payers can be challenging, to say the least, providers should use software tools that assess historical data and estimate allowable expenses for specific payers and procedures.” Partnering with a revenue cycle or patient portal vendor can also help providers develop a patient-facing tool that allows consumers to access cost estimates. EXPANDING LOW-COST, CONVENIENT CARE OPTIONS Consumers expect to not only pay for healthcare like they do in other industries, but they are also demanding more convenient options for getting services. Office hours at a local primary care will not do for consumers who are focused value. Consumers are more willing than ever to go to lower-cost, convenient care settings, like retail clinics or even their own homes, to receive care. A HRI survey found that 61 percent of individuals would use an at-home strep test purchased at retail store if the healthcare costs were lower than seeing a provider. Almost 50 percent also said they were very or somewhat likely to have stitches or staples removed at a clinic in a retail story or pharmacy for a lower cost. Providers are recognizing that traditional care delivery settings are not aligned with the healthcare consumerism trend. And failing to address the consumer could lead patients to competing retail clinics or other low-cost providers. “Many vertical and horizontal integrations are all happening because there's opportunity to serve the patient more like a consumer and the consumer is demanding better access, better choice, and hopefully better costs,” PwC’s Health Services Leader Gurpreet Singh stated. “All of the players that surround the consumer are making major adjustments and changes to deliver services to that consumer.” Providers are making strides to provide convenient access options for consumers. However, consulting firm Kaufman Hall stated in their annual State of Consumer report that providers are still focusing on traditional approaches like developing urgent care centers and freestanding imaging sites. More innovative approaches would be to establish a network of retail clinics or offer concierge primary care. Additionally, delivering more services and visits via technology would significantly improve the consumer experience, the consulting firm explained. Consumers are more comfortable receiving digital care. Over three-quarters of patients (77 percent) are willing to have a virtual care encounter, and 19 percent have already done so, an Advisory Board survey showed. “Across industries, consumers have become accustomed to using virtual technology for both real-time and asynchronous interactions. Healthcare providers can no longer wait to catch up,” said Advisory Board National Strategy Partner Tom Cassels. “Providers have designed care access around their own convenience and will increasingly find patients willing to pay for their own convenience and alternatives to driving to physician offices for medical expertise,” Cassels continued. With high-deductible health plan enrollment expected to increase and technology advancing, healthcare consumerism is here for the long haul. Providers should be retooling their revenue collection and care delivery strategies to ensure they are meeting consumer demands. Failing to account for the consumer in the revenue cycle could result in dramatic financial losses as well as patient volume decreases.
// // Psychiatric data
Over 50 years ago, President John F. Kennedy presented a Special Message to Congress identifying mental illness as one of America’s “most critical health problems.” The result was the Community Mental Health Act of 1963, one of the final pieces of legislation he signed before his death in November of that year.
// // Psychiatric data
WORK & FAMILY More workplaces are allowing time off for employees facing stress, anxiety or depression, but not all bosses are understanding of their workers’ needs
// // Psychiatric data
US Representative Joseph P. Kennedy III wants to put a dollar figure on the amount the United States spends as a result of limited access to mental and behavioral health services, a tally of incarceration and addiction-fighting costs he says will help make the case that the money would be better spent addressing the root issue of mental health.
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Do the youngest members of your team seem more stressed or anxious than the rest? 2018 is time to see emotional intelligence, mindfulness and mental health take centre stage in business. Why? Because UK millennials have the some of the poorest mental wellbeing in the world, behind only Japan, according to a 2017 survey, commissioned by the Varkey Foundation, of more than 20,000 15 to 21-year-olds in 20 countries. And, for business leaders, it’s in their interest to create a nurturing working environment for millennials, who will make up 75 per cent of the workforce by 2025. Most employers agree that a healthy workforce is a better performing workforce. Additionally, six in 10 employees say they’d feel more motivated and more likely to recommend their company as a good place to work if their employer took action to support mental wellbeing, according to a survey by mental health charity Mind.
// // Integrated Health
From the latest research to illustrative case studies for integrated healthcare, we're rounded up the most interesting news from September, 2016. Check out the stories below to stay up-to-date.
// // Integrated Health
Introduction In the United States, healthcare facilities are largely privately owned and operated, with 58% of US hospitals being non-profit, 21% being governmentally owned, and 21% being investor-owned. The US spends more per capita ($9,267), and a greater percentage of its GDP (17.4%) on healthcare than any other nation. In addition to being the most expensive, the US healthcare system was found to be the worst performing out of 11 developed countries in terms of health access, efficiency, and equity. Equity includes issues related to insurance coverage (being uninsured or underinsured), as well as proper coverage for behavioral health and psychiatric conditions, and demographic health disparities (racial/ethnic, sex, age, disability status, socioeconomic status). Efficiency of healthcare delivery has also been found to relate directly to outcome for patients. Equity and efficiency with respect to healthcare delivery of course impact healthcare access for a given individual.
// // Integrated Health
A large cross-section of the population is endowed with both physical and psychological disabilities that manifest in chronic conditions or complex illnesses. This diverse group of individuals has complicated needs that frequently require a combination of medical, physical, psychological and social interventions. These people require an amalgam of services delivered by multiple providers in several settings. This presents major challenges to both patients and practitioners: coordinating patient care, ensuring services are delivered, managing crises, and coping with individual stressors.
