ear Telehealth Infrastructure, Interop, Technology Platforms
- Telemedicine > Tech Review
- Telehealth platform Trends - seen as critical part
- Review of Fundamentals
- Cigna Teledoc $70 vs $20 regular visit - Not cool or chosen by many!
- Patient USP: Convenience for non-critical care
- Telemedicine and Disruption of Health Care and Trends
- Aging population
- Rapid growth of Telemedicine
- Patients Survey: 66% Would love the choice - but at what price?
- System/AI POV: Compatible with current methods of care - Clinical visits => Video visits
- Provider USP: Provides Telemedicine to extend reach and reduce cost/visit
- Mobile Tech How done
- Global Telehealth and Equitable Doctor Supply, Demand - Salaries
- Why Doctors deserve Good Salaries
- What is true supply and CAGR of Doctors
- Doctor shortage in Some States and All Rural Areas
- Comparing Doctor Salaries
- Doctor Salary Levels adds 10%+ to Health Care Spending
- Residency Cartel : Makes a Monopoly and Reduces supply of doctors
- Plans for Increasing Residency Seats - ASKING FOR MORE MONEY!
- Medical colleges limited seats used to be a bottleneck - but competition forced more openings!
- Residency Seats Capped by Lobbying from Doctors Associations
- PAs, NPs opposed by Doctors
- Health Care Technology: Mobile and Health Backend Consulting Companies
- Health Cloud Success Stories
- CVS Health Company
- Canopy Health
Telemedicine > Tech Review
h Home Technology
- Telemedicine for Home Repairs? - The New York Times
- Ready to Sell? Here’s How to Refresh Your Home During Lockdown - The New York Times
Core Conferencing - More secure than Zoom - meets HIPAA
Telehealth platform Trends - seen as critical part
Review of Fundamentals
Cigna Teledoc $70 vs $20 regular visit - Not cool or chosen by many!
Patient USP: Convenience for non-critical care
Video Visits feature allows members dealing with minor, non-emergency health issues to videoconference directly
Video Visits through the MyCanopyHealth app will create a streamlined patient experience where their members will have access to skilled providers without having to log in to a different app or program. - American Well platform - but probably doctors from IPAs.
Telemedicine and Disruption of Health Care and Trends
Aging populations globally drive demand for healthcare services higher and in affluent elderly convenience trumps it.
Rapid growth of Telemedicine
Telemedicine offers a less-expensive way to provide some of those services. Teladoc's industry leadership and its broad array of services should give it a solid competitive advantage in capitalizing on this opportunity. * Teladoc sees a 43% CAGR in Q1'19 with a big rise in membership and higher utilization of its services.
Patients Survey: 66% Would love the choice - but at what price?
While telehealth and videoconferencing have been available for years in the healthcare industry, more convenient, intuitive, and interactive platforms have increased patient interest and utilization. American Well’s 2017 Consumer Survey found that 66 percent of Americans are willing to have a virtual visit with a doctor and that 69 percent of all U.S. adults believe that virtual visits result in the most accurate diagnosis. https://www.americanwell.com/resources/telehealth-index-2017-consumer-survey-2/
System/AI POV: Compatible with current methods of care - Clinical visits => Video visits
Provider USP: Provides Telemedicine to extend reach and reduce cost/visit
Industry analysts estimate that members can save between $200 and $370 per appointment through Video Visits because they allow patients to move care to lower-cost settings and reduce unnecessary ancillary and follow-up care.
Mobile Tech How done
Canopy Health members must simply download the MyCanopyHealth mobile app from their smartphone’s app store and create an account. Once logged in, members have access to all the app’s digital features, including the Video Visits interface powered by American Well.
Video Visits feature allows members dealing with minor, non-emergency health issues to videoconference directly and in real-time with an experienced clinician who can assess their symptoms and determine next steps. Video Visit summaries are stored in the private and secure dashboard in the MyCanopyHealth mobile app and can be shared automatically with the member’s primary care physician.
Global Telehealth and Equitable Doctor Supply, Demand - Salaries
Why Doctors deserve Good Salaries
They are highly skilled professionals who save lives
Need to attract best. They have the brains
Need to work hard - A strong work ethic like doctors can to make lots of money in other sectors, like law or finance. On top of that, many work long hours
High cost of medical education - Doctors are saddled with lots of student debt after years of education.
What is true supply and CAGR of Doctors
The American Medical Association, one of the main organizations representing U.S. doctors, says the total number of doctors has more than quadrupled since 1965, greatly outpacing population growth.
Doctor shortage in Some States and All Rural Areas
There is a doctor shortage in many states.
Comparing Doctor Salaries
A 2011 study in Health Affairs found American doctors, who make an average salary of almost $300,000, are paid around twice as much as doctors in other rich countries.
Doctor Salary Levels adds 10%+ to Health Care Spending
The salaries of the roughly one million doctors in the U.S. account for about eight percent of total healthcare spending. .. Allowing an increased supply of doctors to lower their salaries to competitive levels would save Americans $100 billion a year — or roughly $300 per person. - Baker estimates
Residency Cartel : Makes a Monopoly and Reduces supply of doctors
A big reason why doctor salaries are so high is Cartel like rules that restrict the number of people who can get residencies. - Dean Baker, Senior Economist at the Center for Economic and Policy Research
U.S. residency system turns away thousands of perfectly qualified students every year.
Some growth in seats, but not enough. While the number of residencies has increased about 26% over the last decade, Baker and the Association of American Medical Colleges argues it's a bottleneck preventing an adequate supply of doctors.
These include many foreign doctors, who are barred from practicing here unless they complete a residency within the country.
Plans for Increasing Residency Seats - ASKING FOR MORE MONEY!
- On surface support, but in background restricting seats!
AMA talks up includes increasing the size and number of med schools and funding for residencies. https://www.ama-assn.org/press-center/press-releases/ama-builds-efforts-expand-funding-graduate-medical-education-0
AMA currently supports the Resident Physician Shortage Reduction Act of 2019, which would increase the number of Medicare-funded residency slots by 15,000 over five years. https://www.menendez.senate.gov/news-and-events/press/menendez-boozman-schumer-introduce-bipartisan-legislation-to-combat-doctor-shortage-as-crisis-worsens
Medical colleges limited seats used to be a bottleneck - but competition forced more openings!
A few years ago I looked at Kaiser's choices for selecting a doctor. It seemed 90%+ of "available" doctors accepting new patients were either freshly minted from South India after mandatory residencies in US, or from the Bahamas or "Doctors made in Central America/Mexico". On the other hand our pedaetrician etc. seemed to quit Kaiser after a few years. Suffice it to say, we as a family dropped Kaiser pretty soon after. Their rates were as high as any other, and had a vertical monopoly on all services rendered, yet doctors did not seem "esteemed" but rather "all our doctors are board certified".
POINT IS: The low end or cost-conscious health systems started scraping the bottom tier. In contrast Sutter Health, i.e. PAMF in the Peninsula had doctors from Stanford, UCSF, etc.
Residency Seats Capped by Lobbying from Doctors Associations
Most of the funding for residencies comes from the Medicare program, and Congress capped the number of residencies the program funds in 1997. "It was originally frozen as a response to lobbying from doctors who were complaining that there were too many doctors," - Baker
PAs, NPs opposed by Doctors
Similarly, trade groups for doctors have also been lobbying against allowing nurse practitioners, physician assistants and other medical professionals to play a larger role in treating patients. The result of policies like these, is a market with less competition, driving up prices for everyone. - Baker.
Health Care Technology: Mobile and Health Backend Consulting Companies
Health Cloud Success Stories
360-degree cloud AND mobile services solution
Canopy Health’s digital strategy could essentially be broken down into three critical signature moves, all of which leveraged Progress Health Cloud:
BRANDING/public website, for which Progress Health Cloud provides the provider and service ancillary directory
Web-based “Find a Doctor” application,
A suite of mobile applications, which are built on the Progress Health Cloud framework
SSO adapters to connect to Salesforce Identity, IBM Initiate and other services
A member portal, which uses the same architecture for Progress
Strategy to Sell into accounts
Need the most reliable and mature platform.
VISION. We also liked that Progress had a short-term and long-term vision for the healthcare space.”
TOOLS & DOCS. Progress Health Cloud has been developed and designed tools and documentation specifically for developers to accelerate development and maintenance
HAND HOLDING, SUPPORT When Canopy Health encountered some challenges with its identity access management solution, Progress created a proof-of-concept free of charge to help Canopy Health get through the issue.
PROVE COST SAVING S. Between initial development costs and application maintenance, Canopy Health estimates a cost savings of 70% using the platform.
360-degree - not single-point application.
RAPID DEVELOPMENT IN 6 WEEKS. Canopy Health has been able to improve development times significantly when compared to the industry average—the firm can develop hefty feature functions in as few as six weeks. Canopy has also sped up development from approximately 18-20 weeks using a traditional Waterfall approach to six weeks with Progress.
RAPID TWEAKS. Canopy's developers can make any urgent tweaks and adjustments to data as needed, which helps them be more agile.
Progress.com Health Cloud
Progress Kinvey (originally, Progress Health Cloud) was used to develop Canopy Health’s find a doctor, but but after realizing its strengths in the mobile development space, the solution became the heart of Canopy Health’s digital strategy.
Canopy Health Use Case transitioning to Progress Health Cloud,
Mobile apps are critical to solution - not just EHR or Cloud. The challenge is two-fold:
Developing mobile apps is difficult due to the sheer number of different operating systems and platform specifications. Building an application with a good user experience across all of these platforms requires a lot of time and energy.
Even once the application has been developed, maintaining an application across multiple platforms is still difficult and cumbersome.
With the increase in demand and popularity of telehealth, Canopy Health sought an advanced, forward-thinking technology partner to bring their MyCanopyHealth mobile app feature Video Visits to reality. We’re very excited about the launch of MyCanopyHealth, our new mobile app for Canopy Health members .. One of the stand-out features is a telehealth option we call Video Visits, which is powered by American Well. - Cathy Farmer, Director of Mobile and Web Delivery at Canopy Health and Program Manager for Digital Strategy and Implementation, Canopy Health. - “We were trying to find an mBaaS platform that would help us accelerate and standardize development across all of these different architectures,” explained Pamela Hudson, Chief Information Officer, Canopy Health. “After doing our research, Progress was the
[TOC] # Health Care Provider Network Innovation
CVS Health Company
PBM - Mail Order integration - but conflict of interest
HealthHubs - transforming Pharmacy Stores to Full-Stack Provider Care
Called HealthHUBs, the stores boast more health services and products like blood testing and sleep apnea machines. It said it would add 1,500 HealthHUBs by the end of 2021.
CVS hopes that after its expensive $70b acquisition of Aetna, by combining drugstores, pharmacy benefits and health insurance, it can better tailor its stores to treat chronic diseases and other costly conditions, improve the stores’ performance and lower health-care costs.
“We can address the chronic disease patients of Aetna, lower medical costs and serve customers better than they’re currently being served" - CVS President
## HealthHubs concentrated in existing Aetna areas, with heavier Chronic disease burdens
Newer stores will emphasize places where Aetna members live and where CVS already has clinics.
Will try to sell to other health Insurers - add to their networks, and Tailor to Demographics there
In a community with a large Medicaid population might offer more health services than products since those communities tend to lack primary care services.
Younger area with a large population of new mothers might use the HealthHUBs’ new wellness rooms to host classes before and after birth. Or a store in a place with many senior citizens might host bingo and mental games to tackle social isolation or memory acuity.
In the existing HealthHUBs, Hourican said CVS has seen increases in foot traffic, MinuteClinic visits, prescriptions dispensed and sales of products in the front of the stores since remodeling the stores. People are starting to visit the clinics for chronic disease management, particularly diabetes, instead of the typical cough or flu visit, he said.
About - IPAs, UCSF join-up
A physician- and hospital-owned medical alliance that focuses on delivering a refreshing approach to healthcare and providing transparent, affordable care from exceptional physicians.
Canopy Health’s mission is to reinvent healthcare in the Bay Area and meet the needs of its members.
With a goal of building its network up from its current 15,000 members to 250,000+ members, Canopy will need to provide the best digital healthcare experience in the Bay Area and Progress Health Cloud is a big part of that.
With the increase in demand and popularity of telehealth, Canopy Health sought an advanced, forward-thinking technology partner to bring their MyCanopyHealth mobile app feature Video Visits to reality. We’re very excited about the launch of MyCanopyHealth, our new mobile app for Canopy Health members .. One of the stand-out features is a telehealth option we call Video Visits, which is powered by American Well. - Cathy Farmer, Director of Mobile and Web Delivery at Canopy Health.
Incorporated in March 2015 as an affiliation between UCSF Health and John Muir Health, Canopy Health aims to provide a top-quality continuum of care across the San Francisco Bay Area through partnerships with primary care providers, community hospitals, top-tier academic medical facilities, and medical groups.
In addition to its founding members, Canopy Health currently includes four physician groups — Hill Physicians Medical Group, John Muir Health Physician Network, Meritage Medical Network, and Santa Clara County IPA (SCCIPA). Canopy Health also includes 18 participating medical centers across eight Bay Area counties — including Alameda, Contra Costa, Marin, San Francisco, San Mateo, Santa Clara, Solano, and Sonoma.