This Month in Digital Health: It’s All About the Benjamins

Welcome to This Month in Digital Health, where I’m carrying over the format from September and providing a deeper dive into a few topics, as opposed to an awkward shallow foot-first jump into several topics. Money caught my eye this time around, either directly (the cost of care, where folks are investing) or indirectly (one state’s plan to make care more accessible and therefore more affordable).

Healthcare wants to invest wisely in technology and buildings

From the No Kidding Department, healthcare organizations want measurable ROI from IT investments. In practice, that means focusing on administrative processes such as revenue cycle management and patient engagement. (They mean the part that involves supporting care management through outreach in between appointments, not the drafting of care plans or stuff like that, for my patient engagement peeps.) They’re also prioritizing solutions that work with what they already have – which may be good news for Oracle’s all-in push to integrate EHR, ERP, and all its other enterprise systems before it loses all its customers to Epic or MEDITECH.

My take: These reports are never all that surprising. At the same time, given the graveyard of pilot projects in purgatory at most large health systems, most of us take them with a few grains of salt. That said, signs also point to health systems rethinking capital spending amid technology adoption and macroeconomic trends, along with the omnipresent desire to shift care away from the emergency department. (Whether the intention is to truly reduce the cost of care or simply shift it somewhere else is something only executives can answer after looking deep within their own hearts.)

Anyway, I wouldn’t be surprised if most healthcare orgs do take a more pragmatic approach to IT spending. Sadly, as is often the case, that may mean bad news for patients; the ROI for meaningful efforts to improve, say, outcomes for patients with chronic conditions often takes longer than either the shelf life of the vendor contract or the tenure of the executive champion for the implementation. Providers also tend to need insurer champions, too – and as you’ll read below, those relationships are a bit sour these days.

Despite objections, Utah leans into AI for prescriptions

Earlier this year, Utah and Doctronic partnered to use AI to renew certain prescriptions for patients with chronic conditions in a first-of-its-kind arrangement in the United States. The state has since added August AI as a partner for prescription renewals, named Nolla Health as a partner for initial AI prescriptions for acne treatment based on a patient’s selfies, and selected Expert Fitness as a virtual pelvic floor therapy partner. Not surprisingly, this has reignited a debate about AI’s role in the practice of medicine, even if more than 80% of physicians already use AI in their day-to-day work.

My take: Results of the initial Utah-Doctronic pilot showed that reviewing physicians found the AI renewal authorization appropriate in 97% of cases. (More than 90% were approved the first time; the others were approved when a second physician reviewed the initial reviewer’s request for additional information.) For renewing existing prescriptions, that very well could be an acceptable rate, as it means physicians only need to intervene for fewer than 1 in 10 patients.

The dermatology use case kinda sorta makes sense to me.

• That specialty has been an early and eager adopter of asynchronous telemedicine; I for one have had pink eye and allergies diagnosed from photographs alone.
• One could reasonably argue that acne treatment is a relatively low-stakes scenario, as there’s a low likelihood of severe side effects or contraindications compared to other conditions.
• It’s totally optional, so patients who aren’t feeling it can submit photos through a portal or schedule an old-fashioned in-person appointment.
• Demand is bound to be high; I’d hardly blame anyone of any age for seeking quick relief for acne on their face.

It’s definitely a leap forward for removing the human in the loop, but healthcare has to start somewhere. This use case might as well be it.

Insurance costs are going up, and no one can be bothered to do anything about it

You already know that healthcare costs too damn much. Costs for employer-sponsored plans are due to increase more than 8% next year, and many small businesses have opted to drop healthcare coverage. As costs rise, more than 25% of Americans owe medical debt, and that’s before next year’s Medicaid cuts, work requirements, and eligibility changes kick in fully. Medicare Advantage isn’t doing much better, as carriers are making seniors pay more and/or trimming benefits and/or exiting markets where profitability is low.

The issue is more nuanced than it seems. One paper found that, by and large, healthcare premiums are going up because healthcare costs are going up, not (entirely) because insurance executives are raising rates and swimming in bathtubs of money like Scrooge McDuck. Another paper found that provider-sponsored plans are better at negotiating prices, ostensibly because they’re negotiating with themselves, though more than a few are shutting down. Good times.

My take: In a less imperfect world, insurers and providers would be coming together to discuss how rising prices impact the individuals they’ve taken an oath to serve and have meaningful conversations about driving down costs. (You know, the stuff their executives always talk about when they share the stage at big healthcare conferences.) Instead, they’re getting into fights about whether providers’ AI agents are upcoding medical procedures so they can get paid more – and doing so because insurers’ AI agents keep denying their claims for opaque reasons. Since they’re clearly not interested in solving the problem on their own, and since the problem of rising process clearly hasn’t solved itself, I think we’re overdue for a large-scale intervention.

Some other interesting news

• Healthcare Brew interviewed one of the authors of a nature health paper about their research into using EHR data to get a glimpse into real-time public health data – in this case, ED visits attributable to heat waves. Being able to identify patients potentially vulnerable to heat offers an opportunity for proactive outreach to, say, make sure they get medications renewed before extreme heat sets in.
• Healthcare IT News posted a two–part series on asynchronous telehealth, which is arguably poised to see a surge in interest amid the one-two punch of increased demand for remote / chronic condition monitoring and decreased availability of clinical professionals. Vital as it may prove to be, the model will only work if clinicians and their employers actually get paid.