Tag: Digital health

This Month in Digital Health: Confirming Things We Already Knew

~ iambeastwood ~ 1 Comment

Welcome to This Month in Digital Health. Here, I highlight news articles and trends that recently caught my attention and attempt to explain why they matter. The main theme for the last few weeks has been reports and stories confirming things we already knew – which is still important, because it always helps to hammer home the message.

AI is complicated. AI was a big talking point at HLTH, what with the AMA announcing its Center for Digital Health and AI (to develop policy and training resources, among other things) and the Cleveland Clinic CEO saying AI is necessary for solving big problems like access to affordable care. Easier said than done, though, as 49% of orgs are seeing AI innovation delayed, while AI’s many ethical issues resemble a can repeatedly kicked down the road and healthcare’s slow sales cycles leave AI vendors waiting for the check to come in the mail.

Insurers aren’t popular. Forrester found only 54% of consumers view health insurers are trustworthy, and only 53% understand claims decisions. Insurers are trying to curry favor by streamlining prior authorization, though most consumers said they’ll believe it when they see it. It certainly doesn’t help that 60% of consumers blame insurers for medical debt and 70% say healthcare is unaffordable – a problem that will get worse before it gets better.

Everyone wants ROI. Not everyone gets it. Half of digital health purchasers use performance-based contracts; the Peterson Health Technology Institute expects that number to rise as health plans, hospitals, and employers scrutinize contracts to ensure they deliver value. When it comes to virtual care, fewer than 30% of providers earn significant ROI, as Healthcare Dive put it, citing Sage Growth Partners. That might explain why Amwell is mulling the sale of legacy assets that aren’t part of its virtual care platform.

Private equity likes money. Two fairly damning reports from Health Affairs illustrate what private equity’s doing to healthcare. One found hospice facilities owned by PE had higher profits and lower per-patient spending compared to other ownership models, and another found specialists affiliated with PE negotiated higher prices than independent physicians. Mind you, other for-profit entities exist in healthcare, and non-profits don’t always hold up their end of the bargain; it’s still not a good look.

Other things we already knew or saw coming from miles away:

That’s all for now. Tune in next month to see if the trends are more of the same.

Scheduling a Colonoscopy Shouldn’t Be This Hard

close up photo of a stethoscope
~ iambeastwood ~ Leave a comment

I recently hit a milestone birthday. Depending on whom you ask, I’m either “has a slightly better chance of qualifying for the Boston Marathon” years old or “needs to schedule a preventive colonoscopy” years old.

Fortunately, my patient portal happily reminded me of the latter. (I won’t say which portal it is, but I will say it rhymes with “Chai Mart.”) My portal even went a step further and surfaced a Request Appointment button.

“Hooray!” I said to myself as a classic borderline Gen X / millennial who likes talking to a stranger on the phone about as much as, well, getting a colonoscopy. I eagerly clicked the button.

My portal gave me three options for scheduling the procedure: My current PCP, my previous PCP, and my podiatrist. Now, all three are good doctors and lovely people – and not the least bit qualified to give me a colonoscopy.

There’s a cost of being too convenient

For years, keynote speakers have talked about making healthcare more convenient, much like many other industries. If you can order a burrito or plane ticket from your phone, the argument goes, then why not schedule an appointment?

I’d argue, though, that being too convenient does a disservice to the healthcare organization and the consumer / patient. The portal isn’t the ideal place to give patients free rein to schedule an appointment with anyone within a provider network, especially one as large as mine. (Again, I won’t name it, but it’s the one based in the Boston area that likes to spend a lot on both rebranding and construction projects.)

Limiting that functionality to providers with whom a patient has an established relationship is annoying, but it’s also a sensible business practice. What’s the business value of not just suggesting but making it possible for patients to do something they simply can’t and shouldn’t do?

If I tried to schedule a colonoscopy with any of those providers from the portal, it would probably trigger a six-step workflow that ends in some poor administrative staffer calling me when they should be eating lunch to recite a phone number that I could find after approximately 3 seconds of sleuthing online. (Finding the page with the phone number is one thing; scheduling the appointment is another. It took a while, but I got it done.)

More isn’t better, especially when it gets messy

I went through this experience as I started in earnest on my next eBook, which attempts to unpack the long and winding road for patient engagement technology over the last 10 years. (The timeline is only somewhat arbitrary; I made the move from journalist to research analyst in June 2015.)

There’s a duality at play here. On one hand, technology such as the portal is a lot better than it was a decade ago. It’s possible to schedule (some) appointments, log in for video visits, communicate with providers, view test results, and even link records from external sources such as your pharmacy. Each of those tasks used to require a different application or website, along with some combination of phone calls, CDs, faxes, and expletives. Some of this stemmed from portals developing these features natively; in other cases, they acquired the functionality from a once-burgeoning ecosystem of patient engagement point solutions.

On the other hand, there’s still a long way to go. For starters, more isn’t necessarily better. Just because I can do all that in my portal doesn’t mean I should, or that I want to. In fact, seeing a list of 20-odd things I can do is quite intimidating, especially if I’ve logged in with a very specific task in mind.

In addition, though there are clear benefits to having far fewer point solutions for patient engagement, we’ve lost a little bit along the way. For good or ill, those products were purpose-built to solve a single problem. They become homogenized once they’re folded into a portal trying to serve the needs of a patient population that may number in the millions.

The third issue is the general messiness of patient workflows. Effective technology needs automation, and automation is extremely challenging when workflows differ for quite literally every end user. Case in point: I called Large Affiliated Boston Hospital No. 1 to schedule my colonoscopy, only to find out my PCP has placed the order at Large Affiliated Boston Hospital No. 2, which then set up my procedure at Affiliated Boston-Area Outpatient Facility No. 13-A. (I think it’s near a Wegman’s. I may go there for lunch.)

Stop ignoring small problems with easy fixes, please

Here’s the thing. We can accept (albeit begrudgingly) that the workflow above is bewildering, and unlikely to be made simpler without systemic change irrespective of what technology is in place. But why do we have to accept that smaller problems with easier solutions have been largely ignored?

Let’s go back to the “Schedule a Colonoscopy” kerfuffle within the portal. If a patient clearly cannot go through with the workflow – in my case, not being able to receive a clinical service from my current roster of providers – then why not make that “Schedule” button go away? Or, leave it there but make it point to a page that says, “Hey, to schedule this procedure, you need to call this number?” Heck, I’d wager an error page would be preferrable for most users than a prompt to do something that’s straight up not possible. At least that way, the patient and the person they inevitably have to call on the phone can have a hearty guffaw at how the $1.2 billion EHR implementation can’t do something that’s laughingly basic and also a well-accepted clinical recommendation.

Is it extra custom coding? Yes. Is it difficult custom coding? At the risk of sounding like an overconfident and mediocre middle-aged white dude, I’m guessing it probably takes less time than it would take the provider organization and EHR vendor to get on the phone and argue over who, under their contract, is responsible for completing such work.

I know the industry isn’t going to solve the patient engagement problem quickly, with existing technology, and/or for the majority of patients, especially given the current reimbursement and regulatory environment for preventive care and the general state of balance sheets for digital health companies. Plus, let’s be honest: From patients getting kicked off insurance to funding streams drying up to the basic tenets of science and medicine facing an all-out assault, the industry has bigger fish to fry than ensuring a fairly seamless colonoscopy-scheduling experience for overconfident and mediocre middle-aged white dudes.

Still, when you hear leaders at all levels at all healthcare stakeholders talk about focusing on the proverbial low-hanging fruit in improving the patient experience – small fixes that could have a big impact – it’s hard to look at examples like this one and wonder why no one’s bothered to look under the hood.

The Beastwood Files: January(ish) 2025

~ iambeastwood ~ Leave a comment

Well, the New Year kicked off without much of a hitch, and then some sort of lovely crud hit our household at the end of January. Luckily, none of us were sick for more than a couple days – apparently vaccines work??!? – though it was enough to throw off the ol’ schedule I made up for myself to publish these posts and keep the masses happy. So it goes.

Things I Wrote

Updates on Goals

  • Still working on the eBook, though the first draft is finished now. Haven’t gotten started on the new website. Did book a sitting for new headshots. Now need to get a haircut – and the cash to pay for it.
  • Running was going quite well until first my son and then I came down with whatever cold/flu we had. Hot sauce consumption has sadly levelled of, though I imagine it might help with the congestion. Or hurt. On second thought…

Stuff I Read

  • When I wasn’t getting equal parts frustrated and sad about the state of our country, I came across a not-terribly-scientific “study” suggesting Boston is the best U.S. city for introverts. This is based on our proliferation of libraries, coffee shops, and hybrid jobs. Add to that my favorite hobbies (running and hiking) and I don’t think I’ve ever felt more closely aligned to a stereotype or a place.

Adventures in Fatherhood

  • Lately, my son has gotten into just randomly saying “potty,” as one does. My response is to pretend he said “party,” loudly ask “IS IT PARTY TIME?” and then dance like the awkward middle-aged white man that I am. He does not like that.
  • Also, he would like you to know I am a Bad Dad. Why? On three (3) successive evenings, I got the temperature of the bath water wrong. On the upside, we now have a new favorite funny word: Lukewarm. “It’s when your friend Luke isn’t hot.”
  • We have discovered the Museum of Science in Boston – specifically, the room with the rotating exhibit. For the holidays, there was a model train, which of course we went to see more than once. Our aim in going back? “I want to see what’s where the trains were.” It helps that the cafeteria sells ice cream and croissants and has a view of the Red Line.

Happy February, everyone. In between your sneezes, keep fighting.

Digital health’s dilemma: There ain’t gonna be any middle (sized hospitals) any more

~ iambeastwood ~ Leave a comment

Between ViVE and HIMSS, much of healthcare IT has spent the waning days of winter perusing rows of vendors in expo halls. As the digital health market has matured over the last few years, the shiny objects on display seem to be fewer and farther between. Companies that were selling overvalued vaporware are increasingly disappearing, either going out of business or (much like my old, beloved Honda Fit) getting acquired for the technological equivalent of spare parts.

At the same time, and not necessarily coincidentally, investors and health systems alike have become savvier buyers. They have a far better understanding of what digital health products they actually need, as opposed to the products that look good in a pitch deck but will only add clinical, operational, or technical complexity. The side eye the industry is giving generative AI is a good example of this: Executives are happy to automate payment processing or clinical documentation, but they maintain healthy skepticism about most other use cases.

This maturation of the market is a good thing. Health system buyers are a lot less likely to get fooled, and they’re a lot more likely to get something that complements – if not directly integrates with – the clinical systems and workflows they already have in place. Meanwhile, the products that pass the test continue to get noticed. Instead of playing 4D chess to convince the market they’re The Next Big Thing, they can just explain what they do and why customers choose them. In other words, they can let the results speak for themselves.

That said, I worry the market for digital health vendors to sell to is shrinking. One reason is increased competition. As market-leading products gets better, those around them strive to improve as well. (I wish the 2024 Boston Red Sox were taking this lesson to heart, but that’s another topic for another day.) As the also-rans burn out or fade away, the bar gets higher for everyone else.

Smart vendors will be able to respond to competitive threats. They always have. I’m not sure they can respond as well to the other challenge that’s looming: A shrinking customer base.

Everything’s bigger in enterprise IT

There are oodles (official, technical term) of categories of digital health vendors who find themselves essentially competing with technology giants. Epic is beefing up analytics. Microsoft is pumping resources into ambient clinical voice. Google is striving to be a longitudinal patient record, among other things. Oracle is trying to bridge gaps between EHR and non-clinical systems like ERP. Everyone’s focusing on process automation.

Large hospital systems have longstanding relationships with these big vendors. They can support the scale of their implementations, not to mention the computing needs of their research efforts. It’s a lot easier for them to add a few line items to an existing contract for a new product (even if it costs more) than it is to ramp up a pilot with an unproven (to them) product.

In fact, a recent report from KLAS and UPMC found 70% of health systems are planning to adopt AI tools from their incumbent EHR vendors. That’s bad news for anyone pitching a standalone AI solution, no matter how firmly founders believe they are uniquely positioned to solve a problem . Plus, as an experienced developer put it on Twitter, incumbent vendors know their customers’ needs a lot better than a startup that can only speculate from afar.

On the other hand, small hospital systems (especially in rural areas) are literally trying to keep the lights on. They’d be interested in automating RCM if they had an actual IT department instead of two Help Desk employees trading morning and evening shifts. They’d be interested in SDoH data ingestion if there was a qualified data scientist living within 100 miles willing to accept a nonprofit’s salary. They’d be interested in a digital front door that increases acquisition and retention rates if they weren’t losing money on every new patient they got.

A shrinking customer base

That leaves digital health vendors to compete for the middle: The hospitals that aren’t too small to fear going out of business in a few months and aren’t too big to already have massive contracts with Big Tech in hand. These are great organizations to pitch. By and large, they know they have work to do, they’re committed to changing for the better, and they’re willing to take a chance on scrappy startups that remind them a lot of themselves.

The problem, to borrow from Pearl Jam’s “Porch,” is that market trends suggest there ain’t gonna be any middle any more. The uncertain future of the small, independent hospital has left many leaders to consider acquisition as the only option for staying open.

That will leave digital health vendors in a bind. Small hospital systems may fall in love with scrappy startups and their solution for any number of operational efficiencies, but their new corporate overlords are going to want everyone on the same enterprise-ready system. After all, it’s easier to manage one vendor and optimize one system than it it to juggle a dozen, especially if the software is merely adjacent to something as integral to operations as EHR, imaging, or RCM.

Ultimately, and unfortunately, it’s not going to matter how good the digital health solution may be. Unless the company is doing something truly transformational, it’s likely to lose out to the incumbent that has already shown executives it can deliver what it promised – or has enough leverage to walk away altogether if a customer is contemplating a standalone solution instead of turning on the incumbent vendor’s module that, philosophically if not technically, does the same thing.

Possible paths forward

I feel like this scenario leaves digital health companies with four paths forward.

Get in an enterprise app store and pray. This seems like a common strategy. On the face of it, it makes sense. Once potential customers see that you integrate with what they already have, your value proposition is a lot easier to prove. The challenge is making sure the new App Store Certified badges on your website don’t lead to complacency. Even if you’re the first vendor in your given market category (more on that later), others are sure to follow. The bigger danger with complacency, though, is that there’s no guarantee your gracious app store host isn’t thinking about how it can develop the same technology right into its application and, in a release cycle or two, quietly no longer have a need for you. (After all, as noted, most IT teams would rather manage another module for an existing application than a brand-new one, even if the new one is better, faster, stronger, etc.)

Get acquired by Big Tech. Hey, if you can’t beat ’em, join ’em. This route seems to make the most sense for companies that have done about as much as they can with the product they have without turning into a consulting firm. Offering services is a lot different than offering products. Even mature, grounded startups will struggle to compete – not just against standalone consultancies but also the armies of implementation specialists that Big Tech employs. Of course, it may be difficult for a company to admit it doesn’t have much left in the tank and is ready to be sold, especially if its founder is still heavily involved in day-to-day operations. (Then again, issuing minor improvements in multiple product releases in a row isn’t going to wow many customers, especially if they start to see Big Tech catching up to you.)

Stand your ground in a niche. Those vendor lists routinely published by CB Insights, KLAS Research, and the like are chock full of healthcare technology sub-markets. Sure, anyone with enough marketing money can create their own category. However, the bigger picture is a point that people smarter than me have made several times: Healthcare is in fact hundreds of billion-dollar markets, in large part because there are hundreds of processes that need to be optimized and modernized. Becoming a leader in a single niche – instead of, say, reinventing medical records or claims processing – may be a better recipe for success. (The challenge is if the niche turns out to be too small, as we’re seeing with a lot of condition-specific care management products. Even if they’re end-to-end, and even if they demonstrate fantastic outcomes, their value is sadly quite limited to a single condition.)

See what you can offer to other markets. This is admittedly contrary to my previous point, but there are certain healthcare problems – stuff like data aggregation, enrollment, engagement, and billing – that transcend the industry’s various vertical markets. (Here, I’m thinking provider, payer, integrated provider-payer, pharmacy, pharmaceutical, retail health, urgent care, and telehealth.) This is tricky: The value proposition for each healthcare vertical is different, as is the overall readiness and willingness to address the given problem. At the same time, if a digital health company can convince multiple stakeholders already working together that it has the chops to solve a shared problem, then it has a pretty compelling case to make for the larger market. (The key is already working together: Get the larger stakeholders to advocate for you on your behalf. That way, you already have a foot in the door and a cup of coffee waiting for you.)

It’s all about priorities

There’s no right answer for what those oodles of digital health vendors ought to do. Nor do the options outlined above guarantee success. Aiming to be acquired may look good on paper, but at a time when companies seem willing to lay off like 10% of workers before they can finish breakfast, eliminating the proverbial redundancies following a merger will be horrible for current morale and future recruiting.

Or, take pivoting into another market. Life science seems like a safe bet, as most firms are flush with cash and are crying out for more insight into patient needs and wants throughout the drug development life cycle. But can you support workflows that are likely unfamiliar to you – and can you add value above and beyond what the dozens of data aggregators targeting this market are already doing? Retail health and brick-and-mortar urgent care seemed like a safe bet, too, but then everyone realized it was not, in fact, magically profitable to create a brand-new entry point into the care delivery system two aisles over from the celebrity gossip magazines. (Everyone, that is, except the skeptics shouting that from the very beginning. Admittedly, I wasn’t one of them.)

As this is a free blog, I’m not a paid consultant, and my master’s degree is in history and not business administration, I can conclude with wishy-washy statements. If you’re a digital health vendor staring down your future, here’s my advice to you: Try to figure out what’s right for your company, your customers, your technology, and your people – and also figure out in what order you prioritize those four things. I doubt this will be easy, but I think it will help companies make an exit on their own terms.