Ramping up for HIMSS 2012

It’s hard to believe that HIMSS 2012 is just around the corner.  As we look ahead amid the consolidation and investment opportunities in healthcare, if you are at HIMSS this year and would like to exchange perspectives on the industry or bring us up to speed on your progress for the year, please let us know.

Here is what’s on our radar related to our research and advisor agenda for the year.

• Why ‘consumerism’ is impacting healthcare delivery models at an unprecedented pace
• How mobile applications are key tools for navigating a ‘B2C shift’ in healthcare
• Where innovations are evolving quickly to meet the demographic shift of seniors
• How productivity tied to health is a growing focus for employers
• Why compliance-centric issues ranging from payment integrity to improved patient outcomes are dominating many health care cost debates
• How the shift toward ACOs and Medical homes is radically altering care delivery models
• The impacts of ‘life beyond the EMR’ as more granular clinical documentation will substantially increase risks associated with reimbursement, compliance, and productivity.
• How healthcare is being driven by data and analytics to build a more complete picture of a patient
• Where the pharma market is shifting away from paper-based systems and processes and calling for innovations that reduce cost across the clinical development landscape

Let us know what you’re thinking about…see you at HIMSS in a few weeks!

Chris Hoffmann

Chris Hoffmann is a Senior Director at TripleTree covering ‘consumerism’ and where legacy and edge technologies are impacting healthcare. Follow Chris on Twitter or e-mail him at choffmann@triple-tree.com.

Read Full Post »

Consumer Directed Health to Social Media…’Consumerism’ Has Become the Undeniable Force in Healthcare

Healthcare can no longer deny nor ignore the importance of social media.  As a communication platform, it’s being used to educate, engage and empower consumers about topics ranging from legislation, hospital rankings, and ER wait times, to patient satisfaction, chronic illness management and health improvement.  Collaborative applications around seeking, sorting, assessing and ranking health information and experience have become part of our connected culture.

As “consumerism” increasingly impacts the healthcare landscape – payers, providers and other healthcare stakeholders are investing in technologies ranging from collaboration and contact center tools, to next generation video and self service platforms.  Consumerism is forcing these organizations to change their cultural barriers to how customer interactions need to be supported, and the pace of legislative mandates is exposing the healthcare information systems that can’t nimbly react to creating new products, or support online conversations.

Blogger Ed Bennet tracks 1,188 hospitals which are proving their seriousness about social media usage as they update:

• 548 YouTube Channels
• 1018 Facebook pages
• 788 Twitter Accounts
• 458 LinkedIn Accounts
• 913 Foursquare
• 137 Blogs

The impact of social media in healthcare goes beyond just an inexpensive channel that targets consumers.  Social media is fundamentally changing how payers, providers, and healthcare stakeholders manage their brand and influence purchasing decisions.

• For payers its managing customer service touch points through insurance exchanges, one of the few ways for them to maintain loyalty.

• For providers its connecting care providers with patients and is no longer about a gadget or app, but for measurable opportunities to share knowledge, build loyalty and improve processes that can influence how they manage care and patient relationships.

• For other healthcare stakeholders it’s supporting their brand and customer interactions with thoughtful, engaged support allowing for the ability to listen in on conversations already occurring about the industry, products, news, issues, etc.

Social media is a powerful source of information for consumers, and an equally powerful communication channel for providers of health information and support services.  For payers, providers and other healthcare stakeholders, TripleTree considers social media the lowest cost enabler of consumerism with a technical heritage linking it to cloud-based CRM and collaboration platforms.  In addition, social media is a cornerstone for marketing and branding initiatives in many industries.   With social media in healthcare, the old models for marketing, sales and service have been transformed.

Let us know what you think.

Chris Hoffmann

Chris Hoffmann is a Senior Director at TripleTree covering Cloud, SaaS and enterprise applications and specializes in CRM, loyalty and collaboration solutions across numerous industries. Follow Chris on Twitter or e-mail him at choffmann@triple-tree.com.

Read Full Post »

5 MD’s, 4 CEO’s, a PhD and a CIO agree on “what”, they’re now focused on “how”

Last Friday, the TripleTree Health Executive Roundtable (HER) convened for their annual discussion and debate on this year’s theme…consumerism in health care in a post reform world.  In the spirit of giving you, our faithful reader, a glimpse into the upcoming research report from the HER, below I’ve summarized some of the opinions expressed during our day and a half gathering.

• Patients as consumers are emerging from being an afterthought to center stage…
  • “Getting consumers to understand price and its relationship to quality and value is important”
  • “In order to achieve customer loyalty, we must find a way to individualize care”
  • “Trust is key in driving change of consumers”
  • “Business focus is tough if the consumer isn’t at the center of decision making”

• Current health care models support (and create) dysfunction and call for innovation…
  • “Physicians are only paid through the tyranny of the office visit”
  • “Managed Care neither manages nor cares”
  • “Unfortunately, our current reimbursement model is inefficient, yet is at the center meaningful changes for patients to become consumers”

• For electronic health records (EHRs) and other technologies, start with the end in mind..
  • “EHRs must get the right info into the right hands, but there is no consensus on what that info is and that is where the question of purpose”
  • “It a stretch to think that technology alone will change practice, culture trumps strategy”
  • “Technology is ahead of the change curve and misaligned with reality”
  • “ICD-10 is akin to ‘academics gone wild’”

Needless to say, we witnessed a spirited and opinion filled day-and-a-half session!

While it’s not controversial to opine that innovation in health care is a fragmented pursuit, and as our roundtable focused on how best practices from financial services, retail and media can be applied to consumerism in health care; the often cited hurdles of reimbursement and physician-patient-payer connectedness remained as massive hurdles.

We will publish the collective viewpoints on consumerism in healthcare from our HER this quarter, including companion video interviews bringing each individual opinion to life.  We’ll host both on our web site, and would be happy to send you the link when published.  Let us know if you would like a copy of the report and have a great week!

Joanna Roth

Joanna Roth is a Senior Analyst at TripleTree covering the healthcare and technology industry, specializing in education solutions. Follow Joanna on Twitter or e-mail her at jroth@triple-tree.com.

Read Full Post »

TripleTree, LLC Advises Connextions in Sale to OptumHealth

Year to date, we’ve used the tag “consumerism” several times to reference innovation and consolidation where health care payers and providers are yielding control to consumers regarding more control in healthcare decision making.

TripleTree research is often brought to life through our deal flow, and we were pleased last week to announce that our client Connextions, announced its acquisition by OptumHealth – a seminal illustration of why consumerism in healthcare is so relevant.

Click here to read the full press release.

Carriers, providers, employers and other healthcare stakeholders are realizing that optimizing customer experience needs to become a critical component to their service delivery platforms.

The Connextions platform and use of analytics around member behaviors have created a unique acquisition, retention and up-sell platform for top carriers in the U.S., and a growing number of public and private hosts of insurance exchanges.

Click here to learn more about TripleTree’s perspectives on the impacts of consumerism and look for future research from our team on Seniors, Informatics, ACOs, Consumer Engagement and Social Media – all topics where consumerism is a key undercurrent.

Have a great week!

Chris Hoffmann

Chris Hoffmann is a Senior Director at TripleTree covering Cloud, SaaS and enterprise applications and specializes in CRM, loyalty and collaboration solutions across numerous industries. Follow Chris on Twitter or e-mail him at choffmann@triple-tree.com.

Read Full Post »

Successful M&A Exits in the Consumer Healthcare Device Market

Consumer healthcare devices are everywhere. They help people track physical activity, measure caloric intake, and play a vital role in personal health and wellness achievements.  Driven by consumer engagement, technology proliferation and a billion dollar-plus market opportunity – investors are pouring millions of dollars into this market with the hopes of a big return (see examples below).  Public exits (IPOs) are tough, so the path to liquidity for many of these firms will be acquisition.

• $70 million raised by Bluetooth headset maker to enter health monitoring market.
• $50 million raised by mobile consumer focused diabetes management system.
• Best Buy invests in mobile fitness ear bud technology.

Few companies have yet reached a size and adoption threshold to be deemed a success, but as the winners emerge product design, value proposition, access to customers, defensible intellectual properly and ability to integrate will factor into their strategic paths. Here is a check list for the CEOs who are considering an exit in the next 8-10 quarters:

• Competition – Separating from the pack of consumer health device companies is difficult.  There are dozens of credible companies and scores of wannabes (100+ according to our market definition).  While most of companies in this category are below $15 million in annual revenue, the strongest players have venture backing, cash reserves and relevant consumer and healthcare experience sitting on their Board.

• Customer Adoption – Consumers are tough critics and prone to device abandonment.  Winners in this category with figure out how to provide a consumer health device that is easy to use, convenient, and effective.  Also, given that consumer health devices today attract a narrow user based, successful vendors will figure out a way to expand adoption and find a broader audience of which to market and sell its product.

• Distribution – Signing a big distribution deal can be the best way to gain quick, sustainable market exposure. For these vendors it can be a great way to develop a strong, sustainable partnership that could lead to M&A down the road if the partnership is successful. Especially in the consumer market these major distribution channels can make or break a business in the early innings.  Acquirers will look for devices that can be sold effectively through multiple channels. Winners will maintain a broader sales strategy and not become dependent on a single distributor, which makes the business susceptible to channel risk and unattractive for a premium M&A event.

• Finding the Right Business Model – This is the biggest stumbling block for most consumer healthcare device companies.   In most cases, larger companies are less acquisitive when a business cannot demonstrate a scaleable business model.  Many vendors in this space simply want to achieve user adoption at the expense of a longer-term revenue plan, when they should be thinking about keeping customers over a five year (or longer) period.

• Recurring R&D costs – Companies in this market must continuously re-invent themselves with smaller, sleeker devices.  This can be the most taxing aspect of the market and certainly hurts a company’s chances of becoming highly profitable, especially when they are investing in growth.  Manageable cost structures, vertically integrated manufacturing models, web-based user interfaces and other features are all relevant to a complete product experience.

TripleTree has monitored the consumer health devices space for years and we’re bullish about the prospects for continued innovation and growth.  We’re watching the emerging companies address consumerism in thoughtful and innovative ways and look forward to watching the evolving strategic relationships between these innovators and global players.

Let us know if you have additional thoughts on this market or a different perspective.

Michael Boardman

Michael Boardman is an associate at TripleTree covering the healthcare and technology industries, specializing in clinical software solutions.  Follow Michael on Twitter or e-mail him at mboardman@triple-tree.com.

Read Full Post »

Viewing Healthcare Consumerism through another Lens (pun intended)

As a senior analyst for a research based investment bank, it shouldn’t be surprising when personal health experiences and areas of focus for our strategic advisory practice collide.

With increasing frequency, TripleTree is discovering thriving healthcare solutions whose business model is based on consumerism.  This is a departure from traditional models where health plan reimbursement ruled the day, and fee-for-service payment models were avoided.

My recent experience with a Lasik consultation offered a terrific case study on the force multiplier of consumerism and prompted me to conduct a quick assessment of its impact on elective surgeries.  Done thousands of times each day at clinics in every community, elective procedures like Lasik are the apex of value pricing, where customer service is the only differentiator between providers.

• Patient experience:  After some online research, I scheduled an appointment with a clinic and my experience commenced in a flower-adorned office (resembling more of a day spa than an out-patient waiting room).
• Patient information:  First step…upon check in, an iPad was provided as a platform for capturing personal information and answers to a battery of questions.
• Patient preference:  Second step…a selection of color preferences was offered to support my experience.  Upon blurting out “yellow”…not only was a yellow folder and welcome packet presented, but now a range of “yellow themed” accoutrements will follow me through the procedure.
• Patient peace of mind:  Third step…a facility tour.  Here is where my yellow theme will come to life as the surgical procedure is staged and conducted in a glass surrounded room where lighting, music and temperature are tailored to my preference.
• Patient education:  Fourth step…dilate my eyes for pre-op consultation.  Again, an iPad was presented, but this time to play an informational video trumpeting the credentials of the surgeon, facility and post-procedure information.
• Patient access: Last step…a discussion with the surgeon including thorough Q/A session and the encouragement to contact him (phone or email) with any questions.

This all points to how aware this clinic was to my choices, and its local competition.  In fact, health information tools like Castlight Health show me that 10 Lasik clinics are within a 20 mile radius of my home.

Consumerism in healthcare isn’t a zero sum calculation…but when viewed through the lens of a Lasik consultation (sorry, pun intended); perhaps it can be considered as a formula that calculates the “economics of trust” as one weighs hope for improved eyesight with the decision of who can provide it.  Or:

“A provider’s ability to differentiate

as it relates to my health need”

+

“The level of frustration that my ‘other doctors’

don’t offer the same individualized approach”

Consumer engagement and consumerism is a primary theme of our research agenda for 2011 and we’re starting to see the emergence of “consumer as payer” drive a range of innovations…in Lasik and other more pressing areas like diabetes management.  Retail health settings (MinuteClinic); community health approaches (LifeLine Screening); tailored care (GetWellNetworks); drug prescription kiosks (InstyMeds); and other compelling innovations are converging on the consumer as health reform shifts payment models from pure fee-for-service to value-based approaches.

My Lasik procedure at $1200 per eye comes with a lifetime guarantee…but when its all said and done, my out of pocket will actually exceed $3000.  The side note (as my husband pointed out); is that because my out of pocket ‘elective’ procedure will help me say goodbye to my eyeglasses; he’ll happily elect to say hello to a new set of golf clubs to keep things in balance.

Let us know what you think!

Joanna

Joanna Roth is a Senior Analyst at TripleTree covering the healthcare and technology industry, specializing in education solutions. Follow Joanna on Twitter or e-mail her at jroth@triple-tree.com.

Read Full Post »

Consumerism in Healthcare

The U.S. healthcare system is entering a new era for consumers.  Consumers have become engaged ‘healthcare stakeholders’ and are demanding greater understanding of their options around care and costs.  As a result, consumers (aka patients, employees, and health plan members), are starting to realize that their influence (which has been steadily building over the last decade) have meaningful clout in the healthcare economy.  Below are four relevant initiatives we assessing:

• Health programs, care reminders, and incentives.  Consumers want easy access to online tools and resources that enable care direction and lifestyle management including programs like:
  • Medication Therapy Management tools that connect patients with physicians and pharmacists.
  • Care reminders that can be securely pushed to consumers through electronic messaging mediums such as phone, email, and text message.
  • Incentives can be a strong driver towards encouraging healthy behavior with insurance discounts for health and wellness activities like joining a health club.
• Better options, access to care, and transparency
  • Allowing patients to take more control of their care options and reviewing the costs associated with those procedures is a major factor in healthcare consumerism.
  • By providing education, pricing data, and easily accessible online content, patients can make more informed decision about care, which drives patient awareness, improves adherence, and transparency.
• A ‘retail-like’ healthcare experience
  • Customer satisfaction surveys typically rank ‘shopping for health insurance’ at or near the bottom of most industries.
  •  Traditional consumer expansion about a ‘retail’ shopping experience has been lost in health insurance, and consumers need online tools such as portals, comparison engines and programs for population health management (PHM). Opening this business-to-consumer (B2C) channel will create more clarity around cost, treatment options, and alternatives.
• Flexible payment options and improved customer service.  Most consumers would agree that managing the payment process for healthcare related expenses can be a nightmare. 
  • Wouldn’t it be great if a single trip the hospital resulted in one bill that included all charges and a single explanation of benefits (EOB)?   The lack of quality and continuity in customer service and support creates additional consumer frustration. Traditional customer relationship management (CRM) software tools that provide a 360 degree view of the customer in other verticals such as retail and financial services are only beginning to penetrate the healthcare market. Consumers want tools that provide more flexible payment options, simplicity around billing and cost, and an improved experience with customer service.

As consumers become more engaged healthcare stakeholders, the demand will increase for greater understanding of their care options, access, transparency, and costs.  Until recently there was little incentive for insurance companies and provider groups to change the model, and holding healthcare organizations accountable for these changes now is engendering consumer choice via competition, not legislation.  For more, check out our recent Principals Forum interview on the drivers of consumerism in healthcare and let us know what you think.

Michael Boardman

Michael Boardman is an associate at TripleTree covering the healthcare and technology industries, specializing in clinical software solutions.  Follow Michael on Twitter or e-mail him at mboardman@triple-tree.com.

Read Full Post »

HIX: Finding the pony hidden within the ACA’s “exchange concept”

Change is coming to the U.S. health insurance market and the road will be bumpy.  Nowhere is the change more apparent than the current debate surrounding the state-run public health insurance exchanges. Our research underscores that the Affordable Care Act of 2010 underestimated the cost and complexity of establishing public exchanges. In spite of these issues, new and unforeseen opportunities are emerging relative to health insurance distribution. The application of retail, product design and customer service expertise could be transformational relative to the health insurance market for individuals.

As the Affordable Care Act (ACA) marks its first anniversary, a number of key questions remain. One of the largest revolves around the costs and benefits for the federally mandated and state-run competitive marketplaces called Health Insurance Exchanges (HIX), where individuals will be able to shop for and purchase health insurance. The public (state-run) HIX is one of the cornerstones of the health reform legislation, and for individuals without healthcare coverage today – an estimated 34 million people – the public HIXs are the intended mechanism by which individuals will acquire health insurance.

Our latest research report assesses the ACA requirement that each state build and operate a multi-channel (i.e. online, phone, and paper-based) marketplace where any qualified individual can shop for and buy health insurance.  The legislation provides some specifics as to what types of “essential health benefits” must be provided within the exchange, dictates guidelines and mandates as to how the states must run the HIX, and defines specific features the exchanges must possess. These include:

• A choice of certified and approved health plans from different carriers.

• Simple plan comparison tools that allow consumers to research and select the best policy for their needs.

• Enrollment assistance for those purchasing private insurance, and eligibility information for those qualified to receive government subsidies or Medicaid enrollment.

• A process for recouping operational costs of the HIX through surcharges in order to make them self-sustaining.

For these exchange-based insurance policies, federal and state law will closely regulate the products and benefits offered and the prices insurance companies can charge for their products. To keep the HIXs viable, insurance companies are forbidden from undercutting prices of products sold on a public exchange with competing products in the open market. They will also be required to pool risks across exchange and non-exchange participants. Further, the U.S. Department of Health and Human Services (HHS) will mandate a set of essential health benefits that must be provided under each policy, including coverage and deductible tiers for each plan offered.

While the public HIX concept seems simple and straight forward, our research predicts that their implementation will be fraught with costs, technical challenges, and sustainability issues that are neither recognized nor acknowledged, much less understood. Thus far, much of the debate about HIXs has focused on constitutional questions – and therefore political issues – related to the individual mandate which would compel citizens to purchase health insurance. As the states ramp their HIX implementation efforts in order to meet the 2014 deadline, we anticipate that several new challenges will come to the forefront. They will need to be addressed and will propel further change.

Healthcare reform and the resultant need for serving the individual market are propelling new approaches to capturing share in the insurance marketplace, and we expect that a range of new market entrants are just around the corner. Recognizing that it is still early in the progression of these alternative, free-market approaches, this report will review the concept of “private” insurance exchanges and reveal how they will likely serve a larger population than their public counterparts, and will provide more compelling insurance options and opportunities.

Thanks and have a great week.

Scott Donahue

Scott Donahue is a Vice President at TripleTree covering infrastructure and application technologies across numerous industries and specializes in assessing the “master brands” of IT and Healthcare. Follow Scott on Twitter or e-mail him at sdonahue@triple-tree.com

Read Full Post »

Data Aggregation and M&A Activity Bookend Outlook for Health Information Exchanges

Health Information Exchanges (HIEs) have been a hot topic in healthcare IT dating back to 2009.  HIEs are so often mentioned with interoperability platforms, data exchanges and integration engines that it has been difficult to sort out the actual services performed by an HIE, much less the relevant vendors and their solutions.

TripleTree defined HIEs as aggregators of electronic patient-centric, clinical information from disparate, unconnected information systems into a common repository for translation in a common format.  HIEs eliminate the need for patients having several EMRs for their health information – in some ways it becomes the virtual master patient record.

Three measurable benefits from the ability of providers to pull patient information from an HIE for a more accurate, real-time view of the patient’s health history resulting in better patient care and reduced costs include:

• Enhanced care coordination
• Prevention of harmful drug interactions
• Elimination of redundant tests and procedures

The mixture of consumerism and reform in healthcare is forcing this inevitable shift toward HIEs – and since Q1’10 we’ve seen four market proof points:

• Harris acquires Carefx: Feb 2011 – Harris acquired Carefx for $155m to expand Harris’ capabilities in government healthcare, provide an entry into the commercial healthcare market, and strengthen its position as a provider of interoperability solutions.
• Aetna acquires Medicity: Dec 2010 – Aetna acquired Medicity for $500m as a potential counter to Ingenix’s acquisition of Axolotl and a way for Aetna to become more relevant in the provider market.
• Ingenix acquires Axolotl: Aug 2010 –  Ingenix continued its 2010 buying spree and picked up a leader in the HIE space with Axoltol.  With Ingenix’s growing portfolio of HIT assets, we’re closely watching how they integrate Axolotl with their other clinical assets.
• Lawson acquires Healthvision (Cloverleaf): Jan 2010 – Lawson made a move to expand their healthcare presence “beyond just an apps vendor” to become a more integrated HIT player.

Despite this consolidation, a number of standalone, pure play HIE vendors (Wellogic, Informatics Corporation of America (ICA), MobileMD, HealthUnity, Orion Health) offer relevant solutions.  Aggregating patient and clinical data into a common repository is (and will be) relatively simple.  Complexity will come from those vendors who begin to build new applications that leverage the patient-centric, rich clinical data to create “data assets” on the backs of HIEs – a key to feeding the insatiable appetite around Accountable Care Organizations (ACOs) and the marketplaces growing need to influence:

• Care coordination
• Decision support and evidence-based care protocols
• Real time monitoring and event-driven triggers
• Longitudinal patient reporting
• Provider quality reporting and benchmarking
• Unified patient dashboards

The winners won’t be “data plumbers” or “just integrators” but will focus on adding the applications that leverage data into new business models.  It’s still too early to tell if the consolidators can beat out the specialist pure play providers, but if you have any thoughts or would like to hear more about this sector let us know.

Thanks and have a good week.

Judd Stevens

Judd Stevens is an associate at TripleTree covering the healthcare industry, specializing in the impacts and transformation of health plans in a post-reform world.  Follow Judd on Twitter or e-mail him at jstevens@triple-tree.com.

Read Full Post »

Health2.0 Event Supports Conversation on Healthcare Consumerism

Last week, my colleague, Ryan Stewart participated as a keynote presenter for a regional Health 2.0 event.  As leading resources for innovative healthcare technology organizations, TripleTree and Health 2.0 are aligned in their belief that the growth of user-generated healthcare will foster a wave of consumerism across the industry. TripleTree has identified “consumerism” as critical for engaging consumers to take a greater degree of control in their own health and breaking down the traditional roadblocks that have caused a disconnect between payers, providers and consumers within our healthcare system.

TripleTree continues its active role in the mHealth (mobile and wireless health) arena and closely follows dozens of innovators who enable a free flow of healthcare information between various systems.  Ryan’s presentation outlines several macro-trends where mHealth is supporting this information flow and facilitating patient access to care information through greater patient participation in health-related decisions. You can view the presentation here.

Joe Long

Joe Long is an analyst at TripleTree covering the healthcare sector, with a focus on the approaches and technologies surrounding health insurance exchanges.  You can email him at jlong@triple-tree.com.

Read Full Post »