Cynthia Hundorfean

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As providers of medicine, our primary focus is-and always should be-the care and comfort of our patients.

But it can’t be our only focus. From affordability issues to the caregiver burnout epidemic, many of the challenges that face our industry in 2020 and beyond will require us to rethink the way we engage with our various stakeholders, taking a more holistic view of the entire healthcare system. These include:


	Of course, we want to create the best possible experience for our patients and customers. But to do that, we also have to create healthier workplaces for our employees, particularly on the provider side.

Medicine is a demanding field, and some clinical settings are inherently more stressful than others. We continuously ask a lot of our employees.

Which is why we need to have their backs, particularly when it comes to creating a culture of wellness. There’s a growing body of evidence suggesting a direct correlation between employee engagement and well-being, patient experience, and quality of care. Improving the overall workplace culture often improves patient outcomes.

In other words, it’s all interrelated-and if our employees aren’t at their best, our patients can’t be, either.

IT’s Influence on Patient Care, Provider Accountability

There are a lot of complex pieces to this puzzle.

It means doing more to secure the safety of our caregivers, protecting nurses and aides from the violence that occasionally visits the emergency department. It means ensuring employees have enough time for meal breaks, so that they are properly hydrated and nourished. It means tightening the mental health safety net, deploying wellness resources proactively rather than reactively.

Above all, it means taking better care of each other.


	These are separate concepts, but from the perspective of the patient and the consumer, they go hand-in-hand.

Why? Because patients, while they may not understand the full complexity of our industry, understand at a basic level that health care simply costs too much. According to CMS, nearly one in five dollars in this country is spent on healthcare services or prescription medicine. And as high-deductible health plans continue to surge-about half of the pre-Medicare commercial market now has a high-deductible health plan-our patients are exposed to more and more out-of-pocket costs. 

Bending the cost curve will require more preventive medicine, reducing overutilized testing and procedures, and delivering lower-acuity care in less-expensive settings.

It also requires a greater commitment to value-based care. As an industry, we’ve been predicting this shift for a while, but it’s happening slowly. At some point, we’ll have to jump in feet first.


	On one hand, our national goal is to provide better care for lower cost.

On the other hand, in order to achieve that goal, we know that we have to invest in the future -artificial intelligence, robotics, virtual health systems, and more modern care facilities. Over the coming decade, medicine will be virtualized and access will be democratized. All of this will come at a cost.

How do we bear the cost together, while minimizing financial impact to our customers? It will require increasing collaboration-and in some cases, full-scale integration-between payers, providers, and ancillary stakeholders.

Traditional boundaries between payer and provider, between pharmacy and supplier, have been blurring for years, and for good reason: Without clear sightlines among stakeholders, it’s hard for providers and insurers to align on the future state of healthcare.

Integration promotes that alignment and understanding. It also provides a shared platform to address current and future cost burdens, to streamline patient billing, to create value from big data, and to simplify the overall navigation of the healthcare industry for our patients.

Vertical integration won’t solve all of the industry challenges, but it can allow a more unified approach toward advancing the goals of improved health, greater affordability, and better experiences for employees and patients.

Cynthia Hundorfean is president and CEO of Allegheny Health Network (AHN), an integrated healthcare delivery system that serves Western Pennsylvania. AHN is part of the Highmark Health family of companies.

Articles

Many of the challenges that face our industry in 2020 will require a fresh way of thinking.

Investing in the Future

For all the progress science and medicine have made over the last century in treating diabetes-particularly adult-onset diabetes-we haven’t done a very good job of preventing it.

 in the U.S. since the early 1990s, diagnosed diabetes rates have doubled over the last 20 years. On the current pace, 40% of Americans will be living with diabetes or prediabetes within the next few years, and diabetes-related spending and lost productivity will cost the country $500 billion annually within the next decade.

It is one of the nation’s costliest public health emergencies-and it will remain so, unless we make a coordinated effort to bend the curve. I talk to clinicians and subject-matter experts about diabetes care often, and have come to understand there are a few ways we should approach this:

 like diabetes might have seen their primary care physician three or four times a year. Apart from those visits, they were on their own when it came to managing their disease.

We can’t allow that to happen anymore. It takes a multidisciplinary team to address diabetes symptoms, especially when it comes to patients with records of poor treatment adherence. That means PCPs, endocrinologists, pharmacists, social workers, diabetes educators, and behavioral health specialists have to be on the same page when it comes to creating individualized treatment plans and identifying the barriers to care that exist for so many patients living with diabetes.

Of course, if providers and insurers are focused solely on disease management, we’ve already lost the battle. We have a lot of analytical tools at our disposal, and we need to better utilize them in order to identify those living with prediabetes conditions, allowing our care teams to intervene before it becomes a chronic disease.  

Emerging research confirms what we’ve pretty much known all along-the key to preventing and mitigating type 2 diabetes is tied to what we eat.

As providers, we have to acknowledge that what we’ve done for the last 30 years-actively prescribing medicines and passively monitoring a patient’s diet-has not been terribly effective. That means embracing a more nutrition-centric treatment model and taking a more active role in dietary control. Some providers have even opened fresh food “farmacies” where dieticians, in consultation with physicians, can “prescribe” several days’ worth of free fruits, vegetables, and high-protein foods to type 2 diabetes patients who are also food insecure.

The Benefits of a Team-Based Approach in Disease Management

For many patients, medication is a simpler fix than lifestyle modification-even if those medications are extremely costly. But it’s our job to help patients and their families understand that eating well allows them to live well, too. It’s hard work for all stakeholders, but the health benefits are evident.

Many patients living with diabetes are very good about monitoring their blood sugar levels and responding accordingly. Others need more hands-on care.

Fortunately, there are a number of new technologies that help patients manage their diabetes and more easily understand their glucose readings. These Internet-connected technologies also present clinicians, researchers, insurers, and others a great opportunity to collect and share diabetes data, with an end goal of providing predictive, real-time care to patients living with the disease. And smartphones, growing more ubiquitous each year, have the potential to become the standard platform for remote monitoring, education, and clinician consultation.

That potential is exciting for those of us in healthcare, but the race to make sense of these rich streams of data may be confusing in the short term. Providers, insurers, and device manufacturers will have to work together to ensure that these new technologies are cost-effective and tied to appropriate reimbursement schedules.

But if we can sort through those issues-and I believe that we will-we have a remarkable opportunity to avert new diabetes cases, and to improve the lives of millions of existing diabetes patients with more responsive, more convenient, more affordable care.

 editorial advisor, is president and CEO of Allegheny Health Network (AHN), an integrated healthcare delivery system that serves Western Pennsylvania. AHN is part of the Highmark Health family of companies.

Diabetes is one of the nation’s costliest public health emergencies. Here are three fresh approaches that can make a difference.

3 New Approaches to Provide Individualized Diabetes Care

In 1975, a cancer diagnosis of any kind meant a patient had less than a 50% chance of surviving more than five years. Today, that five-year survival rate is closing in on 70%. And the rate is much higher for certain cancer sites, so long as the cancer is detected at an early stage.

Clearly, we’ve come a long way in 40 years-but we still have a long way to go. Cancer care needs to be more collaborative and evidenced-based. It needs to be more focused on prevention and psychosocial wellness. And on top of all that, it needs to be more affordable and accessible.  

Opinion: Top Trends Influencing the Future of Affordable Cancer Care

When we speak of “personalized medicine” in the context of cancer care, we’re often referring to next-generation genomic sequencing, data science, targeted therapies, and immunotherapies.

And those are vitally important weapons in our ongoing fight against cancer. But personalized care is much bigger than that-it’s about a holistic approach to multidisciplinary care coordination. From the moment of diagnosis to a patient’s final treatment, at every point along the care continuum-surgery, radiation, pathology, imaging, chemotherapy, dietary, rehab-the care needs to be precisely organized around the patient’s convenience, preferences, and best interests.  

I’ll give you an example: In recent years, some health systems (including ours) have opened after-hours oncology clinics. Many cancer patients experience side effects to their care-nausea, pain, fever and more-and if the symptoms hit after 4 p.m., those patients may require a trip to the emergency room. But an ER is the last place a cancer patient should be, because of increased susceptibility to the types of infections that are often present in a hospital emergency setting.

These after-hour oncology centers are open late (and in some cases, 24/7), and they provide safe care alternatives for cancer patients with urgent symptoms. This leads to better outcomes.

Providing comprehensive cancer care is an all-in effort that, increasingly, requires investment and creative thinking from payers, too. Over the last several years, insurers across the country have become more involved, and it’s a trend that will accelerate.

The partnerships make sense. Insurers have a wealth of claims data that can be beneficial to oncologists, and oncologists possess the clinical data and up-to-date technical knowledge that is required to make timely treatment decisions. Carriers have also developed bundled payment models for clinics that adhere to certain best practices, as determined through real-time collaboration with staff oncology experts. And some insurers are considering payments for remote oncology care and out-of-the-office triage, which allows practices to deploy clinical resources in nontraditional ways.

It’s no secret that cancer care is expensive, in America and around the world. Yes, we’ve made remarkable progress in understanding and treating cancer, but the truth is that our current delivery models provide those treatments at an unsustainable cost.

Three Best Practices for Welcoming New Cancer Patients

A lot of that cost is tied up in the latest oral medicines and cell-based therapies, which can run hundreds of thousands of dollars per year (or per even dose). But there are other, systemic costs that we as providers and insurers must work to address if we want to reduce the budget stress and “financial toxicity” of cancer treatment. Our challenge in the years ahead is to ensure that cost of care reflects the value of care-because when the cost of cancer care is prohibitive, we’re doing a poor job of serving our patients and their families.

 editorial advisor, is president and CEO of Allegheny Health Network (AHN), an integrated healthcare delivery system that serves Western Pennsylvania. AHN is part of the Highmark Health family of companies.

More affordable, more collaborative, and more personalized care is our cancer care challenge. Here’s how we get there.

Time to Address ‘Financial Toxicity’ of Cancer Treatment 

	Sound clinical and business decisions in healthcare hinge on high-quality data. Capitalizing on available data resources is a technological challenge for any industry, but healthcare faces the steepest challenges of all-no other industry encounters so much volume, variety, and velocity of information, and in no other industry are the decision-making stakes so clearly a matter of life and death.

	While it’s an exciting time for predictive analytics in healthcare, it’s also important to be realistic about what data-mining, modeling and machine-learning can and cannot accomplish. Even the most sophisticated electronic health record (EHR) system can’t generate outcome improvements without first being coupled with other metadata sources, to provide needed layers of context and evidence.

	Despite limitations and growing pains, the potential benefits of using predictive analytics within healthcare are enormous, particularly when health networks and payers are willing to work together. As financing systems and care delivery networks collaborate more closely, even to the point of full integration, predictive and prescriptive analytics will inform how all parties manage at-risk populations, identify candidates for clinical intervention, and provide better value and care to individual consumers.

 To provide more cost-effective care, providers must manage space and personnel resources optimally. Many hospitals already use software to help predict emergency room utilization, or to predict no-shows for specialty appointments.

	These algorithms are getting more sophisticated every year. Computers will soon know where the flu is spiking, when there’s a big game or concert in town, and how those real-time trends are likely to affect emergency room admissions hour by hour.

. It’s not enough to conduct analytical deep-dives after a sepsis case or a central line-associated bloodstream infection (CLABSI) report.

	Today, health systems are piloting real-time analytics platforms that look for advanced warning signs of serious infections. They determine which central lines are due for maintenance, or identify patients that are at risk for sepsis by using “sniffer” algorithms to assign risk scores.

	There’s a lot at stake for all parties: 250,000 CLABSIs are reported annually in the U.S., according to the CDC, while sepsis may contribute to half of all in-hospital deaths and account for $24 billion a year in hospital costs, according to recent studies. The networks that can figure out how to predict, and prevent, infections will squeeze cost out of the system and create a safer care environment for patients.

 Treating cancer effectively is like solving a puzzle, and oncological cost management is a challenge for health carriers. Because there is so much variability and cost built into cancer treatment, the prospect of using analytics to augment value-based oncological care is tantalizing.

	That’s why health systems are now leveraging analytics to make clinical decisions that help chemotherapy patients avoid extra hospitalizations, and protect payers from associated expenses.

	Hospitalizations can be circumvented if we are able to effectively comb through and interpret the relevant clinical and treatment data. Different factors-the type of chemotherapy agent, the patient’s age and weight, the cancer stage-feed into risk scores, and those risk scores can then be married with predictive models that can anticipate health outcomes for an individual.

	That’s where the real promise of analytics lies-not just predictive medicine, but personalized, prescriptive medicine, creating a better, high-value care experience for our patients.

 editorial advisor, is president and CEO of 

), an integrated healthcare delivery system that serves Western Pennsylvania. AHN is part of the Highmark Health family of companies.

Personalized, prescriptive medicine creates higher-value care for patients

Author | Cynthia Hundorfean

Articles

Investing in the Future

3 New Approaches to Provide Individualized Diabetes Care

Time to Address ‘Financial Toxicity’ of Cancer Treatment

Three improvements data promises to deliver