Health 2.0 Executive Vice President and co-founder Indu Subaiya provides perspectives on the way innovation will impact health systems.
You could say that Indu Subaiya, MD, MBA, operates at the leading edge of healthcare innovation. In her job as executive vice president of Health 2.0, a conference and media company she co-founded, she is exposed to emerging technologies, solutions, and the leaders of companies who are seeking to transform the healthcare system. In 2017, Health 2.0 was acquired by HIMSS and the 2019 conference will take place September 16‒18 in Santa Clara, California.
Born in Bangalore, India, Subaiya grew up on Long Island, New York. She graduated from Renaissance School of Medicine at Stony Brook University, but decided to take a different path, forgoing her medical residency to explore a different side of healthcare. She received her MBA from the Haas School of Business at University of California, Berkeley, and is a passionate advocate to end healthcare disparities and increase diversity across the leadership ranks of the industry.
In addition to her healthcare and technology endeavors, Subaiya is also a writer and filmmaker, achieving recognition for her short film, The Apartment, at the Indian World Film Festival. She has directed several short documentaries that explore technology and patient-centered care.
I caught up with Subaiya at HIMSS19, and spoke with her about the impact of innovation on healthcare systems. She shared six wide-ranging insights that will help healthcare organizations hone their approach to innovation.
1. Develop a strategic approach to innovation
"Have a strategy," says Subaiya. The current era of digital health began about 10 to 12 years ago, she says, and most health systems have had a fragmented approach to innovation. Initiatives might have been launched by the emergency department, pediatrics, or radiology, but no one provided strategic oversight across an enterprise.
"The worlds [within a health system] weren't talking to each other," she says. In the meantime, "CIOs have not been replaced, but we have these new creatures called the chief innovation officer … and the CMIO [chief medical innovation officer]. These new people … are helping health systems get organized and pull back on the 150 pilots [the system's executives] did not know they had and figure out which ones are working. [They are asking], 'Which ones were just experiments that failed? What is our strategy now?' "
Instead of a scattershot approach, health systems are beginning to focus on a few strategic priorities. Subaiya served on a HIMSS19 panel with The University of Texas MD Anderson Cancer Center Vice President and Chief Innovation Officer Rebecca Kaul who advised audience members to narrow their focus to five or fewer initiatives. "Mayo [Clinic] is going through a similar process right now," Subaiya says.
Healthcare organizations can move innovation forward through partnerships, investments in outside companies, or building capabilities internally. "I think that the best thing they can do is develop thoughtful strategies, prioritize, and then work really closely with the pilots," she says.
It's also essential to educate yourself about the variety of tech companies that are emerging. "Don't look just outside your window because sometimes people with a great solution may be coming from another state; they may come from abroad." For example, she mentions that Sweden and Denmark are hotbeds of healthcare technology right now.
"Don't be afraid to take risks, but do it with a strategy," Subaiya says. "Now that you have FHIR being blessed, don't hoard your data, but be thoughtful and strategic about how [developers] want to connect in this ecosystem."
2. Pay attention to needs where outside innovators are filling gaps
Subaiya says that innovators are emerging to fill gaps in areas where health systems are not performing well. By letting others gain market traction in this space, health systems may be giving away their future power. The top three vulnerabilities include:
1. Data analytics and real-world evidence (RWE). RWE refers to information that can be collected outside the EMR. "It's the life data that we can collect year-round," says Subaiya, through wearable technology, for example. "Health systems aren't there yet," she says.
2. Complex chronic conditions. "When you're dealing with multiple comorbidities, or you're frail and elderly and heart failure keeps happening and the health system just takes you into the ER and sends you home over and over again," she says, "that's not good enough. Innovators will come up with care models to address the needs of these patients, she predicts. "They will deliver better outcomes and go straight to CMS and get reimbursed."
3. Meeting patients where they are. "Everybody's talking about this, whether it's in the home or mobile," says Subaiya. "Is it telemedicine? It's a part of it." Innovators in this space use telemedicine tools and AI, but those who will achieve success will also address solutions that enhance the patient and physician experience. "I think health systems have a lot to learn there," she says.
"The good news, though, is I'm seeing [progress] in … operational efficiency, which everybody is concerned about now as we move into more of a value-based environment," she says.
3. Keep an eye on nontraditional players who may gain future power
As she looks to the horizon, Subaiya sees another development that should pique the curiosity of health system executives.
"[There's] a new type of technology platform where companies are 'inverting the stack,' " says Subaiya. Rather than selling a specific solution to a health system, such as an artificial intelligence or remote care product, she explains, these companies integrate those elements and more into a solution, then hire their own clinical professionals, to offer complete, end-to-end care delivery packages.
Initially these don't appear to be a competitive threat, she says, because they may be focused on a specific issue, like elderly care or diabetes virtual care management.
"But when you start packaging those platforms with mechanisms for reimbursement, which many of them are now doing … once you're in their member network, you're basically being completely taken care of in that very high touch, clinically oriented way," says Subaiya. "So they almost then become a provider too."
As an example, she cites Devoted Health which raised $300 million in Series B funding last fall and was approved by CMS to offer Medicare Advantage plans to seniors, which it couples with personal health guides. "Underneath Devoted Health's stack is basically a layer of technology and services that's highly tech-enabled and data-enabled," says Subaiya.
4. Accelerate growth and adoption of virtual care
Most health systems are involved in or exploring some form of telehealth, and many are expanding their virtual care programs as part of their strategic priorities to provide care wherever patients are located. There are three things to consider when implementing a virtual care program.
1. Reimbursement. Educating payers and the Centers for Medicare & Medicaid Services is paramount because they impact reimbursement. Advocacy and evidence-based arguments are necessary to sway policy, Subaiya says.
She cites the ruling from CMS, now in effect, which allows reimbursement for home-based care, as a small win, because it only applies under certain circumstances.
"If we're going to be stuck with winning reimbursement for one small thing at a time and each win takes three years, we're not going to get there," she says. "We need to make sure that wherever a patient is [located], the provider should be able to get paid."
Also critical to address is reimbursement for examining data generated by monitoring patients at home and using wearable devices. "That whole piece of reimbursement around telehealth, around absorbing that datamaking time to engage in a different wayis going to require revamping how we pay," Subaiya says.
2. Work flow. Virtual care also changes work flow because someone needs to monitor patient data on a regular basis. Organizations need to examine how to incorporate technology and the resulting data monitoring into processes in a manner that isn't intrusive. "It's going to involve how you use not just doctors, but nurses, case managers, and home health workers," says Subaiya. "So you've got to figure out your work force, which is not easy, and train them in some of these new digital skills."
3. Clinical validation. While new technologies are constantly emerging, "the frontier that we need to do the most work on is the actual clinical validation," says Subaiya. Inaccurate monitors or devices that produce invalid data create challenges that can harm patient care. "We need to figure out how to measure those clinical outcomes and then validate them."
5. Employ FHIR to light the way for innovation
Over the past several years, Subaiya has been watching the evolution of FHIR (Fast Healthcare Interoperability Resources), a development that arose from innovators in the digital health ecosystem trying to connect to the EMR.
On the opening day of the HIMSS19 conference, the Department of Health and Human Services announced proposed new rules for interoperability. The ruling states that organizations don't own patient data, and it must be shared. Conference attendees welcomed the change, but many said that it's just the beginning, and more work is needed.
The proposal mandates that FHIR will be the standard now for all payers, hospitals, stakeholders, and vendors to share their data sets, says Subaiya. "That was shocking to me in a good way."
6. Use storytelling as a means of innovation
Innovation is not just about deploying new technology; an innovative approach to communication also can impact the way health systems enhance the patient and physician experience. As a technology influencer who also makes films, Subaiya's career navigates through these seemingly separate worlds. She sees a benefit in bringing them together.
"I'm going to quote my friend, Ann Mond Johnson, who is [CEO] of the American Telemedicine Association," says Subaiya. "She says we've got to do a better job of storytelling. We don't tell stories properly in this industry, and it's vital to [present] a human face."
For example, last year organizers of the Health 2.0 event brought the story behind the high rate of physician burnout and suicide to life by showcasing a documentary about the subject, Do No Harm. Compared to other professions, physicians have the greatest rate of suicide, which is twice the level of the general population.
"You can share those statistics … but sometimes you need a different way to tell a story," says Subaiya. The film and discussions with the filmmaker, she says, provided a powerful way to deliver the message.
This idea is crucial to health systems that are focused on enhancing the patient experience, she says. "How do you know what people are really experiencing if you don't ask them or hear it in their own voice? It affects your workforce; it affects the patients; it may even affect how the organization tells its story."
Mandy Roth is the innovations editor at HealthLeaders.
Photo credit: Shutterstock
Narrowing the focus of innovation enables health systems to become more strategic.
Niche companies may look benign today but could gain power by providing better outcomes and receiving direct reimbursement from CMS.
Consider the value of storytelling.