What Was and Wasn’t Said at HLTH 2018

One of the latest additions to the healthcare industry’s long list of conferences this week brought together prominent thought leaders and investors to discuss a myriad of health innovation topics — from value-based care to vertical integration.

With an emoji-forward market presence, HLTH 2018 planners (who also created Shoptalk and Money20/20) pulled together a speaker lineup that read like a list of who’s who in the digital health space, including CEOs from athenahealth, 23andMe, Allscripts and Fitbit, to name a few.

With the inaugural conference in the books, Healthcare Dive pulled together the highlights.

Walmart’s announcement was kind of a snooze

Walmart was set up to make a large announcement at the conference when executives from the company took the HLTH mainstage. There have been rumors that the retailer could purchase insurer Humana and the company is currently retrofitting 500 locations with plans to expand pharmacy areas with consultation rooms.

But the big news was simply that Walmart is demanding change in the healthcare industry.

“Healthcare is a top concern for Americans and has been for decades,” Marcus Osborne, VP of health transformation at Walmart, told the audience. “Wars come and go. The economy declines and improves … but healthcare remains consistent.”

Price and access are the top concerns. “As angry as Americans are, if they really knew what was going on, they’d be angrier,” he said, citing wasteful spending as one touchpoint. “I bet many of you have come here expecting some announcement,” he said. “So let me announce this as clearly and loudly as I can. I won’t stand for this. … Walmart isn’t going to stand for this.”

Walmart covers about 1 million employees. Lisa Woods, senior director of healthcare benefits at the company, shared some insights into data from its Centers of Excellence (COE) program in partnership with Mayo Clinic. Through the program, 50% of patients who local providers would recommend for spine surgery heard from the COEs the procedure wasn’t necessary, and dates for returning to work were reduced by three weeks.

Osborne promoted “optimized networks” to provide consumers price and cost transparency as well as funneling patients to providers with higher-quality performance.

Reading into the tea leaves of the no-hard-news announcement, it’s still expected that Walmart will reveal something big at some point. Whether it’s forcing more price transparency or buying a payer is still yet to be seen. “I think they’re dead serious about making a play at it,” Mark Ganz, CEO and president of Cambia Health Solutions later told an audience at HLTH, adding there’s “no question that will have an impact. And I welcome it.”

Keep in mind, if Walmart wasn’t serious about healthcare, its executives may not have shown up.

CVS Health wants to complement, not compete, with primary care

CVS Health recently announced its intent to purchase Aetna, a move many in the industry say has far-reaching implications for care delivery. Troy Brennan, EVP and CMO at CVS Health, discussed the retailer’s plans for the larger healthcare space.

“Without true innovation, more people will simply be without healthcare,” read one of Brennan’s slides. The slide data showed that 60% of those at less than 150%-400% of the federal poverty level have liquid assets less than their deductible. “That means they can’t afford it if they get sick,” Brennan said, adding that CVS wants to “create a new chassis for population health management.”

Brennan said digital intelligence combined with human touch will help create better levels of engagement to drive down healthcare costs. For example, if an HbA1c level can be reduced by 1 point, the cost of care is reduced by $2,400.

Assuming the Aetna deal clears regulatory hurdles, CVS will look to population health with initial efforts to focus on three target groups:

• Patients with five common chronic diseases (diabetes, hypertension, hyperlipidemia, asthma and depression);
• Fragile patients who disproportionately contribute a large share of total healthcare costs; and
• Transitioning patients from a hospital setting who require readmissions prevention focus.

To support interventions with these patient populations, CVS Health will explore four major categories:

• Intervention coordination at CVS Pharmacy and MinuteClinics;
• Health monitoring and data collection in patients’ homes;
• Patient outreach via digital tools; and
• Connectivity with primary care providers to assist with preventive care.

Brennan said CVS ultimately wants to be complementary to primary care, not compete with it. Last year, CVS referred 3.7 million people to primary care providers who didn’t already have one. “The critical thing … of getting anybody engaged is making sure that it is convenient,” Brennan said. “That’s what we have to do with healthcare.”

Jonathan Bush didn’t address the elephant in the room

On the morning athenahealth CEO Jonathan Bush was set to address the conference, news broke that Elliott Management offered a cash buyout of the company in an offer valued north of $6 billion.

Athenahealth said it was reviewing the unsolicited bid and will “determine the course of action that it believes is in the best interest of the company and athenahealth shareholders.”

Bush, an outspoken company figure, didn’t address the news during his two appearances on HLTH’s mainstage, one to discuss physician burnout and another for a live taping of the “A Healthy Dose” podcast with hosts Trevor Price and Stephen Kraus.

He was on message in both appearances, promoting the company’s push on platform services. Athenahealth recently revamped its network infrastructure to handle more app-like tools and services, including those developed by third party vendors. These “microservices” could be used by physicians to help alleviate documentation times and reduce physician burnout overall.

“Physicians spend 4-8 hours per week on documentation,” one of Bush’s slides read. “In these last eight years, physicians have lost a lot of latitude,” he said.

Reducing administrative burden to focus on patients has been a big push in the industry. Bush and his team are hoping their products can help with that reduction and therefore create brand-loyalty among customers who want to spend more time with patients.

Bush believes tools and resources that are fun, easy to use and which physicians can decide for themselves whether they like will help workflows and workplace satisfaction in the future. “The notion of tools that work, that give the doctors more power with their strokes of activity … drive up engagement,” he said.

Uber tackling food deserts?

As Silicon Valley tech companies build their businesses, some have waded into healthcare as a growth opportunity. Social determinants of health offer a potential avenue for these companies to find their place in healthcare.

Both Uber and Lyft this year have announced healthcare plays, offering rides to and from places of care.

Lauren Steingold, head of strategy at Uber Health, told HLTH that its platform has resulted in reduced appointment cancellations. The company is working on proving efficacy and seeing whether data show the platform is helping to contribute to improved patient outcomes.

Steingold hinted that future healthcare pushes could be on the table for the company. Uber Health is currently focused on patient encounters but it could step further into SDoH initiatives by partnering with Uber Eats to address food deserts, she said. “We’ve seen a number of partners using the … APIs to have their caregivers transport meals to patients that may have just been discharged from a hospital or have a specific meal plan they need to adhere to,” Steingold said. “We’re excited to see those use cases starting now.”

Interoperability has been a burden on the industry for a long time. In a more connected healthcare ecosystem that thought leaders envision, data liquidity will be critical. “Healthcare in the United States is now digital,” Allscripts CEO Paul Black told the HLTH audience.

“There’s no way that there’s only going to be one electronic medical record that’s out there,” he said. “It’s just impossible for that to occur. There are multiple different transaction systems. That begins the need for adding a couple of new, innovative ideas.”

Consumers are bearing more financial responsibility for healthcare and have an expectation of providers being “always on.” That’s coupled with a desire for personalized interactions. Those trends need to be considered when building new products, Black said.

Interoperability will be critical for these new ideas. “That will get solved,” he said.

There are some caveats. If data is to be put to work, it must be useful and relevant to the way physicians practice as well as presented in a framework users enjoy.

Looking farther out, Black said consumers should be connected with their DNA information to better understand their health. “The connection of the digital framework with interoperability getting all the data in a way that makes sense to caregivers and to consumers and getting consumers connected to their DNA will have a transformative effect long term,” Black said.

Fitbit wants to make wearables ‘must-have’

Fitbit has sold more than 78 million devices and posted $1.6 billion in revenue last year, but has yet to produce “must-have” devices.

CEO and co-founder James Park is trying to change that, and healthcare is a big part of the effort. “These devices need to evolve with the needs of the healthcare ecosystem,” Park said at HLTH.

The company recently partnered with Google to help chronic condition management by pairing Google Cloud’s Healthcare API with Fitbit’s recent Twine Health platform acquisition. This week, Fitbit unveiled a bevy of new health apps and clock faces. The new apps include diabetes management app Dexcom, medication management app Diplomat Pharmacy and Go365 by Humana, a wellness and rewards app.

It’s an effort to make the Fitbit part of the national healthcare lexicon.

Fitbit is participating in more than 600 research studies, including National Institutes of Health’s All of Us and the FDA’s pre-certification digital health pilot programs.

While software will be a big part of Fitbit’s overall strategy, Park said consumer engagement is really the key to driving behavioral change. The evolution of wearables will require research over areas like which times of the day are right to nudge users more. “There’s still a lot to come,” he said. “We’re working hard to figure out how do we go from a really great ‘nice to have’ to a ‘must have.'”

One quick thing: No IPO on 23andMe’s horizon

Anne Wojcicki, the CEO of personal genetics testing company 23andMe, addressed speculation of taking the company public during her time at HLTH.

The answer: a definite no.

“Who wants to be a public company?” Wojcicki asked, saying it’s not fun to report earnings and she and the company are still working on growth. She said there’s a time and place for an IPO, but now is not that time.

She did offer a concise takeaway from the conference. “Healthcare is ripe for innovation,” she said.