💡 HTN | Community Brain Trust | 10/10
🧵TOP THREADS OF THE WEEK
In case you missed them, here are highlights of a few interesting conversations from different channels:
Threads included below:
- Preference for FHIR API endpoints vs proprietary API endpoints
- Tips for cold outreach to reporters
- Transparency in doctor performance: should patients have access to outcome data?
- Sources for collecting social determinants of health data
- Understanding the challenges of DTC patient health records
1. Preference for FHIR API endpoints vs proprietary API endpoints
Q: Curious how folks think about vendors that offer FHIR API endpoints vs proprietary API endpoints. Do you all have a preference for using FHIR API endpoints (generic and the fairly similar across vendors) or vendor specific API endpoints (often designed for a specific task or to answer a specific question specialized for the vendor).
– JP Patil | via #buildersask
Thread Summary: HTNers discuss their preference for using FHIR API endpoints versus vendor-specific API endpoints. While industry standards and standardization are favored, some members acknowledge the need for custom API endpoints to accomplish specific business needs and workflows.
Jason Kulatunga: I'm a bit biased because I'm building a PHR that will need to integrate with dozens of EHRs, but I'm 100% behind the standardization train.
As a developer, being able to depend on certain standardized functionality is immensely valuable:
1. SMART-on-FHIR means I can depend on a certain authn/authz flow, and prepare my users for it.
2. FHIR API (+ USCDI patient access) means that I can write a "single" API client to sync FHIR resources to my own database.
3. A majority of the complexity in our PHR is around handling the differences when EHR systems decide to do something non-standard
Having said that, FHIR isn't perfect:
1. the FHIR standard isn't as proscriptive as it could be since it needs to handle competing needs in some cases.
2. The spec is complex & a moving target.
3. Some functionality that is immensely valuable is not part of the standard (patient record bulk export, etc) -- which is where custom API endpoints/FHIR extensions are valuable.
2. Tips for cold outreach to reporters
Q: Does anyone have any tips on how best to cold outreach to a reporter? We are a small startup gaining momentum and looking to leverage some PR to help keep the ball rolling. Any info / advice is helpful. Thanks!
– Sara White | via #buildersask
Thread Summary: A tactical thread of HTNers sharing tips and advice on how to effectively cold outreach to reporters for PR purposes. Top suggestions include following journalists on social media, emailing them directly as the CEO/founder, offering to be a resource or provide expertise, and leveraging investor connections. Main emphasize is on the importance of building momentum and awareness for your business through authentic storytelling.
Kevin O'Leary: I'd very much agree with @Margarette Jung, particularly on that third point about doing it yourself versus outsourcing to others. A couple other random observations:
1. I'd suggest that you don't make the initial outreach about pitching your business directly - they're inundated with stuff like that. Instead think about how you can be a resource / help them. If they're interested in xyz topic and you're an expert on that, or your company happens to address that, offer to give them your perspective on the space. @David Cooper I hadn't seen that resource before but looks very much along these lines.
2. I'd not get too overly focused on cold outreach as the end goal. as you hinted at your end goal is about building momentum / awareness for your business - certainly getting a big article on your company can help with that, but it doesn't need to be the starting point. You telling your story / narrative in an authentic way publicly I think can go a long way in this regard (and eventually lead to those reporters reaching out to you, versus the opposite direction).
3. And lastly, if you're at the stage where you have investors definitely lean on them for connections / intro conversations to various reporters
3. Transparency in doctor performance: should patients have access to outcome data?
Q: Saw this tweet and it got me thinking – it should be possible to lookup any doctor and see how experienced they are at performing a given procedure, treating a particular diagnosis, or prescribing a particular medication. Would be worthwhile to know as a patient how many "reps" your doctor has at a managing particular thing. Taking it a step further would enable lookup of outcomes for any particular doctor – seems that population health / quality data mostly exists at the system / population level – why not make this more transparent?
– Ryan Gallagher | via #topic-new-company-ideas
Thread Summary: HTNers discuss the idea of making doctor performance data transparent and accessible to patients. The conversation explores the benefits of knowing a doctor's experience and outcomes for specific procedures, diagnoses, and medications. The discussion also touches on the limitations and challenges of collecting and evaluating provider data.
Nate Maslak: We do partner with CareJourney for this! There is a lot of work to do on driving complete coverage of this data — unfortunately there are upstream data limitations in terms of where we can glean this data (I.e. not every provider can be evaluated based on their claims experience / patient satisfaction). Reason to be optimistic is that there is an increasing amount of data sources coming to market and new technologies allow companies like CareJourney and Ribbon to process that data much faster. It’s certainly not a perfect measure of performance, but there is quite a bit of research that demonstrates that these scores are predictive of outcomes where they are relevant.
4. Sources for collecting social determinants of health data
Q: Looking into ways of collecting social determinants of health data (such as education, physical environments, financial) to help with hospital readmission prediction. Anyone have any ideas (besides looking at zipcodes of patients)?
– Ciara | via #topic-ai-ml
Thread Summary: HTNers brainstorm resources for collecting SDOH data - Decision Point Health and Socially Determined are two mentions. However, several folks warn against barriers / gaps in commercially purchases data sources that challenge the utility of them.
Shelby Chartkoff: One warning re: commercially purchased data sources is that data is often imputed from/to varying levels of geography and then applied back to the "matched" individuals. Vendors are often not explicit about their appended data's quality and precision (geographic or otherwise).
I did a pre-purchase evaluation study several years back (and now I'm kicking myself because I can't remember which vendor off the top of my head!) I assessed the utility of the data for prediction models to recommend which fields to purchase, and many of these interesting quirks came out through that process.
I should add: my comment above doesn't imply that those fields are useless from a pure prediction standpoint. Just that careful assessment is necessary. And some fields can appear to be predictive on their own, but it's a false front d/t their association with other factors. All of which is to say: I’m pro careful investment in outside data, but I'd certainly maximize internal data first, have a deep understanding of your best baseline models without outside data (and experiment with zip code or geocoded patient address + public sources…), and consider the kind of eval I did before a big spend.
5. Understanding the challenges of DTC patient health records
Q: Besides OneRecord, Ciitizen, CommonHealth (Commons Project), and (I guess) Apple Health, what are the more successful successful "DTC" (direct to consumer) patient PHRs (patient health records)? Bonus, what makes them successful?
– Kevin Maloy | via #buildersask
Thread Summary: In this thread, HTNers discuss the most successful direct-to-consumer (DTC) patient health record (PHR) platforms. The definition of success varies, but factors such as popularity, longevity, and patient access are considered. The conversation also touches on the monetization challenges and limitations of PHRs, with some HTNers questioning the utility of PHRs in general.
Brendan Keeler: But PHRs in general aren't useful / monetizable today for well-documented reasons and usually evolve into virtual first care, provider partnerships, or clinical trials funnel a la Evidation.
PHR is a tool. Tools are used to solve problems. Other tools are better equipped / have unique advantages to solve almost all patient problems better than PHRs are enabled to do so given regulatory incentives and barriers.
🤖HTN KNOWLEDGE BOT
If you have your own question(s) to ask, don’t forget that a good place to start is our HTN Knowledge Bot. It’s our smart search tool that makes it easier to access the wisdom shared within the HTN powered by ChatGPT. You can log in and use it on the website (here) or see how to use it directly in Slack here.
Check out the example ask below!
Tell me about the headwinds in the Medicare Advantage market
Knowledge Bot Answer:
In the Medicare Advantage market, there are several headwinds that are worth noting.
1. Risk Adjustment Controversy: There has been ongoing debate and controversy surrounding risk adjustment in Medicare Advantage. The NY Times published an article highlighting how some large insurers are using risk adjustment to increase revenue from the government. The article suggests that private insurers are over-billing the government by billions of dollars annually. This raises concerns about the sustainability and profitability of Medicare Advantage plans. (source)
2. Reduction in Star Ratings: Medicare Star Ratings play a significant role in determining the quality bonus payments for Medicare Advantage plans. In the 2023 Star Ratings release, almost 20% of plans lost their 4+ star designation, making them ineligible for quality bonus payments. This can have a significant impact on the revenue of Medicare Advantage health plans in 2024. CVS, for example, issued an 8-K filing stating that only 21% of its members will be in 4+ star plans in 2023, compared to 87% in 2022. (source)
3. Member Churn and Marketing Practices: Member acquisition and retention have been challenging in the Medicare Advantage market. There have been concerns about deceptive marketing practices and confusion caused by third-party marketing organizations. CMS has cracked down on deceptive marketing practices, which can impact enrollment and member churn. It's important for Medicare Advantage plans to ensure transparent and ethical marketing practices to maintain member trust. (source)
These headwinds highlight the complexities and potential risks in the Medicare Advantage market. It's crucial for insurers and startups operating in this space to navigate these challenges and ensure compliance with regulations while delivering high-quality care to beneficiaries.
Here we highlight helpful resources from across the community:
- Psychiatry Tomorrow: Stella's Acquisition of Field Trip Health via Carlene MacMillan, MD – The team at Psychiatry Tomorrow dig into the recent acquisition of Field Trip Health with founders from each org.