In my last blog post, I talked about managing care within the medical neighborhood, what I consider the health care version of “it takes a village.” Now, let’s move beyond the neighborhood and talk more specifically about the neighbors.

“Who is my neighbor?” may sound like the title of a sermon, but to paraphrase an old political slogan, “It’s the relationship, stupid.” If we retreat into our private little kingdoms like tribal warlords, we will never achieve better outcomes for our patients.

In Colorado, there is an excellent medical neighborhood in the city of Grand Junction. In last November’s Forbes magazine, Rick Ungar detailed the success that the doctors, hospital and major health insurance plan have been able to achieve. I’ll hit the high points here.

Medicare spending in Grand Junction is just $5,873 per patient, compared to the national average of $8,304. The cost of chronic disease management in this area is 1/3 the national average. Low-income patients on Medicaid are more than twice as likely to get preventive care. Low birth weight babies are a rarity.

How was all this accomplished? Did the citizens of Grand Junction form a consumer group? Did the government provide a new program?

No, the doctors, hospital executives and predominant insurance company in the region worked together. Specifically, the doctors formed an IPA (Independent Physicians Association) where good relationships amongst the doctors allowed them to take a hard look at spending. With a solid primary care base, care management was more taken care of more easily.

The insurer, Rocky Mountain Health Plan, a non-profit company, agreed to pool the money collected from private payers with the money collected from Medicaid and Medicare. This allowed the doctors to treat everyone the same, no matter who was paying the bills. Finally, the hospital was able to manage its own costs so even as the number of bed days declined, the hospital could stay financially viable.

For another example, let’s move across the country to Camden, New Jersey to look at “Hot Spotters.” Atul Gawande’s wonderful New Yorker article from January 2011 has all the details but, again, I’ll hit the highlights below.
Dr. Joseph Brenner is a family physician living in an impoverished community in New Jersey. Poring through data provided by local hospitals, he identified the sickest individuals in his neighborhood. Then, by “building relationships” with these people, managing their care and coordinating their community resources, Dr. Brenner and his colleagues have been able to reduce medical costs for these first 36 “super-users” by over $500,000 in just two years.

This is not to say we must all become like Grand Junction, Colorado or Camden, New Jersey. But, I think there may be some themes worth copying.

First, primary care physicians must have the resources necessary to manage their patient populations. This means being able to look at their data with an eye toward chronic disease management and proactive care for high risk patients.

Second, PCPs must be able to look at the care provided by their sub-specialist neighbors. This means outcome and cost data must be readily available.

Third, hospitals must take a hard look at their revenue streams and stop the medical arms race for the fanciest new suite for the care of this or that disease. Finally, insurers must provide meaningful data back to the doctors so we can see where the money is being spent and who is spending it. Risk stratification is not just a term for health insurance companies—all care givers must become comfortable looking at the data.

The stakes are high. As a country, we can’t continue to increase health care spending. The good news is that relationships with our neighbors in our medical neighborhoods can still save us.

It’s that time of year again: flu season. We’ve been reading about this year’s flu in the news, and (as a group of data nerds) tracking it online through CDC reporting and Google’s Flu Trends.

We thought we’d see what we could add to the conversation. So we dug into our athenaNet data set of 40 million patient records to see how this flu season is developing.

Here is what we found so far:

This flu season is severe, but may have already peaked. By our metric, you’d have to go back to the 2009-2010 flu season (the second wave of H1N1 “swine flu”) to find a season that reached the intensity levels we’re seeing right now. However, our data is showing a glimmer of hope: Two weeks ago, flu incidence decreased for the first time since the start of the 2012-2013 flu season, and last week it stayed level. Our data is right in line with other sources right up until this past week (CDC numbers come out on Friday), so we’re confident these patterns are an excellent real-time “flu view” (sorry, CDC)!

Last week’s flu uptick is driven by regional variation. The South, Midwest and Northeast regions of the country seem to have hit their peak levels already, but the flu has continued to ramp up in the West over the past few weeks. Based on flu patterns from the past several years, our guess is that the West reached its peak levels last week, though there have been flu seasons with a second strong peak (2001-2002, for example).

The flu has hit the West. At the end of December, most of the South and Northeast were starting to experience intense flu rates. Over the two weeks that followed, this year’s flu had taken over almost the entire country: 

The news coverage and vaccination campaigns seem to be working: more people are getting vaccinated. In October, we saw the usual peak in vaccinations this flu season. However, following the January 4 CDC report that recommended vaccination in light of the flu continuing to spread across the country, we saw an uptick in vaccination rates last week, as seen in the accompanying chart. Hopefully, these preventative steps will get us to the end of this flu season more quickly.

We’ll continue monitoring this situation over the coming weeks, and will post updated findings as they come in. Hopefully, our next post will continue to show the flu abating across the country. Until then, join the growing number of people who are getting vaccinated (find a vaccine near you) if you haven’t already, wash your hands frequently, and stay healthy!

So, if you are reading this, you probably understand that this Internet thing is going to be big. In fact, maybe you used this “Internet” to do all your Christmas shopping this year.

Like me, you may even think that NO isolated instances of software will hold any active health information within the decade. But you may not be all the way with me when I tell you that it isn’t just cloud-based software that will hold it, but a cloud-based marketplace for service.

Remember that blog post a few years back where I showed the software evolution exhibit from some future museum of ancient computing history? We need the service company in that diagram, not just the cloud computing company that precedes it, and, for that to work, we need permission to monetize the whole supply chain.

For example, the person who best knows what electronic information is needed by Cardiac, Vascular & Thoracic Surgeons (CVTS) of Greater Cincinnati (new client…woo hoo!) is someone who does not live in Washington D.C. In fact, even if someone in D.C. told them what to need, CVTS wouldn’t receive it. It would be a tiny bit off—since no one is incented to provide accurate and complete referral information—and no one would return CVTS’s call when the primary care group got it wrong. And CVTS wouldn’t hassle too much about it because they don’t want that primary care group to get pissed and start using another surgery group. Is this a hard thing to understand?

Maybe everyone buys it but they don’t see an alternative? Is there an alternative? I thought you’d never ask!

What if CVTS could design and then re-design over time what data they wanted? What if they could do it online in a little portal? Every time they piloted and adjusted a care pathway for a procedure, they would adjust the data they require in their portal. Then everyone who refers to them would start pulling the required data from their medical records. Why? Because these data would be pulled automatically by the network of cloud-based information services that sits behind all the area practices…and because CVTS would be paying for the information if and only if the data arrived electronically and complete.

The cloud-based players would be expert at pulling said data and at prompting the staff of referral-sending practices (in 6th grade English because that’s how everyone rolls except in health care)…if they weren’t, they would have lost to athenahealth, which is already expert at this.

Now pull the camera back from CVTS, and you see a social movement that would make even Arlo Guthrie cry an “Alice’s Restaurant” tear.

That is, you can get anything you want…if you make it easy and pay for it.

So why is it not happening?

Is the world really just waiting for athenahealth to get big enough to do it for everyone? I’m flattered, but I think not.

No, it isn’t happening primarily because it is illegal under the Stark and anti-kickback laws.

We need to change this.

The voters of California’s 13th congressional district already changed out Pete Stark (my first Christmas present).

Now we need to adjust his law and others so that the single most important health reform of the 21st century—the emergence of a sustainable market for the exchange of health information—can finally rise.

Happy holidays, everyone!

Welcome to the inaugural Cloud Analytics blog post, brought to you by the athenaNet Intelligence team. We are a crew of data geeks who firmly believe athenahealth’s greatest asset—other than our clients and coworkers—is our data. While our colleagues are busily building the country’s first health information backbone, our team digs through and mines our massive and growing cloud-based database with an eye toward improving physician and practice performance and nudging the health care industry toward a better future.

Just how big a data set are we talking?

• 40 million patients
• 27,000 physicians on the network
• 11,000 non-physician practitioners
• More than 12 years of data
• Input from clients in 48 states

With that kind of scale, we can slice and dice and then share out knowledge with a thoroughness and intelligence that only a cloud-based service can provide.

In future posts, we’ll discuss important or simply interesting themes and trends, each offering a data-driven look at a facet of health care in the United States. This is a tremendous opportunity for us to share our point of view, in real time, on the industry with the greatest impact on our economy and society.

So, to kick it off, here’s our first data insight of the series, a demographic profile of our physician and patient populations.

What does our physician population look like? Very similar to national averages!

Compared to the national population, athenahealth physicians are slightly older (82% over 40 for athenahealth vs. 74% over 40 for U.S.), slightly more male, and very slightly less specialized. Here, we exclude residents and pinch-hitting docs (locum tenens) given year-to-year fluctuations of these two groups. In future posts, depending on the research topic, data for all physicians and non-physician practitioners may be included.

Geographically, we are dispersed across all the lower 48 states, with physicians representing 77 specialties. This map shows athenahealth’s primary care physician (PCP) percentage (the “Specialty” row in the first chart) for each state. Here, you can see that states in the Midwest and West have a higher concentration of PCPs than in the East. In absolute terms, we are well represented in states with large metropolitan populations such as California, Texas, Pennsylvania and Florida.

What does our patient population look like? Again, similar to national averages.

Compared to the national population, athenahealth patients skew older and more female. They are also more likely to be insured, based on patients with claims reimbursed between August 2010 and July 2012. This is consistent with the observation that females, older patients, and patients with insurance are more likely to seek care.

A geographical view of the percentage of patients in each state who are insured shows variation across different areas of the country. As of November 2012, our data draws from approximately 29 million patients with encounters in the last 24 months, or ~9% of the US population. This large footprint forms the core of our research, enabling us to provide a robust and representative view of population health and care delivery patterns.

So that’s a baseline view of our data. What do you think? We already have the data lined up for subsequent posts, on a wide array of topics, but we’d really like to hear from you. What kind of data and trends would you like us to examine more closely? Drop a comment to let us know.

As a tee-up to our next post, here’s a preview of out-of-pocket costs data that we’ll be exploring next. More specifically, we’ll look into deductibles as a percent of what insurers agree to pay providers, or the “contracted rate.”

What does it look like for 2010-2011? Do these trends portend the impact of health care reform, even before its enactment in 2014? Stay tuned!

As you can imagine, we are always on the hunt for top-drawer talent to help us realize our vision of building the nation’s health information backbone. By now, many Bostonians have seen our billboards—“Can your code fix healthcare?”—aimed at promising developers and placed in strategic locations in and around Boston’s public transit system. In the recruiting world, we compete for top talent with all the big tech players like Google, Amazon, Microsoft and a host of other  employers in the Boston area. The cool thing is that if we can get a technologist to look at athenahealth, they quickly realize two things: There is a very meaningful opportunity to help fix something that is massively broken in this country; and they’ll get a lot of the same perks they would at other tech companies.

These days there are plenty of stories out there about free sodas, foosball tables and laundry services as the staple benefits for tech companies. At athenahealth, we believe it’s important to have these types of benefits, but we pick carefully to make sure they align well with our values. We are not just trying to keep up with the Joneses— we’re actually trying to make our employees’ lives easier and more fulfilling.

Like many companies, we have free soda in the fridges (and very good beer… gasp! Yes,we do expect our employees to act like adults… double gasp.) Unlike many companies, we have an on-site Community Supported Agriculture (CSA) program through The Farm School. Nothing like organic, grass-fed beef to enhance engagement! We even have our café chef cook up all kinds of delicious meals using this fresh, local produce.

The tangible perks are great, but we should acknowledge that most athenahealth employees are really in it for themselves—and by that, I mean they are looking for real career growth. We have invested heavily in training our employees, both on the nuts-and-bolts of health care and our products, have a growing leadership development program, and  can boast a 33% or higher transfer and promotion rate.

When we talk about having implicit opportunities to grow at athenahealth, we can say that one in three athenistas will find themselves in a new role within the company this year and every year. Personally, I have had the fortunate opportunity to work for athenahealth for 15 years and I have had seven different roles. No wonder I haven’t left!

All of these perks and development opportunities really come back to the fact that, as an organization, we believe in innovation. We encourage everyone to try new things, so much so that some of us call it “launch and learn.” This is a very common mentality in smaller start-ups, more out of necessity than anything else. But as athenahealth has grown over the years, we realized this was a special part of our culture we did not want to lose. So we invested in it. 

As a result of this culture of innovation, we have been able to create something special. Our “social code” seems to be running smoothly and surprisingly well across the diverse “operating systems” of our 2,000+ employees. And there is no better validation for this than our recent selection as one of the top places to work in Massachusetts by the Boston Globe, both by size and as a tech company. And we made these lists based on the program’s independent survey of our employees. I’d take that as affirmation that our code is working!