Medicaid Blue Button API Use Cases

This post is simply a list of use cases that helps all of us understand why the Medicaid Blue Button API is super important to Medicaid members.

Btw – here is the list of apps that are built using the CMS Medicare Blue Button API and another list of apps that have agreed to the CARIN code of conduct.

Providers

Claims data is one component of a patient’s complete, longitudinal digital health record adding cost, coverage and adherence.

These are ways in which Medicaid members having access to their claims information or sharing this data with their Provider can have an impact.

  • Providers can share data with each other given a patients consent
  • Patients can download their claims data into a personal health record like Apple Health and show information to their provider during the visit
  • Patients receive Infrequent procedure reminders (ex: annual exam, colonoscopy every 5 years, etc)
  • Easy way for family member/caregiver to access medical information in emergency (important for authorization access not to time out too quickly). Apple is also working on this (emerging).
  • Improving care coordination by sharing information with all members of a Medicaid member’s care team
  • Decreases printing of records a provider needs to do
  • An at-risk provider having difficulty accessing a patient’s longitudinal claims record (like we heard re: the Oncology Care Model – which shares such data up to six months after the initial trigger event) could gain more timely access to this data via Medicaid member granting permission.
  • Comparing & reconciling patient-level payor EOBs vs provider bills
  • Automatic pre-population of initial visit forms (save time, increase accuracy)

Example: Did Jane have a Cervical Cancer screening at her last OB/GYN visit?

  • Jane, a 55 yr old female Medicaid member visits her PCP. She is handed an iPad to checkin and sees “Login to your Medicaid account to share data with Dr. Smith.”
  • She logs with her Medicaid username and password
  • She sees a spinning wheel and reads “Your Medicaid claims data has been downloaded and is up-to-date!”
  • Her claims data from Medicaid is synced to Dr. Smith’s EMR
  • Dr. Smith pulls up her chart during the visit and sees that she’s had the recommended Cervical Cancer screening
  • The Provider is complying with this screening CMS quality measure

Research

From Apple’s Research Kit to Verily’s Project Baseline, making it easy for a patient to contribute health data to a clinical trial or research study is powerful.

  • A Contract Research Organization (CRO) can incorporate Medicaid claims data to improve the accuracy of monitoring during a Clinical Trial.
  • Apps like Verily’s Project Baseline enable participants to connect a variety of personal health data sources to better inform the researchers.
  • Clinical Trial enrollment – A research organization can pre-populate a medication list for a patient during clinical trial enrollment.
  • Donate data to research (ex: precision medicine, “All of Us” research cohort/Sync for Science, Health eHeart Study (UCSF)

Prescriptions

  • Medication adherence
  • Navigating affordable care options (eg brand vs generic medication)

Example: Signup for home delivery of medication 

XYZ Pharma is a full-service pharmacy that sorts your medication by the dose and delivers it to your door.  They would use Medicaid claims history to reduce the Patient’s burden during the signup process, to better understand their prior billing cadence and to build a better profile of their medication history.

Health and Fitness

Example: Personal Health Record

A 59 year old woman from Cleveland, OH named Bettie has an iPhone 8 and a Fitbit her son bought her for Christmas.  Her friend told her about an iPhone app that lets her see all of her medical records on her phone called “MedView”.  She searches for it in the app store and downloads it.  Her favorite apps on the iPhone are Weather.com and Facebook.  She opens the app and it asks her to login with her Medicaid account.  She enters her username and password and sees a “welcome message” display on the app.  Success!  The app shows her some personally identifiable information and tells her it’s downloading her entire record from Medicaid.  She sees a status bar going to 100%.  A few seconds later she sees a timeline view of her information.

Financial

  • Forecasting & planning a personal health care budget (based on previous year information)
  • Connect your Medicaid data to health insurance shopping app or an accounting app like Quicken for tax deductions.

Brainstorming list

Below is a list of terms and concepts to trigger more ideas about how patient access to claims data can help make an impact on people’s lives and health.

  • Folks moving from Medicaid to Medicare or from private health insurance on to Medicaid or vice-versa 
  • eLTSS examples
  • Home Health Care
  • Assisted Living
  • Primary Care
  • Senior Social Networks
  • Wearables
  • Transportation
  • Patient Portals
  • Chronic Disease Management
  • Social Isolation
  • Preventative Care
  • Medication Adherence
  • Digital Therapeutics 
  • EHR interoperability
  • Longitudinal Patient record
  • Patient education
  • Preference-sensitive care
  • Medication reconciliation & adherence tools
  • Care team indexing & name/ID sharing with other providers
  • Evidence-based clinical decision support
  • Quality-related application & services for Accountable Care Organizations (ACOs)
  • Chronic disease management (including personal health tracking – eg for patients with diabetes)

Good Articles

Use of the Blue Button Online Tool for Sharing Health Information: Qualitative Interviews With Patients and Providers (PubMed 2015)

New iPhone Health app feature gives doctors easier access to data (The Verge, June 2021)

Consumer Access to Vaccine Records

As millions of Americans receive vaccinations in the coming months, will there be a consumer demand for vaccine data or “proof of vaccine” on their smartphones?

This NY Times article is a great read.

There is a serious debate on whether health passes, electronic vaccine credentials, proof of vaccine, etc is truly needed. Assuming it does happen, below is a quick summary of some of the puzzle pieces.

Patient Portals

When a provider administers a vaccine, it is entered into their electronic medical record system. Today, people can use apps on their smartphones to connect with the doctor’s electronic medical system called a “Patient Portal”. You setup a username and password with your doctor to login to the Patient Portal website to view your health records such as lab results, immunizations and prescriptions. 

Apps like Apple Health and CommonPass (Android) use common health data standards (HL7 FHIR) and application programming interfaces (APIs) to connect with these patient portals if your doctor has opted to make this available.

Here’s an example from Aaron Miri, CIO UT Austin showing vaccine records from a EHR connected to an iPhone displaying within the Apple Health app.

Immunization Information Systems

Each state, US territory and many large cities have an Immunization Information System (IIS) that is basically a big database that doctors, public health clinics and others have to report every vaccination into.

Vendors like Envision WebIZ and STC Health One that build these IIS systems that governments buy have consumer access portals.

Here’s an example from Nevada.

These portals use name, phone number and date or birth to match records and then the person can print out their vaccination records.

Hopefully, these vendors will introduce APIs that enable consumers connect their immunization records to their smartphones. States rely on these vendors and will likely not build these APIs on their own.

Work and School Safety Apps

There are a bunch of products that now help businesses and schools manage the health and safety of their populations. These tools will have features to track vaccinations.

An open question is whether these tools will be able to directly access vaccine records for their populations from the immunization information systems and in-turn enable consumers to have this data on their smartphones.

Tech stuff

Below is a list of additional reading on the technical topics related to interoperability of immunization data.

Medicaid Blue Button for States

States don’t need their own API sandboxes, code samples or developer support to enable 3rd party developers to adopt the new Medicaid APIs required by the CMS Interoperability and Patient Access Rule.

The rule basically says each state Medicaid plan (and many other types of plans) needs to “build their own Blue Button API” as many state health IT people say.`

I was part of the team that built the CMS Blue Button API. We had to do a few things:

  1. Map claims data to FHIR, setup a FHIR server, build an auth service, setup an API gateway
  2. Build a developer portal with a sandbox, docs, sample apps, production API access process and more.
  3. Procure the project in a way there was long-term investment in continuous improvement to the infrastructure, APIs and developer experience.

My friend Sam’s blog post Building your own Claims API from 2018 is a great read to better understand what our CMS team did and you’ll have to do for your state.

Because all states will be using the FHIR and OAuth standards, all of their APIs should be pretty much the same. This is super important because it means that states shouldn’t build their own sandboxes, docs or sample apps.

Let’s build a coalition

A group of states and organizations should get together and build an API sandbox. This will give developers a chance to play around with the APIs and prototype them into their own apps.

There should be a github site with a bunch of sample apps or build on CMS’s github along with more tutorials like Install an Angular Client App.

I’m looking forward to seeing what thought-leaders like the CARIN Alliance, CMS, vendors and states will do to bring people together here. Sharing things like a Blue Button sandbox will save taxpayer dollars and accelerate time-to-market for most states.

Happy Building!

Thinking about the Government’s Role in Healthcare and Life Sciences Technology Innovation

My personal philosophy of Government is one that takes a long-term view, provides infrastructure and conditions to enable Citizens, and holds the massive responsibility to self-regulate and optimize itself.

I have read four books recently that have really informed my views and inspired me about the role of our Government in Technology:

I want to see Government continue giving Entrepreneurs Access to:

  • Data
  • Policy Makers and Regulators
  • Pilot programs

The Entrepreneurs, Venture Capitalists and Big Tech Giants will build products, fund ideas and get innovation to the people. Government will ultimately set the regulations. Lately, Government has also taken on an increasing role in sponsoring hackathons and innovation challenges (Challenge.gov) to promote adoption of their data sources and generate awareness of their role in the overall tech ecosystem. From the JOBS Act to Patent Reform to Cybersecurity to the Open Data Initiative to the America Invents Act, there are many good examples of progress outlined on Whitehouse.gov.

I also recommend this Recode Decode interview with the U.S. Chief Data Scientist DJ Patil for good examples of how various Government Agencies are using data to iterate on problems.

As I zoom in on Healthcare and Life Sciences I think about:

  • HL7, FHIR and data interoperability
  • Open Data Initiatives and Data.gov
  • FDA regulation, Medical Devices and GxP compliance
  • HIPPA compliance
  • Cures Act
  • Moonshots
  • Why do we allow drug ads?
  • Reproductive rights
  • Medicaid, Medicare
  • ACA impacts and opportunities

There are incredible examples of Government using their scale to make progress such as the Million Veteran Program (Genome study) in which Veterans volunteer their DNA analysis and health information into a massive database for Researchers. Government is also funding technology pilots and new approaches to improving care such as a Mount Sinai paramedicine pilot in which Paramedics consult via telemedicine with Docs and treat the patient in their home without transporting them to the hospital.

I hope our Government continues to build upon the power of open data, collaborate with Entrepreneurs and view Healthcare as a fundamental right for our society and citizens.

The First 90 Days for a Product Manager New To Healthcare

I talk to Product Managers all the time that are considering building products or features that would move them into the Healthcare space. This post is for them.

As you venture into Healthcare, you are embarking on the most TLA filled space imaginable. Talk to other Product Managers that are veterans in the space and you’ll barely be able to follow along. They are not trying to sound smart, it’s simply that the TLAs get ingrained so deep that it takes real effort to not use them.

You’ll also come across a few big topics like:

  • How regulation impacts business models
  • Selling into large Healthcare organizations
  • HIPAA and GxP
  • Healthcare and Life Sciences are very different

I began my first 90 days as a PM in Healthcare on a beach in Florida with my wife and kids on Thanksgiving break. I lounged around reading/listening to these 3 books:

Doing this gave me an understanding of the ACA, Pharma and all of the problems especially in the US Healthcare system. I was beginning to understand some of the TLAs.

My next step was to talk with other Product Managers. I had to ask a lot of dumb questions in these conversations but everyone was super nice and helpful. #givefirst These conversations helped me build a list of news, people, podcasts, blogs, etc that now make up my daily healthcare and biotech information pipeline. On a daily basis I found myself reviewing the Healthcare Top 100 and thinking about the business models of these companies. I subscribed to daily healthcare industry news from Becker’s Hospital Review, STAT and Modern Healthcare. I followed Zdogg and David Chase on LinkedIn. I listened to podcasts from Catalyze.io and a16z.

At this point in my first 90 days I was back in the office, still under a nice “you are still new” grace period and learning from everyone I could. The next step was to talk to Techstars Alumni, Denver-based Founders and friends of mine that are running Healthcare Startups. I had 50 conversations in two weeks and summarized most of them in a shared Box folder the team uses. For a handful of the conversations, I summarized and sent an email to entire team to raise awareness. This quickly established me as the expert for our “Healthcare Startup Developer” persona.

In the first 90 days:

  • Tell stories to build empathy about the people the product is trying to help.
  • Establish yourself as the voice of the customer on your team.
  • Show you are passionate and curious about the problems to be solved and the people you are trying to help.

It’s been one year since I began my journey as a Product Manager in Healthcare. I am once again sitting on the beach over Thanksgiving break pondering our Product Roadmap, Industry trends and reading everything I can about AI in Healthcare, Big Data Analytics use cases, Serverless Compute, how the ACA may change in the next Administration, CRISPR and more.

If you want help with your first 90 days, please don’t hesitate to reach out….and good luck!

Photo Credit: https://unsplash.com/@joaosilas

Healthcare and Life Sciences Corporate Venture Capital

Moving from a background in AI and Developer Tools to Healthcare has required a crash course in healthcare policy, finance, technology and regulations. I’ve always looked to investing trends and analysis to help me better understand a market. Looking at Corporate Venture Capital (CVC) in healthcare and life sciences is a fun exercise.

“over 48% of the top Fortune 100 companies have a corporate VC arm and these corporate VCs have participated in 24% of total deals globally for the past 4 years.” [source]

First, a few basics on Corporate Venture Capital…

Why does the Corporate Venture Group exist?

  • Generate financial returns for Limited Partners (LPs) including parent Corporation
  • Generate revenue for the Corporation
  • M&A channel
  • Licensing, Divestiture, Partnerships
  • Foster Innovation, Identify Global Market Opportunities, funding initiatives that need to exist outside parent Corporation structure

What do Corporate Venture Groups do?

  • Build a Portfolio of Investments that could range from Series A to “evergreen”
  • Build an Ecosystem of Strategic Partners
  • Generate revenue from revenue share deals and equity positions
  • Invest as a Limited Partner (LP) in other Venture firms

So, what’s going on in Healthcare and Life Sciences Corporate Venture funds?

From this CB Insights report, you can see the most active funds include Merck Global Health Innovation Fund, Kaiser Permanente Ventures, Lilly Ventures, Siemens Venture Capital, Pfizer Venture Investments, Novartis Venture Funds, GE Ventures and of course Google Ventures.

Corporate Venture Capital (CVC) in Healthcare

Includes Information Technology, Therapeutics, Diagnostics and Drug Delivery, Diagnostics, Behavioral Health, retail healthcare and rise of consumerism, new provider payment models, delivery of care, implementation of the Affordable Care Act, Data and Analytics.

Kaiser Permanente Ventures

Siemens Venture Capital

Mitsubishi Healthcare

Vesalius Ventures (Vanguard Ventures, Fremont Ventures and Guidant Corporation)

GE Healthymagination

Merck Global Health Innovation Fund

Johnson & Johnson Innovation

Zaffre Investments (BCBS of Massachusetts)

BlueCross BlueShield Venture Partners

MemorialCare Innovation Fund

McKesson Ventures

Cambia Health Solutions

Rex Strategic Innovations

Corporate Venture Capital (CVC) in Life Sciences

Includes Biotechnology, Biopharma, Medical Devices and Diagnostics, Drug Discovery, Pharmaceutical services, Pharma value chain.

Nova Novartis Venture Fund and Novo Ventures

Mitsubishi Life Science

MedImmune Ventures (AstraZeneca)

SR One (GlaxoSmithKline)

Lilly Ventures (Eli Lilly and Company)

Amgen Ventures

Roche Venture Fund

Samsung Ventures

F-Prime Capital Partners (Fidelity Biosciences)

Takeda Ventures

Baxter

Pfizer

Some additional reading:

Making Sense of Corporate Venture Capital

The 117 Most Active Corporate VC Firms Of The Last Year

Digital Health Funding: 2015 Year in Review (Rock Health)

Tencent, Google Capital Invest In Indian Healthcare Startup Practo

Medtronic, Sequoia launch $60M VC fund for Chinese med tech startups

Understanding the portfolios of these Healthcare and Life Sciences Corporate Venture Capital funds, the backgrounds of the Partners, where they are based and what companies they invest in help paint a picture for where things are going.

To learn a bit more about Healthcare technology read There’s a lot going on in Healthcare tech right now.

There’s a lot going on in Healthcare Tech

In 2015, venture funding of digital health companies surpassed $4.3B and accounted for 7% of total VC funding in the US. Deal sizes are growing and the percentage of later stage deals is increasing signaling a maturing in healthcare investments.

In my first six months as part of the Watson Health team, I’ve observed a few trends such as:

Google’s Investment in India will impact Healthcare
Google announced they will train 2M Indians on Android OS and promote internet use among rural women by 2019. In India, 5% of the population has health insurance (“cash for care”) and over 70% live in rural areas without access to quality healthcare (source). No doubt Entrepreneurs and Engineers will be creating major innovations in this space. Related: IBM and Manipal announcement

a16z is talking about Digital Therapeutics
Behavioral change is an area Startups/Developers/Apps have and will continue to embrace. A positive signal is a16z’s movement into this space asVijay Pande talks about in this interview. In this class of app, Email/SMS/Push Notifications/Phone calls are the engagement mechanisms.

VC Investing has increased == Startup activity is very hot
A few months ago Rock Health published their 2015 Healthcare Funding report, a must read. Combine this funding data with a review of new Healthcare products on Product Hunt,new Healthcare companies raising capital on AngelList and scanning Dan Primack’s Term Sheet or any other funding source and you will have a good grasp of the pace.

Regulation continues to provide opportunities
Today, major Health IT spend is in certified electronic health record (CEHRT) technology needed to comply with the federal meaningful use (MU) program, better security systems, and ICD-10 conversion software. Coming soon, additional legislation from the Protecting Access to Medicare Act kicks in mandating “that starting January 1, 2017, physicians ordering advanced diagnostic imaging exams (CT, MRI, nuclear medicine and PET) must consult government- approved, evidence-based appropriate-use criteria, namely through a CDS system.” (source)

Another helpful way to look at the Healthcare VC space is to think about the trends and contrast with VC investments.

Macro-Trends

  • The Consumerization of Healthcare
  • Consolidation of and competition between Hospitals and Integrated delivery systems
  • Strategic Investing (ex: Mayo investing in Helix)
  • Monitoring and Prevention
  • “Obamacare” disruption

Healthcare Funding Categories

  • Health IT Software
  • Digital Health
  • Medical Devices
  • Payer Disruption
  • Biotech

For further reading, I recommend checking out the various portfolio companies from Rock Health, Kapor Capital, SafeGuard, Arsenal and GV. Also checkout the Accelerator programs like Techstars Cedars-Sinai andMore Disruption Please to get a feel for the early stage. CB Insights is always publishing great insights such as this Healthcare IoT market map.

Here’s a brief sampling of some investments I’ve seen recently in these areas:

  • Patient Engagement
  • Prescription Management
  • Healthcare Analytics
  • Genetic Testing
  • Elder Care
  • Life Sciences
  • Medical Devices
  • Nanotechnology
  • Biotech
  • Insurance
  • Gene Therapy
  • Health and Wellness
  • Digital Health
  • Health IT

In Health IT software:

Care Coordination: Patientping, HealthLoop
Payer Management: Oration
Data Analytics: Medivo, BeneStream
EMRs: Elation

In Digital Health we see:

“Communities” like:

  • Health coaches (eating, personal trainers, etc)
  • Community for X
  • Competition
  • Reviews and Ratings
  • Connecting Providers (Patientping), Caregivers to Seniors (Honor)
  • Crowdsourcing data (Human Dx)

“Monitoring” is a huge category including:

  • “smart devices”, watch, smart phones
  • insights, behaviorial analytics
  • personal health and nutrition assistants
  • DNA and other self testing (23andme, Helix, uBiome)

Health and Wellness Platforms like ShareCare, Welltok and Omada Health.

Products like monthly food (Birchbox) and care packages (Citrus Lane).

Content like articles, daily emails and health guides (HealthSherpa)

Dev Tools like HIPPA data stores (TrueVault, Aptible, Catalyze.io) and IoT data streaming (Sense360).

In Biotech we see…

Biorepository, Genetic Analysis, Cellular Models, Regenerative Medicine, Bioinformatic Analytics.

Startups are using new techniques to harden defensibility into their business models such as creating Developer Ecosystems and baking in data network effects. A good example of data network effects at work is Recombine, a genetic testing company. They have built a network of partner clinics that administer its tests; with each new test, Recombine gathers more DNA data which (with appropriate consent) it can run machine learning on to improve its tests and nimbly develop new ones (therefore gathering more data). Recombine uses Machine Learning tools to find and learn patterns in historical data and uses these patterns to generate predictions. Recombine is 4 years old and has raised $3.3M.

I hope this post gets your brain spinning on all of the opportunity and innovation that’s happening in healthcare.

Using Trigger Lists in Product Management

I’m a big fan of “trigger lists”. The exercise of building them and the value they bring to a Mind Mapping or Design process have proved beneficial to me over the years. One of my favorites is David Allen’s GTD Incompletion Trigger List.

Recently, I transitioned from obsessing over providing Developers with APIs that would help them build amazing things with AI to obsessing about Healthcare and how AI can provide better care while lowering costs.

I pounded a Doppio and spent an hour brainstorming this trigger list to help me empathize with Users and better understand Actors in the crazy ecosystem that is today’s Healthcare tech.

I am a…

Healthy person
Cancer survivor
Farmer
Factory Floor Worker
CRO Administrator
CIO
CFO
CEO
Developer
Product Manager
Auditor
Patient
Physician
Nurse
RN
PA
Administrator
Researcher
Daughter
Son
Parent
Community Oncology Clinic
Hospital CEO
CMS Employee
FDA Committee Member

And I have…

Outcome data
Clinical trials
Drug databases
Medical journals
App Store Reviews
Medical Devices
Demographics
Avatars
Full Contact API data
Clinical Trial Participants
Patient data
Lab results
Population data
Reimbursement data
Patent filings
Hunches
Students
Research and Health kit data
Hospital trends
Emails
Tweets
Blog posts
Survey results
Internet searches
Essays
Product reviews
X-rays
Photos
Instagram searches
A list of questions

And I want to…

Find Patterns
Organize my data
Filter my data
Search my data
Understand social media
Build an Android app
Surface correlations
Have access to information

So I can…

Comply with regulations
Stay up-to-date
Collaborate with a Physician
Track my progress
Get credit for a course
Be reminded of an appointment
Find cost savings
Sell an app
Make people healthier
Prove a point
Get reimbursed
Understand health trends
Track my Clinical Trial
Find a Hospital
Research and buy my medication
Predict outcomes
Make more money
Connect data together
Build a treatment plan
Find a Clinical Trial
Predict the Future
Support Meaningful Use
Make evidence-based clinical decisions
Analyze adverse events
Provide better treatment “in the field”

For those familiar with Agile, you’ll recognize the “As a User I want” format of this trigger list.

We all have so much stuck in our heads, try creating one of these trigger lists for something in your world and you’ll be surprised at how it can help.