Wall Street Journal
A lot has changed in the way the health-care industry uses technology since Bruce Goodman became Humana Inc.'s chief information officer in 1999. And, he says, there's still a lot of work to be done.
Mr. Goodman, who joined the Louisville, Ky., health-insurance giant amid the Y2K frenzy over the ability of computers to deal with a year ending in 00, sees both technical and creative challenges looming for his industry. His primary goal is to get doctors, patients and insurers fuller information more quickly.
Mr. Goodman recently discussed these challenges and more with The Wall Street Journal. Here are edited excerpts of the conversation:
Mr. Goodman, who joined the Louisville, Ky., health-insurance giant amid the Y2K frenzy over the ability of computers to deal with a year ending in 00, sees both technical and creative challenges looming for his industry. His primary goal is to get doctors, patients and insurers fuller information more quickly.
Mr. Goodman recently discussed these challenges and more with The Wall Street Journal. Here are edited excerpts of the conversation:
An Echo of Y2K
THE WALL STREET JOURNAL: Do you think we'll ever see something like Y2K again?
Mr. Goodman: The health-care industry is going to go through something equivalent to Y2K in a couple of years. There is a new code that the government is promoting around how you describe medical procedures called ICD-10. And that significantly expands the code set when a doctor describes what they have done for a patient.
So the old code said, "broken leg." The new code set gets much more specific as to exactly what part of the leg is broken and why it got broken. Tennis accident, skiing accident; it is really detailed.
You have got to go through all the systems where those kinds of codes are carried and expand those fields and bring in those new code sets. A lot of it can be automated. But it means remediating millions of millions of lines of code across lots of systems—systems hospitals use, we use, doctors' offices use. [When completed] it gives you more capability. You can do much more refined studies in terms of what is going on.
WSJ: How much freedom do you give Humana employees when it comes to using technology?
Mr. Goodman: They have a lot of freedom, but we are in a highly regulated business. We have some very confidential information about our members, and we are very sensitive to the level of security and the devices employees use. Our data center is attacked millions of times a month from the Internet. So we don't have our users using devices that can bring viruses and worms and Trojans and phishing expeditions into the mother ship.
WSJ: How can you tell which ones meet that criteria?
Mr. Goodman: For example, currently the Apple iPhone doesn't. It is not a secure enough platform where we would allow our highly confidential data to move. We tightly control laptops and other things that we give to our people. BlackBerrys, by the way, do satisfy the requirement, and we have those.
WSJ: What's the difference between the iPhone and the BlackBerry?
Mr. Goodman: The main difference is that if you lose a BlackBerry there are ways of ensuring that if somebody else picks it up, they can't get into the network and access your private data. There is a way of basically shutting it down. It's much more challenging to do that on the Apple devices.
Reforming the System
WSJ: There's a lot of talk now about using technology to reform the health-care system. What have you guys done to date?
Mr. Goodman: You want doctors to use your Web site for self service. The difficulty was that a typical doctor's office has patients from dozens of different health plans. So, each health plan has various degrees of advancement in terms of providing Web capability, right? And then the doctors would have to train their staff, which tends to have a fairly high turnover in the front office, to use all of those different systems. So, we got to a certain point of adoption and we were having a hard time getting beyond that.
We went and had a conversation with a competitor, Blue Cross Blue Shield of Florida, and said, "This is silly. Why don't we come up with a uniform Web portal for doctors?" Now more than 95% of all the doctors' offices in Florida use this capability, and it includes Aetna, UnitedHealth, Cigna, a lot of local plans and ourselves, so that the majority of patients that come into a doctor's office, they can go to that one Web site and get the information they need.
[We've since partnered with plans in other states and] we're rolling out in Texas, Illinois, Oklahoma and New Mexico. Not only has it been successful in terms of increasing adoption of the Web, but we have also gone off into clinical transactions, like e-prescribing. The venture has gone from practically no revenue to $70 million in revenue. And it does 600 million transactions a year.
THE WALL STREET JOURNAL: Do you think we'll ever see something like Y2K again?
Mr. Goodman: The health-care industry is going to go through something equivalent to Y2K in a couple of years. There is a new code that the government is promoting around how you describe medical procedures called ICD-10. And that significantly expands the code set when a doctor describes what they have done for a patient.
So the old code said, "broken leg." The new code set gets much more specific as to exactly what part of the leg is broken and why it got broken. Tennis accident, skiing accident; it is really detailed.
You have got to go through all the systems where those kinds of codes are carried and expand those fields and bring in those new code sets. A lot of it can be automated. But it means remediating millions of millions of lines of code across lots of systems—systems hospitals use, we use, doctors' offices use. [When completed] it gives you more capability. You can do much more refined studies in terms of what is going on.
WSJ: How much freedom do you give Humana employees when it comes to using technology?
Mr. Goodman: They have a lot of freedom, but we are in a highly regulated business. We have some very confidential information about our members, and we are very sensitive to the level of security and the devices employees use. Our data center is attacked millions of times a month from the Internet. So we don't have our users using devices that can bring viruses and worms and Trojans and phishing expeditions into the mother ship.
WSJ: How can you tell which ones meet that criteria?
Mr. Goodman: For example, currently the Apple iPhone doesn't. It is not a secure enough platform where we would allow our highly confidential data to move. We tightly control laptops and other things that we give to our people. BlackBerrys, by the way, do satisfy the requirement, and we have those.
WSJ: What's the difference between the iPhone and the BlackBerry?
Mr. Goodman: The main difference is that if you lose a BlackBerry there are ways of ensuring that if somebody else picks it up, they can't get into the network and access your private data. There is a way of basically shutting it down. It's much more challenging to do that on the Apple devices.
Reforming the System
WSJ: There's a lot of talk now about using technology to reform the health-care system. What have you guys done to date?
Mr. Goodman: You want doctors to use your Web site for self service. The difficulty was that a typical doctor's office has patients from dozens of different health plans. So, each health plan has various degrees of advancement in terms of providing Web capability, right? And then the doctors would have to train their staff, which tends to have a fairly high turnover in the front office, to use all of those different systems. So, we got to a certain point of adoption and we were having a hard time getting beyond that.
We went and had a conversation with a competitor, Blue Cross Blue Shield of Florida, and said, "This is silly. Why don't we come up with a uniform Web portal for doctors?" Now more than 95% of all the doctors' offices in Florida use this capability, and it includes Aetna, UnitedHealth, Cigna, a lot of local plans and ourselves, so that the majority of patients that come into a doctor's office, they can go to that one Web site and get the information they need.
[We've since partnered with plans in other states and] we're rolling out in Texas, Illinois, Oklahoma and New Mexico. Not only has it been successful in terms of increasing adoption of the Web, but we have also gone off into clinical transactions, like e-prescribing. The venture has gone from practically no revenue to $70 million in revenue. And it does 600 million transactions a year.
WSJ: Is this the model for how technology can improve health care?
Mr. Goodman: Absolutely. What many people don't realize is that health plans are in a unique position to provide information about the patient.
If a member is seeing more than one doctor or is getting prescriptions from more than one doctor, we see all of that if we insure them. We know when a member didn't refill a prescription, so we can tell a doctor there is a gap in adherence. If doctors are doing e-prescribing using hand-held devices, we can show them lower-cost drug options for their patients at the time of the script writing.
More to Do
WSJ: What parts are missing now?
Mr. Goodman: A number of things. Very few doctors' offices have electronic medical-records systems. And patients don't do a personal health record because a lot of them don't see the value of it. And frankly until you connect all the pieces and crunch it with data analytics, there isn't a lot of value to it. Part of [what will drive] adoption is getting everybody hooked up, and then generating actionable information that is useful to everybody in the system. You could take a lot of money out of the system by doing that.
WSJ: Who has to make this happen?
Mr. Goodman: What's disappointing about what's going on in Washington is that health plans are viewed as the villains, and we're actually in the best position to promote some of these advances because we have the data. We can provide monetary incentives to the doctors and to the [patients] to take advantage of whatever data analytics we do and, therefore, drive the adoption. And with the adoption you improve quality of care and you lower the cost of care.
When you have a not-for-profit organization or a plan, [they just don't have the incentive] to connect the doctors. When you have somebody who's in it for a profit, you have a motivation to root out fraud and abuse and to try to really improve the quality of care, because it costs less if you have good care.
Looking Ahead
WSJ: How will the experience of being a patient be different in the future than it is now?
Mr. Goodman: To get an appointment at a doctor's office you'd go onto the Web, whether you're using a smart phone or not. And when you show up at the doctor's office, let's say it was your first visit, a lot of information that normally they would ask you for has already been downloaded.
In the exam office, there is a monitor and the doctor has everything in front of him or her. If there is a prescription needed, the doctor can do that electronically and can find out what's the most cost-effective drug for you and make sure you don't have a drug interaction [issue], because you have already had all of your prescription information downloaded.
To pay, you have an ID card, or maybe your cellphone, that immediately connects you, and your claim is adjudicated in real time. There is no paperwork.
WSJ: We started by talking about 10 years ago. Looking ahead 10 years, what happens to IT?
Mr. Goodman: I think there is always a place for people that really understand technology and can deliver an industrial-strength capability into the business. Maybe everybody will walk around with a contact lens that has 5G capability and an earplug, and you are integrated into the Internet.
I absolutely think [that sort of thing] is going to happen. I don't know if it is in 10 years, but bandwidth is going up. Cost of computers is going down. Size of computers is going down. Cost of storage, size of storage is going down. Those are the key trends. They make everything possible.
You get an embedded chip. Maybe it gets its energy from your stomach. You could burn 100 calories a day to keep your electronically embedded stuff going.
WSJ: How will the experience of being a patient be different in the future than it is now?
Mr. Goodman: To get an appointment at a doctor's office you'd go onto the Web, whether you're using a smart phone or not. And when you show up at the doctor's office, let's say it was your first visit, a lot of information that normally they would ask you for has already been downloaded.
In the exam office, there is a monitor and the doctor has everything in front of him or her. If there is a prescription needed, the doctor can do that electronically and can find out what's the most cost-effective drug for you and make sure you don't have a drug interaction [issue], because you have already had all of your prescription information downloaded.
To pay, you have an ID card, or maybe your cellphone, that immediately connects you, and your claim is adjudicated in real time. There is no paperwork.
WSJ: We started by talking about 10 years ago. Looking ahead 10 years, what happens to IT?
Mr. Goodman: I think there is always a place for people that really understand technology and can deliver an industrial-strength capability into the business. Maybe everybody will walk around with a contact lens that has 5G capability and an earplug, and you are integrated into the Internet.
I absolutely think [that sort of thing] is going to happen. I don't know if it is in 10 years, but bandwidth is going up. Cost of computers is going down. Size of computers is going down. Cost of storage, size of storage is going down. Those are the key trends. They make everything possible.
You get an embedded chip. Maybe it gets its energy from your stomach. You could burn 100 calories a day to keep your electronically embedded stuff going.
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