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The Healthcare Influencer Series Part 3: Leah Binder

  • 25 April 2018
  • Expert Insights

This post is part of our new Healthcare Influencer series in which we interview the world's leading experts to get their take on the state of the industry, the top trends to watch for, and what the future holds.

The following is an interview we recently had with Leah Binder, President and CEO of The Leapfrog Group.

1. How has the Healthcare industry evolved in the past 5 years?

LB: The greatest change has been the influence of consumers. This is actually a tsunami that occurred while policymakers were focused elsewhere. One day we turned around after all the political battles about Obamacare and realized the landscape and economy of healthcare look entirely different thanks to aggressive market forces that were largely unintentional. They were triggered by the growth of high-deductible health plans, which were first authorized by legislation during the Bush Administration and now cover one in three American workers.

Under these plans, coverage for virtually all health services including prescription drugs kicks in only after the enrollee spends the full deductible, which is at a minimum $2700 for a family plan this year. But most have deductibles of $3,000-5,000 or even more. The majority of covered people never hit the deductible, so they pay virtually everything themselves. The patient becomes the payor. In other industries the name for that is “consumer.” While I think patients are only beginning to act as more assertive consumers, providers responded with urgency to this new economic reality, reshaping their practice to better respond to the needs and desires of the patient.

Actuaries also believe the advent of the price-conscious patient-payor has slowed the growth of health spending overall, a trend we thought was a pipe dream a few years ago. There are many hazards to high deductible plans, and experts debate their merits, but they are growing and it’s time to wake up and smell the impact.

2. What are the top Healthcare technology trends you're seeing?

Trend #1: First, major implementation challenges in healthcare settings. The federal government invested billions of dollars through the meaningful use program incentivizing health systems to adopt electronic medical records and computerized prescriber order entry (CPOE). But for many health systems, they bought the technology cart and put it before the horse.

Today we are discovering major problems with the way the new technology is implemented. Physicians are unhappy with EMRs, which are increasingly blamed for burnout and dysfunctional practice patterns like studying the screen instead of the patient in the exam room. We find that CPOE and bar code medication administration are now ubiquitous in hospitals but often not as effective as they should be in promoting safety. For instance, on the Leapfrog Hospital Survey we give hospitals a simulation test to run on their CPOE system—a set of dummy orders for a set of dummy patients, to test how well the CPOE system alerts to common prescribing errors.

We find that about a third of the orders that would result in harm to the patient don’t get alerted correctly. With bar coding, our survey results suggest that only about a third of hospitals are putting in place all the best practices known to make the systems effective at protecting patients from safety problems.

Trend #2: Second, an explosion in the use of “big data”, in particular, claims data. We see a number of startups in the market with very innovative approaches to communicating insights from claims data. Some are using AI to try to help employers or plans predict the highest-risk populations in need of earlier intervention. This is exciting to see, but I always caution people that we are much earlier in this technology than most people think. Claims data is remarkably limited in its ability to convey accurate and meaningful information, and we can’t get our hands on enough of it anyway. And whatever surprising insights predictive analytics can offer are muted by the sad reality that medical science is not great at prevention anyway. We may be able to identify at-risk individuals, but knowing how to help them head off the cancer or heart disease is not a strength.

Trend #3: Finally, the use of telemedicine has been dramatic. Virtually every large employer in the country has either incorporated telemedicine into their workplace or plans to do so. Medicare is moving in that direction with recent legislation paying for it under Medicare Advantage. I think this alone will change healthcare delivery in fundamental ways in the near future.

3. How will AI change the Healthcare industry?

LB: I think its greatest potential comes from reducing harm to patients from misdiagnosis and other safety problems. The diagnostic problem has emerged as a defining issue of the patient safety movement, because researchers increasingly recognize its widespread implications for the quality and cost-effectiveness of health care delivery throughout the system. Centering diagnosis on the cognitive capacity of one physician or even one team of physicians is increasingly problematic as medicine grows in complexity and the body of knowledge expands exponentially. AI has the potential to support diagnosis by not only helping match symptoms to potential diagnostic categories, but assessing the experience of large groups of other patients in order to understand the odds that a particular diagnosis is correct or an intervention is most likely to work.

4. What's the future of Healthcare?

LB: Healthcare will pivot to respond to the needs and demands of consumers, who will increasingly pay more of the costs out of their own pockets. The aging of the millennials—currently by population a larger generation than the Baby Boomers—will expand the use of technology to accelerate that transition. This in turn will bring new opportunities for quality and efficiency still unimagined today.

About Leah Binder

Since 2008, Leah Binder has served as President & CEO of The Leapfrog Group, a national nonprofit based in Washington, D.C., representing employers and other purchasers of healthcare calling for improved safety and quality in hospitals. She is a regular contributor to and other publications, and consistently cited among the most influential people and top 25 women in healthcare and patient safety.

Under her leadership, The Leapfrog Group launched the Hospital Safety Grade, which assigns letter grades on the safety of general hospitals across the country. She fostered groundbreaking innovation in transparency and payment policy through the annual Leapfrog Hospital Survey, which sets high standards for hospital quality and publicly reports information available from no other source. Leapfrog’s leadership is widely credited as key to significant advances in healthcare delivery, including reductions in early elective deliveries and other maternity measures, improvements in medication safety, reductions in infections, and the acceleration of health care transparency.

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