One-on-One With Micky Tripathi on Arcadia Move, COVID-19, and Data Privacy

June 3, 2020
The week-respected health IT voice discusses an array of issues related to his move to a population health management company, gaps in public health, and more

In late April, population health management solutions company Arcadia announced it would be acquiring certain assets of the nonprofit Massachusetts eHealth Collaborative (MAeHC), a health IT services firm that delivers strategic guidance, project management, data warehousing and analytics services, and hands-on implementation support to help its clients improve their clinical and business performance. MAeHC also plays a significant leadership role in advising and leading various interoperability and standards activities, including HL7 and FHIR.

MAeHC’s president and CEO, Micky Tripathi, Ph.D., a well-known health IT pioneer, was part of the transaction, taking a new position at Arcadia that was created for him—Chief Alliance Officer. In a recent interview with Healthcare Innovation Managing Editor Rajiv Leventhal, Tripathi discusses the nuances of the move, what his early priorities will be at Arcadia, the role population health management plays in the COVID-19 pandemic, and other issues around digital health innovation and data privacy. Below are excerpts of that discussion.

First off, congratulations on all the latest moves. What are some initial initiatives you’ll be focusing on at Arcadia?

We founded MAeHC in 2004 and we came to the conclusion after 16 years that we had outlived our nonprofit status, and that it didn’t make sense for us to continue as a nonprofit organization because the market had moved. In some ways we felt “mission accomplished,” since our original mission was to help promote the use of health IT in provider settings primarily, but also across the industry. Of course we aren’t solely responsible for the adoption of EHRs, but we felt like we played a part in helping the industry move forward. Now that the industry has moved to the next chapter of optimizing health IT systems, it didn’t make sense for us to continue as a nonprofit, and that suggested a transition was necessary. So rather than striking out on our own as a for-profit, we thought it would be better to merge forces with a larger organization that would have forward stability and who we were aligned with from a business and value perspective. So Arcadia was a natural partner for us, as we have been working with them for years—sometimes competing, but often working together with the same customers.  

As of May 1, I’ve been the Chief Alliance Officer at Arcadia, a new position on the executive leadership team. I will be primary focused on strategic alliances, meaning working with strategic partners on areas of mutual benefit that may or not be revenue generating, but more in the way of strategic alignment for longer-term benefit. So I’ll be developing a strategy for those kinds of partnerships, and then trying to forge and cultivate those.

Part of that will be related to my continued role in the national level activities. I am very involved in running the Argonaut Project, and I’m on the board of HL7, the Sequoia Project, CommonWell, and the FHIR Foundation, and I will continue in all of those roles. Arcadia was very supportive in making individual contributions to those activities. So there’s a two-way conduit: to be able to enrich my participation in those activities by being able to bring to bear a lot of the real-life experiences that Arcadia has on the ground, with lessons learned in data aggregation, value-based purchasing, quality measurement, and accountable care, but also going the other way so Arcadia can be able to take advantage of standards-based approaches to things in a little more of a deliberate way than they have done in the past.

Will MAeHC continue operating within Arcadia?

Arcadia didn’t actually acquire MAeHC because in Massachusetts, you cannot acquire a nonprofit organization [in this manner], so Arcadia acquired a significant number of assets of MAeHC, as well as a number of employees who made the transition, including me. MAeHC still exists as a corporate entity; what happens in a nonprofit transition like this is that you go through a process of taking the assets you have as a nonprofit entity and distribute them in some manner that’s consistent with your nonprofit mission. The longer-term goal over the next 12 to 18 months will be to eventually stand down and dissolve MAeHC, but the nonprofit organization still exists, the board exists, and the staff is managing the transition. They will take all the assets that MAeHC has and work on a plan that will be approved by the attorney general, and distribute those in a manner that’s consistent with the nonprofit mission.

What role do you see population health management playing in a global health crisis such as COVID-19?

As we have seen at the micro and macro levels here in the U.S., data is more important than almost anything if you want to get your arms around how to best address the needs of patients and make the best use of your own resources, particularly for provider organizations that are caught in the perfect storm of having higher demand for certain types of services, but no revenue for other services, and therefore being in the ironic situation of having high demand but being financially unstable. So it’s [about] understanding which patients are at highest risk and then understanding my best approaches for effectively delivering services to those patients. All of this relies on having a view on your patient population, and having the data that help you understand disease progressions as well as how to react to certain diagnostic indicators.

Outside of the obvious one, telehealth, which digital health innovations are catching your eyes these days in the fight against COVID-19?

You’re right; telehealth is the easy one. It’s intuitively obvious that telehealth is very beneficial in this very weird circumstance where you literally have patients who don’t want to leave their houses. We are starting to see momentum for other [things], too, such as apps and the ability for patients to self-manage in certain ways, and then using health data to be able to perform other types of functions that we may not think of being directly related to treatment, but will have a broader healthcare impact. Right now, we have patients who are increasingly trying to figure out if they are at risk and if they have symptoms they should be concerned about.

So imagine having an app in which patients can submit their symptoms, but you can bounce those symptoms against what you know about the patient. That’s based on having rich data. There is a whole model [gearing] toward app enablement, as well as AI, to be able to take that information and assess the current state, while also doing predictive work to give patients a better sense of what they should do next. As we know with COVID, depending on a patient’s risk status, the best thing is often to not come to the doctor’s office or hospital, but stay at home. We don’t have cures for COVID. That’s a weird anomaly with this; we are identifying patients, we may know they have COVID, and we’re still saying, “stay at home.”

Hopefully, this will be an avenue that doesn’t fade as the crisis starts to ebb, and that is the greater integration of the clinical base of information that we have with patient engagement and public health. Even given everything we have done with Meaningful Use,  public health has basically been on the sideline. [The pandemic] has exposed a whole bunch of things in the U.S. that have pointed to huge gaps in public health infrastructure that other countries don’t have, [especially] when looking at what Germany and South Korea have been able to accomplish. That’s because those countries have a robust, well-funded, and well-structured public health system. We have huge gaps here, despite having invested $30 billion in EHRs.

Part of that is because we didn’t have Meaningful Use for public health; we had it for provider organizations, but not for public health, so while all systems became electronic, we didn’t give public health organizations the corresponding level of funding for them to invest in technology that would better engage providers and patients, so they could monitor what’s going on, and then actively case manage. Before a year, ago [few] people knew what public health case management means. Now, everyone knows what it means. What worries me, though, is that our interest in this will drop off again until the next pandemic comes.

The government’s interoperability final rules, along with the pandemic, have put data privacy back in the spotlight. What are your thoughts on the balance that needs to be struck here?

We have lots of protections around data that have been appropriate, and pre-COVID, we were entering a world where you were starting to see accessibility through these apps by organizations and vendors outside of HIPAA. That in of itself was raising some privacy concerns about the technology getting out ahead of it. And then in the COVID world, all of a sudden we see the need to have this data being made available, and it can’t be the kind of thing where there’s too much of a barrier around the free and timely flow of information where you have consent being the barrier to sharing information. The non-sharing of information for whatever reason could have an effect on many other people other than the patient. Figuring out that balance will be hugely important.

One of the conversations going on around data sharing with public health is how to manage the minimum necessary sharing of information with public health. You can share a CCD with a public health agency, but the concern for provider organizations and others is you are sending way more information than we need for COVID. This has actually been a barrier.

The other big issue is the Apple and Google contact tracing project, and the negotiations they have had with different state agencies around the sharing of that data. That presents yet another version of the privacy dilemma; at what point do you sieve to the great penetration that certain vendors have with a large part of the population, [knowing] they stand outside of HIPAA so they can offer beneficial solutions to society, but because they aren’t covered by HIPAA, we don’t have a real ability to regulate what it is they are doing, outside of the assurances they make as companies. I’m not sure how big an issue this [privacy dilemma] would be anyway, since when you see the uptake for contact tracing apps has been low in countries like Singapore and South Korea, but the policy issue still remains.

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