Congress and the President struggle to “repeal and replace” the Affordable Care Act (“Obamacare”). What Americans need for their health and healthcare, as well as those who provide and pay for it, seem lost in rhetoric. This is not a political debate but vague unscientific dialogue centered on words like “access” rather than what that means to patients seeking health care. It is painfully clear that there are too many pressures for all the wrong reasons to achieve the legislative solutions so urgently needed. Fundamental to our dilemma is the failure to understand and acknowledge the problems, without which there will be no successful solutions.
While the central issue is whether quality health care is a right or a privilege, the underlying considerations are simply financial. A basic tenet of business to achieve a solution is to identify the problem, the need of the market. One of the reasons that health care and health are such enigmas to identify the solution is that the problem is multifactorial and complex with competing constituencies. Unraveling the ACA is difficult because it addresses this complexity and the linkages in its provisions. ACA provisions do not merely focus on insurance coverage and finance; remarkably they had begun to solve the costs, quality and outcomes of care.
Quture continues to believe that the ultimate solution to the problems of health and health care requires transformation of the payment, delivery (medical), quality, analytics, health and scientific models that are the fundamental to health care.
First and most significant, transformation of the perverse payment model for health care in America mandated value-based payment to replace one of the root causes of the costs of care – fee-for-value payment. QualOptima was recently determined to be one of the 50 Most Promising Healthcare Solution Providers 2016, because we were adjudged to be the top value-based payment and outcomes informatics platform. Despite the chaos ahead in healthcare reform policies, legislation and regulations, Quture is proceeding in the belief that the value and outcomes-driven fee-for-value transition will continue nationally. We are prepared and are considering modifications in how the QualOptima informatics platform would operate, however, if the payment model retreats to the failed fee-for-service model.
Quture also believes that individuals seeking health care insurance, optimal health care, personalized precision care, and selection of the most qualified providers will find themselves more isolated and alone – with less accurate information for data-driven decisions readily available – than ever before. It appears that efforts will be made to replace ACA provisions with high risk pools, more access to health insurance from non-resident states with less consumer protections, and health savings accounts. Such legislation will, in our opinion, make health care more expensive, less insured, more difficult to get into large diverse risk pools, fewer people with insurance they can count on when they make a claim, and with more sub-optimal care and medical errors.
Quture’s perspectives and analysis compels us to renew our conclusion that our QualOptima informatics platform is the free-enterprise solution to the health and health care crises in America. We will be marketing and selling into another 2-3 years of uncertainty, perhaps chaos, emerging from what has been eight-plus years of wrangling over insurance coverage, access to health care, cost, quality and rampant medical errors at the federal and state levels.
The future of Quture in this uncertainty analysis requires (1) an assessment of the QualOptima Universal Informatics Platform for positioning, and (2) in targeted customer segments re-evaluated in the perspective of the uncertainty in the healthcare ecosystems. Quture is strategically positioned in each customer segment for the essential financial and market drivers across this spectrum of urgent needs. (3) These analyses demand a careful evaluation of the investment, revenue and operations of the Company in view of this uncertainty, the market opportunities and potentials available to Quture, and our operations strategies and logistics.
(1) The QualOptima Universal Informatics Platform:
After five (5) years of designing and developing Quture’s QualOptima product, the most significant realization is that the product, originally quality and patient safety focused, has matured to become the innovative complete solution to transform health and health care. QualOptima empowers value-driven, patient-centered, personalized care focused on real-time and predictive patient management and patient safety, with optimal quality demonstrated by outcomes correlated with resource use and cost.
Quture as a company and QualOptima as its product are best visualized as three (3) business entities and strategies triangles operating on a single universal informatics platform as shown below.
Quture considers QualOptima a connectivity and analytics system. Connectivity is essential to the future success of QualOptima as the informatics platform that will connect people to their unified patient-controlled health record infrastructure (see Mandl KD & Kohane IS, “Time for a Patient-Driven Health Information Economy?,” New England Journal of Medicine 374(3):205-08, 2016). Quture is convinced that individuals seeking
- wellness and optimal health,
- the best insurance vendor and coverage for them,
- optimal providers most suited to give that care,
- the most favorable diagnostic and treatment modalities personalized for them, and
- expectations for optimal outcomes measured by analytics,
must immediately begin to control their own health data. These individuals will collect their own wellness and fitness data integrated into their unique patient-controlled health record infrastructure. Quture Health metrics and technologies will provide advanced metrics to empower these individuals with insight and predictive analytics for their own wellness and health care, as well as available to them to share with their healthcare clinicians and coaches.
Provider connectivity will rely upon this patient-controlled health record infrastructure rather than disparate data dispersed across various vendor and provider databases and without the personalized wellness and fitness data integrated into a single unified informatics platform. Personalized precision health and medical care will empower individuals, as well as their providers, to achieve optimal lifestyles, care and outcomes. Payers will be empowered with this de-identified data to incentivize their insured individuals, working with their employers or risk pool, for reduced premiums, contributions and co-pays.
QualOptima analytics will focus on unique opportunities to maintain health and wellness, including disease interception and prevention, selection of modalities of diagnosis and treatment, and providers best suited to achieve optimal outcomes measured by clinical and financial performance. One essential causative factor in the healthcare crisis is extraordinary variation by local and provider.
Quture has engineered the QualOptima Universal Informatics Platform through vast experience in reviewing the clinical performance and outcomes of hundreds of healthcare organizations, by thousands of physicians, for hundreds of thousands of patients. Quture’s core competence and value proposition reside in its embedded evidence-based metrics, clinical content and analytic algorithms developed from this vast experience.
An informatics platform creates a biomedical knowledge management system that is applied clinically to maintain the health of the populace, provide quality and safety of care provided individuals when they are ill, and enhance biomedical science. The knowledge management system embeds sophisticated technologies including data mining (deriving new knowledge from large databases), natural language or text processing, cognitive science, human interface design, decision support, databases, and algorithms for analyzing large amounts of data generated in public health, clinical research, or genomics/proteomics.
The QualOptima informatics platform embeds the technology Quture invented and engineered to empower providers, payers and patients (“P³”) for data-driven decisions (“D³”) to achieve optimal wellness and health care. Quture’s P³D³© PaaS informatics platform is the complete solution to transform the fundamental payment, delivery (medical), quality, analytics, health and scientific models that are the basis of health care. By anticipating value-driven outcomes for payment, Quture has become the most promising informatics system for value-based, optimal clinical, operational and financial outcomes.
QualOptima disruptive technology is central to Quture customer segments as the free enterprise solution to improving health and health care outcomes while reducing costs. QualOptima is not only disruptive, it is transformational. Quture is positioned by its QualOptima Informatics Platform to become the foremost global provider of value-based clinical intelligence and knowledge solutions.
(2) Quture Customer Segments:
Quture’s technology and informatics systems provide solutions across the boundaries of traditional customer segments. Our P³ (patients, providers and payers), who will find themselves more isolated and alone with few scientific resources in uncertain and chaotic markets, will urgently need our data-driven decisions (D³) complete solution.
Our evaluation of the uncertainty and chaos in the healthcare ecosystem compels the Company to re-evaluate prioritization of market segments. Healthcare providers, our traditional market, now continue to be paralyzed to make logical vendor product decisions.
Quture’s short-range marketing focus to health care providers is introduction of the Quture HFACs Medical Malpractice System. This strategy introduces the HFACS causation and classification system for patient safety as an element of quality care and optimal outcomes.
However, our value-driven QualOptima Universal Informatics Platform is the right product for the future of healthcare providers whose strategies focus on optimal outcomes, not the fee-for-service perverse payment system. Quture’s provider and insurer customers will come from those committed to urgent solutions that will determine their future to thrive from value-driven outcomes. The longer-range strategy, which will continue to be manifest as demonstration projects for hospitals and physician groups, remains focused on these hospital and physician group customers whose strategies are value-based outcomes. These demonstration projects will provide revenue intended for both short and long-term engagements.
Insurance companies, both health care and medical malpractice, will be customer segments that are consistent with these two (2) market strategies for value-driven outcomes and patient safety. Quture HFACS is intended to be an immediate source of revenue from both med mal insurers and healthcare providers, as well as potential investment from the medical malpractice insurance segment.
Employers and employer benefit and support entities are the emerging customer segment most likely and immediately to benefit from the QualOptima Informatics Platform. This major shift in priorities is intended to become a major source of both revenues and investments.
Quture’s healthcare provider and insurer customers will come from those committed to urgent solutions that will determine their future to thrive from value-driven outcomes.
Quture Health for personalized precision health and medical care becomes a more immediate market priority for individuals and populations as a customer segment. Our conclusion that individuals will find themselves isolated and alone as resolving uncertainties result from federal legislation and corresponding regulatory changes is the basis for this market prioritization. The technologies invented and engineered into the QualOptima Informatics Platform, such as the myQuture LifePlan and HealthScape©, will become clear in the context of specific strategic announcements.
People, whether patients or seeking optimal health and wellness, will seek to be empowered in this uncertain and chaotic environment. Empowering individuals with patient-controlled medical records infrastructure on the QualOptima Universal Informatics Platform will soon begin with a women’s health innovation. We anticipate an announcement of Quture Health strategies for clinical decision support tools for providers to brand their practices with aligned patient mobile apps and analytics tools to maintain optimal wellness and coordinate with their caregivers.
Our pharma, medical device and mobile apps, as well as omics customers, will be committed to digital and precision health. Quture’s initiatives in 2016 to incorporate the QualOptima Universal Informatics Platform for disease interception and the application of remote monitoring will continue and expand in 2017.
Quture’s changing prioritization of customer segments is possible because we designed and developed the product to be a universal informatics platform connecting all these segments. We began announcing that strategy on our website in 2015. As the first-to-market clinical intelligence solution for healthcare providers, payers, employers, individuals and insurance companies to achieve optimal clinical, financial and operational outcomes, we are more confident than ever in these decisions.
(3) Investments and Revenue:
Quture’s immediate reaction to the impending “repeal and replace” ACA legislation was profound frustration and pessimism. Americans and those engaged in the health and health care ecosystem should not be subjected to continuing uncertainty leading to chaos from challenges to established public policy and legislation. It is easy to proclaim what you are against; it is difficult, yes even complex, to announce for public scrutiny what you are for. There has been too much disruption without transformation. Quture has been committed to value-driven payment for health care, because it transforms a perverse payment model, fee-for-service, to a payment model that focuses on optimal clinical, operational and financial outcomes.
At its formation in 2011, Quture stated its commitment to our QualOptima product that is both disruptive and transformational. Marketing and selling in the contentious legislative environment over the life of the Company has been extremely difficult and challenging. Quture’s QualOptima Universal Informatics Platform is the right product at the right time, despite this prevailing uncertain future of health care.
However, as events continue to unfold, the isolation of individuals finding themselves and their employers and alone for their wellness and health care compel us to realize that Quture’s future is more favorable for both revenues and investments. The Company, with our QualOptima product that crosses the boundaries of all customer segments, positions Quture to become a dominant vendor in the health and healthcare analytics market of at least $24 billion in 2016, estimated to increase to $55 billion by 2021.
Even more significant, the personalized medicine market size is now expected to reach US $2,452.5 billion by 2022. These projections include evaluation that determined personalized medical care and nutrition accounted for the largest share of the market in 2014. This large share is due in large measure to the highly capital-intensive nature of implementation of healthcare information technology and telemedicine applications. In 2014 North America was the largest regional market, with revenue estimated at over US $500.0 billion. Presence of sophisticated healthcare infrastructure, favorable government initiatives pertaining to cancer research, and the presence of high patient and practitioner awareness levels are some key drivers of this market.
Quture’s investment and revenues focus on employers and employer benefit and support entities, as well as people as individuals. Wellness, optimal health care, and financial incentives for insurance are the logical strategies for the QualOptima Informatics Platform. Our conclusion that individuals will find themselves isolated and alone as resolving uncertainties result from federal legislation and corresponding regulatory changes, as well as these market forces, are the basis for this market prioritization. Our strategies for Quture Health in personalized precision health and medical care began several years ago. That decision, in the midst of the more immediate market, makes our expansion into the individual, populations, employer and payer customer segments even more compelling.
Startlingly, there is absolutely no mention or attention in the federal legislative changes to even consider the third leading cause of death in America – preventable medical errors. Left with the pervasive impacts of liability for preventable death and injury, medical malpractice insurance and re-insurance companies, as well as self-insured trusts of hospital systems, remain an immediate marketing focus for sales. Quture is actively engaged in negotiations for both investments in this new HFACS application of QualOptima and as a stand-alone causation factors for human and systems errors classification product.
The exponential improvement in QualOptima’s Causation Analysis, Classification and Interventions System will transform quality and risk management (including adverse event investigation and medical error interventions).
For these reasons, Quture is even more confident in my statement as quoted in our most recent press release upon recognition as one of the 50 Most Promising Healthcare Solution Providers 2016. “I believe that positioning our Company and product forecast a most favorable 2017 for Quture. We intend to complete negotiations begun last year that will confirm this forecast in our most immediate areas of focus. And we also look forward to reporting our financials with expertise retained and working with us. With our health, quality of life and, in fact the American economy at stake, Quture has demonstrated the same commitments as our customers as we now look forward to 2017.”