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eHealth Initiative: New Payment Models Driving Population Health

eHealth Initiative: New Payment Models Driving Population Health | Healthcare and Technology news | Scoop.it

Value-based payment models aren't going away, making population health initiatives ever more critical, Tricia Nguyen, executive vice president for population health at Texas Health Resources, said during a webinar presenting results from the eHealth Initiative's latest population health survey. 

 

Nguyen, who also serves as president of the Texas Health Population Health, Education & Innovation Center, warned against the wait-and-see attitude some are taking.

 

Among 59 responses of individuals used from accountable care organizations, hospitals and health systems, physician practices, health insurance companies and elsewhere, 68.1 percent said they had created new roles or hired staff for population health.

 

Additionally, 68.1 percent said they had begun activities and 76.6 percent had purchased population health or analytics technology; 72.3 percent anticipate making such investments.

 

Nguyen said there's no single best technology for population health, but there are best-of-breed solutions from multiple vendors. Interoperability remains a huge problem, though, she added.

 

She also pointed to a study that found patients were contacted up to 15 times in the days following hospital discharge because various providers can't share data.

 

Population health management activities, according to the survey, are most often aimed at readmission risk (81 percent), multiple chronic conditions (79 percent), ER super users (77 percent) and specific diseases (70 percent).

 

Eighty-three percent of respondents said they measure success by intermediate outcomes and healthcare processes (72 percent), cost savings (70 percent) and patient satisfaction (70 percent). Thirty-seven percent said they're integrating patient-reported data.

 

These percentages far surpass the Centers for Medicare & Medicaid Services's goal of having 30 percent of providers in value-based payment models by the end of 2016, suggesting the results are skewed, said moderator Charles Kennedy, CEO of Accountable Care Solutions at Aetna.

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ACA's Mandate To Buy Coverage May Be GOP-Friendly

ACA's Mandate To Buy Coverage May Be GOP-Friendly | Healthcare and Technology news | Scoop.it

Whether it’s a penalty to pick a drug plan under Medicare or the new Republican proposal to replace the Affordable Care Act or the President’s health law alone, penalties abound for being uninsured.

A new analysis by the Urban Institute said “individual responsibility” requirements akin to the controversial individual mandate included in the Affordable Care Act requiring individuals to buy coverage or face a tax penalty also exist in other health reform proposals and existing health insurance programs.


Some, like the Medicare Part D drug coverage for seniors and Medicare Part B’s physician services for the elderly, have been in place for years. Another, a new Republican proposal to replace the ACA, also has its penalties.


The so-called “Patient Choice, Affordability, Responsibility, and Empowerment Act” or PCARE, proposed by Republican Rep. Fred Upton of Michigan and GOP Sens. Orrin Hatch of Utah and Richard Burr of North Carolina would “impose strong penalties on the uninsured,” Urban Institute health policy researchers Linda Blumberg and John Holahan wrote in their analysis out this week called, “the New Bipartisan Consensus for an Individual Mandate.”


“Specifically, if individuals fail to maintain continuous coverage, they can be medically underwritten or effectively denied insurance in the nongroup market,” the Urban Institute’s authors wrote of the Hatch-Burr-Upton legislation. “Medicare Parts B and D also have provisions that penalize individuals for failing to promptly enroll in coverage for the same reason, yet this approach to an individual mandate has not been controversial.”


All of the proposals share the common thread that health insurance, particularly coverage that involves the private insurance market, need an individual responsibility component to ensure healthy people are in the insurance risk pool. Without healthy people buying coverage and paying premiums, claims submitted largely by sick policyholders would lead to soaring health care costs.


The individual responsibility provision has long been the stance of health care interests like the American Medical Association and the health insurance lobby, America’s Health Insurance Plans, which represents Aetna (AET), Cigna (CI), Humana (HUM), UnitedHealth Group (UNH) and most Blue Cross and Blue Shield plans.

“If you want to keep a private market-centered approach and prevent discrimination in insurance against those with health problems, you have to have a mechanism that brings in and holds in the healthy,” Blumberg, seniors fellow at the Urban Institute’s health policy center told Forbes in an interview. “You have to have an individual mandate to hold the healthy into the insurance risk pools.”


The GOP’s Obamacare replacement requires individuals to have insurance “continuously for 18 months to be guaranteed access to a private nongroup insurance policy,” the Institute said in a statement accompanying their analysis. Meanwhile, the ACA imposes tax penalties for those individuals who go without insurance for more than three months in any given year. And Medicare Parts B and D have penalties that are much steeper than the ACA’s for those who delay enrolling after they become eligible.


“Under both programs, penalties are assessed on those who enroll, disenroll and then enroll again,” the institute fellows wrote.


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The Medical Internet of Things: What You Need to Know

The Medical Internet of Things: What You Need to Know | Healthcare and Technology news | Scoop.it

Gartner has estimated that some 6.4 billion connected things will be in use by the end of 2016, with some 5.5 million new things getting connected every day. There’s been a clear boom in health and fitness wearables, with healthcare consumers investing in tracking devices – sometimes with their employer’s encouragement – and the MedTech industry has jumped on this in a big way.

 

Fascinating IoT applications are being developed today, often through unlikely partnerships. For example, medical devices company Medtronic is developing an application that transmits wearables data to the IBM Watson cognitive computing and predictive analytics platform. And Swiss pharma company Novartis is joining hands with Qualcomm to develop an internet-connected inhaler that can send information to a cloud-based big data analytics platform for healthcare providers to use in treating patients. These are exciting examples of how technology and analytics can support personalized medicine.

 

 

However, there are a couple of big issues that the IoT movement has to contend with when it comes to the Medical Internet of Things (IoT). These issues concern us as consumers, and they also concern our employers and our healthcare providers equally.

 

 

Data security:

 

The medtech industry is widely seen as unprepared for the security risk and vulnerability to hacking that their devices can cause for the rest of the healthcare system. This has im

Gartner has estimated that some 6.4 billion connected things will be in use by the end of 2016, with some 5.5 million new things getting connected every day. There’s been a clear boom in health and fitness wearables, with healthcare consumers investing in tracking devices – sometimes with their employer’s encouragement – and the MedTech industry has jumped on this in a big way.

 

Fascinating IoT applications are being developed today, often through unlikely partnerships. For example, medical devices company Medtronic is developing an application that transmits wearables data to the IBM Watson cognitive computing and predictive analytics platform. And Swiss pharma company Novartis is joining hands with Qualcomm to develop an internet-connected inhaler that can send information to a cloud-based big data analytics platform for healthcare providers to use in treating patients. These are exciting examples of how technology and analytics can support personalized medicine.

 

 

However, there are a couple of big issues that the IoT movement has to contend with when it comes to the Medical Internet of Things (IoT). These issues concern us as consumers, and they also concern our employers and our healthcare providers equally.

 

 

Data security:

 

The medtech industry is widely seen as unprepared for the security risk and vulnerability to hacking that their devices can cause for the rest of the healthcare system. This has immediate repercussions for consumers who may be unaware of the exposure of their personal medical information to cybercriminals. In addition, as healthcare providers start using medical information from these interconnected devices in a cloud-based environment, their enterprise IT, specifically electronic health record (EHR) systems, could be seriously compromised and vulnerable to hackers. And this brings us to the other, emerging issue that is beginning to get some attention in the exchange of IoT data.

 

 

Privacy and legal concerns:

 

While there are undisputable benefits for healthcare consumers as physicians gain access to medical information from a range of connected devices, there is a real threat to privacy as well. We start with the question of who owns the data. State law in the U.S varies when it comes to this question, and device makers and other software providers may lay claim to the data which can be used against consumers. At the same time, collecting personal data through devices imposes a set of legal requirements on enterprises, starting with proper disclosures about the collection and use of the information.

 

Many healthcare providers are leery of collecting any IoT data because of a combination of these factors. In my recent conversations with CISO-level executives, I sensed a real concern around the potential for these connected devices to do harm to enterprises through cyberattacks. In addition, there may be unexpected consequences of collecting this data, such as employers being held accountable for wrongfully using the data in termination-related lawsuits.

 

Increasingly, these complex issues are drawing the attention of regulators who are mandated to protect consumer interests and safeguard privacy. Indeed, this may cause a dilemma to medical device manufacturers who want to provide consumers with a rich experience on the one hand but also need to comply with FDA rules and complex requirements. The recent case of FDA intervention in the case of lab test company Theranos is also a cautionary tale for companies looking to play “fast and loose” with new technologies that may put consumers at risk.

 

 

Eventually, all these challenges will need to be overcome, simply because the potential benefits of using IoT data for improving health and wellness far exceed the downsides and risks. However, the challenge we face is that technology is evolving at an explosive pace and the regulatory and legal infrastructures are unprepared for the sudden increase in complexity that all this causes. We are going to see very interesting times ahead.

mediate repercussions for consumers who may be unaware of the exposure of their personal medical information to cybercriminals. In addition, as healthcare providers start using medical information from these interconnected devices in a cloud-based environment, their enterprise IT, specifically electronic health record (EHR) systems, could be seriously compromised and vulnerable to hackers. And this brings us to the other, emerging issue that is beginning to get some attention in the exchange of IoT data.

 

 

Privacy and legal concerns:

 

While there are undisputable benefits for healthcare consumers as physicians gain access to medical information from a range of connected devices, there is a real threat to privacy as well. We start with the question of who owns the data. State law in the U.S varies when it comes to this question, and device makers and other software providers may lay claim to the data which can be used against consumers. At the same time, collecting personal data through devices imposes a set of legal requirements on enterprises, starting with proper disclosures about the collection and use of the information.

 

Many healthcare providers are leery of collecting any IoT data because of a combination of these factors. In my recent conversations with CISO-level executives, I sensed a real concern around the potential for these connected devices to do harm to enterprises through cyberattacks. In addition, there may be unexpected consequences of collecting this data, such as employers being held accountable for wrongfully using the data in termination-related lawsuits.

 

Increasingly, these complex issues are drawing the attention of regulators who are mandated to protect consumer interests and safeguard privacy. Indeed, this may cause a dilemma to medical device manufacturers who want to provide consumers with a rich experience on the one hand but also need to comply with FDA rules and complex requirements. The recent case of FDA intervention in the case of lab test company Theranos is also a cautionary tale for companies looking to play “fast and loose” with new technologies that may put consumers at risk.

 

 

Eventually, all these challenges will need to be overcome, simply because the potential benefits of using IoT data for improving health and wellness far exceed the downsides and risks. However, the challenge we face is that technology is evolving at an explosive pace and the regulatory and legal infrastructures are unprepared for the sudden increase in complexity that all this causes. We are going to see very interesting times ahead.

Technical Dr. Inc.'s insight:

Contact Details :
inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com/tdr

more...
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