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Helping Patients Understand Insurance Benefits is Key

Helping Patients Understand Insurance Benefits is Key | Healthcare and Technology news | Scoop.it

Over the past several weeks, I've had the task of helping my own dad through some health issues. The biggest issue that we have run into multiple times is insurance challenges.


I know that I typically give you hints and tips to help lower your accounts receivable, get you paid on time, and manage your billing staff. But I'm going to take a different tack this week; focusing on the patient's viewpoint.


Before I get into the details of our struggle to help dad see the appropriate specialists, I feel it's most important to note that you and I are healthcare professionals. We do this job, everyday. We are immersed in professional jargon that sounds foreign to the typical patient. We understand (for the most part) that the laws are in place to protect the patient. We have to learn how to play nice with the insurance companies so that our practices get paid. Our patients don't really see this. From a patient's standpoint, they simply buy an insurance plan; they ask the practice to file a claim; and the insurance company pays what the practice is due. However, you and I know this is certainly not the case.


There is a huge gap between reality and what the patient thinks happens with their insurance plan. They do not understand that not only is it a plan they purchased, but they must also understand the nuances of that plan. Is outpatient physical therapy a covered benefit? Does the plan have a deductible? Is there a copay or coinsurance associated with some visits and not others? Is the doctor in network? The typical patient is truly not aware that this type of information is their responsibility to know.


So, that said, let me share my story. My dad has a Medicare replacement plan. He still thinks he has Medicare primary and UnitedHealthcare as a secondary insurance. So, lesson one when explaining patients' benefits prior to being seen is that they understand if they have a replacement plan, and not Medicare with a secondary.

Next, his primary physician referred him to a specialist. The specialist was 50 miles away. I'm not kidding. Dad gets to the appointment, and the office manager took him aside and said they do not accept his insurance; but he could pay the $3,000 out-of-network rate if he wanted to. No phone call, no warning about the physician's out-of-network status, nothing. Dad walked out and drove back 50 miles to his house and called me a few hours later. The next morning, Dad and I did a conference call with his medical group. I asked them why there wasn't a specialist in their group that he could see? I also said that if there isn't a physician that fits the requirements of Dad's care, they would have to provide the authorization to see an out-of-network physician, as that was not Dad's problem they didn't fill up their network. A few hours later poof! They found a doctor only 10 minutes from his house that was just credentialed that day. Shocking, I know.


So, the medical group contacted the doctor's office and set up an appointment. They called us back on another conference call and let us know everything was taken care of. I asked, "Okay, I have my pen and paper, can you please provide the authorization number for this visit?" There was silence on the other end of the line. There were four people telling us seconds ago that everything was set up and ready to go and no one could provide the authorization number. They asked for a few minutes to call us back. The phone rang, an authorization for three visits was provided, I took names, phone numbers, etc.


My dad was so frustrated and completely confused about why things are so complicated, and wondered how was he supposed to know all of this?! Technically, he is supposed to know these things, but honestly, there is no way he would ever have been able to get this figured out without my help.


I suppose my point is when you have a patient that needs an authorization, or does not understand the difference between in-network and out-of-network status, please take the time to work with them. Be patient. Be kind. They are in pain or sick, and the last thing they want to worry about is their insurance plan.


It would be ideal if the insurance company took the time to explain plan details and teach patients how best to utilize their plan benefits. We know this will never happen, as it would be very costly for the insurance company.


Take it easy on your patients and find it in your heart to spend the necessary time with your patient; remember this likely someone's dad, mom, sister, or brother.

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Study Links Polluted Air in China to 1.6 Million Deaths a Year

Study Links Polluted Air in China to 1.6 Million Deaths a Year | Healthcare and Technology news | Scoop.it

Outdoor air pollution contributes to the deaths of an estimated 1.6 million people in China every year, or about 4,400 people a day, according to a newly released scientific paper.


The paper maps the geographic sources of China’s toxic air and concludes that much of the smog that routinely shrouds Beijing comes from emissions in a distant industrial zone, a finding that may complicate the government’s efforts to clean up the capital city’s air in time for the 2022 Winter Olympics.


The authors are members of Berkeley Earth, a research organization based in Berkeley, Calif., that uses statistical techniques to analyze environmental issues. The paper has been accepted for publication in the peer-reviewed scientific journal PLOS One, according to the organization.


According to the data presented in the paper, about three-eighths of the Chinese population breathe air that would be rated “unhealthy” by United States standards. The most dangerous of the pollutants studied were fine airborne particles less than 2.5 microns in diameter, which can find their way deep into human lungs, be absorbed into the bloodstream and cause a host of health problems, including asthma, strokes, lung cancer and heart attacks.


The organization is well known for a study that reviewed the concerns of people who reject established climate science and found that the rise in global average temperatures has been caused “almost entirely” by human activity.


The researchers used similar statistical methods to assess Chinese air pollution. They analyzed four months’ worth of hourly readings taken at 1,500 ground stations in mainland China, Taiwan and other places in the region, including South Korea. The group said it was publishing the raw data so other researchers could use it to perform their own studies.


Berkeley Earth’s analysis is consistent with earlier indications that China has not been able to successfully tackle its air pollution problems.


Greenpeace East Asia found in April that, of 360 cities in China, more than 90 percent failed to meet national air quality standards in the first three months of 2015.


The Berkeley Earth paper’s findings present data saying that air pollution contributes to 17 percent of all deaths in the nation each year. The group says its mortality estimates are based on a World Health Organization framework for projecting death rates from five diseases known to be associated with exposure to various levels of fine-particulate pollution. The authors calculate that the annual toll is 95 percent likely to fall between 700,000 and 2.2 million deaths, and their estimate of 1.6 million a year is the midpoint of that range.


The Chinese government is sensitive about public data showing that air pollution is killing its citizens, or even allusions to such a conclusion. Though the authorities have gradually permitted greater public access to air quality readings, censors routinely purge Chinese websites and social media channels of information that the ruling Communist Party worries might provoke popular unrest. In March, after a lengthy documentary video about the health effects of air pollution circulated widely online, the party’s central propaganda department ordered Chinese websites to delete it.


Much of China’s air pollution comes from the large-scale burning of coal. Using pollution measurements and wind patterns, the researchers concluded that much of the smog afflicting Beijing came not from sources in the city, but rather from coal-burning factories 200 miles southwest in Shijiazhuang, the capital of Hebei Province and a major industrial hub.


Promises to clean up Beijing’s air were a centerpiece of the nation’s bid to host the 2022 Winter Olympics. The mayor of Beijing, Wang Anshun, championed restrictions on vehicles in the city, and state news media outlets lauded projects to replace coal-fired heating systems in urban areas with systems that use natural gas and generate far less particulate pollution.


“We will improve the air quality not only for the Games, but also for the demand of our people,” said Shen Xue, an Olympic gold medalist and ambassador for the 2022 bid, according to a report last month by Xinhua, the state news agency.


The Berkeley Earth paper showed, however, that to clear the skies over Beijing, mitigation measures will be needed across a broad stretch of the country southwest of the capital, affecting tens of millions of people. “It’s not enough to clean up the city,” said Elizabeth Muller, executive director of the organization. “You’re going to also have to clean up the entire industrial region 200 miles away.”

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Digital Solutions the Key to Behavioral Health's Future

Digital Solutions the Key to Behavioral Health's Future | Healthcare and Technology news | Scoop.it

Behavioral health is often regarded as the Cinderella of healthcare. It’s a specialty that is poorly funded and rarely at the cutting edge of service innovation or therapeutic breakthroughs. The health economic burden is huge and the life expectancy of people with a serious mental illness is substantially reduced. Behavioral health conditions are difficult to treat, monitoring outcomes is challenging and, if treatment is sub-optimal, risk is high. All in all, it’s not a very happy story.


Behavioral healthcare has been hampered by many things, including the clinical consultation process. Compare a psychiatric consultation with the clinic visit of a respiratory physician; he listens to a patient’s chest and takes a spirometer reading to assess progress. The cardiologist checks the patient’s heart murmur and blood pressure, and the gastroenterologist runs some labs and examines the patient on the couch. Behavioral healthcare lacks comparable quantitative measures to assist diagnosis, assess disease severity, and monitor treatment response. Clinicians can use rating scales to evaluate psychiatric symptoms, but they take time to administer in the clinic. So, we talk to our patients to assess progress and to detect subtle signals and changes. Of course, we complete a physical examination from time to time and we watch our patients as we talk to them, but the backbone of a routine psychiatric follow-up is a structured conversation and questions — not a physical exam, not labs.


It’s this characteristic of behavioral healthcare that will enable Cinderella to shed her rags and step into the limelight. Health informatics is providing a unique and wonderful opportunity for psychiatric care, and it’s a break-through that is not available on the same scale to other specialties because they don’t “just talk.”


Digital health technologies offer the potential for close and cost-effective, long-term remote monitoring of patients with mental health disorders. Smartphone applications and patient-facing Web portals enable patients and caretakers to assess and report status to the clinical team on a regular basis from home. Behavioral health is ideally suited also for telehealth assessments and therapeutic interventions; enabling rapid, cost-effective, efficient, and convenient care delivery.


The potential impact of a digitally-enabled behavioral health ecosystem is enormous.


Remotely collected data, or patient reported outcomes (PRO), using apps and Web portals allow clinicians to intervene early in response to signs of deterioration or troublesome side effects. This reduces relapses and avoids the associated events that are hugely costly in human and economic terms; hospital admissions, absence from work, suicide, violence, breakdown of social networks and relationships, and so on. Data collected in “real-time” is not subject to the biases of how the patient is feeling at the time of the three monthly clinic visits when the clinician asks, “How have you been since I last saw you?” Rich and detailed information can be collected longitudinally that would be impossible to obtain retrospectively, and it can be automatically plotted, analyzed, and summarized to support decision making. Technologies that empower patients improve engagement. A patient caseload can be triaged to prioritize appointments according to the “live” clinical need, facilitating population-based care.


All this is based on talking and answering questions. No labs, no physical exam. So, all you innovative behavioral healthcare professionals out there, prepare to go to the ball. We may even marry the prince.

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The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles

The Hidden Side of Health Care: How Rural Pennsylvania Is Facing and Overcoming Obstacles | Healthcare and Technology news | Scoop.it

Although Pennsylvania is the sixth most populous and ninth most densely populated state in the Union, based on information from the United States Census Bureau from 2010 and 2013, it also is home to a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of the 67 counties in the state are classified as rural, and all but two counties have rural areas. Approximately 27 percent of Pennsylvanians lived in rural counties in 2010, The Center for Rural Pennsylvania reports.


Although rural living offers many advantages, according to the National Rural Health Association (NRHA), rural healthcare in America faces challenges not seen in urban areas. Population loss, poverty and access to healthcare have been problematic in recent years. Here are just a few of the initiatives that have been launched to improve the health needs and overall well-being of rural Pennsylvanians.


Healthcare Issues in Rural Pennsylvania


In general, rural residents in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets, and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.


Population Loss


Between 2000 and 2010, Gary Rotstein of the Pittsburgh Post-Gazettereports, rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only due to eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.


In some places, the situation is bleak. Rotstein highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18,” Rotstein adds. “That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”


For rural areas where population is declining or (slowly) rising, healthcare faces challenges. Economic opportunity is threatened when workers and students pursue a better future. And when healthcare professionals depart, accessibility is undermined. In addition, communities with a disproportionately older population can require more healthcare resources, at the same time as access is dwindling.


Economic Challenges


According to the Rural Assistance Center (RAC), rural Pennsylvania lagged behind urban areas in poverty, unemployment and income for 2013:


14.3 percent poverty rate; 13.6 percent in urban areas

7.9 percent unemployment rate; 7.3 percent in urban areas

$36,099 per-capita income; $46,202 for the state

The Center for Rural Pennsylvania adds that from 2007 to 2011, 39 percent of rural households had incomes below $35,000.


Access to Healthcare


Rural Pennsylvania also has less access to healthcare than is available in urban areas. The Center for Rural Pennsylvania reports that in 2008, rural counties had just one primary care physician for every 1,507 residents, while urban counties had one physician for every 981 residents. In 2009, rural counties had one practicing dentist for every 2,665 residents, while urban areas had one for every 1,845 residents.


Solutions and Initiatives


In response to some of the healthcare challenges facing residents in rural Pennsylvania, the following solutions and initiatives have been developed.


Telehealth


Based on a 2014 research report from The Center for Rural Pennsylvania, telehealth can promote strong health to reduce chronic conditions and diseases, educate the public and healthcare workers, enable senior citizens to remain in their homes and much more. Using videoconferencing, online remote monitoring and diagnostic scans, electronic health records and other tools, telehealth can help providers give high-quality, affordable and accessible healthcare even in remote locations.


The study estimated that telehealth’s universal implementation would result in a 22 percent savings for the first year, increasing to 66 percent for the 20th year. Instead of a healthcare cost of $25,500 per person each year, the cost would be just $8,500; Pennsylvania would save $194 billion in the 20th year of implementation. Not only would the healthcare be less expensive, it would also be higher quality.


Currently, telehealth in rural Pennsylvania is not widely used and quality is poor. However, investing in the infrastructure and getting more healthcare providers on board can help improve the quality and access to this care, giving rural residents the chance to experience affordable, quality healthcare.


Rural Healthcare Funding


Federal programs are available to help rural areas across the country improve healthcare delivery. One example is the Rural Health Care Coordination Network Partnership Program, which supports organizations that are trying to improve the outcomes chronic diseases, specifically chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and Type 2 diabetes. It awards up to $200,000 per year for three years to qualified rural health networks.

These types of programs can help overcome the economic disparity that most rural communities faced, compared to urban areas.


The Office of Rural Health Policy (ORHP), part of the Health Resources and Services Administration (HRSA), offers other grant programs and initiatives to help support healthcare in rural areas across the country.


Expanding the Scope of Healthcare Workers


The need for more accessible healthcare is not just an issue in rural areas. According to the HRSA, there is a projected shortage of 20,400 primary care physicians across the U.S. for 2020, if the current system remains unchanged. To counter this trend, the HRSA projects the number of nurse practitioners and physician assistants to increase.


Nurses are expected to play an integral role in meeting the need for increased healthcare practitioners. In 2010, the Institute of Medicineannounced that nurses would need to respond to the changes taking place in the healthcare system, which gives nurses more opportunities to provide quality care. It called for higher education standards, including 80 percent of all nurses to hold bachelor’s degrees. To meet these needs, nursing is growing quickly; the Bureau of Labor Statistics already expects the profession to grow by more 19 percent through 2022, making it one of the fastest growing professions in the country.


In rural Pennsylvania, a higher concentration of educated nurses could help make up for this shortage of physicians and the changes taking place in the healthcare system.

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Does the Affordable Care Act Guarantee Healthcare as a Right?

Does the Affordable Care Act Guarantee Healthcare as a Right? | Healthcare and Technology news | Scoop.it

In his recent celebratory remarks after the Supreme Court (SCOTUS) upheld the legality of subsidies/tax credits under the Affordable Care Act (ACA), President Obama had this to say: "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate -- we finally declared that in America, healthcare is not a privilege for a few, but a right for all." (1)


It would be good if this were true, but it is not. Healthcare as a right has been debated over many years, but is still not in place for all Americans as this country remains an outlier among advanced industrial countries around the world. Instead, despite the ACA, we continue to have a patchwork of ever-changing programs assuring access to health care for some people some of the time.


Let's look at what we do have in this respect. In the 1960s, Congress established a broad right to health care under statutory law by enacting Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) for the elderly, disabled, people living in poverty, and children. In the 1980s it passed the Emergency Medical Treatment and Active Labor Act (EMTALA) requiring all Medicare-funded hospitals with emergency departments to provide appropriate emergency and labor care. More recently, Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) in 2013, which assures a right to equal access to care for patients with medical and mental health problems. SCOTUS has established a right to health care for prisoners and has protected some limited rights for women's reproductive care (2), but has never interpreted the Constitution as guaranteeing a right to health care for all Americans. In fact, the words "health," "health care," "medical care," and "medicine" do not appear in the Constitution. (3) 


It is disingenuous to claim that health care is a right in the U. S. when we consider these inconvenient facts:


  • 35 million uninsured, plus another similar number underinsured.
  • The first question asked of us in seeking care is "what is your insurance?"
  • 21 states have opted out of Medicaid expansion under the ACA.
  • Medicaid eligibility and coverage varies widely from one state to
  • another, in many cases falling far short of necessary care.
  • As the costs of insurance and health care continue to rise and shift
  • more to patients, a growing part of the population cannot afford either and forgo seeking care.
  • More than 40 million Americans now have an account in collection for medical debt. (4)


This situation stands in sharp contrast to elsewhere in advanced societies. Healthcare has been recognized as a right since 1948 when the General Assembly of the United Nations adopted a Universal Declaration of Human Rights including access to health care. (5) The right to health care was also later adopted by the World Health Organization (WHO) in its Declaration on the Rights of Patients. (6) As a result, most of Western Europe, Scandinavia, the United Kingdom, Canada, Taiwan, and many other countries have one or another form of national health insurance assuring access to care for their populations. Here we spend twice as much and still have no universal access to health care.


Can we ever see this country coming around to universal access to health care based on medical need, not ability to pay? The record shows that we never can, or will, as long as we permit corporate stakeholders in our medical-industrial complex to call the shots, and as long as they succeed in perpetuating our exploitive for-profit system. There is a fix -- single-payer national health insurance, as embodied in H. R. 676, Expanded and Improved Medicare for All.

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In Colorado, a Collaboration Around Healthcare Technology

In Colorado, a Collaboration Around Healthcare Technology | Healthcare and Technology news | Scoop.it

Across the country, technology and clinical leaders are figuring out ways to try to promote greater interoperability of healthcare data. For seemingly everyone, it’s been an uphill climb and a steep learning curve. In the U.S., there have been pockets of success; some states are at the forefront of true data exchange, while others aren’t quite as mature.


 In one of these pockets is Colorado, where the Denver-based Colorado Regional Health Information Organization (CORHIO) recently announced that its health information exchange (HIE) has grown in number of users by 111 percent, with the amount of data available in the network having grown by 118 percent in the past year. That marks the third consecutive year of triple-digit growth rates for the organization, which, as of a few months ago, encompasses 5,705 active providers/users, 47 connected hospitals, and with more than 223 million clinical messages having been sent.


To this end, also in Colorado are the Englewood-based Centura Health (with hospitals also spanning across Western Kansas) and the Aurora-based University of Colorado Health (UC Health), two organizations that will be represented at the iHT2 Health IT Summit in Denver on July 21 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC). At the conference will be a panel on “Strategies to Advance Interoperability,” where Steve Hess, CIO at University of Colorado Health and Dana Moore, senior vice president/CIO and managing director, service center, at Centura Health, among others, will address the most effective models and mechanisms for exchanging data.


In Aurora, University of Colorado Health came together as a unified system about three years ago when all of its IT components collapsed into one core set which included the Verona, Wis.-based Epic Systems as the organization’s core electronic health record (EHR), Hess says, who says the health system’s HIE strategy is multi-faceted. “We do offer hosting Epic for independent community practices that want to use our EHR for their own continuity of care and clinical collaboration needs,” Hess says. “We also use a built-in HIE, Epic’s Care Everywhere, to exchange records, and that works very well for Epic-to-Epic health information exchange. We have exchanged records with systems in all 50 states using that methodology,” Hess says.


UC Health is also a part of CORHIO, and that’s where a lot of statewide collaboration has occurred. “There is exchange of not only demographics, labs and discharge summaries, but also immunization and public health interfaces through the HIE,” Hess says. “We are on a journey of health information exchange, and we’re fairly early on that journey. Exchange is happening but the next generation functionalities of orders and results, exchanging CCDs (continuity of care documents), things like that, are still in the early stages,” he says.  “In the meantime, we collectively look at technology not as a competitive advantage but a way to help patient care, doctors, and nurses across the state and beyond. We know our organizations will compete in terms of quality and service and other things, but we’re trying out best not to compete with technology.”


Meanwhile, at Centura Health, Moore says that the organization initially started its own private HIE in 2005 with a company that is now part of Cerner’s arsenal, but wasn’t even an established vendor at the time. Once CORHIO came around, however, Centura quickly migrated over. “We didn’t want to have a competing product and wanted to promote collaboration within the state. When CORHIO was in its infancy, Steve [Hess] and I were frequently helping them build its model,” Moore says. Then, in 2006, Centura installed the Westwood, Mass.-based MEDITECH EHR across its acute care facilities first, eventually expanding into ambulatory and home care. Now, Centura, which did receive Healthcare Information and Management Systems Society (HIMSS) Stage 7 designation, is in the process of switching over to Epic, Moore notes.


Bringing the Data to the Doctor


For both UC Health and Centura, the key to successful health IT adoption and electronic data exchange is that this time around, the HIE brings data into the physician’s workflow so he or she doesn’t have to leave that workflow to see the data. “Success is always relative, and one of the big issues with HIE in Colorado five or 10 years ago was workflow,” Moore says. “Clinicians had to go out of their workflow and try to find the patient. From a user standpoint, it wasn’t successful. The advancements we made getting HIE in their workflow have proven that we are leaps and bounds from where we were,” he says.


Hess agrees that keeping clinicians in the workflow that they use predominantly is crucial. “With CORHIO’s and Epic’s tools, the idea is to bring the data within the workflow of the doctor rather than make them go out of it. There has been a lot of interface work around that,” he says. As such, UC Health has approximately 800,000 records exchanged electronically each year, Hess says, noting that examples of the data being exchanged include complete patient records, CCD summaries, electronic lab results, and immunization and syndromic surveillance exchange.


Despite successes at both organizations, Hess and Moore understand that there is still a ways to go before true interoperability is achieved. For one, Hess says that not having universal patient identifiers will continue to be a struggle for everyone. “A big part in what all these things require is knowing which patient is which,” he says. “Having to pull our different medical record and encounter numbers and hope/make sure that we’re sending data on the right patient is a struggle that might never be solved in our lifetime.”


Hess adds that if you think about the old way of exchanging records where one facility called another and got a 36-page fax of patient data sent over, oftentimes the person trying to pull the clinically relevant data from that fax wasn’t the doctor. “As a result, sometimes that data would go ignored,” Hess says. “So now our struggle will be separating the noise from the gold. If we get 10 CCDs on 10 different encounters across four different care settings, how do we take all that data and turn it into information for the clinicians? I don’t want to have a bunch of CCDs acting like a stack of a paper on a fax machine,” he says.


 This, Hess says, is the next big hurdle, what he calls “HIE 3.0.” He says, “We need to figure out how to stratify the data and present it in manner that allows clinicians to do the right thing with it. If we’re not careful we can overwhelm them and they could potentially ignore the data like they did with the faxes.”


Moore adds that another pitfall is getting providers on board to the HIE. While he notes that most of the major hospitals in Colorado are on CORHIO, there are still some that are not, and that’s a problem, he says. “Also, we talk about CORHIO and that is great, but we have hospitals that border the state too; we actually have a hospital in Kansas right now,” he says. “It’s great that Epic talks across all 50 states, but getting all of these HIEs to talk to each other has been a big challenge, which is ironic since that’s what they’re designed to do.”

Moving forward, a major part of the solution is collaboration on the part of providers as well as vendors, Moore says. “A lot of the onus is on the providers, as we need to be the ones at table bringing people together and removing roadblocks. Vendors respond to the market, so if we as providers—their ultimate customers—demand collaboration and exchange, then they’ll have to respond,” he says.  He adds that close-minded vendors are also part of the problem. “This vendor needs to exchange information with this one and you try to bring two competitors to the table. That’s not easy,” he says.


As such, according to Hess, a lot of vendors see their technology as a competitive advantage. Organizations that do this, rather than use their service or quality as the advantage, are slow to the collaboration table because they don’t want to level the playing field, Hess says. “But we all need to do things in similar ways, and our service and quality will be what brings doctors and patients to us. We need vendors and providers to say ‘we need to level the technology playing field.’ We really need to push that. When someone who is influential goes off that path and starts to do things differently, we get in trouble,” Hess says.

Moore adds that while nationwide interoperability efforts such as CommonWell have popped up, they might not be in it for the greater good as much as some people think. “I’m not necessarily buying that it’s for the greater good, but rather for a competitive advantage or a response to Epic’s Care Everywhere [product]. It would be great if all the vendors got together to make HIE transparent across all platforms without a third party, as that would make everyone’s life easier. But I don’t see that happening. I see them continuing to compete to try to gain market share,” Moore says.


Nonetheless, Hess warns that complete consolidation on one EHR vendor such as Epic or Cerner wouldn’t good either, as that could stifle innovation. “Some of these vendors are expensive and will never get into the small hospitals, the moms-and-pops,” he says. “We have to come up with better ways to share data. This is a journey; if you look back on HIE five years ago compared with today, people would be amazed with the progress. At the same time, we all wish it would be easier,” he says.


Back in Colorado, Moore notes that the healthcare IT leaders in the state meet quarterly, pick up the phone often, and collaborate to ensure the residents of the state get the absolute best care from a technology standpoint. “We want to make sure that the tools we provide our providers with are the absolute best,” he says. Hess, who has been in the state for six years after living in the Mid-Atlantic region, adds that the penetration of robust, mature adoption of health IT in care setting is pretty deep in Colorado. “Without that deep maturity level the collaboration conversations would be much harder,” Hess says. “The combination of the collaboration that goes on and the health IT adoption is a pretty powerful formula.”

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How New Jersey Public Policy Fails Primary-Care Physicians

How New Jersey Public Policy Fails Primary-Care Physicians | Healthcare and Technology news | Scoop.it

We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.


With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.


Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  


As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.


The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.


Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

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PA’s Health Information Exchange Awards $674K to Hospitals

PA’s Health Information Exchange Awards $674K to Hospitals | Healthcare and Technology news | Scoop.it

The institution of a health information exchange (HIE) is imperative for the healthcare industry, as it allows for effective data sharing among multiple medical facilities located on opposite sides of the country and coordinates care throughout patient-centered medical homes, accountable care organizations (ACOs), and other healthcare settings.


The Penssylvania e-Health Partnership Authority is one such health information exchange institution, which has recently awarded onboarding grants of more than $674,000.00 to connect multiple hospitals and other healthcare providers including ambulatory care practices to its Pennsylvania Patient & Provider Network (P3N), according to a company press release.


Approximately $67,000 of the awards come from state funding while about $607,000 comes from federal funds. The program’s funding comes from the Centers for Medicare & Medicaid Services (CMS) and is being awarded with the assistance of the Pennsylvania Department of Human Services.
By integrating provider networks to health information organizations (HIOs), the P3N creates a strong system for electronic health information exchange. The release states that $355,000 is being awarded to the HealthShare Exchange of Southeastern Pennsylvania.


“The benefits of eHIE to patients and providers are significant,” Alix Goss, Executive Director of the Authority, stated in the press release. “This grant program is critical to helping providers connect to HIOs, and HIOs connect to the P3N.”


“As more HIOs join the P3N along with their connected providers, more patients will experience better coordination of their care, faster access to their clinical results, and reduced redundancy of medical tests,” Goss continued. “The bottom line for patients, providers, and the healthcare system will be improved patient safety and healthcare quality.”


These onboarding grants are helpful in terms of supporting sustainability among private-sector HIOs and assisting in increasing its membership. Additionally, the program brings about a stronger emphasis on the participation in electronic health information exchange, supporting healthcare reforms, and offering high-quality healthcare services.


The performance period for this grant ends on September 30, 2015 and is part of the Medicaid EHR Incentive Program. The onboarding grant funding itself is covered mostly by CMS while the Authority covers 10 percent of it.


Spreading health information exchange platforms throughout the nation is vital in the industry’s efforts to reduce medical errors, support population health management, improve care coordination, and offer better quality care.


While health information exchange remains vital to improving medical care services, there are certain regions throughout the United States that have not embraced the use of HIE platforms. Rhode Island is one example. Go Local Prov reports that as many as eight out of ten physicians in Rhode Island are not using the state’s health information exchange. Rhode Island Medical Society Government Relations Director Steven DeToy explained some of the reasons for the low numbers of health information exchange adoption.


"First, not every physician has a computer that they use for EHRs," DeToy told the news source. "Second, some of those who do, have a system that isn't CurrentCare compatible as of right now, but hopefully will be. There have been some proprietary issues. Certain EHRs don't allow physicians to prescribe electronically.”

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Health insurer Centene adds muscle with $6.3 billion Health Net deal

Health insurer Centene adds muscle with $6.3 billion Health Net deal | Healthcare and Technology news | Scoop.it

U.S. health insurer Centene Corp will buy smaller rival Health Net Inc for $6.3 billion, underscoring the healthcare industry's rush to bulk up to negotiate better prices with suppliers and hospitals, and attract new customers.


Health Net's shares touched a record high of $76.67 on Thursday, but stayed shy of Centene's offer of $78.57, which is at a 21 percent premium. Centene shares were down 3 percent at $78.42.


The deal comes a week after the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law, keeping a large chunk of patients intact under the Medicare and Medicaid programs.


Insurers have said subsidies are key to bringing in new customers and the ruling has removed uncertainty for insurers looking for acquisitions. It could also spur more deal making in the health insurance sector, which has already seen a blitz of merger activity this year.


Aetna Inc, the third largest insurer is looking to buy smaller rival Humana Inc. No. 2 Anthem Inc has offered to buy Cigna Corp to create the largest insurer in the country, toppling UnitedHealth Group Inc . Media reports have also said UnitedHealth could be eyeing Cigna and Aetna.


Health insurers are not alone in trying to beef up.


Drugmakers, retailers and pharmacy benefit managers have contributed to the wave of healthcare acquisitions since 2014, pushing deal-making in the industry to record levels.


Also, an expected increase in federal interest rates, which will make borrowing costly, is expected to push companies to close deals over the next few months.


UnitedHealth could bid for either Health Net or Centene, or even the combined company, Leerink & Co analyst Anagha Gupte said. Gupte said she now expects other smaller insurers such as WellCare Health Plans Inc and Molina Healthcare Inc to merge.


Centene's buyout of Health Net will catapult it to the top of the government insurance heap, ahead of bigger rivals who dominate the private insurance market.


The combined company will serve more than 10 million members across the country, but will still be small in terms of total membership. Market leader UnitedHealth, for example, has nearly 46 million members.


Centene, which will also assume $500 million in Health Net debt, said the deal is expected to boost adjusted profit by more than 20 percent in the first year.

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Aetna to buy Humana for $37 billion in largest insurance deal

Aetna to buy Humana for $37 billion in largest insurance deal | Healthcare and Technology news | Scoop.it

 Health insurer Aetna Inc on Friday said it would buy smaller rival Humana Inc for about $37 billion in cash and stock, in the largest ever deal in the insurance industry.


The combination will push Aetna close to Anthem Inc's No.2 insurer spot by membership, and would nearly triple Aetna's Medicare Advantage business.


The deal will face antitrust scrutiny but if it goes through it would dwarf the previous largest insurance deal announced just this week, where Swiss property and casualty giant ACE Ltd announced it was buying Chubb Corp for $28 billion. It would also dwarf Anthem Inc's purchase of WellPoint in 2004 for $16.6 billion.


Analysts have said that M&A activity in the healthcare sector had been waiting for last week's Supreme Court ruling on Obamacare, which upheld key subsidies that underpin the reform and thus gave more certainty to healthcare insurers.


The bigger the insurer, the more power it has negotiating prices and improving its doctor networks.


Anthem has offered to buy Cigna Corp to create the largest insurer in the country, toppling UnitedHealth Group Inc .


Media reports have also said UnitedHealth could be eyeing Cigna and Aetna. On Thursday, Centene Corp said it would buy smaller rival Health Net Inc for $6.3 billion.


ANTITRUST ISSUES


Antitrust authorities, who were aggressive in their review of the failed deal between Comcast and Time Warner Cable , are expected to scrutinize how the combination of insurers will affect competition for each line of insurance: Medicare, Medicaid for the poor, individual insurance, commercial insurance for small and large businesses and the large employer business.


Aetna and Humana are in nine of the same states in Medicare Advantage. Combined, they would have market share of 88 percent in Kansas, 80 percent in West Virginia, 58 percent in Iowa and 51 percent in Missouri.


Wall Street analysts and some antitrust experts have said they expect the combination will be approved, although regulators may ask for some divestitures.


Others have said it is unclear that this group of regulators will stick to the usual review playbook for such a large deal and may add other restrictions.


The Justice Department, which reviews insurance mergers, will scrutinize deals city-by-city to see if the combination would have a monopoly in any metropolitan area, said Andre Barlow, a veteran of the department who is now at Washington law firm Doyle, Barlow and Mazard PLLC.


Aetna said the combined company is projected to have over 33 million medical members, based on memberships as of March 31. Operating revenue is expected to be about $115 billion this year, with approximately 56 percent from government-sponsored programs including Medicare and Medicaid.


Last week, the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law, keeping a large chunk of patients intact under the Medicare and Medicaid programs.


Insurers have said subsidies are key to bringing in new customers and the ruling has removed uncertainty for insurers looking for acquisitions. It could also spur more deal making in the health insurance sector, which has already seen a blitz of merger activity this year.


U.S. Senate Majority Leader Mitch McConnell, of Kentucky, praised Humana's presence in his home state but also noted the role of the healthcare law in the merger.


"This morning's announcement, as I predicted during the debate five years ago, is the inevitable result of Obamacare’s push toward consolidation as doctors, hospitals, and insurers merge in response to an ever-growing government," the Republican said in a statement.


The deal includes a $1 billion break-up fee payable by Aetna to Humana, should the deal fail because of antitrust concerns, an Aetna spokeswoman confirmed. The fee was first reported by the Wall Street Journal.


CASH AND SHARES


Hartford, Conn.-based Aetna said it would pay Humana shareholders $125 in cash and 0.8375 Aetna shares for each share held. The offer of about $230 per share is a 23 percent premium to Humana's closing price on Thursday.


Following the deal, Aetna shareholders would own about 74 percent of the combined company with Humana shareholders owning the rest. Aetna Chief Executive Mark Bertolini will serve as chairman and CEO of the combined company.


The deal is expected to close in the second half of 2016 and add to operating earnings per share from 2017.


Humana's sale has been anticipated since May when it was first reported that Cigna Corp and Aetna were interested, and multiple sources confirmed to Reuters that the company was entertaining offers.


Humana, based in Louisville, Kentucky, has been under pressure for more than a year from investors, which include activist fund Glenview Capital Management, to produce higher returns.


Last year Humana hired a CFO from investment bank Goldman Sachs and went through a strategic review that included asset sales. But it missed several quarters of earnings targets and struggled with profits in its individual business, disappointing Wall Street.


Aetna said it has received commitments from Citi and UBS Investment Bank to finance the deal.


Citi and Lazard are financial advisers for Aetna and Davis Polk & Wardwell LLP is its legal adviser. Goldman Sachs is the financial adviser to Humana, while Fried, Frank, Harris, Shriver & Jacobson LLP is its legal adviser.

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Under Healthcare Reform, Where Do Practicing Physicians Go From Here?

Under Healthcare Reform, Where Do Practicing Physicians Go From Here? | Healthcare and Technology news | Scoop.it

It’s a fascinating time these days in healthcare, on so many levels. And discussions in the past week—mine and others’—have only underscored that fact.


First, there was my breakfast and interview with Scott Weingarten, M.D., the senior vice president and chief clinical transformation officer at Cedars-Sinai Health System in Los Angeles. Reconnecting with Scott Weingarten reminded me once again of what a vortex we’ve been flying into and through, lately in our industry. Southern California is one of the more advanced managed care markets in the U.S., and yet even there, change has proven to be challenging for physicians. And if anyone is in a position to know just how challenging all this is, it is Dr. Weingarten. As he told me a week-and-a-half ago, when asked what the key to helping physicians move forward to optimize care is, “It’s a combination of things. I think physicians want to do the right thing. They went to med school to help patients; they’re trained in the scientific method. And they need to know that what they’re doing is scientifically valid. If you can’t convince physicians that something is the right thing to do for patients, they’re not going to do it.”


Weingarten, who practiced for years as an internist before he went into administration at Cedars, then co-founded Zynx Health (which provides evidence-based guidelines), and then came back to Cedars two-and-a-half years ago,  told me this: “ I used to be a practicing physician; and if someone couldn’t convince me something was right for my patients, I wouldn’t do it, either. So they need to understand that all of this is good for their patients; and they need to understand all the changes taking place at the national and local level; and also to understand how change will help them better take care of their patients.”


Weingarten believes that the MACRA (Medicare Access and CHIP Reauthorization Act of 2015) law that eliminated the SGR (sustainable growth rate) problems under Medicare, and which mandates either participation in the new Merit-based Incentive Payment Program, or MIPS, or participation in alternative payment models, which push practicing physicians forward quickly, once they figure out their options. “We provide them with those resources to help them, because it’s very hard for physicians in small practices,” he noted, of his organization’s clinical transformation and performance improvement work at Cedars-Sinai, because “with MIPS—in 2019, physicians will either need to participate in alternative payment models, or in MIPS. Beginning 2019, they’ll get a 5-percent annual bonus for participating, whereas there could be up to a 9-percent downside under MIPS in Medicare reimbursement over time, and that could be very difficult for the physicians.” And of course, “A lot of physicians are trying to figure out what alternative payment models mean for them,” he noted, “so we try to explain to them what’s going on and what it means.”


Not every physician is practicing in an integrated health system like that of Cedars-Sinai, where senior executives are working assiduously towards clinical transformation—and even have a senior vice president for clinical transformation, in Scott Weingarten. Joseph Valenti, M.D., an obstetrician-gynecologist who practices at the Denton, Texas-based Caring for Women practice, recently told HCI Associate Editor Rajiv Leventhal, that physicians like himself are becoming stressed by some aspects of healthcare reform. Asked why he believes that some doctors are wary of joining accountable care organizations, Dr. Valenti said, “I think that a lot of physicians are not completely convinced that the data is out there to demonstrate that they could potentially develop the savings necessary, and prevent hospital admissions and readmissions. Much of the healthcare spending that is extreme right now is in hospitals, not clinician offices,” he said, “so the concern is, can you keep this person out of the hospital? Also in terms of Medicare ACOs, you’re going to be assigned 5,000 patients at least, and they could be the sickest patients out there, so there is no guarantee that you can make them well enough and be assured that they don’t need to come back to the hospital. So maybe you can’t demonstrate shared savings. And the ACO stats prove this; one-third of them are working, one-third are breaking even; and one-third are leaving the program. “


Meanwhile, electronic health records and other clinical information systems are fascinating in this context, because they are absolutely essential to moving forward on value-based care delivery and payment and clinical transformation, but the implementation of an EHR/EMR itself is really, as everyone says, “table stakes”—that go-live is only the first step in a very long process for physician practices. “As Dr. Valenti expressed it to Rajiv, “This is the story with EMRs—no one has compelled them to simply ‘come up to snuff.’ The concern is that I will put my whole future in the hands of this IT system, and maybe it will work but maybe it won’t. The cost of this for us was over a quarter of a million dollars, and we’re not as satisfied as we should be given the cost. We can’t believe the number of bugs and glitches with it,” he said. “There are eight providers in our group, and we do like the ability to access our EMR from anywhere when a patient calls middle of night. I wouldn’t go back to paper, even though I know a lot of doctors actually would—many have been jaded by EMRs that were not well supported and cost them a ton of money and time. I call these things unfunded mandates—things we must do but no one is funding anyone to do them.”


All these issues were definitely on the minds of the CMIOs and other medical informaticists gathered in Ojai, California last week for the annual AMDIS Physician-Computer Connection Symposium. There are so many “to-do’s” when it comes to optimizing the use of clinical information systems in order to really accomplish the clinical transformation that will be required to fundamentally reengineer the U.S. healthcare system in the coming years. As Doug Fridsma, M.D., Ph.D., of AMIA (the American Medical Informatics Association) noted in his AMDIS address, physician documentation processes need to be seriously revamped; regulations need to be made more focused in their approach; there needs to be greater transparency around EHR functions; and clinical IS innovation among vendors must be encouraged.


Referring to his association’s recently published “EHR 2020” report, Fridsma said of himself and his association with regard to the policy recommendations made in the report, “We said, if you’re going to focus regulation and increase transparency and encourage attempts to simplify documentation, make sure to keep your patient at the center, as the North Star.”


I think that that comment will be very important going forward, particularly with regard to helping physicians in practice to do the very difficult work of transforming patient care to improve outcomes around both care quality and cost.


Certainly, Scott Weingarten and his colleagues at Cedars-Sinai know that. Their challenge is to figure out how to optimally leverage IT tools to support physicians in creating their own clinical transformations while also contributing to broader processes of transformation across their integrated health system. And they’re learning as they go, in terms of ACO and population health development.


So here’s the thing: Scott Weingarten, Joseph Valenti, and Doug Fridsma are all very, very smart doctors. They’re all trying to do what they can in their organizations to move their organizations forward, and in some way, to move the physician community, and U.S. healthcare, forward.


And all this change-making is inherently, and inevitably, messy. Because for U.S. healthcare to successfully move into its next phases of evolution, we will need for federal policy mandates, private health insurer initiatives, hospital, medical group, and health system efforts, and individual physicians’ delivery process changes, all to move forward, in some broadly coordinated way. And yet, the reality never matches the theory—thus Dr. Valenti’s legitimate complaints about some of the challenges facing practicing physicians. In particular, he is quite right that demanding accountability from physicians for outcomes that are partly actually the responsibility of patients, is problematic.

Yet it is still in everyone’s interest for individual physicians in practice, whether solo (though few are left in true solo practice anymore) or in organized groups, to feel themselves to be a part of change, and to be “self-change agents,” as it were. And good medical practice governance, and good IT governance, will be essential to any such advances.


So how physicians move forward under healthcare reform (public and private alike) is a question that concerns all of us in healthcare. But only time will tell as to exactly how it all plays out. So stay tuned, because the kinds of discussions that I and my fellow editors at HCI have been having in the past couple of weeks speak to some of the deeper issues facing our entire industry. Personally, I can’t wait to see exactly how everything plays out. It certainly will be a fascinating next couple of years!

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Obamacare ruling ends threat to U.S. hospitals, insurers

Obamacare ruling ends threat to U.S. hospitals, insurers | Healthcare and Technology news | Scoop.it

The U.S. hospital and health insurance industries breathed a collective sigh of relief on Thursday after the U.S. Supreme Court upheld subsidies for individuals under President Barack Obama's signature healthcare law.


Shares in hospitals surged, with several hitting all-time highs, on the expectation that patients would be able to continue paying for services. Health insurer stocks also gained. Wall Street analysts called the ruling positive for an industry on the edge of consolidation.


Health economists have estimated $15 billion to $22 billion in healthcare spending was at risk with the decision. About 10 million Americans have insurance through the healthcare law's insurance exchanges and, of those, 6.4 million have subsidies.


The court ruled 6-3 that the 2010 Affordable Care Act (ACA), widely known as Obamacare, did not limit subsidies to states that establish their own online healthcare exchanges. It marked the second time in three years that the high court ruled against a major challenge to the law.


Trinity Health, one of the largest not-for-profit health systems, was holding a board meeting when the ruling hit.


"There was a ‘Yahoo!’ and a big round of applause," Dr. Richard Gilfillan, chief executive of the Livonia, Michigan-based hospital chain said.


Insurers said subsidies were key to bringing in new customers.

"For a lot of the individuals who were depending on these subsidies in order to have coverage, I think it is a major sigh of relief," said J. Mario Molina, chief executive of insurer Molina Healthcare.


Annie Wisecarver, 53, of Shepherdstown, West Virginia, receives a monthly subsidy of about $200 to buy Obamacare insurance.

"I really only purchased insurance for an emergency, like if I fell off a mountain and broke my leg," Wisecarver said. "I can’t see myself spending $300 or $400 a month on insurance just because I might have an accident."


The ruling could remove uncertainty for the insurers who are seeking deals, like Anthem Inc and Aetna Inc, Leerink Partners analyst Ana Gupte said.


Anthem is pursuing an acquisition of Cigna even after being rejected, while sources previously told Reuters that Humana put itself up for sale last month, with Cigna and Aetna making offers. Bloomberg reported on Thursday that an Aetna-Humana deal could be reached as soon as this weekend.


Humana jumped 7.5 percent. Aetna Inc gained 3.6 percent, Anthem Inc 1,1 percent, Cigna Corp 2.6 percent, and UnitedHealth Group Inc rose 2.7 percent.


Among hospitals, shares of Community Health Systems were up 13.3 percent, HCA Holdings rose 8.5 percent and Tenet Healthcare jumped 12.2 percent. HCA, Universal Health Services and LifePoint Health hit lifetime highs.


'PEACE OF MIND'


Since the subsidies were introduced last year, they have helped hospitals reduce the losses from covering the cost of uninsured patients.


"It's just a very positive thing because it takes away the overhang on the company and the industry," said Alan Miller, CEO of Universal Health Services, which has hospitals in 37 states.


Bill Carpenter, chief executive of Lifepoint Hospitals, which has 64 hospitals in 20 states, was at an offsite patient safety event and said everybody in the room was excited about the ruling.


"We are just are so pleased that those people who have secured coverage through state exchanges will have the peace of mind to know that their coverage is going to continue," Carpenter said, calling on states to expand Medicaid to more income levels, another goal of the ACA. "In many states, this has been about politics and not policy."


In Florida, one of the biggest remaining issues is expanding Medicaid, said Jim Nathan, president and chief executive of Lee Memorial Health System in Fort Myers, one of Florida's largest public, not-for-profit health systems.


Jason Montrie, president of Land of Lincoln Health, a non-profit CO-OP health insurance company launched in 2013 with the government funding of the Affordable Care Act, said subsidies are vital to most of its more than 50,000 members.


"We're relieved that our court made the right decision here," Montrie said.


Options activity had been sanguine in the days and weeks leading up to the ruling, with many traders betting on a rally in the hospital names after the Supreme Court decision.


The S&P 500 healthcare sector is up 11.3 percent in 2015 so far. The sector accounts for about 15 percent of the S&P 500 index.

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Margarito Cruz's curator insight, December 10, 2015 10:05 PM

The role being discussed in this article is about Cheif Executive. I didnt realize that so many people were under Obama's Obamacare. I agree with these actions because of all the accidents that happen everyday. People who dont have insurance face the same dangers that the people that do have it. It would be nice to know that theres something that will pay for the ones not as wealthy. Obama is the organizer of Obamacare.

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Are We Getting Closer to the Top of the HIE Mountain?

Are We Getting Closer to the Top of the HIE Mountain? | Healthcare and Technology news | Scoop.it

Two weeks ago, I finally completed the long, enduring process of buying my first home in Hoboken, N.J. The journey, from start to finish, took months to complete, the money put into it was substantial, and the paperwork and effort to try to make sure that everything went smoothly (Does it ever when it comes to real estate?) was rigorous, to put it kindly.


One of the strangest parts about this process, from a personal standpoint, is that I won’t be living in the home! Instead, I see it as an investment opportunity that I hope will pay off in the long run. Will it? It’s hard to say as of right now—the real estate market will dictate how it works out for me in the future, and it might be years and years down the road until I know if it was a savvy move or not.


The quick lesson here: sometimes in life, it takes a really long time to see tangible results for the efforts that we have put in. This couldn’t be more accurate when it comes to health information exchanges (HIE). The investment that our country has put into developing and maintaining HIE platforms has been gigantic, in the form of half a billion dollars, yet many naysayers believe that the return on that investment might never come.


To date, it’s been pretty hard to argue with them. Interestingly enough, I actually blogged about this very issue back in December, referencing a study from the Santa Monica, Calif.-based research organization RAND Corporation which found that due to the lack of evaluation on HIEs in the U.S., simply put, it has been too difficult to determine if they have been successful or not.  It’s too early to judge them, the researchers of that report found. “There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said at the time.


Recently, I read another review on HIEs, one that had similar conclusions to the RAND study in terms of early evaluation, although this study had a more optimistic outlook. This latest report, “The benefits of health information exchange platforms: Measuring the returns on a half a billion dollar investment,” from Niam Yaraghi, a fellow in the Washington, D.C.-based Brookings Institution’s Center for Technology Innovation, studied the effects of accessing patient information through an HIE platform on the number of the laboratory tests and radiology examinations performed in two emergency departments in Western New York in 2014, via the region’s HIE, HEALTHeLINK. While Yaraghi readily admits that true HIE benefits won’t be realized until more providers join HIE platforms, and subsequently share data, he sees that there is significant potential.


Yaraghi’s analysis looked at two groups of patients in the ED, one group whose care involved querying HEALTHeLINK’s database of clinically relevant information from a patient’s medical history, and the other group whose care did not involve an HIE query. The study revealed that querying the HIE’s database is associated with significant utilization reduction in ED settings. In the first ED setting, querying the database is associated with respectively, a 25 percent and 26 percent reduction in the estimated number of laboratory tests and radiology examinations. In the second ED setting, querying the HIE’s database is associated with a 47 percent reduction in the estimated number of radiology examinations.


In his conclusion, Yaraghi writes, “The efforts by Congress, patient advocacy groups, and most importantly the shift towards value-based payments promise complete interoperability in the near future. After more than a decade of concerted national efforts, we are now on the verge of realizing the returns on our investments on health IT. HIE platforms have the potential to leverage the national investments on interoperability and radically improve the efficiency of healthcare services.”


Comparatively speaking, the aforementioned RAND study found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare. “It is pretty well established that the U.S. healthcare system is highly fragmented,” RAND’s Rubin said. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information. There is no sign of that problem getting better, and in fact it may get worse if medicine continues to become more specialized.”


Indeed, as Yaraghi notes, getting providers on board and increasing the volume of data available on the HIE platform will be the key moving forward. “A RHIO (regional health information organization) without data is an expensive yet empty glass of water,” he writes.  “At the beginning, RHIOs could help physicians have a better understanding of the patients’ condition as much as an empty glass could help them quench their thirst.” Undoubtedly, as HIE organizations look to get providers more involved and willing to share data, the providers themselves are looking for more out of the HIEs. A recent report from NORC at the University of Chicago, funded by the Office of the National Coordinator for Health Information Technology (ONC), found that providers highlight the potential for HIE to ease access to actionable data that integrates data from across the care continuum and provides clinicians with information at the point of care to improve care delivery and care coordination.


At the end of the day, it’s all about value, as with most things in life. If the general public values my condo in Hoboken, and I get renters to pay me to live there, I’m almost certainly going to see a return on my investment. Similarly, if physicians across the U.S. see value in HIEs, the federal government will eventually see a return on their investment as well, in the form of lower healthcare costs and better patient outcomes. As Yaraghi writes, “This is the first study in which access to an HIE platform was provided to all of the patients in a treatment group, while the care of the others in the control group did not include querying an HIE platform.” I hope that this research serves a stepping stone for moreresearch in this area—and down the road, a return on our enormous expenditure into health information exchanges.

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7 ways physicians can improve health care quality

7 ways physicians can improve health care quality | Healthcare and Technology news | Scoop.it

Patients want to receive health care that is of the highest quality. Physicians want to provide it. But what is “high-quality health care?” On that, few agree.


Ask most Americans and they’re unsure where to find it. They know they want to be kept healthy, have rapid access to personalized care whenever they need it and be charged only what they can afford.

Ask the leaders of the national medical and surgical societies, and they are likely to define quality as having access to the latest — and often the most richly reimbursed — procedures, diagnostic imaging, and genetic testing.

Ask physicians themselves and, well, they’re already overwhelmed by the exponential growth in clinical measures of quality developed for public and private pay-for-performance formulas.


Even so, medicine is coming closer to a definition of high-quality health care — and also to a system for evaluating how physicians and medical groups perform. The Institute of Medicine (IOM), a highly regarded independent organization established by Congress to advise on health care issues — the gold standard on improving our nation’s health – recently released a report: “Vital Signs: Core Metrics for Health and Health Care Progress.”


The IOM panel of experts identified 15 measures, narrowed down from hundreds, with the best potential for improving health, including reducing the overall rate of preventable deaths.The consensus: If the U.S. systematically raises its performance in each of these 15 domains, the quality of life for millions would improve dramatically.


This IOM report is important, even though it received surprisingly scant media attention. It should serve as a starting point and a road map about how clinical practice can most effectively lift the quality of care delivered to patients.

But let me come back to the report itself in a minute.


The quality conundrum


A little context about the issue of quality might help here. At last count, the number of health care quality measures in place was in the thousands. The Joint Commission has 57 just for inpatient care at hospitals. The Healthcare Effectiveness Data and Information Set has about 81. The National Quality Forum currently endorses more than 630. The Centers for Medicare & Medicaid Services has no fewer than about 1,700.


That may explain why keeping track is such a challenge for all parties involved.


Perceptions of quality are of course subjective. According to the Merriam-Webster Dictionary, quality is “how good or bad something is; a characteristic or feature that someone or something has; a high level of value or excellence.” The Oxford Dictionary says quality is “the standard of something as measured against other things of a similar kind; the degree of excellence of something” It cites this example: “The hospital ranks in the top tier in quality of care.”


The upshot here is a paradox: a definition that is itself ill-defined – and as such, leaves plenty of uncertainty and doubt.


7 actions physicians can take


That’s why the IOM report is so valuable and welcome. It cites 15 “vital signs,” but let’s focus on the seven that relate to direct health care delivery and better care for patients.


1. Overweight and obesity. Physicians should help their patients exercise regularly, eat a healthy diet and maintain their weight within a normal range. More than two-thirds of Americans are overweight or obese. Specifically, physicians can make diet and weight management a vital sign and counsel every patient on the options available.


2. Addictive behaviors. Eliminating smoking and alcohol abuse, along with reducing the percentage of people who are overweight, would dramatically lower the incidence of diabetes, lung cancer, and cardiovascular disease. Physicians should engage and educate patients about approaches to take to quit smoking and alcohol abuse, and provide advice and resources toward that end. Today, addiction to nicotine, alcohol, opiates and other psychoactive drugs continues at unacceptably high rates.


3. Preventive services. Physicians should urge patients to take the recommended screening tests and stay current on their vaccinations. Preventive screenings alone could dramatically lower the risk of dying from cancer, heart disease, and strokes.


Combining this with smoking cessation and exercise could help avoid 200,000 heart attacks and strokes in the U.S. each year, and reduce the mortality from cancer by tens of thousands yearly, based on an internal analysis done by The Permanente Medical Group’s Division of Research.


Screen for colon cancer in fewer than 50 percent of patients, rather than in 80 percent to 90 percent, and you double the chances of dying from an invasive adenocarcinoma. Smoke at the national average of 18 percent, rather than at under 10 percent, and you dramatically increase lung cancer, emphysema, and heart attacks.


Preventive services present a valuable opportunity for both improving health and reducing health expenditures.


4. Patient safety. Physicians and nurses can, through rigorous practice, help patients avoid hospital-acquired infections, pressure ulcers, medication errors and wrong-site surgery. Even a decade after the 1999 IOM report, “To Err is Human” — with its estimate that 100,000 patients die each year from medical errors, the equivalent of a jetliner crashing each day — these so called “never events” still occur too frequently.


And when patients develop infections like sepsis, or suffer an adverse drug reaction, they face a higher chance of dying in the hospital, and experiencing problems long after hospital discharge. Avoiding harm has been a core value of the medical profession from the time of Hippocrates, and is “first among equals” when it comes to the principal responsibilities of the health care system. Yet medical errors with adverse outcomes are still far too common.


5. Unintended pregnancy. Physicians should take the opportunity to focus on ensuring the health of an expectant mother in order to increase the chances for a healthy baby and safe delivery, whether a pregnancy is unintended or the result of careful planning.


An estimated 50 percent of pregnancies in the US are unplanned, and occur in women across the spectrum of child-bearing years, and among women in every socioeconomic demographic. Unintended pregnancy results from social, behavioral, cultural, and health factors, including — and perhaps most especially — women’s lack of knowledge about and access to tools for family planning.


Research has demonstrated that medical care soon after conception is critical, and identified ways to reduce the risks of a maternal or fetal complication. Good nutrition, along with avoidance of drugs, alcohol and cigarette smoke, are essential. After birth, comprehensive medical care and early diagnosis of problems can prevent longer-term health problems and future complications.


6. Access to care. Access to health care is one of the most powerful determinants of clinical outcomes. The ability to access care when needed is a vital precondition for a high-quality health system.

Physicians in integrated, multi-specialty practices have advantages in ensuring patients get all the care needed thanks to comprehensive electronic health records. But in today’s fragmented health care system, with close to 15 percent of the population still uninsured, health care still remains beyond the reach of all too many Americans. Policy makers are relentlessly pursuing affordable access.


7. Evidence-based care. Physicians should see to it that patients receive medical care based on the most current scientific evidence for what is appropriate and effective, rather than on an anecdote or an “in my experience” approach. Physicians working in hospitals with electronic health records can do so, deciding about care according to scientifically validated protocols for complex problems like heart attacks, strokes, and hip fractures.


In the not-too-distant past, when physicians lacked many of the current diagnostic tools and access to sophisticated information technology, medical practice was far more art than science.


Even today, variation in how physicians treat patients with the same problem is unwarranted, and leads to system-wide under performance and less-than-optimal clinical outcomes.


Fortunately, medical practice today is far more science than art.


What patients should do


The best quality, then, according to the IOM, is not based on using a robot, providing transplantation or completing genetic sequencing. The reality is that, contrary to what some might assume, these often advertised technologies have minimal impact on mortality.


And quality is not a result of individual technical excellence in performing procedures such as heart surgery, neurosurgery or hip replacement surgery. The variation from surgeon to surgeon is far less than people assume. In fact, many health care experts now perceive overuse of these high-intensity surgical interventions to be a problem that sometimes results in associated complications and minimal improvements in clinical outcomes.


The list, in short, is more practical than exotic or “sexy,” offering the interventions which have the greatest impact on human life.

The IOM committee concluded that leadership “at nearly every level of the health care system” will be required to adopt, implement, refine and maintain these core measures. And among the many stakeholders, physician leadership will be key.


Patients should make health choices based on these 15 vital signs from the IOM. They enable people to distinguish the most important quality measures from all the “noise” about what are the newest and most exotic tools and approaches available. More specifically, patients would be wise to select a personal physician or medical group whose practice philosophy incorporates these approaches — and whose clinical results in each area are superior.


We physicians are obligated to heed the IOM recommendations on behalf of our patients, the better to fulfill health care’s promise of easing suffering and extending lives. This is where American health care should invest its efforts. The IOM is a gift to both physicians and patients. Taking our eyes off what will most impact the health of all would be a mistake our nation can ill afford.

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What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market?

What Does IBM’s Acquisition of Merge Healthcare Say About the Healthcare IT Market? | Healthcare and Technology news | Scoop.it

As if everyone’s heads in healthcare IT weren’t already spinning like that of Linda Blair in 1973’s “The Exorcist,” here comes yet another acquisition in healthcare IT, this time the Armonk, N.Y.-based IBM announcing on Thursday its acquisition of the Chicago-based Merge Healthcare.


All mergers and acquisitions are interesting, but this one offers particular facets worth pondering. First of all, of course, its timing, less than four months after that giant company had just swallowed up the Dallas-based Phytel and the Cleveland-based Explorys back in April, a move announced during the HIMSS Conference.


That double acquisition is one of the reasons that we editors at Healthcare Informatics made IBM one of our “Most Interesting Vendors” this year, as its trajectory has encapsulated some of the mergers and acquisitions that have taken place in order to give some vendors a particular edge as competition intensifies in the healthcare IT world. As Senior Editor Rajiv Leventhal wrote regarding IBM’s analytics push, “Enter the Watson Health Cloud, which IBM will sell to doctors, hospitals, insurers and patients. That offering will be the centerpiece of a new dedicated, Boston-area business unit, IBM Watson Health, which now includes both Explorys and Phytel.” Leventhal quoted Anil Jain, M.D., chief medical officer (CMO) for Explorys, as saying that “[IBM] is complimenting much of what we do around traditional analytics using machine learning algorithms with some of the cognitive computing and the Watson analytics that Watson Health group will be leveraging. We became the content that will fuel some of the next generation analytics that Watson has become famous for.”


In a blog published today on AuntMinnie.com, staff writer Erik Ridley wrote this: “For IBM's new Watson Health unit, the deal gives the company access to Merge's image management and analysis software and its installed base of more than 7,500 U.S. institutions, clinical research institutes, and pharmaceutical companies. IBM is adding Merge to other recent acquisitions, such as population health firm Phytel and cloud-based healthcare intelligence company Explorys.”

Ridley went on to note that “IBM plans to offer Watson Health Cloud to analyze and cross-reference images against lab results, electronic health records (EHRs), genomic tests, clinical studies, and other health-related sources. In aggregate, these represent 315 billion data points and 90 million unique records, according to the company. This could provide Merge's installed base with a useful consolidated, patient-centric view of current and historical images, EHRs, data from wearable devices, and other related medical data.”


So far, so good. I think that IBM is gaining clear advantage in acquiring Merge Healthcare at this time., as it brings imaging informatics into the fold and potentially will integrate elements of imaging informatics with its already-advancing work in analytics. Indeed, Joe Marion, a Wisconsin-based consultant who blogs regularly for Healthcare Informatics and who is one of the most knowledgeable observers of the imaging informatics sector around, sees clearly the advantages to this pairing. As Joe wrote Thursday in a blog on this site, “Today, IBM is a different company than it was thirty years ago, as is the healthcare industry.  Much of the “big iron” emphasis is gone, and the company has much more of a services focus these days.  Cloud computing was never a factor in the past, and today, coupled with Watson, it offers much more potential for delivery of storage and analytics solutions.”


Joe further noted that, “In the age of past efforts, there were much larger barriers between Information Technology (IT) and clinical departments.  That is why IBM chose to partner with GE to address RIS-PACS [radiology information system/picture archiving and communications system (issues)] previously, as the two complemented one another in terms of hospital administration emphasis.  Today, there is much more IT emphasis on clinical systems and their integration across the enterprise.  And,” he added, “the healthcare environment today is radically different than in the age of past efforts, given increased regulation and greater provider consolidation.  An IBM-Merge combination should have much broader appeal to integrated delivery networks (IDN’s) who might benefit from greater interoperability and better business analytics.”


I agree completely with Joe’s perspective on this. Now, what about Merge Healthcare itself? I’ve been following Merge very closely as a company for several years now. Merge has some very talented senior executives, and solutions that are respected and appreciated by providers. The challenge for the company’s senior management has been facing is the shifting landscape of the imaging informatics market right now. PACS solutions have become almost totally commoditized; I’m sure there are PACS systems that are at last marginally better than others, but, given the accelerating demands facing patient care organizations, the need to move quickly into accountable care- and population health-based arrangements, and clinicians’ demands for always-available computing, even significant solution quality differentiation is simply no longer enough (and let’s not even talk about how commoditized RIS solutions have become).


So, clearly, for senior executives at Merge, a respected company that has been going through some major management changes and has been treading water in a rapidly shifting imaging informatics vendor landscape, this deal makes a lot of sense, too.


The challenge now will be to make this pairing work for current Merge Healthcare customers and for IBM customers—and customers of the former Phytel and Explorys, too. We all know about the trajectories of healthcare IT vendors that have grown too rapidly through acquisition and that have ended up becoming a jumble of unintegrated parts.

IBM’s moves so far seem thoughtful and precisely judged. Only time will tell how everything turns out ultimately—and clearly, that will depend on execution. Skillful execution is to healthcare IT what location is to real estate—a fundamental element of success. And this trajectory for IBM is a fascinating one. So stay tuned—because this is going to be an interesting path ahead.

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America is Still the Land of Opportunity for Doctors

America is Still the Land of Opportunity for Doctors | Healthcare and Technology news | Scoop.it

Like many of you I've recently taken some time off to enjoy and reflect on the most American of holidays, July 4th. Despite the politically charged climate and other social and economic challenges we currently face together as a nation, the United States offers physicians a combination of opportunities and resources that are hard to duplicate anywhere else.


1. American doctors have unmatched professional resources.


The United States provides the modern physician and her practice with a good supply of educated and well-trained healthcare workers and great external support and resources as well. Very few countries have the large number of specialized and well-trained lawyers, accountants, marketing experts, coding and collections teams, compliance managers, and all the others we take for granted. Add to that our exceptionally well-developed CME system, peer networks, and low-cost or free resources and expert information provided by Physicians Practice and its affiliate publications, and the extent of the support available to all doctors who make an effort to take advantage of these resources becomes clear. Very few other countries can compete with the U.S. in these areas and many turn to our materials and standards for this help.


2. America loves a winner.


By this I mean that Americans value ethics, service, and excellence; and this gives you a chance to compete on a relatively level playing field by running the best practice you can. Sure, there are always competitors with bigger offices and budgets, but it's been my experience that even small practices with committed and passionate owners and managers can still retain a loyal patient base and thrive and grow. We are a culture that values people, relationships, and results.


3. We have an infrastructure that supports business and progress.


Yes, we've all seen the reports about our aging roads, bridges, etc., and we probably can all name one specific example in our own town. That said, the availability of regular and dependable mail, Internet service, dependable sanitation, power, water, untainted drugs, labs and diagnostic facilities that turn around results in mere hours in an affordable way, and the protection of first responders are just a minute example of things we all take for granted in this country. Those of you that may have been born outside this country or who have traveled internationally understand that these are advantages not enjoyed by the majority of the people on this planet. How would you like to be running a practice in Greece this week?


4. We generally follow the rules.


The rule of law provides protection and predictability in many areas that other countries still can't offer. You have the protection and guidance of laws in many areas that are meant to protect you, the public, and your employees. Your property is yours and you can use the law to make sure it stays that way, and to limit the unreasonable claims of others, and to protect your own rights. We also have the protection of the rule of law ensuring that all of our citizens have equal protection and freedoms, in areas ranging from consumer protection laws that enforce professional licensing and prosecute those who act recklessly or fraudulently to simple issues like preventing the public from being exposed to counterfeit drugs — a problem that plagues millions of doctors and patients worldwide.


Sure, there are examples of bad actors and criminals in every city and state; the difference is that we have the resources and a system to deal with and actually prosecute them. The United States allows us the freedom and stability to make long-term plans for our businesses, families, and futures relatively free of threats from roving drug gangs, the collapse of our currency, mass civil insurrection, civil war, and countless other issues that billions of people in other parts of the world (some right next door) currently face every day. Are we perfect? No, we never will be, but we strive to be, and have a massive team of local and national civic and professional leaders that are working to protect and better us.


I couldn't possibly address all the things that make America great for you and your patients in a single column, and of course we have many issues that need improvement and reform. But, the thing that gives me comfort (and what I hope you choose to focus on today), is that we have the will, freedom, and resources to so improve our personal circumstances.

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Sophia Nguyen's curator insight, July 18, 2015 7:45 AM

This was an interesting read because this gives me more confidence in my decision to go into the medical field as a potential career in the future. It's also reassuring to know that America is still a good place to want to become a doctor.

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White House Announces New Precision Medicine Commitments

White House Announces New Precision Medicine Commitments | Healthcare and Technology news | Scoop.it

The Obama Administration has announced new commitments to its precision medicine initiative (PMI) that it unveiled six months ago.

The initiative, which President Barack Obama touched on in his State of the Union address in January, aims to pioneer a new model of patient-powered research to accelerate biomedical discoveries and provide clinicians with new tools, knowledge, and therapies to select which treatments will work best for which patients.


This week, the Administration launched new commitments, which include:


Guiding Principles for Protecting Privacy and Building Trust: The White House is unveiling draft PMI guiding principles that seek to build privacy into the design of the PMI research cohort, which will include one million or more Americans who agree to share data about their health. The White House is seeking public feedback on the privacy and trust principles online through August 7, 2015.


New Tools for Patients: In collaboration with federal partners, the Department of Health and Human Services Office of the National Coordinator for Health IT (ONC) and Office for Civil Rights (OCR) will work to address barriers that prevent patients from accessing their health data. OCR will develop additional guidance materials to educate the public and health care providers about a patient’s right to access his or her health information under the Health Insurance Portability and Accountability Act (HIPAA).


Research Awards to Unlock Data Insights: The Department of Veteran Affairs (VA) is announcing awards to support four research projects on key questions relevant to precision medicine using the rich data from the Million Veterans Program (MVP), the largest U.S. repository of genetic, clinical, lifestyle and military exposure data.

Additionally, private sector commitments related to the initiative launched this week include:


Duke Center for Applied Genomics and Precision Medicine: Duke has developed a platform called MeTree that helps individuals have challenging but necessary conversations with loved ones and care providers about family health histories, so that physicians can tailor care to patients’ unique risk profiles.


Flip the Clinic: Flip the Clinic, a project of the Robert Wood Johnson Foundation, is announcing a collaboration with more than 160,000 clinicians and staff practicing at sites across the United States, who have pledged to inform patients about their right to get digital copies of their medical records.


Genetic Alliance: Along with collaborators, such as Cerner, Genetic Alliance is launching new capabilities for Platform for Engaging Everyone Responsibly (PEER), a data registry that empowers participants to share their data with medical researchers, advocacy groups, and others.


GetMyHealthData: The GetMyHealthData campaign is pledging to help thousands of consumers over the next 12 months access and download their own clinical health data, so they can use it to understand and improve their health, their care, and the system as a whole—including donating their data for research.


Sage Bionetworks: Recognizing the importance of health-data liberation, and the role of data in driving research studies, Sage Bionetworks is announcing that it will support clinical studies that import electronic health-record information to its open source research platform and that it will release open-source informed-consent prototypes to support these studies.


The White House also is honoring "Champions of Change" in precision medicine, which includes nine individuals who are working to use data and innovation to improve healthcare.

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Sophia Nguyen's curator insight, July 24, 2015 7:55 AM

I found this interesting because it shows how important the world of healthcare and how the president has taken notice that it's important for consumers to understand their health and take charge of it.

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CVS Health quits U.S. Chamber of Commerce over tobacco stance

CVS Health quits U.S. Chamber of Commerce over tobacco stance | Healthcare and Technology news | Scoop.it

CVS Health Corp said it was withdrawing its membership from the U.S. Chamber of Commerce after media reports that the trade group was lobbying globally against anti-smoking laws.


The No. 2 U.S. drugstore chain said it was "surprised" to read recent reports on the chamber's position on tobacco products outside the United States.


The New York Times reported last week that the chamber and its foreign affiliates were lobbying against anti-smoking laws such as restrictions on smoking in public places and bans on menthol and slim cigarettes, mainly in developing countries. 


"CVS's purpose is to help people on their path to better health, and we fundamentally believe tobacco use is in direct conflict with this purpose," CVS spokesman David Palombi said in an emailed statement on Tuesday.


The chamber, however, said that it did not support smoking and it called the report "a concerted misinformation campaign."


"... we support protecting the intellectual property and trademarks of all legal products in all industries and oppose singling out certain industries for discriminatory treatment," the trade group said in an email.


CVS was the first major U.S. drugstore chain to stop selling tobacco products last year.

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Getting a checkup will be very different in the not-so-distant future

Getting a checkup will be very different in the not-so-distant future | Healthcare and Technology news | Scoop.it

Sometime in the not-so-distant future, getting a checkup will be very different.


When the doctor writes down your symptoms, it will be cross-checked with others in your area, making it easier to identify outbreaks and epidemics sooner. If you complain of shortness of breath, your phone’s heart rate monitor will instantly report how well your heart has functioned over the last month. Those readings then could be aggregated with others in your community, revealing hidden trends. As your doctor thinks about the best treatment for you, big-data analysis will help her assess how various options have worked for others with similar histories and body chemistry.


This is the promise of big data in healthcare. And, it’s not just while you’re at the doctor. Medical research and findings are now being combined into massive searchable databases, making it easier to assess and compare results. Databases can absorb terabytes worth of disparate data, including things like the weather. This will make it clearer whether it’s the drug — or something extraneous like humidity — that’s making people feel better.


But all this is in its infancy, with the sector moving slowly and cautiously. The Affordable Care Act now mandates that doctors switch to electronic health records when they treat Medicare patients. So far, they’re not especially sophisticated.

“Electronic health records right now are only collecting about 100 megabytes of data per patient, per year,” says Dale Sanders, senior vice president of strategy at Health Catalyst, an analytics firm. “Most patients, if they knew how poorly informed healthcare was from a data perspective, would be really disappointed.”


Health Catalyst is one of a number of companies — big and small — working to change that, seeing the immense potential to both improve care and save money. US healthcare industry expenditures are approaching $3 trillion annually. The McKinsey Global Institute estimated in 2013 that deploying big data could create $100 billion in value every year across the healthcare industry.


In Pittsburgh, a major hospital system teamed up in March with the city’s biggest universities to advance big-data analytics in healthcare. As part of a consortium, Carnegie Mellon University is working on artificial intelligence that draws on databases of studies and health records.


Andrew Moore, Dean of Carnegie Mellon’s School of Computer Science, imagines a day when his phone gives his doctor a more accurate report on his health than he can himself.

“If he or she asks me, ‘have you been getting out of breath much lately?’ and I say, ‘I don’t think so,’ at that point I would like my cell phone to chime in and say, ‘yes, you have, actually, Andrew,'” he says. “That would be awesome for me and the physician.


Moore expects the systems to be able to trace hospital-borne infections back to a specific piece of equipment or patient. Or, some might make it possible to diagnose a rash with a smartphone photo.

The Pittsburgh Health Alliance plans to spend $10-$20 million a year on its big-data collaboration. Carnegie Mellon joins with the University of Pittsburgh Medical Center and the University of Pittsburgh on the project, and UPMC already takes in info from 200 sources.


And big data has the potential to become big business. In 2013, investors put nearly $200 million into analytics and big-data startups, according to research firm Gartner. There have been similar size investments in digital medical devices and personalized medicine. The government is investing millions in analyzing medical databases, too. That’s not to mention health-tracking research and products from the likes of Apple, Google, and FitBit.


“Hospital systems realize that healthcare is becoming more and more an information technology business,” Moore says.


For all the excitement over big data’s potential for personalized medicine and better public health, it’s not without obstacles and risks. Moore worries about security, knowing that any breach of privacy will threaten public acceptance of the whole industry.


Sanders of Health Catalyst thinks the real promise of big data is improving the basics of healthcare. “We keep attaching big data to these moonshot kinds of expectations,” he says. To Sanders, big data isn’t a revolution. It’s a way to improve the fundamentals of care, like reducing hospital-borne infections.


“Reducing variability in care and reducing over treatment of patients is probably the most important place for any organization in healthcare to start,” he says.


And perhaps the biggest challenge for big data is culture. Doctors and hospitals tend to be understandably cautious and skeptical about adopting new technology, waiting for it to be sufficiently proven safe and effective. But as analytics improve, and the pressure to bring down the cost of healthcare builds, most agree big data will become a big deal in medicine.

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Many docs come to work sick

Many docs come to work sick | Healthcare and Technology news | Scoop.it

Many doctors, nurses, midwives and physicians assistants come to work sick even through they know it puts patients at risk, a new survey suggests.


Many said they don’t call in sick because they don’t want to let colleagues or patients down by taking a sick day, and they were concerned about finding staff to cover their absence.


At the Children’s Hospital of Philadelphia, Julia E. Szymczak and colleagues analyzed survey responses collected last year from 536 doctors and advanced practice clinicians at their institution.


More than 95 percent believed that working while sick puts patients at risk, but 83 percent still said they had come to work with symptoms like diarrhea, fever and respiratory complaints during the previous year.


About 9 percent had worked while sick at least five times over the previous year. Doctors were more likely than nurses or physicians assistants to work while sick.


Analyzing their comments, the researchers found that many report extreme difficulty finding coverage when they’re sick, and there is a strong cultural norm to come in to work unless extraordinarily ill.

The findings are reported in JAMA Pediatrics. The researchers were not able to respond to a request for comment by press time.


Sick health care workers present a real risk for patients, especially ones who are immunocompromised, like cancer patients or transplant patients, said Dr. Jeffrey R. Starke of the Baylor College of Medicine in Houston, who coauthored a commentary on the new study.


“Most of us have policies restricting visitation by visitors who are ill, we screen them for signs or symptoms,” Starke told Reuters Health by phone. “Yet we don’t do the same thing for ourselves.”


Most hospitals do not have a specific policy restricting ill healthcare workers, and developing and enforcing these policies may help address the issue, he said.


These policies should put the decision about who is well enough to come into work into someone else’s hands, not the doctor’s, Starke said.


Aside from spreading illness in the hospital, sick doctors likely perform worse on the job than healthy ones, he said.

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The Feminization of Health Care

The Feminization of Health Care | Healthcare and Technology news | Scoop.it

Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.


A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.


A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.


A New Approach to Care


This is what I mean by the feminization of health care – delivering care in more team-based ways characterized by collaboration and the use of social networks. This approach is in sharp contrast to the patriarchal, hierarchical model that is traditionally masculine.


When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group. We get a kind of infectious excitement to innovate and create change. The team-based care that is becoming the norm in the United States operates with outcomes in mind but is supported by a network – and a more balanced management style.


Observation and experience during my more than 20 years as a physician reveal some well-defined patterns and trends. The traditional masculine, top-down hierarchical style of management is certainly employed by some women and, on the other side of the ledger, there are men who possess a team-based leadership approach. Yet in general, it has been my experience that the management styles of men and women as a whole are different.


I have found that organizations with a hierarchical approach feel much more focused on compliance, and on the idea that people do things because they have to (because it’s what they are paid for) rather than because they want to (which connects with their sense of purpose). Despite the fact that a large majority of workers in health care are women, most mainstream health care organizations – like most large corporations – operate with this patriarchal mindset.


Alignment with ACOs


The feminization of health care is well-aligned with the trend toward Accountable Care Organizations and other team-based approaches. Creating an ACO, by definition, requires building an effective inter-professional, interdisciplinary team. And the team must be capable of caring for the patient from the clinic to rehabilitation to home – with all of the actors working together around the individual patient. The “lone-wolf” leadership style is counterproductive in this sort of setting.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group.


The feminization trend is particularly evident in middle layers of management where there is rapid growth of a management style that is team-based, collaborative, interdependent, and helps people develop and perform as highly as possible. This has been happening throughout Kaiser Permanente where there are more women in leadership as chiefs of service, as physicians in chief, assistant physicians in chief, and hospital leaders.


In addition, there are active social networks among interregional teams, using network-based learning to accelerate making care better for our members. In this model people come together as peers, organized around a common purpose rather than under a hierarchy.


Glass Ceiling in Health Care


While this trend is pervasive within middle management the news is less encouraging at the top. According to a report by Rock Health, women represent only 21 percent of executives and 21 percent of board members at Fortune 500 health care companies despite making up more than half the health care workforce.


At senior management levels and in board rooms, leaders-as-heroes and leaders who drive results top-down remain highly valued. At these levels there is clearly greater comfort with authoritative rather than collaborative, servant leaders.


I believe that greater balance in leadership and management styles can accelerate capitalizing on the benefits of the feminization of health care. If we are to transform health care in the United States we need to get “unstuck” from our reliance on the traditional models of leadership in our industry.


Hierarchical models have moved us toward greater accountability for results. However, we are not going to manage our way out of our current health care crisis. We need to learn our way out, enabling disruptive thinking from a much larger set of contributors.


We need to evolve our health care leadership both because the traditional hierarchical approach excludes many women and because, quite honestly, the method has not gotten us where we need to be. Adding in the “yin” to complement the “yang,” the feminine to the masculine can bring the benefits of balance, inclusion, and diversity to help transform the industry.


Historically, health care providers and health care leaders have been selected for and nurtured traits that are traditionally seen as “masculine” – traits such as heroism, independence, and competition. Yet it is clear that as people live longer with more complex conditions, the more traditionally “feminine” traits of interdependence, empathy, and networking become more important. Even in the most technically challenging health care event, the outcome for the patient is determined by a team.

A successful outcome for surgery on a brain tumor requires the heroic hands of a neurosurgeon, along with the primary care diagnostician, the radiologist, nurses, physical and occupational therapists, oncologists, radiation oncologists, the spouse, children, home health aides, friends, neighbors, and the list goes on. It truly takes a village to create a healing environment around individuals with complex conditions.

A lone hero is a lonely voice. A highly coordinated, synchronized team of participants working in concert with the goals, desires, and wishes of the patient and family create the symphony.


A New Approach to Care


This is what I mean by the feminization of health care – delivering care in more team-based ways characterized by collaboration and the use of social networks. This approach is in sharp contrast to the patriarchal, hierarchical model that is traditionally masculine.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group. We get a kind of infectious excitement to innovate and create change. The team-based care that is becoming the norm in the United States operates with outcomes in mind but is supported by a network – and a more balanced management style.

Observation and experience during my more than 20 years as a physician reveal some well-defined patterns and trends. The traditional masculine, top-down hierarchical style of management is certainly employed by some women and, on the other side of the ledger, there are men who possess a team-based leadership approach. Yet in general, it has been my experience that the management styles of men and women as a whole are different.

I have found that organizations with a hierarchical approach feel much more focused on compliance, and on the idea that people do things because they have to (because it’s what they are paid for) rather than because they want to (which connects with their sense of purpose). Despite the fact that a large majority of workers in health care are women, most mainstream health care organizations – like most large corporations – operate with this patriarchal mindset.

Alignment with ACOs


The feminization of health care is well-aligned with the trend toward Accountable Care Organizations and other team-based approaches. Creating an ACO, by definition, requires building an effective inter-professional, interdisciplinary team. And the team must be capable of caring for the patient from the clinic to rehabilitation to home – with all of the actors working together around the individual patient. The “lone-wolf” leadership style is counterproductive in this sort of setting.

When doctors, nurses, medical assistants, and other valuable team members work in collaborative, interdisciplinary teams organized around a common goal we unleash the power of the group.

The feminization trend is particularly evident in middle layers of management where there is rapid growth of a management style that is team-based, collaborative, interdependent, and helps people develop and perform as highly as possible. This has been happening throughout Kaiser Permanente where there are more women in leadership as chiefs of service, as physicians in chief, assistant physicians in chief, and hospital leaders.

In addition, there are active social networks among interregional teams, using network-based learning to accelerate making care better for our members. In this model people come together as peers, organized around a common purpose rather than under a hierarchy.

Glass Ceiling in Health Care


While this trend is pervasive within middle management the news is less encouraging at the top. According to a report by Rock Health, women represent only 21 percent of executives and 21 percent of board members at Fortune 500 health care companies despite making up more than half the health care workforce.


At senior management levels and in board rooms, leaders-as-heroes and leaders who drive results top-down remain highly valued. At these levels there is clearly greater comfort with authoritative rather than collaborative, servant leaders.

I believe that greater balance in leadership and management styles can accelerate capitalizing on the benefits of the feminization of health care. If we are to transform health care in the United States we need to get “unstuck” from our reliance on the traditional models of leadership in our industry.

Hierarchical models have moved us toward greater accountability for results. However, we are not going to manage our way out of our current health care crisis. We need to learn our way out, enabling disruptive thinking from a much larger set of contributors.

We need to evolve our health care leadership both because the traditional hierarchical approach excludes many women and because, quite honestly, the method has not gotten us where we need to be. Adding in the “yin” to complement the “yang,” the feminine to the masculine can bring the benefits of balance, inclusion, and diversity to help transform the industry.

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US adults step away from the tanning bed

US adults step away from the tanning bed | Healthcare and Technology news | Scoop.it

Slowly but surely, individuals are turning their backs on indoor tanning -- without catching any rays -- according to a new study.

To be clear, the practice is still in full swing with an estimated 7.8 million women and 1.9 million men still flocking to tanning beds despite a decades-old link to increased cancer risk, according to the study.

Yet the rates dipped from 5.5 percent in 2010 to 4.2 percent in 2013, the study concluded.


In the study, which was published online in a research letter by JAMA Dermatology, a team from the Centers for Disease Control and Prevention, Atlanta, worked with data from 59,145 individuals.

The team was able to identify decreases in tanning bed use among those aged between 18 and 29, whose rates dipped from 11.3 percent in 2010 to 8.6 percent in 2013.


In this group, women made up 8.6 percent of indoor tanners in 2010 and 6.5 percent in 2013 while men represented 2.2 percent in 2010 and 1.7 percent in 2013.


Women who use tanning beds saw a 28 percent drop in the oldest age bracket, and college graduates' use of tanning beds dropped 45 percent.


Whereas women in fair or poor health saw a dip of 33 percent, very fit women abandoned tanning bed use by 23 percent.


Their male counterparts, however, flocked to indoor tanning salons, upping their frequency by 177 percent in the 40 to 49 age bracket.

Tanning bed use was 71 percent higher in men age 50 or older, however, cancer survivors discontinued use by 45 percent.


The research team attributes the dip to increased awareness and the classification of indoor tanning beds as carcinogenic as well as a 10 percent excise tax that exists nationwide.


"Physicians can also play a role through behavioral counseling, which is recommended for fair-skinned persons aged 10 to 24 years," write the researchers. "Continued surveillance of indoor tanning will aid program planning and evaluation by measuring the effect of skin cancer prevention policies and monitoring progress."

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Keeping Blood Pressure Low in Those Under 50

Keeping Blood Pressure Low in Those Under 50 | Healthcare and Technology news | Scoop.it

Higher blood pressure in young adulthood increases the risk for coronary heart disease, a new study found.

Researchers followed almost 3,500 men and women for 25 years with periodic physical examinations beginning in 1985, when all were healthy and 18 to 30 years old. They calculated their cumulative exposure to high blood pressure over the years.

The scientists, writing in The Journal of the American College of Cardiology, studied left ventricular dysfunction — damage to the part of the heart that pumps blood to the entire body except the lungs. Left ventricle impairment is a main cause of heart failure. They found the higher the blood pressure, the greater the damage to the left ventricle. In addition, even after adjusting for other risk factors, chronic high blood pressure in young adulthood increased coronary calcium in middle age to a degree similar to that of the initial stages of atherosclerosis.

“This paper highlights that in the first half of adult life, it’s very important to keep blood pressure as low as one can,” said the lead author, Dr. João A.C. Lima, a professor of medicine at Johns Hopkins, adding that “130/80 or 130/70 should be the goal for people under 50.”

Current guidelines advise treatment at 140/90 for people ages 30 to 59.

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Healthcare Industry in Midst of Digital Revolution

Healthcare Industry in Midst of Digital Revolution | Healthcare and Technology news | Scoop.it

Healthcare executives expect that, within the next three years, their industry will need to focus as much on training machines as they do on training people, according to a new report by the New York City-based Accenture.


The industry report, “Accenture Healthcare Technology Vision 2015,” is based on a survey of 601 doctors, 1,000 consumers and 101healthcare executives, and highlights emerging technology trends that will affect the health industry in the next three to five years.


Roughly four-in-five (84 percent) health executives agree or strongly agree that their industry will need to focus as much on training machines—such as using algorithms, intelligent software and machine learning—as they do on training people in the next three years. In fact, most of those surveyed (83 percent) agree that provider organizations, driven by a surge in clinical data, will soon need to manage intelligent machines as well as employees.


Intelligent machines will also support the surge in health data from various disparate sources, such as diagnostic tests, internet-connected devices, genomics and medical records. In fact, access to large volumes of new patient data is driving some challenges, as the survey found 41 percent of health executives said their data volume has grown more than 50 percent last year. This data explosion, accompanied by advances in processing power, analytics and cognitive technology, is fueling smarter software that makes it easier to turn big data into better decisions and better healthcare. Approximately half of the healthcare executives surveyed said they use rule-based algorithms (59 percent of respondents), machine learning (52 percent), intelligent agents (49 percent) and predictive analytics (45 percent) to infuse intelligence into systems.


Beyond turning massive amounts of new data into insights, this wave of new technology will create a single platform for data generated by patients, doctors and clinicians. Patient-generated data is already demonstrating benefits among health executives, as nearly three-fourths (73 percent of respondents) have seen positive ROI from their investment in these technologies, such as wearables tracking an individual’s fitness and vital signs. In addition, Accenture found that most physicians (85 percent) believe that wearables improve a patient’s engagement with their own health, while three-fourths (76 percent) of patients believe that wearables have the potential to help them better manage their health and potentially improve it. This is also why health monitoring is the top reason more than half (54 percent) of patients use smartphone applications.


“As the digital revolution gains momentum, doctors and clinicians will use machines to augment human labor, personalize care and manage more complex tasks,” Kaveh Safavi, M.D., who leads Accenture’s health business, said in a statement. “The digital revolution is also creating a data goldmine that can spark medical breakthroughs and improve individualized treatment plans.”

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Mobile has put patients in the driver's seat. Here's how.

Mobile has put patients in the driver's seat. Here's how. | Healthcare and Technology news | Scoop.it

Many people used to believe that Facebook was an extremely defensible business and that it would be almost impossible for another social network to compete.

It has grown to an enormous scale with massive troves of data and more than 1.5 billion monthly users. The thinking around their defensibility was that because all of your friends and photos and updates are already stored on Facebook, it would be tedious and unnecessary to switch to another social network. Everything you need is there. Why go somewhere else?

Facebook did have quite a bit of defensibility back when the predominant access point to the service was the desktop web. Moving your data to a new social network was painful and impractical. But now that the main access point to social is our mobile phone (more than half of Facebook’s traffic comes through mobile) things have changed dramatically.

We now carry around all of the key elements of a social network on our cell phones. Our phones carry our location, our photos, and our address book and allow us to message anyone at no cost from anywhere in the world. With the click of the touchscreen, we can view and connect with all of our friends on a new social network and instantly recreate our social graph. We can take a photo and instantly send it to a multiple social networks. We can easily join different social networks with different groups of friends focused around different needs. The friction of leaving Facebook and joining a new network has disappeared. This wasn’t possible with the desktop web, or it was at least much more difficult.


As a result of the increasing use of mobile, we’ve seen lots of new social networks emerge. (There are now dozens of social networking apps with 1 million+ downloads in Apple’s App store, including Kik, WhatsApp, Tumblr, Google+, Instagram, Snapchat and many others.)

This increased use of mobile has reduced the friction of launching a new social network to near zero and, as a result, has shifted ownership of data away from the network and back to the individual. Trying to own the data and lock-in the consumer is no longer a viable strategy.

Facebook is well aware of this and has adjusted by rapidly buying up many of these new networks. We’ll likely see more acquisitions like these in the months to come.


Over the last several years, large health care provider organizations and health care software vendors have been employing a similar strategy to that of Facebook. Health systems have been growing by buying up ambulatory, community-based sites and employing doctors to build out giant systems that can offer clinical services across the entire continuum of caregiving the patient no reason to go anywhere else. In parallel, providers and software vendors have been creating a single patient record (including blood tests, physician notes, imaging and other data) that flows across the entire provider organization and can be easily shared with providers across the system. This avoids all of the classic frustration associated with having to fax your x-rays from one provider to another. Everything exists on the web in one single record. Providers then roll out a patient-facing portal that lays across the patient record where the patient can access all of their data (mostly through the desktop Web).


The strategy is simple. Providers are telling the patient to 1) stay with us because we do everything, and you don’t need to go anywhere else; and, 2) you can’t go anywhere else because we have all of your data.


But as we saw with Facebook, now that a consumer’s primary entry point to the web is their mobile phone, this strategy has some flaws.

Not only do our phones enable messaging and carry our location and address book and photos, they can also carry data on our movement, our sleep, our heart-rate, the prescriptions we’re taking, our body temperature and, with the use of implanted devices, much, much more. This real-time data that we carry on our phones is arguably more valuable than the data stored in our clinician’s patient record that only gets refreshed while we’re sitting in the examination room.

Increasingly, providers will own some patient data but the patient will own more data and better data.


Like Facebook, health care providers are trying lock in their customer by owning the data. But the increasing use of mobile has changed the game. Just like social network users can effortlessly syndicate their own data out to multiple social networks, a patient will be able to syndicate their real-time clinically relevant data out to multiple providers, regardless of which system they’re associated with.

Mobile has put patients in the driver’s seat.


Meanwhile, with the emergence of home care and telehealth and urgent care clinics and apps and implants that manage more serious and chronic conditions, in many ways health care has actually become more fragmented. The traditional providers may be consolidating, but new players are creating new channels for care and causing more fragmentation across the industry. Where and when and how care is delivered is being completely reshaped.


But unlike Facebook, large health care providers can’t buy their way out of this conundrum. First, because they don’t have enough cash (most are non-profits with microscopic profit margins) and second because health care is local. Health systems are no longer just competing with the hospital across the street; they’re competing with web services that are available to the global market.


As a result, large provider organizations are going to have to consider new ways of providing value and will have to select which segments of patients they want to serve.


In short, they can’t own the patient because they can’t own the data.

The idea of locking the patient into one network of providers was always a bit flimsy. But the strategy was somewhat understandable. A lot of this was driven by the trend towards value-based payments and the convenience of ‘owning’ a patient under that model.


But the lessons of Facebook are clear. Locking up the data is not a path to success.


Social networks and health care providers must focus on what they do best and focus on serving the consumer they want to serve and abandon their attempts to win by owning data that isn’t theirs to own.

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