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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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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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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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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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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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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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The Supreme Court's Surprise Ruling Saves Obamacare

The Supreme Court's Surprise Ruling Saves Obamacare | Healthcare and Technology news | Scoop.it

The Affordable Care Act survived its second major challenge at the U.S. Supreme Court on Thursday. In a 6-to-3 decision, the justices ruled that the Internal Revenue Service can continue to provide health-insurance subsidies to middle-class people living in all states.


At issue in the case, King v. Burwell, was whether the subsidies should go to residents of the roughly three dozen states that use the federal health-insurance exchange, in addition to those who live in states that run their own exchanges.


It’s a highly technical difference, but had the decision gone the other way, Obamacare might have unraveled. Individuals who receive these subsidies make less than $48,000 per year, and many would struggle to afford health-insurance plans without the government’s financial help. Health-policy analysts feared that, without the subsidies in place, healthy people would withdraw from the health-insurance exchanges in large numbers. That, in turn, would cause premiums to skyrocket, making insurance unaffordable to almost anyone who does not receive insurance coverage through their jobs.

The Affordable Care Act gave states the option to either set up their own exchanges or to rely on the federal government’s marketplace through Healthcare.gov. The part of the law that describes the subsidies said they should only apply to people in the exchanges “established by the state.” The plaintiffs in the King case said that clause meant the IRS was offering subsidies to residents of federal-exchange states illegally.

In the opinion of the Court, Chief Justice John Roberts dismissed the idea that the fate of the entire Obamacare law should hinge on such a technicality.

“In petitioners’ view, Congress made the viability of the entire Affordable Care Act turn on the ultimate ancillary provision: a sub sub-sub section of the Tax Code,” he wrote. “We doubt that is what Congress meant to do.”


Many patient advocates cheered the decision. “It means that millions of people with serious health conditions such as cancer will continue to have access to essential treatment and care, and millions of others at risk for disease will be able to afford preventive screenings and tests that could save their lives,” said Chris Hansen, president of the American Cancer Society’s advocacy arm, in a statement.


Justices Antonin Scalia, Clarence Thomas, and Samuel Alito dissented, writing, “Words no longer have meaning if an Exchange that is not established by a State is ‘established by the State.’”


Roberts concludes by saying that the Court is attempting to respect what Congress hoped to accomplish in passing the law: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them.”


There are still a few, more minor, legal challenges to Obamacare remaining. But at least for now, the law lives to see another day.

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Jannell Alino's curator insight, August 27, 2015 7:43 PM

Congress passed the Affordable Care Act and the Supreme Court ruled that the IRS will be able to continue to administer health insurance to middle class people to all in the United States. If this did not pull through Obamacare would have left thousands of people without insurance and helpless. Many who are on Obamacare make less than 48K a year and need assistance from the government. If this were to happen a large number of healthy people would withdraw from health insurances causing prices to go up and then no one would be able to afford health insurance! The Affordable Care Act gives states the option to set up their own exchanges or rely on the government. With the passing of this act people suffering from serious illness will be able to care and have access to treatment as well as others who are susceptible to illness. Some conclusions that can be drawn from this article are that by the passing of this act thousands of citizens are still able to have health insurance and do not have to pay with an arm and a leg. Yes this argument is logical because it would be irrational to take away a program that has aided so many Americans in getting the health care they need. This relates because if this act was to fail our health insurance prices would go up and going to get a simple checkup would cost a fortune! I think it is great that the congress passed this act because I would want everyone to be able to have the privilege to seek out help if they were ill. No there is no bias, it is objective to all citizens in the united states. 

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Oculus Rift Virtual Reality Headset Used to Fight Phobias

Oculus Rift Virtual Reality Headset Used to Fight Phobias | Healthcare and Technology news | Scoop.it
While the Oculus Rift, a virtual reality immersion device, is slated for release only early next year, researchers are already trying to implement practical uses for it. At Santa Clara University a couple engineering and computer science students are working on using the Rift to fight phobias, initially focusing on a fear of heights and flying. With a background in video games, the pair teamed up with the chair of the university’s psychology department to study how phobias are treated and how to create a virtual reality experience that will progressively address patient fears.

The investigators came up with a system that pairs a Rift headset with a touchscreen tablet. The patient wears the Rift, while a therapist uses the tablet to guide the experience and tailor it to the patient’s unique needs. In their heights simulation, for example, the treatment starts with the patient virtually standing on top of a building. Initially it is not very tall, but the therapist can slowly increase the building’s height while watching the emotional response of the patient. By increasing the height without terrifying the patient, the therapy can gently nudge acrophobics to get used to being on tall objects and hopefully eventually lose their fear.

While the heights in the virtual world may frighten patients, the team noted that because wearers of the device know they can take it off at any time, they seem to more accepting of trying out the system. Of course an important step will be to actually test the system with real patients to see whether it is truly effective at allaying fears once and for all.
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Lyfe Media's curator insight, June 17, 2015 10:01 AM

The Oculus Rift virtual headset is going to create a world of opportunity for doctors, therapists, and counselors alike. Dealing with patients and their fears can be one of the most difficult topics to approach, especially since a lot of our fears are irrational or impossible. It's exciting to see the world of technology colliding with modern medicine in such an innovative, helpful way.

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Population Health: The Path Forward

Population Health: The Path Forward | Healthcare and Technology news | Scoop.it

What does the future hold for the population health management concept? The present moment in U.S. healthcare is filled with both challenge and opportunity in this absolutely critical area of endeavor. On the one hand, the population health idea has taken off as it has never before. It is embedded in virtually all the main policy initiatives coming out of all the major public and private purchasers and payers of healthcare, whether in some of the mandates coming out of the Affordable Care Act (ACA), or embedded in the value-based purchasing (VBP) initiatives coming out of the federal Centers for Medicare and Medicaid Services (CMS) for the Medicare program, or from nearly any of the major VBP programs sponsored by virtually all of the major U.S. health plans.


Yet the reality of the moment is that, despite all the policy incentives forcing providers to begin to take action, most patient care organizations are still in the very early stages in terms of leveraging healthcare IT and data to support and facilitate population health. Indeed, on the journey of 1,000 miles, most industry observers agree that we are in the first steps of that journey.


Not surprisingly, mixed sentiments were on display among the industry leaders participating in the 15th annual Population Health Colloquium, held on March 23 at the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia, and chaired by David Nash, M.D., dean of the Jefferson School of Population Health.

“I expect us to talk more about data [in the next couple of years], because I think people are going to be drowning in data,” said Drew Harris, director of the Jefferson School of Population Health. “We are generating so much data that the question is, are we going to be able to turn that data into knowledge and actionable intelligence? We need to have new systems in place to better help clinicians use the data so they can figure out what to do with that Fitbit on somebody’s wrist or the Apple Watch that folks are going to expect somebody to help them analyze.” He also urged fellow participants to focus on patient engagement to make population health become truly successful.


Still, Brian Silverstein, M.D., president of HC Wisdom, a Glencoe, Ill.-based consulting firm, cautioned attendees that, “While I would like to be optimistic, I think next year is going to be tough. We are either going to be schizophrenic or bipolar. I am not sure which one. There is such great work going on and people are going to be aware that it is possible to do things to deliver better care at a lower cost. But some organizations are going to be entrenched in something and not getting results, so there is going to be an increasing level of frustration.”


In that context, said Mark Wagar, president of the Northridge, Calif.-based Heritage Provider Network, which encompasses more than 30,000 physicians in several states, “Sorting and stratify data to focus on a population doesn’t require perfect data. If you are waiting for someone from a big data company to come in and produce it all at once, it is not going to happen. We have 30,000 independent physicians. They are not all on one EMR, and are not going to be anytime soon, and we have patients to serve in the meantime. We have created some off-the-shelf systems combined with some proprietary systems where we can cross-match and collect as much data as possible,” he noted.


Making the Health IT Connection


That discussion in March at Thomas Jefferson University mirrors countless discussions around policy, strategy, process, and tactics taking place these days. Within the broader context of the push towards population health, industry leaders agree that the healthcare IT needed to facilitate pop health is just now being implemented, and is being implemented very unevenly at that.


For example, says Charles Kennedy, M.D., chief population officer at Healthagen LLC, a subsidiary of the Hartford, Conn.-based Aetna, and a health insurer executive helping to guide dozens of accountable care organizations (ACOs), “Health IT systems which offer the equivalent of a clinical navigation system are woefully under-deployed.  Achieving the required information state requires a new HIT infrastructure, supporting integrated administrative, claims and clinical data from all sources reorganized and optimized to assist with value-based care interventions for each individual’s health and care.  These records must be not only semantically interoperable, but must also be structured in such a way that provides useful and usable information on each individual patient,” he urges. “Today, however, many EMRs function like electronic file cabinets. “


The key to successfully leveraging health IT for population health management, says Judy Murphy, R.N., is that “The success is not just in the measurement and analytics, but in the ability to impact the health of populations. It’s leveraging the health IT for actual care coordination.” In October 2014, Murphy became chief nursing officer and director, Global Business Services, at IBM Healthcare. Prior to that, she had been chief nursing officer and director of the Office of Clinical Quality and Safety in the Office of the National Coordinator for Health IT (ONC). On a practical level, Murphy says, “It all starts with capturing the correct data in a data warehouse. And 80 percent of healthcare data today is not structured. So they either have to structure it or run it through natural language processing, or Watson.”


What should CIOs and other senior healthcare IT leaders be thinking about as their organizations begin to pursue population health? “They need to be thinking about what is involved in information-sharing with the post-acute world,” says Charles E. “Chuck” Christian, vice president and CIO at St. Francis Hospital in Columbus, Georgia, and the current chair of the board of the College of Healthcare Information Management Executives (CHIME). “There are a lot of new post-acute care settings we need to think about. Part of the problem,” he notes, “is that some post-acute providers, especially nursing homes, haven’t fully automated yet; but we’re getting there. And we’re developing data sets. So it’s a symbiosis: we’re helping nursing homes and other post-acute providers to help us. If we can appropriately transition the patient to their level of care, that is what’s important.”

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HHS, CVS Partner for Personalized Preventive Care

HHS, CVS Partner for Personalized Preventive Care | Healthcare and Technology news | Scoop.it

The U.S. Department of Health and Human Services (HHS) and CVS are collaborating to promote an online tool that provides recommendations for the personalized preventive services patients should receive based on their age and gender. 


Many of these preventive services are available to patients at MinuteClinic and CVS/pharmacy locations, as well as at their physician's office, and many are now covered by most insurance without additional co-pays or other cost sharing under the Affordable Care Act. The recommendations, officials say, come from government-recognized clinical experts.


Announced this week at Health Datapolooza 2015 in Washington, D.C., CVS Health says it is the first national partner to work with HHS to take advantage of the technology-based tools, developed within the Department by the Office of Disease Prevention and Health Promotion, which make it possible for the myhealthfinder tool to be available on MinuteClinic.com and at www.cvs.com/myhealthfinder.


Commonly recommended preventive services available at MinuteClinic include blood pressure checks, cholesterol screenings, wellness counseling and routine vaccinations. In a blog post accompanying the announcement, Acting Assistant Secretary for Health (ASH) and National Coordinator for Health Information Technology (ONC) Karen DeSalvo, M.D. said, “Our collaboration with CVS Health was made possible by one of our projects that has been an example of innovation in the federal government since 1997. Nearly two decades ago, healthfinder.gov was the first government website designed to share health information with consumers and improve health literacy.


Since then, the Office of Disease Prevention and Health Promotion within HHS has developed the current healthfinder.gov website into a trusted, credible source for easy-to-understand prevention and wellness information. Through myhealthfinder, an interactive tool available on the website, you can enter your age, sex, and pregnancy status to receive customized wellness and prevention information along with steps you can take with your provider and at home to prevent illnesses and improve your health.”


What’s more, DeSalvo said, “To make myhealthfinder more readily available to more people, we recently developed a free, publically available application programming interface (API) to integrate the tool into any website. The API imports up-to-date information directly from healthfinder.gov. This tool supports physicians and the care team, and is an easy way to help people understand the recommended preventive services that are often available to them at no out of pocket cost thanks to the Affordable Care Act,” DeSalvo said.

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IT could save $100B for US healthcare

IT could save $100B for US healthcare | Healthcare and Technology news | Scoop.it

New research from Accenture projects that digital health tools will save the U.S. healthcare industry more than $100 billion over the next four years.


In 2014 alone, it calculates, technology such as Web-enabled devices, digital diagnostic tools and other FDA-approved IT help achieve some $6 billion in reduced costs – mostly thanks to things such as improved medication adherence, behavior modifications and fewer emergency room visits.

Accenture expects that number to approach $10 billion this year and $18 billion next year – increasing to $30 billion in 2017 and $50 billion in 2018 as these technologies take hold, proliferate and evolve.


It also predicts that FDA approval of digital health tools will triple by the end of 2018, to 100 (up from from just 33 this past year).


"A digital disruption is playing out in healthcare, as witnessed by the emergence of new business models and technology that will change the nature of patient interactions, alter consumer expectations and ultimately improve health outcomes," said Rick Ratliff, Accenture's managing director of digital health solutions in a press statement.

Factors, such as government health IT mandates, payment reform and other regulatory changes are accelerate the growth of FDA-approved digital solutions, the report shows.


Increasing ubiquity of health IT among physicians and patients will enable more and more devices to integrate withpatient portals and digital health records, according to Accenture, which finds that one in four U.S. physicians routinely use telemonitoring devices for some aspect of chronic disease management.


Meanwhile, as more and more patients take charge of their own care, the number of U.S. consumers who own a wearable fitness device will double in the next five years, according to Accenture, from 22 percent this year to 43 percent by 2020. More than half (57 percent) of consumers track their health online, such as medical history (37 percent), physical activity (34 percent) and symptoms (33 percent), according its poll.


Recent FDA guidelines for low-risk health products – setting a regulatory line between wellness tools and medical devices – will enable more clarity, expedite regulatory pathways and could drive 30 percent annual growth of digital tools through 2018.


The evolution toward value-based care is also creating fertile ground for clinical and business strategies that incorporate these technologies, with Accenture projecting digital health funding to reach $6.5 billion by 2018.


"The proliferation of Internet-connected solutions and evolving regulatory guidelines are blurring the lines between clinical and consumer health solutions," said Ratliff. "As consumer health platforms support more 'medical' devices, rather than just today's wellness trackers, they'll create a viable self-care model in a segment that today is occupied by chronic-disease monitoring companies."

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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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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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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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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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Cases of Wish-Bone ranch dressing recalled

Cases of Wish-Bone ranch dressing recalled | Healthcare and Technology news | Scoop.it

The makers of Wish-Bone Ranch Salad dressing are recalling thousands of bottles of the popular product because they contain blue cheese dressing instead.

Because blue cheese dressing contains eggs, those accidentally-filled products could be dangerous for anyone with an egg allergy.

New Jersey-based Pinnacle Foods Group said blue cheese dressing was accidentally filled into 8,678 cases of 24-ounce bottles labeled as Wish-Bone Ranch Salad Dressing.

"Those people who have allergies or severe sensitivity to eggs run the risk of serious or life-threatening allergic reaction if they consume this product," Pinnacle said. But it is still safe to eat for people who are not allergic to eggs.

Egg allergies strike mostly children and usually lead to skin rashes, nasal congestion or vomiting,according to the Mayo Clinic, but there is little danger of life-threatening anaphylaxis.

The bottles of dressing affected were filled on April 23, 2015, by a contract company, Pinnacle said. Consumers can identify them by their "best by" date of "Feb 17 16," and may return them for a full refund.

    Pinnacle said it notified the Food and Drug Administration about the issue, and has advised distributors and retailers of the product to remove affected bottles from their assortments.

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    The Security Risks of Medical Devices

    The Security Risks of Medical Devices | Healthcare and Technology news | Scoop.it
    There are a large number of potential attack vectors on any network. Medical devices on a healthcare network is certainly one of them. While medical devices represent a potential threat, it is important to keep in mind that the threat level posed by any given medical device should be determined by a Security Risk Assessment (SRA) and dealt with appropriately.

    So let’s assume the worst case and discuss the issues associated with medical devices. First off, it must be recognized that any device connected to a network represents a potential incursion point. Medical devices are regulated by the FDA, and that agency realized the security implications of medical devices as far back as November 2009, when it issued this advisory. In it, the FDA emphasized the following points:

    Medical device manufacturers and user facilities should work together to ensure that cybersecurity threats are addressed in a timely manner.
    The agency typically does not need to review or approve medical device software changes made for cybersecurity reasons.
    All software changes that address cybersecurity threats should be validated before installation to ensure they do not affect the safety and effectiveness of the medical devices.


    Software patches and updates are essential to the continued safe and effective performance of medical devices.


    Many device manufacturers are way behind on cybersecurity issues. As an example, many devices are still running on Windows XP today, even though we are one year past the XP support deadline. They are often loathe to update their software for a new operating system. In other situations device manufacturers use the XP support issue as a way to force a client to purchase a new device at a very high price. All healthcare facilities would be well advised to review any purchase and support contracts for medical devices and make sure that things such as Windows upgrades do not force unwanted or unnecessary changes down the road. While there are options to remediate risks around obsolete operating systems, they are unnecessary and costly. Manufacturers should be supporting their products in a commercially reasonable manner.

    Why would anyone be interested in hacking into a medical device? Of course there are those that would argue that anything that can be hacked will be hacked, “just because”. While it is possible that hacking could also occur to disrupt the operations of the device, the more likely reason is that getting onto a medical device represents a backdoor into a network with a treasure trove of PHI that can be sold for high prices on the black market. Medical devices are often accessible outside of normal network logon requirements. That is because manufacturers maintain separate, backdoor access for maintenance reasons.


    Hackers armed with knowledge of default passwords and other default logon information can have great success targeting a medical device. For example, this article details examples of a blood gas analyzer, a PACS system and an X-Ray system that were hacked. Many times healthcare IT departments are unaware or unable to remediate backdoor access to these systems. These are perhaps more “valuable” as a hack because they are hard to detect and can go unnoticed for a long period of time. As a reminder, the Target data breach last year was initiated because the access that a third party had to the retailer’s network was compromised. A complete SRA should inventory all network connected medical devices and analyze the access/credentials that a device has, and any associated security threat. The best defense is a good offense – make sure that networked devices have proper security built in and implemented. Then your devices will no longer be “the weak link in the chain”.

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    Beyond games, Oculus virtual reality headset finds medical uses

    Beyond games, Oculus virtual reality headset finds medical uses | Healthcare and Technology news | Scoop.it

    To help treat soldiers with post-traumatic stress disorder, Jennifer Patterson turned to a gadget typically associated with video games: the virtual reality headset from Oculus, a company Facebook Inc bought for $2 billion last year.


    Patterson, an engineering student at the University of Pittsburgh, studied a software used on the prototype of the head-mounted display that creates virtual settings, such as a Middle Eastern-themed city or desert road, that soldiers would otherwise avoid, as a way to help them recover from their PTSD.


    She hopes doctors and therapists around the country will better understand how the technology can be helpful to their own patients.


    Patterson is one of a handful of researchers who have used the display for experimental treatments and studies that range from treating glaucoma patients to easing pain in burn victims.


    While there are no estimates of the potential size of the market for virtual reality applications in the health care field, analysts say that success in this area would likely spur even broader adoption in a range of industries, such as education, fashion, media and telecommunications.


    The potential size of those markets is quite large, possibly surpassing $5 billion over the next three years, according to some estimates, especially as the gadget's uses extend far beyond gaming.


    Facebook CEO Mark Zuckerberg has said he views virtual reality as the next major computing platform, and he is working hard to ensure that it is. While Oculus headsets will not be available to consumers until 2016, the company has made prototypes of the system available to developers since 2013, with the expectation that an array of applications will be available to those buying headsets after the formal launch.


    The company plans to hold a news event Thursday in San Francisco but has not specified what it will announce. It declined to comment for this story.


    Virtual reality is not new to medicine or therapy, but its affordability is. Doctors and researchers often shell out $30,000 to more than $300,000 for medical headsets and simulators while the Oculus is available to developers for $350 to $400.


    The more expensive medical virtual reality sets will still be needed for certain studies, doctors and researchers said, because of their accuracy in detecting sensitive movements and because patients with severe facial burns cannot use a head-mounted Oculus device.


    But they still expect the Oculus Rift and other cheaper virtual reality headsets to quickly replace the expensive ones.


    "As more and more companies get involved in this, we will keep seeing inexpensive and very accurate systems," said Felipe Medeiros, a professor at the University of California San Diego who used the Oculus device to evaluate patients with glaucoma, a disease of the eye's optic nerve.


    FLOOD VIRTUAL MARKET


    Other companies, including Sony Corp, Samsung Electronics Co Ltd, Microsoft Corp, Google Inc and HTC Corp have either already released virtual reality headsets or plan to do so in the next year.


    Oculus, however, has already distributed more than 100,000 units of its developer version. This is more than has been available in the history of virtual reality, giving it early brand recognition among medical researchers, analysts said.


    "Oculus has basically jumped out in front," said Hunter Hoffman, a virtual reality researcher at the University of Washington Seattle who used the Oculus Rift to ease severe pain in an 11-year-old burn victim.


    Some headsets, such as Sony's Morpheus, are built exclusively for video games. Oculus, however, allows researchers and developers to create their own software, whether for specialized applications like health care or for video games.


    In Medeiros's study, for example, he evaluated patients with glaucoma. He created a simulated environment that made patients feel as though they were moving through a tunnel and then studied their bodies' responses.


    That helped researchers predict the likelihood of a fall for glaucoma patients, allowing doctors to teach them how to avoid it.


    Medeiros and other researchers said future studies will compare the inexpensive headsets against one another. But because of Oculus's early availability, it has already become the most popular headset.


    "Oculus has done a great job of keeping themselves front and center and making themselves the product that everyone has to be compared against," said Brian Blau, Gartner research director.

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    Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace

    Mayo Clinic, Apervita Collaborate for Self-Service Health Measures Marketplace | Healthcare and Technology news | Scoop.it

    The Rochester, Minn.-based Mayo Clinic and the health analytics and data community and marketplace Apervita are launching a health measures platform that will allow health professionals to publish or subscribe health measures which will turn definitions into analytics.


    According to the companies, while there are already thousands of health measures for quality, safety, outcomes, and finance that are increasingly the basis for measurement of performance and reimbursement for value-based care, they are notoriously complex and organizations struggle with the costly process of implementing and maintaining them. This often results in delays of more than 12 months to report new measures or update existing measures.


    With this new approach, Apervita will offer a family of open interfaces, including open web service APIs, allowing standard measure definitions to be imported, edited, published, executed and exported. Once an author has developed a measure, it can be connected to different data sets as well as shared through a global marketplace. Measure results can be displayed on the Apervita platform or accessed through APIs for display within electronic medical records (EMRs), third-party systems and mobile applications. The import and export of measures supports the Centers for Medicare and Medicaid Services (CMS) quality data model (QDM) through which all modern measures are today made available, the companies say.


    “Healthcare providers and facilities should focus on what they do best, providing high quality patient care. After all, that’s what health are measures are designed to enable,” Dr. Jyotishman Pathak Ph.D., professor of Biomedical Informatics at Mayo Clinic, said in a statement. “With thousands of healthcare measures which continuously evolve, keeping track of, implementing and monitoring the measures has shifted some of that focus away from the patients, and it needs to shift back.”

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    More Patients, Not Fewer, Turn To Health Clinics After Obamacare

    More Patients, Not Fewer, Turn To Health Clinics After Obamacare | Healthcare and Technology news | Scoop.it

    Nurse practitioner Martha Brinsko helps a lot of patients manage their diabetes at the Charlotte Community Health Clinic in North Carolina.

    “Most mornings when you check your sugar, what would you say kind of the average is?” Brinsko asked patient Diana Coble.


    Coble hesitated before explaining she ran out of the supplies she needs to check her blood sugar levels, and she didn’t have the gas money to get back to the clinic sooner. Brinsko helped Coble stock up again.


    “If you need to get more than one box, get more than one box,” Brinsko said. “But you need to check them every morning so that we can adjust things.”


    Coble, who is unemployed, lives with her sister and can’t afford insurance even now that the health law is in place, relies on the clinic for health care.


    “They do a great job with everything,” Coble said. “I couldn’t do without them.”


    Nancy Hudson was the clinic’s director as Obamacare rolled out and now consults for the clinic. She expected the insurance exchange, or marketplace, established under the Affordable Care Act would reduce the number of uninsured patients the clinic sees. The opposite happened, she says.


    “What we found within our patient population and within the community is that a lot of the advertisement and information about the marketplace brought people [in who] didn’t know anything about free clinics and did not qualify for any of the programs within the ACA marketplace,” Hudson says.


    And now they get free or low-cost care at the clinic, which is designated by the government at an FQHC, or federally qualified health center.


    The health law was designed to cover the poorest people by expanding Medicaid, the federal-state program for low-income people. But the Supreme Court made that optional. The result in states that didn’t expand Medicaid is a gap, where some people make too much money to qualify for Medicaid but not enough to qualify for insurance subsidies. In North Carolina, about 319,000 people, like Coble, fall into the Medicaid gap.


    “Over half of the people that we see would’ve been eligible for Medicaid expansion had the state elected to exercise that option,” says Ben Money is president of the association that represents North Carolina’s community health centers.


    North Carolina is among the 21 states, including many in the South, that are currently saying no to Medicaid expansion. Louisiana is another.


    Dr. Gary Wiltz, the CEO of 10 community health centers in the southwestern part of Louisiana, says demand has surged. “We’ve gone from 10,000 patients to 20,000 in the last six or seven years, so we’ve doubled,” he says.


    Wiltz says other things are at play, too. The economic recovery hasn’t reached many of the poorest people, and some who do qualify for Obamacare subsidies say their options are still too expensive.

    “The need keeps increasing, and I think that’s reflected throughout all the states,” he says.


    Wiltz, who also heads the board of directors for the National Association of Community Health Centers, says clinics are packed even in states that expanded Medicaid. After all, most of the clinics treat Medicaid patients too.


    The Charlotte clinic’s Nancy Hudson says there’s another part of the health law helping fuel the growth: additional funding for community health centers.


    Hudson found out last week her clinic is getting about $700,000 to expand in partnership with Goodwill.


    “Many of their clients did not have any access to health care,” she says. “They can’t train and sustain a job if they don’t have the basic needs taken care of, and health care is one of them.”

    Nationwide, the federal government estimates its latest round of funding will lead to about 650,000 people getting better access to health care.


    This story is part of a reporting partnership with NPR, WFAE and Kaiser Health News.


    Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

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