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Fixing health care doesn't necessarily need political reform

Fixing health care doesn't necessarily need political reform | Healthcare and Technology news |

It’s very hard to find a product or service that is both lousy and unaffordable. Such expensive duds are usually quickly replaced by cheaper and better competitors. Prior to the Affordable Care Act, health care was becoming more expensive every year while simultaneously becoming less convenient, less personal, and less satisfying. In 2009, I wrote a series of four posts explaining how the health care marketplace reached such a sorry state and offering a suggestion for reform.

Since then, the Affordable Care Act has passed. For many, insurance has become much more affordable, but whether this translates to better or more affordable care remains to be seen. If it results in many patients receiving affordable insurance that very few physicians accept, then the situation will be a repetition of the Massachusetts experience with universal coverage: Everyone has insurance; no one has a doctor.

At the same time, the intrusive and complex bureaucracy that physicians must navigate to collect insurance payments has vastly expanded. Physicians are now coerced into serving as the workforce for Federal plans to collect health care data, cut costs, and make their care increasingly legible to payers but increasingly opaque to patients.

Bear with me for just a few examples. In an ill-advised plan called “meaningful use,” physicians receive incentives for submitting complex reports documenting their use of electronic health records (EHRs). The time and effort required to comply with this program has earned it much scorn from physicians. And the incentives will likely distort the true value of EHRs and inflate their costs.

The International Classification of Diseases (ICD) is the coding system used by physicians and billers to report to insurance companies patients’ diagnoses. In October, the government will update ICD to its tenth version. ICD-10 will contain radically more complexity than its predecessors. It is widely ridiculed for the detail with which diseases must be reported. (Code V91.07XA is for a “burn due to water-skis on fire.”) The transition to ICD-10 was already postponed once, and I predict it will cause much disruption and grief.

My last example is the recently passed sustainable growth rate (SGR) fix which gets rid of the annual congressional scramble to increase Medicare reimbursement to physicians by increasing reimbursement in the short term, but tying reimbursement to outcomes measures in the long term. This is sure to become a data collection and reporting hassle that makes doctors long for the simpler days of meaningful use.

I honestly believe that there has been more bureaucratic complexity added to the typical physician’s life in the last few years than in the twenty years before that. None of it cares for a single patient.

Two weeks ago, my family and I spent ten days visiting New York City. We had a wonderful time. The services that completely transformed our experience were the ride sharing services of Uber and Lyft. We never used public transportation. We never hailed a taxi. For longer trips (and a family of five) this was likely cheaper than train tickets. For shorter trips, it meant not handling cash, never finding bus or subway stops, and never referring to transit schedules.

For years, passengers complained about high taxi prices and poor taxi service, and potential competitors complained about the legalized monopolies given to taxi companies by city governments. But rather than bang their heads against these barriers, companies like Uber and Lyft just started giving people rides.

This was an epiphany to me. I had always assumed that fixing the health care marketplace would mean political reform — undoing the myriad laws that substituted insurance for health care and caused prices to skyrocket, and dismantling the byzantine bureaucracy that physicians must navigate. Now, I understand that political reform is both unrealistic and unnecessary.

Doctors and patients aren’t waiting for political reform. More and more doctors are “going off the grid” to provide excellent care unencumbered by insurance regulations. Concierge primary care is just one example. The Surgery Center of Oklahoma lists on its website the prices for every surgery it offers. The prices are all-inclusive. You won’t get a separate bill from the anesthesiologist, the surgeon, and the facility. And they don’t care what insurance you have because they won’t deal with any insurance company. Other innovative companies are using video conferencing technology to connect patients to doctors thousands of miles away. LUX Healthcare Network (with which I’m proud to be associated) is building a multi-specialty concierge physician network.

I argued six years ago that using insurance for routine care is wasteful. I now realize that attempts at universal coverage and the bureaucracy that comes with it — ICD-10, meaningful use — will never be repealed. This bureaucracy will become the taxi monopolies of health care — increasingly ignored by both doctors and patients and increasingly irrelevant. The successful enterprises in health care will connect doctors and patients and then get out of the way. Like Uber and Lyft they will help patients find the service they want at a price they’re happy to pay, and they will facilitate not regulate the delivery of excellent care.

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The Consumerization of Healthcare: Can Providers Keep Pace?

The Consumerization of Healthcare: Can Providers Keep Pace? | Healthcare and Technology news |

Healthcare is undergoing a wave of consumerization. Changing regulations are requiring patients to contribute more financially toward their own care, turning them into true healthcare consumers and motivating them to make more careful and informed decisions. At the same time, the consumerization of healthcare is driving more players into the healthcare space – from tech giants like Google and Apple, to convenience-focused retailers like Walmart and CVS. These new entrants are not only creating savvier, more informed patients, but are opening up more choices for where and how consumers direct their healthcare dollars.

I see three key changes that providers will need to make in order to compete with new entrants and adapt to this new era of healthcare consumerization:

  • Making patient information a shared responsibility. The days of keeping each consumer’s information locked up in a filing cabinet and available only through a paper document request process are long over. Many providers have already started making progress by using patient portals to share information. Today’s patient portals are only a beginning. Instead of information flowing from provider to patient, consumers will increasingly want and need to contribute more of their own information, such as daily readings from weight scales, wearables or in-home test results.
  • Allowing more variety in care settings. Patients are increasingly looking for care to come to them instead of traveling to a hospital or doctor’s office. Healthcare providers are shifting care to the home and to other outpatient settings in an effort to respond to these new demands for convenience, and new connected technologies and mobile devices are making it easier to deliver quality care in new settings.
  • Delivering more personal healthcare. In an era of healthcare consumerization, healthcare providers need to think more like other industries. This is challenging because of the perverse incentives associated with fee for service. For many patients, interacting with the healthcare system is like dealing with the DMV. Interactions can be lengthy, complicated and frustrating. However, healthcare organizations that put the patient at the center of their care delivery processes can improve the health and wellness of their communities; drive patient satisfaction and engagement, which are critical to controlling costs; and increase quality and profitability. This can start with simple measures, like providing a multi-lingual staff, addressing people by a preferred name, knowing personal histories and providing more convenient after-hours access that other industries have mastered.

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BYOD causing IT headaches

BYOD causing IT headaches | Healthcare and Technology news |

"There's an app for that" may be an effective marketing phrase, but don't expect hospital security officials to appreciate it. The proliferation of personal devices and the apps that drive them is one of the biggest security concerns to hit healthcare in the digital age.

Known as BYOD – "bring your own device" – the new environment exists due to the pervasiveness of personal mobility devices among healthcare professionals in recent years. The devices have become well entrenched in a very short time, as studies show that approximately 80 percent of healthcare workers currently use a personal mobile device, whether smart phone or tablet.

The situation is a double-edged sword, with mobility giving clinicians the ability to access healthcare data at anytime from anywhere, but the flurry of unchecked apps also create an air of hospital IT vulnerability to security breaches, intrusive malware, viruses and worms.

"This issue is a huge challenge and the industry needs to get out in front of it," says Chris Bowen, chief privacy and security officer for Tempe, Ariz.-based ClearDATA. "It is a situation that needs to be controlled."

Therefore, hospitals need to implement a BYOD strategy, security specialists say, but it can be a complex process. If not implemented correctly, they contend it can potentially expose protected health information and actually create a greater risk of data breach.

"The first step is to assess risk before implementing any BYOD strategy, said Ron Sadowski, director of technology solutions for the RSA Security Management division of Hopkinton, Mass.-based EMC. Sadowski made his comment at a recent security panel discussion sponsored by Health IT Outcomes.

"Data sprawl is the biggest problem and, in terms of priority, it should rate the highest."

The next step is to focus on the data that isn't being controlled, but should be, Sadowski said.

"Figure out how it is outside the controls and prioritize accordingly," he said. "PHI (personal health information) is the most valuable information and is the most vulnerable. Use that to guide your efforts."

Device 'infiltration'

Mark Roberts, manager of mobile technology at Yale New Haven (Conn.) Health, also participated in the panel discussion and summed up the challenge that healthcare organizations are facing with the app situation: "We had to conduct the risk assessment after the devices had already infiltrated the organization."

The Yale New Haven security team examined the types of devices that were out there and the type of data they were accessing, Roberts said. After making a determination, he said the team initiated a BYOD policy governing how data could be accessed, security requirements for which devices are acceptable and then published the information for everyone affected.

"Once we got our arms around it, we revisited it and tweaked it appropriately in that manner," Roberts said. "We have a lot of consolidation going on and there are different policies and security models within the organization, but we are standardizing everything."

The text threat

Siva Subramanian, senior vice president of mobile products for Los Angeles-based Zynx Health, says he doesn't see mobile apps as a true security threat.

"They are a transformation of healthcare delivery – it has become a largely mobile industry," he said. "It is an additional layer of complexity that CIOs need to manage."

Text messaging, on the other hand, presents a greater danger, Subramanian says.

"The elephant in the room is texting," he said. "CIOs may have pretended it's not happening, but it is and they can't ignore it anymore."

Texting is vulnerable on several fronts, Subramanian says – there are no log-ins or credentials required, no authorization is needed to access information and texts can easily be sent to the wrong person.

Zynx has a program called Contest Messaging, which is HIPAA compliant software designed to take guesswork out correspondence by identifying care team members and correlating health information with each patient.

Ongoing challenge

While the news is dominated by massive data breaches at major retailers, Sony Pictures and Apple's iCloud, Bowen maintains that most security missteps in healthcare are due to ordinary carelessness – lost devices and lack of sufficient encryption. And while it would be easy to blame complacency, Bowen doesn't believe that is the reason for breaches in healthcare.

"The industry is enduring a massive shift in technology, from EHRs to getting physicians up to speed on data automation," he said. "Then there is the evolution to ICD-10 and the overall squeeze on margins in healthcare, which is causing security to be overworked, under-sourced and needing help with basic elements of defense and depth. It is a swale you don't want to sail into."

Cloud safety?

Despite the headlines caused by the iCloud breach, Bowen maintains that cloud security is tight for the most part.

"You'd be surprised at how secure they are," he said. "If you really look at it, a purpose-built cloud can be more secure than an on-premises server."

Across the healthcare industry, organizations are increasingly embracing the cloud and trusting its security, confidentiality and reliability, Bowen said.

"We've had some major healthcare organizations become clients in the past year or so," he said. "We've seen a huge uptick in interest in the cloud."

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Big Data in Healthcare: A Cause for Concern?

Big Data in Healthcare: A Cause for Concern? | Healthcare and Technology news |

A federal advisory panel has kicked off discussions about the privacy and security challenges related to the use of big data in healthcare, with a goal of making policy recommendations in the coming weeks.

During the Jan. 12 meeting of the Health IT Policy Committee's Privacy and Security Workgroup - formerly called the Tiger Team - members began sorting through a number of key big data themes that emerged from two public hearings the group hosted in December. The workgroup and the committee will make recommendations to the Office of the National Coordinator for Health IT, which could ultimately lead to new policies from the Department of Health and Human Services.

Last month's hearings included testimony from a number of stakeholders from various segments of the healthcare sector. For instance, testimony highlighted that while analyzing big data can bring big potential benefits, including better treatment outcomes and lower costs, it also can bring privacy risks to individuals, says workgroup Chair Deven McGraw, an attorney at the law firm Manatt, Phelps & Phillips, LLP.

The workgroup will now help to assess whether the nation has the right policy framework in place "in order to maximize what is good about what health data presents for us, while addressing the concerns that are raised," McGraw says.

Big Data Challenges

Big data concerns that emerged from the hearings in December included whether various "tools" that are commonly used to help protect an individual's health data privacy are sufficient, given the complexities of various big data use cases, McGraw says.

Those "tools" include data de-identification methods; patient consent; transparency to patients and consumers about how their data might be used; various practices related to data collection, use and purpose; and security measures to protect data.

Other concerns arising from the testimony that the workgroup plans to dig into relate to the legal landscape, such as whether there are regulatory gaps in HIPAA and other laws regarding keeping health data used for big data analytics private.

The workgroup, which will continue its discussion on Jan. 26, will also consider the harm that could be caused if big data is not kept private, including discrimination, medical identity theft, and mistrust of the healthcare system.

In early February, however, the workgroup will temporarily shift gears to discuss ONC's 10-year interoperability roadmap, which is expected to be released in late January. The roadmap will focus on secure health data exchange.

Nevertheless, the workgroup hopes to hammer out some preliminary findings or early recommendations about protecting big data so that it can make a presentation at the March 10 meeting of the HIT Policy Committee, McGraw says.

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Can interoperability go from idea to reality?

Can interoperability go from idea to reality? | Healthcare and Technology news |

Interoperability is one of those words you can't avoid if you work in the health IT industry, and its use is only going to grow as 2015 wears on.

It's a controversial topic, with most agreeing it is essential if healthcare technology is to move forward, but others adding that it won't be achieved in the current healthcare environment. Many are calling on industry and government to work together to create better transparency and interoperability.

To that end, interoperability is a key focus of the Office of the National Coordinator for Health IT. The government agency in January released its 10-year Interoperability Roadmap. The roadmap's goal is to provide steps to be taken in both the private and public sectors to create an interoperable health IT ecosystem over the next decade, according to ONC.

The push from the ONC to focus on interoperability comes as the agency looks to move past Meaningful Use.

As thousands gather in Chicago in April for HIMSS15, the topic of interoperability will kick off with a keynote at Sunday's preconference Health Information Exchange Symposium. ONC Interoperability Portfolio Manager Erica Galvez will address the agency's roadmap and how the government is working with the healthcare industry to make interoperability reality; there also will be a roadmap discussion run by Galvez and Steven Posnack, ONC's director of the Office of Standards and Technology, on Monday.

Additionally, on Wednesday, Massachusetts eHealth Collaborative President and CEO Micky Tripathi and Epic President Carl Dvorak will lead a session on HL7's Fast Healthcare Interoperability Resources (FHIR) standard. Another panel discussion Thursday will pinpoint how to address patient information in electronic health records pulled from different clinical systems.

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Accountable Care, Quality Metrics Must Combine for Improvement

Accountable Care, Quality Metrics Must Combine for Improvement | Healthcare and Technology news |

The healthcare industry has taken many positive steps towards improving the measurement of quality and patient outcomes, says Margaret E. O’Kane, MHA, President of the National Committee for Quality Assurance (NCQA), but true improvement comes from the marriage of metrics with innovative reform of payment and care delivery systems.  In a commentary for the American Journal of Managed Care, O’Kane states that providers, payers, and regulators must continue to promote the business case for providing the highest possible quality of care for patients.

“The accomplishments of the last quarter-century are real and significant,” O’Kane says. NCQA is celebrating its 25 year anniversary in 2015, and the healthcare quality measurement landscape looks significantly different today.  “In 1990, measuring quality was just an idea—today it is an everyday reality. Most Americans—more than 171 million—are enrolled in health plans that report NCQA’s HEDIS (Healthcare Effectiveness Data and Information Set) clinical quality measures.”

HEDIS scores are now used by Medicare, the majority of state Medicaid plans, and numerous private insurers to benchmark performance, reward improvement, and pinpoint opportunities for change.  HEDIS, along with similar patient satisfaction and outcomes measures designed to drive quality improvement, will become increasingly important as more and more industry stakeholders adopt the principles and strategies of accountable care. As HHS and private industry set ambitious goals for cost and risk sharing, benefit structures for patients and provider networks should respond appropriately.

While high-deductible plans have become the norm for patients, who are now expected to shoulder a larger proportion of costs, patients do not always invest in necessary care when they feel unable to afford the large out-of-pocket bills that will result.

“Rather than the blunt instrument of the high deductible, a better approach is Value-Based Insurance Design (VBID)—low co-pays for high value services and medications, higher for those that don’t improve heath,” O’Kane suggests. “An interesting twist is to give a financial incentive to members with chronic conditions to choose a PCMH or accountable care organization with active care management.”

Quality measurement should also be used to distinguish high-quality, high-value providers from those with poorer outcomes in order to make it easier for patients to make better choices for their health and their wallets.  In order to ensure that providers deliver high-quality care, payers should create clear financial incentives.

“This is no small set of tasks,” O’Kane acknowledges. “Over the past 25 years, consumers have become accustomed to the paradigm of choice. Providers have been rewarded for doing more and for giving more complex care. These are deeply embedded cultural norms that need to change. Now, as payers look at what is being purchased, they can act as market makers who drive volume and rewards to the delivery systems that have accepted the challenge of delivering quality, patient-centered care that is affordable.”

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Cerner big data platform gets new client

Cerner big data platform gets new client | Healthcare and Technology news |

Truman Medical Centers and the University of Missouri-Kansas City's Center for Health Insights have teamed up on a new initiative that will harness data from electronic medical records, de-identifying it and digesting it into a database that can help inform better care decisions.

Both organizations will partner with EMR giant Cerner to leverage its Health Facts data warehouse platform to drive the analytics initiative. Health Facts extracts data from both clinical and financial IT systems, de-identifies the data, standardizes terms through mapping to common nomenclature and has the ability to create adverse drug events and outcomes reports.

The platform, as Cerner officials described, will allow the two-hospital TMC to use its current clinical and financial data and transform it into a usable form that can be leveraged to improve patient safety and care outcomes. What's more, TMC officials anticipate the data analysis can also be used to reduce specific health disparities and reduce costs for certain procedures.

Specifically, with the platform TMC officials will be able to use the generated reports and compare one's organization's performance with other clients who use the warehouse. The warehouse already includes millions of EMR records from inpatient, ED and outpatient visits from patients nationwide.

"The centerpiece of this partnership provides tools to accelerate clinical and translational research and ultimately provide better health outcomes," said Lawrence Dreyfus, UMKC vice chancellor for Research and Economic Development, in a Feb. 18 press statement. "We couldn't be more excited about the prospects that this partnership holds for healthcare decisions that ultimately improve care and reduce costs."

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