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Telehealth Program at Banner Health Reduced Costs, Hospitalizations

Telehealth Program at Banner Health Reduced Costs, Hospitalizations | Healthcare and Technology news |

The Phoenix, Az.-based Banner Health has announced successful results from its at-home telehealth pilot program for patients with multiple chronic conditions.

The Intensive Ambulatory Care (IAC) pilot program, done in partnership with the Netherlands-based Royal Philips, focuses on the most complex and highest cost patients —the top five percent of patients who account for 50 percent of healthcare spending. The program first launched in 2013 and aims to improve patient outcomes care team efficiency and prevent IAC patients from entering the acute care environment where costs are significantly higher.

As part of the pilot, Philips and Banner assessed the results of 135 patients to determine the effectiveness of the IAC program in meeting its clinical and financial goals. An analysis of the results of each patient's first six months demonstrated that the program:

  • Reduced costs of care by 27 percent. This cost savings was driven primarily by a reduction in hospitalization rates and days in the hospital as well as a reduction in professional service and outpatient costs.
  • Reduced acute and long term care costs by 32 percent. This cost reduction was primarily due to a significant decrease in hospitalizations.
  • Reduced hospitalizations by 45 percent. Prior to enrollment in the IAC program there were 11.5 hospitalizations per 100 patients per month; after enrollment the acute and long-term hospitalization rate dropped to 6.3 hospitalizations per 100 patients per month.
  • What’s more, the acute short term hospital stays decreased from 7.7 hospitalizations per 100 patients per month to 4.9; long term care home health or other facility stays decreased from 3.9 hospitalizations per 100 patients per month to 1.4; and the average number of days in the hospital per 100 patients per month also trended down from approximately 90 to 66.   

“The results of our at-home telehealth pilot with Philips have been dramatic and are indicative of the exponential success such a program could have by engaging patients in their own care and building a strong support system around them" said Dr. Hargobind Khurana, senior medical director of health management Banner. "As we continue to expand this program we anticipate seeing further proof that telehealth programs can address readmissions rates reduce costs and improve the health and quality of life for patients with multiple chronic diseases."

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The power of the spoken word (into the EMR)

The power of the spoken word (into the EMR) | Healthcare and Technology news |

How do you get physicians to adopt mobile technology? Tie it into something they already do – such as talk into their smartphones.

That's what Billy "Eddy" Stephens, FHIMSS, vice president and CIO of Mobile, Alabama-based Infirmary Health did when he introduced Nuance's speech integration technology to the health system's Epic EMR platform. While many of his doctors told him they "don't do technology,” they all were attached to their iPhones.

'That was something they were accustomed to doing," he said. "So it was easy to get them to take this one more step."

Stephens, speaking at a Tuesday morning mHealth Knowledge Center session in the Exhibit Hall of the HIMSS15 Annual Conference and Exhibition, says mobile integration of the four-hospital system's EMR is crucial to success, because doctors no longer want to be tied to workstations. They want to add to the EMR on the go, no matter where they're located. And when they're with a patient, they don't want to have to turn their back and type something into a computer.

The answer? Nuance's Speech Anywhere platform, integrated with Haiku and Canto apps, currently allows some 350 physicians in the Infirmary Health system to dictate their progress notes and one-off orders into their iPhones or tablets. The data is entered into the EMR in real time; the physician can even enter notes as he or she is facing a patient.

"The patient actually being able to hear the information going into the medical record is a new dynamic," said Jonathon Dreyer, Nuance's cloud and mobile solutions marketing director. "It's all about getting that information into the system in real time so that it's available for the next person. They can't wait for the doctor to walk down the hall, find a desktop, log in and type in their notes."

The technology, says Stephens, is as natural as talking on the telephone.

"It's everywhere now," he said. "I talk to my truck to make phone calls and send text messages. It's a simple communication tool, and it's probably one of the least intrusive technologies that we've ever implemented."

As a result, Stephens said, the health system has all but eliminated paper progress notes and one-off orders – he wonders if the next phase of the technology will allow them to process order sets in this fashion. And the EMR, he said, is a more complete and dynamic document.

"It's one of the key factors that is allowing us to be successful," Stephens said.

"It's the richness of the narrative and all the data that can be derived from that," added Dreyer.

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Nearly Seven in 10 Patients Would Avoid Healthcare Providers That Undergo a Data Breach

Nearly Seven in 10 Patients Would Avoid Healthcare Providers That Undergo a Data Breach | Healthcare and Technology news |
A new survey from TransUnion Healthcare found that more than half of recent hospital patients are willing to switch healthcare providers if their current provider undergoes a data breach. Nearly seven in 10 respondents (65%) would avoid healthcare providers that experience a data breach.

Older and younger consumer groups responded differently to data breaches. While 73% of recent patients ages 18 to 34 said they were likely to switch healthcare providers, older consumers were less willing. Nearly two-thirds (64%) of patients older than 55 were not likely to consider switching healthcare providers following a data breach.

“Older consumers may have long-standing loyalties to their current doctors, making them less likely to seek a new healthcare provider following a data breach,” said Gerry McCarthy, president of TransUnion Healthcare. “However, younger patients are far more likely to at least consider moving to a new provider if there is a data breach. With more than 80 million millennials recently entering the healthcare market, providers that are not armed with the proper tools to protect and recover from data breaches run the risk of losing potentially long-term customers.”

Other survey insights on consumers’ expectations following a data breach include:

· Nearly half of consumers (46%) expect a response or notification within one day of the breach.

· 31% of consumers expect to receive a response or notification within one to three days.

· Seven in 10 (72%) consumers expect providers to offer at least one year of free credit monitoring after a breach.

· Nearly six in 10 (59%) consumers expect a dedicated phone hotline for questions.

· More than half of consumers (55%) expect a dedicated website with additional details.

“The hours and days immediately following a data breach are crucial for consumers’ perceptions of a healthcare provider,” said McCarthy. “With the right tools, hospitals and providers can quickly notify consumers of a breach, and change consumer sentiments toward their brand.”
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The New Next Generation ACO Model: Cause for Optimism?

The New Next Generation ACO Model: Cause for Optimism? | Healthcare and Technology news |

Tuesday, March 10, will inevitably looked back on as important day for CMS (the Centers for Medicare and Medicaid Services) and for the ACO (accountable care organization) concept, whether positively or (hopefully not) negatively so. That’s because now, in addition to the Medicare Shared Savings Program (MSSP) ACO model and the Pioneer ACO Program, CMS unveiled a third option, the Next Generation ACO.

As our news story on Tuesday afternoon reported, “The U.S. Department of Health and Human Services announced on March 10 that the Centers for Medicare & Medicaid Services (CMS) had launched a new accountable care organization (ACO) initiative, creating a new vehicle called the Next Generation ACO Model. The announcement came via The CMS Blog, and was authored by Patrick Conway, M.D., Deputy Administrator for Innovation and Quality and Chief Medical Officer for CMS.”

We reported the text of the announcement, in which Dr. Conway noted in The CMS Blog that “This model builds on the successes of earlier ACO models, such as the Pioneer ACO Model, and further enables innovation by providers to improve care for patients. Made possible by the Affordable Care Act,” Dr. Conway continued, ”ACOs encourage quality improvement and care coordination to help improve our health care system. ACOs are a critical part of achieving the Department’s goals of delivery system reform nationally – aimed at better care, smarter spending and healthier people.”

And on the Next Generation ACO web page, CMS explained that “The Next Generation ACO Model is an initiative for ACOs that are experienced in coordinating care for populations of patients. It will allow these provider groups to assume higher levels of financial risk and reward than are available under the current Pioneer Model and Shared Savings Program (MSSP). The goal of the Model,” according to its website, “is to test whether strong financial incentives for ACOs, coupled with tools to support better patient engagement and care management, can improve health outcomes and lower expenditures for Original Medicare fee-for-service (FFS) beneficiaries.”

The description from the website went on to say that “Included in the Next Generation ACO Model are strong patient protections to ensure that patients have access to and receive high-quality care. Like other Medicare ACO initiatives, this Model will be evaluated on its ability to deliver better care for individuals, better health for populations, and lower growth in expenditures. This is in accordance with the Department of Health and Human Services’ “Better, Smarter, Healthier” approach to improving our nation’s health care and setting clear, measurable goals and a timeline to move the Medicare program -- and the health care system at large -- toward paying providers based on the quality rather than the quantity of care they provide to patients. In addition, CMS will publicly report the performance of the Next Generation Pioneer ACOs on quality metrics, including patient experience ratings, on its website.”

We’re still just beginning to learn the first details about this model, but already, provider associations are applauding CMS’s move. Shortly after the announcement, the Charlotte-based Premier healthcare alliance released a statement, attributed to Blair Childs, senior vice president of public affairs at Premier, stating that “Members of the Premier healthcare alliance strongly support well-designed alternative payment models.  We are eager to begin working with our members to assess the Next Generation ACO Model. Today’s announcement,” the statement said, “gives healthcare providers another Medicare payment option with substantially greater flexibility to provide innovative, high quality care to a defined group of beneficiaries.”

Premier leaders particularly liked the fact that CMS seemed to signal a shift towards more flexibility in terms of delivery and payment models. “With this announcement, providers have even more choices, which will enable the market to both mature and evolve,” Premier’s statement said.

Only time—and the revelation of all the details of beneficiary attribution, risk adjustment, outcomes measures, and payment nuances—will tell how this all turns out. But I think it can be fairly said that senior officials at CMS are doing active thinking these days around how to keep the ACO concept alive, and hopefully, thriving—because their flexibility, their agility, and their collaborativeness with providers, will be essential to the nurturance of the ACO concept, in the public payment sphere, going forward.

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Why Medical ID Fraud Is Rapidly Growing

Why Medical ID Fraud Is Rapidly Growing | Healthcare and Technology news |

As the healthcare industry continues to digitize patient records, that data is a growing target for cybercriminals intent on committing medical identity theft and fraud, says Ann Patterson of the Medical Identity Fraud Alliance.

In fact, the number of individuals affected by medical identity theft in the U.S. increased 22 percent in 2014 vs. the previous year - an increase of nearly half a million victims, according to The 2014 Fifth Annual Study on Medical Identity Theft. The study, conducted last November by the Ponemon Institute, was co-sponsored by the alliance.

Ponemon Institute estimates that medical identity theft incidents affected 2 million victims in 2014, nearly double the number of victims affected when the survey was first conducted five years ago.

"As the health industry creates more and more electronic health records and becomes fully digitized ... it just creates more cyber data for hackers to try to attack," Patterson says in an interview with Information Security Media Group.

"Medical records are highly lucrative on the black market," even more so than credit card data, she notes.

It's not just the data stored by healthcare providers and health plans that is being targeted, she warns. Consumers also need to safeguard their medical information, whether it's by shredding paper-based "explanation of benefits" documents they receive in the mail from insurers, or being more mindful of the information they share on social media.

"Cybercriminals are really good at aggregating and data mining all kinds of data that's available on online platforms, like social media, to create really rich, robust medical identity about you, Patterson says. "It's not just your date of birth, Social Security number, and health plan ID number ... that need to be protected. All other health information can be aggregated to create a really rich identity that can be exploited."

In its 2013 study, Ponemon found that about third of medical ID fraud victims were faced with various out-of-pocket expenses, such as legal fees. But in 2014, about 65 percent of medical ID fraud victims dug into their pockets, paying, on average, about $13,000 to clean up the mess left by medical ID fraudsters, Patterson says. "However, what we're finding is that oftentimes, even after spending all of that money, the problem doesn't get solved. Your medical record is still not correct." That's because false information can become part of an individual's medical record when someone fraudulently receives treatment as a result of identity theft.

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The Myth of Doctors Getting Overwhelmed by E-mail

The Myth of Doctors Getting Overwhelmed by E-mail | Healthcare and Technology news |

I heard a variation of that quote when interviewing people for the patient-provider communication chapter of the book I co-wrote (HIMSS 2014 Book of the Year -Engage! Transforming Healthcare Through Digital Patient Engagement). For the organizations who’ve pushed patient portals the furthest into their patient base, email has always been the foundation. In other words, email is the gateway drug for patient engagement which Leonard Kish called the blockbuster “drug” of the century.

Physicians are understandably concerned about being overwhelmed by emails if they provide an option for secure messaging. As healthcare transforms, financial incentives have a big effect on the willingness to take on what many perceive to be “more unpaid work” (forgetting the fact that playing voicemail tag is also unpaid and frustratingly inefficient). Interestingly, the physicians who have given out their phone number or enabled secure email (without remuneration) haven’t found they are overwhelmed by any means. In the case of the groundbreaking Open Notes study, many of the doctors just heard crickets.

A recent addition the Open Notes initiative was Kaiser. When they instituted Open Notes, traffic to their portal increased 400% yet the volume of e-mail traffic to doctors was flat. For those who have proactively enabled email communications, they have experienced a number of benefits. See the section below on improvements in outcomes simply by having email. [Disclosure: One of the capabilities included in the patient relationship management system my company provides is secure email.]

Dr. Ted Epperly has been a family doctor for decades and describes his experience as follows:

“I give them both my phone number and a way to contact me via email. In over 30 years of being a physician I have had this privilege abused less than 5 times. On the flip side it has led to many occasions where I have been able to expedite care and save countless number of office visits, ER visits and hospitalizations. That is patient-centered care and I personally feel better for it.”

Dr. Howard Luks is an orthopedic surgeon also has experienced similar benefits.

“Physicians underestimate the fact that opening up a digital channel to facilitate post visit, post-surgery, etc. comments and questions can and does provide a very real ROI if you dive into the typical workflow pattern that evolves when a patient calls with questions. If my assistant or nurse is tracking me down after fielding a phone call, they are not available to perform work that will lead to income. If I can answer a question with a brief email it saves everyone time and enables him or her to remain active in meaningful tasks. So… there are tangible reasons why the use of digital communications in this day and age are worthwhile, but many are not savvy enough to realize the upsides and fear that they will be inundated with an enormous number of useless emails. I can tell you that it never happens and patients start most every email with ” sorry, but I …”. They are very respectful of the opportunity to engage in this format and they are very cognizant of the fact that it does take away from my other clinical related activities.

It is clear that physicians can impact how their patients use secure messaging. Physicians who suggest that their patients follow up digitally will introduce it with messages that state, “After you’ve taken these new medicines for a couple of weeks, please send me a secure message and tell me how you are doing.” They also advertise their willingness and ability to engage with patients via secure messaging knowing they will have more digital encounters than their counterparts who mention it rarely or not at all.

As physicians do more of their visits via secure messaging, however, systems will need to think about new models for compensating providers that acknowledge writing a thoughtful message to a patient does take time and needs to be balanced with other work. Some organizations, such as Group Health, expect over a quarter of their doctors’ time will be spent responding to email. The most important driver is reimbursing on outcomes. When that happens, email simply becomes a tool like any other organization (outside healthcare) to enhance communication with their clientele.

Secure Email Improves Outcomes

In a 2010 study done at Kaiser Permanente reported in Health Affairs of 35,423 people with diabetes, hypertension, or both, the use of secure patient-physician e-mail within a two-month period was associated with a statistically significant improvement in effectiveness of care as measured by the Healthcare Effectiveness Data and Information Set (HEDIS). In addition, the use of e-mail was associated with an improvement of 2.0–6.5 percentage points in performance on other HEDIS measures such as glycemic (HbA1c), cholesterol, and blood pressure screening and control.

The Lund Report indicates that Kaiser patients enrolled in their patient portal, which includes secure messaging with doctors, access to clinical data, and self-service transactions, are 2.6 times more likely to stay with the organization than those who are do not participate online (see more on avoiding system leakage in ACOs hereand the business case for patient engagement). Countries such as Denmark provide incentives for doctors to communicate electronically reported in a Commonwealth Fund report entitled Issues in International Health Policy. The result: 80% of physician/patient communication in Denmark is asynchronous (i.e., people talking to each other serially rather than simultaneously). At first, that can sound high until we think about the rest of our lives whether it is conducting business or communicating with friends, where asynchronous communications (e.g., such as email, voicemail, or texting) are the norm.

Email can be one way to address the problem that patients remember so little of what they are told in the provider’s office. Modern healthcare systems are using patient relationship management systems that include the ability to Flip the Clinic visit frequently built on top of a messaging system. Other options include providing a clinical summary to patients after the visit (as recommended by Meaningful Use measures) and providing documentation of a care plan online for patients to refer to later.

Skepticism Persists in Some Circles

Despite what I outlined above, we hear all the time from doctors who think e-mail would be a pain in the neck, and refuse to do it, and worry about liability, etc., Some also believe that most of the doctors who are in favor of it, work in larger practices or hospital-related practices, so there’s a lot of back-up staff and support to help out with things. I’d ask doctors who read this to share whether they believe that is the case.

Independent of the workload implications, I’ve yet to meet the doctor who isn’t passionate about improving outcomes. In a follow-on piece, I’ll outline how doctors are seeing how they can improve outcomes and the overall experience of their patients using simple, ubiquitous secure email.

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How Healthcare Can Use Social Media Effectively And Compliantly

How Healthcare Can Use Social Media Effectively And Compliantly | Healthcare and Technology news |

As a regulated industry, many healthcare organizations have avoided the use of social media, and have even tried to squelch its use by their employees. However, some healthcare providers are beginning to realize that there are opportunities to serve the public, patients and physicians, all while building awareness and enhancing their brand.

Who Is Using Social Media?
Consumers, especially the younger generation, use social media to research and to make health decisions. These decisions include the selection of their doctor, hospitals and even courses of treatment for both themselves and their family, including their parents. These consumers are well-versed in social media and expect their providers to be equally adept.

Patients, who are already active social media users, consider themselves part of a tribe and tend to trust others on social media more than other sources. It only makes sense that they will use social media to connect with each other to share their experiences with both rare and common disease and health issues.

Physicians can use social media to network professionally with colleagues and peers and to share medical knowledge within the medical community. Some doctors also believe that the authenticity of social media can drive better quality of care.

In short, social media is a platform where the public, patients and healthcare professionals can communicate about health issues and possibly improve health outcomes. However, as the healthcare industry slowly begins to embrace social media, the legal and risks of non-compliance with rules and regulations have never been higher.

Compliance With Rules and Regulations
There are multiple federal and state rules and regulations that govern communications within the healthcare industry. One of the main challenges facing healthcare organizations is the protection of the privacy of patient information. To this end, firms must also show that they are supervising the activities of their employees with access to patient information. Companies planning to use social media also need to ensure that their electronic records are complete, secure and tamper-proof for record retention and audit purposes. Non-compliance with healthcare regulations can not only damage the reputation of a firm, it can also impact the bottom-line.

Legal Issues
In addition to being compliant with various rules and regulations, healthcare providers should also consider legal issues such as patient privacy, litigation and physician licensing before using social media.

Federal and state privacy laws limit providers’ unfettered ability to interact with patients through social media because anything that can be used to identify a patient, including pictures, is protected. Should patient information be disclosed through social media without patient authorization, providers would be subject to fines and other penalties.

Healthcare providers are vulnerable to lawsuits from a wide variety of sources. Firms may be required to produce information requested by the opposing party, which may include social media. This means that firms need to be prepared to capture, archive and make all electronic communications available on demand. Expensive fines, loss of the lawsuits and negative publicity could result if this is managed poorly, or not at all.

Healthcare professionals need to be careful about providing medical advice to patients using social media. If a patient receiving the medical advice from a doctor through social media is located in a state in which the doctor is not licensed, the doctor giving the advice risks liability under state licensing laws.

Use Social Media Effectively And Compliantly
In spite of the risks, healthcare organizations can begin to use social media to support better health outcomes for the community. However, before they begin, they need to follow some steps to stay compliant and to help avert legal issues:

  1. Gain support from executive leadership and develop metrics for success.
  2. Create a Social Media Working Group with representatives from across the organization to address concerns and talk through solutions.
  3. Interpret existing rules and regulations protecting patient information and maintaining records as it pertains to social media.
  4. Establish an acceptable employee use policy for social media and clearly communicate the policy to all staff.
  5. Put technology in place that controls and monitors social media communications in real-time and flags any posts that contain certain key words or phrases for review before they can be posted.
  6. Capture records with a system that preserves the format of social media communications, including edits and deletions. If asked, you want to be able to swiftly search and retrieve past communications in context.
  7. Archive electronic records so that they are e-discoverable in the event of litigation or upon the request of regulators and in accordance with federal and state recordkeeping rules.
  8. Conduct education and training programs for staff who will be using social media, including real-life examples to illustrate how to use social media and how not to use it.
  9. Craft a content strategy and create a library of content that may be easily posted on social media by staff to reduce the chances of patient information being leaked.
  10. Develop processes for Legal and Compliance to approve content before it is posted on social media.
  11. Deploy an ongoing feedback loop to show executive leadership how social media programs are meeting metrics.

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Insurers take 1st steps to alter how doctors, hospitals paid

Insurers take 1st steps to alter how doctors, hospitals paid | Healthcare and Technology news |

A nationwide initiative to make the fragmented and costly health care system more efficient could affect the more than 340,000 people in Wisconsin enrolled in Medicare Advantage plans.

Most probably are unaware that anything has changed. But there's a chance their care could be more coordinated, adhere more closely to clinical guidelines and cost less because of the initiative.

Humana and UnitedHealthcare — two of the largest health insurers that offer Medicare Advantage plans — are striking agreements with what are known as accountable care organizations.

The organizations, also known as ACOs, have become one of the key levers in the effort to improve the quality of care and slow the rise in costs.

In an accountable care organization, health systems, physician networks or both are responsible for the cost and quality of care for a defined group of patients. If they provide care at a lower cost while meeting certain benchmarks for quality, they can receive bonuses. Under some of the agreements or contracts, they can pay penalties when they don't.

At the start of this year, there were 744 accountable care organizations nationwide, up from 64 at the beginning of 2011, and an estimated 23.5 million people are covered by health plans with contracts with the organizations, according to Leavitt Partners, a consulting firm.

That included 7.8 million people covered by traditional Medicare.

Medicare Advantage plans — private health plans that are an alternative to traditional Medicare — are adding to those numbers.

Humana, which has 72,000 people enrolled in its Medicare Advantage plans in Wisconsin, has signed contracts with accountable care organizations run by many of the large health systems in Wisconsin.

It entered into an agreement with Aurora Health Care this year. It has agreements with ProHealth Care, United Hospital System in Kenosha, Prevea Health in Green Bay and Aspirus in Wausau.

It also has agreements with accountable care organizations run by Bellin Health in Green Bay and ThedaCare in the Fox Valley as well as Integrated Health Network of Wisconsin, which includes Froedtert Health, Wheaton Franciscan Healthcare, Columbia St. Mary's and other health systems.

UnitedHealthcare entered into a similar agreement this year with Integrated Health Network for more than 30,000 of the 123,000 people in the state enrolled in its Medicare Advantage plans.

The agreements vary and for now start with paying bonuses for meeting certain quality measures, such as reducing emergency department visits.

"We don't have a one size fits all," said Caraline Coats, a Humana vice president.

Payment system overhaul

The goal is to revamp the way doctors and hospitals are paid and in the process improve a health care system too often marked by inefficiencies, lack of coordination, poor quality and high costs.

Accountable care organizations are seen as one of the ways to move away from the system in which hospitals and doctors are paid for the services they provide rather than improving health — what often is described as moving from paying for "volume" to paying for "value."

The system provides few incentives to provide quality care or control costs. In many cases, health systems stand to make more money when they don't.

The results can be seen throughout the health care system.

The Institute of Medicine, the health arm of the National Academy of Sciences, estimates that excess costs accounted for 31% of total health spending in 2009. The sources include:

■Unnecessary services: $210 billion.

■Inefficiently delivered care: $130 billion.

■Missed prevention opportunities: $55 billion.

Humana's and UnitedHealthcare's agreements for their Medicare Advantage plans are a long way from the ultimate goal of changing the way hospitals and doctors are paid. Both know that health systems will need time to change the way care is delivered.

Think of the challenge just in lessening the variation in how hundreds or thousands of physicians, each making dozens if not hundreds of decisions a day, practice medicine.

"This stuff doesn't happen overnight," said Ryan Catignani, who oversees contracting for Humana in Michigan and Wisconsin.

Humana nonetheless wants to have 75% of the people in its Medicare Advantage plans covered by contracts at least partly tied to performance by 2017.

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Facing data integration demands

Facing data integration demands | Healthcare and Technology news |

The healthcare industry is naturally rich with data -- clinical, patient, claim, hospital system, financial, pharmacy and, most recently, data from wearable technology.

It’s clear that analyzing this data collectively can drastically improve patient care and both clinical and financial outcomes, but how to actually collect, read, integrate, understand and leverage the data remains a broken process.

From a technology perspective, data is sourced from a myriad of systems with varied levels of sophistication, accessibility, transparency and quality. Systems designed decades ago prior to the advent of Big Data are still prevalent, and pulling data from them can range from merely difficult to downright arcane. On top of that, between payers, providers and patients, the opportunities to combine data sets can far exceed the willingness or ability of all parties to collaborate. Add to that the poor state of healthcare data integration tools, and you have quite a challenge to make sense of the healthcare puzzle.

The industry is faced with the challenge of enabling these vast and varied systems to talk to one another in a meaningful way that generates actionable value. So, where do we stand when it comes to facing data integration demands, and where can we improve?

We’re still sorely lacking when it comes to addressing integration. Large legacy software systems and the practice of manually collecting information is just the tip of the iceberg. Sadly, much of the healthcare analytics story still remains buried in hidden spreadsheet formulas. To really solve the data dilemma, we need to rethink our approach to integrating data by first integrating teams, integrating concepts and integrating technologies. Only then can we meaningfully integrate data.

Integrating Teams – Team design is one of the largest hindrances to quality data integration. Too often, IT teams are tasked with collecting data for an entirely separate analytics team, who then needs to provide reports to drive a separate clinical transformation team. Those who use the data are too far disconnected from the data collection process, while those tasked with collecting the data frequently have a poor understanding of the business need or even the source of the data itself. There are definite silos throughout the data lifecycle process. Not only are teams operating under singular mindsets, the points of data transfer or handoff can be sloppy and important details can be missed. Skill sets for data retrieval, organization, interpretation and action must become intertwined in order for data integration to improve. Crossover of team members can also help mitigate the lost efficiencies.

Without the full picture or people available to connect the dots, there is a huge margin for misinterpretation or missed opportunities. Building teams that include skilled professionals who understand and have access to the full picture will result in quicker and more effective advancements. We need good, accurate, timely data from all different parts of the business.

Integrating Concepts – Teams of data professionals will universally agree that your systems don’t talk to one another well because they model data differently, and lack solid relational keys to tie similar concepts across systems. As a common example, each data system will contain its own definition of what constitutes a person, an eligible member, and a patient. And each system represents these concepts with, at best, their own internally created unique keys, or at worst, no meaningful key at all. Either way, important concepts don’t map cleanly across systems. There are techniques for data unification across systems, but they often require system experts, external key lookups, a sophisticated data integration team, and constant grooming. Proper data warehousing techniques can help, but frequently the grander promises of a full-on Enterprise Data Warehouse have overshadowed the simpler and smaller utilitarian wins such as this.

Integrating Technology – Even with more comprehensive teams and data model concepts we still need technology for these vast data sets to talk with one another. Currently, we’re dealing with legacy systems that can’t handle the magnitude of data being generated, or collaborate effectively with new software. On top of these outdated systems, the integration tools the industry has adopted serve general-purpose data integration needs, requiring custom build-outs to address the specific demands of the healthcare system. Tooling that effectively and naturally understands and validates industry coding, provides meaningful data profiling, componentizes processing for reuse, and can handle the sheer volume of healthcare data is a must. Off-the-shelf general-purpose data integration tools may be appealing at the time of purchase, but require a huge investment in building up the missing library of established healthcare data expertise, making the hard path from data, to knowledge, to wisdom that much longer.

Data integration demands can’t be solved in one fell swoop, but if the cornerstones of people, processes and technology are each properly advanced, we can effectively begin to see more immediate, effective and impactful outcomes from healthcare data analysis. 

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Americans want health information shared easily among docs

Americans want health information shared easily among docs | Healthcare and Technology news |

Nearly three-quarters of Americans say it's very important that their critical health information can be easily shared among healthcare providers, a survey from the Society of Participatory Medicine reveals.

In addition, 87 percent of respondents oppose any fees being charged to either healthcare providers or patients for that transfer of information to take place.

The 1,011 adults polled were selected randomly from landline and cell phone numbers.

Nearly 20 percent of respondents said they or a family member had experienced a problem in receiving care because records could not easily be shared among providers.

Doctors are forced to pay anywhere between $5,000 to $50,000 to set up connections with blood and pathology laboratories, health information exchanges or governments, according to a recent Politico story. Sometimes additional fees are charged each time a doctor sends or receives data.

Just this week, Peter DeVault, director of interoperability at Epic Systems, revealed at a Senate committee hearing that the company charges $2.35 per patient, per year for Epic EHR clients to exchange data with other providers.

"We have the technology. What we need is for health care providers and systems developers to put patient interests ahead of business needs. None of them would exist were it not for the patients," Daniel Z. Sands, M.D., co-founder and co-chair of the Society of Participatory Medicine, says in the survey announcement.

Experts at the Senate committee hearing testified that vendors and healthcare organizations use patient data as a competitive advantage, and that data-sharing is less likely to occur in competitive markets.

In a paper from the Brookings Institution, Niam Yaraghi, a fellow in governance studies at the Center for Technology Innovation, posits that the fee-for-service reimbursement model serves as a disincentive to share data. He also argues that Stage 3 of the Meaningful Use program will likely set the interoperability bar too low and likely will help only the dominant vendors, who will need only to provide a minimum amount of interoperability.

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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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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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2015 Brings Increased Collaboration, Connectivity and Focus on Security

2015 Brings Increased Collaboration, Connectivity and Focus on Security | Healthcare and Technology news |

The healthcare industry is known for being conservative and slow-moving. It can take years, or even decades, for changes to take hold. In fact, (as a side bar), my company recently executed an agreement with a system that took two years to get through legal. Yes, you read that right: two years to get through the contract process—and we’re not a difficult company to work with! But I digress… New reimbursement models will demand clinicians and their organizations to collaborate and share information more regularly, suggesting that the pace of change should increase steadily. The quickened pace will usher in new programs, models, and enabling technologies that will transform the industry into one that’s more collaborative, connected and united.

As we enter 2015, I see five trends driving change:

  • Expect more market consolidation. In the past few years alone, we’ve seen a record number of mergers and acquisitions in healthcare. This trend will continue throughout much of 2015, resulting in more complex healthcare delivery organizations, with care team members working in the acute, ambulatory and post-acute care settings. These health systems will look for tools to facilitate collaboration and communications among clinicians to speed time to intervention, which is critical to reducing the cost of care and improving quality and outcomes.
  • Shared risk models will drive collaboration. Healthcare delivery organizations are adopting value-based reimbursement, readmission reduction, bundled payments, and other delivery models with the common goals of reducing costs and improving outcomes. The success of these models depends upon effective care coordination, which, in turn, depends upon effective communications. In 2015, healthcare constituents of all kinds – payers, providers, and the suppliers who support them will increase their focus on collaboration. In addition, the patient will increasingly join this collaborative effort. We’ll start to see more demand for comprehensive solutions across the healthcare ecosystem to unite clinicians and patients inside and outside the “four walls” of the hospital.
  • Emergence of real-time healthcare system. Increased data collection via EMRs, big data analytics, clinical decision support, increased clinician mobility, and the realization of the Internet of Things (IoT) will jointly lead to the emergence of a real-time healthcare system. These forces are unstoppable and will only continue in 2015—pushing healthcare delivery organizations to find ways to connect care team members across the continuum in real-time so that clinicians can be aware of the pertinent things that are happening with their patients right now.
  • Interoperability goals to expand. The healthcare industry has talked about EHR interoperability for several years, but still little progress has been made. In 2015, the focus will broaden to interoperability across all technologies. Healthcare organizations will focus on connecting all tools, from EHRs to monitors to communication devices, so that they can share data and information, to help the industry manage patient care across entire populations.
  • Heightened focus on security. Every healthcare organization is dealing with protected patient health information (PHI). However, some organizations understand the risks associated with communicating PHI across organizational boundaries more than others. In light of 2014’s slew of healthcare data breaches, which exposed more than 9 million patient records, healthcare organizations will step up their efforts to develop comprehensive security strategies to address all risks facing the fidelity of patient health information – and their organizations’ reputations.

Jack Christiana's curator insight, February 12, 2015 8:58 AM

The healthcare industry will continue to be HOT sector for collaboration in 2015