By Josh Marsh, vice president and general manager Sonexus access and patient support, Cardinal Health.
Every patient’s journey through the healthcare system is different, but patients on specialty medications need extra support with navigating both high costs and overcoming barriers to access. For specialty patients, streamlining access to care is especially critical.
Looking back at 2023, below are five industry trends that have made a big impact on both the patient and provider experience. These trends – some positive and some negative – have shaped the patient journey over the past year and provide insight into how the patient services hub industry will evolve in the new year to come.
Digital assistant chatbots allow for increased flexibility and efficiency
Over the past year, artificial intelligence (AI)-powered digital assistant chatbots have played an important role in removing obstacles that prolong and complicate patient access to life-changing therapies. Chatbots allow for flexibility in the patient’s schedule by assisting with tasks and providing information without the need to pick up the phone.
These tasks include filling in missing health data, uploading insurance cards and answering questions about certain services available, all while simulating human conversation. Many physician offices prefer chatbots, due to the ability to communicate with the patient services hub without major disruption to their workflow. This allows providers to allocate more time to other parts of the patient’s health journey.
The digital assistant chatbot’s 24/7 availability gives flexibility to both patients and physicians, and makes a real impact on improving patient access and speed-to-therapy. The key to an effective digital assistant chatbot experience is to ensure that the technology is powered by a human when necessary, resulting in a custom-fit patient experience.
In cases where a more complex issue needs to be solved for the patient or provider’s office, a live team member should be able to seamlessly take over from a digital interaction. This experience can still be delivered virtually via the digital assistant chatbot, or the patient can be connected via phone.
By Ken Perez, healthcare marketing, strategy and policy consultant
The 340B Drug Pricing Program was created in 1992 to give safety-net providers—those that deliver a significant level of both healthcare and other health-related services to the uninsured, Medicaid, and other vulnerable populations—discounts on outpatient drugs to “stretch scare federal resources as far as possible, reaching more eligible patients and providing more comprehensive services.”
In brief, the program requires drug makers participating in Medicaid and Medicare Part B to provide discounts on outpatient drugs to 340B providers, which include various types of hospitals and certain federal grantees, such as federally qualified health centers (FQHCs) and comprehensive hemophilia treatment centers. These providers are referred to as covered entities (CEs).
In recent years, there has been much debate regarding the legality of the use of contract pharmacies by 340B CEs. One other, arguably even more fundamental, issue is the definition of a “patient” of a 340B CE who is eligible to receive a 340B drug.
On November 3, the U.S. District Court for the District of South Carolina issued a monumental decision endorsing a broader view of the definition of such a patient. In Genesis Healthcare, Inc. v. Becerra, the South Carolina district court overturned part of the government’s definition of a 340B-eligible patient, ruling in favor of Genesis Healthcare, Inc., a FQHC CE that filed a lawsuit in 2018 challenging a Health Resources and Services Administration (HRSA) audit finding that Genesis violated the 340B statute by using 340B drugs for ineligible patients.
According to the Veterans Health Care Act of 1992, the law which established the 340B Program, CEs are prohibited from transferring or reselling a 340B drug to a “person who is not a patient of the entity.” The definition of a 340B-eligible patient is critical to a CE’s ability to benefit from 340B participation because CEs can generate 340B savings by purchasing outpatient drugs at discounted prices, administering or dispensing them to eligible patients, and receiving payer reimbursement. The scope of the 340B patient definition determines how widely CEs can use 340B drugs and generate 340B savings.
Have you heard about the ultrasonic pocket devices that connect to your phone and that are 50 times less expensive than hospital machines? Or did you notice that virtual reality expedites cures in rehab centers? Or that artificial intelligence can identify lung malignancies more accurately than medical professionals? These are just a few advancements that are remarkably quickly changing medicine today.
Though no one can foresee the future, the innovations and ideas that follow at least offer a peek at it. They are at the forefront of healthcare, like the individuals behind them. Check out the list that will reshape the medical and public health that is anticipated to occur in the 2020s, especially in 2024 onwards.
Medical supplies delivered by drones
UPS has been flying an autonomous drone to transfer vital medical samples, such as blood or tissue, between two branches of a hospital 150 yards apart in Raleigh, North Carolina, since March as part of a trial program dubbed Flight Forward. Although the drones couldn’t cover the same distance as quickly as a fleet-footed runner, the initiative proved successful as a proof-of-concept, and in October the FAA approved the company’s expansion to 20 hospitals nationwide over the 2 years. In case of critical truck accidents and road accidents, sending medicines to victims will no longer be a time-consuming issue.
Diabetes treatment using stem cells
Of the 1.25 million Americans who suffer from type 1 diabetes, Doug Melton, a scientist at Harvard University, was particularly interested in his two children, Emma and Sam. Insulin injections, numerous daily blood-glucose tests, and a lifetime of cautious eating are possible treatment options. Melton takes an alternative tack, generating insulin-producing replacement beta cells using stem cells.
The business has developed a tiny implantable device that can house millions of replacement beta cells, allowing immune cells to stay outside while still allowing glucose and insulin to pass through.
In today’s dynamic healthcare landscape, the integration of artificial intelligence (AI) solutions is becoming increasingly crucial. Healthcare organizations need to balance superior patient care with operational complexities. The adoption of AI presents a transformative opportunity, empowering your organization to enhance various facets of your healthcare services.
You may be wondering, “Why should I embrace AI solutions for my healthcare organization?” The answer lies in the numerous benefits AI brings to the table. In this blog, we’ll shed light on a few reasons why healthcare organizations, just like yours, are wholeheartedly embracing AI.
Enhance Diagnostics and Precision Medicine
In the healthcare sector, AI technologies are actively advancing diagnostic accuracy, particularly concerning dangerous diseases. A study published in the National Library of Medicine highlights the extensive utilization of AI in enhancing medical diagnostics. These technologies, proficient in interacting with medical image data, contribute significantly to disease diagnosis and prediction.
For instance, AI’s capability to detect tumors in medical images stands out, providing a crucial advantage in early-stage diagnosis and subsequent treatment. The study emphasizes the pivotal role played by AI-based algorithms in identifying patients who might otherwise go undiagnosed, including rare diseases. This effectiveness opens up abundant opportunities for early intervention and improved patient outcomes.
Personalize Patient Care with Predictive Analytics
Harnessing predictive analytics through AI is revolutionizing patient care, offering tailored interventions, and enhancing healthcare outcomes. Grand View Research reveals that the global healthcare predictive analytics market reached $11.7 billion in 2022, underscoring the widespread adoption of this transformative approach.
Predictive analytics allows healthcare organizations to proactively anticipate patient needs, facilitating personalized treatment plans. This proactive approach enables timely interventions and preventive measures based on individual patient data, contributing to a more patient-centric healthcare model. The insights derived from analyzing vast datasets enable healthcare professionals to optimize resource allocation, reduce unnecessary procedures, and streamline patient care pathways.
Enable Clean Water for Healthcare Facilities
Ensuring clean water for healthcare facilities is a paramount objective embraced by healthcare organizations leveraging AI solutions. AI technologies facilitate the efficient management of water resources, optimizing usage and minimizing wastage within healthcare infrastructure. By actively monitoring water quality and consumption patterns, AI-driven systems enable healthcare facilities to identify potential issues promptly.
Access to clean water is crucial for healthcare organizations, as a lack of it can lead to disease outbreaks, challenging the healthcare industry’s ethos. Your organization should learn from past incidents, such as the Camp Lejeune water contamination, which resulted in severe chronic conditions. According to TorHoerman Law, the incident affected veterans, family members, and workers, causing them to suffer from diseases like cancer and Parkinson’s disease.
Technology is significantly altering the healthcare sector, influencing how and when medical decisions and treatments are made. The healthcare sector demands easily accessible and precise medical data, as well as an automated process to reduce repetitive administrative tasks. The emphasis is on improving health outcomes and patient-physician communication.
Healthcare software can help to bridge the communication gap between departments, healthcare specialists, and patients. It minimizes the complexity and time of the medical care procedure.
What is healthcare software?
Healthcare software is any software designed for the healthcare industry to help medical facilities and equipment management for patients and medical personnel to monitor health issues remotely.
Don’t confuse healthcare software with medical software. Medical software is represented by a set of tools used to improve the operational efficiency, profitability, and the quality of medical care. It includes medical devices, monitoring, and evaluating patients’ medical conditions to figure out the best treatment option. Healthcare software in hospitals focuses on electronic records, appointment scheduling automation, enhancing the patient experience while engaging with a specific hospital or pharmacy, as well as drug delivery, logistics, billing, and accounting operations.
Why is using software essential in the healthcare industry?
In most instances, the digitalization of the healthcare system allows for faster diagnosis and personalized treatments for patients. First, healthcare software systems help the community by addressing the majority of a hospital’s demands and operations. Let’s look at how custom healthcare software development can benefit your business:
A new report by Emsisoft documents an increase in ransomware attacks in the US, with 2,207 US hospitals, schools and governments directly impacted in 2023.
According to the report, last year a total of 46 hospital systems and 141 hospitals were hit by ransomware attacks and at least 32 of the 46 systems had protected health information stolen.
Citing data from a University of Minnesota School of Public Health study, between 2016 to 2021, errors and delays from attacks on the US healthcare systems killed an estimated 42 to 67 Medicare patients, or about one per month.
“The longer the ransomware problem remains unfixed, the more people will be killed by it. The only viable mechanism by which governments can quickly reduce ransomware volumes is to ban ransom payments. Ransomware is a profit-driven enterprise. If it is made unprofitable, most attacks will quickly stop,” the report says.
Experts with Cigent, EchoMark and Horizon3.ai offer perspective:
By Shyam Manoj Karunakaran, executive vice president of health plans, CitiusTech.
While VBC (Value based care) is the current focus point for the healthcare industry, it is important for organizations in this sector to ensure successful and efficient management in VBC. In this article, I would like to draw your attention toward the challenges in effective contract management and how best to overcome these.
Path to value for Value-based Care
The growing markets in healthcare are now centered around government-sponsored programs like Medicare Advantage (MA), the Affordable Care Act (ACA) marketplaces, and Medicaid. This trend is steering healthcare organizations towards more direct patient engagement and the management of high-risk, high-acuity patients. As healthcare organizations increasingly focus on Medicare Advantage, ACA, and Medicaid, they encounter a unique set of challenges, encompassing system integration, data interoperability, and effective data handling, among other critical aspects.
Addressing the SaaS Sprawl
Over the years, healthcare organizations have made significant investments in a variety of SaaS solutions to facilitate their day-to-day operations. These solutions, each housing data in different data centers or cloud environments, have become integral to their business processes. However, as the focus intensifies on managing high-risk and high-acuity patients, along with an increased emphasis on direct consumer engagement, there arises a critical need to integrate data and processes across this sprawling landscape of disparate SaaS systems. This integration is essential for a holistic view of patient care and efficient service delivery.
If you find credentialing uninspiring, consider this cautionary tale. In a frequently cited negligent credentialing case, an Illinois jury awarded the plaintiff nearly $8 million dollars when the patient’s foot had to be amputated due to damage caused by the operating physician who had not completed his 12-month podiatric surgical residency and was not board certified.
Although physician credentialing may seem like a tedious administrative task, poor execution can result in serious consequences. Credentialing mistakes lead to financial losses on provider services, delays in claim reimbursements, fines or penalties, exclusion from federally funded programs, and harm to patients. Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. Deviating from best practice credentialing procedures puts organizations at risk for claims of negligence that could allow a lawsuit to move forward.
Best practice physician credentialing is the process in which a practitioner’s credentials are obtained, assessed, and fully verified. The proper credentialing steps can be complex and time-consuming but are a fundamental responsibility of hospitals and healthcare facilities.
To mitigate risk to your organization, avoid these eight common physician credentialing mistakes made by practitioners and the facilities that credential them.
Mistake No. 1: Relying on limited staff and administration.
Physician credentialing, also known as medical or provider credentialing, is a laborious process that requires precision, attention to detail, and patience. All certifications and licenses must be verified for every provider who administers services to patients. Depending on its size, a healthcare organization could be required to verify the employment histories and qualifications of hundreds or even thousands of physicians. This includes each practitioner’s education, medical training, residency, licenses, as well as any certifications issued by a board in the physician’s area of specialty.
Properly credentialing every single individual is an enormous amount of work for a team to handle. Hospitals or health systems may not allocate adequate resources or staff to complete the medical credentialing process, resulting in lost revenue and stressed, overworked staff who are more likely to make mistakes.
Technology is significantly altering the healthcare sector, influencing how and when medical decisions and treatments are made. The healthcare sector demands easily accessible and precise medical data, as well as an automated process to reduce repetitive administrative tasks. The emphasis is on improving health outcomes and patient-physician communication.
By Shyam Manoj Karunakaran, executive vice president of health plans, 