Medicaid Needs To Lead the Charge in Remote Patient Monitoring

By Juan Pablo Segura, co-founder, Babyscripts.

Juan Pablo Segura
Juan Pablo Segura

In a system that is straining under the pressure of an increasingly sick and aging population, the benefits of digital healthcare are indisputable. Technology has played a crucial role in the industry’s continued transition to value-based care, driving costs down while increasing access to personalized care. But despite the rapid gains that technology has affected, policy-makers have been slow to catch up. Until recently, the Centers for Medicare and Medicaid Services (CMS) enforced rules dis-incentivizing doctors to consider using new technologies.

Yet effective January of this year, CMS instituted important changes to their reimbursement policies that encourage the use of digital health tools. Most significant among these changes is the un-bundling of the Medicare/Medicaid CPT code 99091, a decision that specifically affects the adoption and deployment of remote patient monitoring (RPM) devices. In the past, CMS has only offered financial incentives for live, audiovisual virtual visits, excluding RPM—and thus excluding a major demographic from the possibility of affordable and accessible care. With the un-bundling, financial incentives for RPM are not only available, but also are deployed across multiple providers, allowing nurses and care managers as well as physicians to analyze and monitor data, creating efficiencies and lowering costs.

The creation of a code specifically for RPM marks an important shift in the stance towards digital health, establishing it as a standalone benefit with intrinsic value. With this policy, CMS is acknowledging and validating the research that has shown the tremendous benefits of RPM, primarily the economic benefits that come from transitioning the center of care from expensive hospitals and tertiary care clinics to the home.

But while the CPT un-bundling represents an important victory for RPM, it also serves to highlight the policy’s inadequacies and the large margin for growth. With the update, care providers no longer have to worry about fully funding RPM from their original operating budgets, but the reimbursement rate ($60 per patient per month) is still far too low to be effective in most cases. Other requirements, such as a prior wellness visit with the patient and a limit of one charge to the code per month, further restrict its effectiveness.

Perhaps most problematic, while the un-bundling will have an immediate positive impact on patients over the age of 65, a large patient demographic could be outside the bounds of its effects. Commercial plans are under no requirement to follow the updated CPT guidelines, and more importantly, neither is Medicaid. And while Medicaid is the smaller of the two government run-healthcare plans (compare Medicaid’s revenue of $565.5 billion to Medicare’s $672.1 billion), it is outpacing Medicare by 10 percent in rates of spending (increasing by 3.9 percent in 2016 compared to Medicare’s 3.3 percent).

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Remarks by CMS Administrator Seema Verma at the HIMSS18 Conference

Seema Verma
Seema Verma

Thank you Jared (Kushner) for that kind introduction. It has been an honor to work alongside visionaries like you; somebody who really understands at a very personal level as I do, the need and potential of innovation to better serve Americans. Having the Office of American Innovation involved is critical, and I’m grateful for Jared’s involvement, his hard work, and his leadership. It’s an honor to serve with him, and I am grateful for his service to our country.

It is a privilege to be with you here today and speak about the amazing advancements happening all across the nation in healthcare. One of the most exciting parts about being the CMS Administrator is the opportunity to see the cutting-edge breakthroughs that are happening every day. As we walk the exhibit hall of this conference, it is easy to be struck by how innovation is accelerating in healthcare.

We have procedures that we couldn’t have imagined a generation ago that are saving thousands of lives.

And it doesn’t stop with traditional healthcare innovators. The automobile industry is partnering with leading technology companies to perfect driver-less cars that may one day give independence to our nation’s elderly and people with disabilities. And through smart phones and wear-able technology, we are compiling health information every second, and Americans are using that information to track activity, calories, and heart rates. Innovators are even developing ways to monitor chronic illness with electronic watches. The list of innovation is endless.

But while all of this technology is changing every area of our lives, we face enormous challenges in healthcare, and the value that we are receiving for the amount of money that is being spent.

Last year CMS released a report showing that the rate of growth in healthcare spending is not slowing down. Despite all of the changes and regulations over the past decade, healthcare continues to grow more quickly than the overall economy. By 2026, we will be spending one in every $5 on healthcare.

This matters to each and every one of us because this increase in spending will continue to crowd out funding for other priorities, such as roads and schools, as well as national defense. Not to mention it means higher healthcare spending for each and every one of us. We’ve already seen our costs go up, with health insurance premiums, co-pays and deductibles.

And yet, this national increase in spending has not addressed many of America’s healthcare challenges. Entire communities have been ravaged by the opioid epidemic, and we rank poorly compared to other countries when it comes to preventing premature births, infant mortality and chronic diseases. It’s clear that when it comes to the most consequential measures of health and wellness, we need to get much more for our money.

The system we have is unsustainable, and it cannot continue. And President Trump agrees.

Last year, the President announced an Executive Order: Promoting Healthcare Choice and Competition Across the United States. Through his executive order the President made clear that he wants his administration working to change the rate of growth of healthcare spending so that competition can be fostered in healthcare markets, so that patients, and the American people, may receive better value for our investment in healthcare.

Secretary Azar and I are working for competition and better value by moving away from a fee-for-service approach, to a system that is value-based – and that rewards value over volume. This means paying providers on the outcomes they achieve, making people healthier rather than how many procedures they perform. Now many of you have heard this all before.

But, I’ve always been struck by how seldom the patient is mentioned in discussions around value-based care. Let me be clear, we will not achieve value-based care until we put the patient at the center of our healthcare system. Until patients can make their own decisions based on quality and value health care costs will continue to grow at an unsustainable rate. This administration is dedicated to putting patients first, to be empowered consumers of health care that have the information they need to be engaged and active decision-makers in their care. Through this empowerment, there will be a competitive advantage for providers that deliver coordinated, quality care, at the best value, to attract patients who are shopping for value.

I have spent a lot of time talking to Americans from all walks of life, and they are demanding more accountability from the health care system. As they are paying more through higher premiums and higher deductibles, they want to know how much services are going to cost, and they want to shop around for the best price. They don’t want to be paying for duplicate tests, or unnecessary care, and they are demanding a higher level of service and efficiency from the healthcare system.

In every other area of our lives, we are receiving better services that leverage innovation in technology. We can take our ATM card to any bank across the globe, and that bank can access our accounts. We can track every credit card purchase, and every phone carrier honors our cell phone number, and we receive ads for products we were only thinking about buying – or so it may seem.

So it should be no surprise that Americans have the same consumer friendly demands for healthcare. Americans are demanding that when they go to the doctor, the doctor spends more time with them, and less time on paperwork or typing into a computer.

To that end, in our drive towards value-based care, CMS adopted an approach that we call “Patients Over Paperwork.” Patients Over Paperwork is a direct result of President Trump’s Cut the Red Tape initiative, which aims to restore patients as the priority of everything we do, and eliminate burdensome regulations that have outlived their purpose.

We have held meetings in cities across America, and received thousands of letters. And one of the most common complaints we have heard from both patients and providers has been the inefficiency of Electronic Health Records – or EHRs, and the inability of providers to effectively coordinate care for their patients.

Now tremendous progress has been made in the adoption of EHRs. The technology for data sharing has advanced, and data is often shared effectively within a given healthcare system, with inpatient and outpatient doctors in the same provider system able to share and edit the same clinical record.

Despite this progress, it is extremely rare for different provider systems to be able to share data. In most cases there is not yet a business case for doing that – it’s in the financial interest of the provider systems to hold on to the data for their patients.

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6 Apps for Low-Income Patients to Access Healthcare Facilities

By Ray Parker, internet marketer and creative writer, IQVIS

Ray Parker

For people diagnosed with various diseases and without treatment, the problem could worsen. However, going to doctor and have a medical checkup needs to be reviewed multiple times, especially for low-income patients. The mammoth fee could break you up financially if you are living paycheck to paycheck. Moreover, affording pricey health insurance is nearly impossible for low-income people.

According to Gallup Sharecare Well-Being Index, “11.7 percent of Americans were uninsured in the second quarter of 2017, up from a record low of 10.9 percent at the end of 2016.”

Living in a digital era, our dependency on technology is getting greater day by day. Making use of this technology, low-income people can also benefit from treatment through the apps available on the app market. Have a look at some of them.

AmWell

If you are sick and can’t afford to pay doctor’s fee, try AmWell available on Android and iOS. The app is specifically designed to ensure 24/7 access to health for low-income people. See your doctor within minutes without commuting for hours or sitting in the waiting room.

Whether you are looking for someone who can perform therapy to deal with anxiety and depression or urgent care for respiratory infections or a sore throat, AmWell is a doctor in your pocket. The prices are nominal and you don’t need to break the bank after consulting your doctor.

MyChart

MyChart is also another app for low income people available for both Android and iOS. The app helps you stay in touch with your physician, view and pay your bill, manage your appointments and review test results. Before you can use this app, you must create an account through MyChart website.

MyMedical

MyMedical is a great app available for both Android and iOS users. With this app, you can keep your personal medical information. In other words, it is a record-keeping app for your health info. You can keep multiple records including your parents, spouse or children.

The app also comes with translation feature to help explain medical jargon from your records, letting you know what it means. The app is very useful in emergency cases, listing aid information such as emergency contacts for first responders.

First Aid by American Red Cross

First Aid is yet another app available for both iOS and Android. Emergencies can erupt out of nowhere and this app gives emergency response tips for situations that require quick action. For example, if a person goes through the sudden heart attack, choking or snake bit, First Aid by American Red Cross will guide through immediate actions to avoid loss of life. The app can be accessed without connecting to the internet and is available for free.

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New Technology Could Boost Patient Adherence Leading to Better Outcomes

By Patrick Anquetil, CEO and co-founder, Portal Instruments.

Patrick Anquetil
Patrick Anquetil

Medications only work if people take them. And yet, it’s estimated that patients take only half of the doses they are prescribed by healthcare professionals. That holds true regardless of whether the medication is for life-threatening conditions, or just a simple infection. With 190 million Americans affected by one or more chronic conditions, most of which are managed through medication, the consequences across society of non-adherence becomes substantial.

Non-adherence to medication causes about 125,000 deaths a year. As much as 25 percent of hospital and nursing home admissions can be traced back to the patient not taking their prescribed medication, and non-adherence causes 30 to 50 percent of treatment failures.

It’s estimated that in the U.S. alone, non-adherence costs the healthcare system about $100 billion to $290 billion a year. If adherence were a disease, it would be one of the largest and most expensive disease categories.

Costs and Benefits

With the consequences so severe, the question then becomes: Why don’t patients take their medication? The issue has been studied for decades and yet the rate of adherence hasn’t changed much during the past 30 years.

Research has shown that patients often don’t truly appreciate the importance of medications to their health. Cost is also a factor. Patients sometimes determine that the cost of medication outweigh the benefits. In some cases, the complexity of the treatment is an issue.

The solution then is complex and must be addressed on multiple levels. A study by the World Health Organization showed that adherence rates are influenced by the structure of healthcare systems, the patient-provider relationship, the recommended treatment, and socioeconomic factors.

Technology Aids

But with modern technology, healthcare providers now have new tools they can use to combat non-adherence. Apps and other intelligent tools can facilitate ease of use, enhance patient-physician communication, improve comfort, and make administration of medications more convenient.

Developers, for example, are creating interactive software products that can track dosages, provide reminders, and communicate information directly to healthcare providers. They are also employing games to incentivize adherence by rewarding patients who stay on top of their treatment plan. Smart pill bottles, boxes, and caps that alert the patient to missed dosages are becoming more commonplace and will take an important role in coming years.

New technologies that can make following the medical regime easier and more tolerable for the patient can also improve adherence. In some cases, this may be as simple as an extended release medication that results in taking one pill a day instead of two. In other cases, new technologies that reduce the number of steps involved in a treatment or simplify the process can reduce non-adherence. This is particularly true for elderly patients who might lack dexterity or the ability to follow complex protocols with procedures such as administering eye drops, or using inhalers.

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Hospitals Have A Smartphone Problem

By Sean McGowan, writer, Codal Inc.

Sean McGowan
Sean McGowan

In just a few short years, we’ve witnessed the smartphone’s rise from bleeding-edge innovation to household fixture. We’ve watched it permeate every industry, establishing itself as essential to how we interact and operate, to the point where we’ve come to define our times by it—this is the smartphone age.

But mobile technology’s diffusion into the mainstream hasn’t been uniform. Some industries have greeted the mobile revolution with open arms, while others have resisted this paradigm shift (to varying degrees of success).

The healthcare sector falls somewhere in between, and that’s a cause for serious concern. After all, the purpose of technology is to improve the quality of our lives, our society, and our human experience, and it’s alarming that health care—arguably the most direct way to do just that—isn’t leveraging mobile tech to its full potential.

Hospitals, clinics, and other care facilities are facing challenges when it comes to successful mobile health (or mHealth) solutions. And as a mobile app development company with an extensive background in the medical sector, Codal has a few ideas about how to cure this smartphone affliction.

Is There A Doctor In The House?

Just like a doctor diagnosing a patient, let’s start by ruling out what isn’t the issue.

This year, popular medical publication Physicians Practice surveyed 187 doctors, nurses, and other healthcare workers to find that a massive 75.9 percent of them said their facility used some form of mHealth on weekly basis. Safe to say, adoption isn’t the problem here.

But the same survey found that the majority of those care facilities were using those solutions between just 0 and 5 hours a week. They might have access to mHealth solutions, but they certainly aren’t using them in their day-to-day practices. The question is why.

The brass of these hospitals certainly doesn’t need to be convinced— not if over 75 percent of them are willing to invest in mHealth solutions. But perhaps we need to dig deeper. Perhaps it’s the physicians themselves who aren’t willing to implement these smartphone tools in their workflows.

But another recent study, this one conducted by the American Medical Association, found that 85 percent of 1300 physicians surveyed believed that digital health solutions gave them an advantage in their ability to care for their patients. The figure attached illustrates a more in-depth breakdown of these findings.

The AMA’s study went even further, attempting to identify exactly what attracted these physicians to digital tools like mHealth. The primary reasons cited were improving work efficiency, enhancing diagnostic ability, and most importantly, increasing patient safety. And these were just the most popular factors—the full responses are a laundry list of the benefits mHealth solutions offer.

Another notable conclusion was the high amount of younger physicians that were especially optimistic about the impact digital tools could have. This finding suggests that these solutions are indeed the future of medical practice in the healthcare sector.

So if everything is pointing towards mHealth dominating hospitals and clinics across the country, why isn’t it? If it’s not the higher-ups or the users themselves, what’s left? The quality of the mHealth solutions themselves.

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Outcomes-Based Pricing for Pharmaceuticals: An Emerging Opportunity for Application of Analytics

By Ken Perez, vice president of healthcare policy, Omnicell, Inc.

Ken Perez
Ken Perez

Paying for high-cost drugs based on the patient outcomes they produce—an approach known as outcomes-based pricing—is gaining momentum as health plans seek to slow the growth of healthcare costs in the face of rapidly escalating drug prices.

Under outcomes-based pricing, health plans and drug manufacturers agree to a contract in which the revenue the manufacturer receives is adjusted based on how well the medication performs in a real-world population. In practical terms, in the event the patient outcomes are less favorable than expected, the manufacturer must issue a refund or rebate to the health plan, which in effect constitutes a price adjustment.

Aetna, Anthem, Cigna, Harvard Pilgrim and UnitedHealth Group have all signed outcomes-based contracts with drug makers. According to Avalere Health, a healthcare consulting and research firm, one in four health plans has at least one outcomes-based contract, and another 30 percent of health plans were negotiating one or more outcomes-based contracts as of early 2017.

Several of the early outcomes-based deals are for treating common, high-cost conditions for which there is a lot of outcomes data, such as high cholesterol and diabetes. According to the Centers for Disease Control and Prevention, over 100 million American adults have cholesterol levels above healthy levels, and similarly, more than 100 million American adults have diabetes or prediabetes.

In addition, pharmaceutical firms with new cancer drugs that have little data proving their longer-term outcomes value should be motivated to enter into outcomes-based agreements.

Given the Trump administration’s anti-regulation bent and focus on spurring drug price competition through expedited approval of generics and biosimilars, the Department of Health and Human Services is unlikely to experiment with outcomes-based pricing during the next few years. Thus, commercial health plans should remain the key promoters of outcomes-based pricing for the foreseeable future.

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10 Tips to Develop Perfect Document Management System for Clinical Trials

By Helena Bogdanova, a tech journalist with OCSICO. She covers tech news on IoT, mobile applications, healthcare and custom software development.

Helena Bogdanova
Helena Bogdanova

What does it take to release a new medication or medical device? We buy simple meds for flu, never wondering how many resources have been spent and people involved so that these small pieces could appear in our hands. An army of healthcare professionals conducts researches and clinical trials to produce safe and effective medications or medical equipment.

Clinical trials imply large amount of data that has to be documented: test and monitoring results, information about alleged dosage, the effect a new drug is expected to produce and so on. All the information is of great importance and must be carefully systematized and stored with the opportunity to be used for new or additional research after a medication or device has entered the market.

Data sharing problem

In the age of IT, most of the researchers prefer electronic documents to paper ones. It significantly accelerates the workflow as there is no need in digging in paper piles to find a necessary file.

Electronic information can be easily sent via e-mail to a colleague or uploaded to the cloud and become accessible to all authorized users. This is faster than dealing with traditional paper documents, but still isn’t quick enough. Users have to open an application each time again if it doesn’t have “always on top” feature or click on an e-mail box to check for new letters. Being very busy, researchers can’t do this right away, slowing down the workflow. Thanks to built-in reminders, a document management system can make the process of data sharing much more dynamic.

The way out

Companies that provide clinical trial research services are challenged to make the information exchange process more convenient to their employees and customers. For this purpose, they turn to the specialists in the healthcare software development services to create a  smart and user-friendly document management system.

Hints for developers

  1. The easier the better

Functionality first! Too colorful UI design isn’t the right solution for a medical document management system. Convenience, quick access to information and fast data sharing — these are the aspects to focus on. Too many small elements and bright colors are likely to confuse and distract a user. Look at the colors of some already existing medical web portals or software: catchy but not annoying.

  1.        Ensure close cooperation

Finding a common language with a customer isn’t always an easy task. IT specialists have to build up close communication with each client to understand what kind of system is needed. A thought-out software requirements specification, flowing from thoroughly documented client’s expectations, serves as the basis of the effective solution development process.

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Hiring the Right Staff is Vital in Healthcare

By Naeem K. Manz, an experienced blogger, digital content and social marketer. He enjoys writing about the latest news in business, technology and health. 

The healthcare industry is run on trust: Trust between the doctors and their patients, between all the staff working in the building, even between the medics and the suppliers of all the hospital technology. Trust is the only way that people can surrender themselves to the hands of medical professionals and believe that they are doing the best they can.

This is why the hiring process for jobs in the healthcare industry is so stringent — and it should be. Whether you are a custodian or an MD, you are surrounded by vulnerable people all day long, working in their best interests even when they aren’t able to make decisions for themselves.

So what should you do as the hiring committee to ensure that only the best, most suitable staff are hired?

Image Credit: Flickr

Background Checks

After receiving all the applications for the job, you should do thorough background checks. Usually, this will include calling previous employers or given referees to ask about work history, but given the setting, you may also wish to do more in-depth checks. A good method is reverse phone lookup on Check Them. All you need to do is enter in their phone number (usually found on their CV) and you will receive a report on everything you need to know from their location to social media profiles.

This depth of background check might sound extreme, but in our modern world, it is always better to be sure that you know exactly who you are hiring, what their past is and whether any concern is flagged up ahead of time.

The Interview

Once you are satisfied with the background check, you should always invite the successful candidates to interview face to face. At the interview, you aren’t looking for qualifications or background information, now you are looking at how they respond to certain scenarios and whether you think that they would fit into your existing team.

One of the key things to point out here is that you should always be looking to create a diverse team of people with complementary skills. This is the best way to ensure that problems can be solved quickly and creatively and that everyone can learn something from someone else. As the medical profession moves so fast, this is vital for patient health.

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How mHealth Technology Improves Population Health Messaging

By Saqib Ayaz, co-founder, Workflow Management and Optimization.

Saqib Ayaz
Saqib Ayaz

Gone are the days when people had to rush to the doctor for regular checkups or medications. Now, with technological advancements, they don’t need to go to the hospital for every small or big health issue. All these are possible because of smartphones. Smartphones have now become a perfect mHealth tool for customized medicine, sending targeted information as well as notification and collecting individual data. Do you know what the best part is? The data that are being used in order to boost population health programs, is getting huge success.

The reason behind the success of this population health messaging using smartphones is simple. An estimated 96 percent of people around the world are using smartphones. This makes it easier for mHealth messaging programs to reach almost all the people in a defined population. Compared to phone calls, people, these days, are making more use of texting and emails to communicate. This has let the healthcare providers create customized and interactive messages that are rich in content and that drives engagement. There are many population health programs that are based on mHealth such as maternal health, smoking, infant health, physical activity, weight loss as well as depression or anxiety. There are also other programs that give people a reminder to visit a doctor for checkups of their children. Some others include programs that are aimed at chronic populations with asthma, diabetes or HIV.

According to a recent study, 91 percent of people admitted that their knowledge of IEHP services was improved with text messages. Compared to a control group, their engagement rate was 2.5 times better. Also, among them, 10 percent participated in a series of health challenges, while one-third completed the challenges. It can be said that there are mainly two reasons why this text messaging became so popular:

  1. About 98 percent of people read it
  2. Text messaging is used by almost 80 percent of the U.S.’ Medicaid population

According to experts, if healthcare providers are going to use mHealth messaging, then they may follow the below-mentioned tips in order to create an effective engagement platform –

What if the patients do not understand what their doctors want them to do and why? This is why it is important that you teach the patients very well as to why and what they need to do so that they can properly follow the care instructions. You can provide them with supplemental information or clarify instructions that were given to them at the time of face-to-face office visit. This way, they will get to know what exactly they need to do with the new medical device. Ask them questions regarding the instructions that have been given and clear their doubts if they have any.

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Power Is In the Hands of the Consumer: Are We Ready?

By Mark Weber, SVP of healthcare development, Infor.

Mark Weber
Mark Weber

With payer models changing, it is time to start thinking of patients as both clients and customers. Are they as satisfied with the cost of service as they are their experience and outcomes? Will they keep coming back?

With high deductible and health savings plans shifting more of the patient cost burden to their own pocketbooks, healthcare consumers are motivated to make more informed care choices. The good news, for them, is that they have a lot more options, as nontraditional players such as retail clinics, online diagnosis sites and others have entered the market. There is more information about those choices available to them, whenever and wherever they need it.

However, all of that creates more competitive pressure among providers. Patients can be an organization’s biggest cheerleaders—or biggest detractors. That means like any brand, healthcare providers must work hard to maintain loyalty to remaining successful—or even sustainable—in the industry. And technology is helping lead the transformation.

The Era of Consumerism Is Here

According to Shafiq Rab, CIO of Rush University Medical Center, “It is all coming together as the ‘day of the patient.’ We call it care where you are. Where you want it. How you want it.”

He then went on to say that while technology continues to support the era of big data, digital innovations and advances also provide healthcare’s biggest opportunity to streamline the care experience across the continuum.

EHR Is Just a Start

One of the biggest evolutions is the implementation and proliferation of the electronic health record (EHR). It has been a catalyst for more efficient, personalized care and is integral to a better patient experience.

However, if the EHR is unable to connect to disparate systems, or across facilities (especially in this era of increasing mergers and acquisitions), or between non-affiliated organizations, its value decreases as the potential for real interoperability is lost.

What healthcare organizations really need is an engine that pulls together the EHR and other systems. To have a single patient data source, organizations need to streamline the exchange and aggregation of clinical data within an organization, and between its facilities and partners. Do not forget that such an engine needs to be built with standards such as FHIR as a top consideration and can create apps that allow patients to schedule appointments via laptop, tablet and phone.

Even efficiencies a patient cannot see are key to patient satisfaction and a positive consumer experience. Such efficiencies include the processes that power everything from claims processing to supply chain to equipment maintenance. If supplies are missing or need to be tracked down, patient care and experience are compromised. Or imagine arriving at your appointment and finding the MRI machine is down. A truly integrated system will provide real-time, role-based insight to minimize risks, issues and service disruption.

As savvy consumers demand more cost transparency, revenue generation must be balanced with the constant need for cost efficiencies. As a healthcare organization, a wise endeavor is to bring accounting and cost analysis to a new level by allocating patient and department expenses, such as procedural and lab test costs. From there, you need to break down expenses by patient cohort, surgeon, procedure or provider. Imagine getting a bill from the hospital that clearly outlines charges in a manner that you, as a consumer, can easily understand. Not only does that help achieve a higher level of consumer satisfaction, but it helps the healthcare organization understand the true cost of patient care.

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