HIMSS16: Let’s Talk About what Happened in Vegas

Guest post by Jeff Kaplan, chief strategy officer, ZirMed.

Jeff Kaplan
Jeff Kaplan

The 40,000 healthcare and healthcare IT professionals who gathered at the Sands Expo in Vegas brought a different vibe for HIMSS 2016. The halls buzzed with activity and an overall optimism that belied any of the potential causes for uncertainty—politics, a down stock market, increases in uncompensated care, the movement toward fee-for-value, or the staggering shift in patient responsibility.

For those who attended HIMSS 2015 in Chicago, the difference was visible in vendor messaging and audible in conversations during the conference. Among all attendees the optimism seemed well founded, grounded in reality. We all see significant opportunity to drive improvement in healthcare for our generation and generations to come. That’s why we came to HIMSS – we’ve placed our bets.

In that spirit, let’s talk about where healthcare is doubling down, where it’s hit a perfect blackjack, and which trends pushed as providers look for the next deal.

Double Down – Data Interoperability

Out of the gate at HIMSS 2016, there was increased focus and emphasis on the importance of data interoperability and integration. From booth signage to the increase in dedicated vendors to industry veterans evangelizing on the topic, you couldn’t miss the tells from all players—everyone wants to show they have a strong hand when it comes to interoperability. Epic’s Judy Faulkner made a play that Epic wasn’t just the leader of the interoperability movement – they were in fact the originator (see her interview with Healthcare IT News here).

Of course, wander off into other parts of the exhibition hall and it wasn’t long before you heard the all-too-familiar complaints about closed-system platforms – that they limit innovation by outside companies and technologists who can build applications to add additional value. In the era of Salesforce.com and other open platform successes, many HIMSS attendees spoke of their hope that companies like Cerner and Epic will follow suit.

Blackjack – Data Analytics

Over the last year vendors heard providers loud and clear – healthcare providers need hard ROI on any new initiatives, especially as many have EHR/HCIS sunk costs in the tens of millions of dollars. They need a sure thing—and the changes evident at HIMSS 2016 reflected that shift. Buzzwords like “Big Data” thankfully went to the wayside and were replaced with meaningful discussion around data analytics and data warehousing. Providers know they’ve amassed a wealth of clinical and financial data—now they’re looking for ways to increase the quality of patient care while driving down costs.

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Expect Privacy and Security Focus at HIMSS16

Guest post by Adam Hawkins, vice president client services, CynergisTek.

Adam Hawkins
Adam Hawkins

HIMSS 2016 is right around the corner, and I’m sure everyone is excited about the prospects of conferencing in Las Vegas. This location certainly has a lot going on to keep everyone busy, on and off the exhibit floor. There should be many new healthcare technology players to see and learn about, and it is always interesting to visit the innovation area. Hopefully, we’ll get to hear what folks like KLAS, HIMSS Analytics and other research organizations are working on in 2016 as well.

For instance, KLAS is continuing its work toward including security vendors as its own category, and has a new study underway to look at service providers in this space. That study won’t be completed in time for HIMSS, but they should be able to preview what they hope to accomplish with the study and what its report will include. I think it will be an important read for everyone in our industry.

Interoperability is a huge area of concentration in healthcare at the moment with the Office of the National Coordinator, Health & Human Services and HIMSS all very much involved in this discussion. There are sure to be several presentations on this and related topics. Hopefully we will hear how security and privacy will be addressed, as they are critical components of making many of our health initiatives successful and rely heavily on interoperability for success.

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6 Tips to Navigate the Population Health Jungle at HIMSS16

Guest post by Linda Lockwood, solutions director and service line owner, health solutions, CTG.

Linda Lockwood, RN, MBA, PCMH CCE
Linda Lockwood

With HIMSS 2016 fast approaching, the hunt for the perfect Population Health tool will be underway. Whether you’re a HIMSS veteran or a first-time attendee, expect to be caught in a jungle of vendors, each promising the latest and greatest Population Health tools.

HIMSS seems to grow each year, and with so many vendors, solutions and offerings, and the buzz happening during the event, it can be a challenge to carefully evaluate Population Health tools to help inform a decision.

HIMSS can make you excited for the future of your organization, but can also be overwhelming with so many Population Health options to consider. These six tips can help you separate fact from fiction and select a tool that best meets the population health needs of your organization:

Identify organizational goals for population health and match your tool choice to those goals: It’s important to understand what your organizational goals are, as they will drive the selection of tools. If you have not entered into risk bearing agreements, but want to be prepared, perhaps you may want to start off with a tool that supports development of registries and profiles physician performance. You will also want to identify your high risk, high cost patients, and be sure you have the ability to track this performance over time. This information may be available from your financial systems, but you also will need to have the ability to drill down to the device, and supply level—as well as use of medications and supplies including blood products—to identify opportunities for improvement.

How does joining an ACO impact your decision? If you have plans to join an ACO, your needs may include the ability to perform Care Management and Care Coordination and Patient Engagement. You will want to be sure that there is interoperability between the hospital, physician offices and care managers as well as the payers. Reporting becomes critical with an ACO as certain metrics must be reported on a regular basis. As you evaluate tools, ask if they have pre-build reports that include some of the standard measures that a MSSP requires, as well as CMS.

Think about mergers and acquisitions: If you are in the process of a merger or acquiring physicians, you must ensure whatever tool you include has the ability to aggregate data from multiple EHRs and formulate a plan to support interoperability for sharing and exchanging key data. If you are self insured, your organization will have access to data about your population. If you are focusing on wellness and prevention, you will want tools to support patient engagement, health and wellness. Alternately, if have high risk patients, you require Population Health tools to support care coordination, outreach, pharmacy and lab adherence and wellness reminders.

Make data quality a priority: The ability to have accurate, reliable data is crucial with any Population Health or reporting tool. If a data governance system is in place, it’s important to understand what source data you will need to populate the tool. Be sure you know where key data is entered in the system and the common values for that data. In tandem with this, the organization should identify data stewards and business owners. Data governance must have organization-wide commitment, and business owners who are actively engaged.

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Analytics, Coordination and Patient Empowerment Will Lead to Better Population Health Management

Guest post by Terry Edwards, CEO, PerfectServe.

Terry Edwards
Terry Edwards

Over the past few years, healthcare technology has seen many advances. We’ve achieved mass-market adoption of EHRs, many organizations are making meaningful progress on data aggregation and warehousing information from multiple diverse systems, and wearables and other sensors show much potential to unlock personal information about each patient. The pace of change in healthcare is quickening, with each new technology or initiative sending off a chain of reactions across the entire ecosystem, ultimately improving patient care.

I see three trends driving the industry toward change:

Analytics will help predict population heath management

One of the persistent industry challenges is the “datafication” of healthcare. We’re amassing more and more data now than ever before. And new sources (like wearable devices) and new health factors (like DNA) will contribute even more. This data explosion is putting increased pressure on healthcare organizations to effectively make this data useful by delivering efficiency gains, improve quality of care and reduce overall healthcare costs.

Navigating this digitized healthcare environment will require increasingly sophisticated tools to help handle the influx of data and make the overload of healthcare information useful. In 2016, the industry will begin to take concrete steps to transition to a world where every clinician will see a snapshot of each of their patients to help them synthesize the critical clinical information they need to make a care decision. Moreover, hyper-complex algorithms will allow providers not only to know their patients, but to accurately predict their healthcare trajectories. By giving providers insights into how each patient is trending, clinicians will be able to make better-informed, precise decisions in real-time.

Consolidation leads to new healthcare models, improved outcomes

New models for effective population health management continue to drive change across healthcare systems. These models incentivize stakeholders to optimize costs, identify organizational efficiencies and improve decision-making processes to deliver better care at a lower cost through an emphasis on care coordination and collaboration.

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Optimizing Every Revenue Opportunity through the Value Cycle

Guest post by Mark Montgomery, CMO, Craneware.

Mark Montgomery
Mark Montgomery

Three major trends are driving change in healthcare, and all three will also drive IT demand. First is the movement toward managing population health in various forms. Taking on this financial and clinical risk will require processing and making decisions based on the demographic, clinical and financial data that have been filling warehouses everywhere.

Secondly there is the rise of consumerism. Individuals faced with rising out-of-pocket expenses are doing more self-directed research on their health and doing more comparison-shopping. Providers will continue to respond with medical malls, clinics aligned with retail pharmacies, telemedicine and other innovations to control costs and still deliver care.

Even though more Americans than ever are insured, high-deductible plans can affect providers’ debt and charity care. Patient-friendly point-of-service collections and finance plans will require IT investment, as will more efficient collections processes.

The third trend – the move by government and private payers toward value-based reimbursement – will continue to affect the industry in 2016 and beyond. Even though fee-for-service is still the dominant reimbursement model, the U.S. Department of Health & Human Service’s January 2015 announcement that Medicare would be “tying 50 percent of payments to these {value-based} models by the end of 2018” has seen providers taking a hard look at quality and cost of care.

While payment will increasingly be determined by quality of outcomes rather than quantity of services billed, quality and cost – the components of value – aren’t connected in a straight line. They are affected by every department in a provider system, and no system can manage what it can’t measure. If that data can be accurately collected and analyzed, it can inform decision makers not only on how successful they are at delivering quality care, but also whether the cost of delivery exceeds their reimbursement.

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Population Health: Five Important Questions to Ask When Integrating Your Data

Guest post by Thomas J. Van Gilder, MD, JD, MPH, chief medical officer and vice president of informatics and analytics, Transcend Insights.

Thomas Van Gilder
Thomas Van Gilder

Population health has become a puzzle of processes and technologies to improve health outcomes, enhance the physician-patient experience, and reduce costs. Although the healthcare industry is making great strides toward achieving these goals, a necessary step—the integration of clinical, claims and wellness data—has just begun.

Today, many medical business decisions are based on claims data; yet, robust insights into clinical quality require clinical data. Furthermore, information that is not typically found in healthcare information systems, such as that from wearable devices, and from those who may have little to no contact with the health care system, needs to be incorporated into population health management systems.

Accessibility to clinical, claims and wellness data can provide physicians and care teams with a more complete view of the care delivery system journey and an integrated view of a patient’s data as he or she has engaged the healthcare system. With a broader view of a population’s health and various opportunities to proactively address an individual’s care, a physician or care team can help prevent adverse events or future disease to ultimately improve the health and well-being of the individuals they serve.

As we embark on this journey to complete the population health puzzle, it is important that healthcare systems, physicians and care teams optimize the value of integrating clinical, claims and wellness data by considering the five questions I have outlined below.

  1. Do you have a reliable, complete and manageable way to access clinical, claims and wellness data?

Clinical data, in its current state, requires an “interoperable platform” to be able to present a single, comprehensive view of a patient’s or population’s health data at the point of care. An interoperable platform connects disparate electronic health record (EHR) systems across a community to collect and provide access to information in a secure and confidential way.

Claims data, traditionally aggregated from health insurers, and now from Accountable Care Organizations, needs to be integrated as well to create a more complete picture of an individual’s or population’s health. Not only does claims data yield rich insights that may not be present in clinical information alone—for example, completed pharmacy transactions—but it can also display health-related activity that occurs outside of any given health system. This could pertain to the use of a non-network urgent care facility or activity that might not be captured in an EHR, such as retail pharmacy vaccinations.

Wellness data generated from things such as immunization campaigns, wellness fairs or wearable health technologies, which seem to be on the rise, can help provide a broader record of an individual’s health so that a physician or care team does not have to rely only on sick encounters. Wellness data can help physicians and care teams identify opportunities in the course of an individual’s health, to intervene earlier and try to prevent some of the complications, or even some of the illnesses, from occurring in the first place.

Therefore, ensuring all of this valuable health information is accounted for to generate a more complete picture of a given patient’s or population’s health, requires accessibility to the data, achieved through community-wide interoperability, and a thoughtful plan for using the data to drive quality improvement, care experience enhancements, and reduced health care costs and utilization—the “Triple Aim.”

  1. Do you have a way to normalize your data and corroborate your inferences?

Transitioning from data access to achieving the Triple Aim requires that clinical, claims and wellness data make sense together, across various systems and coding schema. In other words, the data must be normalized, duplicate and time-decayed information removed, and data gaps filled in by interpretation or clinical corroboration with other information.

Normalization requires a platform and an approach that first recognizes that clinical, claims and wellness data may conflict or overlap, and provides a systematic way to address these issues. This all requires solid quality assurance activities, software, and staff with sufficient data science skills to be able to bring clinical, claims, and wellness data together and use the integrated data set to provide actionable health intelligence.

Additionally, as standards are becoming more broadly adopted and health systems are becoming more sophisticated in their use of information technology, data normalization will become more seamless. Until then, I believe it will remain a critical issue.

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Health IT Thought Leader Highlight: Jim Lacy, CFO, ZirMed

Jim Lacy Biography Pictures
Jim Lacy

In the following conversation, Jim Lacy, CFO and general counsel of ZirMed, discusses the company’s mission, goals and growth; his passion for healthcare and serving those who work in it; ZirMed’s transition from a clearinghouse to a revenue cycle management, population health and predictive analytics firm; why privacy has become the biggest issue very few are seriously talking about; and the changing face of healthcare as a whole.

Tell me more about ZirMed, the brand, its solutions, and your mission for it.

Our core mission is to help healthcare providers, hospitals and health systems get paid. It sounds simple, but efficiently and effectively getting providers paid for their services and supporting their mission in an ever-evolving technological, regulatory, and clinical environment is incredibly complex.

ZirMed is uniquely positioned to deliver a comprehensive end-to-end platform of cloud-based financial and clinical performance management solutions. That means that at every point in the revenue cycle, we have solutions that support healthcare providers in collecting monies from payers and patients, and do it as quickly, efficiently, and cost-effectively as possible. Our solutions address the challenges of the current fee-for-service and consumer-driven payment systems, and also support fee-for-value reimbursement, broadly defined as population health management.

ZirMed’s solutions are logically oriented to address the revenue cycle needs of providers ranging from small physician practices and durable medical equipment providers to the largest hospitals and health systems. At the front end, we offer Patient Access solutions focused on registration and check-in to streamline pre-registration, estimate patient responsibility, accurately verify eligibility, and more.

Core to our mission of getting hospitals and health systems paid for services provided is our Charge Integrity solution. We use big-data and predictive analytics to identify and capture charges, resolve process inefficiencies, improve coding compliance, and ensure the complete integrity of all inpatient and outpatient billing.

Our claims and A/R management solutions include robust edits and rules aggregating claims across an entire system, and provide highly efficient claims and receivables workflows, reduce preventable denials, and deliver insights into financial performance for critical decision support.

With the ability to process vast amounts of data and provider metrics across an organization, our cost and utilization solutions benchmark provider performance, stratify risk, and support fee-for-value reimbursement programs.

Population health management has come to hold very different meanings across different organizations. Our population risk management solutions combine clinical and financial information, enabling insights into patient populations while identifying risk, analyzing discharges for readmission risks, and managing referrals across an integrated system.

And, of course, healthcare is always about the patients. We offer a comprehensive suite of Patient Engagement solutions including consumer-friendly billing and payment options and a patient portal offering online payment, statement management, and two-way messaging between the patient and provider.

What about you? What keeps your passion for this mission, and organization, alive? Tell me more about what excites you about your work and why you love what you do?

I love what I do, and couldn’t design a better job for myself than this one: I get to be a CFO, counsel and influence product design, all within the course of a normal day.

My roles are seemingly very different and one person holding them is rather non-traditional; however, there is logic to the fit. ZirMed develops financially focused software solutions in a highly regulated healthcare environment. We deal with billions of transactions and hundreds of billions of dollars annually with an extreme focus on privacy, security and compliancy. My background from the provider side of healthcare prior to joining ZirMed directly influences the types of solutions we build and how we deploy them to positively impact provider organizations.

Ric Sinclair, our VP of product, and his team excel at designing and delivering great software that’s beautiful, powerful, and easy to use. Their role is to take all this complexity and make it as simple and easy as possible for users and managers in client organizations. My role is to weave my experiences into the design of our products and support the role of the client in everything we build.

So I’m doing what I love and working with incredibly smart, talented people every day. That makes it easy to stay passionate and excited about my work and about ZirMed.

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Analytics Outweighs Accountable Care, Population Health, ICD-10 as an IT Priority, say Health System Execs

A new survey of senior information technology executives at some of the nation’s largest health systems reveals that their top priority for IT infrastructure investment is analytics – a technology that is central to achieving the systematic quality improvements and cost reductions required by healthcare reform.

Health Catalyst surveyed members of the College of Healthcare Information Management Executives (CHIME), all chief information officers (CIOs) or other senior IT executives of US healthcare organizations. Survey respondents provided a high-level view of the many competing priorities for IT investment that hospital leaders face in the era of “value-based care” – a term describing elements of the Affordable Care Act as well as private industry incentives that reward providers for improving their patients’ health.

Most experts agree that value-based care will require hospitals to use sophisticated analytics to comb through terabytes of clinical and financial data to reveal actionable opportunities for improving quality and efficiency. The survey’s findings confirm that view, with 54 percent of respondents rating analytics as their highest IT priority, followed by investments in population health initiatives (42 percent), ICD-10 (30 percent), accountable care/shared risk initiatives (29 percent), and consolidation-related investments (11 percent).

importance of the IT infrastructure investments

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Please: Don’t Say Population Health Again

Joel Splan
Joel Splan

Guest post by Joel Splan, chief executive officer, Galen Healthcare Solutions.

On the first day of HIMSS 2014 in Orlando, I stepped into a bewildering echo chamber. “We’re doing population health,” repeated everyone, be they physicians at a hospital whose EHR system my company implemented, the IT directors of other hospitals looking to update their EHR system or competing EHR experts. Everyone was interested in buying it, and everyone was interested in selling it. On one particular walk of the floor a colleague quipped, “Will there be a prize for the one millionth person to say ‘population health?’”

Despite this obsessive buzz nobody seemed able to define what population health is. It’s the proverbial elephant described by touch rather than sight. Is it a concept of health or a study of the various factors that affect health? Is it a course of action for the treatment of the population in its entirety or individual patients only?

The Affordable Care Act, which cites population health as an essential component of its mandate, aims to expand access to the healthcare delivery system, improve the quality of care, enhance prevention, make healthcare providers responsible for outcomes, and promote disease prevention at the community level.

All of this is commendable, but, in the end, what is population health? What does it look like? Will we recognize it if we achieve it? A friend of mine on the payer side observes that vendors claim it’s everything and providers don’t know exactly what they want it to be. Put those together and the term becomes meaningless.

There are additional questions about population health that remain unanswered. Is it an outcome, as the ACA approach suggests, or is it a foundation built on big data, analytics, ACO tools, bundled payments, systems consolidations or something else? At every HIMSS booth, the answer to these questions was a resounding “Yes.”

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