By Anne Dabrow-Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN and Dale Schumacher, MD, MPH
When nurses are armed with the latest evidence-based nursing procedures at the point of care and real-time step-by-step guides for clinical decision making at the bedside, Hospital Value-Based Purchasing (VBP) Program scores go up. That was the primary finding of a study undertaken by the Rockburn Institute in partnership with Wolters Kluwer Health, which found that hospitals where nurses used two specific evidence-based Clinical Decision Support (CDS) tools for two years had an average rank that was nearly 25 percent higher than their peers.
The findings are a rare instance where the intervention—in this case Lippincott Procedures and Lippincott Advisor from Wolters Kluwer—can be clearly associated with change in practice and quality improvement. In fact, the study’s findings clearly support the value and use of point-of-care CDS tools in a clinical setting to augment nurses’ substantial knowledge when needed. The results also demonstrate the close relationship between nurse, information, patient and performance improvement, which ultimately leads to improved quality and efficiency.
A VBP Primer
The Centers for Medicare and Medicaid Services (CMS), through its Hospital VBP Program, has incentivized hospitals to improve patient care and minimize costs by structuring its reimbursement system to reward care quality rather than service quantity. To fund the program, CMS reduces each hospital’s base operating payment by up to 2 percent, which hospitals can earn back (along with bonuses) by achieving high VBP performance scores.
In effect, VBP pits hospitals against each other and their own past performance to show achievement and improvement. Performance is currently assessed using four quality domains: 1) Clinical Care, 2) Experience and Coordination of Care, 3) Safety, and 4) Efficiency and Cost Reduction.
Each participating hospital receives an achievement and improvement score for each domain. The higher of the two is selected and weighted accordingly. All domain scores are then summed together to create the VBP Total Performance Score (TPS). This score is then converted into the hospital’s “adjustment factor,” a multiplier CMS applies to a hospital’s base payment covering each patient’s stay during a given time period.
Adjustment factors above 1.0 indicate that a hospital will receive back from CMS their full withholding plus a bonus. Hospitals with an adjustment factor below 1.0 will be assessed a penalty. For example, a hospital with a VBP adjustment factor of 0.9903 would be paid 99.03% of what Medicare usually reimburses for each service. It’s important to note that the VBP program is a mix of withholding repayment and bonus (or penalty) and required by law to be budget neutral.
The Study Methodology
To determine if and to what extent CDS could help hospitals improve performance on key metrics, the Rockburn Institute evaluated data compiled over a three-year period from all U.S.-based hospitals with a CMS Certification Number that participated in the VBP program. From this base of approximately 3,000 hospitals, 41 facilities were identified that utilized both Lippincott Procedures and Lippincott Advisor for the complete 2014 and 2015 calendar years.
The performance of hospitals using the CDS tools—which represented a mix of community-based clinics, hospitals serving large geographic regions and large university-based systems in 20 different states—was compared to the other hospitals that had received VBP scores for 2014 and 2015. Scores of the 41 CDS facilities were then evaluated for 2017 against their previous years’ results.
By Abhinav Shashank, co-founder and president, Innovaccer.
Abhinav Shashank
Consider a situation where healthcare is not just an industry term — a situation where EHRs are not an integral part of physicians schedule but just a support to providing care. All considered, imagine a situation where patient-centric care actually involves the patient, and patient engagement is not just a buzzword but a reality. Unfortunately, all these imaginations were supposed to be a reality, but still, healthcare managers and organizations are struggling with the problems such as the lack of patients’ adherence to medication, varying trends in the population health, and a lot more. Patient population, nowadays, expect the same on-demand delivery convenience from the healthcare organizations as they get from the other companies, like Netflix.
Why is Patient Engagement the Core of Providing Patient-centric Care?
To understand the value of the patient in the entire care continuum, let us take an example. Consider a patient, Marcus, who works at an IT firm and is affiliated to a Commercial ACO in his county. Marcus is a 65-year-old male suffering from comorbidities like Type 1 Diabetes, and diabetic retinopathy. He is at constant risk of sporadic elevated blood pressure.
In the year 2016, Marcus visited the ED approximately five times. Considering the situation, his primary care physician referred him to a specialist and prepared a schedule comprising at least two monthly visits.
The year 2017 started with a lot of workload for him at his firm, and he was unable to keep up with the prescribed schedule. Because of improper communication between his PCP and him, his physician was not able to keep track of Marcus’s health. As a result, the ED utilization rate for Marcus increased from five times to nine times. Because of enhanced stress and improper quality of care, the sporadic episodes of elevated blood pressure turned into a constant problem of hypertension. Also, the overall cost of care for Marcus increased drastically.
Challenges in Achieving True Patient Engagement
Patient engagement, in itself, is not as simple as ABC. It is not just bringing patients in the cycle of care continuum but enhancing the patient’s skills, ability, knowledge, and most importantly, willingness to participate in the task of managing his own care. The concept of providing care with “engaged patients” sounds great theoretically, but it is not that smooth sailing. According to a survey, nearly 87 percent of the patient population believes that communication with their doctor apart from their scheduled appointments is really important.
The major flaw is the lack of awareness among the patients regarding their care procedures. Many patients are ignorant of the clinical processes which a physician follows, and they might miss out on major health details. With no actual knowledge of the disease symptoms, patients might not report to their physicians which might lead to reduced patient engagement, not to mention the increased risk of developing a chronic disease.
Care teams play a vital role in engaging the patients through regular follow-ups. Irregular and fragmented workflows of care managers and lack of personalization might lead to the generation of ineffective care plans for the patients. Reduction in patient engagement could also be the result of under utilization of technologies to analyze the massive amount of patient data that care managers have at their disposal. Through building more personalized care plans, patients can be engaged at a more grass-roots level.
Driving Effective Engagements through Value-based Care
Predictive population health analytics is the answer to nearly every problem linked with patient engagement. Advanced predictive analytics tools will help in dealing with the problems of disparate data systems and can pinpoint the exact area on which healthcare organizations can focus. Leveraging the insights obtained by data analytics, care teams can prepare the statistical models to prioritize each patient and can take necessary measures to engage patients in the process of decision-making. Understanding the patients’ habits by the care teams increases the chances of preparing personalized care plans for them and enhancing the level of patient satisfaction.
Intiva Health is the first truly integrated career platform for healthcare professionals. It redefines the medical credentialing process by making it faster, more efficient and more secure.
Elevator pitch
Intiva Health provides healthcare professionals with a single place to manage their credentials,continuing education, new job opportunities, secure messaging needs and more. It is built on the Hashgraph digital ledger platform, which means it is faster, more secure, and more error proof than blockchain.
Founders’ story
Intiva Health was founded in 2006 as a staffing agency for surgical services and emergency rooms. Today the Austin, Texas company it has reinvented itself as a digital health startup featuring a next generation blockchain technology that cuts the time it takes for the medical credentialing process from months to seconds, improves HIPAA compliance,and makes document tampering or theft almost impossible.
Marketing/promotion strategy
Intiva Health focuses its marketing and PR efforts on licensed medical professionals (LMPs), practice managers, and the facilities where they work including medical groups, hospitals and professional associations.The company launched a new brand awareness campaign in March 2018 that included the introduction of the Intiva Token, a new cryptocurrency that LMPs can use to purchase continuing education classes, cyber insurance and other services.
Intiva is also partnering with the National Osteoporosis Foundation to test the advantages of using the IntivaToken for charitable donations.
Market opportunity
The Intiva Health Platform automates the burdensome tasks of credential and licensure management, continuing education, and discovering job opportunities for healthcare professionals. Intiva Health’s new ReadyDoc™credential verification solution, built on top of the Hashgraph distributed ledger technology, disrupts the existing broken, slow, and error-prone healthcare credentialing system, which today can take weeks or months to verify credentials, and is subject to tampering.
Intiva believes that ReadyDoc can replace the current processes of credentialing and primary source verification by storing documents and credentials in a Hashgraph-based distributed ledger. Providers and facilities can obtain information that is pre-verified, securely stored, and readily available, creating an ongoing, self-auditing verification of provider work history and clinical reputation.
ReadyDoc will act fluidly between health systems and facilities across the U.S., allowing organizations to instantly verify work history and clinical reputations. In the event of an emergency like the Houston hurricane, facilities will be able staff up by vetting the credentials of qualified providers instantly. ReadyDoc eliminates redundancy and the need for third party verification organizations, letting medical professionals get to work sooner.
Unlocking the genomic code to usher in a new era of medical technology.
Founders’ story
The core Shivom team came together after numerous meetings at blockchain and genomics conferences. During these, we frequently reached conclusions on how to solve the current issues in the medical domain, by combining the bleeding-edge of blockchain technology with genomic sequencing.
Marketing/promotion strategy
The fuel that powers the Shivom platform is community involvement. We aim to forge meaningful partnerships with medical groups around the world, which can then interact directly with the Shivom blockchain and its users.
Market opportunity
Shivom’s target audience? Everyone. Big data analysis requires big data sets, and in the case of the platform, the more users having sequenced and uploaded their genomic data means that there is a larger pool of information to draw from. Of course, a large part of the offering is the secure storage of this information is securely stored, and the individuals to whom it belongs can choose to monetize it by allowing access to innovators in the medical space.
Who are your competitors?
There are few competitors in this space – somewhat reassuring, as our vision is to unite players in the medical field. However, Nebula is a blockchain platform also occupying the genetic niche.
How your company differentiates itself from the competition and what differentiates Shivom?
Simply put, Shivom is a blockchain storage and analytics platform for genetic information. On top of its core functionality, it also enables users to profit from their data by sharing it with institutions.
Differentiating it from similar projects is its magnitude – a global reach and a unique classification system for genomic ID. On the roadmap are integrated AI protocols for in-depth insights.
Business model
Shivom is still in its infancy, although we anticipate that, in moving forward, revenue will be generated by pharmaceutical companies wishing to use data in their research. Additional revenue will stem from a range of apps and services (to glean insights on one’s uploaded data) and the sale of sequencing kits.
Babyscripts is a virtual care platform for prenatal care powered by mobile apps that drive better patient decision making, IOT devices for remote monitoring, and a host of population health tools to give providers access to patient data in real time.
Founders’ story
Juan Pablo Segura
It seems unlikely that two childless bachelors, with no healthcare experience, would start a pregnancy company, but Juan Pablo Segura and Anish Sebastian founded Babyscripts, now the most impactful digital health tool in the obstetrical market. In 2014, with a passion to improve the current healthcare system due to family health struggles, business savvy, and the tenacity to succeed, these two former Deloitte consultants found themselves in front of the Chair of Obstetrics at George Washington School of Medicine & Health Sciences, Dr. Nancy Gaba, which started the journey of Babyscripts.
Marketing/promotion strategy
Babyscripts sells to health systems, private practices, and payers to support women’s health initiatives in pregnancy care. Babyscripts is then delivered by a care provider to an expectant mother at the beginning of her pregnancy. It is deployed through risk-specific modules that are tied to the clinical/social risk of a patient at the point of care.
Anish Sebastian
Market opportunity
Each year, 4 million babies are born in the United States. Babyscripts works with the providers of care for these pregnancies – health systems and private practices – to support better access to care and better quality of care. Currently, nearly half of the counties in the United States don’t have access to an OB-GYN, according to the American College of Nurse-Midwives. The American Congress of Obstetricians and Gynecologists estimated that in 2020, there will be between 6,000 and 8,000 fewer OB-GYNs in the country than needed. Babyscripts is the only clinically validated tool that allows doctors to automate aspects of care, enabling there to be greater efficiency in the workflow, enabling doctors to touch more patients in a meaningful way.
Who are your competitors?
Our competition can be categorized in a few areas:
There are Consumer Maternity Apps in the market (ex. What to Expect, BabyCenter, The Bump)
Payer focused apps and programs for maternity (Wildflower Health, Ovia Pregnancy)
Non-Obstetric based clinical apps (ex. Wellpass, Vivify Health, Conversa Health)
How your company differentiates itself from the competition and what differentiates Babyscripts?
Babyscripts is the only platform that connects the clinical provider and patients together using technology, while at the same time lowering the cost of care. By including the provider and all of their guidance, specific information and advice into the equation, it ensures that a patient is getting information that aligns with her provider’s care plan, while keeping engagement high. Additionally, Babyscripts is the only clinical tool that is singularly focused on solving obstetrical problems.
In 2017, a new type of pill bottle was invented that could save $300 billion and 125,000 deaths a year. This is the estimated cost of people forgetting to take their medication. Remembering to take your daily prescription is difficult for anyone, but for people living with decreased memory function, it can be almost impossible.
Not doing so can slow down the recovery process. Technology is now helping to send reminders to take the medication and to keep track of a patient’s dosage intake. This is set to save both lives and money, meaning a win for everyone involved. The addition of internet capabilities to everyday objects is known as ‘the internet of things’ and it could revolutionize the healthcare industry.
The cost of missed prescriptions
For people with serious heart conditions or neurological concerns, medication is essential to their continued well-being and recovery after surgery or other medical procedure. It really is a matter of life or death for many to ensure that they remember to take their prescription pills. The human cost of missed prescriptions is estimated at 125,000 deaths a year.
Then there is the cost to the economy. Pills are a cost-effective way to prevent serious conditions before they arise. If you forget to take one, then you may require additional and expensive medical support. This is estimated to cost $300 billion each year.
What are smart pill bottles?
Many use smartphone reminders to give a daily alert letting the user know that it is time to take a pill. However, this can happen when the person is out and can’t access their pills until later, by which time they may have forgotten. Smart pill bottles have internet capabilities built into them, so they can monitor when the lid is opened and whether a dose has been taken.
This means that the bottle is always aware if a pill is due to the user and can continuously offer reminders. This is simple technology, but this is exactly why it is so effective. Anyone, regardless of tech knowledge, can use this and over millions of cases, it could make a substantial impact.
Smartphone app solutions
Unfortunately, smart pill bottles aren’t yet widely available. However, if you are taking prescription medication and own a smartphone, there are other steps you can take. Apps, such as Patient Partner, are designed, not only to offer reminders but to offer education as well. Understanding why taking pills is so important can help you to remember. It is easy to forget to do something as simple as throwing a pill in your mouth; an action which has no immediate effect and so appears somewhat irrelevant on the surface level. These apps are free to install, easy to use, could make a huge difference in the life of someone who regularly needs to take medication.
By Helen Waters, executive vice president, MEDITECH.
Helen Waters
What would you do if you won the lottery? Regardless whether or not you play, you’ve surely pondered the question. Recently, during the frenzy around one mega jackpot or another, I had an interesting conversation with a friend. She told me if she were to win she’d replace everything she owned with the “very best” version of every item. When I asked how she’d know a product was the best, she told me she’d simply choose the most expensive option. In her thinking, she would have money to spare, and buying the products with the highest price tag would guarantee high quality. She admitted she might spend a little more than necessary, but she’d be able to afford it.
My reaction—which I didn’t express quite so bluntly—was, how wasteful and misguided!
As Americans we like to think that the market, uncorrupted by human influence, effectively sets prices for products and services that are in line with their value. But there are many reasons that markets don’t always work this way, particularly in the complex world of healthcare.
The more I thought about it, the more I realized that this kind of thinking guides some of the ways we make purchasing decisions in healthcare. Many patients, for example, feel that brand-name drugs must be superior to their generic counterparts—even when clinical trials demonstrate comparable effectiveness—simply because they’re priced higher and accompanied by persuasive advertising. Patients often lobby their physicians for expensive tests or procedures that have little to no evidence of efficacy for their conditions. And yes, even in our industry, otherwise-savvy executives can spend much more than necessary for healthcare information technology.
Over the past decade, the cost of electronic health record software and services has skyrocketed, far outpacing inflation and becoming untethered from real value. It’s understandable how this began, as the ARRA and HITECH Act infused cash into the market along with strong incentives to adopt the technology (as well as disincentives for falling behind). But those days are long gone. Hospital margins have continued to shrink. To the best of my knowledge, no healthcare facility has won the lottery lately.
Whether you’re buying a new appliance, a new car, or a new EHR, it’s important to do your homework. Look at the data. Perform a real comparative analysis. This means more than simply perusing marketing literature, conducting feature comparisons, or reviewing anecdotal feedback. It means looking at outcomes. Unlike many other products, software is abstract. You can’t touch it or see it to assess its value. You need to evaluate the impact it has and the satisfaction levels of the organizations that use it.
Just like a good physician wants to see evidence of the benefits of a drug, procedure, or care protocol by evaluating patient outcomes, healthcare executives must demand proof that an EHR is improving clinical and financial outcomes at organizations like theirs. Some important questions to ask:
Federal healthcare organizations, such as CMS, have spent billions of dollars over the years trying to bridge the gap between medical data and quality patient care with interoperability requirements and data integration, the mesh used to try and bridge the gap. Many government rules have been written to address the type of mesh needed and many EHR companies have claimed to meet these government requirements and claim the throne of the ultimate mesh maker.
However, hospitals and clinics found the mesh contained many holes, such as enabling hospitals to customize EHRs, but only if the EHR customers purchased the EHR systems for the manufacturers for millions of dollars that hospitals could ill afford. Also issues such as proprietary connectivity to their own brands that left the hospitals’ other EHR systems to serve as dead-end data silos. Rules and solutions came and went, but few had any teeth until now.
Anyone for A Slice Of PI?
To end the lack of interoperability morass and data duplication, the Department of Health and Human Services (HHS) issued 1,883 pages of proposed changes to Medicare and Medicaid. The changes rename the Merit-Based Incentive Payment System (MIPS) Advancing Care Information performance category to Promoting Interoperability (PI).
CMS announced the change as part of a proposed rule that will transform the EHR Incentive Programs commonly known as meaningful use under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed policies are part of the MyHealthEData initiative, which prioritizes patient health data access and interoperability improvements.
But this time the name change wasn’t just that. For the first time a new CMS rule specifically requires providers to share data to participate in the life blood of hospital reimbursement—Medicare and Medicaid. The rule also floats the idea of revising Medicare and Medicaid co-pays to require hospitals to share patient records electronically with other hospitals, community providers and patients — a clear-cut demand for interoperability.
PI also reduces hospital interoperability requirements from 16 to six, revamping the program to a points-based scoring system and is requiring that hospitals make patients’ EHRs available to them on the day they leave the hospital beginning in 2019.
Does Your EHR Have the Right Stuff?
While this news from CMS appears to be a step in the right direction to solve a problem that has plagued the healthcare industry for many years, it must first be made a reality by those ultimately responsible for its implementation—hospital HIT organizations. The days of data obstruction and silo logic must end with a focus on new EHR markets built on interoperability.
Interoperability requires multiple layers to demonstrate an EHR system can be accessed. Meanwhile, every EHR system claims to support some form of interoperability, ranging from web interfaces to API protocols or to the lowest and highest cost HL7. However, healthcare systems will have to demonstrate their operability to CMS to abide by PI and therefore allow access of their EHR systems. Hospitals and clinics can encounter many challenges with this, such as HIPAA compliance and support for their infrastructure for open secure access, requiring an HIE and the funds to support data synchronization and IT support.
Intiva Health
Unlocking the genomic code to usher in a new era of medical technology.
In 2017, a 
