By Ken Perez, vice president of healthcare policy, Omnicell, Inc.
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.
By Helena Bogdanova, a tech journalist with OCSICO. She covers tech news on IoT, mobile applications, healthcare and custom software development.
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
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.
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.
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.
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:
About 98 percent of people read it
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 –
Tell patients what they need to do to get the desired results
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.
By Mark Weber, SVP of healthcare development, Infor.
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.
In the handful of years since the Affordable Care Act expanded coverage to millions of previously uninsured and underinsured Americans, hospitals and health systems have seen an increase in patients. The influx has meant that the number of incoming phone calls has skyrocketed for healthcare organizations. As systems struggle to handle increased patient volume, upgrading contact center services is proving to be an important venture.
Regardless of the current state of a contact center’s operations, virtually every healthcare organization can make improvements to better serve patients and staff and strengthen their bottom line. Organizations can do this by accurately identifying where they are on the contact center maturity curve, asking smart questions about readiness to move forward and strategically deploying technology.
Hospitals and health systems are at widely different junctures on the journey toward modernizing their contact centers. Therefore, as part of planning for upgrades, organizations should perform a self-examination and determine what level of operation they are at currently. Some of the questions teams can ask as they work to identify where they are on the maturity curve include:
Are our contact center systems and processes on par with our competitors?
How many sources of patient data do we currently use?
Are we tracking and leveraging patient communication preferences in our EHR? Are we using those preferences?
Are we routing callers through a “single front door” regardless of the phone number they dial?
Do our agents have the ability to schedule for all physicians within a respective specialty (including primary care) or clinic, both hospital and ambulatory?
By considering these and other questions, hospitals and health systems can start to understand their contact center’s maturity level and how much room there is for growth and improvement. The next step is to think about what it will take to actually implement change, and evaluate readiness. To do this, organizations may want to ask questions like:
How comfortable are we when it comes to adopting new technologies?
Is our organization committed to embracing technology so we can maximize operational efficiencies and effectiveness while still maintaining the human touch?
How much do we prioritize providing a “world class” access experience for our patients and providers?
Cultural challenges sometimes make focusing on contact center optimization difficult for hospitals and health systems, because the culture within many organizations does not support contact center investments. Unfortunately, when hospitals and health systems neglect contact center updates, patient experiences and satisfaction suffer. For hospitals, maintaining high patient satisfaction is more important than ever because the financial impact of patient experiences has increased due to consumerization and value-based payment programs.
One solution that may help generate support for contact center updates is to conduct an evaluation of the competitive risk of not modernizing. The results of a competitive analysis may help spur internal support for technology upgrades and other contact center improvements.
Technology is obviously an essential part of every successful contact center, which is why so many have adopted physician answering services to help manage call volumes. With the right technology and a strategic plan for how to use it, hospitals and health systems can offer features like a single entryway into their organization, predictive interactive voice response and automatic data pass with transfers. For the following outlined reasons, these contact center features are must-haves for modern contact centers.
A Single Entryway – Having a single point of entry for all patients ensures that every patient is greeted with a consistently branded user experience. It also means less confusion and frustration for callers and staff. When calls are routed through an automated centralized phone system, efficiency increases. Overall, hospitals have more control over each caller’s experience when calls are routed through one main gateway.
Intelligent Predictive Interactive Voice Response – Interactive voice response (IVR) systems allow hospitals to automate call routing and handle higher volumes of calls. Also, an intelligent IVR makes navigation easier for patients because it can detect what they need. Ideally, when a patient calls a hospital, the IVR system will authenticate the patient, identify possible reasons for their call and connect them to the appropriate destination. The right IVR technology will not only make communications more efficient, but also more patient centered.
Automatic Data Pass with Transfers – Staff can better and more quickly assist callers if background information is transferred with each incoming call. Without automatic data pass there is typically a lot of duplication when team members end up asking patients for information they have already provided. Rather than having staff repeat work by asking questions and gathering info that has already been collected, teams can rely on technology to automatically provide necessary data.
Utilizing technology to drive automation, increase efficiency and improve patient experiences should be the aim for hospitals and health systems. Finding ways to do these things requires an understanding of current contact center operations, executive buy-in and, in most cases, technology updates. While there are challenges that come along with modernization, contact center improvements allow healthcare organizations to better service a larger number of patients.
The joint venture just announced between Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. is anticipated to bring profound transformation to the healthcare industry. By joining forces, these three giants hope to leverage their technological, sales, and investment expertise to address and resolve the many inefficiencies in the current U.S. healthcare system. The objective of this partnership is to harness their considerable scale and operational efficiency to manage healthcare’s rapidly growing costs, placing greater emphasis on providing high-value healthcare services.
Regardless of whether the partners are successful in disrupting the healthcare industry, one positive outcome is the strength these new players bring the comparative weakness of the fragmented American healthcare system into sharp relief. In the press release, Berkshire Hathaway Chairman and CEO Warren Buffett explains the primary motivator of the joint venture with the now-infamous phrase, “The ballooning costs of healthcare act as a hungry tapeworm on the American economy.” With healthcare accounting for 17.9 percent of the gross domestic product in 2016, the “hungry tapeworm” of exploding healthcare costs is fueled by the widespread inefficiencies of the U.S. healthcare system.
The industry is still riding out significant aftershocks from recent M&A activity. In the last month alone, CVS purchased Aetna for $69 billion to remake the consumer healthcare experience, Catholic Health Initiatives (CHI) and Dignity Health joined forces to expand their reach across 28 states with 700 care sites and 139 hospitals, and Providence St. Joseph Health and Ascension are expected to merge to create the largest hospital operator in America. In the statement, Amazon Founder and Chief Executive Jeff Bezos acknowledges, “The healthcare system is complex, and we enter into this challenge open-eyed about the degree of difficulty.” With the healthcare industry in the midst of significant upheaval, any new players will face an uphill battle in addressing rising healthcare costs and creating transparency within a notoriously-opaque system.
Addressing the “Tapeworm Effect,” as Buffet mentions, presents a blue ocean for disruptive innovation. The paradigm shift from fee-for-service to value-based care models requires healthcare systems to become increasingly patient-centric. To lower their costs, healthcare systems must eliminate variations and inefficiencies in their care processes that lead to poor patient outcomes, such as hospital-acquired infections and 30-day readmissions. By investing in data-driven technology, healthcare organizations can create systemic improvements in care delivery at every touchpoint across the patient journey.
By Donald Voltz,MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Donald Voltz, MD
Healthcare is evolving quickly and HIMSS 18 offers a broad range of healthcare issues to explore. New requirements for implementing HIT systems have changed dramatically in the last few years as new health IT priorities and procedures have emerged. Convergence in the health care sector has accelerated the need for interoperability, not just for EHRs, but also across clinical, financial, and operational systems. This need is also challenging and changing one of the biggest traditions in healthcare—the doctor patient medical visit.
In the past, patients would simply make appointments to visit their physicians. Now, we have the popularity of Annual Wellness Visits (AWVs) and the growing need for chronic care treatments caused by the opioid epidemic and other behavioral health issues. This trend is causing physicians to be the ones actively pursuing patients, but with both sides reaping the benefits of this new arrangement. The new approach to the traditional doctor-patient relationship enables patients to receive better care while clinics and hospitals build up a roster of new and potentially long care patients.
Disrupting this office visit tradition are also larger, long-term HIT trends, such as the widespread implementation of electronic health records (EHR) and other healthcare practices. However, these trends spurred many challenges, but also a great deal of opportunities, many of which have yet to be fully capitalized upon. To understand these changes, we need to be cognizant of the increasing opportunities patients and physicians have in accessing and interfacing with the healthcare system.
Patients have a great deal more choices and entry points to the complex and dynamic healthcare system than they had even 10 years ago. When Medicare, Medicaid, organ transplantation and synthetic insulin were coming in vogue 50 years ago, patients had relatively limited access to healthcare. Those that did often choose to enter the system through a single physician who they had built a long-term relationship with and who served as the conductor of any labs, studies or further consultation from specialists. With the implementation of governmental and private healthcare insurance options, patients had improved access to care. Commensurate with this increased access to care, an increased national health expenditure followed.
With increased costs, healthcare responded by changing the way patients interacted with the system. Beginning in the ‘70s and continuing into the ‘80s, the rise of HMOs and capitation attempted to improve national healthcare, but this led to limitations in patients’ choice and began the concept of bundling services, cost sharing, and expansion of preventative care. Other managed care plans and a focus on utilization of care continued to decrease the cost of care.
Although many aspects of these managed care structures benefited patients, such as preventive services and prescription coverage, access to services and specific physicians were constrained as “in” and “out” of network coverage, limiting patient choices. The implementation of EHRs has established the foundation upon which opportunities are and will be found to improve healthcare quality by improving the decisions being made.
Enhanced access of patient data by authorized patients, professionals and algorithms focusing on analytics or artificial intelligence is now a requirement for enhanced patient engagement, improving professionals’ delivery of care, enhancing clinical decision making and optimizing patient outcomes while maintaining choices that are consistent with best practices, patient values and prior empirical experiences.
Evolving Relationship Drives Healthcare Revenue
While the doctor-patient relationship has evolved, hospital systems and physicians must still derive revenue which is still at the core of that relationship. The healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWVs), chronic care and service care transitions between physical and behavioral health services. Hospitals and healthcare clinics that can connect these services with technologies such as bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.
“Programs such as revenue cycle management are important for any healthcare institution’s bottom line, but when carriers can actually drive revenue using cloud based, bi-directional interoperability technologies that enable doctors to spend more time with patients and therefore provide superior care, then flipping the traditional patient-doctor relationship is a winning trend for the healthcare industry,” said Doug Brown, managing partner, Black Book Research.
Driving this trend are new apps and innovations that address the payment gap caused by medical billing and collections processes with outdated EHR platforms and inoperable systems. New technologies from organizations, such as Core Care Medical and others, fueled by the growth of cloud computing in the healthcare industry are improving real-time communication and data exchange. Here are some examples of how this is working which you might not hear about at HIMSS.
Hospital CEO Drives Revenue with Doctor Patient Visit Apps
A healthcare colleague, David Conejo, CEO, Rehobath McKinley Christian Healthcare Services (RMCHS) is boosting revenue right now using this doctor/patient flipping model as a strategy to help in his effort to improve behavioral healthcare for Gallup, New Mexico’s large Indian Reservation community who suffer from addiction to alcoholism and opioids.
He integrates data from the hospitals’ three clinics using a cloud application that streamlines data from AWVs and integrates it with any EHR system without data duplication. The Zoeticx ProVizion app also allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits. He can then enter the relevant data about the patient.
In addition, it includes everything else that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurers billing requirements. RMCHS’ business is growing with full or near-full compliance. And with its ACO in startup mode, RMCHS is also receiving a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues being generated.
The fact that more patients can be seen is a bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day that’s an extra 180 minutes. More minutes, more patients.
