Author: Scott Rupp

Health IT’s Responsibility to Produce Actionable Healthcare Data in 2016

Guest post by LeRoy E. Jones, chief executive officer, GSI Health, LLC.

The Care Coordination LeadersThe health IT revolution is here and 2016 will be the year that actionable data brings it full circle.

Opportunities to achieve meaningful use with electronic health records (EHRs) are available and many healthcare organizations have already realized elevated care coordination with healthcare IT. However, improved care coordination is only a small piece of HIT’s full potential to produce a higher level synthesis of information that delivers actionable data to clinicians. As the healthcare industry transitions to a value-based model in which organizations are compensated not for services performed but for keeping patients and populations well, achieving a higher level of operational efficiency is what patient care requires and what executives expect to receive from their EHR investment. This approach emphasizes outcomes and value rather than procedures and fees, incentivizing providers to improve efficiency by better managing their populations. Garnering actionable insights for frontline clinicians through an evolved EHR framework is the unified responsibility of EHR providers, IT professionals and care coordination managers – and a task that will monopolize HIT in 2016.

The data void in historical EHR concepts
Traditionally, care has been based on the “inside the four walls” EHR, which means insights are derived from limited data, and next steps are determined by what the patient’s problem is today or what they choose to communicate to their caregiver. If outside information is available from clinical and claims data, it is sparse and often inaccessible to the caregiver. This presents an unavoidable need to make clinical information actionable by readily transforming operational and care data that’s housed in care management tools into usable insights for care delivery and improvement. Likewise, when care management tools are armed with indicators of care gaps, they can do a better job at highlighting those patients during the care process, and feeding care activities to analytics appropriately tagged with metadata or other enhanced information to enrich further analysis.

Filling the gaps to achieve actionable data
To deliver actionable data in a clinical context, HIT platform advancements must integrate and analyze data from across the community—including medical, behavioral, and social information—to provide the big picture of patient and population health. Further, the operational information about moving a patient through the care process (e.g., outreach, education, arranging a ride, etc.) is vital to tuning care delivery as a holistic system rather than just optimizing the points of care alone. This innovative approach consolidates diverse and fragmented data in a single comprehensive care plan, with meaningful insights that empowers the full spectrum of care, from clinical providers (e.g., physicians, nurses, behavioral health professionals, staff) to non-clinical providers (e.g., care managers, case managers, social workers), to patients and their caregivers. Armed with granular patient and population insights that span the continuum, care teams are able to proactively address gaps in patient care, allocate scarce resources, and strategically identify at-risk patients in time for cost-effective interventions. This transition also requires altering the way underlying data concepts are represented by elevating EHR infrastructures and technical standards to accommodate a high-level synthesis of information.

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Data Governance at Top of Healthcare IT To-Do Lists in 2016

Guest post by Susan Kanvik, healthcare senior director, Point B.

Susan Kanvik
Susan Kanvik

The goals of data governance have long been clear outside of the healthcare industry. Organizations want to enable better decision-making, reduce operational friction, protect the needs of data stakeholders, train management and staff to adopt common approaches to data issues, build standard, repeatable processes, reduce costs and increase effectiveness through coordination of efforts and ensure transparency of processes.

That’s a tall order. And one that’s coming to healthcare this year for several reasons:

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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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Five Key Trends Will Shape Inpatient Telemedicine in 2016

Guest post by Dr. Talbot “Mac” McCormick, president and CEO, Eagle Hospital Physicians.

Talbot "Mac" McCormick, M.D.
Talbot “Mac” McCormick, M.D.

Looking back at 2015, we see significant trends impacting inpatient telemedicine that will gain strength through 2016. Here are the Top Five: How they impacted healthcare, and how they will change hospital medicine moving forward.

 More Legislation and Regulation Activity

A recent report from the National Conference of State Legislatures showed there were 200 telemedicine bills introduced in all but eight states in 2015. The federal government also introduced the TELEMedicine for MEDicare Act of 2015 and the Veteran’s E-Health and Telemedicine Support Act of 2015, which are aimed at creating an interstate license for those practicing telemedicine for these patient populations. Last year, 32 states and the District of Columbia enacted telemedicine parity laws, requiring health plans to reimburse telemedicine the same way—and at the same cost—as in-person service. We expect to see more of this activity as telemedicine becomes an increasingly integral part of healthcare in America.

Easier Licensure Across States

Currently, if you have a group of physicians caring for patients in hospitals in four or five states, they must become licensed in each of those states. As noted above, recent legislation (along with new telehealth licensing compacts between states) will make it easier for physicians to get a license across state lines. This will clearly help facilitate the use of telemedicine services

Growing Financial Support

Today, the payer response can best be described as a patchwork. Medicare typically doesn’t reimburse for inpatient telemedicine (except in rural areas as Medicaid), and the commercial payers tend to vary from state to state. There isn’t a uniform basis for reimbursements. Many hospitals end up financing most of the costs of inpatient physician services delivered with telemedicine?and we all know healthcare dollars are tight for everybody. However, the physician reimbursement is moving, albeit slowly. The state parity laws will help. So, too, will having more commercial payers recognize the value of telemedicine services. For example, UnitedHealth Group announced plans to expand coverage for virtual physician visits to employer-sponsored and individual plan participants, increasing those covered from approximately 1 million to well more than 20 million. Better reimbursement structures will help fortify hospitals’ financial underpinnings and alleviate some of the burden they’ve been forced to bear.

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Looking Ahead: Analytics Move from Informational to Actionable

Rose Higgins
Rose Higgins

Guest post by Rose Higgins, president, North America, SCIO Health Analytics

Since they were first introduced, analytics have primarily been used to help healthcare organizations understand past events. In other words, they’ve been informational. That’s important, because as George Santayana is famously quoted as saying, “Those who cannot remember the past are condemned to repeat it.” But understanding what happened, or even why it happened, doesn’t necessarily tell you what actions to take to either avoid or improve upon the prior results.

In 2016, analytics will evolve to show us what will occur if we continue down the same path (predictive), as well as the possible outcomes of several different alternatives (prescriptive), helping healthcare organizations make better decisions.

Here are a few ways the evolution of analytics will manifest itself in the coming year.

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The Outlook for ACA Healthcare Delivery Reforms

Guest post by Ken Perez, vice president of healthcare policy, Omnicell, Inc.

Ken Perez
Ken Perez

The Patient Protection and Affordable Care Act (ACA) mandated five major healthcare delivery reforms that collectively aim to improve care quality and slow the growth of healthcare spending. In the five years since passage of the ACA, each of these delivery reforms has been implemented, revised and broadened.

What is the outlook for these changes? Clearly, the long-term strategic intent of the Obama administration is to shift Medicare payments from fee for service to fee for value. On Jan. 26, 2015, Health and Human Services Secretary Sylvia Burwell set forth quantified goals and an aggressive timeline for directing an increasing share of Medicare payments through alternative payment models (APMs) such as accountable care organizations (ACOs) and bundled payments, from 20 percent in 2014 to 50 percent in 2018. Let’s consider each of the major healthcare delivery reforms.

Accountable Care Organizations

On January 11, the Centers for Medicare & Medicaid Services (CMS) announced that 477 organizations are participating in one of Medicare’s four accountable care programs.

With 434 current participants, the Medicare Shared Savings Program (MSSP) accounts for the vast majority (91 percent) of the total. Although the total number of MSSP ACOs has grown steadily each year since the program’s inception in 2012, cumulatively about 100 ACOs (19 percent) have dropped out of the program.

Medicare’s first ACO program, the higher-risk, higher-reward Pioneer ACO Model, suffered numerous departures during the second half of 2015, as the number of Pioneers has dropped from 32 original participants announced in December 2011 to a current total of nine, a 72 percent decline. However, some of the departing Pioneers have transferred to the MSSP or the even higher-risk, higher-reward Next Generation ACO Model, which was launched in March 2015.

CMS also disclosed that 21 organizations are participating in the Next Generation ACO Model, including five former Pioneers. The remaining 13 of the 477 ACOs are the initial participants in the first disease-specific Medicare ACO program, the Comprehensive ESRD Care Model, which was announced in October 2015.

Despite these seemingly impressive numbers, to achieve the aforementioned goal of flowing half of Medicare payments through APMs by 2018, CMS needs even more growth in the number of Medicare ACOs coming onboard in the next couple of years, perhaps 150-200 net new ACOs per year in 2017 and 2018.

Bundled Payments

In 2013, CMS launched the Bundled Payments for Care Improvement Initiative (BPCI), a voluntary program which offers providers four episode-based payment models. In three of the models, implementation is divided into two phases. During Phase 1, “the preparation period,” CMS shares data and helps the participating providers learn in preparation for Phase 2, “risk-bearing implementation,” in which the providers begin bearing financial risk with CMS for some or all of their episodes. CMS required all participants to transition at least one episode (e.g., Acute Myocardial Infarction) into Phase 2 by July 1, 2015, to continue participating in the BPCI.

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6 Healthcare Predictions for 2016

Guest post by Torben Nielsen, senior vice president product and strategy, HealthSparq.

Torben Nielsen
Torben Nielsen

The past few years have seen record investments in digital health. More than $12 billion have been poured into digital health companies in 2014 and 2015 alone, according to Rock Health, and there’s no indication of any slowing in 2016.  Here are my predictions for what’s in store for health care in the New Year:

#1: Fragmented and disparate data sets turning into relevant and comprehensive information sets

Healthcare data sources have been siloed and fragmented for years. Data in electronic health records (EHRs) have worked within the hospital setting (to some degree), but not across systems, or for the consumer. Patient portals have attempted to bring data together, but with limited adoption due to sporadic data, old interfaces and no clear use model. With new data standards, APIs, and open source developments, data will become more fluid and accessible. We will finally start to see data portability and data integration in ways not witnessed before. This will be to the benefit of the consumer, who will be able to share and embed data from different sources into their preferred view. This will ultimately create a more relevant and engaged experience for the healthcare consumer.

#2 Continuous and team-based care on the rise

Along with a deeper and more portable experience of one’s own healthcare information (both from the healthcare system and via patient-driven data) comes a more continuous and streamlined patient-doctor experience. Interaction between the patient and the system will happen via Wi-Fi enabled technology and smart devices allowing for a continuous stream of data and information. This will benefit the doctor, who will be able to interact and react much faster. It will also do away with the “information black-outs” that often occurs between the time a patient visits their physician, all the way until their next scheduled visit. The patient will also be able to better track their condition. Furthermore, much of this information can be shared with the patient’s broader care team such as significant others, children, specialists, etc. This will ultimately benefit the care provider, the patient and the overall system.

#3 Millennials will be the catalysts for the healthcare consumer revolution

One of the most over-used buzzwords in the healthcare industry today is “consumer/patient engagement.” Everyone seems to have a solution for driving up engagement for the masses. However, it’s a fallacy to believe that anyone or everyone will engage in a particular system, process or technology. As is the case with most products, an early-adopter segment needs to be identified to successfully scale and ramp up sales. For healthcare, millennials will be a great catalyst for change and the movement towards consumerism. This generation has grown up with Uber, Amazon, Instagram and Facetime. They will demand a much more efficient and technology driven healthcare experience. They will push for a seamless and personalized experience, and their voice will become stronger and stronger over the years as they start consuming healthcare to a greater extent.

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Health IT’s Responsibility to Produce Actionable Data in 2016

Guest post by LeRoy E. Jones, CEO, GSI Health, LLC.

LeRoy Jones
LeRoy Jones

The health IT revolution is here and 2016 will be the year that actionable data brings it full circle.

Opportunities to achieve meaningful use with electronic health records (EHRs) are available and many healthcare organizations have already realized elevated care coordination with healthcare IT. However, improved care coordination is only a small piece of HIT’s full potential to produce a higher level synthesis of information that delivers actionable data to clinicians. As the healthcare industry transitions to a value-based model in which organizations are compensated not for services performed but for keeping patients and populations well, achieving a higher level of operational efficiency is what patient care requires and what executives expect to receive from their EHR investment.

This approach emphasizes outcomes and value rather than procedures and fees, incentivizing providers to improve efficiency by better managing their populations. Garnering actionable insights for frontline clinicians through an evolved EHR framework is the unified responsibility of EHR providers, IT professionals and care coordination managers – and a task that will monopolize HIT in 2016.

The data void in historical EHR concepts
Traditionally, care has been based on the “inside the four walls” EHR, which means insights are derived from limited data, and next steps are determined by what the patient’s problem is today or what they choose to communicate to their caregiver. If outside information is available from clinical and claims data, it is sparse and often inaccessible to the caregiver. This presents an unavoidable need to make clinical information actionable by readily transforming operational and care data that’s housed in care management tools into usable insights for care delivery and improvement. Likewise, when care management tools are armed with indicators of care gaps, they can do a better job at highlighting those patients during the care process, and feeding care activities to analytics appropriately tagged with metadata or other enhanced information to enrich further analysis.

Filling the gaps to achieve actionable data
To deliver actionable data in a clinical context, HIT platform advancements must integrate and analyze data from across the community—including medical, behavioral and social information—to provide the big picture of patient and population health. Further, the operational information about moving a patient through the care process (e.g., outreach, education, arranging a ride, etc.) is vital to tuning care delivery as a holistic system rather than just optimizing the points of care alone. This innovative approach consolidates diverse and fragmented data in a single comprehensive care plan, with meaningful insights that empowers the full spectrum of care, from clinical providers (e.g., physicians, nurses, behavioral health professionals, staff) to non-clinical providers (e.g., care managers, case managers, social workers), to patients and their caregivers.

Continue Reading