Physicians can now get reimbursed for the coordination effort that is involved in managing a patient following a hospital discharge. ACT.md’s TCM-specific Health ACT Sets facilitate a structured, standardized, and proven process for optimal care coordination to reduce hospital re-admissions and support TCM billing. The ACT Sets are structured in a way for providers to assess complexity, complete care actions required by CMS, and follow specific time sensitive requirements for care delivery and billing. ACT.md takes the complexity out of the TCM Billing process and pays for itself within months.
Elevator pitch
ACT.md is the platform for team-based care. Care teams need a way to jointly manage medical conditions in concert with behavioral, social, and functional needs. With ACT.md’s high-tech, high-touch platform and project management-like approach, healthcare organizations can engage in collaborative care planning, efficiently manage in-between visit care, and make safe, reliable handoffs across the care continuum. Our customers have seen a 30 percent reduction in the time spent on care coordination activities and improved compliance to care plans through meaningful caregiver and patient engagement.
Product/service description
Through an elegant and intuitive cloud-based technology, the web-based solution connects all members of a dynamic care team, including the patient and their trusted caregivers. We enable our customers to efficiently develop, reliably execute, and securely communicate a patient-centered care plan across their teams. The technology is complimented with a flexible care coordination workforce service offering to ensure nothing falls through the cracks and clinicians are working at the top of their license.
Origin story
Ted Quinn
“At ACT.md we are patients, caregivers, physicians, nurses, public health professionals, engineers, and operational leaders. We have personally experienced the significant challenges associated with managing complex care and are working to make life better for patients and everyone supporting them,” said Ted Quinn, CEO and Co-Founder, ACT.md.
Founder’s story
The company was founded by Ted Quinn along with Ken Mandl, MD and Zak Kohane, MD, both nationally-renowned healthcare informatics experts. The company was incubated at Boston Children’s Hospital and Harvard Innovation Lab.
“We were inspired to launch ACT.md after observing for decades the constant dropped handoffs across the various providers caring for patients. So we created ACT.md as an operating system for team-based care that drives action toward improved outcomes and reduced costs,” said Dr. Kenneth Mandl, co-founder, ACT.md, professor at Harvard Medical School and director of the Boston Children’s Hospital Computational Health Informatics Program.
Marketing/promotion strategy
Kenneth Mandl
Every healthcare entity is dealing with change management around care delivery and care coordination. We’re sharing our vision of team-based care and it is resonating with the market.
We’re proud to work with our world-renowned advisory board – including John Halamka, MD, CIO at Beth Israel Deaconess Medical Center, and Troy Brennan, MD, CMO at CVS Caremark – who help us share our vision with the nation’s leading providers and payers.
Market opportunity
According to Frost & Sullivan, the care coordination software market is expected to grow at a 26.1 percent compound annual growth rate between 2015 and 2020.
How your company differentiates itself from the competition
EMR/EHR vendors are the incumbents in the market, but they are not designed to do this job. Up to 70 percent of provider/patient work is conducted in the informal region outside the EMR, especially work related to the coordination of care. We have heard directly from healthcare organizations we are working with that with the leading EMR there is no way to track the status of handoffs, connect with outside providers and family caregivers, and that they really need a Care Coordination Record. This is the job that ACT.md is being hired to do, and we are getting traction with large health systems across the country.
ACT.md shines in complex care settings. The company is focused on powering team-based care for high-risk, high-cost patients.
Beverly Glass Buchman, senior vice president of marketing, TouchCare.
Beverly Glass Buchman
Numerous studies show that patient involvement in their own healthcare leads to reduced costs and better outcomes. It is especially beneficial for managing chronic diseases, such as diabetes, asthma and heart disease, and it will become even more vital as the industry continues to move from volume-based care to a value-based care system.
Still, in a recent CommonWealth Fund study, 86 percent of providers said patient engagement has been challenging, specifically when it comes to adopting healthy behaviors and being compliant with treatment protocols and standard care recommendations. The challenge lies in continuing the doctor-patient conversation between office visits. Many physicians struggle to stay connected with patients and follow up between office visits, while balancing their ever-demanding schedules and precious time off.
Mobile technology can help. It can serve as a key component for improving engagement simply by adapting to a patient’s lifestyle. Nearly every American owns a smartphone today and daily usage time continues to skyrocket.
Look at the numbers for American smartphone usage:
64 percent own a smartphone (PewResearch Center)
3 hours each day using their smartphones (ExactTarget)
People download three apps per month on average (comScore)
57 percent of smartphone owners use apps every single day (comScore)
Leveraging text messages, digital portals, and telemedicine video consults can engage your patients between appointments in a way that’s both convenient and familiar. For example, a remote video appointment allows a physician to check in between office visits to ensure medication adherence, discuss recent test results or receive patient feedback to help in shared decision making as treatment progresses. And it can be as easy as Skype or Facetime.
Scheduled virtual video consults can provide valuable data that will help tailor delivery of care to improve outcomes, all while saving money for both the provider and the patient.
Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the fourth installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.
Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read other installments in the series, go here: Health IT’s Most Pressing Issues, Health IT’s Most Pressing Issues (Part 2) and Health IT’s Most Pressing Issues (Part 3). Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.
First and foremost, of all the issues facing healthcare technology, I believe the top issue is the interoperability (or lack thereof) of most electronic medical records systems. Interfacing systems from disparate vendors usually takes expensive custom development, but hopefully the push for free access to EMR/EHR APIs in Stage 3 of the Meaningful Use Incentive program will finally bring semantic interoperability to health IT.
Paul Cioni, senior vice president, Healthcare & Infor Solutions Sales, Velocity Technology Solutions The top issue facing healthcare CIOs is that there is simply too much for them to do, including major initiatives involving information security, patient confidentiality, and revenue cycle management and reimbursement. Most are focusing on what’s urgent, rather than on what’s important. All of these issues are not only competing for a CIO’s budget, but also for his/her time. With so many things on the “as soon as possible” priority list, healthcare CIOs barely have time to strategically plan. It’s difficult for CIOs to create a five-year plan for the organization’s IT when they’re trying to figure out the next five months. A disaster recovery plan, for example, may not get created when CIOs are more concerned with downtime of clinical applications or the reporting of a data breach to the regulatory authorities.
Paul Cioni
The use of the cloud — with a comprehensive but flexible portfolio of service options- helps relieve CIOs from what I call the “tyranny of the urgent.” By allowing a cloud provider to manage a variety of back-office and ERP-related functions, the CIO can shift his focus to systems that affect clinical outcomes. Extending the secure, private cloud approach to clinical systems liberates key resources — budget and people — to focus on achieving meaningful use or embracing population health initiatives. Cloud deployment options like disaster recovery as a service or desktop as a service can conserve capital dollars and speed time to outcome. It’s not one issue – it’s all of them.
Health IT’s most pressing issues may be so prevalent that they can’t be contained to a single post, as is obvious here, the third installment in the series detailing some of the biggest IT issues. There are differing opinions as to what the most important issues are, but there are many clear and overwhelming problems for the sector. Data, security, interoperability and compliance are some of the more obvious, according to the following experts, but those are not all, as you likely know and we’ll continue to see.
Here, we continue to offer the perspective of some of healthcare’s insiders who offer their opinions on health IT’s greatest problems and where we should be spending a good deal, if not most, of our focus. If you’d like to read the first installment in the series, go here: Health IT’s Most Pressing Issues and Health IT’s Most Pressing Issues (Part 2). Also, feel free to let us know if you agree with the following, or add what you think are some of the sector’s biggest boondoggles.
The healthcare industry has undoubtedly become a bigger target for security threats and data breaches in recent years and in my opinion that can be attributed in large part to the industry’s movement to virtualization and the cloud. By adopting these agile, effective and cost-effective modern technological trends, it also widens the network’s attack surface area, and in turn, raises the potential risk for security threats.
We actually conducted some research recently that addresses evolving security challenges, including those impacting the healthcare industry, with the introduction of cloud infrastructures. The issue is highlighted by the fact that the growing popularity of cloud adoption has been identified as one of the key reasons IT and security professionals (57 percent) find securing their networks more difficult today than two years ago.
Paul Brient
Paul Brient, CEO, PatientKeeper, Inc. No industry on Earth has computerized its operations with a goal to reduce productivity and efficiency. That would be absurd. Yet we see countless articles and complaints by physicians about the fact that computerization of their workflows has made them less productive, less efficient and potentially less effective. An EHR is supposed to “automate and streamline the clinician’s workflow.” But does it really? Unfortunately, no. At least not yet. Impediments to using hospital EHRs demand attention because physicians are by far the most expensive and limited resource in the healthcare system. Hopefully, the next few years will bring about the innovation and new approaches necessary to make EHRs truly work for physicians. Otherwise, the $36 billion and the countless hours hospitals across the country have spent implementing electronic systems will have been squandered.
Email security is one of healthcare’s top IT issues, thanks, in part, to budget constraints. Many healthcare organizations have already allocated the majority of IT dollars to improving systems that manage electronic patient records in order to meet HIPAA compliance. As such, data security may fall to the wayside, leaving sensitive customer information vulnerable to sophisticated cyber-attacks that combine social engineering and spear-phishing to penetrate organizations’ networks and steal critical data. Most of the major data breaches that have occurred over the past year have been initiated by this type of email-based threat. The only defense against this level of attack is a layered approach to security, which has evolved beyond traditional email security solutions that may have been adequate a few years ago, but are no longer a match for highly-targeted spear-phishing attacks.
Dr. Rae Hayward, HCISPP, director of education and training at (ISC)²
Dr. Rae Hayward
According to the 2015 (ISC)² Global Information Security Workforce Study, global healthcare industry professionals identified the following top security threats as the most concerning: malware (77 percent), application vulnerabilities (74 percent), configuration mistakes/oversights (70 percent), mobile devices (69 percent) and faulty network/system configuration (65 percent). Also, customer privacy violations, damage to the organization’s reputation and breach of laws and regulations were ranked equally as top priorities for healthcare IT security professionals.
So what do these professionals believe will help to resolve these issues? Healthcare respondents believe that network monitoring and intelligence (76 percent), along with improved intrusion detection and prevention technologies (73 percent) are security technologies that will provide significant improvements to the security posture of their organizations. Other research shows that having a business continuity management plan involved in remediation efforts will help to reduce the costs associated with a breach. Having a formal incident response plan in place prior to any incident decreases the average cost of the data breach. A strong security posture decreases not only incidents, but also the loss of data when a breach occurs.
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
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.
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.”
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.
HealthLoop connects doctors and patients with timely and actionable information, improving patient satisfaction and driving better outcomes. HealthLoop is a cloud-based platform that automates follow-up care; keeping doctors, patients and care-givers connected between visits with clinical information that is insightful, actionable and engaging. Its peer-reviewed follow-up plans automate the routine aspects of care while tracking patient progress and monitoring clinical areas of concern. Its analytics engine sifts through and filters the deluge of patient-generated data in realtime; focusing the care team’s time and attention on patients who need them the most.
Elevator pitch
HealthLoop automates physician and patient connectivity to create an empathetic engagement reducing patient readmission rates by half. It is a technology leader in the field of patient engagement.
Product/service description
HealthLoop’s sophisticated, HIPAA-compliant messaging platform automatically delivers timely check-ins to patients during an episode of care. For example: a knee surgery patient receives daily check-ins from their doctor helping them prepare for surgery and follow pre-op instructions. After being discharged from the hospital, the patient gets daily follow-ups reminding them to change their bandages, work on exercises and watch for signs of infection. This personalized patient experience is delivered with no extra work from medical practice staff. Complications are caught and resolved early through the platform and patient outcomes and physician ratings improve as a result.
Origin/founder’s story
Jordan Shlain MD
Practicing physician Dr. Jordan Shlain was looking to solve a communication problem he encountered with his own patients. As much as he wanted to deliver a caring, VIP experience to each patient, he simply didn’t have the time or the tools to do it automatically. In what Dr. Shlain calls “innovation by irritation,” he had been painstakingly tracking patients between visits in an Excel spreadsheet before hiring a developer to turn it into easy technology. HealthLoop was founded in 2009 based on this original concept.
Marketing/promotion strategy
HealthLoop works with medical practices, departments and hospitals across the country. The company is active at conferences including HIMSS and AAOS. Word-of-mouth from physicians who are able to save time while also delivering personalized care is also a significant driver.
Market opportunity
The rapidly changing reimbursement landscape has created a boom for HealthLoop’s technology. With mandatory bundled payments for hip and knee surgery (CCJR) on the horizon for 2016, increasingly healthcare providers are looking for solutions to provide personalized, responsive service to patients. The patient engagement market is expected to surpass $13.7 billion by 2019.
How your company differentiates itself from the competition
Compared to the typical passive “patient portal,” HealthLoop offers a much more sophisticated and personalized experience to patients. The company tracks an industry-leading patient engagement rate (more than 70 percent). By delivering timely, empathetic messages, HealthLoop has created a platform that is truly useful to patients, physicians and staff.
Errors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.
While many organizations have placed a priority on avoiding billing errors, they still occur. And with the upcoming transition to ICD-10, home health and hospice providers are under even more pressure to get billing right the first time, every time. By most accounts, providers can expect to see a spike in rejected claims during the first few months of ICD-10 implementation; some estimate that as many as 10 percent of all claims will be rejected as coders get used to the new procedures. That’s bound to have an effect on payments and cash flow, so it’s vital that agencies work with their billing offices to identify common errors now, and look for ways to overcome them.
Preparing for the Transition
Ideally, home health agencies should be in the final stages of preparing for the launch of ICD-10 now. August 3 marked the beginning of the 60-day episode period that would end on October 1, when ICD-10 goes into effect. This means that agencies that are beginning care episodes now are required to submit RAPs in ICD-9, but code them in both ICD-9 and ICD-10, so that when the final bill is submitted to Medicare, it will be in the correct format. In many ways, this gives home health providers an advantage, since they will have two months’ worth of practice with the new codes on almost every chart, where most other providers are only practicing dual coding on some charts.
Because of the dual coding requirements, most home health providers have already switched to an ICD-10 compliant software solution. Now is the time to identify gaps in training, and adjust intake procedures, forms and other resources that affect how services are billed. Mitigating potential obstacles now will prevent denied claims later, and smooth the transition.
The Most Common Errors
While the new coding procedures will undoubtedly be a learning curve for many providers, you can reduce the overall number of denied or delayed claims by paying close attention to the most common errors and taking steps to avoid them. These include:
Guest post by Karen Holzberger, vice president and general manager, diagnostic solutions, Nuance Healthcare.
Karen Holzberger
A few years ago, there was a witty car commercial advertising an alert feature that took the guesswork out of filling your tires by gently beeping to signal the appropriate pressure had been reached. It featured a series of vignettes where the car horn would beep, cautioning the owner to reconsider just as he was about to overdo something (for instance, betting all of his money on one roll of the dice). The concept of getting a reminder at the point of a decision is a compelling one, particularly if it can save you time or aggravation and guide you to do the right thing. In healthcare, any technology that can provide that level of support will have a profound impact on patient care.
Albeit humorous, that car commercial wasn’t far off the mark with healthcare challenges. Unnecessary medical imaging exposes patients to additional radiation doses and results in approximately $12 billion wasted each year, but it has also has another unintended downstream effect. It has fueled a culture of medical certainty, where tests are ordered in hopes of shedding light on some of the grey areas of diagnostic imaging, including incidental findings. The reality is that incidental findings are almost always a given, but not always a problem. So how do you know what to test further and what to monitor? And while one radiologist may choose the former option with a patient who has an incidental node finding, another might decide to go with the latter option, so who is right?
Beep! It’s important
It is important that when a radiologist sees a nodule and it has certain characteristics, he or she makes recommendation for follow-up imaging, which is why the American College of Radiology (ACR) has released clinical guidelines on incidental findings. By offering standard clinical decision support on findings covering eleven organs, the ACR is helping radiologists protect their patients through established best practices for diagnostic testing.
This is a great step forward for the industry, but some hospitals are taking it one step further. Massachusetts General Hospital (MGH) is using its radiology reporting platform to provide real-time quality guidance at the point-of-care to drive better patient care. Now, when a radiologist is reading a report and notes an incidental finding, the system will automatically ping her with evidence-based recommendations for that finding. For instance, if the node is a certain size, it should be tested further.
The results of having this information at the radiologists’ fingertips are impressive. In fact, studies show that when these clinical guidelines are built into existing workflows, 90 percent of radiologists align with them, as opposed to alternative methods, such as paper print outs, which result in 50 percent concordance.
HealthLoop connects doctors and patients with timely and actionable information, improving patient satisfaction and driving better outcomes. HealthLoop is a cloud-based platform that automates follow-up care; keeping doctors, patients and care-givers connected between visits with clinical information that is insightful, actionable and engaging. Its peer-reviewed follow-up plans automate the routine aspects of care while tracking patient progress and monitoring clinical areas of concern. Its analytics engine sifts through and filters the deluge of patient-generated data in realtime; focusing the care team’s time and attention on patients who need them the most.
Errors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.