Guest post by Lindy Benton, CEO and president, MEA|NEA.
Lindy Benton
For nearly 20 years, MEA|NEA has provided secure health information exchange to medical and dental providers. We are growing, in an effort to provide our clients with even more options to achieve the best in secure information exchange and healthcare communications. Recently we announced that MEA|NEA acquired The White Stone Group, Inc., a best-in class provider of healthcare communication management solutions. The reason why is simple: To create a single, integrated platform for the secure exchange of protected health information and communication management between patients, providers, payers and health plans.
The White Stone Group’s products, led by its Trace communication suite, strengthen and complement MEA|NEA’s current portfolio of HIPAA-compliant solutions for health information exchange and revenue cycle management. Combining the two proven technology solutions gives our clients one place to find the best in secure exchange of health information and efficient management of healthcare communication including voice, fax, image, data and electronic documents. Our clients will benefit by seeing a reduction in denied claims, improved cash flow, increased up-front collections, reduced readmissions and improved HCAHPS scores.
Even though we’re growing, the work we do will remain committed to empowering medical and dental providers, payers, health plans and partners who work with us to achieve efficiency and cost-savings. In fact, together as a collective effort, our solutions will better serve clients in their ability to more effectively manage critical patient information that typically resides outside the electronic health record, and close gaps in documentation and improving the continuum care through a fully accessible patient record.
As a combined effort, we’ll go forward serving more than one million customers across the medical and dental markets. Specifically, MEA|NEA will now consist of two complementary business units — one focused on providers, patients and payers in the dental space and the other focused on the same audiences in the medical space. We are now more dedicated than ever to advancing healthcare delivery by improving coordination of patient information and closing gaps in communication processes across the continuum of care. We’ll do this through a suite of highly-integrated software solutions that facilitate the secure exchange of health information and the efficient management of healthcare communication.
As such, we’ll continue to deliver added functionality for each solution in our set and support our clients in their current environments while bringing the best of each solution together on a common client-facing delivery model. We also plan to add new functionality to the foundation of the combined platforms to create best-in-class solutions that establish competitive differentiation in the markets we serve, even expanding into new areas as opportunities present themselves. We also remain dedicated to ensuring that physician, patient and payer information is protected with state-of-the-art security while maintaining client confidentiality.
Medical and dental organizations now only have to partner with a single provider for secure, centralized management and exchange of critical healthcare information and communication through one electronic platform. The result is a complete view of patient information exchanged across the continuum of care from pre-service to post-discharge. Today, more than 500 hospitals and 55,000 dental offices leverage this data to boost financial and operational performance, streamline care coordination and enhance patient experiences.
Guest post 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.
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CMS), which would fundamentally change telemedicine as it is practiced.
CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.
Thanh Tran
The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings. Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.
The time has come for a paradigm shift to re-engineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained, proprietary, inoperable systems. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment. That has now changed since one Healthcare 2.0 innovator has been able to connect the CMS guideline dots.
Huge Market Opportunity
According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million. With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.
The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggled to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.
The CMS guidelines are as follows:
24×7 access to clinical staff
Patient care continuum
Collaboration, coordination between primary care providers and other care services
Electronic management of care transition among care providers
Coordination between home and community care services
Patient engagement
Here is how these guidelines are now being addressed:
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
Ken Perez
“We have to take the long view, and be focused on iterating, evolving, and improving the concept, rather than seeking summary judgment.” – Farzad Mostashari, former national coordinator for health information technology, commenting on accountable care organizations
On Aug. 25, 2015, the Centers for Medicare and Medicaid Services (CMS) released 2014 financial and quality performance results for 353 accountable care organizations, 333 in the Medicare Shared Savings Program (MSSP) and 20 in the Pioneer ACO Model (although as of this writing, the CMS website only lists 19 Pioneer ACOs). As is customary, proponents (such as CMS) and critics of ACOs interpreted the results quite differently, as a glass half-full or half-empty.
Pioneer ACO Performance
During the third performance year, the Pioneer ACOs generated total model savings of $120 million. That figure constitutes a 24 percent increase versus the $96 million of savings produced during the previous year. A total of 15 ACOs (75 percent of all Pioneers) were able to generate savings during performance year three, compared with 14 ACOs (61 percent of all Pioneers) for the prior year. Of those generating savings in the most recent performance year, 11 Pioneers produced savings that exceeded the minimum savings rate, garnering shared savings payments totaling $82 million. One quarter of the 20 Pioneers generated losses, with three generating losses beyond a minimum loss rate, requiring them to make $9 million in shared-loss payments to CMS.
The Pioneers improved the quality of care delivered during performance year three, as their mean quality score rose from 85.2 percent to 87.2 percent year-to-year. The Pioneers improved in 28 of 33 quality measures and generated average improvements of 3.6 percent across all quality measures compared to Performance year two. CMS highlighted significant improvement in medication reconciliation (up from 70 percent to 84 percent), screening for clinical depression and follow-up plan (up from 50 percent to 60 percent), and qualification for an electronic health record incentive payment (up from 77 percent to 86 percent).
Moreover, Pioneer ACOs improved the average performance score for patient and caregiver experience in five out of seven measures compared to performance year two.
Guest post by Christina Richards, vice president, AOptix.
Christina Richards
In recent years, the healthcare industry has experienced a Renaissance of sorts with the development and adoption of mobile and connected technologies. As a result, healthcare facilities the world over are increasingly making use of smart technologies to drive better patient outcomes, track equipment, and support overall operations. In addition, the developing practice of telemedicine is becoming increasingly commonplace for doctors in healthcare settings across the United States, which is raising new concerns about the infrastructure needed to support these real-time doctor-patient experiences.
Although the development of these digital technologies for healthcare applications is only in its infancy, we are already beginning to see their wide range of benefits, including the potential to help organizations achieve the Institute for Healthcare Improvement’s (IHI) Triple Aim of bettering the patient experience, improving population health standings and reducing the cost of healthcare. For instance, a 2014 study by Dale H. Yamamoto of Red Quill Consulting, Inc. found that that the average estimated cost of a telehealth patient consultation was $40 to $50 per visit, compared to the average estimated cost of $136 to $176 for in-person acute care.
With the widespread adoption of any new technology however, there is a learning curve to ensure that they can be effectively integrated into existing operations to capture the greatest benefit without compromising the level of care. But what does this entail?
Data
As healthcare facilities become more connected through the Internet of Things, adoption will continue across a broad spectrum of devices and sensors—from wearable tech that monitors patient location and vital signs to analytics platforms that track staff movements and create more efficient workflows. While these devices span a variety of applications, they all share a universal purpose, which is the constant collection and analysis of data.
Likewise, video conferencing and other mobile approaches to telehealth are highly data-intensive, requiring the transmission and processing of large amounts of information. As a result, many healthcare administrators have encountered the need for far more robust mobile networks in their facilities to support the massive amounts of data traveling across their systems.
In considering other data requirements on the horizon, take the case of rapid genomic sequencing. While the new technology allows researchers to quickly determine the complete DNA sequence of an organism to predict disease susceptibility and drug response, the process requires the transfer of massive amounts of data. To make this information more widely accessible, one company, NantHealth, is looking into a method of compressing the data into a more manageable size so it can be shared with other facilities through high-capacity wireless connections, rather than strictly relying on fiber. With ever-growing levels of data becoming necessary in the healthcare system, new technologies and methods for managing it across various networks will become even more important.
For many practices, the focus this year has been on ICD-10 and preparing for an effective transition. As a result, a growing problem has been slipping under the radar—patient collections.
Today, patient due amounts make up 30 percent or more of practice accounts receivable. And the longer it takes the practice to collect from a patient, the less they get paid. According to Mary Pat Whaley, after 60 days the percentage collected drops to below 60 percent.
ICD-10 will likely remain a key focus for practices through the end of 2015 at least. But don’t let that stop you from taking some time to look at the state of your patient collections. This infographic shows how the landscape is changing and what practices can do to ensure they get paid.
Although life in rural communities offers many advantages, the rural healthcare system in America faces challenges not seen in urban areas, for obvious reason: population loss, poverty and access to healthcare have been problematic in recent years.
Taking a look at Pennsylvania, which is the sixth most populous and ninth most densely populated state in the US, based on information from the United States Census Bureau from 2010 and 2013, as a state it hosts a significant amount of rural areas. According to the Pennsylvania Rural Health Association, 48 of its 67 counties classified as rural, and all but two counties have rural areas. More than one quarter of Pennsylvanians live in rural counties.
Thus, it’s as good a place as any to examine some of the unique issues facing rural communities, who even though they may be within driving distance to some of the best medical care in the world, they are unable to access it each day without some sort of life altering obstacle.
In general, residents of rural communities in the U.S. are less healthy than those in urban environments. According to Unite for Sight, “rural residents smoke more, exercise less, have less nutritional diets and are more likely to be obese than suburban residents.” Already against the odds, residents in rural Pennsylvania face several specific problems that jeopardize the state of healthcare in the area.
Population Loss
Between 2000 and 2010, the Pittsburgh Post-Gazette reported that rural Pennsylvania counties grew by 2.2 percent while urban counties grew by 3.9 percent. However, the small increase in rural counties was only because of the eastern counties. Western rural counties decreased by 0.9 percent, and by another 0.5 percent from 2010 to 2012.
In some places, the situation is bleak. The newspaper highlights the population loss in Taylor Township, a part of Lawrence County that experienced a 13.6 percent population loss from 2000 to 2010. “Of its 1,052 residents, more than twice as many are over age 65 as under 18. That ratio is practically unheard of among municipalities and doesn’t bode well for the township’s future.”
Guest post by Gillian Christie, health innovation analyst, Vitality Institute
Gillian Christie
“Everyone I knew was on drugs for depression, drank too much and had severe sleeping problems.” – former Amazon employee
Jess Bezos’s beloved Amazon.com is the latest company facing criticism for its workplace practices. Jodi Kantor and David Streitfeld’s recently published article in the New York Times depicts Amazon as relentlessly pushing the boundaries of white-collar workers to achieve its sky high ambitions. While evidence suggests that a degree of stress can motivate employees to improve productivity in the short- and medium-term, demanding work cultures like Amazon’s contribute to poor physical and mental health among employees in the long-term.
Chronic diseases – diseases of long duration and slow progression like cardiovascular disease, type 2 diabetes and various cancers – now represent the leading cause of death and disability worldwide. These diseases further contribute to poor workforce productivity and threaten economic competitiveness. A majority of these diseases are largely preventable by modifying underlying risk factors, including physical activity and nutrition, minimizing excess alcohol intake, and avoiding tobacco use. Personalized health technologies – wearables, smartwatches, and mobile health applications – have emerged to empower individuals to track and modify their health behaviors, both inside and outside the workplace. These technologies connect a consumer with a device, a central data hub, and at times a healthcare professional and social network.
The proliferation of personalized health technologies has contributed to consumers engaging in healthier behaviors, but concerns have also emerged regarding the data generated by these devices. Is personal health data accurate, reliable and trustworthy? Is it being reused for marketing or advertising purposes? How do we know that data is secure and protected from cybercriminals? Consumers too often remain in the dark on how their data is used, stored, secured, and shared with others – be it their healthcare provider, employer, or unbeknownst third parties.
Consumers are expected to use more devices in coming years, meaning that more information on habits and preferences will become available to businesses. The global consulting firm Accenture contends that organizations focused on building a reputation based on offering superior services while respectfully using data will emerge as dominant market leaders. Accountability will ensure that companies comply with traditional regulation while proactively practicing self-regulation. “Digital trust is the currency of today,” according to Accenture.
To proactively address consumer concerns associated with personalized health technology, Vitality has launched a global public consultation on a draft set of guidelines running from July to October 2015. The six points addressed are:
Guest post by Greg Mancusi-Ungaro, CMO, BrandProtect
Greg Mancusi-Ungaro
Since 2009, the personal health information of almost 30 million Americans has been compromised. From Partners Healthcare and Anthem to the UCLA Health System and Children’s National Health System, it’s clear that healthcare organizations are a hot target, especially as medical records include exactly the kind of valuable data cyber criminals want to get their hands on. And, since information like social security numbers and birthdates can’t be “turned off” in the ways that stolen credit card numbers can, once cyber criminals get ahold of such records, they can do significant damage with them like counterfeiting patients’ identities.
It is crucial that the healthcare industry be vigilant when it comes to cyber security. From hospitals and insurers, to medical groups and individual practices, health-related organizations must ensure they are taking all possible measures to keep the personal information of their patients – not to mention their own brand reputation and business – safe. That begs some questions: Why are healthcare organizations such a hot target? How are they (and their patients) being targeted, and, and what can the industry do to stay one step ahead of cybercriminals and mitigate the ensuing risks?
What Makes Healthcare a Prime Target?
Healthcare organizations are a large target for many reasons. First and foremost, they possess extremely valuable assets, including the personal, family and billing information of their patients. It isn’t the blood type or cholesterol reports that make electronic health records the most valuable records on the cybercrime black market; it is the virtually complete personal identity information, including social security numbers, parents, maiden names, addresses, emails, children names and, in some cases, complete information of close friends. They are the holy grail of the identity theft world.
Second, the available attack surface in the healthcare industry is very complex. The healthcare industry contains many different organizations that have, over the past few years, moved to electronic systems, but not to a truly centralized electronic system. The reality of today’s healthcare records infrastructure is that there are many networks, data formats, communications protocols, passwords and access points all patched together. Not only is this amalgamated network challenging to maintain, it creates massive opportunities for compromise. Cybercriminals know this.
Healthcare is in the Cybercrime Crosshairs
Doctors are at the center of the healthcare universe. They interact and interface with patients, insurers, services providers and hospitals. Their office networks and smart devices connect with practically every network that affects their business. But doctors are not information technology or security experts. Less than 40 percent of doctors based in the U.S. feel that their cybersecurity processes are above average. Their lack of technical savvy and security knowledge makes them easy pickings for sophisticated cybercriminals. They need education and protection.
Patients are also prime targets. The Affordable Care Act (ACA) has accelerated the dramatic shift of health insurance and medical services to a digital transaction model. With the emergence of affordable individual policies, not tied to employer offerings, and online markets for health insurance, many more individuals are using online recourses to evaluate insurance options, enroll and manage their healthcare. Patients also go online to update their records, view and manage results and appointments, and make payments. Insurers and hospitals use email to communicate and confirm transactions, or to flag issues with accounts or with payments. This is where cybercriminals see their opportunity. Additionally, the ACA has introduced healthcare options – requiring online healthcare management — to many families who are not as familiar with online risks, so they are easy prey for phishing and other cyberattacks.
Reducing the Risk of a Successful Attack
Almost all cyber events start out the same way, with a successful attack on a single individual (an employee, doctor or patient) or device. This initial incursion, whether through malware, social engineering or another means, can lead to illegal network access and records theft over the course of weeks or months. But if a healthcare organization can successfully reduce the risk of a successful first attack, they make it harder for cyber criminals to gain this access.
Although life in rural communities offers many advantages, the rural healthcare system in America faces challenges not seen in urban areas, for obvious reason: population loss, poverty and access to healthcare have been problematic in recent years.