By William Flood, MD, MS, chief medical officer/Eviti, NantHealth.
William Flood
The COVID-19 crisis has created a perfect storm of challenges for payers as they adapt to a new normal that continues to evolve. It’s also opened up a host of opportunities for creating positive change that will enable providers and payers to run smarter businesses and provide more quality care for patients.
During a recent webinar, healthcare payers participated in interactive polling and unanimously agreed that COVID-19 has significantly changed the healthcare landscape, altering the routine day-to-day management of care and the operations that happen around it, including medical plans.
Here are some of the key aspects payers are tackling as they move forward:
Shifts in Plan Membership
The economic downturn caused by the pandemic has led to significant increases in unemployment, As healthcare coverage is frequently tied to employment, this leads to significant increase in the number of uninsured. According to a May 2020 Kaiser Family Foundation study, 45 million Americas were unemployed at that time, and it’s estimated that about 27 million are uninsured because of that loss.
While we won’t have exact numbers on how much membership has changed until open enrollment periods begin, likely in January 2021, we do know that this increase in unemployment has driven a shift from private to public plans.
It escalates the steady decline in private plans that we’ve seen for the past thirty years, putting increased pressure on government-sponsored plans like Medicare and Medicaid and providing opportunity for insurers who have not already done so to enter these markets. During a time of economic challenge, this requires reevaluation of current processes to construct more valuable and affordable approaches for stakeholders: payers, patients, and providers.
By Rakhee Langer, vice president, healow telehealth solutions, eClinicalWorks.
When the COVID-19 pandemic hit, it sparked revolutionary change across the health care industry, from a more focused need for ongoing communication with patients and telehealth solutions. Practices immediately had to shift their in-office visits to an online presence — changing with the times.
Initially, there was hesitation from both the patient and the provider whether conducting online visits would prove to be on par with in-person visits. However, the concerns surrounding technology adoption were quickly mitigated and both patients and providers found that telehealth was not just easy to adopt but also facilitated a productive medium for care.
During the peak of the pandemic, almost all visits were conducted via telehealth, helping to ensure the safety of both the patient and the provider. It was key to determine which types of visits could be done over telehealth.
We found that providers across all specialties—including neurology, behavioral health, pediatrics and dermatology—found ways to continue providing effective and comprehensive care. Of course, there are exceptions and certain types of visits that require an in-person physical examination.
However, physicians have found that telehealth is an avenue to conduct pre-surgery consults, post-surgery follow-ups and screenings in which it may not require the patient to come into the office. All specialties, including urgent care centers, have begun to use telehealth as well as solutions for check-in and bill payment that limit contact and thus reduce potential exposure to COVID-19.
Operating a healthcare business these days is a constant balancing act between trying to ensure profitability and never compromising patient care in the face of ever-increasing legislation. It’s a tough position, and little wonder that businesses in this sector have some of the highest operating and administration costs.
But when cutting corners could mean the difference, quite literally, between life and death, it can be a challenge to identify areas that could be streamlined.
However, that doesn’t mean that it can’t be done at all. There are savings to be made as some processes are extremely wasteful — you just have to approach it with a logical plan and think carefully through all the implications before taking action.
Identify Your Inefficient Processes
The fact is that money is often wasted on the wrong areas, and this can be dangerous when it causes spending to be restricted in other areas which are really key, such as staff training and development. To save money, you also have to know where to spend money, and things like ensuring the right tools for computational biologist and ongoing clinical training are critical.
Where you can take a closer look at ways to increase profitability are areas like administration, where processes are quite often overly-complex and not patient-friendly. Although meeting the requirements of a complex regulatory landscape remains a central challenge for those working in healthcare, we shouldn’t let it become a barrier to streamlining paperwork and administration processes, which can often benefit hugely from a certain degree of automation, especially as software becomes smart enough to easily handle more complicated businesses.
By Dan Schulte, MBA, CHFP, senior vice president, provider operations, HGS.
Dan Schulte
As outbreaks of COVID-19 continue to crop up around the country, the ongoing public health crisis is just one facet of the situation; economic disruption is another grim reality, including for the healthcare industry itself. The American Hospital Association estimates COVID-19 will result in losses of $202.6 billion for the country’s hospitals and health systems due to factors such as the cancellation of nonemergency procedures; the high cost of treating a patient with COVID-19; and the millions of Americans who could become suddenly uninsured due to the economic implications of the virus.
Providers must improve cash flow to remain stable, which will require new revenue cycle management strategies supported by technology. Artificial intelligence (AI), machine learning (ML), and robotic process automation (RPA) together can provide an effective automation strategy that will help healthcare systems recover and retain more of their revenue — while boosting patient satisfaction — as they navigate this costly crisis.
Nine revenue cycle functions ripe for automation include:
Prior authorizations: With manual prior authorizations requiring an average of 21 minutes and as much as 45 minutes per transaction, the opportunity to drive cost savings through automation is significant. Because of well-defined business rules in this area and structured data that systems exchange in conducting prior authorizations, RPA can significantly improve this process: Implementing a “bot” that can perform the same tasks repetitively and without variation can help reduce error rates, so patients can get the authorization they need quickly, and lower the likelihood of claim denials.
Eligibility and benefit verification: While fully electronic transactions account for more than 84% of all eligibility and benefit verification transactions — a positive development — more can be done to reduce wasteful spending in this part of the revenue cycle. As the starting point for care delivery, this function represents a significant potential for improvement via intelligent automation. The focused manager will ensure that the EDI tools bring the right data across to the patient accounting system (timely, accurate and complete data), and will have the necessary add-ons to find the last 15% of data from screen scraping and outsourcing to a reliable service provider.
Since the start of the COVID-19 outbreak, the healthcare industry has had to adapt to closures, adopt automated processes and utilize telehealth more than ever before. Providers have been inundated with patient messages, phone calls and payments; in need of mobile-first solutions and custom workflows.
Relatient, a SaaS-based patient engagement company, helped University Physicians’ Association (UPA) to revamp its patient billing process for medical practices across East Tennessee, streamlining revenue cycle management (RCM) operations and extending a patient-friendly financial experience to patients and caregivers. The result was a 43% increase in patient payments with mobile-first billing.
Flexibility is key to meeting patient needs, and Relatient granted UPA the ability to extend self-service tools like mobile payments to the majority of patients who want this kind of access without neglecting those who still prefer to interact over a phone call. In addition to Relatient’s work with UPA, there are many other simple, practical ways to improve the patient experience.
The COVID-19 pandemic has indeed shed some light on the healthcare sector, especially in terms of how services are rendered. Even though remote care services have been around for a while, they have only now started gaining popularity.
These services continue to revolutionize the healthcare sector even beyond the pandemic, which is a welcome innovation. With the speed at which the world is moving, and with the changes that come with it, healthcare cannot remain the same since livelihoods depend on it. There is the need, however, for a more customer-centered approach when it comes to telehealth, that will be discussed in this article.
Why must telehealth focus on the customer experience?
There are a lot of benefits of telemedicine and telehealth in general, and there is evidence to prove it. It is cost-effective and speeds up the process of diagnosis, not to mention the convenience it brings. However, in conversations about the implementations, one of the things that are not at the top of the list is patient (or customer) satisfaction. This is surprising because when it comes to healthcare, patients need the reassurance of the results of the service they have paid for, and they need to reap all the benefits of the service and more.
What it means to create a patient-centered experience is to consider the patient’s satisfaction before other features, including how sophisticated the technology is, when evaluating the platforms. There are a few questions to answer in this regard. For example, how easy would patients find it to use the platform? Will they be eager to use it? Would the service be faster than when receiving care in person? And what is there any significant difference in the quality and outcomes of the service?
In creating a telehealth platform that answers these questions and many others for the benefits of the customer, there is an opportunity to reap certain benefits. For one, the financial incentive that comes from taking this initiative cannot be passed on. Facilities and organizations that go this route also get to gain new clients and hence more business.
Medial EarlySign’s mission is focused on finding extraordinary clinical insights inside billions of ordinary EHR databases. With more than 10 years of longitudinal data, Medial EarlySign’s data sets cover more than 20 million patient lives and 150 million patient years. They include geographically, ethnically, racially, and economically diverse populations with diverse health statuses.
Medial EarlySign has developed a secure HIPAA-compliant information architecture to protect patient data security. Additionally, internal procedures ensure high quality conduct of clinical studies in compliance with applicable international regulations and legal requirements. It works to safeguard the rights and well-being of participants, including privacy and confidentiality of their information, and the accuracy and completeness of the reported data.
What is the single-most innovative technology you are currently delivering to health systems or medical groups?
Medial EarlySign develops AI-based software solutions that help healthcare systems with the early detection and prevention of high-burden diseases, such as lower GI disorders, diabetes and related complications, COVID-19 and flu complications and more. It is the only company to successfully achieve peer-reviewed and clinically validated insights by leveraging routinely available medical information, such as blood test results and other EHR data, to assist in early prediction, prioritization and intervention for improved patient outcomes.
How is your product or service innovating the work being done in these organization to provide care or make systems run smoother?
EarlySign’s proprietary machine learning-based solutions analyze the dozens of “hidden” factors residing in electronic health records, including routine laboratory tests results, demographics, medications and diagnostic codes, to accurately predict who is at highest risk of having or developing specific life-threatening conditions, creating opportunities for early intervention strategies and more effective prioritization of resources. Medial EarlySign’s AI-based software models are already being used by global healthcare systems to help detect and prevent high-burden diseases.
Using EarlySign solutions, providers have begun leveraging data and delivering personalized, preventative interventions that has helped shift the conversation of the medical community from sick care to health care.
What is the primary need fulfilled by the product or service?
With the move to value-based care, health players need to be more effective and able to reach out to individuals with rising risk trajectories. Medial EarlySign enables this with a practical approach and focused solutions that allow short deployment times and demonstrate clear value, while the use of routinely available data can address large global populations.
Having your child suffer from childbirth is among the most gut-wrenching things that a mother has to deal with. There are many mothers who feel guilty about the hardships that their child has to go through. Birth traumas like brachial plexus injuries can have long-term effects. Thankfully, the healthcare industry is now receptive to advancements in diagnostics, therapies, and overall management of such cases. In this post, we’ll look at the current diagnostic practices and advanced treatment options available for brachial plexus injuries.
Current Diagnostic Modalities
Some of the currently used diagnostic modalities for damaged brachial plexus include:
Diffusion-Weighted Magnetic Resonance Neurography
In the past, most doctors would use standard magnetic resonance imaging (MRI) to localize the injury, specifically near the damaged nerve roots. However, without a 3-D image of the nerve sheaths, it was difficult to fully visualize the extent of the injuries and the adjacent structures.
Diagnostic modalities have evolved to include diffusion-weighted magnetic resonance neurography that allows doctors and surgeons to see the structures more accurately with 3-D images. Due to this, medical professionals can now make a proper assessment of how to approach treatment.
