AVANT Communications has released its inaugural State of Disruption study. The AVANT Insight Report is supported with sponsorship from 8×8, Flexential, HOSTING, Masergy, NICE inContact and Oracle Communications — all partners in the master agent’s growing portfolio of best-in-class solutions.
Powered by AVANT’s ecosystem of channel sales professionals, or trusted advisors, the State of Disruption report surveyed 300 U.S. enterprise technology leaders at the manager level and above who lead tech purchasing decisions. AVANT examined four key components of enterprise tech stacks — compute IT infrastructure, voice infrastructure, network infrastructure and cybersecurity — with an eye on how companies are shifting from physical and/or in-house solutions to third-party and/or cloud-based solutions.
Drew Lydecker
“We see the pace of change in IT accelerating with enterprises literally struggling to evolve or die. Trusted Advisors are uniquely equipped to help them navigate the rapid rate of technological change,” said Drew Lydecker, president and co-founder, AVANT. “We’re pleased to release the State of Disruption report as a pulse for forward-thinking IT teams and the experts who enable their decision-making. From networking infrastructure to cybersecurity to breakthrough technologies likes SD-WAN, we are seeing disruption across the board as organizations in all industries are advancing digital transformation.”
The survey reveals the state of digital transformation efforts, the roles trusted advisors and other third parties play in the process, and the rate at which disruptive technologies are replacing legacy solutions, with key findings including:
74 percent of companies that see themselves as leaders in innovation rely upon Trusted Advisors for assistance in IT technology decision making
58 percent of respondents cited increased agility, flexibility and scalability as the most important reason for IT decision-making
74 percent of technology decision-makers are more likely than not to feel a cyberattack could cost them their job
In this report, AVANT also examined the rate at which new technologies are disrupting legacy infrastructure. These findings are presented as a Rate of Disruption Index (RDI), which represents the transformation from legacy to modern digital technologies organizations expect to see from the end of 2018 to the end of 2019; a detailed explanation of the RDI can be found on pages 7 and 8 of the report. Key findings include:
From pre-SD-WAN networks to SD-WAN: SD-WAN is the most disruptive overall technology category reviewed, with respondents anticipating a 13 percent RDI from 2018 to 2019, with the consulting/business services industry forecasting the greatest level of disruption with a 20 percent RDI
From in-house servers/data centers to third-party colocation: Migration of company data centers to colocation facilities is most disruptive in companies with $100 million to $1 billion in revenue, with those organizations reporting an RDI of 26 percent
From in-house PBX/key systems/voice circuits to cloud-based UCaaS: Respondents overall report an RDI of 7 percent to UCaaS, with the greatest disruption in companies with $10 million to $100 million in revenue which see an RDI of 14 percent
From in-house security resources to third-party managed security services: Adoption of third-party security services is most disruptive in the ecommerce segment, with a 12 percent RDI in this industry
From physical servers to cloud-based IT infrastructure: Adoption of cloud IT compute infrastructure is also expected to increase more amongst ecommerce companies than any other industry, with a 14 percent RDI amongst ecommerce survey respondents
While SD-WAN is rapidly transforming legacy networks, MPLS is not going away:
The reality is that very few people are doing great things with SDoH at this point. A lot of vendors and providers are thinking and talking about SDoH, but many of them don’t yet understand which social determinants are relevant or what to do about them. While the area is too new to boast a list of best practices, an introduction and discussion to the topic might be helpful for those considering a foray into SDoH.
What are SDoH?
The Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, defines SDoH as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
If you think that sounds broad, you’re absolutely right. These determinants cover everything from how clean your water is to what your friends are like. The factors are innumerable. Stakeholders estimate that only 20 percent of one’s health is based on clinical care received from healthcare providers, with another 20 percent to 30 percent based on genetics and at least 50 percent based on SDoH.
With those assessments in mind, it seems unfair that almost everything related to health is pinned on provider organizations. The healthcare system cannot be the only player. We say that it takes a village to raise a child, and it would take a village to adequately deal with social determinants.
But those working in healthcare can’t just wait for villages to get involved. As the market continues to shift toward value-based reimbursement, health systems, payers, and vendors will be expected to incorporate SDoH into their tools and patient care. A few principles might help these stakeholders to get started.
The beginnings of a SDoH strategy
An organization’s first step in incorporating SDoH into their strategy should be to decide which data is the most important. For example, it probably wouldn’t help a physician to know which university a diabetic patient attended, but it could help a lot to know that the patient orders takeout almost daily because he doesn’t have a car and isn’t within walking distance of a grocery store with healthy options. These are aspects that, one day, may fall under the banner of SDoH.
Once an organization knows which data elements they want, they can determine how to get it. Unfortunately, the regional nature of SDoH data makes creating an excellent database very difficult. This is why we need vendors to keep SDoH on their minds. Providers need their vendor partners to incorporate SDoH data into their EMRs, population health tools, and other platforms. Healthcare organizations can also gather data by conducting assessments on-site or at patients’ homes.
Now more than ever, the healthcare industry is leveraging new technologies to provide patients with improved, innovative care. The innovation attracting the most buzz in the healthcare industry today is artificial intelligence (AI). However, despite the ongoing hype of robots and algorithms as industry game-changers, results to date from early applications of AI in healthcare have fallen short of realizing dreams of sweeping improvements.
IBM’s Watson is an excellent example of how these improvements “in healthcare” will require a more step-by-step approach and may take longer to achieve than initially thought. In 2011, Watson garnered worldwide attention by winning a game of Jeopardy against two of the show’s greatest champions. Within healthcare, Watson’s win gave rise to hope that AI was on the precipice of full-scale deployment that would transform the industry and dramatically improve patient outcomes.
For several reasons, that hasn’t quite happened yet, and Watson has found it challenging to deliver improved patient outcomes. While those critical of AI have been quick to jump on these struggles, it’s crucial to acknowledge that Watson suffers from several common obstacles faced by AI in healthcare. These include the lack of high-quality data that can be used to train an algorithm, the low number of available training cases, implicit bias, and the differences in guidelines between the U.S. and other countries.
However, as the industry collectively works to address these issues, I envision three major areas where AI will soon transform personalized medicine.
Individualizing the patient-clinician relationship
Clinicians are already equipping themselves to better serve their patients with the predictive and organizational benefits of AI. This technology will move the field away from a “one-size fits all” approach and make the clinician-patient relationship more individualized, fostering trust.
This would be no small feat for improving the patient-clinician relationship, especially for those suffering from chronic conditions. A study by West Corporation in 2018 found that only 12 percent of chronic condition patients feel strongly that their provider is doing a good job of delivering information specific to their needs and condition.
When a clinician provides patients with unique, individualized solutions, patients feel empowered and are more comfortable speaking up throughout the treatment process. When a patient is comfortable enough to report symptoms, no matter how trivial they may seem, personalized medicine thrives.
With the help of AI, clinicians can search extensive amounts of information to find the causes of patient-reported symptoms and alter patient care accordingly. These improvements can be referenced by other clinicians and lead to large-scale medical breakthroughs.
On April 5, 2019, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that updates the Medicare Advantage (MA or Part C) and Medicare Prescription Drug Benefit (Part D) programs by promoting innovative plan designs, improved quality, and choices for patients.
CMS took significant action to increase MA plan choices for the 2019 plan year and aims to continue to expand opportunities so that patients have access to MA plans that meet their unique health needs. In continuing the efforts to increase plan flexibility and plan choices for patients, CMS is finalizing additional flexibilities that will provide patients with more MA options and new benefits.
This fact sheet discusses the major provisions of the final rule (CMS-4185-F) that will implement certain provisions of the Bipartisan Budget Act of 2018, improve MA and Part D program quality and accessibility, and clarify program integrity policies. The final rule can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/.
Implementing the Bipartisan Budget Act of 2018 Provisions
CMS is implementing several sections of the Bipartisan Budget Act of 2018 (Public Law 115-123):
Section 50323 allows MA plans to offer “additional telehealth benefits” as part of the government-funded “basic benefits”;
Section 50311 requires increased integration of Medicare and Medicaid benefits and appeals and grievance processes for MA Dual Eligible Special Needs Plans (D-SNPs); and
Section 50354 requires the Secretary to establish a process to allow Part D plan sponsors to request standard extracts of Medicare Parts A and B claims data regarding their enrollees.
Medicare Advantage Plans Offering Additional Telehealth Benefits
The Bipartisan Budget Act of 2018 allows MA plans to include “additional telehealth benefits” (telehealth benefits beyond what Original Medicare allows) in their bids for the basic Medicare benefits, starting in plan year 2020. Under this final rule, MA enrollees may have great opportunities to receive healthcare services from places like their homes, rather than being required to go to a healthcare facility. MA plans will now have broader flexibility than is currently available in how they pay for coverage of telehealth benefits to meet the needs of their enrollees.
These changes will provide MA plans with the ability to offer expanded telehealth coverage to meet the needs of their patients. Patients in MA plans have always been able to receive more telehealth services than those in original Medicare, and with the final rule there is an even greater likelihood that these patients will have access to telehealth services from more providers and in more parts of the country than before, whether they live in rural or urban areas.
Integration Requirements for D-SNPs
CMS is finalizing new minimum criteria for Medicare and Medicaid integration in D-SNPs for contract year 2021 and subsequent years. Pursuant to the requirements in the Bipartisan Budget Act of 2018, we will require that D-SNPs meet the integration criteria either by, at a minimum, (1) covering Medicaid long-term services and supports and/or behavioral health services through a capitated payment from a state Medicaid agency; or (2) notifying the state Medicaid agency (or its designee) of hospital and skilled nursing facility admissions for at least one group of high-risk full-benefit dual eligible individuals, as determined by the state Medicaid agency.
Unified Grievance and Appeals Procedures for D-SNPs
CMS is finalizing rules to unify Medicare and Medicaid grievance and appeals processes for certain D-SNPs and affiliated Medicaid managed care plans. The processes will apply to D-SNPs with fully aligned enrollment and the affiliated Medicaid managed care organization, where one organization is responsible for managing Medicare and Medicaid benefits for all enrollees. In such D-SNPs, enrollees will have simpler, more straightforward grievance and appeals processes. The Bipartisan Budget Act of 2018 requires compliance with unified grievance and appeal procedures beginning in contract year 2021.
The FDA released guidance last year noting that electronic health records (EHRs) have the potential to improve clinical trials, leading to greater safety and efficacy. But tapping that potential, according to the agency, requires interoperability — the ability of two or more products, technologies or systems to 1) exchange information, and 2) to use the information that has been exchanged without special effort on the part of the user.
The healthcare industry, driven by meaningful-use requirements, is focused on wider efforts to promote interoperability. Many of them emphasize technology, including advances such as Fast Healthcare Interoperability Resources (FHIR) tools and Substitutable Medical Applications, Reusable Technologies (SMART) standards. But while the technology is crucial, it is equally as important to recognize the group of stakeholders who could play a critical role in making systems more interoperable, and thus improve the clinical trials process:
The patients themselves.
Interoperability
Interoperability has the potential to help increase care coordination, improve safety, support patients in making the most informed healthcare decisions, reduce costs, and help public health and health promotion efforts. In addition, interoperability can have a role in drug development, as the 21st Century Cures Act mandates that the FDA include Real-World Data (RWD) — data gathered during routine clinical care – in regulatory decision making. This RWD can be in part derived from the EHR-generated data, standardized and shared through the interoperability process.
The growing availability of information (digital health data is increasing by 48 percent each year) creates the potential for better patient care, including improved clinical trials. Unfortunately, despite strides made in interoperability, data in medical records are still too often packaged in ways (i.e., handwritten notes and medical device feeds) that are hard to share or standardized.
By Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
Articles on social media channels that carry a sense of apprehension regarding the future of our healthcare system sadden me. However, I learned a long time ago that you never win by arguing with the referee, and that the most logical way to react to apprehensions is to prove them wrong based on concrete evidence.
Building a sustainable model for care delivery is not a tough nut to crack as long as organizations have the right approach. If healthcare leaders can adapt to the constantly changing needs of providers and payers alike, they can steer their organizations towards a better future.
What if we already know all the answers?
Patient outcomes depend on a number of factors. I know cities with poor air quality have a higher percentage of patients with lung-related diseases than the green countryside. Similarly, patients who follow-up with their doctors more often usually take less time to recover from a problem as compared to less engaged patients.
Care management is one area I genuinely believe is an answer to a plethora of problems that surround our healthcare system. However, enabling a culture of managed care is easier said than done. To begin with, it is quintessential to make providers and patients believe in its very significance. This can be achieved by promoting patient engagement, streamlining referrals, increasing annual wellness visits, and regular follow-up meetings, among others.
Creating pathways for automated care management procedures
Baby boomers, millennials, middle-aged people, and kids? everyone has different needs and expectations. However, every patient longs for comfortable, connected, and cost-effective care.
Continuity of care is the key here. Care delivery is an end-to-end process. Care coordination and its various domains? transitional, chronic, and post-acute, among others? holds the potential to improve care and cost outcomes drastically. The more providers know about their patients, the easier it gets to impart care in a much more personalized and evidence-based manner.
Making things easier for patients shouldn’t come at the cost of frustrated providers. Provider and patient satisfaction are, in fact, interdependent. For instance, organizations should ensure that there are little or no skipped appointments and at the same time, calling patients to remind them of their scheduled meetings should be the least of providers’ concerns.
Medfusion announces a partnership with athenahealth, Inc. through athenahealth’s Marketplace program. As part of the athenahealth Marketplace, this newly integrated application is now available to athenahealth’s growing network of 120,000 healthcare providers, allowing patients to book appointments directly from a provider’s website — that fully conform to practice rules.
“Medfusion solutions simplify practice workflows and improve the patient experience,” said Kimberly Labow, Medfusion CEO. “We are excited to partner with athenahealth to accelerate the adoption of patient-and-provider-friendly patient self-scheduling solutions. By providing 24/7 access to scheduling—according to practice-defined rules — providers can fill schedule gaps, decrease call volume, attract new patients, and reduce no-shows.”
athenahealth is a network-enabled, results-oriented services company that offers medical record, revenue cycle, patient engagement, care coordination, and population health services for hospital and ambulatory clients. The company’s vision is to build a national health information backbone to help make healthcare work as it should. As a Marketplace partner, Medfusion joins a network of like-minded healthcare professionals who are looking to disrupt established approaches in healthcare that simply aren’t working, aren’t good enough, or aren’t advancing the industry and help providers thrive in the face of industry change.
Amazon announced that a version of their virtual assistant technology, Alexa, is now HIPAA-eligible. This means it’s available for applications that are subject to the data privacy and security requirements of HIPAA. The new HIPAA-eligible version of Alexa, specifically the Alexa Skills Kit, is now available to a limited number of developers by invitation only.
Why?
Amazon has seen increasing interest in Alexa’s potentialto serve as a virtual healthcare assistant. While devices like PCs, tablets, and smartphones have contributed to advances in healthcare, they’ve been problematic for some aspects of patient engagement – particularly among the elderly and others whophysically cannot – or will not – use them.
The idea of a smart, always-available, hands-free, voice-powered virtual assistant that can answer questions, deliver medication reminders, facilitate communication with one’s doctor, provide health coaching, and more, has piqued the interest of the healthcare community. Amazon has responded.
What’s different
Until now, Alexa’s use in healthcare has been mostly limited to questionanswering services – voice apps, or “skills” in Alexa parlance, that answer general questions about health conditions, treatments, symptoms, etc. Amazon Echo users, for example, canaccess health benefit information from a skill like Answers by Cigna, or tap into one of many symptom checkers in the Alexa marketplace. The big change is that Alexa can now be used in certain applications that collect and transmit protected health information (PHI).
Thisopensa whole new world of voice applications beyond basic Q&A, such as remote patient monitoring population health, medication adherence and clinical trial optimization. It seemed inevitable that voice assistants like Alexa and smart speaker-equipped devices like the Amazon Echo would find their way into clinical applications. Amazon’s announcement confirms this.
Beware
Organizations must understand the full range of issues surrounding the “what, why and how” of securing, voice-first healthcare applications. HIPAA is just the start. There is no formal certification process for HIPAA, and it applies only in the U.S.Also, many healthcare IT departments use other industry standards or ?have created their own standards for data privacy and security. In their eyes, completely securing a voice application may go well beyond ensuring that a service provider will sign a HIPAAbusiness associate agreement. Issues like user authentication, data privacy in shared spaces,network and device hacking, secure system integration (e.g. with an EHR), should all be addressed.Continue Reading
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