By Amy Heymans (Cueva), founder and chief experience officer, Mad*Pow.
Amy Heymans (Cueva)
The scene: a brisk, sunny spring morning by the Charles River in Boston. More than 300 of the health industry’s brightest minds gathered from across the globe for two days of presentations, workshops, discussions and connections. The ninth annual Health Experience Design Conference, hosted by Mad*Pow’s Center for Health Experience Design, took place on April 2 and 3, 2019, and focused on designing for transformative change in health.
Mad*Pow launched the HXD Conference in 2011 to fill a void at the crossroads of health and design, and to explore how human centered design and innovation could transform health. Each year, HXD brings together a diverse community of executives and practitioners in design, innovation, research, strategy and technology to help accelerate the transformation of our health system. Presentations from high-profile thought leaders and health futurists provide inspiration and energy, and thoughtfully designed workshops and interactive activities spark discussions and form connections.
The theme of HXD 2019 was “Real World Change: Improving Health through Design and Innovation.” This theme was explored through presentations and workshop tracks on designing for health behavior change and systems change, health equity and disparities, service design in the healthcare space, and financial wellbeing. Eleven diverse and compelling keynote speakers addressed the conference from the main stage, including Steve Downs, chief technology and strategy officer at the Robert Wood Johnson Foundation; Karen Dillon, New York Times best-selling author; Cheryl Dahle, founder and CEO of Flip Labs; Vanessa Mason, research director of Institute for the Future; and Travis McCready, president and CEO, Massachusetts Life Sciences Center.
Steve Downs challenged attendees to consider how we might use technology to re-imagine and re-shape the fundamentals of everyday life to improve health. For this to succeed, we must establish health as a core value and explicit design goal, and embed it deeply within everything we design.
Karen Dillon, author of NYT best seller How Will You Measure Your Life, encouraged each attendee to ponder the course of their life and whether their resource allocation matches their goals. She urged the audience to consider whether they find intrinsic motivation in their jobs, and whether they’re standing for something they’re proud of.
Cheryl Dahle detailed her work with Flip Labs to tackle the global overfishing problem, and used this example of transition design to highlight the similarities between various complex human systems. Vanessa Mason examined shifting power dynamics in healthcare, including changes in gender norms as they relate to the tech industry, health struggles faced by millennials, and mental health and gaming addiction.
If it isn’t already clear, the headlines are signaling that the era of healthcare innovation is upon us and moving swiftly. Managed Medicaid plans could be losing out on millions of contracted lives (and money) by lagging in the adoption of digital telehealth resources to improve access to care and patient outcomes. Leveraging an eConsult solution is a proven way to increase access to high-quality care while lowering system cost, ensuring innovation scoring opportunities are not missed.
Innovation is the new constant
Although the pace of innovation in healthcare has traditionally been slow, organizations are increasingly seeking new ways to innovate in order to support value-based care models. Recent partnerships formed between Amazon, Berkshire Hathaway and JPMorgan Chase, CVS and Aetna, Cigna and Express Scripts, and so on strongly indicate that innovations rooted in providing better care for lower costs are paramount to the success and growth of healthcare.
Payers whose ongoing strategies are not placing precedence upon innovation will be left in the dust. Not only will this be costly for access and quality, it can jeopardize managed Medicaid payers’ chance of re-procuring and expanding contracts.
Managed Medicaid Plans must innovate to reach objectives
Managed Medicaid plans need innovations to improve the value and efficiency of healthcare provided. To ensure they’re getting the best value, state Medicaid programs re-procure contracts with managed care payer groups on a perpetual basis — sometimes as frequently as every three years. States use these periods as an opportunity to seek updated solutions to long-standing or emerging challenges, often assigning points to questions that speak to innovations in care delivery for Medicaid recipients.
Key Medicaid challenges
Barriers to care and access within Medicaid programs are often among the most important issues states and managed care plans are attempting to address. The Kaiser Family Foundation 2017 survey of Medicaid managed care plans reported high rates of difficulty in recruitment for some specialties and listed provider supply as a leading challenge.
Timely access to care is key to healthcare goals, as delays in accessing necessary care exacerbate health conditions, in turn leading to more costly treatment and poor outcomes. This lack of care access worsens a health crisis that could have been easily avoided with more proactive (and less expensive) care.
A key takeaway from 2018’s 11th annual Medicaid Managed Care Summit was that, “Reforming healthcare in the U.S. is not about spending more money, but about moving around the dollars that we’re already spending.” Adoption of eConsult platforms allows health plans to solidify their value-based initiatives and Medicaid payers to expand access to needed specialist services, bring new physician access points to urban and rural areas and leverage the latest in technology and sophisticated referral protocols to help meet members’ care needs.
By Carol Amick, manager of healthcare services, CompliancePoint.
Carol Amick
According to the United States Department of Health and Human Services, approximately 70 percent of organizations are not HIPAA Compliant. The Health Insurance Portability and Accountability Act, known as HIPAA mandates industry wide standards for healthcare information and electronic billing, and requires protection as well as confidential handling of protected health information.
According to HIPAA rules, any company that deals with protected information must have a physical network and process security measures that are followed to ensure compliance. It may be safe to say that many organizations are still perplexed about HIPAA audits, enforcements and compliance. As a result, the number of organizations that fail to meet compliance each year remain the majority. To begin understanding compliance, healthcare organizations would be wise to consider three key recommendations.
Analyze the past, to avoid making the same mistake twice
It is important for hospitals and healthcare facilities to look at some of the common mistakes that are repeatedly noted in HIPAA security reviews. HIPAA states that out of all the reviews completed, there are a number of frequent compliance violations and issues that are found each year. This includes impermissible uses and disclosures of protected health information, lack of safeguards to protect health information, lack of patient access to their personal health information, lack of administrative safeguards on electronic protected health information, and use or disclosure of more than the minimum protected health information. Protecting valuable data by analyzing past mistakes is an important step in the compliance process.
Perform a risk assessment and GAP analysis
One preventative measure in assessing an organization’s compliance with HIPAA is a risk analysis and a GAP analysis. The confusion and lack of understanding around the two examinations has been common among healthcare professionals in the marketplace for some time. Not understanding the differences can be detrimental to an organization, and puts them at a significantly higher risk. According to HHS and OCR guidelines, all healthcare organizations must specifically conduct a risk analysis to be deemed within HIPAA compliance.
A HIPAA GAP analysis can be used to measure the organizations information security standing against HIPAA, which is part of HHS audit protocol. Comparing the organization’s current practices to the HHS OCR audit protocol will identify the strengths and weakness of the security program. From there, the organization can determine whether they have reasonable and appropriate administrative, physical and technical safeguards in place to protect patient health. Performance of the GAP analysis also allows the organization to develop an audit response toolkit, which includes the data and documentation that would be able to support compliance with the HIPAA regulations to regulatory agencies.
By Aaron Perreira, director of integrated marketing, Kareo.
Aaron Perreira
A nationwide survey conducted by Kareo reveals an interesting fact for everyone involved in healthcare technology. One of the primary sources from which independent medical practices get advice and information on adoption of new technology is their billing companies.
Independent medical practices remain the primary healthcare delivery system for patients in the U.S. Physician-owned practices see 990.8 million visits, or 3.1 visits per person in the U.S. each year. In contrast, hospital outpatient visits number 125.7 million per year, or .4 visits per person. At the same time, these independent practices – small businesses in most cases – are greatly impacted by the rapidly changing healthcare arena.
Regulatory changes, technology infrastructure demands and increasingly large administrative burdens have put pressure on independent practices in recent years, and they do not have the resources or economies of scale that larger hospital practices have to address them. Experts agree that the primary hope for independent practices thriving efficiently and cost effectively in the emerging healthcare landscape depends upon the effective integration of technology.
One of the steps many independent practices take to help alleviate some of their administrative burden is the outsourcing of billing. Nearly one-third (28 percent) of physicians and medical practitioners who do not currently outsource medical billing indicated that they plan to do so over the next two years. As a result, medical billing companies expect an average revenue growth of 12 percent during 2019 as utilization of outsourced billing by independent medical practices continues to increase. Of course, the primary service billing companies bring to practices is – billing.
The survey highlights that extensive revenue cycle expertise at the specialty level is a successful strategy for building a billing company to scale. Forty-seven percent of small billing companies specialize in order to differentiate themselves, while 58 percent of medium-sized businesses do. As might be expected, large billing companies tend to diversify across a wider range of medical specialties, responding to the rapid growth (11 percent since 2012) in multi-specialty medical practices.
Billing companies are also becoming specialists in patient collections because of the significant increase in high deductible insurance plans – the average deductible for employer-based plans reached nearly $1,500 in 2018 and the average deductible for individual A?ordable Care Act (ACA) Bronze plans was more than $5,800 in 2018. Of those surveyed, patient balances account for an average of 23 percent of total collections.
Significantly, billing companies have found an important path to growth in value-added services. Despite the rapid growth of healthcare technology solutions, many smaller practices are still slow to adopt new technology. Billing companies serving small, independent practices have the opportunity to recommend technology to help them improve efficiency, stay competitive in the healthcare delivery marketplace, and run a more profitable practice. Helping medical practices implement and leverage technology is something that 75 percent of billing companies report doing today, with the adoption of integrated EHR and billing software the top area of focus.
With the establishment of value-based payment models that tie reimbursement to the documentation of quality care, many billing companies are seeing the importance of having their clients use a certified EHR that is integrated into their billing platform. The current replacement rate for EHRs is estimated to be as high as 50 percent in the United States, presenting significant opportunity for billing companies to advise on replacement options that will streamline their revenue cycle management process. The survey shows 86 percent of high-growth billing companies are statistically more likely to recommend an EHR solution to their clients that integrates with their billing software/practice management solution.
The Kareo survey points to an interesting chain – the future of American healthcare depends on independent practices. The success of independent practices moving forward depends on technology. And the recent Kareo survey shows that adoption of technology by independent practices depends, to a great extent, on their billing companies.
NVIDIA and the American College of Radiology announced a collaboration to enable thousands of radiologists nationwide to create and use AI for diagnostic radiology in their own facilities, using their own data, to meet their own clinical needs.
Following a successful three-month pilot program by both parties, ACR is integrating the NVIDIA Clara AI toolkit into the newly announced ACR Data Science Institute ACR AI-LAB, a free software platform that will be made available to more than 38,000 ACR members and other radiology professionals to build, share, locally adapt and validate AI algorithms, while also ensuring patient data stays protected at the local institution.
The NVIDIA Clara AI toolkit is a key part of the NVIDIA Clara developer platform, which is designed to enable software-defined medical instruments and intelligent workflows. A platform to create data and algorithm pipelines, NVIDIA Clara consists of libraries for data and image processing, AI model processing, and visualization. For AI, the toolkit includes libraries for data annotation, model training, model adaptation, model federation and large-scale deployment.
Making the vision of the ACR AI-LAB a reality requires the collaboration of the entire ecosystem, including industry leaders GE Healthcare, Nuance and NVIDIA, along with a vast network of healthcare startups and leading research institutes. NVIDIA Clara powers GE Healthcare’s Edison AI platform and the Nuance AI Marketplace, both of which are supporting the AI-LAB and are key solutions for the deployment of AI within the radiology workflow.
Bibb Allen Jr.
“This collaboration marks a significant milestone in an extraordinary ACR Data Science Institute project, helping enable the launch of the ACR AI-LAB, giving radiologists in any practice environment an opportunity to become involved in AI development at their own institutions, using their own patient data to meet their own clinical needs,” said Bibb Allen Jr., M.D., FACR and chief medical officer of the Data Science Institute at the American College of Radiology.
“NVIDIA builds platforms that democratize the use of AI and we purpose-built the Clara AI toolkit to give every radiologist the opportunity to develop AI tools that are customized to their patients and their clinical practice,” said Kimberly Powell, vice president of Healthcare at NVIDIA. “Our successful pilot with the ACR is the first of many that will make AI more accessible to the entire field of radiology.”
Successful pilot paves way to democratized AI for healthcare
An initial pilot with the Ohio State University (OSU) and the Massachusetts General Hospital and Brigham and Women’s Hospital’s Center for Clinical Data Science (CCDS) helped NVIDIA and ACR define the assets and pathways necessary to enable facilities to work together and with industry to refine AI algorithms without sharing potentially sensitive patient data. Bringing an AI model to the patient data, instead of patient data to the model, can help increase diversity in algorithm training, facilitate validation of the algorithms and enable radiologists to learn the steps needed to adapt algorithms to their institutions’ clinical needs.
Morphisec released findings from the 2019 Morphisec Consumer Healthcare: Cybersecurity Threat Index. The report surveyed more than 1,000 consumers, weighted for the U.S. population, to get their perspective and understanding of the threatscape surrounding the healthcare industry, and how attackers are targeting their personal health information.
While the $36 billion shift to electronic health records (EHRs) and the adoption of new enabling technologies has improved the quality of healthcare over the last decade, cybersecurity vulnerabilities have emerged as a byproduct that has made the industry vulnerable to a growing number of highly advanced threats. In February, Morphisec Labs identified an ongoing cyberattack in which hacker group FIN6 expanded into the healthcare field targeting a diagnostic image processing firm.
Sophisticated cyberattackers are now attuned to the vulnerabilities that exist within the industry and are targeting it more than double the rate seen across other sectors. This attack frequency poses considerable risk to healthcare organizations and more importantly to the patients’ data they are securing. As Morphisec continues to assist healthcare providers with improving their cyber defenses and protecting patient data, it examined how the increasing amount of healthcare cyberattacks are impacting the mindset of consumers.
Highlights from the Morphisec 2019 Consumer Healthcare: Cybersecurity Threat Index include:
Fifty-four percent of consumers say “they don’t know if a cyberattack has hit their healthcare providers,” despite HIPAA laws requiring providers to notify patients when their information has been compromised.
Healthcare portal use by consumers has increased to 42 percent this year from 28 percent in 2018, increasing the need for providers to protect internet-facing websites, which hackers are actively targeting.
Forty-five percent of consumers say they believe that their health information is more secure on their personal electronic devices (iPhone, laptop, etc.) than on the electronic devices within their healthcare provider.
More than 50 percent of consumers say they play a role alongside their provider in protecting shared health information, but nearly 80 percent of consumers admit they are not prepared to handle threats to health data on their own.
Consumers are more fearful of a health data breach (59 percent) than hackers gaining access to an internet-connected medical device (41 percent).
Consumers believe web (24 percent) and endpoint defenses (21 percent) are providers’ weakest links in protecting their data.
Ever since you were a tween, you have wanted to work in the health industry. Now that you are an adult, you still dream of being part of the medical industry in some capacity, but you would prefer to be your own boss instead of working in a hospital or starting up your own practice.
Fortunately, there are a number of jobs that relate to medicine and health that you can do from home and/or on your own time. For example, consider the following trio of ideas:
Home-based medical billing business
In order for the medical industry to function, payments must come in on a regular basis. If the idea of learning medical codes and working on a computer in a home office sounds appealing, you can pursue a health industry job in medical billing. There are a number of options in the medical billing industry, including working with family practitioners, psychologists and/or nursing homes. If you have previous experience in one area of healthcare, you might find it easier to focus on that industry when setting up your medical billing business; you might also be able to network with physicians from that field. To set up this type of home-based business, you will need a clearinghouse, which is a company that electronically receives and sends medical billing claims, a computer, medical billing software, insurance forms and reference materials including coding books.
Tallahassee Memorial HealthCare (TMH) has selected Atlanta-based Gozio Health to develop a mobile wayfinding platform for patients and visitors. The experiential wayfinding app will provide users with interactive maps and step-by-step navigation to doctor’s offices, cafeterias, pharmacies, nearby restrooms, parking decks and other points of interest within the TMH health system.
“Serving a 17-county region in north Florida and southern Georgia, TMH chose mobile wayfinding to improve the overall patient experience of our extensive network and guide patients directly to their point of care,” said Stephanie Derzypolski, vice president and chief communications officer at Tallahassee Memorial HealthCare.
TMH patients will have physician directories at their fingertips and the ability to customize their app by creating favorites. TMH plans to expand app features such as appointment scheduling, emergency department and urgent care wait times, and access to medical records, to help with all their medical care needs.
Joshua Titus
“As we continue to expand Gozio’s services to hospitals across the country, we are pleased to partner with Tallahassee Memorial HealthCare, the first healthcare system in North Florida to adopt experiential mobile wayfinding,” remarked Joshua Titus, CEO and founder Gozio Health. “Gozio’s partnership with TMH will assist them with providing patient and family-centered, quality healthcare to the communities that they serve.”
TMH’s wayfinding platform will provide turn-by-turn directions from home to the closest parking spot and on to patients’ point of care and include Tallahassee Memorial Hospital, Tallahassee Memorial Hospital’s Women’s Pavilion, three off-site clinic/urgent care offices, and three parking decks.
Significantly, billing companies have found an important path to growth in value-added services. Despite the rapid growth of healthcare technology solutions, many smaller practices are still slow to adopt new technology. Billing companies serving small, independent practices have the opportunity to recommend technology to help them improve efficiency, stay competitive in the healthcare delivery marketplace, and run a more profitable practice. Helping medical practices implement and leverage technology is something that 75 percent of billing companies report doing today, with the adoption of integrated EHR and billing software the top area of focus.
NVIDIA and the American College of Radiology announced a collaboration to enable thousands of radiologists nationwide to create and use AI for diagnostic radiology in their own facilities, using their own data, to meet their own clinical needs.
Morphisec
Ever since you were a tween, you have wanted to work in the health industry. Now that you are an adult, you still dream of being part of the medical industry in some capacity, but you would prefer to be your own boss instead of working in a hospital or starting up your own practice.
Tallahassee Memorial HealthCare (TMH) has selected Atlanta-based Gozio Health to develop a mobile wayfinding platform for patients and visitors. The experiential wayfinding app will provide users with interactive maps and step-by-step navigation to doctor’s offices, cafeterias, pharmacies, nearby restrooms, parking decks and other points of interest within the TMH health system.