Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace. Building on a five-year partnership, Inovalon’s newest listing on the Marketplace offers healthcare providers sophisticated revenue cycle management (RCM) tools that are seamlessly integrated into PointClickCare’s Electronic Health Record (EHR).
The Inovalon EASE All-Payer claims management software, powered by the Inovalon ONE Platform, helps providers achieve a 99% first-pass acceptance rate among commercial and Medicare payers. The solution leverages an advanced payer rules engine that validates claims based on the latest requirements from the Centers for Medicare & Medicaid Services and Commercial insurers. The solution also allows users to easily create custom, facility-specific business rules that improve the accuracy of claims processed in each location.
Unlike other solutions, EASE All-Payer automatically checks claim eligibility and historical responses upon submission, enabling users to identify and correct upstream eligibility issues before transmitting to the payer. Additionally, the solution’s integration with Inovalon’s MORE2 Registry enables providers to easily source missing patient information, such as the Medicare Beneficiary Identifier, which can significantly reduce claims denials and improve first pass yield.
Also offered on the PointClickCare Marketplace is Inovalon’s Workforce Management solution, a fully mobile, real-time scheduling and open shift management application that scales from single units to entire enterprises. Inovalon solutions available on the Marketplace allow PointClickCare customers to operate within a single platform to launch, manage, and utilize applications, resulting in greater data accessibility and a unified user experience.
“We are pleased to enter the next phase of our long-standing partnership with PointClickCare supporting thousands of providers with the integrated tools they need to optimize financial and operational performance,” said Julie Lambert, president and general manager of the Inovalon Provider business unit. “Inovalon powers thousands of facilities with its industry-leading solutions, and our latest listing on the PointClickCare Marketplace ensures they are easily accessible to our joint customers.”
Particle Health, a developer-friendly API platform for bi-directional healthcare data exchange, announced the availability of its white paper that highlights the most comprehensive view of Health Information Network data performance available to date and provides vital information to gain a true understanding of healthcare interoperability.
The paper, 2023: State of U.S. Healthcare’s National Network Data Exchanges, analyzes not only quantitative comparisons of the data currently exchanged on HINs but also the work that still needs to be done in order to spread the true value of the networks across all stakeholders in the healthcare ecosystem. The report also details critical information on how to successfully leverage HIN data when building digital healthcare tools and operating healthcare organizations or digital platforms.
The recent paper revealed that the nation’s three largest Health Information Networks have indexed healthcare records for the vast majority of Americans, as shown by Particle’s platform finding data across HINs for about nine out of every 10 patients searched for. The CommonWell Health Alliance has access to 29,000 sites and 153 million individuals; Carequality has access to 55,000 sites and 300,000,000 document exchanges per month; and eHealth Exchange has access to 75,000 sites and 120 million individuals. A sample of queryable data found that a plurality (about 45%) of health data available on HINs was generated within the past three years.
To help digital health organizations looking to gain deeper insights into how to search and return patient data more successfully on HINs, Particle Health studied its own technical data from connecting to the three major HINs. By mapping out each network’s endpoints in the U.S., the company was able to rank states by their endpoints per capita. Particle Health found that in 2022, on average:
Query success rates (requests from doctors in which their patients’ data was returned) varied widely by state – from a low of 37.9% in Montana to 95% in Michigan
Endpoints per state were diverse, with one network listing three endpoints in a state and another having more than 4,000 in a different state
51.3 files were returned per successful endpoint match
There were over 2.3 matching endpoints per patient query
A query completion took one minute
134 files were returned per patient
“No matter who you treat, it’s very likely that your patients’ medical records can be found on Health Information Networks,” explained Troy Bannister, CEO of Particle Health. “Today, clinicians can access these networks. Patients, insurers and other stakeholders may not realize they’ll soon be able to directly obtain relevant records as well. We’re about to enter a game-changing era in healthcare as Health Information Network access expands.”
For this paper, Particle Health also reviewed upcoming HIN improvements and health IT landscape changes that will likely drive a surge in requests for data. Two notable changes include:
The Trusted Exchange Framework and Common Agreement (TEFCA), a government initiative that’s leading to nationwide baseline standards for clinical data sharing, will re-order the landscape for HINs with participation in data exchange with Qualified Health Information Networks (QHINs). These specialized HINs will connect to each other, serving as the core infrastructure for healthcare data exchange.
The 2016 21st Century Cures Act makes it clear that healthcare organizations must respond to requests from individuals in technically feasible ways – a policy called Anti-Information Blocking – with enforcement that officially began this past October. If a doctor can get records from a HIN, then patients should be able to access them in that same manner as well. Particle has identified how HINs are still playing catch up with the rule, while sorting through complicated multi-stakeholder policy, security and technical nuance.
A Developer-Friendly Approach to Consolidate Network Access
Direct integration with a HIN is prohibitively difficult for most organizations, as a great deal of specialized work needs to be done to maximize the value of network connectivity. Particle Health was founded to make a wide array of diverse network data accessible and actionable for the many stakeholders and organizations that would benefit from network participation. In its role, the company consolidates each network within a single API implementation, making it manageable to leverage the data from multiple HINs covering over 270 million patient lives.
Bannister said, “Many organizations simply don’t know that this fantasy – a nationwide way to locate and exchange medical records – already exists. With our birds-eye view of different Health Information Networks, Particle Health has seen provider organizations use patient data to efficiently improve outcomes. That’s why we’re working hard to make Health Information Networks more accessible to new digital health participants.”
A new report by the Private Equity Stakeholder Project (PESP), “Private Equity Descends on Rural Healthcare,” provides an unprecedented look at the private equity industry’s incursion into rural healthcare. The findings were led by PESP healthcare researchers Eileen O’Grady, Michael Fenne, and Mary Bugbee.
“Healthcare systems in America’s rural communities are experiencing an escalating crisis,” said O’Grady, PESP Healthcare Director. “Rural hospitals are closing at a dangerous rate. Chronic staffing shortages plague providers, and the health of people living in rural areas is, by most measures, significantly worse than in non-rural areas. Despite these challenges, private equity appears to still find opportunities to profit off this struggling industry, thereby adding to the strife.”
This sweeping survey examines the extent to which private equity (PE) has invested in rural health, as well as key financial drivers of significant investment activity in this uniquely distressed part of our health system. The new report also examines case studies of PE-owned companies in several rural healthcare sectors that highlight some of the risks posed by private equity’s incursion into rural healthcare.
PESP shares previously unreported data revealing that private equity firms own at least 130 rural hospitals. The private equity firms that dominate the list include Apollo Global Management (LifePoint Health, Scion Health), GoldenTree Asset Management and Davidson Kempner (Quorum Health), and Equity Group Investments (Ardent Health Services).
Similar to private equity’s involvement in other sectors of the healthcare industry, quality of service at PE-owned hospitals can be questionable. “A series of case studies in this report reveals a range of quality issues,” O’Grady added. “Even with substantial financial assistance received during the pandemic, three of the six rural hospitals that closed in 2021 and 2022 were PE-owned.”
In addition to traditional hospital ownership, the PESP report lays bare a new tactic utilized by private equity firms to extract additional value from hospitals they own. By creating separate hospital management companies, these firms have provided themselves new avenues to harvest profits from both nonprofit and public healthcare providers, entities that historically would have not given high returns for their ownership.
“This report includes truly expansive analysis on private equity’s interest and sustained investment in rural healthcare,” O’Grady said. “Private equity’s influence extends far beyond the hospitals they own. In addition to providing a list of PE-owned rural healthcare companies across a variety of specialties, our research digs into several key sectors including emergency care and transport, travel nursing, and behavioral health.”
Finally, the report analyzes the potential motives of PE investment in rural health and proposes policy recommendations to ensure that private equity cannot exploit rural health providers at the cost of quality of care. Some of PESP’s policy recommendations include:
Increasing oversight over changes in hospital ownership
Placing limits on sale-leaseback transactions
Passing the Travel Nursing Agency Transparency Study Act
Holding private equity firms accountable for Medicare/Medicaid fraud by portfolio companies
Increasing public investment in rural health initiatives
By Brian Selfridge, healthcare cybersecurity and risk leader, CORL Technologies.
For anyone invested in Third Party Risk Management (TPRM), the last few years have been at once painful and heartening. On the painful side of the ledger, we’ve seen multiple high-profile breaches resulting in stolen patient data, reduced services and loss of trust on the part of many patients.
On the heartening side, these unfortunate incidents have made many healthcare organizations get much more serious about TPRM, treating it as an integral part of day-to-day operations.
That said, we have a long way to go. Spend any time with employees of healthcare organizations and you will hear the same message over and over again: things are better than they were, but TPRM remains fundamentally broken.
With that in mind, it’s worth taking a step back and assessing where we are with TPRM as 2022 draws to a close. What are the lingering pain points? In what areas could we stand to do a better job? Understanding the answers to these questions will help us think ahead to a better, brighter future for TPRM.
Everyone is Struggling to Keep Their Heads Above Water
The number of third-party vendors used by healthcare organizations has exploded in recent years, and this trend shows no signs of slowing down. Each one of these vendors, of course, represents a potential risk to the healthcare organization, and accordingly each one needs to be thoroughly vetted.
Of course, there is only so much time in the day, and fully vetting each third-party vendor using the standard methods takes time and resources––two of the rarest and most precious commodities in the healthcare industry.
This is a problem not just for the healthcare organizations but for the vendors themselves: each day they are flooded with more and more due diligence requests, more and more questionnaires, and because these requests are rarely standardized––i.e., every healthcare organization has its own demands and expectations––properly addressing every single issue can feel impossible.
Add in the fact that many healthcare organizations themselves function as third-party vendors and you have a recipe for an infinite backlog. Compliance concerns are forgotten, unaddressed, or addressed only partially, while critical patient information is left vulnerable. It’s an untenable situation.
Responses from Stephen Dean, co-founder, Keona Health.
What telehealth should focus on?
First, recognize that telehealth is more than telemedicine. The first needed focus is on the rest of the patient journey outside the 15-minute conversation with the doctor. Patients want ALL aspects of their health journey to be easily handled in the moment, on their smartphone.
Telehealth includes any processes and tasks performed by medical professionals remotely. The Health Resources and Services Administration (HSRA) acknowledges this need and defines telehealth very broadly:
“Any use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration.” –Health Resources and Services Administration (HRSA)
Examples of what the rest of the patient journey looks like – Finding a doctor, getting a referral, booking an appointment, validating insurance, checking in, processing payments, getting prescriptions, getting related health education, or handling any customer service needs.
The second focus should be on improving the technology within the telemedicine visit itself. The telemedicine visit is typically a video call with the provider. The technology should facilitate the administration, documentation, and operations side of the telemedicine visit. These involve tasks such as facilitating the doctor’s documentation, placing of orders and creating tasks. Current technology too often forces the doctor to focus more on the EHR than on the patient.
The third focus should be on provider training. Standardized training needs to be developed for the providers and their support staff for navigating the extra complexities that telehealth provides. Many organizations have developed their own, but it needs to be standardized and shared across organizations. Telehealth requires advanced training around such things as communication skills, navigating tools and technologies, and decision-making when you detect an unsafe situation, and you don’t have your normal escalation options available.
Challenges in implementing telehealth services in healthcare
The challenges for telehealth are far greater than what you would expect from other industries. First of all, the medical variation and factors to consider alone are highly complex. Add to that the fact that telehealth communication is different. Excellent telehealth communication requires establishing a therapeutic relationship with the patient within 30 seconds.
Clinical safety considerations are different with telehealth than in person, and every telehealth staff member needs to be aware of them. The telehealth work itself is different, in that on one hand it is more isolated and remote, and on the other hand it requires familiarity with more technologies and tools. In healthcare, those technologies and tools are almost certainly fragmented as is the underlying patient data.
None of these challenges is a trivial one. Addressing them takes dedicated focus by a mix of clinical and technical expertise.
By Jordan Miller, MD, senior medical director of dermatology, ModMed.
When consumer technology companies release smartphones and TVs with new and exciting capabilities, I tend to ask myself, “How valuable is this new feature?” or “Should I make an upgrade?” As a dermatologist in a privately-owned clinic in Arizona, I have to play dual roles of physician and business owner, which requires similar evaluations about technology trends for my clinic in addition to following the most recent developments in clinical care, such as new studies and patient surveys.
Taking on a multi-faceted role puts a premium on my time and means I have to work efficiently to identify and implement new technologies and IT solutions to run the practice. Healthcare IT is evolving at an unprecedented pace, and it’s crucial to react to the newest technologies when they present an opportunity to improve the practice’s workflow in a meaningful and lasting way. However, not all new tech is “good” tech and practices have to parse out which capabilities will deliver true value versus the tech trends that are simply a fad.
Here is how I identify and implement meaningful new IT trends into my practice:
Consider the patient experience
Healthcare provider organizations have to pay attention to patient feedback to identify IT trends. A recent survey from ModMed found that some patients will choose one doctor over another based on tech capability – including website functionality and the options to schedule and pay for appointments online or via a digital application. The survey also revealed patients often keep a “mental scorecard” of what they like and dislike about a doctor’s office and use that grade to determine if they’ll stay with that doctor.
When IT implementations (or lack thereof) start to influence where patients receive their care, provider organizations need to take notice. Patients are less loyal to their care providers than in previous generations, because they have elevated expectations of what a patient experience should look like — and rightfully so. As a physician, I cannot only consider the time that patients spend in my office. I also have to consider their time in the waiting room, their conversations with the front desk staff, and any communications they receive from my office when they are home.
By Joe McMurray, senior vice president of patient experience, Zotec Partners.
A July 2022 report confirmed what most providers have seen coming during this time of rampant inflation: Unexpected healthcare costs can be crippling for the majority of Americans. Many factors have influenced this fact, including rising high-deductible plans, ongoing pandemic stress, and the general truth that patients are often sick, scared, or confused — or a mix of all three. This strain poses many challenges for healthcare providers and their revenue cycle teams, highlighting the importance of patient-centric financial experiences.
Calculating cost estimates on unexpected medical encounters is a very challenging process, and if done so inaccurately, it can push patients to switch medical providers. According to PYMNTS, 46% of unwell patients have canceled an appointment because of high cost estimates, and two-fifths of patients who received inaccurate cost estimates spent more on healthcare than they could afford. Healthcare providers and organizations have seen drastic reductions in payment as a result.
Understanding Why Patients Don’t Pay
According to research by Debt.com, 45% of Americans have outstanding medical debt. Some reasons why patients can’t pay their debts includes financial hardship (which can be from job loss), murky healthcare billing systems, unexpected billings (especially during the holidays), and ambiguities with insurance. Inflation isn’t helping the situation, with almost 60% of people forgoing healthcare due to higher living expenses across the board.
Unpaid medical bills and their resulting medical debt are typically the outcomes of a combination of factors. First and foremost are unexpected healthcare costs, which is precisely what it sounds like: unplanned and unbudgeted medical expenses. The continued hike in high deductible plans and increased out-of-pocket expenses has also hit healthcare consumers’ wallets.
Additionally, uncertainty around billing is an issue for patients who need clarification on their responsibilities, billing due dates, or even which providers they saw during their encounters. Finally, technology can be a barrier to patient payments. When patients can’t access, understand, or act quickly on their bills, they are less likely to make a payment or pay in full.
Improving the Financial Experience for Patients
Health systems and clinicians shape patient care experiences, which can unfortunately lead to medical debt and devastating consequences in certain circumstances. So, what can healthcare providers do to alleviate these financial pressures for patients and set them up for success beyond diagnosis and treatment?
The first and most obvious response is to get the bill covered by the carrier prior to sending it to the patient. With advanced technology partners, this is a goal that should and can be explored. However, if there is still a patient portion, the following four steps will enhance the experience for all:
• Patient Education and Awareness
Healthcare organizations can help individuals make educated decisions about how to plan and pay for their care. Enhancing medical billing transparency means ensuring patients are aware of out-of-pocket expenses, including cost-of-care discussions in provider-patient interactions.
With the federal No Surprises Act in effect, patients now have increased transparency into what scheduled medical encounters cost. However, these estimates can only be accurate if no unplanned medical care or treatment is needed during service. By communicating up front with patients about additional costs, they will be more empowered when making healthcare decisions.
Once a patient receives a bill, it should be accurate, easy to understand, and convenient for them to take action.
• Payment Choices and Flexibility
Healthcare organizations can help patients with medical expenses by expanding, simplifying, and innovating payment options and plans. Offering more ways to pay based on patients’ preferences is essential, as is giving patients more time and flexibility. No two patients are alike, and based on their propensity to pay, providers can offer patients customized communications that offer payments through paper, phone, text, email, or portal access.
Offering payment plans is a proven way to increase collection rates. Patients who are offered additional time, even if it’s just a few weeks more, are more likely to make payments or pay their bills in full, reducing likelihood of medical debt. By adding a few more weeks to the billing cycle, providers can offer patients a more dignified and effective way to pay for services at a time most suitable for their financial situations.
• Compassionate Care Continuum
Healthcare expenses are a source of anxiety for many patients. Intimidating collection steps won’t do them any good, but a more compassionate billing approach could help increase patient payments.
Team members should utilize compassionate language as they guide patients through their journeys. When patients are confused, they should be met with a responsive contact center that leads with empathy and understanding. After all, calm patients feel more confident in their billing and are increasingly more vested in paying for the services rendered.
• Simple and Streamlined Technology
Providers should implement portals that make it easy for patients to pay bills, schedule appointments, review payment plans, and share feedback. Empowering patients with a self-service option enables greater transparency and customized experiences — all leading to higher payment capture.
By developing an extensive and dynamic patient journey by persona, organizations can customize communications by patient demographics and propensity-to-pay. This allows them to use the most innovative, intelligent means to request and receive payment. If providers don’t have a portal that meets these criteria, there are technology-enabled revenue cycle services partners that can further enhance the patient experience.
No two patients have the same pain points when it comes to medical expenses. And considering the economic landscape evolves daily, healthcare needs to be ready to adjust accordingly. Providers need to find flexible and intuitive ways to connect with patients and offer a variety of payment options to engage compassionately throughout the entire healthcare journey.
Do you know the estimated revenue generated in 2023 from the healthcare industry will be around?$63.9 billion?The healthcare industry is extremely competitive, and survival is often challenging. Medical businesses spend around 10% to 15% of their revenue on medical practice marketing.This guide covers some of the best healthcare marketing ideas.
Why do you need marketing ideas in healthcare?
There was a time when medical practitioners and drug companies were fewer, and medical practice marketing meant word of mouth. But time has changed, and customers today are spoiled for choices that made the healthcare industry reconsider its marketing strategy. Marketers with innovative health promotion ideas can reach out to more people and retain existing clients.
When traditional marketing ideas for healthcare sound expensive, use the digital marketing space. It helps you connect with prospective patients and promote your medical practice at reasonable rates.
Top 5 marketing ideas for the healthcare industry
Listed below are the most creative marketing ideas in healthcare.
Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace. Building on a five-year partnership, Inovalon’s newest listing on the Marketplace offers healthcare providers sophisticated revenue cycle management (RCM) tools that are seamlessly integrated into PointClickCare’s Electronic Health Record (EHR).
Responses from Stephen Dean, co-founder, 
