Category: Editorial

Sharing Too Much? A Tale of Privacy, Big Data and Sleep Technologies

By Brooke Faulkner, freelance writer, @faulknercreek.

The proliferation of wearable mobile-connected devices has done a lot of good for people trying to lead healthier lives. People are able to gather data about their sleep to help them get better rest, track insomnia, stress, and exercise, and keep up to date on their own daily routines and health.

Many of the devices exist not just as trackers but as ways for people to motivate themselves to exercise more, go to bed at more regular times, and other little things that slip by in the daily grind.

Specialists can access information far more quickly and easily to help us with medical problems. With the way technology is advancing, you can now even also use online apps to calculate sleeping patterns and wake up times.

Healthcare Data in the Modern Age

Sleep is absolutely related to health. Many health issues affect our sleep or are caused by issues with sleeping. A number of medical professionals are interested in how, when, and for how long we sleep. These days, that information is stored in digital medical records, which have a number of advantages. Specialists can access information far more quickly and easily to help us with medical problems.

There are, however, disadvantages to medical records being easily accessible and easily updatable. Privacy and security have become major concerns for healthcare providers, as the records contain our most sensitive information, which proves highly valuable to hackers.

Official medical records, however, are just the tip of the iceberg. We use the internet not only as a go-to for advice about medical conditions, but as a method to voluntarily record all sorts of data about us. Recording, storing, and tracking sleep data on our personal devices gives us a lot of power to “do it yourself” when it comes to preventative health and tracking changes in our sleep patterns. This ease of use, however, comes with a cost. It’s not all about sinister hackers, either; that data can be used in all sorts of ways that are, while not outright damaging, at least partially invasive.

Wearables, Bluetooth and Data

Tech companies are working on more advanced ways to use high-tech devices to track our sleep. These include wearables and even devices that don’t need to be attached to the body. The amount of information gathered, and its accuracy, varies greatly by device. The Bluetooth connectivity and the ability to store, track, and share the data the devices collect are parts of their appeal.

The number and type of people who benefit from this information is vast. Sleep disorders are a common side effect of other medical disorders, and managing sleep is an important part of living a healthy lifestyle, especially for people who are at greater risk for certain conditions.

You don’t need to have or be at risk for medical complications to make use of sleep data, however. There are plenty of careers in the U.S. which require people to work long or unconventional hours. Night shifts and long shifts, such as those worked by nurses, can cause havoc with the circadian rhythms that regulate our sleep. This can create complications for otherwise completely healthy people. Being able to self-regulate with the help of wearable devices is a great advantage.

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Harnessing Innovation to Serve and Create Value for Patients

By Georgia Mitsi, PhD, MBA, senior director and head of digital healthcare initiatives, Sunovion Pharmaceuticals Inc.

Georgia Mitsi
Georgia Mitsi

Innovation is not a choice but rather a growth mindset, which creates an environment for building a sustainable business. This mindset allows for objectivity and contributions towards a bigger shared purpose. Innovation is about challenging the status quo with processes that do not work and trying new ways. Innovation is driven by positivity and optimism. Innovation offers options and it should be pursued relentlessly because it provides new opportunities for employees to grow and become even more engaged and productive.

Ultimately, innovation can help to ensure a company’s future. But, harnessing innovation does not need to be daunting, and can be done in small steps.

Many types of companies within the healthcare ecosystem have been leveraging technology to harness innovation, and the pharmaceutical industry in particular is exploring new ways to do so, which is changing the established business model. Technology offers opportunities to redefine the future of the pharmaceutical industry and to contribute towards innovation. Technology though is not a panacea and while it is still rapidly evolving, the focus should be on the “how” and not necessarily the “what” of technology. With regard to digital health care, there are three “hows” that should be considered:

  1. Prevention: How can we protect people from getting sick?
  2. Diagnosis: How can we improve people’s healthcare experience?
  3. Monitoring: How can we better support people and their families during the most challenging periods of their lives?

The new category of digital therapeutics has the potential for creating easy-to-use solutions for all three areas—prevention, diagnosis and monitoring.

Finding Sweet Spots, Enabling Cross-sector Partnerships

It is important to think for a moment how life has changed to understand how the pharmaceutical business can take advantage of the changing dynamics.

Let’s imagine Jenny. Jenny has a place that she calls home; a place that feels secure, relaxed and happy. She has a family, pets and friends. She shops to cover her basic needs and creates opportunities for entertainment. When she gets sick, she goes to the doctor, to the pharmacy and from time to time she may end up at a hospital for additional tests. But Jenny has also a demanding job and a long commute. Her life is busy and time is the most precious commodity. Technology has provided Jenny with the opportunity to make her life more convenient because a lot of her basic needs can be met online. She can easily order groceries, buy clothes, connect with her family and friends, make restaurant reservations, plan her next vacation, work online, read books, complete financial transactions and even receive medical services and medications. Therefore, technology contributes to Jenny’s well-being by making her life more convenient.

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Limit Your CPT Code Set Updates to January? Here’s Why That’s a Bad Idea

By Sudhir Singh, Coding Institute.

Payers don’t accept deleted CPT codes, so your claims can’t succeed if your medical procedure codes are out of date. But do you know how often you need to update your CPT code set? It may be more often than you think. Here are some pointers to keep in mind to give your claims their best chance at accurate payment.

Make the Biggest Transition with January Updates

Each year, a new CPT code set is effective on January 1. For instance, for CPT codes, 2018 codes will give way to the 2019 code set on Jan. 1, 2019.

If you use an online CPT code search product, you’ll want to be sure that the updates are searchable January 1. It’s also helpful if the CPT lookup includes deleted codes (marked with the deletion date) because you use the code set based on the date of service. You may need access to previous code sets to finish filing claims and for working on appeals.

Reminder: You need to update your CPT modifiers list, as well as your procedure code lookup resource each January.

Plan for These Other Regular CPT Code Set Releases, Too

The AMA, which owns and maintains the CPT code set, implements certain types of codes more than once a year. You should be aware of these updates and have a strategy for ensuring you have them when you need them. All specialties may see CPT updates throughout the year, but path/lab coders need to watch for a few special categories that apply to them.

Category III and vaccine codes: Category I vaccine codes and Category III codes (temporary codes for emerging technology and services) are implemented January 1 and July 1. You’ll typically find them posted on the AMA site six months before the codes are effective, giving you time to learn how to apply them.

Category II: Category II codes are tracking codes that you may use for performance measurement programs, like MIPS. The AMA site indicates you may see release March 15, July 15 and November 15, with implementation three months after release.

Molecular pathology tier 2 codes: To help with reporting MoPath procedures, these codes go from approved to effective quickly. After approval by the CPT  Editorial Panel, codes are released to the AMA site March 1, September 1, and December 1. The effective date may be as soon as one month after the release.

Administrative MAAA codes: Similar to the MoPath codes, Multianalyte Assays with Algorithmic Analyses (MAAA) see a quickened schedule. After Panel approval, the codes are released to the AMA site March 1, September 1, and December 1. The effective date is typically one month after release, although some codes are held until the major January 1 update.

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AMA Announces “Playbook” to Successfully Adopt Digital Health

The American Medical Association (AMA) has created a new resource to help physicians extend care beyond the exam room with technologies that are “changing the way patients interact with healthcare.”  The Digital Health Implementation Playbook offers a guide to the most efficient path for applying digital health solutions including key steps, best practices, and resources to accelerate and achieve digital health adoption. The AMA made this announcement in conjunction with the Digital Health Collaborative and Connected Health Conference.


Physicians are optimistic about the potential of digital health innovation to benefit medicine and expect to use more digital health tools in the near future, however, complex factors inhibit adoption. During an AMA-convened summit this year, innovators, researchers, physicians and decision makers warned that adoption and implementation of digital health solutions can be difficult and time-consuming.

“Implementing digital health technology has been a challenge for those without a clear course to success,” said AMA chair-elect Jesse M. Ehrenfeld, M.D., M.P.H. “The AMA is committed to making technology an asset, not a burden, and the Playbook provides the medical community with widespread access to a proven path for implementing digitally enabled health and care. The Playbook’s road map is based on institutional knowledge and best practices convened by the AMA from a wide array of experts in the field.”

The Playbook is designed for care teams and administrators in medical practices of all sizes and areas of specialty. The Playbook is a living document that will be updated to include new content over time. As the Playbook evolves, it will provide a helpful 12-steps process to guide the implementation of a variety of digital health solutions. The first six steps are fundamental to the implementation of any digital health solution. The subsequent six steps focus on specific digital health solutions and the unique considerations relevant to that specific technology.

Currently, the Playbook provides resources for the implementation of remote patient monitoring (RPM) using devices, trackers and sensors to capture and record patient generated health data outside of the traditional clinical environment. RPM provides clinicians the opportunity to apply patient generated health data to improve the management of chronic disease and engage patients in their own care.

As more connected devices and wearables are validated as accurate, reliable and effective health care tools, the medical community is increasingly looking to integrate digital health and mobile health technology into medical practices to better understand and manage chronic diseases outside of the practice environment as health care shifts toward value-based reimbursements.

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Wearable Devices Can Help Improve Health

The current decade has seen the boom of wearable tech. Today, we have embraced this tech and are using it in daily routine. Apart from being a fashion statement and geeky, these devices serve a noble purpose. They watch out for you. Yes, they keep an eye on your health and help to save you against several issues. In the following, I will explain that in detail.

Wearable tech comes in several forms including:

Most of these products contain sensor collect raw data. They feed this data to a database for analysis. The analysis triggers a response. The response can be an alert to a physician to contact the patient suffering from abnormal symptoms. These can help the doctor communicate with the patient and give them advice.

People who spend their time juggling between tasks more likely ignore their health. This negligence makes the test consume more time and delays reports. Therefore, wearing something that remains in contact with human skin to continuously and carefully monitor someone’s activity and fitness in real time can have its benefits. In short, wearable tech offers timely awareness on various health issues to both the patient and doctor.

With that said, following are four ways that help healthcare services improve their approach:

Real-time health monitoring

The rapid growth in tech has improved remote health monitoring. The real-time health monitoring devices are playing an important role and the products are developed to consider cost, usability, accuracy and security of data.

The technology also facilitates two-way communication between the doctor and patient, offering up-to-date healthcare information. The RMS system comes with two interfaces, one geared toward the user, and the second one designed for the doctor. The patient interface contains wearable sensors to extract medical data of the patient.

The listening port transfers information to a web server that accesses the data for doctor’s interface. For instance, a remote monitoring device with diagnostic framework finds an underlying health issue in real time. It can help avoid a potential health issue and let the patient recover. This system is compatible with several wearable sensors to extra the data and helps to learn different parameters including:

These parameters help to detect severe issues beforehand.

Fitness

Healthcare centers like Beach Pain Center encourage the adoption of modern tech in a fitness routine. Wearable tech helps people with their fitness resolution, improving their chances of success. Fitness wearable helps to monitor or even tracking fitness metrics as the distance walked on run calorie consumption and even quality of sleep. These trackers sync to a computer for real-time tracking for health-related data.

These trackers are geared towards fitness maniacs or people trying to achieve a healthier outlook, like practicing chiropractic. It guides the user towards success.

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The Global Healthcare Crisis

By Karim Babay, CEO, HealthSapiens.

Karim Babay
Karim Babay

Healthcare is a major expense worldwide and is estimated to account for $3 trillion in spending in the United States, and $6 trillion globally.

Combined healthcare spending in the five major world regions is expected to reach 8.7 trillion by 2020, up from $7 trillion in 2015. Global healthcare spending is projected to increase at an annual rate of 4.1 percent in 2017 through 2021, up from just 1.3 percent in 2012 through 2016. Aging and increasing populations, developing market expansion in advanced medical treatment, and rising labor costs drive spending growth. Still, global costs will vary wildly.

Per-person healthcare spending will span from $11,356 per person per year in the U.S. to just $53 in Pakistan in 2021.

Unfortunately, higher spending levels don’t always produce better health outcomes and value. For example, the United States continues to spend considerably more on healthcare (16.9 percent of GDP in 2016) than comparable countries, but it is in the lower half of the life expectancy rankings, according to the Organization of Economic Cooperation and Development (OECD). Historically, the United States healthcare payment system has been predominantly a fee-for- service model, and this has enabled a model of healthcare whereby a large driving force is obtaining profit. This has undermined the consumer-centric nature of the healthcare field.

The U.S. healthcare system is currently perceived as experiencing a growing crisis in terms of the level of access it provides, its costs, and the quality of care provided. Globally speaking, access to quality healthcare has reached crisis levels in many developing nations.

A Global Crisis

From a global perspective, most nations on the planet are too poor, and their healthcare system too disorganized, to provide any kind of efficient mass medical care. Clearly, such systems go against human ethics and create an even greater disparity—widening the gap between rich and poor. The rich can afford healthcare, while the poor stay sick or die. Even worse, in rural regions of Africa, India, China, and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may scratch enough money or barter to obtain some medical advice, or only have access to a village healer using home remedies that may not be necessarily effective against disease.

Ironically, only the industrialized countries—perhaps 40 of the world’s 195 countries—have established healthcare systems, consolidated within each nation (Beveridge, Bismarck, National Health Insurance, and out-of-pocket ). Almost all nations have a variant or fusion of these models, but there are still issues in every system despite the policy-makers’ best efforts.

The Beveridge Model, for example, is not in the best interest of the people. It relies on very high taxes for basic healthcare, without providing access or incentives for preventative care, thus raising the bar of healthcare expenditure. The lack of individualization forces healthier people to be charged the same amount as the fatally sick. Canada is a highly cited example of a nation using a Beveridge Model.

The Bismarck Model, on the other hand, uses an insurance system which is usually financed jointly by employer and employees through payroll deduction. This system causes higher costs of healthcare and diminishes efficiency. Cost issues are often addressed by raising premiums instead of controlling prices. While the fixed price for procedures helps to control costs, the quality of healthcare from different providers varies. Most healthcare services are covered by a mandatory health insurance; beyond that, the patient co-pays for a portion of care at the time of treatment. This system, utilized in Germany, is flawed as it offers no alternative to compensate individuals for the rising costs implemented by the government, pharmaceutical, and private insurance companies.

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Survey: Cost Transformation Is Imperative, But Hospital Efforts Lag Behind

Fewer than one-in-five healthcare executives has seen cost reductions of more than 5 percent in any priority area in the last year. This is one of many concerning findings in Kaufman Hall’s new 2018 State of Cost Transformation in U.S. Hospitals and Health Systems: Time for Big Steps report.

The report is Kaufman Hall’s second annual in-depth look at the priorities and progress healthcare executives are making in reducing organizational costs. The 2018 report shows that hospitals will need to take big strides and tackle more transformative initiatives. Progress is being made on some fronts, but it is slower than what many experts consider to be required of hospitals and health systems.

Increasing leadership accountability

Evidence of progress can be found in the following:

“U.S. hospitals are facing increasing pressures, so these percentages need to be much, much higher,” said Lance Robinson, managing director at Kaufman Hall. “The combined effect of the shift to a new business model, competitive pressures from expanding health systems, new retail options that are siphoning off high-margin services, and the need to raise capital for strategic growth initiatives is quickly putting hospitals in an untenable position.

“Our hope is that this new report helps healthcare executives see where they stand in relation to their peers — and that progress needs to be made in most organizations,” he added. “We also hope it provides actionable insights to help them accelerate their cost transformation efforts by tackling initiatives such as eliminating, repurposing, or redesigning capital-intensive, inefficient structures, programs, and processes.”

Cost reduction still focused on traditional targets

Among the key findings is that most of the cost transformation that has occurred so far has been in traditional cost reduction areas such as supply chain and other non-labor costs, where 64 percent of executives reported a reduction of three percent or more since 2017. Little progress has been made, however, in areas with the greatest potential for transforming cost structure, such as service rationalization, where 61 percent reported no progress in the past year, or reduction of inappropriate clinical variation (46 percent).

The numbers skewed even higher for organizations with more than 10 hospitals, with 60 percent reporting no progress in reducing inappropriate clinical variation, and 57 percent saying no progress has been made in improving physician enterprise management (versus 44 percent overall).

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A Quick Guide For Finding the Right Insurance Plan

Getting the right health insurance is tricky. You need to mind a few things to assure you sign the right contract between you and the insurer. Following, we will discuss a few tips that will help you find the ideal insurance package according to your needs, budget, and the market landscape.

Evaluate Your Condition

Health insurance is a commitment. You may have to pay more than you need, and it suggests you don’t have the right coverage. The following tips will help you.

Know Your Needs

Do you have any major plan, and want additional benefits? Try to lower out of pocket expenses or find another pan that suits you.

Long/Short Term

If you are starting your project and want a plan designed for self-employed workers, then consider a long-term plan. If you lose your job or landed in a temporary situation, then you will be better off with short-term insurance. Short-term insurance can last anywhere between one and six months.

Your Use

Do you visit the doctor often, or do you depend on the insurance to take your care? Do you have scheduled appointments with a doctor or not? You need to consider your medical needs and expenses recently. Mention your medical condition, history, and medicine. This will you get an idea of what to look for.

Extra Protection       

Are you considering lump-sum benefits for hospital stays, surgery or other health issues? If yes, then limited medical or severe illness coverage can help save money. If you are not convinced to trust an insurance company, you can always handle the unexpected expenses using your savings, right?

Your Budget

What’s your definition of an affordable insurance plan that is unique and caters to your needs. Hate to break the ice, but what looks cheap based on monthly premiums could end up costing more out of pocket expenses. Consider the whole picture. What can you afford to spend on your healthcare? You must consider your premiums, co-insurance, prescriptions, over the counter drugs, services not covered by insurance and other expense. If needed, also consider your vision and dental coverage.

Collect and Compare Quotes

Consider both supplemental coverage and short-term medical plans. Online insurance quotes don’t commit you to a plan, and lets you make an informed decision. So, collect a few quotes, and make a list. Compare both quotes and plans. Once you have made a list, narrow down your options. Consider the premium, coinsurance, drug coverage, co-pays, deductibles and out-of-pocket expenses. Run the numbers according to the expected use of benefits and ensure the plan will work with your budget and needs.

Plan Network Providers

Take a closer look at your options. Do you need an in-network provider, or will you choose anyone? If you need in-network care, then check the plan’s provider list. It will ensure you have access to your doctor, specialist, institutes and hospital. Yes, you won’t have to visit someone you don’t like. However, some plans work with a national provider network and can offer a gigantic benefit.

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