Guest post by Ken Perez, vice president of healthcare policy, Omnicell, Inc.
Ken Perez
The recently concluded debate about the American Health Care Act (AHCA), the Republicans’ first attempt at a Patient Protection and Affordable Care Act (ACA) replacement plan, centered largely around issues of insurance coverage and access to care.
The real turning point for the AHCA seemed to be the Congressional Budget Office’s March 13 release of its analysis of the bill, which concluded, among many things, that millions more Americans would be uninsured under the AHCA than under the ACA (14 million in 2018, 21 million in 2020, and 24 million in 2026).
After it became clear that the roughly three-dozen member Republican House Freedom Caucus—which sought a more aggressive piece of legislation that would gut the ACA—would not support the bill, House Speaker Paul Ryan concluded that the Republicans lacked the needed votes. Thus, on March 24, he pulled the AHCA from the floor. Ryan told reporters, “I don’t know what else to say other than Obamacare is the law of the land” and “We’re going to be living with Obamacare for the foreseeable future.”
With the focus mainly on coverage and access issues, a largely unasked question has been, “What will happen to value-based care?” The AHCA did not address this area, though, perhaps the Republicans intended to cover it in phase two or three of their grand plan to repeal and replace the ACA. As originally envisioned by congressional Republicans, phase two will consist of executive branch initiatives (e.g., actions by the Department of Health and Human Services and presidential executive orders), and phase three will include subsequent pieces of legislation addressing other aspects of the ACA.
The fate of value-based care is an important topic because U.S. healthcare costs continue to escalate and outpace general inflation—increasing 5.8 percent and reaching $3.2 trillion in 2015, equal to almost $10,000 per person per year. In addition, the ACA mandated five major healthcare delivery reforms promoting value-based care:
The Hospital Value-Based Purchasing (VBP) Program
The Hospital-Acquired Condition Reduction Program (HACRP)
The Medicare Shared Savings Program (MSSP)
The national pilot program for payment bundling
The Hospital Readmissions Reduction Program (HRRP)
Moreover, the ACA provided funding of $10 billion over 10 years for the Center for Medicare and Medicaid Innovation (CMMI), which was tasked with testing and evaluating various payment and service delivery models involving, in most cases, voluntary provider participation, with only a few models being mandatory.
Guest post by Nora Lissy, RN, BSN, MBA, director of healthcare information, Dimensional Insight.
Nora Lissy
It’s no surprise that chronic diseases are killing the United States both physically and financially. According to the Centers for Disease Control and Prevention (CDC), seven of the top 10 causes of death in 2010 were from chronic diseases, where two of the conditions—heart disease and cancer—together accounted for nearly 48 percent of all deaths. To add to the problem – effectively treating these conditions comes with an exceedingly high price tag. According to U.S. News & World Report, 86 percent of all healthcare spending is currently going towards the treatment of these chronic diseases, equating to more than $3 trillion annually.
So how can the healthcare industry combat the rise of chronic conditions while keeping escalating treatment costs down?
One of the most effective tools for monitoring chronic disease management while still keeping an eye on care costs is business intelligence. Business intelligence has continued to increase in prevalence within the healthcare industry in recent years. According to a HIMSS Analytics study, 41 percent of hospital respondents reported they currently use clinical and business intelligence tools for their analytics, with that number expected to continue to increase over the next two years. With business intelligence continuing to prove its value within healthcare, physicians are starting to see the true potential of this data-driven tool to positively impact the industry as whole, including with the management and overall cost of chronic diseases.
Below are three ways that business intelligence can help to improve chronic disease management and lower the rising costs of care.
Care plan adherence: Chronic conditions such as heart disease, diabetes and hypertension all require consistent adherence to care plans to improve a patient’s health status. A major part of this also includes frequent follow up appointments scheduled by physician offices that allow providers to check in on a patient’s progress. A business intelligence capability can significantly help with ensuring that these consistent follow ups occur. Through work queues and alerts, physicians can gain insight and visibility into each individual patient within a population cohort, allowing them to use the most accurate and timely information when scheduling follow up appointments. Business intelligence also provides insight into disease trends across a patient population. Through these insights, physicians can also allow for more personalized and cost effective treatment plans to be leveraged.
Guest post by Kate Jester-Brod, vice president of client success, EoScene.
Kate Jester-Brod
Since Hurricane Katrina, the healthcare industry has been pushing towards maintaining comprehensive EHRs. The concept of an EHR combined with the concepts of the health information exchange (HIE) creates a means for patients and providers to always have a 30,000-foot view of the patient’s health. Which then begs the question, ‘what about the actual healthcare facilities?’ What does their 30,000-foot view look like? Are facility and staff doing their part to support exceptional and safe patient care?
In the most basic of explanations, enterprise risk covers the overall opinion of others towards your organization. It can affect revenue, staff retention, grant funding, and much more. In the healthcare industry, the enterprise is at risk at many levels. Drug safety, staff and patient safety, clinical outcomes, facilities maintenance, public relations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are some but not all of the components of enterprise risk.
Moreover, reducing enterprise risk in any industry includes reducing not only overhead and operational costs but also consumer costs. In healthcare reducing costs for consumers can increase patient satisfaction, which is an obvious connection. More interesting, however, are recent news stories reporting on suits against major hospital systems for frauds and schemes—or applauding them for lowering healthcare costs.
While telemedicine and home health are increasingly major components of healthcare, much of healthcare operates in a facility like a hospital or clinic. Facilities, along with structural integrities and heating, ventilation, and air (HVA) systems, also include patient equipment and a state of cleanliness. All of these components comprise the environment of patient care and healing, and the enterprise. By taking control of these areas a hospital or healthcare facility becomes one step closer to protecting the enterprise.
The best way to protect it is to predict and manage risk before problems happen. This is even more critical as the healthcare industry works towards the Institute for Healthcare Improvement’s Triple Aim as a means to optimize care. The three components of the Triple Aim complement and overlap the need to reduce enterprise risk.
Fundamentally, the Triple Aim works towards creating system-level metrics to measure success. Enterprise risk is at the center of these metrics that ultimately drive decision making. Understanding the policies and procedures that make up facilities management, patient safety, accreditation, and the overall health of the system can significantly reduce enterprise risk while supporting more effective decision making.
Taking control of facilities management can directly impact the reduction of enterprise risk. Facilities Management holds many different responsibilities in a healthcare system, including emergency management, fire safety, patient and staff safety, infection prevention, environmental services, utilities and equipment, accreditation, and many others.
Improving patient-centered care with consideration for facility compliance results in tangible ways to improve the Triple Aim. The electronics health record is assumed to document all the components of the Triple Aim, but this clinically based monitoring system focuses on provider-patient experience and overlooks other components of the healthcare environment.
Utilizing facilities information technology plays a critical role in establishing the foundation necessary to achieve positive results in achieving the Triple Aim. Recent innovation in health facilities IT has resulted in quality improvement and measurement from the ground up and has the potential to address an often overlooked component of that we all strive for in Triple Aim.
Digital technology is arguably the best gifts of the 20th century as it has largely influenced the way the world works. Right from business to education and health, there is no sector that has been left untouched or uninfluenced by the digital revolution. Especially when we speak of the healthcare industry, we can see the huge impact that digital revolution has left on it and took it to the next stage of evolution. There are a number of benefits offered by digital revolution to the healthcare industry that has helped both patients and healthcare professionals. Let us know some of the best benefits offered by digital revolution:
Easy communication between doctor and patient
Communication plays a vital role in a doctor-patient relationship. However, there are various factors that affect free communication including long waiting hours, concerns about disclosing personal details in front of other patients and language proficiency/expression disorders. Most importantly the present state of mind of patients of doctors (agitated, confused, angry, annoyed or absent) can ruin entire communication. Patient portals offer an excellent environment for hassle-free and instant communication between doctor and patient. The patient does not have to physically visit the doctor and wait for his turn. He can message him from comforts of his home. Besides, he does not have the hesitation in revealing any personal details of any nature as he is not in a public place. He does not have to go through the hierarchy (receptionist, attendant, assistants, etc.) and can directly communicate with the doctor one-on-one.)
Relation between multiple healthcare specialists
Many patients suffer from multiple diseases or disorders that need services of different specialists. Needless to say, it is very important for all the specialists involved to maintain constant communication and share details with one another to offer the best support. Besides, some medications don’t go along well with one another. With the help of constant information sharing the specialists can identify the other medications; the patients are taking and design their medication schedule accordingly. It can also speed up the treatment, eliminate unnecessary administration jobs like attending phone calls and also allows the specialists to create, monitor, manage and modify the referral flow.
Security of data even in most unfavorable conditions
No matter how secured physical records of a hospital may be, there are always the possibilities of losing them during unexpected conditions like staff negligence or disaster. However, that’s not the case with Digital Records. It can be saved online and can be accessed from anywhere. Besides it also saves time as the digital records can be accessed by multiple health professionals at the same time. It is especially helpful for the patients who are being treated for multiple health disorders by different professionals located in different areas. The shareable information is secured using best and foolproof technology.
With technology advancing all around the world, the approach to healthcare is also rapidly evolving. As healthcare professionals, there’s a lot to learn from other countries about how to streamline procedures to provide faster and better service. Here are a few innovative ways other parts of the world are taking care of patients.
Australia
Technological development in Australia has seen a quick trend toward home-based health care procedures. The country down under now allows patients to easily monitor and test their health wherever and whenever they please. As Budget Direct reports, such innovations include the oral home-based HIV test. Oral tests for HIV have been viewed with skepticism for some time; however, this simple test, which involves running a swab across the gum-line and then placing it in a solution, has similar accuracy to the other rapid HIV test on the Australian market, which requires a finger prick and blood sample.
Further innovations by scientists in Australia have seen a line of bionic devices that provide on-site diagnostic. Look for smaller and rural hospitals to adapt these devices in the future, as many in Australia already have. Accurate diagnostics can save hospitals thousands in the event they must airlift a patient to a larger, more equipped hospital.
Germany
From automotive technology to healthcare, Germany has a strong reputation for being a pioneer in many industries. The ReinHeart, for example, is an artificial heart that provides a technical alternative to a heart transplant. The ReinHeart has been in development since 2009 and is still in an early stage. The ReinHeart’s pump unit replaces a failed human heart, and the control unit is implantable and powered by an internal battery that can be charged wirelessly through the skin. The user interface is worn with the external batteries on a waistband or belt.
Reliability is a key concern of ReinHeart’s. Once implanted it must run continuously without repair. Due to the long wait time and donor deficit associated with heart transplants, the device is designed to be a new therapy for terminal heart failure and has been tested in a collection of experiments.
China
China’s technological development has been closely linked to mobile apps and devices. When it comes to health care, the country has seen technology that caters to higher mobility and ease of use. Specifically, tech giant Baidu formulated a set of chopsticks that test for food contamination and sends the details back to a linked mobile device or desktop. Assisting in prevention and mobile monitoring, the technology also looks at calorie counting to assist individuals in constant maintenance of their health in relation to the food they’re eating.
Mexico
One of the greatest aspects of technology is the convenience and quick response it provides. MedicallHome is an innovative program based in Mexico that provides specific and detailed telephone-based health care advice. Staffed by paramedics and health care professionals, the service can focus on the specific needs of the patient and allows them to solve any queries quickly.
MedicallHome was ahead of its time when it was first established in 1998. It now serves more than five million people in Mexico, showing how well received its services have been for nearly 20 years. While this solution is not the most tech-focused, it illustrates how simple technologies can be creatively utilized in the health care industry to assist patients quickly and thoroughly.
Healthcare is a complicated, fast-paced and often stressful industry. So why not use technology to make some of these procedures quicker and more user friendly? All around the world, health care professionals are using a variety of different innovative technologies to improve a patient’s experience.
President Trump’s promises to reform and deregulate the FDA seem doomed to do the opposite of what they were intended to do.
His track record on other issues notwithstanding, Trump might be excused for not knowing that American medicine is a bizarro-world where the good intentions of outsiders and insiders alike transmogrify into destruction, disruption, and bureaucratic chaos.
Big Business That Depends on Regulation
In a world where insurance wasn’t a prerequisite for accessing almost any care, and the free market actually was the primary force in driving patient and provider behaviors, broad strokes deregulation might work.
But in America’s healthcare system, “access” isn’t access. Rather, having a payer on board who will cover drugs, treatment, and providers is “access.” Simply knowing that a new wonder-drug exists doesn’t help people who need it. Steamrolling the FDA so that drugmakers can offer the drug on the open market, it should come as no surprise, also helps no one in particular. Because payers–insurers–look to the FDA for evidence of a drug’s value and clinical efficacy (rather than, say, patients desperate for a cure or drugmakers looking to cash in), disrupting the approval process serves also to disrupt payer confidence.
In other words, without the FDA’s lengthy, cumbersome, and expensive approval process, payers will be shy to cover new drugs–and thereby enable patients to access them. Drugmakers, by extension, would rather not face the uncertainty of what payers, providers, and patients might decide to do with new drugs absent the structured system of insurers taking their cues from the FDA, and thereby driving the behavior of the rest of the system.
To be fair, the FDA and its system for testing and approving new medications and devices has flaws. An overreliance on drugmakers’ own data, rather than independent research, sometimes leads to a lack of rigor and poor follow-up allowing unsafe drugs and devices to slip through to market only to be proven faulty by consumers, rather than regulators. A lack of clarity in its labeling requirements creates onerous demands on manufacturers and retailers, yet provides little to no benefit to the very consumers it is supposed to help protect and inform. There is no shortage of ways in which the FDA and its operations could be improved.
But Trump’s approach to the FDA treats the organization like a Gordian knot — something more easily cut through than carefully managed — with predictably mixed and messy results. He isn’t entirely wrong that there are problems to be solved, but his approach also isn’t graceful or nuanced. More than that, though, it makes the mistake so ubiquitous in business and leadership today, of relying too much on generously vague terms like “innovation” and the amorphous power of “science” at large to provide cures not just for injury and illness, but all of society’s woes.
When Will Science Save Us
In a tech-obsessed period of American life, the instinct–apparently shared from the Trump White House on down through to developers and plenty of consumers and patients–is to rely more on automation and digital systems like EHRs to facilitate the spread of knowledge, best practices, and to capture performance and quality metrics. But overcoming both the imperfections of the FDA as well as the habits of practicing clinicians may still fall to the humans of the medical profession, rather than to their tools and tech.
Guest post by Nora Lissy, RN, BSN, MBA, director of healthcare information, Dimensional Insight.
It’s no surprise that chronic diseases are killing the United States both physically and financially. According to the Centers for Disease Control and Prevention (CDC), seven of the top 10 causes of death in 2010 were from chronic diseases, where two of the conditions—heart disease and cancer—together accounted for nearly 48 percent of all deaths. To add to the problem – effectively treating these conditions comes with an exceedingly high price tag. According to U.S. News & World Report, 86 percent of all healthcare spending is currently going towards the treatment of these chronic diseases, equating to more than $3 trillion annually.
So how can the healthcare industry combat the rise of chronic conditions while keeping escalating treatment costs down?
One of the most effective tools for monitoring chronic disease management while still keeping an eye on care costs is business intelligence. Business intelligence has continued to increase in prevalence within the healthcare industry in recent years. According to a HIMSS Analytics study, 41 percent of hospital respondents reported they currently use clinical and business intelligence tools for their analytics, with that number expected to continue to increase over the next two years. With business intelligence continuing to prove its value within healthcare, physicians are starting to see the true potential of this data-driven tool to positively impact the industry as whole, including with the management and overall cost of chronic diseases.
Below are three ways that business intelligence can help to improve chronic disease management and lower the rising costs of care.
We put a lot of faith in health technology: to make us better, to save our systems, to revolutionize healthcare. We may be looking at it from the wrong side entirely.
The social determinants of health matter more than our ability to deploy doctors or provide insurance; physical and mental, health is always more social than clinical.
But most of our health tech that is supposed to be revolutionary is aimed at clinical factors, rather than the social determinants of health. Yes, telehealth can increase reach, but it is still just a matter of touchpoints, not a fundamental change to the lifestyles and cultures that determine health.
Same with all our EHR systems creating more ways to record information, more ways to quantify patients, to put more emphasis on engagement and quality-based reimbursement. Even genomics and personalized medicine are taking a backseat to soliciting reviews and trying to turn the patient experience into a number. It all puts greater focus on the clinical encounters, on how patients “feel” broadly about each minute aspect of their time in the medical facility.
A Digital Disease
As politicians trade blows on minimum wages and the ACA, the likelihood grows that insurance benefits and livable incomes (and lifestyles) will get pushed further out of reach for more people.
Modern work is tech-centric, which means lots of sitting, and manages to facilitate increased snacking without being particularly physical, a double-whammy that prevents employment or higher incomes from leading to healthier choices. For the less-skilled, normally accessible jobs are in the sights of automation and disruption. While tech is taking over medicine and opening up new possibilities, it is also transforming the labor market and closing countless doors to workers.
By extension, technology is changing the social framework that determines public health. Income inequality is growing, wage growth is stagnant, and no amount of awareness can change these front-of-mind concerns for people who may well want to eat better and exercise more, or even commit to seeing the doctor more often and following his or her advice to the letter.
Poor people can’t necessarily eat better as a simple matter of choice or doctor’s orders. Planning meals and purchasing healthful foods is a tax on limited resources–time as well as money. Working three jobs to pay the bills, many lower income individuals also don’t necessarily have time to exercise. And more likely than not, those working even high-paying jobs are sitting all day, sapping their bodies of energy and resilience, undoing the good of their intentions and smart devices alike through attrition.
