Guest post by Steve Tutewohl, strategic accounts officer, Valence Health.
Steve Tutewohl
Payers and providers have always had inherent tension. Their business models never provided a true incentive to work together.
However, as the industry moves toward value-based care, providers and payers are now incentivized to focus on improving quality while lowering costs.
When I got into the healthcare business 20 years ago, as an actuary working on the provider side, my clients were taking bold risks with limited information, little analytical support and hardly any data. Today, providers often have more access to data than payers.
Healthcare is at a critical juncture, which creates a great opportunity for different types of professionals, including actuaries. We will continue to find new purposes, new roles and new responsibilities in healthcare, because the need for sophisticated analytics is growing exponentially every year.
One of the first Affordable Care Act challenges actuaries were uniquely prepared to address was the financial impact of risk adjustment transfers when the healthcare exchange opened.
The insurance industry had never seen anything of this magnitude before. It could either be catastrophic or a huge boon for healthcare insurers depending on how it paid out. Insurers are used to dealing with a certain level of uncertainty, but no company is comfortable operating blindly indefinitely. Based on our understanding of the business and our technical know-how, actuaries were able to offer providers and payers:
Risk score projections to estimate year-end metrics
Risk score opportunity models that identify likely missing HCC coding
Risk transfer year-end projections based upon a series of complex assumptions
Allocations of risk transfers back to individual members to see which segments of the block of business are profitable and which are loss leaders
Effective payer-provider partnerships are formed when both align on a value proposition. They have to see and understand what value the other one brings to the equation.
On the provider side, it’s pretty simple: They are looking to secure their patient base and increase their market share. On the payer side, there are slightly different objectives. If they are going to move towards assigning risk to providers, they need assurances the provider network can bend the cost curve so they, as payers, can focus on selling product.
Guest post by Gaby Loria, analyst for mental health software, Software Advice.
Gaby Loria
There are certain factors clinicians are constantly working to improve at their practices, such as:
While these three P’s apply to every health care provider, regardless of practice size or specialty, they are especially important for independent physicians.
Solo and small practice doctors face more challenges than their counterparts in group-owned or hospital-affiliated organizations. They shoulder all the responsibility for:
Ensuring care quality
Retaining and attracting patients
Paying the office’s overhead costs
Keeping up with shifting regulatory requirements, which some say favor larger providers
For all of these reasons, it’s wise for small practices to invest in health IT tools that can give them an edge in a competitive and increasingly data-driven industry. The three tech trends we describe below can help improve performance, increase profitability and impact productivity without breaking tight budgets.
Improve Performance with Population Health Tools
The goal of managing population health is to achieve measurable improvements in the health outcomes of a group of people. In other words, taking steps to help groups of patients get healthier instead of solely focusing on one individual’s treatment plan at a time.
That may sound like a lot of work, but it’s not—if you have the right IT. Nowadays, there are a number of population health-enabled capabilities that are built into electronic health records (EHR) software systems commonly used by small practices. The breadth and depth of these capabilities vary depending on the system, but here are some examples:
Leveraging an EHR’s reporting module to pinpoint the percentage of prediabetic patients at a practice, then specifically sending those patients information about diet and exercise changes to lower their risk of developing Type 2 diabetes.
Setting targeted, automated appointment reminders to women who have not had a breast cancer screening in more than a year, making them more likely to come in for preventive care.
Using software to generate risk assessments grouping patients by the severity of their chronic conditions. These assessments are based on patients’ digitized clinical records, so it’s easier to identify at-risk patients.
This technology makes it feasible for busy physicians to provide extra attention and care to patient populations that need it most, so they can prevent a worsening condition from developing. Such clinical interventions on a group scale can therefore make it possible to improve the overall health of a practice’s patient base.
Increase Profitability via Telemedicine
Telemedicine is the use of technology to support remote medical services. One of the most lucrative ways small practices can adopt telemedicine is by offering video consultations, which are virtual patient-physician interactions enabled by videoconferencing software. This allows doctors to see more patients per day without adding overhead costs (e.g., office space or staffing).
Interested physicians have two main options to capitalize on this trend:
The first is to get an EHR with integrated videoconferencing capabilities. This is ideal for practices that want to offer telemedicine services to existing patients. Depending on their state laws, they may be able to get reimbursed for these virtual consultations.
Alternatively, doctors can sign up to be a provider for a stand-alone platform (e.g., Teladoc, eVisit and American Well). This is better suited for practices looking to attract new patients. Some platforms charge doctors a monthly subscription fee, while others treat practitioners as independent contractors who get a percentage of whatever the patient pays per visit.
Healthcare jobs are plentiful, and at least through 2024, the demand for healthcare professionals such as nurses, anesthesiologists and physicians will only continue to rise.
The Bureau of Labor Statistics has said that healthcare jobs are “expected to have the fastest employment growth and to add the most jobs between 2014 and 2024.” Given the healthcare industry’s propensity for increased growth, hospitals need to embrace scalable IT—for their own sake and for the sake of their patients.
Fortunately, there are options.
Healthcare organizations increasingly rely on cloud-based IT solutions, and SADA Systems has reported that the number of organizations living in the cloud could be as high as 89 percent. There’s a reason for the high percentage—cloud solutions are safe, scalable, and efficient.
Hospital data safety is no small concern.
In 2008, 9.4 percent of hospitals used EHRs. By 2014, the percentage had skyrocketed to 96.9 percent. The switch to digital records was necessary, but in the rush to modernize, hospitals were left more vulnerable to data theft than other industries that had migrated more slowly.
According to Niam Yaraghi, healthcare systems are left with an additional concern. “Hospitals cannot tolerate the consequences of computer lockdowns,” writes Yaraghi. “If Wal-Mart gets attacked, it will likely shut down for a short period of time and fix the issue…Hospitals on the other hand, are dealing with patients’ lives.”
Cloud-based IT solutions provide both reliable security and almost nonexistent downtime.
Further arguments for cloud IT include the sheer number of patients hospitals see every year. Hospitals treat 136.3 million patients in the emergency room alone, according to cdc.gov, and believe it or not, that number is growing. Cloud IT accommodates growing demand seamlessly.
Advances in technology have fundamentally altered and inarguably improved the way we drive, shop and travel. Just ask anybody who uses Google Maps, Foodler or Uber.
Sadly, however, information technology has failed to deliver so far in the most crucial service of all – healthcare. This is at least partly because electronic health records (EHR) systems grew out of the computer systems that run the hospital’s inner workings — patient scheduling, admission and discharge, staff payroll and accounts receivable. For system designers, physicians’ needs were an afterthought, which is problematic because physicians are, after all, the linchpin of the healthcare delivery system.
To begin pulling healthcare IT out of the past, we must first take a look at how it supports physicians. The short answer today is “not well.” In fact, EHRs are creating as much frustration as benefit. Problems include poor presentation of patient data, fragmented information sources and unwieldy user interfaces that require dozens of mouse clicks or screen taps. It’s no wonder more than half of physicians who responded to a recent survey claimed their EHR system had negative impacts on costs, efficiency and productivity – three things IT should help, not hinder. These issues not only affect physicians’ professional satisfaction, they contribute to the phenomenon of physician burnout, which is a growing concern across healthcare. Studies show some 30 percent of primary-care physicians age 35 to 49 plan to leave medicine, and there’s an expected shortage of 25,000 surgeons by 2025. A Mayo Clinic study released earlier this year directly connected the burnout problem to physicians’ use of EHRs.
Today’s EHRs have done little more than “pave the cow paths.” We’ve gotten rid of paper in the hospital and made processes electronic, which is why EHRs can legitimately claim to have reduced transcription errors. But eliminating paper is just table stakes; the critical next phase is to do for healthcare what Uber has done for transportation: Reinvent the process so it’s optimized for and native to the technology that enables it.
Patients and physicians can and should advocate for such change. Today, patients have access to a vast body of information—the notes a doctor took, quality of care rankings, the level of personalization provided—and it’s only going to increase. As Lygeia Ricciardi, former director of the Office of Consumer eHealth at ONC said, “Getting access to personal health information is the start of engaging patients to be full partners in their care.”
Predictive analytics and advanced labor management are the most important – and underutilized – methods to assure that provider organizations have the right caregivers in the right places at the right times.
A recent survey of nurse managers by AMN Healthcare and Avantas, Predictive Analytics in Healthcare 2016: Optimizing Nurse Staffing in an Era of Workforce Shortages, (available on the AMN website) brought the need for more awareness to light in just a few stats related to staffing and scheduling:
94 percent of nurse managers say that understaffing hurts staff morale
Nearly 70 percent say they are very concerned about the impact on patient satisfaction
More than 50 percent say they are very concerned about the effect on quality of care
The survey also revealed a lack of sophisticated scheduling tools being utilized:
24 percent use paper-based scheduling and staffing tools
19 percent use simple digital spreadsheets
23 percent don’t use any scheduling tools at all
Further, the survey found that while nearly 90 percent of nurse managers said that a technology that can accurately forecast patient demand and staffing needs would be helpful, 80 percent were unaware that such a solution exists.
Strategies to Fulfill the Potential Predictive Analytics
This process to predict future patient demand and strategically plan clinician scheduling and staffing is scalable, cost effective and accurate. First, staffing data are processed with advanced algorithms, then forecasting models are created and validated, customized for each unit or service area within the organization, allowing workforce projections up to 120 days prior to the shift. The forecast is updated weekly, and by 30 days in advance of the shift, the forecast of staffing need is 97 percent accurate.
Compared to how scheduling and staffing is conducted at most healthcare organizations today, predictive analytics may seem like something out of a sci-fi movie. The truth is, this sophisticated forecasting of labor needs has been leveraged in other industries with great success. And, in healthcare, it can lay the foundation for significant advancement in utilization of staff, leading to improvements in morale, quality, and financial results. The advanced labor management strategies and tools layered on an accurate projection of staffing needs – months and weeks in advance of the shift – will turn an accurate forecast into an effective resource management strategy.
Adopting Workforce Analytics Every organization’s staffing mix should be unique to the fluctuations in its patient volume. Once an organization understands its demand, it can then determine its supply – scheduling and staffing to meet patient demand in the most productive manner possible. The organization can analyze and solve the problems that reduce its available supply of core staff, such as leaves of absence, continuing education, training and other issues. This precision understanding of workforce availability is then layered with patient volume predictions, and the result is accurate insight into the core and contingency staffing levels needed to meet patient demand.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
Since 1966, Americans have received more Nobel Prizes in Medicine than rest of the world combined with astonishing advancement in medical treatments, but how much of it reflected on ground level is still a troublesome figure. The soaring costs of healthcare; the amount spent on healthcare is approximately 20 percent of the country’s GDP and the amount spent on one person per year is going to be roughly $10,000 in 2017; much higher than any other country. Despite ACA, more than 30 million people in the U.S. are still uninsured. With so many concerns, the healthcare industry needs innovation to change this bleak picture.
Innovative solutions have emerged in these aspects – the delivery of treatments to patients, the technology as well as the business aspects. A few innovations in healthcare are here to stay, resulting in a more convenient and effective treatment for patients today, where time is of the essence and providing patients a better future is a priority.
Big Data. Big Use. Big Outcomes
Data-driven innovations are poised to do wonders in healthcare industry. Big data has been used to predict diseases, find their cure, improve the quality of care and avoid preventable deaths. From increasing awareness in patients to transforming data into information, big data offers healthcare a paradigm shift. Instead of analyzing a single patient’s data, we can now explore entire patient population and predict patients’ health trend.
Some healthcare leaders have already extracted value from big data and are already putting them to good use. Many value-focused healthcare organizations are working to improve healthcare delivery and healthcare delivery and patient outcomes by making an integrated technology system that will allow practices to deliver evidence-based care that is more coordinated and personalized.
Nursing is increasingly becoming as “high tech” as it is a “high touch” profession.
Today’s nurses have more technology at their disposal than any nurses ever before, and as one might expect, it’s considerably improving patient care. #Nursing explains all the necessities as well as the advantages and benefits of selecting nursing as a career.
Today’s nurses have more technology at their disposal than any nurses ever before, and as one might expect, it’s considerably improving patient care. #Nursing explains all the necessities as well as the advantages and benefits of selecting nursing as a career.
One area where nurses are putting technology to use is in informatics. Officially known as the study of information, in the world of health care, health informatics is the management of health information. Using electronic medical records, devices that collect health information electronically, and other electronic information standards, health informatics nurses are responsible for managing, interpreting, and communicating the data that comes in and out of health care facilities, all with one primary purpose: Improving the quality of patient care.
But how does that happen, specifically? How are nurses using informatics as a way to improve the care they — and their colleagues — provide to patients? As it turns out, there are several key ways that informatics is part of that effort.
Improved Documentation
Documentation has long been considered an important part of the nursing profession, but it’s more vital than ever to the delivery of quality care. While the theory and practice of nursing, the standards of nursing practice, legal and ethical considerations, and other points that are taught in advanced nursing programs all influence the practice of nursing, it’s information, and specifically, electronic documentation, that is having the greatest influence on modern nursing.
Modern nursing care is driven by individual patient needs and history — information that is collected and organized in electronic patient records. By documenting a patient’s condition, and sharing that information electronically, nurses are able to more effectively manage care, and by extension, improve the quality of that care.
A great deal of documentation takes place automatically thanks to connected devices, which collect specific information in real time and transmit it to patient records. By looking at the documentation of a patient’s condition over time, nurses can make better decisions about how to provide care and when changes or adjustments need to be made.
Reduced Medical Errors
Patient safety is a primary concern of any health care provider, and nurses are often on the front lines of ensuring that their patients are kept safe and preventing medication errors, misdiagnoses, falls, and other problems. Health informatics provides important data that can prevent these errors; for example, an electronic record can provide information about a possible dangerous medication interaction or allergy that might not otherwise be immediately apparent. Armed with data, nurses can make quick decisions that keep their patients safe.
Nurse practice error allegations and patient complaints are one of the leading causes of nursing board license investigations, disciplinary actions and malpractice lawsuits. Complaints have been surging in recent years due to the ease of filing complaints online. Health informatics allow standardizing many patient care decisions which makes it easier for healthcare organizations to limit their liability and assure compliance with the Nursing Practice Act and other medical care standards.
In fact, in a study by the Agency for Healthcare Research and Quality (AHRQ), a majority of nurses reported that when they have access to EHRs, they have fewer problems with getting patients ready for discharge, fewer medication errors, and better quality of care. And when it comes to transfers between departments, nearly 15 percent of the nurses surveyed reported that information was more likely to be shared and less likely to “fall between the cracks” when electronic systems are used.
Do you know how tech is disrupting the traditional healthcare market? Well, we do, and we have gathered all the information you need to know about this topic in one infographic. Today technology is constantly evolving and starting to take over surprising segments of our lives. The leading health tech accelerators, startups, companies and minds are doing their best to make this industry grow. Every day med tech makes people feel safe and more comfortable, it helps us to have more control over our health and body. We’ve made a research on the biggest challenges of the health tech sector, on global investment in health tech companies, on health tech influencers to follow, on the reasons of health tech industry growth and more interesting stuff.
It didn’t take much time for investors to see the perspectiveness of the health tech sector and to start investing in it. Such companies as Y Combinator, Dreamit Ventures, GE Ventures, Google Ventures, Rock Health and many others started to invest into dozens of health tech startups. At the same time a lot of different governmental programs were established, with the purpose to support health tech development and healthcare innovations. Canada founded a new $20 million Health Technology Innovation Evaluation Fund to support made-in-Ontario technologies. In Australia $4 million Mental Health Innovation Fund supports health tech startups to come up with health-driven innovations fighting with mental illness. At the same time, with $4.5 billion funding from the government, 2015 became the year of digital health for the US.
The biggest challenges of the health tech sector are: difficulty of market entry for new generation drugs; misuse of USB ports can cause medical devices to malfunction; robotic surgery: complications because of insufficient training; and other factors. A lot has been done yet there is still much to accomplish. So the following infographic about health tech and its role in healthcare industry attempts to give you important information in a creative way. We hope you’ll like it.
Nursing is increasingly becoming as “high tech” as it is a “high touch” profession.