Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
The digitization of healthcare was a much-needed change brought after years of hard work and effort. One might wonder how could one justify the expenditure of $10 billion in a span of five years just on digitization. The problem intensifies when after several studies we find out that EHRs only reciprocate around 30 to 35 cents on a dollar and sometimes the figure dips to 15 cents.
Why have we digitized healthcare when the efforts required to get the desired result is still too much? I think we haven’t used the available technological aids appropriately. It is like driving a car at midnight and not knowing that you have headlights. You can have a clear view of your path, you can get to your destination fairly fast but can’t because you don’t know what is going to help you and in what way, your performance is reduced to a great extent to be able to achieve what you desire
Justified use of EHR could create the needed ecosystem
According to a report, 10 percent to 20 percent of savings are possible if a value-focused healthcare organizations capitalize on EHRs and interact with their patients better through technology. The amount that could be saved annually per bed is in between $10,000 and $20,000.
Meaningful Use
There are incentives for meaningful use of EHRs, but the truth is that the return through meaningful use incentives is somewhere around 15 or 20 cents on a dollars. There have been implementation, stabilization and optimization problems that have made it hard for healthcare organizations to extract the best out of EHRs. Practices will have to start using data as a source of innovation and come up with solutions that’ll not provide them better incentives but assist them in providing even better patient-centric care.
There are certain key points one can work on to make their healthcare ecosystem more efficient and patient-centric. Only judicious data usage from data disparate sources can help in so many ways, imagine what else is possible with advanced solutions. The integration of EHR with different disparate sources could be really beneficial in understanding the factors that drive value-based care. For instance, with the help of various data one can perform:
Population Health Management: With the help of data collected from different sources, impact at a population could be created and analyzed. Once you have the data of millions of patients, imagine all the things that are possible. Identification of at-risk patients, stratification of patients on the basis of various disease registries, better decision making, and a lot more. According to a study, due to disease management programs the cost of care were reduced by $136 per member per month because of reduction in admission rates by 29 percent.
Variations in Care Delivery: Efficient analytics and data management can help answer many questions. The medication process could be streamlined on the basis of past cases, and identified opportunities could be capitalized. Also, a thorough data-driven analytics could provide substantial insights on the performance of various facilities and how they differ when it comes to care delivery process.
Guest post by Todd Greenwood, PhD, MPH, director of digital strategy, and Benjamin Dean, digital and business strategist, Medullan.
Todd Greenwood, PhD, MPH
Once upon a time, all that pharmaceutical companies had to do to get their drugs on formulary was to package their clinical data and convince payers that their products performed better (or better enough) in clinical trials. Contracts were struck and the revenues flowed. For most new specialty drugs, those days are now history.
With the average retail price of a specialty drug used on a chronic basis exceeding $53,000 (according to an AARP study), nearly 200 times the average price of generics, payers are demanding that pharmaceutical companies make data-driven, value-based cases before access is granted. Even when payers are convinced , they build stipulations into value-based contracts that require manufacturers to prove that outcomes are being met with their covered lives, or else the pharmaceutical company will face additional penalties or further restrictions.
This all means that the data that manufacturers have used to drive regulatory approval are insufficient for garnering payer formulary access. Companies are being required to prove that their drugs work in the real world – not just within the carefully controlled environment of a clinical study. Across therapeutic areas from osteoporosis to oncology, payers have and are currently using real world evidence studies to define their formularies. Payers want to know how expensive specialty drugs will perform as patients adhere to (or in most cases don’t adhere to) their medications, and outside of the rarified air of a traditional clinical trial.
Benjamin Dean
Equally importantly, payers want to know how drugs affect the most important (and most expensive) health outcomes. Clinical data showing that a drug performed some percentage better than either a category leader or a placebo is now insufficient for new specialty drugs. Instead, payers need to know how health outcomes improved and how effective the drugs were at keeping patients out of the hospital and away from the catastrophic costs.
While it may sound easy, providing this kind of data is far from simple. Clinical trial data is controlled, clean and contained. Surveillance data (AKA real-world data) is a different beast, because patients are complicated. We have multiple conditions, take multiple medications, and we are inconsistent, rarely complying with our doctors’ orders. Moreover, the outcomes that payers care about – hospitalization, disability and death – can be difficult to distill. The data needs to be compiled from a variety of sources: medical and prescription drug claims, electronic health records, the lab (genomic and pathology data) and directly from the patient. Compounded with this, different populations of patients have different risks, and comparing one to another is fraught with difficulty. Finally, real world data can take time to accumulate. In order to know if a drug is working “in the wild”, researchers need to follow enough patients, for long enough, to observe negative health events of interest.
Take, for example, the new class of hyperlipidemia drugs, PCSK9-inhibitors. These injection drugs have been shown to cut LDL cholesterol levels in half, compared with about a 20 percent reduction for statin-class drugs like Zetia. But given the high price of these drugs ($14,000 per year in the US) plus their potential to be prescribed to a significant percentage of the population, payers have largely refused an access foothold. Payer organizations in the US and around the world are asking the same question: how well do these drugs work in real patient populations and to what end? Given that these drugs will be sanctioned for high-risk patients (many of whom will continue to use statin class drugs as combination therapy), payers are concerned about adherence, and ultimately if there is lower cardiac risk and fewer related cardiac events in patient populations. Many economists are asking: can’t we achieve the same ends for far less money by getting patients to adhere more faithfully to their statins?
The need is clear: pharma companies who have invested significantly to develop and launch new specialty drugs have to prove their worth with real world data. But in markets like the US, where providers are typically siloed and disconnected, it’s challenging to capture patient-level condition and drug utilization data, and effectively append it with hospitalizations, other outcomes evidence and costs in order to develop a complete picture.
But there’s hope. As the specialty drug market begins to shift to a value-based model, new ways of tracking real-world usage and connecting it to outcomes are emerging. This is where digital health is poised to play a critical role.
Whether you’re a student in school to become a medical assistant or already working in the field, we can bet that you’ve had a question or two that wasn’t easily answered by an instructor or coworker. The beauty of education and training today is that when that happens you needn’t spend hours flipping through books and manuals to find the information.
While it’s always best to have your questions answered “from the horse’s mouth,” these free medical apps can help put your mind at ease and get you an answer in a pinch.
Epocrates is the #1 medical reference app and go to mobile tool for U.S. physicians and medical providers. It’s hard to believe that it’s free with all of the features it offers. Through the app you can:
Look up OTC and name/brand drug information
Identify potential drug interactions
Access news and up to date research
Perform drug calculations
athena text messaging
athenatext messaging might be the most interesting feature of this app. You can set up a texting service within your care group to share images and communicate with people in your office about patients while still adhering to HIPAA laws.
Medscape is a similar alternative to Epocrates that has many of the same features in an easy to use design. One thing that sets it apart from Epocrates is that it is not just one app but a family of three that each serves a slightly different purpose.
Medscape
Look up OTC and name/brand drug information
Identify Interactions
Perform Drug Calculations
Medscape Medplus News App
Get up to date news related to your field of specialty
Follow medical trends and share information with your followers
Search topics and personalize what’s shown to you
Medscape CME and Education App
Earn CME/CE credit directly from the app
Train with a variety of formats including video and audio
Guest post by Tatsiana Levdikova, copywriter, Effective Soft.
Tatsiana Levdikova
Hospital managers want to be sure that hospital staff constantly improve their skills and share relevant information with their colleagues. Automated solutions cannot become a substitute for a discussion where healthcare professionals can exchange their knowledge and share their ideas, but routine tasks can be arranged in the form of a workflow portal.
Usage of such a portal has a number of advantages:
It will help employees to save their time;
It will enable hospital managers to assign different access privileges to users, thus restricting access to medical data;
The portal can automatically create and send out reports like the ones covering employee performance.
This portal can be used to create its own medical knowledge base for the hospital.
A hospital is a place where like-minded people work and spend much time together. Not to lag behind other healthcare professionals, hospital staff must keep abreast of the latest trends and developments in medicine. However, being extremely busy during their working hours, the personnel has not time to discuss medical trends and developments on the fly: according to the National Center for Health Statistics the mean wait time in U.S. emergency departments increased 25 percent, from 46.5 minutes to 58.1 minutes from 2003 through 2009.
A hospital communication portal seems to be the right choice in this case. However, it should be noted that developers of custom hospital software and such portals in particular must pay close attention to the specifics a medical organization has.
The portal will enable the personnel to share valuable medical information, such as aspects of people, companies, news and other things of interest in a convenient, efficient, and fast way. Besides, it is important to give users an ability to comment.
Users would have their own profiles enabling them to connect directly with each other. The profiles could also include basic information on departments where users work, room numbers, working hours, specializations, and more.
Capabilities of the portal could be extended further by adding elements of social networks by making it possible for users to upload videos and images, tagging other users to them, etc. A general chat or forum could also be launched. All in all, the portal could become an important part of the HRM reporting system and assist hospital managers in managing sources and personnel.
Such a portal has the potential to become much more than a communication tool. It could become an effective hospital automation tool:
Guest post by Dave Willsey, CEO and co-founder, Integrify.
David Willsey
Data security is a top concern of every healthcare provider today. And for good reason. A recent news story from The Wall Street Journal reported that healthcare is “frequently cited as one of the industries most exposed to cyberattack due to large networks with numerous access points and vulnerable, legacy computer systems.”
If there is an industry more vulnerable to hackers today than healthcare organizations, you’d have to search far and wide to find it. Healthcare hacking is a growing problem. It is a trend that will not change course anytime soon.
Unfortunately, hospitals and other providers present a target rich environment for criminals and malicious hackers. And, to make matters worse, a recent study by researchers at three leading universities concluded that additional threats are coming from within “the house” as clinicians and other staff are taking shortcuts and finding workarounds to security measures in an attempt to deliver better patient care.
The federal government response to this growing threat is two-fold: mandatory reporting of data breaches and financial penalties that sting when violations of protected health information occur.
When it comes to reporting and ensuring continuous improvement to guard against future risk to data security, the number-one best practice today is a well-conceived, executable and automated incident response plan (IRP).
The good news is seven-in-ten providers have an IRP in place. The not-so-good-news is most of those plans are based on manual, labor intensive, error-prone processes. What’s needed to step-up the game for healthcare providers is an automated IRP workflow process. Automation is the only way to protect your data as the threat continues to evolve in the future.
Secure data and information is the chief reason to automate IRP workflow. But ROI is another major business driver to invest in automation. Here’s why – you’ll get quick payback from more accurate information about threats and breaches sooner in the process before they get out of hand; your teams will be able to execute with rapid response times that lead to fast resolution when compared to manual processes; and, finally, automation will bring your leadership team and other key stakeholders a unique capability to apply analytics and intelligence to support and measure continuous improvement in critical processes against future threats.
Automated IRP can provide all users with a simple incident reporting tool across the healthcare ecosystem – if a doctor or nurse or someone in the pharmacy formulary, for example, notices a potential security issue, that user can immediately trigger an automated IRP process. This action would notify the front line responder teams who can then escalate a response if needed.
Effective incident response planning addresses three key areas – people, process and data. With people, it’s very important that the roles of each person handling patient data are well identified and this would include all clinical staff, billing and administrative personnel, insurance agents, IT personnel, outside vendors, contractors, and others.
Guest post by John Squire, president and COO, Amazing Charts.
John Squire
Why do so many small medical practices give up a significant portion of their earnings to outside billers? Depending on its geographic location, volume of billing, and other factors, a practice will pay an average of seven percent of its total revenue to a biller, which could be the difference between profit or loss, maybe even success or failure.
In many cases, the reasons given are that no one in the office has experience with medical billing and the physician doesn’t believe a small staff can handle the added burden of work. But if you dig a little deeper, these assumptions are often wrong.
As a developer of electronic health record (EHR) and practice management (PM) software for small practices, my company hears a lot about billing directly from physicians and staff. We’ve learned exactly who does the billing and how they do it once a practice starts using a PM system for the very first time.
In one case, a medical assistant was able to learn everything he needed to know about billing from the PM product training alone. That’s because the physician specializes in podiatry, so the practice uses a limited set of billing codes. With a relatively light patient workload, this Medical Assistant has more than enough time to handle billing functions during normal office hours.
At another practice, when a gynecologist questioned her staff, she learned that her receptionist was eager to start doing something else, preferably from home so she could care for young children. The receptionist became certified in medical coding at a local community college on her own time, and now uses the PM system remotely and visits the office once a week every few weeks.
In a third practice we know, the pediatrician himself shares the work of billing with two of his part-time staffers, who welcomed the extra hours of pay. One staffer had knowledge of billing from a past job, while another was eager to learn. They all handle billing together as a team, so there’s no burden on any single person.
Guest post by Susmit Pal, healthcare strategist, Healthcare & Life Sciences, Dell EMC
Susmit Pal
Aging populations and the rising incidence of chronic disease consume a disproportionate amount of healthcare resources. In the United States, about 75 percent of healthcare dollars go to chronic disease care and two out of every three Medicare recipients suffer from at least two chronic diseases.[1] The pressure for relief will grow as the population ages with approximately 10,000 new patients estimated to enroll in Medicare every day for the next 15 years.[2] The current demand for resources for chronic disease care combined with the imminent spike in Medicare enrollment beg for achievable solutions and strategies that address costs, care quality and outcomes in the short term.
Enter the Internet of Things (IoT), also referred to as the Internet of Medical Things (IoMT) within the healthcare industry. IoT is something that most are well-familiar with, but for the sake of clarity, we define it here as the purposeful connection of intelligent sensors, devices, and software to computer networking systems using Bluetooth, Wi-Fi, RFID or M2M wireless technology in order to promote an inter-functionality that serves a greater purpose. In healthcare, that greater purpose is the achievement of less costly and more information-driven and efficient patient care. Think wearable devices and wireless pill bottles, nanotechnology and ingestibles, and network-enabled medical devices like stethoscopes that can transmit cardiac data directly into a patient’s electronic health record (EHR).
The Impact on Chronic Disease Management IoT shows great promise in helping to improve the health of patients with chronic conditions. Combinations of remote monitoring, analytics and mobile platforms have repeatedly cut re-admissions of high risk patients with congestive heart failure (CHF) by more than half.[3] Evermore affordable and easier-to-use devices, such as wireless scales and heart rate and blood pressure monitors are improving overall wellness for the chronically ill. In fact, some researchers estimate that the value of improved health in patients with chronic disease using remote monitoring could amount to $1.1 trillion per year by 2025.[4]
At the consumer level, the rapid increase in the type and variety of personal mobile fitness trackers like Fitbit®, and online fitness applications for consumers demonstrates comfort with IoT to monitor physical health. Their very existence has created an avenue for patients to become more accustomed to tracking and managing their health online. In response, healthcare organizations are beginning to incorporate them into their consumer engagement strategies, while payers are starting to offer discounts and incentives tied to wellness management.
IoT is also helping to spur on some rather exciting new technological advancements in chronic disease management. Connected wheelchairs, for instance, are enabling people with disabilities to engage with care providers on a whole new level, communicating health alerts to care teams and repair notices to manufacturers. A group from the University of Missouri is spearheading a development project to utilize home monitoring sensors in an effort to prevent falls among the elderly by providing alerts to the patient when there is a fall risk, while Dell Healthcare is working with hospitals to leverage the use of tablets with integrated card readers to enable remote healthcare for home-based treatments.
There exists an even greater potential for IoT to impact chronic disease management at a population-level when combined with data analytics. For instance, Health Net Connect (HNC) has initiated a population diabetic management program with the intent to improve clinical outcomes and healthcare savings for diabetes, one of the deadliest and most costly of chronic diseases—and the results are impressive. They captured vitals and blood work from study participants over a 6-month period to measure the impact that routine teleconferencing and patient monitoring had on outcome. Patients in the program showed a significant decrease in key biomarkers, including 9.5 percent lower HB A1C and 35 percent decrease in LDL. To put that into perspective, for every 1 percent drop in HB A1C they estimate an $8,600 annual savings, and for every 1 percent decrease in LDL there is a 1 percent decrease in coronary heart disease, which costs on average a million dollars over a lifetime. HNC is continuing this program, noting that “this project has, and currently is demonstrating return on investment with cost savings, improved access for program members to their physician, improved clinical outcomes, and improved knowledge by program members on their disease condition.”[5]
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
Currently, one of the most discussed topics in the healthcare industry is MACRA; a complex 962-page document that is supposed to redesign the entire healthcare industry. Know all about MACRA in six questions.
What is MACRA?
MACRA stands for Medicare Access and CHIP Reauthorization Act. It’ll repeal the current Sustainable Growth Rate (SGR) Formula and extend CHIP for two more years. Extending CHIP for two more years (in total four years now) will help tens of millions of kids in retaining their insurance.
SGR was introduced in 1997, as a method to curb the Medicare expenditures. Under SGR the physician payments were cut if the overall expenditure was above the benchmark. This payment cut system turned out to be a major reason for significant losses incurred by physicians. Fearing payment cuts, many physicians started denying services to Medicare beneficiaries.
In 2015, “Doc Fix” or MACRA was proposed, which as the name suggests fixed the unprecedented payment cuts. If it weren’t for “Doc Fix,” physicians would have faced 21 percent payment cuts in 2015.
The Notice for Proposed Rulemaking (NPRM) was issued on Apr. 27, 2016, and the final rule will come in November. MACRA’s full implementation will begin from 1st January 2017.
What will MACRA change/replace?
The idea behind implementing MACRA is to create something that works and is enduring. MACRA would bring changes through its unified framework called “Quality Payment Program,” which has been further divided into Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APMs).
All those who will be eligible for MIPS are called Eligible Clinicians. The term has expanded from “Eligible Provider” to “Eligible Clinicians.” It will include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and groups of such clinicians. This expansion has increased the number of people who will receive payments from Medicare. CMS might expand to Medicare part B after two years, which will include therapists, clinical social workers, clinical psychologists.
To keep health information flexible and user-centric, and bring all these changes with better care opportunities, MIPS will evaluate eligible clinicians on four measures namely: Quality Category to replace PQRS; resource use category to replace value-based modifier; Advanced Care Information (ACI) to replace meaningful use; Clinical Practice Improvement Activities (CPIA).
How will the four categories measure the performance?
Quality Category: Instead of reporting on nine measures, Clinicians will have the choice to pick speciality-specific measures. They can choose six measures to report to CMS that suits them the best reflecting their practice. But one of these measures must be an outcome measure or a high-priority measure and one must be a cross-cutting measure. Clinicians can also choose to report a specialty measure. Clinicians can report through Claims, Electronic Health Record (EHR), Clinical Registry, Qualified, Clinical Data Registry (QCDR) or Group practice reporting web portal.
For the year one, quality category will have 50 percent weight in the performance scoring procedure.
Resource Use: Clinicians are not required to report for this, CMS will calculate these measures based on claims and “availability of sufficient volume.” To account for the differences among specialties, CMS has proposed to add 41 episode-based measures. These episode groups have potential to provide more actionable insights on measure resource use than the various cost measures.
For the year one, resource use category will have 10 percent weight in the performance scoring procedure.
Advancing Care Information: Clinicians can report on the measures that suit their practices the best and reflect how the EHR technology is being used for daily needs, with particular emphasis on the interoperability and information exchange. The performance score does not use threshold and allows physicians to receive partial credits on measures.
For the year one, advancing care information category will have 25 percent weight in the performance scoring procedure.
Clinical Practice Improvement Activities: In this category, clinicians would be rewarded for activities that improves overall care delivery such as care coordination, beneficiary engagement, and patient safety. Clinicians can choose practices’ goal from a list of 90 plus activities. This category does not require a full year reporting. CPIA activities need to be performed for at least 90 days during the performance period.
For the year one, CPIA Category will have 15 percent weight in the performance scoring procedure.
