Guest post by Thomas J. Van Gilder, MD, JD, MPH, chief medical officer and vice president of informatics and analytics, Transcend Insights.
Thomas Van Gilder
Population health has become a puzzle of processes and technologies to improve health outcomes, enhance the physician-patient experience, and reduce costs. Although the healthcare industry is making great strides toward achieving these goals, a necessary step—the integration of clinical, claims and wellness data—has just begun.
Today, many medical business decisions are based on claims data; yet, robust insights into clinical quality require clinical data. Furthermore, information that is not typically found in healthcare information systems, such as that from wearable devices, and from those who may have little to no contact with the health care system, needs to be incorporated into population health management systems.
Accessibility to clinical, claims and wellness data can provide physicians and care teams with a more complete view of the care delivery system journey and an integrated view of a patient’s data as he or she has engaged the healthcare system. With a broader view of a population’s health and various opportunities to proactively address an individual’s care, a physician or care team can help prevent adverse events or future disease to ultimately improve the health and well-being of the individuals they serve.
As we embark on this journey to complete the population health puzzle, it is important that healthcare systems, physicians and care teams optimize the value of integrating clinical, claims and wellness data by considering the five questions I have outlined below.
Do you have a reliable, complete and manageable way to access clinical, claims and wellness data?
Clinical data, in its current state, requires an “interoperable platform” to be able to present a single, comprehensive view of a patient’s or population’s health data at the point of care. An interoperable platform connects disparate electronic health record (EHR) systems across a community to collect and provide access to information in a secure and confidential way.
Claims data, traditionally aggregated from health insurers, and now from Accountable Care Organizations, needs to be integrated as well to create a more complete picture of an individual’s or population’s health. Not only does claims data yield rich insights that may not be present in clinical information alone—for example, completed pharmacy transactions—but it can also display health-related activity that occurs outside of any given health system. This could pertain to the use of a non-network urgent care facility or activity that might not be captured in an EHR, such as retail pharmacy vaccinations.
Wellness data generated from things such as immunization campaigns, wellness fairs or wearable health technologies, which seem to be on the rise, can help provide a broader record of an individual’s health so that a physician or care team does not have to rely only on sick encounters. Wellness data can help physicians and care teams identify opportunities in the course of an individual’s health, to intervene earlier and try to prevent some of the complications, or even some of the illnesses, from occurring in the first place.
Therefore, ensuring all of this valuable health information is accounted for to generate a more complete picture of a given patient’s or population’s health, requires accessibility to the data, achieved through community-wide interoperability, and a thoughtful plan for using the data to drive quality improvement, care experience enhancements, and reduced health care costs and utilization—the “Triple Aim.”
Do you have a way to normalize your data and corroborate your inferences?
Transitioning from data access to achieving the Triple Aim requires that clinical, claims and wellness data make sense together, across various systems and coding schema. In other words, the data must be normalized, duplicate and time-decayed information removed, and data gaps filled in by interpretation or clinical corroboration with other information.
Normalization requires a platform and an approach that first recognizes that clinical, claims and wellness data may conflict or overlap, and provides a systematic way to address these issues. This all requires solid quality assurance activities, software, and staff with sufficient data science skills to be able to bring clinical, claims, and wellness data together and use the integrated data set to provide actionable health intelligence.
Additionally, as standards are becoming more broadly adopted and health systems are becoming more sophisticated in their use of information technology, data normalization will become more seamless. Until then, I believe it will remain a critical issue.
HealthLoop connects doctors and patients with timely and actionable information, improving patient satisfaction and driving better outcomes. HealthLoop is a cloud-based platform that automates follow-up care; keeping doctors, patients and care-givers connected between visits with clinical information that is insightful, actionable and engaging. Its peer-reviewed follow-up plans automate the routine aspects of care while tracking patient progress and monitoring clinical areas of concern. Its analytics engine sifts through and filters the deluge of patient-generated data in realtime; focusing the care team’s time and attention on patients who need them the most.
Elevator pitch
HealthLoop automates physician and patient connectivity to create an empathetic engagement reducing patient readmission rates by half. It is a technology leader in the field of patient engagement.
Product/service description
HealthLoop’s sophisticated, HIPAA-compliant messaging platform automatically delivers timely check-ins to patients during an episode of care. For example: a knee surgery patient receives daily check-ins from their doctor helping them prepare for surgery and follow pre-op instructions. After being discharged from the hospital, the patient gets daily follow-ups reminding them to change their bandages, work on exercises and watch for signs of infection. This personalized patient experience is delivered with no extra work from medical practice staff. Complications are caught and resolved early through the platform and patient outcomes and physician ratings improve as a result.
Origin/founder’s story
Jordan Shlain MD
Practicing physician Dr. Jordan Shlain was looking to solve a communication problem he encountered with his own patients. As much as he wanted to deliver a caring, VIP experience to each patient, he simply didn’t have the time or the tools to do it automatically. In what Dr. Shlain calls “innovation by irritation,” he had been painstakingly tracking patients between visits in an Excel spreadsheet before hiring a developer to turn it into easy technology. HealthLoop was founded in 2009 based on this original concept.
Marketing/promotion strategy
HealthLoop works with medical practices, departments and hospitals across the country. The company is active at conferences including HIMSS and AAOS. Word-of-mouth from physicians who are able to save time while also delivering personalized care is also a significant driver.
Market opportunity
The rapidly changing reimbursement landscape has created a boom for HealthLoop’s technology. With mandatory bundled payments for hip and knee surgery (CCJR) on the horizon for 2016, increasingly healthcare providers are looking for solutions to provide personalized, responsive service to patients. The patient engagement market is expected to surpass $13.7 billion by 2019.
How your company differentiates itself from the competition
Compared to the typical passive “patient portal,” HealthLoop offers a much more sophisticated and personalized experience to patients. The company tracks an industry-leading patient engagement rate (more than 70 percent). By delivering timely, empathetic messages, HealthLoop has created a platform that is truly useful to patients, physicians and staff.
Errors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.
While many organizations have placed a priority on avoiding billing errors, they still occur. And with the upcoming transition to ICD-10, home health and hospice providers are under even more pressure to get billing right the first time, every time. By most accounts, providers can expect to see a spike in rejected claims during the first few months of ICD-10 implementation; some estimate that as many as 10 percent of all claims will be rejected as coders get used to the new procedures. That’s bound to have an effect on payments and cash flow, so it’s vital that agencies work with their billing offices to identify common errors now, and look for ways to overcome them.
Preparing for the Transition
Ideally, home health agencies should be in the final stages of preparing for the launch of ICD-10 now. August 3 marked the beginning of the 60-day episode period that would end on October 1, when ICD-10 goes into effect. This means that agencies that are beginning care episodes now are required to submit RAPs in ICD-9, but code them in both ICD-9 and ICD-10, so that when the final bill is submitted to Medicare, it will be in the correct format. In many ways, this gives home health providers an advantage, since they will have two months’ worth of practice with the new codes on almost every chart, where most other providers are only practicing dual coding on some charts.
Because of the dual coding requirements, most home health providers have already switched to an ICD-10 compliant software solution. Now is the time to identify gaps in training, and adjust intake procedures, forms and other resources that affect how services are billed. Mitigating potential obstacles now will prevent denied claims later, and smooth the transition.
The Most Common Errors
While the new coding procedures will undoubtedly be a learning curve for many providers, you can reduce the overall number of denied or delayed claims by paying close attention to the most common errors and taking steps to avoid them. These include:
Guest post by Karen Holzberger, vice president and general manager, diagnostic solutions, Nuance Healthcare.
Karen Holzberger
A few years ago, there was a witty car commercial advertising an alert feature that took the guesswork out of filling your tires by gently beeping to signal the appropriate pressure had been reached. It featured a series of vignettes where the car horn would beep, cautioning the owner to reconsider just as he was about to overdo something (for instance, betting all of his money on one roll of the dice). The concept of getting a reminder at the point of a decision is a compelling one, particularly if it can save you time or aggravation and guide you to do the right thing. In healthcare, any technology that can provide that level of support will have a profound impact on patient care.
Albeit humorous, that car commercial wasn’t far off the mark with healthcare challenges. Unnecessary medical imaging exposes patients to additional radiation doses and results in approximately $12 billion wasted each year, but it has also has another unintended downstream effect. It has fueled a culture of medical certainty, where tests are ordered in hopes of shedding light on some of the grey areas of diagnostic imaging, including incidental findings. The reality is that incidental findings are almost always a given, but not always a problem. So how do you know what to test further and what to monitor? And while one radiologist may choose the former option with a patient who has an incidental node finding, another might decide to go with the latter option, so who is right?
Beep! It’s important
It is important that when a radiologist sees a nodule and it has certain characteristics, he or she makes recommendation for follow-up imaging, which is why the American College of Radiology (ACR) has released clinical guidelines on incidental findings. By offering standard clinical decision support on findings covering eleven organs, the ACR is helping radiologists protect their patients through established best practices for diagnostic testing.
This is a great step forward for the industry, but some hospitals are taking it one step further. Massachusetts General Hospital (MGH) is using its radiology reporting platform to provide real-time quality guidance at the point-of-care to drive better patient care. Now, when a radiologist is reading a report and notes an incidental finding, the system will automatically ping her with evidence-based recommendations for that finding. For instance, if the node is a certain size, it should be tested further.
The results of having this information at the radiologists’ fingertips are impressive. In fact, studies show that when these clinical guidelines are built into existing workflows, 90 percent of radiologists align with them, as opposed to alternative methods, such as paper print outs, which result in 50 percent concordance.
Guest post by Lindy Benton, CEO and president, MEA|NEA.
Lindy Benton
For nearly 20 years, MEA|NEA has provided secure health information exchange to medical and dental providers. We are growing, in an effort to provide our clients with even more options to achieve the best in secure information exchange and healthcare communications. Recently we announced that MEA|NEA acquired The White Stone Group, Inc., a best-in class provider of healthcare communication management solutions. The reason why is simple: To create a single, integrated platform for the secure exchange of protected health information and communication management between patients, providers, payers and health plans.
The White Stone Group’s products, led by its Trace communication suite, strengthen and complement MEA|NEA’s current portfolio of HIPAA-compliant solutions for health information exchange and revenue cycle management. Combining the two proven technology solutions gives our clients one place to find the best in secure exchange of health information and efficient management of healthcare communication including voice, fax, image, data and electronic documents. Our clients will benefit by seeing a reduction in denied claims, improved cash flow, increased up-front collections, reduced readmissions and improved HCAHPS scores.
Even though we’re growing, the work we do will remain committed to empowering medical and dental providers, payers, health plans and partners who work with us to achieve efficiency and cost-savings. In fact, together as a collective effort, our solutions will better serve clients in their ability to more effectively manage critical patient information that typically resides outside the electronic health record, and close gaps in documentation and improving the continuum care through a fully accessible patient record.
As a combined effort, we’ll go forward serving more than one million customers across the medical and dental markets. Specifically, MEA|NEA will now consist of two complementary business units — one focused on providers, patients and payers in the dental space and the other focused on the same audiences in the medical space. We are now more dedicated than ever to advancing healthcare delivery by improving coordination of patient information and closing gaps in communication processes across the continuum of care. We’ll do this through a suite of highly-integrated software solutions that facilitate the secure exchange of health information and the efficient management of healthcare communication.
As such, we’ll continue to deliver added functionality for each solution in our set and support our clients in their current environments while bringing the best of each solution together on a common client-facing delivery model. We also plan to add new functionality to the foundation of the combined platforms to create best-in-class solutions that establish competitive differentiation in the markets we serve, even expanding into new areas as opportunities present themselves. We also remain dedicated to ensuring that physician, patient and payer information is protected with state-of-the-art security while maintaining client confidentiality.
Medical and dental organizations now only have to partner with a single provider for secure, centralized management and exchange of critical healthcare information and communication through one electronic platform. The result is a complete view of patient information exchanged across the continuum of care from pre-service to post-discharge. Today, more than 500 hospitals and 55,000 dental offices leverage this data to boost financial and operational performance, streamline care coordination and enhance patient experiences.
Guest post by Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CMS), which would fundamentally change telemedicine as it is practiced.
CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.
Thanh Tran
The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings. Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.
The time has come for a paradigm shift to re-engineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained, proprietary, inoperable systems. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment. That has now changed since one Healthcare 2.0 innovator has been able to connect the CMS guideline dots.
Huge Market Opportunity
According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million. With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.
The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggled to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.
The CMS guidelines are as follows:
24×7 access to clinical staff
Patient care continuum
Collaboration, coordination between primary care providers and other care services
Electronic management of care transition among care providers
Coordination between home and community care services
Patient engagement
Here is how these guidelines are now being addressed:
Guest post by Ken Perez, vice president of healthcare policy, Omnicell.
Ken Perez
“We have to take the long view, and be focused on iterating, evolving, and improving the concept, rather than seeking summary judgment.” – Farzad Mostashari, former national coordinator for health information technology, commenting on accountable care organizations
On Aug. 25, 2015, the Centers for Medicare and Medicaid Services (CMS) released 2014 financial and quality performance results for 353 accountable care organizations, 333 in the Medicare Shared Savings Program (MSSP) and 20 in the Pioneer ACO Model (although as of this writing, the CMS website only lists 19 Pioneer ACOs). As is customary, proponents (such as CMS) and critics of ACOs interpreted the results quite differently, as a glass half-full or half-empty.
Pioneer ACO Performance
During the third performance year, the Pioneer ACOs generated total model savings of $120 million. That figure constitutes a 24 percent increase versus the $96 million of savings produced during the previous year. A total of 15 ACOs (75 percent of all Pioneers) were able to generate savings during performance year three, compared with 14 ACOs (61 percent of all Pioneers) for the prior year. Of those generating savings in the most recent performance year, 11 Pioneers produced savings that exceeded the minimum savings rate, garnering shared savings payments totaling $82 million. One quarter of the 20 Pioneers generated losses, with three generating losses beyond a minimum loss rate, requiring them to make $9 million in shared-loss payments to CMS.
The Pioneers improved the quality of care delivered during performance year three, as their mean quality score rose from 85.2 percent to 87.2 percent year-to-year. The Pioneers improved in 28 of 33 quality measures and generated average improvements of 3.6 percent across all quality measures compared to Performance year two. CMS highlighted significant improvement in medication reconciliation (up from 70 percent to 84 percent), screening for clinical depression and follow-up plan (up from 50 percent to 60 percent), and qualification for an electronic health record incentive payment (up from 77 percent to 86 percent).
Moreover, Pioneer ACOs improved the average performance score for patient and caregiver experience in five out of seven measures compared to performance year two.
Guest post by Christina Richards, vice president, AOptix.
Christina Richards
In recent years, the healthcare industry has experienced a Renaissance of sorts with the development and adoption of mobile and connected technologies. As a result, healthcare facilities the world over are increasingly making use of smart technologies to drive better patient outcomes, track equipment, and support overall operations. In addition, the developing practice of telemedicine is becoming increasingly commonplace for doctors in healthcare settings across the United States, which is raising new concerns about the infrastructure needed to support these real-time doctor-patient experiences.
Although the development of these digital technologies for healthcare applications is only in its infancy, we are already beginning to see their wide range of benefits, including the potential to help organizations achieve the Institute for Healthcare Improvement’s (IHI) Triple Aim of bettering the patient experience, improving population health standings and reducing the cost of healthcare. For instance, a 2014 study by Dale H. Yamamoto of Red Quill Consulting, Inc. found that that the average estimated cost of a telehealth patient consultation was $40 to $50 per visit, compared to the average estimated cost of $136 to $176 for in-person acute care.
With the widespread adoption of any new technology however, there is a learning curve to ensure that they can be effectively integrated into existing operations to capture the greatest benefit without compromising the level of care. But what does this entail?
Data
As healthcare facilities become more connected through the Internet of Things, adoption will continue across a broad spectrum of devices and sensors—from wearable tech that monitors patient location and vital signs to analytics platforms that track staff movements and create more efficient workflows. While these devices span a variety of applications, they all share a universal purpose, which is the constant collection and analysis of data.
Likewise, video conferencing and other mobile approaches to telehealth are highly data-intensive, requiring the transmission and processing of large amounts of information. As a result, many healthcare administrators have encountered the need for far more robust mobile networks in their facilities to support the massive amounts of data traveling across their systems.
In considering other data requirements on the horizon, take the case of rapid genomic sequencing. While the new technology allows researchers to quickly determine the complete DNA sequence of an organism to predict disease susceptibility and drug response, the process requires the transfer of massive amounts of data. To make this information more widely accessible, one company, NantHealth, is looking into a method of compressing the data into a more manageable size so it can be shared with other facilities through high-capacity wireless connections, rather than strictly relying on fiber. With ever-growing levels of data becoming necessary in the healthcare system, new technologies and methods for managing it across various networks will become even more important.
HealthLoop connects doctors and patients with timely and actionable information, improving patient satisfaction and driving better outcomes. HealthLoop is a cloud-based platform that automates follow-up care; keeping doctors, patients and care-givers connected between visits with clinical information that is insightful, actionable and engaging. Its peer-reviewed follow-up plans automate the routine aspects of care while tracking patient progress and monitoring clinical areas of concern. Its analytics engine sifts through and filters the deluge of patient-generated data in realtime; focusing the care team’s time and attention on patients who need them the most.
Errors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.
