Guest post by April Wortham Collins, manager of customer segment analysis, Decision Resources Group.
April Wortham Collins
Under the traditional fee-for-service reimbursement model, providers and payers are natural adversaries. To maintain a steady source of revenue, providers are incentivized to render as many services as possible without running afoul of controls designed by payers to keep utilization in check. When healthcare costs inevitably creep up, providers demand higher reimbursements from payers. Payers, trying to keep claim in check and health insurance premiums competitive, respond by restricting members’ access to certain providers.
It’s this tension between payers and providers that forms the backbone of the U.S. healthcare system. At least, it has until recently. Policy and political leaders have come to realize that, absent of other factors such as quality, efficiency and patient satisfaction, healthcare costs will continue to rise, creating a weight under which the system will eventually collapse.
Enter the accountable care organization, a new model for healthcare delivery and reimbursement that exemplifies the key tenants of the Affordable Care Act and the healthcare Triple Aim: improving the patient experience of care, improving the health of populations and reducing per capita costs. Unlike the fee-for-service reimbursement model that rewards providers based on volume of services, the ACO model rewards providers for achieving specified quality objectives and constraining costs.
On their face, ACOs would seem to encourage cooperation between payers and providers. After all, to improve population health, providers need claims data and the type of technology solutions that payers have been investing in for decades. And to reduce healthcare costs, payers need to partner with quality providers with proven track records for keeping patients healthy. Ask any patient who has bounced back and forth between doctors’ offices and their health insurance company trying to sort out a medical bill, and the opportunity for improving the patient experience of care is tremendous.
So far, many ACOs are doing just that. Of the nearly 1,100 ACO contracts that Decision Resources Group is tracking today, more than half are commercial agreements involving 70 private payers. The largest private-payer ACO initiative in the country is led by Cigna, whose Collaborative Accountable Care program has 124 ACO agreements in 29 states encompassing more than 24,000 primary-care physicians and 27,000 specialists.
However, other aspects of healthcare reform are adding fuel to the payer-provider fire—and ACOs are a flashpoint. To keep health insurance premiums competitive, payers are excluding high-cost providers from their networks. Many of these narrow or exclusive provider networks also function as an ACO, with attached health plan products that are proving popular in public health insurance exchanges.
Today’s physicians face an increasing array of non-clinical demands on their time, from filling out paperwork to sorting through insurance denials. As a result, the amount of time doctors have to actually see patients has been reduced.
The combination of decreasing number of physicians, increasing demand for quality care, and rising costs of healthcare has created a challenging environment for both patients and healthcare professionals.
Nearly all of us have experienced long wait times at a physician’s office, often for minor ailments or routine follow-ups. These lengthy wait times are causing more and more patients to skip follow-up visits or turn to unreliable online medical services and websites for information. This not only erodes the doctor-patient relationship, but it puts patient health at risk. Furthermore, the information is not properly shared with the patient’s actual physician.
Today’s ultra-connected world has a solution that can bring the doctor-patient relationship into the 21st century: telemedicine.
Telemedicine is a suite of technology solutions that enables doctors to communicate with and treat patients via text, video and audio – and it can be used by physicians, nurses, office staff, any healthcare professional and, of course, patients. Telemedicine allows physicians to provide more convenient, real-time interactions with their own patients, for triaging acute issues and for quick follow up visits that can save the entire health system time and money.
And it’s far from the latest medical fad. Telemedicine is already one of the fastest growing segments in healthcare. According to the American Telemedicine Association, half of all U.S. hospitals now use some form of telemedicine. Similarly, Health Affairs has predicted an increase in domestic telehealth revenue by almost 20 percent per year, to $1.9 billion by 2018.
Connecting to patients, anywhere and anytime
Clearly, these solutions have ushered in a new age of medicine. Technology can also provide real-time data on patient vital signs, blood sugars and other information to improve the monitoring of chronic conditions, reducing readmission rates and keeping our patients healthier outside of the hospital.
Factors fueling the growth of telemedicine are as follows: a shortage of physicians in rural and remote areas, the high prevalence of chronic diseases, growing elderly populations, increasing numbers of smartphone users and the need for improved quality of care.
Telemedicine solutions fall into two broad categories: remote patient monitoring and online/digital communications. Remote patient monitoring links home healthcare equipment (heart monitors, dialysis equipment, etc.) to the internet and then securely reports patient data back to a healthcare provider.
Guest post by Joyce Mullen, vice president and general manager, Dell OEM Solutions.
Joyce Mullen
Technology is rapidly transforming the healthcare industry and the way we approach patient care, as organizations adopt the latest solutions in mobility, data analytics, Internet of Things and cloud computing. From telemedicine to wearables to 3D printing to alternative communication techniques, this is truly the golden age of healthcare innovation.
Through our OEM Solutions group, we are proud to be providing the underlying technology and services that enable so many inspirational companies make a real difference in people’s lives through healthcare innovations. Two examples I am really excited about are HealthSpot, which is developing a network of private kiosks equipped with two-way, high-def video screens enabling patients to interact directly with remote physicians; and Prentke Romich, which created a revolutionary device that helps people with disabilities communicate effectively. Rooted in these innovations is IT and the need for security, efficiency and reliability.
Connecting patients with physicians … virtually
We all know that visiting the emergency room for a health issue can be a frustrating experience, with long waits and impersonal service being the norm. But HealthSpot, an Ohio-based telehealth company founded in 2010, is offering a convenient and game-changing alternative. The company has introduced the HealthSpot station, a freestanding private kiosk equipped with a two-way, high-def video screen enabling patients to interact directly with remote physicians. Patients inside the station can be weighed on a built-in scale and use a thermometer, otoscope, magnascope, blood pressure cuff, stethoscope or other medical devices, with information and images transmitted electronically and securely to the physician. Physicians can then make a diagnosis and write prescription on the spot.
So far HealthSpot has installed stations in urgent-care facilities and hospitals, along with four test markets in retail pharmacies in Ohio and are expanding rapidly. As the company continues to scale, Dell is working with them to build a well-integrated IT infrastructure that includes hardware, software and services. Plans include more than 10,000 stations across the U.S. in the next few years, so be on the lookout for a HealthSpot station near you.
Developing language through technology
Prentke Romich Company (PRC) is the worldwide leader in the development of assistive technology and augmentative communication (AAC) solutions for people with severe disabilities. The company is committed to helping individuals achieve their greatest potential by delivering intuitive communication solutions that are focused on language development.
When PRC wanted to introduce a Windows- and tablet-based AAC solution, it faced a critical challenge: finding the right technology. Children with disabilities already face perceptions and bias, and they don’t want assistive technology that makes them look even more different. In a world of iPads and other sleek devices, their products needed to be as aesthetically pleasing as possible. The product also needed to be responsive and high performing enough to handle PRC’s Unity language system.
It’s no surprise that the communication landscape is evolving. While face-to-face conversation will always be an important form of interaction, individuals are increasingly engaging in dialogue — both personal and professional — with the help of technology (Skype, Google Hangouts, FaceTime, etc.).
These technologies have influenced new programs in the healthcare industry, and telemedicine has taken flight. Through one-on-one conferencing with doctors, either over-the-phone or via video, programs like Doctor on Demand and AnywhereCare connect patients with doctors in as little as 30 minutes, diagnosing everything from the common cold to sprains.
Technology and the rise in global communication have made their impact on language services in medical facilities as well. With a non-English speaking population that represents 20 percent of the population and has grown 81 percent since 1990, healthcare interpreting — whether it occurs face-to-face, over the phone or via video — is incredibly crucial to ensure accurate patient communication and, ultimately, safe medical practices.
Interpreting in the medical industry is nothing new. Healthcare providers have long brought interpreters into their facilities to bridge conversations with patients who speak a language other than English. Title VI of the Civil Rights Act of 1964 required medical providers to use interpreters when necessary. With an increasingly diverse population, this policy was reinforced by President Clinton’s Executive Order 13166 in 2000, which sought to improve access to services for people with limited English proficiency.
While the need for interpreting in healthcare is evergreen, the language industry has more services available now than ever before. Medical interpreting has a broader set of options when it comes to communicating.
Testifying before the Senate Committee on Health, Education, Labor & Pensions (HELP), DirectTrust president and CEO David C. Kibbe, MD MBA, urged the federal government to take action to help overcome the problems impeding the sharing of health information between and among parties authorized to access electronic health data, commonly referred to as “information blocking.”
David Kibbe
“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” testified Dr. Kibbe, one of the nation’s foremost authorities on health information exchange security issues. Dr. Kibbe’s organization, DirectTrust, is a health care industry alliance created by and for participants in the Direct exchange network used for secure, interoperable exchange of health information.
Dr. Kibbe testified at a full Senate HELP committee hearing titled “Achieving the Promise of Health Information Technology: Information Blocking and Potential Solutions. During his testimony, Dr. Kibbe enumerated the problems with information blocking and offered suggestions to help improve upon the current situation in the near-term. Among the many actions Dr. Kibbe suggests the government take to help overcome information blocking include:
Continue to shed light on these problems, and work with trade groups, standards and policies organizations, and others to set expectations for interoperability of EHRs and other applications certified as interoperable, especially those that have been federally subsidized within the meaningful use programs.
Bring better and improved EHR certification processes forward beyond the testing laboratory so that the utility and usability of interoperability features of ONC certified EHR products in the field becomes part of the public record, and can be used in purchasing decisions. Collaboration and partnership with non-profit trade groups to achieve this goal would be advisable.
Accelerate federal agency use of and demand for open, standards-based interoperable HIE (health information exchange) with private sector providers and provider organizations, thereby removing reliance on paper-based mail, fax, e-fax and courier for these federal programs.
Examples include Veterans Health Administration referrals to and from private sector medical practices and hospitals; Veterans Benefits Administration health information exchanges with private sector medical practices and hospitals; the use by Medicare, Medicaid, and state agencies of interoperable HIE for communications with private sector providers and provider organizations for limitation of fraud, payment adjudication, claims attachments requests, and other administrative transactions now done via fax and mail.
Continue to tie more robust ONC EHR certification and use of certified EHR technology to participation in value-based purchasing programs, wherein interoperability and collaboration across multiple organizations in multiple-vendor environments is financially rewarding to providers and their health IT vendors. Demand for collaboration and interoperability is best driven by underlying business models and business cases supported by regulation and oversight.
Guest post by Paul Smith, management consultant, North Highland.
Paul Smith
Information collaboration is not new, but there is an increasingly critical need for effective collaboration to create an efficient healthcare ecosystem. How can healthcare organizations design collaborative frameworks that allow them to successfully manage vast amounts of data and create actionable information from that data?
One of the first, and perhaps most important steps, is to understand why it’s imperative to foster an environment that encourages and promotes information collaboration. The amount of data companies use to track performance can be overwhelming, and many companies are inclined to abandon their quest to connect results across the organization, particularly when redundant data sources conspire across the enterprise to prevent a single source of truth. While it’s easy to understand why it happens, this approach can inhibit an organization’s ability to address the management of its data.
The implementation of an effective, collaborative framework is imperative. Not only does it have short-term impact, like enforcing consistent data quality and use, but it also improves business results. Active collaboration can lower management costs and enhance an organization’s ability to analyze and interpret information over the long haul and:
Improves the user experience for management, physicians, nurses, and patients
Reduces data inaccuracies and redundancies
Offers impact analysis across the organization for change requests
Enhances the organization’s ability to drive insight analysis and action creation based on a balanced information asset environment
Furthermore, if a healthcare organization chooses not to enforce a collaborative information framework, there may be financial consequences. Inconsistency in reporting can lead to noncompliance with provisions of the Affordable Care Act, which require uniform reporting and analytics.
Interoperability Accelerator
What’s really at stake? One example of the potential damage insufficient collaboration can create is evidenced in North Highland’s recent work with a healthcare organization that wanted to improve its management environment. During the onboarding process, new requirements and analytics were captured and documented. The requirements were then coded, tested and deployed prior to completion of the data loads. The missing component was an understanding of the impact that those changes had to legacy analytics in use across the client’s enterprise. As a consequence of no established metadata environment, changes made to the analytical applications impacted numerous analytics and reporting downstream- resulting in massive rework. North Highland worked to remediate data continuity throughout the effected systems and establish a scalable metadata framework to grow analytical capabilities with the future needs of the organization.
This example underscores why it is imperative to implement a model that addresses and improves interoperability, collaboration, and information knowledge, which eliminates a significant amount of risk and creates a highly effective information collaboration governance program.
One successful model that can be followed to address this issue emphasizes a business first approach and requires that there is an overall culture of collaboration both internally and externally. It is based on three fundamental disciplines and supported with metadata foundation that connects and maintains the relationships between the three disciplines. The model’s pillars include:
The Business Information Discipline (BID), which defines the data and information necessary to support the operational goals of each department, business unit or division within the organization. Roles and responsibilities within the BID vary based on the size of the organization, but certain roles are central to the discipline.
The Systems and Network Discipline (SND), which defines the system roles and network analyst roles within the information environment. This is the discipline with the largest concentration of technical resources, each having a degree of stewardship responsibility.
The Information Asset Discipline (IAD), which is responsible for creating, maintaining and delivering information asset management for the organization. IAD outlines governance implementation, stewardship roles and general management of information, enabling impact analysis across the organization.
Organizations must respond to healthcare laws and adapt business models to comply with necessary requirements, all the while continuing to monitor reform-related legislative changes and regulatory guidance. By following the outlined framework, healthcare organizations can create an unbreakable foundation that ensures consistency in data and enhances enterprise agility.
Guest post by Num Pisutha-Arnond, managing partner, Curas, Inc.
Num Pisutha-Arnond
Now that we are approaching the final stage of meaningful use, what has all of this regulation, incentives and penalties gotten us? The answer to that is unclear. Instead, what we are starting to see is a more introspective look at electronic health records. The real question has nothing to do with meaningful use, which was an externally mandated set of systems and requirements. Today, practices find themselves internally motivated to examine exactly what they would like to get out of this system that you have spent a lot of time, money and effort putting in. How can they improve operations, their finances, patient care and experience? What is the practice itself trying to accomplish? The answer to that varies significantly by specialty, practice size, geography, and your goals and priorities as they relate to your practice.
Because we’re already beginning to see life after meaningful use, and have been for the past 18 to 24 months, we can provide insight into some common goals and how practices are moving beyond meaningful use to achieve what cannot be measured by the criteria set forth by CMS.
The primary goals that we have experienced with our clients can be broken down into a few categories:
Better patient care
Better patient experience
Improved practice profitability
Provider and staff quality of life
Better patient care
Items related to this category often include the creation of patient dashboards/reports and patient recalls/campaigns to stay engaged with patients. However, the most effective, and often tougher initiative to implement, is a point of care system that lets providers and staff know when a patient should possibly have a certain test or procedure performed without having to search for data across different progress notes or screens.
Better patient experience
Most practices and vendors immediately jump to patient portals, kiosks and apps when discussing these goals. However, these are just a few of the tools that can be used to improve patient experience. In some cases, these tools may actually not enhance the experience if they are lacking in usability or if they are deployed in an uncoordinated manner. What is needed is a look at the overall patient experience from when they first call to the practice to when they have left the practice and need to be contacted by the practice. In some cases, the existing software and tools that have been implemented will work if the process is refined. In other cases, new software and tools may be needed. In others, you might even consider eliminating some of the technology to make a better experience for the patient.
Health data security and patient engagement are top priorities for the nation’s hospitals, according to results of the 17th annual HealthCare’s Most Wired Survey, released today by the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME).
The 2015 Most Wired survey and benchmarking study, in partnership with CHIME and sponsored by VMware, is a leading industry barometer measuring information technology (IT) use and adoption among hospitals nationwide. The survey of more than 741 participants, representing more than 2,213 hospitals, examined how organizations are leveraging IT to improve performance for value-based healthcare in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration.
According to the survey, hospitals are taking more aggressive privacy and security measures to protect and safeguard patient data. Top growth areas in security among this year’s Most Wired organizations include privacy audit systems, provisioning systems, data loss prevention, single sign-on and identity management. The survey also found:
96 percent of Most Wired organizations use intrusion detection systems compared to 85 percent of the all respondents. Privacy audit systems (94 percent) and security incident event management (93 percent) are also widely used.
79 percent of Most Wired organizations conduct incident response exercises or tabletop tests annually, a high-level estimate of the current potential for success of a cybersecurity incident response plan, compared to 37 percent of all responding hospitals.
83 percent of Most Wired organizations report that hospital board oversight of risk management and reduction includes cybersecurity risk.
“With the rising number of patient data breaches and cybersecurity attacks threatening the healthcare industry, protecting patient health information is a top priority for hospital customers,” said Frank Nydam, senior director of healthcare at VMware. “Coupled with the incredible technology innovation taking place today, healthcare organizations need to have security as a foundational component of their mobility, cloud and networking strategy and incorporated into the very fabric of the organization.”
