David Caldwell is the vice president of sales and marketing at Transcend Insights, a wholly owned subsidiary of Humana Inc., dedicated to simplifying population health. Transcend Insights helps manage the complexities of population health through community-wide interoperability, real-time healthcare analytics and intuitive care tools. The company’s HealthLogix platform provides healthcare systems, physicians and care teams with valuable clinical insights that enable more informed decisions at the point of care, enhance the patient experience and reduce costs.
Here, Caldwell discusses how the firm serves its clients; the benefits of analytics and its impact on ACOs; population health initiatives; and the future of the company.
Tell us a bit about your product offerings and the role that they play in the health care technology space.
Transcend Insights is a population health management company that provides health care systems, physicians and care teams with advanced community-wide interoperability, real-time health care analytics and intuitive care tools designed to simplify the complexities of population health. The new company represents the merging of three leading health care technology businesses—Certify Data Systems, Anvita Health and nliven systems. We integrated Anvita’s health care analytics into Certify’s HealthLogix™ platform to provide physicians and care teams with the real-time insights necessary to improve health outcomes and reduce costs. In addition, we made these insights accessible at the fingertips of physicians and care teams through a mobile point of care solution, a technology we gained from nliven.
Today, Transcend Insights works with more than 130 health systems, serving at least 600 hospitals and over 20,000 physicians. Through community-wide interoperability, we help large health care systems gain access to both acute care and ambulatory data that reside in various silos across the care continuum.
We analyze 2.3 billion clinical data points on 10.8 million patients every day. Our analytics engine offers more than 33,000 evidence-based clinical rules and last year identified over 36 million opportunities to improve care and helped our clients close 4.3 million gaps in care.
Lastly, we leveraged nliven’s expertise in mobile health technology to develop a mobile point of care solution that allows physicians and care teams to not only visualize data but also gather and assimilate patient data in real-time.
Who are your customers and what level of clinician typically accesses your product on a day-to-day basis?
The vast majority of our customers are multi-hospital, integrated health care delivery networks that have purchased our product to help them move from a fee-for-service to a value-based care delivery model. Our customers utilize the HealthLogix platform to reach both contracted and affiliated physicians, and to piece together disparate electronic health record (EHR) system data across the care continuum.
Guest post by Devin Jollimore, training coordinator, Mission Safety Services.
We live in an age where the use of technology dominates our lives and these technological developments have had an amazingly positive impact on the healthcare industry. Healthcare technology has heavily influenced the improvement in our health and the increased life expectancy we are seeing today.
In particular, the progress we have made in cancer research and the greater survival rates have been heavily influenced by developments in technology. It’s amazing that healthcare technology played a role in saving 1.2 million lives between 1991 and 2009 thanks to progress in cancer treatments and detection.
Malaria is thought to have killed more people than all wars put together and technology is helping reduce this startling statistic. Something as simple as a bed net with insecticide has reduced malaria in children under 5 by 20 percent.
Also, stem cell research has limitless possibilities to save lives. We are still progressing with this development, but diseases, such as heart disease and Alzheimer’s, may be hugely reduced through stem cell research and we are already making good progress.
Let’s not forget the importance of the Internet and how it has increased healthcare efficiency. Healthcare facilities are reaching patients through social media and doctors have access to thousands of medical books at the touch of a button.
This infographic from Mission Safety Services outlines the progress we have made, the work that is being done, and possible future developments in technology that have potential to make real change.
More than 33 million Americans who have high-deductible health plans, also known as “HDHP” policies, struggle to find local doctors within their budget because healthcare costs have previously remained mysterious, until after one reaches the specialist’s office. To solve this dilemma, Doctible.com has launched a search platform that lists the costs of procedures and checkups upfront so that patients understand prices before booking their appointments. Plus, clients can also quickly search for and compare doctors by price, reviews, location and specialty.
Founded in 2013, the “Doctible” website now serves the San Diego area — with future plans to expand and eventually create a nationwide healthcare search engine to help people make faster, better and more affordable decisions about their options for a wide variety of medical services. Here are the principles that make it work and the positive changes it can lead to:
The solution lies in the search engine’s transparent facts
The Doctible medical-services search engine instantly pulls together all the key information about the type of doctor someone is looking for in a list that takes less than a minute to scan, allowing users to find the right doctor and make a booking more quickly and efficiently without regretting their decision later. The design is simple and powerful. Anyone can get fast results by just entering their zip code, the type of doctor they need to see and the type of procedure they want. Instantly, visitors get a list of doctors that shows exactly how far away they are from one’s home, how much the doctor charges in cash for the procedure, their average insurance price and their ratings based on past reviews from real patients.
At HIMSS this year, multiple speakers laid out visions for a future where parents could consult with a pediatrician via a telemedicine encounter during the middle of the night, take their children to receive immunization shots at a retail clinic, and have all of this information aggregated in their primary care provider’s record so that providing an up to date immunization record at the start of the next school year is as simple as logging into the PCP’s patient portal and printing out the immunization record. In short, multiple speakers presented visions of a truly interoperable future where patient information is exchanged seamlessly between providers, healthcare applications on smartphones, and insurers.
While initiatives such as the CommonWell Health Alliance, Epic’s Care Everywhere, and regional health information exchanges attempt to address the interoperability challenge, these fall short of fully supporting the future vision described above. Today’s solutions do not address smartphone applications and still require manual intervention to ensure that suggested record matches truly belong to the same patient before the records are linked. This process is costly but manageable in an environment where a low volume of patient records are matched between large provider organizations. In a future world where patient data is available from a multitude of websites, smartphone applications and traditional healthcare organizations, it would be cost prohibitive to manually review and verify all potential record matches.
Of course, one solution to this dilemma would be to improve patient matching algorithms and no longer require manual review of records before they are linked. However, for this to be possible, a standard set of data attributes would need to be captured by any application that would use or generate patient data. In a 2014 industry report to the Office of the National Coordinator for Health Information Technology, first name, last name, middle name, suffix, date of birth, current address, historical address, current phone number, historical phone number, and gender were identified as data attributes that should be standardized. Many of the suggestions in this report were incorporated into the Shared Nationwide Interoperability Roadmap that the ONC released in January 2015.
The proposed rule for meaningful use Stage 3 was announced on Friday, March 20, 2015, and is now available for comment by stakeholders. Here are five highlights of the Stage 3 proposed rule and what I see as three provider wins:
Highlights
2017 is now a Flex Year– Meaningful use Stage 3 was originally slated to begin in 2017 for providers that had completed Stage 2; now 2017 is a flex year. This means that providers who would have progressed from Stage 2 to Stage 3 in 2017 now have the option to stay in Stage 2 an additional year. Only providers who use an EHR certified to the 2015 ONC standards will be allowed to attest to Stage 3.
Every provider will be Meaningful Use Stage 3 in 2018 even if 2018 is the provider’s first reporting year – In order to simplify the meaningful use program, all providers will be in the same stage. This will allow group practices to focus on a single set of measures for all providers.
Meaningful Use Stage 3 is the final stage of meaningful use– However, CMS is clear that because it expects technology and care standards to evolve over time it will consider (and we expect) that there will be future rulemaking related to meaningful use Stage 3 somewhere down the line.
All providers will report for one calendar year – in an effort to continue to align meaningful use with other government reporting programs such as PQRS, all providers will report for a full year based on the calendar with one exception. Medicaid first year providers will still be allowed to report based on a 90-day period measurement period. In the past CMS has shortened measurement periods based on provider feedback and we expect that to be true about this year. This year (2015) was slated to be a full year for most providers, but we expect it to be scaled back to a quarterly measurement period because of the continued side effects of the poor implementation of Stage 2 last year. For 2017 and beyond, we expect the implementation will be smoother and we don’t foresee more flexibility on measurement periods beginning next year.
There are eight objectives and some objectives have more than one measure – the total number of measures that providers will be required to report is 16.
Wins for Providers in the Meaningful Use Stage 2 Proposed Rule
I see three wins for providers in the meaningful use Stage 3 Rule, including:
In the following conversation, Jim Lacy, CFO and general counsel of ZirMed, discusses the company’s mission, goals and growth; his passion for healthcare and serving those who work in it; ZirMed’s transition from a clearinghouse to a revenue cycle management, population health and predictive analytics firm; why privacy has become the biggest issue very few are seriously talking about; and the changing face of healthcare as a whole.
Tell me more about ZirMed, the brand, its solutions, and your mission for it.
Our core mission is to help healthcare providers, hospitals and health systems get paid. It sounds simple, but efficiently and effectively getting providers paid for their services and supporting their mission in an ever-evolving technological, regulatory, and clinical environment is incredibly complex.
ZirMed is uniquely positioned to deliver a comprehensive end-to-end platform of cloud-based financial and clinical performance management solutions. That means that at every point in the revenue cycle, we have solutions that support healthcare providers in collecting monies from payers and patients, and do it as quickly, efficiently, and cost-effectively as possible. Our solutions address the challenges of the current fee-for-service and consumer-driven payment systems, and also support fee-for-value reimbursement, broadly defined as population health management.
ZirMed’s solutions are logically oriented to address the revenue cycle needs of providers ranging from small physician practices and durable medical equipment providers to the largest hospitals and health systems. At the front end, we offer Patient Access solutions focused on registration and check-in to streamline pre-registration, estimate patient responsibility, accurately verify eligibility, and more.
Core to our mission of getting hospitals and health systems paid for services provided is our Charge Integrity solution. We use big-data and predictive analytics to identify and capture charges, resolve process inefficiencies, improve coding compliance, and ensure the complete integrity of all inpatient and outpatient billing.
Our claims and A/R management solutions include robust edits and rules aggregating claims across an entire system, and provide highly efficient claims and receivables workflows, reduce preventable denials, and deliver insights into financial performance for critical decision support.
With the ability to process vast amounts of data and provider metrics across an organization, our cost and utilization solutions benchmark provider performance, stratify risk, and support fee-for-value reimbursement programs.
Population health management has come to hold very different meanings across different organizations. Our population risk management solutions combine clinical and financial information, enabling insights into patient populations while identifying risk, analyzing discharges for readmission risks, and managing referrals across an integrated system.
And, of course, healthcare is always about the patients. We offer a comprehensive suite of Patient Engagement solutions including consumer-friendly billing and payment options and a patient portal offering online payment, statement management, and two-way messaging between the patient and provider.
What about you? What keeps your passion for this mission, and organization, alive? Tell me more about what excites you about your work and why you love what you do?
I love what I do, and couldn’t design a better job for myself than this one: I get to be a CFO, counsel and influence product design, all within the course of a normal day.
My roles are seemingly very different and one person holding them is rather non-traditional; however, there is logic to the fit. ZirMed develops financially focused software solutions in a highly regulated healthcare environment. We deal with billions of transactions and hundreds of billions of dollars annually with an extreme focus on privacy, security and compliancy. My background from the provider side of healthcare prior to joining ZirMed directly influences the types of solutions we build and how we deploy them to positively impact provider organizations.
Ric Sinclair, our VP of product, and his team excel at designing and delivering great software that’s beautiful, powerful, and easy to use. Their role is to take all this complexity and make it as simple and easy as possible for users and managers in client organizations. My role is to weave my experiences into the design of our products and support the role of the client in everything we build.
So I’m doing what I love and working with incredibly smart, talented people every day. That makes it easy to stay passionate and excited about my work and about ZirMed.
Deb Dahl, vice president of patient care and innovation at Banner Health, discusses her experiences managing the telehealth program for the health system. Banner Health is a nonprofit health system based in Phoenix operating more than 20 hospitals and specialized facilities. It is the second largest employer in Arizona, providing emergency care, hospital care, hospice, long-term care, outpatient surgery centers, labs, rehab services, pharmacies, and ambulatory clinics, which include Banner Arizona Medical Clinic and Banner Medical Group.
The health system is a long-time user of telehealth technology, which has had a profound positive impact on providing patient care and is seen as a major benefit to the organization.
Have you used telehealth services in your practice to provide care?
Yes, we have had a long standing relationship with Philips collaborating on telehealth programs, using a “technology, people and process” approach to healthcare. We started with a single facility in 2007, and our telehealth program now reaches more than 400 beds at 18 facilities in Arizona, Colorado, Wyoming and Nebraska with plans to cover our Fairbanks, Alaska, facility and Nevada site some time in 2015. Across these facilities we utilize telehealth in the intensive care unit, acute care, skilled nursing facility, and ambulatory space (patients at home). We use a command center approach, which allows a dedicated team of physicians, nurse practitioners, nurses, pharmacists and social workers. We provide coverage to more than 400 ICU beds in five states, more than 200 medical/surgical patients, neuro and behavioral health ED coverage, 500 complex chronic members at home, as well as simple low acuity on demand home visits.
What’s it like? Is it all it’s cracked up to be?
Yes, we went live with our first 50 ICU beds in 2006. With our program growth, we’ve experienced great results: in 2013 our ICU results were among the top three in the U.S. Using APACHE as the actual to predictive model Banner saved more than 33,000 ICU days, 47,000 hospital days and 1,890 lives in 2013. We are expecting similar results for 2014.
As the excitement of the festivities continued to roil on in Chicago for the annual Healthcare Information and Management Systems Society (HIMSS) conference, and as health systems leaders merged with colleagues and partners for what is health IT’s biggest event of the year, I was not among those in attendance. As the conference opened and buzz at the show began to swell, excitement for news and new developments flowed from nearly every available channel, I was back home, far from the excitement of the show or its announcements, developments and news makers.
As health system leaders and their technology partners discussed how their solutions could make care better, engage patients more effectively and lead to better outcomes, greater efficiencies and higher quality care, my wife and I were in the center of the care universe in the heart of our local hospital where I was helping her through the delivery of our second child. Though the process was relatively straight forward and was done very quickly, the experience made me realize several things about healthcare technology from the patient’s perspective.
The first thing is that no matter how important we claim the technology used in the care setting to be, it matters little to those receiving care. For those receiving care, they want and need a seamless process where they have immediate access, without a wall of technology between them, to their care providers whether that’s a nurse, physician or some other support personnel. Patients, at the point of care, don’t want to face the burdens of interacting with the technology their caregivers are concerned with, but we as patients want their full attention. If patients must break through a fourth wall of technology, as I’ve seen to be the case on more than one occasion, the care staff, and more importantly, the health system, has failed the patient.
Secondly, patient engagement is more than a portal or access to one. And while patient engagement means different things to different provider types – like ambulatory vs. in-patient –the patient is still at the heart of the care, not the technology. Those who believe that technology can solve the patient engagement ills are wrong, and likely are failing to truly engage patients because they believe the myth that it can. Perhaps meaningful use has bastardized the term “patient engagement,” but it’s a sad thing when the entirety of that conversation centers around some form of technology or device. The irony of an event like HIMSS, where most of health’s relevant vendors clamor to meet with health system leaders, is that the buzz is built to surround the movement of the patient. The patient is at the heart of care, not technology or some bolt-on software solution.
We, patients, have been at the heart of care since the existence of healthcare; technology is an infant at play here. Let’s not forget that.
