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.
The National Association for Trusted Exchange (NATE) and Michigan Health Information Network Shared Services (MiHIN) have released a new video to educate consumers on their rights to access their own health information, and to encourage consumers to take control of their health using smart devices and simple applications to request, view and store their personal health details.
Despite significant efforts from the healthcare industry to improve methods to securely communicate protected patient health data, many consumers remain unaware of their rights and options to view and manage their personal health information. Access to health details can benefit patients in multiple ways, from making it easier to remember health history when filling out forms at a new doctor’s office to helping to care for a family member in need of assistance.
The new NATE/MiHIN video, viewable at http://tinyurl.com/bluebuttonvideo, was created as a brief introduction for consumers and healthcare providers. The video seeks to:
Educate patients and doctors on patients’ rights and options to access their health information
Teach patients how to get a Direct secure email address, which is necessary for secure transmission of health details online
Encourage patients to talk with their doctors about accessing their information electronically
Educate patients on applications enabled with the Blue Button Electronic Health Record Retrieval System for health data
Encourage doctors to adopt Direct secure email solutions to share data with patients
“Using our smart devices with a Blue Button-enabled application enables any of us to receive and share our personal health records using the same secure methods used by doctors today,” said Aaron Seib, NATE CEO. “These Blue Button-enabled applications can help patients make sure their information is accurate, make it easier for you to share your information with all of your doctors, and generally have it available whenever and where ever you need it.”
Guest post by Alex Tate, digital marketing specialist, content strategist and a health IT consultant at CureMD.
Most conductors are sounding out the last call for passengers to climb aboard the ICD-10 train. Although the trains won’t reach full steam until Oct. 1, 2015, the test runs will commence shortly. You’re probably wondering why passengers have to sit through these test runs, right? This is because the journey will last for at least 10 years, so everyone needs to get accustomed to the environment of this locomotive.
Your practice is the train, you are its railroad engineer, the conductor is your practice manager, but who are the passengers? Surely not the patients; they don’t need to apply the codes, do they? The answer to both questions is no. The passengers are your medical billing software vendors, you clearinghouses, your payers, and most importantly – your billers and coders.
If you haven’t started inquiring if these stakeholders and their systems will be ready before time, you could suffer from huge reimbursement disruptions once claims become dependent on these new codes. However, you still have time to get your engines running, and here’s what you need to do:
Contact your medical billing vendor
The first passenger on your train, irrespective of the number of trolleys you’re carrying, is your practice management (PM) or medical billing software vendor. This is because you need to inquire if your billing software is ready for the new codes. If not, you’ll not be able to get your claims through because they’ll contain defunct codes.
Additionally, you must also inquire if the vendor has a clear mapping process for ICD-10 conversion. If upgrades cost extra, or if you’ll need more training, you should have that in mind beforehand.
Lastly, ask them when you’ll be able to begin internal and external testing using these new codes, and if they have any recommendations for streamlining the process.
Those who are familiar with the new Apple smartwatch will know that one of the big focal points for new technology is in healthcare. The “Health Kit” is already available, but now Apple is releasing its “Research Kit.” The information that is collected via their Apple watch Research Kit will be used by scientists and hospitals around the world to understand better a whole array of health issues, such as diabetes, breast cancer and asthma.
Here, The Smart Phone Company provides some insight into the Apple Watch and its development into the Research Kit.
The Key to Medical Developments
The main thing that scientists are lacking, to help them in the understanding of diseases, is numbers. To be able to see patterns and trends, it is useful to have much data to compare, and this is where the Apple watch Research Kit comes into play. By being able to measure a number of variables from people all over the world, scientists and researches can have the information that they need at their fingertips.
With the new Apple watch Research Kit, researchers will be able to design apps which, using existing Apple technology, allows them to gather data that previously was only available in the lab. It also gives Apple watch users the ability to check up on their own health and see correspondences between activity and diet, and their health.
Guest post by Deanne Kasim, IDC research director, payer health IT.
Part of the role of being a research director is to analyze current industry trends, developments and policies and help clients navigate these IT, market, economic and regulatory changes. A post-health reform environment has accelerated the rate of change in all these areas. I recently developed a discussion of the top 10 areas of change payers need to focus on for the next 12 to 18 months (http://www.idc.com/getdoc.jsp?containerId=HI253579). The following is a brief discussion of the top three predictions.
Payers need to develop greater understanding of who their consumers are and adopt more of an omni-channel approach for reaching and meaningfully engaging different population segments.
Consumers understand how to assess the concept of value in other areas of their lives, such as researching information to purchase a new car, a major appliance, or a house. But they do not have nearly as good of an understanding on the way health insurance works, how to necessarily use it, or how to define value in insurance benefits and care choices. Health reform has forever changed the business model of health insurance and placed consumers front and center in the equation. This increased emphasis on the consumer needed to happen a long time ago and now payers are challenged to radically change how they develop, market, and administer health insurance benefits accordingly. IT tools and applications are quickly evolving to better support the consumer’s purchase decisions and use of insurance benefits, and payers are continuing to realize the potential and importance of this developing product area.
According to IDC Health Insights’ 2014 Payer Survey, payers were split between increasing the 2014 budget for consumer engagement strategies (49 percent) and keeping the budget the same (51 percent). I fully anticipate these numbers will be higher in this year’s survey, as more payers commit additional resources to the development and support of thoughtful consumer engagement strategies, processes and IT applications.
As the industry moves from pay-for-volume to pay-for-value payers need to form more “win-win” relationships with providers and this requires leadership, trust and the IT applications and analytics to support this.
The longtime practice of paying for volume is changing rapidly to pay for value, and the U.S. Centers for Medicare & Medicaid Services (CMS) continues to lead developments in pay for value methods, including a variety of value-based reimbursement (VBR) practices, pay-for-performance (P4P) and global or episodic payments. The establishment of patient centered medical home (PCMH) and accountable care organization (ACO) models, combined with the reduced reimbursement realities under the ACA, has incentivized more providers and payers to explore new, mutually beneficial reimbursement arrangements. Providers and payers will have an increasing need for analytics applications to help predict and monitor clinical quality outcomes and financial performance measures in order to make VBR arrangements work for all involved stakeholders. In addition, as payers continue to employ narrow networks as part of their public HIX business line strategy, VBR arrangements with the contracted providers can enhance the performance of both payers and participating providers.
Dean Stephens is the CEO of Healthline, a media group and a health information technology company. Here Stephens discusses healthcare analytics and how it’s important to providers and patients; the ever-increasing importance of harvesting useable and life-changing information from unstructured big data; analytics in population health; the importance of ACOs and the future of Healthline.
Tell me about your background and your role at Healthline. I grew up in a small, blue-collar town in New England and was fortunate enough to attend an Ivy League college, which was a rare thing for this town. After college and graduate school, I got lucky to land a policy analyst position for the Washington State governor, but in no time, got drafted into management consulting at Deloitte. Much of my consulting time was spent in the healthcare industry learning first-hand how “upside down” the industry was. Thus, I joined other entrepreneurs to re-imagine this muddled industry and joined Healthline as CEO in 2001, not knowing then that I would end up building two companies simultaneously.
What does Healthline do and how has the company evolved?
Healthline’s mission is to make the people of the world healthier through the power of information. And we do this through two business units – our media group, which consists of our consumer health website Healthline.com, and our health information technology group, which includes a range of search and data analytics solutions built on our market-leading medical taxonomy. We are currently working with some of healthcare’s largest brands, including AARP, Aetna, Pfizer, Sanofi, UnitedHealth Group, Microsoft, IBM, GE and Elsevier.
Describe your personal view of analytics and what that means to the rest of us. Why is this important?
Healthcare is the most information-intensive industry on the planet. The number of diseases recognized today and the permutations on the treatment matches to individuals have exploded over the past 20 years. It’s impossible for an individual physician or a large, sophisticated provider or payer institution to deliver effective treatment across all patients without analyzing vast amounts of complicated data. We limped along in the traditional fee-for-service realm. Now as the healthcare market shifts to value-based reimbursement, the value of information and analysis rises dramatically as providers shift from being rewarded for sick care to well care.
Two big communicable disease scares—Ebola and measles—gripped the attention of the general public recently. They did so with enough strength that the average person on the street spoke out and demanded that actions be taken to protect themselves and families. It was virulent on social media. The total count of Ebola deaths at the end of last year was 5,021 worldwide. The CDC reported 10 Ebola cases treated in the U.S. and two patients died as of January 2015. There were 121 total measles cases in the U.S. this year in 17 states. All but 18 of the measles cases were because of an outbreak that spread from Disneyland in California.
What is remarkable is that these two infectious diseases affected a total of less than 200 people across the nation. Yet it triggered a vigorous response from masses of people who were afraid that they could contract Ebola when the actual chances were significantly lower than dying from a lightening strike. The spread of measles among children erupted into online wars between the vaccinated and unvaccinated.
Contrast this with the lack of concern over the flu vaccine’s low effectiveness against this year’s virus, which the CDC estimates kill 3,300 to 49,000 people in the U.S. every year. Warnings from the CDC that the flu strain this year is worse and getting the flu shot will at least temper the illness seems to have had little effect on increasing vaccinations.
Ebola attracted the public’s attention with such obsessive coverage that the public expected exposed individuals to be quarantined even though an individual had no symptoms to indicate a contagious state. More importantly, contact with fluids of an infected person is necessary to become infected. Contrast this with measles where the air and surfaces an infected person has coughed or sneezed remain contaminated for up to two hours. Measles is contagious up to four days before the telltale rash appears. According to the CDC, about one in every 1,000 children who contract measles will die and 90 percent of the non-immune people close to an infected person will get it.
Fear was the driver for Ebola’s patient engagement. The measles outbreak engaged parents because it raised the issue of the high rate of non-immunized children of a highly contagious and serious disease, but there were no calls to quarantine measles victims and guard them as with Ebola victims.
Those who are familiar with the new Apple smartwatch will know that one of the big focal points for new technology is in healthcare. The “Health Kit” is already available, but now Apple is releasing its “Research Kit.” The information that is collected via their Apple watch Research Kit will be used by scientists and hospitals around the world to understand better a whole array of health issues, such as diabetes, breast cancer and asthma.
