In an ideal world, a patient should be able to visit the doctor whenever he has health concerns. However, for many patients, particularly the millions living with lifelong chronic diseases, such as diabetes, heart failure and chronic obstructive pulmonary disease (COPD), meeting this need is a challenge because of several reasons. Key among these are: lack of time and limited access to a nearby health facility. These obstacles, in turn, sometimes create even bigger problems, such as patients’ failure to practice daily routines of disease prevention and management, resulting in worsening of their conditions and triggering the need for emergent care.
Fortunately, a solution is underway. Experts are taking advantage of today’s modern technology—telehealth — and are using it to bring healthcare education and services closer to consumers. Most simply put, telehealthcare provides contact between clinicians and patients who are at some distance from each other, and uses telecommunication-ready tools to “see” each other and undergo clinical examinations even at a distance.
Through telehealth, patients can easily get in touch with their doctors without having to worry about geographical distances. From a residential setting, not only can a simple and known tool like a telephone be used as an audio communications device to connect patients with their clinicians, but an array of monitoring devices, such as blood pressure cuffs, pulse oximetry measurement tools, weight scales, and others, can also be used to transmit current vital sign readings for clinicians’ review. In the same manner, physicians can use today’s information technology to easily access their patients’ electronic health records and monitor their patients’ development outside the walls of their clinics or hospitals.
Truly, telehealthcare and remote monitoring have enabled many healthcare practitioners to help manage the chronic health conditions of their patients, and subsequently, help improve their patients’ quality of life.
The healthcare payments market is growing rapidly and is estimated to reach $5 trillion by 2022 as a total of both payer and consumer payments. The fastest growing portion of the market is payments from consumers for healthcare services and health plan premiums as a result of shifting payment responsibility and changes because of health reform.
However, the healthcare industry is struggling to address the new role of consumers in the payments process with more than 30 percent of healthcare dollars considered to be wasted because of inefficient, disjointed payment processing and costs associated with paper-based billing and administrative processes. These costs are expected to continue to increase unless the healthcare industry recognizes and addresses the critical role of consumer choice and the impact of the digital economy on payment options.
These latest trends and best practices presented in InstaMed’s Trends in Healthcare Payments Annual Report 2014 outline a critical need for healthcare industry professionals to focus on consumer preferences and their emerging role in the payments process. Healthcare providers and payers who offer consumers preferred payment methods, including card payments and online payments, reduce confusion and ultimately increase collections. Additionally, new electronic payment channels, such as mobile payments and Apple Pay, will further accommodate consumers’ expectations for simple billing and convenient ways to pay. A focus on streamlining the consumer payment experience will improve collection rates, increase consumer satisfaction, and enhance profitability and cash flow.
The following infographic illustrates the top trends, industry challenges and best practices to enable healthcare organizations to adapt to the future of healthcare payments. For more information, download the full report: www.instamed.com/trends.
Co-founder and former president and CEO of the College of Healthcare Information Management Executives (CHIME) Richard A. Correll announced his plans to retire at the end of the month, after 23 years. Correll has been serving as the organization’s chief operating officer and senior strategic advisor since April 2013 following the appointment of CEO Russell P. Branzell.
Correll has led the CHIME organization since it was created more than two decades ago as a nonprofit, professional association for senior IT leaders in healthcare.
“My years serving CHIME have been a privilege and the most rewarding of my career,” said Correll in a statement. “With the indispensable support of our members, board and staff, the organization has become a recognized leader and advocate for the CIO role and the effective use of information management to improve patient care quality and safety.
Correll helped forme CHIME in 1992, enlisting 192 charter members in the first year, led by founding board chair Dr. John Glaser. While serving on the HIMSS board in the 1980s, Correll identified the need for a professional organization dedicated to the development of the emerging top healthcare IT executives taking on the new title of CIO. Today, CHIME has grown to more than 1,500 members and 150 Foundation firm supporters.
“Our ability to utilize information technology to improve the quality, safety and efficiency of care has been significantly furthered because of the efforts of Rich Correll,” said Glaser, senior vice president of Cerner in a statement. “Rich’s creation and leadership of CHIME have led to major advances in the knowledge, skills and capabilities of the healthcare IT leadership community. His legacy is substantial; we all have been shaped his work.”
After CHIME was formed, Correll and Glaser spearheaded the creation of the CHIME Foundation in 1994, comprised of healthcare IT vendors and consultants to partner with the members of CHIME, and in 2007, a second office location in Washington, D.C. to create sustained contact with lawmakers while informing and influencing federal policies meant to transform the delivery of healthcare through IT.
In January of this year, Anthem, Inc. a managed care provider, learned of a cyber attack to their IT system. This attack, which occurred over several weeks beginning in December, 2014, compromised the identities over 80 million customers. The breach, in which the healthcare information of millions were compromised, constitutes a serious HIPAA violation, exposing the provider to potentially devastating legal liability.
Unfortunately, this sort of breach perpetrated against healthcare providers is becoming ever more common. The Ponemon Institute, along with ID Experts, issued a report in May this year that showcased healthcare data breaches. The Fifth Annual Benchmark Study on Privacy and Security of Healthcare Data calculates a 125 percent growth in healthcare cyber attacks over the past five years. Although employee negligence and lost or stolen devices still result in many data breaches, a shift is occurring from accidental loss to intentional targeting of data that reveals individuals’ names, Social Security numbers, and other personal information.
The reason that healthcare providers are being targeted is that the information they maintain to provide care for their patients is often substantial enough that cyber criminals can use the data from a single healthcare provider to engage in identity theft. Moreover, cyber criminals target healthcare data because they recognize that many healthcare facilities, including insurance companies, don’t have the resources or technologies to prevent or to detect attacks.
Anthem is a large corporate entity that can afford and use the technology required to protect HIPAA sensitive data, and yet the breach still occurred. What can other healthcare businesses do to prevent or detect a cyber attack on HIPAA sensitive data?
Meeting Standards, Avoiding Fines
The growing use of electronic health records and electronic protected health information (ePHI) accounts for the need to protect information contained in these records. But while these records are often well secured, an often overlooked vulnerability point is credit card processing. Payment Card Industry Data Security Standard (PCI DSS) and HIPAA rules require entities to maintain reasonable and appropriate safeguards for protecting credit card payments. What this actually translates into actionable steps, however, is less clear. To that end, here are four rules to follow when accepting credit card payments to ensure that you’re meeting HIPAA/PCI mandated or suggested compliance guidelines:
PwC’s Health Research Institute (HRI) projects U.S. medical inflation will dip to 6.5 percent in 2016, capping a 10-year trend of slowing employer medical cost-trend growth in the employer-sponsored market. In the latest installment of its annual report Medical Cost Trend: Behind the Numbers, HRI identifies three factors that are expected to reduce the medical growth rate in 2016:
The Affordable Care Act’s looming “Cadillac tax” on high-priced plans which is accelerating cost-shifting from employers to employees to reduce costs;
Greater adoption of “virtual care” technology that can be more efficient and convenient than traditional medical care; and
New health advisers helping to steer consumers to more efficient healthcare.
Despite the year-over-year slowdown, HRI also reported that medical inflation still outpaces general inflation, underscoring the challenges ahead for the health industry. In fact, Behind the Numbers identified two factors that will likely exert inflationary pressure on health spending in the year ahead:
New specialty drugs entering the market in 2015 and 2016 will continue to push health spending growth upward; and
Major cyber-security breaches are forcing health companies to step up investments to guard personal health data, adding to the overall cost of delivering care.
“While the health industry has improved in efficiency over the past decade, the slowing employer medical cost growth is because of the increased role of savvy health consumers facing higher cost-sharing responsibilities and more complex decisions,” said Kelly Barnes, PwC’s U.S. health industries leader. “This will continue to impact the New Health Economy in the coming years.”
From relieving people of repetitive tasks, to building everything around us that shapes our lifestyle, and on to transformation of volumes of data into new insights and perspectives, software has become the new feedstock for the human evolution. All facets of life are touched by software, and healthcare is no exception.
The Complex Web of Health Industry
The health and social care industry is a highly fragmented and complex industry with medical practitioners, nurses, health professionals, hospitals, clinics, government, and non-government agencies all providing health services.
Martin Callinan
The spectrum of healthcare providers range from individual clinicians such as general practitioners to large monolithic entities, such as the National Health Service in the UK, which is the third largest employer in the world today.
Health and social care providers offer a complex and diverse range of facilities and services. By the nature of these services, the healthcare industry is driven by large and varied amounts of data which in turn require varied and complex IT systems to manage this data. Generally, these systems come under the umbrella term of eHealth. While there is no consensus on the exact definition of eHealth, two example definitions are:
“…the cost-effective and secure use of information and communication technologies in support of the health and health-related fields including healthcare, health surveillance and health education, knowledge and research.” –The World Health Organization (WHO)
“…the use of modern information and communication technologies to meet needs of citizens, patients, healthcare professionals, healthcare providers, as well as policy makers.” –The European Commission
Whatever way people choose to define eHealth, it generally encompasses:
Guest post by Deanne Primozic Kasim, research director, payer health IT, IDC Health Insights.
Who will be the next big health plan to merge with and/or acquire Humana? This has been the topic of a lot of industry conversation and I have actually thought about starting an online betting pool. In lieu of creating a “bracket challenge,” I have been informally asking opinions on this topic and the results are all over the map. A deal for either Humana, valued at $27 billion, or Medicaid provider Centene Corp., at $8.3 billion, would be the biggest acquisition of a U.S. payer in more than a decade. It’s an exciting time this summer with the upcoming Supreme Court decision on the legality of insurance subsidies on the federal marketplace, and an anticipated consolidation between Humana and another large insurer.
Why will health plan consolidation continue? Two major reasons:
Increasing Medicare and Medicaid memberships
According to the Centers for Medicare and Medicaid Services (CMS), Medicare membership is expected to reach 68.4 million in 2023, up from a projected 54.4 million this year. In addition, Medicaid will add 9.3 million people over the same period. Baby boomers are hitting Medicare eligibility at a rate approaching 10,000 per day. Part of the reason companies like Humana and Centene are attractive acquisitions to other payers is because of the size of their Medicare and Medicaid memberships. It is important to note that regardless of how mergers and/or acquisitions play out, payers with multiple lines of government-sponsored business will need effective processes and related IT tools for understanding the complex demographics and health needs of these members. Many Medicare and Medicaid members are high-risk/high-value patients who have clinical and non-clinical factors that can result in the development of costly and complex conditions.
Here are some selected FAQs about telehealth service delivery that focus most particularly on the home healthcare arena, which is most probably the health service sector most unaffected by new technology introduction and use until recent decades. Strictly hands-on, or ‘high touch” care service delivery was the order of the day throughout the 20th century. Yet home healthcare is likely to become a very critical component for achieving the much broader and longer term view of patient care delivery after patients’ discharge from hospital. It is then and at home that patients will receive subsequent services through their continuum of care that will keep them well over a long term.
Can I get reimbursed for providing telehealth?
The answer is yes, usually, for providing home telehealth services but not in the usual billing scenarios most home healthcare organizations are used to for submitting bills to Medicare or other insurers. As of now, mid-2015, changes in Medicare and Medicaid fee for services are just coming on-board affecting home telehealth service delivery. There is still a long way to go until Medicare will not very much require face-to-face home healthcare visits during a patient’s admission period—this is the same insurer who absolutely required specific documentation about every portion of nurses’ contact with patients and let the home health agencies (HHAs) know that to CMS, if something was not documented [e.g., a telephone call between nurse and patient about wellness directives] , it didn’t happen [and the bill would therefore not be paid]. Today there are many insurers beyond Medicare that are paying for home telehealthcare (e.g., Aetna, United Healthcare), but it’s very early on—we need to return to this question later this year.
How will I develop a home telehealth service capability? How will I develop a strategic and operating plan for this new delivery channel? Where will I get the technology? What type of training will be required of my people and what will the cost of training be and how many employee hours need to be dedicated to this training?
It’s best to keep in mind that, although the technology is new, you’re not beginning with a blank slate for running a healthcare service delivery business. While all of these questions about telehealth tool acquisition and use are important, the very first question to ask, not mentioned in this list of questions is, hands down, who are my HHA’s most costly patients? An agency-wide chart review would reveal that these are the patients that require the most visits, and additional training in self-management skills and routines.
Once identified, and these are usually patients living with specific chronic diseases and conditions, such as congestive heart failure (CHF) and non-healing wounds, then the subsequent questions can be addressed. In earlier days of home telehealth service delivery (ca. mid-1990s), a full-scale workstation was typically available that could be assigned to any home healthcare patient and came fitted with telecommunications-ready vital sign measuring peripheral devices such as a blood pressure cuff and pulse oximeter, as well as glucometer for measuring diabetic patients’ blood sugar levels even though some patients didn’t have diabetes. These were kind of a one-size-fits-all system, though these proved to be too costly for HHAs and too complicated for patients to use regularly and correctly. More common now is to order and assign only needed and stand-alone telecommunications-ready peripherals devices for patients to perform daily measurements and transmit them to their clinicians.
The healthcare payments market is growing rapidly and is estimated to reach $5 trillion by 2022 as a total of both payer and consumer payments. The fastest growing portion of the market is payments from consumers for healthcare services and health plan premiums as a result of shifting payment responsibility and changes because of health reform.
PwC’s 
