By Bobby Sherwood, vice president of product development, GuidingCare.
A lack of interoperability permeates U.S healthcare. Despite the rapid adoption of new technologies, we have failed to fully realize some of the most impactful opportunities they present. Data silos that hinder collaboration, efficiency, and innovation stubbornly persist across the industry. For health plans, embracing digital transformation to digitize process and improve member experience pays dividends, but can come with difficult integration and interoperability challenges if not done properly.
There has been a recent spotlight on government initiatives and regulations to address these growing concerns. Take the new CMS proposed rule on interoperability and prior authorization, which will require payers to implement an electronic prior authorization process, shorten the time frames for payers to respond to prior authorization requests, and establish policies to make the prior authorization process more efficient and transparent.
In a world where nearly anything can be instantaneously ordered from your mobile phone or laptop and delivered overnight, it seems inconceivable that prior authorizations – something so critical to member and population health – is managed by an antiquated system. This seamless exchange of data will reduce provider abrasion, improve the member experience and potentially their health outcomes, and ultimately decrease the cost of care, as the manual effort and time linked to prior authorizations markedly decreases.
As we execute on the year ahead, interoperability remains top-of-mind for stakeholders: a new report suggests that barriers such as poor data quality and information sharing remain challenging to over 60% of healthcare executives. For health plans prioritizing interoperability, consider these three areas of focus:
By Richard Dion, PharmD, pharmacy clinical program manager for clinical surveillance and compliance, Wolters Kluwer Health.
In recent years, the data collected by health systems has skyrocketed in volume. Unfortunately, studies show that up to 97% of data collected in hospitals is not used to inform or improve care — an issue that could offer new opportunities for both providers and patients. Hot-button topics like inpatient Opioid Stewardship could benefit from an increased utilization of available data.
Institutions looking to leverage existing data to improve quality and safety of opioid use should consider several steps to create meaningful and attainable data-backed goals.
From the outset, it’s important to consider who would drive these programs within hospitals and health systems. Leadership roles, as well as day-to-day drivers of activities, will require thoughtful selection and designation. Leadership plays a critical role in overall organizational buy-in, while pharmacists within a health system can provide the education and support necessary for physicians to optimize electronic healthcare records (EHR) and other data to provide appropriate pain management options. With the recent relaxation of opioid prescribing guidelines from the Centers for Disease Control and Prevention (CDC) to no longer promoting strict thresholds for pain medication doses and duration, developing standardized opioid stewardship programs based on local data is critical.
When it comes to analyzing existing information for care decisions, utilizing local data is vital to a complete understanding of opioid use and patient needs within the health system. Some EHRs and third-party applications may have metrics and dashboards available, but sites may need to curate their own data to fit organizational needs. Technologies such as dashboards that offer a composite view of patient and prescribing data are invaluable to providers to identify patterns and at-risk patients. There may still be several areas where manual processes are prevalent and / or necessary. While individualized care for patients is important to maintain, creating structure using automation that can help identify patterns and insights from data can be invaluable in preventing and treating opioid use disorder (OUD) efficiently and effectively.
Finding the right rehab center that fits your needs and insurance requirements can be a daunting task. Fortunately, advancements in health technology have made this process easier and more accessible for patients. Here are 10 ways health tech is empowering patients to find rehab centers that fit their insurance needs.
Online Directories
Online directories, such as the Substance Abuse and Mental Health Services Administration (SAMHSA) directory, provide a comprehensive list of rehab centers that accept insurance. Patients can filter their search based on their location, insurance provider, and treatment preferences.
Mobile Apps
Mobile apps like Addicaid and Sober Grid provide users with a platform to connect with other individuals in recovery, find nearby meetings, and access resources such as insurance information and local rehab centers.
Telemedicine
Telemedicine allows patients to receive virtual consultations with medical professionals, enabling them to discuss treatment options and insurance coverage from the comfort of their own home. This is particularly beneficial for individuals living in rural areas or with mobility issues.
Insurance Provider Portals
Many health insurance providers offer online portals where patients can search for detox and rehab centers that accept their coverage. These portals often provide information on treatment options, in-network providers, and co-pay information. Patients can simply log in to their insurance provider’s portal to access a detox that takes Cigna, Anthem or other insurance providers. This can save patients time and frustration by eliminating the need for multiple phone calls to different providers. Additionally, some insurance providers may offer additional resources for patients seeking detox, such as care coordinators or case managers who can help patients navigate the complex insurance process and find the best detox center for their needs.
In the rapidly-evolving landscape of biopharmaceuticals, it has become increasingly important for companies to establish effective partnerships in order to stay competitive. One such partnership that has gained popularity in recent years is the collaboration between biopharmaceutical companies and contract development and manufacturing organizations (CDMOs). In this article, we will discuss how to build an effective CDMO partnership in biopharma.
First and foremost, it is important to identify the key areas where a CDMO can add value. This can include services such as cell line development CDMO, process development, and clinical manufacturing. By leveraging the expertise of a CDMO, biopharmaceutical companies can accelerate their drug development timelines and reduce costs.
Once the key areas of focus have been identified, it is important to evaluate potential CDMO partners based on their capabilities, experience, and track record. It is also important to consider factors such as geographic location, regulatory compliance, and intellectual property protection. A thorough due diligence process is essential to ensure that the chosen CDMO is the right fit for the specific needs of the biopharmaceutical company.
Communication is also a critical component of a successful CDMO partnership. Clear and frequent communication between the biopharmaceutical company and the CDMO can help to ensure that both parties are aligned on project timelines, budgets, and expectations. Additionally, regular updates and progress reports can help to identify and address any issues that may arise during the course of the project.
By Dan Pichette, executive vice president, Output.
When we think of innovation in healthcare, what comes to mind? For many, it may be fancy diagnostic machines or breakthrough drug therapies. But sometimes, it can be as simple as a 3D-printed cover for an insulin pod. A product, or an improved process, that solves a need. While medical settings like hospitals and clinics are good at managing patient care, it can still be challenging to create and manage a culture of innovation.
According to Stanford University, innovation management is the process of taking imaginative concepts from inception to implementation, beginning with “the fostering of an environment where a new idea is encouraged.” In healthcare, stringent regulations and multilayered administration can often discourage this process. Staff in large medical environments often work within silos where close teamwork can incubate new ideas, but whose independence from each other can also isolate communication.
Embracing Innovation
Innovation is a key goal for the World Health Organization. Since 2017, the WHO Innovation Network, a digital and in-person network of global colleagues, has been engaged in learning and sharing events exploring “new ways of applying innovation in WHO’s work to accelerate health impact.” For its part, the American Medical Association has its seven-year-old Medical Education Innovation Challenge, enlisting small teams to propose a change to an aspect of medical education that better prepares students to meet future healthcare needs.
Nurses, the employees most on the front lines of medical care, are welcoming improvements. Nursing Management Journal exhorted that even though the healthcare industry is “innately risk-averse,” nurses must not only embrace new technologies such as AI, virtual reality and advances in genomic science, nurse leaders should proactively foster a culture of innovation, encouraging divergent thinking and promoting autonomy to instill confidence in employees.
Some institutions of higher learning have recognized the role that innovation increasingly plays in the medical sphere. Temple University’s Fox School of Business offers a 12-credit Graduate Certificate in Healthcare Innovation Management designed for current professionals looking toward the industry’s future. These credits can be applied to graduate degree programs such as Temple’s Master of Health Administration or its appropriately named Master of Science in Innovation Management and Entrepreneurship.
A Pandemic Catalyst
There is little doubt that the pandemic has shepherded unprecedented change. A May 2021 McKinsey survey, which polled over 100 industry leaders from medical providers to health payers to pharmaceutical and technology companies, found close to 90% of respondents agreed that the Covid pandemic “will fundamentally change the way they do business, requiring new products, services, processes, and business models.” Two main areas where they expected significant changes to endure: digital acceleration (from telehealth to digitally enabled clinical trials and customer-engagement models) and the workplace of the future (spanning remote patient care and virtual collaboration for professionals in the pharmaceutical and medtech industries).
The McKinsey Healthcare Innovation Through Crisis Survey concluded that adapting to these shifts, among others, will require many healthcare organizations to transform their operations and mindsets. During times of crisis, prioritizing innovation can “help unlock growth in the recovery, provided leaders approach it with commitment and establish key capabilities and processes.”
Medicare is a federal health insurance program in the United States that provides coverage to people 65 or older and some younger people with specific disabilities. The program is divided into several parts, covering different medical services and expenses. Medicare was first introduced in 1965 as Part of President Lyndon B. Johnson’s Great Society program and has since become an essential safety net for millions of Americans. However, navigating the different parts of Medicare and understanding its eligibility requirements and costs can be complex and daunting. This article will explore the meaning and coverage of Medicare Parts A, B, C, D, as well as eligibility, enrollment, and costs.
Medicare Part A
Medicare Part A or hospital insurance, covers inpatient hospital care, skilled nursing facilities, hospice care, and some home health care services. It is typically accessible to those who have paid Medicare taxes for at least ten years while working. Part A covers hospital stays of up to 90 days, with additional coverage for up to 60 “lifetime reserve days” beyond that. It also covers skilled nursing facilities for up to 100 days after a qualifying hospital stay. Hospice care is covered for those with a life span of six months or less, and some home health care services are covered for those who are homebound and need skilled nursing or therapy services. There are deductibles and coinsurance costs associated with Part A, depending on the length of the hospital stay.
By Ken Perez, marketing and strategy advisor to Vindeca Health and former vice president of healthcare policy and government affairs, Omnicell.
On Jan. 30, the Biden administration notified Congress that it plans to let the public health emergency (PHE) and the national emergency declarations related to the COVID-19 pandemic expire on May 11. The end of these declarations logically follows President Joe Biden’s “Sixty Minutes” interview that aired on Sept. 18, 2022 during which he stated, “The pandemic is over. We still have a problem with COVID. We’re still doing a lot of work on it, but the pandemic is over. If you notice, no one’s wearing masks. Everybody seems to be in pretty good shape.”
Accordingly, on February 9, the Department of Health and Human Services (HHS) cited these developments since the peak of the Omicron surge at the end of January 2022 to justify the end of the two emergency declarations:
Daily COVID-19 reported cases are down 92%
COVID-19 deaths have declined by over 80%; and
New COVID-19 hospitalizations are down nearly 80%
Background
On Jan. 31, 2020, then-HHS Secretary Alex Azar, under section 319 of the Public Health Service Act, declared a public health emergency because of the continued spread of COVID-19. As of that date, there had been an estimated 16 cases of COVID-19 in the U.S., nearly 10,000 people had been diagnosed with the virus globally, and more than 200 had died, all in China. The following day, the World Health Organization (WHO) declared a global health emergency.
According to a report by the World Health Organization, digital health technologies such as companion apps have the potential to transform healthcare delivery by improving health outcomes, reducing healthcare costs, and enhancing the patient’s experience. Meanwhile, as digital health technologies continue to advance, companion apps are poised to play an increasingly important role in preventive healthcare.
In this blog post, we will explore how companion apps can support individuals in staying on top of their preventive healthcare measures.
1. Scheduling Regular Check-ups and Screenings
Companion apps can assist people in making appointments with their healthcare professionals for routine check-ups and screenings. Numerous apps let users keep track of their medical history in one simple place and set reminders for upcoming appointments. With this, people can identify potential health issues early on and take proactive measures to treat them by getting frequent checkups and tests.
2. Staying Up-to-Date with Vaccinations
Companion apps can also help individuals stay up-to-date with their vaccinations. Some apps provide reminders for when vaccines are due, while others can even help users find vaccine clinics in their area. Staying up-to-date with vaccinations is important for protecting against infectious diseases and maintaining good overall health.
