By Brian Cafferty, vice president of RPA development, Tebra.
Robotic process automation (RPA) is a software technology that uses “bots” to replace repetitive, rule-based tasks and processes. In everyday life, people use RPA technology anytime they rely on form auto-fills, credit card payments, call center menus, or banking automation.
While the hyper-automation trend has taken root in most industries, bots are just starting to catch on in medical practices. The average practice performs many time-consuming and repetitive administrative tasks that require large amounts of data to be pulled, categorized, summarized, and reported. However, these tasks don’t require specialized knowledge. RPA can provide task automation across the organization, from front-office tasks to operational processes to patient interaction and bill payment. In addition, minimizing manual processes can reduce error rates that cost time and money.
Our customers and early adopters of RPA report that within the first three to six months of implementation, they saw improvements of 50% in operational efficiencies, 200% in claims processing speed, 30% in revenue per clinical encounter, 95% clean claims and only 2-3% claim denial rates.
Automating essential workflow
Onboarding new patients is a process you can automate while improving the patient experience. For example, a bot can provide an integrated data connection between your electronic health record (EHR) and billing platform. As patients complete the intake and insurance forms, this information is automatically entered into your billing platform.
As more patients demand convenient digital touchpoints, bots can maximize back-office efficiency with appointment scheduling. Bots can process patient appointment requests by presenting available time slots and adding selected appointments to the practice’s database. In addition, the RPA tools can assist with patient check-in, validating health plan coverage, and arranging pre-authorizations for planned procedures and treatments. For smaller practices or those with lean office staff, these automations can significantly reduce time spent on non-revenue-generating tasks.
For practices that need to migrate patient EHR data when transitioning from one practice management software to another, bots can initiate keystrokes to create a clinical note for each patient encounter to ensure the patient’s complete medical history is captured accurately.
By reducing the administrative tasks that do not require specialized knowledge or a human touchpoint, your practice staff can focus on delivering better care to improve patient outcomes and grow your practice.
By Dr. Harietta Eleftherochorinou, vice president 0f innovation ventures, IQVIA.
Patients, health systems and CROs are embracing digital health, as indicated by the number of digital health apps, digital diagnostics, digital biomarkers, digital therapeutics and devices being created. At the same time, over a third of these apps don’t survive longer than a year, devices struggle to get regulatory approval, digital biomarkers are yet to be proven, while digital diagnostics and digital therapeutics are not cheaper alternatives to the standard of care. The question skeptics therefore have is “what is the real value of digital health to patients and the healthcare systems?” Below, there are several tangible value-points of digital health in quantified metrics to give an answer.
The digital health innovation market is experiencing exponential growth. Investments of $24 billion were made globally in digital health in 2020 according to the IQVIA Institute Digital Health Trends 2021 report. And according to CBInsights, in 2021, $39.6 billion were invested on digital health alone, out of the total $100 billion invested globally in healthcare startups. These investments are resulting in greater numbers of mobile apps, wearable devices and other digital tools.
Digital apps are redefining the health experience
Multiple types of digital health tools contributed to mitigating the impact of the pandemic and are now established part of the digital health landscape. Consumer apps remain the most widely available and used digital tool with more than 90,000 new digital health apps added in 2020 — an average of more than 250 apps per day — resulting in over 350,000 apps currently available. Apps are increasingly focused on health condition management rather than wellness management, with the former now accounting for 47% of all apps in 2020, up from 28% in 2015, and with mental health, diabetes and cardiovascular disease-related apps accounting for almost half of disease-specific apps. Downloads and use of apps are heavily skewed with 83% of apps being installed fewer than 5,000 times and collectively accounting for less than 1% of total downloads, while a cohort of 110 apps have each been downloaded more than 10 million times and in aggregate make up almost 50% of total downloads.
Moreover, patients have easy, mobile access to health information and quality healthcare. For example, the Moodpath app allows users to track their mental health through cognitive behavioral therapy. At the same time, mobile apps connect doctors with patients who need assistance in real-time, thus easing the burden on healthcare workers. HealthTap is one such mobile app which offers 24×7 virtual assistance to patients by connecting them to certified doctors through call, text, or video call. .The value is increased patient engagement, patient education on one’s own condition and patient centricity coming to life rather than talked about.
Positive results from digital therapeutics
With the incorporation of technology to assist with the treating, preventing and managing of specific diseases, innovation amongst digital therapeutics and digital care products is increasing. According to the IQVIA report, Digital Therapeutics (DTx), and Digital Care (DC) products — incorporating software to treat, prevent or manage specific diseases or conditions — have been proliferating. Over 250 such products are now identified, including about 150 products that are commercially available, and the rest in development.
Digital therapeutics, which typically focus on a narrow clinical indication and generate evidence of clinical efficacy, follow a development path that typically requires market authorization by a regulatory body and sometimes a prescription from a provider, though some may be exempt. Neurologic and psychiatric conditions are a key focus of both DTx and DCs, making up over two-thirds of all DTx indications and over 40% of DCs, respectively, with DCs also used by patients suffering from endocrinology, oncology and cardiovascular conditions.
Oxygen therapy, or the administration of medical oxygen, has increasingly been used to treat various medical conditions, such as chronic obstructive pulmonary disease, cancer, and cystic fibrosis. Oxygen therapy is ideal for most patients who can’t receive adequate oxygen volumes from regular breathing. It also helps those who need high concentrations of oxygen for various reasons.
One of the major drivers of hyperbaric chamber sales is the increasing preference and shift from traditional cylinder-based oxygen tanks to portable devices. There’s also a growing preference for portable oxygen units over stationary concentrators. Below are a few oxygen therapy trends and outlooks for 2023 and beyond.
COVID-19’s Impact on Demand for Oxygen Therapy
While the incidence rates of the pandemic have significantly declined, oxygen therapy was a major treatment option for patients diagnosed with COVID-19. Oxygen therapy at high rates was a vital treatment because the disease directly affected the patients’ lungs and breathing abilities.
Interestingly, the market shift from stationary to portable oxygen concentrators slightly slowed in 2020. This is partly because healthcare providers allocated more resources and focused on availing less-costly stationary oxygen cylinders. Very few patients also required portable oxygen devices, thanks to worldwide lockdown measures and stay-at-home orders designed to contain the pandemic.
However, the demand for portable oxygen devices is poised to increase for various reasons. Stationary concentrators witnessed increased demand in 2020 because they were effective in most high-risk situations. However, there’s an increase in the number of aging adults developing respiratory conditions, subsequently increasing the demand for oxygen therapy.
An estimated sixteen million people suffer from COPD, with millions still undiagnosed. Patients with COPD are also prone to other severe respiratory issues, including COVID-19, which has increased the adoption of oxygen therapy and the introduction of advanced delivery methods, such as nasal therapies.
Increased Demand for Remote Oxygen Therapy Monitoring
Besides increasing the oxygen demand, the pandemic also made it crucial to have home-based oxygen monitoring devices. Remote oxygen monitoring devices connect oxygen equipment with smartphone apps. This allows clinicians to monitor various aspects of oxygen therapy remotely.
The trend of improved health data transmission will also grow exponentially with the introduction of wearable technologies, wireless 5G networks, and advances in photoplethysmography sensors. PPG sensors are non-invasive devices that use photodetectors to measure variations in blood. These sensors are positioned at specific body parts, such as fingertips, forehead, and earlobes.
By Paul Schuhmacher, managing director in the healthcare practice, AArete.
At the onset of COVID-19, public health emergency (PHE) declarations rapidly transformed the healthcare industry and insurance landscape. In the first few months alone, an estimated 7.7 million jobs that provided employer-sponsored insurance were lost, leaving 14.6 million workers and dependents uninsured.
Continuous eligibility provisions through the PHE saw Medicaid enrollment grow by approximately 15.5 million individuals between February 2020 and December 2021, many of whom gained or kept their eligibility due to pandemic-related eligibility changes.
A recent report by the Assistant Secretary for Planning and Evaluation (ASPE) showed a historically low uninsured rate of 8% in the first quarter of 2022, but that number is destined to grow. The looming end of the PHE will be a cause for celebration in many regards. Still, Medicaid health plans are rightly on edge because of the approaching logistical nightmares and financial losses the unwinding period will bring.
The PHE has been extended through January 11, 2023, and the Biden administration has promised to give 60-days’ notice before its conclusion. When it does end, 15 million individuals are projected to leave Medicaid, including 8.2 million who will leave due to loss in coverage and will need to transition to another source of coverage and 6.8 million who will lose coverage despite fulfilling eligibility requirements.
This rapid loss of coverage is also predicted to disproportionately impact Black and Hispanic individuals. The two groups have historically faced significant barriers to accessing quality healthcare and are more likely than white adults to forgo needed care due to cost.
Affordable Care Act provisions have helped reduce disparities these groups face. However, according to the ASPE report, Hispanics make up one-third of those predicted to experience churn and over one-quarter of those who will become ineligible for Medicaid. Meanwhile, Black individuals could comprise 15 percent of those experiencing churn and 14 percent of those expected to lose eligibility.
When taken together, this points toward a tumultuous and overwhelming period — not only for the millions of Americans who will become uninsured but also for the health plans tasked with balancing a deluge of work and the strains of providing timely, quality healthcare options to those who need it.
Inovalon, a leading provider of cloud-based software solutions empowering data-driven healthcare, today announced the addition of its EASE All-Payer claims management solution to the PointClickCare Marketplace. Building on a five-year partnership, Inovalon’s newest listing on the Marketplace offers healthcare providers sophisticated revenue cycle management (RCM) tools that are seamlessly integrated into PointClickCare’s Electronic Health Record (EHR).
The Inovalon EASE All-Payer claims management software, powered by the Inovalon ONE Platform, helps providers achieve a 99% first-pass acceptance rate among commercial and Medicare payers. The solution leverages an advanced payer rules engine that validates claims based on the latest requirements from the Centers for Medicare & Medicaid Services and Commercial insurers. The solution also allows users to easily create custom, facility-specific business rules that improve the accuracy of claims processed in each location.
Unlike other solutions, EASE All-Payer automatically checks claim eligibility and historical responses upon submission, enabling users to identify and correct upstream eligibility issues before transmitting to the payer. Additionally, the solution’s integration with Inovalon’s MORE2 Registry enables providers to easily source missing patient information, such as the Medicare Beneficiary Identifier, which can significantly reduce claims denials and improve first pass yield.
Also offered on the PointClickCare Marketplace is Inovalon’s Workforce Management solution, a fully mobile, real-time scheduling and open shift management application that scales from single units to entire enterprises. Inovalon solutions available on the Marketplace allow PointClickCare customers to operate within a single platform to launch, manage, and utilize applications, resulting in greater data accessibility and a unified user experience.
“We are pleased to enter the next phase of our long-standing partnership with PointClickCare supporting thousands of providers with the integrated tools they need to optimize financial and operational performance,” said Julie Lambert, president and general manager of the Inovalon Provider business unit. “Inovalon powers thousands of facilities with its industry-leading solutions, and our latest listing on the PointClickCare Marketplace ensures they are easily accessible to our joint customers.”
Particle Health, a developer-friendly API platform for bi-directional healthcare data exchange, announced the availability of its white paper that highlights the most comprehensive view of Health Information Network data performance available to date and provides vital information to gain a true understanding of healthcare interoperability.
The paper, 2023: State of U.S. Healthcare’s National Network Data Exchanges, analyzes not only quantitative comparisons of the data currently exchanged on HINs but also the work that still needs to be done in order to spread the true value of the networks across all stakeholders in the healthcare ecosystem. The report also details critical information on how to successfully leverage HIN data when building digital healthcare tools and operating healthcare organizations or digital platforms.
The recent paper revealed that the nation’s three largest Health Information Networks have indexed healthcare records for the vast majority of Americans, as shown by Particle’s platform finding data across HINs for about nine out of every 10 patients searched for. The CommonWell Health Alliance has access to 29,000 sites and 153 million individuals; Carequality has access to 55,000 sites and 300,000,000 document exchanges per month; and eHealth Exchange has access to 75,000 sites and 120 million individuals. A sample of queryable data found that a plurality (about 45%) of health data available on HINs was generated within the past three years.
To help digital health organizations looking to gain deeper insights into how to search and return patient data more successfully on HINs, Particle Health studied its own technical data from connecting to the three major HINs. By mapping out each network’s endpoints in the U.S., the company was able to rank states by their endpoints per capita. Particle Health found that in 2022, on average:
Query success rates (requests from doctors in which their patients’ data was returned) varied widely by state – from a low of 37.9% in Montana to 95% in Michigan
Endpoints per state were diverse, with one network listing three endpoints in a state and another having more than 4,000 in a different state
51.3 files were returned per successful endpoint match
There were over 2.3 matching endpoints per patient query
A query completion took one minute
134 files were returned per patient
“No matter who you treat, it’s very likely that your patients’ medical records can be found on Health Information Networks,” explained Troy Bannister, CEO of Particle Health. “Today, clinicians can access these networks. Patients, insurers and other stakeholders may not realize they’ll soon be able to directly obtain relevant records as well. We’re about to enter a game-changing era in healthcare as Health Information Network access expands.”
For this paper, Particle Health also reviewed upcoming HIN improvements and health IT landscape changes that will likely drive a surge in requests for data. Two notable changes include:
The Trusted Exchange Framework and Common Agreement (TEFCA), a government initiative that’s leading to nationwide baseline standards for clinical data sharing, will re-order the landscape for HINs with participation in data exchange with Qualified Health Information Networks (QHINs). These specialized HINs will connect to each other, serving as the core infrastructure for healthcare data exchange.
The 2016 21st Century Cures Act makes it clear that healthcare organizations must respond to requests from individuals in technically feasible ways – a policy called Anti-Information Blocking – with enforcement that officially began this past October. If a doctor can get records from a HIN, then patients should be able to access them in that same manner as well. Particle has identified how HINs are still playing catch up with the rule, while sorting through complicated multi-stakeholder policy, security and technical nuance.
A Developer-Friendly Approach to Consolidate Network Access
Direct integration with a HIN is prohibitively difficult for most organizations, as a great deal of specialized work needs to be done to maximize the value of network connectivity. Particle Health was founded to make a wide array of diverse network data accessible and actionable for the many stakeholders and organizations that would benefit from network participation. In its role, the company consolidates each network within a single API implementation, making it manageable to leverage the data from multiple HINs covering over 270 million patient lives.
Bannister said, “Many organizations simply don’t know that this fantasy – a nationwide way to locate and exchange medical records – already exists. With our birds-eye view of different Health Information Networks, Particle Health has seen provider organizations use patient data to efficiently improve outcomes. That’s why we’re working hard to make Health Information Networks more accessible to new digital health participants.”
A new report by the Private Equity Stakeholder Project (PESP), “Private Equity Descends on Rural Healthcare,” provides an unprecedented look at the private equity industry’s incursion into rural healthcare. The findings were led by PESP healthcare researchers Eileen O’Grady, Michael Fenne, and Mary Bugbee.
“Healthcare systems in America’s rural communities are experiencing an escalating crisis,” said O’Grady, PESP Healthcare Director. “Rural hospitals are closing at a dangerous rate. Chronic staffing shortages plague providers, and the health of people living in rural areas is, by most measures, significantly worse than in non-rural areas. Despite these challenges, private equity appears to still find opportunities to profit off this struggling industry, thereby adding to the strife.”
This sweeping survey examines the extent to which private equity (PE) has invested in rural health, as well as key financial drivers of significant investment activity in this uniquely distressed part of our health system. The new report also examines case studies of PE-owned companies in several rural healthcare sectors that highlight some of the risks posed by private equity’s incursion into rural healthcare.
PESP shares previously unreported data revealing that private equity firms own at least 130 rural hospitals. The private equity firms that dominate the list include Apollo Global Management (LifePoint Health, Scion Health), GoldenTree Asset Management and Davidson Kempner (Quorum Health), and Equity Group Investments (Ardent Health Services).
Similar to private equity’s involvement in other sectors of the healthcare industry, quality of service at PE-owned hospitals can be questionable. “A series of case studies in this report reveals a range of quality issues,” O’Grady added. “Even with substantial financial assistance received during the pandemic, three of the six rural hospitals that closed in 2021 and 2022 were PE-owned.”
In addition to traditional hospital ownership, the PESP report lays bare a new tactic utilized by private equity firms to extract additional value from hospitals they own. By creating separate hospital management companies, these firms have provided themselves new avenues to harvest profits from both nonprofit and public healthcare providers, entities that historically would have not given high returns for their ownership.
“This report includes truly expansive analysis on private equity’s interest and sustained investment in rural healthcare,” O’Grady said. “Private equity’s influence extends far beyond the hospitals they own. In addition to providing a list of PE-owned rural healthcare companies across a variety of specialties, our research digs into several key sectors including emergency care and transport, travel nursing, and behavioral health.”
Finally, the report analyzes the potential motives of PE investment in rural health and proposes policy recommendations to ensure that private equity cannot exploit rural health providers at the cost of quality of care. Some of PESP’s policy recommendations include:
Increasing oversight over changes in hospital ownership
Placing limits on sale-leaseback transactions
Passing the Travel Nursing Agency Transparency Study Act
Holding private equity firms accountable for Medicare/Medicaid fraud by portfolio companies
Increasing public investment in rural health initiatives
By Brian Selfridge, healthcare cybersecurity and risk leader, CORL Technologies.
For anyone invested in Third Party Risk Management (TPRM), the last few years have been at once painful and heartening. On the painful side of the ledger, we’ve seen multiple high-profile breaches resulting in stolen patient data, reduced services and loss of trust on the part of many patients.
On the heartening side, these unfortunate incidents have made many healthcare organizations get much more serious about TPRM, treating it as an integral part of day-to-day operations.
That said, we have a long way to go. Spend any time with employees of healthcare organizations and you will hear the same message over and over again: things are better than they were, but TPRM remains fundamentally broken.
With that in mind, it’s worth taking a step back and assessing where we are with TPRM as 2022 draws to a close. What are the lingering pain points? In what areas could we stand to do a better job? Understanding the answers to these questions will help us think ahead to a better, brighter future for TPRM.
Everyone is Struggling to Keep Their Heads Above Water
The number of third-party vendors used by healthcare organizations has exploded in recent years, and this trend shows no signs of slowing down. Each one of these vendors, of course, represents a potential risk to the healthcare organization, and accordingly each one needs to be thoroughly vetted.
Of course, there is only so much time in the day, and fully vetting each third-party vendor using the standard methods takes time and resources––two of the rarest and most precious commodities in the healthcare industry.
This is a problem not just for the healthcare organizations but for the vendors themselves: each day they are flooded with more and more due diligence requests, more and more questionnaires, and because these requests are rarely standardized––i.e., every healthcare organization has its own demands and expectations––properly addressing every single issue can feel impossible.
Add in the fact that many healthcare organizations themselves function as third-party vendors and you have a recipe for an infinite backlog. Compliance concerns are forgotten, unaddressed, or addressed only partially, while critical patient information is left vulnerable. It’s an untenable situation.
By Paul Schuhmacher, managing director in the healthcare practice, 
