A Pain Point for Every Healthcare Stakeholder: Easing the Sting of Prior Authorization

By Jeffrey Sullivan, chief technology officer of the cloud fax division, J2 Global, Inc.

Jeffrey Sullivan

Time may heal most wounds, but it has done little to lessen the sting of prior authorization.

Despite decades of streamlining and automating healthcare business transactions, prior authorization remains one of the most burdensome, complex and costly administrative activities in the industry that creates hardship for all stakeholders—providers, payors and patients, contributing an estimated $25 billion per year to healthcare costs in the U.S. This is primarily because it remains a largely manual process and, therefore, prone to error.

With the number of transactions steadily increasing year over year, providers and payors need to collaborate and push for an electronic solution. The effort will involve changes to technologies as well as processes and regulations.

The high cost of business as usual

Prior authorization (PA) is a check run by insurance companies and third-party payors before they agree to cover the cost of certain healthcare services and medications. It was designed to ensure patients received the most appropriate and cost-effective care. However, increased demand for documentation, along with lack of standardization and automation, are undermining its original intent.

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Top 5 Digital Healthcare Trends To Follow

The increasing implementation of digital solutions is setting new trends in health technologies. In more than 50% of cases, consumers of European healthcare services are actively responding to the current trend in digital healthcare to use various applications:

  1. control your health
  2. to measure your fitness level
  3. make a follow-up appointment
  4. to fill prescription drugs
  5. to share health-related data with your doctors.
  6. Health technology trends in 2020

Healthcare delivery and healthcare prevention are based on AI technologies and diagnostics based on a personalized approach, which means implementing virtual healthcare and the accelerated global use of digital health tools and applications.

According to digital health experts, the specific areas that promise to grow in 2020 are as follows

Artificial health Intelligence

In recent years, digital technologies’ versatility has given birth to new health trends based on artificial intelligence. A significant wave of innovations in the AI healthcare market should prevail.

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Healthcare’s Most Innovative Companies of 2020: LeanTaaS

At Electronic Health Reporter, we take innovations from healthcare companies very seriously. For nearly a decade, we’ve featured their work, products, news and thought leaders in an effort to bring our readers the best, most in-depth insight about the organizations powering healthcare. That mission lies at the heart of all we do, for the benefit of our audience.

For the first time, we are officially naming some of the most progressive companies in healthcare technology, in our inaugural class of the best, most innovative brands serving health systems and medical groups. Our call for nominations for this “award” series received hundreds of submissions. From these, we selected the best companies from that class. The work these organizations are doing is forward-thinking; award-worthy, we think. We think you’ll agree with all of our choices.

In each of the profiles to come in this series, we’re share their stories — from their own perspective, through their own responses to our questions about what makes them remarkable. Some of the names featured here you’ll recognize, some you won’t. But we believe you’ll agree – all those profiled are doing innovative, groundbreaking work! That said, here’s a member of our inaugural class:

LeanTaaS

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Meeting Patient Demands With Virtual Care Beyond COVID-19

By Michael Morgan, CEO, Updox.

Michael Morgan

Once COVID-19 was officially declared a pandemic and states across the country began issuing shelter in place orders, one thing became very clear: there was a crucial need for healthcare providers to adopt innovative solutions to continue caring for patients.

Practices needed a way to see their patients outside the office — and they needed it fast. As a result, telehealth quickly changed from a ‘plus’ or ‘nice to have’ to a requirement to stay in business.

At a time when many patients were quarantined and canceling appointments, practices were losing a significant amount of revenue. Telehealth provided a way for physicians to continue seeing their patients and keep their offices running.

In fact, implementing telehealth can also save practices an average of $200 per patient by reducing costs associated with missed or canceled patient appointments. As a result, telehealth skyrocketed during COVID-19, with nearly half of Americans (42%) reporting having used telehealth services since the pandemic first began, according to a recent Harris Poll survey commissioned by Updox.

Now that patients have become accustomed to the telehealth experience with their trusted physician, which is being provided by independent practices and large health systems alike, virtual care is on track to becoming fully integrated into our healthcare system. As we look ahead, healthcare providers will need to start balancing virtual and in-office appointments – and as they do, they will continue to adopt innovative new virtual care solutions that meet changing consumer expectations. Here is a look at what’s in store.

Meeting Patient Demands

According to the survey by Updox, around half of Americans say that if they were to use telehealth services post COVID-19, convenience (51%) would be among the most important factors to them. Drilling down deeper, of patients who like using telehealth services, 65% say it’s because telehealth visits are more convenient than in-office appointments. Additionally, Americans who like using telehealth like it because it’s easier to schedule an appointment via telehealth than an in-office appointment (44%), and because follow-ups/communications post-appointment are more streamlined (38%).

In the traditional healthcare environment, patients would often have to block out hours for a doctor’s appointment. But with telehealth, a visit can take as little as 15 minutes. This is not only more convenient for patients, but it also enables physicians to “see” more patients during the day. By using virtual care solutions, physicians can reach their patients at the touch of a button.

They can collect information ahead of the visit and send follow-ups out via text and even alert their whole patient base to important updates by broadcast messages. They can safely and effectively care for patients while helping reduce exposure to staff. Additionally, by leveraging video chat vs. a phone call, they can garner a stronger, more personal connection with patients, ultimately increasing patient engagement and satisfaction.

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Interoperability and Efficient Health Data Exchange Needed Now More Than Ever

By Scott Galbari, chief technology officer and CISO, Lyniate.

Scott Galbari

For as long as healthcare data has existed, so has the healthcare industry’s challenges with interoperability. The pursuit of healthcare data interoperability has been a longstanding industry challenge, and with the recently finalized interoperability rules from the ONC/CMS going into effect at the end of this month (though deadlines will be extended until mid-2021), interoperability yet again is at the center of many healthcare discussions.

The rules, which aim to provide patients with greater control over their health data and eliminate information blocking, has not been without its critics. Some argue this rule will put patients at risk by inadvertently exposing patient health data to security breaches. However, the spread of the coronavirus pandemic across the United States has underscored the dire need for seamless, bi-directional data exchange. The new rules’ focus on FHIR and APIs to enhance electronic health information sharing are proving to be exactly what we need in the current crisis.

The coronavirus has necessitated all kinds of changes — from rapidly escalating the use of telemedicine, to standing-up temporary testing sites and care centers, to meeting enhanced public health reporting requirements — all of which would have been much more easily addressed if the new rules’ requirements were already in place, and all of which have presented significant challenges amid the COVID-19 crisis.

Because of these unprecedented circumstances, healthcare stakeholders are being required to share health information and data at increasingly high volumes, emphasizing the importance of strengthening the internal infrastructures of these organizations to ensure they can properly send, receive, and analyze health information. However, because of the strain COVID-19 has put on healthcare organizations, the Department of Health and Human Services (HHS) has decided to push out the timeline for meeting the rules’ requirements. While the reasoning for this is understandable, in many ways it is unfortunate that these requirements were not already in place prior to the pandemic.

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Top 9 Challenges For Physician Billing Services Are Expected To Face In 2020

The rise of this decade has brought new and complicated challenges that are accompanied by some other problems that left unresolved during the last decade. 2020 has come up with some unprecedented and unpredictable host of challenges such as global medical emergency because of the vast exposure of COVID-19 making its way from China to the US in a few days.

This global crisis has thrust upon a lot of burden on the medical practitioners, especially on physicians. In a physician’s office or any healthcare center, it has increased burden on both front-end and back-end departments of the healthcare centers and both seem to be in turmoil in such circumstances. Along, with these challenges physicians have to also suffer from the financial crisis due to changing rules and policies for physician billing services. It is the hardest challenge for physicians to align their financial policies with respect to the real-time changes in medical coding and physician medical billing services.

In this article, I have mentioned the following top 10 challenges for physician billing services that are quite difficult to encounter;

Excessive Administrative Burden

It has always been a cumbersome task for the physicians to handle the burden of excessive stress of managing both patients and physician medical billing services. This is not a new issue and physicians have been facing this issue all around America for decades. No matter their association with the private or public practice, no matter if they are practicing individually or on a large-scale healthcare center, they have to improvise administrative responsibilities.

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Healthcare’s Most Innovative Companies of 2020: Copeland Clinical AI (C2-Ai)

At Electronic Health Reporter, we take innovations from healthcare companies very seriously. For nearly a decade, we’ve featured their work, products, news and thought leaders in an effort to bring our readers the best, most in-depth insight about the organizations powering healthcare. That mission lies at the heart of all we do, for the benefit of our audience.

For the first time, we are officially naming some of the most progressive companies in healthcare technology, in our inaugural class of the best, most innovative brands serving health systems and medical groups. Our call for nominations for this “award” series received hundreds of submissions. From these, we selected the best companies from that class. The work these organizations are doing is forward-thinking; award-worthy, we think. We think you’ll agree with all of our choices.

In each of the profiles to come in this series, we’re share their stories — from their own perspective, through their own responses to our questions about what makes them remarkable. Some of the names featured here you’ll recognize, some you won’t. But we believe you’ll agree – all those profiled are doing innovative, groundbreaking work! That said, here’s a member of our inaugural class:

Copeland Clinical AI (C2-Ai)

What is the single-most innovative technology you are currently delivering to health systems or medical groups? 

We use AI-backed systems to help hospitals resolve avoidable variation, harm, and mortality with typical monitoring and reporting systems that currently are only able to detect 10% of what our systems can detect. Meaning, through our systems, we can see substantially more information then what current hospital systems are providing executives. Using the world’s largest patient dataset (140 million records from 46 countries) and built around the work of the developer of the world’s most commonly used patient safety system, POSSUM, we have built predictive applications that save lives, prevent harm and help hospital systems improve margins.

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Machine Learning Is Poised To Transform The Patient Experience — If We Let It

Machine Learning for Marketing - IE Exponential Learning Blog

By Ray D’Onofrio, principal data architect, SPR.

Could Amazon’s personal assistant, Alexa, predict when you will be sick? Or, if Siri is the first to know you have COVID-19.  It’s not as far-fetched as it sounds. Artificial intelligence (AI) is already transforming healthcare in a number of ways and by combining today’s technology with available data from a range of sources (e.g., electronic health records (EHR), personal buying habits, etc.), we can achieve even more important breakthroughs.

There is limitless potential in the way AI and machine learning (ML) can better equip healthcare professionals for their jobs. Instead of replacing our doctors and nurses, the technology works alongside their skills and expertise to elevate their patient care overall. This pairing of human and machine can create an efficient workplace for clinicians to deliver even more quality care to patients at scale.

The expanded use of AI and ML in healthcare hinges on several factors, including data ownership concerns and the ethical implications of providing healthcare data to technology companies like Google and Amazon. But with the right approach, it’s possible to leverage AI and ML to achieve better medical outcomes.

We don’t know how to effectively use AI yet

We’re familiar with the potential applications of AI in healthcare. For example, we know that in many cases, AI is better equipped to detect skin cancer than a human doctor. In addition to improving diagnoses, AI also holds promise in the development of customized treatment plans and giving patients greater control over their conditions. When AI and clinicians work together — such as when Harvard combined analysis from human pathologists with AI to identify breast cancer cells — it can produce even more effective results.

While the potential uses for ML and AI in the healthcare space are vast, these technologies are only as effective as the data that is available to them. If we could access all of the patient’s available data, — from their electronic health record, to their data stored by Google, Amazon and other technology providers — we would have a more comprehensive view of the patient’s health and significantly improve their experience using today’s technology.

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Top Pain Management Technologies

Medic, Hospital, Laboratory, Medical, Health, Doctor

According to the Centers for Disease Control and Prevention, more than 50 million American adults had chronic pain in 2016. That is a whopping 24 percent of the population unable to go about their daily business normally.

Opioids are among the most popular conventional ways of managing chronic pain, but the emergence of the opioid epidemic has had researchers looking for equally effective but less damaging alternatives. The following are four healthcare technological advances used in the management of pain:

1.    Electrical Stimulation

Electrical stimulation, or simply E-stim, is a physical therapy technique that uses electrode pads and an electrical stimulation device. The pads are attached to the skin on the painful area and connected to the E-stim device, whose work is to generate electric impulses. The impulses vary in intensity, and the physiotherapist will use the patient’s tolerance to calibrate the device.

E-stim technology works by stimulating the affected muscle’s contractions. Depending on the device’s settings and the target tissue, these contractions can take the form of rapid, painless twitches or be completely unnoticeable.

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Solutions For Improving Laboratory Workflow and Productivity

Pathology Referral Testing and Reporting Services ...

As the need for increased testing and vaccinations in response to global pandemics continue to rise, more laboratories are popping up across the country. In order to meet the growing demands, however, it becomes necessary for labs to provide accurate and efficient results. Though there are a lot of factors that play a role in the accuracy and efficiency of laboratories, part of it boils down to workflow and productivity.

When things run smoothly in your lab, your team is able to optimize their time and complete more processes. As laboratory processes are constantly changing and more technological tools, equipment, and resources are developed, lab managers are strongly encouraged to periodically consider ways to make completing tasks easier.

Lab Layout and Design

Whether you know it or not, the layout/design of your laboratory space can have a significant impact on efficiency, productivity, and the certifications you can acquire. If the work stations, lab equipment, and supplies are located in areas that aren’t conducive to efficient workflow, it can quickly become a problem. Departments aren’t able to collaborate with each other, certain areas of the lab become high-traffic areas creating lines to perform tasks, and time is wasted in trying to access equipment and supplies.

Though there are lots of ways to set up your laboratory, an open concept seems to be most popular. An open concept design is essentially one in which everything is easily visible and accessible to lab employees while still providing them with designated spaces to work. To determine which layout will work best in your lab, consider each process and the responsibilities of each employee. Based on this information, you can then position work stations, equipment, and supplies in a manner that works best for your team.

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