By George Mathew, chief medical officer, North America, DXC Technology
Connected consumers, and their data, will play a critical
role in transforming the next era of healthcare. In fact, global industry analyst IDC
that by the end of 2020, 25 percent of the data used in medical care will be
collected and shared with healthcare systems by patients themselves.
Using devices, such as wearable fitness trackers,
biometrics, implants and digital voice assistants, patients will generate
real-time information about their diet, fitness and sleep habits, mood and purchasing
behavior. Providers will be able to access and
analyze a more complete picture of each patient, enabling them to make better
care decisions, faster.
However, for this trend to truly drive
transformation, organizations will need innovative approaches to care delivery
that engage patients to actively share their healthcare data and participate in
directing their own health services.
Patient-friendly Care Delivery
As increasingly empowered consumers,
patients are demanding a shift from the traditional reactive model of
healthcare toward one that is more proactive, continuous and collaborative in
delivering the most relevant care when and how it is
needed. Recognizing this trend, many healthcare organizations are investing in
tools that are designed to provide more personalized patient experiences.
care tools can include electronic portals, mobile applications, wearables,
chatbots or patient relationship management systems that capture more data and enable
patients to conveniently access their health information. Patients can also use
these digital tools to more-readily monitor their care plans, communicate with
providers, access support networks, request appointments and prescription
refills, and support behavioral changes through push notifications that guide
them toward the next-best actions for maintaining their health. They can become
more involved, and engaged, in managing their own health and building a robust
record of actionable data.
For health organizations to maximize patient-driven insights, they can prioritize digital platforms that automate data collection, integration and measurement to reduce patient effort, and to ensure that analytics capabilities are as predictive as possible to amplify preventive services.
Transparency and Collaboration
will also need to earn and maintain patients’ trust by approaching care decisions collaboratively
and being transparent about how patient data may be collected and used to drive
health outcomes. Healthcare organizations may consider creating an information
base of health data with shared access by patients, providers and third-party
communities where the patient feels a strong affinity, such as their fitness
center or employee wellness program. Through proper consent and individualized access
based on role, multiple entities can contribute and extract from this pool of
data, driving richer insights for acute health concerns or providing
“dashboards” for longer-term well-being and family health.
Additionally, providers can
view patients as partners in working toward shared incentives in value-based
care. For example, digital health apps could be used to analyze all available
data and bundle health services into care-plan options that optimize provider
resources. This approach helps patients personalize a plan based on their
desired outcomes, budget and lifestyle goals.
providers may also consider establishing official partnerships with
self-organizing patient cooperatives designed to collate their data and work as
a group to trade aggregated information for discounted health services and
financial incentives. This type of model could, for example, allow the
cooperative to pool their data to pre-buy services or procedures directly from
both examples, providers can offer affordable, personalized care while
strengthening their relationships with patients and, ultimately, creating a
truly connected healthcare system.
no question that patient-generated health data has become a valuable resource
for providers. Healthcare organizations that can engage patients to collect and
share their personal health data will derive rich, new insights that positively influence
clinical decisions and drive higher quality care. To do this successfully,
providers can prioritize personalized inpatient, outpatient and virtual
services that combine consumer-friendly technologies and innovative incentives.
patient experiences and clinical effectiveness will create new opportunities
and imperatives to advance the future of care.
By Jared Jost, vice president of marketing, PatientPop.
Of all the changes we’ve seen in the last century, the digital revolution has an excellent claim on being the most profound. As businesses of every stripe discover just what can be done within the rapidly evolving digital world, ongoing changes continue to shake up the landscape. This affects and benefits medical practices just like any other company or business, and several significant points have emerged that best illustrate how medical practices can take advantage of the changes that have given patients increased access and decision-making power.
1. Acknowledge this is the current world of patient demand
It would be easy for physicians to ignore the details and intricacies of the digital landscape, simply because they have a full schedule and a loyal patient base. Why change? Because patients are expecting digital access, and healthcare providers’ opportunities for acquisition and retention exist online.
A 2019 PatientPop survey found that three out of four people have gone online to find out about a doctor, a dentist, or care. Fifty-seven percent of patients do this with some level of regularity. Being present and available online is simply a matter of going where the patients are.
2. Attract patients the way any business attracts customers
As practice owners will tell you, a healthcare
practice is a healthcare business. Your patients are your customers, and
potential patients in your market are looking for you or your services online.
If you’re not easily found, your business could get lost.
That’s why having a strong web presence is crucial to your success. Not only
does it position your practice to be found more readily online, but it also
delivers a great first impression for patients unfamiliar with your practice.
What are the best steps to get started?
Claim and optimize your
professional profile listings on websites that patients are most likely to
visit. Make sure your information is clear and updated, starting with Google,
Facebook, Yelp, and WebMD. Then move onto other business sites, especially
those that cater to your local market.
Modify and improve your presence. Once you’ve updated all your online profiles (at minimum, get your “NAP” right — name, address, phone number), get more detailed. Include your specialty, photos of your practice and staff, and details about the care services you deliver.
Consider expanding social media. Your Facebook page and presence is essential for local business, but if you have the resources to go further, give it a try. Maybe Instagram. Twitter. YouTube. Think about using video, not just across social media channels, but on your own website. Make your content informative, and show prospective patients that you and your practice are welcoming and deliver top-notch care.
3. Simplify scheduling for patients and staff
One thing that kills online shopping is an
overly complex cart. If it’s tough to get the customer to conclude the sale,
that can mean lost revenue — and a lost customer. In online retail,
this is called “cart abandonment.” Similarly, if you don’t make it easy for an
interested website visitor to make an appointment with your practice, you lose
the opportunity at a new patient.
To encourage that appointment, feature online
scheduling on your own website and across any third-party websites that offer
it. In ideal situations, requests can integrate directly into your EHR’s
scheduling system, per your rules and parameters.
Additionally, set up your mobile presence to allow click-to-call
functions, so that mobile users can call you directly with one click. This
makes for a convenient process and helps you better “convert” website
visitors—mobile or otherwise—into patients.
4. Pay close attention to online reviews, both positive and negative
The 2019 PatientPop survey previously
referenced noted that when patients decide on a healthcare provider, patient
reviews are their most influential online source. Online reviews are one of
your greatest tools in drawing in new potential patients.
Make sure you monitor reviews across the web and when you find negative
reviews—and they do happen to everyone—be ready to respond promptly and
concisely. Tell any dissatisfied patient that you appreciate their feedback,
want to address their concerns, and can speak with them directly to remedy the
situation. You’ll show that patient, and any others reading the interaction,
that you’re the kind of doctor who listens and responds to your patients.
5. Keep it simple
It can be tempting to quickly add new software
or service to meet an immediate need or tackle a business problem. But that
often requires adding more along the way —
to cover website management, SEO, online reputation management, blog
development — burdening your practice with
multiple tools and extra costs. Instead, look for an all-in-one offering that
can connect all the points of your web presence and online reputation in one
practice growth solution. You’ll get unified
insight into how well your efforts are performing, and a single point of contact
for your ongoing needs.
As the digital age continues to produce new
and exciting developments, making these fit into your current operations will
help produce the best chances at success going forward.
By Chris Jaeger, advisor for ACO and health system strategy, AristaMD.
In April 2019, CMS announced the Primary
Cares Initiative which is expected to reduce administrative burdens and
increase patient care while decreasing healthcare costs. Learn more about the
payment models of the Primary Cares Initiatives, and how eConsults directly
support this new initiative.
While the healthcare landscape has never
been static, rarely has it seen such radical changes as within recent decades.
The United States’ population continues to age, and the prevalence of chronic
conditions such as obesity, diabetes, heart disease, and anxiety/depression contribute
to a substantially increased demand for care. These factors are pushing a shift
from a provider-centric model toward more efficient, outcomes-based models that
put the patient at the center and heavily rely on primary care as the steward
of patient care.
Primary care is a vital resource in
dealing with the many factors altering the healthcare landscape. A 2019 study
published in JAMA Internal Medicine
corroborates this, finding that for every 10 additional primary care physicians
per 100,000 people, patients saw a 51.5-day increased life expectancy—more than
2.5 times the increase associated with additional
nonprimary care physicians. For years, primary care delivery has shifted along with
changes in the healthcare landscape. Innovations in primary care and aligned
incentive models reward more continuous and comprehensive healthcare, as
opposed to care delivery and reimbursement models for discrete moments or
episodes of care highlighted by numerous appointments and separate visits to
different providers. These innovations strive to put patients at the center of
care above all else.
To promote further adoption of
primary-care based models, the U.S. Department of Health and Human Services
(HHS) and Centers for Medicare & Medicaid Services (CMS) recently announced
a set of payment models meant to further transform primary care through
value-based options under the new Primary Cares Initiative. This
voluntary initiative will test financial risk and payments for primary care
physicians (PCPs) based on performance and efficiency, including five new
payment models under two paths: Primary Care First (PCF) and Direct Contracting
(DC). These models, slated to hit 20 states in the year 2020, seek to address
the many difficulties in paying for, and incentivizing, valuable primary care
within current payment models.
Primary Cares Initiative payment models
aimed to PCPs
All five of the payment models described
in the Primary Cares Initiative are aimed at PCPs in the hopes of improving
services at these linchpins within the healthcare system. However, these models
can be grouped into two distinct categories–Primary
Care First and Direct Contracting–and there are variations within these groups.
Primary Care First
The models categorized under PCF are aimed
squarely at relieving strained hospital resources and improving health outcomes
through primary care. These models aim to more adequately reward primary care
providers through performance-based payment adjustments, in the hopes that this
will be an effective way to reduce the overuse of hospitals for healthcare
needs. These two models are:
Primary Care First
(PCF): The general PCF model will test whether
risk- and performance-based payments for primary care practitioners will reduce
Medicare expenditures while preserving or improving quality of care. Under this
option, payment will be provided to an advanced primary care site based on the
size of its patient population (on top of a flat primary care visit fee), and adjusted
based on performance within “easily understood, actionable outcomes,” according
to CMS. The performance-based adjustment represents a potential quarterly
upside of up to 50 percent of revenue as well as a potential small downside (10
percent of revenue).
Primary Care First
–High Need Populations: In
addition to the general PCF model, the Primary Cares Initiative includes a
payment model specifically geared toward practices specializing in care for
high-need patient populations. This includes patients with chronic care needs
and a group the model refers to as seriously ill populations (SIP). This
payment model creates an option for high-need patients without a primary care
physician to receive care from a participating practice if the patient
The direct contracting path includes a pair of risk-sharing payment models, both voluntary, along with a third payment model for which CMS is seeking public input. Like the PCF models, these models aim to reward those providing more efficient, high-quality care. However, these models are geared toward organizations with experience serving broader patient populations rather than individual primary care practices. The three models are:
– Global Population-Based Payment (PBP): Participants
in the Global model will take on the full share of risk, but also be eligible
for 100 percent of any savings achieved on the total cost of care for aligned beneficiaries.
– Professional PBP: Under the
Professional model, participants will retain both savings and losses accrued on
the total cost of care for aligned beneficiaries, but at a rate of 50 percent.
– Geographic PBP: The Geographic
model is similar to the Global model, but with an important caveat:
Participants would accrue 100 percent of savings or losses on the total cost of
care, but only for aligned beneficiaries within a target region. The
stated aim for this model is to drive accountability to a local level so that
communities can develop strategies tailored to more individualized needs. CMS
is still seeking input on this model, however.
Additional healthcare initiatives strengthening
As mentioned above, primary care is a
crucial avenue for fostering improved health outcomes for a wide range of
patients and populations. In addition to increased life expectancy, some
motivations for focusing on improved primary care include the following:
Adults in the U.S. who have a primary care provider have 19 percent lower odds of premature death than those who only see specialists for their care.
People who have a primary care provider save 33 percent on healthcare over their peers who only see specialists.
A study in a North Carolina ER found that nearly 60 percent of the patients’ problems could have been addressed in a primary care clinic for a savings of 320 percent to 720 percent — that’s a value of a three to seven times reduction in healthcare spend.
For many, primary care serves as the entry point to the healthcare system, as individuals and families alike head first to their primary care physician for treatment. Primary care emphasizes population health and managing chronic illness. As such, primary care is an ideal means for improving our healthcare system on many fronts including access, cost of care, and quality of healthcare services.
Given the benefits listed above, it’s no surprise that so much attention has been paid to improve primary care, and the Primary Cares Initiative is not the first such effort. Programs such as the Patient-Centered Medical Home (PCMH), the Comprehensive Primary Care (CPC+) program, and Medicare Advantage Value-based Insurance Design (VBID) test model give healthcare stakeholders the means to promote triple and quadruple goals of allocating resources more efficiently, improving health outcomes, and improving the experience of all individuals involved–including both physicians and patients.
As its name implies, the PCMH is focused
on putting patients at the center of healthcare. It recognizes the value of team-based
primary care, and five core attributes are
included in this model:
quality and safety
Beyond PCMH is the CPC+ program, an
initiative aimed squarely at care sites that have demonstrated significant
improvement and transformation in pursuit of value-based goals. Payers are invited by CMS to participate in
the program if they provide, or aim to provide, care practices that go beyond
fee-for-service payments based solely on visits and episodic appointments. Through
this program, CMS aims to work with payers representing 5 to 7 markets and accounting
for roughly 525 practices (around 75 practices in each market). Some 330,750
patients would be reached by this initiative, which focuses on several
functions for practices to achieve greater healthcare successes including:
Planned care and
By their nature, Medicare Advantage (MA) plans
seek to optimize the delivery of healthcare for their members. Receiving
capitated payments to provide all Medicare-covered services to plan
participants, plan objectives are the perfect setting to test models of care
delivery that may reduce cost while being able to offer beneficiaries improved access,
options, and quality of care–versus traditional Medicare plans. MA plans have proven to be more efficient in
reducing expenditures than both Accountable Care Organizations (ACOs) and
traditional Medicare. The Medicare
Advantage Value-Based Insurance Design (VBID) model was introduced in 2017 by CMS to allow MA plans the opportunity to
offer supplemental benefits or reduced cost-sharing for enrollees with certain
chronic conditions who engage with services/providers that are of highest
clinical value to them. CMS released major changes to the VBID model in January 2019, and plans to
test new additions 2020 to 2024. The updates are intended to
lower costs while increasing the quality and coverage of care for Medicare
beneficiaries and include:
Allowing customization of cost-sharing based on chronic condition, socioeconomic status, or both, including some non-health related benefits, such as transportation.
Expanding eligibility to include chronic condition special needs plans (SNPs), dual eligible SNPs, institutional SNPs, and regional preferred provider organizations.
Bolstering the rewards and incentives programs that plans can offer beneficiaries to take steps to improving their health.
Increasing access to telehealth services.
Thus, the Primary Cares Initiative
represents not just a single push to improve the healthcare system as a whole
through primary care, but an overarching drive to do so via many initiatives
and programs. Bringing more practices on board with initiatives such as the
PCMH, CPC+, innovation within Medicare Advantage, and the Primary Cares
Initiative will undoubtedly solidify the success of these and future programs,
as stakeholders and policymakers come to a greater understanding of how to
incentivize and create a path toward improved healthcare outcomes.
eConsults directly support Primary Cares Initiatives
by maximizing primary care’s value in healthcare delivery
A continuing challenge in maximizing the
efficiency and effectiveness of primary care is that of managing specialist
referrals. Electronic consultations (eConsults) have gained favor in meeting
this challenge. eConsults help in reducing variations in referrals, increasing
access to specialist care and consultations among broader populations, and
reducing wait times for specialist visits.
With the new CMS Primary Cares Initiative
targeting advanced primary care practices for these payment models, eConsults
are becoming increasingly valuable. Advanced primary care practices are defined as those that
demonstrate an aim toward implementing fundamental strategies that focus on
patient needs, with primary care as the foundation for maximizing value in
healthcare delivery. These practices focus squarely on improving primary care
in terms of health outcomes and lower costs. A key component of such advanced
primary care practices is shepherding resources to improve efficiency and
effectiveness in order to achieve their goals.
eConsults — which directly support
improved health outcomes, reduced costs, and increased provider and patient
satisfaction — are one such resource. As more health systems look toward
creating PCMH models and consider adopting new value-based payment models under
the Primary Cares Initiative to better manage the health of their patient
population, eConsult systems will be instrumental in improving team-based care
coordination and communication.
Hospitals and health systems are under enormous pressure
to provide high quality care in an environment of declining reimbursements and
shifting payment models. With the rise in value-based payments, provider
organizations must increasingly focus on the health and performance metrics
across whole populations.
To provide patient-centered care and remain financially
viable, providers need to adopt technologies that expand the reach and
targeting of their care teams and enable them to forge personal connections
with patients. Many provider organizations have been slow to adopt technology
for fear of de-personalizing the patient relationship. Yet technological
solutions designed for people and their specific, pressing needs can be
Take Interactive Voice Response calls (IVR), for example.
These automated calls can extend the reach of care teams who need to find out
from patients how they’re progressing in their recovery. Even better, these
calls give patients a chance to check in with caregivers using the most
natural, familiar technology there is: the telephone and the human voice. From
pre-procedure to post-discharge, here are three ways voice technology can
reduce costs while achieving better outcomes:
1. Staying Connected with Patients after Discharge
Discharge is one of the most critical handoffs in healthcare. Traditionally hospitals have employed nurses to make phone calls to recently discharged patients. But what may seem like a simple chat is in fact far more labor intensive. The volume of calls required, and the time needed to connect with patients, establish rapport and elicit critical information has made this an expensive and time-consuming endeavor. IVR calls can reduce the burden on nursing staff while also increasing the level of constructive interaction with patients.
For example, our team worked with a hospital that used two nurses to call as many patients post-discharge as they could. In a one-month period the nurses made 1,932 calls to patients – and of those calls, only 5.2% resulted in a situation that actually required the nurses’ clinical knowledge. The two nurses then started over, this time using IVR. During a same one-month period, the nurses were able to reach out to four times as many patients and connected with 79.8%. The higher rate of connection gave the hospital far more visibility into the actual health status of its discharged patients. It also saved time so nurses could concentrate on personal patient interventions that required their clinical expertise and training.
2. Breaking Down Behavioral Barriers
Voice User Interface (VUI) design is increasingly
utilized to foster emotional connections with patients and help them self-manage
their conditions. As hospitals and providers look to reduce “white coat
syndrome,” and find ways for patients to feel more comfortable sharing
information in a non-judgmental setting, human-centered VUI design can bring a
unique approach to personalization.
For instance, one of our programs reached out to patients newly diagnosed with diabetes. With focus on empathic VUI design, these patients were asked to report on key indicators such as their weight fluctuation, medications, and access to follow-up care. Flagging logic then signaled any instance when a patient may need a live nurse or some other intervention. Surprisingly, these automated calls also elicited sensitive information that may have otherwise not been flagged.
Most enrollees said depression had hindered their ability to manage their condition and 83% also said they had not discussed these issues with a healthcare professional. When given the choice, over half of those respondents opted for additional phone calls that were specifically designed to offer emotional support. Even more, the depression scores of nearly three-quarters of patients decreased over the course of their interactions.
3. Reducing Readmissions
As a last example, patients who engage with IVR phone calls are less likely to be readmitted to the hospital. At one major hospital system, 80% of enrolled patients engaged with calls and they were readmitted less often than those who did not engage. (10.7% 30-day readmission rate vs. 13%.) This result means that voice technology is helping to solve a known and important health quality problem —reducing the rate of unnecessary readmissions—as well as helping hospitals to avoid Medicare penalties. In addition, the decreased readmissions rate frees up beds for new revenue-generating patient admissions.
And the nurse caregivers are now able to work at the top of their license, increasing their job satisfaction as well as their efficiency. In the end, it’s not just caregiver satisfaction and patient outcomes that improve. Patients also appreciate the follow up from these calls, leading to increased patient satisfaction and HCAHP scores.
Ultimately, scaling patient outreach efforts with
interactive voice technology offers a number of benefits for health systems:
from more efficient and effective care management to better patient outcomes at
less cost. That’s a win-win for providers and patients alike.
At this point, most of us in healthcare have read similar statistics about why we need to do more to address social determinants of health (SDoH) — the conditions in which people are born, grow, live, work and age, and how those factors impact individuals’ health — to improve patient outcomes. These conditions and their resulting social needs include, but are not limited to, a person’s equitable access to nutrition, housing, transportation, education, and employment opportunities.
Time is of the essence to tackle some of these social determinants, especially when coupled with the rapidly shifting patient demographic, sometimes called the “silver tsunami.”
SDoH studies in no short supply
It seems everyone is in a race to figure out what SDoH approach will move the needle toward lower risk for their patient populations. But payers, in particular, have taken on a hefty amount of the leg work needed with social determinant “barriers to care” studies, because they are generally the most financially accountable, from a population health analytics perspective, to remove them.
Recent news about of these payer SDoH pilot programs and research studies have been both interesting and useful across the care continuum, a summary of which include:
WellCare, which provides managed care plans for over 4.4 million Americans, ran a pilot program on over 33,000 patients, referring them to more than 100,000 community-based social services programs, and was able to reduce inpatient spending by 53%, outpatient spending by 23%, and emergency spending by 26%.
In its Bold Goal 2019 Progress Report, Humana focused on patients in specific lines of business, including their Medicare Advantage program, where 91% of seniors who have at least one chronic condition. They enacted the Centers for Disease Control and Prevention’s “Healthy Days” self-reporting method of measuring healthy vs. unhealthy days and have also screened half a million people for SDoH since 2018, with the goal to screen one million by 2019. Humana notes that these social barriers are “deeply personal,” which requires closer partnership to track and measure population health.
Blue Cross is already instituting food, nutrition, and housing services as part of some of its plans. But it also recently announced an investment of $40 million with Solera Health, to address both mental health and SDoH matters, including “food insecurity, medically tailored meals, transportation, falls prevention, and social isolation” with lifestyle modification programs such as diabetes or management, and tobacco cessation programs.
A study by the Anthem Public Policy Institute says individuals and the public (researchers and journalists) perceive SDoH differently. Individuals tend to lead with concerns about the health care “system,” whether they can find the right provider, followed by whether they have adequate “social support.” The public tends to “frame health outcomes through the lens of structural factors like education and income level perhaps, in part, because these factors are easier to measure.”
UnitedHealthcare and the American Medical Association partnered to expand the existing ICD-10 diagnostic codes being used to identify social and economic barriers to care. This adds 23 more codes to that list, some of which would “indicate a patient’s inability to pay for prescriptions, inadequate social interaction, or fears about losing housing.”
workflows provide best locale for SDoH communication
Despite all of the various innovative steps being taken to bring SDoH to the forefront, we know that most patients still aren’t talking about SDoH concerns with their physicians. There are many reasons why, but one logical solution to bolster SDoH communication between physicians and patients is to incorporate, at minimum, the ability to identify social needs where they are already doing business — in these EHR, CRM, and other third-party platforms.
As is evidenced by the silo’d health IT data systems that have for too long crippled the health care industry’s transparency and ROI, we know that simply identifying social barriers to care is not enough. Within the designated “source of truth” that is most responsible for driving patient engagement, whether that is an EHR, CRM, or other platform, we need to build — or integrate — expanded capabilities for SDoH identification, referrals, and tracking each throughout the continuum of care to close the gaps that currently exist.
That is not to say that physicians must now wear yet another hat — that of a social worker or a social services case manager. But being asked to solve SDoH from the current physician’s workflow perspective, without integrating SDoH into the patient record, is basically saying to physicians:
“Improve clinical outcomes. But first, you must identify non-clinical data, be responsible for referrals to improve these individual circumstances, and track each of those referrals’ progress, all in different platforms, and none of which talk to one another.”
This is not setting our patients or their physicians up for success.
The idea of a standardized SDoH screening mechanism within the EHR has been endorsed by the National Academy of Medicine, the Medicare Access and Children’s Health Information Program Reauthorization Act of 2015, the 2016 Centers for Medicare and Medicaid Services’ Quality Strategy, and several other organizations, as released in an Annals of Family Medicine study. But unfortunately, in this first U.S. study of its kind to address feasibility, “little is (currently) known about how to capture and present (SDoH) information in community health centers’ EHRs.” Nor did the study conclude how to integrate EHR-based documentation needs into community health centers’ existing workflows.
The main barriers cited in the Annals’ study were that EHR-based SDoH tools: (1) Create a too-fragmented view of the patient, with relevant data in too many disparate locations (2) Might add a layer of difficulty to obtain and act on SDoH data (3) If SDoH patient information has been acquired on paper, that requires yet another dual, manual data entry problem when “referral workflows were (already) seen as too time-consuming, especially when no follow-up was planned,” resulting in “an unmanageable follow-up workload.”
To date, the EHR has done a good job of serving most of the goals to take our country’s health records digital. But it is also safe to say that the EHR, in and of itself, cannot be all things to all persons working in health care. In addition to the major enterprise EHR systems, there is a proliferation of specialty, industry-specific EHRs, which may or may not have separate CRM platforms, not to mention all of the other third-party, various other platforms you can see within any one given practice, such as separate billing and referral management types of platforms. There is a reason that “interoperability” among all of these disparate health care data systems has become another hot topic for the industry.
To yield maximum value for our customers, integrating SDoH data is best-approached from a workflows perspective — not just connecting disparate data systems for the sake of “more data,” but to make caregivers’ lives easier, and to create actionable data that enable better business decisions. And we already know that one of the easiest ways to improve efficiency for health care organizations is to remove dual, manual entry between EHR, CRM, and other third-party platforms that hold patient data — these are the first and most valid case studies of how to improve organizational efficiency while bolstering patient care.
There has been a flurry of innovative partnerships and technological improvements to address SDoH, all of which should ultimately be supported by policy changes — each of these as prevailing themes at trade shows and conferences in recent years, such as the America’s Health Insurance Plans’ (AHIP) annual conference, held recently in Nashville. Meanwhile, we look forward to participating in more discussions about how those of us in health IT can do our part — bridging SDoH informational and communication gaps between physicians and patients. This could include integrating non-clinical SDoH concerns into the patient’s clinical record, in and out of these platforms, establishing standards for capturing SDoH to make data-sharing easier, and even incorporating social services databases for more streamlined SDoH-specific “referral management.”
We talk a lot about how to achieve interoperability in healthcare, with all of its disparate data systems, and SDoH is another compelling and recent reason why we must accelerate these solutions, which would ultimately benefit health care and all of its stakeholders — patients, physicians, payers, and everyone in between.
TMR’s study expects neurological navigation systems to emerge as leaders in the realm of surgical navigation systems due to high prevalence of brain tumors. According to the National Brain Tumor Society, approximately 700,000 people in the U.S. are living with brain tumor. This number further incites the need for advanced neurological navigation systems.
Navigating within the precincts of a skull multiplies the risk of damage to the vertebral column. However, advanced neuronavigation devices such as the one developed by Medtronic addresses these concerns. This device, called the StealthStation S8, is a highly efficient system that uses electromagnetic tracking capabilities and 3-D segmentation tools to create tumor models.
Influx of 3-D printing technology in the healthcare sector Operating on tumor models prepares the doctors to operate the actual tumor. It instills confidence in the surgeons that further amplifies the success rate of the surgery. Furthering the use of 3-D segmentation tools, the researchers have invented advanced 3-D printing technologies that are changing the game for surgical navigation.
Researchers from the Tel Aviv University printed the first 3-D heart using the patient’s biological parts and cells. The end stage heart disease can only be treated with heart transplantation. However, the shortage of heart donors stems the need for advancements in the armamentarium of cardiology.
This research has not only given a new direction to regenerative medicines but heightened the demand for 3-D printing technologies. According to TMR’s study, this trend is expected to turn the tides in the surgical navigation systems industry.
Intra-surgical visualization is imperative while performing a surgery. 3-D printing technology transforms a 3-D medical image into an object of the patient’s actual size. A combination of this model and augmented reality (AR) applications offers the surgeons a real-life operating experience in a virtual environment.
This technology helps the surgeons gain a better understanding of the nature of the surgery. It overcomes the shortcomings of single modality imaging and facilitates accurate intra-surgical visualization. Besides, the combination of cloud computing and 3-D printing technology further explores the possibilities in the realm of surgical navigation. It enables the development of prosthetic limbs and streamlines the 3-D printing process. This explains why the clinicians are keen on deploying the cloud computing technology.
Migration of surgical platforms to cloud computing
Cloud computing, though this technology is still young in the medical
industry, it is graduating in the arena of surgical navigation. It facilitates
the high computational power required for surgical navigation. Moreover, the
advancements in the medical image computing techniques such as the graphics
processing unit (GPU) facilitate improved medical image processing performance.
Recently, bioengineers developed a self-navigating medical robot that can
navigate in the patient’s heart. Earlier, surgeons used a joystick to monitor
tiny robots in the patient’s body. However, this newly developed robot works
exactly like an autonomous vehicle. The optical sensor in the robot uses
artificial intelligence algorithms that direct its path inside the heart.
Such discoveries have highly motivated the surgical platforms to deploy
cloud computing solutions. The fact that it breaks the restrictions of physical
location has also inundated its use. A cloud surgical planning application
enables multiple surgeons to work on the same case irrespective of where they
are located. This enables the surgeons to make accurate incisions, thus
facilitating a pain-free treatment for the patients.
The spiraling need for minimally invasive surgeries help the surgical navigation systems gain prominence in the market, states TMR. To sum it all up, surgical navigation gives healthcare professionals the liberty to navigate surgical equipment with tremendous ease. Moreover, the high morbidity because of cancer with nearly 9.6 million people dying in 2018 has necessitated the use of advanced surgical techniques. This has opened the doors for new clinical studies relating to surgical navigation such as molecular imaging and intraoperative microscopy.
The digital age has of course brought tremendous advances to healthcare, but one area in particular has lagged: medical imaging. The sad truth is that two-thirds of the world’s population still has no regular access to medical imaging. In many cases, even those who do have access to the technology still must wait weeks or months for medical scanners to become available. This means that diagnostic results often arrive too late and people do not get treated in a timely manner, sometimes with fatal consequences.
Early detection by medical imaging (or lack thereof) is perhaps the most important factor in the nearly 8.8 million lives lost each year to cancer, according to the World Health Organization. When detected early using medical imaging systems like CT scanners, cancer has a 70 percent to 99 percent survival rate, according to Marshfield Clinic Health System Foundation.
Not all of the limitations in medical imaging are technological, and it is important to note there are simply not enough radiologists and diagnostics experts being trained in this field currently. Even in developed countries like the United Kingdom, there is a serious shortage of senior radiologists; while the workload of scan interpretation has increased by 30 percent in the U.K. since 2012, the number of radiologists has increased by just 15 percent.
But, a key technological
impediment is causing what I believe to be the real reason behind the disparity
in medical imaging: price. For example, CT scanners can cost $3 million, even
before the high cost of maintenance is figured in. This cost is well beyond the
means of most healthcare systems in the world, and most countries can only
afford a few medical imaging systems to service their entire citizenry. Because
of this, even in a highly developed country like the U.S., some insurance companies will only cover a
medical imaging procedure, such as a mammogram, every two years, not every
year. So imagine how hard it is for people in developing countries to get the
timely medical imaging they need.
Fortunately, however, the holdup
in medical technology is relatively straightforward, and it lies at the heart
of the science underpinning almost all medical imaging technology, from CT
scans to MRIs. It is the source of the X-rays, which has remained unchanged since
their discovery more than a century ago in 1895 by the German physicist Wilhelm
Röntgen, who simply labeled this newfound ray “X,” standing for unknown. The
Behind even our most advanced X-ray equipment is the same analog bulb little changed from Röntgen’s era. It looks like a big lightbulb — although far more expensive, about $150,000 to $200,000 each — and similarly needs to be replaced frequently. Also like the common lightbulb, but at a much more extreme scale, these X-ray bulbs produce huge amounts of heat.
In fact, a part of the reason for the rotating inside a CT-scan is to dissipate this heat, as it would otherwise melt through the machine at more than a thousand degrees Celsius. That spinning reaches somewhere in the neighborhood of 13 G forces, meaning the machine needs to be built with the precision of fighter jets — a primary reason only a handful of companies in the entire world are qualified to make them.
The fundamental analog nature of
X-ray devices is why, despite advances on the frontend thanks to the digital
era, we take a step back to the 19th century the moment the X-ray turns on.
Thankfully, however, I am sure it won’t always be this way; there is an
enormously exciting new advance under development, which I am proud to say I am
spearheading in conjunction with some of the brightest minds in physics. This
technology is called ‘cold-cathodes’ — a source of X-ray that works at room
temperature and can be from a device as small as the silicon chips in your
computers. Instead of using heat to generate X-rays, cold cathodes use an
electric field to draw out the electrons that eventually become X-rays (I am
skipping a step or two for the sake of simplicity, but this the key
Cold-cathode technology has
tantalized with its potential for several years, but my company, Nanox, believes we have found the key to mass
production with a different process, which was originally intended for
flatscreen TVs. We are converting it to far more impactful uses. The intended
result would work very much like a “tricorder” on the Star Trek series: small,
producing far less radiation than current methods, and most importantly,
readily accessible to almost every country and village, no matter how far
What if we could democratize
medical imaging? What if we could provide at least one medical screening for
every person on the planet every year? Through their ubiquity, cold-cathode
X-ray machines could save lives with early detection, making healthcare more
affordable and accessible to all people globally. Bringing the X-ray into the
digital era is a critical step in achieving true democratization of healthcare.
As an entrepreneur, I can’t think of anything more rewarding than that.
The US healthcare system has serious systemic problems. While the cost of healthcare continues to escalate, access to care is more difficult than ever. As a country we are getting sicker, chronic conditions are on the rise and, for the first time, longevity may be on the decline.
While the usual constituents grapple with these problems, Amazon has quietly put together a syndicate including Berkshire Hathaway and JP Morgan to provide better and more affordable healthcare for its combined 1.2 million workers.
The joint effort between Amazon and Berkshire is called Haven and makes sense because many companies of size today are self-insured to provide healthcare at lower costs. But this is different. Jeff Bezos, Jamie Dimon and Warren Buffett seem to be personally involved in the development of Haven. So, what could they possibility have up their sleeves?
At the same time, many Democrats running for president are promising single payer health system (Medicare for all) as the solution to controlling costs and providing quality health care for everyone. Republicans argue that this is socialism and will result in unacceptable increases in taxes that will ruin our economy.
While politicians debate, Amazon’s real objective may be to create a health payer to rival all payers with tens of millions of Amazon Prime Members as health plan members.
With Amazon’s buying power, scale and capabilities, the e-commerce giant could create a health payer offering that could render the need for a single payer system moot.
The company’s buying power and clout representing tens of millions of members allows it to negotiate the lowest prices on the planet for drugs and medical treatment. Who knows … maybe Amazon will build its own drug manufacturing laboratories?
And with its fulfillment and shipping capabilities, it could deliver prescriptions to your door (maybe by drone) almost immediately, eliminating the need to ever visit a pharmacy again.
With its rapidly evolving tech platform, including Alexis and health monitoring devices, it could monitor health conditions and contact providers before medical emergencies occur.
What’s more, Amazon could take telemedicine and concierge medicine to another level with connectivity to providers anytime, anywhere, without the red tape that makes healthcare so difficult to access today. And it might even buy large health systems and shake them up by eliminating red tape while dramatically improving access to quality care. Even identity cards from doctors can change in the future. You can expect doctors IDs and specialist ID lanyards turning into digital identifiers in the future.
Lastly, let’s not forget Amazon’s ability to harness artificial
intelligence and machine learning to deliver better, smarter, more efficient
health care without ever talking to a doctor.
Bernie Sanders may be right when he argues that access to quality healthcare is a basic human right. But given all the roadblocks, lobbying and politics blocking the way to a government single payer system, it just may be delivered by Jeff Bezos rather than Uncle Sam. Hold on to your seats – healthcare is about to be disrupted big time.
By Kathleen Riordan and Apurva Subramanian, healthcare experts, PA Consulting.
Over the next decade one in five US residents will be over the age of 65, over 70 percent of whom will require some form of Long-Term Services and Support (LTSS) as they continue to age. The resources required to meet the care needs of our senior generation will triple by 2040.
The industry is reaching a tipping point and CMS – the primary payer for these services – is going to look for innovative ways to curb costs while maintaining high-quality, patient-centric care. Value-based payment models in other health service organizations incentive providers to do just this. Historically, LTSS have been left out of value-based care payment arrangements; however, with the increase in use and cost of LTSS, CMS is gradually incorporating value-based care models in this industry to nudge providers into more innovative ways of delivering care.
For example, in 2019, skilled nursing facilities began
receiving quality-adjusted payments for all Medicare Fee-For-Service (FFS)
patient-stays. CMS is now withholding 2 percent of all Medicare FFS payments
and giving facilities the opportunity to earn this back through an assessment
of its performance on the 30-day all-cause hospital readmission quality
measure. Recent results show that 73 percent of nearly 15,000 skilled nursing
facilities reporting data received payment penalties for performance on the
hospital readmission measure, with 20 percent receiving the maximum penalty of
the entire 2 percent withholding.
Now is the time for long-term care organizations to act, as the initiatives CMS is proposing will significantly affect the industry. On the agenda for CMS is a range of payment incentives including:
Adding two new quality measures in 2020 to assess health information sharing from skilled nursing facilities to other providers and to patients.
Transitioning all Medicare Part A payments to skilled nursing facilities into a new model that reimburses based on the clinical condition of the patient and their service needs.
Implementing new payment rules for all Medicare-certified home health agencies to incorporate home health services into value-based payment models by eliminating therapy thresholds in determining payments and reimbursing based on the clinical condition of the patient.
Potentially expanding the Home Health Value-Based Purchasing model across the US.
Increasing payment adjustments up to 8 percent by 2022 for Medicare-certified Home Health Agencies operating in 9 HHVBP pilot states.
The payment models in both skilled nursing and home health represent a shift that CMS is making to include all ancillary providers into the value-based care arena. Long-term care organizations can learn from hospitals and physician groups who proactively approached this coming wave of value-based payment reform. Organizations that are collecting and acting on data in a timely manner, establishing efficient cost-reducing processes, and integrating effectively within the care continuum will thrive in the new financial environment.
So how can long-term care providers implement an effective value-based care model? Follow these four steps.
Understand value-based program requirements and determine the necessary people, processes, and technologies needed to adjust operations to achieve program success. The challenging part for long-term care is going to be in operationalizing new value-based care program requirements. Those organizations that can effectively arrange the right people, processes, and technology stand to soar above the rest. Advancements in technology have enabled organizations to progress further, faster. Currently, many vendors in the market offer telemedicine technologies and remote patient monitoring applications to care for high-acuity patients in more effective ways. For example, long term care providers can use telehealth to provide support to elder patients allowing them to stay in their homes longer. A great example is the Argenti care technology program in the UK that placed a configured Amazon Echo device in on-demand senior care services, the pilot was highly successful and improved outcomes and reduced cost. Some skilled nursing facilities are even investing in putting in motion detectors in patient rooms to assess movement anomalies to ensure patients get the right care when they need it. Investing in the right technologies to ensure a high-quality care experience can accelerate a LTSS provider’s ability to adapt to value-based care models.
Use data and processes improvement methodologies to recognize and reduce unnecessary costs and develop best-practice processes. Long-term care service providers should already be collecting and using data to generate insights to inform best-practices in both the cost and delivery of care. The Visiting Nurses Association of New York, the oldest nonprofit home and community-based health organization, is already using robust data analytics to drive clinical and operational decision-making by creating a model to proactively predict when a patient may benefit from a different or higher level of care. For those organizations without a robust data analytics strategy, steps can be taken to capture, track, and analyze clinical and claims data to understand population-based characteristics and care needs. In doing so, LTSS organizations can establish benchmarks and reporting to create the drive toward more clinically and cost-effective approaches to care.
Build relationships with providers across the care continuum to create open lines of communication and develop smooth processes for patient care transitions. Crucial to the success of long-term care organizations in transitioning to value-based models is the ability to develop clear processes and means of communication with providers along the patient care continuum to ensure smooth transitions in and out of care and a streamlined flow of information among providers. Currently, NYU Langone Health is partnering with 11 high-quality skilled nursing facilities to create a preferred network where organizations are coming together to improve care transitions by openly sharing quality, readmission, and length of stay data. In doing so, these organizations are learning from one another to improve their own performance standards and proactively prepare for additional upcoming incentives created through value-based care payment models. The transition to a culture of continuous improvement is often a challenge for organizations, as employees at all levels have to recognize and work to overcome the ineffectiveness in largely entrenched processes and procedures. However, in building a culture of continuous improvement where all employees have the capacity and ability to step outside of their daily whirlwind of job demands and look for efficiencies ultimately leads to innovative and productive ways of thinking and acting.
Partner with local community organizations to enhance your current service offerings. Value-based care models are intended to keep costs down while ensuring patients continue to receive high-quality medical care. The elderly population is a vulnerable population and requires additional support systems in place to have all their health care needs met. Building connections with local community organizations to help patients as they transition out of nursing care to their home or while receiving in-home care can set your organization up for success. Local area agencies on aging can connect long-term care providers with the right community resources to support their patient populations. Local community organizations can provide support with social care needs like transportation, fall-risk assessments, nutrition and meal preparation, community-based engagement, all of which have been shown to not only reduce hospital readmission rates, but also improve the health and well-being of the elderly.
Long-term care service providers need to invest time and budget into comprehensive data collection and analysis, implementation of process improvement methodologies, and advanced technological devices to proactively adjust to payment reform. Navigating the integration of value-based care models for long-term service and support organizations can seem like a dauting journey. But we have seen that organizations that prepare effective strategies for implementing the four activities outlined above are more likely to experience a smoother transition.
Tech Mahindra, a provider of digital transformation and consulting services and solutions has announced the acquisition of Mad*Pow, a strategic design consultancy headquartered in the US. The addition of Mad*Pow to the Tech Mahindra portfolio is expected to help bolster capabilities in customer experience (CX) and digital transformation such as research, experience strategy and service design, user experience design, behavior change design, content strategy, mobile app and web development, design ops, data science and analytics.
The Boston-area consultancy will complement to Tech Mahindra’s existing offerings and capabilities across design, marketing and commerce.
CP Gurnani, managing director and CEO, Tech Mahindra, said, “Mad*Pow’s acquisition is in sync with Tech Mahindra’s global digital charter. With this collaboration, our digital footprint will take a deeper root not just in the US, but in the wider ecosystem world over. I welcome the Mad*Pow team into the Tech Mahindra family, and I am confident that together we will achieve greater success.”
pioneer in the experience design field, Mad*Pow leverages strategic design and
the psychology of motivation to create innovative experiences and compelling
digital solutions for global clients. Mad*Pow’s unique human-centered design
approach is fueled by deep empathy and an understanding of behavior science,
which will create real differentiation for Tech Mahindra’s 900+ customers.
Will Powley, founder and chief creative officer, Mad*Pow, said, “Tech Mahindra’s experience and reach will enable Mad*Pow to scale faster by greatly enhancing its digital transformation offerings with existing and potential clients. The collaboration will also create vast opportunities for Mad*Pow to provide it’s unique and differentiated strategic design services to Tech Mahindra’s large global customer base.”
Vivek Agarwal, global head of corporate development, Tech Mahindra, said, “We are excited to announce Tech Mahindra’s key acquisition of a digital asset in North America. The addition of Mad*Pow to Tech Mahindra family will greatly enhance our ability to create and deliver enhanced customer experiences for our global clients.”
acquisition underlines Tech Mahindra’s focus on digital growth, under the
TechMNxt charter, which focuses on leveraging next generation technologies and
solutions to disrupt and enable digital transformation, and to build and
deliver cutting-edge technology solutions and services to address real world
problems to meet the customer’s evolving and dynamic needs.