Most likely, in one of the few lucid moments you have in your hectic, even chaotic schedule you contemplate healthcare’s greatest problems, its most pressing questions that must be solved, obstacles and the most important hurdles that must be overcome, and how doing so would alleviate many of your woes. That’s likely an overstatement. The problems are many, some of the obstacles overwhelming.
There are opportunities, of course. But opportunities often come from problems that must be solved. And, as the saying goes, for everyone you ask, you’re likely to receive a different answer to what needs to be first addressed. So, in this series (see part 1 and part 3), we examine some of healthcare’s most pressing challenges, according to some of the sector’s most knowledgeable voices.
Without further delay, the following are some of the problems in need of solutions. Or, in other words, some of healthcare’s greatest opportunities. What is healthcare’s most pressing question, problem, hurdle, obstacle, thing to overcome? And how that can be solved/addressed?
Lynn Carroll, chief of strategy & operations, HSBlox
Lynn Carroll
Preventable medical errors are the third leading cause of death in the U.S., and frequently can be linked to inaccurate patient data, according to a study by Johns Hopkins University. Machine learning should be used to solve patient-matching challenges by analyzing and consolidating patient data from multiple systems, such as EHRs, medical charts, e-prescribing technologies, clinical documentation solutions and revenue cycle management platforms, and by creating longitudinal patient records that can be transparently shared among the patient’s care team, optimizing care coordination. The patient-matching solution is then combined with blockchain to disseminate the relevant patient data to all parties who have permission to view it.
Extending care coordination beyond the hospital walls heavily burdens providers and healthcare administrators. As the industry continues to shift from fee-for-service to value-based care, optimizing care teams to address social determinants of health and drive patient engagement is paramount. Today’s health systems must leverage an agile workforce and intuitive technology to deliver 360-degree patient-centered care.
Dr. Samant Virk, physician, founder and CEO, MediSprout
Samant Virk, MD
As a practicing physician for the last 15 years, I had a growing frustration with the fact that more than 70 percent of my time was consumed by administrative tasks that took away from my ability to help patients. The biggest challenge of healthcare right now is that we’ve lost touch with that physician and patient connection. Question: How can we reconnect physicians with patients — tech has driven a wedge between us and it’s time to fix this. Doctors would love to spend more time with the patients that need them the most while getting paid for follow-up care and communications that eats up their day. We believe that technology is the solution here.
Healthcare must shift its focus from viewing patients as “customers” and instead consider patients as “partners” within the broader healthcare ecosystem. All of the exciting innovation underway (including the increased adoption of virtual care and telehealth) should reflect what is required for the patient/partner to better manage his/her healthcare throughout the care continuum. To solve for healthcare that is truly consumer-centric, the broader healthcare ecosystem needs to identify the best investments to make which will drive quicker and better outcomes for the individual consumer (e.g., the patient/partner), overall population health, healthcare professionals, and healthcare organizations.
Price transparency for the Employers and the patient. The explanation of benefits (EOB) does not contain real financial payments between the payer and the provider. The real numbers are considered proprietary. A patient nor employer benefit plan cannot control their healthcare costs if they do not know how much was paid and for what service. At a grocery store, each item is tagged with the name of the product and the price. In healthcare the service and or product is not presented to the patient prior to the receipt of service and the services are not itemized on the bill. What to do? Make is illegal for payers and providers to have proprietary payments on healthcare goods and services.
John D’Amore, president and chief strategy officer, Diameter Health
The most pressing problem for US healthcare is improving quality of care while reducing cost. Intelligently leveraging clinical information — for predictive analytics, precision medicine, population health analytics and other analytic purposes — is critical to solving this problem. The largest impediment to actionable analytics is dirty clinical data entered by more than four million clinicians into more than one hundred certified EHRs resulting in a clear and present need for scalable technology to normalize, de-duplicate and enrich clinical data so that data scientists can spend more time identifying actionable insights from data, and less time fixing clinical data.
I see our shortage of primary care physicians as the biggest challenge the American healthcare system faces over the next 20 years. PCPs are crucial to the patient experience, and preventative care that can help drive value. Tied to this is my concern is the lack of investment/acceleration in technology designed to improve physician experience and utilization. PCPs spend way too much time entering data when there are opportunities like voice assisted scribe or authentication that reduce data entry and allows them to spend more time completely focused on patients providing quality care.
By Donald Voltz,MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Donald Voltz, MD
Healthcare is evolving quickly and HIMSS 18 offers a broad range of healthcare issues to explore. New requirements for implementing HIT systems have changed dramatically in the last few years as new health IT priorities and procedures have emerged. Convergence in the health care sector has accelerated the need for interoperability, not just for EHRs, but also across clinical, financial, and operational systems. This need is also challenging and changing one of the biggest traditions in healthcare—the doctor patient medical visit.
In the past, patients would simply make appointments to visit their physicians. Now, we have the popularity of Annual Wellness Visits (AWVs) and the growing need for chronic care treatments caused by the opioid epidemic and other behavioral health issues. This trend is causing physicians to be the ones actively pursuing patients, but with both sides reaping the benefits of this new arrangement. The new approach to the traditional doctor-patient relationship enables patients to receive better care while clinics and hospitals build up a roster of new and potentially long care patients.
Disrupting this office visit tradition are also larger, long-term HIT trends, such as the widespread implementation of electronic health records (EHR) and other healthcare practices. However, these trends spurred many challenges, but also a great deal of opportunities, many of which have yet to be fully capitalized upon. To understand these changes, we need to be cognizant of the increasing opportunities patients and physicians have in accessing and interfacing with the healthcare system.
Patients have a great deal more choices and entry points to the complex and dynamic healthcare system than they had even 10 years ago. When Medicare, Medicaid, organ transplantation and synthetic insulin were coming in vogue 50 years ago, patients had relatively limited access to healthcare. Those that did often choose to enter the system through a single physician who they had built a long-term relationship with and who served as the conductor of any labs, studies or further consultation from specialists. With the implementation of governmental and private healthcare insurance options, patients had improved access to care. Commensurate with this increased access to care, an increased national health expenditure followed.
With increased costs, healthcare responded by changing the way patients interacted with the system. Beginning in the ‘70s and continuing into the ‘80s, the rise of HMOs and capitation attempted to improve national healthcare, but this led to limitations in patients’ choice and began the concept of bundling services, cost sharing, and expansion of preventative care. Other managed care plans and a focus on utilization of care continued to decrease the cost of care.
Although many aspects of these managed care structures benefited patients, such as preventive services and prescription coverage, access to services and specific physicians were constrained as “in” and “out” of network coverage, limiting patient choices. The implementation of EHRs has established the foundation upon which opportunities are and will be found to improve healthcare quality by improving the decisions being made.
Enhanced access of patient data by authorized patients, professionals and algorithms focusing on analytics or artificial intelligence is now a requirement for enhanced patient engagement, improving professionals’ delivery of care, enhancing clinical decision making and optimizing patient outcomes while maintaining choices that are consistent with best practices, patient values and prior empirical experiences.
Evolving Relationship Drives Healthcare Revenue
While the doctor-patient relationship has evolved, hospital systems and physicians must still derive revenue which is still at the core of that relationship. The healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWVs), chronic care and service care transitions between physical and behavioral health services. Hospitals and healthcare clinics that can connect these services with technologies such as bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.
“Programs such as revenue cycle management are important for any healthcare institution’s bottom line, but when carriers can actually drive revenue using cloud based, bi-directional interoperability technologies that enable doctors to spend more time with patients and therefore provide superior care, then flipping the traditional patient-doctor relationship is a winning trend for the healthcare industry,” said Doug Brown, managing partner, Black Book Research.
Driving this trend are new apps and innovations that address the payment gap caused by medical billing and collections processes with outdated EHR platforms and inoperable systems. New technologies from organizations, such as Core Care Medical and others, fueled by the growth of cloud computing in the healthcare industry are improving real-time communication and data exchange. Here are some examples of how this is working which you might not hear about at HIMSS.
Hospital CEO Drives Revenue with Doctor Patient Visit Apps
A healthcare colleague, David Conejo, CEO, Rehobath McKinley Christian Healthcare Services (RMCHS) is boosting revenue right now using this doctor/patient flipping model as a strategy to help in his effort to improve behavioral healthcare for Gallup, New Mexico’s large Indian Reservation community who suffer from addiction to alcoholism and opioids.
He integrates data from the hospitals’ three clinics using a cloud application that streamlines data from AWVs and integrates it with any EHR system without data duplication. The Zoeticx ProVizion app also allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits. He can then enter the relevant data about the patient.
In addition, it includes everything else that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurers billing requirements. RMCHS’ business is growing with full or near-full compliance. And with its ACO in startup mode, RMCHS is also receiving a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues being generated.
The fact that more patients can be seen is a bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day that’s an extra 180 minutes. More minutes, more patients.
Guest post by Richard Loomis, MD, chief medical officer and VP of informatics, Practice Fusion.
Richard Loomis, MD
If you bill Medicare, changes are coming in 2017 that may affect your reimbursements. Existing programs such as the electronic health record (EHR) Incentive Program (meaningful use) and the Physician Quality Reporting System (PQRS) are being replaced by a new payment system called the Quality Payment Program (QPP), which is a complex, multi-track program that will adjust payments from -9 percent to +37 percent by 2022. The Centers for Medicare & Medicaid Services (CMS) recently released the final rule that will implement the QPP as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
While the 2,300-page final rule outlining the new program is complex, successful participation in 2017 doesn’t have to be. Here are some tips on how to participate in the QPP starting January 1, 2017 to minimize the risk of any negative adjustment to your Medicare Part B payments beginning in 2019.
Step 1: Check if you qualify to participate
CMS has expanded the range of clinicians able to participate in the QPP compared to Meaningful Use (MU). Eligible clinicians now include physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. However, you’re excluded from participating in 2017 if:
You’re a clinician enrolling in Medicare for the first time. You’re exempt from reporting on measures and activities for the Merit-Based Incentive Payment System (MIPS) until the 2018 performance year.
Your practice meets the low-volume threshold. This means your Medicare Part B allowed charges ? $30,000 OR you see ? 100 patients covered by Medicare Part B during the 2017 calendar year.
Step 2: Choose your participation track
Although the QPP will begin January 1, 2017, there will be a ramp-up period with less financial risk for eligible clinicians in at least the first two years of the program. CMS designated 2017 as a transition year to help providers get started in either of the two participation tracks: MIPS or the Advanced Alternative Payment Models (Advanced APMs).
MIPS
MIPS streamlines current Medicare value and quality program measures — PQRS, Value Modifier (VM) Program and MU — into a single MIPS composite performance score that will be used to adjust payments. All eligible clinicians who are not participating in an Advanced APM should report under MIPS in 2017. Conversely, you’re not required to participate in MIPS if you’re participating in an eligible Advanced APM, as described below. Some APMs, by virtue of their structure, are not considered Advanced APMs by CMS. If you participate in an APM that doesn’t qualify as an Advanced APM, it will increase your favorable scoring under the MIPS participation track.
Advanced APMs
APMs are new approaches to paying for medical care through Medicare that provide incentive payments to support high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. The main difference between the MIPS and Advanced APM programs are that Advanced APMs require practices to take on more financial and technological risks.
They receive a five percent lump sum bonus payments for the years 2019-2024.
They will receive a higher fee schedule update for 2026 and onward.
It’s important to note that if you stop participating in an Advanced APM during 2017, you should make sure you’ve seen enough patients or received enough payments through an Advanced APM to qualify for the five percent bonus. If you haven’t met these thresholds, you may need to participate in MIPS reporting to avoid a negative payment adjustment.
Physicians can now get reimbursed for the coordination effort that is involved in managing a patient following a hospital discharge. ACT.md’s TCM-specific Health ACT Sets facilitate a structured, standardized, and proven process for optimal care coordination to reduce hospital re-admissions and support TCM billing. The ACT Sets are structured in a way for providers to assess complexity, complete care actions required by CMS, and follow specific time sensitive requirements for care delivery and billing. ACT.md takes the complexity out of the TCM Billing process and pays for itself within months.
Elevator pitch
ACT.md is the platform for team-based care. Care teams need a way to jointly manage medical conditions in concert with behavioral, social, and functional needs. With ACT.md’s high-tech, high-touch platform and project management-like approach, healthcare organizations can engage in collaborative care planning, efficiently manage in-between visit care, and make safe, reliable handoffs across the care continuum. Our customers have seen a 30 percent reduction in the time spent on care coordination activities and improved compliance to care plans through meaningful caregiver and patient engagement.
Product/service description
Through an elegant and intuitive cloud-based technology, the web-based solution connects all members of a dynamic care team, including the patient and their trusted caregivers. We enable our customers to efficiently develop, reliably execute, and securely communicate a patient-centered care plan across their teams. The technology is complimented with a flexible care coordination workforce service offering to ensure nothing falls through the cracks and clinicians are working at the top of their license.
Origin story
Ted Quinn
“At ACT.md we are patients, caregivers, physicians, nurses, public health professionals, engineers, and operational leaders. We have personally experienced the significant challenges associated with managing complex care and are working to make life better for patients and everyone supporting them,” said Ted Quinn, CEO and Co-Founder, ACT.md.
Founder’s story
The company was founded by Ted Quinn along with Ken Mandl, MD and Zak Kohane, MD, both nationally-renowned healthcare informatics experts. The company was incubated at Boston Children’s Hospital and Harvard Innovation Lab.
“We were inspired to launch ACT.md after observing for decades the constant dropped handoffs across the various providers caring for patients. So we created ACT.md as an operating system for team-based care that drives action toward improved outcomes and reduced costs,” said Dr. Kenneth Mandl, co-founder, ACT.md, professor at Harvard Medical School and director of the Boston Children’s Hospital Computational Health Informatics Program.
Marketing/promotion strategy
Kenneth Mandl
Every healthcare entity is dealing with change management around care delivery and care coordination. We’re sharing our vision of team-based care and it is resonating with the market.
We’re proud to work with our world-renowned advisory board – including John Halamka, MD, CIO at Beth Israel Deaconess Medical Center, and Troy Brennan, MD, CMO at CVS Caremark – who help us share our vision with the nation’s leading providers and payers.
Market opportunity
According to Frost & Sullivan, the care coordination software market is expected to grow at a 26.1 percent compound annual growth rate between 2015 and 2020.
How your company differentiates itself from the competition
EMR/EHR vendors are the incumbents in the market, but they are not designed to do this job. Up to 70 percent of provider/patient work is conducted in the informal region outside the EMR, especially work related to the coordination of care. We have heard directly from healthcare organizations we are working with that with the leading EMR there is no way to track the status of handoffs, connect with outside providers and family caregivers, and that they really need a Care Coordination Record. This is the job that ACT.md is being hired to do, and we are getting traction with large health systems across the country.
ACT.md shines in complex care settings. The company is focused on powering team-based care for high-risk, high-cost patients.
Guest post by Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Telemedicine is about reaching out to patients in remote locations, but limited to videoconferencing between patients and health providers. It is similar to a face-to-face service with the exception that the patient and primary care provider are not physically together. Such efficiency is limited in term of scope and only addresses the geographical challenge and scarcity of physician availability, a far cry from what CMS wanted for its Chronic Care Management Services (CMS), which would fundamentally change telemedicine as it is practiced.
CCM services bring the telemedicine definition to the next level – a quiet continuous monitoring and collaboration from all care services to the patient, given the ability to anticipate and engage in care issues. Such ability not only curbs care costs, it would also increase care provider bandwidth, giving them the ability to cover more patients with better efficiency. The challenge is not on the requirements part of CCM services, but the lack of an IT solution to really address all CMS guidelines, including its intent to enforce the concepts through the healthcare industry.
Thanh Tran
The New England Journal of Medicine has covered the major challenges from the new CCM guidelines, touching on all the major shortcomings in today healthcare IT offerings. Healthcare providers recognized that the fee-for-service system, which restricts payments for primary care to office-based visits, is poorly designed to support the core activities of primary care, which involve substantial time outside office visits for tasks such as care coordination, patient communication, medication refills, and care provided electronically or by telephone.
The time has come for a paradigm shift to re-engineer how we deliver care and manage our patients. To arrive at a new plateau requires rethinking the needs of our patients and how to meet these needs in an already resource constrained, proprietary, inoperable systems. Unless we develop solutions that both integrate with and enhance the technologies currently available and those yet to be realized, we will not realize a return on health IT investment. That has now changed since one Healthcare 2.0 innovator has been able to connect the CMS guideline dots.
Huge Market Opportunity
According to the 2010 Census, the number of people older than 65 years was 40 million with increasing trends to 56 million in 2020 and not reaching a plateau until 2050 at 83.7 million. With two-thirds of Medicare beneficiaries having two or more chronic conditions while one-third has more than three chronic conditions according to CMS data, putting the number of patients who qualify for CCM services at 15 million. This number is predicted to continue on an upward trend until 2050.
The World Health Organization (WHO) recognized the growing burden this trend in chronic disease places on the healthcare system and addressed the need for innovative solutions in their 2002 report. While the potential market is huge, in the billions of dollars yearly, healthcare organizations have been struggled to address the CMS guidelines with key requirements from CMS. We can no longer afford not to address the needs of patient with chronic medical conditions along with engaging them in their healthcare decisions.
The CMS guidelines are as follows:
24×7 access to clinical staff
Patient care continuum
Collaboration, coordination between primary care providers and other care services
Electronic management of care transition among care providers
Coordination between home and community care services
Patient engagement
Here is how these guidelines are now being addressed:
It’s called healthcare for a reason. Technology is a powerful tool, but people are the solution. The Twine Health Collaborative Care Platform allows for the co-creation and tracking of personalized care plans that serve as common ground for continuous collaboration between patients, coaches and their clinicians. Patients get support from their care team, on their terms whenever, wherever they are: so they reach their health goals faster and focus on living.
Healthcare has lost its way. In recent years the “care” has fallen by the wayside — victim of flawed automation efforts, perverse payment models and the constant pressure to reduce costs. Technology is a powerful tool. However, if not used properly it’s impersonal and the human connections, which are critically important to caregiving, get lost. People are the solution to better healthcare.
People are the most underutilized resource in health. Twine Health changes the game by empowering them to take an active role in their care, learning along the way, and overtime building self-efficacy. Twine Health surfaces patients who need help at just the right time, allowing them to remain effective even as panel sizes grow. Coaches provide the ongoing support and expertise that is key to successful behavioral change. This also allows clinicians the time and focus to practice at the top of their license, interacting directly with patients when challenging medical conditions arise.
Elevator Pitch
The Twine Collaborative Care Platform is a new class of digital health technology that helps patients build self-efficacy via continuous support from coaches and their clinicians. Spun out of research performed at the MIT Media Lab, and proven cost effective via clinical trials and commercial pilots, Twine delivers results that cannot be ignored – 90 percent of patients reach their health goals (e.g., blood pressure < 140/90) within 3 months at 1/3 the cost of the standard of care.
Founder’s Story
John O Moore MD, PhD
John Moore, MD, PhD, is the co-founder and CEO of Twine Health. Moore’s passion for a better healthcare system started during his medical training where he was frustrated to learn that the best diagnostic and treatment capabilities did not result in healthier and engaged people. To be successful, Moore realized patients had to be in control of their own care, but also recognized the clear need for expert support. Moore came up with the idea for Twine Health during six years at the MIT Media Lab where he studied the healthcare delivery model and created a revolutionary approach to care: technology-supported apprenticeship. Bringing together advances in health psychology, learning science and human-computer interaction, Twine is designed to become the primary tool for teamwork between patients and clinicians. Before attending medical school, Moore received a BS in Biomedical engineering, and was a Fulbright Scholar.
Marketing/Promotion Strategy
Patients, coaches and clinicians are looking for a better way to provide and receive care – a way to make health care healthier. Twine Health provides clinicians, and the health organizations (HCOs) they work for, an effective and scalable chronic care platform that improves outcomes, reduces costs and increases patient and clinician satisfaction. The results speak for themselves:
instaRounds provides the most comprehensive mobile and web platform for physicians to communicate with one another, share call schedules, follow their appointments, allow cross coverage and, for the first time ever, give physicians a mobile patient sign-out application.
Elevator pitch
Imagine a platform in which physicians can communicate in a Twitter-like feed with one another about those patients currently under their care. By real-time updates, critical decision making and care planning can occur seamlessly with the patient benefiting the most.
Product/service description
instaRounds is a mobile and web platform that enables physicians to securely communicate with one another in a patients’ care team, by use of a patent-pending format that allows simple-to-use template interfaces that provides seamless patient sign out. Studies have shown that the most critical time in patient care is during the handoff of the patients from one provider to another; instaRounds nearly eliminates errors in sign out.
Providers can use either a web interface or the more popular mobile app, available on iTunes and Google Play, to communicate with members of their team.
Founder’s story
instaRounds was founded by Kurian Thott, MD, a gynecologic surgeon who felt the void in patient care when it was almost impossible for members in his own practice to communicate securely and HIPAA compliantly. He figured there had to be a better way and when he found none, he created instaRounds. Built on the idea that for patient care to be better, physicians needed to communicate with one another, and instaRounds gives physicians this power.
Guest post by William Daniel, M.D., medical director of Quality at Mid-America Heart Institute, Kansas City, and Chief Medical Officer for Emerge CDS.
With the new wave of healthcare reform upon us, hospitals are seeking ways to meet requirements of . With a growing number of hospitals incorporating electronic health records, health IT tools are becoming more prevalent. In fact in August 2012, a second stage of meaningful use guidelines for EHRs was set requiring physicians to use some form of clinical decision support in their practice.
The purpose of clinical decision software (CDS) software is to help the doctor?patient work process run more smoothly, however, often times, hospital staffs complain about technologies adding more time and money to the work flow. In a CompTIA’s study, 56 percent of respondents noted a need to make health IT tools easier to use, improve interoperability and increase operating speed.
