If it isn’t already clear, the headlines are signaling that the era of healthcare innovation is upon us and moving swiftly. Managed Medicaid plans could be losing out on millions of contracted lives (and money) by lagging in the adoption of digital telehealth resources to improve access to care and patient outcomes. Leveraging an eConsult solution is a proven way to increase access to high-quality care while lowering system cost, ensuring innovation scoring opportunities are not missed.
Innovation is the new constant
Although the pace of innovation in healthcare has traditionally been slow, organizations are increasingly seeking new ways to innovate in order to support value-based care models. Recent partnerships formed between Amazon, Berkshire Hathaway and JPMorgan Chase, CVS and Aetna, Cigna and Express Scripts, and so on strongly indicate that innovations rooted in providing better care for lower costs are paramount to the success and growth of healthcare.
Payers whose ongoing strategies are not placing precedence upon innovation will be left in the dust. Not only will this be costly for access and quality, it can jeopardize managed Medicaid payers’ chance of re-procuring and expanding contracts.
Managed Medicaid Plans must innovate to reach objectives
Managed Medicaid plans need innovations to improve the value and efficiency of healthcare provided. To ensure they’re getting the best value, state Medicaid programs re-procure contracts with managed care payer groups on a perpetual basis — sometimes as frequently as every three years. States use these periods as an opportunity to seek updated solutions to long-standing or emerging challenges, often assigning points to questions that speak to innovations in care delivery for Medicaid recipients.
Key Medicaid challenges
Barriers to care and access within Medicaid programs are often among the most important issues states and managed care plans are attempting to address. The Kaiser Family Foundation 2017 survey of Medicaid managed care plans reported high rates of difficulty in recruitment for some specialties and listed provider supply as a leading challenge.
Timely access to care is key to healthcare goals, as delays in accessing necessary care exacerbate health conditions, in turn leading to more costly treatment and poor outcomes. This lack of care access worsens a health crisis that could have been easily avoided with more proactive (and less expensive) care.
A key takeaway from 2018’s 11th annual Medicaid Managed Care Summit was that, “Reforming healthcare in the U.S. is not about spending more money, but about moving around the dollars that we’re already spending.” Adoption of eConsult platforms allows health plans to solidify their value-based initiatives and Medicaid payers to expand access to needed specialist services, bring new physician access points to urban and rural areas and leverage the latest in technology and sophisticated referral protocols to help meet members’ care needs.
Patient is not a word typically used to describe the current generation of tech savvy, time saving, health conscious millennials – and it shows in their healthcare decisions, too. Fewer individuals choose to see their primary care physician, and more are turning to quick clinics or urgent care offices for care. According to a survey by NPR, one in five respondents reported going to an urgent care facility at least once in the last two years for common ailments because of the lack of available appointments at their primary care provider. And typically, urgent care offices can guarantee same day appointments, with short wait times of 30 minutes or less.
Although patients are commonly turning to these solutions to meet their needs, most still prefer being treated by their own doctor who knows them and their medical history. Ask patients why they opted to go to the urgent care center, or even more cumbersome, the emergency room for a non-emergent issue and the answer generally boils down to convenience. Primary care physicians are finding a solution through telemedicine that not only provides their patients with additional options for care but can increase practice revenue.
Telemedicine provides patients with the opportunity to meet with their doctor regarding common yet non-life-threatening conditions. Some of the conditions that are most commonly treated through telemedicine in a primary care setting are a cough, runny nose, sore throat, musculoskeletal pain, pink eye or urinary symptoms that do not warrant a physical exam to diagnose. Additionally, lab reviews, medication refills, and managing widespread chronic conditions including diabetes and hypertension can be effectively handled through virtual visits.
By seeing these patients virtually in addition to in-office visits, these physicians can maximize their time by increasing the number of patients they see in a day while still maintaining a quality level of care. Happier patients, and increased revenue? Who could ask for better.
Here are some of the most common conditions that Dr. Kaufmann of the Kaufmann Clinic, one of the primary care practices that uses ExamMed’s technology, treats virtually through telemedicine:
Cough/Sore Throat: Many patients see the provider for a sore throat unknowing if it’s strep throat, allergies or a cold. A virtual appointment can determine if in-person testing and/or antibiotic treatment is needed.
Urinary Symptoms: Urinary infections are extremely common. Although a less common condition for men, according to the National Institute of Health, 50 percent to 60 percent of women will experience a UTI in their lifetime. Urinary infections can easily be managed virtually, including diagnoses and treatment.
Follow-up Appointments: Many follow-up appointments do not require a physical examination. Rather than taking the time to travel to a doctor’s appointment to discuss a new medication, patients can talk with their doctor virtually.
Pink Eye: A highly contagious infection, pink eye is diagnosed in more than three million people each year. Rather than potentially exposing others to the germs, pink eye can be easily diagnosed, treated and reevaluated through virtual appointments.
While telemedicine is not the solution for all appointments, it is a great addition to couple traditional, in-person visits. Virtual care enhances a practice’s capabilities, improves patient outcomes and offers a convenient option. Blending telemedicine services into a medical practice is a strategic move that will benefit both patients and providers long-term.
Life Image and swyMed announce a new strategic partnership to enhance telestroke capabilities. This engagement will improve the ability for physicians to collaborate and coordinate care while using swyMed’s offering by seamlessly integrating relevant clinical and imaging data into the telemedicine encounter. The agreement also deepens swyMed’s ability to connect to neurologists and primary stroke centers, which are already part of the Life Image network. Life Image is currently supporting more than 140 stroke centers within its U.S. network.
This new partnership will advance swyMed’s telestroke solution by combining the exceptional bandwidth management capabilities in its videoconferencing platforms, which are highly beneficial for rural area hospitals, with access to all relevant medical records, diagnostic imaging, and other critical clinical data.
This data is made available through the Life Image clinical image exchange, which is integrated into the workflows of 80 percent of all large health systems and academic medical centers in the U.S. The engagement will also provide Life Image hospital customers with a value-added telestroke solution as part of the Life Image Interoperability Suite, to extend neurology departments’ reach beyond the walls of the organization and deliver timely, high-quality care for patients affected by stroke.
Evie Jennes
“Despite widespread knowledge that every moment counts when it comes to treating acute ischemic stroke, a majority of stroke patients do not receive adequate treatment in time due to lack of access to primary stroke centers and appropriate specialists,” said Evie Jennes, CCO, swyMed. “We have dedicated extensive efforts to innovating solutions to overcome these challenges and optimize outcomes among stoke patients. By engaging with Life Image, we can now provide immediate access to imaging and clinical data to speed up diagnosis and treatment, as well as connect swyMed users to premier neurology centers and leading research facilities through Life Image’s extensive provider network.”
There are several access-related challenges associated with acute stroke treatment, which are further compounded by the fact that diagnosis and treatment are incredibly time-sensitive and require a specialist. Unfortunately, research shows a severe lack of stroke specialists in the U.S.: only 55 percent of Americans reside within 60 miles of a primary stroke center, and there are only an estimated 1,100 neurologists specializing in stroke nationwide.
This new strategic partnership between swyMed and Life Image will address these data access and specialist shortage issues by offering immediate connectivity, even in the most bandwidth-challenged areas, to stroke specialists across the U.S., and integrating all relevant medical data into the telemedicine encounter to allow diagnosis and treatment to begin before the patient arrives at the hospital.
atthew A. Michela
“Providers have long struggled with interoperability and data-integration issues across systems and locations, and these issues come to a head when caring for a stroke patient. Paramedics and emergency room doctors especially need to immediately reach stroke specialists and provide them with the patient’s neurological exam and other imaging and clinical data in order to achieve the best-possible outcome for the patient,” said Matthew A. Michela, president and CEO, Life Image.
“We see this partnership with swyMed as an important opportunity to advance the clinical practice of telestroke. Whether it’s a rural hospital with poor bandwidth or a hospital without stroke specialists, this new engagement will benefit all providers dealing with stroke management by uniting swyMed’s cutting-edge telemedicine platform with our powerful global network of data and integration into thousands of provider workflows nationwide.”
Life Image’s interoperable solution, which integrates into existing workflows, orchestrates the flow of more than 10 million clinical encounters per month. The network connects 1,500 U.S. facilities, 8,000 affiliated sites, 150,000 U.S. providers and 58,000 global clinics with a broader ecosystem of patients, life sciences, medical device companies and telemedicine companies.
Technology is the new creed that has literally touched almost every aspect of our life. Be it communication, traveling, or exercising, we are always interacting with technology. However, healthcare has always been considered a very conservative area in terms of technology deployment. This is because, in its very nature, healthcare mainly deals with human life which calls for utmost precaution. But the emergence of machine learning and artificial intelligence has sparked innovation and a myriad of solutions that are already working in the healthcare industry.
At the forefront of this growth are Android-powered smartphone devices. It’s estimated that 88 percent of all the devices sold in the last quarter of 2018 were all powered by Android. It shouldn’t then come as a surprise that companies are looking to hire Android developers to build health-care related apps.
But what does the future hold for tech solutions in the health industry? In this article, we are going to look at the trends in healthcare to look out for in 2019 and a few examples of apps for healthcare.
Artificial Intelligence and Machine Learning
“If you’re arguing against AI then you’re arguing against safer cars that aren’t going to have accidents, and you’re arguing against being able to better diagnose people when they’re sick.” – Mark Zuckerberg during a live Facebook video in 2016.
Artificial intelligence and machine learning are getting increasingly sophisticated to the extent of surpassing human capability and the potential for these two technologies in the healthcare ecosystem are huge.
One of the biggest potential benefits of AI in 2019 is helping people to stay healthy without consulting a doctor, or at least do it less often. Coupled with the Internet of Medical Things (IoT), AI is already being used to develop consumer health apps that proactively show patients how to stay healthy.
Moreover, AI is increasingly being used by healthcare professionals to gain deep insights and better understand of routine patterns occurring in patients. With these deeper insights, the caregivers are able to give better diagnosis, guidance, and support to the patients. For instance, the American Cancer Society is already using AI to detect cancer at the initial stages with 99 percent accuracy.
Product development is another area that AI and machine learning are being used. R&D in the medical field can be painstakingly slow and costly given that hundreds of variables need to interact with each other. Today, medical researchers are using AI to safely explore biological and chemical interactions of drugs using the discovery process and clinical data.
Another area you can get artificial intelligence in healthcare is through workflow optimization. It helps automate repetitive tasks such as routine paperwork, patient scheduling, and time-folio entry.
Wearables and Augmented Reality
I do think that a significant portion of the population of developed countries, and eventually all countries, will have AR experiences every day, almost like eating three meals a day. It will become that much a part of you.” — Tim Cook at the 2016 Utah Tech Tour – source.
Virtual wearables and augmented reality devices are other emerging healthcare trends proposing to make significant advances in the healthcare space in terms of diagnosis and medical education.
On one side of the scale, virtual reality superimposes a patient in an artificially created surrounding, whereas, augmented reality helps generate layered images to real like objects. As a result, these technologies are and will continue being used by emergency response services providers to relay critical first aid information before the first responders arrive at the hospital.
In the prevention and diagnostics front, VR/AR has allowed medical care providers to create and manipulate different camera colors to reflect or replicate pre-existing effects in their databases.
But perhaps, the biggest impact of VR can be seen in 3D reconstructions of human organs. This has proven important especially when surgeons need to re-create the exact size and positioning of human organs before conducting complicated surgeries. Having the same exact replica of human organs give surgeons the know-how on how to deal with particular organs no matter how small they are.
In terms of medical education, both VW and AR have been great tools in transforming the way students learn. Surgeons are able to rehearse surgery procedures using dummies quicker and without having to use actual human bodies.
The internet age has brought along profound changes in the telemedicine landscape. In the earlier years, telemedicine was strictly limited to doctor and nurse consultation. However, the proliferation of smart mobile devices that are capable of transmitting high-quality videos has opened up avenues for virtual healthcare services from specialists to patients straight in their homes. This is especially paramount in remote areas where doctors can’t easily reach.
By Danielle K. Roberts, a Medicare insurance expert and co-founder, Boomer Benefits.
Danielle Kunkle Roberts
The telehealth revolution gives health providers the opportunity to assist patients in remote or rural areas; the same kind of care that they give to patients in person. It saves money on travel and improves efficiency in healthcare as well.
While telehealth options in healthcare are helpful to individuals at any stage in life, they can be particularly helpful in treating older adults with chronic illnesses. The Centers for Medicare and Medicaid Services have recognized this and have put together guidelines for primary care physicians who treat patients in geographical areas where it may be difficult for those beneficiaries to otherwise gain access to certain specialists and medical experts.
Telehealth services are made available to these Medicare beneficiaries who have signed up for Medicare Part B. Here’s how Medicare covers telemedicine for these people.
Medicare outpatient coverage for telemedicine
Medicare has two original parts: Part A hospital coverage and Part B outpatient coverage. Telehealth services fall under Part B. Medicare Part B will cover a telehealth consultation whenever a consultation is medically necessary, and your Medicare doctor follows the guidelines in arranging the consultation.
The specialist must conduct your teleconsultation using two-way interactive communication that must include both live audio and video feeds. Fortunately, with the prevalence of digital technologies and telehealth platforms, this has become common practice for most healthcare organizations.
The Medicare beneficiary needs to live within designated rural areas, and the video conferencing call must be held at a designated originating site. Approved originating sites include your physician’s office or rural health clinic. Calls can also be conducted from within a federally qualified health center, a skilled nursing facility, inpatient hospital, critical access hospital or community mental health facility.
By George Mathew, M.D., chief medical officer for the North American Healthcare organization, DXC Technology.
George Mathew, MD
In mid-February, nearly 45,000 health information and technology professionals, clinicians, executives and suppliers gathered to explore healthcare’s latest innovations at the annual Health Information and Management Systems Society (HIMSS) conference in Orlando, Florida.
These “champions of healthcare” examined the greatest challenges facing the industry — including an aging population, chronic disease, a lack of actionable information and increasingly demanding consumers. They also explored how new solutions are being enabled by technologies such as predictive analytics, artificial intelligence (AI), machine learning and telemedicine.
The following four trends drove much of the conversation at HIMSS19 and will continue to shape the next wave of healthcare transformation.
Organizing and innovating around patients
As patients gain access to more information about their health and new technologies empower them to be proactive consumers of healthcare, the industry is focusing on how patients as consumers will drive new models of care. Topics such as patient engagement, patient-centric health information exchanges, personalized care and the consumerization of health were prominent during HIMSS19 learning sessions and conversations around the expo hall.
Primary care physicians are at the frontlines of our nation’s health. The average family doctor cares for 2,300 patients with visits varying from acute conditions to chronic diseases. Treating patients with the highest quality of care is a fundamental goal of every physician. However, with a very high volume of patients, limited in-office time and space, and restricted patient availability, doctors actively seek innovative alternatives to meet patient needs. More and more physicians see telemedicine as the solution and are now offering consultations through virtual devices, such as smartphones, tablets and laptops, to their patients.
Our primary care practice, the Kaufmann Clinic that has been around in Atlanta since 1954 and has multiple locations and multiple providers, recognized the need to incorporate telemedicine into our traditional, brick-and-mortar practice. Here are the ways telemedicine has benefited our practice:
Telemedicine optimizes our practice’s capabilities. A physician can only examine a limited number of patients in office due to administrative time, severity of cases, and number of exam rooms. By using telemedicine our practitioners can now increase the number of patients they see in a given day. Seeing less acute patients virtually enables us to be more efficient and effective overall. Not only remote visits, but also in-clinic visits are optimized.
How do you provide care to underserved patients who have difficulty getting to the office? This was the challenge we were trying to solve at the Clark Clinic. Some of our patients don’t have access to a vehicle or are physically restricted and unable to travel far. But, as most of our community is underserved, we needed to collectively identify a solution to ensure we can serve all our patients.
I knew from conversations with other healthcare executives that telemedicine was the solution. I recently learned of a pediatrics office in Jacksonville that uses telemedicine to serve its ADHD patients better. Like the Clark Clinic, its patients found it difficult to comply with required visits. Telemedicine allowed ADHD patients to conduct their appointments remotely. Rates of visit compliance skyrocketed. We realized then that telemedicine technology would be ideal for a rural community.
We have experienced seismic shifts in the popularity of telemedicine. Technology has largely influenced every aspect of our society. With instant access to every component of life, people are developing a dependence on technology. In healthcare, patients want easy and efficient access to healthcare, without having to wait for hours in the office. After a telemedicine visit, they are convinced of its value. The process is simple — download the healow TeleVisits app and schedule an appointment. There is no doubt patient satisfaction has improved.
At the Clark Clinic, our slogan is “We are wherever you are” and telehealth allows us to provide the same level of care no matter where our patients are located. With multiple clinics across central Florida, our doctors are often on the road. There have been various situations where patients had urgent visits but couldn’t be seen because our doctor was miles away. But with telemedicine, the doctor can schedule a remote appointment and conduct and treat patients in need while maintaining the established provider-patient relationship. Amazingly, our physicians have even noted that in most cases they are able to make accurate judgments, all from observing a patient’s speech, breathing, motions, and mood.
Our patients who reside at local assisted living facilities also love the convenience of telemedicine. These individuals appreciate the ability to download the app directly onto their phone or tablet and schedule an appointment with their doctor. Typically, they take the call in their room, and all their health questions are quickly answered. We’ve also heard from their families and loved ones, who enjoy the reassurance that, with telehealth, the level of care never wavers and access to quality care is not limited.
At the forefront of this growth are Android-powered smartphone devices. It’s estimated that 88 percent of all the devices sold in the last quarter of 2018 were all powered by Android. It shouldn’t then come as a surprise that companies are looking to 
Another area you can get artificial intelligence in healthcare is through workflow optimization. It helps automate repetitive tasks such as routine paperwork, patient scheduling, and time-folio entry.
