Guest post by Jeff Kaplan, chief strategy officer, ZirMed.
Jeff Kaplan
The 40,000 healthcare and healthcare IT professionals who gathered at the Sands Expo in Vegas brought a different vibe for HIMSS 2016. The halls buzzed with activity and an overall optimism that belied any of the potential causes for uncertainty—politics, a down stock market, increases in uncompensated care, the movement toward fee-for-value, or the staggering shift in patient responsibility.
For those who attended HIMSS 2015 in Chicago, the difference was visible in vendor messaging and audible in conversations during the conference. Among all attendees the optimism seemed well founded, grounded in reality. We all see significant opportunity to drive improvement in healthcare for our generation and generations to come. That’s why we came to HIMSS – we’ve placed our bets.
In that spirit, let’s talk about where healthcare is doubling down, where it’s hit a perfect blackjack, and which trends pushed as providers look for the next deal.
Double Down – Data Interoperability
Out of the gate at HIMSS 2016, there was increased focus and emphasis on the importance of data interoperability and integration. From booth signage to the increase in dedicated vendors to industry veterans evangelizing on the topic, you couldn’t miss the tells from all players—everyone wants to show they have a strong hand when it comes to interoperability. Epic’s Judy Faulkner made a play that Epic wasn’t just the leader of the interoperability movement – they were in fact the originator (see her interview with Healthcare IT Newshere).
Of course, wander off into other parts of the exhibition hall and it wasn’t long before you heard the all-too-familiar complaints about closed-system platforms – that they limit innovation by outside companies and technologists who can build applications to add additional value. In the era of Salesforce.com and other open platform successes, many HIMSS attendees spoke of their hope that companies like Cerner and Epic will follow suit.
Blackjack – Data Analytics
Over the last year vendors heard providers loud and clear – healthcare providers need hard ROI on any new initiatives, especially as many have EHR/HCIS sunk costs in the tens of millions of dollars. They need a sure thing—and the changes evident at HIMSS 2016 reflected that shift. Buzzwords like “Big Data” thankfully went to the wayside and were replaced with meaningful discussion around data analytics and data warehousing. Providers know they’ve amassed a wealth of clinical and financial data—now they’re looking for ways to increase the quality of patient care while driving down costs.
Guest post by Crystal Ewing, senior business analyst and manager of regulatory strategy, ZirMed.
Crystal Ewing
Denial management is an industry-wide challenge—and despite traditional approaches intended to reduce denial rates, it’s one that continues to grow. Frankly, this is absurd.
I say that because, despite the recent announcements from CMS regarding changes to how they will process ICD-10-coded claims for the first year, denials will likely still increase under ICD-10—and that’s something healthcare providers don’t need to suffer in full, because it is possible to reduce their denial rates before ICD-10. Ultimately this will be more impactful than any denial management program specifically targeting ICD-10-related denials, because the “everyday” denials will otherwise endure and continue to delay A/R long after whatever disruption ICD-10 causes has long faded into distant memory.
Here are two simple truths:
90 percent of denials are preventable
More than 60 percent of denials are recoverable
So where does this leave healthcare organizations seeking to decrease denials ahead of ICD-10, a change that—despite recent announcements from CMS—is nonetheless likely to bring with it a spike in denials?
Exactly where they’ve always been—in need of straightforward best practices that actually help them drive down everyday denials that create A/R delays, back-office backlogs, and an unreliable revenue cycle.
Step 1: Thoughtful Automation
Let’s step through a common process for working denials, just to clarify why it’s such a headache.
Here are some time-study figures—per each denial, staff spend:
4 minutes identifying the denial and routing it appropriately
+ 10 minutes gathering information
+ 30 minutes compiling and filling out appeal letter and materials
+ 5 minutes just documenting all their activity related to the denial
and visit/log in to the associated payer’s website for 25 percent of denials
That is unacceptable—which is an opinion. But it’s also unnecessary, and that’s a fact. Each of the time-consuming manual processes mentioned above can be eliminated or significantly reduced through thoughtful automation and workflow-focused software development.
Reducing research time and enabling staff to easily resubmit denied claims are two of the biggest denial management time-savers—period.
In the following conversation, Jim Lacy, CFO and general counsel of ZirMed, discusses the company’s mission, goals and growth; his passion for healthcare and serving those who work in it; ZirMed’s transition from a clearinghouse to a revenue cycle management, population health and predictive analytics firm; why privacy has become the biggest issue very few are seriously talking about; and the changing face of healthcare as a whole.
Tell me more about ZirMed, the brand, its solutions, and your mission for it.
Our core mission is to help healthcare providers, hospitals and health systems get paid. It sounds simple, but efficiently and effectively getting providers paid for their services and supporting their mission in an ever-evolving technological, regulatory, and clinical environment is incredibly complex.
ZirMed is uniquely positioned to deliver a comprehensive end-to-end platform of cloud-based financial and clinical performance management solutions. That means that at every point in the revenue cycle, we have solutions that support healthcare providers in collecting monies from payers and patients, and do it as quickly, efficiently, and cost-effectively as possible. Our solutions address the challenges of the current fee-for-service and consumer-driven payment systems, and also support fee-for-value reimbursement, broadly defined as population health management.
ZirMed’s solutions are logically oriented to address the revenue cycle needs of providers ranging from small physician practices and durable medical equipment providers to the largest hospitals and health systems. At the front end, we offer Patient Access solutions focused on registration and check-in to streamline pre-registration, estimate patient responsibility, accurately verify eligibility, and more.
Core to our mission of getting hospitals and health systems paid for services provided is our Charge Integrity solution. We use big-data and predictive analytics to identify and capture charges, resolve process inefficiencies, improve coding compliance, and ensure the complete integrity of all inpatient and outpatient billing.
Our claims and A/R management solutions include robust edits and rules aggregating claims across an entire system, and provide highly efficient claims and receivables workflows, reduce preventable denials, and deliver insights into financial performance for critical decision support.
With the ability to process vast amounts of data and provider metrics across an organization, our cost and utilization solutions benchmark provider performance, stratify risk, and support fee-for-value reimbursement programs.
Population health management has come to hold very different meanings across different organizations. Our population risk management solutions combine clinical and financial information, enabling insights into patient populations while identifying risk, analyzing discharges for readmission risks, and managing referrals across an integrated system.
And, of course, healthcare is always about the patients. We offer a comprehensive suite of Patient Engagement solutions including consumer-friendly billing and payment options and a patient portal offering online payment, statement management, and two-way messaging between the patient and provider.
What about you? What keeps your passion for this mission, and organization, alive? Tell me more about what excites you about your work and why you love what you do?
I love what I do, and couldn’t design a better job for myself than this one: I get to be a CFO, counsel and influence product design, all within the course of a normal day.
My roles are seemingly very different and one person holding them is rather non-traditional; however, there is logic to the fit. ZirMed develops financially focused software solutions in a highly regulated healthcare environment. We deal with billions of transactions and hundreds of billions of dollars annually with an extreme focus on privacy, security and compliancy. My background from the provider side of healthcare prior to joining ZirMed directly influences the types of solutions we build and how we deploy them to positively impact provider organizations.
Ric Sinclair, our VP of product, and his team excel at designing and delivering great software that’s beautiful, powerful, and easy to use. Their role is to take all this complexity and make it as simple and easy as possible for users and managers in client organizations. My role is to weave my experiences into the design of our products and support the role of the client in everything we build.
So I’m doing what I love and working with incredibly smart, talented people every day. That makes it easy to stay passionate and excited about my work and about ZirMed.
Dan Ward is VP of revenue integrity at MethodCare, now part of ZirMed.
To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.
Let’s say, for example, you’re sitting around the house one rainy October Saturday and decide to view a few movies using Netflix’s streaming service. First you watched Field of Dreams then you decided, hey, this rain isn’t letting up any time soon, and that dog doesn’t want to go out in it any more than I do. So, after a brief backyard sojourn during which you and the dog confirmed that 38 degrees and rainy is in fact unpleasant — you reconvened your Netflixing and ended up watching Bull Durham, as well. Further, let us also assume that you enjoyed both movies and watched them all the way through.
As the credits rolled on Bull Durham, the critical question for Netflix was the same it always is: What would you enjoy watching next — specifically, what should Netflix recommend? Based upon the day’s viewing you may have a soft spot for baseball movies. Though it could just as easily be the case that you’re Kevin Costner’s biggest fan and the fact that you queued up two of his baseball movies was pure coincidence.
Given the uncertainty orbiting these pieces of information, maybe the best prediction would be Dances with Wolves, starring Kevin Costner. Or maybe the right pick would be Moneyball, the story of how the Oakland A’s leveraged data-driven, evidence-based sabermetrics to remain competitive against much more highly capitalized MLB teams. But what if neither Kevin Costner nor baseball is the most important correlation—what if the best predictor of whether you’ll like a film is simply whether it’s a sports movie from the late 80s?
As with all forms of predictive analytics, the question of what to recommend multiplies in complexity as overlapping variables (often in the form of unstructured data) are added and subsequently considered within algorithmic equations that power, in this case, Netflix’s recommendation engine. Further complicating the matter, it’s likely that you’re not the only person to have watched both of these films in close proximity and there are likely to be numerous “motivations” for such viewings across the population. It becomes apparent rather quickly the inherent challenge of something that seems, on the surface, as straightforward as a recommendation engine.
In healthcare we face these same kinds of challenges, just in a different form. The questions we ask are which gaps in care create the greatest risk for the patient, or which specific combinations of gaps in care correlate with readmissions—so that clinical outreach coordinators and other staff can prioritize whom to contact right away. We ask which types of claims are most likely to be under-coded or missing charges—so that organizations can make best use of finite resources like staff time and ensure the greatest positive impact on overall financial performance.
A day removed from the chaos (and wonderment and bliss) of HIMSS14 I thought I’d provide you with some of my thoughts about my experiences at the event. First, it was a wonderful, albeit tiresome experience. I was glad, and proud, to be back.
I attended the show twice before – in 2011 and 2012 as a vendor – and this third time as a reporter. In sum, I enjoyed it much more being there as a member of the press. It was more enriching and engaging and I was able to learn more about what’s actually going on in the space.
My only regret: Not being able to connect with colleagues of mine in the blogosphere. If truth should be told, I would have liked to have personally met as many as possible. The presence of several at the show was noticeable and lively. I crossed paths with several of them, but was not actually able to shake hands and say hello. I take full responsibility. Perhaps I’m a bit shy and introverted.
However, I met many other great people and had great conversations at the show. Omnicell, Verisk Health, Allscripts, ZirMed, MedSys Group and SAS stand out. I saw some great displays and some great IT. However, there were many times in which I was bored. One vendor, for example (with what can probably be described as having the biggest social media presence on Twitter while there) did not live up to the hype, and likely needs some ongoing communication training to help its officers learn how to stay on point and drive a story home; a totally missed opportunity from this reporter’s perspective.
Overall, I tend to agree with John Lynn. I saw very little that was truly exciting and innovative; nothing that really knocked my socks off.
Day 2 at HIMSS14 was much the same as day 1: Lots of walking, talking and great meetings with great organizations. I can’t thank enough vendors like Verisk Health, Omnicell, Amazing Charts and SAS for the great information they’ve shared, and for the perspectives about the market, trends and what’s ahead (and what’s behind).
Electronic health records are now foundational, and in many cases, they’ve lost their sex appeal. Though there’s an obvious and huge presence by them here, this year’s HIMSS doesn’t seem to have the same energy around the technology, from my point-of-view, that they did two or three years ago, for obvious reasons. Though their importance is still great, as we all know, other issues are taking center stage. ICD-10 is the obvious elephant in the room.
“Risk” is the biggest buzz word I’ve heard here in Orlando. I’ve heard it dozens of times. “Patient engagement” seems overcooked, according to those I’ve spoken to; an aspirational concept, yes, but actionable in an an entirely different story. Lofty goals and strategy, fewer practical best practices approaches for proceeding.
Patient engagement has only just begun, or at least is just developing past its infancy, and I look forward to seeing how it matures as a concept. Remember, just a couple years ago, those with vested interest claim patient portals would solve the ever elusive patient engagement issue. Portals clearly have not done so. Why would they? I remain skeptical that the actual patient is at the heart of this conversation rather how a systems can implement “best practices.” We’ll see, I suppose.
That said, HIMSS14 remains a wonderful experience and I’m glad to be here and meeting some wonderful people. I look forward to what today brings. Likely, more walking!
The following is a list of organizations I’ll personally be visiting with at HIMSS14, along with several others. Each has a compelling story and I’m looking forward to learning more about them.
Any thoughts on who you think I might be missing, or have overlooked?
AirStrip provides a complete, vendor and data source agnostic enterprise-wide clinical mobility solution, which enables clinicians to improve the health of individuals and populations. With deep clinical expertise and strong roots in mobile technology and data integration, AirStrip is empowering the nation’s leading health systems as the industry continues to evolve to new business models, accountable care and shared risk. Based in San Antonio, Texas, AirStrip allows health systems to unlock the full potential of their existing technology investments with a complete mobility solution that provides access to critical patient data across the care continuum. AirStrip is backed by investments from Sequoia Capital, Qualcomm, Inc., Hospital Corporation of America (HCA) and the Wellcome Trust. AirStrip’s customers includes HCA, Texas Health Resources, Vanguard Health Systems (part of Tenet Healthcare Corporation), Dignity Health and Ardent Health Services.
Allscripts delivers the insights that healthcare providers require to generate world-class outcomes. The company’s Electronic Health Record, practice management and other clinical, revenue cycle, connectivity and information solutions create a Connected Community of Health for physicians, hospitals and post-acute organizations.
Axial’s products improve the quality of patient care, and reduce the cost of providing it, by credentialing the most qualified providers, delivering point of care decision support tools, and utilizing a 360-degree cloud-based predictive model to stratify risk and quantify outcomes. Axial furthers the IHI Triple Aim of driving healthcare value by developing cost-effective, quality-based treatment pathways combined with seamless IT and workflow integration.
