consumerization,Generation Z,Millennials,patient experience,satisfaction surveys

Paving the Road to Consumerized Healthcare – and Better Patient Experiences – in the United States and Beyond

Robbie Hughes, Founder and Chief Executive Officer, Lumeon

Written by: Robbie Hughes, Founder and Chief Executive Officer, Lumeon

When you think of one industry in particular that has mastered the creation of a seamless, digitally integrated experience for the customer journey – with automated coordination across all stakeholders and touchpoints – what comes to mind?

Despite the criticism that it receives, the airline industry can be considered a success when it comes to its ability to orchestrate the customer’s journey and improve customer experience. Gone are the days when a passenger would call a travel agent to book or manage their itinerary. We now research, book and manage flights digitally though a website or app. This allows us to check-in, upgrade and receive loyalty benefits, and keeps us up-to-date with real-time flight status, from check-in times to delays, all the way through to compensation, rebooking and satisfaction surveys. In other words, airlines are seamlessly connecting what could otherwise be a highly fragmented journey for their traveller – from exploring flight options, to completing a journey, and everything in between.

Online services now provide consumers with a simple, elegant experience, while the true sophistication happens seamlessly in the background by automating and orchestrating the engagement, with business processes and fluid data exchange. This sort of seamless and automatic, digital experience is exactly what consumers have come to expect from everything they touch in their daily lives.

Healthcare is no exception. The industry is in the midst of a movement toward the consumerization of the industry, largely driven by Millennials and Generation Z who are accustomed to our new world of always-on, instant service.

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Cavirin,cloud computing,Compliance,cybersecurity,HIMSS,HIPAA,security

The cloud can help solve the healthcare IT crisis… with a well-planned journey

Anupam Sahai, Vice President, Product Management, Cavirin

Part 1 of 5 of “Moving healthcare to the cloud”

Written by: Anupam Sahai, Vice President, Product Management, Cavirin

Time to perk your ears up! If you haven’t been paying attention, the healthcare industry, whether you’re ready to admit it or not, is in the midst of an IT crisis. With an ever-increasing influx of security threats looming, healthcare IT leaders, now more than ever, need to embrace the power of change to transform how doctors, nurses, staff and patients consume IT. This was just one of the key themes presented back in March at the HIMMS18 conference in Las Vegas.

Threats are coming in from several fronts. Here are a few reasons why many CIOs and CTOs are finding it hard to get a good night’s sleep:

The fallacy of thinking compliance = a strong security posture

Some organizations think that abiding by regulations such as HIPAA makes them safe, but this has been proven to be incorrect. Let’s take a real public example. In February 2015, Anthem disclosed that criminal hackers had broken into its servers and had potentially stolen more than 37.5 million records that contained personally identifiable information. 20 days later, Anthem raised the number to 78.8 million records. According to Anthem, the data breach extended into multiple brands that Anthem uses to market its healthcare plans, including Anthem Blue Cross and Blue Shield, Amerigroup, Caremore, and UniCare. The security breach occurred even though Anthem was HIPAA compliant.

Vulnerable legacy equipment

For decades, manufacturers like Siemens, Bosch, Honeywell and others have built embedded systems that run on operating systems from the Stone Age—unpatched, insecure and vulnerable. An example of this includes Siemens medical scanners. Hackers can exploit trivial flaws in the network-connected devices to run arbitrary malicious code on the equipment. These remotely-accessible vulnerabilities lurked in all Siemens positron emission tomography and computed tomography scanners running Microsoft Windows 7.

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Why partnerships are key to driving healthcare forward

Brent Shafer, CEO Philips North America

Written by: Brent Shafer

It’s no secret that our healthcare system is up against enormous challenges, such as aging populations and growing chronic and lifestyle-related diseases, while providers struggle to increase access and quality of care. However, a brighter future is at hand with a more seamless, collaborative approach by hospitals and health technology companies that put patient care as the focus. As connected technologies continue to disrupt and transform the healthcare industry for the better, healthcare leaders must bridge the gap between bringing innovations forward that can change patient care and driving actual integration into health systems. In fact, this year’s Philips Future Health Index (FHI) data revealed that both healthcare providers (86%) and consumers (61%) believe a more integrated healthcare system would improve the quality of healthcare in the United States.

Without better integration, global access to quality healthcare will continue to decline. If broadly adopted, however, connected technologies have tremendous potential to provide solutions to the resource shortages confronting healthcare in many countries. We will be better able to track and manage the health of populations both inside and outside hospital walls, while simultaneously decreasing unacceptably long wait times, rising cost and severe staff shortages.

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POC adviser,Wolters Kluwer

Baton Rouge general Adds POC Advisor from Wolters Kluwer to reduce sepsis

November 2, 2017 – Wolters Kluwer Health today announced that Baton Rouge General will deploy POC Advisor™, leveraging its clinical surveillance and analytics to reduce sepsis mortality and morbidity rates. The clinical intelligence platform will be a central component of the “Most Wired” hospital’s overall clinical and technology strategy.

“Using advanced technology is key to preserving and restoring health,” said Bennett Cheramie, Vice President of Information Technology at Baton Rouge General. “By making our front-line team members aware of patients with sepsis, POC Advisor will help us treat sepsis in its earliest stages.”

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Precision medicine: From one-size-fits-all to personalized healthcare

Scientist pipetteAdvances in technology are essential if precision medicine is going to become reality.

Imagine a future in which, rather than using symptoms to identify a disease, your genes, metabolism, and gut microbiome inform how your individual health is managed. This is the vision of precision medicine.

Traditional medicine uses symptoms to diagnose diseases, and drugs to treat these symptoms. But precision medicine aims to turn this concept on its head.

By identifying the factors that predispose a person to a particular disease and the molecular mechanisms that cause the condition, treatment and prevention strategies can be tailored to each individual. 

So, how do we get from traditional to precision medicine? Advances in genetics and molecular analysis techniques have been a deciding factor, as has getting patients involved with managing their own health.

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Beyond privacy concerns: Interactive gadgets can pose threat to children’s psychology

Children, who are learning what’s appropriate social interaction, can be affected more than adults by the human-computer relationship that’s becoming more commonplace in homes. In other public health news: early menopause, the shingles vaccine, fatty liver disease, racism, and gun safety.

NPR: Parenting in the age of Alexa, are artificial intelligence devices safe for kids?
Earlier this month, the toy-giant Mattel announced it had pulled the plug on plans to sell an interactive gadget for children. The device, called Aristotle, looked similar to a baby monitor with a camera. Critics called it creepy. Powered by artificial intelligence, Aristotle could get to know your child — at least that was how the device was being pitched. (Doucleff and Aubrey, 10/30)

The New York Times: Underweight women at risk of early menopause
Underweight women are at increased risk for early menopause, a new study has found. This study, in Human Reproduction, followed 78,759 premenopausal women ages 25 to 42 beginning in 1989. Over the following 22 years, 2,804 of them reported natural menopause before age 45. (Bakalar, 10/26)

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Amazon is poised to enter Pharma landscape — so what will that look like?

Stat: Who wins and who loses if Amazon enters the prescription drug business

Will pharma be the next business Amazon disrupts?In industry after industry, the company has turned practices and expectations inside out — and the pharmaceutical world is the latest poised for change as speculation mounts that Amazon will soon start selling prescription medicines. Anticipation has been building for months, in fact, but it heightened last week on the news that Amazon (AMZN) obtained wholesale pharmacy licenses in at least a dozen states. (Silverman, 10/30)

Bloomberg: Amazon’s ambitious October spooks stocks standing in its path
The looming threat of Amazon.com Inc. siphoned billions in market cap from Under Armour Inc. to FedEx Corp. to Walgreens Boots Alliance Inc. — more than $30 billion combined — in October. Companies are gearing up to face Bezos’s behemoth heading into the holiday season, with some appearing ready to get creative as the state of their industries is shaken. (Smith, 10/31)

The New York Times: The more lavish the gifts to doctors, the costlier the drugs they prescribe
When drug companies give gifts to doctors, the doctors prescribe more — and more expensive — drugs. The more lavish the gifts, the greater the effect. Researchers used data from the Center for Medicaid and Medicare Services on the prescriptions written by doctors in Washington, and information from the D.C. Department of Health on gifts from pharmaceutical and medical device companies given to providers in 2013. (Bakalar, 10/25)

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Inc,Messagepoint

Automation spells relief for medicare advantage organizations

Daron Domino, Vice President, Messagepoint

Written by: Daron Domino

It’s a familiar, tiring drill every year for those who work for Medicare Advantage Organizations (MAOs). There is a frantic rush from the time your organization makes its bid submission on the first Monday in June through the middle of August when plan materials need to go to print. Material preparation teams are tasked with preparing benefit materials such as the Annual Notice of Change, Evidence of Coverage, and Summary of Benefit that are compliant with CMS marketing guidelines, ensuring that all regulatory language, benefits and operational information is 100 percent accurate. Sitting between Product and Compliance, material preparation teams are challenged during the annual enrollment period (AEP) preparation as they process a sea of ad-hoc change requests.

Because of CMS timelines and the Sept. 30 in-home date, the annual update process typically starts ahead of benefits and plan approval being complete. So, there is risk of doing work to prepare materials for a plan, or plans, that may not receive CMS approval.

For most MAOs, the annual materials preparation process has been largely manual, resulting in increased efforts and risk of error. Many have attempted to automate the process only to find significant lead-times, costs, complexity, and ultimately a different set of challenges.

With a traditional document automation approach, data and rules drive the process. Those taking this approach spend most of their time managing a long list of business rules. One company we interviewed ended up with thousands of rules to drive benefits and content across their Individual market and Group plans. Automation was intended to simplify the annual process, reduce time and effort, and ultimately eliminate human error. Their attempt resulted in a process that requires an IT skill-set to set up and manage complex rules and a complex QA process to assess the impact of rule changes across plans, both of which have effectively eliminated any cost benefit. As a result, the team supporting materials preparation continues to work endless hours each summer.

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EMR data integration

EMR data integration: Still a long way to go

Bill Sun, X by 2

Written by: Bill Sun

The advent of Electronic Medical Records (EMR) has been a boon to the operational and analytical abilities of healthcare analytics firms and medical providers, allowing them to more accurately document, track and create the analytics required to better care for patients. Likewise, patients have benefited from the ability to track and monitor their care needs across time, allowing proactive actions to take place when identified and recommended by their healthcare providers. One of the core goals of an EMR-based medical practice is to improve the overall quality of care over time across their particular patient population. This is welcome news all around, but it ultimately entirely depends on the effective and efficient creation, organization, normalization and distribution of medical practice and patient-related data. And that’s where the trouble begins.

For all its benefits—realized and potential—the process of aggregating and consuming EMR (and its offspring the Electronic Health Records or EHR) information is still problematic at best. To date, there is no single technical standard for creating, formatting and distributing EMR data between healthcare analytics firms and EMR vendors. The net result of that is the sub-optimization of the accuracy and usefulness of EMR data. That’s not only an operational issue for healthcare analytics firms but also a serious quality of care issue for patients.

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MACRA Success,RCM

Re-evaluating the Role of RCM for MACRA Success

It’s hard to believe we’re already well into the latter half of the first Medicare Access and CHIP Reauthorization Act (MACRA) reporting year. With the clock ticking, pressure continues to mount for physician organizations to close the inaugural year with strong momentum before 2018. Although CMS recently proposed several changes that may make Year 2 of the MACRA Quality Payment Program (QPP) less challenging for some providers, it could be more demanding for other organizations.

For Year 1, healthcare leaders identified “revising data management/reporting mechanisms to meet new reporting requirements” as the top QPP challenge within the fifth annual Healthcare IT Industry Outlook Survey. That difficulty is unlikely to change for 2018. Because the QPP ties provider reimbursement incentives to care quality, improvement activities, costs and electronic health record (EHR) utilization, alignment has been critical this year, but will be especially crucial moving into 2018. Given that, what opportunities can the revenue cycle management (RCM) team take advantage of to improve their MACRA performance for the remainder of this year into next?

Assembling the Right Team

Traditionally, provider organizations have focused reporting needs on claims and reimbursement data, working within separate data silos, disconnected from associated facilities. In the transition to value-based care, they’re finding it more imperative to work cohesively across three key resource groups to access and obtain the right data for MACRA needed to attain positive or even neutral adjustments to reimbursement.

Providers need to form a strategic cross-disciplinary team including representation from financial, clinical and operational IT departments to maximize access to the right data across the patient-care continuum. Considering the two reporting paths, either Advanced Alternative Payment Models (APMs) or Merit-based Incentive Payment System (MIPS), the revenue cycle representatives on the committee can offer key insights into program measure selection.

In fact, RCM representation is so critical that one might argue that successful MACRA strategy cannot move forward without it. This financial team offers specific insight into which MACRA measures to select, by tapping into their knowledge of values and performance from past physician incentive reporting programs. For example, historical data from the Physician Quality Reporting Program (PQRS) and the Value Based Payment Modifier (VBPM) can point to which measures offer the highest potential for positive reimbursement adjustments. The QPP provides options of measures to report within each category, and the right scoring criteria can make a big difference in reporting success.

Making the Most of MACRA
With RCM representation as a critical decision maker, consider utilizing theses best practices to excel with MACRA QPP reporting.

  • Get the basics. Get a solid understanding of the QPP and the two path options. Consider the best reporting measures from the full set of options for your organization. Utilize industry resources like the Centers for Medicare & Medicaid Services (CMS) QPP measure guide for your pick-your-pace reporting to avoid penalty before the first year ends.
  • Use your physician group’s medical specialties mix to your advantage. Many program measures are focused on specific population health concerns, which may relate to some medical specialties more heavily than others. If your providers already have specific-focus care programs for one of the chronic disease groups, attaining key measures for those may be easier.
  • Check out helpful resources. CMS released several resources for MIPS-eligible clinicians through the QPP. The MIPS participation factsheet covers program exemptions, participant expectations and guidelines. CMS-approved MIPS qualified registries serve as a data submission option on behalf of both individual and groups of eligible clinicians.
  • Look ahead into expanded exemptions. QPP year 2’s leniencies relieve small and rural practices by expanding exemption threshold to cover clinicians or groups who have billed less than $90,000 in Medicare Part B or treat fewer than 200 Part B patients. Your RCM staff should be able to determine quickly if your practice is below this threshold.
  • Set the foundation. MACRA reporting is lost without accurate data. Data analytics tools can work with optimized EHR systems to effectively collect, maintain, document and analyze meaningful patient data, moving beyond the abyss of unstructured information and capturing the entire picture of patient care. Likewise, while providers can continue using 2014 certified EHR technology (CEHRT) for MIPS Year 2, those who use 2015 CEHRT are eligible for a 10 percentage point bonus under the ACI category.
  • Know where you stand. If you submitted quality data in the last calendar year, consider your Quality and Resource Use Report (QRUR) from CMS, which analyzes performance at the Tax Identification Number (TIN) level. Reviewing this will help you assess performance in terms of cost and quality to consider areas to improve. Aspects of this report, like PQRS and Value-Based Payment Modifier, are rolled into MACRA. In addition the QRUR will highlight your physicians ranking among their peers to give you added insight into how forecasting will impact reimbursement as the reporting year unfolds.
  • Ensure accurate coding. Make sure billers and coders fully assess the coding system to find inaccuracies, looking for risks like downcoding or missing modifiers that can impact the overall picture of care and revenue opportunity. The importance of this type of post-care analysis cannot be overstated as these steps can dramatically alter a physician’s composite score.
  • Use 2017 to solidify footing. Reporting requirements will only accelerate after 2017. Although the pick-your-pace guideline applies this year, 2018 requires a full year of data for both the quality and cost categories (though cost has no weight on the final score). An organization should use this initial reporting year to reassess performance improvement measures while cementing its MACRA governance committee for long-term success. Under MIPS, adjustments to reimbursement and/or penalty opportunity increases to 9 percent by 2022, so use this first year as a jumping point.
  • Consider future path options. While most organizations may report under MIPS within this first year, they don’t necessarily have to follow suit in future reporting periods. With the insight from financials, decide whether MIPS or APMs reporting best fits long-term stability and growth.
  • Explore virtual groups. An addition to the QPP for Year 2 is virtual-group participation in MIPS. Virtual groups consist of solo practitioners and groups comprised of 10 or fewer MIPS-eligible clinicians coming together virtually for 2018 performance participation with at least one other solo practitioner or group. Your RCM staff is integral in deciding if a virtual group will be financially advantageous for the practice in Year 2 and afterwards.
  • Evaluate future composition of physician groups. Change is constant within the overall composition of physician groups, both from the perspective of new additions or that of attrition. Managers need to consider this financial perspective for impact on MACRA reporting since there is a two-year gap between financial reporting and reimbursement adjustments. QPP final scores will impact providers beyond reimbursement as physician scores will be published online and shared on third-party sites.

So whether you are beginning your MACRA reporting path, moving through strategic planning or in the midst of data collection, consider the significance of RCM on QPP reporting alignment and success, including governance leadership and insight into operational effectiveness. Without financial entities at the MACRA decision-making table, the full picture of reporting measure selection and outcomes cannot be seen.

 

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