Archive for October, 2015

Infographic: Meet Today’s Healthcare Consumer

October 30th, 2015 by Melanie Matthews

Consumer engagement is increasing in three important areas—provider partnerships, online health information searches and technology use, according to findings from Deloitte's 2015 Survey of U.S. Health Care Consumers.

A new infographic by Deloitte looks at how these trends are impacting today's healthcare consumer.

Meet Today's Healthcare Consumer

Skyrocketing private exchange participation rates—industry estimates predict more than 40 million people may be enrolled in private insurance exchanges within three years—carry implications for health insurers in terms of how the various market segments are succeeding or failing to attract business.

Private Insurance Exchanges: Adapting Insurer Strategies to the New Marketplaces details the radical transformation underway in how employers and consumers offer and shop for coverage. It discusses the current status of private exchanges, reviews the inventory in existence today, and shares thoughts from market consultants and insurance executives on how new business strategies will be influenced by new entrants to the private exchange space and the participation of insurers and brokers.

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Infographic: Patient Out-of-Network Fees

October 28th, 2015 by Melanie Matthews

Patients who seek care from out-of-network providers or specialists, see, on average, potential excess charges of 300 percent compared to Medicare's fee for the same treatment or procedure, according to a new infographic by AHIP.

The infographic compares the out-of-network charge for 10 healthcare encounters compared with the Medicare payment for that service.

Patient Out-of-Network Fees

Narrow networks—for both medical and pharmacy providers—are gradually becoming more accepted by carriers, plan sponsors and patients. Smaller provider networks allow payers to manage overall healthcare costs while still maintaining access to benefits—an important consideration as plan designs become more commoditized in the age of public and private health insurance exchanges.

Narrow Network Strategies and Trends for Health Plans and PBMs outlines the tactics health plans are using to restrict medical and pharmacy networks while still maintaining adequate access to care and positive relationships with providers. It also summarizes case studies of health plans and PBMs that have formed narrow networks and the results they’ve seen.

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The Value of Unlocking Unstructured Patient Data

October 27th, 2015 by John Smithwick, CEO, RoundingWell

In this guest post, RoundingWell CEO John Smithwick explains why all healthcare data should be structured and ready for interpretation and analysis, no matter how it is initially collected.


Getting patients diagnosed correctly and treated appropriately depends on providers gathering both quantitative data, which is typically structured, and qualitative data, which is typically unstructured. When comparing both types of data, it’s more challenging to manage and derive value from unstructured data.

Structured data is that which is quantifiable and measureable, such as signs like lab results, blood sugar levels and cholesterol. This type of data is objective and can be entered discretely into EMRs via predefined fields. Since the data is structured, software systems are able to understand the meaning of the data, interpret the data and report on it. Structured data can be put to use by clinicians at the point of care to aid their decision-making.

On the other hand qualitative data, such as symptoms like pain, discomfort and fatigue, is considered unstructured data. This type of data is subjective to the patient and is often gathered through conversations based on what the clinician asks and what the patient discloses. While it might seem like a simple exchange of niceties between clinician and patient, these communications provide a lot of information to the clinician, such as whether a patient is experiencing depression, or notices shortness of breath upon standing.

Correct diagnoses and appropriate treatments are dependent on managing both structured and unstructured data. Managing each type of data appropriately also greatly influences the outcomes a healthcare organization is able to deliver. As the amount of reimbursements tied to outcomes increases, delivering quality outcomes becomes all the more important.

Problems with Unstructured Data

Managing structured data is usually handled well. It’s in the management of unstructured data where problems arise. There are two primary problems with unstructured data:

  • The first problem is technical. Unstructured data is most often recorded in EMRs in free text fields or note fields. Data stored this way makes it very difficult for software systems to interpret, understand and analyze.
  • The second problem is process-related. Unstructured data is not gathered consistently or systematically. A clinician only knows about symptoms if he or she asks the patient, which doesn't always happen, or if the patient discloses the information, which, again, doesn't always happen. When symptoms are overlooked or patients withhold information, clinicians can’t make the right diagnosis or give the best treatment.

The ballooning amount of data available is its own issue. In 2012, worldwide digital healthcare data was estimated to be equal to 500 petabytes, and that number is only growing: the data is expected to reach 25,000 petabytes in 2020. It can be a daunting challenge for healthcare organizations to gain value from this mountain of data. To add to this, industry consensus is that approximately 80 percent of all healthcare data is unstructured data.

What the Future Holds for Unstructured Data

So, what if technology could not only ensure patients were being diagnosed correctly, but also automate the process? Cloud-based care management and patient engagement software are providing new ways for healthcare organizations to unlock the value of unstructured data. In essence, by creating “structured symptoms”—gathering patient-reported symptoms and discretely capturing them in a way the data could be analyzed.

These platforms systematically assess patients for symptoms (and signs) that they might not get asked about directly by a provider, and that they might not self-disclose because they don't think it's important (or because they simply forget). Care management software then stores patient symptom information in a structured way, allowing this previously unstructured data to be analyzed and made actionable.

The bottom line? Whether gathered via care management software, EHR or patient-specific physician insights, all data should be structured and be ready for interpretation and analysis. This is especially critical in value-based models: for any risk-bearing entity, getting this complete picture is absolutely critical in order to give patients the right treatment at the right time, to improve outcomes and prevent adverse health events.

John Smithwick

About the Author: John Smithwick is the CEO of RoundingWell. He co-founded RoundingWell in 2011 following four years at Nashville's Healthways, where he led the design effort for its Web-based disease and lifestyle management product offerings. Prior to his work at Healthways, he worked in product management at Microsoft in Redmond, Wash. and in technology strategy consulting with Accenture in Boston, Mass. A graduate of the University of Richmond, he holds a master's of business administration from the University of Pennsylvania’s Wharton School of Business.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Where Are You on the Healthcare Analytics Journey?

October 26th, 2015 by Melanie Matthews

Where Are You on the Healthcare Analytics Journey?To be successful in the value-based care and population health management paradigm, healthcare organizations must be able to leverage data to drive better outcomes, improve the patient experience and create cost efficiencies, according to a new infographic by IBM.

The infographic drills down on five layers of data analytics, the type of data that is collected at each layer and the how that data can be used.

While widespread adoption of electronic health records has generated new streams of actionable patient data, John C. Lincoln has taken data mining to new levels to enhance performance of its accountable care organization (ACO).

Beyond the EMR: Mining Population Health Analytics to Elevate Accountable Care reviews the concentrated data dig undertaken by John C. Lincoln to prepare for participation in the CMS Medicare Shared Savings Program (MSSP).

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Infographic: Chronic Care Management Reimbursement Trends

October 23rd, 2015 by Melanie Matthews

Chronic Care Management Reimbursement TrendsPhysician participation in the chronic care management program is expected to grow to 70 percent of all practices by the third quarter of 2016, according to a new infographic by Smartlink Mobile.

The infographic looks at the program's impact on physician practices and practices' understanding of the program requirements.

Starting this past January, Medicare is reimbursing physician practices for select Chronic Care Management (CCM) services not previously eligible for reimbursement, underscoring the vital role of care management in primary care.

Physician Reimbursement for Chronic Care Management: Identifying New Practice Revenue Opportunities offers practical guidance for physician practices to maximize CCM reimbursement.

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Medicare Chronic Care Management Reimbursement: Clarifying EHR Use and Electronic Requirements

October 22nd, 2015 by Patricia Donovan

Just one-fifth of U.S. physician practices participate in CMS's Chronic Care Management Program.

Nearly 70 percent of physicians nationwide admit they do not fully understand the Medicare Chronic Care Management (CCM) program, according to an August 2015 study by Smartlink Mobile Systems. The survey of 45,000 American physician practices determined that while 20 percent do participate in CCM, there is a great deal of confusion surrounding the CMS program designed to curb the cost of coordinating care for 34.4 million Medicare fee-for-service beneficiaries with two or more chronic diseases—particularly when it comes to meeting CCM's electronic requirements.

The CCM initiative pays participating physician practices a monthly fee for twenty minutes of non-face-to-face patient care.

Earlier this year, Dr. Paul Rudolf, partner, Arnold & Porter LLP, and Nicole Liffrig, counsel, Arnold & Porter LLP, delved into CMS requirements and discussed approaches and challenges to meeting the CCM requirements, including a practice's requirements for electronic health records (EHRs):

The CCM care plan is all the clinical staff needs to have access to in order to count time toward the 20 minutes. In terms of the EHR itself, the practice is only required for certain specified services within the Chronic Care Management. For example, the practice has to create a structured recording of demographics, problems, medications and allergies within the EHR, and then that information must inform the care plan. The care plan will include that type of information but doesn’t have to include everything that is in the EHR.

The practice also must put into the EHR a structured clinical summary record, which is discussed at some length in the final rule. In addition, the EHR must document that there’s written consent for the CCM services and all the other things the practice explained to the patient when the patient gave consent.

In addition, the care plan must be provided to the patient. That could be a hard copy or an electronic copy. The communication to and from home with community-based providers regarding their psychosocial needs and functional deficits also must be in the EHR.

Essentially, the electronic care plan is a distilled version of the EHR containing the pertinent information clinical staff would need to provide CCM services.

However, in spite of this interpretation, one Medicare contractor recently suggested that in order to count time toward the 20 minutes, the clinical staff has to have access to the EHR. We believe that is an incorrect interpretation of the rule. We believe the practitioners only need access to the electronic care plan.

The last thing I would like to mention about the EHR is that use of the EHR to provide care plans and other information to all off-site clinical staff and to other practitioners could theoretically raise privacy concerns. These are not new privacy concerns, but any practice that is going to provide CCM services needs to be cognizant of potential HIPAA issues and make sure they are in compliance. One thing that can be done in this regard is to have the individuals with EHR access sign business associate agreements.

Source: Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue

http://hin.3dcartstores.com/Chronic-Care-Management-Reimbursement-Compliance-Physician-Requirements-for-Value-Based-Revenue_p_5027.html

Chronic Care Management Reimbursement Compliance: Physician Requirements for Value-Based Revenue sets the record straight on CCM reimbursement compliance, offering strategies for navigating obstacles and meeting requirements. In this 25-page resource, attorneys Dr. Paul Rudolf, partner, Arnold & Porter LLP, and Nicole Liffrig, counsel, Arnold & Porter LLP, drill down into chronic care management requirements outlined in the 2015 Medicare Physician Fee Schedule.

Infographic: Patient Demands Drive Health IT Transformation

October 21st, 2015 by Melanie Matthews

Today's healthcare consumer demands are driving IT transformation, according to a new infographic by CDW Healthcare.

The infographic examines how patients want to communicate with their physician and new routes of patient education and access to care.

Patient Demands Drive Health IT Transformation

As the healthcare industry's understanding of the importance of an empowered, engaged patient has increased, Intermountain Healthcare changed its mission statement to reflect the critical role of patients in a value-based healthcare system. "Helping people live the healthiest lives possible" embodies the new environment of shared accountability between patients and providers that is fostered at Intermountain Healthcare.

During A Patient Engagement Framework: Intermountain Healthcare's Approach for a Value-Based System, a 45-minute webinar, on October 28th at 1:30 p.m., Tammy Richards, corporate director of patient and clinical engagement at Intermountain Healthcare, will share the key tenets of Intermountain's patient engagement strategy.

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HINfographic: Patient Engagement Tactics to Drive Satisfaction, Care Plan Adherence and Quality

October 19th, 2015 by Melanie Matthews

Today's value-focused healthcare models theorize that engaged patients not only are healthier and more satisfied but also may generate fewer costs than the non-engaged. Whether patient engagement translates to a healthy bottom line remains to be seen. In the meantime, the inaugural Patient Engagement survey by the Healthcare Intelligence Network identified a range of tactics in use by 133 healthcare organizations to improve overall population health engagement.

A new infographic by HIN examines the types of tools healthcare organizations use to engage patients and drills down on the use of patient portals within patient engagement programs.

2015 Healthcare Benchmarks: Patient EngagementTransformational patient-centered models emerging post-ACA are designed to succeed with a core of engaged, activated patients, yet enlistment of individuals in chronic care management, telehealth and other health enhancement interventions continues to challenge the healthcare industry.

2015 Healthcare Benchmarks: Patient Engagement documents strategies, program components, successes and challenges of engaging patients and health plan members in self-care from 133 organizations responding to the 2015 Patient Engagement survey by the Healthcare Intelligence Network. Click here for more information.

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Infographic: A Comparison of ACA Marketplace and Employer Health Plan Costs

October 16th, 2015 by Melanie Matthews

Healthcare premium costs for lower-income enrollees in the ACA Marketplace are similar to those with employer coverage, according to The Commonwealth Fund.

A new infographic by The Commonwealth Fund examines the premium levels of marketplace and employer plan enrollees, as well as deductible levels for these segments.

A Comparison of ACA Marketplace and Employer Health Plan Costs

2014 Performance Measures for Individual, Small-Group and Large-Group Risk-Based Plans

Commercial Health Plan Market Metrics provides a snapshot of the rapidly evolving commercial risk health insurance market, by assessing the impact of the individual mandate, exchanges and other Affordable Care Act initiatives. Filled with charts and statistics applying metrics such as membership, premium revenue and claims expenses, it measures which plans made profits—and how profitable they were—in various segments of this market during the first full year of ACA implementation.

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Infographic: Why Use Telemedicine in the ICU?

October 14th, 2015 by Melanie Matthews

With the dramatic increase in the number of ICU patients in the United States, combined with a shortage of qualified ICU intensivists, many hospitals are turning to telemedicine to help monitor ICU patients.

A new infographic by Eagle Hospital Physicians shows how telemedicine is currently being used in the ICU along with the benefits of cost-savings and improved quality of care that hospitals and other healthcare facilities are realizing.

Why Use Telemedicine in the ICU?

The world of digitally enabled care is exploding: the number of patients using telehealth services will rise to 7 million in 2018, according to IHS Technology; healthcare apps and 'wearables' are trending in technology circles and healthcare providers' offices; and CMS's new 'Next Generation ACO' model is expected to favor expanded telehealth coverage.

2015 Healthcare Benchmarks: Telehealth & Telemedicine delivers actionable new telehealth metrics on technologies, program components, successes and ROI from 115 healthcare organizations. This 60-page report, now in its fourth year, documents benchmarks on current and planned telehealth and telemedicine initiatives, with historical perspective from 2009 to present.

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