Archive for November, 2016

Infographic: Overcoming 5 Data Challenges Preventing Effective Physician Alignment

November 14th, 2016 by Melanie Matthews

Achieving physician alignment, critical to the success of health systems, requires a view into physician activity and referrals, according to a new infographic by Evariant.

Claims data is the best source of information to help analyze and identify referral patterns to move toward achieving physician alignment, but analyzing this information does not come without its own unique set of challenges. The infographic examines five data challenges preventing effective physician alignment and how to overcome them.

Overcoming 5 Data Challenges Preventing Effective Physician Alignment

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability In today’s value-based healthcare sphere, providers must not only shoulder more responsibility for healthcare outcomes, cost and quality but also align with emerging compensation models rewarding these efforts—models that often seem confusing or contradictory. The challenges for payors and partners in creating a common value-based vision are sizing the reimbursement model to the provider organization and engaging physicians’ skills, knowledge and behaviors to foster program success.

6 Value-Based Physician Reimbursement Models: Action Plans for Alignment, Analytics and Profitability examines a set of provider compensation models across the collaboration continuum, advising adopters on potential pitfalls and suggesting strategies to survive implementation bumps.

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ACA Afterlife: Unwinding Obamacare Under the Trump Administration

November 14th, 2016 by Patricia Donovan

The people have spoken: the future of the ACA is healthcare's most pressing concern for 2017.

The people have spoken: the future of the Affordable Care Act is healthcare’s most consuming concern for 2017.

If U.S. President-elect Donald J. Trump delivers on his campaign promises, the ‘repeal and replacement’ of the Affordable Care Act (ACA) should be an early priority for the nation’s chief executive-in-waiting.

That prospect sent shock waves through the healthcare industry, as evidenced by a snapshot of post-election responses to the ongoing Healthcare Trends in 2017 survey sponsored by the Healthcare Intelligence Network.

“The change or replacement of Obamacare might affect us significantly, including changing our USA market priority over other markets,” contributed one respondent.

“We don’t know what ACA repeal implications will mean for us,” offered another.

Other respondents identified “changes to our government structure and the unknown impact” as well as “lack of clarity post-election” as their most pressing concerns for the year ahead.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Given Trump’s ambitious healthcare agenda, much is at stake for industry stakeholders. But is it possible for the incoming administration to unravel the ACA, when the public already has been exposed to many of its provisions? And if repeal is possible, how long might the process take?

Greg Mertz, managing director for Physician Strategies Group, LLC, advises healthcare organizations not to panic about the ACA’s demise. “A ‘“repeal and replace’ means that Trump admits Obamacare can’t go away. Nothing will happen quickly, and whatever happens will be less dramatic than many expect,” predicts Mertz, who points to Trump’s lack of specifics as to what might replace Obamacare as further evidence.

“House Speaker Paul Ryan, R-Wisconsin, has already put forward his plan for healthcare reform, so I would think his ideas will be a pivotal part of what eventually gets passed,” continues Mertz. “However, Congress still decides what happens, so whatever Trump proposes will be mired in hearings, staff work, and debate for at least the next year. This means that we limp along with a broken program as we argue what is better.”

Also based on Ryan’s healthcare proposals, Travis Ansel, senior manager of strategic services for Healthcare Strategy Group, is advising providers to brace for more Health Savings Account (HSA)-related payment woes. “Ryan’s plans for Medicare, which have loomed over the industry for five years, bring with them increased patient payment obligations,” Ansel explains. “Expect more and more employer-based coverages to shift to HSAs as well. We can expect payors to raise insurance premiums across the board as the Republican-led Congress unwinds the ACA.”

Ansel pointed out that major payors were forced to shift their business models and infrastructure to compete in an ACA-focused market. “The quick shift back will be a reality these payors are not prepared for and not prepared to succeed under,” he concludes.

As payor margins suffer, adds Mertz, pressure will be placed on commercial insurers to raise reimbursement to offset the gap. “Employers will howl and the feds will be pressured to control costs, especially big pharma.”

Where Mertz does expect activity is within the Health Insurance Exchanges created by the ACA. “The insurance exchanges are in trouble already, so we would expect that providers that were seeing significant numbers of exchange-insured individuals would have likely seen a drop in those numbers regardless. I think the number of uninsured will increase in the short-term, as many will decide that paying the penalty is better than paying the premium.”

As to what healthcare might look like under the Trump administration, Mertz thinks the industry will see tax credits or vouchers. “However, I seriously doubt we’ll see a government-sponsored alternative, which I think we would have seen with (the Democratic presidential nominee) former U.S. Secretary of State Hillary Clinton.”

On the provider side, Mertz expects that while physicians will see little impact, hospitals will see a rise in charity care, and no major increase in income.

For a post-election roadmap to the challenges and opportunities facing healthcare in the year ahead under GOP leadership, don’t miss Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a live webcast on Thursday, November 17 at 1:30 Eastern.

Take the Healthcare Trends 2017 survey and receive an executive summary of the results.

Infographic: Hidden Encrypted Threats Impact Healthcare

November 11th, 2016 by Melanie Matthews

Healthcare organizations are increasingly targeted by cyber criminals seeking to steal electronic protected health information, electronic health records, personally identifiable information and other confidential patient data, according to a new infographic by A10.

The infographic examines the healthcare cyber threat, the need for SSL, why healthcare organizations have been slow to adopt SSL and the top SSL decryption tools.

2016 Healthcare Benchmarks: Digital HealthPerson-centric health management is slowly acknowledging the device-driven lives of patients and health plan members and incorporating these tools into care delivery and management efforts.

2016 Healthcare Benchmarks: Digital Health examines program goals, platforms, components, development strategies, target populations and health conditions, patient engagement metrics, results and challenges reported by healthcare organizations responding to the February 2016 Digital Health survey by the Healthcare Intelligence Network.

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Infographic: Health Re-imagined

November 9th, 2016 by Melanie Matthews

Cost, quality and access challenges will continue to spur healthcare reform initiatives, according to a new infographic by EY.

The infographic examines how the growth of patients with chronic disease is impacting the system, how connected healthcare is transforming healthcare and what’s driving developments in personalized medicine.

Trends Shaping the Healthcare Industry in 2017: A Strategic Planning SessionThe potential for changes to the healthcare regulatory environment and market structure based on the outcome of this year’s Presidential and congressional elections, the continued drive toward value-based models and the upcoming changes in physician reimbursement are just some of the trends that will continue to impact the healthcare industry in 2017. Combined with the consolidation in the industry and flux in the health insurance exchange market, there’s no shortage of challenges and opportunities for healthcare organizations in the year ahead.

Trends Shaping the Healthcare Industry in 2017: A Strategic Planning Session, a 45-minute webinar on November 17, 2016, at 1:30 p.m. Eastern, Steven Valentine, vice president, Advisory Consulting Services, Premier Inc., will provide a roadmap to the key issues, challenges and opportunities for healthcare organizations in 2017.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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Infographic: 24/7 Online Health

November 7th, 2016 by Melanie Matthews

Seventy percent of U.S. patients are comfortable communicating with doctors via text, email and video, according to a new infographic by Anthem.

The infographic examines how telehealth services could address the primary care shortage and access to care issues while potentially reducing costs.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System Encouraged by early success in coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients. At that scaling-up juncture, the challenge for CHRISTUS shifted to balancing its mission of keeping patients healthy and in their homes with maintaining revenue streams sufficient to keep its doors open in a largely fee-for-service environment.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge.

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Infographic: Moms and Health Technology

November 4th, 2016 by Melanie Matthews

Moms are benefiting from the merger of technology and healthcare, according to a new infographic by EmpowerHER.

The infographic drills down on how Moms use technology in healthcare and their perception of telehealth services.

2016 Healthcare Benchmarks: Digital HealthPerson-centric health management is slowly acknowledging the device-driven lives of patients and health plan members and incorporating these tools into care delivery and management efforts.

2016 Healthcare Benchmarks: Digital Health examines program goals, platforms, components, development strategies, target populations and health conditions, patient engagement metrics, results and challenges reported by healthcare organizations responding to the February 2016 Digital Health survey by the Healthcare Intelligence Network.

Click here for more information.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

MACRAeconomics: Chronic Care Management Is the Future of Medicare Reimbursement

November 3rd, 2016 by Patricia Donovan

The newly finalized 2017 Physician Fee Schedule expands Chronic Care Management codes to complex patients with multiple chronic illnesses.

Managing a Medicare population, particularly when the majority has two or more chronic illnesses, can be daunting. But in the current realm of healthcare reimbursement, the care of these beneficiaries is rife with opportunity.

“Depending on the manner in which you’re managing your Medicare Part B demographic, you have an opportunity to generate from 100 to 120 percent of the Medicare fee schedule under MACRA,” noted Barry Allison, chief information officer, the Center for Primary Care, during Physician Chronic Care Management Reimbursement: Setting MACRA’s MIPS Path for 2017.

During this October 2016 webinar now available for replay, Allison described how early adoption of Medicare’s Chronic Care Management (CCM) Reimbursement program enhanced the Center’s MACRA-readiness under the Merit-based Incentive Payment System (MIPS) path. By identifying the more than three-quarters of its 24,000 active Medicare beneficiaries that met CMS’s CCM requirements, the Center had a ready pool of patients on which to overlay CMS’s care coordination best practices and begin earning crucial CCM revenue.

“CMS recognizes that care management is a critical component of primary care. It contributes to better health and care for individuals, as well as reduced spending,” said Allison, who estimates his 40-provider organization is the largest chronic care management initiative in the Southeast.

Using the value-based modifier data available within CMS’s Quality Use and Resource Report (QRUR), The Center for Primary Care further identified its percentage of high-risk Medicare patients for more focused care management.

Accessing and reviewing QRUR reports, available from the CMS Enterprise Identity Management (EIDM) desk, is an essential prerequisite to MACRA participation, advised Allison, who also detailed the type of reports and data available from the QRUR. “Procure that data as soon as possible, because you can learn a lot about what CMS will be looking for in the future, and how the value-based modifier will actually become a part of that MACRA multi-pronged approach.”

While his organization’s CCM program utilized ENLI software to identify ‘hot-spotter’ data elements such as unfilled prescriptions or ER visits for specific conditions, physician practices that lack this technology still have many tools at their disposal—even appointment scheduling software—to identify high-risk patients.

“Open up consistent lines of dialogue and engage your providers. Sit down with them and say, ‘You know your patients better than anyone else. Tell us who to reach out to.'” With or without CCM software, practices should “document, document, document” the amount of time devoted to CCM, as well as how that time benefited patients.

Long-term planning rather than a reactive view will better position physician practices for success under MACRA’s Quality Payment Program, Allison concluded. The Center is already estimating how it will fare under Medicare’s newly finalized 2017 Physician Fee Schedule (PFS). Next year’s PFS significantly updates CCM, offering new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.

“For us, CCM is not really focused on the near term revenue as much as it is about the long term action-reaction we can have in the patient’s life, and how our physicians are paid over the next three years.”

Click here for an interview with Barry Allison on the MACRA Prerequisite of Procuring QRUR Performance Data to Maximize MIPS Success.

Infographic: The Increasing Retail Mindset of Healthcare Plans

November 2nd, 2016 by Melanie Matthews

To succeed in attracting and retaining consumers, health plans need to change their focus to become more like retailers—engaging their plan members in the channels they prefer and creating an enduring value exchange, according to a new infographic by RedPoint Global Inc.

The infographic examines how health plans are expanding customer interactions with online channels, the need for multi-channel touch points and the impact of member engagement on retention.

A profitable by-product of CMS’s aggressive pursuit of value-based healthcare delivery is a menu of revenue opportunities associated with care management of the Medicare population.

Physician Reimbursement in 2016: 4 Billable Medicare Events to Maximize Care Management Revenue and Results details the ways in which Bon Secours Medical Group (BSMG) leverages a team-based care approach, expanded care access and technology to capitalize on four Medicare billing events: transitional care management, chronic care management, Medicare annual wellness visits and advance care planning.

Click here for more information.

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Have an infographic you’d like featured on our site? Click here for submission guidelines.