Archive for the ‘Healthcare Benchmarks’ Category

Guest Post: A Report on Healthcare Data Security & Privacy Compliance

July 26th, 2018 by Gary Palgon

Privacy and security regulations for enterprise data in healthcare organizations are complex and current efforts to bolster enterprise data compliance among all organizations, including those in healthcare, are immature and ineffective, according to a recent study conducted by Aberdeen, an industry analyst firm.

In fact, 86 percent of 112 hospitals and hospital groups in the study are dealing with multiple types of data and data-related processes that are subject to compliance requirements. This is not surprising because healthcare organizations generate, collect, store and manage financial transactions, personally identifiable information, protected health information, employee records and confidential or intellectual property records such as partnership agreements and contracts.

When asked if their organizations were compliant with 11 common regulations and frameworks for data privacy and security, only 65 percent reported achievement. PHI has the highest percentage of compliance reported—85 percent. The lowest compliance rates were reported for ISO 27001 and the General Data Protection Regulation at 63 percent and 48 percent respectively.

To measure the maturity of healthcare organizations’ efforts to comply with privacy and security requirements for data, Aberdeen developed a Net Maturity Index across six key elements of an enterprise data lifecycle. An index score above 50 percent indicates strong maturity in compliance activities and below 50 percent indicates immaturity.

Managing data, which includes normalizing, cleansing, validating and correlating data, earned a 66.6 percent score for healthcare respondents, the only element that indicated maturity. Scores for other key elements were:

  • 49 percent for storing data—persistent, on-demand, self-service access to data;
  • 41.2 percent for protecting data—encryption, tokenization;
  • 33.4 percent for syndicating data between any two applications—including mobile, connected devices, on-premises or cloud;
  • 25.4 percent for ingesting data into a common repository—cloud-based, data lakes; and
  • 3.9 percent for integrating data from multiple sources—disparate sources, formats and protocols

The immaturity of the data lifecycle and associated enterprise data compliance efforts has real-world consequences for healthcare entities. Four out of five (81 percent) study participants reported at least one data privacy and non-compliance issue in the past year, and two out of three (66 percent) reported at least one data breach in the past year.

Investment in data compliance efforts is not lacking. A median of 37 percent of the overall IT budget of healthcare survey respondents is allocated to data compliance activities. This is a significant amount of funding to still experience data breaches, data compliance issues and low percentage of achievement of compliance with multiple enterprise data security and privacy regulations. When compared to respondents from life science and other industries, healthcare respondents reported the highest percentage of the IT budget devoted to data compliance.

The survey also indicated that healthcare organizations are more likely than organizations in other industries to have instituted compliance-specific governance processes and appointed specialized leadership such as data protection officers, compliance officers or chief risk officers, to oversee enterprise data compliance initiatives. While these are often considered to be best practices for achieving data compliance, still less than half of all healthcare organizations have instituted these approaches. Having specialized leadership is one of the most likely ways to effectively address enterprise data security and privacy compliance issues but it may also present further complications. Although the role may be assigned to an individual, the task of ensuring compliance with multiple regulations that evolve and change along with new technology and the addition of new data sources, requires an expertise that is difficult to achieve and oversee by one person who probably wears multiple hats in the organization.

One solution to the complex, challenging task of achieving data security and privacy compliance is the use of third-party providers who can address the healthcare organization’s need to enhance integration, management and storage of data. Providers who are experts at data management and integration but also provide the added value of the expertise needed to ensure compliance with regulatory requirements affecting data will offset some of the burden on hospital staff. The solution is not a simple application or a one-off project. Achieving and sustaining compliance with data privacy and security rules as they evolve is an ongoing effort.

The study also points to the need to better manage financial investment in compliance strategies. One option for healthcare organizations is managed services agreements with data management and integration providers. Switching to a predictable, monthly fee versus periodic capital investment or ongoing efforts that are ineffective frees IT funds to be used to advance other hospital goals.

Although many healthcare organizations do not consider outsourcing some of their data management, integration and compliance challenges, but choosing a partner wisely—one with expertise in healthcare as well as other data-centric industries with multiple privacy and security requirements—can reduce the compliance burden on an already overworked hospital IT staff and make funds available to continue digital transformation or other strategic initiatives.

Read the overall survey report here: Enterprise Data in 2018: The State of Privacy and Security Compliance

Read the brief on results for healthcare organizations here: Enterprise Data in 2018: The State of Privacy and Security Compliance in Healthcare

About the Author:

Gary Palgon

Gary Palgon

Gary Palgon is vice president of healthcare and life sciences solutions at Liaison Technologies. In this role, Gary leverages more than two decades of product management, sales, and marketing experience to develop and expand Liaison’s data-inspired solutions for the healthcare and life sciences. His unique blend of expertise bridges the gap between the technical and business aspects of healthcare, data security, and electronic commerce.

HINfographic: Case Management Trends: Face-to-Face Patient Encounters Edge Out Telephonic

September 6th, 2017 by Melanie Matthews

As integrated care management takes hold, patients are much more likely to interact with a case manager at their healthcare provider’s office today than they were four years ago, say respondents to the 2017 Case Management Survey by the Healthcare Intelligence Network. The embedding or colocating of case managers within points of care rose from 54 percent in 2013 to 66 percent this year, the survey found.

A new infographic by HIN examines the top case manager-patient interactions, case management monthly caseloads, details on return on investment for case management programs and more case management trends.

At the point of care or behind the scenes, care coordination by healthcare case managers helps to elevate clinical, quality and financial outcomes in population health management and chronic care, the all-important hallmarks of value-based care.

2017 Healthcare Benchmarks: Case Management provides actionable information from 78 healthcare organizations on the role of case management in the healthcare continuum, from targeted populations and conditions to the advantages and challenges of embedded case management to CM hiring and evaluation standards. Assessment of case management ROI and impact on key care components are also provided.

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Infographic: U.S. Healthcare Spending

August 16th, 2017 by Melanie Matthews

Total healthcare spending is expected to rise to one-fifth of the U.S. economy by 2025, according to a new infographic by the Peterson Center on Healthcare.

The infographic drills down on U.S. healthcare spending trends as well as the impact of unnecessary and ineffective spending.

HIN’s Healthcare Benchmark Series provides continuous qualitative data on industry trends to empower healthcare companies to assess strengths, weaknesses and opportunities to improve by comparing organizational performance to reported metrics.

Details about HIN Benchmark resources:

  • Feedback from 1,000 respondents annually;
  • Thousands of sector-specific data points, sorted by hospital, health plan and provider;
  • Year-over-year data analysis;
  • 8 to 10 trending topics annually.

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2017 ACO Snapshot: As Adoption Swells, Social Determinants of Health High on Accountable Care Agenda

June 29th, 2017 by Patricia Donovan

Nearly two-thirds of 2017 ACO Survey respondents attribute a reduction in hospital readmissions to accountable care activity.

Healthcare organizations may have been wary back in 2011, when the Department of Health and Human Services (HHS) first introduced the accountable care organization (ACO) model. The HHS viewed the ACO framework as a tool to contain skyrocketing healthcare costs.

Fast-forward six years, and most resistance to ACOs appears to have dissipated. According to 2017 ACO metrics from the Healthcare Intelligence Network (HIN), ACO adoption more than doubled from 2013 to 2017, with the number of healthcare organizations participating in ACOs rising from 34 to 71 percent.

During that same period, the percentage of ACOs using shared savings models to reimburse its providers increased from 22 to 33 percent, HIN’s fourth comprehensive ACO snapshot found.

And in the spirit of delivering patient-centered, value-based care, ACOs have embraced a whole-person approach. In new ACO benchmarks identified this year, 37 percent of ACOs assess members for social determinants of health (SDOH). In support of that trend, the 2017 survey also found that one-third of responding ACOs include behavioral health providers.

Since that first accountable care foray by HHS, the number of ACO models has proliferated. The May 2017 HIN survey found that, of current ACO initiatives, the Medicare Shared Savings Program (MSSP) from the Centers for Medicare and Medicaid Services (CMS) remains the front runner, with MSSP participation hovering near the same 66 percent level attained in HIN’s 2013 ACO snapshot.

Looking ahead to ACO models launching in 2018, 24 percent of respondents will embrace the Medicare ACO Track 1+ Model, a payment design that incorporates more limited downside risk.

This 2017 accountable care snapshot, which reflects feedback from 104 hospitals, health systems, payors, physician practices and others, also captured the following trends:

  • More than half—57 percent—participate in the Medicare Chronic Care Management program;
  • Cost and provider reimbursement are the top ACO challenges for 18 percent of 2017 respondents;
  • Clinical outcomes are the most telling measure of ACO success, say 83 percent of responding ACOs;
  • Twenty-nine percent of respondents not currently administering an ACO expect to launch an accountable care organization in the coming year;
  • 75 percent expect CMS to try and proactively assign Medicare beneficiaries to physician ACO panels to boost patient and provider participation.

Download HIN’s latest white paper, “Accountable Care Organizations in 2017: ACO Adoption Doubles in 4 Years As Shared Savings Gain Favor,” for a summary of May 2017 feedback from 104 hospitals and health systems, multi-specialty physician practices, health plans, and others on ACO activity.

Top 2017 Chronic Care Management Modes and 13 More CCM Trends

May 2nd, 2017 by Patricia Donovan

Availability of chronic care management rose 14 percent from 2015 to 2017, according to new metrics from the Healthcare Intelligence Network.

The majority of chronic care management (CCM) outreach is conducted telephonically, say 88 percent of respondents to a 2017 Chronic Care Management survey by the Healthcare Intelligence Network (HIN), followed by face-to-face visits (65 percent) and home visits (44 percent).

This preference for telephonic CCM has remained unchanged since 2015, when HIN first canvassed healthcare executives on chronic care management practices. More than one hundred healthcare companies completed the 2017 CCM survey.

In addition, the April 2017 CCM survey captured a 14 percent increase in chronic care management programs over the two-year-span: from 55 percent in 2015 to 69 percent in 2017. Three-fourths of 2017 responding CCM programs target either Medicare beneficiaries or individuals with chronic comorbid conditions, with management of care transitions the top CCM component for 86 percent of programs.

In terms of reimbursement, payment levels for CCM services remained steady at 35 percent from 2015 to 2017. However, HIN’s second comprehensive CCM survey determined that 32 percent of respondents currently bill Medicare using CMS Chronic Care Management codes introduced in 2015.

Forty percent of these Medicare CCM participants believe CMS’s 2017 program changes will reduce administrative burden associated with CCM, the survey documented.

Other metrics from HIN’s 2017 CCM survey include the following:

  • A diagnosis of diabetes remains the leading criterion for CCM admission, said 92 percent;
  • Use of healthcare claims as the top tool for identifying or risk-stratifying individuals for CCM continues at 2015’s 70-percent levels;
  • Seventy percent of respondents target individuals with behavioral health diagnoses for CCM interventions;
  • Patient engagement remains the top challenge of chronic care management, with just under one-third of 2017 respondents reporting this obstacle
  • Responsibilities of RN care managers for CCM rose over two years, with 43 percent of 2017 respondents assigning primary CCM responsibility to these professionals (up from 29 percent in 2015); and
  • Two-thirds of respondents observed a drop in hospitalizations that they attribute to chronic care management.

Download an executive summary of 2017 Chronic Care Management survey results.

2016 Population Health Management Snapshot: Most Interventions Telephonic and 9 More PHM Trends

May 19th, 2016 by Patricia Donovan

Most population health management interventions are conducted telephonically, according to HIN's latest PHM metrics.

The majority of outreach in the burgeoning field of population health management is delivered telephonically, according to 84 percent of respondents to an April 2016 Population Health Management (PHM) survey by the Healthcare Intelligence Network.

This third comprehensive PHM assessment also determined that data analytics use in population health management continues to rise, though more slowly than it did from 2012 to 2014, when EHR and registry use tripled.

Additionally, the survey found that 70 percent of respondents have committed to population health management, up from 56 percent in 2012. At the same time, many lament payor reluctance to cover essential PHM services like health coaching and group visits they see as critical to PHM success.

To accrue clinical and financial gains from PHM’s data-driven, risk-stratified care coordination approach, 90 percent provide chronic care management (CCM) services, a strategy that results in PHM ROI between 2:1 and 3:1 for 12 percent of these CCM adopters.

In condition-specific PHM metrics new for 2016, diabetes tops the list of health targets for PHM interventions, say 88 percent.

A health risk assessment (HRA) remains the primary instrument for identifying individuals for PHM interventions, say 70 percent, up from 64 percent in 2014.

Also paramount to PHM success under value-based healthcare reimbursement is strategic oversight of the ‘rising risk’— individuals with two or more unmanaged health conditions. One quarter of 2016 respondents focus PHM attention on their ‘rising risk’ populations, the April 2016 survey determined.

In recent years, population health management (PHM) has ranked as the healthcare space richest with opportunity, according to HIN’s annual industry trends snapshots.

Download an executive summary of 2016 Population Health Management survey results.

11 Value-Based Healthcare Reimbursement Trends to Know

November 24th, 2015 by Patricia Donovan

value-based reimbursement

One-fifth of healthcare companies experience annual savings of $100,000 to $500,000 from value-based payment models, finds a new Healthcare Intelligence Network Savings survey.

A survey by the Healthcare Intelligence Network on the growing trend of fee-for-value payments has documented healthy adoption rates, measured savings and steady gains in the area of preventive services related to fee-for-value formulas.

Seventy-one percent of survey respondents employ a value-based reimbursement or alternative payment model, according to the October 2015 survey. The study also determined that of those respondents not yet exploring a fee-for-value approach, 26 percent plan to do so in the coming year.

In assessing value-based payment formulas, 56 percent of respondents favor a pay-for-performance model, with 71 percent employing these models in contracts for commercial populations.

Despite healthy adoption of alternative payment approaches, one quarter of respondents say the infrastructure required to sustain value-based payment models is the reimbursement trend’s most significant hurdle—greater even than the challenge of data integration or patient engagement, the survey determined.

In evaluating healthcare providers for value-based rewards, respondents most often review markers tied to quality (82 percent), hospital readmissions (56 percent) and patient satisfaction (56 percent) to determine payment, the survey found. The use of physician report cards to track provider performance was reported by 63 percent of respondents.

The shift toward fee-for-value has had the greatest impact on the area of prevention, respondents said, with 69 percent attributing a rise in preventive care to value-based reimbursement models.

Other survey findings included the following:

  • Twenty-one percent of respondents reported savings from value-based payment models as ranging from $100,000 to $500,000 annually.
  • Value-based payment contracts most often were executed for populations having more than 100,000 beneficiaries.
  • Fifty-six percent said the market lacks sufficient technological support for value-based payment models.

Download an executive summary of results from the Value-Based Reimbursement survey.

ACO Evolution from 2011-2015: 8 Year-Over-Year Trends

July 21st, 2015 by Patricia Donovan

ACO Trends 2011-2015

Today's ACOs are larger, busier and better staffed than they were four years ago, according to a HIN year-over-year analysis.

Adoption of accountable care organizations (ACO) has more than tripled in four years and clinical integration continues to challenge non-adopters, according to a Healthcare Intelligence Network analysis of accountable care organization benchmarks from 2011 to 2015.

According to year-over-year ACO metrics published in 2015 Healthcare Benchmarks: Accountable Care Organizations, the percentage of healthcare organizations in ACOs has climbed from 14 to 50 percent in the last four years.

Leadership of ACOs by payor-provider co-ops or health plans has slowed to a trickle during this period, while the percentage of physician-hospital organization (PHOs) firmly grasping administration reins has nearly doubled—from 15 percent in 2011 to 28 percent among 2015 respondents.

ACO Staffs Support Healthcare Integration

The ACO staff has become more diverse, boasting more specialists, health coaches and clinical psychologists to support integration of behavioral health and primary care, the ‘sweet spot’ of patient-centered medicine. Watchwords are care coordination and care management, according to 2015 respondents who shared ACO success stories.

Staffing within ACOs has swelled as well: 29 percent of 2015 survey respondents support 500-1,000 physicians within its ACO, nearly double the 17 percent reporting this staffing ratio in 2011.

The average ACO is also busier than ever, with 61 percent encompassing 10,000 covered lives or more, up from 42 percent in 2011, perhaps reflecting consolidation occurring across the healthcare landscape.

Today, healthcare organizations are more conservative about time required to adequately frame an ACO, with 20 percent of 2015 respondents reporting that two years or more was needed, up from 4 percent in 2011, while the percentage requiring 12 to 18 months for ACO creation dropped from 50 percent in 2011 to 37 percent this year.

Reimbursement Shifts from Volume- to Value-Based

The retrospective data supports the industry’s transition from the traditional fee for service payment environment to the value-based reimbursement structure favored today, with 45 percent of 2015 respondents favoring a FFS + care coordination + shared savings payment model, up from 15 percent in 2012. (Note: 2011 respondents were not surveyed on reimbursement models).

This handwriting is on CMS’s wall, in the form of its pledge to move half of Medicare payments into value-based payment models by 2018. More than half of 2015 respondents—54 percent—expressed faith in the federal payor’s ability to meet this financial goal.

Despite the latest benchmarks, operational ACOs insist no two accountable care organizations are alike. In the experience of Steward Health Care Network, a top-performing Medicare Pioneer ACO, “When you’ve seen one ACO, you ‘ve really seen…one ACO.” Having ended Pioneer performance year two with gross savings of $19.2 million, Steward still must scale the perennial hurdles of physician engagement, performance improvement and care management, explained Kelly Clements, Steward’s Pioneer program director.

This year’s ACO survey benchmarks bear this out. Clinical integration, which can only succeed with the support of an engaged physician population, is still the biggest barrier to ACO formation, say 17 percent of 2015 survey respondents with no plans for accountable care.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

Infographic: The Growing Industry, Effects of mHealth

April 11th, 2014 by Jackie Lyons

mHealth is currently a $1.3 billion industry that is expected to reach $20 billion by 2018, according to a new infographic from Mobile Future and Infield Health.

This infographic shows savings attributed to remote patient monitoring and medication adherence resulting from mHealth. It also assesses how mobile tools are transforming healthcare as more Americans, including healthcare providers, adopt mobile devices and wireless connectivity, and more.

Learn more about mHealth in 2013 Healthcare Benchmarks: Mobile Health, which delivers a snapshot of mHealth trends, including current and planned mHealth initiatives, types and purpose of mHealth interventions, targeted populations and health conditions, and challenges, impact and results from mHealth efforts. This 50-page resource provides selected metrics on the use of mHealth for medication adherence, health coaching and population health management programs.

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Hospitals More Likely to Offer Nutrition Health Coaching, Group Sessions

February 26th, 2014 by Jessica Fornarotto

Health coaching is a critical tool in population health management, helping to boost self-management of disease and reduce risk and associated cost across the health continuum. In its fourth Health Coaching e-survey, conducted in 2013, the Healthcare Intelligence Network captured the ways in which healthcare organizations implement health coaching as well as the financial and clinical outcomes that result from this health improvement strategy.

Drilling down to the hospital/health system perspective, this survey analyzed this sector’s health coaching program components, delivery methods, and more.

Health coaching programs by hospitals and health systems are more inclined to address weight management, tobacco cessation and nutrition than coaching programs overall, survey results reveal. For example, 87 percent of responding hospitals offer nutrition-related coaching, versus 70 percent overall.

Conversely, this sector, which comprised 27 percent of survey respondents, is only a third as likely to address falls prevention (7 percent versus 19 percent overall) and much less likely to address medication adherence (33 percent versus 51 percent overall).

When Coaching is Provided

Coaching delivery methods differed for this sector as well. While no respondent in this sector reported the use of a smartphone app, responding hospitals/health systems were three times as likely as health coaching or disease management respondents to conduct group coaching sessions (53 percent of hospitals versus 14 percent of health coaching or disease management organizations), and significantly more likely to conduct face-to-face coaching (73 percent versus 59 percent overall).

Hospitals/health systems are only half as likely to mandate participation in coaching (7 percent versus 12 percent overall), yet are more likely to incent program participation (60 percent of hospitals/health systems versus 50 percent overall).

Excerpted from: 2013 Healthcare Benchmarks: Health Coaching