Infographic: Overcoming Today’s Healthcare Data Protection Challenges

October 18th, 2019 by Melanie Matthews

By protecting patient data and ensuring it’s available to everyone who needs it, healthcare organizations are helping to safeguard patient care, according to a new infographic by Arcserve (USA) LLC.

The infographic examines healthcare data storage challenges, the financial consequences of not protecting data properly and the biggest barriers to IT transformation.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results Between Medicare’s aggressive migration to value-based payment models and MACRA’s 2017 Quality Payment Program rollout, healthcare providers must accept the inevitability of participation in fee-for-quality reimbursement design—as well as cultivating a grounding in health data analytics to enhance success.

As an early adopter of the Medicare Shared Savings Program (MSSP) and the largest sponsor of MSSP accountable care organizations (ACOs), Collaborative Health Systems (CHS) is uniquely positioned to advise providers on the benefits of data analytics and technology, which CHS views as a major driver in its achievements in the MSSP arena. In performance year 2014, nine of CHS’s 24 MSSP ACOs generated savings and received payments of almost $27 million.

Health Analytics in Accountable Care: Leveraging Data to Transform ACO Performance and Results documents the accomplishments of CHS’s 24 ACOs under the MSSP program, the crucial role of data analytics in CHS operations, and the many lessons learned as an early trailblazer in value-based care delivery.

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Infographic: The Use of Mobile Devices in Healthcare

October 16th, 2019 by Melanie Matthews

In recent years, more and more medical professionals make use of mobile devices and apps to help facilitate the delivery of top-quality care to their patients, according to a new infographic by Home Healthcare Adaptations.

The infographic looks at how mobile devices are used in healthcare, frequently used apps, benefits of mobile apps in healthcare and concerns over mobile healthcare use.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringArtificial intelligence. Automation. Blockchain. Robotics.

Once the domain of science fiction, these telehealth technologies have begun to transform the fabric of healthcare delivery systems. As further proof of telehealth’s explosive growth, the use of wearable health-tracking devices and remote patient monitoring has proliferated, and the Centers for Medicare and Medicaid Services (CMS) has added several new provider telehealth billing codes for calendar year 2018.

2018 Healthcare Benchmarks: Telehealth & Remote Patient Monitoring delivers the latest actionable telehealth and remote patient monitoring metrics on tools, applications, challenges, successes and ROI from healthcare organizations across the care spectrum. This 60-page report, now in its fifth edition, documents benchmarks on current and planned telehealth and remote patient monitoring initiatives as well as the use of emerging technologies in the healthcare space.

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Infographic: Healthcare Revenue Cycle Trends

October 14th, 2019 by Melanie Matthews

Electronic health record adoption challenges are still outweighing benefits, according to a study on the impact of EHRs, consumer self-pay, and IT budgets on revenue cycle operations by Navigant Consulting, Inc. and HFMA, highlighted in a new infographic.

The infographic explores: the struggles health systems face to optimize available EHR functions and upgrades; consumer self-pay concerns; revenue cycle IT budget growth; and more.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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Infographic: Are You Investing in the Right Patient Experience Technology?

October 11th, 2019 by Melanie Matthews

For digitally-connected healthcare to have transformative effects, patient-provider IT solution alignment is essential. This is especially true as changing payment models make the patient experience even more important, according to a new infographic by Spectrum Enterprise.

The infographic examines which technology solutions health system leaders said are extremely/very important to prioritize when seeking to enhance the patient experience.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action PlanUnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs. Armed with data from its Press Ganey and CAHPS ® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

During Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan a 45-minute webinar, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: 2019 UnitedHealthcare Consumer Sentiment Survey

October 9th, 2019 by Melanie Matthews

Many Americans want technology—such as artificial intelligence—to help make healthcare decisions, and a record number say they have used the internet and mobile apps to comparison shop for care, according to a new infographic by UnitedHealthcare.

The infographic provides insights into Americans’ healthcare knowledge, opinions and preferences.

With health coach support on two fronts, PinnacleHealth Systems is changing the patient engagement conversation—both among its staff of clinicians and its most disengaged patient population.

Dual Approach to Patient Engagement: Activating High Utilizers and Coaching Clinicians describes PinnacleHealth System’s two-pronged strategy for prioritizing patient engagement within its culture, and elevating key quality and clinical metrics in the process.

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Infographic: Insights from McKinsey’s Consumer Social Determinants of Health Survey

October 7th, 2019 by Melanie Matthews

Food security was the most common unmet social need, according to a survey by McKinsey & Company on consumers’ views of social determinants of health. Survey highlights are featured in an infographic by McKinsey & Company.

The infographic sheds light on how social determinants of health affect healthcare utilization rates and consumers’ interest in social program offerings.

2019 Healthcare Benchmarks: Social Determinants of HealthOne-third of Americans are grappling with stress tied to meeting their basic human needs such as stable housing, adequate food, and reliable transportation, according to the results of a new national survey from Kaiser Permanente. The survey, Social Needs in America, also found that Americans overwhelmingly want healthcare providers to be involved in identifying and addressing these non-medical social needs.

2019 Healthcare Benchmarks: Social Determinants of Health is the second comprehensive analysis by the Healthcare Intelligence Network of programs aimed at addressing social determinants of health (SDOH), including populations prioritized for SDOH screening, preferred screening tools, interventions, results and ROI.

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Infographic: 10 Telemedicine Reimbursement Myths & Realities

October 4th, 2019 by Melanie Matthews

Misconceptions about telemedicine reimbursement are the leading reason providers are reluctant to adopt telemedicine solutions, according to a new infographic by GlobalMed.

The infographic debunks the most common myths providers believe with regard to telemedicine.

Real-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation’s (NYCHHC) House Calls Telehealth Program that significantly lowered patients’ A1C blood glucose levels.

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Guest Post: 6 Barriers to Automating Prior Authorization

October 3rd, 2019 by April Todd

Automating prior authorizations could save the healthcare industry $417 million annually.

Prior authorization has been used for decades as an important check to ensure prescribed medical treatment is safe and appropriate. In recent years, however, it has become regarded by many as a frustrating, time consuming barrier to care.

Much of the frustration has to do with the fact that the overwhelming majority of prior authorizations are conducted using manual processes that can take days, and, in some cases, weeks, delaying patient care. Prior authorizations are also a financial burden on providers and plans. So much so that the industry could save $417 million annually if these transactions were automated, according to the 2018 CAQH Index.

In spite of the widespread frustration, the number of prior authorizations increased by 14 percent in 2018 over the previous year.

Increasing automation seems like an obvious solution, especially when there has been a federally-mandated standard for automating part of the process for more than a decade. But that just is not happening fast enough.

A recent CAQH CORE, an organization formed by the industry to develop common business rules to support healthcare transactions, white paper, identified six factors that have slowed end-to-end automation of prior authorization:

  1. Data is inconsistent

    Health plans use codes to communicate status, errors and next steps for prior authorizations—including the need for clinical documentation to prove medical necessity. But today, these requirements differ across (and within) health plans, and providers can’t easily identify what information is required. This lack of uniformity— and use of overly generic codes— limit adoption of the standard prior authorization transaction by providers.

  2. No federally mandated standard for “attachments” or clinical documentation

    As part of standard prior authorization requests, providers are asked to include “attachments” or clinical documentation. However, there is no national standard or uniformity for the supporting clinical documentation. This creates a sense of uncertainty about investments in various solutions, and results in workarounds that providers are asked to support.

  3. Lack of integration between clinical and administrative systems

    Electronic prior authorization requests typically require the use of practice management systems (PMS) and data from electronic health record (EHR) systems. But integration between PMS and EHR systems is limited. This forces most providers to retrieve clinical information from the EHR and manually enter it into the prior authorization request. This is not only an obvious source of human error, but also a frustrating drain on productivity and efficiency.

  4. Limited vendor products that support electronic prior authorization

    Only 12 percent of vendor products support electronic prior authorization, according to the 2017 CAQH Index. For all other electronic transactions, vendor support is between 74 percent and 91 percent.

    Some vendors indicated that, while their systems do currently support prior authorization, this functionality is not part of the core product offering. That is, prior authorization functionality may be available in some vendor systems, but only in a premium configuration.

  5. State requirements for manual intervention

    Some state legislatures have mandated that certain steps of the prior authorization process be handled manually. For example, in both Colorado and Rhode Island, health plans are required to give providers an opportunity to speak directly by phone or in person with a qualified medical professional before issuing an adverse determination. Some of these manual requirements are in place because a phone call or written letter may be a more trusted mode of receiving communication regarding determinations.

  6. Lack of provider awareness

    Many providers are unaware that HIPAA requires health plans to offer the standard prior authorization request to conduct prior authorizations electronically. Greater demand from providers can incent broader use of the standard and encourage development of vendor products to support its exchange.

How Do We Get to Automation?

Currently, there is a groundswell of support from a diverse group of stakeholders to improve the prior authorization process. The Department of Health and Human Services, federal and state policymakers, providers and health plans, industry coalitions and standard-setting organizations are all motivated to resolve the administrative burden associated with prior authorization—creating an unprecedented opportunity to find alignment and implement solutions.

So, Where Do We Start?

To reduce the prior authorization burden, it is important for all stakeholders to participate in developing standards that support automation, and follow them. CAQH CORE’s participating organizations, which encompass 75 percent of insured lives, have developed two sets of operating rules that are already addressing several of the challenges identified above. By adopting the Phase IV and V CAQH CORE Operating Rules, and participating in CAQH CORE’s prior authorization pilots, healthcare stakeholders can help accelerate the move toward automation of prior authorization.

This renewed spirit of collaboration is the pathway to reducing the prior authorization administrative burden. It is imperative for all stakeholders to actively encourage and participate in this collaborative momentum toward a more automated prior authorization end-to-end workflow.

April Todd

April Todd

About the Author: April Todd leads CAQH CORE, an initiative of CAQH that was formed to drive the creation and adoption of healthcare operating rules that support standards, accelerate interoperability and align administrative and clinical activities among providers, payers, and consumers. CAQH CORE is industry-led—representing more than 75 percent of insured Americans, including health plans, healthcare providers, vendors, government entities, and standard setting organizations. Five phases of CAQH CORE Operating Rules and Certification Test Suites have been issued to date.

Infographic: How Blockchain Can Be Used to Improve Healthcare

October 2nd, 2019 by Melanie Matthews

As more organizations take an interest in blockchain, 70 percent of healthcare organizations will have invested in the technology by 2025, according to a new infographic by the Association of State and Territorial Health Officials.

The infographic examines how to share data securely and how to overcome healthcare technology challenges.

2018 Healthcare Benchmarks: Telehealth & Remote Patient MonitoringArtificial intelligence. Automation. Blockchain. Robotics.

Once the domain of science fiction, these telehealth technologies have begun to transform the fabric of healthcare delivery systems. As further proof of telehealth’s explosive growth, the use of wearable health-tracking devices and remote patient monitoring has proliferated, and the Centers for Medicare and Medicaid Services (CMS) has added several new provider telehealth billing codes for calendar year 2018.

2018 Healthcare Benchmarks: Telehealth & Remote Patient Monitoring delivers the latest actionable telehealth and remote patient monitoring metrics on tools, applications, challenges, successes and ROI from healthcare organizations across the care spectrum. This 60-page report, now in its fifth edition, documents benchmarks on current and planned telehealth and remote patient monitoring initiatives as well as the use of emerging technologies in the healthcare space.

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Infographic: Top 10 Promising Population Health Approaches

September 30th, 2019 by Melanie Matthews

Public health officials are key in leading strategies and crafting policies that foster clinical innovation, leverage data analytics and public health informatics and address social determinants of health to advance health equity and improve population health, according to a new infographic by the Association of State and Territorial Health Officials.

The infographic identifies 10 approaches that state and territorial health officials may explore with their partners in the community, healthcare sector and other governmental agencies to achieve optimal health for all.

2018 Healthcare Benchmarks: Population Health ManagementAs the healthcare industry’s pace from volume-based to value-based healthcare payment models accelerates so does the demand for more effective management of population health. With the growth of these payment models, healthcare organizations are taking on more risk in terms of shared savings and shared risk arrangements and are investing heavily in programs to support population health. These programs are expanding in both scope of services and health conditions and disease states managed. With the help of advanced technologies in healthcare, this growth will only continue.

2018 Healthcare Benchmarks: Population Health Management is the fourth comprehensive analysis of population health management by the Healthcare Intelligence Network, capturing key metrics such as populations, health conditions and health risk levels targeted by population health management programs; risk stratification criteria; prevalence of value-based payment models supporting population health management programs; population health management processes, tools, workflows and forms; and program outcomes and ROI from responding healthcare organizations. Click here for more information.

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