1.800.360.0603

GE Healthcare Camden Group Insights Blog

Top 10 Health IT and Analytics Considerations for Effective and Efficient Care Management

Posted by Matthew Smith on May 23, 2016 1:55:44 PM

By Cindy Friend, MBA, MSN, RN, Senior Manager, GE Healthcare Camden Group

HIT.pngThe demand for meaningful and actionable data in healthcare has never been as prevalent as it is today. While most healthcare organizations are utilizing some form of health information technology (“health IT”) platforms to capture clinical documentation, system integration and broad spectrum analytic capabilities offered by these platforms are very underdeveloped. As pay-for-value becomes the standard for healthcare service reimbursement, organizations are beginning to realize the importance of establishing more efficient and effective care management processes that are supported by robust health IT systems and analytics frameworks. Below are 10 key health IT and analytic considerations to enable an effective care management program.

  1. Data Governance. Data is the crux of healthcare improvement. It is critical to establish a data governance council consisting of an interdisciplinary team that is responsible for developing a set of processes that serve as a quality control mechanism for handling information. These mechanisms define lines of responsibility and establish methods to foster the accessibility, completeness, and integrity of data. Strong data governance that can validate the accuracy of the data is critical to instill trust among clinicians. The absence of a data governance structure exposes the risk of clinicians contesting the accuracy and usefulness of the performance information produced by the data, thereby reducing its value to continuous improvement initiatives.
  2. Health IT Strategy. An organization must develop a health IT and analytics strategy to determine the types of health IT necessary to support the clinical and operational processes of the organization. The most essential component in the development of a successful health IT strategy is to gain consensus from all affected stakeholders. Attempting to implement a strategy without the buy-in from the affected stakeholders will be extremely difficult, if not impossible, because clinicians will not support the efforts and may challenge the types of health IT implemented.
  3. Systems and Technology Framework. The systems and technology framework of healthcare organizations is very complex. Organizations must inventory the various systems and develop a blueprint to guide system selection, technical and functional builds, consistent standards, and information output. All of these aspects affect clinical operations, and the implications must be considered and risks mitigated. Neglecting this activity will have serious implications on system integration and data aggregation efforts.
  4. System Integration and Solution Architecture. Healthcare organizations have various technology systems and platforms that were typically implemented at a point in time to serve a specific business need without extensive thought or planning given to system integration. The result of this approach is that these systems are not designed to “speak to each other”. Organizations must build an enterprise architectural approach that allows platform integration of multiple disparate systems, supports system interoperability, and establishes a centralized master data management structure.
  5. Solutions Search and Selection. Commonly, a systems and technology inventory reveals gaps in the framework, and the organization must embark on a search and selection process to identify a system to fulfill the need(s). It is important to establish a systematic approach to IT system selection so that the evaluation of the systems is comparative. More important, the organization must enlist the help of an interdisciplinary team to evaluate and score the systems based on a pre-defined list of functionality and standards. The process must be executed very methodically, starting with defining the system requirements, developing the evaluation criteria, training the evaluation team, conducting the system demonstrations, reviewing test cases, and selecting the system of choice. In addition, the organization must establish an enterprise approach to system search and selection, which can help minimize ad hoc purchases that can conflict with the overall integration strategy.
  6. Workflow Redesign. Clinical workflow redesign is integral with any health IT solution implementation. Before even embarking on system selection, an organization must first understand the clinical workflow. This will provide insight to the existing processes and protocols and enable the organization to select a technology solution that will best support clinical operations by incorporating solution sets that promote workflow redesign around functional roles, care model redesign, clinical decision support, and clinical protocols. Failure to consider the clinical implications when selecting a system will lead to an underutilized system and decrease efficiencies.
  7. Clinical Health IT Optimization. Clinical care optimization is critical to maximize the value of the health IT system. Health IT systems are rarely used to their fullest potential. This underutilization can have negative impacts on many facets of a healthcare organization, including patient safety, quality of care, clinical performance, staff satisfaction, and revenue capture. The organization can improve the functional use of systems and applications through utilization evaluation, reeducation of clinical documentation requirements, and system functionality retraining for clinical staff. Failure to optimize clinical health IT systems leaves the organization vulnerable and at risk for poor coordination of care, fragmented communication, performance penalties, staff turnover, and decreased revenue.
  8.  Integrated Analytics and Reporting Strategy. An integrated analytics strategy is imperative to establish a streamlined approach to developing, managing, updating, and reporting performance measures. Many organizations are faced with various regulatory, accreditation, and quality program reporting requirements. Typically, report writers will build ad hoc reports according to the specifications requested, but report reviews reveal that many of these reports include the same metrics. Organizations must catalogue the performance measures contained in all reports. This accounting should include the details of the measure (e.g., numerator and denominator), discreet data needed to calculate the measure, the source system for the data, the purpose of the measure, the report measure owner (both requester and developer), the user(s) of the information, and the user  status (internal or external). This will help the organization to delineate the various reports, identify duplications, and establish consistency across the clinical analytics and reporting requirements.
  9. Clinical Informatics and Analytics. In line with the analytics and reporting strategy, an organization must define an approach and process to ensure that solution capabilities enable the collection of discreet clinical data that supports the development of reliable, action-oriented reports. An important component to developing a sound clinical informatics and analytics process is having an interdisciplinary team composed of IT, clinical, and report analyst representatives. This team composition will ensure that the information needed from the clinical team is addressed, the technical team can build it, and that it is structured so that analysts can easily generate the necessary reports.
  10. Actionable Data Analytics. Once the type of information that is needed for analytical reports is determined and the process by which this information will be captured is defined, an organization needs to determine the most effective way to present the information, to whom the information should be provided, and how frequently in a timely manner. Most important is designing reports that present data in a usable, action-oriented, and meaningful way. The way in which data is presented can make the difference between impactful care management and quality improvement results and futile care coordination efforts.

Cindy FriendMs. Friend is a senior manager in the population health practice at GE Healthcare Camden Group. She is a registered nurse with more than 20 years of experience in healthcare administration, clinical delivery, and health information technology--both in the public and private sectors. Ms. Friend’s areas of expertise include assessing, designing, and activating strategies to support population health management, such as patient-centered medical homes, Medicare Shared Saving Programs, accountable care organizations, clinical integration, and strategies around care management, clinical informatics, quality improvement, and risk-based contracting. She may be reached at cindy.friend@ge.com.

Topics: HIT, Health IT, Data Analytics, Workflow Redesign, Data Governance, Cindy Friend

New Download: Building the Information Management and Data Governance Strategy for Value-Based Care

Posted by Matthew Smith on Aug 6, 2015 10:37:35 AM

Download, USBThis new download from The Camden Group focuses on how successful organizations:

  • Identify current information technology solution needs and challenges
  • Categorize existing issues in capturing and aggregating data as well as translating this information into clinical workflows
  • Create the blueprint for an information management and data governance strategy
  • Document and prioritize steps related to the "future state" information technology solutions framework and management strategies needed to support current and future business needs.

To download the PDF document, please click the button below to access the download page.

Data Governance, Value-Based Care, Population Health

Topics: Value-Based Care, Population Health, HIT, HealthIT, Data Governance

Building the Data Governance Strategy for Effective Population Health Alliances

Posted by Matthew Smith on Aug 5, 2015 12:42:52 PM

By Tara Tesch, MHSA, Senior Manager, The Camden Group

This is the third of three articles in the Population Health Alliances series. The first article examined physician engagement strategies and detailed specific strategies that have proven successful for alliances. The second article focused on the value of true care redesign.

High-performing organizations possess robust information technology ("IT") infrastructure and associated tools to deliver, track, and document patient-centered, evidence-based care at the point of service and can disseminate actionable and meaningful data quickly and transparently. IT infrastructure implementation is an iterative process and rarely do organizations have a “fully baked” IT solution at the onset of implementation.There is no single vendor that can provide a comprehensive data analytics solution to meet all needs (see graphic below) at this time.


 Future State CI Network Platform

Population Health, Data Governance

© The Camden Group 2015


In order to truly impact how care is delivered, end users must have actionable information in real time to support care redesign efforts. Providing patient-relevant decision support at the point of care can improve provider effectiveness in delivering appropriate and necessary interventions, furthering the organization’s goals of improving individual and population health. Too many organizations stall in developing their IT infrastructure by letting “great get in the way of good.” IT should support the care not drive it, therefore, systems and tools must translate and support care redesign. Too much data that is not well organized or analyzed can simply create confusion and cloud the necessary focus required to impact population health.

It is critical for population health alliances to have a well thought-out IT strategy and data management plan that will provide connectivity between members. The strategy should call for a means to collect the data, offer a robust tool to aggregate the data, and support reporting that will translate information into behavioral change and allow providers to more effectively communicate with and engage patients. The key factor for success: build your strategy beginning with the end in mind.


 Data Governance Strategy Build

© The Camden Group 2015


Success begins with the development of an information management and data governance strategy, which includes a data governance structure (who is going to own it, clean it, analyze it), organizational structure (what resources and types are required), and core data needs (reportable, transactional). An objective of the strategy is to take data and create meaningful information that leads to action-oriented knowledge. Out of the strategy, capabilities will be identified that drive interoperability and analytics requirements. These requirements should provide the criteria for selecting health information technology (“HIT”) that support the business and clinical needs of the alliance. Avoid buying the tool then trying to create a strategy around it; this will inevitably fail.

Defining Objectives

Designing the data strategy requires a sophisticated understanding of the alliance’s business and clinical objectives, clinical guidelines and care processes, and requirements of analytics to support these activities. First, define the end goal (outputs) such as care management or value-based contracting, and identify the data sources that will be used (i.e., EHR, claims, ADT, etc.). Next, determine how the data will be used to support the outputs; will it be reportable and retrospective (e.g., risk stratification, predictive modeling, scorecards) or transactional and action-oriented (e.g., point of care, gap closure, alerts, real time analysis to support decision-making).

To be successful, this planning process must include clinical/operational leadership (e.g., chief medical informatics officer, care management leads), in addition to finance and the member organization chief information officers. Staffing should include a data architect and a clinical informaticist able to translate the data into clinically meaningful information.

Once the strategy has been defined, identify the data requirements and associated capabilities. This may include standard processes and reporting templates – tools to automate the current state and optimize care delivery. Next, select a vendor that either has the ability to grow with your organization as it evolves or decide to pursue a “plug and play” vendor approach. Either way, the vendor must support the alliance’s CIN data requirements and capabilities.

In the end, it is critical to maintain strong, positive relationships with clinicians during the design and development of these key technology capabilities. Clinicians drive the clinical care of patients and care models to support the delivery of clinical protocols. Organizational and individual needs will evolve based upon initial successes and challenges, and clinicians will bring forth a multitude of suggested and needed changes after the initial “go live.” Technology is the tool to support the clinical requirements, and developing ongoing processes to solicit clinician feedback for continued improvement is an important contributor to long-term success.

Data Governance, Value-Based Care, Population Health


Ms. Tesch is a senior manager with The Camden Group in the clinical integration practice with more than 18 years of experience as a healthcare leader and strategist. Ms. Tesch specializes in value-based care delivery strategic planning, CIN development and implementation for commercial, Medicare, and Medicaid populations, health information technology data governance and analytics strategy, as well as care management strategy, design, and implementation. She has worked with a variety of healthcare providers, including integrated delivery networks, academic health centers, regional referral centers, rural community providers, and national non-profit and faith-based health systems. She may be reached at ttesch@thecamdengroup.com or 312-775-1700.

Topics: Population Health, HIT, HealthIT, Data Analytics, Population Health Alliance, Tara Tesch, Data Governance

ONC Outlines Timelines for Interoperability Goals (with Infographic)

Posted by Matthew Smith on Jan 30, 2015 10:05:00 AM

The Camden Group, Interoperability, Health IT, Population HealthThis morning, the Office of the National Coordinator for Health Information Technology ("ONC") released the first draft of its interoperability roadmap to deliver better care through the exchange and use of health information technology ("IT").

The roadmap lays out the plans for the next three years in order to meet the goals first laid out in ONC’s “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve Health IT Infrastructure,” which was first issued in June 2014.
 
“Great progress has been made to digitize the care experience, and now it’s time to free up this data so patients and providers can securely access their health information when and where they need it,” HHS Secretary Sylvia M. Burwell said in a statement. “A successful learning system relies on an interoperable health IT system where information can be collected, shared, and used to improve health, facilitate research, and inform clinical outcomes.”
 
The roadmap will provide guidelines so the majority of individuals and providers can send, receive, find, and use a common set of electronic clinical information across the care continuum and at the nationwide level by the end of 2017.
 
The report also outlined four important actions for both public and private sector stakeholders to take to enable interoperability of electronic health information in the near term:

  1. Establish a coordinated governance framework and process for nationwide health IT interoperability
  2. Improve technical standards and implementation guidance for sharing and using a common clinical data set
  3. Enhance incentives for sharing electronic health information according to common technical standards, starting with a common clinical data set
  4. Clarify privacy and security requirements that enable interoperability

The roadmap also provides more detailed near-term actions for each high priority area, a common clinical data set of 19 basic elements, and an updated estimated timeline of select high-level critical actions.
 
The plan from ONC is open to the public for comment until April 3.
 
“While we have made great strides as a nation to improve [electronic health record] adoption, we must pivot towards true interoperability based on clear, defined, and enforceable standards,” Russell P. Branzell, FCHIME, CHCIO, president and chief executive officer of the College of Healthcare Information Management Executives, said. “This Roadmap incorporates a tremendous amount of stakeholder input and articulates a clear path towards interoperability. It is a cornerstone in the continuing evolution of federal health IT policymaking.”

Below is an infographic developed by HealthIt.gov which displays the Shared Nationwide Interoperability Roadmap: The Journey to Better Health and Care. The nation relies on Health IT to securely, efficiently and effectively share electronic health information with patient consent to achieve better care, smarter spending and healthier people. Interoperability will transform our health system from a static one to a learning health system that improves individual, community and population health.

To view a full-size version of this infographic, click on the image or click here

shared nationwide interoperability roadmap resized 600

Topics: Population Health, HIT, Health IT, Infographic, ONC, Interoperability Roadmap

Top 10 Trends and Implications for Medical Groups in 2015

Posted by Matthew Smith on Jan 27, 2015 2:23:00 PM
By Mary Witt, MSW
Senior Vice President, The Camden Group


016_healthcare_consultant.juSuccess in 2015 requires clear thinking and decisive action. Whether independent or hospital/system-owned, medical groups cannot continue to do business as usual and expect to succeed in 2015. Increasing financial pressures, the move to fee-for-value, and increased expectations for quality require new ways of doing business. Here are the top 10 trends for 2015 that can provide direction and focus as medical groups plan for the year ahead.

1. A focus on performance optimization is necessary for success. Medical groups can no longer be satisfied with median performance. Medical groups that are not pushing themselves to excel will find themselves left behind as top performers emerge and gain market dominance. Also, as financial pressures increase for hospitals and health systems, they will no longer be able to sustain the high losses experienced by many hospital-owned medical groups. It is critical that medical groups assess their performance as compared to industry best practices and implement a performance improvement plan to address any deficits. To sustain forward momentum, medical groups should establish clear accountabilities for performance throughout the medical group by creating measurable performance standards, continually measuring performance against targets through the use of dashboard reports, developing action plans to address variances, and incorporating performance expectations into job descriptions.

2. Patient collections cannot be ignored. With the increase in high deductible plans and patient copays, medical groups are seeing a significant increase in the dollars owed by patients. Therefore, an effective patient collection process that starts when the appointment is scheduled is critical to ensuring that all revenue owed is collected. When the appointment is scheduled, patients should be informed of copay and deductible amounts as well as outstanding balances, and the expectation that payment is due at the time of the visit should be established. Time of service collections should include collection of all monies owed for the services provided that day as well as any outstanding balances.

3. 2015 brings increasing competition from nontraditional organizations. New, non-traditional competitors are entering the outpatient medical care market. Retail firms such as WalMart, Walgreen’s, CVS, and RiteAid have created primary care clinics; while some have partnered with local providers, more often they have created their own clinics or partnered with national firms. Target and Kaiser Permanente have developed a partnership to provide primary and specialty care in clinics in Target stores that will be open to nonKaiser enrollees. Payers such as Anthem California are marketing e-visits directly to their enrollees bypassing the traditional in person physicianpatient relationship. Partnering with non-traditional organizations is an option that should be assessed as well as considering non-traditional practice locations. It is important to understand what patients want and expect of the practice to retain them. Regularly survey patients about their experience with the practice; consider the use of focus groups to gather more in-depth data on what is important to them.

4. Physician compensation models require redesign. As medical groups prepare for fee-for-value payment, increasing competition, and a focus on quality, there is likely a need to redesign their compensation model to better align incentives with the new environmental realities. What worked in the past is unlikely to work in the future. It is important to understand how quickly the market is shifting from fee-for-service to value-based payment in order to determine what needs to be changed and how quickly it needs to happen. Medical groups will want to develop a road map to broaden compensation incentives to prepare for fee-for-value payments. Consider adding incentives for care coordination, quality, and efficiency in addition to productivity. Initially, it may make sense to devote a small percentage of compensation to these new metrics to prepare for the future if the market is not demanding immediate change.

5. Transparency is becoming increasingly important. The era of transparency in cost and quality is here. Payers are publishing provider charges by Current Procedural Terminology (“CPT”) code; CMS has published Medicare payments made to physicians. Employers are demanding price transparency, especially as they move to high deductible plans and pass more cost on to their employees. States are creating multipayer pricing databases based on payer claims data and providing access to consumers. Many new websites enable consumers to shop price and quality. Quality is being tracked more vigilantly, and quality scores are readily available to the consumer through a variety of websites. With all of this data available, it is important that medical groups understand how their pricing and quality compare to their competitors and take action to ensure that high prices and poor quality do not cost them patients.

6. Mastery of technology cannot be ignored. Medicare demands that medical groups report on quality or face penalties, and payers increasingly link payments to quality reporting or results. Therefore, medical practices need to be able to collect, analyze, and exchange data. Also, as expenses increase, and operational demands become increasingly complex, the ability to automate work is critical to improving efficiency. New care models increasingly rely on real-time access to patient clinical data as well as access to tools such as telemedicine or health monitoring devices. Effective use of technology to improve results is a necessary element for future success. Evaluating current work flows and looking for inefficiencies (e.g., duplicate data entry, multiple handoffs) can lead to identifying opportunities for automation. Explore the use of telephone technology to automate tasks such as appointment and payment balance reminders. Participate in a health information exchange that provides two-way communication and clinical results with hospitals, referring physicians, and other health providers. Use an electronic health record to assist clinicians in the care of their patients; the use of real-time prompts assists physicians in performing preventive services and informs them when test results are outside of normal.

7. Managing a population of patients requires new care delivery models. Managing a population of patients requires a change in how care is delivered. The focus is no longer on episodic care, but instead focuses on managing the total healthcare needs of a population of patients. The emphasis shifts to “providing the right care at the right time in the right place.” Redesigning care involves transforming both how care is delivered and who delivers the care. Re-examine roles within the practice to ensure that everyone is working to the top of their license/expertise. Successful management of a population of patients requires an expanded team approach to care. New care team members can include advanced practice clinicians, care managers, social workers, pharmacists, nutritionists, and health coaches with leadership and direction provided by the physician. Reexamine the workflow in the office to assure that as the care model evolves, the work flow is adapted to facilitate efficient use of space and staff. Explore the feasibility of using e-visits, tele-health, and group visits to improve access, responsiveness, and maximize patient engagement. Consider the operational and financial feasibility of implementing Medicare’s newly reimbursed chronic care management.

8. Patient engagement leads to better outcomes. Patients actively engaged in their care have better outcomes and utilize fewer health resources. In order to maximize patient engagement, medical practices must move from telling patients what to do to assisting them to develop the knowledge, skills, and confidence necessary to be an active partner in their care. Train physicians and staff on communication skills and motivational interviewing and integrate expectations into physician and staff performance expectations. Ensure that patients are actively engaged in discussing their health and developing their care plan. The use of patient portals can be an effective means of maintaining communication with patients and monitoring their adherence to care plans.

9. Patient demand for access is not going away. Thus, ensuring timely patient access has to be a medical group priority if the practice is to have satisfied patients. To understand patient access, routinely monitor third next appointment availability. Calculate the practice’s patient demand versus practice capacity, and implement strategies to increase capacity as needed. Consider allowing patients to schedule their own visits through a patient portal, providing evening and weekend hours, offering e-visits, and communicating by email and text. Practices should also employ strategies to facilitate regular communication with their patients through e-mail blasts, texting, and social media.

10. Physicians will continue to move toward the employment model. As the complexity of medical practice and economic pressures increases, and the demand for capital for practice infrastructure (e.g., electronic health record, care team staffing) grows, more physicians are choosing to become employed, and that trend is likely to accelerate over the next few years. This provides opportunities for existing medical groups and hospitals/health systems to add physicians to their practices as they seek to capture a greater population. To ensure a successful employment relationship, medical groups and physicians both need to clearly define their goals and expected outcomes and then develop a set of criteria to guide decisions as opportunities are considered.

As medical groups grapple with the many challenges of 2015, it is important to focus on optimizing performance and preparing for value-based reimbursement by meeting the needs of patients efficiently and effectively. Concentrate on how to create a strategic advantage by establishing capabilities or attributes that will distinguish your group from competitors. In difficult times like these, superior, nimble, focused performance will lead to success.

Mary Witt, The Camden Group, Physician ServicesMs. Witt is a senior vice president with The Camden Group and has over 25 years of healthcare experience. She has held management positions in hospitals, health systems, and management services organizations (MSOs). She has extensive experience in medical group and integrated delivery system development and management. This includes developing patient-centered medical homes, practice management, performance improvement, physician compensation, managed care, strategic planning, healthcare marketing, and physician recruitment. She may be reached at mwitt@thecamdengroup.com or 424-201-3971.

 

Topics: Clinical Integration, Population Health, HIT, HealthIT, Mary Witt, Medical Group, Medical Groups, Clinically Integrated Networks, Physician Compensation, Patient Engagement, The Camden Group, Trends

2015 Healthcare Trends: Continued Consolidation, Population Health

Posted by Matthew Smith on Jan 6, 2015 2:36:00 PM

2015 Healthcare TrendsIn its annual predictions for the year ahead, our colleagues at The Camden Group, one of the nation’s largest healthcare business advisory firms, released their outlook for 2015. The firm’s experts forecast continued provider consolidation and a drive to providing a better “value proposition” to the consumer and payer. Additionally, there will be a renewed focus on cost management and a steady stream of transactions that consolidate the acute, ambulatory, medical group and post-acute care components of the delivery system. And, keep an eye on the nation’s capital for further developments. The Camden Group takes a look at pain points, the bottom line, politics, opportunities, consolidation and acquisition, as well as insurance trends:

Pain Points: Show Me Where It Hurts

  • A few hot areas to watch that could impact hospitals: continuation of sequestration for healthcare expenditures, changes to the 340B drug purchase program and site-neutral payment reforms (e.g., imaging), including hospital-based clinics.
  • Inpatient volume will remain soft. Hospitals will continue to struggle as inpatient use stagnates and pressures build to find new ways to reduce expenses, grow revenue and improve access to capital.

The Bottom Line: A Need for Surgical Precision

  • Revenue reductions will continue to put a squeeze on the bottom line. Growth of public and private health insurance exchanges, sequestration (Medicare), state budget issues (Medicaid) and soft volumes will create challenges for the healthcare system.
  • The human factor: With salaries, wages, and benefits typically accounting for 50 to 55 percent of a hospital’s operating expenses, organizations will continue to reduce non-clinical personnel.
  • Also on the chopping block: non-core service expenditures, streamlining clinical and nonclinical processes, and refining compliance with group purchasing organizations and vendor relationships.
  • Information technology (“IT”) will gobble up a greater portion of capital expenditures. As population health management continues to grow and take hold of the “new approach” to healthcare in the U.S., IT will remain a major investment. The new spend will target: patient registries, analytics using population data, a data warehouse linking data from across the continuum and analytics using payer claims as well as internal data. Lastly, the drive to engage the patient will start with patient portals, wellness outreach, providing patient access to their medical record and, in some cases, telehealth as an element in this space.

Politics: What Happens in D.C. Doesn’t Stay in D.C.

  • The Republicans will hold significant influence on a national level with their control of Congress.
  • “With Republicans taking control of Congress – yet lacking 60 Senate seats or 67 seats to override a veto – parts of ‘Obamacare’ are going to change,” says Steven T. Valentine, president of The Camden Group. “A full repeal of the Affordable Care Act is highly unlikely; however some parts will be eliminated and others likely watered down. At the end of the day, most health systems and medical groups should continue to move ahead with developing population health management capabilities in response to the need to demonstrate value.”
  • President Obama stands ready to veto policies and legislation he does not support and is ready to use his executive order powers to extend his influence.
  • The public insurance exchanges may find strong headwinds due to the Republicans carving out some pieces, thereby reducing the population accessing the exchange. The wildcard to watch: the Supreme Court has agreed to hear the debate on issues with the subsidies; expect a decision in June.
Opportunity Knocks
  • Clinicians have developed and are using new care models and economic incentives to reduce resource consumption. The growth of the Patient-Centered Medical Home, episodes of care management (e.g., co-management and bundled payment arrangements), accountable care organizations (“ACOs”) and clinical integration will all continue to grow and expand.
  • Population health will continue to be the focus for many organizations. The growth of ACOs in both numbers and population reflects this trend. Employers will continue to demand better value for their healthcare dollars. Medical groups, hospitals and health systems will be required to invest more resources and money into the infrastructure build-out to manage the populations’ health. As a result, expect to see IT spend that will focus on: EMR interfaces, data warehousing (collection) and analytics. Providers that want to embrace population health will need to adopt a payment model that rewards them for delivering a better “value” to the patient and payer.
  • Competition between healthcare providers will focus on capturing a defined population. Figure 1, below, identifies highest priority access points. The trend is that health systems and hospitals are adding hospitals, clinics, health plans, direct contracts with employers, physician practices and ambulatory sites to their continuum of care delivery system/network.Pyramids of success resized 600
  • Population Health, The Camden GroupTransparency will grow, albeit ahead of the consumer’s interest in using the information. Numerous websites, states and health plans offer quality and price information. All competitors play by the same rules, and the public sees the same data, because that is all they have. Medicare, Medicaid, health plans and proprietary databases all provide information on quality, satisfaction and cost. Providers will have to dedicate resources to provide a more standardized and reliable data set to offer more accurate and useful information.
  • Physician resources: As physicians in the Baby Boomer generation start their long-delayed retirements (their investments have returned, and their practice is at peak value), hospitals and medical groups will identify opportunities to staff clinics, urgent care centers and physician practices with these newly retired physicians willing to work part-time for someone else or on “fill-in” shifts.

Consolidation and Acquisition: Shaking Things Up

  • Consolidation will continue at a strong pace and spread. Consolidation of imaging services will accelerate this year. Radiology benefit managers, pricing transparency, higher out-of-pocket co-pays, health plan contracts that redirect business and cut-throat pricing will pressure the profitability of these centers. Additionally, expect consolidation in the postacute care world as referral patterns change and ACOs, clinically integrated networks and health plans alter business and clinical relationships.
  • Hospital and physician alignment will continue to be a top priority for hospitals. In the never-ending quest to capture a greater population, health systems and hospitals will continue to acquire medical groups and physician organizations.
  • Medical group consolidation: Of note is the acquisition of medical groups and physician organizations by other medical groups; this trend should accelerate in 2015.
  • Academic medical centers will enter more markets to acquire medical groups and clinics and provide more access points to their system.
  • Other opportunities: Additionally, we have seen a steady increase in co-management agreements, bundled payments, ACOs and clinically integrated organizations focused on aligning the economic interest of all parties. Expect all of these alignment vehicles to continue to increase and become more sophisticated in their economic incentives, trying to produce greater value.

Insurance Trends: More Marketplace Disruption

  • Direct employer contracting and private insurance exchanges will be a small but growing trend, led by the continued growth in high deductible health plans.
  • Public insurance exchanges will have little new impact this year compared to last year.
  • High deductible PPO products will continue to grow.
  • Commercial HMO enrollment will continue its slow decline.
  • Medicare Advantage enrollment will continue to grow as the population ages in.
  • Employers also will increasingly add value to their healthcare benefits through the addition of wellness programs, healthy lifestyle, education and prevention.

In conclusion, management should focus on these trends and be prepared for some unexpected twists through 2015. Everyone will be looking for better value, and the pressure is on health systems, hospitals and doctors to deliver.

Population Health, Practice Management, Clinical Integration

Topics: Clinical Integration, Population Health, HIT, Health IT, Information Technology, Healthcare Consolidation, Steve Valentine

Infographic: Utilizing the Cloud to Meet Healthcare Reform Mandates

Posted by Matthew Smith on Oct 3, 2014 9:47:00 AM

Infographic, Cloud, Reform MandateNow that healthcare in America is evolving as rapidly as technology, hospitals are expected to transform their archaic IT systems to meet reform requirements or face significant penalties from the government. Add to the mix a lack of skilled IT workers and an operating system that is already functioning at a loss, and the next few years look very grim. How can hospitals meet the mandates and recover their cumbersome IT systems? This infographic from Innotas outlines what these facilities need to implement to meet a brighter future.

To view a full-size version of this infographic, click here.

Infographic, Reform mandate

Topics: EHR, EMR, HIT, Health IT, Infographic, Health Care Reform

Infographic: Physician Adoption of Health IT

Posted by Matthew Smith on Sep 25, 2014 11:06:00 AM

Infographic, Health DirectionsThe Deloitte Survey of U.S. Physicians provides data-driven insights on physicians’ perceptions of the health care system and their thoughts on health care reform. Research conclusions include their perspectives and attitudes about health care reform, the future of the medical profession, and HIT. As they have done in past years, the Deloitte Center for Health Solutions conducted a survey and compiled the findings in an infographic, below.

The survey polled a nationally representative sample of up to approximately 600 U.S. primary care and specialist physicians to understand their perspectives and attitudes about health care reform, the future of the medical profession, and HIT.

Most U.S. physicians are concerned that the future of the medical profession may be in jeopardy and consider many changes in the market to be a threat. They believe that the performance of the U.S. health care system is suboptimal, but the Affordable Care Act is a good start to addressing issues of access and cost.

Key takeaways:

  • Nine out of 10 physicians are interested in mobile health technology; those who are not tend to be older and have long-established solo practices.
  • Users of the technology outnumber non-users in favoring its benefits for accessing clinical information, researching diseases and treatments, and pursuing continuing education.
  • Three out of four physicians say EHRs increase costs and do not save time.
 
To view a larger version of the HealthIT infographic, click here

Infographic, EHR, EMR, HealthIT, HIT, Health IT

Topics: EHR, EMR, HIT, Health IT, HealthIT, Infographic, Mobile Health, mHealth

CMS Releases New and Updated FAQs for the EHR Incentive Programs

Posted by Matthew Smith on Sep 24, 2014 11:10:00 AM

EHR, EMR, CMS, Meaningful UseTo keep you updated with information on the Medicare and Medicaid EHR Incentive Programs, CMS recently added one new FAQ and updated seven FAQs to the CMS FAQ system. We encourage you to stay informed by taking a few minutes to review the new information below.

 

New FAQ:

  1. For Measure 2 of the Stage 2 Summary of Care objective for the EHR Incentive Programs, may an eligible professional,  eligible hospital, or critical access hospital count a transition of care or referral in its numerator for the measure if they electronically create and send a summary of care document using their CEHRT to a third party organization that plays a role in determining the next provider of care and ultimately delivers the summary of care document? Read the answer.

Updated FAQs:

  1. If my practice does not typically collect information on any of the core, alternate core, and additional clinical quality measures (CQMs) listed in the Final Rule on the Medicare and Medicaid EHR Incentive Programs, do I need to report on CQMs for which I do not have any data? Read the answer.
  2. Can eligible professionals use CQMs from the alternate core set to meet the requirement of reporting three additional measures for the Medicare and Medicaid EHR Incentive Programs? Read the answer.
  3. If one of the measures for the core set of CQMs for eligible professionals is not applicable for my patient population, am I excluded from reporting that measure for the Medicare or Medicaid EHR Incentive Programs? Read the answer.
  4. If none of the core, alternate core, or additional clinical quality measures adopted for the Medicare and Medicaid EHR incentive programs apply, am I exempt from reporting on all CQMs? Read the answer.
  5. If the denominators for all three of the core CQM are zero, do I have to report on the additional CQMs for eligible professionals under the Medicare and Medicaid EHR Incentive Programs? Read the answer.
  6. For the Medicare and Medicaid EHR Incentive Programs, if the certified EHR technology possessed by an eligible professional generates zero denominators for all CQMs in the additional set that it can calculate, is the eligible professional responsible for determining whether they have zero denominators or data for any remaining CQMs in the additional set that their certified EHR technology is not capable of calculating? Read the answer.
  7. I am an eligible professional who has successfully attested for the Medicare EHR Incentive Program, so why haven't I received my incentive payment yet? Read the answer.
Want more information about the EHR Incentive Programs?
Make sure to visit the Medicare and Medicaid EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Topics: EHR, EMR, Meaningful Use, Electronic Health Records, CMS, HIT, Health IT

October 3 is Last Day for 1st-year Medicare EPs to Begin a 2014 Reporting Period

Posted by Matthew Smith on Sep 16, 2014 11:58:00 AM

Deadline, EHR, EMR, The last day to begin a 2014 reporting period for first-year Medicare eligible professionals is October 3rd.

Here are a few key points eligible professionals who have not yet started participation in the Medicare EHR Incentive Program should know.

Earning Incentives

  • October 3rd is the last day to start the 90-day reporting period in 2014 for the Medicare EHR Incentive Program. 
  • If you start participation by October 3, you will have the opportunity to receive an incentive for 2014, and if you continue to achieve meaningful use, can earn incentive payments for 2015 and 2016 participation.  
  • If you wait and start participation in 2015, you will not be eligible to receive incentive payments, but can avoid payment adjustments.

Avoiding Adjustments

  • You will not avoid the payment adjustment in 2015, as you will not be able to attest to 90 days of data by October 1, 2014.
  • If you applied for a 2015 hardship exception by July 1, 2014, you may avoid the payment adjustment.
  • If you attest to 2014 data by February 28, 2015, you will avoid the 2016 payment adjustment.

Medicare eligible professionals must attest to demonstrating meaningful use every year to receive an incentive and avoid a payment adjustment.

For More Information

To learn more about other eHealth events and National Health IT Week, visit the CMS Events page on the eHealth website. For more information about the EHR Incentive Programs, visit the CMS EHR website.

Topics: EHR, EMR, Electronic Health Records, Medicare, CMS, HIT, Health IT

Subscribe to Email Updates

Value Model, Health Analytics

Posts by Topic

Follow Me