Health Care's Future IT Value Proposition

Posted by Don McDaniel on Sep 7, 2017 11:00:00 AM

McKinsey & Company recently published the results and analysis of a global survey on IT’s future value proposition. While many expect IT, and CIOs for that matter, to play a growing role in improving business results, IT still suffers from performance issues and unfulfilled promise. The survey suggests that CIOs must raise their skills and influence within their respective organizations. Of the 709 respondents, many felt IT will contribute most through innovation and integration – that is, better integrating solutions that support business results. As I read this and applied it to the healthcare industry, I couldn’t help but think about how these issues related to the current malaise – an ambivalent sense that we’re not sure whether technology is advancing progress, or further complicating it. There are more than a couple of general conclusions from the survey that apply explicitly to healthcare.

First, integration seems to be even more important in industries with legacy technologies, and the healthcare business is full of proprietary, siloed, premise-based technologies. One explicit use case in today’s migration to value-based medicine is the challenge of providing relevant, timely information to caregivers operating in delivery environments with multiple electronic health records. There is no easy way to build sustainable integration today, but this must be solved in the future.

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Topics: Value-Based Healthcare, Healthcare IT, IT and analytics, Role of CIO

What Could Medicare Do To Drive Change

Posted by Don McDaniel on Aug 29, 2017 11:00:00 AM

There’s been a lot of discussion about reforming our health care system over many generations and presidential administrations, and most recently in the run-up to and immediate period after the election of Donald Trump. Republicans promised for 7 years to repeal and replace Obamacare only to (so-far) fail miserably at walking-the-walk.  I believe the political milieu, is at best a red herring, innocuous and really noise.  The fact is the value movement that we’re talking about in health care is really a market movement.  The proverbial train has left the station and market principals are already starting to disrupt the industry.

I was participating in a recent panel about innovation in healthcare, and the moderator asked the panelists, “what one thing would you do to change the status quo, to drive innovation ?”. My colleagues, all experts, but all practioners in the “old health economy” shared all the conventional wisdom; all the responses were, at best, representative of incrementalism.  I had the luxury of answering last, and used the time to my benefit for once.  I suggested that completely privatizing Medicare would be my choice.  Privatizing or “Marketizing” Medicare would expose one of the world’s biggest monopolies (short of true single payer government plans) to market forces.  From a budgetary perspective, privatizing Medicare from its current defined-benefit approach to a defined budget, or defined-contribution model would allow CMS to more predictably budget for growth in the program, and leverage the market of many willing sellers of insurance and services. 
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Topics: Value-Based Healthcare, medicare, Healthcare Innovation

It's All About The Doctors

Posted by Don McDaniel on Aug 3, 2017 11:00:00 AM

I recently attended a great health care industry “futures” conference, a chance to get the pulse of the industry through discussion with key thought leaders.  Despite all the noise around ACA, “repeal and replace”, “skinny repeal”, etc., there were two take-aways that reinforced what I’ve already been feeling.

The first is the need for much better, much deeper, much more transparent payer and provider collaboration.  Call this “joining the dark side”, coopetition, etc. – the demands of new health care consumers and their surrogates will demand more seamless collaboration.  Collaboration is a vague, over used phrase; in my estimation, both those paying for and financing care (purchasers and their payer representatives; often health insurers) and those delivering and (increasingly – see high deductibles and higher co-pays) financing care (providers) must be more willing to work together to solve problems.  This requires compromise, and a long-view.  One of my favorite sayings is, “Pigs go to feed, hogs go to slaughter”; we have too many hogs and not enough pigs. 

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Topics: ACA, Payer Provider Collaboration, Physician Success, Community Based Physicians

The Telemedicine Battle: when will the benefits outweigh the challenges?

Posted by Continuum on Jun 13, 2017 11:30:00 AM

Though telemedicine has been a segment of the healthcare industry for years, the use of telehealth technology has not expanded to meet its full potential. Telemedicine still has a few challenges to overcome, the biggest being the lack of strong financial incentives for implementation and utilization—despite telehealth’s capacity to lower overall healthcare usage and save time for providers.

The healthcare industry lacks a unifying drive to incorporate telemedicine into physicians’ day to day routines, since in many states providers are not reimbursed for tele-visits at the same rate as in-person visits. Continuum Health's CMO, Dr. Michael Renzi, recently wrote on his difficulty embracing telemedicine due to a continuing need for fee-for-service payments. Though telemedicine offers great opportunities for practices, it is stymied by the lack of proper reimbursement.

Yet with the volatility surrounding healthcare policy under the Trump administration, there is hope that new or further developed healthcare legislation could incentivize telemedicine for providers, helping them to achieve the Triple Aim.

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Topics: Telehealth, Telemedicine, virtual medicine

Primary Care Providers Can Lower the Cost of Healthcare

Posted by Continuum on Apr 18, 2017 11:02:00 AM

Today’s patients have numerous choices of hospitals, urgent care, and other ambulatory care centers when they seek treatment. While primary care providers (PCPs) can typically help patients with these decisions, patients sometimes visit these facilities before consulting their PCPs for treatment or preventative care. Expensive hospital visits can drive up healthcare costs and have a negative impact on quality overall—but fortunately, PCPs have some options to help keep costs down. 

PCPs lower healthcare utilization

Independent PCPs emphasize quality of care through their personalized interactions and relationships with their patients. When PCPs are readily available in a community, patients are less likely to seek treatment at a specialized facility, hospital, or urgent care center.1 Unnecessary emergency room visits are a drain on the nation’s healthcare system when the source of the visit could have been treated or prevented by a primary care provider.

PCPs focus on establishing a rapport with their entire patient population. These relationships allow doctors to draw conclusions about a patient’s overall health or potential illnesses on an ongoing basis. Consistent, meaningful visits build a bond between patient and provider, which encourages the patient to seek treatment from his or her PCP over a hospital physician.

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Topics: cost of care, lower cost of care, independent physician, hospital employment, Primary Care Providers

Connected Care: How the 'Internet of Things' will Advance Healthcare

Posted by David Kovel on Apr 4, 2017 11:00:00 AM

5 Key Points Physicians Should Know

In today’s digital world, we have smartphones, smart homes -- and increasingly we will have smart healthcare. From pills to pacemakers, a growing number of medical devices will be connected to the internet, enabling both patients and physicians to enhance the health of individuals and populations. Another aspect of this trend – telemedicine – is already taking off, with particular support from employers and encouragement by the federal government.

These advances, known generally as the Internet of Things (IoT), offer huge promise for the future of healthcare. Telemedicine is already saving money for patients, providers and payers, especially by reducing the frequency and length of hospital visits1.

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Topics: internet of things, digital healthcare, connected care, healthcare technology

Independence vs. Employment for Physicians

Posted by Continuum on Mar 21, 2017 11:01:00 AM

Is employment really the answer?

Hospital employment, with its promises of financial security, fewer administrative duties, and more stable working hours offer a strong case for physicians.  From 2007 to 2016, the number of independent physicians has decreased by 28 percent.1,2 Many physicians have opted for employment within a large health organization because it appears more appealing than fighting to maintain an independent practice; but the number of physicians pushing for independence may be on the rise.

This shift is being triggered as physicians find those promises aren’t always grounded in reality. Physicians feel that an employed position will require less administrative tasks and thereby provide more time to spend with patients. Yet administrative duties are inescapable. Most physicians are still required to maintain quality of care reporting and accurate EHR entries, whether they are independent or employed.

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Topics: independent physician practice, independent physician, hospital employment

Telehealth: the best idea that may never happen

Posted by Michael Renzi, DO, FACP on Mar 7, 2017 11:02:00 AM

Telehealth is the wave of the future for PHM and VBC—but who’s going to pay?

When it comes to defining the factors that will have the biggest impact on the future of healthcare in the United States, it’s no wonder that connected care is among them.  As our technology improves and new devices hit the market seemingly every week, the ability to capitalize on these innovations to improve care delivery and patient engagement is a no-brainer.

But, two questions come up when I talk to my clinical colleagues: Should I offer telehealth services, and how can I pay for them? My answers: yes, and maybe try a tip jar at the front desk.

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Topics: payer reimbursement, Telehealth, Telemedicine

New Medicare reporting requirements: MACRA, MIPS & APMs Key Dates & Deadlines

Posted by Continuum on Feb 28, 2017 11:00:00 AM

As many physicians are aware, major changes are underway in how Medicare will reimburse them. The Centers for Medicare and Medicaid Services (CMS) is phasing in new reporting requirements focusing on “value” of care: measures of quality, overall cost of care, and patient satisfaction. Increasingly, how doctors address these new requirements will directly affect their reimbursement – potentially leading to financial rewards or penalties. Moreover, commercial payers are starting to follow Medicare’s lead. 

Here’s a quick refresher on the basics, including important dates for most physicians who see Medicare patients:  

  • The Medicare Access & CHIP Authorization Act (MACRA) of 2015 requires doctors to choose a reporting path – either the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (Advanced APM).
  • MIPS is comprised of Quality, Improvement Activities, Advancing Care Information, and Cost. MIPS payment adjustments will start at +/-4% for the 2017 reporting year (2019 payment year) and increase over time. (Cost will not affect payment adjustments until 2018).
  • Advanced APMs offer higher financial incentives than the MIPS track, but require more advanced levels of value-based activities. APMs also require physicians to be part of a larger group, such as an accountable care organization (ACO) or medical home, and to bear greater financial risk.
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Topics: MIPS, APMs, MACRA

The Rise of the Narrow Network

Posted by Continuum on Feb 21, 2017 10:30:00 AM

Despite helping reduce costs, are narrow networks the true way of the future?

It's time for a change. As limited provider choice in exchanges rises, and the need to track quality across the patient’s care delivery continuum creates a bigger impact on providers’ bottom lines, practices will need to find means to protect their revenue. This is forcing more and more provider organizations to develop preferred partner lists—another way of saying narrow networks.

There are two key groups impacted by this shift, and they seem to have different feelings about the pros and cons of narrow networks.  

  •  Patient benefits: The healthcare industry can expect to see more narrowing as time goes on. This is, in part, thanks to the benefits to healthcare consumers. Narrow networks offer cheaper premiums—on average, those premiums are 17 percent less than plans with broader networks.[i] In fact, nearly 70 percent of the lowest priced plans are built around narrow networks, ultra narrow networks, and tiered narrow networks.[ii] The downside, though, is higher prices for out-of-network costs—which were, on average, 300 percent higher than the average Medicare rates for 97 common medical procedures.[iii]
  •  Provider concerns: This trend is causing some anxiety amongst providers, and for a couple of different reasons. Providers’ ability to retain their patients may be challenged if their system of narrow networks is not clearly defined. In addition, providers may not have a clear understanding of how their participation or performance will be measured—or what may cause them not to be invited to participate in an ultra-narrow network.
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Topics: healthcare exchanges, narrow network

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