News 2/7/17

Top News

Teladoc partners with Compass Professional Health Services to offer its patients in-network referrals to PCPs and specialists, including oncologists and orthopedists, via its virtual consult platform. Dallas-based CPHS has traditionally offered its health navigation services to employers and payers. Its foray into telemedicine makes sense given the need for greater care coordination between an increasingly fragmented primary/urgent care ecosystem that includes retail clinics, urgent care practices, telemedicine providers, and brick-and-mortar practices.

Webinars

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Announcements and Implementations

Innovaccer adds MIPS Platform (not to be confused with the company’s MIPS Calculator) to its Datashop operating system to help physicians monitor performance, manage data, and submit it to CMS.

Atlanta-based Illuma Care Connections launches technology-based care coordination services for optometrists, ophthalmologists, PCPs, and payers. Providers within Illuma’s network can share data via the company’s HIE-like platform acquired from OcuHub, as well as identify and schedule appointments for patients at risk for vision problems. CEO Stephen Kendig, who also led OcuHub before it folded last year, helped launch the company in 2016 after stints with SoloHealth (now Pursuant Health) and Novartis.

Modernizing Medicine adds MIPS composite score reporting, analytics, and benchmarking reports to its EMA EHR. As a qualified registry, the company can report MIPS scores on a physician’s behalf, though I wonder if it charges a separate fee to do so. The cost of reporting MIPS data was definitely on the mind of one presumably independent physician during last week’s CMS MIPS overview webinar; she asked the presenters if it mattered how/who reported the data, alluding to the fact that her EHR vendor would charge a fee. Is it cost prohibitive to lay this at the feet of vendors? Do physician practices have the time to do it themselves? I’d love to hear from readers about what they plan on doing in this area.

InstaMed develops Secure Token payment functionality, which enables physicians and payers to offer portal-based online payment services without fear of compromising cardholder data.

HIPAA One gives users the ability to manage staff permissions and assessments in its HIPAA Security Risk Analysis software.

Oregon Advanced Imaging will implement RCM services from McKesson Business Performance Services at its three facilities in southern Oregon.

Talix upgrades its Coding InSight analytics tool to offer commercial payers and providers the ability to risk-stratify their members and patients by health insurance exchange metal level and age group. The company believes the new capability will enable users to better identify high-risk coders, eliminate coding gaps, and more accurately document conditions.

People

Livongo Health appoints Mark McClellan, MD (Duke University), Richard Milani, MD (Ochsner Health System), Anne Peters, MD (University of Southern California), William Polonsky (University of California San Diego), and author and consultant Susan Weiner to its new advisory board. The company, which specializes in technology-fueled diabetes management programs, has raised nearly $86 million since opening for business in 2014. CEO Glen Tullman, formerly of Allscripts, has targeted the company’s services to employers, signing 150 so far with another 50 expected to come on board in the next two months.

Telemedicine

Here’s an interesting twist on hotel marketing and customer retention: Royal Kona Resort in Hawaii begins offering Hawaii-based DocNow telemedicine services to its guests via Ipad available at the front desk. “Providing guests with the best experience, food, and amenities to ensure they have a memorable Hawai‘i vacation has always been our top priority,” says President of Hawaiian Hotels and Resorts Tom Bell. “It’s a natural extension of our mission to offer our guests immediate access to quality care instead of allowing them to lose any of their valuable vacation time waiting in the lobby of an urgent care clinic.” It’s certainly a good idea from a marketing perspective, but I wonder how many guests will actually use it, given the propensity of nearly every traveler (some of whom may have covered telemedicine visits through their employer or health insurance company) to have their own smartphone or tablet on hand.

Other

The local paper looks into the new-to-me trend of microclinics, highlighting Happy Doc owner and sole staff member Lara Knudsen. She opened her three-room, 300 square-foot office in 2013 after holding several town hall meetings to determine what people in the Salem, OR community wanted from a clinic. “The number-one complaint from the community,” Knudsen says, “was they had to wait weeks to get appointments and spent too much time in the waiting room for five minutes with a doctor that barely looked at them. With this model, my day is much more relaxing. I feel like I can listen to my patients. I have a lot more control instead of someone else making decisions.” The New Patients section of the Happy Doc website points to Knudsen’s use of healthcare technology: She asks all of her new patients to sign up for a 30-day trial of her Hello Health patient portal, which carries an annual subscription fee of between $35 and $65.

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From the Consultant’s Corner 2/7/16

Healthcare Reform’s Impact on Revenue Cycle Integration

The Affordable Care Act has expanded access to more than 20 million Americans who were uninsured. MIPS will accelerate the shift from fee-for-service to value-based reimbursement. While only 30 percent of healthcare payments were value-based in 2015, that is expected to rise to 50 percent by 2018. This shift demands closer integration between clinical and financial operations. After years of working to qualify for Meaningful Use, PQRS and other reimbursement incentives, value-based programs including MACRA now require organizations to tackle even tougher clinical/financial integration issues, such as how to improve patient access and better manage care quality. Managing patient care, in terms of access, services, and costs, however, requires clinical and financial operations to coordinate their efforts and align their priorities. The integration of EHRs, clinical workflows, and care coordination are vital to the revenue cycle. A clinically-driven revenue cycle has created a paradigm shift in the traditional revenue cycle mindset.

Healthcare reform and the shift to value-based care has placed a greater emphasis on improving patient access. This includes access to the appropriate medical services in a timely fashion (patient satisfaction, patient “keepage,” and care management), patient-centric financial counseling and proactive self-pay strategies. A more defined focus on patient access in the front-end sets the foundation for a clinically-driven revenue cycle. With these thoughts in mind, there are three key areas of the revenue cycle where healthcare organizations must focus integration efforts:

1. Patient Access

A clinically-driven revenue cycle starts from the time a patient calls to schedule an appointment. The increase in patient payment responsibility places critical emphasis on front-end functions including eligibility verification, prior authorization, and financial counseling. These activities, as well as patient check-in, also represent an ideal opportunity to address outstanding patient responsibilities.

Financial transparency can also increase patient satisfaction and help reduce the current bad debt average of 25-30 percent, but this requires an adjustment of focus and resources to the front-end of the revenue cycle to improve overall performance measures. An increasingly common approach adopted by many organizations is to centralize patient access operations, standardize policies and procedures, and leverage PM technology in order to:

• Ensure the capture of clean demographic and insurance data.
• Validate insurance coverage.
• Educate patients on their estimated responsibility.
• Assess patient propensity to pay and offer financial counseling.
• Collect patient payments like co-pays when registering or at time of
  check-in.

A centralized access center provides the patient with a single point of contact to address all front-end related questions and allows staff to be proactive rather than reactive. These preemptive measures will enhance patient satisfaction, which greatly influences reimbursement. A satisfied patient is less likely to seek services outside of their system. From a reimbursement perspective, this enables more effective care management in a value-based environment.

2. Integration of Clinical and Financial Workflows

With patient access and front-end operations being a large influencer of reimbursement, another factor that affects the revenue cycle is how clinical documentation and coding workflows are implemented and executed. Clinical workflows and EHR design must support, not hinder, a clinician’s ability to document patient care. It is also essential for physicians and staff to be properly trained on those systems. If diagnoses, orders, procedures, etc., are not properly documented/coded, it will ultimately result in billing delays or potentially lost revenues. If something is not captured, it will not be billed for on the back-end, which results in a loss of revenue. Long-term, this also impacts the ability to effectively manage population health programs.

The various technologies available to healthcare organizations contributes to revenue cycle workflows. Workflows and processes must parallel the technology being utilized. Fully integrated clinical and financial systems do provide several benefits. Organizations should adapt IT systems to support the clinical workflow and resist the urge to alter their workflow to accommodate IT platforms.

3. Reimbursement Analysis

Value-based contracts require more complex reimbursement analysis than periodic, retrospective reviews to see whether insurance claims were paid according to contract terms. Going forward, both financial and clinical teams will need to work together to assess reimbursement. The quality department will need to continually monitor clinical metrics for accuracy, for example, while the financial department will need to ensure accurate payment based on those metrics. Tight clinical/financial system integration — or clinical and financial reporting from one system — can help practices better manage cost and quality data together.

New Opportunity

Consolidating patient access, developing collections efficiencies, and bringing clinical and financial viewpoints to the reimbursement process can help practices thrive under value-based care. Keep in mind that these strategies all require integrated technologies, not technology-dictated workflows. With emerging value-based models, tremendous opportunity exists for organizations to create a clinically-driven revenue cycle that reduces costs and improves the patient experience — all the while achieving key tenets of healthcare reform.

Brad Boyd is president of Culbert Healthcare Solutions.

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News 2/6/17

Top News

President Trump tells Fox News that changes to the Affordable Care Act likely won’t go into effect until next year. “It’s in the process and maybe it will take till sometime into next year, but we are certainly going to be in the process,” he explained. “It’s very complicated. I would like to say by the end of the year, at least the rudiments.” Open enrollment for 2017 ended last week with a reported 9.2 million people signing up for insurance on the federal exchange, and an anticipated 3 million signing up for coverage via state-based exchanges. HHS has said that the ACA has helped 20 million people gain healthcare coverage since President Obama signed it into law in 2010.

HIStalk Practice Announcements and Requests

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Webinars

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Announcements and Implementations

Community Care of North Carolina partners with the National Community Pharmacists Association to launch a CMS-funded pilot program that will deploy electronic care plans among community pharmacists. The digital document will be shared between participating CCNC physicians and NCPA pharmacists, and conform to EHR-friendly standards already in use. The three-year program will define its success based on clinical quality, practice efficiency, and interoperability. Lantana Consulting Group has been tapped to help with implementation support.

Acquisitions, Funding, Business, and Stock

Jawbone looks to raise money to fund its transition away from an unsuccessful fitness band manufacturer into a company that sells healthcare products and services directly to providers. The company seems to have sold off its speaker business, which, along with headsets, helped get it off the ground in 2007. Its downward spiral in the wearables business has been well documented: Reports circulated in 2016 of an attempt to sell off some assets ahead of a sale or liquidation, and ongoing legal wranglings with Fitbit haven’t done much to inspire investor confidence.

People

The Georgia Academy of Family Physicians elects Lake Oconee Urgent Care CEO and Medical Director Eddie Richardson Jr., MD president.

The Sequoia Project adds new members to its Board of Directors including Brian Ahier (Medicity), Elise Anthony (ONC), Peter DeVault (Epic), David Horrocks (CRISP), Steve Posnack (ONC), and Ryan Stewart (Dignity Health).

Telemedicine

InnovaTel Telepsychiatry secures $2 million in private equity funding from Canyon Healthcare Partners. The Erie, PA-based company, which launched in 2014 as part of Gannon University’s Erie Technology Incubator, plans to use the financing to hire additional staff and further develop its telepsychiatry services for clinics and hospitals, particularly those in underserved and rural communities.

Government and Politics

CMS extends the PQRS reporting program deadline from February 28 to March 13. Physicians that fail to report 2016 data will incur a 2-percent cut in Medicare payments next year.

Other

Shields Health Care Group scores big with its latest ad – debuted during the Super Bowl – featuring New England Patriots quarterback Tom Brady. The ad features Brady pulling out a fifth Super Bowl ring and placing it in a locker before heading back for an MRI. The kicker is that the ad was filmed at the same time as one that aired in October and showed Brady pulling of four rings. Shields CEO explained that, “With Tom Brady and the Patriots we had a feeling the season would come to a thrilling end, and we sure are glad to have filmed the new ending. We couldn’t be prouder to partner with Tom Brady – now a five-time Super Bowl champion – and we are privileged Tom chose Shields as one of his only local endorsements in recent years.”

Delaware Health Information Network scores regional airtime during the Super Bowl with a 30-second ad touting its HIE capabilities and their impact on patient care throughout the state. “DHIN’s doing big things in Delaware and across the region,” says COO Randy Farmer. “What better time to engage consumers than during one of the biggest TV viewing days of the year?” The ad is the organization’s first attempt at connecting directly with consumers, and will soon be followed by radio, print, and digital messaging. I couldn’t find much in the way of details about the big things DHIN is doing, though I did come across this HIStalk reader comment from 2010 – three years after DHIN launched its HIE capabilities:

From Careener: “Re: DHIN. I don’t know if you saw this Delaware dust-up (no, not former witches as US Senate candidates). The Republican candidate for US Representative took a shot at his opponent over the Delaware Health Information Network, saying it is ‘mismanaged … with no tangible benefit.” I was involved with DHIN as a provider and it was, and is, an unqualified success, with Delaware being the first state to have statewide results delivery, HIE to EMR integration, and public health integration for pandemic and reportable results reporting. It is the model other stares are following. Love reading your updates, please keep up the good work.”

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Population Health Management Weekly Wrap Up 2/5/17

Liz Tingley, RN (Pinnacol Assurance) joins EQHealth Solutions as project director for its Colorado Prior Authorization Request Program, which helps the state’s Dept. of Health Care Policy and Financing improve access and outcomes for Medicaid beneficiaries.

I2I Population Health hires Cary McNamara (Agilum Healthcare Intelligence) as CFO.

Alameda Health System (CA) enlists Conifer Health Solutions to provide managed care support services for its HealthPAC program, which offers comprehensive healthcare to 33,000 patients in Alameda County. Services provided will include population health management, financial risk management, and nurse consulting services.

A new Black Book report finds that population health management technology is a fast-growing sector even though providers are forging ahead using only stopgap tools from their EHR vendor, they’re dealing with community HIEs that offer poor population health modeling data, and they have limited data availability beyond their own EHR’s health snapshots. Hospitals report that they will need new PHM and IT talent, but shortages may limit availability. The top three best-of-breed vendors were IBM Watson Health, Evolent Health, and The Advisory Board Company, while the top three PHM and value-based care consultants were Premier, The Advisory Board Company, and Evolent Health.

Rio Grande Valley Health Alliance, a Texas-based ACO comprised of 18 primary care practices, attributes its nearly $14 million in savings in 2015 to population health management technology from Lightbeam Health Solutions. The ACO has saved $28 million since forming in 2013, and was one of only four such organizations in the 2015 program to achieve a 100-percent quality score. RGVHA next plans to roll out Lightbeam’s Cohort Builder to help it better identify high-risk patients and the care programs that would best suit them.

Sponsor Updates

• Nordic will sponsor the inaugural Epic North Carolina Users Group Meeting February 8-9 in Greensboro.

Blog Posts

• AI technology spreads its wings in healthcare sector (Intelligent Medical Objects)

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Jenn, Mr. H, Lorre

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News 2/2/17

Top News

Former Vice President Joe Biden establishes the Biden Foundation to continue his work around the Cancer Moonshot. The educational foundation will also focus on equality initiatives, moving the Violence Against Women Act forward, supporting military service members, and increasing access to high-quality, affordable education.

Webinars

February 8 (Wednesday) 1:00 ET. “Machine Learning Using Healthcare.ai: a Hands-on Learning Session.” Sponsored by Health Catalyst. Presenter: Levi Thatcher, director of data science, Health Catalyst. This webinar offers a tour of Healthcare.ai, a free predictive analytics platform for healthcare, with a live demo of using it to implement a healthcare-specific machine learning model from data source to patient impact. The presenter will go through a hands-on coding example while sharing his insights on the value of predictive analytics, the best path towards implementation, and avoiding common pitfalls.

Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.

Announcements and Implementations

Behavioral health and developmental disability services provider HealthWest implements the Cx360 EHR from Core Solutions at its facilities in Muskegon, IL.

MAP Health Management will offer patients of its patient engagement technology end users a biometric pill dispensation device from Intent Solutions to help track medication adherence in real time. MAP will begin offering the TAD device as part of a pilot program this March that will focus on substance abuse disorder patients at high risk of relapse.

People

Jess Cramer (VillageMD) joins XG Health Solutions as VP of care management.

AMC Health announces new hires for its provider market: Christopher Taylor (Medtronic) will serve as SVP and GM; Laura King, RN (Medtronic) as VP; and Christopher Miller as VP of sales.

Bart Thompson (Atomic World Media) joins Green Circle Health as senior director of business development.

Telemedicine

TheDocApp formally launches its virtual visit service. CEO and founder Nick Garulay comes to the Naples, FL-based endeavor from the world of luxury and exotic vehicles. His LinkedIn profile proudly states that his Ambassador Auto Sales venture was “created in 2000 with 6k saved from waiting on tables.”

Government and Politics

NIH opens up funding opportunities for precision medicine initiative recruitment and outreach efforts. Up to $15 million will be made available over the next three years to help applicants build out the initiative’s cohort of 1 million US citizens willing to participate in long-term research efforts, including genome mapping. Applications are due March 24.

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Jenn, Mr. H, Lorre

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