Population Health Management Weekly Wrap Up 10/16/16

Population health management technology vendor Altruista Health hires Munish Khaneja, MD, MPH (EmblemHealth) as chief medical officer.

Ellyn Theophilopoulos, MD (Clearwater Free Clinic) joins EQHealth Solutions as corporate senior medical director.

Siemens Healthineers will resell  IBM Watson Health’s population health management solutions. The companies will also work together to create new solutions in a five-year strategic alliance.

Creo Wellness names Joe Anastasia (Business Operations Consulting) COO and Jeff Burke (Burke Consulting) an advisor focusing on technology and data security. Co-founder Tonya Mallory has stepped into an advisory role. The Henrico, VA-based health, wellness, and technology company offers providers EHR integration, chronic care management content delivery, disease management and prevention programs, and patient engagement solutions. The company has raised $2.25 million since it launched in 2015.

Irving, TX-based HealthSmart, which administers health plans for self-funded employers, extends its contract with ZeOmega and upgrades to the latest version its population health management software. HealthSmart is especially interested in using the Jiva solution to help with ICD-10 compliance projects and its case and disease management initiatives.

South Florida Behavioral Health Network selects ODH’s Mentrics behavioral population health management technology to improve care coordination between mental health, substance use, and social support services within jail diversion programs.

Insurer Highmark will implement Welltok’s CafeWell Rewards program for its Medicare Advantage policyholders. The consumer wellness software vendor raised $33.7 million in a Series E funding round earlier this month, increasing its total to $164 million.

Evolent Health completes its acquisition of Valence Health, paying $219 million rather than the originally announced $145 million since the sale price was tied to Evolent’s share price. Evolent says Valence will generate revenue of around $85 million this year.

GE announces the winning communities of its HealthyCities Leadership Academy Open Innovation Challenge, each of which will receive $25,000 to develop population health improvement projects with public and private stakeholders. The nine winners will go on to participate in a year-long collaborative with GE as they seek to get their projects off the ground and compete for a final, shareable prize of $250,000.

3M Health Information Systems and Verily Life Sciences will work together to analyze population-level datasets into usable quality measures for complications, readmissions and mortality, and cost.

HMS Holdings updates its Essette Suite of care management tools, adding business intelligence capabilities to its care management and population health management technologies.

Sponsor Updates

• Intelligent Medical Objects and NVoq will exhibit at AHIMA October 15-19 in Baltimore.
• Nordic will sponsor Piedmont Healthcare’s Southeast User Group Meeting October 18 in Atlanta.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 10/13/16

Top News

In an effort to improve physician satisfaction and reduce administrative burden, CMS will incorporate physician feedback into its ongoing review of regulations and policies related to the move to advanced payment models within MACRA. The initiative will be led by senior MDs within CMS, who will report to Deputy Administrator and Director Shantanu Agrawal, MD. Regional CMS offices will host local meetings within the first six months to ensure physicians working in the trenches have an opportunity to voice their concerns.

As part of the initiative, CMS will launch an 18-month pilot program that will reduce medical review/scrutiny for physicians practicing within certain APMs. “CMS is turning a new page in assessing not only how to reward for quality, but also to reduce administrative hurdles,” says Agrawal. “I look forward to hearing about what steps we can take to make the practice of medicine in Medicare more efficient and rewarding.”

The American College of Physicians has already weighed in with its support, adding that it hopes the pilot program will eventually be expanded to include the Comprehensive Primary Care Plus and patient-centered medical home programs.

On a side note, HHS Acting Administrator Andy Slavitt hints at the release date of a final MACRA rule in his tweet above.

HIStalk Practice Announcements and Requests

If you’re a HIStalk Practice, HIStalk, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and I’ll include your company in our downloadable exhibitors guide. I won’t be attending this year, and so would happily consider running reader reviews of the conference. Email me if you’re interested in contributing.

Webinars

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

Raintree Systems adds electronic payment solutions from TransFirst to its EHR and PM technologies for specialties including physical, behavioral, and pediatric therapy.

Suncoast Community Health Centers selects SRG Technology’s TopCare No-Show Roster to help it improve patient no-show rates at its FQHCs in Hillsborough County, FL.

MedCart Specialty Pharmacy utilizes CareSpeak Communications technology to launch an SMS-based messaging program it hopes will help improve the medication adherence of its patients with chronic conditions. The new program will enable patients to message MedCart pharmacists, request refills, and receive reminders.

M3 adds content from clinical trial recruitment tech company EPatientFinder to its ecosystem of digital healthcare information services and websites for physicians.

Allscripts adds the voice-controlled MDLog patient data documentation app from MDOps to its developer program.

Acquisitions, Funding, Business, and Stock

Genomic decision-support company ActX joins Athenahealth’s More Disruption Please program and marketplace. Launched in 2012 by Andrew Ury, MD – founder of the first commercial EHR company way back in 1983, the company has developed technology that automatically checks prescriptions and alerts physicians of potentially adverse drug reactions, efficacy, or dosing issues based on a patient’s genetic makeup.

Primary care company Iora Health raises $75 million in a Series D round of financing led by Temasek, a new investor based in Singapore. Iora will use the cash infusion to increase its presence beyond the 11 states it currently operates in. Founder and CEO Rushika Fernandopulle, MD has alluded to the need for Iora’s services “globally,” and so I wonder if Singapore may end up being part of its expansion plans

For now, Humana adds five Iora Health primary care practices to its Medicare Advantage Plan networks in Arizona, Colorado, and Washington. This marks the third consecutive year the two companies have collaborated. The payer hopes to have 75 percent of its MAP members seeing providers that have made the switch to value-based payment models by the end of next year; it has reached 61 percent thus far.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

Readers Write: Understanding the Implications of Risk Adjustment

Understanding the Implications of Risk Adjustment
By Anand Shroff

Physicians love data. And though they readily absorb the intricate details of evidence-based care and outcomes, most physicians have incomplete visibility into the health of the populations they serve. For this, they may rely on their health plan partners to analyze the data and provide the details. Going forward, this reliance on others for data threatens to severely impact how physicians are reimbursed for their services.

The Impact of MACRA

Merit-based and risk-based reimbursement models are being introduced, and so physicians need to accurately assess the acuity of their patients to prosper in this new reimbursement environment. Under the MACRA reforms, Medicare providers will either be paid under a new Merit-Based Incentive Payment System (MIPS) or receive incentive payments for participation in Advanced Alternative Payment Models (APMs). Based on CMS calculations, about 92 percent of eligible clinicians will fall into the MIPS track, and about 8 percent will fall into the APM track. Physicians participating in the MIPS will be subject to payment adjustments based on their performance in four categories – quality, resource use, clinical practice improvement activities, and advancing care information. In advanced APMs – for example, certain ACOs – clinicians accept risk for providing coordinated, high-quality care. Under both tracks, risk adjustment will impact how Medicare providers are paid; providers will need to make sure their adjusted reimbursements accurately reflect the risk present in the populations that they serve.

In order to succeed under these reforms, physicians will need to know, for example, which patients:

• Need to be seen – and when – to adequately document conditions.
• Have gaps in their treatment of chronic conditions.
• Have multiple conditions, and whether some have been addressed, while others have not.

A Change in Perspective

Going forward, with reimbursement based on value rather than volume, physicians will need to ensure they can perform risk adjustment accurately. Simply conducting patient encounters and submitting claims for services provided will not be sufficient to identify risk and earn commensurate reimbursement. Medicare providers will need to fully document conditions and code diagnoses on claims. This is a fundamental shift in approach that physicians haven’t been formally trained to do in medical school or in the years that they’ve served their profession.

Physicians will need additional data to drive performance improvement and favorable financial outcomes. Currently, physicians either rely on payers for risk adjustment data, or they can gain some insights from the Quality and Resource Use Reports (QRUR) provided by CMS. In short, relying on data from others to be paid more accurately isn’t a sound strategy. Physicians need greater transparency into their performance – and performance against their peers – to take control of their processes and financial health. Prospering in this new environment will require physicians to become educated about risk adjustment, understand its rules, and know how to use it to their advantage.

What is Risk Adjustment?

Risk adjustment is an actuarial tool that ensures that the cost of caring for a patient does not exceed the payment received to administer that patient’s benefits. Risk adjustment utilizes a data-driven approach to ensure optimal patient care and to correlate payments via an average risk adjustment factor that reflects the health conditions of the at-risk insured population. In order to impact a patient’s risk score for payment, and thereby impact RAF, two critical steps need to occur. First, the physician must properly document the identified condition(s) in the patient’s EHR; and second, the condition must be translated into codes (using standard ICD-10-CM codes applicable to the Hierarchical Condition Category model) and then be submitted to the payer with sufficient documentation. In 2016, the care for over 90 million American lives will be managed under risk-based payment programs. This number is growing at the rate of 15-20 percent annually.

The Need for Analytics

Once physicians understand how their day-to-day encounters with patients impact the computation of RAF scores, data analytic tools can be integrated at the point of care to help pinpoint gaps. To succeed, analytic tools are required to help providers:

• Obtain accurate assessments of risks within the population.
• Measure their performance in terms of value and how they compare to peers.
• Actively manage the health of the populations they serve.
• Pinpoint patients with health conditions who require targeted interventions.
• Assess how much they should get paid based upon their work and the severity of the health conditions within the population they serve.

With the right analytic tools and data, physicians can gain a better understanding of risk adjustment and make it work to their advantage. It will be important for physicians to master these tools in the years ahead and think as both clinicians and business people, since the value that physicians deliver will be used to rank them against their peers and determine their reimbursement.

Anand Shroff is co-founder and chief technology and product officer of Health Fidelity in San Mateo, CA.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 10/12/16

Top News

Axial Healthcare raises a $16.5 million Series B investment led by venture-growth equity fund Oak HC/FT. The Nashville-based company, which raised $8 million last year, will use the new financing to further develop its cloud-based decision-support software for pain management. Oak HC/FT Venture Partner Nancy Brown will join Axial’s Board of Directors.

HIStalk Practice Announcements and Requests

If you’re a HIStalk Practice, HIStalk, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and I’ll include your company in our downloadable exhibitors guide. I won’t be attending this year, and so would happily consider running reader reviews of the conference. Email me if you’re interested in contributing.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 8 (Tuesday) 1:00 ET. “A CMIO’s Perspective on the Successful 25 Hospital Rollout of Electronic Physician Documentation.” Sponsored by Crossings Healthcare. Presenter: Ori Lotan, MD, CMIO, Universal Health Services. UHS rolled out Cerner Millennium’s electronic physician documentation to its 6,000 active medical staff members — 95 percent of them independent practitioners who also work in competitor facilities — across 25 acute care hospitals. UHS’s clinical informatics team used Cerner’s MPage development toolkit to improve the usability, efficiency, communications capability, and quality metric performance of Dynamic Documentation, embedding clinical decision support and also using Nuance’s cloud-based speech recognition product for the narrative bookends of physician notes. This CMIO-led webinar will describe how UHS achieved 70 percent voluntary physician adoption within one month of go-live, saved $3 million in annual transcription expense, and raised EHR satisfaction to 75 percent. It will include a short demonstration of the software that UHS developed to optimize the physician experience.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

Encompass Medical Partners adds HIPAA-compliant IT maintenance and security services to its line of RCM, HR, and clinical offerings for physician practices.

ChartWise Medical Systems adds new real-time reporting and management dashboards to its computer-assisted CDI software.

People

The Tolan Group promotes Kaye Johnson to associate partner. She will lead the executive search firm’s new telehealth/digital health practice.

Acquisitions, Funding, Business, and Stock

Wolff Olins North America President Tim Allen, who led Zocdoc’s rebrand last year, believes traditional healthcare companies suffer from a love of “familiar visual cues like shields and crosses” (and blues and greens) when it comes to branding. “At the root of design,” he explains, “is the process of solving problems with creativity. There’s no way to take on the new health care challenges of affordability, access, obesity, wellness, or preventive care without design. Functionally, you’re designing for people so that they can achieve goals. Emotionally, you’re hopefully creating a sense of wonder and delight.” While Mr. H sometimes gives short shrift to the logic behind company rebrandings, I do believe that there is a sort of science to it. It puts me in mind of Dodge Communications President Brad Dodge’s blistering reviews of exhibitor booths at HIMSS several years ago …

And speaking of Zocdoc … the appointment-scheduling app vendor has joined forces with Oscar, Foursquare, Virgin Hotels, and several other companies to encourage employers to offer paid “Unsick” days off so that employees can schedule annual wellness checkups. The campaign coincides with a Zocdoc survey that found 60 percent of workers feel uncomfortable taking time off for such preventive care visits, and 50 percent feel missing work for such reasons will harm their chances of a promotion.CEO Oliver Kharraz, MD was surprised to learn that a third of his employees weren’t using all of the preventive services covered by the company’s health plan. “It was really shocking to me to see that, because we’re a health-care company,” he said. “There needs to be explicit permission for employees to go there.”

Telemedicine

Zoom+ launches a chat-based telemedicine app to complement its health insurance offerings and chain of primary care clinics in Portland and Seattle. The company, which has been the subject of several protests due to its refusal to accept Medicaid and Medicare, has announced it will withdraw its plans from the federal insurance marketplace next year. It was one of the smallest carriers in the Portland market, signing up just 839 members last year and losing $3.8 million in the process.

Other

The inaugural Cybathlon comes to Switzerland, bringing together competitors, technologists, and developers to highlight the ways in which futuristic assistive technologies help disabled people overcome the more practical challenges of daily life. Medals were awarded in six races – brain-computer interface race, functional electrical stimulation bike race, powered arm prosthesis race, powered exoskeleton race, powered leg prosthesis race, and powered wheelchair race, with Iceland and Switzerland taking home the most honors.

Sponsor Updates

• Aprima will exhibit at the Texas Association of Community Health Centers meeting October 17-18 in Dallas.
• MedScape includes E-MDs as a leading vendor for usability and customer satisfaction in its latest EHR report.
• EClinicalWorks will exhibit at the AOAO Annual Meeting October 13-15 in Washington, DC.
• Nordic is recognized in “Best Places to Work in Healthcare” for the third straight year.

Blog Posts

• Dense Breasts? Patient Education can Help Women Feel More Empowered and Informed (Healthwise)

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

News 10/11/16

Top News

The latest figures from Rock Health paint a not-so-rosy picture for digital health IPOs. The $142.6 million raised so far this year is a far cry from the $2 billion raised last year; granted, only two companies – NantHealth and Tabula Rasa HealthCare – have gone through the process thus far, while six made the leap in 2015. It’s also the least amount raised in public markets since 2012. Analysts are betting that San Francisco-based IRhythm, which has developed software that monitors and aggregates heartbeat data, will bump up this year’s figure when it IPOs in the coming weeks.

HIStalk Practice Announcements and Requests

If you’re a HIStalk Practice, HIStalk, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and I’ll include your company in our downloadable exhibitors guide. I won’t be attending this year, and so would happily consider running reader reviews of the conference. Email me if you’re interested in contributing.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

October 25 (Tuesday) 1:30 ET. “Data Privacy/Insider Threat Mitigation: What Hospitals Can Learn From Other Industries.” Sponsored by HIStalk. Presenters: Robert Kuller, chief commercial officer, Haystack Informatics; Mitchell Parker, CISSP, executive director of information security and compliance, Indiana University Health. Cybersecurity insurers believe that hospitals are too focused on perimeter threats, ransomware, and the threat of OCR audits instead of insider threats, which are far more common but less likely to earn media attention. Attendees will learn how behavior analytics is being used to profile insiders and detect unusual behaviors proactively and to place privacy/insider risk within the risk management matrix.

November 9 (Wednesday) 1:00 ET. “How to Create Healthcare Apps That Get Used and Maybe Even Loved.” Sponsored by MedData. Presenter: Jeff Harper, founder and CEO, Duet Health. Patients, clinicians, and hospital employees are also consumers who manage many aspects of their non-medical lives on their mobile devices. Don’t crush their high technology expectations with poorly designed, seldom used apps that tarnish your carefully protected image. Your app represents your brand and carries high expectations on both sides. This webinar will describe how to build a mobile healthcare app that puts the user first, meets their needs (which are often different from their wants), creates "stickiness," and delivers the expected benefits to everyone involved.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

Modernizing Medicine’s GMed subsidiary develops iPad-friendly patient check-in technology compatible with its EHR and PM software for gastroenterologists.

People

John Camperlengo (Quartet Health) joins Zelis Healthcare as general counsel and chief compliance officer.

The Chartis Group adds Mary Jo Morrison (Allina Health), Mark Pasquale (Missouri Health Connection), and Robert Schwartz, MD (University of Pittsburgh Medical Center) as principals of its IT practice.

Telemedicine

DigiSight Technologies adds secure app-based imaging and messaging to its smartphone-based Paxos Scope technology for eye exams and care coordination.

HealthTap joins several other telemedicine vendors in offering free services to those affected by Hurricane Matthew in the US and Caribbean. It has also added storm-specific resources, checklists, and tips to its library of health advice.

Amerigroup will roll out telemedicine benefits from LiveHealth Online to its Medicare Advantage plan members in New Jersey beginning January 1.

Other

This doesn’t have anything to do with healthcare IT, but it was too warm and fuzzy not to share.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.