HealthFlock

As healthcare buzz goes, “Big Data” has got to be one of the most thrown around phrases of the moment, nipping at the heels of “Obamacare” and maintaining a slight edge over “patient engagement.” I’m also fairly confident it is one of the least understood phrases in healthcare right now. It is used in every part of the industry – from physicians to vendors to payers, and even by some patients. But, as with any industry, subtle shifts in definition occur as different groups throw the phrase around.

Continue reading The Big Deal Behind Big Data in Healthcare »

We are on the cusp of a new era of healthcare technology and services. The incremental reduction of reimbursement for services, anticipated increase of patient volume and reimbursement tied to clinical outcomes is the tipping point of driving healthcare providers to rethink their service delivery model. Healthcare is historically slow to change the manner they do business until it is tied to reimbursement. An example is the shift in the market when managed care was introduced driving organizations to change their business practices. The current market shift of tying clinical outcomes to reimbursement is forcing healthcare providers to explore how they need to change their business practices to be profitable and serve the community in a quality manner.

mHealth technology is quickly moving towards market adoption and commoditization. We are seeing numerous prototypes and proof-of-concept solutions where a smart phone with software and biometric sensors are delivering real-time …

Continue reading The next era of healthcare technology and services, converge to support a changing healthcare business model »

A recent study published in the New England Journal of Medicine* on the Oregon Medicaid program has elicited reactions fitting for that twilight zone at the intersection of academic research and politics. Kaiser Health News characterized the paper as serving a “Rorschach test for how partisans and health policy wonks view the health care law”**

Oregon did a limited expansion of Medicaid in 2008 by offering coverage to individuals who met income and other eligibility requirements and were winners of a lottery. That meant that about 30,000 adults were newly enrolled in the Medicaid program out of 90,000 eligible. The state thus created a classic experiment with a control group and a treatment group.

The study found significant differences in the two group’s access and utilization of health care, a substantial improvement in mental health outcomes for the Medicaid covered population, a significant reduction in financial strain on covered families and significant …

Continue reading Oregon Rorschach Tests »

“Everybody knows that kids need “baby shots” – immunizations that protect against once-common childhood diseases. The shots are required for school entry, so most children are up-to-date by the time that they are five years old. But what many of their parents and grandparents don’t realize is that adults need immunizations as well. And the adults lag far behind the kids in getting the shots that they need.” This quote from Daniel Blumenthal M.D. of Morehouse School of Medicine was stated to address a bill currently pending in the Georgia legislature which would permit pharmacists to administer adult immunizations that are currently off-limits. Today, pharmacists can administer flu shots for adults but many other shots must be given in the physician’s office.

Vaccinations are one of the few advances in science and health care that have been able to prevent and or eradicate certain diseases. Think about it! We take a pill for Hypertension but it doesn’t go …

Continue reading Expanding Privileges for Expanding Populations »

For years now, we have held on to the hope that health information technology (health IT) solutions would translate into better health outcomes. We have indeed seen signs that physicians and hospitals which deploy health IT solutions like electronic health records (EHRs) provide better care.

We have also hoped that the day of an interoperable platform would allow healthcare professionals and facilities to access individual patient’s health information. Some progress has been made in a couple of states in terms of creating a legitimate health information exchange (HIE). However, the process of building, implementing and sustaining an HIE needs accelerating in most states including Georgia.

But as data is gathered, stored and analyzed, we have new, emerging opportunities which have promise. The term “big data” has surfaced as a new buzzword in healthcare.

Data is growing and moving faster than healthcare organizations can consume it. Most medical data is unstructured but …

Continue reading Achieving Personalized Healthcare from Big Data Analytics »

This is the most common question I receive after going through the arduous proposed 501(r) regulations with providers. Most of the proposed regulations for 501(r) 4-6 were released last summer; however, the IRS remained virtually silent until the end of April on proposed penalties for violating those regulations. The new proposed penalties will take a scaled approach similar to the penalties for HIPPA breach.

According to the proposed regulations a minor and inadvertent violation, which is corrected promptly, will not be considered a breach. Omissions, over the minor and inadvertent level, but not willful and egregious, which are promptly discovered and corrected, will be forgiven with correct disclosures. Only those violations found to be willful and egregious will result in remove of the 501(c)3 status.

Now before you celebrate and cancel your extensive implementation plans for your new improved and widely publicized FAP, let us think for a moment about what willful and …

Continue reading Will I really lose my 501(c)3 status? »

The state of Georgia’s health information exchange (HIE) has recently taken on new meaning for patients and providers, as the program looks to expand its network thanks to additional funding.

Continue reading Don’t Let the State of Georgia’s Health Information Exchange Confuse You »

In a complex regulated healthcare world, providers are constantly trying to ensure that they can remain viable and provide the best quality services to patients. However, the ever-changing regulations impact how providers are permitted to provide care, share information, bill for services, document services and where the services can be delivered. While the regulations constantly change the providers’ day-to-day behavior, two themes are consistent throughout the laws. First, providers will soon be paid based upon quality outcomes instead of the volume of patients treated. Second, providers will be driven to reduce costs related to delivering care to be viable. In order to achieve quality outcomes and reduce costs, the provider is not in complete control. In fact, providers can only accomplish quality outcomes and reduce costs when a patient is engaged and accountable for his or her healthcare.

Because of Accountable Care Organizations (ACOs), the hospital compare …

Continue reading Patient Engagement: A Providers’ Challenge »

We are nearing an inflection point in the delivery of healthcare that will redefine how most of us receive medical services. The market demand for healthcare services is about to explode, and the supply of caregivers cannot meet this demand. The imbalance of demand to supply with the constraints of limited budgeted dollars, redefines the level of medical care and types of services provided. Here are a few changes we could see on a national level:

• Hospitals will consolidate and capture market share based upon geographic boundaries. They will be responsible and at-risk for the care of a patient population within their defined geographic area.
• Not-for-profit hospitals will no longer exist. All hospitals will be considered for-profit and taxed respectively.
• The number of hospital beds will stop growing and over time contract due to the tightening of reimbursement. Care delivery is directed further away from the acute care setting, and closer to a patient’s home.
• High tech …

Continue reading What Healthcare Could Look Like in Five to Ten Years »

Despite dire predictions most employers currently offer health insurance coverage to their employees are going to “dump” their coverage as a result of the Affordable Care Act (ACA) in 2014. Those who do drop coverage will do so because their employees get better or lower cost coverage in the public health insurance exchanges than the employer can offer. However, the ACA will have profound impacts on the health insurance as an employee benefit by removing many of the barriers to the creation of private health insurance exchanges.

With apologies to Will Rogers the employment-based system of financing health care has been called the worst possible way for gaining access to health care: except for all the others. The employment-based system mitigates the problem fo adverse risk selection that would make a wholly individual insurance market unsustainable.

Many employers over the last two decades have expressed a wish to discontinue health insurance as part of employee …

Continue reading The Step After The Next Step For Employer Health Insurance »