Archive for April, 2013

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

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.

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Patient Engagement: A Providers’ Challenge

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 …

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What Healthcare Could Look Like in Five to Ten Years

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 capital …

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The Step After The Next Step For Employer Health Insurance

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 …

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Research and Prevention May Keep You Awake

Healthy People 2020 (national agenda for optimal health and prevention) added sleep health objectives to our national agenda for good reasons. Did you know that 2.5% of fatal motor vehicle accidents are caused by “Drowsy Drivers”? A recent study by the CDC reported that 4.2% of respondents to a national survey stated that they had fallen asleep while driving in the last 30 days. So we should begin to think about driving while drowsy and driving while asleep as additional hazard categories. No pun intended!

This information can be startling but it presents opportunities to implement prevention strategies that help save lives. I’m not talking about new laws that will serve to penalize on the back end, but public health and clinical interventions that avoid medical complications. Many of us have been sleepy behind the wheel after a hard days work, but we probably never thought of it as a significant risk to the population. When you are sitting in afternoon traffic on I-285, how …

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The Secret Sauce of Healthcare Reform

There’s a lot going on with healthcare reform.  The thousands of pages that outline the Affordable Care Act are intimidating for any lay person and even some experts to understand.  Its aim though is relatively simple:  better patient care, improved population health, and lower costs.  But how do you really achieve that?

There are a number of exciting initiatives that are underway to reach this triple aim.  Yet, from my perspective, I would argue that the secret sauce of healthcare reform centers on case management.  Case management can be defined as the coordination of health services across different providers and locations to promote quality, cost-effective outcomes for patients.  At its heart is a case manager or care navigator.  (Not to be confused with “exchange navigators”; the Feds released a proposed rule last week that defined the eligibility of people who are tasked with providing guidance to people enrolling in the federal health insurance exchanges)

Care …

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The Importance of Innovation in Healthcare

r&dIn 1955, Dr. Jonas Salk announced to the world that he had developed a vaccine for poliomyelitis (or polio) and the world was forever changed. No more would there be the need for polio wards or iron lungs. Innovation is hugely important in healthcare.

Just 25 years ago, if a patient came to a hospital with a heart attack, the best that could be done for the patient was to inject morphine for pain and lidocaine, which doctors believed would prevent dangerous irregular heartbeats … and hope and pray for the best. Now, as a result of medical breakthroughs like statin therapy to treat the progression of atherosclerosis, the American Heart Association indicates that we have seen a near 40 percent reduction in deaths due to coronary artery disease since 1998.
In 1989, at the International AIDS Meeting, Dr. Samuel Broder declared that AIDS was a chronic condition and that treatment of the disease meant that AIDS was no longer an automatic death sentence. Medical breakthroughs are …

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Healthcare Business in the Relationship Era: 5 Ways to Succeed

The healthcare industry is dramatically changing. It’s happening because of technology, politics, economics, and empowered consumers. Today’s consumer is connected, juggling multiple devices, on the go, and want their voices heard. They crave information and connections—practically in real-time. This is every organization’s new business reality.

Experts and pundits have coined it the “Relationship Era.” As empowered consumers access social and digital platforms to voice opinions, the days of mass, one-way marketing are gone. It’s a two-way relationship now. The healthcare industry, ironically, hasn’t exactly been the best in developing “relationships” with patients, members or consumers. It’s been a bit of a machine pushing you through the process. Whether its doctors with increasingly limited face time or the cloud of uncertainty over insurance fees and processes, the healthcare industry hasn’t gotten high marks in personal relations. But that’s changing. Businesses and …

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