Archive for the ‘Management’ Category

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 …

Continue reading The Secret Sauce of Healthcare Reform »

At the recent HIMSS trade show, six large healthcare IT companies (McKesson, Cerner, athenahealth, Allscripts, Relay Health, Greenway Medical Technologies) announced the formation of a not-for-profit company called CommonWell Health Alliance. The purpose of this organization is to create frictionless movement of patient-centered data across all settings of care and among all health care IT systems[1].

This is a profound announcement from companies that did not embrace the frictionless movement of data across systems within an acute care setting let alone outside the four walls of a hospital. This is great news for all of those organizations that lacked the clout or financial assets to interface their best of breed systems with the large name brand solutions. Historically, the price and effort of sharing data with the larger acute care vendors was cost prohibitive. The price and effort became a barrier to entry keeping best-of-breed competition out of a healthcare provider’s …

Continue reading Is the Healthcare IT companies’ announcement of seamless interoperability marketing hype or a social awakening? »

Is this a good time for ICD-10? Providers are mandated to implement ICD-10 for outpatient diagnosis coding by October 1, 2014. This could not be at a worse time for healthcare organizations especially small practices. ICD-10 diagnosis codes are used by your provider to describe your illness and are submitted to insurance companies for payment. Providers currently use an older version called ICD-9. ICD-10 will increase the number of available diagnosis codes from 13,000 to 68,000. Medical Economic journal recently estimated the cost per practice to be $83,000-$2.7million according to the practice size.

The American Academy of Family Physicians (AAFP) recently indicated that providers should not have to bear the economic burden of upgrading to ICD-10. Upgrading requires practice management IT system changes that can be expensive for providers at a time when they are already spending big bucks to implement and upgrade their electronic health records. Meaningful Use Stage II is …

Continue reading A Good Time for ICD-10? »

Healthcare payment reform is a work in process. The Centers for Medicare and Medicaid Services (CMS) Innovation Center is rolling out various test projects to identify how to bend the curve of healthcare costs while improving quality outcomes. These projects are gravitating towards a common underlying reimbursement theme, a fixed payment for services covering the episode of care (ambulatory, acute, and post-acute services) with a linkage to quality outcomes. Present healthcare IT solutions do not meet the anticipated needs of the market for this new form of reimbursement. There are two key requirements a healthcare provider’s IT solution needs to provide:

• Episode of care (ambulatory, acute and post-acute services) integrated platform supporting the data acquisition, measuring and monitoring of total services delivered
• Financial accounting system to forecast, measure and manage the distribution of a fixed payment to various providers participating in the episode of …

Continue reading Healthcare Payment Reform Redefines Healthcare IT Solution Requirements »

As we ring in the New Year, many features of the Accountable Care Act (ObamaCare) will begin to take shape. State Benefit (Insurance) Exchanges will begin to unfold. The Medicare and Medicaid Innovation Center within HHS will continue to examine and support promising models of care delivery. Cost containment programs like Accountable Care Organizations (ACOs) will begin to reshape the way Medicare pays for healthcare services.

So what are Accountable Care Organizations (ACOs)?

ACOs are organizations created by either groups of doctors or hospitals that improve quality measures in five key areas that impact affect patient care:
• Patient (caregiver) experience and satisfaction;
• Care coordination;
• Patient safety;
• Preventive health; and
• At-risk population health management.

HHS wants to improve the quality of care Medicare patients receive. ACOs are seen as a way to drive improved care through better coordination of healthcare …

Continue reading Transforming Healthcare One Medicare Patient at a Time »

With the implementation of the Patient Protection and Affordable Care Act (PPACA), the delivery of healthcare will transform in the near time horizon. These changes are driven by necessity. There are three key dynamics changing what healthcare will look like in the near future:

1. Growing patient demand – increasing number of baby boomers going on to Medicare and the uninsured receiving medical coverage
2. Declining number of physicians
3. Reduction of reimbursement to healthcare providers

How the market responds to these dynamics is evolving though it will require a convergence of technology with a broader range of healthcare services.

Technology

Technology provides the infrastructure to support scaling of solutions. It will also be an enabler of delivering quality healthcare in a cost effective manner. Here are some examples of how technology is used today and we can anticipate expansion:

• Telemedicine – Neurologist are on-call using a computer with a camera and live video feed …

Continue reading Healthcare Delivery and Care Coordination Changes on the Horizon »

The recent reelection of President Obama solidifies the future of the Patient Protection and Affordable Care Act (PPACA). A number of healthcare providers (hospitals, physicians, post-acute services, etc.) sat on the sidelines awaiting the outcome of the Presidential election to determine if they needed to start rethinking their business model and what changes are required. Now that we have the answer the PPACA is here to stay, healthcare providers are starting to reassess how they need to redefine their businesses and strategic business relationships.

An underlying principle that all healthcare providers will base their strategic planning against is that the demand for healthcare will rise and the level of reimbursement will decline.  Various payment models are being tested by CMS, and we can expect more variations over the next year or two. With the power of the PPACA, CMS can rapidly adopt a payment model that demonstrates effective results reducing costs and make it a …

Continue reading The Affordable Care Act is solidified with the election – Healthcare providers will need to accelerate their plans for payment reform »

Healthcare providers today continue to invest and expand their information technology footprint to meet increasing demands of data. As we hear about healthcare provider financials put at risk due to RAC (Recovery Audit Contractor) audits, self-reporting appropriate use of ICDs (Implantable Cardioverter Defibrillator), pay-for-performance, Bundled Payments for episodes care, Accountable Care Organization, etc., there is an increasing expenditure of technology to meet these growing information demands.

Given the enormous amount of information presently collected at the patient, physician and procedure level, is the issue that healthcare providers are not collecting enough data to support these ever growing and changing business needs?

I would make the argument that the existing information platform for most healthcare providers collects more than sufficient information allowing organizations to measure their operational performance and address both the present and upcoming …

Continue reading Do Healthcare Providers need to invest in more information technology or focus on leveraging existing information? »

This past week held the first presidential debate between President Obama and hopeful Mitt Romney.  While the debate centered on domestic policy, each candidate at points spoke of the role that domestic issues have on U.S. global competitiveness, citing the US economy and unemployment as examples.  I believe that healthcare has an equal standing in this regards; a clear case can be made that our healthcare problems have a direct impact on US foreign policy.  This might be one of the few areas in the healthcare debate that both Mitt Romney and Barack Obama can agree.

Continue reading It is not all politics when talking healthcare »

Any patient can tell that several things can determine whether he or she is happy with a visit to their doctor’s office.  Many factors play a role in patient satisfaction, including the level of care provided by the physician, staff friendliness, facility cleanliness, speediness of answering telephone calls, and wait times.  Wait time (time spent in both the waiting room and exam room before seen by a doctor) in particular is frequently cited as the single most important factor in determining patient satisfaction.  In fact, a national survey found that 40% of the variance in patient satisfaction can be explained by the amount of time a patient waits to see their doctor.

Some have argued and even research has shown that the negative effect of long waiting time “may be so pervasive that good physician care cannot make up for it.”  (Probst 1997).  In other words, a patient could immediately bond with staff, meaningfully connect with their physician in the first minute …

Continue reading Patient Satisfaction + Wait Times: More Important than Anything Else »