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How Value-Based Reimbursement is Forcing Care Team Collaboration

Posted on December 5, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

At the CHIME 2016 Fall Forum, we sat down with Terry Edwards, CEO and President of PerfectServe, to talk about how care team collaboration was becoming essential in the world of value based reimbursement. This major shift in healthcare is becoming an essential piece of every healthcare organization’s strategy.

In our discussion, we talk about the infrastructure needed to handle the shift to value based care. We also dive into the important topic of physician burnout and how to overcome it. We explore what it really takes to create a collaborative team model in healthcare. Finally, we ask Terry Edwards to share some of the stories of this type of collaboration in action.

Learn more about care team collaboration in our interview with Terry Edwards below:

Be sure to also check out all of Healthcare Scene’s interviews with top leaders in healthcare IT.

Is Innovation Missing at MGMA 2016?

Posted on November 2, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This week I’ve been at the MGMA Annual Conference in San Francisco. It’s been a very interesting event with a ton of people that really want to improve healthcare. I’m always impressed by these practice administrators passion for their work and their desire to do what’s right for patients.

While I love their passion, I can’t help but feel that there’s a clear lack of innovation at MGMA. More specifically the practice executives and not the MGMA organizations itself. Instead of trying to figure out and participate in new business models that will take their practice to the next level, most healthcare practices seem focused on optimizing their existing practice.

Sure, many of them are focused on various government regulations like MACRA. In fact, I’d suggest that most of them are too focused on government regulations. No doubt that’s part of why healthcare executives at MGMA aren’t focused on innovation. They’re too busy dealing with government regulation to be able to have time to sit down and think how they could take patient care to the next level or create new business models.

The two places I do think we see some interest in innovation is the shift to value based reimbursement and the change to direct primary care. The problem with value based care is that people don’t really know what that’s going to be. Most are in wait and see mode to see where it’s all going to go. Direct primary care is quite interesting to many, but that largely only applies to primary care and many feel it’s limited in which primary care practices can and should participate (I know that many people firmly disagree with this idea).

I guess that means that MGMA stands in somewhat stark contrast to many of the other healthcare conferences out there. Maybe that’s not such a bad thing. We need to optimize our current processes as well. I just think that many of these medical practice executives would benefit from more effort talking about where healthcare is heading in the future.

It’s great that patients can now schedule an appointment on a physician website. However, are practices ready for appointments to be auto scheduled based on personal device data or through a simple request through Amazon’s echo? I know that’s ahead of the curve, but it’s not that far off either.

Value Based Reimbursement Research Results in Time for #AHIPInstitute

Posted on June 15, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

McKesson Health Solutions has commissioned a new National Research study on Value Based Reimbursement. Here’s a quick summary of some of the findings:

The rapid pace of change in healthcare payment continues unabated, with payers reporting they are 58% along the continuum towards full value-based reimbursement, a 10% leap since 2014. Hospitals aren’t far behind, reporting they’re now 50% along the value continuum, up 4% in the past two years.

Those numbers were a bit shocking to me. It doesn’t feel like we’ve gotten that far in the shift to value based reimbursement. Does it feel like it to you? I knew we were headed that direction, but definitely thought we had just begun. These numbers paint a much different story.

This week I’m excited to attend my first AHIP Institute. I’ll be exploring this shift in all its gory details.

Along with this study and with AHIP starting tomorrow, McKesson has been sharing a number of cartoons about the healthcare industry. Here are a few of them they tweeted out:

Healthcare Costs

Healthcare Payment Pathway

Aggregate Fitness Tracker Data is More Valuable than Individual Results?

Posted on March 30, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A recent New York Times article made an interesting conclusion about the value of fitness tracker data:

Ultimately, it is those aggregate numbers that offer the most exciting possibilities: The collective data stream from our devices amounts to by far the largest and most comprehensive observational health trial ever conducted. We have the data; now we just need to figure out what it means.

As a preface to this discussion, it’s worth letting you take a minute to read my article about the clinical relevance of FitBit data (or lack thereof). For those who don’t click over, I argue that doctors don’t care about FitBit (and other Fitness Tracker) data because it’s not clinically relevant. However, new sensors are on their way that will be clinically relevant.

While I fundamentally believe that current FitBit data isn’t that interesting to the individual, it’s worth considering if the aggregate FitBit data is going to provide some clinical and health insights. My reaction is that the aggregate FitBit data is likely to provide a much larger benefit than the individual data. Although, that’s not saying too much since I just said that I didn’t think it was that clinically relevant for an individual.

I do think the aggregate data will tell an interesting story about the population as a whole. If we get enough data (and this will likely require all fitness tracking companies to work together), then we could look at some interesting trends that happen across various regions and shifts in activity over time.

One of the big complaints about value based reimbursement efforts is that there’s no baseline that will allow a doctor to say that their patient population is sicker than another doctor’s population. However, under this new model, we’re planning to reimburse them based on how well they keep the population healthy. We can all see how this isn’t fair and could lead to doctors only working with the most healthy patients.

Could a baseline of personal health tracking data (yes, it will likely need to be more than just step trackers) allow us to understand in a really detailed way the health or sickness of a physician’s patient population?

Yes, this all gets quite messy very quickly. However, it also gets quite exciting. Could enough data help us understand what doctors have said for years, “My patients are more sick!”? I think it could. It won’t be perfect, but it will be better than what we have today.

Of course, the solutions to actually improving the health of patients is a whole other challenge. However, understanding the health of a population as compared to other populations and how their health changes over time is going to be very valuable to the future of healthcare as we know it.

Insightful Tweets from Farzad Mostashari’s Session at #MGMA15

Posted on October 13, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, Farzad Mostashari took the stage at the MGMA Annual Conference. As a man that I respect and someone that has deep connections and insights into what’s happening in Washington and how that plays out in actual practice (thanks to his ACO company), I was interested in the insights he’d share.

Here’s a quick Twitter roundup of some of the insights he shared:

Solving Medical Device Interoperability – Is Qualcomm Building that Platform?

Posted on September 15, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve spent some time in the mHealth and mobile health space (which are basically the same thing), then you’ve likely run into Qualcomm. They’ve made a big investment in that space with their Qualcomm Life initiative together with their 2Net platform that helps home health devices connect and share data. In many ways it made a lot of sense for a wireless provider (mostly chips from my understanding) to get involved in this space since it was a way for them to sell more chips. It seems like every new medical device needs some wireless technology embedded in it. On the other hand it sometimes felt awkward since Qualcomm really doesn’t directly sell products to healthcare organizations or consumers.

Many people probably missed the announcement that Qualcomm Life acquired Capsule Tech. A lot of people in healthcare don’t know about Capsule Tech. Even fewer probably know about Qualcomm Life. However, Capsule Tech has done a great job building a business around medical device management. Capsule Tech is known as the black box under the hospital bed that captures all the medical device data in a hospital room and sends that data where it needs to go. They’ve recently expanded beyond the black boxes into things like data analytics, but at their core they’re all about collecting and sharing medical device data.

When you think about it from that perspective, that’s kind of what Qualcomm Life has been doing with home health devices and their 2Net platform. They’re collecting and sharing home health data where it needs to go.

As you look at a combined company, you can easily see a platform for medical device data starting to form. It will take some time for them to make it a reality, but you can see how Capsule together with Qualcomm Life could become the hub of medical device data. Now they have expertise in hospital grade medical devices and more patient focused home health devices as well. I can’t think of any other organization that’s merging the two like they could do. Some specific healthcare organizations are doing it on their own, but not a vendor.

Kevin Phillips, VP of Marketing and Product Management at Capsule Tech, told me that many of their customers were asking them for medical device solutions that reached into the home. It makes sense that a hospital using Capsule Tech for their enterprise medical devices would turn to them for their home health efforts as well. Now that Capsule Tech is part of Qualcomm Life, they’ll have a suite of solutions they can make available to their hospital customers.

From the 2Net partner perspective, Capsule Tech brings a large number of healthcare organizations to the table that could now consider buying their wireless health solutions. The key is going to be how well Qualcomm can integrate their 2Net platform with Capsule Tech. Capsule Tech has integrated with pretty much all of the major EHR vendors out there. Can Qualcomm leverage these EHR integrations to the benefit of their 2Net partners?

I asked this very question of Dr. James R. Mault, VP and Chief Medical Officer of Qualcomm Life. He danced around the subject citing the EHR blocking that was highlighted by ONC earlier this year and how many EHR vendors and health systems have made it really hard to create these type of integrations. However, Dr. Mault also described how there’s been some major changes recently in this regard thanks to the push towards value based care and reduced hospital readmissions. Organizations are realizing they have to start opening up. I’d describe his answer as hopeful, but realistic when it comes to the challenges they face with EHR integrations. If Qualcomm Life could offer their partners a path to the EHR through Capsule Tech, that would be a real coup.

At the end of the day, the proof is in the pudding. This conceptual medical device data sharing platform across the healthcare enterprise and home health sounds great. I’ll be interested in how Qualcomm Life and Capsule Tech do at executing it. Are hospitals really ready to purchase the home health products? Will these solutions help them in their value based reimbursement, ACO, and/or reduced hospital readmission efforts? It’s going to be interesting to watch and see which Qualcomm Life partners are of interest to the hospital market. I told them I’d follow up at HIMSS 2016 to see how they’re doing.

7 Strategies for Revenue Cycle Management Success

Posted on August 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I came across a whitepaper called 7 Strategies for Revenue Cycle Management Success. I continue to be amazed by how many practices can benefit from better revenue cycle management. So much so that hundreds of companies thrive on the back of a practice’s revenue. This is true for a number of EHR companies as well.

For those who don’t want to download the full whitepaper with all the details on the 7 strategies, here’s the list:

Strategy #1: Monitor Payments
Strategy #2: Perform Financial Clearance
Strategy #3: Collect from Patients
Strategy #4: Manage Denials
Strategy #5: Establish Employee Expectations
Strategy #6: Avoid the Snowball Effect
Strategy #7: Report on Key Performance Indicators (KPIs)

As I look through this list and read through the whitepaper, all of it just points to quality management of processes. There’s nothing on the list that’s rocket science. It’s just taking the time and effort to make sure that all of your practice’s processes are well organized and thorough. As you can imagine, that’s a problem for many organizations. That’s why so many practices outsource this work to another company.

When I consider where revenue cycle management is headed, I wonder how these new value based reimbursement models will impact revenue cycle management companies. My guess is that many of them will just see it as the same process applied to new clinical values and measures. However, I think that value based reimbursement is going to require companies to go much deeper with a practice. If the practice is now responsible for a population of users and not just the ones they’ve seen in their office, that’s going to take a very different skill set.

What is clear to me is that many practices are going to need some help from an outside company even in a value based reimbursement environment. I’m just not sure which companies will be providing those services.

Farzad Mostashari’s Aledade Raises $30 Million on the Back of the Switch to Value Based Care

Posted on June 15, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On Aledade’s 1 year anniversary, they just announced that they’ve raised a $30 million Series B round of funding from new investor ARCH Venture Partners and return investor Venrock. That brings their total funding to $35 million. For those not familiar with Aledade, it was Founded by Farzad Mostashari and Mat Kendall soon after Farzad left ONC. They work with independent, primary care physicians who want to participate in ACOs and value based reimbursement programs.

Farzad’s blog post announcing the funding says that by end of the year Aledade will have 100 physician practices managing 75,000 Medicare Patients. With such small numbers, this should illustrate what a huge opportunity value based reimbursement will be for many companies that get it right.

Aledade has an interesting business model. They take about $500/provider as a membership fee and then they split the value based reimbursement commission with the provider. 60% of the reimbursement goes to the provider and 40% goes to Aledade. I’ll be interested to see how well this commission structure holds up. While certainly not an Apple to Apples comparison, doctors are use to paying 5-10% commission to billing companies. Will they be ok with paying 40% to what will feel like a billing company to many? Is this an opportunity for medical billing companies?

I have no doubt that physicians and hospitals are going to need a great mix of technology and healthcare knowledge to be successful in this new world of value based reimbursement. Aledade is on the cutting edge of this trend. Time will tell if they’re too early or right on time for the change.

In a recent article in the Palm Beach Post, they said the following about Aledade:

Thanks to Aledade’s focus on data analytics and physician reminders, Mostashari’s doctors became five times more likely to give recommended preventative care to their older patients, such as annual wellness visits and vaccinations against pneumonia.

This sounds great on face. It’s great that primary care physicians are interested in the wellness of their patients. I also think it’s great that we have a method for incentivizing these kinds of actions. However, my fear with this trend is that we’ll push out guidelines for “wellness care” without knowing if those guidelines actually improve someone’s health.

One lesson Mostashari should have learned well from meaningful use is that if you regulate something too early, you might freeze something in regulation that adds a lot of burden without actually improving healthcare. I’m glad they’re on the cutting edge of this trend. Let’s just be thoughtful that we don’t give our doctors more hoops to jump through that don’t actually provide value. That’s the massive challenge we face with the shift to value based reimbursement and we’re just getting started.

Aledade and company are explorers of a new land. I think we’ve only found the Bahamas. Most of us believe the Americas are still out there to be discovered, but we haven’t found it yet. So, let’s be careful drawing the final maps.

The Future Of…Patient Engagement

Posted on March 19, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the #HIMSS15 Blog Carnival which explores “The Future of…” across 5 different healthcare IT topics.

Healthcare has a major challenge when it comes to the term “Patient Engagement.” $36 billion of government money and something called meaningful use has corrupted the word Patient Engagement. While meaningful use requires “5% patient engagement”, that’s a far cry from actually engaging with patients. Anyone that’s attested to meaningful use knows what I mean.

As we move past meaningful use, what then will patient engagement actually look like?

When I start to think about the future of patient engagement, I’m taken back to my experience with a new primary care provider that’s trying to Restore Humanity to Healthcare (see Restore Humanity to Healthcare part 2 as well). In this case, I’m exploring the idea of unlimited primary care along with a primary care team that includes a doctor, but also includes a wellness coordinator that’s interested in my wellness and not just my presenting problem.

Once you take the payment portion out of primary care, it dramatically changes the equation for me. Gone are the fears of going to the doctor because you don’t want to pay the co-pay. Gone are the days where a doctor needs to see you in the office in order to be able to make money from the visit. With unlimited primary care, an email, phone call or text message that solves the problem is a great solution for the doctor and the patient.

Of course, this model of primary care is only one example of the shift that’s going to drive us to patient engagement. ACOs and value based care models are going to require a much deeper relationship between doctors and patients. Trust me that 5% patient engagement through an online portal isn’t going to be enough in these new models.

Plus, these new models are going to really convert our current sick care system into a true healthcare system. I like to call this new model “Treating Healthy Patients.” Quite frankly we’re not ready for this change right now, but in the future we’ll have to adapt. The biggest change is going to be in how we define “patient” and “healthy.”

The wave of connected medical devices and innovation are going to completely reframe how we look at health. Instead of describing ourselves as healthy, the data will tell us that we’re all sick. We’re just at different points in the continuum of sickness.

In the future, patient engagement will be the key to treating each of us individually. The symptoms will change from coughing and vomiting to 85% risk for diabetes and 76% risk for a heart attack. We thought we had patient compliance issues when someone is coughing and vomiting (ie. something they want to fix). Now imagine patient compliance challenges when the patient isn’t feeling any pain, but they need to change something in order to avoid some major health problem.

I think this describes perfectly why we’re entering one of the most challenging times in healthcare. It’s a dramatic shift in how we think about healthcare and has a new set of more challenging problems that we’ve never solved. One of the keys to solving these new challenges is patient engagement.

What’s Your Value Based Care Strategy? What Role Does IT Play?

Posted on February 23, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I pretty regularly take a look at various healthcare IT whitepapers to glean insights into what’s happening in the industry and what advice vendors are offering healthcare organizations. I’ve been keeping a special eye on the changing reimbursement model and move to value based care and so I was interested in this whitepaper titled “How to Win with Value-based Care: Developing Your Practice’s EHR Strategy.”

The whitepaper starts with a dive into some of the changing care and reimbursement models that are emerging in healthcare. Then they offer this 4 step “Winning Strategy” for being ready for these changes:
Step 1: Assess your current situation
Step 2: Develop a customized VBC Plan that’s right for your practice
Step 3: Determine IT solution needs
Step 4: Implementation

In many ways, this 4 step plan could be applied to any project. Of course, the whitepaper dives into a lot more detail for each step. Although, I was struck by step 3. It takes for granted that value based reimbursement will require an IT solution. This whitepaper comes from a healthcare IT company with some value based IT product offerings so you have to question whether IT will be at the core of a practice’s value based care strategy or not.

As I think about the future of coordinated care and value based reimbursement, I think it’s more than fair to say that technology will be at the center of these initiatives. Value based care requires data to prove the quality of the care you’re providing. Certainly you could try and collect some of this data on paper, but does anyone think this is reasonable?

Try identifying all overweight patients in your patient population using paper chats. I can see in my mind’s eye an army of medical records professionals sifting through stacks of paper charts. It’s not a pretty solution and it’s fraught with error. That’s one query on an EHR system.

One of the biggest elements of value based reimbursement will be communication with patients. Can we build that real time communication on the back of snail mail? It sounds almost silly talking about it. Of course we’re going to use mobile devices, secure messages, and even secure video communication. We still have A LOT of work to do in this regard, but it’s the future.

Of course technology is going to be at the core of value based reimbursement. It’s the only way to accomplish what we’re striving to accomplish. The next question is: will the EHR make this possible or are we going to need something new and more advanced?