Developed by the Office of the National Coordinator for Health Information Technology (ONC), the plan, last updated in 2015, was further updated in accordance with the Health Information Technology for Economic and Clinical Act.
The key principles of the plan include:
Putting individuals first by focusing on person-centered care
Focusing on value by promoting and pursuing activities that improve health and care quality
Building a culture of secure access to health information
Putting research into action, encouraging innovation and competition
Developing health IT policies in transparent and accountable processes
The plan continues the momentum of the Twenty-First Century Cures Act and "reflects the federal government’s commitment to making patients’ electronic health information accessible on their smartphones,” said Don Rucker, MD, national coordinator for health IT, in a news release.
The federal agencies that collaborated on the plan regulate, purchase, develop, and use health IT to help deliver care and improve patient health. They fund and contribute to health IT research, development, and deployment at the local, tribal, state, and national level.
Federal agencies also coordinate across public and private sectors to align standards, promote innovation and competition, and share best practices. The plan can serve as a roadmap for these initiatives and as a catalyst for complementary activities in the private sector.
“We value [the plan] as an example of our shared federal vision to leverage health IT to reduce burden, promote the interoperable exchange of health information across the health care system, lower costs, and ultimately improve patient care,” said Seema Verma, administrator of the Centers for Medicare & Medicaid Services, in the release.
Continuity of care meets the telehealth needs of employees and their employers.
The patient-centered medical home, combined with telehealth, is not a typical combination.
But one provider organization is covering 30,000 lives and has served more than 100,000 visits in 2020, this year of the pandemic, through such an offering.
Offered through employers and also real estate building landlords, Eden Health combines telehealth with medical home methods to enable the process of family members seeing the same primary care specialist over time, improving continuity of care and reducing costs in the process.
The four-year-old, NCQA-certified medical home operated by Eden Health, serves a variety of employers, including Emigrant Bank, Stack Overflow, and Golf. During the seven months of the COVID-19 pandemic, Eden Health's business has grown sevenfold, according to CEO Matt McCambridge.
“What we've built is really a concierge doctor for every person," McCambridge says. "It's coordination of care that's integrated with the medical delivery of care with clinicians, care navigators, behavioral health providers, and physical therapists in a patient-centered medical home format."
With five brick-and-mortar clinic locations in New York and New Jersey, as well as staff visits to employer sites, New York–based, U.S.-focused Eden Health complements telehealth available in all 50 states with in-person physicals, screenings, vaccinations, lab work, and physical therapy as needed.
A changed visit mix
The pandemic changed its visit mix. Before it, Eden Health patients did two-thirds of their visits virtually. Now, virtual visits comprise 99% of all visits. McCambridge contends that the medical home aspect of its practice distinguishes it from almost all other telemedicine providers. As a general rule, those providers do not permit patients to see the same primary care physician each time, building up a continuity of care, but instead typically provide a different physician for each episode of care.
When asked if Eden Health patient outcomes exceed those of traditional telehealth or brick-and-mortar systems, McCambridge replies that the company tracks all the outcome data that any NCQA-accredited medical home tracks, such as the Generalized Anxiety Disorder Assessment (GAD-7) and the Patient Health Questionnaire (PHQ-9) depression module, as well as HEDIS metrics. "We're really proud that we have a collaborative care model on the behavioral health side," he says. "About 96% of our patients who are diagnosed with depression actually receive treatment for that."
Pictured: Matt McCambridge, CEO of Eden Health. Photo courtesy of Eden Health
As a value-based care provider, Eden Health pays its physicians a salary, and the usual fee-for-service incentives to generate billable hours and referrals are not present. "The average primary care physician out there is referring patients to a specialist 33% of the time," McCambridge says. "On our end, we refer 10% of the time to a specialist, so we significantly decrease the rate at which specialist refers happen, and do a lot more care at the primary care level, by spending more time with the patient."
When referrals do occur, Eden Health's primary care physicians take care to make them as accurate as possible. "We are going to do the lab work and the image work that's going to be required ahead of time," McCambridge says. "When they enter the specialist's office, that specialist is going to know it's a pretty high probability that that person is going to need that kind of care, rather than having 40% of their day spent telling people, 'I'm not the right specialist for you.' "
Following specialist visits, Eden Health follows up with patients to make certain that the patient understands the care plan. "It ends up with patients being more compliant, and specialists can know they're handing patients off to somebody who will manage their care plan over time," McCambridge says.
Employers are driving this vision of care in response to the continuing spiraling costs of fee-for-service care. "Typically, there's not much leverage for the employer to do a whole lot," McCambridge says. "You have to be quite big, and I'm not sure there's really much economic incentive for the hospital systems to do something differently."
McCambridge started Eden Health after having been dismayed to see his sister endure a series of post-ER incomplete or incorrectly diagnosed medical ailments, as more than 70 specialists failed to coordinate her care. "Luckily, about four years in, there was a primary care provider who was able to bring the pieces together with a few specialists, get her the right care, and allow her to grow out of the condition."
Such poorly coordinated specialist care can also lead to unnecessary surgeries that not only endanger patients, but also further inflate already-inflating healthcare costs.
Among all Eden Health patients, 60% have Eden Health as their primary care provider of record, and 40% use Eden Health in some supplementary capacity. This could be for various reasons, such as not having their regular primary care provider available at 2 a.m., or their traditional provider's inability to guide patients through specialty care, McCambridge says.
Telehealth services, even those covered by employers, traditionally have had difficulties getting adoption beyond single-digit percentages of employee populations. McCambridge contends that marrying telehealth with the medical home model achieves the kind of adoption of telehealth that episodic telehealth providers still dream of, and providing medical home services in the bargain helps employers get the kind of engagement that often eludes traditional healthcare systems. "It's not an afterthought, or maybe something that's not the real focus of the [traditional] healthcare institution that's providing care," he says.
More transparency, better human curation, and standards to control privacy were some of the solutions presented at the Precision Medicine World Conference to address healthcare systems' hesitancy to implement AI.
Amid advances in precision medicine, healthcare is facing the twin challenges of having to curate and tailor the use of patient data to drive genomics-powered breakthroughs.
"There aren't a lot of physicians saying, 'Bring me more AI,' " said John Mattison, MD, emeritus CMIO and assistant medical director of Kaiser Permanente. "Every physician is saying bring me a safer and more efficient way to deliver care."
Mattison recalled his prolonged conversations with the original developers of IBM's Watson AI technology. "Initially they had no human curation whatsoever," he said. "As Stanford has published over and over again, most of medical published literature is subsequently refuted or ignored, because it's wrong. The original Watson approach was pure machine curation of reported literature without any human curation."
But human curation is not without its own biases. Watson's value to Kaiser was further eroded by Watson's focus on oncology patient data from Memorial Sloan Kettering Cancer Center and MD Anderson Cancer Center, Mattison said.
"I don't really want curation from those two institutions, because they're fee for service, and you get all these biases. The amount of money the drug companies spend on lobbying doctors to use their more expensive novel drugs is remarkably influential. If you're involved in clinical care, you want to take the best output of machine learning and you want to make sure that you have good human curation," which in Kaiser's case, emphasizes value-based care over fee-for-service, he added.
A key in human curation of machine learning and AI is how transparent the curation is, and how accessible the authoring environment for such curation is, so clinicians can make appropriate substitutions for their own requirements, Mattison said.
Revealing how patient data will be used
A current challenge of health systems is being approached by machine learning and AI companies who remain in stealth mode and are not being up-front about how and where that technology will share patient data, making it difficult for chief data officers to introduce the technology to the health system.
"Using [the patient data] for some commercial, unexpected purpose is very different than using it for the purpose that you have agreed with the health system that you're going to be using it with," said Cora Han, JD, chief health data officer with UC Health, the umbrella organization for UCSF, UCLA, UC Irvine, UC Davis, UC San Diego, and UC Riverside health systems.
A recurring theme during the conference was the need for a third party to provide trusted certification that machine learning and AI algorithms are free from bias, such as confirmation bias or ascertainment bias, meaning basing algorithms on a cohort of patients who do not represent the entire population served by the health system.
"We have no certification groups right now that certify these things as being fair," said Atul Butte, MD, director of UCSF's Bakar Computational Health Sciences Institute. "Imagine a world in five to 10 years where we're only going to buy or license methods or algorithms that have been certified as being fair in our population, in the University of California."
UCLA Health has met or exceeded the goal of representing its own demographics within Atlas, the systems community health initiative that "aims to recruit 150,000 patients across the health system with the goal of creating California's largest genomic resource that can be used for translational medicine," according to the UCLA Health website.
"We are a far cry from [meeting] L.A. county" demographics, said Clara Lajonchere, PhD, deputy director of the UCLA Institute for Precision Health. Currently, 15% of Atlas patients are Latino, and 6%–7% are African-American. "While those rates exceed that of some of the other large-scale studies, it still really underlies how critical diversity is going to be."
Alliances drive machine learning and AI-fueled innovation
HIPAA, which has enabled business associates such as nference to safely enter patient-sharing relationships with providers such as Mayo, can work against the principle of transparency. "If a tech company signs a BAA with a hospital system, [outsiders] don't get to see that contract," Butte said. "We could take it on faith that all the right terms were put in that contract, but sometimes just naming two entities in a sentence seems sinister and ominous in some ways."
Health systems with more than 100 years of trust associated with their brand find themselves partnering with startups with little or no such trust, and this creates additional tension in the healthcare system.
In addition, concerns linger that deidentified data will somehow be able to be reidentified through the course of its use and sharing by innovative startups.
"Whole genomes, it's hard to deidentify those," Han said. "These are issues that we will be working through."
“We just need to develop a set of standards about how privacy is controlled,” said Brook Byers, founder and partner with Kleiner Perkins, a Silicon Valley venture capital firm.
Ever since the electronic medical record came to dominate healthcare IT spending, other innovative applications have taken a back seat at budget and resource allocation time.
But with EMRs/EHRs now installed at virtually every healthcare organization, the time is ripe for other innovative applications to rise and shine.
While certain technologies remain in the planning stages, others are making a difference today. Some are based on mobile platforms.
Others leverage the increasing power of analytics. Still others are adding the power of video in ways that go beyond two-way teleconferencing.
And yet others look toward a future assisted by avatars leveraging machine intelligence, acting as extensions of clinical staff who are then free to focus on more critical tasks.
In this overview, we examine five such innovative technologies, their costs and benefits, and how they point the way to even more innovations to come, as the next round of IT technology bets gets placed.
ACO Tech: MSSP Quality Reporting Tools
Accountable care organizations participating in Medicare Shared Savings Programs (MSSP) have sometimes struggled to meet quality performance standards and generate savings above their minimum savings rate.
Scottsdale-based Innovation Care Partners (ICP), an affiliate of HonorHealth located in Scottsdale, Arizona, is an ACO with 85,000 covered lives, more than 1,600 physicians, and 500 practice locations.
In performance year 2016, ICP scored 96% across all quality measures, and overall saved about $18.7 million on a population of 18,000 Medicare beneficiaries.
ICP received a shared savings payment of $8.9 million.
"We're the only Medicare shared savings plan in Arizona that earned shared savings in its first year, and we're the only one to earn shared savings three years in a row," says Faron Thompson, chief operating officer of ICP.
Using MSSP quality reporting tool technology codeveloped with Orion Health, a global company that develops software to help with efficiency and outcomes in healthcare, ICP delved deep into the data in its physician practices, most of which are independent from the ACO, Thompson says.
"We went from very complicated spreadsheets and secure emails and hounding practices to get us data in the first year to the second year. The practices were so happy about the web-based tool and how easy it was to use, they were asking us to start early," Thompson says.
Traditional analytics failed to capture all the quality metrics for a variety of reasons. In the past, attempts to capture patient quality data were centered around that patient's primary care physician.
Now, using the technology, ICP can also assign patients, from a reporting perspective, to specialists, such as cardiologists, who may possess quality data that was previously not being aggregated with the primary care physician–reported data, Thompson says.
Orion's key contribution is pulling this quality data out of the multitude of EHRs in use at the various independent practices, without requiring as much labor-intensive work and staffing on the ACO's part, he says.
Thompson says it is difficult to quantify the total dollars the ACO has spent on this initiative, since the investment includes intangibles such as staff time and resources.
"The ACO should have staff to oversee and manage the quality reporting effort," he says. "They need this whether they use this tech or not. We have about two FTEs to do that."
Looking forward, ICP intends to apply this same technology with Medicare Advantage plans that require more automated reporting, Thompson says.
ICP employs six physician practice liaisons, each of which carries an average load of 80 practices each. MSSP reporting takes place once a year, but MA reporting imposes a burden on these liaisons throughout the entire year, he says.
In addition, ICP pays care management fees to its primary care offices to help shoulder the reporting burden.
"We ask a lot of our primary care offices: Every month there's some data collection, reporting, or patient review analysis," Thompson says. "It is a burden on them, so to help offset that we pay them $5 per commercial patient per month, and $10 for a Medicare patient, in what we call care management fees. We calculate it monthly and we pay it out quarterly, and that really helps with the engagement and some of the pushback when a practice says, ‘Oh, I don't have time to do this.'
"We explain that care management fees are provided to help with the extra burden. Usually when they realize that, and that they're getting, in some cases, some reasonably considerable extra income, it helps with all the extra stuff we're asking them to do."
These care management fees apply to a wide range of programs beyond MSSP and MA, including efforts to identify frequent-flyer emergency room patients, as well as new or emerging quality initiatives, he says.
Now that ICP has been identified as a Track 2 advanced payment model MSSP for 2018 under MACRA, these practices will be individually responsible for continuing to demonstrate their use of advancing care information, the successor to meaningful use, Thompson says.
Otherwise, ICP continues to shoulder the reporting burdens as before.
"We actually got into the ACO expecting that we wouldn't do well, because Arizona is one of the lowest Medicare cost states in the country already," Thompson says. "We didn't think there was a lot of opportunity to squeeze out cost, but we are pleasantly surprised that our business model works and, in our first year, we earned something."
Other ACOs may spend more or less than ICP did to achieve similar outcomes, depending on the technology selected, configuration, upgrades, and support needed, along with several other variables unique to that organization's business model and projected growth plans, Thompson adds.
Truly, a video is worth a thousand words when it comes to treating Parkinson's patients at the Parkinson's Disease & Movement Disorders Institute at Weill Cornell Medicine, the biomedical research unit and medical school of Ithaca, New York–based Cornell University.
Using remote monitoring visual analytics software from San Francisco–based CaptureProof, clinicians are able to automate the Parkinson's scale from a patient's home.
In a 2016 pilot done at Weill Cornell Medicine, 16 participants ranging from ages 51 to 77 were able to perform Parkinson's neurological evaluations at home using an iPod Touch.
CaptureProof's system provides a HIPAA-compliant iPod or Android app to guide patients or a companion to record a series of prescribed movements following video examples.
These videos have text instruction overlay and examples to follow, and photos have an overlay in the camera to help capture the same angle.
The evaluations consisted of standard motions used to evaluate progression of Parkinson's, such as tapping fingers, opening and closing the palm of a hand, and leaving the hand at rest—the same motions clinicians have these patients perform when they appear for face-to-face evaluations.
But because the results are captured by the mobile device, the participants did not have to make the often arduous trip through New York traffic to travel from their homes to Weill Cornell.
Clinicians could access the patients' recorded video at a time of their choosing, and then rate patient performance as measured by the protocols.
During the 16-patient trial enrollment, on the same day as patients' CaptureProof use, clinicians also rated the patient performance in person, and concluded that patients were able to perform the movements via CaptureProof just as reliably, says Natalie Hellmers, a nurse practitioner at Weill Cornell.
Using the CaptureProof technology did require patients to be assisted by what the clinicians describe as a care partner (e.g., a spouse or significant other) who could film the patient's movements during CaptureProof sessions.
One issue that came up during the trial was getting patients and care partners to capture the video from the proper angle. "If you're filming too high or too low, you're not seeing the fingers move, or if the leg is actually rising or staying in the same position," Hellmers says.
This same technology is lending itself to a variety of other uses, such as documenting the progression of a healing burn wound, or recording the progress of a patient's rehabilitation exercises, she notes.
CaptureProof's technology allows more flexibility than traditional Parkinson's evaluations in that clinician and patient do not have to be on the same schedule, Hellmers says.
In addition, such videos can eventually become part of the medical record, and permit direct viewing of patient videos performed over a period of time—another way to spot trends that goes beyond written observations, she adds.
In the case of Parkinson's patients, the video can also distinguish between tremors (rhythmic movements) and other involuntary movements.
Having access to this level of detail can affect the clinician's medication plan for the patient.
Weill Cornell is now preparing to conduct a second round of pilot testing. In this round, Weill Cornell clinicians plan to add additional movement exams, as well as offer a video upload section where participants can record videos of activities of daily living that are proving to be difficult, such as buttoning a button or playing the piano.
The devices used cost between $199 and $229 per phone, Hellmers says. The study utilized existing clinical and research staff at Weill Cornell and did not require any additional staffing resources.
The round-two start date is currently subject to the approval of an Institutional Review Board. Beyond that study, Hellmers envisions a day when this video analysis could be integrated into the standard of care for a variety of diseases.
Behavioral Health App
The University of Pittsburgh Medical Center (UPMC) leveraged technology to implement an alternative care pathway for behavioral health conditions, centered around primary care.
In creating the pathway, UPMC introduced a behavioral health app into the primary care physician's options for subsequent "prescription."
Because UPMC is both a payer and provider, the imperative for this initiative grew out of a desire to control costs and improve patient outcomes, rather than merely grow traditional fee-for-service practices.
The mobile-first, behavioral health app, known as Lantern, uses evidence-based cognitive behavioral therapy, and was developed by Lantern, a 2012 Silicon Valley startup, originally funded by a $4 million NIH grant and initially offered to consumers through mobile device app stores.
In an initial six-month trial with 200 patients, UPMC saw a significant reduction in patient anxiety and improvement in quality of life, versus results through traditional primary care approaches.
Transforming the app into something that primary care physicians could prescribe involved close coordination between the startup and UPMC's entrepreneurial arm, UPMC Enterprises, starting in early 2016.
At that time, UPMC Enterprises also took a $17 million investment stake in the company Lantern.
"[The app] can be an extension of care for existing behavioral therapists, so they can see more patients, or it can be used as an adjunct to treatment."
—Eva Szigethy, MD, PhD, psychiatrist, University of Pittsburgh Medical Center
The Lantern app assigns each user a health coach. Although the coaches are not licensed psychotherapists, they undergo rigorous training and supervision, says Eva Szigethy, MD, PhD, a UPMC psychiatrist.
These coaches are the first line in monitoring risk assessments, and they communicate with patients from the outset via text messaging. "They usually respond to patients within 24 hours, and they're really helping to motivate patients to keep using the app and problem-solve with patients who aren't using the app," she says.
So far, 75% of the UPMC primary care patients who have tried Lantern have completed at least three different cognitive behavioral therapy techniques, and even more impressive, have experienced a 38% reduction in their behavioral health symptoms, Szigethy says.
These techniques, such as a deep breathing technique, typically require less than five minutes each to perform, and users can repeat them as often as desired.
"Anxiety and depression are being increasingly recognized as a medical burden not just in already identified psychiatric populations, but in primary care," Szigethy says. "The current standard of care for treating anxiety and depression consists of making an appointment with a behavioral health specialist and/or prescribing medication, and both of those can be problematic. There's a shortage of providers. Psychotropic medications are expensive. They have side effects. The cognitive behavioral therapy patients do better."
Szigethy, who is also codirector of UPMC's Total Care Inflammatory Bowel Disease (IBD) Medical Home, a joint effort with the UPMC Health Plan and a subspecialty medical home for IBD patients, says Lantern shows promise in helping IBD patients integrate cognitive behavioral therapy into their overall treatment plan.
In an ongoing open trial involving 12 patients at a time, 98% of such patients engaged in using Lantern, says Szigethy.
In a study published in Gastroenterology, UPMC also revealed that a social worker attached to Total Care-IBD was able to reduce the time and effort needed to work with each individual patient by 50%, Szigethy adds.
Science has known for years of a strong correlation between behavioral health and chronic diseases such as IBD, according to Rasu Shrestha, MD, chief innovation officer at UPMC and executive vice president at UPMC Enterprises.
Szigethy notes that medical services utilization for those IBD patients using Lantern is declining and, if these trends continue, it will allow the IBD medical home to reallocate team resources and double the number of patients that can be seen in the next year, she says.
"It can be an extension of care for existing behavioral therapists, so they can see more patients, or it can be used as an adjunct to treatment or as a first-line therapy before you put someone on a psychotropic medication. For all those reasons, it was compelling to test a product like Lantern in the UPMC environment," she says.
Invisible Patients: Population Health Visualization Technology
Finding high-risk patients has been the mainstay of population health technology. Finding patients who are at risk of becoming high-risk patients—so-called "invisible patients"—is population health's next challenge.
At nonprofit Phoenix, Arizona–based Banner Health, technology from BaseHealth in California is beginning to identify these invisible patients and prompt clinicians to reach out to them before they become high-risk patients.
Targeting its Medicare Advantage (MA) population, Banner is using BaseHealth analytics to find these patients more quickly than traditional analysis, says Michael Parris, senior director for business intelligence, analytics, and abstraction at the 28-hospital organization.
The BaseHealth technology, developed in collaboration with Banner, provides visualization and other front-end facing software interfaces to pinpoint the exact nature of a condition, such as blood pressure, family history, or age, leading to the prediction of future illness.
"This gives us a much better way to actually target the right patient that I can do an intervention on," Parris says. "It gives us not just who's going to get sick, but what and why they are at risk."
This effort with BaseHealth's technology, which cost Banner $480,000 in its first year, plus 3.5 full-time equivalent (FTE) employees at $110,000 per FTE, is occurring at scale. Banner Health has 50,000 lives in its MA population.
An assortment of case management staff, including PharmDs and social workers, is intervening with the identified invisible patients to have them actively monitored on risk factors such as blood pressure and high cholesterol, Parris says.
"[The technology] gives us a much better way to actually target the right patient that I can do an intervention on."
—Michael Parris, senior director for business intelligence, analytics, and abstraction; Banner Health
At the end of the initiative's third month, Banner is beginning its initial data analysis, so results are just now emerging.
But a proof of concept with BaseHealth over the past 18 months compared who the BaseHealth algorithms predicted would get sick with the names of those patients who actually got sick, and based upon those promising results, Banner entered into contract with BaseHealth in May 2017.
"What we're looking for out of those 50,000 individuals is who is going to be your next 5% of high-cost utilizers that are going to use 50% or more of our insurance spend," Parris says. That list consists of between 2,000 and 3,000 individuals.
"From that you actually whittle that down to a smaller group of individuals you can intervene on, so we're working with somewhere around 800 to 1,000 individuals at this time from that 50,000.
"If I just targeted the top 5%, even the predicted top 5%, I may not be giving them the right intervention or the right resources, and it will also waste resources because I will be targeting individuals that won't benefit from any intervention," he says.
Without the BaseHealth technology, Banner would never be able to build care programs around specific interventions, notes Parris. "It just is throwing spaghetti at the wall when you don't know exactly what you're targeting," he says.
Because of an MA risk-sharing arrangement with Blue Cross Blue Shield, Banner also stands to share in any money saved as a result of these interventions, Parris adds.
In addition, the BaseHealth technology is helping Banner predict its future PMPM costs for a population. "We've used it to help us negotiate on contracts already," Parris says.
To better serve its nearly 1,000 patients, nonprofit Massachusetts-based healthcare organization Element Care extended its services in participants' homes through the use of avatar technology developed by California-based care.coach.
Element Care, which operates eight sites on the North Shore of Boston and in the Massachusetts portion of Merrimack Valley and employs around 300 staff, has a mission to help people live safely and comfortably in their homes and their communities for as long as they can, keeping their stays minimal in hospitals and nursing facilities.
The avatars, which take the form of a cartoon cat or dog, integrate the care of a 24/7 team into a single persona, unlike traditional telemedicine with its seemingly endless succession of new caregivers' faces.
The experience blends software-driven health coaching—part chatbot—with the frequent involvement of care.coach's own team of caregivers, who step in to direct these avatars when software reaches thresholds that indicate human intervention is required.
Founded in 1995, Element Care, provider of Programs of All-Inclusive Care for the Elderly (PACE), has used an interdisciplinary, team-based approach to achieve these goals, funded and run through Medicare and Medicaid. As a capitated program, PACE enables providers to deliver all services participants need rather than only those reimbursable under Medicare and Medicaid fee-for-service plans.
Since Element Care is both the insurer and the provider of care to its customers, "the healthier we can keep our participants, the more likely they will be able to remain living safely in the community," says clinical administrative manager Kendra Seavey.
Element Care calls this "wraparound care" for its participants. When a participant has a care.coach avatar in the home, it can even be a tonic for loneliness, by offering word games or trivia games.
As with more traditional telemedicine, these patients are also under video surveillance, though at any time they can put the avatar and its tablet-based camera to sleep for privacy reasons, keeping in mind the system is designed to wake itself up after a prescribed time interval.
"Since receiving the avatar, [our patient] has had no emergency department visits or hospitalizations."
—Kendra Seavey, clinical administrative manager, Element Care
Element Care did a preliminary pilot program with the care.coach avatars from March through July 2017 with 12 participants and found that the potential financial rewards are substantial.
"We saw a reduction in emergency department utilization and hospital admissions, and we were able to reduce some of our costly after-hour nursing visits," Seavey says. "Our participants even reported that their degree of loneliness, nervousness, and anxiety had actually decreased since receiving their avatars."
As an example of the preliminary savings, one patient had recently suffered a significant loss in her personal life and had little support in her home.
"Since receiving the avatar, she has had no emergency department visits or hospitalizations, and we have logged 13 avatar interventions that have helped mitigate anxiety that previously would have resulted in an emergency department visit," Seavey says. "This is a projected savings of about $7,000."
Yet another patient who had required 11 nursing visits per week to take his medications is now being reminded by the care.coach avatar to take those medications. Seavey says the savings are $2,000 monthly—money that Element Care can put back into care levels for other patients and programs.
The care.coach avatar-driven protocols, along with protocols developed by Element Care, can pertain to specific patient diagnoses.
At the end of the four-month trial period, Element Care expanded the program to a total of 30 participants and is working on rolling the avatars out as more of a standard service at Element Care.
Element Care pays a monthly charge per device provided by care.coach. The charge is all-inclusive of the device, 24/7 service, and 4G internet service, Seavey notes.
Element Care does receive capitated per-member per-month funding from Medicare and Medicaid, which it has used to fund this program for participants, Seavey says. There was no need to apply for or receive grant funding for this initiative, she adds.
Privacy was one consideration when placing these avatars in participants' homes.
"We are in an urban setting with a lot of different social issues, and we were concerned about what these avatars were going to see," Seavey says. "Before placing an avatar in a participant's home, we review all aspects of the service and privacy protocols of the avatars. The health advocates on the other end are also respectful of privacy."
Only 23% of net patient revenue comes from value-based payments. In three years, that that is expected to more than double to 48%. Managing financial risk is a must for healthcare organizations.
With the shift from fee-for-service to value-based payment on the upswing, most finance leaders in the healthcare provider industry are focused on adopting and operating risk-based reimbursement models for medical services. Providers must master essential competencies: assessing risk in patient populations and risk-based payment models, and controlling clinical risk through patient engagement strategies.
A May 2017 HealthLeaders Intelligence Report on Value-Based Readiness surveyed more than 150 providers on their current mix of fee-for-service and value-based payment methods. Currently, 74% of those providers are dependent on fee-for-service payment, while the remaining 26% depend on value-based payment. In three years, providers say that mix will change to 48% fee-for-service and 52% value-based payment.
The same survey found that 77% of net patient revenue in those provider organizations currently come from fee-for-service, with the remaining 23% being derived from value-based payment. In three years, those sources are expected to change to 52% and 48% respectively.
In a new HealthLeaders Roundtable Report, Success Strategies for Managing Risk-Based Contracts, learn about these strategies and how you might apply them to your own organizations.
Here are a few vital questions this report explores:
Do your physicians feel like stakeholders during this transition?
Are your ACO risk-sharing arrangements less predictable than arrangements made with commercial insurers?
Why did many pioneer ACOs fall by the wayside, and what lessons do they hold for your organization?
Are you using the correct mix of licensed and non-licensed case managers to most efficiently manage populations under risk-based contracts?
Patients face various risks, and this report describes some of the surprising ways these can impact the success or failure of an organization’s risk-based contract. Participants discuss the importance of risk stratification, allowing them to apply more resources to high-risk patients identified through the risk stratification process.
The panelists describe how data analytics play an important role, but require that organizations go well beyond merely merging claims data with EHR data. Learn how other, non-traditional data can provide the additional insight that could make the difference between success and failure.
Another hot topic: Medicare Advantage, in part because it has several elements in common with Medicare’s new reimbursement system for clinicians under MACRA. In this report, learn about the keys to success in Medicare Advantage contracting.
One element, important to any risk arrangement or global payment contract, is tight specialty referral, to control high specialty costs.
Finally in this report, learn how high-deductible health plans are impacting risk-based contracts.
Participants in this panel include:
Alan Lazaroff MD, co-founder and coding medical director, Physician Health Partners, Denver, CO
Louis Levitt MD, vice president and physician, The Centers for Advanced Orthopaedics, Bethesda, MD
Rick Lopez MD, senior vice president of population health, Atrius Health, Newton, MA
Kerri Schroeder, senior vice president and credit products executive, Bank of America Merrill Lynch, Seattle, WA
Christopher Cheney (moderator), senior finance editor, HealthLeaders Media
Consolidation between hospitals and physician groups is real. So are their patients’ higher deductibles, coinsurance, and copays, and overall large increase in self-pay receivables all impact billing office workflows.
Until recently, it was common for a fully integrated healthcare delivery system to be operating two separate and distinct patient accounting systems. But health systems operate on razor-thin margins, so they must spend less time trying to collect, and more time posting full, accurate payments and avoiding rework. Download this report now to learn more about how Bank of America, working with health systems running Epic and utilizing its Single Billing Office functions, can make measurable progress on these objectives.
The move to a single billing office or a consolidated patient financial service center is one key: providing a single point of contact for hospitals and physicians.
Banks are deploying state-of-the-art technology to help. An experienced banking partner can ensure a successful integration – reconciling health plan payments and remittances.
Technologies such as scannable lockboxes can facilitate the posting of patient payments and customized data feeds representing payment transactions. The result: increased automation, fewer AR days, greater billing process accuracy, and turn-key, patient-friendly billing processes.
In a new HealthLeaders Roundtable Report, Innovative Approaches to Optimizing Revenue Cycle Operations at Healthcare Providers, learn about the latest trends and important strategies for ensuring a seamless transition to a Single Billing Office powered by Epic EHR technology.
Participants in this panel include:
Olusegun Ishmael, medical director of occupational health and ER physician, Paris (Illinois) Community Hospital
Krishna Ramachandran, chief administrative officer, DuPage Medical Group, Downers Grove, Illinois
Melinda Ramsdell, senior vice president and senior treasury sales manager, Southeast healthcare and institutions, Bank of America Merrill Lynch, Orlando, Florida
Marti Strand, chief revenue cycle officer, Allegeny Health Network, Pittsburgh
Christopher Cheney (moderator), senior finance editor, HealthLeaders Media
Consolidating into one billing system is friendlier to the patient, but it can result in a more complicated receivable, because there may be several accounts represented on a single statement. Learn how banks can electronically reconcile deposits to the electronic remittance forms, posting payments more quickly and efficiently. This automated process involves the bank developing customized data feeds and placing a digital deposit record into the system.
Simplified billing allows organizations to have fewer staff doing billing and collections, and allows them to collect cash more quickly. The metrics show enhancements in AR days, improved cash flow, and working capital.
The huge investment health systems are making in Epic is all about capturing all of the right data the first time. But banking experience is critical – in integrating with Epic and in meeting key metrics: better cash flow, better posting rates, fewer bad debts, a decrease in AR days, an increase in recovery of denied or underpaid claims, fewer paper processes, and greater overall efficiency.
Single Billing Office consolidations are incorporating physician, group, home health, and hospital information on the same billing statement. As providers process incoming cash from such statements, Epic provides some necessary functions to reconcile this cash to the appropriate accounts, but partners such as Bank of America are playing a key role in rounding out those functions.
In particular, Bank of America is helping health systems create a single lockbox to manage all these payments. In this report, learn also how providers are generating clean claims and avoiding expensive and time-consuming rework later on in the revenue cycle.