PokitBlog – The Business of Health https://blog.pokitdok.com Tue, 13 Nov 2018 16:00:39 +0000 en-US hourly 1 72753138 What Do Patients Want in a Patient Portal? https://blog.pokitdok.com/patient-portal/ https://blog.pokitdok.com/patient-portal/#respond Tue, 13 Nov 2018 16:00:39 +0000 http://blog.pokitdok.com/?p=3962 Nearly 90 percent of healthcare practices have a patient portal, but are they improving patient outcomes? We discuss how to create a portal patients will use.

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The implementation of the Centers for Medicare and Medicaid Service's (CMS) Electronic Health Record Incentive Program, also known as Meaningful Use, sent medical practices scrambling to implement patient portals.

To reap the program's incentives, practices must demonstrate that a certain percentage of patients can access their health information through patient portals. Unfortunately, many providers have set up portals only for the sake of compliance -- without considering how patients would use the tool or how to encourage patients to use them at all.

Practices that treat these portals merely as a checkbox toward CMS compliance are missing the extraordinary opportunities these portals provide to improve both clinical and financial outcomes, says John Barnett, project coordinator at Iflexion.

These practices are also harming their own ability to connect with patients. Ninety percent of practices had a patient portal as of 2018, according to MGMA Consulting principal Pamela Ballou-Nelson. The problem, however, is that less than 20 percent of patients on average actually use the portals, Mary Pratt writes in Medical Economics.

Put another way, healthcare practices are missing out on the opportunity to improve outcomes with 80-plus percent of their patients -- an opportunity that could be realized with improved portal design and functionality.

Why Do Practices Need a Thoughtfully Designed Patient Portal?

Improved clinical outcomes from patient portal engagement have already been substantiated through research.

In fact, even more basic forms of digital engagement with patients have proven a net benefit on their health. Analyzing 10 years of data from Kaiser Permanente's MyChart program, researchers Terhilda Garrido, Brian Raymond and Ben Wheatley found that use of secure email systems was linked to a 2 to 6.5 percent increase in Healthcare Effectiveness Data and Information Set (HEDIS) measures, including glycemic index, cholesterol, and blood pressure.

"While the specific mechanisms underlying this association are unclear, contributing factors may include increased continuity of care, greater patient-physician connectedness, and better support for patient self-management," the researchers note.

In other words, getting patients their data -- even via a secure email channel -- strengthens the patient-physician relationship and empowers the patient to take greater responsibility for their own health. A dedicated patient portal amplifies that dynamic.

A thoughtfully designed portal can also boost patient loyalty. "The portal becomes sort of the hub" for managing patients, particularly those with chronic illnesses who need ongoing care, says David Clain, research manager at athenaResearch. "It's not just how you get a patient to come in and fill a spot, but how you make sure that you see them often enough that you can really have a good handle on their health status and you can intervene early and often if you have to."

A patient portal can improve communication, streamline patient registration and scheduling, and allow practitioners to focus on patient care rather than administrative minutiae, says Amy DeMarco, marketing specialist at Henry Schein MicroMD. To reach these goals, however, the portal must be designed with the patient's needs in mind.

medical team meeting with woman in hospital room - patient portal

What Makes a Patient Portal User-Friendly?

Most patients want a portal to offer three primary features: the ability to schedule medical appointments online, the ability to view information regarding their health, and the option to view and pay their medical bills online, says Gaby Loria, team lead and video producer at Software Advice. These common requests indicate that "patients want to take a more proactive role in interactions with your practice. This is a win-win."

Providing additional healthcare information or data tracking can also boost patient portal engagement. According to a 2018 study by Steve Alfons van den Bulck and his team of fellow researchers in the Journal of Medical Internet Research, of 433 surveyed patients, 93.7 percent stated that a patient portal or app that could notify them when they needed to take action to protect their health would significantly improve their quality of life and allow them to assume greater responsibility for their own healthcare.

More than 80 percent of respondents were interested in features that would allow them to track their symptoms over time, understand how symptoms were related to biological factors, or find information about expected treatment effects.

Finally, a portal that allows for mobile use is a must, says Eric Wicklund at mHealthIntelligence. To offer optimal ease of use, however, simply redesigning the existing portal for a smaller screen may not be enough. "A truly engaging mobile patient portal takes advantage of the convenience and usability of a mobile device to give patients on the go access to what they want and need," Wicklund says. It loads quickly, is easy to read on a smartphone or tablet, and it allows patients to find answers to their questions quickly.

Designing for Patient and Practice Success

A user-friendly portal also makes it easier for patients and practices to communicate and coordinate, says D'Arcy Gue, director of industry relations for Medsphere Systems Corporation.

For instance, Gue writes, a well-designed portal starts with a well-thought-out signup and login page. "Patients get frustrated and tend not to use the portal if the very first thing they must do is prohibitively complex," she says. A portal with automated password recovery can help make the process easier.

Currently, many portals don't engage patients because they aren't designed with the patient's needs in mind. Rather, they're based on systems created for providers that have been reconfigured to allow certain types of limited patient access. Often, the result is information that is fragmented, non-intuitive, or difficult to understand, particularly for patients with lower health literacy, according to a 2017 study by Jessica L. Baldwin and her team of fellow researchers in Healthcare.

This creates a significant problem when it comes to bill payment tools, says Tom Furr, CEO and founder of PatientPay. For instance, the bill displayed in the patient portal may not match the paper invoice patients are used to receiving, which can cause confusion, and result in patients paying the incorrect amount.

In addition, privacy and security remain concerns in a digital environment, and these concerns can make both patients and practices hesitant about engaging with a robustly-designed portal system, David Twiddy writes in an article in Family Practice Management. For instance, informing patients about steps they can take to protect their own health information (and what steps the practice takes to protect electronic health records) can help allay fears and boost engagement.

To improve patients' willingness to try its portal, Novant Health coordinated the launch with an education campaign, offering information, tip sheets, and targeted advertising, says Lauren Miller, operational engagement project manager for clinic services.

"One of our main goals was maximizing patient engagement, really allowing for that relationship to be maintained outside the clinic, and as a direct result of that, when your patients are more engaged, we could work to engage patient outcomes," Miller says.

Education to allay fears about privacy and to encourage exploration of the patient portal was an essential first step.

bed and computer -- patient portal

Putting It All Together

Integrating the patient portal into the practice's work with patients and teaching them how to use it can have a profound impact on portal adoption, says Erin Zielinski, a family practice manager in New Jersey.

So can designing from the patient's perspective, says Kevin Yamazaki, founder and CEO of Sidebench. Stepping into the patient's shoes to ask questions like "Is the portal easy to use?" "What are the costs and benefits to me?" and "How well does my doctor's office support my use of the portal?" can help practices pinpoint which features are necessary to support patient communication -- and which features simply get in the way.

When it comes to portal design, using the big three patient demands -- scheduling, bill pay, records review -- as a foundation can lay the groundwork for a user-friendly portal. With these three tools in place, building a patient portal that makes it easier for patients to understand their own healthcare, and to communicate their needs with a healthcare provider, can improve clinical and financial outcomes as well as patient loyalty and satisfaction.


PokitDok's Patient Access solutions enable healthcare providers to offer modern commerce experiences that allow consumers to search, schedule, and pay for services online. With white-label front-ends, real-time medical benefits verification, seamless EHR scheduling integrations, and PCI-compliant payments, PokitDok has everything necessary to build and deploy patient portals quickly.

 
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Propensity to Pay: Which Healthcare Payment Predictors Are Most Accurate? https://blog.pokitdok.com/propensity-to-pay/ https://blog.pokitdok.com/propensity-to-pay/#respond Tue, 23 Oct 2018 15:20:05 +0000 http://blog.pokitdok.com/?p=3954 Healthcare providers experience better financial stability when they can make accurate predictions regarding payment, including propensity to pay.

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Prompt, full payments are essential for healthcare providers, who must constantly balance the need to provide quality care with the need to stay financially viable. Meanwhile, ensuring value-based care means considering a wider array of factors than past models have required.

Accurately predicting who will pay how much by what time is a critical ability for healthcare providers. Yet it can be increasingly difficult to calculate the probability of being paid without access to the right tools and data sets. As a result, many key healthcare conversations today center on propensity to pay.

Understanding Propensity to Pay

Propensity to pay can also be framed as a question: "How likely is a patient to pay his or her bill, and what is the probability that a provider will be reimbursed by a payer for the invoiced amount?"

Determining propensity to pay for any one payer can be difficult. One major hurdle, says CMS administrator Seema Verma, is the fact that "clinicians and hospitals have to report an array of measures to different payers." When multiple payers are involved, determining the likelihood that the various sources will contribute amounts that reimburse the total cost of service becomes even more complex -- especially when all these sources operate on their own internal schedules.

The question can be complicated by factors like capitated payments, or pre-arranged payments to provide services on a "per member, per month" basis, says Patrick C. Alguire, MD, director of education and career development at the American College of Physicians.

At the same time, practices must balance other factors that affect their bottom lines, like scheduling and utilization. When a patient misses an appointment, for instance, the provider misses the opportunity to provide and be paid for care. Inefficient scheduling can also lead to uneven utilization, overworking staff and facilities at certain times while leaving them nearly idle at others.

medical marketing and healthcare business analysis report regarding propensity to pay

Addressing Financial Risks Beyond the Patient

Mergers and acquisitions, a common occurrence in healthcare, also come with a slate of financial risks that include risks surrounding payer behavior. "When two systems join together, replacing the contracts the acquirer has with the payer is not a quick, snap-of-the-finger type move," says Healthcare Finance associate editor Jeff Lagasse. When payers are insurance companies, the shift can create situations in which individual patients must be evaluated for their propensity to pay.

While mergers and acquisitions mean that organizations keep getting larger, it is nonetheless a mistake to think that predictive modeling for payment propensity only works for large-scale organizations, says Paul Bradley, chief data scientist at Waystar. "The reality is that it's just as effective for small to mid-size providers, perhaps more so since they have less margin for error in their financials."

To combat risk in the financial realm, some banks are turning to predictive analytics to help predict lifetime customer value, Raghav Bharadwaj writes at TechEmergence. Using artificial intelligence and machine learning algorithms, financial institutions are predicting customers' financial behavior, creating profiles for "ideal" customers and adapting operations to nurture customers with higher lifetime values.

A similar approach could be effective for healthcare providers, Welltok CEO Jeff Margolis says. "While the healthcare industry becomes increasingly adept at applying clinical and claims data to improve care, it has largely ignored other data sources that provide the greatest opportunity to positively impact health and cost at scale," he writes at Harvard Business Review.

This includes consumer data, which also plays a key role in determining the "when, how, and how much" of payments.  

Which Payment Predictors Are Most Accurate?

One of the best ways to determine when, how, and how much a payer is likely to pay is by analyzing payments made in the past, say Eric Nilsson, chief technology officer at SSI Group. By using machine learning algorithms, providers can combine data from a number of sources to see how payers have responded to similar claims in the past, and thus to guess how the payer will likely respond in the future.

The confidence levels in these algorithms "can be 90 percent or greater in many cases," Nilsson says. "Being able to answer when your remit is to be paid can be particularly helpful when trying to forecast end of month revenue for your organization."

The medical conditions patients face also play a role in payment likelihood -- particularly as many insurance policies lapse in the face of more complex, difficult, or costly conditions, EconoSTATS' Wayne Winegarden notes at Forbes.

To understand how patients' conditions affect their propensity to pay, creating the right data set is crucial. A study published in the Journal of Hospital Medicine found that certain events during a patient's hospital stay highly correlate with their likelihood of being readmitted within 30 days. These included both complications that carried extra costs, like C. difficile infections, and those that did not, like vital sign instability upon discharge. Since readmission triggers additional costs, it factors into the propensity to pay equation and is worth spotting.

Spotting trends like these isn't always simple. While access to data is essential for technological solutions to provide accurate predictions, the shift to electronic health records is not yet complete. A 2018 study published in the Journal of Medical Internet Research found that most US hospitals, for instance, exist on a continuum between all-paper and all-electronic records. The researchers predicted that most hospitals will not function in an electronic-only environment until 2035.

To create more accurate tools for determining propensity to pay, it is important to ensure that the algorithms and models used by the system focus on the right data, says John Steensen at VISA. Examining broad trends, like the recent push away from payments for emergency care and hospital-based imaging to urgent care and stand-alone imaging centers, indicate broad behaviors but will have varying effects on payments at the individual provider level, notes Les Masterson at HealthcareDive.

When used correctly, these tools can analyze large quantities of real data to produce better predictions than human interpretation can provide.

customer hands over her payment customer card - propensity to pay

Tools for Managing Risk and Payments

Patients are becoming more educated about healthcare choices and pricing, says Kimberly Zeltsar, executive director of revenue cycle for Kaiser Permanente, Hawaii Region. As a result, providers are improving their patient management systems with enhanced, automated services for patients and better data tracking for internal use. These tools empower patients to better understand and participate in the payment cycle.

Technology is helping healthcare providers manage payment-related risks, as well. In an article for HealthITAnalytics, Jennifer Bresnick advocates for the use of blockchain-based solutions for tracking payer data, allowing for a wide range of payment predictors to be weighted and analyzed in determining a patient's ability to pay. Smart contracts, in particular, could make it easier for providers to manage payments, Bresnick says.

A 2018 study in Computers and Society predicted that blockchain-based solutions for healthcare that address questions like propensity to pay would be more generalizable, and thus more effective, if they relied on a number of data points gathered across a variety of organizations.

PokitDok's Payment Risk solution enables lending institutions, payment solutions, health systems, and medical practitioners to calculate the financial risk of healthcare transactions before an episode of care, and to make new financing options available to patients for non-acute medical services. Our Payment Risk algorithm combines public, customer, and proprietary data to estimate the likelihood that a patient will pay their bill, and to calculate the probability that a provider will be reimbursed by a payer for a specific amount.

 
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How Can Behavioral Telehealth Fulfill Its Potential? https://blog.pokitdok.com/behavioral-telehealth/ https://blog.pokitdok.com/behavioral-telehealth/#respond Tue, 25 Sep 2018 15:00:01 +0000 http://blog.pokitdok.com/?p=3946 Behavioral medicine is uniquely suited to digital delivery. We look at the increasing interest in behavioral telehealth, its opportunities and its challenges.

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Behavioral health has become nearly synonymous with mental health in many conversations. With its focus on addressing specific actions or behaviors that cause distress and ill health, behavioral health has the potential to empower patients to make concrete, lasting changes that lead to an increased sense of control, well-being, and ability to manage their physical and mental health issues.

Because behavioral health often focuses on teaching strategies that patients can then apply to their daily lives, it is well-suited to the rise of telemedicine, in which practitioners and patients confer via phone or video conference.

Here, we examine the rise of behavioral telehealth in recent years and the opportunities and challenges it faces in reaching its potential.

Why Has Behavioral Health Embraced Technology?

Approximately 18.5 percent of US adults struggle with mental illness symptoms each year, according to the National Alliance on Mental Illness. Nearly the same number, 18.1 percent, will deal with a condition that responds to treatment via behavioral health at some point in their lifetimes, says NAMI.

Psychiatry was one of the first specialties to adopt technological solutions to reach more patients. Today, "assessments performed via videoconferencing are reliable, and telepsychiatric interventions lead to clinical outcomes that are comparable to in-person treatment," write David Cohn and Hossam Mahmoud of Regroup Therapy.

The use of technological tools to expand the reach of psychiatrists and other mental and behavioral health services providers has helped to address the chronic shortage of staff and resources in these areas, as well. Today, about 48 percent of psychiatry and mental health counseling practices say they use behavioral telehealth tools, according to a March 2018 study by Shannon Mace, Adriano Boccanelli and Megan Dormond at the University of Michigan Behavioral Health Workforce Research Center.

Patients with a wide range of chronic medical conditions often experience co-occurring behavioral health issues, exacerbating symptoms of the chronic condition, as well as depression, anxiety and stress.

In a February 2018 article in Psychiatric Services, researchers Loren Dent, Aimee Peters, Patrick L. Kerr, Heidi Mochari-Greenberger and Reena L. Pande studied a standardized program to provide cognitive behavioral therapy (CBT) to such patients. "A retrospective before-after evaluation of the program demonstrated national reach, high patient satisfaction, and significant reductions in symptoms of depression, anxiety, and stress," the researchers wrote.

tech - behavioral telehealth

Opportunities for Behavioral Telehealth

As behavioral telehealth proves its effectiveness, more stakeholders are jumping on board. Perhaps one of the most exciting, from a provider's perspective, is employer-funded insurance programs. In 2018, 56 percent of employers said they planned to offer insurance that covered behavioral telehealth services, Bruce Japsen writes at Forbes.

One extraordinary opportunity for behavioral telehealth is the chance for providers to see inside a patient's life. "You can actually get into their environment," says Zereana Jess-Huff.

For instance, behavioral health patients can carry their devices around their home, showing their providers how they live and where they spend their time. The provider can use what they observe to give specific advice on environmental, lifestyle or behavioral changes that are directly relevant to the patient's personal situation.

Behavioral telehealth also provides alternatives for the treatment of chronic pain, a condition that affects more than 100 million Americans, and which is frequently accompanied by depression, anxiety, and other mental health symptoms, says Lily Mercer at Health Recovery Solutions. Behavioral treatment can help chronic pain patients manage not only the mental health symptoms, but also address behaviors that may aggravate the pain itself, notes Erica Hoffman at Mental Health First Aid.

Being able to connect with patients at home also means fewer missed appointments. When patients don't have to deal with timing, transportation, or the difficulties that co-occurring conditions can cause in getting out of the house, they're more likely to meet with their providers, improving both their treatment and the provider's bottom line.

Telehealth also offers a way to provide many people with support they could not otherwise access. In Polk County, Florida, county officials have created a program that offers free behavioral telehealth services to approximately 84,000 low-income, uninsured county residents, Heather Landi reports at Healthcare Informatics. The program is paid for by a half-cent sales tax increase, approved by county residents.

Regulatory interest in a standardized set of rules and regulations has increased, as well. In July 2017, the Centers for Medicare and Medicaid Services (CMS) announced a plan to design "a potential payment or service delivery model to improve healthcare quality and access, while lowering the cost of care for Medicare, Medicaid, or CHIP beneficiaries with behavioral health conditions," says Eric Wicklund at mHealthIntelligence. The resulting program could easily include behavioral telehealth.

patient - behavioral telehealth

Challenges for Behavioral Telehealth

While behavioral telehealth shows promise, it still faces challenges. For instance, lack of access to either in-person or telehealth-based care still remains a significant hurdle in rural areas, says Jeff Lagasse at Healthcare IT News.

And these rural areas may be where behavioral health can have the greatest impact. Mental health and mental disorders rank highly among the priorities for providers in these areas, according to a brief from the Substance Abuse and Mental Health Services Administration (SAMHSA).

No matter where a patient is located, though, willingness to participate remains an ongoing challenge in behavioral health, whose outcomes often depend on how the patient implements the tools they learn into their daily lives. The use of technology to provide behavioral health support remotely has not changed the fact that patients must still participate in their own recovery, as Charles Townley and Rachel Yalowich note in an article for the National Academy of State Health Policy.

When patients do participate, however, states have seen significant cost reductions as a result of implementing behavioral telehealth programs. They have also seen reductions in the number of prescriptions for psychotropic medications, particularly for children under 5, noted Townley and Yalowich.

While increasing numbers of patients have the tech tools they need to access telehealth services, not all providers have the same access. Network connectivity, uncertainty about reimbursement, and piecemeal implementation have caused many providers to balk at adopting the technology. "Telehealth is easy for patients, but it's hard for doctors and health plans," says Wally Adamson, family physician and staff vice president at LiveHealth Online.

Finally, regulatory responses at the state level have been slow when it comes to behavioral telehealth. Most states focusing solely on psychiatrists' use of the technology, says Amy Lerman, a member of Epstein Becker Green's Health Care and Life Sciences Practice. To date, only New Jersey has released regulations that appear to cover not only physicians but also other practitioners of behavioral health, such as psychologists and therapists.

"We have a pretty under-resourced mental health workforce," says Mike Anderes, president of Inception Health. Access to behavioral telehealth "goes a long way toward fixing a big supply-and-demand mismatch."

Telemedicine providers like Doctor on Demand, Talkspace,Teladoc, and Zipnosis depend on PokitDok's suite of mix and match application programming interfaces (APIs) to help them bring new applications and services to market faster. PokitDok is especially well-suited to behavioral telemedicine applications and services, enabling real-time connections to over 700 payers to confirm medical and pharmacy benefits eligibility, automate claims processing, and more.
  
 
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What to Look For in a Patient Scheduling System https://blog.pokitdok.com/patient-scheduling-system/ https://blog.pokitdok.com/patient-scheduling-system/#respond Fri, 21 Sep 2018 15:13:36 +0000 http://blog.pokitdok.com/?p=3940 A patient scheduling system can do far more than simply keep a calendar. Here, we look at some of the most important features of a modern scheduling system.

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Patient scheduling has come a long way from the days of paper calendars and appointment books. Today, a patient scheduling system can integrate with nearly every other aspect of a medical practice, making it easier to manage not only time, but also money and quality of care.

A centralized scheduling system can help standardize practices, minimize lost revenues, and improve patient satisfaction and care, according to HSG director M. Davis Creech. Today's patient scheduling systems can reach far beyond the calendar to address payments, management, and many other aspects of a healthcare practice.

Here, we look at some of the key features and tools of a powerful, thoughtfully designed patient scheduling system.

Automated Schedule Reminders

Patient no-shows cost US healthcare providers an estimated $150 billion each year, according to JP Medved at Capterra. In one extreme case, 14,000 no-shows in a single year ended up costing one clinic a million dollars.

Automated schedule reminders are an easy way to help reduce the rate of patients who don't appear for their scheduled appointments. When integrated with the scheduling system, these schedule reminders push automatically to the patient's device of choice, making it easier for patients to remember their appointments without requiring any extra tasks from office staff, Nate Comstock writes at Advisory Board.

In addition to reminders, many patients need prompt attention. "In many cases, when a consumer needs care, they need it right away," says Dave Kriesand, vice president of consumer experience at Banner Health. "Having tools that easily match a provider to the consumer's preference makes access easier."

Open-access or same-day scheduling can make it more convenient for patients to schedule appointments, while a system designed to manage this approach can make scheduling and payments easier for the practice to manage, notes SCI Solutions CMO Jamie Gier.

About 52 percent of medical practices currently use one or more communication methods to remind patients of upcoming appointments, according to industry reporter Jacqueline LaPointe. Just under 30 percent call patients to remind them, while fewer than 5 percent rely on text messaging or emails alone.

The right patient scheduling system, however, can integrate multiple methods to make it easier to reach all patients.

card - patient scheduling system

Online Booking and Cancellation (Within Limits)

Allowing patients to schedule appointments online provides a level of convenience that patients-as-consumers increasingly demand.

According to Arash Asli at Yocale, 90 percent of customers want the convenience of online appointment requests or appointment scheduling, and 64 percent of patients are expected to use these services when they're available.

An online system allowing patients to request or schedule appointments saves time for office staff and helps patients remember appointments by allowing them to choose times convenient for them. It can also help reduce no-show rates by controlling when patients can cancel online, Bob La Loggia at AppointmentPlus says.

For instance, your system may allow patients to schedule appointments online and to cancel them online, but only within 48 hours. A well-designed patient scheduling system can be set up to prevent patients from cancelling online within a certain time frame, but still allow office staff to manage appointments within that time frame.

Making Payments Easier

Treating patients as consumers and healthcare as a business puts the onus on patients to understand pricing and to shop for the best prices available whenever they can. In a sector as complex and personalized as healthcare, or course, this search can be difficult. According to Kari Paul at MarketWatch, only about 1 percent of healthcare consumers use price transparency tools online.

Some insurance companies have begun offering incentives for patients to shop around, according to Blue Cross NC chief growth officer John Roos. But pitted against the desire to save money is the desire of patients to see doctors and practices they know and trust.

The answer? An online scheduling system that manages financial data, as well.

For instance, a scheduling system that incorporates insurance and payment information from major insurance companies can help patients predict how much they're likely to spend during their visit, before they make an appointment. This ability to shop, schedule and pay online is convenient for the patient, and it engenders trust. An online appointment system can even be configured to accept payments at the time the appointment is made, streamlining the check-in process and helping practices capture payments up front.

Perhaps the strangest effect of price comparison tools integrated with a scheduling system is that they don't encourage patients to spend less, according to Slate's Helaine Olen. In fact, a 2016 JAMA study indicated that spending actually increases when patients know ahead of time what the final bill will look like. Patients prioritize access and communication when they choose a doctor -- two things that a price comparison and pre-pay option provide.

Whether or not patients actually spend more, the option for them to pay in advance and to understand where that money will go can help practices capture more revenue by mitigating  some common causes that can suppress revenue: consumerism, denials, documentation demands, and poor integration, Healthcare Finance managing editor Beth Jones Sanborn says.

network and data protection concept with padlock and switch - patient scheduling system

Leveraging Your Data

A comprehensive scheduling system collects a great deal of data regarding patient behaviors. It can answer questions surrounding when, where, how, and why patients schedule or cancel appointments, what types of patients are likely to schedule appointments at which times, and more, says Mark Byers, CEO of DSS, Inc.

This data can only benefit healthcare providers if they use it. "Improving hospital operational efficiency through data science boils down to applying predictive analytics to improve planning and execution of key care-delivery processes, chief among them resource utilization, staff schedules, and patient admittance and discharge," writes Sanjeev Agrawal, president of healthcare and CMO at LeanTaaS.

For outpatient healthcare providers, similar concerns exist. The use of analytics can play a key role in improving how resources are used, seeing patients efficiently, and ensuring that both patient and staff schedules run smoothly.

A study in the 2017 AMIA Annual Symposium Proceedings Archive found that electronic health record (EHR) information could be productively analyzed to improve outpatient clinic scheduling templates. A scheduling system that connects seamlessly to the EHR system has the data necessary for analyses that can improve the quality of healthcare while reducing its costs.

Leveraging patient data can also help capture referrals that might otherwise be lost. According to Lance Fusacchia, CFO of MyHealthDirect, up to one-third of patients never follow through on their referral. That represents a significant loss of revenue.

When a scheduling system is well-designed, connects to other major systems, and provides analytics, the system becomes a powerful force for more effective practice management, says Mark Mullarkey, senior vice president at HealthCatalyst.

Security and Privacy Tools

Patient privacy and data security rank higher than cost of care among patient concerns, says Fred Donovan at HealthITSecurity. Meanwhile, concerns about data security and privacy have hindered the adoption of many tools that could improve the delivery of healthcare, including fully functional scheduling platforms that integrate with other legacy systems, note Thora A. Johnson and Jami Vibbert at Venable.

One important privacy and security tool in any scheduling system is the ability to limit user capabilities based on user type, says Amy Vant, a doctor of physical therapy and clinical director of outpatient physical therapy. For instance, front desk staff may be able to schedule appointments only, while medical assistants may have access both to the patient's medical records and to the scheduling system. "This feature helps reduce the likelihood of breaking any privacy and security measures," Vant says.

Scheduling systems have indeed come a long way since the days of paper calendars. Yet rapid advances in technology, coupled with the intense privacy needs of healthcare, have posed challenges as well.

When a scheduling system is thoughtfully tailored to a practice's existing systems and its needs, however, it can help improve patient care, reduce lost revenue, and provide information without compromising privacy.

With PokitDok's Patient Access solutions, healthcare providers can offer modern commerce experiences that allow consumers to search, schedule, and pay for services online. With white-label front-ends, real-time medical benefits verification, seamless EHR scheduling integrations, and PCI-compliant payments, PokitDok has everything necessary to build and deploy quickly.

 
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4 Technologies Changing the Medical Billing Insurance Claims Process https://blog.pokitdok.com/insurance-claims-process/ https://blog.pokitdok.com/insurance-claims-process/#respond Wed, 05 Sep 2018 17:17:34 +0000 http://blog.pokitdok.com/?p=3934 The medical billing insurance claims process is expensive and not always effective. But technology is helping to optimize billing, increase reimbursements and streamline claims management.

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The challenges that healthcare providers face when billing insurance companies and other payers are well-known. Verifying benefits eligibility, ensuring correct coding, and accurately invoicing can all involve significant time and labor. And even then, providers often have to wait in excess of three months to receive payment.

But at a time when claims management is getting more expensive, and relationships between providers and payers are becoming more strained, technology is stepping up to make the entire process smoother for both parties.

The Current Challenges of Medical Billing Insurance Claims

The current climate has healthcare providers facing a slew of challenges when it comes to claims management.

First, there is the cost of the entire process. Billing itself is expensive. Research led by Duke University's Phillip Tseng [registration required] found that the estimated cost of billing in an academic health system ranged from $20 (primary care) to $215 (inpatient surgical procedure). In primary care alone, "it takes $99,581 in billing and insurance-related work per year per primary care physician (PCP) just to get paid, assuming 4860 visits annually," Medscape reports, citing the research of Tseng, et al.

But when claims are denied and trigger an appeal process, the cost can be staggering. Research led by Joshua Gottlieb, an associate professor at the Vancouver School of Economics, estimates that the annual cost of challenged health insurance claims submitted by providers may be as high as $54 billion.

The crux of the problem is that claims are challenged frequently. Rajiv Leventhal at Healthcare Informatics reports that of an estimated $3 trillion in claims submitted by healthcare providers in 2016, 9 percent (or $262 billion) were initially denied.

It's not just a case of getting reimbursed, either, says Sandra Wolfskill, director of healthcare finance policy at Healthcare Financial Management Association (HFMA.) It's a case of getting paid correctly. Revenue integrity -- making sure that care is classified, recorded, charged, and paid correctly -- is becoming increasingly crucial. Even more so now that value-based payment, where reimbursement for treatment is tied to the quality of the treatment provided, is growing.

As providers struggle to get timely and satisfactory reimbursement from payers, they are also struggling to get payment from patients. Jonathan G. Wiik, principal of healthcare strategy at TransUnion Healthcare, highlights in a report how the percentage of healthcare costs absorbed by patients has been steadily rising as a proportion of the final bill, from 8 percent in 2012 to 12.2 percent in 2017.

But patients can't afford these bills.

As Merideth Wilson reports in MedCityNews, healthcare organizations are increasingly struggling to secure reimbursement from patients, as Americans struggle to keep up with their increased financial responsibilities when it comes to healthcare. In the past, bad debt incurred from uncollected patient invoices could be written off with minor impact, as payer reimbursement made up the most significant part of revenue.

Not anymore: Dwindling streams of income from both patients and payers are having a significant impact on healthcare providers' ability to remain financially sound. Staffing cuts and a lack of investment in new technologies are becoming increasingly common as a result.

medical tech - insurance claims process

4 Technologies Improving Medical Insurance Claim Management

Times are changing. In a survey conducted in 2017 by Navigant and HFMA, led by Erick McKesson, 79 percent of hospital and health provider CFOs surveyed reported that technology-related capabilities were their main focus for improving revenue cycle management in the year ahead.

What exactly should executives be focusing on? The four new technologies below make for an excellent starting point.

1. Clinical Documentation Improvement (CDI)

There are numerous reasons for claims denials, but most of them come down to some form of documentation error, according to Karen Meador at the BDO Center for Healthcare Excellence in New York.

If healthcare providers can reduce documentation errors, then the percentage of clean claims will rise, as well as the increased revenue and reduced costs that come with claims that do not require manual intervention and adjudication. Clinical documentation improvement (CDI) technology can help in this regard.

Doug Brown, managing partner at Black Book Market Research, believes that CDI solutions are crucial for ensuring timely and correct reimbursements from both insurers and payers. Research by his firm shows that almost 90 percent of hospitals with more than 150 beds and outsourced clinical documentation functions achieved at least $1.5 million in healthcare revenue, and claims reimbursement following CDI implementation certainly supports this.

2. Blockchains

Blockchain technology also has an important role to play in how providers can improve billing insurance claims. For one, blockchains can make the sharing of data between parties easier and more secure. Cara Sloman, executive vice president at Nadel Phelan, points out that current exchanges of information are hampered by a number of issues such as the need for a trusted intermediary, data interoperability, and inconsistent rules and permissions. With blockchains, health companies can create a complete picture and a single source of truth.

Blockchain technology doesn't just make it easier for providers and payers to share data, says Rahul Sharma, CEO of HSBlox. Because the blockchain can reconcile transactions in near real-time, it can also significantly speed up claims processing and remove the current reliance on third-party clearinghouses.

But that's not all. Technology reporter Michael Kordvani reports that because data stored in the blockchain has a clear audit trail and is so easily accessible, fraud detection will be improved and claims will be easier to audit.

In short, blockchains will make sharing data easier and safer, processing claims quicker, and fraud detection simpler.

portrait of a baby being checked by a doctor using a stethoscope - insurance claims process

3. AI and Computer-Assisted Coding

Automated tracking, real-time data, and artificial intelligence can be combined to make sure billing mistakes are greatly reduced. This is particularly true when it comes to automatically reading and translating medical reports, where AI can play a huge role in optimizing billing for providers.

Kumar Venkatesiah, an eLearning consultant, points out that while the notes that most practitioners and admin staff use are meant to speed up coding, they also contribute to numerous mistakes. Cumulatively, these errors are estimated to total $750 billion a year. But with computer-assisted coding systems, backed by AI, healthcare providers can meaningfully lower the number of these kinds of mistakes. A 2017 report published by WinterGreen Research and led by technical director Ellen T. Curtiss concurs, stating that with computer-assisted coding, 88 percent of the coding can happen automatically without human review.

David Bayer, VP at the Compreno Group, suggests that AI technology can "accurately extract entities, events, and facts," then recognize specific words and decipher their meaning and relationship to one another to ensure that medical records match bills.

That's not all AI can do, however. AI can also be used to verify benefits eligibility in real time. Knowing upfront whether a patient's insurance covers a particular procedure, and for what amount, can mean the difference between getting paid and coming up empty-handed.

4. Automated Systems and Processes Between Both Parties

Health IT professionals don't have to create artificial intelligence for software to be effective. Producing software that allows for automation is often enough.

For John Dugan, a partner at PwC, automation presents a huge opportunity. When it comes to the claims process, Dugan explains, there are still several manual processes that contribute to inaccuracies. The more of this that can be automated, whether through claim scrubbing or followup work, the better.

Indeed, both payers and providers spend huge amounts of time and labor costs communicating and approving requests by phone, fax machine, or email. But automation can largely eliminate this, says Dan Schulte, SVP Healthcare at HGS Inc. When payers and providers share data, automated processes can work much more effectively, thereby freeing up staff time and reducing the costs incurred by claims management.

This kind of technology is just as important for payers as it is for providers, says Medica's Kimberly Branson. Because financing healthcare between payer and provider is so complex, having a system that automates the workflow is critically important and improves both quality and compliance.

Improving Medical Billing Today

This isn't a prediction of the future. All of these technologies are available to healthcare providers today who want to optimize their medical billing insurance claims process and increase reimbursements.

 
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How Better Claims Management Supports Healthcare Practice and Industry Growth https://blog.pokitdok.com/better-claims-management/ https://blog.pokitdok.com/better-claims-management/#respond Mon, 27 Aug 2018 16:51:46 +0000 http://blog.pokitdok.com/?p=3926   As an increasing number of patients converges with decreasing reimbursement rates, pressure is rising in the healthcare industry, particularly in the area of claims management, according to Jacqueline LaPointe at RevCycleIntelligence. This is big news, because this is a market that is expected to reach $13.93 billion by 2023. Meanwhile, claim denial rates from  … Read more

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As an increasing number of patients converges with decreasing reimbursement rates, pressure is rising in the healthcare industry, particularly in the area of claims management, according to Jacqueline LaPointe at RevCycleIntelligence. This is big news, because this is a market that is expected to reach $13.93 billion by 2023.

Meanwhile, claim denial rates from major insurers can be as high as 5 percent, notes Vera Gruessner, writing at the same site. Gruessner also points out that both payers and providers have roles to play in improving claims management -- including ensuring that claims management processes are focused on supporting the overall growth of the healthcare industry.

Here, we look at several key reasons that effective, efficient claims management is essential for healthcare practice and industry growth.

Patients Aren't Patient

Healthcare hasn't been immune to the shift in consumer expectations toward a more personalized approach. However, in their quest to provide a more consumer-friendly patient experience, healthcare providers have largely ignored claims management, and the coding, billing, and collections it entails.

Billing is often a source of frustration for patients, especially the lack of transparency involved in claims processing, and the inefficiency in how payments are handled. This frustration has consequences, as providers transition to a value-based model and patients -- especially those who adopt high deductible health plans -- increasingly comparison shop for healthcare, says Mary Richards, executive director at Partners for Better Care.

As patients increasingly shoulder a larger portion of healthcare expenditures, their own satisfaction with the billing process becomes a greater concern.

Yet providing the care that patients demand can go hand-in-hand with more efficient claims management. A focus on reinvestment in the claims management system, as well as on evidence-based medicine practices, is helping some providers "get it," says John Dugan, CPA, who oversees PwC's healthcare provider practice.

"Having those standardized levels of care that are supported by data analytics for them to understand what the outliers are in the cost to treat, that's where you're seeing savings driven out of the system," Dugan says. "The winners in the game are going to be the ones who really focus on patient/consumer - those patients now become their own payer class."

Here is where process automation intersects with not only claims management itself but also improved patient satisfaction.

"It's a cliché but the term is meeting people where they are," says Ryan Rossier, VP of platform solutions at Medullan. "I think that expression, when done appropriately, can actually create a very high sense of satisfaction."

laptop - claims management

Improving Reimbursement Frees Up Resources For Growth

Insurers and providers alike need resources for sustainable growth, particularly as the number of patients seeking healthcare continues to increase. From an insurer's perspective, this can be difficult: Up to 80 percent of health premiums are spent on claim payments and associated charges, says Healthcare Finance News' Susan Morse.

From a provider's perspective, it's difficult, as well. Medical practices spend about $15,000 each year on denied claims, says Michelle Tohill, director of revenue cycle management at Bonafide.

Better claims management can help address both problems. By embracing technologies that can spot errors, enhance communication, and streamline claim acceptance or denial, both insurers and providers stand to avoid time- and money-consuming resubmission or appeals processes, giving both parties a more reliable sense of the number, type, and value of claims handled.

Much of the technology necessary to improve claims management and free up resources for growth is already available.

One example is artificial intelligence (AI) as a means to systematically identify and correct errors, according to Steffen Hehner et al. at McKinsey & Company. The researchers note that in Germany 8 to 10 percent of all filed claims are incorrect, and that many of these errors are the type that artificial intelligence can catch and fix without costly human intervention.

Growth Is More Efficient With Real-Time Analysis

Big data analytics have transformed the way the healthcare industry gains clinical insights and improves patient care. These tools can also improve the effectiveness of claims management.

"As awareness of big data matures, we are seeing faster and more widespread adoption of [IT operations analytics] technology, and the importance of wire data as a source of insight has become a key topic in conversations with our customers," says Jesse Rothstein, CEO of enterprise technology company ExtraHop Networks.

Vitally important within these conversations is the need to de-silo healthcare information and data, ensuring that important details aren't walled off by legacy systems that don't communicate with one another, says Arien Malec, VP of data platform and acquisition tools at RelayHealth.

Data analysis tools that can work within an interoperable system provide feedback on the entire claims management system, which is essential to long-term improvement says Joncé Smith, VP of Revenue Cycle Management at Stoltenberg Consulting. "When focus is placed on only one phase of the revenue cycle, a performance improvement spike may occur, but it will not be long lasting," Smith explains.

Instead, the most effective improvements to the claims management cycle account for how every phase and component of the patient-provider interaction affect the revenue cycle. With real-time analytics, providers can better understand how various factors affect their claims management, making adjustments where needed to improve efficiency and effectiveness.

doctor - claims management

Final Thoughts

Technology continues to change our way of life, including our methods of providing healthcare -- ensuring that providers are promptly and accurately reimbursed for their work, and that patients have more transparency into the process

Yet to secure sustainable growth for the healthcare industry, Health Catalyst senior advisor Dr. John Haughom suggests that what we need is more disruptive innovation, not less.

"In recent decades, the majority of innovation in healthcare has been centered on the development of new diagnostic procedures, therapies, drugs, or medical devices," Dr. Haughom says. To continue growing, the healthcare industry now needs to turn some of that creative fervor toward technological innovation in claims management.

Claims management is often an afterthought to healthcare providers, whose training and passion focuses on patient care. Yet effective claims management processes, analyses, and oversight are essential not only to effective financial management, but also to the sustainable growth of individual medical practices and the healthcare industry as a whole.

 
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The Challenges and Opportunities of Implementing AI in Healthcare https://blog.pokitdok.com/ai-in-healthcare/ https://blog.pokitdok.com/ai-in-healthcare/#respond Tue, 31 Jul 2018 15:00:02 +0000 http://blog.pokitdok.com/?p=3856 New technology brings with it challenges. To reap the benefits of machine learning, here are the challenges the industry will have to address while introducing AI in healthcare.

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"AI is the new electricity," Andrew Ng, chief scientist at Baidu Research, told Fortune. Ng predicts that the advent of AI-related technologies will transform all industries, as electricity did more than 100 years ago.

Indeed, AI and machine learning seem to be the hottest technologies in healthcare. Heather Mack at MobiHealthNews shares data supporting this:

  • Many AI-focused healthcare companies raised their first equity rounds after January 2015.
  • The number of AI healthcare deals grew more than three-fold from 2012 to 2016.
  • More than a third of hospitals plan to adopt AI within two years.

Despite this fast growth, there are still a multitude of challenges facing the adoption of machine learning specifically, and AI in general, in healthcare. In this article, we examine some of these issues.

Managing and Integrating Large Data Sets

Machine learning has no utility unless it is fed datasets from which to learn. In the healthcare field, the availability of data is not an issue. Thanks to the HITECH component of the American Recovery and Reinvestment Act (ARRA), healthcare data is now readily available both in structured and unstructured formats.  

The issue, Erin Dietsche at MedCityNews says, is that the data is in silos. Author Sebastian Raschka agrees and suggests that the problem can be attributed to how "[healthcare] data is highly heterogenous, and cleaning and combining data from different databases is probably the bottle neck." Dietsche also cites budget constraints on the part of providers, as it is costly to not only maintain current technologies but also invest in new ones.

Jennifer Bresnick at Health IT Analytics suggests that the use of semantic data lakes can offer the flexibility needed to collect and store large amounts of data that can be used to power machine learning. This, Bresnick says, is due to the "unique ability [of data lakes] to synthesize and normalize disparate datasets and draw conclusions from seemingly unrelated pieces of information." The use of data lakes still requires a human touch. Curators are needed to ensure the accuracy, uniformity, and completeness of the data being added to the system.

AI

Interoperability

Related to the issue of integrating large data sets is interoperability. To reap the full benefits of machine learning, it's crucial to synthesize medical and patient data into one system that is accessible to all providers in real-time.

One solution is to migrate all healthcare data into one system that can meet the needs of providers, payers, and patients. However, given the complexity of the healthcare system and its many moving parts, this can be a tall order. A more practical approach would be creating interoperability between the existing systems.

Interoperability will allow the various systems to "speak" with each other and enable providers to keep using their current systems. Providers can use a mix of different systems to manage different functions, as suit their needs, while allowing medical and patient data to be shared with others within the healthcare system. This effectively creates a single database that machine learning can work on in order to provide predictive analytics that can help patient care and improve health outcomes.  

However, interoperability has been a difficult goal to achieve. Bresnick, in another piece, calls it a "perennial concern" and cites "fundamental differences in the way electronic health records are designed and implemented" as a major stumbling block. Unless interoperability can be attained, it's arguable that the full potential of using machine learning in healthcare will be stunted, as well.

security system for database and private data

Protecting Data Security and Patient Privacy

The collection of large datasets, particularly those concerning an individual's medical history, necessarily raises the question of privacy. Currently, there are legal limitations on access to medical data. This restricted access is a barrier to developing robust health-focused algorithms.

However, individual privacy is a genuine concern when it comes to data collection. Stephen Gardner at Bloomberg BNA reports on how international privacy regulators are looking into the ways machine learning and other technologies can affect privacy.

Areas of concern include:

  • the ambiguity of data collection practices,
  • lack of knowledge about how machine learning will use or reuse the data,
  • and the question of accountability for automated decision making.

There are no ready solutions, although there is healthy debate about how to resolve these issues as machine learning technology becomes more proliferated.

Similarly, data security is also a concern. Breach Report 2016: Protected Health Information (PHI) reveals that 81 percent of breached records in 2016 came from hacking attacks, and that there were 335 large-scale personal health information (PHI) data breaches compromising 16,612,985 individual patient records. The security of electronic health records and medical data needs to be improved so that all parties feel more confident in storing and sharing data digitally.

Michael Bruemmer at MedCityNews has three recommendations for improving data security. He suggests scaling up training for staff who handle EHRs to minimize any data breaches by employees. Aside from ensuring basic security protocols are in place, it is important to educate staff on data security policies and procedures and train them to spot signs of security threats. Healthcare organizations should also have a data breach response plan in place and practice the implementation of the plan with their staff. Lastly, investment in security is a must.

Getting 'Truth' From Machine Learning

In an interview with The Mission, Dr. Dave Channin argues that the real issue with data as it pertains to machine learning is "truth." He refers to medical imaging in particular, and the importance of "knowing what is in the image."

The complexity of medical images makes the annotation or validation of data very challenging. Consider these factors: numerous medical imaging devices in the market, thousands of observable imaging features, only 35,000 professionals in the United States trained to annotate, and the need for consensus annotations by multiple expert observers to minimize human error. This lack of granularity is a challenge even for unsupervised machine learning.

doctor

Finding The Balance Between Technology and the Human Touch

As Puneet Gupta at Harvard Science Review puts it, "Machine learning brings about a heated debate on ethics." At the heart of this ethical debate is one big question: To what extent will machine learning replace doctors?

Broadly speaking, most in the field see machine learning as a clinical support tool, as seen in Laura Dyrda's piece at Becker's Hospital Review. Mudit Garg, co-founder and CEO of Qventus, tells Dyrda that advances in machine learning will have the effect of lightening the load on healthcare professionals. "They will be able to focus solely on those issues that require their attention and spend the rest of their time dedicating themselves to their patients," he says.

Lisa Suennen, managing director at GE Ventures, agrees and states that machine learning "allows clinicians to work at the highest level of their ability by making them far more informed and effective patient advocates."

The complex and ever-evolving nature of healthcare means that human doctors will remain a  key part of our healthcare system, regardless of technological advances. "At some point, human judgment is a lot more valuable than any insights AI can provide," Kapila Ratnam at MedCityNews argues.  

As machine learning capabilities are further developed, there could come a point where technology can detect the onset of diseases before they actually manifest. At a point in diagnosis when human tissue and cells may be classed as "indeterminate," doctors can play an important role in deciding whether or not to deliver care.

Ratnam brings up the salient point that studies have shown that often it is best to leave the human body to heal itself without medical intervention, particularly in the early phase of any disease. The bottom line is that there is little room for error when it comes to healthcare, and healthcare professionals are the last line of defense against "artificial stupidity."

Mass vs. Individual

Regardless of how machine learning capabilities in healthcare develop in the future, Bill Simpson at MedCityNews cautions against pinning all our hopes on machine learning. Simpson is of the view that machine learning is not the end all for healthcare because "the [healthcare] system is highly complex and humans are inherently irrational beings."

In his opinion, a personal rather than population view of patient engagement would be more effective. He posits this idea: "What if servers and algorithms were not interested in 1 model to predict the action of 100,000 people, but 100,000 models, to predict the actions of each individual person. What if your data was analyzed over time so that machine learning could give you insights into your own self?"

Giving individuals predictive insight on their own behavior, Simpson believes, would be a more empowering approach. It's certainly something to ponder.

 
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What Pharmacy Executives Need to Know About Copay Accumulators https://blog.pokitdok.com/copay-accumulators/ https://blog.pokitdok.com/copay-accumulators/#respond Mon, 16 Jul 2018 15:00:31 +0000 http://blog.pokitdok.com/?p=3920 As copay accumulators continue to grow in popularity, expect to see more industry ripple effects. Here we shed some light on what a copay accumulator program is and how it works.

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By now, maybe you've heard about copay accumulator programs. You may even have one in place yourself, or you've at least seen one in action.

Scott Dulitz, who recently attended Asembia18, noticed that "if this topic was hot last year, it was on fire by comparison" this year. Indeed, you don't have to look very far to see countless thinkpieces, expert analysis, and even rants about copay accumulators. People are quick to voice their concerns regarding this model and how it will affect patients, drug manufacturers, and pharmacies alike.

But for all the talk about this topic, it's still a fairly new one. That's why we'd like to attempt to shed some light on the subject.

Below, we take a look at copay accumulator programs, how they work, and why so many people are concerned about them. Finally, we will discuss why you need to know about them and what effects they're likely to have.

What is a Copay Accumulator?

To understand why copay accumulators were created, it's important to understand the programs they are designed to replace.

Traditionally, CNBC reporter Angelica LaVito writes, pharmaceutical companies have helped to make their specialty drugs more affordable for patients by providing coupons and copay cards. These programs cap how much a pharmaceutical company will contribute, but those contributions would count toward the patient's deductible and out-of-pocket costs.

In practice, that typically meant insurance would kick in once the copay card limit was reached, as the patient would have already hit their out-of-pocket costs quota.

Those traditional copay assistance programs work well for consumers and pharmaceutical companies, but not so well for payers who are faced with a mounting number of plan members who are meeting their deductibles and out-of-pocket maximums (translation: they are on the hook to underwrite more claims).

To offset the shift in financial burden from consumers to payers, pharmacy benefit managers (PBMs) -- third party administrators who negotiate drug prices on behalf of insurers and pharmacies -- have introduced copay accumulator programs. Under these programs, the contributions from pharmaceutical companies do not count toward patients' deductibles or out-of-pocket costs. That leaves patients to pay the full cost of a drug until they reach their deductible or out-of-pocket maximums, LaVito says.

"Those costs can be eye-popping because they're based on list prices, not the rates payers negotiate," she writes. "Experts have said the practice could cause drug costs to fall because drug manufacturers will kick in more money to help buffer the sticker shock patients experience when their copay cards run out of money and they must pay out of pocket."

portrait of a pharmacist at work in his shop - copay accumulators

Why Are People Concerned?

This tug-of-war between patients, pharma companies, PBMs, and payers leaves pharmacies in a bind. They must either require that consumers absorb a larger proportion of a prescription's out-of-pocket costs and risk their noncompliance with the treatment plan, or pick up the slack by sacrificing some of their own profit margins.

No matter what the pharmacies choose, though, it is the patients themselves who will have to deal most directly with the repercussions. And patients are sensitive to these changes. After all, 42 percent of adult Americans stay informed on their treatment options through research, as Kantar Media notes. They understand how copay accumulator programs end up causing them to pay more, and they aren't happy about it.

They aren't the only ones. People like Stephen J. Ubl, president of the Pharmaceutical Research and Manufacturers of America, criticize these programs. "Copay accumulator programs are nothing more than an insurance scheme that leaves patients financially exposed while benefiting payers' bottom lines," he said in a statement to the LA Times.

Opinions like Ubl's aren't uncommon, even if they aren't quite as sharply phrased. Ami Gopalan at Precision for Value, for example, notes that these copay accumulator programs can result in unintended consequences, such as "patients forgoing other health care services that they can no longer afford or decreasing adherence to drug therapy."

Not surprisingly, the advent of copay accumulators has resulted in a lot of finger pointing by all sides. "Payers point the finger at pharma for high drug prices," notes Jason Poquette, author of the blog The Honest Apothecary. "Pharmaceutical manufacturers point the finger at PBMs and high deductibles and copays which are not affordable without these coupon programs." With no easy answers, the blame often gets passed back and forth with no real solutions being offered.

That said, not everyone believes that copay accumulation programs are the culprit.

For example, Steve Miller, MD, chief medical officer of Express Scripts, blames the struggles of patients on the high cost of drugs, not the copay accumulation programs themselves. "We believe all patients should have access to affordable prescriptions and care, not just those using a medication with drug maker copay assistance. To that end, lowering the cost of drugs to increase access is the best thing pharmaceutical manufacturers can do."

customer - copay accumulators

What Happens Next?

Recently, the National Business Group on Health conducted a survey of about 140 multistate employers with at least 5,000 workers. Of those polled, 17 percent claimed to have a copay accumulator in place. Fifty-six percent were considering them for 2019 or 2020. Peter Pitts, former FDA associate commissioner and president of the Center for Medicine in the Public Interest, reports that copay accumulators could be built into 20 percent of programs by the end of this year.

With such a proliferation of copay accumulators, more and more industry experts are taking the time to weigh in.

Many have their own predictions as to what will happen next. For example, Drug Channels Institute CEO Adam J. Fein, Ph.D., anticipates that copay accumulators will draw the ire of consumers and lead to a drop in revenue for pharmaceutical manufacturers. "Patients don't decide to forgo cancer or HIV treatment because they now have a 'consumer-oriented' incentive," he writes. "More likely, they will just stop filling their specialty drug prescriptions."

As copay accumulator programs continue to grow in popularity, expect to see more of the ripple effects that industry experts have warned are coming.

Mark Bouck, president and CEO of TrialCard, notes: "Pharmaceutical manufacturers will see inflated program reimbursement budgets and lost revenues as patients prematurely stop therapy due to out-of-pocket costs."

Not every industry analyst agrees with that scenario, however. Some argue that the downward pressure on demand could lead to pharmaceutical companies dropping prices. But Vivian Ho, a healthcare economist at Rice University, thinks this is unlikely, especially for expensive specialty drugs. She notes that unless patients are genuinely unable to afford those drugs, the manufacturers will feel no pressure to lower prices.

That said, research indicates that drug prices are already being affected. Sector & Sovereign research analyst Richard Evans notes that US drug prices fell 5.6 percent in the first quarter of 2018. This is significant. The same quarter in 2017 only saw a 1.7-percent drop. He attributes this decline directly to copay accumulator programs.

Whether you believe copay accumulators are unfair, or you believe their effect is indicative of a bigger issue with the price of drugs, Dan Gorenstein, senior reporter for Marketplace's Health Desk, notes that it is the patients who have to buy specialized medicine who will be caught in the crossfire.

"A solution that's going to financially cripple families like mine and many others is the wrong solution," one consumer tells Gorenstein.


PokitDok offers pharmacy solutions that enable real-time access to pharmacy benefits verification, price transparency, and copay information across all government and commercial health insurance plans.  

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An Exploration of the Past, Present, and Future of Meaningful Use https://blog.pokitdok.com/meaningful-use/ https://blog.pokitdok.com/meaningful-use/#respond Tue, 03 Jul 2018 15:15:36 +0000 http://blog.pokitdok.com/?p=3913 Meaningful Use impacts the way healthcare providers enter, store and exchange patient data. This article explores the evolution of the Meaningful Use program.

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Nobody will question whether there are challenges in American healthcare.

From issues related to transparency, communication, and interoperability, the healthcare industry has steep mountains to climb to improve the way insurers, providers, and patients work together to ensure adequate healthcare services for everyone.

One of the mountains that has yet to be scaled is the collection and sharing of patient data. Electronic health records (EHRs) have been identified as one of the solutions to this interoperability problem through the efficiencies created from digitizing and standardizing patient health records.

To incentivize the adoption of EHRs, The Centers for Medicare and Medicaid Services (CMS) introduced the Meaningful Use program nearly a decade ago. Below, we will explore the intentions behind the program, survey how well it has performed, and consider ways it could be improved.

The Ideas and Intentions Behind Meaningful Use

In a webinar focused on Stage 2 of Meaningful Use, Dr. Farzad Mostashari, M.D., the former national coordinator for Health IT at the Department of Health and Human Services, explained that Meaningful Use boils down to one idea: "It's about what's right for the patient, and our goal as a country to get to better health, better healthcare, and lower costs."

The end result of EHR adoption, Dr. Mostashari stated, is that a patient's information follows them "regardless of organizational, geographic or vendor boundaries" so they can receive the best healthcare possible, wherever they are.

Meaningful Use was intended to help create the digital infrastructure necessary to support this goal.

One of the key assumptions of Meaningful Use, notes Dr. Peter Paul Yu in his article for the Journal of Oncology Practice, is that the implementation of EHRs would result in significant savings to healthcare costs that would then sustain the building of this national digital infrastructure.

This is why CMS has offered hospitals and physician groups financial incentives to comply with Meaningful Use. Those incentive dollars are meant to cover most of the costs of HIT investment for providers, notes Dr. Yu.

CMS also took a staged approach for Meaningful Use to encourage EHR adoption, promote innovation, and avoid imposing excessive burden on the healthcare providers who were tasked with implementing the new technologies:

  • Stage 1: Data capture and sharing. The focus of this stage was storing health data electronically in a standardized format.
  • Stage 2: Advanced clinical processes. This stage focused on using EHR software for health information exchange among providers.
  • Stage 3: Improved outcomes. The goal of the last stage was to improve the quality of health information exchanged, with the intention of improving health for patients.

Even with the incentives and assistance from CMS, adoption of Meaningful Use has been inconsistent across the country.

worried young male doctor using computer at desk in hospital -- Meaningful Use

Why There Have Been Roadblocks to Implementation

While the majority of eligible providers have adopted Meaningful Use, not all of them have hit the program's benchmarks at each stage. There have been two primary reasons for this:

1. EHR Technology Usability and User Satisfaction

Providers have struggled to meet the benchmarks of each stage because of the usability of and user satisfaction with EHR technology. Poor usability and the sheer amount of data entry involved, it turns out, has hindered physicians from using EHRs exactly as the program intended.

A 2016 analysis of end-user satisfaction with EHRs, presented at the American Medical Informatics Association Annual Symposium Proceedings, revealed that poorly designed EHR systems actually increase the mental workload of clinicians performing high-level cognitive tasks, which reduces user satisfaction, increases provider frustration, and negatively affects patient safety.

In fact, some EHRs were originally designed in the pre-Internet days, so data sharing functionality was not a priority requirement. Providers using EHRs, then, have to deal with inefficiencies that this lack of interoperability introduces.

The study showed that clinicians expect EHR systems to provide cognitive support that matches the users' high-level, task-based mental processes, not be counter-intuitive to mental or work processes.

2. Time-Consuming Data Entry

In a study published in Family Medicine in 2018 (data collection took place in 2015), researchers concluded that "primary care physicians spent more time working in the EHR than they spent in face-to-face time with patients in clinic visits."

The study showed that the average clinic visit lasted 35.8 minutes. That broke down as 19.3 minutes spent in the EHR and 16.5 minutes in actual face-to-face time with the patient.

These numbers help explain provider discontent with EHR systems, especially among older physicians. As Stephen H. Hanson, PA-C, notes in an article for Physicians Practice, many of the healthcare providers with years of experience see EHRs as an intrusion into the practice of medicine. These older physicians don't have the computer skills to cope with EHR systems and usually don't have any desire to develop them.

Many physicians, regardless of age or experience, are tired of the administrative busy work required by Meaningful Use and EHR systems because it interferes with the personal aspect of a patient visit. Because doctors spend more time looking at a screen, they spend less time engaged with patients.

Dr. Lloyd Minor, Dean of Stanford University School of Medicine, sums it up: "That most fundamental aspect of human communication, which is eye contact, now is being robbed from the medical encounter because of the electronic health record."

Combating the Emphasis on Technology Instead of Patient Care

The general industry consensus regarding EHRs and Meaningful Use is that they place too much emphasis on patient data and not enough on the patients themselves, says Bethany Nock, marketing director at medical device supplier Gebauer Company. The intention of the program -- better patient care -- has been overshadowed by the technological requirements for the program.

CMS recognized this issue and announced in late 2016 that it would be changing the program. These changes would piggyback off the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, shifting from an incentive program based on quantity to a merit-based program focused on quality.

Under the new Quality Payment Program, providers are required to participate in one of two incentive programs:

  • MIPS: Merit-based Incentive Payment System
  • APMs: Advanced Alternative Payment Models

In 2016, former CMS Acting Administrator Andy Slavitt said the changes would focus on achieving better outcomes through EHR systems. MACRA minimized reporting burdens on providers and signaled a shift to prioritizing value over volume. The legislation also encouraged providers to customize technology to suit their needs as opposed to changing their workflow and processes to adhere to government regulatory requirements.

datasharing -- meaningful use

The Path Forward for Meaningful Use

In early 2018, CMS Administrator Seema Verma announced an overhaul of the Meaningful Use program, renamed "Promoting Interoperability."

"We seek to ensure the healthcare system puts patients first," Verma said. "We envision a system that rewards value over volume and where patients reap the benefits through more choices and better health outcomes." The key idea of the new program is data sharing.

Verma outlined some of the key tenets of Promoting Interoperability:

  • Starting in 2019, hospitals will be required to have a patient's EHR available the day they leave the hospital.
  • Providers are still required to use the 2015 edition of certified EHR technology in 2019 as part of demonstrating Meaningful Use.
  • Updates to EHR and related technologies include the use of application programming interfaces (APIs) for patients to collect their health information from multiple providers.
  • Hospitals will have to post their standard list of prices on the internet and in a machine-readable format.

This is where companies like ours step in. PokitDok's APIs can actually introduce secure data-sharing functionality to legacy infrastructure -- even those pre-Internet EHRs. Solutions like these can move American healthcare further along the path toward interoperability.

Images by: vjohns1580, andreypopov/©123RF Stock Photo, gr8effect

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How Providers Can Get the Most Out of Their Patient Portals https://blog.pokitdok.com/patient-portals/ https://blog.pokitdok.com/patient-portals/#respond Tue, 19 Jun 2018 14:54:31 +0000 http://blog.pokitdok.com/?p=3900 Good patient portals help to empower patients, engage them in their own care and modernize the services a provider offers.

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Care providers seeking to grow their businesses must constantly strive to find better ways to connect with patients. One way to do that is via the adoption of patient portals (or the improvement of existing portals).

Rolling out a patient portal helps providers serve patient populations better and build a reputation as a business with heart because, as we have seen, streamlining administrative processes behind the scenes translates to better, faster service to patients.

Mohan Giridharadas, founder and CEO of LeanTaaS, takes the idea to the macro level. Hospitals and care providers, he says, who have their fingers on the pulse of innovation are capitalizing on technology to improve their efficiency, which in turn propels them forward both with service and reputation.

Below, we explore how rolling out successful patient portals helps to empower patients, engage them in their own care, and modernize the services a provider offers.

Facilitating Patient Engagement

Patients have come to expect better access and more control over their health records and their interactions with providers.

To address these expectations, many hospitals and clinics have launched patient portals to help increase engagement with the community they serve.

Edward Marx, CIO of Cleveland Clinic, argues that patient portals engage patients in their own care, which in turn helps them "to be well and stay well." And that's an outcome that benefits everyone.

Patient portals are no longer just scheduling and payment systems. They're engagement systems designed to help patients actually own their health outcomes. The features of a modern patient portal also include the ability for individuals to view their health history, monitor prescription requests and refills, view previous invoices and make payments, and access and complete intake forms before they even set foot in a clinic.

These features can have a huge impact on quality of care and health outcomes for patients. Here are a few examples:

  • Improving medication adherence. Patients often take their medication incorrectly. The team at OpenNotes says poor adherence may lead to 125,000 deaths in the country each year and cause of $100 billion in excess healthcare spending. They have found that useful web portals can help curb this problem. "Encouraging patients to utilize a web portal to view their doctor's note is a cost effective and efficient way to influence medication taking behavior," Eric Wright, PharmD, MPH tells Open Notes.
  • Increasing influenza vaccination coverage. In early 2018, the Journal of General Internal Medicine published a study that found that patient portals can be effective tools in prompting more people to get flu shots.
  • Making care more accessible to certain patient populations. Recently, the U.S. Department of Veterans Affairs began offering patient portals to enable veterans to schedule their own appointments more easily or to schedule their specialty care in a way that is more convenient and intuitive. This, the VA argues, brings patients closer to their care and provides information for continuing care and chronic conditions.
  • Building goodwill between patients and providers. A survey conducted by Massachusetts General Hospital also found that when patients feel the communication they have with their providers is clear and are satisfied with the care they receive, they're less likely to be readmitted to the hospital. That's a great prognosis for patient portal technology.

man communicating with female receptionist

Rolling Out a Patient Portal

Convenience is the name of the game. If a patient portal lacks ease of access, then healthcare organizations will struggle to have patients adopt it.

People are familiar with convenient, easy-to-use applications to access information, and patient portals should be no different. David Bradshaw, executive vice president and chief strategy officer at Memorial Hermann in Houston, stresses that healthcare must keep up with other industries driven by the consumer demand for digital tools that are comfortable, easy, and quick to access.

Of course, implementation of a patient portal involves many intertwined components such as enrollment, marketing, training, support, and workflow design (and redesign). As with any new integration of technology, patient portals have some challenges to overcome.

Some providers choose to target populations of patients they feel get the most value from the portal and are more likely to use it. Since the best marketers of a portal are the more engaged providers, the burden to promote the portal falls directly on the shoulders of the staff.

For providers with the people resources, though, having staff promote and educate patients on the portal isn't a bad onboarding process. Jinous Rouhani, CEO of Austin Area Obstetrics, Gynecology, and Fertility, got patients to register on the clinic's portal by having staff walk them through step by step.

It's important, too, to understand who the portal's users will be, as each patient population group presents its own specific set of challenges. For example:

  • A 2018 study by University of Tennessee researcher Ilana Graetz, Ph.D., et al found that minorities have lower rates of patient portal adoption.
  • Never assume that older patients don't want to use the portal, University of Pittsburgh researcher Taya Irizarry, et al write. That happens to be one of the populations where portal adoption only continues to grow.

After you identify your target population, you need to understand it. Once you know who you're marketing to, you can use that information to shape engagement strategies to encourage adoption of the patient portal, delivering better care in the long run.

nurse showing patient test results on digital tablet

8 Patient Portal Success Stories

Below are some of the healthcare providers who have seen increased patient engagement and better outcomes from recent implementations of (or updates to) their patient portals.

University of Pittsburgh Medical Center

Researchers at UPMC began an initiative to improve patient care for adults with serious mental illness. James Schuster, MD, the chief medical officer for Medicaid, special needs, and behavioral services at UPMC Insurance Services Division, and his team created two models that would bring patient-centered medical homes into the new technological age.

As part of the patient self-directed model, patients used an online portal to consult with medical professionals and access educational materials. Because those with serious mental illness are also at an increased risk for chronic disease, this approach allowed all providers to work together to treat the whole patient. The study found that patients used preventative care services 36 percent more thanks to these models.

Western Sierra Medical Clinic

As a Section 330-funded clinic, WSMC has been a trusted resource for low-income families in Sierra County, California, for decades. In 2012, the Community Health Clinic tried to implement a patient portal. However, it did not adequately integrate the program and thus saw weak results.

In 2015 and 2016, the clinic launched a new patient portal system with a slower rollout and better integration. This time, the results were outstanding. In a short time, WSMC had enrolled 3,600 members in the patient portal and saw a significant decrease in call volume. This system freed up valuable staff time while increasing patient engagement.  

Partners HealthCare

Neil W. Wagle, MD, MBA and his colleagues at Partners HealthCare in Boston have found that Patient-Reported Outcome Measures (PROMs) were the missing link in their practice. Through their online platform, patients can continue to report on their health.

This PROM allows doctors to understand not only how well a patient recovers after a given treatment, but also what their life is like at that time. Over time, this data can help medical professionals understand more about treatments and procedures, and how to care for patients following their discharge.

Sharp Healthcare

"Digital natives" aren't the only patients who want better communication between doctors and patients. Gerilynn Sevenikar, vice president at Sharp Healthcare, says "it's clear that all generations are comfortable with some form of technology when it comes to health-related technologies."

In the first year after rolling out its online payment system, Sharp Healthcare processed more than 10,000 invoices online. Sevenikar says patients like to be able to pay their full balance, pay for a specific procedure, or visit and even set up payment plans online. The online portal allows patients to take control of their finances.

Lafayette General Health

After years of trying to integrate technology into its system, Lafayette General Health in Louisiana found the key to success: Make it work for doctors, too. Instead of having several systems and separating records, the hospital system merged portals.

"We have one record, one patient portal," says Edwina S. Mallery, assistant vice president of information systems. "We engaged physicians for a stronger alignment." The results have changed the system in profound ways. Unnecessary emergency department visits went down, physician satisfaction has gone up, and health records have become more streamlined.

Heritage Valley Health System

In Pennsylvania, the Heritage Valley Health System has successfully implemented an online patient portal through an app. The new system allows patients to check into the emergency room, schedule doctor appointments, and access secure messages from medical professionals.

Christy Kimble, director of clinical services and staff operations for Sewickley Valley Pediatrics, says patients appreciate the new app. "It's nice to be able to do things from your cell phone, your tablet. It's easy for them, if they're on a computer for work all day, if they're on their break, to be able to pop onto the computer, log in to the portal and search for an appointment if they know they need to make an appointment, or they need a refill of their child's medication, and they don't necessarily have time to stay on hold."

Highlands Health for Life

Patient portals work for care providers of all sizes. Highlands Health for Life is a small family practice in Denver that has seen the benefits of this technology.

Whitney Kennedy, MD, leads a team complete with two physician's assistants, front desk staff and a few medical assistants. Their patients range in age, technical ability, and physical condition, but the patient portal has been successful.

This practice has automated many office functions, such as appointment scheduling and delivering lab results. This allows more time for the small staff to meet patient needs. The clinic achieved these goals by making it mandatory for patients to sign up for the portal to receive their lab results.

The United States Air Force

Telehealth is set to change the healthcare industry around the world. For the United States Air Force, it has become a valuable tool, and that branch of the military has implemented a patient portal that allows patients to communicate with their providers entirely online.

In addition to features like online appointment scheduling and lab results, the Air Force has been able to replace some in-person appointments with online counterparts. This has allowed some patients to access specialty services from which they would otherwise be cut off.

Through a combination of telehealth services and a robust patient portal, these patients can receive genetic counseling, mental health counseling, and even nutrition services.

trendy mature man working from home with laptop

The Future is Now

The Air Force's experience with telehealth and patient portals is especially revealing. Recent research from Accenture revealed that three-quarters of healthcare consumers would use virtual care if it were offered. That's a clear signal that patients value convenience in their care delivery.

At the provider level, thoughtful, well-designed patient portals have a big role to play in creating those more convenient, more user-friendly patient experiences. And at the industry level? The research so far indicates better patient engagement leads to better health outcomes.

Images by: dedivan1923/123RF Stock Photo, leaf/©123RF Stock Photo, stockbroker/©123RF Stock Photo, goodluz/©123RF Stock Photo

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