Value-Based Care and Care Coordination: Five Key Takeaways from WakeMed Key Community Care and UC San Diego Health

By Claire Thayer, April 12, 2022

Healthcare organizations face increasing pressures to meet demands of population health and effective care management.  Recently, we hosted a panel discussion webinar, co-sponsored by MCG Health, that identified some of the challenges to delivering value-based care and how providers are leveraging MCG Health solutions for care coordination to develop high-quality care programs.

We caught up with speakers Lindsey Pierce, MSN, RN, CCN, Assistant Director, Population Health UC San Diego Health and Kathryn Tarquini, PhD, RN, CCM, Director, Clinical Services, WakeMed Key Community Care on five key takeaways:

1. How did COVID-19 impact your organizations?

According to the CDC, an estimated 41% of US adults with one underlying medical condition avoided seeking care in 2020. This number jumps to over 50% for people with two of more underlying medical conditions. The COVID-19 pandemic is at least partly to blame for these gaps.

Lindsey Pierce: During the pandemic, we saw that patients were either delaying care or switching over to telehealth visits, and they weren't being screened as adequately. Patients were also very scared and often socially isolated, so there was a further need to use MCG psychosocial assessments to address these new gaps. Like so many organizations, we also had issues with staffing. Nursing students were unable to graduate at a time when we needed nurses, so we took a twofold approach, and we started a nursing student clinical program with our population health team who contacted patients during this time.

Amid the pandemic, we were also starting new programs and making changes to better serve our patients, and it was difficult to get everyone aligned around the needed cultural change. This is something that takes time and it's important to remember to communicate the ‘why’ behind value-based care and make sure that your team understands it. Starting out, it took a little bit of time even for providers to understand that our care managers are part of the care team and we're here to help them. Using physician champions and patient advocates helped to break down those barriers, build rapport across the teams, and now every provider wants our team involved in the patient’s care.

Kathryn Tarquini: One of the challenges we faced was launching a renewed service line - new teams, models, platforms, and tools - in early 2020, alongside the start of a pandemic. We learned to leverage our strong foundation built on the mission and vision of the ACO and the care management model. This meant we had to learn to engage virtually and build and strengthen relationships that way, using multimodal messaging to educate partners and providers about our service lines.

We also listened to what providers and practices were experiencing and needed, especially around the pandemic with things like vaccinations and other care interventions so we could provide solutions to address them when possible. Our technology platform and tools allow for transparency of our care management work, which also helped.

2. How is the transition to value-based care affecting your organization?

Lindsey Pierce: Overall the transition to value-based care has been a tremendously positive impact for UC San Diego Health (UCSD). It's allowed us to help drive some cultural changes that really benefit our patients, and it also gives us the opportunity to generate some revenue or share savings. We found that population health services have been at the forefront for helping to drive cultural change in strategy for value-based care, and we see that for interdisciplinary teams risk stratification and utilization oversight are essential to the success of the care program.

We began in 2016 as the organization started to shift towards growing our value-based contracts. We started in Medicare Shared Savings about three years ago and it helped us to expand and grow our network within San Diego, and we now have around 60% of insured lives under a value-based care arrangement. Before this shift, UCSD was performing significantly higher than the national average on hospital admissions per thousand. Over our three-year journey of aligning workflows, integrating technology, and improving processes, we’ve really been able to bring down avoidable hospital admissions to considerably below the national average.

For organizations who are starting out on this journey, it can seem like a difficult transition going from fee-for-service to value-based care. But at its core value-based care is simple, it's quality divided by cost, and this helps support high quality and cost effective care delivery. Through our population health services, we’re able to provide wrap around services to our patients and that helps us to support high quality of care. I do think we'll see this more in the future in healthcare in the coming years and it’s something that I'm excited to be a part of.

Kathryn Tarquini: WakeMed Key Community Care is an ACO formed in 2014 as a joint venture between WakeMed Health and Hospitals and the Key Physicians Group of independent physicians in the Raleigh, North Carolina area. These organizations came together because they realized the importance of delivering high quality care in a value-based care model. Since the ACO was formed eight years ago, our primary care physicians have come to understand the value of value-based care. They’re now highly experienced and have become strong advocates for this model. In 2020, we brought all population health services in-house and this resulted in the formation of new centralized teams for care management – which is when we began using MCG and Arcadia for our care management needs. This has also helped us to provide higher quality care. The overall effect on the organization is based on the results that we’ve seen in quality, achieving and exceeding quality measures, being able to provide coordinated care, and using tools to proactively care for patients. Currently, there are also a variety of population health and quality initiatives within many departments of the hospital system that are value-based, such as hospital or home and navigator programs. We're working together to align some of these initiatives and connect the leaders to more formally collaborate and create some synergy for greater success. 

3. What role have your technology partners played in supporting your transition to value-based care?

Kathryn Tarquini: Our primary partners that have made our program successful are MCG and Arcadia. These two partners have been critical to creating a strong foundation, and there's a lot of synergy that comes from the alignment and integration of these two. We use MCG guidelines for clinical decision support integrated into Arcadia’s Care management platform to document, track, and manage the care management work and the care managers’ workload – this is at the core of what we do with care management.

Arcadia also provides for our data analytics and management system and allows for data exchange with each other. We have close to 20 different EMRs in our ACO and so it collects and exchanges data with the EMRs to provide proactive tools. For example, a pre-visit planning tool to proactively manage risk and a predictive analytics tool using data from claims, the EMR and census data to identify those patients who are most likely to benefit from care management. The Arcadia platform also provides a way to see the status of quality measures – specifically which quality measures are completed and which ones have a gap – so that the practices can proactively address those by reaching out to patients. It promotes care coordination with the providers and the practice partners by allowing all members of the health care team to view all aspects of the care management process in real time.

The partnership with MCG supports the team with accurate and efficient assessment tools that are easy to read and follow, written in a conversational tone, and with many evidence-based assessment options to choose from. Using MCG also allows us to have standard work at the point of care, and this is especially helpful for our team with diverse experience and expertise. We have a multidisciplinary team of RNs and LCSWs, and what we call case management representatives. Using MCG ensures that everyone is deploying the evidence-based guidelines consistently, which leads to an efficient workflow and positive work experience. 

Lindsey Pierce: It’s important to have partners that understand your organization’s vision and provide tools that allow the team to be organized, efficient and perform at the top of their clinical license. In 2021, we integrated MCG care guidelines into Epic Healthy Planet, and our team was involved from the very beginning. We had super users to make sure that the product worked efficiently. We also have health coaching through text message and remote blood pressure monitoring, so we've created really nice wrap around service for our patients.

With MCG’s partnership, we refined and made sure the workflows were seamless, and it was great from a patient perspective as well. It was an absolute journey, but one of the things we always look for, whether it's the community partner and affiliated provider or vendor, it's making sure that you have a partner who's willing to work with you and reach the ultimate goal and is willing to adapt and change - in healthcare you have to be adaptable and willing to adjust as needed. We found that really great partnership with MCG. We got help and support every step of the way with our Epic super users and from our team who were working on integrating the assessments. In 2024, we're hoping to get population health accredited through NCQA, and I think that will be very well supported based upon the integration of MCG’s assessments. Our text-based health coaching platform also uses MCG’s education materials, so that's fantastic because the patients are hearing the same information consistently whether it's through the text messaging program or if we mail our educational materials. Building strategic partnerships with community organizations, network-affiliated providers, or vendors, it's really important that all are aligned to avoid duplication of services, waste, and coordinate a really seamless experience for our patients. That's something that we've certainly found through the relationships that we've developed with MCG and our other partners.

4. In what ways has predictive analytics helped your organization to improve patient outcomes?

Lindsey Pierce: It’s important to have data analytics that identifies gaps in care opportunities, performs risk stratification and identifies patients most likely to benefit from the program, and turns patient clinical data into actionable information. I think oftentimes as we enter into more value-based care contracts, each will have nuances of the data analytics they're looking for. If you can synthesize down to one overarching goal, this can help to simplify a target for your care team, and that way your team members and providers aren't feeling confused about what they're working towards. We've done that with UC San Diego Health - simplified to just a few simple goals - and we apply them to all of our value-based care agreements and our team is really clear on what we're working towards. They're easy to measure, and it gives us a good place to work on process improvement. We focus primarily on one goal that's lowering all costs: hospital admissions per thousand. We do this because it's very well-defined, easy to measure, and is a metric where our team can make a direct impact. There might be some goals that you maybe don't have great data analytics on; even though it might be a good goal, if you can't share the outcomes, that can make that goal really difficult to work towards.

Kathryn Tarquini: We use data analytics in real-time and just-in-time opportunities to optimize care and proactively manage risk to drive population health management, and predict which patients are most likely to benefit from care management services. One tool that our practices use is the ‘pre-visit planning tool,’ which helps the care team identify quality care gaps and risk coding opportunities just before an office visit. So far, this has helped us achieve exceptional quality scores and lower readmission rates across numerous payers, and we’ve been able to distribute shared savings to participating providers each year. For example, between 2016 and 2019, we distributed nearly $120 million in shared savings from BCBSNC contracts alone.

5. What are some of the major milestones, key players, and successes you’ve seen implementing enterprise-wide value-based care model?

Lindsey Pierce: Key milestones were the development of our community network (community partnerships), growing our team and getting our workflows to be standards-based, along with integration with telemedicine to extend our reach without adding FTEs. We needed involvement from every level, physician champions, leadership, great vendors that can address gaps, and care managers. We found that having solid relationships with our network is one of the first steps we needed to take, and it was really important for us to regularly meet and facilitate goal alignment with that network. That way we were able to share performance milestones and make sure that every provider within the network understood the benefits and also the potential risk. We really focus on having our care team members work to the top of their licensed scope of practice and we also want to give them the tools to have a direct impact on process improvement for our team. We sent them all to LEAN 6 Sigma training and this just helps the team to understand the tools and resources on how to create change as you work towards standardized work in a new program. We joke all the time on our team that the only thing that's consistent is change because we're continually refining our workflows to be lean and patient-centered.

Kathryn Tarquini: There are two main factors that contribute to our success. The first is our providers, and the fact that we’re a physician-led ACO. Our providers are experienced advocates for value-based care – and we have strong relationships with them and their practices. Our model places the patient/PCP relationship at the core of our work. Providers review patients who've been identified for care management by our predictive analytics, and when possible, they alert patients of our pending outreach.

Another factor contributing to our success is the compassionate and highly-skilled care management team we’ve assembled. We help them have a positive experience, professional fulfillment, and joy through this work by equipping them with MCG and other tools, educating them about strategies, skills and trends, and we problem-solve together. By creating a work environment that focuses on continuous quality improvement, fosters collaboration and innovation, and where it's safe to learn and grow from opportunities, we’re able to fulfill our mission and deliver timely, high-quality care to our patients.

We've been seeing upwards of 50-70% engagement with patients through care management, and we have numerous patient stories demonstrating how the team has been able to make a difference in our patients’ lives. We decided last year to reinvest shared savings to provide actual solutions to identify social determinants of health (SDOH)-related barriers. We've been excited to launch two initiatives this year, including a rideshare for transportation support, and a meal service for delivering medically-tailored meals to patients’ homes. We are really looking forward to seeing some of the specific examples and impact that these and other interventions are having on our patients’ health and their health outcomes.

If you missed this informative webinar, we invite you to watch this short recap video here. Additionally, below is a list of webinar supplemental material that may interest you: 

MCG White Paper. Populations at Risk: Optimizing Post-Acute Care Management

On-Demand Physician Leader Webinar Series. Populations at Risk: Optimizing Post-Acute Care Management

MCG White Paper. Population Health: Engaging Patients to Improve Healthcare Outcomes

The MCG Guide to Efficient Care Coordination & Patient Throughput

Catching up with Advisory Board’s Ken Leonczyk on the State of the Health Plan Industry and what health plan leaders need to know for 2022

By Claire Thayer, April 11, 2022

The pandemic has had a significant impact on health plans and in many ways has been a catalyst for change across the healthcare industry. Recently, Ken Leonczyk, Executive Partner, Advisory joined us for a lively discussion on what health plans need to know about key structural shifts of the peri-pandemic period. Ken identifies these six strategic points of inflection that will shift industry structure in the years ahead.

Value-Based Payment

Risk-based payment models will continue to grow, but who participates is an open question. The pandemic has done little to shift long-standing barriers in hospital financial needs, but plans have made headway with independent physician groups. Plans must now think about how the growing array of models fit together in a complex ecosystem.

Physician Alignment

An array of non-hospital suitors—plans, private equity firms, service partners, and national groups—are aligning more closely with physicians through a variety of partnership models. While hospitals may lose power, plans need to prepare to navigate relationships with all manner of new stakeholders throughout physician networks.

Home-Based Care

The wave of investment in home-based care today, centered around start-up financing or grants, does not guarantee long-term, systemic change. The industry may exacerbate existing challenges around staffing supply, care fragmentation, and health inequities. Plans must weigh how their policies will impact network access and marginalized patients.

Virtual Care

Most of the pandemic’s spike in virtual care came from traditional providers, but vendors are angling to transform their offerings to steal patient relationships— not just visits. As plans explore virtual-first products, they must ensure incentives are enough to influence consumers—and brace for fallout with local providers.

Price Transparency

The market will soon be inundated with an unprecedented level of pricing information, but disruption to historic practices will depend on the usability of the data. New vendors are emerging to parse and package the data for end users, so plans must prepare to clarify the broader context of their rates to members, purchasers, and providers.

Health Equity

The past few years brought health equity into stark focus, but to make true progress, leaders must cement equity as a business goal. As plans build equity goals into provider payments and care management actions, they must standardize data collection and analysis to generate evidence for sustainable interventions.

If you missed this informative webinar presentation, State of the Health Plan Industry: Unpacking the potential impact for 2022 planning, we invite you to watch this short webinar recap video here.

You can access the complimentary presentation slides presentation slides here and webinar video here.   To continue the conversation with Ken Leonczyk and learn more about how Advisory Board is working with other health care organizations, drop him an email at healthplan@advisory.com.

Optimizing Post-Acute Care Management: Four Key Takeaways from MCG Health Experts

By Claire Thayer, August 4, 2021

Recently, MCG Health’s Suzanne Doran, Managing Editor and Emily Ferguson, Associate Managing Editor, joined us in a webinar discussion on ways to engage patients, identify social determinants of health, and ultimately improve health outcomes while managing costs.  We caught up with Suzanne and Emily on four key takeaways:

1. Do you have more than one assessment to address Social Determinants of Health?

Suzanne Doran and Emily Ferguson: MCG Health currently has 9 assessments that address Social Determinants of Health. These assessments screen for needs such as food insecurity, homelessness, and social support. Based on individual needs, a plan of care is then generated to assist the patient and care manager address any barriers to care.

2. How are Accountable Care Organizations utilizing evidence-based care guidelines to help improve quality of care for their patients?

Suzanne Doran and Emily Ferguson: Accountable Care Organizations are using evidence-based care guidelines for coordinating care for patients across care settings, including chronic disease management and transitions of care. Evidence-based interventions allow providers to focus on giving their patient the care they need, at the right time. Patient care and quality are improved as a result of evidence guiding practices to improve adherence to preventative services and reduce complications associated with chronic disease. Here are links to some real-world case studies of ACOs using evidence-based guidelines and achieving success: Delaware Valley ACO and UnityPoint Accountable Care.

3. Can you share more information on how you approach building a plan of care for patients?

Suzanne Doran and Emily Ferguson: Care planning is individualized to the patient’s specific care needs and goals in order to incorporate the patient’s personal preferences and account for the patient’s unique medical and psychosocial situation. From the individualized self-care plan, case managers can provide the patient with specific and appropriate education, support, and timely follow-up in a manner that adapts to the patient’s capabilities and needs, versus a general plan that may overwhelm the patient because it’s too much information provided too soon:

4. Tell us more about the teach-back method and best practices for initiating patient understanding using this technique.

Suzanne Doran and Emily Ferguson: The teach-back method clarifies the learner’s understanding of instructions by having the patient give a return demonstration or vocally repeat (in his or her own words) what the patient just learned to assure comprehension of material.  An example of teach-back could be having a patient demonstrate how to administer self-injections by using an insulin syringe to inject an orange. This method has been shown to be effective in discharge planning as well as the patient’s vocalization of what medications they should take, when their next appointment is, or warning signs of a problem to their case manager.

If you missed this informative webinar presentation, Populations at Risk: Optimizing Post-Acute Care Management, we invite you to watch the full On-Demand webinar video or short webinar re-cap video.

Five Questions for Provider Data Experts on the No Surprise Act

by Claire Thayer, June 11, 2021

Recently, LexisNexis Risk Solution’s John Markoff, Senior Director, Provider Data Strategy and Laura Long, Vertical Solutions Consultant, Provider Data joined us in a webinar discussion on the new provider directory accuracy requirements that go into effect in January 2022.  We caught up with John and Laura on five key takeaways:

1. What are some of the common concerns with the No Surprise Act regulations that payers would want to be aware of?

John Markoff and Laura Long: 

• Can the payer outreach to all directory facing providers every 90 days?
• Initial accuracy of a payer’s database.
• Does the payer have ability to process changes from the outreach in a timely manner?
• How will downstream systems be impacted if a provider doesn’t verify, and they need to be removed from the directory?
• Can the payer outreach to all directory facing providers every 90 days?Initial accuracy of a payer’s database.Does the payer have ability to process changes from the outreach in a timely manner?How will downstream systems be impacted if a provider doesn’t verify, and they need to be removed from the directory?

2. Provider data is constantly changing, what are some of the key challenges you're seeing today?

John Markoff and Laura Long: 

It’s a challenge to maintain a high level of accuracy for data attributes that don’t have an authoritative source. Challenges stem from disparate systems, manual processes and out of date sources of data. Payers acquire companies, merge data assets and change systems over time. Resolving the issues that result from this require significant investment from IT, Operations, Data Governance and Provider Management.   

 

3. When evaluating provider data, what are the four key elements of quality?

John Markoff and Laura Long:

• Accuracy – Timely and Correct
• Timeliness – Providing updates in a timely manner
• Completeness – Depth and Breadth
• Governance – Ongoing maintenance and audit resolution

4.  Does this new legislation only impact government sponsored payers?

John Markoff and Laura Long:

This legislation is relevant for any provider listed on a member facing directory, regardless of product line.

5. What steps should payer organizations be taking now to be compliant with the new regulations by the 1/1/2022 effective date?

John Markoff and Laura Long:

• Payers need to start planning now to outreach to payers and ingest that data in a timely manner to meet the timelines presented in the Bill. 
• Conduct a third-party analysis of provider data within their system.       

If you missed this informative webinar presentation, No Surprise - Provider Data Accuracy Mandated, we invite you to watch the full On-Demand webinar video or short webinar re-cap video.

Five Questions for John League with Advisory Board on the State of Telehealth Today and What’s Next?

By Claire Thayer, March 16, 2021

Thanks to the pandemic, telehealth is here to stay! Advisory Board’s Senior Consultant, John League, joined us for a recent webinar on the state of telehealth today, offering insights for health payers in rethinking the digital experience to address downstream utilization, digital inequities, and more!  We caught up with John on five key takeaways:

1. Data is essential to advancing telehealth initiatives. What are the key data elements payers need to prioritize?

John League: All stakeholders need a better understanding of the downstream impact of upstream telehealth. Payers have tended to focus on data about utilization and per-service unit cost of telehealth—which are both important—but that doesn’t provide perspective on longer-term total cost of care or outcomes. We need data on things like how telehealth facilitates care coordination (are care coordination codes used more or less frequently via telehealth?), limits readmissions (including readmission and transfer from skilled-nursing facilities), and impacts other types of utilization (including labs, imaging, referrals, and prescriptions). 

2. What are some of the major challenges and barriers patients face in telehealth adoptions?

John League: Plans and providers can’t simply offer telehealth services; they have to recommend them as appropriate. I hear a lot of organizations worry that patients are increasingly choosing to do in-person visits over telehealth options. When I dig deeper, I often find that patients are getting no guidance on whether telehealth is a good option for their visit. Providers have the most influence here, but plans have a role, too. A recent Optum survey showed that half of patients who had actually used telehealth found out about it from their own doctor. Another 27% found out from their plan. 

Patients also need a quality virtual experience. It should have as many of the features of an in-person visit as possible. It should be at least as easy to schedule. It should provide a diagnosis, treatment plan, prescription, referral, or follow-up steps as appropriate. There should be clear steps for technical preparation and support. And they need to know how much it costs. Most cost-sharing is waived during the public health emergency, but a clear understanding of out-of-pocket costs is going to be essential in the future.

3. How can payers best understand, mitigate, and eliminate disparities and inequities in healthcare using telehealth?

John League: Addressing digital disparity begins with understanding the patients and communities in front of us: Does your organization understand how digital inequity presents in its members and patients? This also means diagnosing the nature of the inequity: Is it a challenge of connectivity, digital literacy, or trust in your organization and platform?

With that information, organizations can assess how their digital health priorities and investments mitigate digital inequities—or, unfortunately, maybe even deepen them. Only when each organization understands the nature of its members’ equity challenges and its own capacity to address them can it begin to partner with other organizations or advocate for policy change.

4. What do you see as the biggest challenge for payers in widespread telehealth adoption?

John League: The biggest challenge for payers is in helping patients and providers make the most valuable use of telehealth possible. I talk a lot about overall utilization rates—percentage of total visits done via telehealth—because that’s relatively easy to understand and quantify. It’s also a decent indicator of overall interest in telehealth. It’s also deceptive.

It's much more important to get the right visit types done virtually than it is to get any specific overall percentage of visits done virtually. There are some visit types that could almost all be virtual, and that’s where there’s big value for members. Are we getting prescription refills done virtually? What about pre- or post-op visits? What about behavioral health visits, or annual wellness checks?

Creating the right incentives and pathways so that patients trust telehealth for those purposes and providers are appropriately compensated for offering it is a significant but not insurmountable challenge.

5. What are your key takeaways in terms of where payers need to go and how to get there on their telehealth journey?

John League: First, don’t rely on pre-pandemic assumptions about telehealth. Telehealth was never deployed at scale before Covid-19. There is more data on its use than ever before. We need to dig into that hard-earned evidence and reassess how telehealth can help meet strategic objectives.

Second, focus on telehealth as a part of the overall care journey. It’s easy to focus on the unit cost of a telehealth visit, but that orientation ignores its potential to reduce total cost of care in other ways.

Finally, remember that telehealth has not reached a tipping point for the underserved. Many of the patients who could benefit most from telehealth aren’t able to access it. Work to develop an understanding of the ways that digital inequity affects your own members and how your organization’s priorities for digital investment will mitigate or deepen that inequity. 

If you missed this informative webinar presentation, Understanding Telehealth Today – and Preparing for its Next “New Normal”, we invite you to watch the full On-Demand webinar video, short webinar re-cap video, or reach John League directly at leaguej@advisory.com.

A New Era in Psychiatric Hospital Accreditation: Four Questions for DNV GL Healthcare

By Claire Thayer, November 19, 2020

Recently, we hosted a Healthcare Web Summit webinar discussion with DNV GL Healthcare to learn about why CMS awarded it 4 years of deeming authority to provide accreditation services to Psychiatric Hospitals. We caught up with DNV GL Healthcare’s Thomas Quinn and Barry Smith on four key takeaways from the webinar:

1. Why did CMS award DNV GL Healthcare 4 years of deeming authority to provide accreditation services to Psychiatric hospitals?

DNV GL Healthcare: CMS will deem an organization between 2 and 6 years for the accreditation service that they are providing. Four years seems to be our initial experience with any newly deemed service we have offered.

2. What are some of the types and different roles for Surveyors?

DNV GL Healthcare: There are 3 different surveyors on each annual survey. We have our clinical surveyor, our generalist surveyor and our physical environment surveyor. The clinical surveyor is going to be focused on patient care units, the clinical setting, chart review, seeing what is going on in a unit, and observing patient and staff interactions. The generalist surveyor is focused on quality management issues, how your quality management system functions, medication management, and they are also involved in reviewing competency and utilization review. The Physical Environment surveyor’s role is to look at the entire physical plant of the organization – they will look at HVAC, fire drills, emergency management, biomed, safety and more.

3. Briefly tell us more about the accreditation process and what can Psychiatric hospitals expect in terms of onsite involvement?

DNV GL Healthcare: The accreditation process begins with the hospital completing a confidential application at no charge.  Once the hospital accepts the pricing and terms, DNV GL Healthcare will add the hospital to our schedule for an unannounced survey.  Initial surveys will consist of an onsite survey by a DNV GL Healthcare survey team.

The NIAHO® and ISO surveys are done together through Tracer Methodology as well as staff and patient interviews. While surveying the hospital to the NIAHO® Requirements, DNV GL Healthcare surveyors also ensure the application of the ISO 9001 standard. Tracer Methodology has been a staple of ISO 9001 audits since ISO 9001’s inception in 1987. All areas of the hospital are surveyed, both clinical and non-clinical. The number of surveyors and the mix of qualifications are determined specifically for each hospital and type of survey being performed. 

The hospital will receive a final report from DNV GL Healthcare within ten business days. The hospital will then have ten calendar days to submit its Corrective Action Plan with timelines for implementation. Once the Corrective Action Plan has been approved, the documentation is submitted to the Accreditation Committee for the final accreditation decision. 

Upon approval by the Accreditation Committee, DNV GL’s accreditation is typically effective on the date of receipt of an approved corrective action plan.  Individual survey results vary and certain circumstances may impact the initial accreditation effective date.  For hospitals new to the Medicare program, or applying for new provider status, the effective date for Medicare participation is always determined by CMS.

4. Where can we learn more about your standards and what's included in the application process?

DNV GL Healthcare: You can view and download all of our standards free of charge at this link: https://www.dnvgl.us/assurance/healthcare/standards.html  

You can also contact us at contacthc@dnvgl.com to request a short conversation to go over the application process and what all you will need to have in order to apply for DNV GL Psychiatric Hospital Accreditation.  Again, all of our standards are available at no charge as is the application.

If you missed this informative webinar presentation, Psychiatric Hospitals Now Have a Choice on Who They Partner With for Their Accreditation, we invite you to watch the full On-Demand webinar video or short webinar re-cap video.

The Impact of Clinical AI: Four Questions for Jvion

By Claire Thayer, September 10, 2020

Recently, Jvion participated in a Healthcare Web Summit webinar discussion of how clinical AI differs from traditional predictive analytics and explored ways in which AI can improve patient risk trajectories while having positive impact on revenue, and identified key steps to implement adoption across organizations.  We caught up with Dr. John Showalter, Chief Product Officer, Jvion on four key takeaways from the webinar:

1. Why clinical AI? What’s the difference to other AI approaches?

Dr. John Showalter: Clinical AI focuses on an understanding of an individual patient and is designed to augment the actions and decisions of a care team. By understanding the individual drivers of risk and best actions to help a patient, an individual plan can be developed. Other AI approaches attempted to automate actions/processes, diagnose problems, or determine risk with a blackbox. The understanding of why and what to do is unique to Jvion.

2. What are the main gaps in traditional analytics like risk stratification and predictive modeling that leave healthcare organizations exposed?

Dr. John Showalter: The main gaps are predicting with non-modifiable risk factors, limited accuracy in risk predictions, population based protocols to respond to risk, and identifying too many individuals at risk. Current cohorting approaches frequently identify so many patients at risk that it is impossible to intervene on all of them effectively, especially when the individual gets an all or nothing population based protocol as an intervention.

3. What are a few of most pressing reasons for clinicians and healthcare organizations like payers to consider data augmentation in today's environment?

Dr. John Showalter: A few are: financial risk due to COVID-19, deferred care due to COVID-19, the aging population, increasing amounts of value-based contracts, increases in uncompensated care, increased consumerism, reducing health disparities.

4. What are the key things an organization should consider to ensure successful implementation and adoption of AI technology?

Dr. John Showalter: A commitment to adapting to the new insights, willingness to change workflows, identifying and tracking value attainment, identifying a need they are committed to fixing, full/broad stakeholder engagement.

If you missed this informative webinar presentation, Addressing the Iron Triangle of Healthcare With Clinical AI: Protecting Revenue While Improving Health Outcomes, we invite you to watch the On-Demand webinar video, short webinar re-cap video, or read the full Executive Brief.

Four Questions for The Whyzen Team at Health Intelligence Company on Solving the Rubix Cube of Health Plan Benefit Design with Analytics

By Claire Thayer

Drs Mary Henderson and Russell Robbins from The Whyzen Team at Health Intelligence Company participated in a Healthcare Web Summit webinar: Solving the Rubix Cube of Health Plan Benefit Design with Analytics.  The discussion highlighted the greater need for near real-time, population-specific health benefits analytics.  The speakers addressed how Whyzen is helping health benefits stakeholders spot outliers and track variations from benchmarks over time with quick views of cost, quality, and utilization.

Additionally, with COVID-19 being top of mind for so many, Whyzen has added reporting capabilities that allow health plans, employers, brokers/consultants identify who and where their most vulnerable employees/members are. This targeted information empowers all users to better allocate care management resources for targeted and impactful interventions.

If you missed this engaging webinar presentation, you’ll want to be sure to watch the Webinar Video. After the webinar, we interviewed the speakers on four key takeaways: 

1. What are some of the ways that employers are mitigating out-of-network costs?

The Whyzen Team at HIC: While out-of-network costs are not the biggest driver of healthcare trends, they are definitely substantial – and largely avoidable. Employers are looking for solid data to provide support for alternatives and programs that comprise key elements of benefit design. Whyzen provides the analysis and justification for appropriate programs.

For starters, employers need to assess the extent to which out-of-network costs drive overall trends. Whyzen – from Health Intelligence Company (HIC) – can help them quantify the scope of the problem and identify where the saving opportunities lie.

For example, for elective surgeries (e.g., bariatric surgery, orthopedic surgery), Whyzen can identify the types of procedures that were performed, the volume of procedures, and whether they were done in or out of network. To avoid high rates charged by out-of-network providers, Whyzen enables employers to guide employees to Centers of Excellence or to align patients’ needs with more appropriate sites of service.

2. You mention that employers are telling you that only "data nerds" can get value out of reporting and analytics solutions. Can you tell us more?

The Whyzen Team at HIC: Frequently, companies that use analytics solutions find them to be cumbersome to navigate, time-consuming  to get to a decision point, and lacking  actionable recommendations at the end of the analysis. As a result, plans, employers, and brokers tend to hand that work off to data experts, thereby distancing their clinical, care management, and benefit design staff from data-driven insights. And data analysts may not understand the clinical, quality, or financial implications of their findings.

Solutions that are accessible, intuitive, and inclusive of many data sources allow users to spend less time analyzing and more time developing strategies and interventions. Health Intelligence Company designed its Whyzen employer reporting solution with those features in mind.

3. How does Whyzen differentiate itself from competing solutions? What are its key strengths and differentiators?

The Whyzen Team at HIC: Whyzen stands out as the industry leader for employer reporting and analytics for a number of reasons:

•    Standard and Customized Reporting:
•    Interactivity
•    National Benchmarks
•    Flexible Analytics
•    Deep External Data Integration
•    Flexibility / User Configurability

4. What types of  benchmarks can Whyzen produce?

The Whyzen Team at HIC: Whyzen utilizes HIC’s National Benchmarking Module (NBM) to provide a rich set of benchmarks. HIC draws on a dataset that contains over 200 million unique lives and over 20 billion healthcare claims. Employers, brokers, and third-party administrators can compare relevant, HIPAA-compliant healthcare performance metrics. Whyzen can examine and compare cost and utilization performance by: 

Geography

•          National vs. regional vs. local
•          Census region and division
•          Region type (urban, suburban, rural, exurban, etc.)
•          State, city, or ZIP Code

Industry

•          Industry category
•          Standard Industrial Classification (SIC) codes

Product

•          Preferred Provider Organization (PPO)
•          Health Maintenance Organization (HMO)

Account Size

•          Small
•          Mid-Market
•          Large

By viewing data through geographic, industry, product, and account size lenses, users can easily:

•          Compare employer accounts
•          Drill into cost and utilization data
•          Explore quality measures, health risk scores, and clinical episode components

HIC’s unmatched data set and rigorous analytic model offer customers the single best view into how their spending compares on any number of dimensions.

For more information on Whyzen or Health Intelligence Company – or to view our recent webinar, “Solving the Rubix Cube of Employee Benefit Design” – click here.

Four Key Takeaways About Stroke Program Certification

By Claire Thayer

Tim Hehr, Stroke Technical Advisor, Stroke Program Development, DNV GL Healthcare and Debbie Camp, Stroke Program Manager, Piedmont Newnan Hospital, participated in a recent Healthcare Web Summit webinar: Stroke Program Certification: Positive Impacts on Safety and Quality Care in the Piedmont Healthcare System.  Piedmont Healthcare is a large hospital system in the Atlanta area, four of their hospitals are DNV GL Healthcare certified stroke centers – a designation they have held for the last 5 years. The discussion offered an overview of the process to achieve a DNV GL Stroke Program Certification as well as focused on how certification has positively impacted the Piedmont Healthcare System.   If you missed this engaging webinar presentation, you’ll want to be sure to watch the Webinar Video. After the webinar, we interviewed the speakers on four key takeaways: 

1. How many levels of stroke certification are offered by DNV GL Healthcare? 

Tim Hehr: There are 4 levels of stroke certification offered by DNV-GL Healthcare:  Acute Stroke Ready, Primary Stroke Center, Primary Stroke Center Plus, and Comprehensive Stroke Center

2. What are a few of the sources and guidelines utilized in the development of the DNV GL Healthcare stroke certification standards? 

Tim Hehr: There are several sources utilized in developing DNV-GL Stroke Center Certification standards including The American Stroke Association, The Brain Attack Coalition, The American Association of Neuroscience Nurses, and The Society of NeuroInterventional Surgery.

3. Describe some of the advantages of DNV GL stroke certification for an organization like Piedmont Healthcare.

Debbie Camp: The biggest advantage is the annual on-site surveys and the collaborative/partnership that is provided by subject matter experts (surveyors’) who truly understand the job we do. The surveyors share best practices from around the country with our Team which has greatly improved our stroke program throughout our system.

4. Can you share examples of specific guidelines that were reviewed at Piedmont and describe how they positively impacted stroke care in that organization?

Debbie Camp: The ppt went through some of the process improvement (PI) initiatives for the non-conformities (NC1-2) and/or opportunities for improvement (OFI’s) that we received from our survey’s.

Because of the PI process being implemented at a system level we are able to ensure best practices across the system.

Below are examples of some of the Standards that matched the PI initiatives that were presented on the webinar.

NC-1 QM.7 (CR.2i) (Door to Monitored Bed)/Code Alteplase

NC-2-1 PC.10 Patient Care Plan of Care (CR.1) /(CR.1g)/Stroke Bleeding Precautions & Documenting Modifiable Risk Factors

NC-2-2 PC.8 Patient Care Protocols/Pre & Post Alteplase Parameters met

NC-2-3 PC.12 Patient Care Diagnostic Testing /Development of the Stroke Narrator to capture MD @ BSD prior to CT

NC-1-2 QM.7 (Quality Mgt Systems) Measurement, Monitoring, Analysis, PC.12 (Pt Care Services), Diagnostic Test, MS.1 (Medical Staff) Admissions Requirements/Development of Stroke Narrator

NC-1-1 PC.4 Patient Care Services Emergency Department/Developing Alteplase Audit Handoff Tool

NC-1-1 Protocols PC.8/CR.3a   &   Required Documentation (MR.4)/(CR.6b)/Standardized S/P CEA order sets and Documentation of V/S & Neuro Checks  

To view the full webinar, Stroke Program Certification: Positive Impacts on Safety and Quality Care in the Piedmont Healthcare System  – click here.

Five Questions for Rachel Sokol with Advisory Board on Frictionless Healthcare Experiences

By Claire Thayer

Rachel Sokol, Managing Director, Payer Research, Advisory Board participated in a Healthcare Web Summit webinar on The Financial Case for a Frictionless Experience.  The discussion highlighted several areas of frictions that highly impact cost of care use, satisfaction and retention efforts and where payers and health systems might think about prioritizing their experience improvement initiatives. If you missed this engaging webinar presentation, you’ll want to be sure to watch the Webinar Video. After the webinar, we interviewed Rachel on five key takeaways: 
 

1. What are a few of the common consumer experience initiatives that health plans are investing in?

Rachel Sokol: The biggest investments we see from plans center around the digital experience – so many plans building new websites, member-only portals, and apps.

2. Your focus of the presentation is on member friction and how this correlates with costly care use. How do you define “friction” from the consumer’s perspective?

Rachel Sokol: We define a “friction” as anything that prevents a consumer from easily and intuitively achieving their goals causing the consumer to hesitate or abandon the health care interaction altogether.

3. Continuing with the discussion on "friction" - what are some of the friction points that would result in a health plan member choosing to go out of network for care services?

Rachel Sokol: The biggest frictions we see leading to out of network use are discrepancies between what the insurer and what the provider say regarding service or physician coverage.

4. Your study points out that members aren't willing to wait for care, even at convenient sites like urgent care and telehealth.  What insights or suggestions do you have for health plans to improve member access?

Rachel Sokol: We’d suggest that plans make it easier for members to access these sites by pre-registering them wherever possible and making the process as familiar as they can with training and promotional materials.

5. To best manage the full member experience cycle, do health plans need to own physician practices in order to reach high levels of member service standards?

Rachel Sokol: Plans don’t have to own practices to offer a seamless experience – but if they don’t, they’ll need a strategy to compete with the expectations set by those that do.  If not ownership, close partnership will be essential to making sure that members have access to high value physicians ready to provide personalized care.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Google to acquire Fitbit in $2.1B deal, challenging Apple

Google plans to acquire wearables maker Fitbit in a deal valued at $2.1 billion, the companies announced Friday. Fitbit's stock soared more than 16% on the news.

Healthcare Dive

Friday, November 1, 2019

IBM, Mayo Clinic, Geisinger among 25 finalists for $1.6M CMS artificial intelligence challenge

Out of more than 300 artificial intelligence proposals, the Centers for Medicare & Medicare Services (CMS) picked 25 organizations for the next stage of its AI challenge including IBM, Booz Allen Hamilton and Mayo Clinic.

Fierce Healthcare

Thursday, October 31, 2019

Hospitals Take Shot At Opioid Makers Over Cost Of Treating Uninsured For Addiction

While thousands of cities and counties have banded together to sue opioid makers and distributors in a federal court, another group of plaintiffs has started to sue on their own: hospitals.

Kaiser Health News

Tuesday, October 29, 2019

Firms Seeking Top Workers Find They Can't Offer Only High-Deductible Health Plans

Everything old is new again. As open enrollment gets underway for next year's job-based health insurance coverage, some employees are seeing traditional plans offered alongside or instead of the plans with sky-high deductibles that may have been their only choice in the past.

NPR

Tuesday, October 29, 2019

Uber lands EHR deal with Cerner

Uber Health is now available on Cerner's EHR platform, allowing U.S. providers and Cerner clients to schedule non-emergency medical transportation for their patients in the ride-hailing giant's first EHR integration.

Healthcare Dive

Monday, October 28, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Pharma Sells States On ‘Netflix Model’ To Wipe Out Hep C. But At What Price?

When a long, black bus bearing the logo of drugmaker AbbVie rolls through Washington state next year, it will promote a new effort to eradicate hepatitis C infections.

Kaiser Health News

Friday, October 25, 2019

Feds owe health insurers $1.6 billion in unpaid subsidies, judge rules

A federal judge this week ordered the federal government to pay about 100 health insurance plans a total $1.6 billion in unpaid subsidies.

Modern Healthcare

Thursday, October 24, 2019

Health system margins rebounded last year but trail 2015 levels

Major U.S. health systems rebounded on their operating margins last year by an average of 13%, but they still average at 30% below 2015 levels, according to a Navigant analysis released Wednesday.

Healthcare Dive

Wednesday, October 23, 2019

Premiums for popular Obamacare plans to drop 4 percent

Premiums for key plans sold on HealthCare.gov will drop by 4 percent on average next year, with several states seeing double-digit declines, the Trump administration said this morning.

Politico

Tuesday, October 22, 2019

UPS flies further into healthcare with CVS, AmerisourceBergen, provider partnerships

UPS Flight Forward, the logistics provider's drone subsidiary, has sealed partnerships with CVS Pharmacy, AmerisourceBergen, Kaiser Permanente and the University of Utah Health System to deliver healthcare supplies via drone.

Healthcare Dive

Tuesday, October 22, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Google nabs ex-Obama official DeSalvo for new chief health role

Google has hired ex-Obama administration official Karen DeSalvo as its first chief health officer, further solidifying its investment in the $3.5 trillion industry by rounding out its healthcare team.

Healthcare Dive

Friday, October 18, 2019

Whistleblower Alleges Medicare Fraud At Iconic Seattle-Based Health Plan

Group Health Cooperative in Seattle, one of the nation’s oldest and most respected nonprofit health insurance plans, is accused of bilking Medicare out of millions of dollars in a federal whistleblower case.

Kaiser Health News

Friday, October 18, 2019

Surprise Settlement In Sutter Health Antitrust Case

Sutter Health has reached a tentative settlement agreement in a closely watched antitrust case brought by self-funded employers, and later joined by the California Attorney General’s Office.

Kaiser Health News

Thursday, October 17, 2019

Medicare, Medicaid hospital payment cuts to hit $252.6B, industry study finds

Reductions in federal payments to hospitals will total $252.6 billion from 2010 through 2029, reflecting the cumulative impact of a series of legislative and regulatory actions, according to a new study from Dobson DaVanzo & Associates, a health economics and policy consulting firm.

Healthcare Dive

Wednesday, October 16, 2019

New study: Full-scale 'Medicare for All' costs $32 trillion over 10 years

The study from the Urban Institute and the Commonwealth Fund found $32.01 trillion in new federal revenue would be needed to pay for the plan, highlighting the immense cost of a proposal at the center of the health care debate raging in the presidential race.

The Hill

Wednesday, October 16, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Sutter, Kaiser among hospitals hit by Northern California blackouts

The blackouts created by the Pacific Gas & Electric (PG&E) utility in Northern California have led to numerous hospitals relying on their backup generators for power.

Healthcare Dive

Friday, October 11, 2019

Amazon Textract now HIPAA-eligible as tech giant expands AI portfolio

Amazon Textract, a machine learning service that automatically extracts selected text and data from scanned documents, is now HIPAA-eligible, Amazon Web Services announced in a blog post Thursday.

Healthcare Dive

Friday, October 11, 2019

How HHS wants to update anti-kickback rules to support value-based care

HHS on Wednesday issued long-anticipated proposed rules to update anti-kickback and physician-referral regulations so they do not interfere with physicians' ability to participate in value-based payment arrangements.

The Advisory Board

Thursday, October 10, 2019

VCU Health Will Halt Patient Lawsuits, Boost Aid In Wake Of KHN Investigation

VCU Health, the major Richmond medical system that includes the state’s largest teaching hospital, said it will no longer file lawsuits against its patients, ending a practice that has affected tens of thousands of people over the years.

Kaiser Health News

Wednesday, October 9, 2019

Waste gobbles up 25% of US healthcare spending, JAMA study finds

The estimated cost of waste in the U.S. healthcare system ranges from $760 billion to $935 billion, or about 25% of the total healthcare spending, according to a report in JAMA issued Monday.

Healthcare Dive

Monday, October 7, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Why Hospitals Are Getting Into The Housing Business

One patient at Denver Health, the city’s largest safety net hospital, occupied a bed for more than four years — a hospital record of 1,558 days. Another admitted for a hard-to-treat bacterial infection needed eight weeks of at-home IV antibiotics, but had no home.

Kaiser Health News

Friday, October 4, 2019

Humana's chief strategy officer: Insurance giant is shifting to be a healthcare company

Insurance giant Humana operates a mail-order pharmacy, has more than 230 owned or alliance primary care clinics and a large home health care provider, Kindred at Home. And the payer continues to build out capabilities to address members' social determinants of health.

Fierce Healthcare

Thursday, October 3, 2019

Trump signs executive order bolstering MA in pushback on 'Medicare for All'

President Donald Trump signed an executive order in Florida on Thursday he said would bolster the Medicare program as numerous Democratic presidential candidates seek to expand the program beyond seniors, a move Trump said would jeopardize the entire program.

Healthcare Dive

Thursday, October 3, 2019

US vaping illnesses top 1,000; death count is up to 18

The number of vaping-related illnesses has surpassed 1,000, and there’s no sign the outbreak is fading, U.S. health officials said Thursday.

The Associated Press

Thursday, October 3, 2019

Walmart To Give Workers Financial Incentives To Use Higher-Quality Doctors

Worried its employees aren’t getting good enough care from doctors in their insurance networks, Walmart next year will test pointing workers in northwestern Arkansas, central Florida and the Dallas-Fort Worth area toward physicians it has found provide better service.

Kaiser Health News

Thursday, October 3, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Vaping-Related Illnesses Climb to 805, C.D.C. Says

The latest weekly tally includes 275 more reports of patients sickened, in 46 states. There are now 12 deaths linked to vaping-related lung injuries.

The New York Times

Friday, September 27, 2019

Senate approves delay in planned DSH cuts

The Senate approved a delay in $4 billion in planned cuts to Medicaid disproportionate share hospital (DSH) payments set to go into effect in November.

Fierce Healthcare

Thursday, September 26, 2019

Uber And Lyft Ride-Sharing Services Hitch Onto Medicaid

Arizona Medicaid Director Jami Snyder heard many complaints about enrollees missing medical appointments because the transportation provided by the state didn’t show or came too late.

Kaiser Health News

Thursday, September 26, 2019

Amazon launches pilot of virtual employee medical service Amazon Care

Amazon is piloting a new virtual health service benefit for employees and their families in the Seattle region. Calling it Amazon Care, the tech giant said the service combines "the best of both virtual and in-person care" by offering virtual visits, in-person primary care visits at patients' homes or offices and prescription delivery.

Fierce Healthcare

Tuesday, September 24, 2019

Walmart announces plan to build healthcare workforce, offering education for $1 a day

As Walmart moves deeper into primary care, the retail giant wants to ensure there is a skilled healthcare workforce to fill critical roles in its 20 care clinics.

Fierce Healthcare

Tuesday, September 24, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

They Got Estimates Before Surgery — And A Bill After That Was 50% More

Before scheduling his hernia surgery, Wolfgang Balzer called the hospital, the surgeon and the anesthesiologist to get estimates for how much the procedure would cost. But when his bill came, the estimates he had obtained were wildly off.

Kaiser Health News

Friday, August 30, 2019

Health insurers slam CMS proposal to alter Medicare Advantage audits

Health insurers and their industry trade groups this week urged the federal government to scrap proposed changes to the way it audits Medicare Advantage plans, warning the changes could result in higher costs and reduced benefits for seniors.

Modern Healthcare

Thursday, August 29, 2019

Medicare Part D paid millions for drugs already covered by Part A hospice benefits

Despite a previous warning, the Center for Medicare and Medicaid Services failed to take steps to ensure the Medicare Part D program does not also pay for medicines that should be covered under the Medicare Part A hospice benefit, resulting in an estimated $161 million in duplicate payments in 2016, according to a new federal government analysis.

Stat News

Thursday, August 29, 2019

Administration ends protection for migrant medical care

The Trump administration has eliminated a protection that lets immigrants remain in the country and avoid deportation while they or their relatives receive life-saving medical treatments or endure other hardships, immigration officials said in letters issued to families this month.

AP News

Monday, August 26, 2019

Judge Cites Opioid ‘Menace,’ Awards Oklahoma $572M In Landmark Case

An Oklahoma judge has ruled that drugmaker Johnson & Johnson helped ignite the state’s opioid crisis by deceptively marketing painkillers and must pay $572 million to the state.

Kaiser Health News

Monday, August 26, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

$16B veterans' health project hits major snag

Veterans Affairs Secretary Robert Wilkie insisted last week that the Trump administration is "on track" with a $16 billion project to connect medical records for the military and vets.

Politico

Friday, August 23, 2019 

Dialysis Industry Spends Big To Protect Profits

The dialysis industry spent about $2.5 million in California on lobbying and campaign contributions in the first half of this year in its ongoing battle to thwart regulation, according to a California Healthline analysis of campaign finance reports filed with the state.

Kaiser Health News

Friday, August 23, 2019 

Opioid Treatment Is Used Vastly More in States That Expanded Medicaid

States that expanded Medicaid under the Affordable Care Act have seen a much bigger increase in prescriptions for a medication that treats opioid addiction than states that chose not to expand the program, a new study has found.

NY Times

Thursday, August 22, 2019 

Exclusive: Cigna seeks sale of group benefits insurance business - sources

U.S. health insurer Cigna Corp is exploring a sale of its group benefits insurance business, which could be valued at as much as $6 billion, four people familiar with the matter said on Tuesday.

Reuters

Wednesday, August 21, 2019 

The Collapse Of A Hospital Empire — And Towns Left In The Wreckage

The money was so good in the beginning, and it seemed it might gush forever, right through tiny country hospitals in Missouri, Oklahoma, Tennessee and into the coffers of companies controlled by Jorge A. Perez, his family and business partners.

Kaiser Health News

Tuesday, August 20, 2019 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Four Questions for Erin Benson and Courtney Timmons with LexisNexis Health Care: Post-Webinar Interview

By Claire Thayer

Erin Benson, Director Market Planning and Courtney Timmons, Market Planning Specialist, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on ways for health plans to reduce the risk of a data breach, the necessary steps to validate and verify member information, and ingredients for a strong multi-factor authentication strategy.  If you missed this engaging webinar presentation, you’ll want to be sure to watch the Webinar Video. After the webinar, we interviewed Erin and Courtney on four key takeaways:  

1. What are some of the key ways health plan members are using their member portals? 

Erin Benson and Courtney Timmons: Health plan members are increasingly using their member portals as a tool to View and get answers to coverage questions

•  Track claims and account activity
•  Locate providers and services
•  Find health advice
•  Manage their member profile
•  Pay bills

2. With the rise of digital healthcare, there's also a rise in online fraud. Tell us more about how this impacts healthcare firms?

Erin Benson and Courtney Timmons: 

As the ways in which members access their data becomes more sophisticated, so too do the ways in which hackers are finding ways to commit fraud:

• More than 1 in 10 new account openings are fraudulent with 60% of those accounts being created using a mobile device
• Call center fraud is up 113%
• A record 1 Billion BOT attacks were seen in Q1 of 2018
• There has been a 202% growth in login attacks since 2016
• And 88% of all ransomware attacks were against healthcare organizations in 2017 –healthcare organizations are known on the black market to pay      

When fraudsters are successful it compromises patients’ trust in the healthcare organization, increases costs if they have to remediate a breach, and potentially leads to member safety risks if any of the patient’s health data is altered and care givers then act on bad information. Not to mention members will go somewhere else if they don’t trust that you can take care of their data.

3. You've mentioned that identity is the key to solving the challenge of balancing member engagement and data security. How do these interact together?

Erin Benson and Courtney Timmons: The healthcare organization should determine when and how to communicate with the member, ensuring updated contact information is maintained to best engage them. The member’s information should be protected from fraudster access. A foundational step is for healthcare organizations to aggregate the many data points about each member into one location linked together by a unique, persistent member-level identifier to create the one golden record about the individual.

Identity management and proofing, in tandem with new technological innovation, allows organizations to:

•  Perform intuitive linking of data points to the accurate identity
•  Leverage cross-industry analytics that allow organizations to determine if an identity enrolling in   your plan actually exists and if all of the identity information is accurate and belongs together, and 
•  Monitor transaction activity across a diverse array of industries from financial, retail, insurance and   government, using machine learning to build analytics, provide fraud intelligence and track   fraudulent behaviors and schemes.
   

In order to protect their data, you have to know who to grant access to and be able to verify their identities. Knowing your members will allow you to validate that the right users get access to their information, while keeping fraudsters out, and providing insight into who is accessing your site, mobile application and/or portal no matter where in the medical journey a member… or fraudster… is trying to gain access. 

4. Identity verification is complex. What are a few key considerations in selecting identity verification layers? 

Erin Benson and Courtney Timmons:  Various types of authentication methods should be used to cover different types of security vulnerabilities.  It is important to implement solutions that serve different purposes, targeting different types of fraud.

Some questions to ask as you develop your strategy are:

• Do we have a way of preventing fraud such as BOT attacks or ransomware by scanning devices trying to gain access to our portal?
• Can we confirm that the user requesting access to the data is the owner of that identity?
• Does the input identity exist and do all of those data elements belong together?

We recommend putting the no to low friction solutions up front in the process and introducing solutions with increasing levels of friction later in the process so only suspicious identities are facing additional scrutiny before logging in or completing a high risk transaction. 

Speaker Panel Answers My Accreditation Questions

By Claire Thayer, July 15, 2019

In June, Iris J. Lundy of Sentara Healthcare, Lorie Gillette and Dr. Robert C. Pendleton of the University of Utah Health, Lori Flies of Houston Methodist, and Patrick Horine, Chief Executive Officer at DNV GL Healthcare participated in a Healthcare Web Summit webinar discussion on how accreditation can be a catalyst for improvement in care quality, patient outcomes and overall operational efficiency. If you missed this lively presentation, you'll want to be sure to watch the Webinar Video. After the webinar, we interviewed our speakers on four key takeaways: 

1. Can you describe some of the quality improvement benefits within your system that have been implemented since contracting with DNV GL Healthcare? 

Lori Flies: At Houston Methodist, a few of the many quality improvement benefits included:

Implementation of ISO 9001 internal survey/internal audit using a process-based approach has improved identification of variations in quality and safety so that we can take corrective actions and evaluate improvement. Another benefit that we implemented was structured management review to quality and safety variations has resulted in leader decisions that drive improvements, such as ED throughput. Lastly, since contracting with DNV GL Healthcare, we’ve experienced stronger integration of clinical and non-clinical aspects of patient care; for example, last year working with both clinical and facility aspects of assessing ligature risk. 

2. You've talked about process owners within each of your hospitals, can you tell us more here? 

Iris Lundy: Each NIAHO standard or an identified process has an owner within the hospital (process owner) and a system lead who serves as the subject matter expert.  These individuals assist with developing educational material and other tools to assist their hospital with successfully implementing.  The system person assists to ensure we are standardizing as much as appropriate across our system.  There is also a VP sponsor for each of these groups to assist with removing barriers when they are identified. 

3. As an academic health system, you've mentioned historic silos within organization structure and clinical specialties. How did implementing management to support ISO 9001 force you to break down these silos? 

Bob Pendleton and Lorie Gillette: At the University of Utah Health, when we implemented a management system as per the ISO 9001 standards, silos were broken down due to the new reporting structure for management review which included adding key directors as well as executive leaders. The goal was to spread system information requiring process improvement and in turn, agree upon shared system goals collaboratively. Providing training and aligning goals on a system level provided the impetus to break down silos.  

4. Can you tell us how DNV GL approaches accreditation and give us a few examples of how you work more collaboratively with hospitals and why this approach is advantageous for the hospital? 

Patrick Horine: We think of our hospitals as partners. This process should be meaningful to the hospital leadership and staff. It is not just about noting a finding, but you want to understand how an organization applies a standard and their process. Doing so enables us to share insight, share ideas on how other organizations meet the requirements, and what they may consider for making improvements. We learn from the hospitals as well that we can improve our process and use to help others. We still hold the hospitals accountable for compliance, we just take a different approach in doing so. This is advantageous because the hospital staff get more from the survey experience. They see the practical application and understanding of the requirements and appreciate this being more than just passing the survey for the certification and about improving for their patients.