Readers Write: Green Light: Why Healthcare Providers Need to Migrate to NCPDP’s Updated E-Prescribing Standard

Green Light: Why Healthcare Providers Need to Migrate to NCPDP’s Updated E-Prescribing Standard
By Andrew Mellin, MD

Andrew Mellin, MD, MBA is VP/CMIO of Surescripts of Arlington, VA.

When you see a green traffic light, what action comes to mind? Assumingly, “go.” But as late as the 1920s, a green light meant stop in some American cities and go in others, creating a dangerous driving experience for drivers used to different systems for traffic lights and patterns. As a result, the Federal Highway Administration mandated in 1935 the national standardization of the red, yellow, and green color scheme that we know today.

Although we don’t often think about standards, they are essential for standardizing materials, products, methods, and services, which result in safety, efficacy, efficiency, and quality control. This is especially true across healthcare.

Since 1997, the National Council for Prescription Drug Programs, or NCPDP, has maintained a national standard known as SCRIPT for electronic prescriptions. The NCPDP SCRIPT Standard for e-prescribing facilitates the transfer of prescription data between various healthcare stakeholders and plays an important role in helping reduce administrative burdens for providers and increasing patient safety.

Unlike traffic lights, healthcare technology is constantly evolving and improving. That’s why in 2018, the Centers for Medicare & Medicaid Services (CMS) issued a final rule adopting the NCPDP SCRIPT Standard v2017071 for E-Prescribing and Medication History for Medicare Part D. This standard sets out to modernize e-prescribing and medication history and improve patient safety and clinician workflows.

Most of the industry has migrated to this new standard, and the tremendous work that thousands of stakeholders across the country have done to upgrade their pharmacies and electronic health records should be applauded. But healthcare providers who haven’t completed this process are subsequently missing out on new features and risk potential disruption to their ability to electronically prescribe medications.

SCRIPT v2017071 makes hundreds of improvements to the e-prescribing process. The enhancements from this version fall into three categories: information sharing, patient safety, and administrative burdens.

The 2017071 standard adds new data segments, elements, and codes to prescriptions that more clearly communicate the prescriber’s intent to the pharmacy. In terms of patient safety, prescribers can now share patient allergies and preferred language with the pharmacy. Finally, the standard helps minimize manual processes that require healthcare providers and pharmacies to step outside their workflows to exchange critical patient care information. For example, it enables pharmacies to request prescriptions for medications they have not previously dispensed electronically versus using fax machines or making telephone calls.

CMS required that healthcare providers sunset the previous NCPDP SCRIPT Standard – v10.6 – by December 31, 2019. With the CMS deadline now more than 18 months behind us, the rest of the healthcare industry is officially retiring SCRIPT v10.6. For healthcare providers who don’t complete their migration by September 1, 2021, their users may begin experiencing service disruptions and will not have access to Surescripts E-Prescribing services.

Migration to SCRIPT Standard v2017071 takes time and work, so healthcare providers must not delay. Organizations can navigate their transition by talking to their EHR or e-Prescribing vendor and by leveraging resources like the NCPDP SCRIPT Implementation Recommendations guide.

NCPDP SCRIPT is more than a standard; it represents our innovative efforts to find better ways to share information and support the health and wellbeing of patients in the United States. The migration light is green, so healthcare providers must hit go.

Readers Write: Inside the Most Challenging Data Problem in Healthcare

Inside the Most Challenging Data Problem in Healthcare
By Navdeep Alam

Navdeep Alam, MS is CTO of Abacus Insights of Boston, MA.

Payer data is one of the most exciting assets in healthcare, holding the most promise for dynamic, meaningful change to the way care is delivered and paid for. It’s also the most challenging data problem to exist in the industry. 

We may not always realize it, but payer data is often the center of discussion around dinner tables across the country. Whether we’re talking about which treatments are covered by our health plan, how much our prescriptions cost, or how our specialists and primary care physicians interact — or fail to interact — we’re actually talking about payer data. When we have questions about our care, the first call we make is to our health plan, and we hope they have the wisdom and expertise to point us in the right direction. 

Payers are the hub of healthcare. Our health plan is where we as consumers begin when we’re trying to navigate the healthcare landscape. Where do we go to receive care? What treatments are best for us as individuals? Which pharmacies can fill our prescriptions?

As we interact with the healthcare system over our lifetimes, our experiences are eventually filed as insurance claims. Health plans hold treasure troves of rich, complex data about the patient journey, information that is critical to understanding how we as individuals experience healthcare. 

This is why healthcare can be so complicated: We have barely scratched the surface in realizing the potential of payer data. 

Healthcare data does not come from a single source. It comes from electronic health records, primarily used for documenting clinical data. It comes from pharmacy records, which were designed primarily for inventory management. And it comes from insurance claims, which lack detail about the patient journey but are necessary for tracking our experiences across the healthcare system. All of this data is growing at an exponential rate. Over 1.2 billion clinical documents are produced annually in the United States, and that figure is growing at a rate of 48% per year — and it’s all held by health plans. 

Health plans are ingesting millions of data points every day, and all of it is necessary to ensure that we, as patients, are receiving the right care at the right cost. If this data were clean and structured in the same format, it could paint a beautifully elaborate picture of how we experience healthcare every day. But it is not: 80% of medical data, for example, is unstructured and therefore disconnected from the wider healthcare system. 

Ultimately, all data challenges across the healthcare system become payer data challenges. Our health plans are burdened with the responsibility of mediating these challenges and piecing together all of the fragments of our healthcare experiences. When we switch plans, those challenges are exacerbated: all of our information is siloed within our old plans, and our new plans are barred from seeing a full picture of our medical histories. This disjointedness within the system, coupled with prohibitive privacy regulations, is how we end up with multiple sources of “truth” for every patient. The result is wide variations in the quality and cost of care we ultimately receive. 

The healthcare industry has been attempting to confront these issues for decades, despite spending nearly $2.1 billion annually to try to resolve them. These challenges can be boiled down to three major roadblocks. 

• Data capture. There is a longstanding inability among health plans to capture clean, and complete data in a timely manner. This is largely due to legacy systems and the continuation of highly manual data processes as best practice, all of which lead to a bevy of downstream issues. 
• Data cleanliness. Payers receive and ingest millions of messy, mis-formatted data points from different providers, data suppliers, and vendors every day. The lack of standardization of these data creates inaccuracies and inconsistencies. Fragmented data often remains siloed within health plans, non-interoperable and underused.
• Data sharing. The lack of standardization of data within health plans makes data sharing impossible. CMS’s interoperability mandate is a much-needed first step toward addressing this issue and will certainly be a driver toward more efficient data sharing practices, but it is exactly that, a first step.

Overcoming these challenges is not impossible, but it requires the best tools and immediate action. According to a recent PwC survey, only 53% of payers have mapped out their data to see what will be impacted by the CMS interoperability mandate. Even more concerning: only 24% of healthcare executives said they see the mandate as a strategic opportunity. Here’s how payers can act now to unlock and realize the full potential of their data.

• Clean up data. Now more than ever, patients have greater control over their data — data which, at the moment, is largely fragmented and incomplete. Payers should strive to achieve a single source of truth for each member. Doing so will allow plans to develop personalized member benefits and give providers a complete view of each patient, allowing them to make more informed clinical decisions and empowering patients to stay healthier, longer.
• Advocate for and improve interoperability. The CMS mandate is a necessary first step, but simply following the mandate is a missed opportunity to innovate and create real change in the ways in which we experience healthcare. It is imperative that payers take up the mantle and champion interoperability from this point forward. We cannot wait for the next iteration of interoperability regulations to improve the quality of healthcare data. Payers should be contemplating ways to ingest quality data, generate new insights, and work with one another to meaningfully engage patients as we experience healthcare.
• Democratize the use of payer data. Payers cannot drive innovation themselves. The promise of interoperability will only be realized once payer data is shared widely, allowing others to drive innovation, improve connectivity, and enhance our interactions with the healthcare system. By giving patients control over their healthcare data, we’re opening a new realm of possibilities. It is upon payers to lead the charge as we step into the future of healthcare.

With the CMS interoperability mandate, health plans have the chance to change the narrative: what has historically been an industry data challenge is now a business opportunity. By taking  action to unlock healthcare data today, health plans can drive efficiency within the industry and innovate to build a more seamless, engaging, and dynamic healthcare system.

Readers Write: Artificial Intelligence Drives a New Medication Management Philosophy

Artificial Intelligence Drives a New Medication Management Philosophy
By Erick Von Schweber

Erick Von Schweber is CEO of Surveyor Health of Foster City, CA.

There are times when advances in technology enable a radical re-envisioning of both what we do and how we do it. Medication management is at that stage, thanks to ongoing developments in artificial intelligence.

Metaphorically, will healthcare use these newfangled mechanical horses to pull its current wagon, or will it open up to radically new possibilities enabled by new technology? Several areas of AI inspire our imaginations. Let’s consider the philosophical inversions made possible.

Clinical pharmacists performing medication management interventions today spend most of their time poring over patient records, mentally integrating what they read. Then, with little time to ponder the patient’s situation, they go on to writing notes and elaborate documentation that few providers will read in entirety, if at all. Yet probabilistic AI reasoning engines coupled with semantic interoperability integrate multifaceted data without glossing over nuances, driving graphical user interfaces providing information visualizations that clinicians understand in seconds – the mental model is on-screen. The clinician can now understand the entire problem space and visually design a solution.  

In this scenario it’s not a matter of man or machine, it’s the collaboration of man and machine, each doing what they do best. Some processes will automate the routine, such as production of documentation, freeing the clinician to spend time doing what only the trained, expert human mind can. Like a financial analyst, they can use that time running what-if simulations to inform their options.

This cooperative interplay between clinician and AI opens up a potential inversion of the customary workflow. Lacking AI, medication optimization today means the clinician attends to each medication in isolation, doing their best to address any issues specific to that therapy and its relational effects with other individual therapies, one at a time (such as duplications and interactions). This traditional workflow leads to Whac-A-Mole, where a considered solution to one issue creates more issues, frequently requiring back-tracking or outright starting over. By visually modeling the entire problem space and assisting the clinician in seeing how to address it fully, AI enables a more productive workflow.

For people outside the AI research community, it’s easy to believe that ML (machine learning) is AI, but the field is far broader. Where ML is about identifying patterns in existing data sets, other areas of AI, such as AI planners, Bayesian probabilistic reasoners, and combinatorial optimization engines, imagine numerous possible scenarios – therapeutic courses of action – then figure out which are viable, which present conflicts, and which make superior tradeoffs for both the patient and the healthcare system. Human cognition inextricably involves both learning and imagination, and in AI circles, imagination, creativity, and metaphor are the vanguard. Indeed, the next steps toward creating an AGI (artificial general intelligence) that operates at near human cognitive levels are focused more on imagination.

We urge those in medication management to free themselves from the bounds that prior generations of technology have restricted them to. It’s time to imagine the future of medication management. 

Readers Write: Addressing the Public “Infodemic” Spurred by COVID-19

Addressing the Public “Infodemic” Spurred by COVID-19
By Denise Basow, MD

Denise Basow, MD is CEO of the Clinical Effectiveness business unit of Wolters Kluwer, Health.

The novel coronavirus proliferated around the globe with lightning speed, spurring an explosion of new medical information over the last 18 months. Care teams on the front lines were desperate to get their hands on the latest guidelines to treat the influx of patients streaming through their emergency departments, but were also faced with misinformation that could potentially harm their patients.

Similarly, patients struggled to understand which information sources to trust so they could protect themselves and their loved ones. The WHO has identified this deluge of information, or “infodemic,” as a primary concern for global health.

According to the WHO, the definition of an infodemic is “too much information, including false or misleading information in digital and physical environments during a disease outbreak, which can cause confusion and risk-taking behaviors that can harm health; it can also lead to mistrust in health authorities, undermining the public health response.”  

Consider that on January 31, 2020 there were 50 studies published on coronavirus within 20 days, which was remarkable progress. Today, there are more than 150,000 studies on coronavirus, with some estimates as high as 400,000 if we include preprint journals and other gray literature.

It is critical that someone make sense of all this information for it to be useful in treating patients, as there is a significant margin for error when considering the immense pressure to do so as quickly as possible to save lives.

While much of my career has focused on getting the latest evidence-based information into the hands of the clinician community to foster the best care everywhere, we can’t forget that patients are a critically important part of the healthcare team. They need the right information as well, and this information should align with the evidence their care teams are using to make treatment decisions.

Fortunately, there is a clear path for combatting misinformation that can lead to an infodemic, and it is critical that the healthcare community understands and embraces it now to mitigate future occurrences:

1. Listen to communities – of clinicians and patients – for the specific questions and concerns that they have.
2. Get the facts into the hands of those communities so they can accurately evaluate risk, particularly around new vaccines in the case of COVID-19.
3. Foster broad understanding of the internet’s ability to produce good and bad information to build resilience to misinformation.
4. Provide tools that empower communities to act, such as education on how to distinguish fact from fiction and everything in between.

Across the world, everyone from government and public health officials to healthcare providers, community leaders, and individual patients need help determining when it’s appropriate to act (or not act) based on the scientific evidence. Everyone should have access to evidence-based information that informs their decisions, and technology should help facilitate, not hinder, that access. We can and we must learn from the COVID-19 infodemic to improve future public health response.

Readers Write: Don’t Cut Corners in Hybrid Cloud Protection

Don’t Cut Corners in Hybrid Cloud Protection
by Pascal Geenens

Pascal Geenens is director of threat intelligence with Radware of Mahwah, NJ.

In the past few months, several high-profile ransomware attacks on healthcare facilities in Las Vegas, Oregon, and New York have resulted in delayed or suspended surgeries and interruption of other patient care, not to mention the loss of millions of dollars to the facilities themselves.

Ransomware is but one of several attack strategies that malicious actors have employed against healthcare facilities. For example, the number of distributed denial-of-service (DDoS) attacks targeting hospitals has also increased since the beginning of 2021.

Healthcare and security teams face incredible challenges following the pandemic. Although keeping patient data available and secure is critical, it is increasingly difficult due to the array of attack vectors and cybersecurity knowledge required to mitigate them. In addition, several mergers of healthcare providers have introduced additional complexity in networks that can overwhelm security teams.

Remote access and online services, such as streaming doctor/patient consultations and online electronic medical records (EMR), have seen exponential growth. Healthcare organizations have had to manage and secure large volumes of patient data and provide 24×7 access to critical applications to ensure a quality user experience and the ability to protect lives. As a result, healthcare remains one of the highest at-risk industries from cybercriminals.

Much of the issue can be traced to the transition — accelerated by COVID-19 — to public clouds, network-connected devices, and the move towards online and application-based services, which mean more vulnerabilities and data breaches. When healthcare services and applications go down, healthcare providers suffer productivity and operational losses, negative customer experiences, and intellectual property losses.

Based upon the results of several industry surveys, don’t expect this race to the cloud to revert. Hybrid cloud configurations are here to stay. Because of the new reality, IT administrators and hackers now have identical access to publicly hosted workloads, using standard connection methods, protocols, and public APIs. As a result, the whole world becomes an insider threat. Workload security, therefore, is defined by the people who can access those workloads, and the permissions they have.

The question then becomes, should healthcare enterprises focus protection on-premises or the cloud? The answer is unequivocally both.

Part of the reason is because another aspect to consider when moving applications to the cloud is the connectivity and accessibility of those applications. When the internet connection from the hospital is suffering from a degraded or total loss of connectivity, all activities come to a grinding halt. Protecting connectivity only with on-premises equipment leaves organizations too vulnerable. On-premises detection and mitigation alone prevented 85% of DDoS cyberattacks, but the other 15% required cloud DDoS protection. Because of the latency introduced by cloud DDoS protection, enterprises sometimes rely only on on-premises protection.

This is a mistake, because even though only 15% of attacks required cloud protection, those attacks represented 92% of attack volume and 84% of the packets. In hybrid deployments, the cloud handles the volumetric attacks while on-premise will typically handle low-and-slow and low-volume DDoS attacks, as well as anomalies and intrusions.

While healthcare organizations face unprecedented challenges, cutting corners in cyber protection isn’t a viable option. Especially during a rapid and complex transition to the cloud, enterprises can’t afford to neglect either on-premises or cloud protections.

Readers Write: How the New ONC Cures Act Will Transform Patient Access to Healthcare Data

How the New ONC Cures Act Will Transform Patient Access to Healthcare Data
By Ariel Katz

Ariel Katz is founder and CEO of H1 of New York, NY.

On April 5, the non-partisan federal rules mandating Open Notes for healthcare data took effect. Known as the Cures Act, the rules specify that clinical notes are among electronic information that must not be blocked and must be made available free of charge to patients.

This is a game changer for any patient who’s ever had trouble getting healthcare providers to share or exchange information on their care – i.e., nearly every US patient, ever.

Data exchange among healthcare providers has been a vexing problem for patients in the US for decades. Providers make patients pay for hard copies of their own files. They force patients to pick up CDs with copies of scans in order to get the data to another provider. They clearly aren’t up to speed on care that’s been provided elsewhere — even when it’s in the same health network — and repeat tests that have already been completed. Patients often get bounced from provider to provider, answering the same questions repeatedly before any care is even provided. The list goes on and on.

All of the problems people thought EHRs were supposed to fix are finally addressed in the Cures Act.

Here are several health initiatives that the Cures Act will catalyze:

Making apps like Apple Health a central place where a person’s complete health data is stored

Patients will be able to access their own health data at any time in one place. This is great for patients, and also really useful for providers in emergencies. For example, say a person from New York gets into a car accident while in Mexico. ER staff can access their health info easily to quickly learn about the patient’s health status and provide the best treatment. Apple Health appears to be emerging as the frontrunner for this, but there are other options. like Google Fit.

Better international data sharing

Right now, the Cures Act applies only to healthcare data in the US. But I believe other countries will quickly follow with their own legislation and standards that will ease secure international data sharing. Increasingly we’re seeing patients, especially those with rare diseases, seeking treatment in multiple countries. Global data sharing would save time and resources, enabling providers to quickly assess what has and hasn’t already been done, leading to quicker and more efficient healthcare.

Better contact tracing for future disease outbreaks

If the Cures Act had been passed earlier – say, in 2019 – it would have completely transformed contact tracing for COVID-19. If all this technology was in place at the start of COVID, contact tracing would have been incredibly simple, and COVID’s effect could have been far less severe in our country, and maybe in the world. If there is ever another pandemic, contact tracing under the Cures Act should be a much faster and simpler process.

The Cures Act seems to have gone into effect almost unnoticed, with very little fanfare. But healthcare pros who are paying attention will quickly realize the potential here for empowering patients with better access to their own health data. Look for a host of new technology solutions enabled by this capability in the coming months.

Readers Write: Alert: Three Keys to Navigating the Traffic Ahead on the Road to Healthcare Access

Alert: Three Keys to Navigating the Traffic Ahead on the Road to Healthcare Access
by Karly Rowe

Karly Rowe, MBA is VP of patient access, identity, and care management products at Experian Health of Franklin, TN.

For any of us who use GPS when we drive, hearing the robot voice warn “alert, traffic ahead” is all too familiar, and usually followed by suggestions for alternate routes to our destinations. In our industry, however, there is only one road, and it’s about to get more crowded, complex, and nuanced. To help patients navigate their way through healthcare in the future, the industry is going to need to innovate.

As the economy emerges from the pandemic, there are dramatic changes in people’s lives and many industries are having to transform their operations in significant ways. For healthcare, we are going to see a changed landscape or, to put it more bluntly, there’s serious traffic ahead.

The impact on employment has been no less than stunning. Data earlier this year revealed that 78 million initial jobless claims had been filed with the Labor Department during the pandemic (that’s almost half of the country’s workforce), and that we had lost more than 10 million jobs. For those of us who remain employed, almost fourth-fifths are working differently, mostly notably through working from home.

These dramatic changes create new barriers impacting patients’ ability to access. Their coverages have changed or been lost entirely, as has their willingness to seek care in the face of their financial situations or other barriers, such as language, and their ability to do so is often impeded (this is especially true for underserved populations). Patient needs have and will also change as they contend with long-haul conditions and Americans in general learn to manage the mental health effects (about half of us have experienced such impacts already) of time in isolation and with limited human contact.

The volume of this transformation is itself a change, and a big one.

The impacts of technology on healthcare should no longer be called revolutionary, but rather the norm, as the pandemic has accelerated the transformation that was already underway. The market for wearables is expected to reach $81.5 billion this year, which is an 18% increase from a year ago. Individuals are using these technologies to manage their own health and the data are factored into a majority of wellness programs. The promise and peril of aggregating and applying these new sources of data aren’t news to you, whether in technical, administrative, or compliance terms. My point is that it’s an unavoidable component of that traffic we face going forward.

And the sheer volume of that component, to the tune of thousands of exabytes in growth annually, is a big one, too.

The road ahead is going to be tough since there are no alternate routes we can take. So, I say we embrace that clarity and apply it to three key areas of work that will help us navigate it:

Invest in tech

Challenging times challenge us to innovate, and it is clear that our systems (the “road” in my analogy) aren’t built to accommodate the changes I noted above. Telehealth is one area that shows immense promise, as patients have grown accustomed to remote interaction during the pandemic. Simply put, getting to a website can be far easier than making an office appointment, and relegating certain diagnostics to remote engagement can be more cost efficient. Integrating that data across touchpoints are important, as is exploring ways to make telemedicine available and attractive to vulnerable populations (the traffic is there, thanks to patients added due to COVID-19, so think about adding lights at entrance ramps to highways to ease traffic access and flow).

Use data to drive patient engagement

It might seem counterintuitive but the engagement and resulting data from interactions beyond the four walls of the clinic can be crucial to better health outcomes. To apply my traffic metaphor again, it’s not necessarily the volume of data, or traffic, that is the problem. Rather, it’s that the lines on the road need to be clearer. According to the Sequoia Project, about 12% of demographic data become outdated within a year due to such facts as 70% of married women change their names. Further, almost a third of that data are misspelled, incomplete, or incorrect. The challenges of consistent and reliable patient identifiers are nothing new, but they take on new currency when the challenges dependent on them increase and become more complex. Today’s solution helps preclude tomorrow’s “traffic” problems.

Don’t make the traffic worse

Patients’ healthcare journeys do not all travel the same road, but rather merge and exit at a number of points, many of which aren’t necessarily traditional sources of health services (and therefore new sources of health-related data). The technologies exist to connect patients to food banks, shelters, counseling services, and community programs, which may serve to lessen the overall impact on traffic. Then, by connecting those services, you can learn more about them and their needs. Insisting that there’s only one way to get to a desired destination – as if there were a single express lane – is old thinking, while considering the opportunities to provide patients with multiple routes while connecting the resulting data and insights into a single, overarching view (a GPS picture, if you will), may be the pathway forward.

We have a clear picture of what the road ahead looks like. While we can’t choose a different route, we can use technologies and tools to make the traffic flow better, faster, and more safely. Times of massive change are challenging, but they can also be inspiring.  We can embrace this opportunity to take our industry where it needs to go.

Readers Write: AI is Essential to Stopping Further COVID-19 Spread and Limiting Future Pandemics — Here’s Why

AI is Essential to Stopping Further COVID-19 Spread and Limiting Future Pandemics — Here’s Why
By Sally Embrey

Sally Embrey, MSPH, MS is VP of public health and health technologies of DataRobot of Boston, MA.

It is safe to say that 2020 showed us the limitations of the US healthcare structure and a long-antiquated approach to public health and emergency preparedness. Under lockdown, it became clear how unequipped the world was to address the scope of the COVID-19 pandemic. Since the onset of the greatest healthcare crisis in our lifetimes, the strengths and weaknesses of our healthcare system came into clear focus, while the consequences of our failures will be felt for years to come.

But how do we move forward? In the United States, COVID-19 spread has varied widely, from states to cities and counties. This spring, as COVID-19 cases in Michigan, New York, and New Jersey were slowly declining, cases in Oregon were increasing at higher rates than anywhere else in the United States, according to The New York Times.

One thing that has been emphasized time and time again is that the absence of more complete, accurate, and representative data was a key and often missing factor in our ability to effectively respond to the COVID-19 pandemic. We also learned that the systems required to process that data were as equally important to delivering the insights needed. The pandemic has made the role of AI in the healthcare field essential to preventing and mitigating future pandemics.

Research groups worldwide built and deployed various AI-driven systems that sought to fight the pandemic. For example, researchers developed systems that automatically analyzed CT images to provide the probability of COVID-19 infection to rapidly detect COVID-19-related pneumonia. Since AI can locate lesions in seconds instead of hours, it can significantly reduce the workload for already overburdened physicians. Other models were developed and deployed throughout COVID-19 to help understand clinical severity and identify the patients most at risk of serious illness and even death. By deploying AI, healthcare systems could prioritize which patients needed to be hospitalized and provided immediate care, and early care was shown numerous times to help with health outcomes.

At the same time, AI systems gave the federal government and state governments insight into where resources were needed most critically. They utilized AI-driven long-term forecasting models to understand the scope and spread of COVID-19, as well as drive site selection during the vaccine trials by predicting where outbreaks were most likely to occur up to eight weeks before cases increased. This could forever change how we enroll individuals into clinical trials, which are typically constrained to research hospitals or highly manual processes. Improving and streamlining the approval of vaccinations is the golden ticket to infectious disease prevention.

Organizations across the healthcare and technology industries also stepped outside of the box to create at-home COVID-19 antigen tests, many of which have an accompanying gamified platform. By combining physical antigen tests with AI and an accessible digital platform, patients are better able to understand their risk of being contagious with COVID-19. Arming people with information about their COVID-19 risk through innovative solutions powered by AI is the solution for slowing and preventing future pandemics.

As a leading nation in health research and technology, we have a responsibility to do better, and we must ensure we can more quickly contain this type of outbreak in the future. By leveraging the importance of complete, accurate, and representative data and combining it with the power of AI and public-private coordination, we can and will be ready to stop future pandemics.

Readers Write: Providers’ Post-Pandemic Assessments of Telemedicine

Providers’ Post-Pandemic Assessments of Telemedicine
By Amanda Hansen

Amanda Hansen is president of AdvancedMD of South Jordan, UT.

Healthcare delivery has shifted dramatically since March 2020, when the COVID-19 pandemic hit. For many providers, telemedicine had fallen into the category of a “someday, maybe” service, not a practice essential that was regularly requested or required of them. But when social distancing mandates were enacted to reduce the potential for infectious exposures, demand and the subsequent adoption of telehealth skyrocketed.

About 90% of providers say they are conducting some of their patient visits via telehealth. They have rapidly scaled offerings to see 50 to 175 times the number of patients via telehealth than they did before the pandemic. Going forward, it is projected that virtual visits will account for $250 billion, or 20%, of what Medicare, Medicaid, and commercial insurers spend on outpatient, office and home health visits.

Given the rapid and event-specific changes to telemedicine’s applications, we were curious about the impact to independent practices and their impressions that will come to shape the future of remote clinical services. Are practices capitalizing on the promise that telemedicine saves them both time and money? What has the effect been on the patient experience? We were interested specifically in the following aspects of telemedicine provision:

• Effect on time spent with patients.
• Effectiveness in reducing barriers.
• Impact of care costs.
• Impact on quality of care

In early April. we partnered with nearly 200 select physician offices to conduct a survey addressing these very questions.

Access

An overwhelming majority of survey respondents, 75%, find that telemedicine reduces or eliminates barriers to care for their patients. For practices, this access is expanded without increasing staff or marketing costs.

The ability to provide effective care is a largely a function of provider availability and visit timing. In many segments of healthcare — such as mental health, primary care, and various specialties — the shortage of providers results in excessive wait times for appointments. Telemedicine makes providers more available and creates opportunities for additional visits, reducing barriers to care.

Convenience

Telemedicine enables flexibility for patients, streamlining care for those outside the immediate area. It also enables quicker resolution for diagnoses and prescribing. Practices offering telemedicine visits are able to divert patients from more costly and complex care settings like emergency rooms. Chronic care patients, in particular, are much more likely to visit with a care provider before the condition enters a crisis and maintain standard care continuity when it is seamless and simple. Convenience remains integral to reducing both barriers and cost of care.

Quality

Among survey respondents, 38% say they are providing more quality care using telemedicine. In one of our other recent surveys, 59% of providers said they feel they are able to provide higher quality care with telemedicine. In the early months of the pandemic, telemedicine allowed practices to remain open to provide the quality services their patients required. Today, the service allows practices to maintain and grow their patient volumes.

Engagement

Telemedicine enables 24% of responding providers to spend more time with patients, but engagement goes beyond time per appointment. Practices that integrate telemedicine with the EHR and other practice management tools like portals, scheduling, text alerts, and claims processing serve patients who are more engaged in their own care. Solutions that meet patients where they are make care management functions seamless and simple. With telemedicine as part of the engagement strategy, patients are getting the same healthcare experience online that they have in traditional, onsite visits, and can even shop for doctors who provide the service and have availability at set times. Engaged patients are healthier patients.

For providers, telemedicine is serving a new purpose. With 271 telehealth case types (with CPT codes) reimbursable by CMS, there are many opportunities to expand utilization and revenue streams. In the decade prior, physicians often engaged in patient phone or video calls without any reimbursement whatsoever. Now, providers are able to deliver services to those who need it with a technology that has proven effective and advantageous.

By reducing costs and breaking down barriers, telemedicine is improving the quality and efficiency of care delivery.

Readers Write: Sharing Diverse Patient Data to Support Clinical Trials: Can We Afford Not To?

Sharing Diverse Patient Data to Support Clinical Trials: Can We Afford Not To?
By Monica Matta

Monica Matta is head of operations and GM of provider business at COTA of Boston, MA.

Flatly,  we cannot.

Clinical trials are the foundation of innovation in the fight against hard-to-treat diseases, including cancers. For the millions of people living with cancer, and the millions more who will be newly diagnosed this year, clinical trials are critically important for opening up new treatment options and paving the way for improved outcomes.

Cancer may affect everyone, but not everyone has equal access to the resources and research projects designed to combat this complex group of diseases. Certain racial and ethnic groups are systematically excluded and chronically disenfranchised when it comes to screening, testing, and clinical care.  These groups, including individuals affected by the socioeconomic and environmental determinants of health, often experience worse health outcomes and mortality at higher rates.

Black patients, for example, are significantly more likely than members of any other group to die from many cancers, including prostate cancer, breast cancer, and multiple myeloma. While black patients account for anywhere from 15-20% of the national incidence of these diseases, they only comprise 3-5% of clinical trial representation. This is a huge problem.

Clinical trials for new therapies are often not truly representative of the populations the therapies will be treating. Lower participation rates not only leave patients without access to potentially ground-breaking therapies, but also leave investigators with worrisome gaps in knowledge about the efficacy and safety of these treatments in the wider, real-world population.

The ethics are clear. There are also financial arguments supporting the need for increased diversity in clinical trials. If manufacturers and payers cannot verify that new therapies are going to achieve the desired result across all potential populations, why should they invest time and resources in distributing these agents to patients?

We simply cannot afford, both morally and more tangibly, not to focus on architecting more representative and inclusive clinical trials.

We can begin to meet the needs of underserved and underrepresented populations by encouraging more individuals to participate in clinical trials and prioritizing the evaluation of real-world outcomes with an emphasis on privacy and ensuring equitable access to the results. In order to do so, investigators must have access to rich, curated, diverse real-world data that accurately capture the experience and outcome of patients from all backgrounds.

Healthcare providers, including cancer centers, oncologists, and other specialists, remain a critical conduit for facilitating education about the benefits of data sharing and connecting patients with clinical trial opportunities. We must continue to build strong relationships between patients, providers, and clinical trial sponsors to gain the trust and input of diverse populations.

As we look to the future, however, there is much potential in leveraging technology and portals to clinical research marketplaces that allow individuals to grant access to their personal data assets for specific, well-defined use cases. These marketplaces will likely include some type of data dividends as compensation for participation. Patients can then become the direct purveyors and benefactors of their data, creating an entirely new model which reengages the right stakeholders in the conversation once more.

As we develop these ideas and tackle the myriad issues around the creation of such a system, we will need to keep informed, empowered patients at the center of all we do. Privacy, security, and equity must remain paramount to ensure our efforts are transparent, sustainable, and effective.

Whatever the next generation of data sharing will look like, we have opportunities right now to meet our obligations to patients. By pairing technical innovations with clinical expertise, we can lay the foundations for more expansive use of real-world data from traditionally underrepresented populations. We can continue to prioritize de-identification and patient privacy as we grow our data-sharing networks to encourage contribution and participation. We can proactively connect with representatives from underserved groups to provide education about clinical trials. We can keep working across the healthcare enterprise to refine our research approaches, expand access to breakthrough therapies, and support patients throughout their healthcare journey.

This is a moral imperative. For the sake of our neighbors, friends, families, and colleagues, we cannot afford not to be inclusive when it comes to clinical trials for cancer and the real-world evaluation of new protocols. The choices we make now will directly impact the lives of millions as we look to a future where sharing patient data with researchers is empowering and rewarding for all.

Readers Write: Taking the Friction Out of Digital Health Adoption

Taking the Friction Out of Digital Health Adoption
By Manny Fombu, MD

Emmanuel “Manny” Fombu, MD, MBA is founder of Marché Health.

COVID-19 showed the value of digital tools, encouraging a flood of new solutions into the market. The resulting confusion has launched a seemingly unending cycle of pilots, delayed digital health adoption, and hampered progress.

In pandemic-hit America, health organizations are expected to do more with less — less patient volume, less funding, less resources, less staff resources. Having the right tools in place can extend and assist burdened care teams, allowing them to improve patient retention and raise STAR ratings / HCAHPS scores.

Staying ahead of the latest digital health innovations can be challenging. Information is coming from disparate sources, creating noise and hindering the ability to garner any actionable insights. With global digital health companies raising $1 billion a week in March 2021, there is no slowing down yet.

However, there still isn’t one unified digital health focused marketplace and community where all key stakeholders in the ecosystem — including health systems, clinicians, payers, consultants, biopharma, entrepreneurs, and investors — can go to, not only to find out which digital health tools work best, but to actually review products, learn, and connect with key decision makers to quickly adopt them.

Today, more than ever, it is crucial for healthcare organizations to simplify the evaluation and adoption of digital health initiatives by adopting a marketplace that meets community engagement needs to educate, connect, and empower individuals in order to stay safe in the tsunami of tools and one-sided information creating friction and plaguing consumers.

An independent, objective, and trusted marketplace helps health systems innovate and improve healthcare outcomes by:

• Lowering acquisition costs.
• Gaining insight through centralized, unbiased data.
• Learning from buyer recommendations.
• Learning about programs that advance patient care.
• Streamlining the procurement process.
• Gaining objective peer-to-peer feedback.

A marketplace must not only connect buyers and sellers, but also create a community where all sides can come together to actually learn from the other and to identify which solution is the best.

These days, it is all about lowering healthcare costs and achieving IHI’s Quadruple Aim (better outcomes, lower costs, and improved patient and clinician experiences). Innovative health systems must make connections that cut through the “app-pollution” that prevents the customer from making better purchasing and partnering decisions leading to empowerment and advocacy , not confusion and frustration.

This can only be achieved by the ability to:

• Compare vendors based on objective, trusted data.
• Make connections.
• Increase transparency.
• Enhance knowledge.
• Simplify elevations.

It is time to break the pilot merry-go-round and find ways to not just increase, but improve digital health adoption. Then, we can achieve the promise that these innovations offer and discuss lasting results.

Readers Write: Provider Scheduling Matters

Provider Scheduling Matters
By Mary Piepenbrink, RN

Mary Piepenbrink, RN, MBA is SVP/GM of PerfectServe Provider Scheduling powered by Lightning Bolt.

It’s time to vanquish dated provider scheduling methods. This subject is near and dear to my heart, but I think we have finally reached critical mass. The market for provider scheduling technology has matured, and real-world results prove it is safe—and wise—to make the leap.

The scheduling market started from a desire to improve physician scheduling at practices, so it was outpatient centric. Using technology to generate equalized, fair schedules in group practices was the original market opportunity. We didn’t call the central problem “burnout” then, but it was there, and it has gotten progressively worse.

Scheduling solutions still solve for those practice and burnout problems, but they have also moved beyond the outpatient office setting, scaling into broader areas to create better workflows and more efficiencies across health systems.  The easiest way for me to demonstrate value—real return on investment—is to create four buckets:

• Value to health system. There are many, but the best scheduling solutions generate real-time, integrated, dynamically updated information for multi-faceted uses across the health system, all leveraged to improve both business and clinical operations.
• Value to care team staff. Simple—speed to care. Scheduling systems must power other applications in the health system so the care team staff can locate and connect with providers in a frictionless way. I was a nurse back in the day, and when I needed an order for my patient, I would check a paper on-call list, hope the needed specialist listed was accurate, hope the pager number hadn’t changed, hope the provider would actually get the page after I dialed it on a landline, then really hope for a fast return call so I could just go deliver care. I also hoped I wouldn’t get pulled away or distracted while waiting only to miss the callback and have to start the whole process over. Today’s clinicians have mobile devices and digital on-call technology, but without accurate, integrated scheduling information, the care team still experiences much of what I used to go through. And there are still lots of pagers! So, scheduling technology helps organizations improve speed to care by facilitating seamless location of (through scheduling information) and connection (via secure communications) with the right provider.
• Value to group practices. Scheduling systems integrated with payroll systems means accuracy in provider pay. The use of advanced technology to auto-generate optimal, fair schedules means greater provider satisfaction. Scheduling issues are the top factor leading to burnout, which is costly for practices. Using scheduling technology that supports capacity / resource management also helps improve patient access, provider utilization, and patient and staff satisfaction. Less burnout means less provider turnover and a better patient experience.
• Value to end user provider. The ability to reduce friction associated with schedule management: accurate pay, ability to easily request time off, ability to easily swap shifts if needed, ability to include preferences that will actually be considered in even the most complex practice, and knowledge that the schedule produced is the most balanced possible and based on proven technology versus the chance of human error. Many providers also actively involve themselves in scheduling, which robs time from patient care.

One of my biggest frustrations is when I see innovative health systems buy the latest technology without articulating what they’re solving for—technology for technology’s sake or “it’s an IT project” instead of realizing the technology’s true value for patients and/or staff and how the other existing IT investments can be exploited (which also makes those systems more valuable). That’s why my healthcare brain and my nurse’s heart were equally joyful when KLAS zeroed in on ROI and found that enterprise scheduling solutions generate tangible outcomes and positive impact. As it turns out, there’s real value to be had if you do this right!

I’ll close with a story . I was chatting with a radiologist who had tried scheduling solutions before but always reverted to manual scheduling. I asked how long it took him to produce his practice’s schedule by hand. “About 20 hours a week,” he said. I replied, “Why on earth don’t you just hire someone, even full-time, to do that for you so you can spend those 20 hours reading films?” His answer was simple: “Because my life matters that much to me, and my partners’ lives matter that much. Unless we can find something as good as me, I’ll keep making the schedules.” In that moment, it became very clear that we need to make what we do in the scheduling world as near-perfect as possible, because it absolutely matters.

Readers Write: Hospitals Shouldn’t Skimp on Meeting May’s ADT Deadline

Hospitals Shouldn’t Skimp on Meeting May’s ADT Deadline
By Claudia Williams

Claudia Williams, MS is CEO of Manifest MedEx of Riverside, CA.

Time is running out. There is now just over a  week to go before the May 1, 2021 deadline for hospitals to meet the Centers for Medicare and Medicaid Services (CMS) regulation requiring hospitals to share event notifications with community providers when a patient is admitted, discharged, or transferred (ADT). If hospitals want to keep getting paid by Medicare and Medicaid, they need to act now.

While it may be anxiety-inducing to compliance and IT departments, this fast-approaching deadline will be a joyful milestone for patients and providers in the community. Studies have shown repeatedly that sending ADT notifications is one of the most impactful ways to enable care coordination and reduce readmissions after a patient is hospitalized. One University of Colorado Hospital study found that patients who didn’t receive follow-up by their primary care provider after discharge were 10 times more likely to be readmitted to a hospital.

The good news is that ADT notifications are easy, especially if hospitals work with a partner that can match and route messages to the right community provider. So easy, in fact, that in a 2019 letter in support of the rule, authors reported they “were unable to find a single example where a hospital was unable to send an ADT notification today due to lack of standards.”

But “meet the mail” approaches won’t cut it. Some hospitals and their vendors are making minimal effort to route notifications to the right community provider. That’s a risky move. This rule is about “delivering” ADT notifications, not just “generating” them, meaning these vital alerts must actually reach the health partners who need them in your community.

Non-profit health information exchanges (HIEs) across the country are a powerful solution for last mile delivery of encounter alerts. Exchanging data for more than 92% of Americans today, these statewide and regional networks have the infrastructure and information to ensure ADT notifications securely and quickly reach the right providers in your community. Hospitals simply share an ADT feed with the HIE. The HIE does all the heavy lifting of matching ADT notifications with the right providers and routing alerts to them in real time. Once notified, providers can act quickly to support patients and ensure they recover safely at home after a hospital stay.

Beyond ADT alerts, HIEs’ roles in care coordination are expanding rapidly. A 2020 report found that nearly all HIEs today have “partnered with one or more of the following community and social service organizations: correctional health, social service agencies, drug and alcohol treatment programs, first responders, school nurses, or blood banks.” With HIEs as partners, hospitals are more effective and efficient hubs of care coordination in the community, improving patient experience, strengthening relationships with referring providers, and resulting in better patient care. COVID-19 has shown just how crucial this collaboration is. New York’s HIEs reported delivering a record-breaking 10 million ADT notifications during the pandemic and doubled the number of patient record look-ups as healthcare leaders there struggled to keep patients safe.

Their report concluded that “Health information exchange (HIE) continues to play a vital role in the delivery and quality of patient care. In 2020, it was demonstrated and verified that the sharing of clinical information can be leveraged even further in support of population health initiatives, playing a role to help predict health outcomes for the coronavirus pandemic and other health care crises that may occur in the future.”

While the May 1 deadline is approaching fast, progress on interoperability is just getting started. HIE partnerships can help hospitals meet new ADT alert requirements but can also help them succeed in value-based care, strengthen community care coordination, reduce paperwork burdens, and improve patient care.

Readers Write: The Disaggregation of Healthcare and Its Implications for Care Coordination

The Disaggregation of Healthcare and Its Implications for Care Coordination
By Dhruv Vasishtha

Dhruv Vasishtha, MBA is director of product management for PatientPing of Boston, MA.

Of all the changes that are taking place in the healthcare industry, perhaps the most important of all is disaggregation – the unbundling of care — into a more open, local, and transparent model that delivers greater control to patients.

This trend towards disaggregation is a positive one, yielding the potential to make healthcare more dynamic, responsive, and innovative. But it poses challenges as well, particularly in the complex areas of care coordination and patient data flow. As Julie Yoo, a general partner at the venture firm Andreeson Horowitz, noted last year, “We are seeing the fundamental topography of the healthcare industry changing before our eyes, and it will impact all the ways that data flows and operations are run.”

This article will look at the following dynamics that are at play in the healthcare industry as it undergoes disaggregation and the implications for care coordination.

The unbundling of hospitals

How we access healthcare is changing. In the past, when we got sick, we all traveled a similar patient journey. We went to our doctor, or if our symptoms were more serious,  we went to the hospital. We got diagnosed and treated and either were hospitalized or returned home.

Today, we have many different points of access to this care beyond the hospital walls. We can receive care from retail clinics, community centers, behavioral health clinics, home healthcare providers, and virtual visits, among other options. COVID-19 has accelerated this trend, making it more acceptable for people to seek accessible, convenient, and affordable care wherever it is available.

Payers are encouraging this shift since care is costly in hospitals and patients increasingly prefer to remain in their homes and receive care conveniently via today’s technologies (telehealth, at-home testing kits, remote monitoring systems) or through medical professionals coming to them. Thanks to these and other technological advancements, along with increased public openness to receiving new methods of care, the boundaries of clinical capacity can now extend beyond traditional physical and geographic lines.

Changing care reimbursement models

The accelerating move away from fee-for-service and toward value-based care models is incentivizing the outsourcing of care to independent providers and shifting the emphasis to products and services that put the patient’s whole care experience first. This trend has similarly accelerated due to COVID-19 as healthcare entities saw how dangerous it was to rely solely on fee-for-service revenues at a time when very few Americans were seeking out care, even if it was necessary.

The US government has also leaned into value-based care, one of the few areas with bipartisan consensus, to create new financial mechanisms that incentivize new types of providers to carve out specific niche of care management and delivery and get paid for it. For example, the Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service beneficiaries.

The new Direct Contracting Model, which began on April 1, 2021, provides participants with increased risk options and is an integral component of the Centers for Medicare and Medicaid Services’ (CMS) strategy to redesign primary care as a platform to drive reductions in costs. Rather than outsourcing services, contracts are being made directly with physicians to deliver care and get reimbursed. As a result, new physician groups are popping up that are removed from the PCP or hospital, and these groups are catering to specific populations or types of care to deliver more efficient, effective care.

Primary care provider independence

Related to the changing care reimbursement models noted above, there is a move towards greater physician independence. After years of acquisitions by hospital groups, doctors are launching their own practices or joining with other independent providers in a move away from employed positions. While employment offers physicians security and stability, independence provides them greater autonomy and flexibility and an opportunity to focus on each patient’s individual needs without limitations.

For patients, the trend towards more independent providers means greater choice, improved quality, increased access, and more affordability. However, it also means that care coordination becomes more complex, as their data is no longer centralized or easily accessible when these patients move different physicians and physician groups for care.

The impact on care coordination

As a result of these shifting market dynamics, there is a lot more fragmentation in the market, which has created an increased need for improved care coordination —  the ability for provider care team members to collaborate on shared patients to support long-term health, the cornerstone of value-based care. The promise of improved collaboration among providers, overall improvement in care quality, and ultimately successful patient outcomes cannot be realized without a successful patient care coordination program.

Care coordination is also an effective means to reduce wasteful spending. An article in JAMA examining waste in the U.S. healthcare system cited ineffective care coordination contributing up to $80 billion in wasted spend. This is because healthcare is often in silos, which leads to miscommunication, unclear ownership, fragmented patient care, and frequently poor outcomes, particularly among the most vulnerable populations.

An effective care coordination strategy can help to bridge gaps and connect silos among care teams. Key to this is the ability to share real-time information about patients’ care encounters across provider types and care settings. For example, if a patient goes to the emergency department (ED), their healthcare provider should be alerted by admission, discharge, and transfer (ADT) e-notifications that allow them to connect directly with the patient and the hospital care team to share critical details about their medical history. From there, they can determine the appropriate care plan, whether it’s post-acute care (PAC), behavioral health treatment, or visiting with their primary care physician.

In March 2020, CMS finalized the new Interoperability and Patient Access Rule to help hospitals better serve their patients through coordinated and collaborative care and prevent patient readmission. The rule creates a new Condition of Participation (CoP) requiring hospitals, psychiatric hospitals, and critical access hospitals to share electronic ADT based e-notifications with other providers across the care continuum whenever patients have inpatient or emergency department care events. With the May 1, 2021 compliance deadline nearing, this interoperability can not only fill in the gaps in care, but also prevent redundant procedures.

Done correctly, care coordination can drive quality outcomes across the care continuum and lead to other benefits for providers, including:

• Lowering ED utilization.
• Preventing hospital readmissions.
• Preventing unnecessary procedures and tests.
• Eliminating medication errors.
• Treating behavioral health problems holistically.
• Identifying and managing social determinants of health.

Conclusion

The disaggregation of healthcare holds the promise of ushering in a new model of care delivery — one that is cheaper, more personalized, and more cost-effective — while still delivering value. The key to its success lies in ensuring that all participants in the care continuum have access to real-time patient data and the ability to coordinate and collaborate with other providers across care settings during patient encounters. Real-time information can provide participants with a new level of clinical intelligence to successfully prioritize and deploy care coordination services and ensure seamless transitions of care for patients while also creating optimal opportunities to achieve shared savings, delivering on the promise of the new care delivery model.

Readers Write: Mandatory Encounter Notifications Keep Physicians in the Care Huddle

Mandatory Encounter Notifications Keep Physicians in the Care Huddle
By Samit Desai, MD

Samit Desai, MD is chief medical officer of Audacious Inquiry of Baltimore, MD.

Primary care physicians (PCPs) are often compared to the quarterback of a football team, as they understand all of the players involved. With this knowledge, PCPs can execute a proper game plan for their patients and direct them along the right routes in the care continuum process.

But imagine a quarterback trying to run the offense without any knowledge of what yard line the team is on. That’s often the situation PCPs face when they do not have up-to-date information about their patients.

With accurate, real-time information—such as when patients are admitted to the hospital or discharged—PCPs can make the right play calls to provide more efficient care, keep patients healthy, and reduce hospital readmissions. The Centers for Medicare and Medicaid Services (CMS) recognizes the importance of these “electronic encounter notifications” to such an extent the agency took the extraordinary step of issuing a mandate: hospitals must make admission, discharge, and transfer data available to patient-identified PCPs and other practitioners, as a condition of participation (CoP) in Medicare and Medicaid. Hospitals must meet this specific e-notification requirement by April 30, 2021.

This is good news, although it is not a simple process. I suspect many hospitals wonder if this CoP notification ruling is simply another administrative hurdle without impact. The truth is that accurate encounter notifications will improve care for patients and keep PCPs in the loop, but hospitals need to prepare now.

CMS has valued this information-sharing process and has encouraged notifications and follow up for years, including through the creation of the TCM Billing Code. These notifications, plus provider outreach to patients that can be as simple as a follow-up call, can help reduce readmissions, which in turn lowers costs for everyone. As the industry continues its steady transition to value-based care, there’s been a greater focus from government, health plans, and providers when it comes to providing access to patient data for improved care coordination. PCPs and providers are better informed through more opportunities to walk through patient conditions, debrief on procedures, conduct medication reconciliation, and coordinate any necessary next steps and communications with specialists.

These notification requirements are new for some hospitals, and compliance is not as simple as flipping a switch. Hospitals are burdened with obstacles and must account for other priorities, including updating registration workflows, supporting new EMR configurations, and preparing for regulatory audits.

To meet these challenges and remain eligible to participate in Medicare and Medicaid, hospitals are increasingly looking for an experienced partner who can help navigate federal regulations and provide the technical capabilities required to deliver effective encounter notifications. For the CoP notification requirement to serve its intended purpose, hospitals should evaluate the options available and look for services that support patient-asserted and provider-attributed alerts.

Transitions of care are among the most crucial moments for patients, and we cannot afford to let anyone fall through the cracks. These new CoP requirements are an encouraging development and will ensure that these critical care coordination technologies are available to patients nationwide.

When hospitals and other providers work from the same playbook and share real-time encounter notifications, patients will benefit from better care coordination, tailored follow ups, and improved health outcomes.

Readers Write: A Proactive Engagement Strategy is Key to Building Patient Relationships and Driving Outcomes and Experience

A Proactive Engagement Strategy is Key to Building Patient Relationships and Driving Outcomes and Experience
By Mike Linnert

Mike Linnert, MBA is founder and CEO of SymphonyRM of Palo Alto, CA.

Each calendar year, we use awareness months to bring attention to different chronic conditions and diseases that affect the lives of millions of people here in the US and around the world. For example, March was National Kidney Month, which highlights the 37 million people in the US – more than 1 in 7 adults – who suffer from chronic kidney disease (CKD). What’s even more alarming: approximately 90% of those with CKD don’t even know they have it. One in 3 American adults is at risk.

CKD is the ninth leading cause of death in the US. Like other chronic conditions, it’s important that we spend time talking about what we, as healthcare innovators and providers, can do to educate those at risk. We need to help those who are suffering manage symptoms and reduce the risk of acute, life-threatening conditions. We also need to increase general awareness of these diseases and their co-morbidities. 

Early awareness and intervention are proven to drive better health outcomes; in fact, early detection is the most effective way to combat CKD.

When we look at the aforementioned statistic – 90% of those with CKD don’t know they have it – the urgency of education and awareness becomes clear. Erkeda DeRouen, MD, a primary care physician and Inlightened expert, reiterates just how critical knowledge can be: “Kidney disease is very important to discuss because it’s one of those ‘silent emergencies,’ what they call ‘silent killers,’ a lot of people think of like heart disease.” According to DeRouen, a lot of people with some degree of CDK can live for years without knowing anything is wrong, given that it doesn’t always have clearly-defined symptoms.

Be proactive with your outreach and communications. Since most patients don’t know they have CKD or potentially other life-threatening conditions, it may be too late by the time they reach out for care. Whether it’s a chronic condition or simply a healthier lifestyle, providers are in a unique position to improve patient awareness about the role they play in their own health, well-being, and outcomes. A well-designed, data-driven engagement strategy that proactively communicates relevant information, such as tips and tricks for eating healthier, can go a long way in furthering their awareness of the conditions for which they are at risk and can drive real change in their own health.

For health systems and providers, one way to do that is through the development and execution of a data-driven engagement strategy. Data and prioritization are key for effective and successful patient engagement. For health systems, it’s not what content a person is likely to consume (think Netflix); rather, it is about the next best action a patient should take for their health and wellness.

Take for example, a patient with several outstanding actions (i.e., Annual Wellness, colonoscopy, cancer screening, glaucoma exam, etc.) that must take place as part of their care journey. How do you effectively reach out to the patient? What’s the most important action for the patient to take right now?

A study from the American Heart Association found that nearly half of patients who received support through a patient engagement tool prior to a cardiology clinic visit had a positive change in their medication therapy compared to less than a third among patients who did not receive the engagement tool. 

The health systems that are able to deliver hyper-relevant and actionable engagement based on data, both during and between encounters, have a great opportunity to drive real impact in reducing the number of Americans at risk of, and suffering from, chronic conditions like chronic kidney disease.

A study conducted by Forrester on behalf of Cedar revealed that more than a quarter of patients switched medical providers because of a poor digital health experience. The research found that in 2020, 28% of patients switched providers because of a poor digital health experience, a 40% increase from 2019.

We can expect these trends to continue as patients expect the convenience of digital healthcare experiences as a result of the pandemic.

Patients’ expectations will continue to evolve as the consumerization of healthcare continues its forward march. As more and more providers and systems recognize the importance of mirroring people’s everyday digital lives, data shows us that patients will make choices to seek healthcare experiences out that fit their lifestyle and meet their expectations. With consumer brands like Amazon expanding their healthcare footprint, the opportunities for patients to seek out the experiences they expect continue to grow.

In order to drive those sought-after experiences, providers and systems should:

• Be proactive. Don’t wait for patients to come to you for information. With the plethora of rich data and insights available in healthcare today, proactively reach out to and engage patients as their health advisor to guide and activate them towards the care they need.
• Be clear. If you want to drive patients to take an action, don’t make them guess why you’re reaching out. Be concise and to the point and then make the action easy to complete.
• Personalize. Personalization extends beyond just email campaigns that include a primary care provider’s name. They have a higher click-through rate than those that are generic or come from the health system, but which channel or medium does each patient prefer to communicate? Will SMS be more effective for some patients? Or perhaps even good old phone calls? What action is the most relevant for the patient now?
• Prioritize with data. Rather than sending blanket messages to every female patient over the age of 50 about scheduling a mammogram and potentially overwhelming radiology, why not prioritize and reach out to those who are most at risk first? Imagine sending a text message with information on breast health and how they can schedule an appointment directly within the text.

Unfortunately, we cannot wave a wand and make all patients healthy no matter how much we wish we could. What we can do is leverage the technology that we have available – that people are already accustomed to using – to drive awareness about patients’ health and wellness that lead to better outcomes and healthier patient populations. In the process, patients might have an experience that makes them want to stick around.

Readers Write: Improving Adherence, Affordability, and Experience with Better Point-of-Care Data

Improving Adherence, Affordability, and Experience with Better Point-of-Care Data
By Christie Callahan

Christie Callahan is chief operating officer of RxRevu of Denver, CO.

As healthcare leaders continue to focus on patient outcomes, preventive care, and total wellbeing, it is essential to keep cost at the center of the discussion. Affordability and access continue to be major barriers to care, with over half of Americans saying they have received a medical bill that they did not have the funds set aside to pay for, and more than 10% of adults reporting delaying or skipping care because of financial reasons.

While there are segments of the population that are uninsured or underinsured (a separate issue to discuss), even those with insurance coverage are unable to proactively manage their healthcare costs. Lack of data and pricing information often causes consumers to forgo care altogether or become frustrated with the burdensome process of researching coverage and cost details.

There is no question that a lack of transparency causes a negative healthcare experience, and nearly everyone knows somebody who has been overwhelmed or surprised by medical bills. The challenge is that the work required to effectively diagnose and treat a potential new condition is often extensive, and the costs aren’t understood until the work has been completed.

Many new regulations and solutions center around patient price transparency. But are we approaching the problem in the right way?

Patients on their own are often incapable of making specific choices about care options without the help of a provider.

Let’s use a simple drug order as an example. Common chronic conditions require near-perfect medication adherence to manage the condition appropriately. While costs can be quite low, if the wrong medication is prescribed, or the patient fills the prescription at the wrong pharmacy, costs can quickly escalate. In this case, a new prescription must be ordered by the provider, requiring additional research by the care team, an additional visit to the pharmacy, and additional time when the patient is not on the medication.

Policies like the Hospital and Health Insurance Price Transparency Rules and the No Surprises Act mandate that plans and providers disclose negotiated rates and cost estimates over the course of the next few years. These rules allow patients, and sometimes providers, to view coverage data and have conversations around the cost of available options to improve affordability.

However, in the prescription drug space, CMS created more specific rules for EHR vendors and Medicare Part D plans, mandating the availability of real-time prescription benefit tools for providers and creating a wave of interest and acceptance of point-of-order solutions. By focusing regulation and technology capabilities on driving transparency for the patient and the provider at the point of care, together they can better manage spend and find affordable care options.

It is essential that we give providers the right tools to view a full picture of their patients and allow for condition and cost management conversations to occur. We need different-in-kind solutions that can make a meaningful difference in the exam room and help drive comprehensive conversations and decisions.

What can be done to accelerate implementation, acceptance, and use of solutions like this?

What is most important today is starting a conversation around how we can better support providers, as we continue to ask them to do more in the exam room.

First, we need better tools and data at the point of care.

• Solutions must be fully integrated into care workflows so providers can quickly and easily take action without feeling burdened by cumbersome tasks. There is often value in partnering with clinical system vendors who are instrumental in ensuring a consistent provider experience through the normalization of patient data and their ability to maximize payer coverage.
• Every patient is unique, with unique insurance coverage, financial situations, and conditions. Therefore, the data displayed within the EHR can no longer be inaccurate, incomplete, or estimated. It must be patient-specific, detailed, and displayed in real time.
• Solutions must allow for broader engagement and support from care team members. Payers and PBMs must be willing to allow access to patient data to create an open network for care providers, regardless of role.S

Second, we need to better align incentives across healthcare stakeholders.

• When patients stay healthy, payers are the primary beneficiary. There continues to be an opportunity to shift that value to providers, as they are best equipped and have the most responsibility to impact patient outcomes. Price transparency tools, in particular, can help care teams better manage risk, as well as better participate in cost-based incentive models.
• Interoperability and price transparency policies have seen recent acceleration. But more can be done to create a truly interconnected and open ecosystem where care teams have access to robust, accurate coverage data and, with patients, are able to deliver the lowest-cost care in real-time.

There has been tremendous progress in healthcare through technology and interoperability innovations, improvements in the ways provider teams manage difficult diagnoses, and advancements in personal health tracking. But high healthcare costs continue to be a top issue for many. While the issue of cost is incredibly complex, if we aren’t able to have informed cost conversations at the point of care, we risk delaying the shift to value and perpetuating a pattern of negative healthcare experiences for patients and providers alike.