EPtalk by Dr. Jayne 12/16/21

The healthcare IT world seems to be going into hibernation for the winter. I don’t expect too many big news stories between here and HIMSS. I’ve started to see some buzz around the Consumer Electronics Show and plan to attend virtually if they ever approve my request for press credentials. I enjoyed the virtual approach last year, although some day I’d like to go in person – they say the atmosphere of the show is really something, although I’ll be interested to see what in-person attendees think of it this year compared to its pre-COVID-19 vibe.

There’s minimal buzz around HIMSS, but I’ve gotten a lot of questions about ViVE. Everyone loves an excuse to go to Miami Beach in March, but the price tag is steep and requesting media credentials would require me to reveal my true identity, so I guess I’ll have to take a pass.

Regardless of the lack of vendor or industry news, academic channels continue to put out good articles. I enjoyed this recent item in the Journal of the American Medical Informatics Association. Titled “Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use,” it does just that, by looking at data from ambulatory care physicians in over 360 health systems in the US that use the Epic EHR. They looked at data from December 2019 to December 2020, capturing the full timeline of the onset of the pandemic. They used data for active use of the EHR, after-hours use, and messaging. I wasn’t surprised that they saw a decrease in EHR use at the beginning of the pandemic. However, utilization not only ramped back up to baseline but increased by July 2020. This was consistent for both in-office and after-hours use.

In-Basket messages increased, largely due to the category of patient messages, which grew to 157% of its pre-pandemic average. Most of my colleagues hate the inbox regardless of the EHR platform. It usually contains not only messages from patients but also refill requests, correspondence from other providers, requests for referrals, preauthorization paperwork, lab results, diagnostic study results, and reminders to complete documentation in a timely fashion.

Some organizations do well at allowing physicians to delegate a large amount of this work to appropriately trained staff members, which allows team-based handling of many patient messages, refill requests, and referral / authorization requests. However, others refuse to let anyone other than the physician do this work, which not only leads to burnout, but can delay care. The savviest organizations report on their inbox workload and monitor how much work is being done by which members of the staff and adjust coverage accordingly. I wish this approach would be more commonly adopted, but as long as physicians continue to do the work without pushing back, there’s not a significant incentive for those organizations to change.

I wrote recently about challenges faced by the US Food and Drug Administration’s Risk Evaluation and Mitigation Strategies (REMS) programs to help mitigate the risks of serious side effects with certain medications. I used the program for the drug Accutane as an example. Little did I know that the IPLEDGE program for Accutane and its generics would implode this week. A colleague wrote in response to a patient complaint about refill delays: “Since Monday, there has been a nationwide issue regarding IPLEDGE and the FDA’s system for controlling isotretinoin prescriptions. They decided to change several things with the system and use a new website without first ensuring the website actually works. It is *literally* a sh*tshow with the nationwide program being shut down, hold times more than six hours for their tech support, and no one able to renew their prescriptions. I would give the office a break as currently no dermatologist in the country can send isotretinoin prescriptions until the FDA fixes the website.”

Sounds like the FDA didn’t learn much from the clozapine website debacle. These are exactly the kind of technology nightmares that physician offices fear, and which can bring even a well-oiled refill process to a screeching halt. Unfortunately, there’s no mitigation for the losses and frustration caused by this type of systems failure for either the providers or the patients. There are enough experienced healthcare IT people out there who know how to plan a project and how to run a go live that this should not be happening. Sounds like there were gaps in end-user testing, help desk support, and a potential reversion plan. Now that this has happened twice, I’d be interested to hear from anyone with FDA connections on what they plan to do to keep it from happening again.

Despite the news we’ve heard in the past that chocolate is good for you, new information shows that boring old multivitamins are more likely to slow brain aging. Preliminary information from the COcoa Supplement and Multivitamin Outcomes Study for the Mind (COSMOS-Mind) showed that taking a multivitamin each day for three years was associated with a 60% slowing of cognitive aging, most notably in patients with pre-existing cardiovascular disease. The findings were presented at the 14th Clinical Trials on Alzheimer’s Disease conference. The impact of vitamin use peaked after two years then remained stable; the reported 60% slowing is equivalent to 1.8 years. I usually treat myself to some dark chocolate around the holidays, and despite the evidence, I won’t be changing that habit.

I was commiserating with a friend recently about the American Medical Association’s monopoly on Current Procedural Terminology codes. Most of the provider-side organizations I have worked with dread the AMA’s license process, which is challenging for smaller organizations that have a lot of part-time users. Some EHR vendors include AMA licensure in their own license fees, but others make you work directly with the AMA to arrange licenses. My friend must know someone with some good AMA connections, because he later sent me a picture of this AMA-branded cheese board set. I’m not sure what exactly it’s trying to convey, since it’s somewhat evocative of what you see in movies when the character who is going to torture someone opens a case with various knives and picks. From a cheese board standpoint, the recessed AMA logo looks like a great place to harbor bacteria.

The holidays always bring out some interesting corporate gifts, although lately I’ve seen more companies making donations on behalf of their workers rather than sending gifts. What’s the most unusual corporate gift you’ve seen? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/16/21

Innovaccer Raises $150 Million Series E Round at $3.2 Billion Valuation, Continues Rapid Growth Trajectory

Analytics and interoperability vendor Innovaccer raises $150 million in a funding round that brings its total raised to $375 million.

Cloudmed Acquires par8o, Advances 340B Discovery Capabilities for Healthcare Providers

RCM company Cloudmed acquires provider referral management technology vendor Par80.

Embold Health Raises $20M in Series B Led by Echo Health Ventures

Physician performance analytics company Embold Health raises $20 million in a Series B investment round, bringing its total funding to $50 million.

Ensemble Health Partners, in Partnership with Caduceus Capital Partners, Leads Series A Round for Janus Health

Revenue cycle automation startup Janus Health raises $8 million in a Series A funding round.

Readers Write: 2022 Trends: How Health Systems Plan to Meet Top Business and Clinical Objectives By Automating Patient Engagement

2022 Trends: How Health Systems Plan to Meet Top Business and Clinical Objectives By Automating Patient Engagement
by Vik Krishnan

Vik Krishnan, MBA is general manager of Intrado Digital Workflows of Omaha, NE.

With hospitals and health systems continuing to face both staffing and supply shortages, many experts are hoping that 2022 will provide some relief, especially if the COVID pandemic finally enters its endemic phase. This will allow healthcare leaders, including health IT executives, to address other crucial priorities. And when it comes to next year’s objectives, enhancing the patient experience ranks at the top of the list, according to 91% of respondents in a recent Intrado survey administered to College of Healthcare Information Management Executives (CHIME) members. Other financial and operational priorities included increasing visit volumes (cited by 68%) and reducing burdens on personnel (49%).

Given these priorities, it isn’t surprising that in the same survey, 51% of healthcare IT executives stated they planned to invest in systems that make it easy to communicate with patients via SMS for different workflows including scheduling, reminders, recalls, referrals, and other patient engagement needs. This can be accomplished using automated, digital technology. The most advanced engagement platforms have deep EHR integration, include chat bot technology, and enable two-way SMS communications in real time between health systems and patients. Chat bot technology, in particular, delivers human-like interaction to patients seeking answers to commonly asked questions without requiring the direct engagement of a staff member. Two-way communication via text message allows patients to schedule, confirm, and/or reschedule appointments when it is most convenient for them.

The majority of respondents (83%) also report that they already use their patient engagement solution to automate basic appointment reminders. However, less than one-third (30%) offer two-way, SMS-based self-scheduling to their patients. This is significant for two reasons. First, SMS is the patient-preferred communications channel, providing a simple, convenient means of engaging with patients. In addition, offering self-scheduling via SMS can positively affect each of the health system leaders’ top objectives, including improving the patient experience and bolstering revenue through increased visit volumes, fewer no-shows, and reducing the burden on call center staff. Perhaps that’s why 47% said they plan to automate appointment self-scheduling or rescheduling directly from SMS messages in the future.

Given the latest advancements in automated patient engagement technology, health systems need to raise their expectations of these platforms and how they can meet their goals. Healthcare organizations will realize gains by leveraging their patient engagement solution for more than appointment scheduling and reminders. This includes a wide variety of tasks that address gaps in care and boost revenue. For instance, just 19% of surveyed executives currently use their engagement tool to manage referrals, even though this area contributes heavily to revenue leakage, impacts quality of care and consumes vast call center resources. And only 38% use digital engagement for pre-procedure patient communications, including, for example, sharing instructions on how patients should prepare for procedures like colonoscopies.

Knowing that providers and support staff devote significant amounts of time to inputting patient data and maintaining EHRs, healthcare IT executives are looking for opportunities to streamline these efforts. In fact, of the respondents who did not plan to automate patient engagement in 2022, 37% expressed concerns that doing so would place even more of a burden on the end user and IT resources. However, certain digital engagement platforms deeply integrate with the EHR the health system already uses. This eliminates the need for manual input by writing patient engagement activities from and directly back into the EHR.

Eighty-seven percent of those surveyed stated that the level of EHR integration offered is among the three key factors they consider when evaluating a potential IT investment. This answer ranked higher than other important considerations like cost, ROI and ease of deployment. Plus, 85% of responding executives said they want the EHR to serve as the “single source of truth” for all patient data, including the documentation of patient engagement activities, responses, and reporting.

Hospitals and health systems have invested heavily in patient portals in response to government mandates requiring transparent access and sharing of healthcare data with patients. This explains why 60% of surveyed healthcare IT professionals reported their institution relies on a portal for all patient engagement needs. And while patient portals do contain valuable information for patients, low portal adoption rates make them a poor choice as a sole communication method. A better solution is complementing the portal with a robust, EHR-integrated patient engagement platform that delivers information and education when and where it is most convenient for the patient—through SMS, email, or phone.

Here’s a practical example that demonstrates the value of having a complementary engagement solution. During the height of the pandemic, in early 2021, demand for the COVID-19 vaccine was so high that the patient portal of one New York-based health system crashed due to the number of patients logging on at the same time to schedule a vaccine appointment. Since the health system also deployed an automated patient engagement tool using two-way SMS outreach, it was still able to bridge the gap and continue to offer patients the ability to schedule and reschedule their COVID-19 vaccines.

This two-pronged approach gives healthcare providers and patients ultimate flexibility. Patients can use the portal for activities like reviewing their health records or downloading test results, while healthcare organizations can deploy automated patient engagement technology to reach patients in real time and in the patient’s preferred communication channel.

The use of automated, digital engagement not only improves the patient experience, it also promotes better health outcomes. Patients are far more likely to engage, schedule an appointment, and adhere to the recommended care plan when they can self-schedule their appointment and easily text a question to providers. SMS patient engagement featuring live chat, in particular, puts an end to cumbersome phone trees and waiting on hold, creating efficiencies for staff, too.

Based on these findings, healthcare IT executives clearly understand the advantages of automating patient engagement and plan to invest in these solutions in the future. Whether it is accomplished via a new solution or applying new workflows to an existing platform, automation of many patient communication tasks can benefit health systems and patients alike.

HIStalk Interviews Rajesh Voddiraju, Group President, Health IPass

Rajesh Voddiraju, MS is founder and group president of Health IPass, a Sphere Company of Oak Brook, IL.

Tell me about yourself and the company.

Sphere is a payments company that, across multiple industries, streamlines the payment process for consumers and in healthcare in particular. We are all about taking friction out of the payment process through an integrated solution that meets the needs of large health systems all the way to the smallest of the healthcare practices.

To what degree is healthcare still using clipboards and badly designed paper forms instead of electronic systems for collecting check-in and billing information?

As we look at how the industry has evolved, the first generation of solutions effectively came up with electronic ways to change these forms from paper-based to an electronic clipboard. Maybe a kiosk, maybe a tablet, and having folks, when they come into the clinic, be able to use electronic mechanisms in terms of the data capture.

We’ve always believed that’s just a starting point. The more you enable patients to be able to do it in advance, the better. The second generation of the evolution focuses not just on doing it in the clinic, but enabling people to do it on any device, any time, with a mobile-first kind of a strategy. Baked in there were some really cool innovations, such as enabling the patient to take a picture of their driver’s license to validate their identity or to take a photo of their insurance card. Being able to read information and ensure that we’ve got a good capture, just like your banking apps do when you scan a check, for example. That type of innovation was a second generation.

We’ve always focused on predictive analytics way beyond just the data capture, how that can streamline the billing process and ultimately make that experience good for both the consumer as well the healthcare provider.

As patients become a significant source of revenue for provider because of health plans with high deductibles, there’s a real pain around collecting patient responsible dollars in a streamlined, easy manner that both educates the consumer as well as makes it easy for that transaction to occur. It’s not just about replacing the electronic clipboard. That is now table stakes. It’s enabling that workflow to occur any time well in advance, on any device, with the right kind of smarts embedded into it.

The third generation is to take it one more level in solving the key issue in healthcare, which is that the consumer doesn’t know what things cost and the merchant — the healthcare provider — literally has no guarantee that they’ll ever get paid. Solving that in a way that educates the consumer and enables price transparency so that there are no surprises later is a big part of the transformation that we as Health IPass and Sphere have brought to healthcare consumer engagement.

Does that inability to tell patients what they will owe upfront limit their willingness to leave their credit card information on file as they do in almost every other industry?

I’ll answer that from two standpoints. One is the regulatory implications. The No Surprises Act is the next evolution of regulatory intervention by both state and federal government to avoid surprise billing and to make sure there is advanced notice for the consumer in terms of what their out-of-pocket is going to be. From a technology standpoint, providers have often struggled to have the right type of technology that enables them — as they become in-network with various insurance companies — what that contracted rate is.

The first part of a triangulation that we do within our platform is to know what the contracted fee schedule is with a particular provider across the different insurance companies. The second is to be able to set up the right kind of rules to say, for example, that if you had a surgery and multiple procedures were done, how does that affect the reimbursement in terms of what the provider would get paid? These were rules that were here before in a black box, where nobody quite knew except the super specialist in billing. Technology now has been able to bring in and codify all of that information.

On top of that, we need to know how that affects a particular patient at a particular point in time. Luckily, through the Affordable Care Act and the administrative simplification that was put forth many years ago, the black box of where a particular patient is in meeting their deductible, the balance remaining, their max out-of-pocket, and the plan design data are easier for companies like us to access.

We built a robust solution around being able to, for regular office visits all the way to surgical interventions, compute, based on all three of these factors, what the patient’s out-of-pocket is. We present it to the patient so that there is no surprise. Then it becomes easier for the patient to opt in and leave a credit card on file because they know it’s not going to be hit for just any amount, that payment assurance is being procured or secured in conjunction with the estimate that has  been provided. We get incredible adoption rates across millions of patients every month and every year.

If a patient checks in through Health IPass, the healthcare provider typically gets paid almost 97.5 cents on the dollar, which is unheard of when most healthcare providers get 50 to 60 cents on the dollar with paper-based practices and the surprises it yields. An educated consumer is definitely a better payer, and our data and our history has proven that for the healthcare provider, that is absolutely the case.

How do you tune the various factors that impact the likelihood of being paid, such as insurance history, provider specialty, the emergent nature of the encounter, and the level of co-pay and deductible involved?

There’s definitely multiple layers of complexity to your point. The first is to take the payer-specific rules and create a library of rules that can be set up across providers. I mentioned the example of multiple procedures, where perhaps the first cohort is paid at 100%, but is the second cohort paid at 50% or is it 33%? Those are typical rules that you could layer a global set of rules. On top of it, we need to always be able to model the individual contract. If you are at Northwestern here in Chicago, for example, who’s a client of Sphere, you have a special contract with Blue Cross Blue Shield of Illinois that enables you for a different reimbursement model on that multiple procedure example. We have to be able to overlay that with a provider-payer specific set of rules within our platform. 

On top of all of that is the variability of where an insured patient is at that particular point in time. We have real-time connectivity with 926 insurance companies across the country. In real time, we know that the patient has this much money remaining on his deductible and this much money on his out-of-pocket maximum, both at an individual level as well as a family level. There’s a lot of computation and artificial intelligence / machine learning that is in play here in terms of making it simple at the end of the day to educate the patient that for a suggested procedure, here’s your out-of-pocket.

Ultimately, the card-on-file mechanism enables the consumer to have peace of mind. The provider is still filing a claim with their insurance company and letting the insurance company adjudicate the claim. Only when you have it down to the penny, the exact amount that is truly the patient out-of-pocket, does an electronic bill get presented. Patients get a text message or email, whatever they prefer as a consumer, and they still have the opportunity to ask for payment assistance or things like that before their card is auto-debited for the exact, down-to-the-penny amount as adjudicated by their insurance company.

Dentist offices make sure that outstanding balances are addressed before they schedule the next appointment. Is it hard on the medical side for practices or clinics to discuss the balance owed, a low propensity-to-pay, or a possible financial hit for patients who are early in their benefit year when they haven’t met their deductibles?

The big difference between dental and medical is typically when you go to a dentist, the dentist knows exactly what is going to be done. A treatment plan has been pre-established. That’s not always the case in the medical world. That’s part of the reason, along with lack of the right tools, that we have surprise billing. There’s a lot more complexity to in-network and out-of-network. The best practice is to embrace this notion that transparency creates better patients and better patient engagement. Obviously that has to be assisted with the right technology.

We’ve taken pride in helping clients remove this paper and these black boxes, whether it’s on the front end of the process or post-visit engagement. We talk about how can we streamline the entire appointment to payment journey as part of our patient engagement process. It’s about allowing the patient to schedule themselves, answer the appropriate screening questions, get on the schedule with the right provider as most convenient for the patient, and take the journey all the way through in terms of setting the expectation based on the type of visit, how the patient has answered a certain set of pre-screening questions, the expected out-of-pocket, and educating them on what the insurance company will and will not cover and where they stand on their benefits early in the process.

Certainly if the patient has outstanding balance — regardless of whether that bill came from a specialist visit like a dermatologist, an orthopedic surgeon who is part of the group, diagnostics, surgeries, or labs — being able to present a consolidated single bill at that moment of engagement by the patient. Eliminate getting 16 different bills that all come at different times. It’s too confusing for someone who may have a household with a few more interactions with the system. Transparency into what their outstanding balance is and presenting payment assistance or payment plans that may be available for that particular patient, as determined and customized by that healthcare provider, is an important step of what we do.

As I mentioned before, the more you educate folks in advance for future care, the more you are able to secure their payment assurance through a card-on-file and streamline the electronic billing process. It works out well for all parties involved. The patient is happy. They don’t get surprised. They don’t have to go look for a stamp. They don’t have to go look for a paper checkbook. It’s very, very good for the health system that was getting 50 or 60 cents on the dollar to suddenly realize that moving to 97.5 cents also creates better patient engagement and better patient satisfaction.

What factors will have the most impact on patient payments and healthcare in general in the next few years?

Number one is increased transparency into patient out-of-pocket expense. We welcome this and are certainly glad to see regulatory intervention, including the No Surprises Act, that will put more impetus behind creating that level of transparency. The second is owning more of the patient journey. We now do everything from upfront patient self-scheduling all the way to, after you’ve had your surgery and you’ve gone home, what are called patient-reported outcomes. What’s your range of motion? How is that improving over time? Being able to leverage technology to provide that type of clinical insight to the surgeon, in this case, to be able to intervene properly with the particular patient.

That’s the range of capabilities that are important, so you don’t have a hodgepodge of vendors that are doing different things and you can create a more streamlined experience for the consumer. Those two big trends is what we are excited about. We feel that we are in a great spot to be able to service the needs of consumers.

Morning Headlines 12/15/21

Shannon Hospital caught in crossfire of ransomware attack on tech giant, payroll software

Shannon Medical Center (TX) reverts to downtime payroll procedures after payroll and workforce management software vendor Kronos experiences a ransomware attack.

XIFIN Expands into Pharmacy Market with Acquisition of OmniSYS

Health IT and RCM vendor Xifin acquires retail pharmacy software company OmniSys for an undisclosed amount.

Cadence Raises $100 Million to Build the Infrastructure of the Future for Health Systems

Remote patient monitoring and virtual care company Cadence raises $100 million in a Series B funding round.

News 12/15/21

Top News

Shannon Medical Center (TX) reverts to downtime payroll procedures after payroll and workforce management software vendor Kronos experiences a ransomware attack Saturday.

Kronos said in an announcement that it expects the outage to last several weeks. It suggests using “alternate business continuity protocols,” which will no doubt put Christmas payrolls at risk.

Kronos says the attack affects Kronos Private Cloud, which includes UKG Workforce Central, UKG TeleStaff, Healthcare Extensions, and Banking Scheduling Solutions. Applications outside Kronos Private Cloud are unaffected.

Reader Comments

From Morty: “Re: Edifecs. Purchased Health Fidelity on the heels of its acquisition of Talix. Interesting moves being made in the risk adjustment space.”

HIStalk Announcements and Requests

I set up a short survey that covers expected turnover at your company, what your employer is doing about it, and your own job changes. I appreciate your taking a couple of minutes to complete the form. A reader expressed alarm at the high amount of turnover that was reported in my most recent poll and hopes to learn more.

Webinars

December 15 (Wednesday) 1 ET. “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications.” Sponsor: Spok. Presenters: Matt Mesnik, MD, chief medical officer, Spok; Kiley Black, MSN, APRN, director of clinical innovation, Spok. The presenters will identify the technologies that most often contribute to clinician burnout, then explain how improving common clinical workflows can help care teams collaborate better and focus on what they do best—taking care of patients. They will describe how a clinical communication and collaboration platform can automate clinical consults and code calls to alleviate burnout.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Cloud, managed services, and analytics company Healthcare Triangle acquires EHR and managed services company DevCool. Healthcare Triangle went public in October, raising $13 million at $4 per share.

Centauri Health Solutions, a Medicare and Medicaid technology vendor, has acquired health data exchange software company Secure Exchange Solutions.

Patient intake technology company Phreesia acquires Insignia Health, co-developer of the Patient Activation Measure program. Results from a PAM assessment, co-developed by researchers at former Insignia Health stakeholder the University of Oregon, are used to improve risk identification, better support patients, and evaluate impact as a patient-reported outcome measure.

Health IT and RCM vendor Xifin acquires retail pharmacy software company OmniSys for an undisclosed amount. OmniSys CEO John King will become president of the new OmniSys division.

Workforce management software vendor Prolucent Health raises $11.5 million in new funding.

People

Gil Kaminski (DaVita Kidney Care) joins Laguna Health as VP of clinical product.

Care Continuity names Steven Mason, Jr. (Iodine Software) CEO.

David Mulligan (PhyzData Healthcare Solutions) joins Carenet Health as EVP of technology.

OneOncology hires Andy Corts (SignalPath) as CTO.

Tissue and implant tracking software vendor TrackCore names John Weller (University of Michigan Health – West) as CISO.

Sales

• Virtua Health (NJ) chooses Kyruus for provider directory, website provider search, and online scheduling.

Announcements and Implementations

Scarborough Health Network implements Epic across its three campuses in Ontario.

Healthcare IT Leaders will enable multilingual support for its COVID-19 contract tracing services in partnership with Voyce.

Other

Announced as a HIMSS22 keynote presenter is Ben Sherwood, which HIMSS describes as “one of Disney’s greatest innovators” who will talk about leading and succeeding during disruption. He left Disney-ABC three years ago after a short three years on the job as president, passed over in favor of executives of Disney-acquired 21st Century Fox. He was the subject of a scathingly funny 1988 article that ridiculed the then-Rhodes Scholar (like his sister) as “the ultimate in a long line of centerless resume featherers” who was raised rich and shallowly ambitious and deemed by his Harvard classmates as “one of the most hated people alive.” Finally they get someone interesting.

Sponsor Updates

• Bamboo Health publishes a new e-book, “CMS’ E-Notifications CoP: The Route to Compliance: Part 4.”
• Change Healthcare releases a new podcast, “Let’s Talk Interop: Moving Toward Electronic HEDIS Measures.”
• Optimum Healthcare IT publishes a case study titled “Optimum CareerPath Accelerates Cutting Edge Software Company Clearsense.”

Blog Posts

• With cloud, the sky’s the limit for image management (Agfa HealthCare)
• Help! One Year of the New Improved DRVS Help Section Part 2: Details & Data (Azara Healthcare)
• Most Read Posts for Epic EHR Optimization (CereCore)
• 2030 Interoperability Projections – EHR Software, Physicians & Patients (ChartLogic)
• Securing Healthcare’s Digital Transformation for Providers, Vendors, and Patients (Clearwater)
• Impact of technology on the future of healthcare post COVID-19 (OBIX Perinatal Data System, developed by Clinical Computer Systems)
• (Part 3) Reaching Patients Along the Specialty Medication Journey: Persistent Patients (ConnectiveRx)
• ‘Ask Your Doctor If:’ How to Talk to Patients About Popular Drug Ads (CoverMyMeds)
• Let’s Celebrate National Influenza Vaccination Week #fightflu (EClinicalWorks)
• Streamlining prior authorizations for faster patient collections (Experian Health)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Morning Headlines 12/14/21

Middleton’s Pivotal Health snags $1.3M investment, seeks another $10M

App-based house call company Pivotal Heath raises $1.3 million in an investment round it hopes will eventually include another $10 million.

Phreesia Announces Acquisition of Insignia Health, LLC, Redoubling Its Commitment to Improve Patients’ Experience and Outcomes

Patient intake technology company Phreesia acquires Insignia Health, developer of the Patient Activation Measure program.

Healthcare Triangle (HCTI) Acquires DevCool, an Electronic Health Record Focused Healthcare IT and Managed Services Company

Healthcare Triangle acquires EHR and managed services company DevCool to add large health systems and IDNs to its customer portfolio.

Curbside Consult with Dr. Jayne 12/13/21

The hot gossip around the physician lounge towards the end of the week centered on CVS Health’s plans to enter the world of primary care delivery. For anyone that missed it, their plan is to use telehealth, new clinics, and teams of physicians, nurses, and pharmacists to help solve the primary care problem. CVS Health believes that because it owns resources across many of the touch points of the healthcare system, it is uniquely positioned to enter the market.

If you are not in the US or are less familiar with the company, it not only owns thousands of retail pharmacy locations (some of which offer urgent care-type services), but also a pharmacy benefit manager (Caremark). Additionally, CVS owns a health insurance company (Aetna), so I don’t disagree that it has a pretty broad portfolio.

Not too long ago, CVS Health began rebranding some of its stores as HealthHub locations. I could never figure out what that differentiator really meant. My local store was rebranded, but nothing changed – still the same products, still the same square footage, and no increase in the number of exam rooms or appointments for its retail clinic. The company plans to keep adding these HealthHub stores (including 1,000 this year) and they are supposed to host a physician-led care team that includes dieticians, mental health professionals, and social workers. At the same time, the company is planning to close several hundred other retail locations as populations shift.

Digging deeper into the company’s press releases, it sounds like the company plans to further shift store formats, stating “Three distinct models will serve as community health destinations,” including sites that are dedicated to primary care, sites that are an enhanced HealthHub “with products and services designed for everyday health and wellness needs,” and traditional CVS Pharmacy stores “that provide prescription services and health, wellness, personal care, and other convenient retail offerings.” I couldn’t find mention of any changes to the CVS relationships with Target stores or the regional grocery chains with which it has also partnered.

I don’t disagree with their goal of providing a resource to better coordinate care or manage chronic conditions. The company is well aware of what we in primary care have known for a long time – primary care services are relative cheap in the grand scheme of healthcare spending (about 10% of annual spend in the US) and can actually help prevent disease and slow the progression of chronic diseases. This can lead to overall savings in healthcare spending.

However, there simply aren’t enough primary care physicians to go around, and in our culture, the perceived value of having a primary care physician is low. People seem to prefer transactional care that happens on their schedule, and I understand that as well.

Knowing that there aren’t enough physicians, many of my physician colleagues were speculating on how CVS plans to do this. CVS apparently plans to acquire physician practices, which should be interesting. Nearly 70% of physicians in the US are employed by hospitals or corporations, which have been on a buying spree during 2019 and 2020. The hospital/health system-employed portion of that number is about 50%. The remaining corporate entities include insurers and private equity firms. When they haven’t been purchased outright, independent physicians are consolidating into larger networks.

When you stratify the data by physician specialty, it becomes more interesting. The specialties with the highest rates of being physician-owned or independent are surgical subspecialties, anesthesiology, and radiology. Among the bottom five: pediatrics, family medicine, and internal medicine – in other words, primary care. I’d be interested to learn more about the CVS Health acquisition strategy because frankly I’m not sure where they’re going to find the headcount. Just because you purchase a practice doesn’t mean a patient will stay with it. Patients may not like how the new practice runs, and I can pretty much bet that a CVS-owned location will run differently than the average private practice.

Physicians may not stay with the practice. Perhaps they are closer to retirement than advertised and decide to leave immediately following any earn-out or guarantee period. Even if you can convince a subset of physicians to join a new practice with CVS Health, they’re likely to be hampered by non-compete clauses or other negative incentives that will make recruiting their patients a challenge. Additionally, folks who have remained independent for this long, in the face of ongoing market consolidation, might not be terribly well suited for the corporate medicine life.

Being cared for by a physician affiliated with a hospital or health system is a powerful idea. Patients, especially those who are medically complex, often feel a sense of security about having all their subspecialists and consulting physicians within the same system. Even with interoperability, there’s a sense that outsiders might not have access to all the records or might not provide the same level of care. There’s also backlash against corporate entities in some communities, with concerns that profit-oriented organizations will use patient medical records for marketing or other purposes.

One of the largest challenges I see for CVS Health acquiring these primary care practices is the matter of electronic health records. Many of the independent practices that they might acquire have EHRs that support that independence, like those from Athenahealth, NextGen Healthcare,EClinicalWorks, Greenway Health, etc. Having been through countless EHR conversions, I know that getting data out of those systems is usually easier said than done. I hope CVS Health has a substantial EHR conversion budget and is right-sizing their staff to handle it because patients expect their records to move with the physician, especially if the whole practice makes a transition.

Additionally, from a human resources standpoint, the altruistic physician candidates who are causing medical school admissions to surge won’t be ready to hang out their shingles for another seven or eight years. There’s no guarantee that they will find primary care attractive unless there are major changes. On the other side, there are a lot of burned-out physicians in the world right now who might just see working for CVS Health as a good thing. Time will tell how well their recruiting efforts will pay off as well as how challenging the technical pieces will be.

What do you think of the CVS Health move into primary care? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Steve Shihadeh, Founder, Get-to-Market Health

Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

Tell me about yourself and the company.

I have spent my whole career at the intersection of healthcare and technology. I worked for SMS, Shared Medical Systems, right out of college. I grew with that company and ended up running sales for them when Siemens took over. I did that for a few years, then went to Microsoft and ran their US healthcare business. I got involved with the Health Solutions Group through Amalga and HealthVault products. I then went to Caradigm and was their chief commercial officer. 

I started to Get-to-Market Health about almost five years ago to help healthcare technology companies improve their go-to-market activities.

Does the number of recent eye-popping funding announcements mean that the old rules have changed, or is it more of a situation where those companies, who may be new to healthcare, need to learn some hard lessons about carving out a niche?

They are eye-popping to everybody. I see good that comes from it and also some challenges. When the right company gets funding, it helps them go faster. We’ve been working with a company in the medical device space that is well funded, on a really solid track, and they are just able go faster than they would be. The investor is betting on a long-term bigger return by letting them go faster now. We have seen examples of telehealth companies that just got incredible valuations. Whether they hold up over time is the question.

Every company we talk to or work with is in the middle of some sort of funding discussions. It’s healthy overall that entrepreneurs can get capital to build a business, but there are some messy spots to it. Think about Practice Fusion, which ended up being worth maybe a fifth of what people thought. Allscripts had to pick up the pieces. Theranos is still in the news every day. So there certainly are some not-pretty pictures, but on balance, equity investors, private equity investors, venture investors, and hospital-backed venture funds are trying to do their due diligence. They are evaluating companies. Saying that it is spawning a renaissance is maybe a little strong, but it is certainly spawning a lot of interesting companies.

The Silicon Valley model involves grabbing market share and chasing growth at all cost. Is the healthcare investment model still valid that assumes that companies need to be able to improve outcomes or reduce cost?

It’s no surprise to anyone that healthcare is slow. Nobody is imagining that they are going to build a real, honest, billion-dollar business in three years. There’s no confusion that healthcare takes time and it’s a complicated business. What is encouraging is that most of the investors we see today are people who only invest in healthcare. They understand it, they get it, and they know the successes and the horror stories.

Providence has a fund. I think Jefferson has a fund near me. Hopkins has a fund and has launched an interesting company. Those folks clearly get healthcare and they are pretty long-cycle investors. They have more patience than some pure private equity company that maybe spend its mornings in manufacturing and its afternoons in healthcare. You have a little smarter investor than you had even a few years ago.

Is it good or bad that the line between investor-funded companies and providers is blurring as providers start funds and companies and companies are opening clinics and telehealth practices?

There are certain things that a for-profit hospital can do a good job on. I’m not sure you or I would want to go get the most complicated surgery ever at a for-profit hospital. They have different niches. For-profit investors have a different horizon in terms of when they want their money back, and their tolerance is low for any hiccups. There will be a fair amount of appeal to the hospital-backed venture and maybe growth equity funds, because the entrepreneur will look at them and say, they get healthcare. They know how hard it is to get things going. I think they will be pretty successful.

They have a lot of work to do to become as capable of investors as the private firms. Whatever you say about the private firms, they know how to crunch the numbers. They know how to value companies. So probably there’s room for both, and I don’t think it’s bad to have them both in the space. If I was an entrepreneur, I would consider both. There’s going to be a better fit depending on what the business is, the model and how much money you need, and how long you’re going to take to build your business.

How will executive job changes affect the plans of companies?

I wonder if what’s behind that is new investment or a need for new investment. Companies that are taking a round of money or have just taken a round have to demonstrate that they are making changes. A lot of times, the investor comes up and says, let’s build a big go-to-market plan, let’s go to three countries instead of one, or let’s go into some new markets. That is probably a big part of the exodus that you see — there’s a financial transaction coming or has happened, and for whatever reason, they decide they want to bring in a new regime to help steer things, or there’s an exit and those folks move on.

We’ve gotten called in several times to help people build go-to-market plans for a new market because they are anticipating some investment and they want to be able to demonstrate to the investment community where they’re going and how they’re going to get there.

Private equity companies are rolling up companies and acquisitions to earn rich returns, with Athenahealth being a recent example. Will that trend continue?

Five years ago, private equity was somewhat of a novel thing in this space. They were able to buy multiple companies, invest in them, and grow them. They are finding out that it’s not so novel. An alternative to buying lots of companies is to buy one and then buy some smaller adjacencies around it to build a bigger, more complete company. HBOC tried to do that, but had trouble integrating all those pieces. I suspect there may be some issues around the corner for those companies. You can buy companies and put a common brand in front of them, but getting them to work together is a big challenge.

Does a successful exit require customers to be satisfied?

It should 100% matter. If I’m an investor and I’m buying a business that has a bunch of unhappy customers, I’m sure not going to pay $17 billion for it. Either there are a bunch of happy customers that the investor found or they didn’t look carefully enough. My thesis is that a company is only worth as much as its customers are willing to stay with them and willing to pay. Happy customers that are renewing, adding on, and buying new things are worth a lot of money. But you look at some of these companies that have disgruntled customers, it’s hard to imagine that the math works. I would think that investors have figured that out and are taking that into account.

Epic would be worth so much money because they have a loyal, happy, renewing, expanding, and growing customers. They are worth more than another EMR company that might not have happy customers and might have lots of negative press. In our experience, the companies that are doing well are worried about taking care of the customers. It’s not all math. They can’t just think that just because they sold 10 systems, they are a valuable company. They have to have happy customers who are going to renew and buy more stuff or else their future value isn’t what they think.

What kind of help do companies need to support their intention to do more than just make short-term sales and instead to position themselves for long-term success?

Getting your product and your company to be viable in the market includes making sure you have a product that customers can understand, value that they can understand, and that you are serious about a happy, successful deployment and an ongoing relationship. We spend a ton of time in that area, because maybe the investor or CEO who doesn’t have a ton of experience in healthcare may not grasp all that. 

If you’ve been around healthcare, you know how important it is to ensure that you have happy customers, that you invest the time and money, and that you have an empathetic viewpoint about what it takes to make customers happy. An unhappy customer is far more important than 10 happy customers. You have to focus on it, and we absolutely get pulled into those discussions all the time.

I had responsibility for our overall customer satisfaction at SMS, Siemens, Microsoft, and Caradigm. I appreciate it. It’s hard. It’s hard to keep them all happy. But if you take care of your customers, even if you have tough times, they reward you for it. They get how hard it is. When Epic or Cerner fixes a rough customer situation, those customers are loyal to them for a long time.

Do you think HIMSS and RSNA exhibitors were as happy as those organizations claimed that professional in-person conference attendance was down two-thirds?

Those conferences are like a stock market that gets overblown and it takes a drop. It’s actually healthy in the long term. RSNA and HIMSS are doing what they have to do, which is putting on as good a face on as possible. But I’ve talked to enough people who were at both shows to know that there was a real lack of potential buyers. If you were interested in meeting with vendor partners, it was helpful, but it was out of balance between what the vendors would have hoped and expected to see in terms of potential buyers and who was there. The shows have gotten too big and too full of themselves and they need to reorient.

I thought the HLTH conference was pretty good. They had a better balance.They didn’t have a ton of buyers there, but it didn’t feel as out of balance as HIMSS and RSNA have felt to me of late.

They are putting a good face on it, but it wasn’t the show that everyone hoped. I talked to some vendors who had a great show at RSNA, generally the newer entrants that had something exciting, innovative, and disruptive. I don’t think the big mainstream players in any of those shows felt good about them.

How have health IT sales and marketing changed as the pandemic approaches the two-year mark?

We have one client that has never had the luxury of a attending HIMSS or a trade show. They have built their business on having connected advisors who can make introductions for them. They built a comprehensive easy way to showcase and demo their product remotely. They figured out a low-cost way to deploy it and even trial it. They never knew the old way since they are pretty new, and they have seen tremendous growth. 

The old model was to get ready for product announcements in the fall, release them in January or February, go to HIMSS, show them, do a couple of events for customers during the year, and then go back to HIMSS. That model was broken and is broken.

We have clients that have done a phenomenal job with social media. They are on every day and they are using customers and third parties to help promote and educate people about their product. We have one client that has done a great job with social, and as we have helped them go to other countries, people in those other countries are already aware of them. They haven’t spent any energy or time yet in those countries because social is global and they’re on their LinkedIn or Instagram pages learning more about them.

When I was at Siemens, I think we had 600 people at RSNA. Clearly HIMSS and RSNA were multi multi-million dollar investments for those big companies. That model is going to change for sure. After RSNA, most of those companies are going to say, OK, next year we’re going to do something different. They will be at at RSNA, but they probably can’t justify as much space.

I did hear from one client at RSNA that there weren’t a lot of middle- and lower-level people at RSNA. The company sent fewer people. They were able to connect with executives who they wanted to see to talk about a product or an issue or something they had. They felt better about that. I don’t think it was all bad, just not a home run.

How will the vendor-CIO dynamic and conference focus change as health systems create more C-level roles that carry IT and digital responsibilities?

The CIO and IT department  are as critical as they’ve ever been, but I don’t think they are the front line any more. The front line is the ultimate end user of the product. Then you have to persuade and educate the CIO, CISO, and the IT department and make sure your product fits in with their protocol around security and IT tech and that you meet whatever their criteria are. I still think that there is benefit for IT folks, including the CIO, to attend HIMSS, especially if they want to get a quick look at 10 different companies, if that’s really the best part about it.

There was a day not that long ago where you would sell an EMR or a piece of medical equipment to IT. Now the CIO defers and says, who’s the champion within the health system who wants and needs this product? Then, how do you help that end user understand the product? What’s the market fit for it? How’s the price? Then the CIO has to judge it and figure out whether it fits in their environment.

What industry changes will we see in 2022?

I’m impressed by companies that meet three key things that separate them. They have an innovative product and an innovative pricing approach. They are disruptive, in a good way, to what has been done before. They have a compelling story behind them.

Every company that has done well in this business has a compelling story. Think about Judy building Epic from one scheduling app at University of Wisconsin into a giant, successful company. Her attention on customer satisfaction and all that. There’s a compelling story there and in other companies where the entrepreneur has believed in his or her niche and built the business.

Successful companies are thoughtful about the business, have a disruptive product and/or pricing model —  because people just can’t spend unlimited money — and they have a compelling story that people can latch onto. When I was at SMS, the two founders had put together a business that met a key need, people could understand it, and there was a compelling story. That helped people buy it. That’s still very true today.

Morning Headlines 12/13/21

CVS Health maps out path to steer into primary care delivery

CVS Health will add primary care centers that offer in-person care and telemedicine services to several hundred of its locations.

Weak defenses made cyberattack on Irish hospitals easy, experts find

Analysis finds that Ireland’s national health service was unprepared for a May ransomware attack that crippled its services after an employee clicked a malicious Excel email attachment.

Reveleer Secures $65 Million To Expand Capabilities To Deliver End-To-End Data Analytics Platform To Healthcare Payers

Health plan member and provider analytics vendor Reveleer raises $65 million in a venture funding round.

Monday Morning Update 12/13/21

Top News

CVS Health says in its yearly investor meeting that the company will add primary care centers to several hundred of its locations and open more HealthHubs.

The primary care centers will employ doctors, nurses, and pharmacists who will offer both in-person and telehealth services.

CVS says it will expand its nurse practitioner-staffed MinuteClinic model by acquiring physician practices and clinics.

“We are closer to the consumer than anyone else,” the CEO said.

CVS owns the country’s biggest pharmacy benefit manager, Caremark, and Aetna, the country’s third-largest health insurer.

HIStalk Announcements and Requests

Over 40% of poll respondents either changed employers in 2021 or plan to do so in 2022.

New poll to your right or here, piggybacking on last week’s poll: Which factor would most influence your decision to take a new job? Most or all of them are important to a given person, but few folks would change jobs unless their #1 factor was satisfied.

Welcome to new HIStalk Platinum Sponsor MedAware. The Avon, CT-based company’s medication safety monitoring platform lives within existing technology systems, EHRs, and devices to identify dangerous medication-related risks throughout the entire patient journey. Built using longitudinal and real-time patient data, advanced machine learning algorithms identify medication errors, opioid dependency risk, evolving adverse drug events, and more. Due to the high clinical relevancy of its medication alerts, providers have been shown to change their prescribing behavior significantly more often than with traditional systems alone. Founded in 2012, MedAware has offices in the United States and Israel. Thanks to MedAware for supporting HIStalk.

Webinars

December 14 (Tuesday) 1 ET.  “Using Cloud to Boost AI and Enterprise Imaging.” Sponsor: CloudWave. Presenters: Larry Sitka, MS, VP/CSIO of enterprise applications, Canon Medical Informatics; Jacob Wheeler, MBA, senior product manager, CloudWave. Enterprise imaging has remained a holdout of data center complexity despite the benefits the cloud offers. The presenters will discuss innovative ways to reduce complexity and lead with disruptive technology using AI, enterprise imaging, and the cloud.

December 15 (Wednesday) 1 ET. “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications.” Sponsor: Spok. Presenters: Matt Mesnik, MD, chief medical officer, Spok; Kiley Black, MSN, APRN, director of clinical innovation, Spok. The presenters will identify the technologies that most often contribute to clinician burnout, then explain how improving common clinical workflows can help care teams collaborate better and focus on what they do best—taking care of patients. They will describe how a clinical communication and collaboration platform can automate clinical consults and code calls to alleviate burnout.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Health plan member and provider analytics vendor Reveleer raises $65 million in a venture funding round. 

Patient prescription support and access platform vendor ConnectiveRx acquires Rx Savings Assistant from Medicom Digital, which finds prescriptions savings offers and embeds them into the EHR, including Epic.

Payments vendor Bottomline Technologies hires an investment bank to review strategic options, including a potential sale of some or all of the company. Its healthcare offerings include user surveillance for privacy visibility, signature capture, electronic forms, and print automation.

Sales

Lehigh Valley Health Network implements Sonifi Health’s in-room technology for service recovery, entertainment, and patient education.

Announcements and Implementations

TriNetX adds Diversity Lens to its real-world research platform to improve clinical trials access for underrepresented patient populations.

Petersburg Medical Center goes live with Cerner, with the Cares Act for COVID-19 relief helping cover the $1.3 million cost of CommunityWorks. The hospital vowed to replace its EHR in March 2021 following discovery that an employee had viewed patient records inappropriately.

Baxter International studies the use of MedAware’s AI-powered medication safety monitoring platform for smart infusion pump programming, concluding that the system can help build and maintain smart infusion drug libraries that can issue real-time warning of possible infusion errors to improve patient safety and reduce clinician alert fatigue. Such warnings are traditionally driven by hospital-developed rules that cover drug dose and rate, unusual concentrations, and uncommon patient weights. 

A new KLAS report looks at how enterprise EHR vendors meet patient access requirements (address verification, cost estimates, coverage discovery, eligibility verification, medical necessity, prior authorizations, propensity to pay, registration QA, and scheduling). Epic customers reported the highest satisfaction, those of Cerner expressed dissatisfaction with use of integrated third-party partner tools, and Meditech’s customers are very satisfied with what they call a workhorse product.

Government and Politics

AHA and AMA sue the federal government over the method that will be used by arbitrators to decide how much insurers will pay for disputed out-of-network bills under the No Surprises Act.

Other

Analysis finds that Ireland’s national health service was unprepared for a May ransomware attack that crippled its services after an employee clicked a malicious Excel email attachment. The HSE was warned about suspicious activity by two of its hospitals and its antivirus software vendor, but did not take action. The report observed that HSE does not have an official in charge of cybersecurity, relies on a team of 15 inexperienced IT employees (two of whom are students), backs up irregularly to offline tape, and hadn’t set up antivirus software correctly on most of its 70,000 devices. The analysis concluded that HSE was lucky that the hackers didn’t target medical devices, didn’t destroy data, didn’t go after HSE’s cloud-based systems, and provided a ransomware decryption key six days after the attack without requiring a ransom to be paid.

A New York Times article says that telehealth has become a widely used lifeline and enables clinicians to observe patients in their normal surroundings, but it has limits to overcome: (a) patients may still need hands-on care or lab work and some prefer in-person visits for that reason; (b) older Americans are less likely to have and/or actively use computers or mobile devices; (c) Medicare beneficiaries who are black, live in rural areas, are less educated, and who live alone use telehealth less often; and (d) telehealth platforms may need to be designed for simpler use and the mandatory use of a provider’s patient portal may limit telehealth uptake.

Sponsor Updates

• Vocera staff volunteer with Second Harvest of Silicon Valley.
• Austin Health in Melbourne will be the first health service in the Asia Pacific region to implement Cerner’s FHIR service.
• OptimizeRx earns a silver Digital Health Award for its COVID-19 consumer health communications campaign and a merit award for its TelaRep clinical decision support tool.
• The Digital Workplace Group honors Nordic Consulting Senior Director Dawn Hancock with its Digital Workplace Leader of the Year Award.
• Premier releases a new episode of its InsideOut Podcast, “The hidden challenge of the pandemic. Managing surging demand and record-setting staffing shortages.”
• Redox releases a new podcast episode, “Olive’s Journey to AI through Robotic Process Automation.”
• Spirion publishes a case study featuring AmerisourceBergen, “Fulfilling healthcare privacy mandates and data protection laws.”
• Business Intelligence Group honors Talkdesk CEO Tiago Paiva with its 2021 Big Awards for Business Entrepreneurship Award.

Blog Posts

• Psychographics in Effective COVID-19 Vaccination Messaging (PatientBond)
• Using Technology to Become a High-Reliability Healthcare Organization (Symplr)
• The Trouble with Payer Policies (PMD)
• How to deliver on-time, on-budget, and on-value health IT projects (Spok)
• A Specialty Medication Insights from a Prescriber and Patient Assistance Program (Surescripts)
• Value-Based Care Advances Access, Quality, Equity and Affordability (Twistle)
• What PTs Need to Know About Medicare Administrative Contractors (WebPT)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

Weekender 12/10/21

Weekly News Recap

• Ambient clinical documentation vendor Robin raises $50 million.
• Cerebral raises $300 million.
• Report: Cotiviti is for sale.
• Claroty uses $400 million in new funding to acquire healthcare IoT vendor Medigate.
• Amazon’s Comprehend Medical NLP service adds SNOMED-CT support and cuts API usage prices by up to 90%.
• The Spokane newspaper calls out problems with the VA’s Cerner implementation at Mann-Grandstaff Medical Center.
• BDO USA acquires Culbert Healthcare Solutions.
• Fortive will acquire specialty EHR vendor Provation for $1.425 billion.
• Netsmart acquires Remarkable Health.

Best Reader Comments

No Surprises Act – “Seems to place a heavy burden on provider administrative staff.” Well, the existing system has placed a pretty hefty burden on patients who have gotten nasty surprise bills. Maybe this will be the incentive for insurers and administrative staff to figure it out. (Bob)

We do a lot of credentialing for providers and the payer systems do not all update from credentialing in any sort of timely manner. A provider may be credentialed but not showing as such in their EDI database. This will be an administrative challenge [under the No Surprises Act] for sure! (Practice Admin)

The real problem is, nobody is going to pay for the things that help doctors take better care of their patients, unless there is an ROI associated with it .. There are a lot of smart and creative people in healthcare IT with a lot of really good ideas who want to do the right thing, but none of us work for free and that’s what it all comes down to at the end of the day. (HIT Girl)

This quote towards the end: “What Cerner does best is capture billable events via exhaustive questions and back-and-forth as you input things.” Reminds me of a conversation I had with my doc at then Partners Healthcare after they went live with Cerner’s major competitor. My doc echoed the same sentiment in saying to me: “It’s a good system for billing I guess, but does nothing for me in helping to care for my patients.” Sad testament to our massive efforts to digitize health. It’s a slow slog. (John Moore)

“What Cerner does best is capture billable events via exhaustive questions and back-and-forth as you input things .. They’re very meaningful to a commercial organization, because that’s how they get paid, but they’re meaningless to the VA.” Well, they’re not meaningful to the actual healthcare providers in the commercial organization. So the problem, although admittedly large in the VA context, is really universal, namely trying to organize clinical information and reasoning using “billing systems with text editors tacked on.” (Robert David Lafsky)

Watercooler Talk Tidbits

Do you know who just helped classrooms in need? Bill, that’s who – his generous donation plus matching funds included those provided by my Anonymous Vendor Executive fully paid to fulfill these Donors Choose teacher grant requests:

• Robotic engineering kits and books for Ms. K’s STEM elementary school class in S. Ozone Park, NY.
• A digital microscope for Mr. E’s middle school class in Muskegon, MI.
• STEM reading and match activities for Ms. A’s middle school class in Hawthorne, CA.
• Headphones for Ms. M’s second grade class in Phoenix, AZ.

ProPublica investigates how billionaires can write off hundreds of millions of dollars in losses from their hobbies, such as purebred horse racing, to reduce their tax bill.The article mentions healthcare billionaire Patrick Soon-Shiong, who hasn’t paid federal taxes in five consecutive years despite having earned nearly $900 million in the past eight years, although his example was more of tax sheltering than hobby losses. 

The LA Times (owned by Patrick Soon-Shiong, with losses deducted from his taxes per the item above) obtains screen shots of Scripps Memorial Hospital using Epic to mark up supply prices by several hundred percent. Sutures that cost $20 were priced at $150 and $99 surgical blades had a price of $665. The hospital responded to the newspaper’s inquiries by confirming the accuracy of the prices, but characterizing itself as the victim of a system in which insurers decide how much of the list price they will pay. The reporter previously notes that Scripps billed a patient $80,000 for a procedure that Medicare says should cost $6,000, with the inflated price covering Scripps-imposed “technical service charges” for the room, equipment, and staff.

The University of Texas’s Hogg Foundation for Mental Health provides a $260,000 grant to digitize and preserve the records of the the state’s first mental illness hospital, the State Lunatic Asylum, which was opened in 1861. All its buildings have been torn down except for its main building, which is a Texas Historic Landmark. A new Austin State Hospital, which will open in November 2023, will have the same number of beds (240) at a cost of $305 million. The records will be preserved for families who can review the records with the approval of the state HHS institutional review board. The hospital’s daily occupancy peaked at 3,330 in 1968 before the implementation of Medicare changed views on mental health beyond locking people up. Similar preservation work was done with the records of Virginia’s Central Lunatic Asylum for Colored Insane, which had a large percentage of black Americans as patients who were admitted for not adequately respecting whites or for being in the wrong place at the wrong time.

The father of University of Montana senior Danny Burton played football there, while his mother graduated from the university’s pharmacy school. Burton is doing both – “Doctor Dan” plays wide receiver for the football team and will complete his pharmacy doctorate in May. 

In Case You Missed It

• News 12/10/21
• EPtalk by Dr. Jayne 12/9/21
• News 12/8/21
• Curbside Consult with Dr. Jayne 12/6/21
• Readers Write: Improvements in Content Quality, Regulations Highlight 2021 Interoperability Trends
• Monday Morning Update 12/6/21

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Morning Headlines 12/10/21

ConnectiveRx Acquires Rx Savings Assistant® from Medicom Digital

Medication access company ConnectiveRx acquires digital prescription savings software vendor Rx Savings Assistant.

Claroty raises $400M to protect ‘cyber-physical’ systems such as IoT and industrial

Industrial IoT security platform vendor Claroty will use $400 million in new Series E funding to acquire healthcare IoT vendor Medigate.

Grand Rounds, now Included Health, is gearing up for an IPO in early 2022

Included Health, formerly Grand Rounds and Doctor on Demand, is reportedly planning an IPO for the first half of 2022.

ChronWell Secures $6m Funding Round

Digital care management company ChronWell raises $6 million, bringing its total funding to just over $13 million.

News 12/10/21

Top News

Ambient clinical documentation vendor Robin raises $50 million in a Series B funding round.

The company says its physician users save 90 minutes per day. It guarantees its work in defending any audits that result.

Co-founder Emilio Galan, MD, MS founded healthcare transparency vendor HonestHealth, while co-founder Noah Auerhahn started and sold shopping portal Extrabux.

Reader Comments

From HisTalk Fan: “Re: Cerner. Sharp HealthCare and Shriners are leaving for Epic.” Verified for Sharp, not yet verified for Shriners (but likely), according to my contacts. Sharp is now an Epic enterprise customer for both the health system and its managed care business. It had been a Cerner user since 1995 and extended its Cerner contract in early 2019 for another eight years. 

From Dr. J: “Re: AirStrip and Nant forming Adjuvare. Patrick Soon-Shiong owns AirStrip since recapitalizing it when Sequoia Capital dumped its holdings.” Thanks. The SEC filing is here.

HIStalk Announcements and Requests

From Patti: “Re: No Surprises Act. Seems to place a heavy burden on provider administrative staff.” CMS hasn’t posted the transcript of Wednesday’s call as I write this, but some of the elements of the act – which takes effect January 1, 2022 – require providers to: (a) not balance-bill for out-of-network emergency services or non-emergency services unless notice and consent is given; (b) provide uninsured or self-pay patients with good-faith cost estimates in advance; (c) accept plan payments for 90 days after a payer-provider contract ends; and (d) submit provider directory information to health plans at the beginning and end of the agreement and when changes are made and reimburse patients who are billed out-of-network rates because of a directory error. The act also establishes an arbitration procedure for provider-plan disputes (taking patients out of the back-and-forth arguing) and authorizes HHS to establish or improve an all-payer claims database. Providers also need to understand their state-specific billing rules and how they overlap with the No Surprises Act. Perhaps someone can elaborate on the practical impact to providers since the act takes effect in just three weeks.

Webinars

December 14 (Tuesday) 1 ET.  “Using Cloud to Boost AI and Enterprise Imaging.” Sponsor: CloudWave. Presenters: Larry Sitka, MS, VP/CSIO of enterprise applications, Canon Medical Informatics; Jacob Wheeler, MBA, senior product manager, CloudWave. Enterprise imaging has remained a holdout of data center complexity despite the benefits the cloud offers. The presenters will discuss innovative ways to reduce complexity and lead with disruptive technology using AI, enterprise imaging, and the cloud.

December 15 (Wednesday) 1 ET. “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications.” Sponsor: Spok. Presenters: Matt Mesnik, MD, chief medical officer, Spok; Kiley Black, MSN, APRN, director of clinical innovation, Spok. The presenters will identify the technologies that most often contribute to clinician burnout, then explain how improving common clinical workflows can help care teams collaborate better and focus on what they do best—taking care of patients. They will describe how a clinical communication and collaboration platform can automate clinical consults and code calls to alleviate burnout.

Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Online mental health services vendor Cerebral raises $300 million in a Series C funding round, increasing its total to $462 million. The company focuses on medications, referring to its providers as “prescribers” and mailing medications to patient homes. Founder Kyle Robertson was an Accenture consultant and founded a college startup website.

Bloomberg reports that the private equity owner of healthcare analytics vendor Cotiviti is considering selling the company for over $15 billion. Veritas Capital acquired the company in a $4.9 billion take-private deal in 2018. The private equity firm also acquired GE Healthcare’s value-based care business and invested in Truven Health Analytics.

Israel will fund a $18 million digital health innovation program that will help providers implement anonymized data-sharing with healthcare startups for research, hoping to develop an international data sharing standard such as the US-based SEER for cancer statistics.

Industrial IoT security platform vendor Claroty will use $400 million in new Series E funding to acquire healthcare IoT vendor Medigate. Medigate co-founder and CEO Jonathan Langer served in the Israel Defense Forces through 2016.

Included Health, formerly Grand Rounds and Doctor on Demand, is reportedly planning an IPO for the first half of 2022.

Sales

• Creative Solutions in Healthcare, the largest skill nursing operator in Texas, deploys the CareSafely quality, safety, and compliance software platform in its 91 facilities.

People

Anne Donovan, MBA (Zelis) joins Wolters Kluwer Health as VP/GM of its Health Language business.

Verisys hires Joe Alberta (Optum) as chief revenue officer.

PatientBond hires Jeff Bohmer, MD (Northwestern Medicine Central DuPage Hospital) as chief medical officer and Mark Spranca, PhD (Mathematica) as chief strategy officer.

Industry long-timer Brian Graves (Optum) joins surgical care team coordination solutions provider RelayOne as chief revenue officer.

Vu Van, MBA (Livongo) joins Transcarent as VP of health systems.

Orchestrate Healthcare hires Eric Boone (InfoBionic) as VP of sales, southeast.

Announcements and Implementations

Google is working with WHO to develop an open source software developer kit for developing FHIR-powered mobile solutions for Android. One of the apps is EmCare, a clinical decision support system that is based on WHO SMART Guidelines.

Amazon’s Comprehend Medical natural language processing service adds support for SNOMED-CT and reduces the charge for using its API by up to 90%.

Goliath Technologies launches Multi-Cloud Monitoring, which provides a unified view of AWS EC2 and Workspaces, Microsoft Azure, Citrix Cloud, and Google Cloud for troubleshooting performance, availability, and end-user experience.

Asynchronous telehealth platform vendor Bright.md announces Navigate, in which patients enter their primary symptom and the app presents the appropriate next step – on-demand asynchronous visit, appointment scheduling, or urgent care — based on health system configuration.

Government and Politics

CDC says its questionably accurate vaccination rates among US seniors – which at times has showed more people in a given age group vaccinated than exist – overestimates first doses and underestimates follow-up doses because it can’t always identify people who get their shots from different providers or states. CDC says that providers are required to de-identify their data, which limits the organization’s ability to match vaccinations to recipients. 

Other

Memorial Sloan Kettering paid $1.4 million in severance to three former executives in 2020, with the largest payment of $700,000 going to former CIO Pat Skarulis.

A study of Epic-using ambulatory care clinicians finds that EHR clinician time and after-hours work dropped early in the pandemic, but had recovered by July 2020. Patient messages increased 157% of the pre-pandemic average, with each message requiring more than two minutes of additional clinician EHR time. The authors speculate that increased messaging was caused by the increased use of patient portals, leading them to conclude that higher message volume will persist.

Epic CEO Judy Faulkner says in a “Hey Judy” EpicShare story that she decided to build an Epic campus when the company hit 300 employees, estimating that a safe bet was a capacity of 10 times the headcount then (3,000 employees). She and Carl Dvorak visited the Microsoft campus where her son worked and then found a Verona corn field that she thought was about the same size, only to find later that the Microsoft campus was 29 acres and the Verona property was 350 acres because “we had no ability whatsoever to correctly judge land mass.” The campus has since expanded to 1,200 acres for its 10,000 employees.

Sponsor Updates

• Meditech celebrates 30 years of supporting healthcare in the UK.
• Healthcare IT Leaders adds multilingual support from Voyce to its COVID-19 contact tracing capabilities.
• The Meditech Podcast, “How genomics will revolutionize healthcare in the next decade,” features First Databank Director of Product Management Anna Dover.
• LexisNexis publishes a case study, “Lehigh Valley Health Network Innovates Strategic Planning in Healthcare with LexisNexis MarketView.”
• Lumeon’s COVID-19 remote home monitoring solution wins a Silver Best in Biz Award in the Best New Product of the Year category.
• DCH Health System (AL), which recently went live with Meditech Expanse, has been named to CHIME’s Digital Health Most Wired list.

Blog Posts

• How a Continuous SOC Can Help Healthcare Facilities Avoid Data Loss (Fortified Health Security)
• The Year of Employee Burnout & How to Address It (Halo Health)
• 5 Things to Consider When Evaluating a Community Connect Host (Healthcare Triangle)
• Three Crucial Mindset Shifts to Reach Peak Financial Healthcare Management (Health Catalyst)
• What Value Does an Epic Service Desk Bring? (Impact Advisors)
• The complexity of COVID-19 variant data (Intelligent Medical Objects)
• Five Steps to a Successful Clinical IT Implementation – Pt 1 (Medhost)
• How to Attract New Talent at Your PT Practice (MWTherapy)
• Vaccine Administration – a year later and still inefficient (NextGate)
• Combining the advantages of close-talk and far-talk speech recognition (Nuance)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
Send news or rumors.
Contact us.

EPtalk by Dr. Jayne 12/9/21

Many physicians are closely watching several cases that are working their way through the US court system, especially those being heard by the US Supreme Court. For anyone who has ever seen oral arguments or read the transcripts, you may have noticed that the justices tend to say what they want to say, and often there is some interesting humor involved. The transcript of Becerra v. Empire Health Foundation did not disappoint. The case questions whether the Department of Health and Human Services followed correct procedures as it created a rule that changed the way Medicare reimbursement rates for hospitals are calculated. Justice Kagan pointed out an issue with the public comment portion of the rulemaking process, asking whether it was “unclear what the commenters thought they were being asked to comment on? In other words, a commenter who said I approve of the status quo, it was unclear whether that was the real status quo or the status quo as mis-described by the agency?”

Justice Breyer tried to reframe the issue, stating “I mean, do I understand this correctly? And the changes I understand it correctly are near zero, okay?” ultimately concluding that “people are exhausted, just like me after reading this case.” Justice Thomas referred to the “indecipherable language,” differentiating the concepts of “entitled to” and “eligible for” while pushing the attorney to explain it in “ordinary language.” Justice Kavanaugh jumped on the bandwagon, explaining the perils of trying to use two different meanings of “entitled” in the same sentence as he illustrated five different problems with the rule. Kavanaugh concludes that “we’ve whacked agency rules for much less than that,” which I found pretty amusing, imagining the members of the Supreme Court as hit people. Trench coats, fedoras, and dark sunglasses, anyone?

I always keep an eye out for articles that look at how companies and individuals are faring with the new normal of working from home. Lenovo has an interesting project in the works that will allow employees to work from one of the most remote locations on Earth. The Work for Humankind Initiative will support volunteers willing to work remotely from an island that is 400 miles of the coast of Chile. Lenovo has been upgrading the technology infrastructure on Robinson Crusoe Island and has built a shared workspace that will be come a community hub once the project is over. Project organizers are looking for volunteers with diverse skill sets who can help support the local community and volunteer 20 hours per week while on the island.

Successful applicants will spend four weeks on the island, from March 1, 2022 through April 10, 2022, and the dates include a 10-day quarantine on arrival. They must be fully vaccinated and willing to undergo COVID-19 testing three times weekly if selected. Finalists will undergo health, background, and psychiatric checks. Of course, the project will feature all the latest and greatest technology from Lenovo, so dedicated Apple users might want to think twice about applying. Interested parties can apply prior to December 30. It sounds intriguing – I’ll have to see if my current consulting gig would consider letting me head south.

From Job Hunter: “Re: sex work. It’s not the kind of healthcare technology piece we usually talk about, but did you see this article about healthcare workers who are leaving the industry for online sex work?” The Medscape article talks about healthcare workers who are struggling to make ends meet and turn to sites such as OnlyFans to supplement their income, or who give up their healthcare careers entirely. One featured UK-based worker made the equivalent of his annual healthcare salary in 22 days using OnlyFans. A featured New York-based emergency medical services worker turned to the site to supplement her income during the pandemic, leading to friction when her co-workers found out. The article goes on to point out the potential of encountering medical students who engage in sex work, which reminded me of the fictional Izzy Stevens in the TV hit “Grey’s Anatomy,” who paid for school by working as a lingerie model. The idea seemed vaguely scandalous at the time, but these days nothing is shocking.

Speaking of burnout and stressed clinicians, a new KLAS report finds that electronic health records might not be the top cause of clinician burnout any more. Nearly 20% of burned-out clinicians list COVID-19 as a top reason. Physicians most commonly list chaotic work environment as a central cause, where nurses cite after-hours workloads. I’m not surprised by the latter based on conversations with my nurse friends, who never get out of work on time and almost universally are looking for new jobs. This matches the KLAS data that shows that since the pandemic started, the percentage of nurses who are likely to leave their organizations in the next 24 months has increased.

My close nurse colleagues have grown tired of having to provide float coverage to patient care units where they might not be fully trained or experienced to care for the patients they’re assigned. I’ll never forget the first night my bestie had to float from the mother/baby unit to an assignment of mostly male medical/surgical patients. There were lots of questions coming my way all night long since the nursing pool was so scarce that she barely had colleagues to ask. I’m always happy to be the phone-a-friend, but the float situation went on for months until enough nurses quit over it that the administration had to reconsider. It’s a shame they didn’t make a better decision earlier before they lost a good chunk of their staff and had to pay exorbitant rates for travel nurses to provide coverage.

COVID-19 cases are rising in my community, and I’ve decided to head back into the clinical trenches on a very part-time basis, providing some cross-coverage for a Direct Primary Care physician while she takes some much-needed time off. It’s a different model than I’ve ever practiced in, and I can’t wait to see what the charts look like when a physician gets to write their notes purely for the sake of patient care and not for billing or any other reason. She uses an EHR I hadn’t heard of before now, and I always love to see how other systems work so I’m looking forward to it.

This weekend was spent doing a lot of administrative tasks, so I figured I’d go ahead and sign up for HIMSS22. The system needs to verify your membership status and I thought the glitch that created this screenshot was pretty funny. I came back later, and the system worked correctly, but it was still worth a chuckle. Will I see you in Orlando in a couple of months? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/9/21

Robin Raises $50 Million to Empower Physicians and Remove Barriers to Health

AI-powered medical scribe vendor Robin raises $50 million in a Series B funding round, bringing its total raised to $65 million.

Cerebral Raises $300 Million in Series C Funding to Democratize Mental Health

Online mental healthcare company Cerebral raises $300 million in a Series C funding round, bringing its total raised to $462 million.

Pair Team Secures $7.3 Million in Funding to Build Primary Care Infrastructure for Medicaid and Underserved Populations

Pair Team, which offers community health centers tech-enabled care teams and digital assistants, raises $7.3 million.

Quartet Health Acquires InnovaTel Telepsychiatry, Making Shared Vision of Speed to Quality Mental Health Care for All a Reality

Mental healthcare company Quartet Health acquires InnovaTel Telepsychiatry following a $60 million investment led by Independence Health Group.

Morning Headlines 12/8/21

‘Veterans here are tired of being guinea pigs’: After more than a year, new health record system still causing problems at Spokane VA hospital

Providers and patients recount numerous issues with the VA’s implementation of Cerner at Mann-Grandstaff Medical Center in Spokane, WA.

BDO USA, LLP Expands Management Advisory Services in Healthcare with the Addition of Culbert Healthcare Solutions, Inc.

Accounting and advisory firm BDO USA acquires 90-employee Culbert Healthcare Solutions.

Suki Announces $55 Million Series C Funding Round

Healthcare voice AI vendor Suki raises $55 million in a Series C funding round that values the business at $400 million.

Veritas Explores Sale of Health IT Firm Cotiviti

Private equity firm Veritas, which sold Athenahealth last month for $17 billion, is reportedly considering selling payer-focused health IT vendor Cotiviti instead of taking it public.