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Morning Headlines 12/21/21

December 20, 2021 Headlines 1 Comment

Oracle Buys Cerner

Oracle will acquire Cerner for $28 billion in an all-cash deal, describing the company as a “revenue growth engine” whose business it will expand globally.

GAO Makes Appointments to the Health Information Technology Advisory Committee

GAO appoints seven new members to HITAC, established by the Cures Act to provide recommendations to ONC.

AliveCor Lists its Industry-leading KardiaMobile 6L in Epic’s App Orchard Marketplace

AliveCor integrates its six-lead personal ECG device with Epic.

Oracle Acquires Cerner

December 20, 2021 News 14 Comments

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Oracle will acquire Cerner for $28.3 billion in equity value in an all-cash deal, the companies announced this morning.

Oracle chairman and CTO Larry Ellison said in a statement, “Working together, Cerner and Oracle have the capacity to transform healthcare delivery by providing medical professionals with better information—enabling them to make better treatment decisions resulting in better patient outcomes. With this acquisition, Oracle’s corporate mission expands to assume the responsibility to provide our overworked medical professionals with a new generation of easier-to-use digital tools that enable access to information via a hands-free voice interface to secure cloud applications. This new generation of medical information systems promises to lower the administrative workload burdening our medical professionals, improve patient privacy and outcomes, and lower overall healthcare costs.”

Oracle vertical industries EVP Mike Sicilia said that Oracle will make Cerner’s systems easier to learn by making Oracle’s hands-free Voice Digital Assistant the primary interface to Millennium.

The transaction is expected to close in 2022. Cerner will operate as an industry business unit within Oracle.

The acquisition, at $95 per Cerner share, represents Oracle’s largest acquisition. Oracle says Cerner will be “a huge additional revenue growth engine for years to come” as Oracle expands its business to additional countries.

Curbside Consult with Dr. Jayne 12/20/21

December 20, 2021 Dr. Jayne No Comments

The news this week has been dominated by surges in COVID-19 cases across the country. Epidemiologists are predicting a January peak and hospitals in many parts of the country are becoming overwhelmed. Staff members at those hospitals, as well as at urgent cares, community health centers, ambulatory offices, etc. are beyond overwhelmed, as they have been fighting this pandemic for nearly two years.

Most of the colleagues who I talk to regularly are beyond stressed as their organizations try to figure out how they’re going to staff another surge. The nursing shortage continues, with some of that work being shifted to physicians, which is increasing their levels of burnout. The thing that bothers them the most is not the hours or the work, but the feeling that they community no longer supports them but instead takes them for granted, or worse, sees them as expendable.

There’s a tremendous push for people to “live their lives,” but the reality is that we would all be better served by dialing it down a notch and sticking close to home for a while. None of us want to be constrained. We’re all tired of it, but it’s a necessity for many families right now as they struggle to protect vulnerable individuals in their households.

Seeing JP Morgan Chase cancel its healthcare conference was bittersweet. Everyone is so desperate for “the old normal,” but cramming people in hotels and restaurants isn’t the right answer. There’s a shortage of home testing kits across the country at the moment and people in some cities are facing long waits for clinic-based testing, so it doesn’t seem right to burden those systems with pre-travel testing. The same goes for people planning to travel out of the country for the holidays, which can generate multiple tests per traveler on their return, depending on workplace and school policies. I’m glad people have the money to travel to the Caribbean, but I feel for the healthcare workers who will grimly trudge through the lines of tanned, happy travelers seeking testing as they wonder when they will be able to take a break. One of my urgent care clients is routinely testing more than 100 patients per day at a single location, which is an unsustainable pace.

Mr. H noted that HIMSS is reviewing its Right of Entry Protocols for HIMSS22 to see how they’ll play in Florida, which has blocked vaccine mandates for workers and won’t allow businesses to require proof of vaccination. I have to say I hadn’t thought of that before registering for the conference, but now it’s giving me pause. We’ll have to see what the case rates look like as the conference is closer. We know that vaccination doesn’t necessarily prevent transmission, but data is good as far as there being less viral shedding and a shorter duration of symptoms. As we get more data about the Omicron variant, that may change, but right now I’m definitely more comfortable being around people who are fully vaccinated as well as masked versus the unmasked people at the supermarket who are talking on the phone as they shop, aerosolizing as they go. Influenza A is starting to rip through our community as well, so if the COVID-19 doesn’t get you, there’s a chance the flu will.

From a healthcare IT standpoint, I’m starting to see hospitals and health systems put projects on hold again as they cite the need to be all hands on deck for patient care issues. Organizations that haven’t already been tuning up their telehealth strategies have probably missed the window of opportunity while utilization was relatively low. Those who have robust telehealth programs are seeing greater demand, and most of the physicians I’ve spoken with are considering retooling their schedules to create dedicated blocks for telehealth visits so that they can minimize disruption to their days. With hospitals canceling elective cases again, patients are left in the lurch, and I feel bad for those who have been waiting for procedures that are again being pushed back.

As we approach the third year of the pandemic, I’m also starting to see physicians look for part-time opportunities due to childcare issues, especially in dual-physician households. As higher wage earners, these couples have historically had greater ability to afford full-time household caregivers such as nannies, but the long hours and unpredictably lengthened days have caused some caregivers to leave their physician employers. There is also some degree of mismatch between COVID-sensitive physician families and caregivers who might not want to be vaccinated or mask at work, just like there is in any other part of the workforce. Parents of young children who were hopeful for a vaccine to be available soon for their children are crushed by the recent Pfizer announcement that they’d be amending the clinical trial for children 6 months to under 5 years of age. This could delay the vaccine by an additional six months as boosters are studied. For those families, it will be a long winter, indeed.

There are so many terrible things that have come with the COVID-19 pandemic that when you come across something good that has come from it, you just have to celebrate it. Partway through the pandemic, I was introduced to what was then called The Covid Cello Project. It started as a group of 17 professional cellists who couldn’t work due to the initial lockdowns and decided to do a virtual collaboration. Since then, it’s grown to over 500 cellists who submit individual recordings that are then compiled and mixed into a group performance. It was rebranded some time ago as The Global Cello Project to reflect its worldwide reach as well as the easing of the pandemic, but now many of us are staying close to home again, so it’s hard not to refer to it by its original name.

The founder challenged us to put our most recent piece together in only nine days (usually we have several weeks) and I spent the first three of those days in the woods, so I’ve really had to work to get my part ready. Tonight was the recording deadline, and with the support of my in-house production crew, I was able to nail it in one take. Now the team gets to work editing all the videos and mixing all the recordings and we all get to be surprised by the finished product. It’s been great to have something to think about and work on that brings people together, even though my fingers have had the most exhausting week of their lives.

What good things have you encountered as a result of the pandemic? Have you taken up a new hobby or found a new passion? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: The EHR is (Still) Dead, But I’m Optimistic

December 20, 2021 Readers Write 2 Comments

The EHR is (Still) Dead, But I’m Optimistic
By Rob Dreussi

Rob Druessi is chief information officer of HCTec of Brentwood, TN.

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In May, HCTec CEO Bill Grana published a company article on the evolution of the EHR entitled, “The EHR Is Dead. Long Live the EHR.” In August, digital health strategy consultant Seth Joseph published a similarly titled article, “Long Live the EHR Platform” on Forbes.com.

The key distinction in the headline encompasses his argument for the future of EHRs. Joseph’s two-part article is both comprehensive and detailed. He provides compelling analysis and research, sourced from industry experts to assert that while the government-backed investment (ARRA, HITECH ACT) into EHR adoption did, in fact, achieve the goal of wider physician and hospital adoption of EHRs based on government Meaningful Use (MU) criteria, EHRs collectively have been a disappointment and have not lived up to the hype.

For the most part, I agree with his points and appreciate his arguments, but drawing on 25 years of healthcare IT leadership as my lens, I politely disagree with a few of them.

To compete in a subsidized marketplace, vendors couldn’t just be best-of-breed for specialized focus areas. They needed robust capabilities to survive. In effect, they grew to be” a mile wide, but an inch short in the most important ways.”

In the short term, EHR vendors certainly focused on becoming certified by the US Department of Health and Human Services (HHS) to be MU-compliant. However, hospitals still had the ability to continue using the best-of-breed approach, as modular certifications allowed systems to be certified using a subset of criteria intended for their specific use. Examples of best-of-breed areas include laboratory, surgical, radiology, pharmacy, decision support, oncology, home health, and revenue cycle.

Many hospitals continue to use specialty systems for all the above. But more frequently, they are looking to decrease the overall complexity of running multiple EHRs. If anything, the MU era accelerated the move from full best-of-breed solutions to a modified hybrid approach, where hospitals use a primary EHR with select departmental solutions as necessary. Then, if and when the EHR vendor can provide a sufficient solution with functionality on par with the independent solution, the supplementary solution is often phased out.

In my experience, best-of-breed systems are difficult to manage and costly to maintain. In instances that my company has seen, many health systems agree with me. To illustrate, a Southeastern-based health system recently migrated one of its markets onto Epic from a combination of Cerner (acute side), a third-party home health system, multiple ambulatory systems, and over 50 related third-party applications. Similarly, we have supported many Epic-based organizations move from their independent departmental solution to Epic’s Beaker module this year.

EHRs went from competing on the value of their product to competing on the breadth of functions they offered. Epic achieved its dominant market share for this reason. It offered hospital CIOs a one-stop shop at a time when the CIO’s job was dependent upon helping the organization achieve Meaningful Use of EHRs, no matter how much physicians detested the actual software.

Introduced in 2009, MU can’t take credit for the complete success of EHRs. Epic, for example, was already long thriving as an EHR market leader for hospitals with 400 or more beds by then. Kaiser Permanente became an Epic client in 2003 as part of a $1.8 billion deal, and by 2005, their client base included the likes of Cleveland Clinic Foundation and Sloan-Kettering Cancer Center. This shows that while MU may have accelerated the move to Epic for many health systems, Epic wasn’t just competing on the MU compliance to win deals. They were winning deals due to their ability to not only provide a solution that handled both the inpatient and outpatient areas, but one that was developed 100% in-house, without the need for mergers or acquisitions.

Normally, CIOs selecting Epic were not dealing with physicians who detested the Epic EHR. Epic was even known in the marketplace for “selecting” its clients. Commonly, in my personal experience with many Epic organizations, the deciding factor was Epic’s ability to provide multiple reference sites running their full product suite, whereas competitors struggled to do the same.

“EHRs have been more than a disappointment: they have largely turned into a national nightmare…. Additionally, while EHRs may improve safety in some areas, they also introduce new risks that are systemic in nature.”

There are undoubtedly drawbacks to EHRs, and we certainly have not yet fully realized the potential of these digital systems, but to say they are a sweeping disappointment suggests that they have not offered any societal benefit. Before EHRs, providers struggled to have a clear picture of a patient’s health background, even within the same organization. A patient could go to the ER and later visit a primary care physician, who had no record of that visit or what occurred during it.

Our nation would have had a difficult time shifting to telehealth during the COVID-19 pandemic without the currently deployed EHRs. With EHR systems, we can now better share critical patient data across a healthcare organization and even across other healthcare systems when required. For those populations who spend different seasons in different parts of the country, the ability for their separate health systems to “talk” and share health information is an invaluable component in their health journey. With an EHR, providers can access real-time, up-to-date patient information, regardless of where treatment was provided. This element alone is vital for patient safety and care.

“By virtually every financial and operational metric, the business prospects for EHRs have gone in one direction over the past decade: down.”

Joseph is correct that EHR vendors have seen a downturn in the number of net new EHR implementations. Recent implementations appear to be driven by mergers and acquisitions or the routine replacement life cycle when the current EHR is not meeting organizational needs, with a traditional selection process to identify a new solution. More commonly, smaller, specific modules are being introduced as opposed to the full EHR implementations. While EHR vendors have seen declining revenues post MU, which is not totally unexpected, their futures are ripe with opportunity. They will adapt to the changing environment and will take steps (or have already taken steps) to size their workforce accordingly based on the future demands for maintenance / support and new implementations.

I share Joseph’s curiosity as to the future of EHRs. For now, Meditech is seeing more traction with its Expanse solution, with HCA most recently announcing they are implementing the solution at three HCA hospitals in the New Hampshire market. Meditech will realize tremendous growth with HCA if they are able to move the system’s vast footprint of hospitals running the Meditech Magic EHR onto their Expanse solution. Meditech would also realize a significant loss of business if HCA moved away from Meditech altogether.

Epic has chosen a strategic route in developing a web-based client (Hyperdrive) to generally replace the desktop client (Hyperspace). Hyperdrive clients should experience cost savings from the reduced manpower and related technologies necessary to support a web-based client. These savings could also open the door for new adoption at smaller organizations by finally making the ongoing TCO of running Epic feasible. During the pandemic, Epic was also able to deliver their clients a solution, including the underlying technology, for patient telehealth visits representing an unexpected boost in revenue, which luckily for Epic, is here to stay for the foreseeable future.

Perhaps the next boom for major EHR providers will be international growth as opposed to domestic. Whatever the next big break is, I’m curious to see what Joseph sees in his crystal ball for the future of EHRs.

Readers Write: COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?

December 20, 2021 Readers Write No Comments

COVID-19 Drastically Cut Lung Cancer Trial Participation. What Can We Do to Reboot?
By Miruna Sasu

Miruna Sasu, PhD, MBA is chief strategy officer at COTA, Inc. of Boston, MA.

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COVID-19 has had a devastating effect on the nation’s health. In addition to hundreds of thousands of deaths directly caused by the virus, millions more patients have been unable to access crucial healthcare services due to lockdown orders, economic stress, and fear of illness.

During the early days of the pandemic, primary care visits declined by nearly 60% before rebounding later in 2020. Screenings for common cancers, including breast, colon, and cervical cancer, dropped by an average of 91%, prompting fears of a wave of advanced cancers in the coming months. 

A new study from the University of Memphis shows that the clinical trial ecosystem has not been exempt from this trend. The pandemic has prompted a 43% decline in enrollment for lung cancer trials, forcing researchers to delay, postpone, or cancel their initiatives.

Lung cancer leads to a quarter of all cancer deaths: more than colon, breast, and prostate cancers combined. Clinical trials are essential for helping to save and extend the lives of lung cancer patients.

My own life is a perfect illustration of how important clinical trials can be. After immigrating from Romania as a child, my grandfather helped to raise me in America. Soon after, he was diagnosed with advanced metastatic lung cancer and given three months to live. We did not have the resources for conventional treatment, but he enrolled in a clinical trial that offered experimental care we could afford.  

Instead of living for three months, he went into remission and got to spend another 30 years with his family. We were lucky to have access to this life-altering program. We knew that the option existed. We lived close enough to the trial site for regular visits. We were able to provide a strong network of support at home. Not every family is so fortunate.

The care access issues of COVID-19 have compounded existing challenges with clinical trial enrollment, including proximity to centralized trial locations and the ability to completely mold one’s life around the demands of constant clinical visits, treatment side effects, and emotional self-care.

We now have the opportunity to rethink how we approach these problems and restart the momentum that has been lost during COVID-19. I believe that three things could potentially be solutions to care access issues and substantially improve trial recruitment and retention for patients:

  • Increasing enrollment. We can start by ensuring that patients from all walks of life are aware that clinical trials may be an option for them. Clinical trials perennially fall short when recruiting diverse and representative populations, excluding far too many underserved individuals from medical research. By using emerging data strategies, such as leveraging multifaceted real-world data to identify new research sites serving representative populations, we can educate more providers and patients about the positive potential of clinical trials. Real-world data from electronic health records, claims, and other sources can also help us match individuals with the most appropriate trials to maximize their odds of better outcomes.
  • Maintaining patients on trials. We also need to make sure that patients have the day-to-day resources they need to stick with the program from start to finish. Non-clinical services, including transportation to appointments, childcare, meal delivery options, and other assistance to mitigate social determinants of health are critical for enabling patients to stay adherent to complex trial protocols.
  • Patient understanding of trial opportunities. Continued trial interest is important for both healthcare providers and patients. We need to work hard to ensure that everyone within the care ecosystem understands their options for clinical trials. As such, building a community of care around clinical trial participants can improve quality of life while making sure that researchers can keep their enrollment numbers where they need to be. To do this, we have to get very good at things such as being able to showcase trial options and providing educational materials to doctors and patients that are tailored for each of these audiences. We also need ask patients questions about life style and quality of life at the right times and provide a variety of easy ways to not only treat but also connect with clinicians and care teams.

Making the investment in these and other strategies could save untold lives and give lung cancer patients, like my grandfather, many more happy moments with their family and friends. 

As we work through the ongoing challenges of the pandemic and continue to design and implement innovative clinical trials, we must commit to enrolling more diverse and inclusive patient cohorts and supporting them holistically during trials so they live their lives to the fullest for as long as possible.

Morning Headlines 12/20/21

December 19, 2021 Headlines 1 Comment

‘The Charges Seem Crazy’: Hospitals Impose a ‘Facility Fee’ — For a Video Visit

KHN reports that Yale New Haven Health System charged a separate facility fee of $50 to $350 for virtual visits.

SoftBank-Backed Mental Health Unicorn Cerebral Reneged On Salaries And Health Insurance For Hundreds Of Therapists

The mental health startup, valued at $4.8 billion in a recent investment, is accused of making more than 200 salaried therapists hourly and tying their ability to buy benefits contingent on hitting quotas.

Cerner Shares Surge On Reports Of $30 Billion Oracle Takeover Bid

CERN shares rose sharply Friday as investors reacted to a report that Oracle is in final talks to acquire the company for $30 billion.

Monday Morning Update 12/20/21

December 19, 2021 News 3 Comments

Top News

Kaiser Health News call out Yale New Haven Health System, which for telehealth visits sends a separate bill for a $50 to $350 facility fee even though telehealth patients never set foot in any of the health system’s buildings.

The health system, warned by the Connecticut Office of the Healthcare Advocate that the state explicitly bans charging facility fees for telehealth visits, blamed a coding mistake.

Despite attributing an error, the health system still argued that the charges are justifiable because they cover the cost of the telehealth software, adding that “we do still have to keep the lights on.”


HIStalk Announcements and Requests

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Hard-to-change company attributes are most important to poll respondents who are seeking new opportunities, but otherwise, throwing down cash doesn’t hurt.

New poll to your right or here: How would an Oracle acquisition of Cerner change healthcare?


Webinars

None schedule soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.


Acquisitions, Funding, Business, and Stock

Online mental healthcare startup Cerebral, which was recently valued at nearly $5 billion after its latest funding round and hired Olympic gymnast Simone Biles as chief impact officer, recently changed hundreds of therapists from salaried workers to hourly and made benefits eligibility contingent on hitting quotas. Patients choose company therapists from its web directory, so the new structure means that therapists have no control over the company’s minimum billed hours threshold.

UK’s business secretary will investigate complaints that Microsoft pushed British companies out of contention for NHS contracts by giving NHS free use of its Teams remote meeting software, which small competitors say is a way to gain overall IT leverage posting as a charitable act. Also complaining is Salesforce, which owns Teams competitor Slack.

Cerner shares closed at Friday $89.77, up 13% on the rumor that Oracle will acquire the company in a $30 billion deal. ORCL shares dropped 6% on the Wall Street Journal report.

Axios reports that the two founders of PillPack, acquired by Amazon in mid-2018 for $1 billion, have been demoted to consultants to the online pharmacy. Employees who reported to T.J. Parker now report to John Love, an Amazon VP who oversees Alexa shopping.


Announcements and Implementations

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KLAS finds that Epic had the largest net gain in US hospitals in 2020 with 101, which gave it 19,000 new beds. Cerner lost a net of 19 hospitals and 10,000 beds. KLAS concludes that while Epic’s biggest-gaining year was 2015 when it added 144 new hospitals, “their growth has never so decisively outpaced the competition’s.” The company lost three hospitals in 2020, all due to M&A. Meditech lost 62% of the decisions made by legacy customers in 2020, with all of its new hospitals being under 100 beds. Most of those that decided not to move to forward to Meditech Expanse chose Epic instead. UPDATE: I’ve corrected the dates – KLAS’s “US Hospital Market Share 2021” report reflects data from 2020, not 2021.


Government and Politics

The Massachusetts Supreme Court rules in favor of a former Meditech employee who claims he was fired for exercising his right to file a rebuttal in his personnel file. Terence Meehan says Meditech reorganized its 12-person regional sales department in demoting three sales reps – including Meehan – to the newly created position of “sales specialists,” who sales reps rarely used because they don’t want to share commissions. Meehan says he and the other demoted employees were placed on performance improvement plans in July 2018, and when he sent his supervisor a rebuttal, the president and CEO of Meditech immediately terminated him. He filed a complaint of wrongful discharge and the court agreed with him.


Sponsor Updates

  • Two member agencies of The Arc New York collaborative will implement Netsmart’s CareFabric platform.
  • Redox releases a new podcast, “Extracting paternalism from the patient experience with B.well CEO Kristen Valdes.”
  • The Pharmacy, IT & Me Podcast features RxRevu CEO Carm Huntress.
  • Talkdesk wins the cloud-based CX solution of the year award at Customer Contact Week.
  • Vocera releases a new podcast, “The Evidence for Team Member Safety and Well-being – Kedar Mate, MD.”
  • Well Health has helped providers facilitate nearly 10 million vaccine appointments and send over 63 million messages related to COVID-19.

Blog Posts


Contacts

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

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Morning Headlines 12/17/21

December 16, 2021 Headlines 1 Comment

Oracle in Talks to Buy Cerner

The Wall Street Journal reports that software giant Oracle is in talks to acquire Cerner in a deal that could be worth $30 billion.

Ophelia Raises $50 Million Series B Led by Tiger Global to Expand Its Novel Approach to Opioid Addiction Treatment

Ophelia, which connects opioid users in 11 states to moonlighting providers who prescribe Suboxone via video visits for $195 per month, raises $50 million in a Series B funding round.

Qualifacts + Credible Acquires InSync Healthcare Solutions

Behavioral health EHR vendor Qualifacts + Credible acquires InSync Healthcare Solutions, a Florida–based company that offers EHR, practice management, and RCM technologies.

News 12/17/21

December 16, 2021 News 3 Comments

Top News

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Innovaccer raises $150 million in a Series E funding round that values the company at $3.2 billion.


Reader Comments

From Marc: “Re: Scarborough Heath Network. The first client in the world to put Epic DR on AWS. Great collaboration with Deloitte, AWS, and Epic.”


HIStalk Announcements and Requests

I’m interested in hearing about turnover experience – yours and your employer’s — via this short, anonymous survey, whose results I’ll aggregate in the next few days.

The JP Morgan healthcare conference, which just moved to a virtual-only format because of attendee concerns about COVID-19, will start 55 days before the first-ever ViVE conference and 63 days before HIMSS22. It’s not a great time to be in the conference business, especially when those two upcoming conferences are in Florida, which bans vaccine mandates (such as for workers at the convention center, hotels, and restaurants) and doesn’t allow requiring customers to provide proof of vaccination. HIMSS says it is reviewing its Right of Entry Protocols for HIMSS22 to determine which ones “comply with prevailing local regulations in Florida,” which is basically what ViVE is doing in simply saying that it will let people know later what it will be allowed to require (we’re just 80 days out). Would you be comfortable attending a conference where attendee vaccination cannot be verified under state law? JPM would have required attendees to prove vaccination and to wear masks indoors.


Webinars

None schedule soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Here’s the recording of Wednesday’s webinar titled “Improve Efficiency, Reduce Burnout: Leveraging Smart Clinical Communications,” presented by Spok.


Acquisitions, Funding, Business, and Stock

Physician performance analytics vendor Embold Health raises $20 million in a Series B funding round. CEO Daniel Stein, MD, MBA founded the company in 2017 after serving as chief medical officer for Walmart’s Care Clinics.

Ophelia, which connects opioid users in 11 states to moonlighting providers who prescribe Suboxone via video visits for $195 per month, raises $50 million in a Series B funding round.

Optum sets the date for completing its $13 billion acquisition of Change Healthcare as April 5, 2022.

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UK-based secure communications platform vendor Hospify will shut down its flagship service on January 31, 2022. The app, which was launched in February 2018, was the first to be approved for general provider and patient use by the NHS Apps Library. The company blames its demise on the government’s early-pandemic waiver of the Data Protection Act, which continues in allowing providers to use non-GDPR compliant consumer messaging apps such as WhatsApp. The company also questions the post-Brexit uncertainties around the UK-EU data agreements. Hospify’s movingly honest and sometimes humorous explanation of its circumstances says that the company will remain in business at it seeks new markets where “data protection is taken more seriously by the relevant governments.”


Sales

  • Low-code app development vendor Appian will use Redox for healthcare data integration.
  • Sage Memorial Hospital goes live on Meditech-as-a-Service with the assistance of Healthcare Triangle.
  • Community Care Cooperative will implement Epic at 12 of its FQHCs.
  • Medicare primary care center operator Oak Street Health will expand its use of real-time patient event notifications from Bamboo Health.

People

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Optimum Healthcare IT promotes Larry Kaiser to chief marketing officer.

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Commure hires Abhijit Mitra, MS, MBA (ServiceNow) as chief product and engineering officer, Manisha Shetty Gulati, MPA, MBA (Clarify Health Solutions) as chief growth officer, and Christine Tibbits, MA (Google Health) as chief people officer.

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St. Luke’s (MN) names Chris Sorenson, MBA (Ascension) to the newly created position of CIO.

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Integris Health hires industry long-timer Bill Hudson, MBA (John Muir Health) as VP/CIO.

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NextGen Healthcare promotes Bob Murry, PhD, MD to chief medical officer. He replaces Betty Rabinowitz, MD, who is retiring.

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Personalized care solutions vendor Happify Health hires Megan Callahan, MPH (Lyft Healthcare) as COO.

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K Health, which offers “people like me” compiled health insights and telehealth, hires Jennifer Pena, MD (Nurx) to the newly created position of chief medical officer. She previously served as White House physician and spent 10 years as a US Army doctor.

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Industry long-timer Thomas “TR” Rush – VP of business development at MedAssist and veteran of a long career at Siemens Healthcare — died unexpectedly last week, two days before the birth of his first grandchild. He was 51.


Announcements and Implementations

A study of Arcadia’s de-identified health history of 150 million patients finds that unvaccinated people were six times less likely to report multiple symptoms of long COVID if they were given their first COVID-19 vaccination in the four weeks after becoming infected. Even those who didn’t get the shot until 4-8 weeks after diagnosis were three times less likely to report multiple long COVID symptoms.

KONZA, the Kansas Health Information Network, releases Translate, which automatically sends ambulatory COVID-19 test results to public health departments without manual entry.

Epic will add mapping, navigation, and location-aware analytics via System1’s MapQuest Business-to-Business service.

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Midwest grocery chain Hy-Vee launches RedBox Rx, a national, low-cost telehealth and online pharmacy service that includes free prescription shipping. The service, which offers telehealth visits for prices ranging from zero to $39, does not accept insurance. It is offered by partner MDBox, the telehealth business of Reliant Immune Diagnostics that also offers testing and monitoring.

Cigna-owned health services vendor Evernorth chooses Omada Health as its preferred vendor for digital chronic care programs for diabetes, hypertension, and prevention. It apparently displaces Livongo, which was acquired in October 2020 for $18.5 billion by Teladoc Health, whose shares dropped on the latest news in valuing the company at $14 billion. TDOC’s market cap has dropped by two-thirds – $28 billion — since February 2021.

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A new KLAS report that covers EHR vendors that offer a wide range of comprehensive solutions for ambulatory practices finds that Epic, NextGen Healthcare, and Cerner earn high user satisfaction with offering technologies that meet most or all of an ambulatory practice’s needs, although the virtual care offerings of those vendors are sometimes passed over in favor of best-of-breed tools. Cerner customers remain concerned about Cerner’s revenue cycle track record and don’t always choose its practice management solution, while all interviewed customers of NextGen Healthcare and Epic report lowered costs and/or increased revenue after implementation.


Government and Politics

Two Republication US senators introduce a bipartisan bill that requires the VA secretary to report the cost, performance metrics, and outcomes of its Cerner project quarterly to Congress.

The Tampa paper notes that while Tampa General Hospital can’t legally donate money to political candidates, its for-profit, outsourced coffee shops have contributed $226,000 to mostly Republican state candidates. The coffee shop corporation’s three directors are Tampa General executives, including EVP/CIO Scott Arnold.


Privacy and Security

AMA calls for app developers to practice “privacy by design” to gain the trust of physicians who have involvement in patient app use. It notes that many people mistakenly believe that direct-to-consumer health apps are regulated by HIPAA. It also notes that developers who use software development kits from companies such as Facebook, Zoom, and Google may knowingly or unknowingly be exposing user data to third party advertisers and data aggregators, including apps that address addiction and recovery. AMA calls for apps to identify the data they are accessing, using, disclosing, and processing before collecting it and to give users control over how their information is used. AMA also calls for apps to get user approval before their data is used to develop and/or train machines or algorithms and to allow them to opt out.


Other

Among the health systems that have said publicly that they are being affected by the Ultimate Kronos Group ransomware attack are Shannon Medical Center (TX), Ascension, Baptist Health (FL), UF Health (FL), Allegheny Health Network (PA), and Franciscan Missionaries of Our Lady Health System (LA). Some UKG time clocks can store punches locally until their memory is full, but the data can’t be collected since Workforce Central connectivity is unavailable. The company recommends re-posting the previous payroll, then working with UKG to reconcile differences after systems are restored (because it’s always fun to ask overpaid employees to give the extra money back right after Christmas). UKG says the attack has left it unable to access customer environments or to provide historical reports or files.

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The president and CEO of Stamford Health (CT) says that virtual health plans “should worry us all” as insurers are using them like 1990s HMO gatekeepers in their virtual-first plans to limit access to physicians, tests, and in-person visits. Kathleen Silard, RN, MS also notes that the virtual health plans often involve third-party companies whose doctors don’t know their patients and whose EHRs make data-sharing harder. She also worries about equity issues due to digital illiteracy and lack of access to computing devices and broadband. She concludes, “I know that technology is a tremendous clinical tool for lowering barriers to care. I hope it becomes a regular site of care for many patients. But don’t confuse virtual care with a virtual health insurance plan. Technology builds walls as easily as it tears them down.”

JP Morgan Chase cancels its in-person 2022 healthcare conference, bowing to pressure to hold the event online instead of in San Francisco January 10-13. The company says it is concerned about COVID-19, which had already resulted in the pullout of vaccine makers Moderna and Amgen, but big-company attendees had already called for the conference to be cancelled due to their safety concerns related to San Francisco crime and homelessness around the conference site. Some experts predict that JPM will resume in a different city in 2023 to skirt San Francisco’s overcharging vendors, but others say those who are buying $1,000 hotel rooms and $200 hourly coffee shop table rental are often conference hangers-on who don’t join the small number of invited attendees inside the Westin St. Francis anyway.


Sponsor Updates

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  • Availity team members decorate 18 Christmas trees at Sulzbacher’s campuses in Jacksonville, FL.
  • Medicomp Systems releases a new “Tell Me Where It Hurts Podcast” featuring National Coordinator Micky Tripathi.
  • Bamboo Health expands its care coordination partnership with Oak Street Health for real-time patient event notifications.
  • IT Central Station has ranked Everbridge’s Digital Operations Platform the top IT alerting and incident management solution.
  • Get Well publishes a new white paper, “How CIOs can lead strategic patient engagement.”
  • According to KLAS, early data on the performance of Meditech’s Professional Services indicate the company is performing above average for its EHR implementation support.
  • Nordic Consulting is ranked #69 of 100 US companies with the best cultures by Comparably. It also ranked #74 of the top 100 companies that are best for women.
  • Healthcare IT Leaders will integrate the IBM Digital Health Pass with its Health Returns enterprise COVID-19 services.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 12/16/21

December 16, 2021 Dr. Jayne 1 Comment

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.

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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

December 15, 2021 Headlines 2 Comments

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

December 15, 2021 Readers Write No Comments

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.

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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

December 15, 2021 Interviews No Comments

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

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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

December 14, 2021 Headlines No Comments

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

December 14, 2021 News 2 Comments

Top News

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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

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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

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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.

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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

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

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

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

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OneOncology hires Andy Corts (SignalPath) as CTO.

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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

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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

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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


Contacts

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

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Morning Headlines 12/14/21

December 13, 2021 Headlines No Comments

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

December 13, 2021 Dr. Jayne 7 Comments

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.

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