At Infosys, our Insurance, Healthcare and Life Sciences teams strive for holistic, better and safer healthcare through the technology we create. In this blog, we will discuss healthcare IT, obstacles, successes, new ideas and much more, with the aim of improving healthcare technology, and quality of life as a result.

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December 20, 2011

Minute Clinics - To be or not to be

Minute Clinics are now called the "Disruptive Innovation" in the Health care Industry. This term refers to a product (or service) that enters a market as a simpler, lower-cost alternative to an existing product that is "overbuilt" for the needs of the market. Using lower-cost technology or workers, the innovation improves until it establishes a dominant market share. (Source: Bohmer, "The Rise of In-Store Clinics.")

Continue reading "Minute Clinics - To be or not to be" »

November 7, 2011

Six aspects to make US Healthcare Sustainable...A thought

Making healthcare affordable, accessible & accountable is not any unique initiatives to any health care system. The pivotal concern has been always to make the healthcare system sustainable. If I have correctly analyzed the prevalent facts & figures, I can well claim that the current US healthcare system is absolutely operating under an unsustainable bubble with a perfect mismatch of cost and quality giving rise to the increasing trend of inequity, inequality and inefficiency. Moreover, with the fast pace in healthcare market the future provisions are never an easy one to grasp. Changes are certain in medical technologies, management of chronic illness, reimbursement patterns, coverage policies & etc. In such a situation, if a healthcare system can't move towards a comprehensive system-wide reform or just aims (even with incremental changes) to address either financing or delivery system problems but not both, it is bound to be dysfunctional, lose its credibility and we will ever continue to waste billions of dollars and thousands of more lives every year. So, as an answer to this issue let me now weave the concept of a "True" sustainable healthcare system". Yes, I agree quality, cost, delivery & financing mechanisms are the four pillars, and still the open question is what is beyond these to reap the full impact in cost, affordability and accessibility and make health-care sustainable and for all including the most vulnerable ones.

Continue reading "Six aspects to make US Healthcare Sustainable...A thought" »

October 31, 2011

Minute Clinics - To be or not to be

Minute Clinics are now called the "Disruptive Innovation" in the Healthcare Industry. This term refers to a product (or service) that enters a market as a simpler, lower-cost alternative to an existing product that is "overbuilt" for the needs of the market. Using lower-cost technology or workers, the innovation improves until it establishes a dominant market share. (Source: Bohmer, "The Rise of In-Store Clinics.")

Continue reading "Minute Clinics - To be or not to be" »

Scope for leveraging IT in establishing patient centred care in an ACO

Better care for individuals is one of the important goals for the ACOs in the Shared Savings Program as established by the Affordable Care Act. This highest-level goal also known as the three-part aim consists of the following:
•Better care for individuals - As described in the Institute of Medicine report, it has six dimensions of quality: Safety, effectiveness, patient-centeredness, timeliness, efficiency and equity
•Better health for populations with respect to educating beneficiaries about the upstream causes of ill health
•Lower the expenditures by eliminating waste and inefficiencies while not withholding any needed care that helps beneficiaries

Continue reading "Scope for leveraging IT in establishing patient centred care in an ACO" »

September 20, 2011

Improving the patient experience with Social Media

In the recent past we have seen a paradigm shift in application of social media to healthcare industry. Studies in this area show optimum utilization of social media can help improve the patient experience. However, there are equal numbers of challenges in adoption of social media tools in healthcare industry (in particular - healthcare providers). Some of the challenges in successful implementation of social media in hospitals include: lack of IT/social media awareness amongst the healthcare providers, need for IT infrastructure, time and resource crunch.

Having said that we also have some of the world class examples in United States of America where social media is revolutionizing the patient experience.

Here is a brief note from Mayo clinic center for social media: "The Mayo Clinic Center for Social Media, a first-of-its-kind social media center focused on health care, builds on Mayo Clinic's leadership among health care providers in adopting social media tools, which began with podcasting in 2005. Mayo Clinic has the most popular medical provider channel on YouTube and more than 175,000 "followers" on Twitter, as well as an active Facebook page with over 50,000 connections. With its News Blog, Podcast Blog and Sharing Mayo Clinic, a blog that enables patients and employees to tell their Mayo Clinic stories, Mayo has been a pioneer in hospital blogging. MayoClinic.com, Mayo's consumer health information site, also hosts a dozen blogs on topics ranging from Alzheimer's to The Mayo Clinic Diet".

The stats on application of social media in hospitals/healthcare providers look very impressive:

1,188 Hospitals have adapted social media and following is the channel-wise distribution:

·         548 YouTube Channels

·         1018 Facebook pages

·         788 Twitter Accounts

·         458 LinkedIn Accounts

·         913 Four Square

·         137 Blogs

There are close to 4000 hospital social networking sites.

(Source: ebennett.org, data as on June, 2011)

The future of social media application in healthcare is definitively very promising and some of the very obvious benefits of application of social media in hospitals include:

Improved doctor - patient interaction

Connect                     

Collaborate/Co-Create

Collective Wisdom                                       

Patient Centric care

Community/Forum

 

We have to wait and watch the revolution happen in healthcare industry through application of social media tools and techniques.

September 15, 2011

Promoting Accountability in ACOs - Part 3

My earlier blogs, part 1 and part 2 detailed the key concepts influencing the success of ACOs and the need of a change management strategy enforcing stakeholders acceptance of ACOs.

Continue reading "Promoting Accountability in ACOs - Part 3" »

"To be or Not to be in an ACO...too early for Providers to decide"

"To be or not to be" seems to be a burning thought in almost every provider these days and this is towards deciding whether or not it is sensible for providers to establish an ACO or join an ACO.

Continue reading ""To be or Not to be in an ACO...too early for Providers to decide"" »

August 18, 2011

Promoting accountability in ACO - A few insights (Part 2)

In the previous blog, we have introduced the two key concepts that are going to influence the success of an Accountable Care Organization (ACO):

• Establishing and adhering to a central Vision

• Establishing a standard clinical process and benchmark

In the previous blog, we had started the discussion on the first topic i.e. Adherence to a central vision, and here we will extend our discussion further on the same.  It has been observed that one of the primary reasons of higher cost of healthcare in the U.S. is the existence of the fragmented healthcare delivery organizations. Collaboration among the constituents has been suggested as one of the solutions if one wants to succeed as an ACO. But is it enough to put a right setup of people, process, technology and infrastructure? Most importantly, the ACO organization has to plan for an effective change management so that the gap between the current and future states in all the areas of healthcare continuum can be bridged.

Continue reading "Promoting accountability in ACO - A few insights (Part 2)" »

July 26, 2011

Promoting accountability in ACO - A few insights (Part 1)

In a successful Accountable Care Organization (ACO), establishing and sustaining the exchange of information flow among the individual constituents matter the most.

The term accountable care organization (ACO) was coined in the Medicare Shared Savings Program as part of the Patient Protection and Accountable Care Act of year 2010 (PPACA). The program, anchored by the Centers for Medicare & Medicaid Services (CMS), will share annual savings for a population of Medicare beneficiaries with a group of providers who form a provider organization that meets the defined criteria. Such groups are called accountable care organizations (ACOs).

Continue reading "Promoting accountability in ACO - A few insights (Part 1)" »

July 14, 2011

Medical Loss ratio: The GOOD-BAD-CONFUSING!

As you might have guessed from my previous posts, I'm more or less in favor of the health care reform mandates, but there are still individual rules I'm concerned about, and some I'm definitely confused about. This post focuses on one such confusing rule--the requirement for payers to use 85 percent member premiums toward the MLR (Medical Loss Ratio). Simply, payers must spend at least 85 percent of the amount they collect toward the cost of care.

Read my views in the article in Health Data Management.

The Medical-Loss Ratio Conundrum

Since I wrote my last blog regarding the confusion that I have withthe whole medical-loss ratio mandate, I have been inundated with e-mails and phone calls. People either took strong opposition to my assertions or supporting my assertions about the uncertainties surrounding the MLR mandate.

Click here to read my views in my blog space in Health Data Management.

 

Accountable Care Organizations - Old Wine in a New Bottle?

Everywhere I turn, I hear about accountable care organizations, especially during provider-focused forums. Nearly everyone is excited about their ACO (and medical home) initiatives, but I've also met with quite a few skeptics who believe that the concept is nothing new and has been tried many times--and failed--in various forms. Interesting!

Click here to read the complete blog in my blog space in Health Data Management:

 

Health Insurance Exchanges - Why Do States have to pay for them at all?

Lately, I have been reading a lot and of course, simultaneously thinking a lot, about the whole business of HIX. The more I think about it the more I start believing that the HIX and subsequently the move towards the individual market could be the ultimate catalyst to bring that major change in US healthcare industry that everybody is looking for. But it could simply be wishful, a bit misty, thinking on part of an increasingly frustrated middle-aged healthcare industry professional. I guess I included half of the healthcare industry professionals out there, along with myself. Anyways, I am going to throw out a bit of what I have been thinking over the next few blogs and would love to hear back from you guys if it makes sense or is just a day-dream.

Read the entire article in Health Data Management Blog :

Insurance Exchanges: Why Do States Have To Pay For Them?

March 17, 2011

Video: State Exchanges & Individual Market- Part 2

Video: State Exchanges & Individual Market- Part 1

March 16, 2011

Video: Health Benefit Exchange - Part 2

Video: Health Benefit Exchange- Part1

March 15, 2011

Video: Healthcare Reform Today & Tomorrow- The focus areas

Video: Healthcare Reform Today & Tomorrow- The Stages

February 16, 2011

IT Infrastructure for Accountable Care Organizations

For long-term effectiveness and sustenance of ACO beyond 3-5 year, unique IT infrastructure is required which will facilitate functioning of providers in an ACO as a unified entity working towards a common goal of reducing healthcare costs and improving healthcare outcomes. Providers in ACO necessarily need to have an Integrated Clinical System (ICS) similar to Electronic Health Record platforms solicited by RHIOs few years ago. Integrated Clinical System will be a comprehensive system with business modules to improve care coordination, clinical decision support and patient safety.

Continue reading "IT Infrastructure for Accountable Care Organizations" »

January 18, 2011

Health Benefit Exchange (HBE) - The different generations

The HHS has defined what, at a minimum, the HBEs will offer in terms of benefits provided to the members. They have also hinted upon a basic set of functionality that will be offered. But does anybody actually believe that exchanges will stick to only the prescribed structure. And here I am not even talking about later generations of the exchanges. I am talking about the very first set of exchanges that will hit the market.

Continue reading "Health Benefit Exchange (HBE) - The different generations" »

Affordable Care Act (ACA)- Healthcare for all

The various provisions of ACA make it a landmark act in the US Healthcare Industry - No Lifetime Limits, No Annual Limits, No Pre-existing conditions for children, Preventive services with no co-pay/ coinsurance, Community Rating etc.

Continue reading "Affordable Care Act (ACA)- Healthcare for all" »

December 27, 2010

Analytics for Accountable Care Organizations

The PPACA recommends a number of payment reform pilots to control rising healthcare costs and Accountable Care Organizations (ACOs) are one of them. ACOs have two-fold objective of reducing healthcare costs by efficient care delivery and improving healthcare outcomes. An ACO will typically be a consortium of primary care physicians, specialist and one or more hospitals that take complete accountability of cost of care and clinical outcomes for their local population. ACOs will be eligible for bonuses if they meet both a quality and cost benchmark and penalties if they fail to meet the benchmark.

Continue reading "Analytics for Accountable Care Organizations" »

December 6, 2010

Meaningful Use Reporting: Buy vs. Build?

A question has been coming up in discussions whether or not a hospital should build or buy a Meaningful Use application.  According to our recent poll of about 100 hospitals, most are leaning towards building one.  But I have my own apprehensions here. Meaningful Use requirements are out for Phase I with Phases II and III to follow.

Continue reading "Meaningful Use Reporting: Buy vs. Build?" »

November 30, 2010

HIEs as a vehicle for Meaningful Use

Meaningful use should not be seen just as installing a certified EHR and generating the required reports. Ability to exchange Health Information securely over the internet is one of the foundations that need to be in place for realizing the key benefits of improved quality of care and patient safety at lower cost. While most of the stage 1 criteria may not have a direct dependency on Health Information Exchanges (HIE), you can expect to see increased relevance of HIEs in near future, in the context of implementing some of the Meaningful Use (MU) requirements.

Continue reading "HIEs as a vehicle for Meaningful Use" »

November 26, 2010

Future of Fraud, Waste and Abuse in the post reform world!

Growth of consumerism, evolution of Insurance exchanges, electronic records with meaningful use etc are the most talked about terminologies in healthcare industry. A lot is being talked about how the industry will face this enormous challenge primarily driven by three mandates - the Patient protection and affordable care act (PPACA, March 2010), the upcoming ICD-10 mandate and American recovery and Reinvestment act (2009). I would like to shift the focus onto 'Healthcare fraud' subject and how it is going to shape up in the post reform world, specifically with respect to ICD-10 mandate.

Continue reading "Future of Fraud, Waste and Abuse in the post reform world!" »

Meaningful Use : A journey towards Healthcare Enterprise Performance Management

ARRA Meaningful Use (MU) mandates have put a transformation pressure on the entire US healthcare ecosystem and is pushing  the use of electronic health records (EHRs) across all provider settings.
The Health Information Technology for Economic and Clinical Health Act (HITECH) has authorized incentive payments through Medicare and Medicaid to clinicians and hospitals when they use EHRs privately and securely to achieve specified improvements in care delivery. Also HITECH  goal is not adoption alone but using  EHRs in a meaningful way by the providers  to achieve significant improvements in care.

Continue reading "Meaningful Use : A journey towards Healthcare Enterprise Performance Management" »

CER - You build it and they will come!!!

This month Nobel Foundation announced the Nobel prizes for 2010. Two of these Nobel prizes were of special interest to me and for the entire healthcare industry. First, the Nobel Prize in Physiology or Medicine 2010 was awarded to Dr. Robert G. Edwards "for the development of in vitro fertilization (IVF)".  Apart from the religious or ethical discussions, this Nobel Prize was an acknowledgment of Dr. Edwards' fifty year long struggle that gave healthcare industry a new dimension by successfully producing the first test tube baby in July of 1978. By some estimates, today more than 40 million children and adults are indebted to Dr. Edward for their precious life on this planet Earth.

Continue reading "CER - You build it and they will come!!! " »

Health Benefit Exchange Vs Individual Market

Health Benefit Exchanges (HBE) or simply individual market - what to focus on? I believe this is the most talked about topic these days. I had very recently attended the AHIP Exchange Conference (NOv 8-10, 2010,Chicago), and somebody mentioned that the volume of the state-sponsored Health Benefit Exchanges is still unknown. But what everyone is sure of - is the fact that quite a significant portion of American population will be either purchasing healthcare insurance from HBEs or through some kind of a similar off-exchange model, by 2016.

Continue reading "Health Benefit Exchange Vs Individual Market" »

October 27, 2010

Meaningful Use as a catalyst for performance management

Blog Post by Charles Podesta, SVP & CIO at Fletcher Allen Healthcare

As a participant of the October 21, 2010 webinar entitled "Meaningful Use a Catalyst for Enterprise Performance Management" I was struck by the high number of participants that planned on using MU as a catalyst to a higher performing organization (good thing) and the high number of participants that thought it was going to be a real stretch for their organization to get to Stage 1 MU (bad thing).  This dynamic tells me that healthcare IT professionals want to do the right thing but may not have the resources to pull it off.  IT professionals should take the opportunity to make the case that meeting Stage 1 MU goes far beyond getting a stimulus check and avoiding penalties in 2015.  I believe that Infosys' HEPM methodology can assist healthcare IT professionals not only with the approval process but also to give comfort to the CEO and board that it's achievable.   I view partnering with Infosys as an insurance policy for your organization. The risk to your organization's future of not meeting stage 1 MU is greater than the effort and resources required to get the job done.  The bar will be higher with Stage 2,3 and beyond and the costs will be greater.  This is not the time to take a wait and see attitude.  Your organization's future is in your hands.

To view the recorded webinar Click here.

(Requires registration)

Thanks!

Chuck.

September 30, 2010

Meaningful Use : A key enabler for ICD 10 compliance for providers

In continuation to my previous blogs about the MU, I am digressing a bit but shall be consistent in my pitch on value transformation. In this major upheaval of health reforms  where the mandates are from compliance to ICD 10 norms, implementing EHR technology or rather implementing "Meaningful Use",  all the objectives, goals of these regulations are in the direction of improving population health, safety and outcomes.

Continue reading "Meaningful Use : A key enabler for ICD 10 compliance for providers " »

Meaningful Use can trigger high-performance culture

There are two distinct aspects of change management that I advocate in the context of Meaningful Use. One is related to end user training and sustained adoption of healthcare IT which I have discussed in one of my earlier blogs. The other is organizational change management to promote high performance culture which I will discuss here.

Continue reading "Meaningful Use can trigger high-performance culture" »

September 27, 2010

The Wellness Revolution!

I attended the employer healthcare congress conference this week in Los Angeles. The conference was divided into 4 separate sub conferences - Self Funding employer (Healthcare and workers comp conference), corporate wellness conference, Volunteer benefits conference and National healthcare reform conference. I was amazed to see such a big gathering of Wellness technology and service vendors. One thing that was very clear was that the wellness revolution will continue. The wellness industry has evolved from being "nice to have" and an attaché to the large disease management and care management programs to being a solution for controlling the rising healthcare cost globally.

Continue reading "The Wellness Revolution!" »

Comparative effectiveness research: Industry need to weigh its benefits

No doubt, comparative effectiveness research (CER) as a topic has risen to prominence in the recent healthcare reform debate. But in my opinion, more than just a topic to debate, the use of this research study in assessing the value of therapeutics has vastly remained undetermined among the majority stakeholders in the industry. This might be a reason, why one could hardly find any discussion on the benefits of embracing this "Mighty Tool" to drive the dynamics of our health care system for a better tomorrow.  Though the industry view this tool more from its ability to promote a "value based purchasing", trust me CER's role in US healthcare is even beyond that, and this is why it needs to be accurately weighed in term of its benefits and adopted in days to come.

Continue reading "Comparative effectiveness research: Industry need to weigh its benefits " »

September 23, 2010

Meaningful Use; a Meaningful Start?

Hospitals are pretty good at measuring and reporting outcomes; it's their business.  But hospitals typically lag far behind other major industries in terms of measuring and reporting how well they are running the business day-to-day.  Looking internally to say this department is doing their job well or not, or this physician, is just not part of the culture, but it could be.  There have been many consultants, consultancies, and product firms that have tried to nudge hospitals in the direction of internal and enterprise performance management, but these efforts tend to run out of steam because, in the end, internal performance doesn't mean much if it doesn't pay.

Continue reading "Meaningful Use; a Meaningful Start?" »

August 31, 2010

Data Collection for Meaningful Use

In my first blog on Meaningful Use (MU), I had identified business process optimization and redesign to facilitate data collection/data quality management for MU as one of the key ingredient for Healthcare Enterprise Performance Management approach towards MU compliance. On delving deeper into the final rule for Meaningful Use, it is emerging that business process redesign will be one of the fundamental requirements for achieving Meaningful Use and more precisely for reporting on Meaningful Use measures.

Continue reading "Data Collection for Meaningful Use" »

Meaningful Use - The cause for proactive performance management!

I've heard it all about Meaningful Use; well, almost.  So many attitudes.  We're a level 6/7 HIMSS hospital, so we're covered and don't have to do much; We don't really care much about Meaningful Use - we'll just figure out how to minimize the penalties; We need the incentive money badly so we're going to do whatever it takes, but we don't know what that is yet exactly; and more.  Single platform hospitals probably have it the easiest job of reporting if the vendors deliver, which they probably will.  But what about the best-of-breed hospital system?  A whole new reporting infrastructure might be required. 

Continue reading "Meaningful Use - The cause for proactive performance management!" »

Implementing "Meaningful Use" not EHR technology!

I am deviating a bit here from my previous blogs. Having read through vaious articles on meaningful use, it appears to me that the context of healthcare reform has shifted from implementing  EHR technology to Implementing "Meaningful Use" , as definition it is a fact.

Continue reading "Implementing "Meaningful Use" not EHR technology!" »

August 26, 2010

Healthcare Payer Industry shifts focus from Group to Individual Consumers.....

Last week I was talking to someone in the business operations of a healthcare payer organization about healthcare reform and its implications on technology investments and strategy. He said that - the bill will force all the healthcare organizations to expedite their efforts in becoming nimble and agile. Rise of consumerism and increasing cost of healthcare has forced the healthcare organizations to become more agile for last few years; this bill (PPACA) has just put a time cap around it.

Continue reading "Healthcare Payer Industry shifts focus from Group to Individual Consumers....." »

August 17, 2010

Leveraging "meaningful use" thrust for sustained improvement

It's now time for the hospitals and physicians to chalk out the roadmap for embracing the meaningful use and set the ball rolling for transforming the way IT is leveraged in healthcare.  I would like to highlight 3 key points in this blog -  Need for a long term strategic approach, Effective change management and leveraging HPM.

Continue reading "Leveraging "meaningful use" thrust for sustained improvement " »

"Meaningful Usage" The real start of US healthcare reform marathon

With recent finalization of the ARRA, I see the providers have geared up to tap the promised $27 billion. No-wonder the focus for them today is only and only "Meaningful Usage". Trust me; if one does a simple googling for "Meaningful Use," over million hits shows that the race has already begun for the giant leap. These are encouraging signs....US healthcare has started thinking BIG. But, yes I mean -there is a but. When the existing challenges of patient safety, clinical quality assurance and escalating cost are still the stumbling blocks in the wheel of care services; can providers really become this shortsighted to just achieve the meaningful usage benchmarks and run the show? I guess, the answer should be No. Achieving meaningful use can only be an initiation of their reform journey, not the destination. This however doesn't mean that Providers should overlook their immediate milestone and start looking at the horizon. After all, one won't be able to make the big, if he doesn't start in small.

Continue reading ""Meaningful Usage" The real start of US healthcare reform marathon" »

July 30, 2010

Meaningful Use : Achieve it by value transformation

In continuation to my previous blog on Meaningful use  Assessment,  post the final rule being released (for the meaningful use ) with much more laxed norms providers must view this wind of change as a opportunity to  implement and transform the organization by viewing the holistic value equation.

Continue reading "Meaningful Use : Achieve it by value transformation" »

In reality Use precedes Meaningful Use

Implementing CCHIT-certified EMR is only the first step; for achieving Meaningful Use (MU). It's very logical that EMR has to be used first before we can expect meaningful use. Starting to use EMR that an organization has implemented sounds deceptively simple and a non-issue but the truth is EMR adoption in US has been significantly low. Umpteen reasons have been attributed to lower adoption of EMR including dollar investments required, unclear ROI, lack of interoperability infrastructure for healthcare data sharing, reduction in face-time with patients at point of care, longer visit times that directly impacts revenues and ineffective training of staff and physicians.

Continue reading "In reality Use precedes Meaningful Use " »

July 29, 2010

The ICD-10 watch game is over: Providers just can't afford to remain in the backseat.

With the incentive induced ARRA, it has been easy for Providers to focus on the implementation of EHR and consequently lose their sight on the impending ICD-10 mandate. But, the rigid ICD-10 compliance date leaves no room for procrastination. There is no doubt that on the industry's ICD-10 trail, far by most the payers have been leading the race. The watch game is over. In my opinion, Providers just can't afford to remain in the backseat.
Even realizing the overhauling ICD-10 impacts in the fabric of the provider business processes, when the time is to establish and execute the strategic transition plans, i think majority of the providers are still grappling with how to integrate the new codes throughout their business spectrum. Also the significant challenge confronting many of them is probably a lack of definitive information about where to start? How to start? It is noteworthy to mention that a considerable chunk of providers are vouching on some form of external help to prepare for ICD-10 implementation- either through package vendors upgrades or outsourcing the most vulnerable HIM piece. "Buy vs. Build" is also a viable option for many. Some are even prioritizing to stabilize on the 5010 platform before they kick start for ICD-10.

Continue reading "The ICD-10 watch game is over: Providers just can't afford to remain in the backseat." »

Why ICD-10 is the perfect opportunity to move away from legacy systems?

Be it the healthcare reform, requiring payers to use at least 80% of their premium revenues to pay claims, or the insurance exchanges driving competition to their doorsteps, the message to US health insurance industry is clear - either run your business efficiently, or go out of business.

Continue reading "Why ICD-10 is the perfect opportunity to move away from legacy systems?" »

June 30, 2010

The Golden Nugget in Meaningful Use

"Meaningful Use" does not need an introduction any more. The sentiment about reporting on CMS defined Meaningful Use (MU) measures to become eligible for ARRA EHR incentives are varied across organizations. Many consider it a necessary evil leading to additional IT investments to support Meaningful Use reporting.  According to a recent PwC report on MU, 80% of the provider CIOs are concerned about meeting MU reporting criteria in time for 2011 incentive payment. Lack of clarity around some of the measures adds to their woes. 

Continue reading "The Golden Nugget in Meaningful Use " »

June 25, 2010

"ICD10 and Meaningful usages... the twains shall meet, for sure"

Deviating a bit from my previous discussion regarding provider's movement, up the EMR adoption chain, today I wanted to take a slight tangential divergence today to talk about the other big guy in the arena. Yes, I am talking about the adoption of ICD10. But is it really a tangential diversion? Isn't that the million dollar question?

Continue reading ""ICD10 and Meaningful usages... the twains shall meet, for sure"" »

June 15, 2010

Meaningful Use - Are you stuck : Take the first step

After the promulgation of ARRA 2009 there has been a huge debate, discussion, mapping of what actually Meaningful Use of EHR is ? Is it just implementing EHR technology , capturing information /using the data,showing better health outcomes  etc.

Continue reading "Meaningful Use - Are you stuck : Take the first step " »

June 7, 2010

Video: Strategies for ICD-10 Implementation

To Learn more about ICD-10 Implementation attend the Infosys' webinar 'Getting Ready for ICD-10'.


June 4, 2010

Video: Disruptive Force or a Sea of Opportunities?

To Learn more about ICD-10 Implementation attend the Infosys' webinar 'Getting Ready for ICD-10'.


June 2, 2010

Video: Role of ICD-10 in Health Reform

To Learn more about ICD-10 Implementation attend the Infosys' webinar 'Getting Ready for ICD-10'.


May 28, 2010

Affordable healthcare for everyone!

Affordable healthcare for everyone. Most Payers are planning to offer healthplans that are basic but cheap. Most of these plans will be very basic and the benefits will not be anywhere near what current plans might offer. But the positive side is that as an individual, you get a lot of flexibility in customizing your plan for your individual needs. This hopefully will be similar to buying a new car. Consider the current scenario to be similar to buying , say a Honda Accord. You buy the car and it comes with most of the features you need. You probably never smoke, but still pay for the cigarette lighter. Maybe you don't like to eat or drink in your car, but you still get the cup holders. Consider buying a Scion, which is highly customizable. You chose what you need in your car. The options are varied, but still it is not going to cost you too much like buying a highly customizable luxury car. The new scenario should also be like this. You should be able to pick and choose what benefits you will most likely use and not get something which you most probably won't use. Say you are too young or too old to have a baby, you probably don't have to opt for the maternity package.

Continue reading "Affordable healthcare for everyone!" »

May 21, 2010

Berlin Wall - Billing System vs. Claims Adjudication System

I know it is tantamount to a Berlin wall to fall, when we talk about unifying two water-tight compartments of US healthcare - The provider and the Payer. The Berlin wall did fall after a quarter century, as times changed. Times are changing for US healthcare as well. Will this healthcare wall between payer and provider fall?

Continue reading "Berlin Wall - Billing System vs. Claims Adjudication System" »

March 31, 2010

Winds of Change for US Healthcare Providers

Healthcare Reform bill is poised to change the economics of US healthcare. Nearly 32 million of currently uninsured population will get insurance coverage and subsidies in healthcare insurance will be available to families with income up to 400% of federal poverty level. Total out-of-pocket expenses would be limited, and insurance companies would be prevented from denying coverage for pre-existing conditions. Insurers would be barred from canceling coverage for sick people, as well as charging higher premiums based on a person's gender or medical history. While this is a welcome step towards healthcare socioeconomic equity, it will throw up unique challenges for insurers and providers to tackle.

Continue reading "Winds of Change for US Healthcare Providers" »

February 25, 2010

Healthcare Reform and its impact on individual market

The debate on Healthcare reform is going on at full throttle in Washington DC as well as the rest of the country. No one knows where this is headed to or can confirm what the outcome will be. It looks more likely that we will see Healthcare exchanges will get setup. Most probably not at the national level, but instead at the state level.

Continue reading "Healthcare Reform and its impact on individual market" »

January 21, 2010

Interoperability Trends within the Healthcare Provider Sector

To begin diving deeper into interoperability within healthcare, let’s talk about interoperability within the healthcare provider sector.  The healthcare provider industry is suffering from, what a colleague has very eloquently described as, ‘extreme heterogeneity’ of IT systems even within a single provider.

Continue reading "Interoperability Trends within the Healthcare Provider Sector" »

December 29, 2009

Interoperability requirements will underpin key health industry and health consumer trends

As the global healthcare industry grapples with tremendous challenges on both cost and quality fronts; the healthcare consumer is simultaneously undergoing an equally dramatic change in behavior, attitude and awareness.  This new-age healthcare consumer will soon demand a significantly more active role in managing his/her own health needs as well as filtering and monitoring the relevant services that would be provided by the health industry.

Continue reading "Interoperability requirements will underpin key health industry and health consumer trends" »

December 14, 2009

The Law of Supply and Demand - "Healthcare Rationing for our Future”

Supply and demand is perhaps one of the most fundamental concepts of economics and it is the backbone of a market economy. Demand refers to how much (quantity) of a product or service is desired by buyers. The quantity demanded is the amount of a product people are willing to buy at a certain price; the relationship between price and quantity demanded is known as the demand relationship. Supply represents how much the market can offer. The quantity supplied refers to the amount of a certain good producers are willing to supply when receiving a certain price. The correlation between price and how much of a good or service is supplied to the market is known as the supply relationship. Price, therefore, is a reflection of supply and demand, according to Investopedia.com, a Forbes company.

Continue reading "The Law of Supply and Demand - "Healthcare Rationing for our Future”" »

November 20, 2009

How is the health reform going to pan out?

The question these days, on everybody’s mind is ‘How is the health reform going to pan out?
With the passage of the bill in the house (though surprisingly narrowly) and with a clear democratic majority in the senate, the issue is not of ‘If’ but more of ‘When’ and ‘In what shape’ the bill will come into being. Now that we have pretty much moved beyond that point, the foremost question becomes what will be the ultimate impact of the reforms on three primary stakeholders, namely the patients, the providers and the payers.

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October 26, 2009

Healthcare reform is all about money!

Healthcare reform is all about money. Most of the discussion happening is around the reform to Healthcare Insurance. The various provisions that are discussed today like universal coverage, removal of restrictions on pre-existing conditions, electronic health records, Health Information exchanges etc are going to increase the cost that is currently borne by the members and the employers. Even without these changes, we are seeing the healthcare costs going up on an annual basis and it has increased consistently and alarmingly in the past 15 years. We have seen employers reduce their share of the expenses as the total price keeps going up. This trend is going to continue. When you talk about removing pre-existing conditions restriction that currently exists or allowing even chronically ill patients to be able to buy affordable (?) health insurance, it sounds great. But what does this mean to the health care costs? This definitely is going to increase the cost burden on the Insurers. So who gets to pay for this additional expense? Of course the member! Or let us consider the scenario where there is a competing government health plan option. Where does the government get the money from to pay for covering everyone? Again the members, who are the tax payers will get to pay for it. So is having Universal coverage not a good thing? Definitely not! So what do we need to focus on? Definitely the most efficient and cost effective way to provide the coverage to everyone. And that means the focus should be on efficiency and eliminating wastage and reduction in errors.

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September 15, 2009

"When you come to a fork in the road; Take it!"

Yogi Berra's second claim to fame is for being one of the most quoted figures in the sports world. He is credited with coining the deceptively simplistic observation, "It ain't over till it's over." But he's also known for his flubs. Yogi takes his experiences as one of baseballs' all-time heroes and turns them into funny, appealing, and moving essays on the game of life. His philosophy is plainspoken and down-to-earth, honest through more than 50 years of reflecting on the game of baseball. Keep trying. Stay humble, Trust your instincts. Most importantly, act. When you come to a fork in the road, take it.

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September 3, 2009

“What is Healthcare Reform”?

As the debate continues and the American People become more educated on the true impact of “Healthcare Reform” the question that begs for an answer is, “What is Healthcare Reform”? Read any article, tune into any top news organization and as soon as you think you understand the meaning from one of the political pundits or news anchors it will change as soon as you listen to another source. Even the politicians responsible for the legislation are confused!

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August 17, 2009

Universal Healthcare- A Possible Solution?

It seems that there are many in the general public who feel that universal health care will answer all the cumulative issues which has caused the current state of health care crisis in America today.  However, before anyone rushes into a “cure all” solution, there needs to be an understanding what universal healthcare is, how it will work for America, and further debate as to whether universal healthcare really is the right answer or if there are better ways for the government to spend taxpayer money towards a different kind of healthcare model.

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Healthcare Change- Finding Common Ground

As recently as a month ago, we might have compiled the multiple healthcare reform bills in search of common themes to prepare for likely changes to come.  Who would have supposed that successfully managing a health insurance organization would require that we become political pundits?  As the conversation unfolds, its resemblance to a dialogue is quickly dissembling into a conflict based on the loudest and last word spoken rather than on the merits of any given proposal. Terms are morphing, healthcare reform is being recast as health insurance reform. Our industry had approached the table with significant contributions, including a willingness to forego benefit exclusions based on pre-existing conditions in the context of a marketplace where effectively all lives are health-insured.  Health insurers are now being cast (by those who oppose reform) as the villain solely responsible for wasteful healthcare costs.

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August 3, 2009

Enterprise Data analytics: Breaking department silos

Organization departments have tendency work in silos and Healthcare Providers are no exception to this.  A leading insurance provider firm in USA was venturing into a new business in Canada and the IT team was busy working on the system requirements for the new business. The CIO sought this opportunity to make maximum out of the capital budget to invest in latest rules engine and custom application development. There was no consideration given to the revenue targets onto this new business or ROI on the IT system investment. Out of curiosity when I asked the CIO, his response was “ROI clouds the mind in any decision making. My priority is to ensure work for my team and have the systems in place to support business. It’s for business SMEs to extract maximum out of the system. This is what I call working in silos of departments by achieving individual department goals.

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Where are you Dr. Henry Ford, MD, MBA?

Will the Henry Ford of healthcare emerge from the current effort to truly lead the reinvention of the US system?  Not even 100 years ago, Henry Ford refined the assembly-line concept and completely transformed the automotive industry from a highly-specialized, one-off, craft-based culture into an industrial juggernaut based on fanatical process consistency, data-driven driven decision-making, and product standardization.  Costs fell almost immediately to unforeseen lows.  Access to automobiles became available to everyone.  Solid, competent, reliable service delivered to everyone.  Isn’t this what we all crave for our Healthcare system?

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June 15, 2009

AHIP 2009 - Key to the HC Reform and Trends for the future

I was at the Institute 2009 conducted by AHIP in San Diego. Excellent weather, fantastic people and exciting ambience has now put San Diego on the top of my list for a repeat visit. However these were just added attractions when compared to the seminar. Almost 1400 people attended, 400 odd from the various health plans and the rest were people trying to sell them some solution or services! It was a motley crew of attendees from an Infosys perspective: Clients, Prospects, Potential and current alliance partners, competitors. The booth area was huge and was extremely well designed to manage the flow of people. We had a protest too and the officer assigned to stand guard at the main building entrance spend 15 minutes talking to me about the pros and cons of the various pubs and steakhouses in the Gaslamp Area – but that’s another story.

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June 10, 2009

“The Wizard of Oz” (Healthcare)

Observations;

There seems to be a divide in the Healthcare Technology World in the U S between those that are proactively pursuing technology because it is necessary, improves quality and a necessary component of compliance and those who are “Capital” challenged and waiting for the “Wizard” to grant them the permission ($) to proceed. The ARRA HIT stimulus bill is effecting Healthcare Executives in different ways. George Halverson, CEO of Kaiser Permanente, one of the largest Healthcare Provider organizations in the world, declared at HIMSS, 2009 in Chicago during his keynote address that it was time to “Fix it Dammit”. While it is obvious that this is one approach there are still those that want the money first.

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June 2, 2009

Have a heart for the poor physician bearing the brunt of healthcare reform initiatives!

Has anyone really given a thought to the plight of the small (and large!) physician as a result of all of the proposed reforms in healthcare?  Doctors, to a large extent, seem to have been made scapegoats in the battle for healthcare reform.  At the same time, true reform is impossible without doctors participating willingly and eagerly. An incredibly ironic situation, but ripe for disaster in the making.

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May 27, 2009

Obama wants to reduce healthcare costs! But How?

After the Health Care Executive consortium meeting with Obama, the number 1 action is to reduce healthcare costs! But How?

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May 26, 2009

American Recovery and Reinvestment Act : The band is still playing on

The American Recovery and Reinvestment Act (ARRA) 2009…
And the band is still playing on

My dear fellow Netizens, have you picked up any nationally renowned newspaper lately and flipped to page 5A, or switched on the tube and frivolously flipped the channel through the umpteen news channels? If you have, then I am sure you could not have escaped the raging debate regarding the ARRA and its impact on the US economy and its social implications and its morality in a society that is considered as the beacon of free market and its….. You get the drift.

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May 22, 2009

Healthcare and IT in focus again

These times are tough for everyone considering the state of the world’s economy. But this is also an exciting time because of all the focus on healthcare and IT.

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Health Payer Survival Kit for a Suffering Economy

The analyst firms are predicting the healthcare sector to be almost recession proof, yet I am aware of layoff announcements in healthcare organizations in recent weeks.

As an astute leader in your healthcare organization, you’re scanning the headlines to find beacons to guide you through the economic doldrums.  One can’t help but notice that the messages for the healthcare sector span the spectrum from hopeful and encouraging to dire.

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Power Shift - Small Physicians become a large Healthcare-IT market in USA

Some more predictions/extrapolations:

Obama’s incentives package has put power in the hands of Physicians.

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Obama’s HC-IT incentive enables power shift from hospitals to Small Physician offices

As per my study here is a summary of Obama’s EMR and EHRS Incentive package:

1. $ 2B for developing standards, EMR installation grants and EHRS @ RHIR [I guess new name for RHIO]
2. $ 21B as incentives on EMR adoption. This is the net cost after anticipated savings of $ 15B are subtracted from the total spend of $ 36B on incentive payments.

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Meaningful EHR Adoption: What it means

The Obama Administration’s effort to get healthcare providers to acquire/adopt EHRs in “meaningful use” is certainly an ambitious dream supported with  more than $21 billion of which about $17.2 billion consists of direct incentives that will be paid through Medicare and Medicaid. Physicians who show “meaningful use” of qualified EHRs will be eligible for $44,000 to $64,000 in subsidies over a five-year period, starting in 2011. Physicians who don’t use start using EHRs meaningfully by 2015 will start to see reductions in their Medicare payments.

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