Healthcare Economy

Minute Clinics - To be or not to be

Tue, 20 Dec 2011 14:31:20 +0000

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.")

2012 is your last chance to assess the impact of ICD10; Don't lose it.

Tue, 20 Dec 2011 14:22:54 +0000

Acute ambiguity exists in the market right now in the ares of product readiness, analysis readiness, and people readiness; There is precious little time remaining to evaluate, decide, and act in these areas to prepare your facility for ICD10.

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

Mon, 07 Nov 2011 11:54:56 +0000

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.

Will HHS grant an extension for ICD 10 compliance beyond Oct 1, 2013?

Mon, 07 Nov 2011 11:43:56 +0000

Many commercial payers started on ICD 10 compliance activities quite early. However, based on my current visibility, a significantly large number of payers that are in the early phases of assessment are not ready for the Oct 1, 2013 date.

Following are the key issues..

Minute Clinics - To be or not to be

Mon, 31 Oct 2011 08:39:07 +0000

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.")

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

Mon, 31 Oct 2011 08:26:29 +0000

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

Improving the patient experience with Social Media

Tue, 20 Sep 2011 12:24:55 +0000

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.

Promoting Accountability in ACOs - Part 3

Thu, 15 Sep 2011 09:03:22 +0000

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.

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

Thu, 15 Sep 2011 08:54:40 +0000

"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.

What is going on with the Health InsuranceExchanges?

Tue, 06 Sep 2011 08:33:31 +0000

It is quite amazing to see the reaction to the health insurance/benefit exchanges that have been mandated by the health reform bill, to be created and maintained by each state to manage its uninsured population. There were 7 states/coalitions that had received the early innovator grants, ranging from just above 6 million to MD, all the way in excess of 50 million to OK. Now that is some range of innovation, I must say. But I deviate. The point is that two of the top 3 grantees have since returned the grants, OK and KS. And by the looks of the conversations we have been hearing in the corridors of power, there may be others who are contemplating a similar response. On the other hand, the second round of grants provided additional funding to the smallest grantee MD, in excess of 20 million dollars.

Read the complete post at my blog space in Health Data Management.

The link below:

http://www.healthdatamanagement.com/blogs/health_care_technology_news-43121-1.html

Disease Management- DMOs way forward

Thu, 25 Aug 2011 07:37:04 +0000

Disease management is an approach to manage chronic illnesses through prevention, patient centricity, evidence based practice guidelines and outcome based with an emphasis to improving the overall health. Traditionally heart diseases, diabetes, pulmonary diseases and asthma are considered in this.

Health Insurance Exchanges - Get your site right

Thu, 18 Aug 2011 08:01:44 +0000

How many times have you got lost looking for the right information in a web site? How many times did you go "phew, not another form!" or "Why are they asking all these questions over and over again?

Starting in 2014, the state health benefit exchanges are required to setup a new marketplace where insurance can be bought the 'Travelocity' style. The health benefit exchange for small employers, un/under insured population will have a platform to view comparable and obtain clear information on benefits and costs of insurance plans.

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

Thu, 18 Aug 2011 07:47:30 +0000

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.

ICD-10: What goes along with Financial Neutrality?

Thu, 04 Aug 2011 08:18:01 +0000

With the transition to ICD-10, payers will certainly leverage the added granularity to improve their existing policies, adjudication rules and benefit categories. So, now certain services will be covered and paid, while others will no longer be covered and might be pended or denied if the claim is filed. These decisions will be crucial during the transition from ICD-9 to ICD-10 because any loss or misinterpretation of information about clinical issues will invariably distort the ability to ensure neutrality with respect to claims payouts. We also know that payers do leverage certain software (DCG/MEG/DxCG/CRGs) to predict their member expenditures or prospective provider reimbursements for members with multiple, combination or complicated conditions. These prediction software systems (which are all in ICD-9 as of today) will be migrated to ICD-10. Lack of clinical coherence in their transformation process will invariably alter the coverage group and risk pool definition, along with the member risk profiling and stratification statistics - all of which will ultimately impact the bigger goal of achieving financial neutrality at an enterprise level.

Please read the complete article in my blog post at ICD10HUb.com.

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

Tue, 26 Jul 2011 08:23:24 +0000

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).