At Infosys, our focus on Healthcare is aimed at radical progress in affordability, wellness, and patient-centricity. We believe technology is a catalyst for game-changing healthcare solutions. In this blog, we discuss challenges, ideas, innovations, and solutions for the healthcare economy.

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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?

Sources of increase in cost:
1. Medical Errors
2. Friction with insurance
3. Shortage of skilled workers
4. Rising costs of new therapies
5. Adoption of IT systems and new technology

Medical errors lead to morbidity/mortality and maybe litigation. Adding to costs. So formula is to reduce errors.

Insurance works on the fundamental that say 100 healthy people pay for illness of say < 10 ill people. If the balance begins to tip towards the other side, then the costs begin to spiral. Then the payer wants to pay less and provider naturally wants to safeguard its income. So the formula is to keep the balance right.

Skilled workforce shortage leads to higher wages, over utilization, and increased chances of failed outcomes. So the formula is to train more workers and in the interim fill the shortfall by aliens/immigrants.

New therapies are unavoidable, because there is a constant battle going on between disease and therapies. One trying to outdo the other! So the formula is to be conservative while using new therapies.

Adoption of IT systems helps in optimizing the processes, removes silos, reduces errors and provides information at the point of care. This is exactly what the incentive package intends to do.

Cutting costs is easier said than done because cost for one stakeholder is revenue for another in the healthcare system.

May 22, 2009

What bare minimum features should a Hospital BI tool provide?

Hospital executives must perform the complex task of keeping pace with the dynamic healthcare environment – constantly changing patient volumes, fluctuating supply costs, stringent government compliance and quality requirements, asset utilization needs, and staffing shortages. Real time actionable information at finger tips can make a difference between life and death in a Hospital scenario. The disparate silos of data across various departments are the biggest bottleneck in providing actionable information. Mergers and acquisitions add to the diversity of hospital information system (HIS) application and data sources, thereby not allowing ‘one version of truth’.

Most hospitals have business intelligence (BI) systems which claim to provide a solution. However I think most BI tools provide post facto analysis and miss out on the real-time aspect. An effective BI solution is the one which accounts for analytics considering “People, Process & Systems” in a hospital.

Most people want to be challenged and to prove what they can do. The human tendency is to get into a comfort zone and main the status quo.  Hospital BI tool should have effective way to set objectives at each level and track the performance against the objectives commonly referred as KPIs. A BI tool should address following needs:

• The BI tool should be able to track the workflows across hospital departments to ensure adherence to standard operating procedures (Evidence based medication).
• The tool should be able to define flexible workflows with set tolerance levels around adherence to key activities and raise alerts, escalations on breach of tolerance levels.

• The systems providing data for BI should ensure effective usage of technology and reduction in human interventions in capture of data. The BI tool should capture/fetch data from the parent system at real time without affecting the performance of the parent system. The tool needs to allow interoperability to enable corrective action by logging into the source system of KPI data.
• The BI tool should have interface inventory around the common interfacing standards to integrate with the HIS systems. It should support seamless integration capabilities for custom interfacing needs.

Collaborative Performance : Making supply chain costs an hospital-wide responsibility

Over the past decade, hospitals have invested their resources in automation of both the clinical and non-clinical processes. The current economic situation will force hospitals to be more cost-efficient and improve operations. Hospital leaders may be restricted to new investments in information technology and will be mandated to reap benefits from current investments. Collaborating Supply Chain and Revenue Cycle functions provide single point of visibility of key metrics for hospital leadership, which will enable efficient real-time decision making; and improve hospital-wide performance.

Unlike other enterprises, hospitals have a unique revenue generation pattern; we will notice that the costs, utilization and revenues are mostly de-linked and many times increased cost does not proportionately translate into increased revenues/reimbursement. This takes us to the very basics of understanding factors that would push or pull revenue. There are many questions that needs to be addressed. However, the biggest question is - “Can we manage an enterprise where we understand the cost of product and service; have no control on utilization of resources and have a little visibility on expected revenues?”
Of the three factors that are mentioned above, only supply cost seems to have clear visibility and hence is being questioned time and again; and utilization and reimbursement linkage to supply cost is neglected.
Comparison between HFMA’s 2005 and 2008 supply chain benchmarking survey reveals that
1. Physician buy-in and Automation, are still persistent challenges over last three years
2. New improvement opportunities are emerging; such as Supply-Revenue integration, Data standardization and management of supplier contracts
Challenges/Improvement opportunities – Supply Chain Leaders

Challenges/Improvement opportunities

Performance in isolation – Challenges for Hospital Supply Chain
Hospitals currently boast of department achievements. For instance, Supply chain uses an ERP solution that reduces supply cost and monitors fulfillment SLA’s at 100%; Case management monitors patient outcomes and benchmarks at par with its peer group; Patient satisfaction is improving by every survey, at the cost of increased services utilization that many times are not reimbursed by payer. Hospital AR can only be as good as its charge capture methods and systems.
However, all these micro successes don’t seem to translate into an overall macro level success. Despite improved performances by individual hospital functions, many hospital report negative margins. One of the key challenges for hospital leadership is visibility of hospital-wide information at a single point

Collaborative Performance: Supply chain – Revenue cycle integration
Reducing supply chain costs is an organization-wide responsibility. Integrating supply chain and revenue cycle systems can help track cost, utilization and reimbursement metrics effectively.

Supply chain need to transform from fulfillment partner of the physicians to role in supply utilization. A collaborative dashboard like the sample below will help each department in the value chain to proactively reduce the costs. The collaboration should aim at not just reducing cost, but also make all the departments responsible for profitability of the hospital.

Illustration of transforming isolated performance to collaborative performance

Moment of truth
A collaboration dashboard will provide real-time alerts for each member of the value chain.

Supply chain – Participates in utilization decision making and is aware of real-time payer reimbursement
Physician offices – Is aware of reimbursement trends and supply alternatives, which effectively reduces denials and reduces cost , yet focused on providing best of patient care
Revenue Cycle – Keeps payer contracts updated, by accessing real-time utilization information and supply costs

Chronic Disease Management scene in India?

In India, a leading hsopital conceptualized the program to lead Outpatient chronic care market and to some extent, extend brand in outpatient care – By offering a comprehensive chronic care model. Here is the evolution of disease management in India:

1999 Patient specific information portal– Pure online model
2001 Online Wellness Channels – Pure Online model
2002 Branded Wellness Channels and Information Kiosks – Brick and Click model
2003  First Disease Management Program called “BreatheEazy” – Program to manage asthma.
2005  Second Disease Management Program called “Healthy Heart “ – Program to manage  chronic Cardio Vascular diseases.
Role of Stakeholders in the program:
Pharmaceutical companies
• Patient education material
• Physician resources for treatment of Asthma and COPD; and co-morbidities
• Advertisement and marketing resources
• Sale of drugs at a discount
• Primary market research to identify program components
Healthcare Provider
• Program deployment
• Patient care
• Call center support
• Patient care
• Education sessions
• Participation in camps (Corporate, school and community)
Patients / Corporate
• Receive care and adhere to program guidelines
• Feedback to call center
• Provide testimonials
IT/BPO companies
• Develop software for data management and health monitors
• Call center support
• Outcomes reporting and data analytics
• Presentations at key seminars – DMAA
Health Insurance
• No role as of now
• No data on actuary on out-patient care
• Out-patient care still not promoted by health insurance plans in India

Typical IT systems/modules involved in program:
The IT systems used in a DM program achieve 4 objectives:
•  Program compliance
•  Patient compliance
•  Data analytics
•  Reporting
The modules, which a typical DM system should have are:
1. Program management module – Scheduling visit, program health etc.
2. Call Center module – In bound and out bound
3. Physician module – PHR, Prescriptions etc
4. MIS – Reporting, data analytics, program support  
•  Relieved patients – Testimonials, challenge camps, group session leaders etc
•  Camps conducted for schools, corporates (Includes Infosys Hyderabad)
•  Very effective database gathering model – Camps, advertisements, primary research, pharmacy coupons, referral centers etc.
•  Outcomes presented at DMAA Annual 2003, 2004
• Lack of health insurance
• Lack of focus on chronic care by leading hospitals – The focus still on critical care – big bucks!!
• Lack of physician support – Physicians in India doesn’t believe in team work compared to a group practice in US.
• One of the leading physician comment was “I do not want to loose my patient to the system. This is a good program, and it will suck in all my patients”
• Only GSK drug need to be prescribed , which limited the quality of treatment.
Going forward :
• In the US, DM programs are driven by Insurance companies to contain cost, control chronic conditions and reduce emergency visits. Health Insurance in India need to follow the model.
• As the cost of chronic care escalates, patients will realize value in DM program. Patients are happy taking SOS medications to preventive care (Salbutamol @ Rs.100 to Salmeterol/Fluticasone @ Rs.500 – Rs.1000)
• Encourage physician’s belief in team work to ‘lone’ care provider.


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