Telemedicine technology has been improving steadily over the past several years, and as the tech gets better, so does its reputation.
Increasingly, payers and providers are realizing that telemedicine has the potential to control costs, but the sector has now crossed a threshold. Complex clinical cases and behavioral health are now being treated viably using a virtual approach.
Much of telemedicine’s appeal lies in accessibility. The lack of access to care through telemedicine negatively affects patient engagement and follow-through, according to new research from telehealth provider Teladoc. Treating mental health, in particular, becomes easier, less costly and less stigmatized when behavioral health treatment can take place in a virtual setting.
“Increasingly, people who are suffering from behavioral health disorders are recognizing that virtual care can often be a highly effective solution,” said Dr. Lew Levy, Teladoc’s chief medical officer. “About 42 million Americans have anxiety disorders, and more than 16 million suffer from major depression. But most haven’t received treatment in the prior year.”
That’s problematic, because in the U.S., 70 percent of people with a behavioral health issue also have a medical comorbidity, the research showed. For those dealing with multiple conditions, such as hypertension and depression, a single point of virtual access to answers to their healthcare needs means improved outcomes through better care coordination. And in a value-based world, better health for patients usually translates into better financial standing for providers.
Whether a patient’s primary malady is behavioral or physical, there’s a cost to the delivery system. Something as simple as adjusting blood pressure medication can often be done in a more cost effective way through a virtual setting.
“There’s a quality aspect as well,” Levy said. “Someone doesn’t have to be in a waiting room where people may be suffering from flu or other illnesses. If they have some complexity to their blood pressure situation they can be referred to some expertise. … For an individual living in rural Maine, the best provider might be a physician with a Maine license practicing in Portland, but it’s an hour car ride for the patient. But now that expertise can be delivered in a convenient way, and with top-notch medical knowledge.”
The potential for telemedicine to address clinical cost becomes clearer when examining a breakdown of what contributes cost to the system. Episodic care, said Levy, drives about 23 percent of the costs. Telehealth programs rooted in general medicine are beginning to tackle those.
When it comes to more complex care, 27 percent of the population drives 40 percent of the costs, including expert medical opinion and behavioral health.
“These are areas in which an individual might have a fairly serious medical condition that has not been very well controlled on a very costly medication, or individuals who might be facing yet another complicated virtual procedure,” Levy said.
Then, at the top of the pyramid, is clinical care, which affects 3 percent of the population but drives 37 percent of the costs, said Levy. Telehealth is addressing this through artificial intelligence, applying it to areas such as challenging oncology cases.
“Putting the medical situation first, I believe, has been some of the key to how we see the delivery of clinical quality, and it’s happening in all of the markets in which we’ve delivered our services,” he said. “The quality of our expert medical opinion service, for instance, is done through leveraging the expertise of board-certified specialists in countless aspects of medicine.”
Costs large and small can be addressed. Say someone wants to use telemedicine to get to the bottom of a pesky skin rash. The patient would typically provide high-resolution photographs for review by a top dermatologist, but if the condition was more complex and chronic — perhaps the patient was having these skin lesions for an extended period of time — an expert would be brought on board to conduct an in-depth interview. If there was pathology involved, the telemedicine group would collect the pathology and review all of the care the patient has received, making substantive treatment changes up to 75 percent of the time to get patients into the correct course of care.
“And we can save money by avoiding therapies and interventions that would not be efficacious in the ongoing care of the individual,” said Levy.
Early results in the behavioral health space have been equally as encouraging. According to its research, Teladoc’s behavioral health service have seen meaningful symptom reduction, with a 32 percent decrease in depression symptoms, a 31 percent reduction in anxiety symptoms and a 20 percent reduction in stress symptoms.
Levy sees telemedicine as being at an inflection point, with growing utilization and acceptance that he only anticipates will grow.
“I do believe quite strongly we are in many ways at the beginning of the story in terms of the ubiquity of virtual care being adopted in the future,” he said.
Disclaimer: This article was written by Jeff Lagasse and originally published in Healthcare Finance here.
Consumers are looking to mobile health tools, such as mHealth apps and wearables, to improve their medication adherence.
A recent study of some 800 prescription medication users, conducted by Russell Research for Express Scripts, finds that roughly half believe mHealth technology would help them become more adherent – and one-third of those would be more likely to use them if the tools were set up for them.
With experts suggesting at least half of the nation’s medication users aren’t taking their drugs as prescribed – costing some $300 billion a year in avoidable healthcare expenses, or $1,000 per person – medication adherence is a significant issue, and one that healthcare experts have vowed to tackle more aggressively.
“This survey shows that while patients with chronic diseases know that medication is critical to their treatment and health, they don’t always act on that knowledge,” Snezana Mahon, PharmD, vice president of St. Louis-based Express Scripts Clinical Solutions, said in a press release. “Given the huge cost of nonadherence to an individual patient’s health, as well as to the country as a whole, it’s essential for patients and clinicians to work together to find solutions to help overcome barriers to adherence.”
Those taking medications would seem to agree. Almost half of those surveyed said taking their drugs as prescribed is the most important part of their health regimen, a percentage higher than those selecting a routine check-up (30 percent).
And they seem interested in improving their habits: 56 percent said reminders would more likely help them improve adherence, and 19 percent said those reminders would definitely help them.
That’s where mHealth comes in.
“The three main drivers of non-adherence come from cost, clinical or behavioral reasons,” said Kyle Amelung, PharmD, BCPS, a senior clinical consultant on Express Scripts. “All three can be solved for through mobile health tools.”
Younger consumers are particularly interested in mobile health technology: 74 percent of those between the ages of 18 and 34 believe such tools would help them, and half would be more likely to use the technology if it was set up for them. Among those age 35-54, the percentages were 62 and 46, respectively.
“We believe success comes from getting within the patient’s flow and reminding them about their health when and how the patient prefers,” Amelung said. “Most people view mobile devices as a personal productivity tool that can be used to check the news, connect with friends or get the score of the game. Incorporating these devices into taking better care of yourself is a logical position – but people still don’t want to be ‘nagged’ by family or friends about their health.”
That point was also made in the survey: 27 percent said they would most not want to be reminded to take their medications by a health device, while 40 percent said a spouse or partner would be most bothersome and 31 percent said the same of a friend. In each case, respondents felt that they’d be nagged by those prods and end up resenting the reminders.
Amelung emphasized that mHealth alone won’t solve the medication adherence issue.
“The key to mHealth tools is partnering them with a live clinician that can oversee the data, flag high-risk patients, and intervene as appropriate,” he said. “Technology is not the solution; technology is the means to an effective solution. … To truly affect change, any proposed solution must be partnered with live clinical support to answer any questions and provide specialized guidance to the patient.”
The survey also shed some interesting light on prescription habits.
More than half of those surveyed feel they’re doing better at sticking to their prescriptions than others – including 60 percent of seniors. And more respondents were unconcerned about missing a medication (31 percent) than were extremely or very concerned (29 percent).
Among other results:
67 percent would be motivated by a reward to take their medications as prescribed.
82 percent would be motivated to take their medications by a financial reward, while 15 percent chose points toward a merchandise purchase and 3 percent selected a charitable contribution.
Only 33 percent understand the financial significance of medication adherence; 35 percent believe the annual cost to healthcare runs about $150 billion (or $500 per person), while 19 percent put that figure at $25 billion ($75 per person) and 12 percent said the cost was around $8.3 billion, or $25 per person.
44 percent cited side effects as the primary reason for not taking medications as prescribed; 28 percent picked inconvenience and 21 percent said they stopped taking their drugs because they were feeling better and felt they didn’t need to continue the prescription.
Amelung said some of the survey’s results surprised him.
“One of the most surprising findings was that two-thirds of those polled say they are more likely to take better care of their health and adhere to their medications when rewarded for their efforts,” he noted. “We all want to be in optimal health, but this data point supports the long-standing belief that only the potential of better health outcomes is not sufficient in getting patients to make the best decisions and take the appropriate actions for their health.”
“In today’s world, the distractions of the moment often get in the way of pursuing what’s in the best interest of our care. We sometimes forgo scheduling or keeping doctor appointments. We skip necessary lab tests or our annual flu shot. Many of us forget to refill our medication or we don’t remember to take it every day. … For most of us, engaging in the right daily behaviors to improve our health is a challenge because these actions fall out of our normal routines and habits – and so, we skip them. Knowing that there must be something more for the patient to obtain and that financial rewards are an effective way to motivate patients, we can offer specific carrots to incentivize healthier actions and lead to decrease costs in the healthcare system.”
Disclaimer: This article appeared in mHealth Intelligence originally and can be found here online.
Information technology professionals have never played a more important role in healthcare or been more responsible for its ultimate success or failure. If information is the new lifeblood of healthcare, data are the platelets that comprise it and IT infrastructure is the circulatory system it moves through. In my 30 years in the industry, I’ve seen technology’s role grow in importance and today I would argue that it is ground zero for each objective of the “Quadruple Aim.”
It’s a new dynamic that reflects a singular reality: Healthcare, depending on who you speak with, is either on the precipice of a technological revolution necessitated by a rapid shift away from a fee-for-service model to value-based care, or alternatively an evolution that reflects a steady transition to a technology-based system that focuses on patient outcomes. In reality, it’s both – a (r)evolution that’s steady in its progress and shaped by a rapidly changing technological environment. Consider how IT is shaping each of the four objectives at the modern hospital:
Improving the Patient’s Experience and Care: IT is increasingly involved directly or indirectly in virtually every aspect of clinical care. In a world of connected devices and clinical hardware, the importance of IT’s role cannot be overstated for both ensuring smooth operation and securing these systems.
Improving Population Health: To impact the health of entire populations requires not only for information to effectively flow between hospitals, physicians’ groups and clinicians, but also payers, pharmacies and patients. IT systems and infrastructure are the conduit through which this information sharing takes place and one could argue, the nervous system required to operate an effective accountable care organization.
Decrease the Per Capita Cost of Healthcare: Through automation, IT by its very nature removes costs from the healthcare system, but its role extends far beyond that. With upcoming initiatives like the Centers for Medicare and Medicaid Services’ Risk Adjustment and Hierarchical Condition Category (HCC) coding, IT will play an important role in ensuring that all related patient information is defensible and properly documented – a reality that will dramatically impact the bottom line.
Improve the Workplace Experience of Doctors and Clinicians: IT’s impact on the fourth objective of the “Quadruple Aim” is no less significant. Initiatives such as EHR optimization have helped free physicians from administrative work and enabled them to do the thing that makes most the happiest – spend more time helping patients.
This isn’t to say that IT inherently achieves the four objectives of the “Quadruple Aim.” Effectively tackling these objectives requires a keen focus on three key areas that ensure data is transformed into actionable information. The first includes business process automation. Before an IT department can put the systems and processes in place to effectively use information across the organization – and with stakeholders across the entire healthcare landscape – it must first understand how data, and the insights gleaned from it, is shared and used. With this knowledge, IT can then automate the sharing, storage and protection of data in ways that make the useful information within it easily attainable, free clinical staff members from an administrative burden and result in faster, better care for patients.
A data and document management process must also be in place. This ensures data is collected and processed in a consistent manner, it’s clean in all of its forms, including structured and unstructured data, and arranged so that it can be used effectively and consistently. These requirements will also increasingly apply to real-time streaming data that stakeholders can use to better serve patients and further population health efforts. For example, pharmacies will be able to alert doctors when a patient fails to pick up their prescription or let the primary-care doctor know in real-time when another caregiver prescribes a potentially contradictory therapy.
Finally, data becomes information when it can be acted on. With analysis and visualization, data can be presented to not only reveal actionable information, but also illustrates patterns. For this reason, business intelligence (BI) and analytics – including self-service – will increasingly be relied upon by both caregivers and operational professionals at hospitals. In addition, dashboard modeling will increasingly show stakeholders where opportunities to better use information lie.
All of this foreshadows a new era for IT – one in which it will significantly shape the patient experience, provide caregivers with the insights and facts they need to shape the health of populations, lower costs and free doctors to help more patients. Are you ready for the (r)evolution?
Disclaimer: This article was written by Marie Murphy and originally published in Health IT Outcomes here.
I remember when visiting a city required paper maps and often actual guidebooks. Today, I tap on a map app on my phone, enter my destination and review options for getting from point A to point B. In recent years, these applications have expanded to integrate ride-sharing, bike-sharing, and public transit information. Map apps provide two key real-time data points to help me compare the different options: the time it will take to get to my destination and the cost.
Behind those data points are elegant algorithms that analyze traffic patterns and conditions, as well as the real-time data exchange between multiple apps through modern, Representational State Transfer (RESTful) application programming interfaces (APIs). What makes our smartphones so powerful is the multitude of apps and software programs that use open and accessible APIs for delivering new products to consumers and businesses, creating new market entrants and opportunities. There is nothing analogous to this app ecosystem in healthcare.
ONC’s interoperability efforts focus on improving individuals’ ability to control their health information so they can shop for and coordinate their own care. While many patients can access their medical information through multiple provider portals, the current ecosystem is frustrating and cumbersome. The more providers they have, the more portals they need to visit, the more usernames and passwords they need to remember. In the end, these steps make it hard for patients to aggregate their information across care settings and prevent them from being empowered consumers.
Just as consumers can see the time to destination and costs using their map apps, they should be able to see quality indicators and costs of their care. As Health and Human Services (HHS) Secretary Azar recently stated, “putting the healthcare consumer in charge, letting them determine value, is a radical reorientation from the way that American healthcare has worked for the past century.” I certainly recognize that issues around pricing for healthcare services and measuring quality are complex, but I am confident that ONC’s efforts will complement new policies across HHS to encourage transparency, leverage Medicare and Medicaid to drive value-based transformation, and reduce regulatory burden on the health system.
As part of ONC’s role in coordinating health information technology (health IT) nationally, we are working with innovators to develop modern APIs that support the use of mobile apps to help individuals manage their own health or the health and care of a loved one. A robust health app ecosystem can lead to disease-specific apps and allow patients to share their health information with researchers working on clinical trials to test a drug or treatment’s efficacy, or monitoring outcomes like those in the National Institutes of Health’s All of Us Research Program.
ONC took a practical step to accelerate the use of APIs in healthcare with the 2015 Edition of the certification criteria adopted as part of the ONC Health IT Certification Program. Specifically, the 2015 Edition includes updated technical requirements that were not available in the prior edition and—to the benefit of the provider and the patient—to support further innovation in APIs and interoperability-focused standards. The 2015 Edition includes “application access” certification criteria that require health IT developers to demonstrate their products can provide application access to core medical and patient information via an API.
The 21st Century Cures Act (Cures) builds on ONC’s 2015 Edition and calls for the development of APIs that do not require “special effort” for developers to access and exchange health information. ONC will address this requirement through rulemaking expected to be issued later in 2018. Ensuring that APIs in the health ecosystem are standardized, transparent, and pro-competitive are the central principles guiding our work. These goals should allow new business models and tools that will expand the transparency of all aspects of healthcare. New tools should allow patients to comparison shop for their healthcare needs like they do when hailing a ride.
The convergence of these actions, the new authorities granted to ONC by Congress in the Cures Act, and efforts by HHS, the Centers for Medicare & Medicaid Services (CMS), the National Institutes for Health (NIH), and the Veterans Administration (VA) with the MyHealthEData initiative are helping promote more consistent data flows, inject market competition in healthcare, and return individual control of their care to the American public.
Disclaimer: This article was originally written by Don Rucker and published on Health IT Buzz online.
Over the past 5 years, healthcare data has fallen prey to unethical attacks that compromise sensitive patient information. If you look back at 2015, it was the worst year in healthcare data security when data breaches hit an all-time high by affecting 113 million individuals approximately.
As of today, the number of breaches reported to the Office for Civil Rights (U.S. Department of Health and Human Services) has been consistently increasing. Also, the number of individuals affected does not seem to improve despite regulatory enforcement procedures and laws drafted to put a check on this.
This infographic by Kays Harbor establishes a comparative analysis and infers how data breach patterns have evolved in all these years up to 2017. It highlights the following major findings:
HIPAA data breaches reported in 2017 were more than double the number of breaches in 2016. Though, the individuals that are estimated to be affected by these breaches was much less than the past four years.
Healthcare providers again made it to the top of the list for reporting 231 data breaches – highest in all these years.
Information technology continues to be a major reason for these breaches so far, showing an upward trend in the contribution of hacking and IT incidents resulting in data loss.
Kentucky based healthcare organization, Commonwealth Health Corporation reportedly filed a breach confirmation related to theft affecting 697,800 individuals.
While Texas reported maximum hacking incidents, breached entities in California filed maximum thefts two years in a row.
Furthermore, it discusses the trends and predictions by the C-suite in the healthcare industry for the coming year. David Muntz, principal at StarBridge Advisors said, “There seems to be a growing gap between the demand and supply of cybersecurity professionals that need to be addressed. On the positive side, vendors are providing strict countermeasures for vulnerable products and services which will result in HIPAA being perceived as an enabler for data sharing as well.”
As a matter of fact, 2018 has set all hopes high and CIOs are looking forward to a decline in the breached numbers with active cybersecurity measures challenging the perils of vulnerable healthcare systems.
Disclaimer: This infographic was designed by Kays Harbor and the article was published by Electronic Health Reporter here.
Privacy and security concerns are linked to reduced patient access of health records and trust in health information technology (HIT). Findings were published April 11 in the Journal of Medical Internet Research.
In this study, researchers examined the effectiveness of HIT by looking at information assurance issues such as privacy concerns and trust in health information.
“Today, the healthcare industry primarily relies on HITs such as electronic medical record (EMR) systems, patient health record (PHR) systems, and technical devices to deliver patient care services,” wrote first author Victoria Kisekka, PhD, and colleagues. “Despite the continued diffusion of HITs within the healthcare sector, there is no theory explaining how HIT success influences perceived patient care quality.”
The study included data from 3,677 cancer patients from a public dataset. Researchers examined the data for correlations between information assurance and attitudes toward health information exchange (HIE), patient access to health records and perceived patient care quality.
Results showed increased privacy concerns of HIT reduced the frequency patients accessed their health records, positive attitudes toward the HIE and perceptions of patient care quality. However, the belief in the effectiveness of security increased patient access to health records and positive attitudes toward HIE. Trust in health information also had a positive correlation with perceptions of HIE and care quality.
“Trust in health information and belief in the effectiveness of information security safeguards increases perceptions of patient care quality,” concluded Kisekka and colleagues. “Privacy concerns reduce patients’ frequency of accessing health records, patients’ positive attitudes toward HIE exchange, and overall perceived patient care quality. Health care organizations are encouraged to implement security safeguards to increase trust, the frequency of health record use, and reduce privacy concerns, consequently increasing patient care quality.”
Disclaimer: This article was originally published in Clinical Innovation online.
Mobile health devices and mHealth initiatives are strongly correlated with higher patient satisfaction scores, according to a recent survey conducted by Vanson Bourne on behalf of Jamf.
The survey of over 600 health IT professionals in Europe and the United States showed that 96 percent of organizations that are currently implementing mHealth technology have seen a positive impact on their patient satisfaction measures. Thirty-two percent of those respondents said they observed a “significant” patient satisfaction increase, the report showed.
In fact, most of these organization leaders stated that improving the patient experience helped to fuel their decision to go mobile.
There is some discordance between organizations that are planning a move to use mHealth tools compared to those in the process of implementing or who have completed implementing. Only 16 percent of organizations that have announced plans to leverage mHealth have seen positive patient satisfaction impacts.
Thirty-nine percent of public healthcare organizations have seen an increase in patient satisfaction at the hands of a mobile health initiative, while 29 percent of private organizations have said the same.
Ninety percent of organizations have implemented, are currently implementing, or have plans to implement some sort of mobile health device. Forty-seven percent of organizations said they want to increase their digital health use in the next two years.
While some mHealth implementation plans are slated to be patient-facing – 56 percent of organizations want to use digital health in patient rooms – most of these tools will be targeted at organization personnel.
Seventy-two percent of organizations will use mHealth in nurses’ stations and 63 percent in administration offices. Fifty-nine percent of respondents said mobile health will likely expand to clinical teams, while 54 percent think these tools will also incorporate other organization staff.
Although a large proportion of health IT professionals noted the benefits of mobile health tools, they do see some pitfalls with their mHealth efforts.
Less than half (48 percent) of respondents expressed confidence in their mobile device management (MDM) tools, which is down from 59 percent of organizations that said the same last year. Forty-nine percent of organizations cited mobile device security as their top concern for this year.
“Security breaches in general are growing exponentially in the healthcare industry,” said Jamf healthcare alliance manager Adam Mahmud. “As mobile device initiatives expand in healthcare for use-cases such as patient engagement and clinical care, it is worrying that healthcare IT decision makers are becoming less confident in their mobile device management solution. Hospitals and clinics need a robust and secure MDM offering to support their mobility initiatives aimed at increasing caregiver efficiencies and improving the patient experience.”
In fact, concerns about mobile device security are what’s holding back 31 percent of healthcare organizations from implementing a mHealth initiative.
Fears about health data security are also impacting patient engagement with digital health tools, found a recent ONC survey.
In 2017, 52 percent of individuals were offered access to their own digital medical records, but 25 percent of patients did not view those records because of data security concerns.
Clinicians and other medical professionals must better educate their patients about the security protocol in place to keep their medical data safe. Patients trust their doctors, so when hearing about the security provisions safeguarding a patient portal or patient-facing EHR, patients tend to feel better about these tools.
Providers must also educate patients about the process of using patient portal tools and their rights to view their own health data, ONC experts note. Recently, ONC released a guidebook aimed at assisting patients with health data access and technology use.
Providers who follow patient data access instructions and review this information with their patients may see better patient portal uptake, more effective digital health use, and overall better patient engagement.
Disclaimer: This article was originally published in Patient Engagement HIT here.
A new large-scale study shows that interactive, tailored text messages can improve medication adherence by 14 percent.
“The program results far exceed our expectations with 44 percent refill rate in the text message group as compared to 30 percent in the non-text group,” Rena Brar Prayaga, the paper’s corresponding author and a behavioral data scientist at mPulse Mobile, said in a statement. “In addition to the difference in refill rates, the 37 percent response rate by this older Medicare population was higher than expected and patient feedback was very positive with 96 percent of the patients indicating that the solution was easy to use.”
The study — conducted at Kaiser Permanente Southern California and using technology from mPulse Mobile — included 88,340 Medicare patients (all over age 65) with multiple chronic conditions. Specifically, patients were taking ora diabetes medications, blood pressure medicines, statins, or some combination of the three. The cohorts were not randomized. All patients were given the option to sign up for text messages, but only 12,272 opted in, leaving 76,068. Both groups received traditional adherence aids like automated and non-automated phone calls reminding them to refill prescriptions.
The mPulse Mobile platform instigated an automated dialogue through which patients could get prescriptions refilled, ask questions, or explain why they had not refilled their prescription. Eighteen percent of text message dialogues resulted in refill requests.
Researchers also used natural language processing to parse the tone of patient responses to the automated message. About half were neutral, 41 percent were positive or very positive, and just 9 percent were negative or very negative. When asked directly whether the service was easy to use, 95 percent of those who responded said yes and 5 percent said no.
“It is worth noting that patients in the texting group engaged at a much higher rate than predicted,” researchers wrote in the study. “We had estimated that the patient response rate would be between 10 percent and 20 percent. … Our target refill request rate was 5 percent to 7 percent since we were messaging an older patient population. At the same time, we hoped that the ease of use of the refill dialogue might draw in more patients and nudge them toward completing their refill requests. The program results far exceeded our expectations. Throughout the three-month program, the response rate was around 37 percent, and the three-month average refill request rate was 18 percent.”
Based on the success of the program, Kaiser Permanente intends to deploy it at additional locations.
Disclaimer: This article was originally published in mobi health news here.
Though significant barriers still stand in the way of the transition to value-based reimbursement, a new study offers encouraging signs that physicians are getting more comfortable with new payment models.
The study, a joint effort between the American Academy of Family Physicians and Humana, follows up on a similar study they conducted in 2015. Representatives from both organizations—plus Health Care Transformation Task Force Executive Director Jeff Micklos—participated in a briefing Wednesday on to discuss the findings.
Amy Mullins, M.D., medical director of quality improvement for AAFP, said one of the data points that stood out the most was that 37% of those surveyed said payments based on quality measures were distributed to physicians at their practice—a “huge jump” from 2015, when it was just 18%.
Micklos also highlighted that finding, noting it’s a good sign that shared savings are trickling down to frontline doctors.
“Without that financial incentive, it’s really hard to convince a medical professional that there’s a sustainable business model there,” he said.
Mullins said it’s also promising that significantly fewer physicians said they were “not at all familiar” with the concept of value-based payments—7% in 2017 versus 12% in 2015. In addition, the study found that more practices are also hiring care management, care coordinators and behavioral health support to prepare for value-based care.
A variety of barriers
It is not all positive news, however. In 2017, only 8% of family physicians agreed with the statement that “quality expectations are easy to meet in value-based payment models,” compared to 13% in 2015. Plus, 62% cited “lack of evidence that using performance measures results in better patient care” as a barrier to adoption.
Even the finding that little more than half of physicians said their practice participates in value-based care models shows there is still work to be done.
“If you didn’t already know, physicians are a skeptical bunch,” Mullins said, later adding, “we are slow adopters for lots of things.”
And while the share of family physicians who have contracts with 10 or more payers remained about the same, Mullins said it’s still noteworthy that it’s as high as 37%. That illustrates how “frustrating and exhausting” it can be for physicians to deal with the myriad quality measures and systems associated with each payer, she added.
One potential barrier not covered in the survey is the uncertainty over what will happen with the Center for Medicare and Medicaid Innovation, Micklos said, noting that Medicare has long been the driver of what happens with the rest of the industry. The Trump administration has asked industry stakeholders for input on an effort to take the innovation center in a “new direction.”
The panelists were less concerned, though, with the administration’s move to end mandatory bundled payment models. Regardless of what specific policy levers are pulled, the move to value is smart for the private sector, as fee-for-services has a “tremendous amount of demonstrable inefficiencies,” said Roy Beveridge, M.D., Humana’s chief medical officer and senior vice president.
Micklos agreed, adding that bringing people “screaming” into certain payment models isn’t the most sustainable concept anyway.
The IT factor
A little more than half of the physicians surveyed said their practices were updating or adding IT infrastructure to prepare to participate in value-based care models. The same share—54%—said as much in 2015.
As important as that is, though, physicians still must have better, easier-to-understand and more timely data to truly move forward on connecting payment to health outcomes, Mullins pointed out.
In that effort, insurers can be a crucial partner, Beveridge said. They have a tremendous amount of analytics and other supports to offer physicians, he said, and thus have the responsibility to share that with physicians so that they can act upon it.
One of the biggest issues that both payers and providers continue to face, however, is the lack of interoperability between electronic health records systems.
From Humana’s point of view, “some of the barriers for interoperability really should not exist,” Beveridge said. But Mullins added that “I don’t know if there is a light at tend end of the tunnel or not,” on fixing the issue.
Disclaimer: This article was originally published in FierceHealthcare here.
Predicting the future of MACRA is difficult as goals continue to change, nonetheless, MACRA appears to be here to stay.
According to a recent study reported on in The Lancet, healthcare spending per capita is higher in the United States than in any other country in the world, and is unsustainable at the current rate. There is widespread agreement among healthcare stakeholders that care delivery and reimbursement must radically transform. Consequently, in 2015, a total of 92 out of 100 U.S. senators voted for the Medicare Access and CHIP Reauthorization Act (MACRA), triggering the shift to value-based care with two paths for reimbursement: The Merit-Based Incentive Payment System (MIPS) and risk-based Advanced Alternative Payment Models (AAPMs).
Where Are We Today?
We are three-quarters of the way through the first performance year for MACRA, and practices are being affected in many ways. Most are working hard to understand and implement the complex requirements of the legislation. A key part of this effort involves working with electronic health record (EHR) vendors to ensure that their technology supports MACRA reporting requirements. Providers must also evaluate their operations, both administratively and clinically, to ensure that they are capturing the data that needs to be reported. The 2017 performance data will be reported from Jan. 1 to March 31, 2018. The amount of data reported will be determined by the Pick Your Pace option selected by the practice.
This year is a transition year for the implementation of MACRA, with the requirements being phased in slowly. For practices participating in MIPS, a very minimal amount of work is required in 2017 to avoid a negative payment adjustment. However, in 2018 there may be more requirements for practices to follow, so they should be using this time wisely to prepare for the coming changes.
What Should Practices Be Doing in The Near Term?
MACRA reporting requirements in the various categories are going to become more stringent over the next few years, placing a greater burden on practices to achieve the highest scores possible to avoid negative payment adjustments and maximize positive payment adjustments.
Although MIPS is the path most providers are on now, they should start looking at opportunities for participating in AAPMs. In 2024 there will be two fee schedules, with AAPM participants operating under a higher reimbursement schedule than MIPS participants. Those in AAPMs will receive a .75 percent annual increase, while MIPS participants will only receive a .25 percent increase. To maximize revenue, the goal for practices should be to drive toward successful AAPM participation.
While MIPS will still be an option, those in MIPS will also face the possibility of a negative 9 percent payment adjustment and a lower fee schedule overall in 2024, based on 2022 performance.
Over the next one to two years, practices should be thinking about long-term goals, getting comfortable with the requirements for MIPS, and working on improving and maximizing their scores in the various categories. They should closely examine their practices to determine what operational and clinical changes they can make to reduce costs of care while increasing quality metrics. By identifying what drives those elements for their practice, they will have the knowledge base to begin building a strong foundation for other, more advanced value-based care models.
Where is MACRA Heading?
The future of MACRA is difficult to predict, as the goal posts keep shifting. Recently, the U.S. Department of Health and Human Services (HHS) issued a proposed rule change to cancel two mandatory bundled payment models: the Episode Payment and the Cardiac Rehabilitation Incentive.
The Department also proposed reducing the number of locations mandated to participate in the Comprehensive Care for Joint Replacement (CJR) model, going from 67 to 34. The Episode Payment and Cardiac Rehab models were scheduled to start on Jan. 1, 2018, and the CJR model is currently in its second performance year.The Department noted in its proposed rule change that it was concerned that engaging in a large mandatory episode payment model at this time might impede its ability to engage providers in future voluntary efforts. It also concluded that reducing the number of required participants in the CJR model would allow it to better evaluate the effects of the model.
The reaction to these proposed rule changes has been mixed. Some stakeholders, such as the American Hospital Association (AHA), expressed concern that hospitals have already made investments in preparation for the new payment models, and delays or cancellations such as this might compromise long-term success. Others agree with HHS’s reasoning. There is also disagreement about the value of mandatory versus voluntary payment models. Hopefully, the HHS decision to cancel the models is not an indication that they are not willing to invest in additional pilot projects.
Assuming there is not continued pushback from HHS, such as under- or over-reimbursement for services provided, more bundled and alternative payment models incorporating collaboration among providers likely will come to the forefront over the next five years. Some sort of risk-based bundled payment model is likely to surface whereby multiple providers, such as hospitals and specialists, are reimbursed for caring for a specific disease and for sharing the risk for the outcomes of that care.
Certain unknowns come with these new emerging payment models. For example, have they been thoroughly tested to ensure that the participating providers are receiving appropriate reimbursement for the care they provide and the results they deliver, or is there some unintended consequence wherein a clinician is reimbursed for work they have not done? If the model is operating correctly, all providers participating in the care should be equitably reimbursed.
MIPS will continue, and in the long term, it should drive practices toward more outcome-based performance. Consequently, even practices participating under MIPS may have to submit data demonstrating improved outcomes and reduced costs.Practices generally seem ready to move to value-based care, so hopefully HHS, the Centers for Medicare & Medicaid Services, and private payers all will continue to move toward that goal.
Practices have already started investing in the technologies and additional staff needed to be successful, so if payers make investments and stay engaged, these models will continue to evolve.
How to Succeed with the New Care Models?
Practices will have to make significant changes to their operations to thrive with the emerging value-based care models. In the past, with the Physician Quality Reporting System (PQRS) and Meaningful Use, practices had to report data, but they did not have to change their way of doing business in a meaningful way. To be successful in the value-based care world, significant transformational change must occur.
For instance, in many practices, physicians tend to operate independently, with a “silo mentality.” With most value-based care models, practices must move to team care, whereby a group of people is responsible for the care the patient receives. The team includes not only clinical staff, but also non-clinical employees who interact with patients. For some practices, this is a difficult transformation.
Education plays a key role, because everyone from the front desk to the back office of the practice must understand that they are all part of the care team and are jointly responsible for patient care and the resulting outcome. The practice also needs a leader to drive value-based care, making sure everyone understands their roles on the team. Additionally, this leader can help the practice utilize their performance reports to improve care, costs, and outcomes.
Technology will also be critical to the success of practices, whether they are participating in MIPS or an AAPM. They must make certain that they gather critical data for quality and cost reports, enabling them to determine if they need to change various aspects of their operations. Value-based care models are data-driven, and practices must have the right technology to capture and utilize the data they need.
Goals are Similar, but Approaches Vary
For the most part, payers, providers, and other stakeholders in the healthcare community are unified in their desire to see a new patient-centric approach to care delivery – one that will result in reduced costs and improved outcomes. Where they differ is in how to achieve this goal.
As long as constructive dialog continues, stakeholders collaborate, and providers start making significant changes in how they deliver care, the framework started by MACRA can grow, providing better outcomes and more cost-effective care.
Disclaimer: This article was written by Linda Pottinger and appeared in ICD10 Monitor here.