The cost of healthcare is at an all-time high and many people feel the fee-for-service model is the main culprit for the skyrocketing costs. From a logical standpoint it makes sense, healthcare providers get paid more by providing more services. As humans we tend to consume too much and spend too much, therefore, ditching the fee-for-service model would result in fewer services and less spending, right?
Not so fast, as logical as that sounds I am not completely sold on that theory. When we look at our lives almost everything we do is based on a fee-for-service model. When we go out to eat, go to the movies, get new tires on our car, get a haircut, hire a baby sitter or hire someone to do our taxes, we do it on a fee-for-service basis. Those providing the previously mentioned services would like to sell us more, but we generally resist because we don’t want to waste OUR money on unnecessary services. Generally speaking when we pay with OUR money we try to get maximum value and good providers try to be as efficient as possible.
Fee-for-service is not unique to healthcare, however, in the healthcare sector we shop with other people’s money. We have very little out-of-pocket cost for additional services and someone else “picks up the tab” for OUR spending. The third-party payer is one of the big reasons for rising costs and inefficiencies in the healthcare industry. It is human nature not to concern ourselves with the total cost of care, but rather, how much WE have to pay. How many times have you received an explanation of benefits and glanced over it only to notice the part that tells you what you are responsible for?
If we implemented a third-party payment model in other service industries we would be faced with the same inflating costs that we are dealing with in healthcare. If you were only responsible for a $30 copay every time you visit your hair stylist you would be inclined to get unnecessary services in addition to a haircut. Why, because YOU aren’t paying for them, someone else is picking up the tab.
Better yet, you are traveling for work and need something to eat. If it were personal travel you would grab a chicken sandwich and call it a night. But work is paying for it, so you have a steak dinner. As far as you are concerned a steak dinner costs the same as a chicken sandwich because YOU aren’t paying for it, you aren’t accountable for payment.
Healthcare costs and inefficiencies are going to continue to increase until we address the third-party payment model. Healthcare consumers need to be accountable and more aware of the total cost of their healthcare. A more aware and accountable healthcare consumer may be the motivation needed to live a healthier life. Or at the very least eat more chicken sandwiches.
During the Connected Health Symposium last week, I noticed a significant trend that I have since been calling the “next big thing for the quantified self movement”. What is the next big thing in a world dominated by fitness trackers and mobile apps? That next big thing is biofeedback. I gained access to quite a few innovators while at the conference. They note that while clinicians have been using biofeedback for eons in order to understand any number of things about a human body, most of those tools do not come in a patient-friendly package. Thanks to these innovators, now they do. Here are four examples quantified self devices that use biofeedback to help patients understand and manage their health.
It is hard to make brain data real to a patient. As a result, up until now there has been virtually nothing a person can do to improve their brain health. Psychoanalysis is highly stigmatized, which causes an even bigger drift to form between patients and cognitive health. In order to fix this, clinicians have created a consumer friendly, clinical grade EEG to provide patients with their first real contact with their brain. The device is called Muse, and it is being dubbed “the brain sensing headband”.
By using the device, patient can improve their cognitive functions and see their outcomes in real time. This device has also shown promising in the treatment of depression and other mental illness. Since this treatment is wrapped in the quantitative self trend, it does not receive the same reluctance that stigmatized psychoanalysis does. This provides promising new treatment options.
During the Connected Health Symposium, it was noted that 75% of physician visits are stress related. Patients are often made to feel that they are “stuck with it” and there is nothing that can be done. However, a really neat connection between the heart and the brain can be used, through the power of feedback, to manage stress related illnesses such as heart disease.
I’m not sure if you knew this, but there is a “brain” in the heart that senses and responds to emotions and communicates through nerves to the brain. This heart-brain communication provides us with a way to manage our stress and get heart healthy through the use of biofeedback. Using biofeedback through tools like HeartMath, patients can gain windows into their hearts and brains to self manage their stress response. While this is certainly empowering for prevention of heart disease, heart disease patients have been studied, and have improved outcomes through using the HeartMath biofeedback system.
Stay tuned for an upcoming experiment that is set to merge the Muse and HeartMath technologies.
If you work in healthcare technology, and you go to a Connected Health Symposium, then you will get your fair share of interesting conference performances. In one such performance, we were introduced to Sensoree, which is a company that creates wearable technology that show visually, through light displays, what the individual wearing the technology is feeling. This proves incredibly helpful for patients with Autism and Alzheimer’s that do not have the ability to communicate their emotional states readily. Sensoree introduced these technologies by having circus performers wear them during an acrobatic dance routine. As they danced, you could see their emotional states changing as a red glow of nervousness as the performers began turned into a blue glow of of focus to a purple glow of bliss.
This last bit, called BioBeats, is a platform for merging entertainment with healthcare. In one very compelling move, BioBeats partnered with music crew Far East Movement in an attempt to connect millions of listeners to their health by way of mobile phone enabled heart beat sensors. As Far East Movement performed, they encouraged their fans to record their hard beats. By the time the song was over, they had collected over 1.5 million heartbeats that were, in real time, transformed into the beat that lived in the background of their performance. Check out this “Turn Up The Love” performance below.
Kent Larson, Director at Perficient recently posted a blog about Partners In Health (PIH) and the new Microsoft tools they are using to help enable their mission to provide a preferential option for the poor in healthcare.
PIH is one of many organizations leading a coalition to combat the Ebola outbreak, working alongside two other organizations – Last Mile Health in Liberia and Wellbody Alliance in Sierra Leone. To help enhance communication and collaboration both domestically and internationally, PIH is migrating to Microsoft Office 365.
Perficient is assisting PIH with their migration to Microsoft’s Office 365 (O365) solution. O365 will allow users to access their email from anywhere in the world on any computer or mobile device with access to the Internet. OneDrive for O365 will enhance collaboration between all PIH users, both domestically and internationally. The platform will provide PIH with a reliable and secure communication toolbox, including storage and collaboration tools. Deployment of O365 across PIH sites in Africa, Haiti, Russia, and the U.S. will enable PIH’s mission to provide a preferential option for the poor in healthcare and will be an important tool to enhance communication as they respond to the Ebola outbreak in West Africa.
To read Kent’s entire post and to learn more about the mission of PIH click here.
Last week, I was at the Connected Health Symposium in Boston. It is with great pleasure that I relay what I was taught during my favorite session by Nir Eyal author of “Hooked: How to Build Habit-Forming Products”.
We know that mobile devices change our day-to-day behavior, but why are mobile devices so good at changing our habits? To understand how, we must understand what habits are and how they are changed. Habits are impulses to do a behavior with little to no conscious thought. When you think about it, social media sites like Facebook, Twitter, Instagram, Pinterest, and SnapChat get us to do some pretty bizarre behaviors as habits. Now, over the span of just a few short years, billions are using these social platform as day-to-day habits that require little to no conscious thought.
It goes to say, then, that creating a habit-forming technology solution of any type would require us to speak directly to the unconscious mind. To do this, Eyal advocates what is calls the “Hook Model”. This is defined as using experience design to connect a user’s problem to your solution with enough frequency to create a habit. To do so, it is critical that your solution include the following four components of a hook:
This is how customer attitudes change and habits are formed. If you are building a technology that requires habits, then you need to ask these five questions to know if you have been successful:
Eyal ended his talk with a discussion on the morality of manipulation. Designing habit-forming products is a form of manipulation. As a result, engineers of these solutions need to be careful. We need to be responsible for the impact we have on changing user behavior by using this power for the force of good by fixing one of the world’s problems.
Transformation is sweeping across healthcare in the United States at a rapid rate. Healthcare organizations, regardless of size, need to embrace new technologies in order to keep up with the quickly changing landscape and comply with evolving regulatory requirements.
The solutions to these challenges have one thing in common, the need for accurate information. In some cases, the information required can be sourced from a single system, but in many situations, the need requires information from a wide range of systems that could include Electronic Medical Records (EMR), Claims, Financial and Human Resources.
The solution for many organizations starts with the creation of an enterprise wide data warehouse (EDW) that serves as their “single version of truth”. At the foundation of the data warehouse is the need for a data model that accurately organizes the data in meaningful ways. Many organizations will build their own data model while others will look to leverage an industry proven data model from an experienced vendor. This choice to buy vs. build, can be one that causes great debate within organizations both large and small.
At a high level, the pros to building your own enterprise data model will come down to flexibility and control. If you choose to build your own customized model, you will get to make each and every design decision based on how your organization operates, this can be very tempting.
The main advantage to buying a data model is the time to implementation. Many of the tough decisions are made for you, based on years of experience across a wide range of customers; purchased models are often much faster to implement.
As the debate continues you will need to weigh factors like experience, time to value, risk, integration accelerators and impact on your staff. Each of these topics needs to be considered as your organization decides whether to buy or build your enterprise data model.
Interested in more information on how to weigh the pros and cons of this critical enterprise decision? Join Perficient on November 18th for a complimentary webinar. We will examine critical factors that need to be evaluated when deciding whether to build or buy an enterprise data model. We will explore real-life client stories and discuss how they benefited from their decisions.
Upcoming Webinar: Healthcare Enterprise Data Model: The Buy vs Build Debate
Tuesday, November 18, 2014 @ 2:00 PM CT
Interoperability between different electronic health record (EHR) systems is one of the most important requirements that hospitals and physicians must meet as they prepare their systems for attestation in Meaningful Use Stage 2.
1) To make sure “information follows the patient regardless of geographic, organizational, or vendor boundaries”
2) To have at least one or more instances in which providers exchange an electronic summary of care with all the clinical data elements between different EHRs. Establishing this connectivity does not insure the real goal of collaborating across the continuum of care for the patient’s benefit.
The debate still rages on the role of the patient in this interoperability process as well. We have all, as patients, had our medical files spread across a family doctor, multiple hospitals, specialists, health plans and today, even multiple pharmacies. The prospect of creating a complete picture is staggering, let alone having all of those healthcare providers really collaborate on our behalf. Is it the patient’s responsibility in this ever-changing healthcare electronic revolution to compile this electronic mess into a coordinated whole or will the industry magically create it as a result of Meaningful Use Stage 2?
It is worth arguing that interoperability in Meaningful Use Stage 2 only creates a baseline of connectivity between two or more systems to exchange information and puts in place the ability of those systems to use the information that has been exchanged. It does not create collaboration on behalf of patients within the healthcare provider community, especially between competing players like local hospital systems or healthcare providers versus payers. Having the ability to connect only trades fax machines for electronic transactions, if tools aren’t employed for physicians for example to collaborate over a single patient.
In advocating for collaboration, let’s examine the reality of an exchange of a set of electronic transactions about a patient versus where the process would need to be for genuine care coordination. Today, a fax from the hospital to the family physician is the notification that the patient was hospitalized and needs follow-up in coming weeks. Based on the type of hospitalization, a call between the attending physician and family physician may be warranted, and a potential referral to a subsequent specialist may be in order. Simply communicating electronic documents doesn’t address the interaction between key people in the decision-making process and the assumption that the inclusion of unstructured physician notes will suffice may be optimistic.
This means that health information exchange is different than health information interoperability. Exchange is necessary for interoperability, but it is not sufficient by itself to achieve health information interoperability, especially to streamline real collaboration on behalf of patients. It is time to examine an expanded view of both interoperability and health information exchange to promote ease of collaboration between the parties involved, including secure physician to physician communications – electronic or instant message, for example, and secure physician to patient communications. As an individual patient having to deal with multiple patient portals today for communicating with my healthcare providers, there is a real concern to address this issue sooner rather than clean up confusion later.
Can we define collaboration in a way that traverses healthcare’s landscape of emerging connectivity?
There has been a lot of debate around the challenges within the healthcare industry. Much of the discussion stems from the fee-for-service model and the focus on services and reimbursement rather than the patient. Health information technology has its own set of challenges when it comes to addressing healthcare issues.
If we truly want to put the patient at the center of their own healthcare experience than we need to take a step back and look at the relationship of the patient and the entire healthcare ecosystem. Healthcare should focus less on the products and services and more on the patient and provider relationship. Furthermore, health IT should support these relationships, however, by its own definition it doesn’t.
By definition, Health information technology (IT) encompasses a wide range of products and services—including software, hardware and infrastructure—designed to collect, store and exchange patient data throughout the clinical practice of medicine.
The definition does not mention the patient and provider relationship and the emphasis is on products and services, software and hardware and does not reflect on the benefits of patient data exchange.
A better health IT definition: An automated approach that facilitates the relationship between the patient and the healthcare system through the accurate and secure electronic exchange of data, ensuring the right data is available at the right time for everyone that is engaged in the patient’s care.
This definition includes 3 critical components:
A new definition will not solve the challenges of the healthcare industry, but it is a good place to start. It may be enough of a push to ensure technology developers are developing meaningful applications that improve patient outcomes, which should be the ultimate goal of health IT.
The success of translational medicine is in the data and the ability to combine multiple sources of data to enable better patient care and outcomes. Unfortunately most academic research organizations (ARO) and hospitals have multiple systems that house data creating an inability to mine through the data to identify clinical insights, disease patterns or treatment options.
Patient records, genomic data and environmental data need to be in sync to speed the process of bringing safer therapies to market and provide “bench to bedside” medicine. Combining multiple sources of data can enable complex and meaningful querying, reporting and analysis for the purposes of improving patient safety and care, boosting operational efficiency, and supporting personalized medicine initiatives. Integrated data will enable implementation and delivery of translational medicine anytime and anywhere.
To register for the webinar click here
Combining Patient Records, Genomic Data and Environmental Data to Enable Translational Medicine
Wednesday, October 15, 2014 | 1:00 PM CT
When you played baseball as a youngster, and stepped into the batter’s box, the last thing you wanted to be was an “easy out”. Ironically, today many healthcare organizations are looking for the “easy out” to rapidly develop the business intelligence reporting needed to address regulatory reporting demands, population health management and chronic condition management, to name just a few.
The pressure to quickly stand-up an enterprise data warehouse, put data governance in place, start loading and cleaning data is intense just to get to the point of creating dashboards and offering mobile BI. Overloaded Healthcare IT teams are dealing with demands to compress traditional time-frames of 18-24 months to get the BI foundation in place down to as little as 4-5 months, start to finish.
This situation begs the old saying of “do you want it fast or do you want it right?” You can bet the answer today is both. Generally, healthcare organizations develop a BI strategy that examines the current state BI architecture, envision a future state BI architecture, document the gaps and create a time phased roadmap to build out the infrastructure, software and development required to meet the business needs. Just describing the process tells us that it will be complex and time consuming, right? Read the rest of this post »
I think most healthcare entities are now moving to a more frequent budget cycle and if academic, they probably have to do a semi-annual legislative budget. They probably also at a minimum re-forecast based on updated actuals once a quarter.
Is their value though to gathering actuals daily or weekly and adjusting tactical plans based on current month trends? In today’s rapidly evolving healthcare environment, provider organizations must be able to identify financial performance gaps continuously and quickly change course when needed. As we discussed in my blog: The Role of Finance Within the Hospital has been Elevated, this requires a partnership with operations to ensure that the correct metrics are correlated within the budget process. Agility is also influenced by the mechanism the hospital uses for budgeting and whether they use a rolling forecast to replace or supplement the annual budget process.
What is a rolling forecast? The rolling forecast is usually a quarterly budget with a two to three year horizon that keeps a close eye on the organization trajectory. Typically the forecast budget is not prepared at the department level but may instead focus on divisions or even at a hospital level. Global budget drivers and assumptions will typically be the same as the annual budget but those unique to a department or division may not be line items. The forecast is built using historical trends, current conditions and future assumptions for budget drivers. Some forecasts may be primarily driven by revenue drivers with expenses flowing from ratios defined to the model. Read the rest of this post »
Is there a correlation between price transparency and cost? I read an article in the HFMA Strategic Financial Planning Newsletter recently about this and I can relate my personal experiences to it wholeheartedly. My observations are that hospitals segregate these two activities but I believe they are explicitly linked. I know there are many factors that influence price setting, not the least of which is the federal government (Medicare/Medicaid), but I suspect the reason that hospitals don’t more closely link pricing to margins is that they lack visibility into their own data.
When I first started working in healthcare in the late 90’s, my only prior exposure to revenue cycle automation came from the airline industry where pricing is tightly linked to both demand and yield. I was part of the team that helped Continental Airlines transition into the era of de-regulation. It didn’t take industry leaders very long to identify the metrics that truly informed pricing once the government was taken out of the equation. This taught me very valuable lessons about analytics and instilled in me a drive to use data to improve operations.
To understand and achieve sufficient transparency and maintain a proactive approach to maintaining margins, hospitals must be capable of correlating costs for supplies and drugs, etc. with the cost of providers and overhead costs. Then they must compare this with the payments from payers, individuals and other purchasers. While we certainly can’t take the federal government out of the equation for hospitals, recent expectations have been set for quality performance that may help the affected organizations begin to take a more margin focused view of pricing. Bringing together the necessary data is not simple and definitely should be approached iteratively using a configurable set of analytic tools that can provide the right data to the right individuals in the organization who manage operations and continue or create new services. Read the rest of this post »
I’m having a good laugh at all of the memes floating through social on the “hugeness” that is the new iPhone 6. Apple even wisely predicted the size sentiment (℅ super user research) and landed a spot featuring Jimmy Fallon and Justin Timberlake that provides a few laughs.
So, while size-by-size comparisons are even a thing in my household (husband has the new phone while I’m skipping a version), I’ve found that my favorite features of the new release are actually a part of iOS8, and, therefore, I don’t need to get the new phone, and the extra inch of screen size that provides, to have them.
Let me explain. I’m a big fan of the Quantified Self, and, as a runner and biking enthusiast, I like apps that help me track my progress. I especially like when those apps are extensible and connect to provide an entire Quantified Self experience. I’m not here to talk about HealthKit, though. I’m here to talk about a lack of functionality I have found in these apps when it comes to safety. I’m a woman running or cycling alone, and sometimes, if my work day creeps into the evening, the sun goes down before I get started. I’ve combed the app store trying to find an answer, and there really aren’t good answers out there. What I need is:
The iOS answers to these problems:
So, there you have it. If you know of any alternative options for exercise safety, then I’d love to hear about them!