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Budgets: Daily, Weekly, Monthly or Annually?

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 Budgets: Daily, Weekly, Monthly, Annuallyevolving 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 »

Hospital Price Transparency – Step 1: Understand True Cost

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 Hospital Price Transparancyprice 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 »

Sure, it’s huge, but this is my favorite new iPhone feature

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.

So what new iPhone feature has me all giddy and excited?  Safety.  FOSgNia

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:

  • A way to alert loved ones passively if I run into trouble while I’m running or riding my bike.  It’s not really reasonable to expect that I can reach for my phone and make a call if I’m, for whatever reason, not able to complete those steps in the process.
  • A way to inform an EMT that may arrive on a scene when I am unable to communicate.

The iOS answers to these problems:

  • Share my Location: When I’m ready for a run, iOS lets me set up a window for when and who I want my whereabouts shared with.  I can set up the time parameters I have for my run, say 7:00 p.m. – 8:00 p.m., and share my location with my husband and best friend until I alert them that I am home.  If they don’t hear from me when they are supposed to, then they not only know something is up, but they know where I am as well. What I’d love for iOS to add is a way to send an alert if I fall during a run or ride.  I know, because of the ActivBeacon app, that this is possible.  The downside of ActivBeacon is that, for whatever reason, the app malfunctions and turns my volume up to full blast when I have both music and the app running at the same time.  Eye of the Tiger loses its motivational effectiveness at that volume.  Trust me, I know.
  • Medical ID:  The Medical ID, part of the Health App can be used by medical responders to know of any allergies or medical conditions I have and who to contact without unlocking my phone.   To do so, open the Health App and click on “Create Medical ID” that you see in red.  In the Medical ID you can add our name, birthday, height, weight, medical conditions, medical notes, allergies, medications, blood type, and organ donor status.  You can also add your emergency contact.   You will also want to make sure that you have the “Show When Locked” feature on.

So, there you have it.  If you know of any alternative options for exercise safety, then I’d love to hear about them!

The Key to Driving Down Healthcare Costs

Healthcare costs are rising at a faster pace than the economy is growing. Hospitals are often the focus of this concern, because they constitute the largest single component of healthcare spending. When looking at hospital costs, it is important to keep in mind that there are both direct and indirect expenses that contribute HighPerformanceCostingExpressway_largeto the total cost of care.

How do we understand total cost of care? Our team of experts leverages a proprietary technology for our clients called the Perficient High-Performance Costing Expressway, which enables transparency of fully burdened margin by service, patient and procedure. For decades, spreadsheets and costing software have been the best alternatives in determining cost of care. It is now more important than ever to transform these methods and leverage administrative, clinical and financial data in order to gain control of healthcare costs. Creating transparent costing models to indicate profitability across multiple dimensions of data is the key to driving healthcare costs down.

Embracing data-driven decision making in a provider setting requires agile thinking to pinpoint and respond to the short- and long-term needs of the organization. This shift requires finance departments to transcend from the typical focus on aggregating data to a value-added analytical view of hospital data. This new approach will provide greater visibility into changes in variables and assumptions and will require organizations to fully understand and ensure transparency exists for key performance indicators.

In evaluating supplies, labor, productivity or clinical effectiveness, the quality/cost/value equation requires an organization to truly understand its data. This includes not only considering the right product at the right place but also applying a broader perspective on clinical evidence for resources used and approaches employed. Data by itself doesn’t make a company successful; organizations must act on information and filter what is useful, appropriate, and above all else actionable. Those few organizations that are able to transform data into decisions and harness the power of insightful and timely analytics are ahead of their competition.

Perficient will be on hand to demonstrate the High-Performance Costing Expressway on display at OpenWorld 2014. Stop by and visit with our Healthcare experts at the Healthcare Solutions in Industry Central (Marriott Hotel 2nd floor).
Not attending #OOW14? Learn more about our costing solution here.

Follow me on twitter @teriemc

Knowledge Drives Precision

In recent years, dramatic advances in molecular biology, genomics, and related technologies have resulted in greater understanding of cancer at the molecular level. It is now possible not only to identify the genetic and molecular variations in each patient’s cancer cells, but to apply the results from the tumor profile, inKnowledge Drives Precision some circumstances, to begin to inform treatment strategies that target the molecular underpinnings of the specific disease in each patient.

“Precision medicine,” also known as “personalized medicine,” is the term used for this transformative new model of health care that involves the selection of diagnostic tests that have the potential to identify changes in each individual patient’s cancer cells. The use of that knowledge may help to prevent and treat cancer through the development of treatment strategies to target these specific molecular alterations. Ultimately, the goal of precision oncology is to improve patient outcomes. 1

I attended a conference session recently on this topic where an esteemed speaker panel took the audience though their vision of a time in our future when we could have a simple blood test on the way to our doctor’s office and arrive at the appointment to find our doctor fully prepared with a diagnosis and the ideal medication would already be identified based on our genetic makeup and perfectly formulated to avoid side effects for which you we are susceptible. Imagine this on a larger scale to speed up drug development, to create more precise therapies, faster and less expensively and apply this approach to improve the lives of people worldwide, at lower cost.

Perficient is helping clients such as the University of Colorado to establish a fully integrated informatics “highway” for precision medicine using the Oracle Health Sciences Translational Research Center platform to address formidable challenges such as:

  • Data Integration – the most foundational challenge is the need for an integrated data infrastructure spanning fully the genotype and phenotype (i.e., molecular and clinical attributes) of research subjects and patients
  • Individual Data Records – relevant data from the basic science, translational, clinical research, and health care domains need to be fully integrated at the individual data record, in order to produce “personalized medicine” models.2

Join us at #OOW14 to hear Michael Ames, MBI, Associate Director, Health Data Compass, Center for Biomedical Informatics and Personalized Medicine, University of Colorado and my colleague Lesli Adams, MPA @LesliAdams during the session “Creating a Digital Healthcare Safety Net with EHA and OBI for Care Transitions” located at the Marriott Marquis – Salon 10/11; Wednesday, October 1, 11:30am – 12:15pm.

We are an Oracle Platinum partner and we’ve gained valuable expertise from nearly 2,000 Oracle projects with our clients the past 15 years and we have amassed vast amounts of best practices and ideas to share. Stop by and visit with our Healthcare experts at the Healthcare Solutions in Industry Central (Marriott Hotel Atrium Lobby) at the Perficient kiosk (HMH-003) for a demo of the Translational Research Center.

Not attending #OOW14? Join our webinar Combining Patient Records, Genomic Data and Environmental Data to Enable Translational Medicine Wednesday, October 15, 2014 1:00 PM – 2:00 PM CT.

Sources:

1 http://www.n-of-one.com/about/what-is-precision-medicine.php

2 Michael Ames, MBI, Associate Director, Health Data Compass, Center for Biomedical Informatics and Personalized Medicine, University of Colorado

 

Follow me on twitter @teriemc

ACA and QRS – Shoot for the Stars Part 3

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In Part 2, I discussed some factors to consider for the data derived measures. In this blog, we will take a closer look at the survey derived measures and what factors a QHP issuer should consider to achieve high scores.

surveyAgain, for reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the Enrollee Satisfaction Survey (ESS) derived measures:

Leverage CAHPS Processes
As mentioned in Part 2, it was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS ESS measures with current CAHPS measures that are typically required during accreditation. And just as an organization should leverage HEDIS for data, make sure to leverage current investments in CAHPS to keep initial costs low while jump starting ESS efforts.
Read the rest of this post »

Patient Information Really Doesn’t Matter

We live in a world of information, everywhere we turn someone is collecting information about us. The technology advancements over the last 10 years are mind-boggling, but new technology is usually escorted by apprehension as our privacy continues to diminish and security is anything but secure. From cookies on Patient Information Really Doesn't Matterthe internet to a basket analysis at the supermarket, “big brother” is always watching.

The healthcare industry is no different. Healthcare organizations are surrounded by data: clinical, operational and financial; internal and external; structured and unstructured. There is so much information that healthcare providers don’t know what to do with it. The problem with healthcare is not a lack of information. The problem is healthcare organizations often have disparate systems that lack continuity. The absence of interoperability within IT infrastructures ultimately means that the right information is not available to the right people at the right time. Healthcare organizations can have all the information in the world, but if the information is not cohesive and can’t be used efficiently to improve clinical outcomes than information really doesn’t matter.

In order for healthcare organizations to improve outcomes, communication between systems is paramount. Despite industry standards such as EDI/X12, HL7 and CDA, information delivery is not effective. Most healthcare organizations understand the importance of untangling the interoperability web, but those same organizations don’t know where to begin.

Government regulations such as Meaningful Use Stage 2 (MU2) are putting additional pressure on healthcare organizations to improve the quality of care, coordination of care and population health management. A strong interoperability backbone that provides system connectivity is the key to attaining MU2. Interoperability transforms information into key insights that drive better clinical outcomes and improve the lives of individuals and communities.

Do you understand the importance of interoperability but not sure where to start? Perficient will be teaming up with technology partners IBM and Oracle to bring you 2 complimentary webinars:

Tackle Healthcare Interoperability Challenges and Improve Transitions of Care
Thursday, September 25th @ 12 CT
Learn More and Register

Engage Patients, Reduce Manual Processes and Drive Key Insights with Interoperability
Tuesday, October 2nd @ 2 CT
Learn More and Register

3 Questions Apple Must Answer to Reduce HealthKit Skepticism

There has been a lot of buzz around Apple’s announcement to enter the healthcare space with the unveiling of their Apple Watch and HealthKit app. HealthKit seems to be gaining momentum due in large part to Apple’s strategic partnerships with healthcare industry heavy-hitters. However, many questions remain 3 Questions Apple Must Answer to Reduce Skepticismunanswered and Apple must address them to gain buy-in from skeptics.

PRIVACY: How will patient information be kept private?
Having all patient information in one place seems like a necessary step to improve quality of care. A centralized location means the right person can have access to the right information at the right time. However, people are concerned about having all their private information in one location is too risky and makes them susceptible to hackers. Recently, Apple addressed privacy concerns by updating their privacy policy and their guidelines for app developers. Apps working with HealthKit, may not use the personal data gathered for advertising or data-mining uses other than for helping manage an individual’s health and fitness, or for medical research. Apple is also considering a “HealthKit Certification” for developers to help address the privacy concerns.

SECURITY: How will patient information be protected?
For years, there have been very little security concerns surrounding Apple, however, concerns over Apple’s security have risen recently after an alleged hack on iCloud led to several risque celebrity photos being published. According to cloud security vendor Skyhigh Networks, over 90% of cloud services used in healthcare pose medium to high security risk. Apple has promised to tighten up security on the iCloud to protect patient information. Healthcare consumers must regain confidence in Apple’s ability to keep their information secure and safe from hackers.

REAL-WORLD USE: How does the HealthKit work?
Lets face it, people are busy, Healthcare professionals are overloaded, and focused first and foremost on providing quality care to their patients. They do not have time to play with an iPhone app, needless to say,  HealthKit data must be streamlined. It must be convenient, provide accurate and timely information and integrate seamlessly into a patient’s electronic medical records. Simply put people aren’t just going to use HealthKit because it is an Apple app, they aren’t going to use it because it is a fad (at least not long-term), they will use it because it is convenient and can improve patient outcomes.

Apple continues to build on their partnerships with major players in the healthcare industry. They are preparing to launch trials with two prominent hospitals in the United States. The trials will focus on a group of people with diabetes and chronic diseases and will offer a glimpse on how the HealthKit will work. The HealthKit app will receive information from regulated medical devices such as glucose monitors and blood pressure meters.

Standford University Hospital is working with Apple to track blood sugar levels in children with diabetes and Duke University is helping to develop a pilot program to track blood pressure, weight and other measurements for patients with heart disease and cancer. The goal with both of these trials is to improve speed and accuracy of data reported. If these pilot programs run smoothly you can expect to see them rapidly expand to other hospitals.

It is still too early to tell what impact Apple will have on the healthcare industry, but they are certainly putting the right pieces together. More work needs to be done to address privacy and security concerns and gain trust from the healthcare community.  Their partnerships with hospitals, medical information services and medical device makers may be the perfect storm,  but the success of HealthKit will depend on those that actually “use” it.

The Meaningful Use Marketing Fail Keeping VPs up at Night

In a recent chat with the VP of a large health system, I learned what keeps him up at night.  His organization, like many across the nation, has invested mountains of time and money in Meaningful Use Stage 2.  Like most health systems (all but 11% says research groups like KLAS) they chose to invest in the patient portal modules available through the EHR vendor.  This Blog_What-Keeps-You-Up-at-Night2is largely because most Meaningful Use patient portal decisions are being made by IT, as opposed to business.  At the top of the list in IT decision making criteria is integration with EHR.  So, VPs like my new friend at this large health system are able to cross off the features required via Meaningful Use quite easy.  All except one…

They are having a heck of a time getting patients to actually adopt the patient portal technology.

It appears as though the “if we build it they will come” concept hasn’t quite held true in the case of patient portal.  In fact, the statistics are rather staggering.  Recent research discussed in the HealthData Management article entitled “Patient Portals Not Yet Go-To Platform for Patients” reveals:

  • Almost half of patients don’t even know if their physician has a patient portal
  • 11 percent are confident their physician “does not” offer one

And here is the kicker for a recovering marketer like myself:

  • Less than half of those surveyed–49.2 percent–report actually being shown a patient portal by their primary care physician either during a visit or outside a visit

And why is this keeping folks like my VP friend awake at night?  Well, first and foremost it is because healthcare providers like him are fans of patient engagement and want to provide patients with the tools they need to stay healthy.  Taking it a step further, Meaningful Use Stage 2 is a financial incentive.  The criteria for getting those incentive dollars are not met when you build a patient portal.  They are met when a critical population of patients adopts the technology. Early results are in, and patients are not adopting.

So, what’s the the underlying problem here?  Well, it’s multifaceted, but much of the error falls in building patient portals that are not user centric.  he user, the patient, is and should be the center of our universe.  However, it is oftentimes not the department of IT, the department largely in charge of Meaningful Use, that invests in stores of knowledge like user experience.   I’ve also been met with many blank stares across conference room tables when I ask healthcare provider portal teams about campaigns their marketing team have created to drive attention to the portal and journey maps that have been created across their patient digital experience to drive patients into the portal.  In my opinion, Meaningful Use is one of the biggest marketing fails I’ve seen in my career thus far.  There is not alignment between IT and the rest of the organization on the measures needed to drive patient engagement.  In my opinion, which has now been validated by this research, a campaign that does not also consider physician adoption of portal technology is a campaign waiting to fail.  If the physicians are not using it, then their patients will not either.

This is why I began the dialogue a few of months back on what the market says you need in your patient portal.  The market, which in reality is simply cumulative actions of patient populations, is the most important input into the creation of a successful patient portal.  You can see some of the components of a user centric patient portal in that series:

 

 

 

 

Apple: The New Digital Hub for Healthcare Data

In 2001, Apple introduced the ipod, and even though they weren’t the first to create a digital music player, the innovation, convenience and simple integration into iTunes, helped the ipod take digital music to the masses. Apple hopes to have a similar experience with the Apple Watch.Apple: The New Digital Hub for Healthcare Data

In a much anticipated event the tech giant revealed the new Apple Watch (VIDEO), a comprehensive health and fitness device that will collect medical and fitness data. Apple’s introduction to the wearable technology space comes at an opportune time. Although wearable technologies have typically been owned by gadget enthusiasts, calorie-counters and fitness buffs, a recent analysis by Citi projected the smartwatch market to reach $10 billion worldwide by 2018. If Apple gets it right, they could be the first to make average people want to buy a wearable device.

Tracking health data is already common amongst many Americans. A January 2013 report by Pew Research found that 69% of U.S. adults track one or more health indicators. Of those that track data, 49% say they store the data in their head and 34% use paper. The Apple Watch will electronically collect the data and share it with healthcare providers through the Apple HealthKit app.

apple_watchThe Apple Watch and HealthKit app are a game changer for the healthcare industry but it is Apple’s partnerships with healthcare industry giants such as Epic and Mayo Clinic that will be the key to their success. These partnerships will be a win-win for everyone as healthcare stakeholders work together to achieve better patient outcomes and lower the cost of healthcare.

The combination of the Apple Watch, the HealthKit app and industry collaboration could help solve the healthcare data collection problem and facilitate continuous wellness rather than sick care. If Apple can solve the data collection challenge and provide seamless medical and fitness integration, the healthcare industry will be dramatically changed, and Apple may become the digital hub for healthcare data.

Do you think Apple will revolutionize the healthcare industry? Lets chat @Perficient_HC

ACA and QRS – Shoot for the Stars Part 2

In ACA and QRS – Shoot for the Stars Part 1, I laid out the overall domains that are going to be used to score QHP plans offered through the Marketplace. In this blog, we will take a closer look at the data derived measures and what factors a QHP issuer should consider to achieve high scores.

HC DataFor reference all 43 of the required measures can be found on the CMS website (click here).

Now let’s take a look at some factors to keep in mind when dealing with the data derived measures:

Leverage Accreditation Processes

It was required to get Health Plans Accredited to offer on-market. In addition, CMS aligned required QRS data measures with HEDIS measures that are typically required during accreditation. So, make sure to leverage current investments to keep initial costs low while jump starting QRS efforts.
Read the rest of this post »

Re-think the Customer Portal Using Cloud

The Affordable Care Act (ACA) has had an enormous effect on health plan organizations. ACA has created choices for consumers,  impacted health plan business models and changed how they serve their members. Health plans are investing in technologies that align with their business strategies and seek scalable and flexible options that improve member interactions and customer service.

In this video, Fernando Acosta, Director of Infrastructure Management, Blue Shield of California discusses the changing healthcare landscape and how Blue Shield of California chose Perficient as their system integration partner because of their healthcare expertise . Perficient’s Doug McCulloh (@dougmcculloh), Director of Business Development is also featured and discusses how Perficient uses portal patterns to speed deployment.

The new robust customer portal allows Blue Shield of California the ability to grow on demand and deploy new environments in hours rather than months and improves customer experience.