So far in this discussion about “What the market says you need in your patient portal” we have been driving toward changes that are core to new engagement models. However, we have not addressed a core enabler: “It’s all about the data!”
Consumers demand access to information that meets their needs and they are not complacent with becoming hunters and gatherers for the information is truly about them. Consumers in today’s market demand accurate and up-to-date information about their health profile, just like they do with respect to their financial profile. However, the systems and processes to make that information available are not all there.
There are various sources of the information that are relevant to the patients/consumers (and also to the providers providing care to their patients). Much of this data has been distributed through the provider community. Some of the data is in the provider’s own systems. Some of the data is in the hospitals EHR systems. Some of the data is in outpatient facility systems. Other data is isolated and hard to locate.
With the push to HIEs some of the data is now becoming more available to the providers and to the patients they serve. However integrating the data into a holistic view is still a challenge. The information still needs to be gathered / extracted from the source systems, transformed into a structure that the HIE can understand and then there are the issues of translating the codes and values to normalized/consistent terms following a defined set of vocabularies. Additionally, ensuring a unified view of the individual can be a challenge. Enterprises IT groups are leveraging Enterprise Master Person Index (EMPI) solutions to construct the golden record of the individual but this also has its challenges.
Once all of the data is assembled (assuming that it is) the next challenge is to get the information to the right person at the right time. The HIE now needs to be integrated to the rest of the enterprise. Exposing the information in terms of the services or APIs can now begin. Finally the Portal (and this is just one of the consumers) can begin to consume these services and make the information available to the consumers. What’s also of importance is that the consumers can access this data from multiple perspectives. The provider can see full episodes of care across multiple care locations. The patient can see their health profile all in one location.
Having a single view of one’s health profile (or even the illusion of) is a powerful tool. Not only does it provide insights for better care, it breaks down the walls of information silos that have challenged providers and patient’s alike. Again, it is all about the data, and integration and interoperability are the key.
Last month I posted “ACA’s Quality Rating System – An opportunity to gain market share”, which explained how QHP issuers can gain market share in the individual space. In that blog I mentioned that, as part of the Quality Rating System, plans offered on the Marketplace will receive a “Star” rating based on a 5 star rating system. Over the next few posts, I would like to take a look at what this means from a health plan’s perspective.
As background, there are 43 measures that will need to be tracked. Out of the 43 measures, 31 are derived from data and 12 are derived from the survey. In addition, the draft QRS scoring specifications published by CMS organizes the 43 required measures into composites that roll up into eight domains. These domains are as follows:
The eight domains are then rolled up in to three summary indicators: 1) Clinical Quality Management; 2) Member Experience; and 3) Plan Efficiency, Affordability and Management. And of course, the final result is a star rating.
In our next installation from the “What the market says you need in your patient portal” series we bring you avatars. These avatars are closely related to our last post on gamification and serious games, but their real value proposition is in what I like to call “high touch digital healthcare.” Many may think that “high touch” and “digital” cannot exist in the same concept, but oh they can. We are actually beginning to see that in some cases patients prefer high touch digital to face-to-face care.
Here are some examples:
Overall, avatars and other forms of digital high touch are a win-win-win. They are low cost (win), add a sense of fun to otherwise lackluster processes (win), and increase quality all at the same time (win). Stay tuned for our final posts in the series where we start to discuss the importance of health information exchange and interoperability as they relate to the patient portal.
More than half way through our “What the market says you need in your patient portal” series I bring to you one of my favorite topics: healthcare gamification and serious games. Games are great at explaining complex systems. There are fewer places one can find complex systems than in the micro and macro worlds of healthcare. In healthcare we’ve seen games of multiple types. Here are some of my favorite examples:
Gamification is the term we use to describe serious games that go beyond strictly trying to entertain. They have a “higher purpose”, so to speak. Designers use game techniques to get players to do something not game-like at all. The possibilities for embedding serious games into patient portals are seemingly endless, but my favorite is in the realm of personalized prevention. The patient portal is a powerful repositiory of patient data and can also function as an empowerment tool. Similar to the build of the patient portal itself, if you want to develop a serious game that works, you must, better than anyone else, understand the purpose of your game. You must know to whom your game is targeted. You must devote a lot of time to figuring out what motivates your intended audience. That understanding must be crystal clear before you even consider how the game should be designed. Document, in detail, what your experience needs to communicate with the gamer. What kinds of puzzles best match this experience? Then consider what type of game genre matches these puzzles. Lastly, consider what platform would need to be used to help the gamer bring action to play.
Building a game that is based on what motivates your audience is what makes a serious game a game. The market will continue to push this functionality onto the patient portal.
Next in our lineup of “What the market says you need in your patient portal” series is social collaboration. This topic brings us to the core of a term that we hear a lot in the industry: patient engagement. What is that, really? Any form of engagement requires communication. Right now communication between provider and patient is getting better, but I’d still say that the relationship is in its “healing” phase. The best way to speed that healing is through creating mechanisms that support healthy communication between the healthcare provider and the patient.
Traditional methods of communication focused on the brick and mortar. There has been noticeable resistance to the idea of email, and far fewer providers offer social capabilities. So why will the market push for it? Because patients are accustomed to using social collaboration and they know it is far more convenient to use that tool over, say, picking up a phone or driving to the office. Providers will find that it is also much more cost effective than standing firm on the old way of doing things.
Patients use social to gather information. The healthy byproduct of this dynamic is a greater emphasis on managing wellness. Every social communication does not require direct communication between patient and physician. Instead, social relies on content to navigate a user towards answers and provides readily available mechanisms to find answers to questions. These “conversations” have the power to personalize experiences on an individual level, as well as deliver rapidly consumable healthcare information that can be personalized to the individual and their health needs. A social collaboration strategy is a success when you are able to engage and interact with the patient in a way that drives them towards the overriding goal of wellness. Everything that you do, or want to accomplish, on the patient portal should support that experience. This not only guides your content and communication objectives, but it can also result in lasting interactions that elevate consumer experience.
To make social collaboration effective, it is important to present content in a fashion and format that makes the most sense to the user. Let’s be honest, social collaboration can be a bit nerve wracking in a HIPAA regulated environment. As such, it is crucial that every social collaboration initiative include a formal governance program. This program will ensure that patient communications stay relevant to the overall goal of wellness. However, with the right strategy, you can embrace the power of social to influence the conversation and amplify the health of your population.
Embracing data-driven decision making in a healthcare 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.
Micro-costing was introduced as the way to discretely measure and quantify true inputs to the cost of patient care. Healthcare costing has historically been isolated from true costs and has relied on averages of averages and “step-down” allocations that are often many layers thick. Most healthcare entities still use spreadsheets for costing and primitive methods that date back to an assembly line model – tools long abandoned by the manufacturing industry that created them. The result is rudimentary cost allocation that fails to match resources and related costs to their services. Allocation methods based on square footage to distribute utilities and administrative services (HR, finance, and procurement) are reasonable. However, using revenue, patient days, or admissions for allocating capital depreciation, pharmacy costs, and radiology utilization are inequitable. Often the drivers from budgeting and capacity planning are divorced from the costing process where assumptions are independent from the costing methodology. This makes it impossible to arrive at informed decisions that will improve financial results.
To stay competitive, healthcare organizations need to streamline inefficient processes and understand the types and the amount of resources they need to deliver care across the enterprise. This can only be achieved through cost transparency and micro-costing. To learn more download our white paper
In this video, my colleague, Lesli Adams discusses the intersection of cost, quality and the patient.
The Intersection of Cost, Quality and the Patient in Healthcare
Lesli and William Bercik, Oracle Director for Healthcare and former CFO, will be presenting a webinar, Align Patient Outcomes with Financial Data: A Formula for Correlating Cost and Quality on August 13, 2014 at 1:00 CT.
Taking our “What the market says you need in your patient portal” series a step further, today we are going to address the market demand for dynamic scheduling. When it comes to the marketing work of drawing patients into the brick and mortar, I often tell clients that, where their website and patient portal are concerned, if they get the Find a Provider tool wrong, then they have gotten everything wrong. It’s an extreme statement, but it is meant to highlight a few key market dynamics:
Enter the new world of scheduling embedded into a market driven patient portal. In this world we allow patients to schedule appointments online by providing them with calendar capabilities. Yes, this is very different from the way that business is currently done. Why? Clinicians work in a very dynamic environment that makes it challenging to manage schedules. Even though it is dramatically different from the way business is currently done, the market is making existing scheduling systems obsolete. Why? It’s surprisingly due to that very same dynamic nature of clinician schedules. The healthcare environment provides a seemingly endless supply of tasks for the clinician. Trying to overlay that dynamic environment over the traditional scheduling system is fraught with the well known long wait times, and poor consumer experience, that patients currently experience. Dynamic scheduling makes appointments easier for both the provider and the patient. Here’s how:
What do you think of the market drive towards dynamic scheduling?
Oracle’s decision to sunset the eGate HL7 integration engine has been a little bit of a headache for healthcare organizations. In reality, it has been an ongoing migraine for those who have not replaced it. eGate customer support is virtually unheard of, and if you are lucky enough to find skilled developers with specific Java and Monk experience you better have a big checkbook.
Additionally, depending on contractors to build, implement and maintain the multiple eGate interfaces results in increased costs, lack of control of interfacing projects and delayed access to important clinical data.
Making the decision to migrate from eGate is only the first step in the process, a process that can seem overwhelming when you consider the hundreds or thousands of application to application healthcare interfaces that need to be streamlined. There are many interface engines available today but when evaluating interface engines it is important to select one that is easy to use, robust, fits in the organizations work environment and aligns with the long-term IT goals.
Your vehicle. Many interface engines are very powerful and require individuals with specific programming skills to design and execute an efficient healthcare integration platform. Typically, these integration solutions are pricey and development time is lengthy. Other interface engines on the market are robust, designed with a simpler approach and require personnel to have basic programming or analyst-level skills. These solutions are usually competitive in price and development time is much shorter.
With many different integration solutions, it is essential for healthcare organizations to take the time to research and identify the one that best fits their environment. Organizations should consider many things including business model, location, size, areas of expertise, services offered and personnel needs. Failure to take these things into consideration can result in a solution that is very costly in time, price, personnel and productivity.
When determining the integration engine that will work best for your organization a thorough analysis should be completed. Below are some key attributes you may want your integration engine to include:
Now that you have identified where you want to go and the vehicle you are going to use, it is time to take a look at the map that will get you to your destination. Read the rest of this post »
Last month I published a post entitled “What the market says you need in your patient portal” that garnered a lot of interest. In that post I addressed the balancing act that healthcare executives face when market based initiatives are sidelined in order to drive focus to regulatory requirements such as Meaningful Use. Sometimes the market and regulatory requirements are in sync. However, when those regulatory initiatives get delayed things get complicated. My advice is that, beyond Meaningful Use, ultimately the market will determine what true patient engagement means, and I highlighted seven features that a market driven portal should have. I will spend time during this series going into detail on those features. They include:
Today we will begin with telehealth. The topic has been in the news quite a bit recently – mostly in terms of telehealth reimbursement. The world of telehealth is not only in a state of transition currently, telehealth is also one of the major net deltas that we will see between healthcare of today and the healthcare of ten years from now. So, what does telehealth look like beyond the virtual visit? We are pushing towards a world where technological innovations will make the brick and mortar less and less relevant even in the world of healthcare. One of the more interesting developments in this area is a push by X Prize, by way of multiple multimillion-dollar prizes, to innovate technologies in such a way to diagnose common medical conditions with no intervention from a health care professional. With this drive in the marketplace in mind, telehealth in a market-driven patient portal you would find:
One in five Medicare patients are readmitted to a hospital within 30 days of discharge, and one in three are readmitted within 90 days. It’s estimated that 75% of all hospital readmissions are preventable. Telehealth provides many benefits as a virtual visit. However, it is taking telehealth beyond the virtual visit that the market will push towards as we work to bring down the cost of care and reduce readmissions. Stay tuned for a future post on how the integration of all of this data takes this effort a giant leap forward.
Anything you think I’m missing? I’d love to hear your thoughts in the comments below.
I’ve talked a lot lately about cost vs. quality but this time, I want to talk about why all this is important by telling a little story.
A few years ago, I was visiting a CFO for a large academic medical center and he was interrupted for a discussion about a chronically ill international patient with a rare form of cancer. The patient and the diagnosis were not verbalized but the discussion was about whether the services needed could (and whether they should) be provided at no cost. This discussion was not only about the pricing or what the expense to the patient’s family would be (no insurance discussion here) but also about whether the institution really understood the cost and impact of providing the service from a margin perspective. The real truth is that they only knew what they charged for the treatment.
Properly allocating costs to understand them at the patient level is the subject of the this video by Oracle’s William Bercik, Director of Healthcare for Oracle and a former CFO.
Properly Allocating Healthcare Costs: The Key to Understanding Profitability
Join us as our team of industry experts discuss how to “Align Patient Outcomes with Financial Data: A Formula for Correlating Cost and Quality” on August 13, 2014. Using a case study discussing multiple scenarios for activity based costing for Pediatric Care Transitions, this webinar will explore how the Perficient High Performance Costing Expressway extracts clinical cost data, consolidates and allocates across the system to discover true patient costs.
Follow me on twitter @ teriemc
“The Wizard of Oz” is a wonderful movie, full of metaphors that can be applied to real life. As I look at the current state of Healthcare, I can’t help but wonder if there is a true “yellow brick road” from volume based care to value based care. If there is, which stops will we make along the way and what roadblocks will we face?
Physician engagement is a crucial component on the road to value-based care. As Michael Porter and Thomas Lee mentioned in their article in the Harvard Business Review, “care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment.” They go on to mention that crucial services, like care coordination, are often not reimbursed, thus further fragmenting healthcare.
As our population ages, these crucial components will need to be addressed as practices, hospitals and payers will be flooded with patients needing coordinated services. So how do we engage our physicians in this battle? Like the Scarecrow, listening and learning needs to take place. We can allow clinicians to work to the level of their licenses to unburden the physicians by coordinating patient care and documentation which becomes available for the treating physician. This will then allow the physician to spend quality time diagnosing and treating the patient, patient and physician satisfaction will rise and overall medical costs will decrease. Payers, Accountable Care organizations (ACO’s), Patient Centered Medical Homes (PCMH) and governmental regulators will see the health care value being generated. With value-based care, these services should be included in reimbursement and quality care should be rewarded. Sounds simple, right?! Read the rest of this post »
In my last blog post, I introduced the fundamentals and importance of healthcare benchmarking. I highlighted the benefits of benchmarking as well as the advantages and disadvantages of various types of benchmarking. The main point I hope you took away was that regardless of the type of benchmarking, the purpose is the same – to help healthcare organizations identify ways to improve their overall performance.
Now that you are aware of what healthcare benchmarking is and why it is important, in this blog post, we will focus on the key steps to implementing an effective benchmarking project to begin reaping those benefits.
Benchmarking Process and Key Steps
It is not secret that a well thought out process is essential to the success of any major project. Implementing a benchmarking project is no different. Below are the key areas of focus to consider before undertaking any benchmarking initiative. I have derived many of the specifics using a variety of resources, such as Six Sigma, the Juran Model, etc., to provide further context around each step. You might say, I have taken the “best of the best” from each resource…coincidence, I think not.
Plan and Prepare
Identify Opportunities and Prioritize1 – Top management must decide which processes are critical to the success of the organization and select projects from these. Once a shortlist of processes to be bench-marked is ready, the processes need to be prioritized as per a predetermined set of criteria to fulfill the requirements of all customers (stakeholders), especially the end customer1.
Deciding the Benchmarking Organization1 - The next step in the process is to decide the organization whose processes will serve as the benchmark. The benchmark can be a single entity or a collective group of companies, which operate at optimal efficiency2. Information on their processes should be gathered from various sources and the most suitable organization selected1. It is always important to ensure that more detailed information about the selected organization will be accessible and that comparison with the organization’s process will be relevant and useful1.
Organize a Benchmarking Team – The most successful benchmarking projects involve a team approach3. The organization should leverage existing teams that may be involved in similar topics to those that are being bench-marked, if possible. In the event a new team needs to be created for a benchmarking project, The Joint Commission, suggests that the organization seek the following when building the team3:
- Individuals closest to and most knowledgeable about the process or issues under investigation
- Individuals critical to implementation of any potential changes
- Individuals likely to be directly affected by any changes that result from a project
- A respected and credible leader who has a broad knowledge base
- An individual who has the authority to make decisions
- Individuals with diverse knowledge base and strong analytical skills
- Individuals familiar with benchmarking and how it can be used in performance improvement
- Individuals who are skeptical, resistant or even opposed to certain ideas and who can service as sounding boards or provide alternative viewpoints.
This step is perhaps the most important, most difficult and most time consuming activity in the process1. It involves creating a plan for collecting data from selected targets, conducting site visits and creating a site visit report4. Many times the information on processes and procedures followed at another company are confidential, and it is not always easy to gather authentic information, even after making a planned and approved visit at another organization1. The preparation for collecting necessary information and documenting this information in a systematic way has to be carefully planned and executed.
Validation and Normalization5 – The key activities here are the validation and normalization of data. Before any meaningful analysis can be performed, it’s essential that all data be validated to establish its accuracy and completeness. Some form of data normalization is usually required for direct comparisons to be made.
Identify Gaps5 – To be of value, the analysis must indicate the benchmarker’s strengths and weaknesses, determine (and, where possible, quantify) gaps between the benchmarker’s performance and the leaders’, and provide recommendations for the focus of performance improvement efforts. Based on this thorough analysis, an improved process(s) should be developed. Properly identifying the gaps will result in a clear picture of the organization’s processes in comparison with others within the business or industry.
Communicating Results – Communicating the benchmarking results and their implications to significant audiences in the organization and motivating them to carry out changes is vital4. It will result in a complete understanding by the target audiences of the necessity for changes in the processes involved and a desire to carry them out4. The communication must be delivered in a very clear, concise, and easily understood format via an appropriate medium5.
Create Goals - The project team’s next step is to set/revise goals for the improvement of the organization’s existing process, close the performance gap(s) identified in step 3 and create realistic and unambiguous new standards for the processes involved1&4. These goals can, and probably should, be stretch goals that will result in a process even better than the other organization’s best-in-class process1. Make sure management has approved and that all in the organization/business area understand.
Develop and Execute Action Plan1 - After the improved process and goals are accepted by all concerned or likely to be affected by it, a formal, detailed action plan is drawn with all key activities taken as inputs as well as the organization’s culture. The detailed action plan should carry the important things like a time line, individuals responsible for carrying out the tasks, any short-fall in the completion of tasks and what stretch targets are taken to compensate the short-falls. Those responsible should be committed enough to ensure that the tasks and assignments are completed on time.
Monitor Process – As with most projects, in order to reap the maximum benefits of the benchmarking process, a systematic evaluation should be carried out on a regular basis2. Senior management must be committed enough to ensure proper coordination of various activities, monitor the progress of implementation of the plan and work as a barrier-remover in the implementation process1. When the revised process is in place, a complete report has to be prepared, showing the benefits of the revised process compared with the expectations at the time of approval of the proposed revision of the process1.
Recalibrate as Necessary4- The organization needs to ensure it remains on the cutting edge by continuously evaluating the bench-marked practices and re-instituting the benchmarking process when necessary. This will prevent complacency by creating the habit of evaluating procedures to identify opportunities to improve.
Benchmarking is a very powerful performance improvement tool. However, it is vital to understand the basis behind it, follow a proven implementation methodology and gain organization-wide commitment to the cause. Benchmarking is critical for healthcare organizations to achieve and sustain the clinical effectiveness and operational performance they so desperately need.
Does your healthcare organization benchmark? Does the organization have a process that is followed similar to the aforementioned process? Has it proven successful?
Resources for this blog post: