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Archive for August, 2011

Opportunities Abound: How to Leverage Increased Data Granularity in the ICD-10 Code Set

by on August 30th, 2011

Join Perficient for our September 15th webinar, “Opportunities Abound: How to Leverage Increased Data Granularity in the ICD-10 Code Set”

Migration from the ICD-9 to ICD-10 code sets is one of the most extensive and risky conversion projects healthcare insurers will face. Conversion will impact organizational structure, business processes, healthcare policies and IT systems. The scope of this change presents significant risks to insurers seeking to achieve financial and benefit neutrality to avoid undermining provider relationships. Insurers will require scalable, high-performance healthcare data transformation as well as comprehensive testing and automated comparison of ICD-10 results versus expected outcomes.

Analytics that use ICD procedure and/or diagnosis codes will change dramatically under ICD-10. The challenge will be in determining how best to take advantage of the greater level of condition, diagnosis and treatment data that will be available after healthcare organizations migrate to the ICD-10 code set. Business intelligence solutions will need to support ICD-9 and ICD-10 codes simultaneously during the transition. Reporting, efficiency and population risk models or other aggregation schemes must be fully remediated to support native ICD-10 as well as native ICD-9 codes. Architectural solutions must support technical platform compatibility and ease of integration in existing models.

Join Perficient for an informative webinar that explores how to leverage the increased data granularity in the ICD-10 code set.  While there are risks, a properly executed ICD-10 implementation will deliver plentiful rewards.

Register for the webinar and receive a free copy of the Harvard Business Review Article, “How to Solve the Cost Crisis in Health Care” by Robert S. Kaplan and Michael E. Porter along with a copy of our most recent white paper, “Implementing ICD-10: Hard Work Brings Rewards”.

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Posted in News, Regulatory Compliance | 2 Comments »

ICD-10 Migration Approach: Systems Remediation

by on August 29th, 2011

Healthcare Payers must determine all business processes and applications impacted by the change to ICD-10. Applications that capture, store, send, receive, or edit diagnosis or procedure codes must be modified. Fields must support alphanumeric characters and expanded to support an extra digit. The new specificity of IDC-10 codes will impact corresponding application logic, business rules, system interfaces and data reporting. And the clock is ticking…

Systems remediation must consider people, business processes and technology when assessing the scope of ICD-10 change. ICD-10 has the potential to impact enrollment, eligibility, claims, adjudication, benefits, pricing, underwriting, medical management, case management, provider payment, provider contracting, and more.

Organizations must understand issues, challenges and opportunities for change when determining extent of change to be undertaken. Clearly, basic coding, revenue cycle processes, EDI transactions and compliance reporting must be changed. Tougher decisions must be made in order to determine the right level of investment in data analytics, reimbursement models and payment monitoring to leverage the detailed data obtained through ICD-10 coding specificity. The most progressive organizations will choose to invest further in development of new products, business relationships, business process and care procedures.

Systems remediation will require a comprehensive assessment of all business process that currently touch ICD9 codes. Organizations must map all enabling technology to business processes. A comprehensive ICD10 systems inventory should include the identification of ownership, accountability and responsibility for both the enabled business process and the enabling technology.

ICD-10 migration complexity will depend upon the underlying technology architecture, count and ease of change of affected system, interfaces and reports. Finally, ICD-10 migration complexity will depend upon data or information transfer relationships with systems vendors, providers, clearinghouses, business partners, regulators and other external entities.

When making “biggest bang for buck” for systems remediation investment decisions, organizations must change business processes and technology, while at the same time trying to maintain normal business operations.  This will not be easy.  Organizations must focus on core capabilities, and then be diligent in picking the right business partners to support the rest of the journey.

Register for our upcoming ICD-10 webinar and receive a free copy of the Harvard Business Review Article, “How to Solve the Cost Crisis in Health Care” by Robert S. Kaplan and Michael E. Porter along with a copy of our most recent white paper, “Implementing ICD-10: Hard Work Brings Rewards”.

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How The Accounting and Health IT Geeks Solved the Healthcare Cost Crisis

by on August 29th, 2011

How’s that for a future headline?

Earlier this week, a coworker passed along a link to an article with a rather bold title, “How to Solve the Cost Crisis in Health Care”.   This article was written by world-renowned Harvard strategists Kaplan and Porter who are best known for the Balanced Scorecard and Five Forces, respectively.  I was interested in understanding the strategist’s solution to the healthcare cost problem.  I ultimately came away with the basic understanding that accounting and IT talent should work together towards this goal.

Kaplan and Porter start the article with a simple phrase that completely reframes the healthcare reform discussion, “The biggest problem with health care isn’t with insurance or politics.  It’s that we’re measuring the wrong things the wrong way.”  What do you think?  I’d be interested to hear your comments below.

Managerial Accounting in Healthcare

Kaplan and Porter ultimately feel that there is an almost complete lack of understanding around the costs required to deliver care.  Costs are currently tracked by specialty or department instead of tracking costs by patient with specific condition over the cycle of care.  Under the idea of “what gets watched gets done” this can (and does) mean disastrous things in terms of escalating healthcare costs.  Tracking costs using managerial accounting methods would allow providers to correct systemic cost issues by linking healthcare costs directly to process improvement.   Likewise, efficient providers can be rewarded for their behavior, causing a shift in underlying motivations and financial results. 

This remedy requires a new way to accurately measure costs and compare them with outcomes.  You can read through Kaplan and Porter’s seven step cost measurement system in more detail, and I’d be interested to hear what you think.  My general feeling is that these two are seriously smart, but their ideas do need to be considered carefully.  With echoes of my accounting professor reverberating in my ear, I agree whole-heartedly that costs can be measured more usefully than they currently are.  However, we must consider why costs are currently measured the way they are and what structural changes are needed to make patient-level costs matter to providers.  However, I would venture to say that, with the help of Health IT initiatives currently under way, we are well on our way toward supporting these new costing methods.

Using Analytics to Support Patient-Level Cost Data

Analyzing costs at this micro level requires strong use of analytics.  Analyzing costs means nothing if you are using bad data.  The healthcare status quo has two main obstacles in this regard:

  1. data granularity in ICD-9 is sub-optimal, and
  2. the healthcare industry is struggling with poor data quality

However, two major health IT initiatives are underway to solve this issue.  The granularity of data provided through ICD-10 will be more in line with Kaplan and Porter’s costing approach.  ICD-10 compliance will provide healthcare organizations with a rich data source.  Also, this increased data granularity can be optimized through the use of business intelligence and analytics tools.  The time has never been better for healthcare organizations to compete on analytics in this way.  Using re-worked analytic reports built around ICD-10 codes, healthcare organizations can examine the bigger picture of total costs using a “single version of the truth” in an intelligent way.  There will be opportunities to build more comprehensive data marts and stronger operational reporting including digital operations dashboards.  For more progressive Health IT teams, ICD-10 remediation could be an opportunity to move to a self-service model for reporting that capitalizes on a new generation of business intelligence tools.

You can learn more about this at our upcoming webinar “Opportunities Abound: Leveraging the Increased Data Granularity in the ICD-10 Code Set”.  Register today

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Posted in Business Intelligence, News, Regulatory Compliance | 3 Comments »

Strengthening Consumer Experience in a Post-Reform Insurance Market

by on August 25th, 2011

As shown in a recent Forrester report, the health insurance industry faces a great deal of discontent from consumers.  Of the 13 industries tracked by Forrester, health plans rank dead last in consumer experience. 

At the same time, the market for individual insurance coverage is growing.  Reform will continue to accelerate this growth.  In this age of health insurance exchange, it is estimated that the health insurance market will be worth almost $60 billion by 2014; the market is expected to grow to almost $200 billion by 2019.   This creates an incredible market opportunity for health insurance companies. 

This confluence of events creates some issues for the health insurance market status quo.  As recent trends have shown, consumer expectations are ahead of what health insurance companies deliver.  These unhappy customers will ultimately flee toward rivals.  Health plans will need to work hard to build consumer experience and loyalty in order to win business in a post reform world.     

Those health plans that work now at improving their customer experience will reap rewards.  In fact, a recent report shows that nearly 50% of customers are willing to pay more for customized health plans.  Now is the time for health plans to take advantage of “mass customization” standards found in other industries.  Health insurers will need to drive change and innovation around consumer experience to win.

In order to do this, health plan customer experience professionals must innovate by reinventing how they interact with consumers.  There are several key ways that this can be accomplished:

  • Build Insurance Customer Loyalty.  Leading health plans are currently canvassing clinicians and patients to understand what level of intervention they would accept from a health plan partner.  The use of CRM would push this research into overdrive.  CRM allows health plans to identify customers and their level of loyalty.  Health plans will also be able to research customer preferences, escalate issues, and build strong  relationships with individual consumer in mass as a result.   
  • Gamify Consumer Experience to Reduce Costs.In order to control costs, health plans often tie incentives to healthy behaviors.  Instead, health plans should start with the customer and consider what they already gravitate towards to encourage a healthful lifestyle.  Our recent pieces “Engaging Patients with “Gamified” Mobile Care” and “What is the Greatest Mobile Health Challenge?“ explore this trend.
  • Use technology to speed time to market.  Investing in technology fosters an innovative community where health plans can partner with providers and consumers.  Using a social media platform can allow health insurers to test initiatives through gathering and refining ideas that would otherwise take months to enact.

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Posted in Collaboration, News | No Comments »

ICD-10 is the Whole Enchilada

by on August 23rd, 2011

A quick and dirty news search of “ICD-10” reveals that in the past month over 140 news articles were posted referencing ICD-10. Why the continued hype about a conversion that is a little more than two years away? The answer is – ICD-10 is a serious feat and requires a substantial outlay of time, effort and funding. At the same time, it is a “learn as you go” conversion that affects nearly all aspects of an organization.

The most taxing part of this process is the fact that it is new to everyone. The only lessons to be learned are from organizations who are already in the trenches of ICD-10. Here is what they say:

“Bear down and plan well,” urged John Dingle, senior health systems engineering analyst at the Mayo Clinic.

“Without the right people in place to execute, ICD-10 implementations can drain an organization.”

These comments confirm that the conversion is more than a big deal – it’s the whole enchilada. It impacts business processes, HIT departments and healthcare policies as well as provides a slew of new data for analyses. It is important that organizations set up their systems appropriately so that both the organization and its patients are benefactors.

It is easy to sit back, read about ICD-10 and learn from other organizations.  However, organizations can no longer afford to drag their heals.  The conversion will take place as scheduled and failure to comply with the government deadline will result in unnecessary havoc.  Do you have questions about ICD-10? Join us on September 15th for a free webinar “Opportunities Abound: Leveraging the Increased Data Granularity in the ICD-10 Code Set”. Register today!

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Posted in News, Regulatory Compliance | 3 Comments »

ICD-10 Migration Approach: Data Impact Assesment

by on August 22nd, 2011

While 5010 has taken a backseat to ICD-10 in the media, payers must still meet the change to 5010 on January 1, 2012 before implementing ICD-10. Version 5010 accommodates the ICD-10 code, and must be in place first before the changeover to ICD-10.

ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2013. Otherwise, claims and other transactions may be rejected, and will need to be resubmited with the ICD-10 codes. This could result in delays which would impact the timing of reimbursements.

The combined 5010 and ICD-10 changes will impact people, process and technology across the entire payer organization. Payers must assess which ICD-9 codes that will have the greatest volatility within a forward and backward crosswalk clinical equivalency map. The primary criteria for assessing code data impact will include frequency of code use and cost of associated benefits.

To put the change effort into context, the support associated to determining defensible medical policy, executing a forward crosswalk and validating the clinical equivalency map with a backward crosswalk for 155,000 combined diagnosis and procedure codes would take 155,000 hours at 1 hour per code. From today, there are only 110 weeks remaing till the ICD-10 compliance deadline of October 1, 2013. Based upon a 40 hour work week, it will take over 35 dedicated staff to just administer the clinical equivalency mapping of all codes.

Rumors persist that CMS (The Centers for Medicare and Medicaid Services) will again reset the ICD-10 compliance deadline, but don’t count on it. Implementation planning should be undertaken with the assumption that the Department of Health and Human Services (HHS) will NOT grant an extension beyond the October 1, 2013 compliance date. HHS has no plans to extend the compliance, which means that covered entities should plan to implement ICD-10 for production use on October 1, 2013.

Most payers will utilize the CMS Gerenal Equivalency Map (GEM) documents for ICD-9 Diagnosis and Procedure code mapping to ICD-10 codes which will support of the forward crosswalk but will not support the backward crosswalk necessary for financial and benefit neutrality verification. Payers will need a method and process of collecting the critical details that explain how and why the codes are related, or where they differ. Payers will have to spend a significant amount of time and effort to evaluate those differences.

Defensibility of code mapping will require a deeper understanding of historical ICD-9 coded claims data and corresponding ICD-10 code mapping. Analytics tool vendors are currently developing and refining their capability to support the automation of the historical claim data analysis to determine frequency of code use and cost of associated benefits. Payers understanding of which ICD-9 codes create revenue risk or associated benefit risk will enable the use of this analysis to prioritize and focus efforts to reduce mapping volitility.

Automating code mapping analysis will reduce the time and resources needed for developing defensible code mapping for individual codes based on frequency of code use and cost of associated benefits.

Do you  have questions about ICD-10?  Join me on September 15th for a free webinar “Opportunities Abound: Leveraging the Increased Data Granularity in the ICD-10 Code Set”.  Register today

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Posted in News, Regulatory Compliance | 1 Comment »

Using Mobile Health to End “One Size Fits None” Healthcare

by on August 22nd, 2011

In our previous posts we discussed “gamification” and how it can be used to create patient experiences that increase adherance to medical protocol.  We also discussed the use of Web 2.0 technologies that bring patients and physicians together to make improvements to that medical protocol.  Fortunately, more and more healthcare organizations are investing in healthcare technology.   It is important to note that those organizations that have been most successful in adopting Health IT initiatives have been those that integrated patients into the development and implementation of the technology used.  They have done this by providing platforms and applications that allow their patients to engage directly with their care. 

Unfortunately, many organizations are still utilizing the “one size fits all” approach to healthcare technology.  This quickly translates into “one size fits none” since these initiatives almost never meet the individual needs of individual users.  Luckily, social and mobile technologies are experiencing rapid innovation in the healthcare space.  Add data interoperability, data analytics, and shared workspaces to these more obvious forms of technology innovation and you get next generation healthcare technology that allows healthcare organizations to engage with patients in a direct, customized fashion.  These platforms allow users to interact, self-organize, and collaborate seamlessly with their data.

The best thing about the “mass customization” of healthcare technology is that patients can access up-to-date and easy to use information using devices they choose at a location of their choice.  Since this technology can adapt according to the needs of each patient, and engages the patient at the point of care, engagement in care translates into adherence to protocol.  Healthcare, by its very nature, is collaborative.  It changes and adapts according to the needs and circumstances of each patient.  It’s about time that the healthcare technology used to implement this care reacts in the same way.

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Can Social Media be Used to Improve Medical Protocol?

by on August 17th, 2011

A colleague of mine recently slipped me a copy of  “A Web 2.0 Model for Patient-Centered Health Informatics Applications” by Mark Weitzel, Andy Smith, Scott de Deugd, and Robert Yates of IBM.  I learned two things as a result of this gesture: 1) my colleagues know me very well and 2) web and social technologies have the potential to enhance medical protocols for patients both on and offline.

Physicians use medical protocol as a plan for evaluating, diagnosing, and treating a condition.  There are protocols for everything from cancer, diabetes, and the common cold.  These protocols are used as guidelines that provide a scaffolding that physicians can use to avoid ineffective treatment while allowing them to tailor treatment using their own experience and the individual needs of a patient.  These protocols are strengthened through information sharing.  This information sharing typically takes place in physician communities, both formal and informal.  However, with advances in healthcare technology, now is the time to invite patients into this data sharing in order to enhance these medical protocols.

As has been highlighted in blog posts on this site and sites across the web, web technologies, fueled by social and online communities, have drawn patients together into communities.  Whether it be public sites like “Patients Like Me” or independant efforts of healthcare organizations to bring their patients together in a collaborative environment, these communities have proven to be a great way to keep patients healthy and engaged in their care.  However, they are also becoming a platform for data sharing.  This data sharing is largely informal, but it has the potential to enhance and improve protocols if patients and their providers are given the tools necessary to analyze the data that is collected.

As highlighted in the articled mentioned above, using open, standards-based Web 2.0 technologies to enhance data exchange and analysis gives us the following benefits:

  • Provides data capture that can be applied to protocol closer to point of care
  • Improves the effectiveness of protocol by increasing the volume and accuracy of data to be applied to medical protocols
  • Can link the protocol used to a specific patient response to that procotol, which can provide “mass customization” of treatment
  • Provides deep analytics and a vast community of physicians that can collaborate and provide feedback on the effectiveness of certain protocols; physicians can annotate decisions and deviations to protocol
  • Provides patients access to specific results and their personal health record
  • Physicians can provide updates, warnings, and advice directly to patients in a social setting
  • The medical community can compare the results of different protocols in different facilities depending on patient situation providing immediate peer feedback.

In a previous blog, The Movement of Patients and Physicians into Social Media, we discussed how patients and physicians are both gathering in social media spaces.  However, due to privacy concerns and lack of guidance, rarely are the two groups collaborating together.  However, through the use of HIPAA compliant social portal technology and enhanced analytics, social physicians and patients have the ability to work together in a collaborative space to enhance their own care and medical protocol for the entire patient community.

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Can the Healthcare Industry create a Society that No Longer Bowls Alone?

by on August 16th, 2011

There was a provocative blog published that linked prescription non-adherence with beliefs, trust and lack of communication. As I read through it, my mind thought of two things: 1. Robert Putnam’s classic publication Bowling Alone and the importance placed on trust to create social capital, and 2. the Advocacy Coalition Framework’s role of beliefs.

According to the article published in the Journal of Psychosomatic Research (2008), “patient beliefs and concerns about medications are stronger predictors of patient non-adherence than clinical and sociodermographic factors”. The importance of trust was also illustrated by Robert Putnam when he described the decline in civic engagement throughout the United States. The point here is simple – we have more information on our hands than ever before and as a result we are experiencing a breakdown in trust, because we don’t always get the right information.

The Advocacy Coalition Framework (ACF) examines how information influences individuals with similar deep core beliefs and explains how getting the right information to individuals is the only way to overcome the issue. The right information in this scenario can only be captured and transmitted if the healthcare industry embraces the ICD-9/ICD-10 disease code transition, Meaningful Use initiative and invests in IT capabilities to link information and provide quality, unbiased information to patients.

This is an incredible opportunity for a data-rich industry to show society that it is the crux of society – that indeed the healthcare industry will overcome breakdowns in trust which result in a society that ‘bowls alone’.  The current changes within the healthcare industry were inevitable – but, the outcomes are to be determined.

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What is the Greatest Mobile Health Challenge?

by on August 15th, 2011

In a post last week I outlined the trend of using “gamification” and mobile technology to solve real-world health problems.  In summary, gamification is the practice of using gameplay mechanics in non-game applications, such as health apps that engage patients and assist them in managing chronic diseases such as diabetes and cancer.  Gamification is becoming the next frontier in patient engagement.  Healthcare organizations, and the patients they serve, can profit from this trend more now than ever before.

However, I think it is important to move beyond conversations about individual applications that assist patients in managing disease.  What do I think the true challenge that gamifacation can solve is? 

Interoperable records that take the burden of collecting and distributing health data away from the patient.

In the case of those managing chronic disease, they are often meeting with various clinicians depending on specialty and treatment protocol.  The list is lengthy: primary care, oncology, labs, physical therapy.   It often falls upon the patient to manage their health data.  Those with chronic disease can be bounced around like pin balls collecting data from one provider to the next so that they can get the best care possible.  This becomes patient as a manual ETL, and, in my opinion, it is unacceptable given the technologies that are available to solve this problem.

Instead, providers should be enabling patients by providing an engaging environment where they can interact with their data seamlessly and in a format they can understand.  The objective should be to build a system that makes data collection seamless and secure.  With their data in the palm of their hand, mobile technology can be used to help patients manage their chronic illness in partnership with their providers.  All of this would happen through a joint partnership between physician and patient toward the ultimate goal of wellness. 

Once health data is properly integrated and provided to the patient in mobile format, that information can then be integrated into disease management apps that engage the patient in managing their care.  By balancing every day care with the engagement provided through mobile applications, patients are truly enabled in their care.   

Picking up from where I left off in the previous post, Mashable highlights a number of tactics healthcare organizations can include in mobile communication with patients through gamification. Here are the five most commonly used mechanics in mobile applications:

  • Points: Points are used in non-game apps as a way to denote achievement and work to keep the user motivated for the next reward or level.  For example, Health Month uses points by asking users to set up weekly health-related goals and they receive points when they stick to those goals for an entire month. Each person starts with 10 “life points”.  The player loses a point every time they break a rule, and the goal is to end the month with at least 1 life point.  Friends can help the player “heal” and earn back points as well.
  • Badges: Merit badges are often used as codes of honor in the gaming world that can also be used to unlock new levels. 
  • Levels: Levels can be used to make the more mundane tasks of every day maintenance more enticing.  How often have I played the same level over and over again in order to unlock the next level just to know what’s beyond the next bend?  It would be embarrassing to admit.
  • Leaderboards: Leaderboards rank users and work to motivate and encourage them to become players. Patients often find an environment where they can engage with “patients like them” to be an integral part of treatment.  Gamification can be a great way to help patients interact in a secure fashion.
  • Challenges: Challenges can range from the simple to complex, and there are a number of ways this can be used to gamify patient experiences around chronic disease.  In one example, I saw users compete for donations to their favorite charities and research foundations.

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Posted in Interoperability, News | 1 Comment »

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