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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.

Perficient Ranked One of the Largest Healthcare Consulting Firms

For the sixth year in a row Perficient has been recognized as one of the largest healthcare management consulting firms by Modern Healthcare. This year we were recognized at #13 on the list, which is comprised of the 70 largest healthcare management consulting firms in the US, ranked by 2013 Perficient Ranked One of the Largest Healthcare Consulting Firmsrevenue from provider consulting fees.

Being ranked one of the largest consulting firms in the healthcare industry is an honor and we are proud to be recognized alongside other influential healthcare firms.

The full list is available for purchase from the Modern Healthcare website.

 

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ACA and QRS – Shoot for the stars! Part 1

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 Shoot for the stars!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:

  • Clinical Effectiveness
  • Patient Safety
  • Care Coordination
  • Prevention
  • Access
  • Doctor and Care
  • Efficiency and Affordability
  • Plan Services

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.

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Market Driven Patient Portal: Avatars for Personalized Coaching

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 Market Driven Patient Portal - Avatars“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:

  • Patient Education: In the realm of patient education, we had a study that used digital avatars with human characteristics to help women through preconception health.  In this case human interaction was not replaced.  Rather, the avatar augmented and furthered the patient experience through the use of digital technology.  The avatar asked initial questions and then triaged the more difficult interactions to clinicians.  This allows clinicians to have more time to deal with complex issues. Add this to a patient portal and you begin to see how patient health concerns can be triaged remotely with the requisite education embedded throughout.
  • Appointment Registration: I love that more and more healthcare organizations are making online pre-registration an option.  Going even a step further many hospitals and ambulatory care centers are digitizing the in person appointment registration, which I mentioned in an earlier post of this series. Let’s add avatars to this process, which adds a “human” touch to an otherwise clinical process (pardon the pun).
  • Patient Discharge: The discharge process is ripe for errors and omissions.  All too many times patients arrive home without having absorbed the right data they need to maintain their health.  The result is often costly readmission.  Even a couple years back I was able to witness a demonstration of the use of avatars during the discharge process.  Through an automated touch display, patients were able to navigate through their discharge instructions in an interactive way.  The avatar even threw in fun questions like whether or not the patient preferred the Red Sox or Yankees (read: the hospital was in Boston).  Patients provided rave reviews for their avatar led discharge experience.  In fact, the experience was rated higher than in person discharge by a wide margin. Now, let’s add this functionality into the patient portal as well to continue that interaction remotely to ensure that those discharge instructions are followed. I’d suspect that you would see a marked improvement in readmissions rates simply because discharge instructions are adhered to.

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.

Market Driven Patient Portal: Gamification and Serious Games

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 Market Driven Patient Portal - Gamification and Serious Gameshealthcare.  In healthcare we’ve seen games of multiple types.  Here are some of my favorite examples:

  • Games that help modify user behavior: Humana took a pioneer stance in the world of serious games in healthcare with their Horsepower Challenge.  Using the craze the followed games like Dance, Dance, Revolution, Humana used “exergaming” in 2009 to challenge 20 members of Congress and 2,000 5th and 6th graders nationwide as they “raced” across the country by taking steps with a pedometer.  She also harkened back to a healthcare game I mentioned in a post back in 2011, namely Re-Mission.
  • Games that train wellness behaviors: In the game Re-Mission, a nanobot named Roxxi is injected into the human body to fight particular types of cancer at the cellular level. Those playing the game are also asked to monitor the patient’s health and report any symptoms to the fictional Dr. West.  Each level of the game informs the player on a variety of treatments and on the importance of staying compliant with medical protocol.  HopeLab trial studies, that were published in peer-reviewed journals, revealed that playing Re-Mission led to more consistent treatment adherence, faster rate of increase in cancer knowledge, and faster rate of increase in self-efficacy. Most notably are blood test results, that showed the measured level of chemotherapy drugs in blood to be higher in players versus the control group.
  • Clinical learning labs: These are the types of gaming environments where practitioners can train in virtual learning labs on an avatar.  A great one is foldit: Solving Puzzles for Science.  foldit, funded through a University of Washington grant, is an attempt by game developers to crowdsource scientific research.  Within a few paragraphs of texts, the gamer is educated on what proteins and amino acids are and why their shapes, and what those shapes fold into, are important.  The goal is to have human “protein folders” work on proteins that do not have a known structure.  Scientists can then take folding strategies that human players have come up with while playing the game and automate those strategies to make protein-predicting software that can fight HIV and cancer more effective.  Beyond protein prediction, protein design has even more direct implications to disable a virus.  Thus far there are not many automated approaches to protein design, so foldit’s human folders are a great source of research.

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.

Market-Driven Patient Portal: Social Collaboration

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 Market Driven Patient Portal - Social Collaborationis 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.