by September 18th, 2014
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.
Again, 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.
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by September 3rd, 2014
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.
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 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 »
by August 19th, 2014
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:
- Clinical Effectiveness
- Patient Safety
- Care Coordination
- 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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by July 15th, 2014
I always find industry acronyms amusing. Sometimes they describe new technologies, other times they are a new name for an existing technology (maybe with a slight twist). And then there are those times when two different technologies, models, theories, etc. end upwith the same acronym. Such is the case with Information as a Service and Infrastructure as a Service. Both are interesting concepts that deserve equal time, but today I would like to talk about Information as a Service (IaaS).
IaaS is certainly not a new concept. It has been around for a while. But it does merit a re-visit every now and then, since many healthcare organizations still struggle with integrating multiple systems and data sources.
At the core of IaaS is the concept of developing a common data model (also known as a canonical model) using schematic mapping and master data management. The common data model that is exposed represents multiple autonomous information sources that organizations use in order to transact business on a daily basis. Read the rest of this post »
by April 11th, 2014
Medicare is basing hospital reimbursements on performance measures. Patient satisfaction determines 30% of the incentive payments, and improved clinical outcomes decide 70 percent (source). So, it is no surprise that the term “patient experience” is rolling off people’s tongues very matter-of-fact like.
With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience. However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting. Therefore, it is equally, if not more important for those in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model.
Positive Outcomes and Opportunities
The benefits to improving patient experience are plentiful, regardless of the care setting. However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities. Here are the exact details they provide:
- Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.
- Patient retention, loyalty, and growth - By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients. As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy. Read the rest of this post »
by February 20th, 2014
Once upon a time last year, in a town not too far from you, there was a big hospital where a bright, young physician was providing care to a sick, old patient. Okay, let me save you some time. This fairytale, unlike those you are used to, doesn’t end simply by having Prince Charming (the physician) swoop in and save the beautiful, damsel in distress (patient). This fairytale has a bit of twist that changes the standard storyline. This twist is referred to as Patient Engagement.
Changing of the Patient-Provider Fairytale
The concept of patient engagement has changed the way providers tell their patient stories. It is no longer, once upon a time, a patient was sick, the physician cured him/her, the end.
The fairytale now reads more like this…
- Patient came in.
- Physician introduces him or her to supporting characters (care team).
- The patient and physician discuss the plot (disease state) with alternative endings (treatment options).
- They co-write the script (care plan), including ideas for props (patient education, care communities, etc.) that will enhance the story.
- The physician quickly publishes (uploads to portal) the manuscript and associated material for review and follow-up (provides email, direct scheduling option, mobile alerts, etc.).
- And instead of “the end”, it is more like, “to be continued…”
Patient engagement is not a new concept, just one that has been brought to the forefront as part of the healthcare industry’s increased efforts around coordinated care. Read the rest of this post »
by February 19th, 2014
Today, a report by market research consulting firm RNCOS released findings that predict the healthcare technology market will grow at a compound annual growth rate of about 10 percent between now and 2018.
About one-third of healthcare organizations now use cloud technology.
According to Fierce Health IT:
Continued innovation and government suppport for such tools will factor into the market’s success, according to the report’s authors. The report examines five trends, including an increase in:
- Wireless and cloud technology
- Government initiatives
- Strategic consolidations
- Reduced operating expenses
- “Technological upgradation”
The cloud offers the advantages of:
- Quickly scalable on-demand infrastructure and storage, which clinics, hospitals and provider offices require.
- Accessibility to healthcare data across multiple settings and geographies, creating a unique opportunity to better serve the patient by sharing information more easily than ever before, and improving operational efficiencies.
- Vendor technological expertise to support the cloud model.
What about compliance, security, and privacy?
Healthcare organizations must comply with complex medical coding and billing rules, along with HIPAA (Health Insurance Portability and Accountability Act) privacy and security regulations. Healthcare data, including Protected Health Information (PHI), must be kept secure, confidential, available only to authorized users, traceable, reversible and preserved for long periods of time. The right cloud solution for a provider must account for all of these concerns while conforming to HIPAA and Meaningful Use requirements.
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by February 14th, 2014
It seems appropriate on Valentine’s Day to write love letters. This is my letter of adoration to Meaningful Use. In the past, I have written about how much time and productivity is wasted in the average physician’s office handling phone calls about prescription refills. My physician’s office has successfully implemented their EMR software, and the patient portal is very, very handy for all of the right reasons. I could wax poetic about the ease of checking on appointments and reviewing lab results. The source of my real happiness is the ease of asking for refills and having the ability to route the request to the right pharmacy. It was love at first click.
Instead of calling the doctor, waiting on hold to talk to the nurse, fretting about getting the medication name and dosage right for the refill, it was magic. I signed into the patient portal in a secure fashion, clicked on medication refills, and there was a correct list of my medications! I selected the ones I needed refilled including a suggested number of days like 30 or 90, selected the pharmacy of my choice and Voila! Several hours later, I received an email confirmation from the pharmacy that they were processing my order. Now honestly, I didn’t have to see what went on behind the curtain in the doctor’s office to review my request, but I’m sure they like the elimination of potential communication errors on medications, too.
My doctor has shared with me about the financial burden of casting out his first EMR investment and starting over with a better EMR software. I have to say that from my point of view, he clearly chose the right one and it actually fulfills the basic tenets of Meaningful Use, particularly from the patient’s point of view. I plan to share my enthusiasm for the patient portal with him including the secure messaging that allowed me tell him that his changes in my medications worked and improved my quality of life. This secure messaging was another plus for productivity, and patient satisfaction, because those positive responses got lost in the challenges of telephone communication in the past. Read the rest of this post »
by February 11th, 2014
I just finished watching a quick slideshow on the Health Data Management website, “Enterprise Analytics: Moving on Up” and as luck would have it, I also watched several sessions of the live Webcast from the Healthcare Innovation Day Conference 2014 in Washington, DC, sponsored by West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).
While I was watching these, I was intrigued by the thought of how Accountable Care Organizations (ACO) can leverage existing solutions, combined with point solutions, to accomplish their reporting, analytics and beyond, and use interoperability wisely. One of the key learning points for me from these sessions was this: “Reframe the problem”….advice from Malcolm Gladwell’s keynote address.
How do we “reframe the problem” when it comes to ACO reporting and analytics? There are defined metrics that are required for these organizations, so how can we leverage existing systems to create these reports and analytics? Do we “build vs. buy”? Depending upon the organizational size, legacy systems and IT support, the decision can be difficult. What is good for one system may not work in another. So where do we start?
A strategic evaluation of current state and desired future state with the development of a road map may be a logical first step. Data Governance also needs to happen early on in the process to allow an organization to create data standards that will drive reporting and analytics. Once these steps have occurred, an organization can feel confident that they can make an informed decision to “build or buy.”
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by January 16th, 2014
A health insurance client of mine recently embarked on an initiative to truly have “trusted data” in its Enterprise Data Warehouse so that business leaders could make decisions based on accurate data. However, how can one truly know if your data is trustable?? In addition to having solid controls in place (e.g., unique indexes on the primary AND natural key), it is also necessary to measure how the data compares to defined quality rules. Without this measurement, trusted data is a hope – not an assured reality.
To enable this measurement, I designed a repository for storing
- configurable data quality rules,
- metadata about data structures to be measured,
- and the results of data quality measurements.
I experienced the need to be able to perform a degree of “inferencing” in the relational database (DB2) being used for this repository. Normally one thinks of inferencing as the domain of semantic modeling and semantic web technologies like RDF, OWL, SPARQL, Pellet, etc. – and these are indeed very powerful technologies that I have written about elsewhere. However, using semantic web technologies wasn’t a possibility for this system.
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by January 10th, 2014
Figure 2: Updated Systematic Review of Effects of Meaningful Use Functionalities on Quality, Safety and Efficiency, By Study Outcome Result (% of Studies)
Health IT evaluation studies, 2007-2013 (n=493). Number of studies by meaningful use functionality in parentheses. Positive defined as health IT improved key aspects of care but none worse off; Mixed-positive defined as positive effects of health IT outweighed the negative effects; Neutral defined as health IT not associated with change in outcome; Negative defined as negative effects of health IT on outcome.
Citation: Jones SS, Rudin RS, Perry T, Shekelle PG. “Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use,” Ann Int Med 2014;160:48-54.
This is a fascinating report on a study by RAND researchers about meaningful use. It shows strong evidence that Health IT improves patient outcomes, specifically quality, safety, and efficiency outcomes.
Michael Furukawa Director at the ONC , and Meghan Gabriel, Economist at the ONC, presented the results from this study in a blog post on HealthIT Buzz. They asked RAND to:
…examine recent evidence on the effects of meaningful use functionalities on quality, safety, and efficiency outcomes. The study was the largest and most comprehensive assessment of the health IT literature to date.
by December 12th, 2013
I enjoyed an article today in IT Business Edge about the ways that Big Data is improving outcomes. We hear that all the time, right? But what does it really mean? Why does more (and better) patient data lead to improved healthcare for all? When business intelligence is leveraged properly to deliver insights to healthcare providers, we see the following:
- Learning what we never knew before:
“Allowing for previously unknown factors involved in disease to be discovered and utilized as drug targets or disease biomarkers.”
- Comparing data points from various sources to individualize treatment plans, improving outcomes.
“We are able to align and compare multiple data points from various sources, tailoring individualized treatment plans for each patient.”
- A move from subjective interpretation to objective diagnosis.A coworker of mine said to me yesterday, “Can you imagine when our kids are older? They’ll be laughing at our stories of how doctors once said to us, ‘Based on your symptoms, I think you have [X disease].'”
She’s right. Diagnoses vary from physician to physician based on his or her background and experience. Not any more! As this article states, we’re facing a “datafication” of patient samples.
“A vast quantity of knowledge that can be statistically analyzed and quickly reviewed by multiple clinicians for solid diagnosis”
- Better – and faster – decisions about treatment as a result of more and better patient data
“Clinicians can systematically extract more information from each patient without requiring multiple rounds of testing.”
- More accurate diagnosis and more appropriate spending on treatments due to reproducible testing”Consistently reproducible test results are possible between clinicians and doctors for more accurate diagnosis and appropriate spending on therapy options.”