By Dr. Anthony Oliva, DO, MMM, FACPE, National Medical Director, Nuance

Rotten Tomatoes has become the trusted online source for film reviews where viewers can rate movies, television shows, and discuss movie trailers. The site is known for its brutally honest feedback, and it’s not easy to score high; in fact, for a feature to be considered “Fresh” it has to have a 60 percent or higher approval rating – everything below is considered to be “Rotten.”

If consumers are taking the time to apply that level of scrutiny to films, how long will it be before we apply that same critical lens and rating system to physicians or a healthcare system? The reality is that it’s already happening – just not how one might expect.

Does sharing really mean caring?

A recent survey shows that more than 70 percent of young millennials (ages 18 to 24) choose their doctors based upon recommendations from family and friends; so for providers, word of mouth is the primary source of new business among this demographic. Millennials are less apt to give feedback to their physicians when they are unhappy with their care; instead, they tell friends, which can pose a big problem for healthcare organizations. What happens when millennials turn to social media and online forums to share negative feedback to the masses unbeknownst to the physician?

With millennials on the verge of surpassing baby boomers as the largest living generation, providers need to solicit input from their younger patients and find new ways to communicate more effectively with them.

Are physician reputations at risk?

Millennials are estimated to spend $200 billion collectively by 2017 and nearly $10 trillion over their lifetime – and they are savvy shoppers. As digital natives, researching a question or looking up a product review is second nature. We’re fast approaching a new paradigm in healthcare where online patient reviews of clinicians will increasingly drive business.

Just like Rotten Tomatoes, new sites culling physician scorecards and quality metrics are emerging, and patients will take them into account as they select care providers. Having this information available for the first time will impact physicians’ reputations and the referral system. Physicians won’t recommend low-scoring specialists, as it will call their credibility into question. And what provider or payer wants to back the physician with a 20 percent approval rating? This change is a surprise to most doctors who, until now, have not worried about online profiles because they weren’t personal; historically, they’ve always been associated with hospitals or large groups.

Good physicians who are poor at clinical documentation are also put at risk. If the severity of a patient’s condition isn’t accurately reflected in their record, physician ratings or scorecard numbers may be skewed. In comparison to a physician who isn’t treating patients who are critically ill, the first physician may not look good to patients.

While it may seem daunting, this is about transparency between physicians and patients. People want and need to become more involved in their care. Being able to research and choose physicians is the right of every patient. The key to success in this new world of healthcare centers around accuracy – getting credit for the care physicians provide to their patients, and being appropriately reimbursed for outcomes.

Security

Do you measure up to the ‘Most Wired’ hospitals?

What are the highest priorities for America’s ‘Most Wired’ hospitals? They are health data security, information access for caregivers, and patient engagement, according to results from the 17th annual “HealthCare’s Most Wired Survey” released in July by the American Hospital Association’s Health Forum and the College of Healthcare Information Management Executives (CHIME). Sponsored by VMware, the 2015 survey and benchmarking study aims to be a bellwether for IT use and adoption among hospitals nationwide.

The survey of more than 741 participants, representing more than 2,213 hospitals, examined how organizations are leveraging IT to improve performance for value-based healthcare in the areas of infrastructure, business and administrative management, quality and safety, and clinical integration. It was conducted between Jan. 15 and March 15, 2015.

According to the survey, hospitals are taking more aggressive privacy and security measures to safeguard patient data. Top growth areas among this year’s Most Wired organizations include privacy audit systems, provisioning systems, data loss prevention, single sign-on, and identity management. The survey also found that 96 percent of Most Wired organizations use intrusion detection systems compared to 85 percent of all respondents. Privacy audit systems (94 percent) and security incident event management (93 percent) are also widely used. Seventy-nine percent of Most Wired organizations conduct incident response exercises or tabletop tests annually, a high-level estimate of the potential for success of a cybersecurity incident response plan, compared to 37 percent of all responding hospitals.

As hospitals and health systems begin to transition away from volume-based care to more integrated, value-based care delivery, they are utilizing IT to facilitate better information exchange across care settings and between hospitals and physicians. According to the survey, the physician portal is a key factor in strengthening physician-hospital alignment. In 84 percent of Most Wired organizations, physicians can view and exchange other facilities’ results in the portal compared with 63 percent of hospitals surveyed, and 76 percent use the portal and electronic health record (EHR) to exchange results with other EHRs and health information exchanges compared to 56 percent of those surveyed.

Driven beyond the requirements of Meaningful Use Stage 2, this year’s Most Wired hospitals are utilizing the benefits of a patient portal to get patients actively involved in their health and healthcare. For instance, 89 percent of Most Wired organizations offer access to the patient portal through a mobile application.

Accountable Care Organizations

ACOs seek firmer financial tech footing

Ninety-five percent of executives at accountable care organizations (ACOs) and provider-based health plans identified financial solutions as among their highest infrastructure priorities in a recently published Black Book survey of more than 200 ACOs and 1,000 provider organizations. But only 19 percent of operational ACOs and 8 percent of hospitals and physician groups believe they have the adequate financial technology and services to be successful in the long term.

On one hand, pressures are mounting to speed up the migration from fee-for-service to value-based payment models. On the other hand, many provider organizations feel they just don’t have the business tools and resources to do so. Twelve percent of healthcare payments are currently made through value-based programs. Black Book estimates this number to surge more than 50 percent by year-end 2019.

Fifty-nine percent of CFOs agree that they are caught between revenue management services that fast-track the inflow of cash to sustain fee-for-service reimbursement and selecting ACO strategic solutions to assemble the groundwork to succeed with imminent risk-bearing payment models (down from 78 percent last year).

Problems with forecasting, coordination of claim and clinical data, and EHR replacements are also delaying progress toward taking on higher risk and incentivized contracts. Overall, 85 percent of all hospital CFOs and 81 percent of ACO executives agree that, without a strong financial solutions vendor to provide value-based reimbursement software and services, they will be forced to opt out of many key risk-based contract opportunities through 2016.

Black Book also measured the user satisfaction of value-based care financial services and software vendors on 18 key performance indicators, and in four functional areas of end-to-end ACO financial solutions. Ranking first (for the second consecutive year) in the survey of value-based financial services outsourcing, consulting, and software is Conifer Health Solutions. Other top-ranked ACO software, outsourced services, and consultants named in the Black Book report “Top Twenty Value-Based Care Financial Services and Software Vendors” in 2015 are: The Advisory Board Company, Health Catalyst, Aetna Medicity, Medecision Cerecons, Alere Wellogic, and McKesson RelayHealth.
Source: Black Book

Patient Relationship Building

Salesforce offers new ways to look at patient data

Healthcare providers looking to build a more complete and easily accessible picture of their patients’ total healthcare ecosystem have a new tool to use to gather and parse all the necessary data.

The Salesforce Health Cloud allows care coordinators to gain a big-picture view of their patients, from current conditions and medications to scheduled appointments and lab results. Data for the profile is populated from multiple sources, including electronic medical records (EMRs), medical devices, wearables, and more. Patient information is presented in Health Cloud’s Timeline view, which allows providers to understand the progression of a patient’s health journey. And by using the Patient Caregiver Map, providers can map household relationships, as well as all providers and specialists involved in a patient’s care.

The HIPAA-compliant system was developed in partnership with leading healthcare organizations, including Centura Health, DJO Global, Radboud University Medical Center, UCSF, and Philips. MuleSoft, Persistent Systems, and other partners offer integrations to leading EMRs from Epic, Cerner, and GE. Systems integrators Accenture, Deloitte Digital, and PwC deliver services for implementation, integration, customization, and content.

Other noteworthy features include the application’s Today screen, which alerts caregivers to timely issues such as missed appointments or a need to refill medications. Private Communities allow care coordinators to collaborate and assign tasks across a patient’s caregiver network, while patients can view progress against a care plan, find answers to common questions quickly, and connect with any provider in their network.

Integrated Devices

Digital medical device startup Eko Devices has received U.S. Food and Drug Administration (FDA) clearance to launch Eko Core, a digital stethoscope that can wirelessly stream heart sounds to a HIPAA-compliant smartphone app. This unit is also the first to integrate heart sounds directly into the patient’s EHR and is the only stethoscope available that enables clinicians to switch between analog and digital modes. The Bluetooth-connected mobile app, available from the Apple App Store, allows clinicians to view a heart sound waveform, save heart sounds directly to a patient’s EHR, and collaborate securely with a cardiologist for a second opinion.

University of California – San Francisco’s Department of Cardiology is leading Eko’s ongoing clinical trial, and Stanford University Department of Medicine will be the first institution in the country to deploy the device as part of an ongoing institutional pilot.