Monthly Archives: July 2016

Prescription For Specialized Costs

US government spends more on healthcare than any other industrialized or high-income countries. But the gains from this investment is not proportionally positive. On average, Americans live shorter lives and are more likely to report a cancer diagnosis, cardiovascular disease or other chronic illnesses. One main reason among many is the average American’s ever decreasing access to primary health services.

There is a looming shortage of primary care providers in the country. Experts predict that by the year 2025, the shortage of primary care providers could become a crisis. Even now it is estimated that one in five sick people visit ER for care, they could have accessed from a primary care center.

The percentage of primary care physicians in the US is at 30%, a gradual decline from 50% five decades ago. According to experts the reason for the downwards trend can be traced to the early 40s and 50s when the general public first adopted the idea of advancement in medicine as specialization. As a result, we now have more specialists than ever before but quality of care and access to care took a hit.

Various case studies have related following problems with specialization:

1.Cost of Expertise:

Specialization adds cost to the health system which will ultimately be passed on to patients. Specialists have a greater chance of over-diagnosing a symptom and patients may be prescribed unwanted and costly treatment regimes. Experts are more likely to overuse healthcare infrastructure than a primary care physician. Many scholars now agree that psychological problems like ADHD, depression and some chronic illnesses like chronic kidney disease and some form of cancer are overdiagnosed.

2. Wrong Diagnosis:

Specialists in a field may diagnose a problem through a limited scope, in an attempt to study an issue from such conformity of their respective expertise may lead specialists to conclude the wrong diagnosis. This drawback to properly diagnose a symptom can affect patients with multiple illnesses. When the government is drawing up plans to curb the cost of treating the chronically ill, this diversified islands of thoughts and actions may not be helpful in realizing it.

3. Biases:

Specialists practicing in a field may be biased in diagnosing symptoms or cases outside their area of expertise. Such biases may lead to medical errors such as overlooking the influence of a treatment on other patient conditions, underestimating the seriousness of other health concerns. These biases may be useful in some cases but in most cases usually just adds up cost and endanger the health of patients.

Improving access to estimated 60 million Americans to primary care is not easy but necessary to ensure quality care for all. Various studies reveal primary care and income disparity are the two major influencers in life expectancy and that access to primary care also leads to improved population health parameters. Some of the major benefits of improving access to primary healthcare are below

1. Early Detection

An early detection of disease can help chances of successfully treating these diseases. Early detection is detrimental for effective treatment of some chronic diseases and conditions.

2. Efficiency

In the absence of specialization, a primary care physician will be able to observe and treat symptoms and illnesses in a holistic way making the whole process more efficient. As the whole healthcare policy is tilting away from cost per service to quality of service, the role of primary care professionals will find new importance.

3. Cost-less:

In the prevalent system, a disease is diagnosed after it has occurred. By identifying diseases at an early stage and providing holistic care primary care can cut down the cost of healthcare. Such a system can reduce the number of chronic care cases and thus remove the burden on healthcare infrastructure and also be making it available for more of the population. This will onset a positive cycle, establishing a cost-efficient healthcare system on its own.

The positive influence of primary care access to population health cannot be denied and efforts must be made to refocus attention on primary holistic care. Hope comes in the form of Accountable Care Organization and other initiatives of both federal and state governments compelling healthcare professionals to work together and improve patient outcome. Strengthened primary care may not solve the puzzle that is the US healthcare system, but it sure can be one decisive piece.

Advantages and Disadvantages of Precision Medicine

Diseases are influenced by various factors that an individual is subjected to, some of which are general factors while others are specific individual factors. While the former is studied in great detail, the latter is not. Understanding individual factors can help us treat disease more effectively or even prevent diseases more altogether.

This method of tailoring treatment to an individual based on specific personalized factors is called Precision Medicine.

Thanks to the rapid advances in the field of genetic mapping, we now understand the influence genes hold on a person’s health and well-being, opening the possibilities for discovering a cure for chronic illnesses like cancer or diabetes. However, the most interesting aspect the concept presents is to cater treatment to patients not on the basis of general understanding of diseases or symptoms, but to the specific need of the patient and critical factors.

The idea of precision medicine is relatively new but holds great promise, and some of the potential advantages of precision medicine are as follows:

1. The efficiency of Care:

Precision medicine makes decisions based on individual specific factors that affect their health. Today, decision making regarding treatments is on the shoulders of the patients, as even doctors do not know how certain treatment will affect a particular individual. With precision, medical providers can cater customized treatment methodology for each of their patients, improving the probability of recovery.

2. Preventive Care:

When the genetic screening process collects enough samples, the results can be used to diagnose genetically caused diseases and even prevent such diseases by understanding the risk of an individual rather than simply reacting to an illness. The presence or absence of some genes can cause diseases, and by studying these variations we can protect ourselves from these diseases.

3. Limit Cost:

Targeted treatment on the basis of genetic mapping can reduce the cost of care with more informed treatment decisions and a greater chance of being effective. The cost will be potentially lower with the focus on preventive care rather than treatment of disease.

4. Population Health:

Studying genetic patterns in a population as a whole, and as sections can help in identifying causes for particular diseases and develop the treatment. Genetic study of sections of a population can predict a likelihood of diseases and early detection.

The advantages listed above make Precision Medicine seem like an attractive investment. These are fields already identified and destined to be addressed by other programs and ideas, but the effect precision medicine can have on healthcare is intense and far-reaching.

But, the skeptics who are not convinced with this plan point out that it has the following drawbacks.

1. Infrastructure Requirements:

Precision medicine has the potential to deeply impact healthcare, but for that, it requires massive infrastructure investments and time to implement. To implement precision medicine, fundamental changes must be made to infrastructure and mechanism of data collection, storage, and sharing. The federal fund earmarked for the development of precision medicine will not cover the requirement and the question of who will have to spend the rest of the fund (state or federal government, providers/patients or payers) is unclear.

2. Legal Problems:

For Precision Medicine to reach peak efficiency, a lot of genomic data must be collected from a large and diverse section of the population. If and when such a massive amount of data is collected, it is legally unclear who owns the data. The government does not own the data and the FDA has blocked individuals from accessing their own genetic information from companies. In addition to legal issues, the collection and storage of such large amounts of data bring privacy into question. As a result, the implementation of such a plan would definitely be met with significant pushback.

3. The relevance of the Information:

According to Former President Obama’s plan, data from 1 million volunteers will be collected for genomic research. The possibility of ‘missing out’ on certain sections of the population or inadequate samples of certain disorders or over-representation of other types of disorder is highly likely.

4. Healthcare Cost:

Ideally, precision medicine can eliminate repeated efforts, readmission and help take preventive measures against disease, stopping the hemorrhage of funds in healthcare. But to reach this stage, it requires massive investment in infrastructure for collecting, storing, and sharing this information.Investment must also be made to security infrastructure to protect the data and other add-on expenses could prove to be a burden.

Precision medicine uses new technologies and techniques to sort and identify the sources for various illnesses to treat, and prevent illness. It holds great hopes but is hampered by the many drawbacks.

The promises it holds are too great for these drawbacks to hold it back for long, and healthcare providers, government and IT professionals should work together to develop a solution to overcome these short-term disadvantages.

Electronic Referral system

Referral is the process of transferring patients under care from one healthcare professional to another due to insufficient resources, experience or expertise. The referral process is identified important for outpatient transitional care. Facilitating an electronic referral system will improve communication between caregivers.

Current referral management systems are confusing for patients, 20-40% of a referred patient does not follow through with referrals. There are numerous reasons for this confusion and prominent among them are the below:

1. Communication Gap :

A traditional referral system is a one-way communication method and is difficult to exchange complex information. Such system leads to redundancies and causes repetition of efforts such as re-ordering of tests. It costs not only the quality of care but can jeopardize patient health or have an impact on patient health outcomes.

2. Paper-Based System :

Although over 90% of the healthcare professionals are using EHR system, there is still a lack of interoperability and the referrals (particularly the ones for out of network) cited cannot be communicated, thus forcing the traditional paper way of communication practice and causing inconvenience to the patients. This procedure is unsafe and not HIPAA regulations compliant. Paper records could be misplaced, lost or stolen putting in danger confidential information.

3. No Dedicated System :

Despite referrals being a vital part of care continuum process, most providers are yet to consider employing a referral solution to ease up the task. Providers are worried that an electronic referral system might make the process impersonal or that it requires training to master the process.

Referrals are an integral part of ensuring modern healthcare. As value-based service method becomes more prominent, so will the importance of referral systems. Studies show that an electronic referral system will reduce waiting times and increase access to specialty care and increase.

Major Benefits of Electronic Referral System are as below :

1. Convenient Referral:

Referral and appointment must happen simultaneously, and key activities must be consolidated. The provider should communicate with the patients to choose the right provider. Thus engaging both the parties can improve the level of satisfaction and increase chances of follow through. A referral management system allows easy and fast data update and quick transfer of information.

2. Secure Information Sharing:

With e-referrals, providers can communicate, share data and ensure care requirements are duly fulfilled. Open communication will reduce redundancy. Such channels of continuous communication ensure the quality of care and will augment physician’s ability. It helps the providers to improve quality of care with minimal effort. Ideally, e- referral system should be able to communicate with EHR making documentation faster and simpler, aiding administration.

3. Reduced Appointment Wait Time:

E referral will reduce patient wait time for routine appointments in specialty care. E referrals are properly categorized according to priorities enabling providers to mind to at most pressing cases. Decluttering referrals translates as increased access to care for those who require it and reduced cost of care for the patients. Increase in population, improvement in access to care and longevity is putting greater pressure on providers. Making the process simple will reduce the load on providers and could make the system work for the benefit of all.

4. Patient Safety:

E referrals enhance proper communication of patient medical condition and urgency of the referral ensuring patient who needs immediate attention gets care. Patients are cared for in a timely manner and a more informed provider can reduce chances of error and repeated efforts.

5. Better Coordination and Communication:

Electronic referrals can aid in care coordination within the organization. Forming an easy route of communication, it is a great tool to communicate with specialists, to send information and get feedback in a timely manner. Primary care providers can work closely with specialist improving their understanding of the requirements and improve the patient experience.

6. Safe, Secure and HIPAA Compliant:

Referral tools offer the benefit of easy and efficient communication technology without many hassles. The Internet makes it convenient for patient and providers too. These tools are HIPAA compliant safe and secure form, designed to transfer sensitive patient information.

Population Health Management

There are multiple factors that are involved in determining population health. Thus making it challenging for healthcare professionals to identify the right set of approach to show progress. While it is generally acknowledged for a simple understanding of making ‘our lives’ healthy, it gets complicated when we include aspects that are influencing the change.

The two main components that are involved in calculating the improvement of population health are mortality and quality of life with respect to health. Positive impact on life expectancy and quality of health relies on technology and active participation of patients. Providers are expected to reach out to patients beyond the hospital walls, set health goals and monitor their progress which is more often than not a two way communication.

It is inevitable to have a metric defined at each step to assess the health outcomes of population groups. One size fits for all approach has not yielded many results. Hence it is time for us to think about outcome-based care to better the results and improve the quality of care offered.

How does financial optimization help?

Both payers and the providers aim at reducing healthcare cost. While payers concentrate on reducing the payment that is going out for healthcare services offered to their clients, providers will be working in cutting down their expense and reducing the number of claim rejections they handle month on month. Though all the functionalities of healthcare system have a common goal of reducing costs, the way one party in the system achieves that, could be of conflicting interest for another party in the system resulting in no benefits for either.

Providers should initially identify the areas of overspending in their operations and must be willing to take action. Investing in technology could help them better the way they function. Though it looks like an expenditure at first sight, analyzing the advantages of employing technology will help optimize their spending in various operations within the system. Return on Investment for technology will be seen through operational profit and increasing efficiency of practice.

Health Evaluation of Population

As the old saying goes, prevention is always better than cure. Healthcare providers must keep careful observation of population, and grouping the population must be made by various parameters that will include, demographics, geographic, etc.

Eliminating language barriers and enhancing communication between the patients and caregivers is vital to improving the patient experience. Patients feel more convenient to communicate to caregivers speaking their language and be willing to discuss their health issues.

Putting modern day technology to use, creates a big difference in the outcome. Among healthcare professionals, some of them have shared their success stories about how an implementation of predictive analytics tools in their practice helped them to be more accurate and efficient.

Effective Data Management and Interoperability

Data management plays a crucial role in improving the standards of care provided to the patients. More often independent physicians associated with an IPA or ACO network face the interoperability challenges, which means, patient information data from one system even within the same network is inaccessible. This happens when the systems in a particular network are not capable of communicating with each other.

Effective data management should be put in place in a way, to let the doctors access patient information on the go and be able to make informed medical actions.

Making this idea into a reality will not only save cost but will also have a positive impact in reducing the mortality.

Patient engagement objectives

Percentage of readmission is increasing consistently and it is one of the biggest concern for providers. It has been understood that many a time, a patient is readmitted for reasons that are avoidable, which results in repeated efforts for hospitals,

Including a care continuity plan at the time of discharge could help reducing readmission rates, and the providers are incentivized for providing transitional care planning and execution.

Care continuity is made simple with an evolution of Technology, EHR can be integrated to TCM solution and patient information can be accessed at the time of need without many efforts.

Continuous care and real-time monitoring can not only avoid readmission but will enhance the care provided to the individuals.

Promising World of Telehealth

Information technology has dramatically changed the frontier of every human endeavor, furthering our reach and fast forwarding innovation. But for the most part, the role of IT in healthcare was limited to categorizing and storing of data.

Many healthcare professionals and IT experts have started experimenting with the possibilities of information technology. Telehealth is one such growing trend explored in a field.

Telehealth refers to using information technology to communicate with peers and patients to remotely facilitate diagnosis, consultation, administrate care and treatment. Telehealth is a broader concept than telemedicine, as it includes non-clinical services such as provider training and administrative services.

The concept of telehealth has many advantages for providers and patients, some of which are:

1. Eliminate Geographic Disadvantage:

Telehealthcare tools will enable providers to overcome the geographic barrier by bringing care to patients. Patients in remote and rural areas can connect with specialists and get the quality care they need. Specialists do not have to spend hours traveling to locations and can use those saved hours to treat more patients.

2. Monitoring and Surveillance:

Patient monitoring devices allow patients with high risk to be remotely monitored effectively. This has implications for healthcare professionals and relatives who live at a distance. With the help of such devices, a gap in care can be detected easily, the reaction to medications can be studied, and providers can immediately intervene when the situation demands it.

3. Improve Healthcare Outcome:

The use of modern patient tracking & monitoring technologies in healthcare makes it easy for provider communication. It helps in early diagnosis thus reducing mortality rates. It also brings in better outcome by creating a better care experience.

4. Provider Retention:

Effective implementation and usage of coordinated care system can reduce area isolation by creating a network of peers from nearby areas and communities. Providers have the liberty to access information that is critical for patient recovery based on the inputs from wearables and patient tracking devices. Teleconferencing can be used for sharing information, extending care, taking medical actions when necessary.

5. Care for the Chronically Ill and Patients in Transition:

Telehealth technologies such as virtual care or home monitoring system could benefit chronically ill patients and the patients in transition. Providers can extend guidance in certain procedures, monitor treatment outcomes and implement other care activities. Acting as an additional layer of care, telehealth could be a vital tool in identifying and acting upon real-time data, reducing costly readmission and ICU visits.

Some studies show a correlation between implementation of telehealth and decrease in mortality, which certainly is a great sign of efficiency.

The concept of telehealth has been around in some form or the other for more than a decade but it is yet to be mainstream. The reasons for which are its drawbacks which can be generally categorized into two, operational and legal.

Operational disadvantages include the unreliability of information from health monitoring devices, quality of communication and the need for technical know-how.

The hurdles of legality in rendering telehealth are many, including the licensure and cross-jurisdictional regulations of practice and standards and the lack of laws regarding reimbursement.

But despite these arbitrary drawbacks, telehealth as a concept holds great promises for improving quality of healthcare. And as payers look more closely into the possibility of reducing expensive checkups and hospital admission, telehealth could provide an answer going forward.

Healthcare – Looking forward to a better tomorrow!

The US Healthcare System consumes a large share of the national GDP which is many times more than any other country on healthcare expenditure; despite lavish investments, the system is struggling to meet parameters like population health and improved quality of care. How can countries provide improved health in a cost-effective manner? Find out more!

The idea of Affordable Care Act was the key remedy to this disparity.

The act aims to shift focus on US healthcare system to enhance the quality of care, simultaneously decreasing the costs that are incurred. The act has thus turned a new leaf in medicine and has created new models of care delivery to cater to the needs of today. One of which is Accountable Care Organization or ACO.

The Accountable Care Organizations are a network of doctors, hospitals and other healthcare professionals who are willing to share resources and responsibility for providing patient-centric coordinated care. Although ACOs’ are part of a shared saving scheme and is also an incentive for providing coordinated care.

The ACOs’ is envisioned to be the foundation on which the new era of cost-efficient care will be built, but some hurdles stand in the way of ACOs and their destiny, following are a few prominent problems:

1. Managerial Challenges:

Many ACOs are run by physicians themselves which means all the paperwork, coordination activity and calculating compensation rest on the shoulders of the physicians. These problems are further amplified in case the ACO lacks a well-defined leadership structure and reporting channel.

Outsourcing operational functions can improve operational performance, but this could mean relinquishing self-governance and physician leadership – two essential qualities of ACOs. Hence, it is important for ACOs to choose a system best suited to its nature and needs.

2. Leveraging on Capabilities:

Different caregivers use different EHR systems, and most of them do not have inter-operating capabilities. The ability to generate and securely share patient information is critical for an ACO to reduce redundancy, and achieve its objectives.
In the absence of an interoperable system, physicians cannot coordinate to ensure continuity of care. For ACOs to be successful they have to function as a single entity providing care. The ACO needs to work on a single EHR system or employee interoperable solution to help the EHRs communicate with each other.

3. Ever-Changing Payment Rules:

The Center for Medicare and Medicaid (CMS), under whose authority a sharing scheme is initiated, may alter or even introduce new schemes and rules sometimes even without much warning. As ACOs grow in efficiency, CMS will adjust the saving targets accordingly and ACOs will find it increasingly difficult to make savings. The ACOs must maintain a flexible operating system to have the ability to turn change into opportunity.

4. Getting More Patients to Participate:

The health of a population cannot be guaranteed without the participation of the population itself. To sidestep this obstacle, the ACOs need to redefine its population to include not only registered patients but also the whole community they serve. Key initiatives should be taken by the ACO to engage the population it serves.

A Stronger Foundation For Tomorrow:

A single step cannot solve a complex problem in a healthcare sector that is usually procedure driven. The ACOs should look for a plausible solution rather than a sufficient answer. The team of practitioners should look at a set of healthcare solutions and focus in the right direction to provide high-quality and cost-efficient health.