Reminders

Healthcare Transformation

Photo of Cynthia BurghardOffline

As conjectures fly regarding the potential disruption the proposed acquisition of Aetna by CVS will have on the healthcare industry, IDC Health Insights will confine its comments to the technology implications, in particular access to and sharing of data within the existing healthcare ecosystem. This blog will also consider the implications of the acquisition creating a local care delivery presence for Aetna with the intent to increase consumer value.


Photo of Cynthia BurghardOffline

Quality of Care - The New Healthcare Currency

By Cynthia Burghard

We hear everyday of the challenges facing provider organizations as they straddle the shifting reimbursement landscape. Well grounded in the fee for service reimbursement models, providers struggle to balance their volume-based operating models with the growth of value-based models. In the former model, if a procedure is done it is reimbursed, regardless of the outcome. The latter it is the outcome that is rewarded and for which at least partial payment is attributed. Adding additional financial risk is the requirement for providers to invest in technology and people to deliver the results required of the contract while not understanding what an expected return on investment might be. We have long understood that improved quality eventually translates into savings, but what are providers to do in the short term to keep the lights on?


Photo of Cynthia BurghardOffline

Embedding machine learning in healthcare is slowly moving into mainstream. Still a very noisy market with what seems like 100s of start-ups. Through the noise emerges vendors that at early stage are applying machine learning to solve some of healthcare's most pressing problems. The use case getting the most traction in the market is the application of machine learning to predictive analytics, particularly to identify patient's with clinical and financial risk. Other applications include automating medical record review to validate Hierarchical Condition Coding (HCC), a process that was manual and caused friction between payers and providers, improving patient engagement for care management through mobile technology and identifying variation in clinical practice and recommending best practices.


Photo of Cynthia BurghardOffline

Watson Health set its sights on applying cognitive/AI on a wide range of healthcare domains including evaluating radiology images, unlocking genomic data to improve diagnoses and treatment decisions, assisting physicians in developing treatment plans for cancer patients and enabling population health. Those skeptics in the healthcare industry that challenged IBM's ability to democratize Watson should take note that Watson for Oncology is being deployed in mainstream hospitals and is actively being used by oncologists across the world.


Photo of Cynthia BurghardOffline

As value-based health matures and expands from the physician practice market to the integrated delivery system market the need for integrated industrial strength data aggregation and warehousing, provided by Oracle, with the intellectual property and functionality for population health management, provided by Enli, is critical. Without this integrated capability healthcare delivery systems will be unable to scale their value-based health programs. Despite efforts by the current administration to dismantle the Affordable Care Act, IDC Health Insights believes value-based health will continue to grow and in the next five years become the dominant model for care and the financing of healthcare. Oracle will benefit from the partnership as they continue to build out their "healthcare offerings" to their global clients. Oracle offers global channel opportunities to Enli as well as the data infrastructure to scale Enli's Care Manager application into large complex delivery systems.


Photo of Cynthia BurghardOffline

IBM redcently held a conference to celebrate the one year (actually 16 months) anniversary of the creation of IBM,s Watson Group. In her opening key note IBM's CEO Virginia Rometty mad a bold statement "In the future, every decision that mankind makes… is going to be informed by a cognitive system like Watson". In a way, this clearly sums up IBM's goals with the Watson Group; the intent of IBM with Watson is to make a huge bet where IBM can use Watson, Watson Health and future Watson based business units to "accelerate expertise and transform industries and professions". Healthcare was a mong the highlighted industries. In April 205 IBM established IBM Watson Health to consolidate its capabilities in healthcare and incorporate two recent acquisition.


Photo of Cynthia BurghardOffline

While attending HIMSS 15 it became clear that an increasing number of suppliers are developing technology to manage post acute transition of care. Increasingly patients want to be discharged home rather than a skilled nursing home but still require support in activities of daily living, medication management and clinical monitoring. Technologies are being developed to support both the home care workers as well as providing remote monitoring so patients clinical condition can be managed and prioritized based on clinical need.


Photo of Cynthia BurghardOffline

On March 10, 2015 The Centers for Medicare and Medicaid (CMS) announced a new ACO model that will increase incentives to determine the degree to which organizations are capable of improving outcomes and decreasing costs. This new model, Next Generation ACO provides flexible payment options to guide healthcare organizations into a value based model of reimbursement. Rates will be determined based on historical cost experience of healthcare organizations and will be based both on improvement and overall goals. High performing organizations (based on regional benchmarks) will receive a discount. Among its other features, the Next Generation ACO provides additional benefits to cover nursing homes without a preceding hospitalization, funds tele-health and increases home care post hospital discharge. Patients will be incented to get the majority of their care from a single provider. The industry pundits are reacting favorably


Photo of Cynthia BurghardOffline

The Chronic Care Management (CCM) program that went into effect on January 1, 2015 reimburses physicians approximately $40 per month for providing 20 minutes of non face to face patient management of chronic illness. There is an annual cap of $238K per physician per year. It is noteworthy that CMS is providing this reimbursement as physicians are already conducting chronic care management without reimbursement. The program allows physicians to create standardized programs that their staff can administer and it provides an "on ramp" to value based care. The requirements are not onerous but require integration with applications and workflow to create and manage each patient encounter.


Photo of Cynthia BurghardOffline

The introduction and deployment of population health management programs by providers include many challenges and opportunities. Brought on by the movement from volume-based payment to payment for value, population health management is nascent. While many health plans have been attempting to manage at-risk populations, they did so with relatively limited data and no collaboration with physicians. There was a time when an individual could be enrolled in multiple programs managed by different vendors. The concept of population health being managed by hospitals and/or physician offices creates the ability to centralize and coordinate care management.


Search this area

About this channel

  • 833k views
  • 245 articles
  • 13 followers
     

Recent Contributors

Recent Comments

  • Top Market Trends fo…
    Jonas Knudsen says:
    HI, Yes I do. At least in western Europe, there is a growing trend to apply IoT technologies as the main infrastructure to handle compliance with traceability regulations. That is, for smart pharmacy, drugs, instrument tracking from sterile services department (SSD) to the operation rooms and back etc. That also adreesses the need for automation,…
    5 months ago
  • Top Market Trends fo…
    guy weiss says:
    Jonas, don' you think that the architecture adopted to address traceability regulation could easily be replaced by IOT solutions. Main drivers: less implementation costs, no packaging line performance decrease, no additional cost for aggregation, and of course interconnexion with smart phone app.
    5 months ago

Viewed 833,770 times