LAS VEGAS—What do consumers want when they interact with the healthcare system?

The answer may partly depend on their age.

At this week’s annual meeting of the Health Information and Management Systems Society, the themes of consumerism and patient engagement were front and center.

Patients are paying for a larger share of their healthcare through high-deductible health plans, and technology is playing a role in helping them find lower-cost care settings and prompting them to pay their bills.

And as more providers get paid based on health outcomes, the hope is that technology will be able to guide people toward healthier behaviors.

Yet the people who are the most tech-savvy aren’t necessarily the largest users of healthcare; those patients tend to be older and poorer.

“When you talk about technology engagement with patients and consumers, they each want different things,” said Tamara St. Claire, chief innovation officer at Xerox Healthcare. “We’re going to have to be flexible.”

For older generations, “It’s really about making their chores about healthcare easier,” she said. For instance, they’re most interested in technology that helps them remember to take their pills or schedule an appointment.

Millennials, meanwhile, tend to be research-focused; they’re finding their providers through online reviews, taking advantage of telehealth services and showing up to appointments armed with information about their conditions and potential treatments.

They’re also far more price sensitive, which means they be the most likely target for price transparency tools.

More than 80% of people under the age of 50 are shopping around for providers, compared to 69% of baby boomers and 56% of people older than age 70, according to a survey that Xerox released at HIMSS.

“People are putting off care because they can’t afford to pay for it,” St. Claire said. It’s strongest with the millennial generation, she added.

Providers are using technology to rethink how they relate to and communicate with their patients, said Hal Wolf, a director at the Chartis Group, an advisory group. They’re also paying increased attention to what’s happening to the patient during their end-to-end experience with the health system, from finding a doctor to paying their bill.

“Patient as consumer” is one of the investment themes this year for San Francisco-based Dignity Health, which every year works with three to five early stage technology companies to take them from startup to commercial enterprise.

That topic also has been getting significant attention at HIMSS, said Rich Roth, Dignity’s chief strategic innovation officer.

“I think there’s a big theme of patient engagement and that’s just such a huge opportunity, especially if you view it more holistically than just Joint Commission,” or patient satisfaction surveys, he said.

HIMSS’ core audience used to be chief information officers back in the days when the primary technology concern was implementing an electronic health records system, said Wolf, who is also the incoming vice chair on the HIMSS’ board of directors.

But today’s technology needs involve strategic concerns like revenue-cycle management, data analytics and population health management.

“Now we’re seeing the CEOs coming to HIMSS,” Wolf said. “They’re coming because they can see so much in one place. It’s all being driven by operations.”

Article source:

read more

Substantial interoperability has yet to be achieved across healthcare, a recent report to Congress from the Office of the National Coordinator’s Health IT Policy Committee shows, held up by reasons including lack of standardization and security concerns.

Here are the five major roadblocks to more widespread data sharing, according to the ONC:

1. Lack of universal standards-based EHR systems’ adoption. True health information exchange won’t happen until a critical majority of providers have installed and are successfully capable using EHRs. Incentive programs have increased adoption nationwide; policymakers must continue to help the remaining providers make the transition.

2. Impact on providers’ day-to-day workflow. Technology has reached the capability of making interoperability possible, but process innovation has yet to catch up. Existing processes must be redesigned to incorporate new technologies – a more prominent problem in the healthcare arena, mostly due to a lack of standardization.

3. Complex privacy and security challenges associated with widespread HIE. Adequate privacy and security is at the forefront of healthcare institutions. The ONC has found HIPAA misunderstandings and privacy law translations detrimental to security, while electronic system design and accommodation rules for privacy laws have been formidable.

4. Need for synchronous collective action among multiple stakeholders. It’s crucial for all participants to agree on the “rules of the road,” especially related to the above issues, if effective interoperability is possible. Standards and rules for patient access must be uniform to bridge existing and future networks.

5. Weak or misaligned incentives. Economic incentives for interoperability can discourage providers. And traditional fee-for-service payment models aren’t enough to persuade providers the extra work is worth it. EHR developers have focused more on a fee-for-service model in the past, thus lowering the demand for interoperability.

Included in the report are ONC’s recommendations on processes to establish over the next six months to foster better interoperability. They are:

1. Develop and implement meaningful measures of the health information exchange-sensitive health outcomes and resource use for public reporting and payment.

2. Develop and implement HIE-sensitive vendor performance measures for certification and public reporting.

3. Set specific HIE-sensitive payment incentives that incorporate specific performance measure criteria and an implementation timeline, establishing clear objectives of required accomplishments under alternative payment models.

4. Convene a Summit of major stakeholders co-led by the federal government (such as, ONC and CMS) and private sector to act on the ONC roadmap to accelerate the move toward interoperability.

To be successful, interoperability will require “multiple stakeholders to act in a coordinated manner,” according to the report’s authors.

Article source:

read more

HHS says few states have taken them up on an offer to receive federal funding for data-mining, which would allow their Medicaid fraud units to search claims. States say they don’t need it, even though the improper payment rate has nearly doubled as the number of enrollees surges.

A 2013 HHS rule allowed state Medicaid fraud control units to use federal funds for the audits, which the agencies previously had been explicitly prohibited from doing.

Only California, Indiana, Louisiana, Michigan, Missouri and Oklahoma have been granted permission to conduct the data-mining. Florida’s Medicaid fraud control unit received approval from the CMS to conduct data-mining as part of a Section 1115 waiver in 2010.

Earlier this year, the CMS revealed that the Medicaid improper payment rate has jumped from 5.8%, or $14.4 billion, in fiscal 2013 to 9.78%, or $29.12 billion, in fiscal 2015.

Richard Stern, director of the Medicaid Fraud Policy and Oversight Division in HHS’ Office of the Inspector General, said he wishes that other Medicaid fraud control units would get on board as increased use of data-mining could be an effective tool to reduce improper payments, especially those relating to fraud.

Still, many of the states reached by Modern Healthcare said they believe their state Medicaid agencies or health departments are producing enough leads from their own data-mining efforts for them to pursue.

“We’ve yet to encounter a situation beyond (our Medicaid agency’s) capacity to provide timely information that would necessitate the extensive investment in personnel, infrastructure, and equipment to essentially duplicate those resources,” said Josh DeVine a spokesman for Tennessee Bureau of Investigation.

Spokespeople for fraud units in Arkansas, Colorado, Massachusetts, Ohio, South Dakota, Texas and West Virginia made similar remarks.

State Medicaid fraud units in Hawaii, New Jersey and Rhode Island are evaluating how data-mining could benefit them, while a spokesman for New York said it may soon seek a waiver with HHS’ OIG.

Some said they want to see how other states fare before enlisting the HHS’ help.

“We are hoping that larger states can make progress in developing a road map for effective implementation before we commit to a specific data-mining strategy or technology,” said Carl Kanefsky, a spokesman for Delaware’s Justice Department.

Article source:

read more