Payers Are Interested In Supporting New Models, But Aren’t Ready

The new HealthEdge State of The Payer survey results revealed that although there is a continued strong interest from payers related to supporting new healthcare business models, the number of people that are ready to support these new models is still lagging.

Although this survey is still open to responses, 100 healthcare payer IT executives already weighed in. The survey respondents selected Medicare and Medicaid expansions, Pay-for-Performance (P4P) and Accountable Care Organizations (ACOs) as the top three models that they are planning to participate in or support over the next three years.

The results showed that respondents are largely ready to support P4P (74 percent), ACOs (52 percent) and Value-Based Benefit Designs (VBBDs) (48 percent). However, only 39.5 percent are ready to support Next-Generation Consumer-Directed Healthcare Plans (CDHPs) and only 46 percent are ready for other models involving new payment approaches.

“As a result, many payers are supporting the models using additional manual processing, which is not a long-term strategy for success. Manual processing continues to increase, particularly as payers try to do things that their legacy administrative platforms were not built to handle,” said Ray Desrochers, executive vice president of sales and marketing at HealthEdge.

Manual processing is very expensive, which only adds to the already strained budget restraints that healthcare CIOs are facing day-to-day. Approximately 61 percent of the survey respondents are paying $6 or more to adjudicate a single claim manually.

Desrochers also commented that HealthEdge is seeing strong payer interest in the pursuit of the individual market on their own versus just through the exchanges. More than 50 percent of the respondents plan to offer products to consumers, with another 14 percent on the fence. This is good news for healthcare solution providers looking to enter the payer market this year and offer these IT executives an in-house data storage solution.

In addition, the survey respondents are overwhelmingly looking at mobile tools to help make connections among payers and members, with 83 percent of the respondents planning to leverage mobile tools for members and 62 percent planning to leverage them for providers.

“There is considerable interest in finding new ways to connect and communicate with everyone involved in the healthcare delivery cycle, and particularly in finding new ways to better link the payers and the members,” Desrochers said.

With the planned adoption of the new care-delivery models, manual processing and mobile tools, new technology will be needed to fill in the gaps that legacy infrastructures will expose. Furthermore, more than half of the respondents are looking to improve internal and external transparency and seek to leverage new technology to do just that. Healthcare CIOs are on the right track, and it is a good time to be an IT vendor in the healthcare space right now.

Trust Is The New Currency Of The CIO

The annual HIMSS 2013 conference kicked off today with the CHIME CIO Forum, a day-long program geared to aid healthcare CIOs stay ahead of the curve.

In order to successfully lead in the right direction, healthcare payer and provider CIOs must build a level of trust within their organizations. Stephen M.R. Covey, the bestselling author and former CEO of Covey Leadership Center, took the stage to speak about the palpability and importance of trust as IT leaders.

“This trust is so foundational. It is at the heart of everything, but because it’s so simple, we often look past it,” Covey said. “CIOs can take any initiative that they are trying to implement and put them into two different environments—one with high trust and one with low trust—and there is a big difference. In a high-trust environment, you get higher collaboration, greater results, faster results and lower costs,” he continued.

The vast majority of the CIOs in the audience agreed with Covey’s proclamation. “Whether it’s with the IT team, other leaders within the organization or within clinicians and patients, it all comes down to the same thing: presence. If you’re not there, you’re not trusted. You have to encourage, cheer on and really support everyone, and I believe that’s how you really gain trust as a CIO,” said Timothy Stettheimer, who serves as the regional CIO of Ascension Health Information Services and senior vice president and CIO of Saint Vincent’s Health System.

Covey shared three of his “big ideas” on trust in the healthcare industry. The first is that trust is an economic driver, not merely a social virtue. The second is that trust is the No. 1 competency of leadership needed in healthcare today. And, the third is that trust is the new currency of CIO both as collaborators and leaders within their organizations. 

“CIOs understand that speed is an important facet to trust. Any time you increase trust, you increase speed and reduce costs. Furthermore, the economics of trust explain that when trust goes up, the speed of processes go up and costs goes down,” commented Covey.

Nothing engages people like being trusted, and nothing disengages people like not being trusted. Covey said that according to recent surveys, 94 percent of patients selected a healthcare provider because of their level of trust with that organization. And, it’s the job of the CIO to build trust in the IT systems that are customer, employee and patient facing.

“A healthcare organization built on trust creates a ‘competitive moat’ in your market. Indeed, there is compelling data to suggest the healthcare organization that owns trust, owns the market,” said Dr. David Shore, director of project management in healthcare programs for Harvard School of Public Health.

So, as a healthcare CIO, how do you build trust among your colleagues, IT team and partners? Well, according to Covey, trust is a function of credibility and behavior. He shared four cores to credibility to help CIOs gain trust: integrity, intent, capabilities, and results.

“Talk straight, create transparency, clarify expectations, practice accountability and extend trust to others,” concluded Covey.

Healthcare IT Goal For 2013: Move From Digital Medicine to Democratizing Medicine

It may be an understatement to say social media, smartphones and mobile devices along with advanced analytics have impacted our daily lives. But through the eyes of healthcare professionals, those technologies have completely transformed the field and will continue to reshape the delivery of healthcare for many years to come.

So says Eric J. Topol, the well-known cardiologist, geneticist and researcher from the Scripps Research Institute who delivered the keynote address at the HIMMS 2013 annual conference.

“We practice medicine today at the population level. We do everything the same way for every patient and fail to recognize that each person is an individual. With technology, we can define them, and that’s where we can make a difference today—we have the tools that we didn’t have before,” Topol said excitedly.

Healthcare technology has already moved to more digital platforms with electronic medical records, health information exchange etc., but by democratizing medicine and allowing patients to take part in their own care, what does this mean for healthcare providers? Well, for starters, it will drive down costs and reduce the need for many doctors’ office visits because technology will allow many evaluations to be done remotely in the comfort of one’s home.

Topol displayed examples of various mobile application technologies for smartphones that the Scripps Research Institute is working on including: digital vital sign monitor, glucose checker, digital voice test (to detect such diseases as Parkinson’s), digital breath test (to detect lung cancer etc.), thyroid and liver test, skin lesion scanner, eyes refraction test etc.

“80 percent of doctors will become unnecessary. We will soon hear: ‘the robot will see you now,’” said Topol. “The idea of going to the doctor’s office will be as foreign as going to the video store,” he joked.

Healthcare CIOs are on the forefront of these massive changes and must help providers take this leap to a more advanced form of care. Doctors should be teaching patients and allowing them to have access to their own data, and healthcare IT executives must make that data available. “It’s their data!” Topol emphasized.

Currently, 68 percent of American physicians refuse to email contact with patients. According to Topol, this must change in 2013 because those physicians, who don’t get on board, will fall off the wagon. And, if doctors take this leap to connected care, this means more work for the IT executives who must monitor that data and ensure its safety—but, it’s all for the good of innovation and improved care.

At this point, none of this can be done without open sourcing, and Topol mentions the need for what he called “MOOM (Massive Open Online Medicine),” which will be hard with the HIPPA compliance rules in effect. However, CIOs have the opportunity to break those barriers and truly make a difference in patient interaction.

“Nothing about me without me. That’s where we want to be with real engagement,” said Topol.

The Top 15 Free Medical iPad Apps For 2013

As we move into another year of the Apple iPad and tablet phenomenon, healthcare provider CIOs are wondering which apps are really beneficial to their organization on an operational level. BYOD is pushing an increasing need for mobility strategies and network infrastructure security, and the iPad craze really means one thing: more work for the healthcare CIO.

Mobile technology has the ability to transform patient care, and while many innovative developers have created free apps that have the ability to drive healthcare into the future of the industry, the iTunes store still remains cluttered with useless duds that simply do not make a clinician’s life easier, thus prompting the need for a comprehensive guide listing the top free medical iPad Apps that healthcare CIOs should consider. And, hey—they’re free!

Below are the 15 most sought-after free medical iPad applications (in no particular order) that all medical professionals with iPads should (must) have, based on a list compiled by iMedicalApps.com, as well as the Apple App Store statistics, deeming these medical applications highest rated and most downloaded.

1. Medscape
2. MicroMedex Drug Information
3. ICD 10 Lite 2013
4. Calculate by QxMD
5. AHRQ ePSS
6. Draw MD series
7. Radiology 2.0: One Night in the ED
8.  iLarynx
9.  inMotion 3D
10.  Cancer.net Mobile
11.  iTriage
12. Lexicomp
13.  Omnio
14. Skyscape Medical Resources 

Medical professionals want to be able to do their jobs more quickly and efficiently and iPad applications, like those mentioned, answer their questions and access their patients’ data in ways they never thought possible. For this reason, many healthcare CIOs have been challenged with the task of distributing or securing iPads on their IT infrastructure.

“Members of our medical staff have said that they love using iPads applications because of the constant connectedness that iPads offer,” said Patrick Wilson, department information security officer at Contra Costa County Health Services.

IT vendors have noticed the significant increase in the need, and desire, for iPads in the healthcare space and are working diligently to provide the best solutions for all their infrastructure and security needs. In a conversation with Mark Hanson, director of strategic accounts for healthcare at Fortinet, he said: “I definitely think those iPad applications are absolutely worth the risks.”

The patients are more and more efficient at understanding what their ailments are; so healthcare professionals have to be able to enable their physicians to understand the latest information on specific problems their patients are facing. IT companies like Fortinet are stepping in to integrate and prevent those devices from infecting the networks and spreading that infection. “Having security-based Wi-Fi devices, like what we offer, are key requirements for healthcare CIOs today when implementing iPad application solutions,” said Hanson.

Social Media In Healthcare: How To Manage The Risks

As social media platforms start to grow in popularity in healthcare payer and provide organizations, CIOs must build a framework of rules and embark upon a mission to educate their employees about social media’s pros and cons.

That was the advice of veteran healthcare IT professional Sriram Bharadwaj, who spoke at the recent Healthcare IT Summit about the positives and negatives of using social media. Due to strict privacy laws and complex regulations, healthcare has been slow and cautious to adopt Twitter, Facebook or LinkedIn for patients, customers, suppliers and employees. But as Bharadwaj pointed out during his keynote presentation, CIOs must find a way to manage these tools due to their overwhelming momentum in the workplace.

“Help employees understand cause and effect of their actions,” said Bharadwaj, principal management consultant at Business Strategix Inc. At the conference, Bharadwaj discussed social media in the workplace and offered advice to IT executives on ways to manage the risks it poses to healthcare organizations.

In the healthcare space, social media is creating huge opportunities across the board. For instance, many see it as a tool for increasing patient connectivity and spreading accurate medical information. Other CIOs see it as a tool for increasing awareness of their organizations or for customer and employee engagement or driving marketing initiatives forward. It also provides a huge advantage in the expansion of connected health and patient involvement in their care.

But despite the promise, few organizations have really embraced social media. Based on Bharadwaj’s research, only Blue Shield of CA and Scripps Health out of the 11 top healthcare payer and provider organizations are using use social media. The other nine have shied away from its use because of the productivity drain, security and solicitation risks involved in its use.

Social media usage does open up an IT department and the overall organization to a wide range of threat management such as malware attacks, attachments in the form malicious and harmful links and websites, along with email and messaging features that bypass corporate anti-spam and anti-malware filtering.

“One piece of advice to mitigate these technology risks is to strengthen your virus and malware protection through frequent virus updates and heightened monitoring,” Bharadwaj told the attendees.

“Stronger enforcement of policies through random audits of devices and data traffic and continuous monitoring with enhanced security operations control center personnel and real-time alerts will also help you avoid certain social media security issues,” he said. He also recommended deploying data leakage protection (DLP) software to track, warn employees and supervisors of possible data loss.

Adhering to compliance policies is a particular challenge for healthcare organizations. Risks include employees unknowingly exposing PHI data through “friending” activities or the possible loss of company source codes, budget information or other sensitive documents or information through tweeting or other social media activity.

“Some ways to manage this is by using collaboration sites and intranet to reinforce messages on a regular basis, training employees on dos and don'ts, and helping supervisors with cheat sheets on how to coach employees on productivity and policies supporting openness to social media,” Bharadwaj said.

Lastly, legal risks, which are the trickiest, are likely to surface as a healthcare organization adopts social media strategies. These risks include inadvertent posting of confidential information leading to insider trading, content disseminated that is copyrighted or trademarked, libel claims, or employees posting comments that may not be fully accurate or true about an individual or a competitor’s services.

“On the legal front, my advice is to update policies to reflect your framework on a social media approach,” said Bharadwaj. “Other ways to avoid legal issues are to document strict enforcement guidelines with consequences for misuse of social media, and taking swift action on employees who violate policies and guidelines.”

CIOs throughout the healthcare spectrum have to embrace and manage social media, said Bharadwaj. Its usage is inevitable and will be pervasive. He joked that every facet of his life is now impacted by social media, even summoning his young daughter to the family dinner table. “I now text her because she won’t answer my calls,” Baradwaj joked.