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.

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.

Connected Healthcare Will Drive Global Change in 2013

Driven by new technology, patient-centered connected healthcare will help people worldwide receive better and more cost-efficient treatment and care, said one of Accenture’s top healthcare consultants.

Rick Ratliff, Accenture’s senior executive of health and public service, speaking at the recent Healthcare IT Summit, disclosed the results of a massive global study on connected healthcare that delved into such global trends as the aging population, a decrease in fitness, and increased incidence of chronic and lifestyle disease.

“At the end of the day, it’s important that the technology supports access to the information at every phase of patient care, and that there is an ability for a single view of patient information to provide all those who are involved in the care with a common view of the patient’s information for fully expedited and coordinated care,” said Ratliff.

He disclosed the findings of Accenture’s study of 3,700 physicians and 160 healthcare experts worldwide that examined connected health, healthcare IT adoption, health information exchanges and insight-driven healthcare.

“We need to digitize healthcare with electronic medical records, and we need to make sure that it’s digitized in a certain way that will allow us to use that information to manage workflow to improve overall healthcare,” said Ratliff. “We, then, need to exchange that data among hospitals, physicians, payer organizations and patients, and use analytics to assess the care, find the gaps and change the behavior of the healthcare system.”

Right now, primary care organizations in Spain and England are leading in the areas of healthcare IT adoption and health information exchange, followed by the U.S. Secondary, or specialist, care organizations in Spain and the U.S. are leading in those areas, with Singapore following very close behind, according to Accenture’s research.

“Here in the U.S., the HITECH Act is driving significant adoption of electronic medical records and we are starting to see slow growth in health information exchange, but there is still a long way to go,” said Ratliff.

The main reason why many countries are falling behind with technology-driven connected healthcare is because of cost. “In addition to cost, there is concern about privacy and lack of interoperability standards, and there is a lack of incentives to drive adoption and utilization of electronic medical records. These issues are seen consistently across the world,” said Ratliff.

According to the survey, only one in five physicians receive incentives for managing patients with chronic conditions while less than 20 percent have incentives for achieving quality measures and only 10 percent have motivation for coordinating care with other organizations.

In the U.S. today, approximately two-thirds of physicians have an electronic medical record system in place, and the U.S. is doing well in using EMRs to capture information during exams, however, there is not as much uptake on the exchange of information. Only about 16 percent of primary care physicians who responded to the survey are doing some level of communication, and about 24 percent of secondary care physicians are communicating via HIEs.

“We are still seeing a lot more progress in the U.S. than we are seeing in some other countries around the world regarding HIE and the use of electronic medical records for connected healthcare, and I am confident that progress will only grow over the next few years,” said Ratliff.

The 4 Pillars Of Technical Innovation In Healthcare

Four major technology trends, which are becoming more intertwined every day, will dominate the healthcare IT landscape in 2013, according to IDC Health Insight’s top researcher, Scott Lundstrom.

These trends—social media, cloud, big data and analytics, and mobility—already are having a big impact on many healthcare provider and payer organizations, but CIOs will be faced with managing and deploying many of these technologies as their use becomes pervasive during the coming year. Lundstrom calls these tech trends the “four pillars” of healthcare IT and recently presented them during a keynote presentation at UBM Technology’s Healthcare IT Summit.

“By using technology we can go out and make a difference in the quality and cost of care,” Lundstrom told the CIOs gathered at the conference. “The answer to doing more with less in healthcare is getting closer to the patient with cloud, analytics, mobile, and social/unified communications.”

Cloud

When it comes to cloud computing, private cloud is emerging as the platform of choice to transform healthcare IT departments and make technology more efficient and accessible. New business requirements are demanding new architectures, and cloud platforms are a priority for payer and provider CIOs.

Healthcare IT executives are using the cloud in many different ways and for varying reasons, but according to IDC Health Insights’ research, both payer and provider healthcare organizations stated that data backup and archiving is the No.1 storage solution in the cloud, with server capacity on demand  a close second.

Security issues, however, may be holding back broader deployment—at least in the short term. Security and availability concerns were stated as the biggest impediments to deploying cloud storage solutions by 22 percent of the payers and by 40 percent of providers surveyed by IDC. “Most breaches are not the result of an inept third party; they are from a laptop left in the car or a USB left on the desk by employees,” said Lundstrom.

Also, healthcare organizations must adhere to HIPAA security safeguards such as security management processes, workstation and device security and access control for proper implementation, which pose further challenges.

With all of the advantages of cloud storage, payer and provider IT executives are slowly looking beyond its challenges and beginning to implement cloud strategies for 2013. According to IDC Health Insights, nearly one-third of both payer and provider organizations are currently researching and evaluating the purchase of cloud technology.  Meanwhile, 31 percent of payer organizations said they are currently deploying cloud technologies while only 16.5 percent of provider organizations said they were using the cloud.

“At the end of the day, the cloud is just another place to put things,” said Lundstrom.

Big Data And Analytics

The explosion of data is creating challenges in healthcare around the volume, variety, velocity and value of information associated with it.

HIEs are certainly a focus area for big data and analytics in 2013 because of the vast amounts of data involved with the sharing process. “We’ve done a great job of getting analytics and research, but we’ve done a really bad job of getting it in the hands of the physicians,” Lundstrom said. The safe exchange of patients’ information will continue to get a lot of payer and provider IT executive attention in the coming months.

At the same time, IT executives’ focus regarding big data and analytics will slightly shift to include care management, population health, care team collaboration, transitions in management, analytics and business intelligence. This move in the focus of data aggregation to big data and analytics is the future of healthcare IT.

Mobile

Mobility’s pervasiveness is creating new demands on healthcare data centers—given the need for instant connectivity, streaming video and the transfer and sharing of large medical images.

Doctors want to the ability to take a CAT scan image from the hospital’s system to their iPad or iPhone simply and seamlessly so that they can travel throughout the hospital with the image. Doctors, nurses and other health payer and provider employees are demanding mobile applications and access to the network, and CIOs must have the back end ready to host such devices.

However, accessing patient data on mobile devices is still a challenge because of security issues and the cost of supporting such devices. “It always seems to be the discussion of the gadget. The gadget is not where the money or difficulty is—supporting the device is also easy from a technical standpoint. The real issue is the money that’s in the back end [network, storage, data centers, virtualization],” said Lundstrom. “We have to grow our mobile platforms to satisfy the gadget demands of the users, and we have to secure information. “

Social Media And Unified Communications

Every customer or patient has a voice, and healthcare payer and provider organizations can use social media to hear those voices and use them to bring tremendous value to patient care. The next generation of consumer engagement will leverage consumers’ social profiles, according to IDC Health Insights, as should be tapped into as a resource to effect positive health behaviors.

IDC Health Insights asked payer and provider IT executives about their top challenges in using or deploying social media tools and found that executive support, justifying expenses of social software, maintaining and keeping track of all the posted content and getting customers to participate were cited most often.

Forty-two percent of payers and 24 percent of providers said their top challenge is getting executive support—the fact that these numbers are slightly low compared to the other challenges proves that healthcare organizations understand the need for social media and technology method innovation.

However, regardless of the challenges, social media is a technology that will thrive in the healthcare industry in 2013, according to IDC Health Insights. “Facebook is an 800-million- user social media application platform, and consumer engagement solutions in healthcare will be increasingly mobile and connected to social networking sites like Facebook in the coming year,” said Lundstrom.