Client News Coverage

The pace of scientific advancement moves faster than ever, and today’s providers, by and large, are open to embracing new best practices and better approaches to medicine. When it comes to optimizing the bottom line, though, many physicians are hesitant to give up traditional manual approaches to revenue cycle management and embrace forward-thinking, data-driven revenue integrity models.

Yet, the stakes are higher than ever for taking a strategic approach to financial health. Today’s practices are facing some of the tightest operational margins in modern history, amid challenges brought on by COVID-19, a continuous decline in reimbursements, and the shift from traditional fee-for-service models to value-based care.

It’s safe to say the U.S. healthcare system’s inherent flaws and dysfunctions have been on full display over the past year. While healthcare stakeholders recognize the need for high-value care, the pandemic has underscored the urgency of investing in models that optimize coordinated, personalized approaches.

Healthcare’s outdated one-size-fits-all, trial-and-error model was performing unacceptably even before the pandemic, wasting up to $935 billion and racking up the highest rate of preventable deaths when compared to peer nations. Notably, research reveals that more than 128,000 people in the U.S. die each year from taking medications as prescribed—four times the number of people killed by prescription painkillers and heroin combined, as reported by the Centers for Disease Control and Prevention.

It has been more than a year since the start of COVID-19 pandemic. While it will be years before we truly know the effect it will have on our overall health, economy and society, there are a lot of things we do know about the impact on health systems.

Healthcare systems stepped up in a heroic way. They managed to test, treat and cure millions of patients. We went from having no standard test for COVID-19 to being able to test more than 2 million people in a single day. (Data from the Covid Tracking Project).

In today’s quality-driven, outcomes-focused landscape, it is important for healthcare organizations to strike the proper balance between driving better patient outcomes and enhancing efficiencies while still controlling overhead costs. A growing number of forward-thinking organizations are accomplishing this by implementing utilization programs that put operational processes under a microscope and turn lagging, outdated workflows into lean, money-saving activities.

It is a wise target, because unnecessary testing and blood waste put a huge financial strain on health systems. More than $340 billion is spent every year on excessive and inefficient care services, while nearly 50% of all blood transfusions and lab tests run across the continuum of care are unnecessary.

The fundamental problem with healthcare can be summed up in one sentence: We expect healthcare services that cater to our individual needs, yet the health care system operates under a one-size-fits-all, trial-and-error model. It is a model that results in missed diagnoses, protracted illnesses, and even premature death and wastes $935 billion annually.

The financial toll of this outmoded approach pales in comparison to the human toll. More than 128,000 people in the U.S. die each year from taking medications as prescribed—four times the number of people killed by prescription painkillers and heroin combined, as reported by the Centers for Disease Control and Prevention.

When it comes to healthcare in the U.S., we expect services that cater to our individual needs from a system that operates under a one-size-fits-all, trial-and-error model — one that results in missed diagnoses, protracted illnesses, and premature death while wasting up to $935 billion annually.

The financial toll of this outmoded approach pales in comparison to the human toll. More than 128,000 people in the U.S. die each year from taking medications as prescribed — four times the number of people killed by prescription painkillers and heroin combined, as reported by the Centers for Disease Control and Prevention.

2020 was an unprecedented year. Health care workers have gone above and beyond in their efforts to fight a global pandemic while continuing to provide care for non-Covid patients. Meanwhile, researchers, entrepreneurs and manufacturers specializing in the health care sector continue to develop new products and services to improve access and outcomes.

To honor their work, the Minneapolis/St. Paul Business Journal has launched our Health Care Heroes awards, recognizing individuals in the Twin Cities for putting innovation, care, dedication and compassion to work to improve the human condition. We received over 115 inspiring and impressive nominations for the inaugural year of this project, making the judging extremely difficult.

The secret to good health? Get enough sleep, eat well — and maybe vote regularly, according to Carrot Health, a Minneapolis firm that's working to better understand what are often called the social determinants of health and has collected data on millions of Americans.

The firm's approach is attracting attention: Carrot has already landed four of the country's top 10 health plans as its clients, CEO Kurt Waltenbaugh said.

The firm seeks to better understand the social factors that make people unhealthy and the barriers that prevent them from getting well. To do that, it needs a whole lot of data.

The explosive popularity of telehealth to ensure ongoing access to care as COVID-19 ravages the nation brings with it an equally rapid rise in patient self-scheduling—an upward trajectory accelerated by the need for streamlined methods of scheduling vaccinations.

Born of necessity, self-scheduling has nonetheless added to the already dismal state of patient matching. Desperate for appointments, many patients inadvertently create multiple medical record numbers as they work through the schedule system, wreaking havoc on health care organizations’ electronic master patient index (EMPI) and EHR systems, as well as the ongoing quest for a 1% or lower duplication rate.

When I founded hc1 a decade ago, I believed that every patient should be treated as a unique individual. We built the hc1 Platform because we saw that if every individual’s laboratory data–which drives 70% of the diagnostic and therapeutic decisions–could be organized intelligently, we could unlock an unprecedented level of clinical decision support to personalize and improve care for all patients.

We knew that the platform would effectively lay the foundation for targeted pharmacogenomics and precision prescribing techniques. What we did not know at the time was that the decision to place our stake in the promise of lab insights would ultimately help drive an improved public health response to an unprecedented crisis: the COVID-19 pandemic.

Electronic Health Reporter»

Overreliance on geographic or population averages to quantify and measure social determinants of health (SDOH) can send healthcare organizations down a costly and inefficient path when it comes to designing interventions to improve outcomes and reduce costs. Because these averages tend to mask the discrete patient experiences, their use can result in programs that fail to fully address the barriers representing the greatest potential for improving health outcomes — and healthcare organizations’ returns on investment.

The Wall Street Journal recently published an article posing that the pandemic is reshaping how Americans care for senior family members, and that more families will opt to keep loved ones at home, rather than relying on senior care facilities. While the pandemic has and will certainly continue to reshape the senior care industry, what might the industry look like in the coming years and after the pandemic?

To find out, we asked senior care industry professionals for their thoughts, insights, and predictions. We’re pleased to share them with you now.

iAdvance Senior Care»

There will be little nostalgia associated with placing 2020 in rearview mirror for most health care stakeholders. Especially on the financial front, the year has left provider organizations with unprecedented challenges that will likely follow them well into 2021.

One report released in September 2020 suggested that for-profit hospitals will continue to see a financial decline for another 12—18 months. In tandem with those challenges, health care organizations face mounting compliance concerns related not only new COVID-19 guidance and telehealth, but also the introduction of new Evaluation and Management (E&M) codes. Add an uptick in audit activity to the mix, and it stands to reason that revenue integrity must become a top priority.

There are various considerations in reopening offices and bringing employees back to work safely, especially now that COVID-19 infections are once more soaring in various areas. If your office is open, then COVID-19 contact tracing solutions are necessary tools in preventing further transmission because they let office managers identify who may be infected or contagious and react appropriately.

“Conscious entrepreneurship” is at the heart of being an entrepreneur. As entrepreneurs, we must be conscious of the world around us and the impact of our actions. For example, at Carrot Health, we are acutely aware there is power — and potential consequences — in using data modeling. For example, Optum (UnitedHealth Group) used models based on historical medical spend to identify future risk. The models were biased against populations with limited access to a doctor (i.e., lower spend), such as BIPOC communities. As an unintended consequence, the models tended to recommend more services to white members than BIPOC members. Failing to understand the bias in your data can result in critical mistakes and, in this case, perpetuate systemic racism.