Client News Coverage

Saying that telehealth has moved front and center amid the COVID-19 pandemic is an understatement. With the Centers for Medicare and Medicaid Services (CMS) now reimbursing for remote care models, adoption of telehealth is rapidly advancing as physicians strive to overcome barriers to continuity of care and maintain operations amid stay-at-home orders.

Notably, one analysis found that from March 14 to April 1, daily telehealth claims for upper respiratory infections using ICD-10 diagnosis codes from private insurance increased nearly 12 times from the daily average over the previous month. In this case, upper respiratory infections were chosen to reflect COVID-19-related illnesses prior to the introduction of a diagnosis code for COVID-19.

Physicians Practice»

While the introduction of new COVID-19 reimbursement rules and regulations have brought on their share of confusion, there is one certainty healthcare organizations can bank on: oversight of incentive dollars will be a regulatory priority. In fact, federal watchdogs are not wasting any time, as reports suggest monitoring of billing and claims data is already underway to ensure that hospitals are not upcoding to take advantage of higher COVID-19 reimbursement rates.

RACmonitor»

The last 15 years have seen steady, continual growth in both Medicare Advantage (MA) enrollment and the number of payers offering MA health plans. Yet much of that growth has gone to handful of large, national vendors—UnitedHealthcare, Humana, the Blues, CVS-Aetna—that control nearly 70% of the market Carrot Health has been analyzing its robust database of consumer information to explore how behavior is changing in light of the pandemic and—dare we imagine—the post-pandemic world.

InsureTech360»

Listen to the entire podcast here»

When you’re an established, comprehensive company bringing products to market in a vertical industry such as healthcare, there’s a certain amount of expectation that runs alongside your everyday processes. That is, of course, until a pandemic comes knocking on your door.

So what happens when an industry hemmed in by HIPAA guidelines and government regulations is given the proverbial green-light to act quickly? They pivot — and they pivot with lightning speed.

In this episode, Sheila Loy discusses how HID Global took a proven, tested product and reworked parts of the platform to meet the need for infectious disease tracking that’s necessary not only in today’s COVID-19 economy, but for future disease-specific crises as well. Sheila gives us insights into:

• The importance of having a strong understanding of your market and how that can help uncover an unmet need

• Staying on track with expectations in a fast moving pivot when your company has historically long go-to-market procedures
• How to know when you have a product that is relevant in the current market — and when you need to add to, or scale back, that product to give clients the most useful end-product for their needs
• Timing and relevance and how they represent half the battle when bringing a product to market
• Why communication and internal education is key to a successful pivot — when everyone is on the same page, it’s easier to make the necessary adjustments and keep your company’s momentum moving forward

Guest Bio

Sheila Loy is the Director of Vertical Segmentation of Strategy at HID Global, a worldwide leader in providing trusted security solutions in the identity and access management space. Sheila manages the framework strategies and how HID goes to market as a comprehensive company in a vertical industry such as healthcare.

You can reach Sheila at  This e-mail address is being protected from spambots. You need JavaScript enabled to view it . You can also visit HID Global’s website to learn about their contact tracing and surge response solutions.

Patient identification and matching (PIM) errors carry consequences that range anywhere from frustration due to relatively minor mistakes to outcomes that can only be described as devastating.

At one end of the spectrum is a scenario in which two siblings were patients at the same physician practice. When a medical assistant didn’t check multiple identifiers for one of the siblings, they accidentally documented in the wrong file, leading the physician to write a note in the incorrect sibling’s chart. This mistake, fortunately, was caught early.

Journal of AHIMA»

On Mar. 9, 2020, the U.S. Department of Health and Human Services (HHS) finalized “two transformative rules that will give patients unprecedented safe, secure access to their health data.” Issued by the Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), the Final Rules implement interoperability and patient access provisions of the 21^st Century Cures Act and support President Trump’s MyHealthEData initiative.

U.S. hospitals are straining under the weight of an influenza season that hit hard and fast, with the Centers for Disease and Prevention (CDC) estimatingat least 280,000 flu hospitalizations out of a minimum of 29 million flu illnesses between Oct. 11, 2019 and Feb. 15, 2020. Now, they’re bracing for a potential pandemic in the form of the novel coronavirus (COVID-19), which has made landfall in the U.S. with the number of confirmed cases climbing.

It’s a one-two punch that can quickly overwhelm emergency departments (ED) and inpatient resources of hospitals that lack optimized patient flow strategies.

HealthIT Answers»

The dynamic of moving from classroom to practice is transformational for any nurse. It’s a sizeable step—one that cannot be taken lightly.

Consider the following real-life experience of a brilliant new nurse who just entered the workforce. Highly recommended, this nurse looked great on paper in terms of grades, but he also possessed the tremendous recall ability of a photographic memory. Yet, his first experience with an emergent situation spoke volumes about preparedness for practice. When he encountered a patient who was not breathing, the newly-graduated nurse froze, unable to take the necessary steps to initiate an emergency “Code Blue.”

Humana recently released some noteworthy figures related to the company’s value-based care programs. An annual review of the health plan’s efforts reported 27% fewer hospital admissions and 14.6% fewer emergency rooms visits compared with traditional approaches.

That’s good news for the healthcare industry in terms of the sizable investment it has made into evolving pay-for-performance models over the past decade, especially in light of early studies that suggested lackluster returns. In fact, one 2016 study published in the British Medical Journal found minimal evidence to support the theory that value-based care models impacted mortality rates.

The question now becomes: What is driving Humana’s results?

HISTalk»

Health plans, accountable care organizations (ACOs), medical homes, and other risk-bearing entities are at a critical juncture: they must achieve “value” at a time when healthcare is facing enormous challenges.

Rising healthcare prices, an aging population, and a rapid increase in costly complex and chronic diseases are driving up healthcare expenditures. Adopting value-based care is key to managing these expenditures as effective value-based strategies support higher quality care, lower costs, and a better patient experience.

Healthcare IT Today»

The evolution of today’s care model from the traditional episodic/disease or “sick” care model to one of more sustainable value-based wellness, continues. The industry is currently building on the success of earlier strategies aimed at chronic disease management, taking performance to the next level by advancing wellness models to focus on early intervention to minimize the potential for disease onset.

AllNurses»

Industry discussions related to social determinants of health (SDoH) have moved to center stage as health care stakeholders recognize the impact these nonclinical factors have on clinical outcomes and costs. SDoH are providing new insights into environmental influences that can hinder or promote a patient’s ability to follow through with care plans and make healthful lifestyle choices. 

ForTheRecord»

Data shared across an organization create a common language that informs decisions and supports organizational goals.

This builds alignment across business activities, catalyzes collaboration and enhances agility in response to competition and changing market dynamics—making the organization smarter, more innovative and more purposeful in its approach.

For health plans, these capabilities are particularly important in increasingly competitive Medicare Advantage (MA) markets, where consumers choose their insurance providers like they choose their medical providers. Add the move toward value-based reimbursement, and it becomes clear that the future belongs to organizations that power decisions with data-driven insights.

FierceHealthcare»

Part One of this two-part series on patient identity management best practices looked at strategies for mitigating errors during data conversion. In Part Two, we examine the factors that are critical to successfully achieving clinical data interoperability.

While the debate underway at the national level focuses on a national patient identifier and what it will take to achieve nationwide interoperability, closer to home healthcare organizations need to keep accurate patient identity and data exchange within their own walls at the forefront.

Healthcare Business Today»

An often-overlooked aspect of merger, acquisition or affiliation arrangements between healthcare organizations is the need to combine master patient index (MPI) databases. When improperly managed, data conversions can have serious short and long-term implications for impacted organizations and their patients.

Healthcare Buisness Today»