Addressing Social Determinants of Health: IT Solutions to Engage Community Resources

Addressing Social Determinants of Health: IT Solutions to Engage Community Resources

What You Should Know:

– The latest report from Chilmark Research examines the
new approaches and tools for utilizing community resources that can address
social determinants of health, giving providers the ability to extend care
beyond the confines of the clinic.

– This research indicates that the next two years will largely bring an expansion of product capabilities with slow and steady growth in implementation as the market better defines key variables and sets standards for performance.


COVID-19 has dramatically increased the overall population’s need for community resource engagement in traditional healthcare settings. The steady march to value-based care (VBC) continually amplifies interest in solutions that contribute to utilization management strategies. Vendors are rising to meet this need by connecting community-based organizations to various healthcare partners so that both may benefit from the coordination of service provision. 

The latest Chilmark Research report, Addressing SDoH: IT Solutions to Engage Community Resources, evaluates these solutions, identifying the strengths and weaknesses of options in the market and predicting how the market will develop in the future. Research in this report is based on interviews with executive leadership teams of solutions vendors, executives from the major EHR companies, and extensive secondary research. 

Vendors discussed in the report include aunt bertha, Cerner, Epic, HealthEC, Healthify, NowPow, Signify Health, Solera, Unite US, Xealth

Leveraging Community Partners Is Key
to Addressing SDoH

Community partners
are some of the best resources providers can
utilize to address the social factors impacting patients’ health status, but
this is a new need for HCOs, which under fee-for-service (FFS) tried to keep
all care within the clinic to maximize revenues. Data management and liquidity
make effective integration with external partners a key barrier to
implementation, while legal and internal engagement issues continue to slow
adoption.

Predicted 10-Year SDoH Adoption Trajectory

This research indicates that the next two years will largely bring an expansion of product capabilities with slow and steady growth in implementation as the market better defines key variables and sets standards for performance. Within five years, a public option for insurance will dramatically increase the rate of solutions adoption, culminating in >80% adoption in provider locations by 2030.

The report provides a roadmap and
predicts key inflection points for the greater adoption of these solutions, and which social determinants have historically been
the best predictors of increased health services utilization. It includes brief
profiles of key vendors providing this functionality, and how they plan to
impact community health.  

“This has been a major challenge to healthcare systems, and people now get that we need to address [SDoH] better. The pandemic has proven to be an additional, critical driver for continued expansion of VBC, which requires understanding all of the factors that can influence a member’s health status,” according to report co-author Jody Ranck. “We see an opportunity here from the pandemic, that it has basically shown us where the failures are in the system today, and that going forward we need to do more to engage resources beyond the clinic.”

Report: Modern Revenue Integrity Solutions Driving Payment Performance

Report: Modern Revenue Integrity Solutions Driving Payment Performance

What You Should Know:

– New Chilmark Research report on revenue integrity
in healthcare reveals a transitional market making strides to address the new
burdens of modern care economics.

– The ongoing COVID-19 public health emergency underscores
the imperative need for automation and reduced administrative costs even
clearer.


Revenue cycle
has and continues to be one of the most difficult challenges in healthcare.
These issues manifest in the claims process of submission, appeal, and
remittance, but the causes are found much earlier in clinical workflows. Rather
than think of these as separate issues, they should all be considered under a
broader category of revenue integrity. The latest report from Chilmark Research,
Revenue Integrity in Healthcare: Solutions Driving Payment Performance
,
reveals a market in flux as new technologies are applied to old problems,
increasingly complicated by contracts that include performance and reporting
requirements.

Modern Revenue Integrity Solutions Can Improve Financial
Performance

New software and platforms can accelerate, automate, and
improve the accuracy of these activities. Automated outreach, demographic and
eligibility checking, computer-assisted coding, natural-language processing,
and more traditional revenue cycle platforms.

These tools are offered by:

– Electronic Health Records (EHRs)

– Independent Platforms

– Best-of-Breed Solutions from outside the Revenue Integrity
space, but with powerful tools to address payment needs

These activities are essential for healthcare enterprises of
all sizes, scopes, and specialties. They are needed whether the organization is
primarily concerned with fee-for-service (FFS) reimbursement or value-based care (VBC).
The ongoing COVID-19 public health emergency has made the need for automation
and reduced administrative costs even clearer. With appointment volumes
dropping, provider organizations are faced with the need for reliable, accurate
payments for their care activities more than ever. These solutions are equally
valuable for traditional provider care and for modern virtual care solutions
like telehealth.

 “Accounting and revenue cycle work can never fix these issues. They need to be addressed where they occur and prevented from showing up in revenue cycle in the first place. One mistake in patient registration that was easy to fix can cause millions in complicated denials down the road.”– Lead Analyst Alex Lennox-Miller

Each type of solution (EHR, Platform, Best of Breed) is
evaluated based on how they address the needs of provider enterprises. The
report reviews the current state of the market, the maturity of solutions, and
the strengths and weaknesses of each solution type. While the current market is
valued at more than $20 billion, projections within the report show its
expected growth to nearly $35 billion in the next five years. The report shows
which segments of this market can expect annual growth rates exceeding 10% and
which will slow to under 2.5%.

Profile of Leading Revenue Integrity Vendors

In addition to the categorical analyses, this report includes 13 profiles of major and promising vendors: 3M, Allscripts, athenahealth, Cerner, Change Healthcare, Hayes|MDAudit, Medicomp Systems, Optum, PatientMatters, RevSpring, Sift, and ZOLL. Each profile includes an assessment of the vendor’s strengths and challenges, detailed descriptions and evaluations of the product capabilities and market execution, and rankings across 24 categories.

Managers and directors of healthcare organizations looking
for ways to address revenue cycle issues, lower clean claims rates, or improve
strategic revenue projections will appreciate the report’s clear breakdown of
vendor offerings and the impacts on their clinical and non-clinical staff.
Payers, including self-insured employers, and other organizations interested in
the total cost of care will find the market overview and product evaluations of
great value, helping them understand the tools and challenges their partner
organizations will be using.

The report is available to subscribers of the Chilmark
Advisory Service
or may be purchased
separately.

Open APIs in Healthcare: The Future of Data Integration Report

Open APIs in Healthcare: The Future of Data Integration Report

What You Should Know:

– The latest Chilmark Research report examines how data-oriented APIs are contributing to development and integration efforts across healthcare from the perspective of the developer.

– Reeling from the impact of the COVID-19 pandemic and
seeking more effective ways to implement new functionality, healthcare
enterprises of all kinds are looking to alternatives for prevailing development
and integration practices.


Unlocking value
from the data scattered across healthcare communities was once a tantalizing
opportunity. After COVID-19,
it is an existential necessity. Chilmark
Research’s
latest Market Trends Report, Open APIs in Healthcare: The Future of Data Integration, captures a market whose approach to data access and
integration will be changing substantially in the coming years and introduces a
subvertical within healthcare
IT
that anticipates a 16% CAGR through 2025.

APIs Are Still New in Healthcare

What You Should Know:  - Latest Chilmark Research report, examines how data-oriented APIs are contributing to development and integration efforts across healthcare from the perspective of the developer. - Reeling from the impact of the COVID-19 pandemic and seeking more effective ways to implement new functionality, healthcare enterprises of all kinds are looking to alternatives for prevailing development and integration practices.  Unlocking value from the data scattered across healthcare communities was once a tantalizing opportunity. After COVID-19, it is an existential necessity. Chilmark Research’s latest Market Trends Report, Open APIs in Healthcare: The Future of Data Integration, captures a market whose approach to data access and integration will be changing substantially in the coming years and introduces a subvertical within healthcare IT that anticipates a 16% CAGR through 2025.   APIs Are Still New in Healthcare  Outside healthcare, the ascendance of data access and integration facilitated by application programming interfaces (APIs) is the culmination of decades of technology evolution and implementation lessons with distributed applications. Across the SaaS landscape in particular, APIs have become the preferred method for accessing data and conducting transactions across applications and organizations. Developers recognize and appreciate the value of loosely coupling their applications and data, wherever each is located. Inside healthcare, many enterprises are hesitant on the topic of APIs, seeing them as too big a leap from established, successful software practices. But they also recognize that eliminating the need for hard-coded interfaces that must be re-implemented every time an application or its underlying data changes will deliver higher programmer productivity and more-responsive applications.   Traditional Integration Methods Fall Short Conventional development and integration approaches proved cumbersome and slow in efforts to contribute to understanding or responding to the current health crisis. Unlocking more value from the data scattered across healthcare communities is — post-COVID-19 — a critical element in clinical and financial renewal. “Enterprises across healthcare were already wrestling with challenging market forces and government mandates,” says Brian Murphy, the report’s lead author and analyst. “Open APIs will play a central role for providers, payers, or any healthcare enterprises that intend to better utilize their data and pursue development efforts that make them — and the broader healthcare community — more responsive and adaptable to the demands of a post-pandemic healthcare system.” Developers Require Accessible Data Developers find data wherever they can from among a large and confusing mix of data holders and associated vendors. This report identifies the sources where different kinds of health-related data are most likely to be API-accessible. It shows how APIs are already contributing to development and integration efforts across healthcare and estimates the much larger potential of widespread adoption. This report includes detailed profiles on 20 public and private organizations and their offerings, including 1upHealth, 4Medica, Allscripts, Apple, Athenahealth, Availity, Blue Button 2.0, Cerner, Change Healthcare, Datica, Epic, Human API, Meditech, NextGen, NCPDP, Particle Health, The Sequoia Project, Redox, Surescripts, and Validic. For more information about the report, visit https://www.chilmarkresearch.com/chilmark_report/open-apis-in-healthcare-the-future-of-data-integration/

Outside healthcare, the ascendance of
data access and integration facilitated by application programming interfaces
(APIs) is the culmination of decades of technology evolution and implementation
lessons with distributed applications. Across the SaaS landscape in particular,
APIs have become the preferred method for accessing data and conducting
transactions across applications and organizations. Developers recognize and
appreciate the value of loosely coupling their applications and data, wherever
each is located.

Inside healthcare, many enterprises are
hesitant on the topic of APIs, seeing them as too big a leap from established,
successful software practices. But they also recognize that eliminating the
need for hard-coded interfaces that must be re-implemented every time an
application or its underlying data changes will deliver higher programmer
productivity and more-responsive applications.

Traditional Integration Methods Fall
Short

Conventional development and
integration approaches proved cumbersome and slow in efforts to contribute to
understanding or responding to the current health crisis. Unlocking more value
from the data scattered across healthcare communities is — post-COVID-19 —
a critical element in clinical and
financial renewal.

“Enterprises across healthcare were already wrestling with challenging market forces and government mandates,” says Brian Murphy, the report’s lead author and analyst. “Open APIs will play a central role for providers, payers, or any healthcare enterprises that intend to better utilize their data and pursue development efforts that make them — and the broader healthcare community — more responsive and adaptable to the demands of a post-pandemic healthcare system.”

Developers Require Accessible Data

Open APIs in Healthcare: The Future of Data Integration Report

Developers find data wherever they can from among a large
and confusing mix of data holders and associated vendors. This report
identifies the sources where different kinds of health-related data are most
likely to be API-accessible. It shows how APIs are already contributing to
development and integration efforts across healthcare and estimates the much
larger potential of widespread adoption.

This report includes detailed profiles on 20 public and
private organizations and their offerings, including 1upHealth, 4Medica,
Allscripts, Apple, Athenahealth, Availity, Blue Button 2.0, Cerner, Change
Healthcare, Datica, Epic, Human API, Meditech, NextGen, NCPDP, Particle Health,
The Sequoia Project, Redox, Surescripts, and Validic.

For more information about the
report, visit https://www.chilmarkresearch.com/chilmark_report/open-apis-in-healthcare-the-future-of-data-integration/