– HealthStream, a provider of workforce
and provider solutions for the healthcare industry acquires ComplyALIGN (incorporated as ProcessDATA,
Ltd.), a Chicago-based healthcare technology company for $2M in cash.
The number of policies and procedures that a typical hospital needs to manage
and continue to process rarely falls below one thousand. Staff members must
know what’s expected of them and have rules and procedures to guide their
day-to-day tasks—and this covers a vast array of practices, including those
involving administrative practices, federal and state compliance, patient care,
medicine, use of IT, and human resources.
With policies in so many areas, policies and procedures for hospitals need to
be well organized, accessible, searchable, and easily updated—all within a
coordinated, collaborative workflow. ComplyALIGN’s policy management system is
a highly sought-after and utilized solution for these needs.
ComplyALIGN’s products are used by over 200 healthcare facilities, including
over 150 hospitals. ComplyALIGN also does business as HospitalPORTAL, which
focuses on hospital intranet solutions that integrate with ComplyALIGN’s policy
– Healthcare private equity firm Heritage Group launches a $300M fund to invest in high-growth healthcare services and technology companies.
– Heritage is backed by some of the leading healthcare organizations in the nation, including large provider systems, payers, and healthcare service providers.
Heritage Group, a Nashville, TN-based healthcare-focused private equity firm, today announced the closing of over $300 million in its oversubscribed third fund, an increase of nearly $100 million over its prior fund in 2016. Heritage will continue its successful strategy of investing in solution-oriented, high-growth healthcare services, and technology businesses that are addressing the industry’s most pressing challenges.
“We are very pleased with the market’s response to our offering, especially during such a challenging economic environment,” said Paul Wallace, partner at Heritage. “We are grateful for the ongoing support of our longtime investors, and we’re excited to welcome several new LPs. We’re fortunate to have a great team and a unique model, which combine to create value for all of our stakeholders.”
Investment Model & Approach
The firm was founded by Rock Morphis and David McClellan in 1986, Heritage seeks to make majority and minority investments, ranging from $20 to $40 million per portfolio company, in high-growth healthcare services and healthcare technology businesses that address the challenges of the U.S. healthcare system. Heritage engages deeply with its strategic investors, who provide unique value and insights through all stages of the deal process, including the identification, evaluation, and subsequent growth of its portfolio companies. The firm’s strategic investors operate over 550 hospitals, with 90,000 beds, and handle approximately 3M discharges annually.
Heritage’s strategic investors and partners represent
national leaders in the payer, provider, IT, and service sectors of healthcare.
This diversity is particularly valuable as these sectors begin to converge in
the shift towards value-based care. Limited Partners include Adventist Health
System (Florida); Amedisys (Louisiana); Cardinal Health (Ohio); Cerner Corp.
(Missouri); Community Health Systems (Tennessee); Health Care Service
Corporation (Illinois); Horizon Healthcare Services (New Jersey); Intermountain
Healthcare (Utah); LifePoint Health (Tennessee); Memorial Hermann Health System
(Texas); Sutter Health (California); Tenet Health (Texas); Trinity Health
(Michigan); and UnityPoint Health (Iowa).
“Heritage’s strategic engagement is outstanding and allows us to work together as true partners. We are able to lend our expertise and share the key pain points that we encounter as we strive to provide care in a value-based model, which requires new ways of reaching and treating consumers and patients,” said Scott Nordlund, chief strategy and growth officer at Banner Health. “Heritage has been instrumental in identifying innovative businesses that solve these concerns for our organization.”
Heritage has invested in some of the leading healthcare
services and technology companies, including Aviacode, AllyAlign Health, Medical Solutions,
Sharecare, Abode Healthcare, MDLIVE, Lumere, Reload, Spero Health, etc.
– Modernizing Medicine announced it has acquired
orthopedics EHR vendor Exscribe bringing together two of the healthcare
industry’s leading, all-in-one orthopedic EHR vendors.
– As part of the acquisition, Exscribe Founder and CEO,
Dr. Sachdev and other members of the Exscribe team will be joining Modernizing
Specialty-specific EHR provider Modernizing Medicine announced it has acquired
health records (EHR) vendor Exscribe.
The acquisition brings together two of the healthcare industry’s leading,
all-in-one orthopedic EHR vendors with a shared mission of increasing practice
efficiency by transforming how healthcare information is created, consumed and
utilized. Modernizing Medicine and Exscribe will work together to accelerate
innovation and bring to market advanced EHR, practice management, and
technology solutions intended to improve physician efficiency, reduce burnout,
and support value-based care.
“Exscribe and Modernizing Medicine have a shared commitment to customer success and improving patient outcomes and we are excited to work together to leverage our combined orthopedics expertise to move the industry forward,” said Dan Cane, CEO of Modernizing Medicine. “Both companies were founded on the belief that the best EHRs are built specialty specific ‘by physicians, for physicians,’ and that product excellence is a direct reflection of the strength of our team. With that, we are excited to welcome the talented individuals at Exscribe to the Modernizing Medicine family and are confident that we can leverage our combined expertise to enhance and grow our solutions to meet the needs of customers of virtually any size and orthopedic specialization.”
Orthopedic Healthcare Solutions
Exscribe was founded in 2000 by nationally-renowned
orthopedic surgeon Ranjan Sachdev, MD, MBA, CHC, who was looking for a better
way to manage his orthopedic practice. Working with a team of orthopedists and
IT professionals, Dr. Sachdev developed the Exscribe Orthopaedic EHR, which today
is among the leading specialty-specific healthcare technology solutions
available. Leveraging machine learning and artificial intelligence, Exscribe’s
EHR is intuitive, enabling orthopedists to use one-click treatment plans for
specific conditions, including orders for surgery and therapy, prescriptions,
patient education, referral letters, and more.
Exscribe Founder and CEO, Dr. Sachdev and other members of
the Exscribe team will be joining Modernizing Medicine, and through the
increased scale and combined expertise, both companies intend to continue
providing world-class technology solutions and support to orthopedic customers.
Modernizing Medicine’s top-rated specialty-specific orthopedic electronic
health records (EHR) system, EMA® Orthopedics, has been named the number one
EHR in orthopedics for three consecutive years by Black Book™.
“Modernizing Medicine is known for its state of the art web based offerings, growing presence in the orthopedics space and commitment to working with customers to build solutions that meet the needs of orthopedists and their office staff,” said Dr. Sachdev. “Existing Exscribe customers will experience very few immediate changes. In the long term, we look forward to leveraging the decades of expertise from both companies to build fully interoperable EHR technologies that solve administrative inefficiencies and promote orthopedic excellence.”
Financial detail of the acquisition were not disclosed.
Healthcare technology companies raised a record of $15.3 billion in 2020, according to a report from Silicon Valley Bank. For the first time, digital health companies surpassed biopharma for the number of deals.
– UnitedHealth Group has reached an agreement to acquire
Change Healthcare in a deal valued at more than $13 billion, marking the first
major acquisition of 2021.
– Change Healthcare will be combined with OptumInsight to
advance a more modern, information, and technology-enabled healthcare platform.
has reached an agreement to acquire
healthcare technology leader Change
Healthcare for more than $13B. As part of the acquisition, Change
Healthcare will be combined with OptumInsight
to provide software and data analytics, technology-enabled services and
research, advisory and revenue cycle management offerings to help make health
care work better for everyone. The acquisition marks one of the largest deals
for UnitedHealth Group as it continues to expand it’s health services under the
Financial Details of Acquisition
UnitedHealth will pay $25.75 a share in cash, the companies said in a joint statement, a 41% premium over Change Healthcare’s closing price Tuesday of $18.24. The $13 billion valuation includes more than $5 billion in debt owed by Change Healthcare. Shares of Change Healthcare were up 31.72% at $24.02 in trading on Wednesday. UnitedHealth shares were up 0.6% at $346.67.
“Together we will help streamline and inform the vital
clinical, administrative and payment processes on which health care providers
and payers depend to serve patients,” said Andrew Witty, President of
UnitedHealth Group and CEO of Optum. “We’re thrilled to welcome Change
Healthcare’s highly skilled team to create a better future for health care.”
Acquisition Impact for Providers and Patients
The combination of OptumInsight and Change Healthcare is expected to simplify services around medical care to improve health outcomes and lower costs
– help clinicians make the most informed and clinically
advanced patient care decisions, more quickly and easily. Change Healthcare
brings widely adopted technology for integrating evidence-based clinical
criteria directly into the clinician’s workflow, while Optum’s clinical
analytics expertise and Individual Health Record can strengthen the evidence
base needed to deliver effective clinical decision support at the point of
care. This can ensure appropriate sites of care and consistently achieve the
best possible health, quality and cost outcomes.
– well-positioned to make health care simpler, more efficient and more effective. A key opportunity is to enhance with insights drawn from billions of claims transactions using Change Healthcare’s intelligent health care network, combined with Optum’s advanced data analytics. This will support significantly faster, more informed and accurate services and processing.
– Change Healthcare’s payment capacities combined with
Optum’s highly automated payment network will simplify financial interactions
among care providers, payers and consumers and accelerate the movement to a
more modern, real-time and transparent payment system. This will ensure
physicians get paid more quickly, accurately and reliably, and provide
consumers the same simplicity and convenience managing their health care
finances they experience with other transactions.
“This opportunity is about advancing connectivity and accelerating innovations and efficiencies essential to a simpler, more intelligent and adaptive health system. We share with Optum a common mission and values and importantly, a sense of urgency to provide our customers and those they serve with the more robust capacities this union makes possible,” said Neil de Crescenzo, President and CEO of Change Healthcare. Upon closing, Mr. de Crescenzo will serve as OptumInsight’s chief executive officer, leading the combined organization.
– Healthcare technology company Forcura names the five
most significant trends for the post-acute care industry in 2021.
The post-acute care (PAC) sector saw some of its most
profound challenges this year, from deadly COVID-19
outbreaks in skilled nursing facilities (SNFs) to a suddenly accelerated need
for the services provided by home health and hospice. The biggest question now
is that what does the post-acute care future hold for all of us?
Forcura, a healthcare technology company that enables safer patient care transitions along the care continuum recently released their report, What Happened and What’s Next in Post-Acute Care,” which synthesizes the top takeaways for the post-acute care industry in 2020, and explores the five themes it projects will be the leading business influencers on the sector in 2021 and for years to come.
The report names these as the five most significant drivers
for the post-acute care industry in 2021:
1. Interoperability: The Industry Inches Closer to a
In its guide to “Interoperability in Healthcare,” HIMSS
as “the ability of different information systems, devices and applications
(systems) to access, exchange, integrate and cooperatively use data in a
coordinated manner, within and across organizational, regional and national
boundaries, to provide timely and seamless portability of information and
optimize the health of individuals and populations globally.”
Individuals and organizations have worked tirelessly for
years to create a technological foundation that will make care transitions
safer and more holistic. They’ve made incredible progress…with patients and PAC
providers beginning to reap the benefits of increased data sharing.
2. Healthcare will be Increasingly Built Around the
Service providers talk about the “user experience” and now
users are finally seeking better care experiences. People are becoming savvier
and more demanding about their healthcare in the same ways they have done so in
consuming other services. While technology is certainly a component of the move
towards patient centricity, it is a tool that enables or enhances care
delivery. Post-acute care is poised for the shift to patient centricity.
3. Payment Models and Reimbursement Plans Remain in Play
The post-acute care industry will continue to be shaped by
regulatory and financial forces. By being proactive, fully understanding the
impacts of payment models (like unified payments), learning from the lessons of
acute care payment reform, and choosing the right partners, PAC providers
should be able to more confidently control their bottom lines in the coming
4. New Business Models are Not Your Parents’ PAC
PAC companies themselves also are beginning to explore new
options for their business operations. Post-acute care is being asked to
deliver better patient outcomes and greater value – and it’s time to respond.
Driven in part by the explosion of home-based health care services from legacy
players and new entrants, PAC organizations will be scrambling to retain as
much patient share as possible. By diversifying, providers can reduce the
vulnerability experienced by single service line agencies.
5. Healthcare for All Remains Elusive
COVID-19 has revealed some harsh realities about the ongoing
effects of structural inequity…to no one’s surprise. Some steps towards equity
are occurring. Research led by Oregon Health & Science University shows
that a new national care program for hip and knee joint replacements seems to
reduce health outcome disparities for Black patients. The CMS Comprehensive
Care for Joint Replacement model is a bundled payment model designed to reduce
spending and improve outcomes for all joint replacement patients. “Although
Black patients were discharged to institutional post-acute care more than white
patients, the gap narrowed under the new bundled payment model. Readmission
risk decreased about 3 percentage points for Black patients under the new
model, and stayed roughly the same for Hispanic and white patients.”
“Everyone realizes that 2020 is historic for the unprecedented disruption and lives lost to the COVID-19 public health crisis” says Forcura founder and CEO, Craig Mandeville, “and operating in-the-moment has been a necessity. It has also possibly reduced the time the industry has to plan for what else is around the corner.” Craig continues, “Our original research and conversations from our CONNECT Summit clearly point to five market drivers that everyone should factor into their strategic initiatives. We’re proud to offer this report and believe it will guide health industry companies to focus more on patients and better secure their bottom lines.”
A global health crisis has thrust us into a scenario in which lives quite literally depend on the ability to virtually connect. Telehealth has rapidly emerged as a vital tool, enabling continuity of care, allowing vulnerable individuals to access their physician from home, and freeing up resources for providers to treat the most critical patients. The acceptance of telehealth and expansion of covered services for the senior population demonstrate that this technology will endure long after COVID-19 subsides.
Prior to the pandemic, just 11% of Americans utilized telehealth compared to 46% so far this year, and virtual healthcare interactions are expected to top 1 billion by year’s end. While the technology has been a life-saver for many, usage depends heavily on the availability of audio-video capabilities, internet access, and technological prowess – potentially leaving vulnerable patients behind.
Seniors Face Physical, Technical and Socioeconomic Barriers to Telehealth
Despite telehealth’s surge, there is growing concern that the rapid shift to digitally delivered care is leaving seniors behind. Telehealth is not inherently accessible for all and with many practices transitioning appointments online, it threatens to cut older adults off from receiving crucial medical care. This is a significant concern, considering older adults account for one-quarter of physician office visits in the United States and often manage multiple conditions and medications, and have a higher rate of disability. This puts an already vulnerable population at a higher risk of severe complications from COVID-19.
Research published recently in JAMA Internal Medicine found that more than a third of adults over age 65 face potential difficulties accessing their doctor through telehealth. Obstacles include familiarity using mobile devices, troubleshooting technical issues that arise, managing hearing or vision impairments, and dealing with cognitive issues like dementia. Many of these difficulties stem from the natural aging process; it is imperative for provider organizations employing telehealth and telehealth vendors to improve offerings that consider vision, hearing, and speaking loss for this population.
While barriers associated with aging are a key factor within the senior population, perhaps the greatest challenges in accessing telehealth are socioeconomic. The rapid shift to digital delivery of care may have left marginalized populations without access to the technological tools needed to access care digitally, such as high-speed internet, a smartphone or a computer.
According to the JAMA study, low-income individuals living in remote or rural locations faced the greatest challenges in accessing telehealth. A second JAMA study, also released this summer indicated that “the proportion of Medicare beneficiaries with digital access was lower among those who were 85 or older, were widowed, had a high school education or less, were Black or Hispanic, received Medicaid, or had a disability.”
These socioeconomic factors are systemic issues that existed prior to the pandemic, and the crisis-driven acceleration of telehealth has magnified these pre-existing challenges and widened racial and class-based disparities. Recent initiatives at the federal level, such as the FCC’s rural telehealth expansion task force, are a step in the right direction, though more sustained action is needed to address additional socioeconomic challenges that are deeply rooted within the healthcare system.
Fortunately, Telehealth Hurdles Can Be Overcome
Recognizing that telehealth isn’t a “one-size fits all” solution is the first step towards addressing the barriers that disproportionately impact seniors and work is needed on multiple levels. Telemedicine consults are impossible without access to the internet, so the first step is to provide and expand access to broadband and internet-connected devices. With more than 15% of the country’s population living in rural areas, expanding broadband access for these individuals is especially crucial. In addition, older adults in community-based living environments need greater access to public wi-fi networks.
Access to mobile and other internet-connected devices is also essential. Products designed with large fonts and icons, closed captioning, and easy set-up procedures may be easier for older adults to use. For example, GrandPad is a tablet designed specifically for seniors and has an intuitive interface that includes basic video calling, enabling seniors to virtually connect with their caregivers.
To address affordability, the Centers for Medicaid and Medicare Services (CMS) allowed for mid-year benefit changes in 2020 to allow for payment or provision of mobile devices for telehealth. Many Medicare Advantage organizations are enhancing plans’ provisions of telehealth coverage and devices for 2021.
In addition to increasing access to broadband and internet-connected devices, providing seniors with proper educational resources is another crucial step. Even if older adults are open to using technology for telehealth visits, many will need additional training. Healthcare organizations may want to connect older patients with community-based technology training programs. Some programs take a multi-generational approach, pairing younger instructors with older students.
For example, Papa is an on-demand service that pairs older adults with younger ‘Papa Pals’ who provide companionship and assistance with tasks such as setting up a new smartphone or tablet.
From a socioeconomic perspective, careful consideration is needed to address the concerns that telehealth may reinforce systemic biases and widen health disparities. Providers may be less conscious of systemic bias toward patients based on race, ethnicity, or educational status.
In turn, providers must address implicit bias head-on, such as offering workplace training and incorporating evidence-based tools to adequately measure and address health disparities. This includes pushing for policies that enable widespread broadband access funding to better connect communities in need.
Health plans can support expanded access to care through benefit design, reducing costs for plan members. To match members and patients with the right resources and assistance, health plans and providers should launch outreach campaigns that are segmented by demographic group. Outreach initiatives could include assessments to determine each person’s ability and comfort level with telehealth.
The Path Forward
Without question, telehealth is playing a central role in delivering care during the current pandemic, and many of its long-touted benefits have been accentuated by the current demand. Telehealth, along with other digital monitoring technologies, have the potential to address several barriers to care for seniors and other vulnerable populations for whom access to in-person care may not be viable, such as those based in remote locations or with mobility issues.
In the post-pandemic era, telehealth can provide greater access and convenience, but if not implemented carefully, the permanent expansion of telehealth may worsen health disparities. Careful consideration and collaboration will be essential in embracing the value of telehealth while mitigating its inherent risks.
If implemented correctly, telehealth can provide continued access to care for our vulnerable aging population and can significantly improve care as well. Enhancing the ability to connect with healthcare providers anytime, anywhere can give seniors the freedom to gracefully age in place.
About Anne Davis
Anne Davis is the Director of Quality Programs & Medicare Strategy at HMS, a healthcare technology, analytics, and engagement solutions company, where she’s focused on the company’s Population Health Management product portfolio.
– Ro announced it has acquired Workpath, a technology
platform that powers on-demand, in-home healthcare and diagnostics services
– Through this acquisition, Ro’s platform will now
uniquely bring together a patient’s doctor, pharmacy, and
diagnostics/lab–offering a personalized, end-to-end experience with no
– Ro is also announcing a partnership with Quest
Diagnostics, which operates more than 2,200 locations nationwide, to process
its lab tests.
Ro, the healthcare technologycompany, today announced it has acquiredWorkpath, a software platform that enables healthcare companies to offer on-demand, in-home care, and diagnostic services with a simple API. The acquisition will enable Ro to seamlessly integrate virtual and in-person care on its own platform and offer these in-home capabilities to other healthcare companies. The ability to send healthcare professionals to, and conduct diagnostic tests in, a patient’s home significantly expands the scope of Ro’s vertically-integrated platform and advances the company’s strategy of becoming a patient’s first call for all of their healthcare needs.
End-to-End In-Home Care Solution
Founded in 2015, Workpath is a technology platform that powers on-demand, in-home healthcare services nationwide. Workpath’s API enables healthcare companies to dispatch phlebotomists and other providers to perform services ranging from blood draws to vaccinations, all from the comfort of a patient’s home. The company’s full-service platform includes scheduling and dispatch software, a nationwide network of healthcare professionals, diagnostic processing and reporting, and more. Workpath is available to 95% of patients across the country and facilitates in-home healthcare services for clinical trial operators, Fortune 100 companies, and the nation’s largest diagnostic laboratories.
Acquisition Creates A New Paradigm for
As part of the acquisition, Workpath will
continue to operate independently as an autonomous entity. Workpath and its API
will continue to be available to other healthcare companies, enabling them to
dispatch healthcare professionals to perform services ranging from blood draws
to vaccinations and other primary care services, all from the comfort of a
patient’s home. The company’s full-service platform includes scheduling and
dispatch software, a nationwide network of healthcare providers, diagnostic
processing and reporting, and more. Ro’s offering of Workpath’s platform will
position the combined company as an integral part of the healthcare industry’s
transition to connect the best of virtual and in-person care.
Enabling End-to-End Care
Ro-affiliated providers will leverage Workpath’s
API to order in-home care or diagnostic services for patients, greatly
expanding the scope of conditions that can be treated or managed through Ro’s
platform. In doing so, Ro will seamlessly connect a patient’s doctor, pharmacy,
and lab on its vertically-integrated platform, enabling end-to-end care from
diagnosis to the delivery of medication to ongoing care. Given that seven of
every ten healthcare decisions require blood work, Ro will start by offering in-home
phlebotomy (blood test) services with results directly delivered through Ro’s
Zachariah Reitano, Co-Founder and CEO of Ro, said: “Ten years from now, more healthcare services will be delivered online or in-home than in every hospital, doctors office, or pharmacy combined, and this acquisition will help accelerate that change. The powerful new platform we’re creating enables Ro, and countless other healthcare companies, to deliver care whenever and wherever patients need it. We look forward to welcoming Workpath to the Ro family and together setting a new standard for vertically integrated healthcare delivery.”
Financial details of the acquisition were not disclosed.
– Innovaccer launches COVID-19 Command
Center to assist healthcare organizations in optimizing their COVID-19
– The solution offers a unified
information hub to manage COVID-19 resources and operations and empower teams
with unprecedented visibility into their environment.
Innovaccer, Inc., a San
Francisco, CA-based healthcare technology company, today announced the launch
of its COVID-19
Command Center to assist healthcare organizations in optimizing their COVID-19
operations. The solution provides real-time insights and predictions into
patient and resource status and helps organizations adjust to their fluctuating
Connect Your Systems to Create a COVID-19 Command Center
Innovaccer helps healthcare organizations build a network of
intelligence while sitting on top of systems of records to provide
enterprise-wide insights and improve efficiencies in financial, operational,
and clinical outcomes. Innovaccer’s COVID-19 Command Center provides a
unified information hub for users to manage their COVID-19 resources by
integrating data from Electronic Health Records (EHRs), supply chains, human
resources, and financial systems.
Manage Your COVID-19 Resources and Information in Real-Time
Dashboards on the solution provide real-time monitoring of
bed capacity, medication inventory, staffing plans, PPE supplies, and other
critical resources. It also automatically generates CDC-compliant reports on
these resources and gives an up-to-date detailed overview of the consumption
rates at each facility.
360-Degree View into COVID Operations
The plug-and-play integrations of the Command Center provide
360-degree visibility into all COVID-19 operations and a system-wide overview
of daily and total year-to-date COVID-19 cases. Its descriptive pandemic
population maps allow continuous tracking of cases across the region and the
COVID-19 Resource Optimization and Inventory Management
Additionally, the solution enables healthcare organizations
to take full control of their COVID-19 management activities by furnishing them
with smart analytics and forecasting capabilities and action plans based on
detailed analyses of COVID-19 trends and resources. The COVID-19 Command Center
provides visibility of their caseloads, inventory, and resource requirements to
more accurately predict upcoming demands.
Why It Matters
“The need for visibility across the network has never been more crucial than during these pandemic times. Healthcare organizations are struggling to gain an edge with visibility into their patients, resources, and facilities,” says Abhinav Shashank, CEO at Innovaccer. “With our COVID-19 Command Center, we aim to solve this problem by providing them with true transparency and in-depth visibility across their networks, operations, and patients. Our solution is built to support the digital transformation of their COVID-19 operations and to help them care as one.”
– DAS Health Ventures acquires healthcare
and managed IT company Randall Technology Services (RandallTech).
– This acquisition adds Allscripts® PM
and EHR solutions to the DAS portfolio of supported products, and DAS Health
has now added additional staff in Texas that will create opportunities for
greater regional support of its entire solutions portfolio.
DAS Health Ventures, Inc., an industry leader in health IT and management, announced today it completed the acquisition of Randall Technology Services, LLC (RandallTech) healthcare and managed IT company based in Amarillo, TX. As part of DAS’ growth strategy, this most recent expansion further strengthens its position in the US healthcare technology space.
Acquisition Enhances DAS Health Market Reach
DAS Health actively serves more than 1,800 clients, and
nearly 3,500 clinicians and 20,000 users nationwide, with offices in Florida,
Nevada, New Hampshire and Texas, and a significant employee presence in 14 key
states. This acquisition adds Allscripts® PM and EHR solutions to the DAS
portfolio of supported products, and DAS Health has now added additional staff
in Texas that will create opportunities for greater regional support of its
entire solutions portfolio.
Increased Support for Existing RandallTech Clients
Randall Technology’s clients will gain an increased depth of support, and a substantially improved value proposition, as DAS Health’s award-winning offerings are robust, including managed IT / MSP services, practice management, and EHR software sales, training, support and hosting, revenue cycle management (RCM), security risk assessments (SRA), cybersecurity, MIPS/MACRA reporting & consulting, mental & behavioral health screenings, chronic care management, telemedicine, and other value-based and patient engagement solutions.
Financial details of the acquisition were not disclosed.
Razor-thin operational margins coupled with substantial and ongoing losses related to COVID-19 are culminating in a perfect storm of bottom-line issues for U.S. hospitals and health systems. A study commissioned by the American Hospital Association (AHA) found that the median hospital margin overall was just 3.5% pre-pandemic, and projected margins will stay in the red for at least half of the nation’s hospitals for the remainder of 2020.
The reality is that an increase in COVID-19 cases will not overcome the pandemic’s devasting financial impact. An internal analysis found that, in the first half of 2020, client organizations documented more than 1.2 million COVID-19 related cases. At least one study suggests that $2,500 will be lost per case–despite a 20% Medicare payment increase. And notably, a positive test result is now required for the increased inpatient payment.
The healthcare industry must face its own “new normal” as the current path is unsustainable, and the future stability of hospitals in communities across the nations is uncertain. If financial leaders do not act now to implement systems and embrace sound revenue integrity practices, they will face unavoidable revenue cycle bottlenecks and limit their ability to capitalize on all appropriate reimbursement opportunities.
The COVID-19 Effect: A Bird’s Eye View
The financial impact of COVID-19 is far-reaching, impacting multiple angles of operations from supply chain costs to lost billing opportunities and compliance issues. Findings from a Physician’s Foundation report released in August suggest that U.S. healthcare spending dropped by 18% during the first quarter of 2020, the steepest decline since 1959.
Already vulnerable 2020 Q1 budgets were met with substantial losses when elective procedures—a sizeable part of income for most health systems—were halted for more than a month in many cases. Many hospitals continue to lose notable revenue associated with emergency care and ancillary testing as patients choose to avoid public settings amid ongoing public safety efforts.
Outpatient visits also dropped a whopping 60% in the wake of the pandemic. While a recent Harvard report suggests that numbers are back on track, the reality is that a resurgence of cases could make consumers wary of both doctor visits and elective procedures again.
In addition, the supply chain quickly became a cost risk for health systems by Q2 2020 as the ability to acquire drugs and medical supplies came at a premium. Meeting cost-containment goals flew out the window as did the ability to create value in purchasing power.
Further exacerbating the situation is an expected increase in denials as healthcare organizations navigate a fluid regulatory environment and learn how to interpret new guidance around coding and billing for COVID-19 related care. For example, while telehealth has proved a game-changer for care continuity across the U.S., reimbursement for these visits remains largely untested. History confirms that in times of rapid change, billing errors increase—and so do claims denials.
While there is little that can be done to minimize the impact of revenue losses and supply chain challenges, healthcare organizations can take proactive steps to identify all revenue opportunities and minimize compliance issues that will undoubtedly surface when auditors come knocking to ensure the appropriate use of COVID-19 stimulus dollars.
Holistically Addressing Revenue
Getting ahead of the current and evolving revenue storm will require healthcare organizations to elevate revenue integrity strategies. Hospitals and health systems should take four steps to get their billing and compliance house in order by addressing:
1. People: Build a cross-functional steering committee that will drive revenue integrity goals through better collaboration between billing and compliance teams.
2. Processes: Strategies that combine the strengths of both retrospective and prospective auditing will identify the root cause of errors and educate stakeholders to ensure clean, timely filed claims from the start.
3. Metrics: Best practice key performance indexes are available and should be used. Clean claim submission, denial rate, bad debt reduction and days in AR are a few to consider.
4. Technology: The role of emerging technologies that use artificial intelligence cannot be understated. Their ability to speed identification of risks, perform targeted audits, identify and address root causes and most importantly, monitor the impact of process improvements is changing current dynamics. For one large pediatric health system in the Southwest, technology-enabled coding and compliance processes resulted in $230 million in reduced COVID-related denials and a financial impact of $2.3 million.
Current manual processes used by many healthcare organizations to assess denials and manage revenue cycle will not provide the transparency needed to both get ahead of problems and identify areas for process improvement and corrective action in today’s complex environment.
About Vasilios Nassiopoulos
Vasilios Nassiopoulosis the Vice President of Platform Strategy and Innovation at Hayes, a healthcare technology provider that partners with the nation’s premier healthcare organizations to improve revenue, mitigate risk and streamline operations to succeed in an evolving healthcare landscape. Vasilios has over 25 years of healthcare experience with extensive knowledge of EHR systems and PMS software from Epic, Cerner, GE Centricity and Meditech. Prior to joining Hayes, Vasilios served Associate Principal at The Chartis Group.
– COTA, Inc., a healthcare technology company that uses
real-world data to bring clarity to cancer care, has secured $34M in funding.
– Access to over one million patient data records and additional
funding support enhanced real-world data and analytics services in oncology.
COTA, Inc., a Boston, MA-based healthcare technology company that uses real-world data to bring clarity to cancer care, today announced it has raised $34 million in Series D funding led by Baptist Health South Florida and ONC Capital with participation from EW Healthcare, Horizon BCBS and other existing investors. This also includes a $20M investment from Varian, who negotiated an option to acquire COTA at a later date.
Bringing Clarity to Cancer
COTA was founded in 2011 by a team of doctors, engineers,
and data scientists to create clarity from fragmented and often-inaccessible
real-world data. The company organizes fragmented, often hidden data from the
real world to provide clarity in cancer care. Combining clinical expertise in
cancer with proprietary technology and advanced analytics, COTA’s platform
helps inform decisions and action in oncology. COTA partners with
providers, payers, and life science companies to ensure that everyone touched
by cancer has a clear path to the right care.
COTA offerings include:
Providers: Curate EHR data that can be
used to drive research and standardization in order to improve patient outcomes
while also reducing costs at your institution.
Payers: Make clinical sense of claims data, providing
insight into performance and related outcomes across sites in order to support
value-based payment models.
Life Sciences: Deeplycurated real-world data accelerates drug development informing the decisions and actions that will deliver the best drugs to patients faster and at a lower cost.
The company will use the latest round of funding to expand
its data access by over 300%, which now well exceeds one million oncology
patient records. This growth will support the company’s commitment to
accelerating the use of real-world data to improve patient outcomes and
increase efficiency in oncology drug development. data helps life science
partners answer key research questions, and in 2020 alone, COTA is projected to
double its life science customers, growing from 8 to 16.
“COTA is proud to receive this validation from leading institutions across the oncology ecosystem.” said Michael Doyle, President and CEO of COTA. “The additional capital combined with our increased data access positions COTA for tremendous growth and enables us to drive innovation in oncology using real-world data. Our high-quality data and technology solutions will improve how cancer is treated and provide much needed clarity to patients as they navigate their cancer journey.”
Removing common and costly workflow barriers from provider
medaptus’ clinical workforce and workflow solutions empowers healthcare delivery entities to achieve their desired patient, clinical and financial outcomes. medaptus has applied information technology to solve problems that are common and costly to healthcare organizations that include single-specialty groups, acute care hospitals, hospital medicine teams, ambulatory care settings, and cancer centers. The company’s information technology solutions enable better revenue capture and integrity, hospital medicine workflows that make sense, and computer-assisted coding for infusion services coding processes.
Volaris Group Background
Volaris has a successful track record of acquiring,
strengthening, and growing vertical market software companies. The medaptus
acquisition expands the company’s footprint in the healthcare information
technology space. Financial details of the acquisition were not disclosed.
Volaris acquires, strengthens, and grows vertical market technology companies. As an operating group of Constellation Software Inc., Volaris is all about strengthening businesses within the markets they compete in and enabling them to grow – whether that growth comes through organic measures such as new initiatives and product development, day-to-day business, or through complementary acquisitions.
“We are delighted to welcome medaptus to our team. The company complements our current healthcare portfolio, adding new customers and unique automation capabilities to the mix. medaptus software solutions address a number of important issues in healthcare and the company’s outstanding track record and service quality reputation provide an excellent opportunity for future growth and innovation,” said Michael Melville, Group Leader at Volaris Group.
Blockchain technology has somewhat infamously been described as “a solution in search of a problem,” but as the healthcare industry responds to the demands of the pandemic, several valuable use cases have surfaced that could benefit from employing the emerging technology.
Due in large part due to its ability to promote trust, transparency, and privacy, blockchain has emerged as today’s best technology-based option for accomplishing the important objective of delivering real-time access to critical information that is presented in a consistent format from trusted sources.
False positives, duplicate records, and privacy issues make it very difficult to derive actionable intelligence with confidence from the current data-sharing infrastructure that exists in the healthcare industry. Further, lack of trust represents another challenge that hinders the formation of greater transparency, as much of the healthcare industry remains reluctant to pervasively share data due to privacy and competitive barriers.
By design, blockchain allows for competing organizations to come together to share data about their patients in a completely auditable way, while maintaining their competitive independence and privacy concerns. It is these fundamental qualities that have helped blockchain emerge as a viable solution for a number of critical healthcare functions whose importance has grown during the COVID-19 pandemic, such as contact tracing, provider credentialing, and patient records-sharing.
Blockchain: The basics Before delving into the specifics of what blockchain can do for healthcare during the pandemic, it is important to establish a general understanding of blockchain’s basics. By no means is it necessary for most healthcare executives to develop a deep knowledge of the technology, but familiarity with its essential elements will enable business leaders to speak roughly the same language as healthcare technology experts as blockchain continues to gain prominence.
Blockchain is a distributed ledger technology that enables users to share trusted and verified information in a decentralized manner. Combined with security and cryptography technology, blockchain can protect the privacy of users who contribute data while also sharing the provenance of the data, enhancing trust.
Blockchain technology provides a safe, effective way to accurately document, maintain, store, and move data – from health records to financial transactions. With blockchain, people can directly engage with others to receive services, transfer money, and perform other common daily tasks we do in business today.
Blockchain use cases The biggest benefits offered by blockchain are associated with greater trust and privacy due to the technology’s ability to enable better data accuracy and verification. At its most basic level, blockchain changes ownership and control of data from one centralized source to multiple sources that contribute data. Following are three COVID-19-related use cases for blockchain in healthcare.
Contact tracing: To follow the potential transmission of the novel coronavirus, many governments have embarked upon contact tracing, in which infected individuals are asked to list all other people they’ve come into contact with over a certain period of time. Decentralization of data helps facilitate critical healthcare operations such as contact tracing because the process is reliant on using granular, sensitive data to inform public health officials of who may be at risk of exposure based on their movements and contacts. In contract tracing, maintaining individuals’ privacy is critical. Earlier this year, blockchain platform Nodle launched a contact-tracing app called “Coalition,” which emphasized user privacy.
Patient-record sharing: Another valuable use case for blockchain as it relates to COVID-19 is the aggregation of patient records during a crisis or disaster to create a “light” electronic health records system, which disparate groups of providers can use to share patient records while treating unfamiliar patients during the pandemic or other crises and natural disasters. Such a platform will allow providers to work with patients who may not have access to their usual provider, but still receive the full range of needed services and prescriptions. The main concept of the solution is that patients’ electronic health records follow them wherever they go. In other words, regardless of where the patient stays during a disaster, there is always access to their personal medical information and they are able to receive required medical services. This patient data can be delivered through a blockchain digital wallet, providing access, security, and integrity of data.
Provider credentialing: Provider credentialing — which is the process of verifying providers’ skills, training and education — is an often-tedious, time-consuming process for both providers and payers that can lead to delays in care that contribute to poor health outcomes. By using blockchain for the process, providers can maintain control of their own data and give health systems, payers and other authorities access to their credentials as they like. Earlier this year, five organizations announced plans to use a new blockchain credentialing system from ProCredEx with the aim of using distributed ledger technology to reduce time and costs associated with the traditional approach to credentialing.
The right technology at the right time It is important to note that blockchain technology requires a cultural and paradigm shift toward broader collaboration across traditionally disparate and potentially competitive entities. The technology facilitates a framework that allows organizations to contribute to joint efforts without risking their intellectual property or proprietary information. However, it will still require an intentional change in behavior to successfully work across different business interests toward a common goal. Nonetheless, to surmount the challenges posed by healthcare’s manual, time-consuming processes for contact tracing, patient record-sharing, and provider credentialing, blockchain represents the right technology at the right time.
About Brett Furst
A senior executive with nearly three decades of experience in selling and managing technology solutions within the manufacturing, CPG, and healthcare industries, Brett Furst serves as president of HHS Technology Group, a software and solutions company serving the needs of commercial enterprises and government agencies.
– The FDA just extended its research collaboration
agreement (RCA) with COTA, specifically looking at how COVID-19 is affecting
– With this expanded agreement, COTA and the FDA will use real-world data to explore the impact of COVID-19 and the pandemic on cancer treatment, with the opportunity to expand into other oncology questions in the future.
COTA, Inc., a healthcare technology
company that uses real-world data to bring clarity to cancer care, today
announced it has extended its Research Collaboration Agreement (RCA) with the
U.S. Food and Drug Administration (FDA) for an additional three years. This
renewed RCA will expand on the objective to explore the applications of
real-world data in oncology, including the impact of COVID-19 and the
pandemic on cancer treatment. As the project advances, the research will
broaden to study other oncology care delivery questions.
Real-world data can provide critical insights into the
delivery of cancer treatment in the routine practice setting, as well as
potential long-term effects post-COVID-19 recovery. The expanded focus of this
RCA will enable the exploration of important research questions to help support
FDA’s understanding of how the COVID-19 pandemic continues to impact patients
Why It Matters
With over 8 million cases of COVID-19 in the United States,
there is a significant need to understand the pandemic’s impact on oncology
care. Additionally, an increasing body
of research has shown that oncology patients may be particularly
susceptible to harm during this pandemic – both in contracting the
condition itself or experiencing care delays.
Cancer patients are particularly at risk of severe complications with COVID-19, and there is currently no understanding of how this can affect their oncology care or progression. Through real-world data, we can begin to understand if COVID-19 should be considered as comorbidity – particularly around clinical trial criteria.
– Cardiac patients and their cardiologists are
experiencing a high number of false positives with remote patient monitoring
devices as a result of signal artifact providing inaccurate data, which can
lead to many complications—other than medical, such as unnecessary tests and
increased medical costs.
– Ambulatory cardiac monitoring provider InfoBionic has devised a way to decrease false positives and increase efficiency.
Remote cardiac monitoring’s false positives—especially on atrial fibrillation (Afib)—hurt everyone, from the patient to the boss who will have to go without an employee when he or she has to go in for unnecessary tests. An estimated 12.1 million people in the United States will have Afib by 2030; Afib increases the risk of stroke, heart failure, and death, and is one of the few cardiac conditions that continue to rise.(1) “We must give the clinician more effective diagnoses, while at the same time increasing confidence in our healthcare technology systems with respect to the accuracy of the same patient data,” expressed Stuart Long, CEO of InfoBionic, a provider of ambulatory cardiac monitoring services.
Impact of Remote
Patient Monitoring on Afib
Afib is a “fluttering feeling that can point to a quivering heart muscle, a notable skipped beat as the mark of a palpitation, and a racing heart rate that sparks other discomforts.” (2) With the rise of remote patient monitoring (RPM) as an effective and economical modality to treat and monitor patients, false positives continue to rise to generate a lack of confidence in the accurate clinical data captured through RPM. False positives can overwhelm the clinician and result in the increased use of resources and downstream costs, and false negatives could have detrimental clinical consequences.(3)
Without a reliable RPM supported by powerful AI solutions, healthcare payers experience higher costs. Heart disease takes an economic toll, as well, costing the nation’s healthcare system $214 billion per year and consuming $138 billion in lost productivity on the job. (4) The cascading effect of false positives run the gamut of the human experience—from the physical and emotional health of the patient to the added out-of-pocket expenses of unnecessary and avoidable tests.
The increased risks of hospital readmissions at a time when healthcare systems are overtaxed and understaffed adds another factor of what could have been an unneeded situation. “InfoBionic AI has all but eliminated the need for physicians to deal with false positives. In fact, 100% of Atrial Fibrillation events longer than 30 seconds are detected accurately (true positive) by InfoBionic’s AI system(6),” said Long.
leveraging cloud computing with continuous arrhythmia monitoring to create a
reliable platform with accurate data collection, an ambulatory cardiac monitor,
such as the MoMe® Kardia device, optimizes AI solutions,
allowing for consistency in the treatment. Integrated sensor measures have been
shown to predict heart failure and might have the potential to
empower patients to participate in their own care.(5) Offering
24-hour monitoring through RPM technology that reduces false positives leads to
the patient becoming more comfortable with the RPM service, which increases the
likelihood the patient will adopt the practice of self-care well into the
future. Cardiac patients with pulmonary or electrolyte problems may need
continuous cardiac monitoring to screen for arrhythmias.
“A primary feature of our MoMe® Kardia is its ability to leverage technology in a way that makes physicians feel more confident via analysis precision that verifies detected cardiac episodes through the algorithm,” said Long. Another distinct advantage is the ability to provide 6 lead analysis instead of the 1 or 2 leads provided by other systems. This affords the physician a much better view of each heartbeat, thereby increasing physician confidence in the accuracy of diagnosis.
provides valuable clinical statistics that guide treatment with the best
patient outcomes. As the leading provider to collect every heartbeat and
transmit it to the cloud in near real time, explains Long, InfoBionic’s AI
algorithms are informed by over 15 million hours of electrocardiogram (ECG)
collected from the entire patient population. With full disclosure transmission
that allows AI algorithms to run on powerful servers in the cloud, the system
utilizes much more intensive processing than could be accomplished on other
patient-worn devices. Multiple patented algorithms are run concurrently on the
ECG stream, each with superior performance on a variety of clinical conditions.
This will be ugly and sad. Racism has cost this country $16 trillion over the last twenty years according to a recent Citigroup report. Much of this loss ($13 trillion) was attributed to discriminatory lending practices and the 6.1 million fewer jobs created as a result, while disparity in wages ($2.7 trillion) and discrimination in housing policies and lost income due to restricted access to higher education accounted for the balance. The report estimates that if these gaps were to be closed, an incremental $5 trillion can be added to U.S. GDP over the next five years alone. Obviously, this does not even begin to account for the extraordinary pain and suffering racism inflicts on our country, much less the dramatic implications to the health and wellbeing for those impacted by racism.
The dramatic increase in unemployment since the onset of COVID-19 has garnered significant attention. While the overall unemployment rate of 7.9% in September is down from the pandemic-high of 14.7% in April, this improvement masks the dramatic discrepancies in rates for minorities; according to the U.S. Bureau of Labor Statistics, white Americans are 7.0% unemployed while the Black unemployment rate is 12.1%. Somewhat jarring, last week Columbia University published an analysis showing that eight million more people are now living in poverty just since the expiration of the Cares Act three months ago, disproportionally hitting minorities.
The story is even more dire when looking at the “True Rate of Unemployment” as defined by the Ludwig Institute for Shared Economic Prosperity which presumes that one needs to earn a minimum living wage of $20,000 to be deemed employed. Under such a definition, Black unemployment is 30.4%, although an improvement from what was seen for the ten years after the Great Recession of 2008.
It is estimated that 100.6 million Americans are out of the labor force now, many of whom are from disadvantaged segments of the population. In fact, for those earning more than $60,000 annually, the unemployment rate is a mere 1.0% below where it stood at the onset of the pandemic. For those who make less than $20 per hour (equivalent to a salary of approximately $27,000), the unemployment rate is 17.5% below where it was in February 2020 according to Opportunity Insights. Shockingly, America’s billionaires net worth has increased more than $850 billion since April.
The difference in life expectancy between white and Black Americans is criminally high – nearly five years, even when adjusted for gender, according to the Centers for Disease Control and Prevention (CDC) data. While the underlying causes are complex and fraught with political overtones, this issue is now front and center as the country struggles with the pandemic.
Sutter Health recently published COVID-19 data that attributed the 2.7x increase in hospitalization rates in their hospitals for Black patients versus white patients to, in part, more advanced illness at the time of admission, arguably reflecting a cultural aversion to the healthcare system or challenges around adequate access. CDC data are even worse, tabulating a 5.0x higher rate of hospitalization, 2.3x greater mortality rate, and 3.0x greater infection rate for Black versus white Americans, respectively. This is particularly troublesome now with case counts spiking 17% just this past week and as winter sets in.
The Kaiser Family Foundation (KFF) forecasts that Medicaid roles will increase by 8.4% in 2021; in June there were 67.9 million Medicaid beneficiaries. It is quite clear that the pandemic is hitting minority and less educated segments of the population harder, often because they tend to be front-line essential workers and/or struggle with greater levels of unemployment. McKinsey recently estimated that as many as 10 million Americans will lose employer-sponsored health insurance due to COVID-19 by the end of 2021.
KFF also highlights the discrepancies in private health insurance rates by race: in 2018, white, Black, and Hispanic uninsured rates were 7.5%, 11.5% and 19.0%, respectively, which further exacerbates difficulties for minorities to access effective healthcare. The Affordable Care Act had a dramatic impact over the past decade as uninsured rates in 2010 were 13.1%, 19. 9% and 32.6%, respectively. This year the average family health insurance premium rose by 4% to more than $21,000.
While there is a heightened level of concern about the pace of coronavirus vaccine development, and whether there will be inappropriate political pressures applied to compromise long-cherished safety protocols, the Black community is expressing a particularly high level of skepticism. According to another KFF study, just under 50% of Black respondents would not take a free and safe vaccine, while only 17% would “definitely” do so. While further underscoring long-held distrust of the healthcare system, this phenomenon risks perpetuating the relatively poor health conditions experienced in many of those communities.
Recognizing this and the other numerous challenges introduced by the pandemic, the Healthcare Anchor Network (HAN) of 39 provider systems (many of whom are Flare Capital LPs) reiterated in September that racism is a public health crisis, putting forth a number of steps to chip away at these issues. First and foremost was a commitment to dramatically improve access to testing in underserved communities, as well as more robust inclusive hiring practices and greater spending with diverse suppliers and vendors.
Importantly, the HAN spotlighted that systemic racism uncouples the public health infrastructure from the private healthcare system, often leading to “generational trauma and poverty.” A profound characterization. A recent Wall Street Journal analysis of CDC data showed a strong link between racism and mental health: in the week following the murder of George Floyd in May, 40.5% of Black adults exhibited symptoms of anxiety and depression (a five-point increase from the week just prior). While somewhat similar to post-traumatic stress disorders, racism is chronic and on-going much like an injury, and should not be considered a disorder. Clinicians have now developed a “Race-Based Traumatic Stress Symptom” scale when evaluating minority patients.
Advances in healthcare technology hold profound promise to improve the health and wellbeing of those most afflicted by racism, particularly during such difficult economic times. According to a provocative analysis by McKinsey (below), many of the most seminal transformative reforms in healthcare have come on the heels of major recessions. Arguably, what has been unleashed on the U.S. economy by COVID-19 may lead to a dramatic restructuring of the healthcare industry, which could usher in a wave of significant innovation to improve conditions for those most disadvantaged.
Entrepreneurship has been one of the great elixirs in the face of such devastating economic conditions and is often looked upon as one approach to reduce economic disparities due to racism. Here, unfortunately, the record is mixed. Given how critical access to capital is, the evidence that racial discrimination compromised many minority groups from accessing emergency funding programs like the Payroll Protection Program (PPP) this past spring is particularly painful. According to the Center for Responsible Lending, 46% of white-owned businesses had accessed bank credit over the past five years (compared to less than 25% for Black-owned businesses) which meaningfully facilitated their ability to secure PPP loans from those same institutions.
Furthermore, a 2016 Federal Reserve Bank study found that only 40% of minority credit applicants secure the full requested amounts of credit when applying as compared to 68% for white-owned applicants. Consistently minority-owned companies pay higher interest rates and have more onerous borrowing terms according to the Department of Commerce’s Minority Business Development Agency. The financial landscape confronting Black-owned businesses is materially more hostile than what white-owned businesses face. Full stop.
Rock Health, a leading seed-stage healthcare technology investor (and partner of Flare Capital), recently conducted an extensive diversity survey. These sober findings further highlight the issues around access to capital for minority entrepreneurs. White and Asian founders were nearly twice as likely to backed by venture capitalists; 48% of Black founders bootstrapped their companies versus 25% of white founders. Of the nearly 250 founder respondents in the survey, 12% identified as Black but only a disappointing 5% of the 425 senior executives in those companies were Black. Just over 80% of Black respondents felt that the digital health sector was either the same or less inclusive from when they initially joined the industry. Obviously, much work is still to be done.
These issues are not at all lost on my partners and our firm. Since we started Flare Capital over six years ago, we have been committed to diversity and inclusion. In addition to simply being the right thing to do, it is the best thing for our business. We will make better investment decisions with a broadly diverse set of perspectives and experiences.
But as inclusive as we felt we were, it is time to do even better. There are systemic causes to these inequities in our industry that we can help address. Over the last four months, we developed a set of new initiatives (summarized below) that we implemented earlier this summer. In summary, we identified two broad dimensions that we are committed to improving upon more equitable access and accelerated career development. Structural challenges exist for many underrepresented entrepreneurs to meet with venture capital firms, much less successfully raise capital. These are fundamental problems that require deliberate, measurable steps from engaging with more diverse founding teams, recruiting more diverse management teams, and partnering with venture firms equally committed to diversity.
BIPOC = Black, Indigenous, People of Color
We recognize that it will take time and significant effort to address these inequities, and that success will be built, in part, upon many small victories. Arguably, Black Lives Matter is the largest movement in our country’s history. The New York Times recently estimated that between 15 to 26 million Americans likely participated in demonstrations since the death of George Floyd in late May. We are proud to be a part of that movement.
About Michael A. Greely
Michael A. Greely is the CoFounder and General Partner at Flare Capital Partners, a venture capital firm focused on investing in early-stage and emerging healthcare technology companies. Previously, Michael was the founding General Partner of Flybridge Capital Partners where he led the firm’s healthcare investments. Current and prior board seats include Aspen Health, BlueTarp Financial, Circulation, Explorys, Functional Neuromodulation, HealthVerity, higi, Iora Health, MicroCHIPS, Nuvesse, PolyRemedy, Predictive Biosciences, Predilytics, T2 Biosystems, TARIS Biomedical, VidSys and Welltok (observer).
The COVID-19 virus is ravaging the planet at a scale not seen since the infamous Spanish Flu of the early 1900s, inflicting immense devastation as the U.S. loses more than 200,000 lives and counting. According to CDC statistics, 94% of patient mortalities associated with COVID-19 were simultaneously suffering from preexisting conditions, leaving a mere 6% of victims with COVID-19 as their sole cause of death. However, while immediate prospects for a mass vaccine might not be until 2021, there is some hope among rural hospital health information technology consultants where the pandemic has hit the hardest.
The fact that four in ten U.S. adults have two or more chronic conditions indicates that our most vulnerable members of the population are also the ones at the greatest risk of succumbing to the pandemic. From consultants laboring alongside healthcare administrators and providers, all must pay close attention to patients harboring 1 of 13 chronic conditions believed to play major roles in COVID-19 mortality, particularly chronic kidney disease, hypertension, diabetes, and COPD.
Vulnerable rural populations must be supervised due to their unique challenges. The CDC indicates 80% of older adults in remote regions have at least one chronic disease with 77% having at least two chronic diseases, significantly increasing COVID-19 mortality rates compared to their urban counterparts.
Health behaviors also play a role in rural patients who have decreased access to healthy food and physical activity while simultaneously suffering high incidences of smoking. These lifestyle choices compound with one another, leading to increased obesity, hypertension, and many other chronic illnesses. Overall, rural patients that fall ill to COVID-19 are more likely to suffer worsened prognosis compared to urban hubs, a problem only bolstered by their inability to properly access healthcare.
Virus Helping Push New Technologies
COVID-19 has shown the cracks in the U.S. healthcare technology system that must be addressed for the future. As the pandemic unfolds, it’s worth noting that not all lasting effects will be negative. Just as the adoption of the Affordable Care Act a decade ago spurred healthcare organizations to digitize their records, the COVID-19 pandemic is accelerating overdue technological shifts crucial to providing better care.
Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that connect patients with both urgent and preventive care without their having to leave home. Perhaps the most prominent change has been the widespread adoption of telehealth services and technologies that use video to connect patients with both urgent and preventive care without their having to leave home.
Even if COVID-19 were to fade away on its own, the next pandemic may not. Furthermore, seasonal influenza serves as a reminder that healthcare is not a skirmish, but a prolonged war against disease. Rather than doom future generations to suffer the same plight our generation has with the pandemic, now is the time to develop innovative IT strategies that focus on protecting our most vulnerable citizens by leveraging existing healthcare initiatives to focus on proactive responses instead of reactive responses.
On the Right Road
While some of the most vulnerable people are the elderly, rural residents, and the poor, the good news for them is that CMS has long advocated the use of preventive care initiatives such as Chronic Care Management (CCM) and Remote Physiologic Monitoring (RPM) to track these geriatric patients. To encourage innovation in this sector, CMS preventive care initiatives provide generous financial incentives to healthcare providers willing to shift from conventional reactive care strategies to a more proactive approach focused on prevention and protection. This should attract rural hospital CEOs who have been struggling even more than usual because of the virus.
These factors led to the creation of numerous patient CCM programs, allowing healthcare executives and providers to remotely track the health status of geriatric patients suffering from numerous chronic conditions. The tracking is at a rate and scope unseen previously through the use of electronic media. Interestingly enough, the patients already being monitored by CCM programs overlap heavily with populations susceptible to COVID-19. To adapt existing infrastructure for the COVID-19 pandemic is a relatively simple task for hospital CIOs.
As noted earlier, one growing CCM program that could be retrofitted to deal with the COVID-19 pandemic are the use of telehealth services in rural locations. Prior to the pandemic, telehealth services were one of the many strategies advocated by the CDC to address the overtaxed healthcare systems found in rural locations.
Better Access, Funding and User Experience for Telehealth
Today, telehealth is about creating digital touchpoints when no other contact is possible or safe. It offers the potential to expand care to people in remote areas who might have limited or nonexistent access, and it could let other health workers handle patient screening and post-care follow-up when a local facility is overwhelmed. As a study published last year in The American Journal of Emergency Medicineaffirms, virtual care can cut the cost of healthcare delivery and relieve strain on busy clinicians.
Telehealth has also gotten a boost from the $2 trillion CARES Act stimulus fund, which provides $130 billion to healthcare organizations fighting the pandemic. The effort also makes it easier for providers to bill for remote services.
The reason for the CDC and hospital administrators’ interest in telehealth was that telehealth meetings could outright remove the need for patients to travel and allow healthcare providers to monitor patients at a fraction of the time. By simply coupling existing telehealth services with CMS preventive care initiatives focused on COVID-19, rural healthcare providers could detect early warning signs of COVID-19.
Integration Key to Preemptive Detection
This integration at a faster and far greater scale could mean much greater preemptive virus detection through routine telehealth meetings. The effect of telehealth would be twofold on hospitals serving rural and urban health communities. It could slow the spread of COVID-19 to a crawl due to decreased patient travel and improved patient prognosis through early and intensive treatment for vulnerable populations with two or more chronic health conditions.
This integrated combination would shift standard reactive care to patient infections to a new monitoring methodology that proactively seeks out infected patients and rapidly administers treatment to those most at risk of mortality. This new combination of preventive care and telehealth services would not only improve patient and community health but would relieve the financial burden incurred from the pandemic due to the existing CMS initiatives subsidizing such undertakings.
In conclusion, preventative care targeting patients with pre-conditions in rural locations are severely lacking in the context of the COVID-19 pandemic. By leveraging CMS preventive care initiatives along with telehealth services, healthcare providers can achieve the following core objectives.
First, there are financial incentives with preventive care services that will relieve the burden on healthcare systems. Second, COVID-19 vulnerable populations will receive the attention and focus from healthcare providers that they deserve to slow the spread through the use of early detection systems and alerts to their primary health provider. Third, by combining with telehealth service, healthcare providers can efficiently and effectively reach out to rural populations that were once inaccessible to standard healthcare practices.
of widely available, easy-to-use systems that automate tasks, such as
scheduling follow-up calls, developing and distributing targeted
communications, and properly responding to questions, makes managing ongoing
relationships difficult, especially for patients with complex medical
conditions. To eliminate such communication barriers, the solution uses
powerful analytics to provide a 360-degree view of patients along with their
utilization trends to easily stratify the most vulnerable patients. With these
views in place, providers can take suitable steps and group patients based on
shared conditions or goals for improved medical management and care delivery.
2-Way Communication at Population & Individual Levels
Built on top of Innovaccer’s proprietary FHIR-enabled Data Activation Platform, the solution enables HIPAA-compliant, two-way communication channels to engage patients at both the population and individual levels. The solution enables care teams to easily manage appointments, monitor patient ratings, and feedback, and conduct one-click appointment booking and prescription renewals. With the solution, the care teams can create patient cohorts based on disease, region, and various other parameters to send bulk outreach emails. It simplifies the process of connecting healthcare teams with patients to provide administrative and clinical support.
“Patient-centricity is the essence of healthcare, and artificial intelligence has always been viewed as the answer to achieving individualized, consumer-oriented healthcare,” says Abhinav Shashank, CEO at Innovaccer. “With our patient relationship management solution, we will resolve the complexity that prevents healthcare organizations from building strong patient relationships. Our goal is to enable healthcare teams to care as one for their patients.”
Without a doubt 2020 has been a devastating year for many; the impact of COVID-19 on both personal lives and businesses has had long-term consequences. At the end of September, the number of COVID-19 cases fell just short of 350 million, with just over 1 million deaths reported. The expectation of a second peak in many countries exposed to the deadly illness is being handled with care, with many governments attempting to minimize the impact of an extreme rise in cases.
COVID-19 the aftermath will be the new normal?
Despite the chaotic attempts to dampen the impact of a second peak, it is inevitable that healthcare facilities will be stretched once again. However, there are key learnings to be had from the first few months of the pandemic, with several healthcare providers opting to be armed with as much information to tackle the likely imminent surge of patients with COVID-19 head-on. The interest in solutions that offer support to clinicians through data analysis is starting to emerge with several COVID-19 specific Artificial Intelligence (AI) algorithms filtering through the medical imaging space.
Stepping into the ICU, the use of analytics and AI-based clinical applications is drawing more attention. Solutions that collect relevant patient information, dissect the information, and offer clinical decision support are paving the way to a more informed clinical environment. Already, early-warning scoring, sepsis detection, and predictive analytics were becoming a focus. The recent COVID-19 outbreak has also driven further interest in COVID-19 specific applications, and tele-ICU solutions, that offer an alternative way to ensure high-risk patients are monitored appropriately in the ICU.
What does the future hold?
Signify Research is currently in the process of assessing the uptake of clinical decision support and AI-based applications in the high acuity and perinatal care settings. An initial assessment has highlighted various solutions that help improve not only the efficiency of care but also improve its quality. Some of the core areas of focus include:
Clinical Decision Support & Predictive Analytics
Due to the abundance of patient data and information required to be regularly assessed and monitored, the high-acuity and perinatal care settings benefit from solutions offering clinical decision support.
The ICU specifically has been a focus of many AI solution providers, with real-time analysis and support of data to provide actionable clinical decision support in time-critical situations. Clinical decision support solutions can collate data and identify missing pieces of information to provide a complete picture of the patient’s status and to support the treatment pathway. Some of the key vendors pathing the way for AI in clinical decision support in the ICU include AiiNTENSE; Ambient Clinical Analytics; Etiometry; BetterCare; AlertWatch; and Vigilanz Corp.
Early-warning protocols are commonly used in hospitals to flag patient deterioration. However, in many hospitals this is often a manual process, utilizing color coding of patient status on a whiteboard in the nurse’s station. Interest in automated early-warning systems that flag patient deterioration using vital signs information is increasing with the mounting pressure on stretched hospital staff.
Examples of early-warning software solutions include the Philips IntelliVue Guardian Solution and the Capsule Early Warning Scoring System (EWSS). Perigen’s PeriWatch Vigilance is the only AI-based early-warning scoring system that is developed to enhance clinical efficiency, timely intervention, and standardization of perinatal care.
The need for solutions that support resource-restricted hospitals has been further exacerbated during the COVID-19 pandemic. Many existing early-warning vendors have updated their surveillance systems to enable more specific capabilities for COVID-19 patients, specifically for ventilated patients. Companies such as Vigilanz Corp’s COVID Quick Start and Capsule Tech’s Clinical Surveillance module for ventilated patients enables healthcare professionals to respond to COVID-19 and other viral respiratory illnesses with customizable rules, reports, and real-time alerts.
Sepsis is the primary cause of death from infection, accounting for 20% of global deaths worldwide. Sepsis frequently occurs from infections acquired in health care settings, which are one of the most frequent adverse events during care delivery and affect hundreds of millions of patients worldwide every year. As death from Sepsis can be prevented, there is a significant focus around monitoring at-risk patients.
Several health systems employ their own early-warning scoring protocol utilizing in-house AI models to help to target sepsis. HCA Healthcare, an American for-profit operator of health care facilities, claims that its own Sepsis AI algorithm (SPOT) can detect sepsis 18-hours before even the best clinician. Commercial AI developers are also focusing their efforts to provide supporting solutions.
The Sepsis DART™ solution from Ambient Clinical Analytics uses AI to automate early detection of potential sepsis conditions and provides smart notifications to improve critical timeliness of care and elimination of errors. Philips ProtocolWatch, installed on Philips IntelliVue bedside patient monitors, simplifies the implementation of evidence-based sepsis care protocols to enable surveillance of post-ICU patients.
The influx of patients into the ICU during the early part of 2020 because of COVID-19 placed not only great strain on the number of ICU beds but also the number of healthcare physicians to support them. Due to the nature of the illness, the number of patients that were monitored through tele-ICU technology increased, although the complex nature of implementing a new tele-ICU solution has meant the increase has not been as pronounced as that of telehealth in primary care settings.
However, its use has enabled physicians to visit and monitor ICU patients virtually, decreasing the frequency and need for them to physically enter an isolation room. As the provision of healthcare is reviewed following the pandemic, it is likely that tele-ICU models will increase in popularity, to protect both the patient and the hospital staff providing direct patient care. Philips provides one of the largest national programs across the US with its eICU program.
Most recently, GE Healthcare has worked with Decisio Health to incorporate its DECISIOInsight® into GE Healthcare’s Mural virtual care solution, to prioritize and optimize ventilator case management. Other vendors active within the tele-ICU space include Ambient Clinical Analytics, Capsule Health, CLEW Med, and iMDsoft.
Figure 1 Signify Research projects the global tele-ICU market to reach just under $1 billion by 2024.
More and more solutions are targeted toward improving the quality of patient care and reducing the cost of care provision. With this, the requirement for devices and software to be interoperable is becoming more apparent. Vendors are looking to work collaboratively to find solutions to common problems within the hospital. HIMMS 2020 showcased several collaborations between core vendors within the high acuity market. Of note, two separate groups demonstrated their capabilities to work together to manage and distribute alarms within a critical care environment, resulting in a quieter experience to aid patient recovery. These included:
– Trauma Recovery in the Quiet ICU – Ascom, B Braun, Epic, Getinge, GuardRFID, Philips
About Kelly Patrick, Principal Analyst at Signify Research
Kelly Patrick is the Principal Analyst at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. She joined Signify Research in 2020 and brings with her 12 years’ experience covering a range of healthcare technology research at IHS Markit/Omdia. Kelly’s core focus has been on the clinical care space, including patient monitoring, respiratory care and infusion.
For most healthcare professionals, providing care to their patients is mandatory. However, there are times when their desire to give patients the best care possible becomes a necessity for compliance, particularly now that hospital negligence has been a constant stress factor for both professionals and patients.
It is a given that any medical treatment has the potential to go wrong. There is never a perfect process, and healthcare workers are very much aware of this, especially when the burden falls on their shoulders to make sure everything goes right. Patients, on the other hand, place their trust in healthcare professionals, as they believe that they know what’s best for them. With all this considered, it’s common for both doctors and patients to have hospital negligence as the least of their concerns. Sadly, it is a reality that happens to many people.
According to http://www.tariolaw.com/, medical malpractice cases are still fairly common, and it’s why many people still refuse to allow technology to be a part of their treatment process. However, recent advancements in healthcare technology have led to the development of applications that can effectively reduce and eliminate the incidence of negligence.
Machine Learning in Healthcare
The use of artificial intelligence (AI), particularly machine learning (ML) in healthcare, has been making great progress in revolutionizing medicine and incidents of medical negligence.
Several startups and enterprises are now leveraging the power of ML to develop algorithms with capabilities that can help doctors predict potential medical problems and come up with effective treatment processes.
The healthcare industry is continually evolving, and there are new illnesses that scientists and epidemiologists are discovering. However, not every doctor can be aware of every published journal. Machine learning tools can scan these journals, match the presenting symptoms, and make diagnostic and therapeutic recommendations based on their readings. In fact, many experts now believe that the spread of COVID-19 could have been prevented had leading doctors been able to use ML to scan for journals about an earlier study that discussed a SARS-like virus with the potential to cause an epidemic.
Removing Specialty Bias
Most cases of medical malpractice arise due to limited knowledge. You cannot expect a dermatologist to diagnose certain infectious diseases of the lungs, for example. Extensive coordination between specialists may cause a patient’s condition to worsen as time passes. With AI technology, computers can process information and suggest possible diagnoses. Doctors can take these recommendations to help narrow down their choices. It will then be easier for a dermatologist to know if they should refer your case to a hematologist or an infectious diseases expert.
Eliminating the Blame Game
Perhaps one of the most vital contributions of technology in hospital negligence is eliminating the blame game. Suppose for example that both the doctor and machine arrive at a misdiagnosis. In this case, it may be easier for the patient to accept that there was no negligence and that their particular case is so rare that there isn’t enough information for diagnosis or treatment. With the full acceptance of their medical condition, it would be easier for patients to welcome adjuvant therapies that can help them get better.
AI in healthcare is still young. There are many facets of medical care that still need refining, bugs to address, and tons of privacy issues to fix. These medical innovations still need time to fully come to fruition and need to be developed in a way that will not cause additional negligence. For now, patients need to place their full trust in their doctors, who, in turn, should care for their patients to the best of their capacity.
Twenty years ago, technology consultants started advising CIOs to build less. That’s when the movement towards Commercial Off the Shelf (COTS) began.
Today, there are many shops, especially those in small and medium-sized organizations, with few programmers who build new applications from scratch.
Yes, they have programmers who configure, script, and integrate various applications but very little is built. For the provider community, we have a habit of either sourcing our needs from our Electronic Health Records (EHR) application vendor or buying a “best of breed” application from a niche vendor.
Moving to Software as a Service (SaaS) has even reduced the dread of upgrades. No doubt buying commercial software has enabled all of us to have access to better solutions and in some cases, may have reduced the ongoing run rate. Still, it means technology costs have gone up and a lot of our technology goals have not been achieved.
For example, interoperability remains a point to point problem. ONC and CMS are still pushing to remove barriers to interoperability and have mandated data exchange with penalties.
CIOs are struggling with the realities of constraint budgets where new programs are starving while dollars go to pay maintenance, integration costs associated with prior purchases (e.g. tech debt).
Then, in a year of the normal pull-and-tug between maintaining current and delivering new systems, COVID-19 arrived and our planning fell short. Technology teams were challenged as never before. They suddenly needed to:
– Enable teams to work from home – even teams who have never worked remotely.
– Stand up telehealth solutions in days – not months.
– Find a good external data source with statistics to integrate and then discover a newer, better source days later.
– Provide real-time updates on the availability of hospital rooms to leadership.
– Provide rapidly evolving guidance to patients on admissions changes, new requirements for entrance to facilities reduced access to admitted patients.
– Be a trusted, consistent source of guidance to reduce the spread of the disease.
This was all new, unplanned work. Work that took resources from other budget areas and other teams. Work that didn’t always meet our aim for better patient care or patient experience.
For example, we saw some providers advertising the availability of telehealth services but requiring a patient to call their primary care doctor to schedule instead of requesting an appointment online. Then due to staff shortages, the patient would land in voice mail, further delaying access to care.
Patients needing tests have been told to get an order from their physician. The truth is telehealth isn’t integrated and isn’t part of our daily processes.
The story here is the emergence of an unsung hero you can’t find on the nightly news: our IT Teams. We need to arm this group of heroes with better tools. Tools where delivery of new programs, updates to existing processes and integrating new data from external sources can be done in days, not months.
Did your clients link to external data sources such as John Hopkins? Did they need to enable test sources from new partners? Did they need to build new mobile applications to integrate workstations in parking lots and third-party locations?
New approach – Low-Code
Today’s challenges require a new approach that is “low-code.” Low-code is shorthand for an application development environment that is primarily visual and uses simple declarative statements to create applications. The primary goal of low-code is to accelerate program delivery.
This is surely a goal for every healthcare technology team. As enterprise clients embrace low-code, they can ensure readiness by putting these building blocks in place so clients can realize the promised value:
– Authentication Management through APIs (OAuth)
– Standardized access through APIs
– Management and Monitoring
In preparation for the adoption of a low-code application platform (LCAP), it is essential to assess the adoption of authentication best practices.
The technology landscape now spans on-prem, private cloud, and public cloud solutions requiring a standardized, tokenized approach to authentication. Without this, security processes will inevitably fall short of the CISO’s goals or will require additional manpower to monitor and maintain.
OAuth is the building block
Given the number of vendors, environments, and the velocity of human interactions (non-employee clinicians, temporary resources of all types, patients, etc.), OAuth is the building block for scalable secure authentication. OAuth is a delegated authentication framework that replaces the need to send credentials in program calls (APIs).
It has been required by CMS for the interoperability rule as a foundation for data sharing. If you haven’t, invest in a centralized identity management system and move to use OAuth to authenticate service and access requests. Standardizing authentication is foundational. Do it before selecting a low-code vendor.
LCAP platforms deliver a variety of methods to access data from other applications. Typical integration patterns include files, database calls (ODBC, JDBC, etc.), and scripting.
Now is the time to adopt API-First and design thinking. Stop building point-to-point integrations – the velocity of LCAP will result in a proliferation of connection methods if interfaces are not standardized.
Using APIs – fast delivery
Using APIs will enable faster delivery and better performance. Providing a set of standardized interfaces that meet the needs of consumers (a fundamental goal of API-First) will reduce test time, production breakage, and upgrade complexity. Don’t wait.
Doing APIs right requires a culture shift – slapping an API on an enterprise application is not the goal. Delivering APIs that drive consumption and adoption by citizen developers and go-to-market programs will power user experiences that truly do more with less.
Management and monitoring
Last but not least is the management and monitoring of your new agile applications, especially the application interactions with your core enterprise applications and external integrations. We have all seen it, a new program or upgrade is delivered, and performance slows to a crawl.
Monitoring and metering access (limited access to X number of calls per time period) is essential to proactively prevent coding errors and shield your client from bad actors. Knowing who is accessing what, and how the load varies, is necessary to achieve the goals of delivery velocity and efficient use of resources.
API Management vendor leaders include policy engines, management, and embedded analytics in their gateways to protect and scale service integrations.
Better, faster, cheaper is our mantra (once again, some of us mutter under our breaths). Adopting low-code will accelerate delivery and help us meet the demands of the new normal.
LCAP demands standardized authentication, application program interfaces (APIs), and secure, monitoring gateways to accelerate adoption while protecting and securing enterprise resources.
About Ruby Raley
Ruby Raley is VP of Healthcare and Life Sciences at Axway. Axway empowers customers to compete and thrive in dynamic marketplaces using hybrid integration solutions to better connect their people, systems, businesses, and digital ecosystems. More than 11,000 organizations in 100 countries rely on Axway to solve their data integration challenges.
– Innovaccer launches a perioperative
optimization solution for surgeons to realize clinical and financial goals with
– The solution redefines surgical planning and
post-surgical recovery with machine learning-based patient stratification for
optimized surgery experience and personalized patient care management.
Innovaccer, Inc., a San Francisco, CA-based healthcare technology company, recently launched its perioperative optimization solution for health systems. The solution optimizes surgeries and ramps up volumes by identifying high-risk patients for pre-surgical intervention while reducing the length of stay, readmissions, and cost. The solution uses advanced analytics and machine learning-based algorithms to proactively identify patients at greater risk for post-surgical complications. Patients are then referred to the pre-surgical optimization clinic for pre-surgical strategies which are personalized for individual patients and specifically designed to minimize post-surgical complications.
Impact of COVID-19 on Elective Surgeries, Non-Essential
has challenged traditional healthcare delivery systems and caused the
postponement of elective surgeries and other non-essential medical care. As
patients wait for their surgeries, it is likely their conditions could
deteriorate and/or patients would return to clinics during a pandemic surge.
Health systems will need to be prepared to address the potential for more
complicated patient health conditions with careful risk assessment.
Pre-Surgical Optimization Platform Features
Innovaccer’s “Pre-Surgical Optimization” solution guides patient prioritization based on an algorithm that factors medical history, patient demographics, allergies, chronic conditions, history, and social determinants of health. Based on the previous data on these patients from the electronic medical record, claims, and the individual’s risk factors, the algorithm estimates the future cost of care for the patient. The algorithm also assigns patients to appropriate case managers using a smart rule engine that assesses a variety of factors including the number of appointments, and the surgeon’s expertise to map the patient to the provider. This approach helps hospitals identify high-risk patients and focus on the patients that will benefit most from pre-surgical interventions.
Return on Investment Model for Healthcare Organizations
Innovaccer has also incorporated a refined return on
investment model designed to make the optimization process revenue positive for
healthcare organizations. The three key pillars of the exclusive model are
sensitivity analysis tools, deep data insights, and performance analytics.
Using this solution, hospitals can track their return on investment in
real-time on a customizable dashboard with metrics including reduced
readmissions, reduced length of stay, and emergency department visits with
their associated costs.
“With about 28 million surgeries canceled worldwide, non-COVID medical care has suffered tremendously. Canceled elective surgeries have impacted patient health conditions and the economic sustainability of health systems,” says Abhinav Shashank, CEO and Co-founder of Innovaccer. “As health systems plan to resume surgical procedures, care managers will need to engage the patient remotely for pre-surgical interventions. Our solution is created to redefine the entire process of optimizing surgery planning and to become more patient-centered and adaptable to the changing care environment. We want to ensure exemplary pre-optimization and post-discharge engagement to reduce readmissions and improve the hospital’s financial impact using the pre-surgical optimization process.”
– Lumeon, the leader in care pathway orchestration
announced it has raised $30M in Series D funding to extend the reach of its
Care Pathway Management (CPM) platform.
– The platform empowers providers to improve care
quality, deliver better outcomes, reduce costs, and ultimately develop and
scale new models of care delivery – particularly important right now as
COVID-19 accelerates the technology-driven transformation of healthcare.
Lumeon, a Boston, MA-based provider of care pathway orchestration, today
announced that it has closed $30M in Series D funding led by new investors
Optum Ventures and Endeavour Vision, with participation from current investors
LSP, MTIP, IPF Partners, Gilde and Amadeus Capital Partners. The investment
will enable the company to extend the reach of its Care Pathway Management
(CPM) platform, which helps healthcare providers automate their patient care coordination
to improve care quality, deliver better outcomes and reduce costs.
Why Care Pathways?
With proven ability to reduce unwarranted
variation and lower the overall cost of care delivery, care pathways are
an increasingly attractive proposition for healthcare providers.
The challenge, however, has always been to take paper-based pathways off the
page and into operational reality. This means being able to direct tasks and
coordinate care across clinicians, ward managers, nurses, patient educators –
the entire team responsible for successful care delivery – even the patient
Deliver Engaging Virtual Care Journeys
Founded in 2005, Lumeon’s platform connects
the care journey across the care continuum, operationalizing care plans beyond
the four walls of your hospital. Lumeon’s CPM platform
uses real-time data to dynamically guide patients and care teams along their
care journeys. By automating, orchestrating and virtualizing care delivery
across care settings, Lumeon’s solutions allow health systems to operate with
predictability and efficiency, delivering optimal care to each patient while
substantially lowering costs for healthcare providers.
Lumeon’s CPM platform
integrates with all electronic health record (EHR) systems in addition to
incorporating required clinical and administrative data from point solutions
and devices, addressing the fragmented nature of healthcare technology and the
challenge of interoperability. By extending beyond the confines of a healthcare
provider’s EHR, Lumeon’s configurable solutions maximize current investments as
organizations evolve their care delivery models.
“While the markets for data analytics, clinical decision support and patient engagement are well established, what is missing today is the ability to effectively connect them to solve the problem of personalizing care delivery in a scalable way,” said Lumeon Founder and CEO Robbie Hughes. “The ‘last mile’ that turns the insight into action is the hardest part for health systems, and is the core of the Lumeon proposition.”
– Siemens Healthineers and Varian Medical announce a $16.4B deal in an all-cash transaction on 2nd August 2020.
– Deal expected to close in 1H 2021.
– Varian Medical will maintain its brand name and operate “independently”
– Siemens AG will drop holding in Siemens Healthineers from 85% to 72% as part of the transaction.
News of the deal between Siemens Healthineers and Varian Medical will have caught many industry onlookers off guard on Sunday evening. Flotation of the Healthineers business segment on the German stock market raised a few eyebrows back in 2017, but with Siemens AG retaining 85% of the stock, many observers postulated little change to the fortunes of the well-known business; an unwieldy technical hardware leader facing an uphill battle in an increasingly digital market.
However, the Varian deal has just made it very clear that Siemens Healthineers has emerged from the IPO with big ambitions and firepower to match. So, what does this mean for the future?
Three benefits of the deal are clear at first glance. Firstly, Siemens Healthineers will be adding an additional mature product set to its already strong modality hardware line-up. Radiation Therapy hardware (linear accelerators, or linac), is the lion’s share of Varian’s business, for which it is market leader holding over 55% of the global installed base in 2019. Combining this with Siemens’ extensive business in diagnostic imaging and diagnostics will create a product line-up that no major peer can today match. It also opens up opportunities for providing “end-to-end” oncology solutions (imaging, diagnostics, and therapy) under one vendor, a strong play in a market where health providers are increasingly looking to limit supply chain complexity and explore long-term managed service deals with fewer vendors.
Secondly, Varian is operating in a relatively exclusive market, with its only main competition coming from market peers Elekta and Accuray Inc. Demand for linacs has been consistently improving in recent years, with Varian suggesting only two-thirds of the Total Addressable Market (TAM) for Radiation Therapy has been catered for so far. The acquisition, therefore, opens a new growth market for Siemens Healthineers to offset the gradual slowing demand for its advanced imaging modality (MRI, CT) business, a more competitive and mature segment. The adoption of Radiation Therapy in emerging markets such as China and India is also well behind advanced imaging modalities, offering new greenfield opportunities near term, a rarity in most of Siemens Healthineers’ core markets.
Thirdly, Varian has grown to a size where progressing to the next level of growth will require substantial investment in operations and new market channels. Revenue growth over the last five years has been patchy, though gross margin remains strong for this sector. If Siemens can leverage its far larger operational and sales network and apply it to Varian’s product segments, none of Varian’s current main competitors will have the resources to compete, unless acquired by another major healthcare technology vendor.
The Digital Gem
While the Radiation Therapy hardware business has gained the most attention for its potential impact on Siemens Healthineers’ business, Varian’s software business is arguably its most valuable jewel, hitting almost $600m and 18% YoY growth in FY19.
Many healthcare providers have become increasingly beleaguered by the challenges of digitalization today, especially in terms of complex integration of diagnostic and clinical applications across the healthcare system. This frustration is especially common in Oncology, which sits at the convergence of major departmental and enterprise IT systems, including the EMR, laboratory, radiology, and surgical segments.
Changing models of care provision towards multidisciplinary collaboration for diagnosis and care have only intensified focus on fixing this issue, with some preferring single-vendor offerings for major clinical or diagnostic departments. The Varian software suite is one of the few premium full-featured oncology IT portfolios available today, competing mostly against main rival Elekta, generalist oncology information system modules from EMR vendors (few of which have the same capability) and a host of smaller standalone specialist IT vendors.
For Siemens Healthineers, the Varian software asset is a great fit. Siemens has for some time been gradually changing direction in its digital strategy, away from large enterprise data management segments towards more targeted diagnostic and operational products. This process began with the sale of its EMR business to Cerner for $1.3B back in 2015, with notably reduced marketing focus and bidding or deal activity on big imaging management deals (PACS, VNA etc.) in North America in recent years.
Instead, Siemens Healthineers has channeled its digital efforts on three main areas where it has specialist capabilities: advanced visualization and access to artificial intelligence for image analysis; digitalization of advanced imaging hardware modalities, including driving efficiency for fleet management and radiology operations; and lab diagnostics automation. While still early in this transformation, this approach is tapping into the main challenges facing most healthcare providers today; improving clinical outcomes at a net neutral or reduced cost, better managing and reducing Total Cost of Ownership (TCO), and implementing autonomous technology to augment clinical and diagnostic practice.
Assuming integration with Siemens’ broader portfolio is not too bumpy, it is already clear how the different software assets of the Varian business sit well with Siemens’ digital strategy. The Aria Oncology Information System platform will provide an entry point for Siemens to build on clinical outcome improvement in Oncology (along with Noona/360 Oncology) while also integrating diagnostic content from the Siemens syngo imaging and AI-radiology applications. Further, with growing attention on operational software to support modality fleet services and radiology operations, Siemens could translate this business into RT linac fleet management, an area currently underserved.
With no competing vendor today able to match this capability in Oncology IT, the potential long-term benefits for Siemens’ digital strategy with Varian far outweigh the risks of integration.
From Morph Suits to Moon-shots
As alluded to in our introduction, perhaps most intriguing is the bullish signal Siemens Healthineers has made to its customers and the wider market about its future.
The Healthineers 2025 strategy identified three clear stages of transformation, with “reinforcing the core portfolio” the key aspect of the 2017-2019 post IPO. In the second phase “upgrading” the business focused on pushing up growth targets and earnings per share across all segments while adding capabilities in allied markets.
Judged against the criteria for the “upgrading” phase, the Varian deal has ticked all the boxes, perhaps clarifying why Siemens was willing to pay a premium:
The scale of the deal has also reinforced that the gradual untethering of Siemens Healthineers from its corporate parent Siemens AG is bearing fruit, both in terms of flexibility to deal-make and the ability to use the financial firepower of its majority shareholder for competitive gain.
The deal, once completed in 1H 2021, also now puts Siemens Healthineers in an exclusive club of medical technology companies with annual revenues above $20B, with a potential position as the third-largest public firm globally (based on 2019 revenues, behind Medtronic and Johnson and Johnson).
It is therefore hard to argue that the Varian acquisition can be viewed as anything but positive for Siemens Healthineers. Given the current impact of the COVID-19 pandemic and expected challenging economic legacy, the growth potential of Varian will help to smooth the expected mid-term dip in some core business over the next few years.
Yet it is the intention and message that Siemens Healthineers is sending with the Varian acquisition that has is perhaps most impressive; despite the turmoil and challenges facing markets today, it fundamentally believes in its strategy to reinvent its healthcare business and target precision medicine long term.
Its major competitors should sit up and take note; Siemens Healthineers is fast re-establishing itself as a leading force within healthcare technology. The morph suits of the “Healthineers” brand launch was just one small step on this journey; the Varian acquisition is going to be one great leap.
About Steve Holloway
Steve Holloway is the Director at Signify Research, an independent supplier of market intelligence and consultancy to the global healthcare technology industry. Steve has 9 years of experience in healthcare technology market intelligence, having served as Senior Analyst at InMedica (part of IMS Research) and Associate Director for IHS Inc.’s Healthcare Technology practice. Steve’s areas of expertise include healthcare IT and medical Imaging.
It wasn’t that long ago that people went to the bank on a Friday to cash their paper paychecks. Maybe they’d put some in checking and take some out in cash. They’d go to the grocery store over the weekend and maybe write one of those checks. Everyone always had to have a pen with them.
It wasn’t that long ago that people would call the ticket agent and discuss flight options for vacation. They’d send a paper ticket in the mail. When it was time to go, people would carry that ticket with them through the airport and onto the plane. (Of course, people could also keep their shoes on and could bring as much shampoo as their heart desired).
It wasn’t that long ago that if someone needed surgery, they’d have to call to schedule it. The hospital would call again the day before to tell them what time to come. People would travel there, fill out a bunch of paperwork, and be wheeled around to several different areas and talk to several different people. Eventually, they’d wake up post-surgery in a hallway with a bunch of other people and hopefully a family member. They’d wheel the person to their room where they’d have a small TV for entertainment, a dry erase board with some names on it and maybe the room number, and a stack of papers on the bedside table – cafeteria menus, instructions, important phone numbers and the like.
Oh wait – that time is now.
Better, more convenient systems are a no brainer for industries like banking and travel, but the hospital experience is still rife with paper handouts, basic cable packages, and manual dry erase boards with markers that don’t work half the time. Patients shouldn’t settle for that, and in this era when COVID-19 has led healthcare to embrace lots of other conveniences (like telehealth for remote doctors’ appointments), they won’t settle for it anymore.
Imagine a new kind of hospital room. While nobody should take a patient’s TV away, there’s so much more that can be done with patient TV. Most people have smart TVs in their homes that serve as a complete hub for their entertainment. Add a smartphone to the mix, and people can do nearly anything from their couch. A hospital bed should be no different.
Since EMRs became mandatory years ago, hospitals have relied on them as the source of truth for patient records and information. But EMRs paired with additional technology can do so much more. Now, hospitals can pull information from the EMR to personalize the patient experience. Imagine a hospital room TV greeting you by name with soothing music and welcoming imagery. Imagine the pillow speaker handset transforming into a smart TV remote where you can peruse movies on demand, live TV, or Netflix. Take it a step further – imagine that TV can talk to your EMR, so you can watch educational content just for you based on your condition, so you can learn about your care, treatment, and how to recover when you go home.
Imagine adding more systems. Integrate dietary systems (in concert with the EMR) to let patients order their meals without sifting through paper and dialing phone numbers – as they do at home when they’re using DoorDash. Imagine letting patients dim the lights, request a blanket, or turn the thermostat up if they’re cold, without climbing out of bed and risking a fall. Imagine letting patients use their phones to input important information for the care team to know, or to video chat with a “visitor,” even during a pandemic when in-person visits aren’t allowed – even if the person on the other end doesn’t have a Zoom account or an iPhone for FaceTime.
Imagine never seeing a dry erase board in a patient room again. Instead, a digital display automatically updates with all the patient’s latest information, based on what’s in the EMR.
Imagine up-to-the-minute precautions displayed instantly and digitally outside each patient’s room so care teams know what PPE they need before they go in.
Technology exists to do all these things. The early adopters are already seeing increased patient satisfaction scores that seem to consistently climb. Beyond that, especially now when nurse retention and preventing care team burnout are paramount, these technologies alleviate the burden on them. Streamlining, digitizing, and virtualizing all aspects of care and a patient’s time in the hospital benefits staff, too. When nurses don’t have to search all over to find markers that work or run back and forth to the printer to get pages of hand-outs for patients, they can spend more quality face time with patients and operate at top of license.
When patient education is delivered in the right way, at the right time to the bedside, you’re not just saving printer paper – you’re giving patients the tools to succeed at home and avoid costly readmissions. It’s time to reimagine healthcare, and there’s no better time than now when the window to adopt new technology is wide open.
About Jeff Fallon
Jeff Fallon brings over 30 years of experience in healthcare technology, medical devices, pharmaceuticals, and diagnostics to eVideon as their Chief Executive Officer. Prior to joining eVideon, he helped distinguished organizations such as Johnson & Johnson and patient experience technology companies forge innovative strategic relationships and strategies.
– Innovaccer has recently partnered with Central Maine
Healthcare (CMH), an integrated healthcare delivery system that serves over
400,000 people in the central, western, and mid-coast regions of the state, to
connect providers with their patients through data-driven telehealth, powered
by its FHIR-enabled Data Activation Platform.
– The care delivery system will conduct data-enabled
virtual visits to assist its providers with efficient, remote care amid the
COVID-19 crisis and beyond.
Innovaccer, Inc., a
San Francisco, CA-based healthcare technology company, has partnered with Central Maine Healthcare (CMH), an integrated
healthcare delivery system that serves over 400,000 people in the central,
western, and mid-coast regions of the state, to connect providers with their
patients through data-driven telehealth,
powered by its FHIR-enabled Data Activation Platform. The collaboration will
empower physicians at CMH with the ability to care for their patients with
real-time virtual visits and remote consultation experiences during the
When many patients are reluctant to visit the clinic to
avoid potential exposure to the coronavirus, healthcare organizations are
implementing virtual exam rooms and data-enabled telehealth visits for
chronically-ill patients in their care.
With Innovaccer’s Virtual Care solution built on top of its
FHIR-enabled Data Activation Platform and its data-driven telehealth
capabilities, the providers at CMH can conduct online patient consultations as
seamlessly as traditional onsite visits. The care teams at CMH can streamline
their workflows with the solution’s automated bulk messaging and outreach
capabilities. The platform will also assist providers in expediting the
follow-up process through telehealth consultations with secure messaging and
improve patient engagement with the health system.
In addition to scheduling HIPAA-compliant HD video visits,
the solution’s virtual patient examination room can empower providers at CMH to
send and receive pre-visit assessments, texts, and email through secure
Providers at CMH will be using the Virtual Care solution to
provide educational material for their patients, conduct smart outreach and
enable pre-visit planning with accurate patient self-assessments. With the
solution, providers at CMH can manage post-call logs to streamline their care
Given the situation we are all in, healthcare needed a new approach to tackle the pandemic. Central Maine Healthcare adopted a modern approach to care delivery where our primary focus was to offer our patients a virtual care option to make it easier for them to seek care, wherever they may be. Innovaccer’s FHIR-enabled Data Activation Platform expertise will be helpful for us in strengthening our virtual care and it will be a good addition to our strategy going forward,” says Steven Martel, MD, Chief Medical Information Officer, CMH
– Medly Pharmacy raises $100M investment co-led by
Volition Capital and Greycroft to propel Medly’s leadership in the $500B+
digital on-demand pharmacy market.
– Medly will use the funding to expand its digital on-demand pharmacy platform, enter new markets, and provide category-leading services to patients and partners across the country that is well-positioned to meet new customer needs.
Founded in 2017 by second-generation pharmacy owners Marg
and Sahaj Patel, Medly Pharmacy is a full-service, digital pharmacy under
parent company Medly Health that offers free same-day prescription delivery.
Combining dedicated customer service with two generations of pharmacy
expertise, Medly works with providers and patients to personalize every aspect
of the care journey.
No-Cost Prescription Delivery Model
Medly provides no-cost prescription delivery to customers’
homes from its branded physical retail locations, which also accommodate
walk-in patients. Medly maximizes convenience and personalized service,
enabling customers to schedule their own delivery window, consult with
pharmacists, and manage their prescriptions directly from a desktop or mobile
Medly has quickly grown into a category-leading digital
pharmacy known for continuously innovating and setting the leading edge of the
fast-growing $500B digital pharmacy segment. Medly has invested heavily in
customer experience as well as the underlying pharmacy technology that creates
value for stakeholders across the entire healthcare ecosystem. Since its
inception, Medly has grown 100X in revenue, added 15,000 providers, 50,000
patients, and delivered over 500,000 prescriptions. The company has a net
promoter score of 87, which is 4.5 times greater than the average pharmacy.
With the investment, Medly will continue to expand its
platform, enter new markets, and provide category-leading services to patients
and partners across the country. The company’s hybrid pharmacy model is
well-positioned to meet new customer needs, especially as healthcare technology
and innovation have come directly into focus in response to coronavirus.
“We continue to improve patient care by empowering customers to access prescription drugs on their own terms through a potent combination of physical and digital pharmacy services,” said Marg Patel, CEO and Co-Founder of Medly. “We are excited to continue to build on that vision by opening locations in new markets and forging meaningful, long-lasting relationships with patients, physicians, drug manufacturers, and insurance companies.”
– Emtiro Health, an
innovative population health company in North Carolina has selected Innovaccer
to deliver data-powered solutions to enhance the efficiency and effectiveness
of care delivery.
– Powered by Innovaccer’s FHIR-enabled Data Activation
Platform, Emtiro Health will create unified patient records that drive
comprehensive, whole-person care management, no matter where they are on the
care continuum. The FHIR-enabled Data Activation Platform will also deliver
highly actionable data, automated care management workflows, and smart patient
Emitro Health, a
Winston Salem, NC-based population
health company, today announced a partnership with Innovaccer, a San Francisco, CA-based
healthcare technology to enable the effective delivery of services to the
patients and providers supported by Emtiro Health.
Emitro Health Background
Emtiro Health supports providers, systems, and payers with unparalleled expertise and knowledge augmented by data and analytics. This platform enhances the patient experience and improves outcomes while delivering effective healthcare at a lower cost. Emtiro Health addresses the systemic barriers to total wellbeing and helps patients chart a course to brighter futures. The organization’s experienced team brings diverse backgrounds and skillsets to complement a whole-practice approach from practice optimization and transformation, data analytics, and quality reporting to the integration of services, such as clinical pharmacy and behavioral health.
Data Activation Platform
Powered by Innovaccer’s FHIR-enabled Data Activation Platform, Emtiro Health will create unified patient records that drive comprehensive, whole-person care management, no matter where they are on the care continuum. The FHIR-enabled Data Activation Platform will also deliver highly actionable data, automated care management workflows, and smart patient engagement. Emtiro Health’s provider partners will be equipped with point-of-care insights that surface relevant information for patient health in real-time. The entire suite of solutions will enable Emtiro Health to improve the effectiveness and efficiency of both providers and care, management teams, allowing them to care as one for patients.
Unified Health Record
FHIR-enabled Data Activation Platform helps healthcare organizations obtain a
complete picture through their unified patient record. The data is then
activated for smart analytics and decision support — so, care teams have the
crucial information they need to provide better care and to care as one.
“Emtiro Health selected Innovaccer to provide customized business intelligence and analytics solutions to our partners to revolutionize how the right level of care is delivered to the right patient at the right time. The Innovaccer data platform coupled with Emtiro Health’s expertise in delivering a total population health model of care management is a game-changer for providers and patients alike,” said Kelly Garrison, President and CEO of Emtiro Health. “In practice, this collaboration will mean more informed care, healthier individuals and healthier communities in North Carolina.”
With public and private healthcare spending significantly outpacing that of other countries, U.S. hospitals face intense pressure to find new ways to capture greater value. More and more, organizations are finding that partnerships with existing vendors can help unlock next-level performance gains in a transformative environment.
Take Nebraska Medicine, for example. In the early 2000s, the health system created multidisciplinary committees to boost revenue integrity and adopted new revenue cycle management processes that strengthened performance—with strong results. But best practices alone are no longer enough to fuel revenue cycle gains at a time of decreased reimbursement, rising out-of-pocket costs, and staffing issues. “You’ve got to be able to get to the data,” says Jana Danielson, Executive Director, Revenue Cycle for Nebraska Medicine—a $1.8 billion academic medical center with two hospitals, ~450 revenue cycle staff, 913,000 hospital billing claims, and 1.6 million physician billing claims per year.
“Without real-time access to data and data analytics, revenue cycle teams risk making decisions based on emotions, not facts,” Danielson says. “Our partnership with a vendor enables our revenue cycle team to more effectively use data to identify our pain points and empower team members to take the right steps for improvement.”
Nebraska Medicine’s experience points to four ways healthcare organizations can establish partnerships with vendors that drive innovation and performance excellence.
1. Look for a partner that will challenge your assumptions around performance
The right partner will dig deeper, not only tracking key performance indicators (KPIs) but also taking a hard look at how these KPIs were calculated.
For example, in revenue cycle management, there are many ways to track clean claim rates, a measure that reflects the quality of claim data that is collected and reported. Some organizations consider a clean claim rate to be the percentage of claims accepted by the payer on the first pass. Others calculate it as the percentage of claims that pass through the organization’s billing department without manual intervention before being submitted to the payer. Depending on how this metric is calculated, sometimes a percentage that seems to indicate above-average performance in comparison with peers may not reflect breakdowns in processes that have occurred before a claim is submitted.
At first glance, Nebraska Medicine’s clean claim rate in 2017 was strong:
95.87 percent for a physician billing and 87.59 percent for hospital billing. However, using claims analytics, the health system uncovered a hidden challenge. Some billers were bypassing the claim edits. In those instances, claims were being submitted before corrections were made. The result: a lower-than-expected clean claim rate.
Nebraska Medicine’s revenue cycle leaders worked with the organization’s vendor to tackle this challenge. The revenue cycle department developed scorecards by individual employees that showed their performance against key metrics, including their rate of bypassed edits, and reiterated expectations for revenue cycle processes. Within three months, the number of bypassed edits significantly decreased. Today, Nebraska Medicine’s clean claims rate averages 93.78 percent—well above the industry standard—for more than 900,000 hospital claims per year.
At Nebraska Medicine, Reduction in Bypassed Claim Edits Drives High Clean Claims Rate
2. Make sure the vendor has both product knowledge and operational expertise
Many vendors make the business case for partnership based on the quality of their product or system, such as a 99 percent clean claim rate or a 3 percent denial rate. Some back up their product expertise by regularly working with clients to optimize their use of a technology or service—and it’s a solid step toward a true partnership.
But the best vendors also commit to understanding the context in which their products or services are used in your organization. They examine your team’s work processes and draw upon their operational expertise to make suggestions for improvement, even when the modifications they propose fall outside their paid relationship with your organization.
Consider that 90 percent of patients expect out-of-pocket estimates before care is delivered—not surprising, given the rise in high deductibles and patients’ expected contribution toward their healthcare costs. Providing a patient financial “concierge” at the point of contact not only helps patients better understand their out-of-pocket obligation but also bolsters an organization’s ability to:
– Collect copays upfront
– Explore barriers to payment and patient-tailored solutions
– Increase point-of-service collections and revenue
The right vendor will offer both tried-and-true and out-of-the-box suggestions to drive increased efficiency and revenue, regardless of whether this boosts the vendor’s bottom line.
We’re at the tip of the iceberg when it comes to using artificial intelligence (AI) in healthcare. AI offers a massive set of capabilities for innovation and improvement in healthcare, including in revenue cycle. For example, the use of machine learning has the potential to elevate revenue cycle performance by predicting:
– When a claim will be paid—and how much—down to the hour of remittance
– The probability that a claim will be denied payment—and why
– Whether a patient encounter will require prior authorization before the date of service
– Whether new edits need to be incorporated into existing workflows based on payer responses and denials
But is now the right time for your organization to invest in AI for revenue cycle, or are there other, more foundational competencies your team should hone first? The best vendors keep a pulse on the industry’s newest innovations and partner with you in determining the right approach for your organization. They also help make the business case for innovation to senior leaders, when appropriate.
As Nebraska Medicine examines opportunities to leverage AI in revenue cycle, it has worked with a claims analytics vendor to assess how payer behavior affects revenue, both in the short term and long term. At a time when the nation’s biggest health plans vary greatly in their time to payment, instant access to payment trends by individual payers empowers Nebraska Medicine to have more candid conversations with payers around performance. It also strengthens Nebraska Medicine’s contract negotiating power.
“We want to make sure we’re not at the bottom of the pile when it comes to our relationships with payers,” Danielson says. “If we are, we need to be able to dive into the specific issues that need to be fixed to improve performance.”
4. View your vendor as a strategic ally
Sometimes, you don’t know what you need until you see it. Other times, the pain points you’re sure to require dedicated focus turn out to be pebble-sized problems, not boulders. The key to finding a true partner in innovation is to actively seek a vendor that demonstrates not just a superior level of service, but also a strong willingness to listen to clients and share candid feedback.
For example, senior leaders at Nebraska Medicine once asked revenue cycle leaders to uncover what they viewed as “skyrocketing denials rate.” Danielson partnered with the health system’s claims analytics vendor to drill down, by payer, into first-pass denial rates, partial denial rates, and more to provide a complete picture of denials status. These efforts showed one payer’s clean claim rate was 10 points lower than that of its peers.
However, the payer did not account for significant patient volume, translating to a small impact on revenue cycle performance. Nebraska Medicine determined it could make a bigger difference in lowering denial rates by focusing on the organization’s largest payer—avoiding a complete overhaul to the revenue cycle team’s payer relations approach.
Creating an Innovation Mindset
The bar for revenue cycle performance is rising, especially with continued dips in reimbursement rates, an uptick in challenges to claim payment, and an environment where consumers are the new payer. Moving past the traditional mindset of what a vendor relationship should look like toward an innovation mindset enables leaders to more fully benefit from a vendor’s subject matter expertise and accelerates gains in performance.
About Eric NilssonEric Nilsson joined The SSI Group, LLC (SSI) as the Chief Technology Officer to lead SSI’s long-term technology vision. He brings nearly 30 years of experience in the software industry with the last 10 in healthcare technology. Prior to joining SSI, he served as the chief technology officer at Nextech and Surgical Information Systems (SIS), where he focused on SaaS, on-premise EMR and practice management solutions as well as inpatient and ambulatory surgery providers from large hospital networks to surgery centers.
The loss of lives and livelihoods from COVID-19 is almost too much to comprehend. And yet, slowly, conversations are emerging about the positives percolating from the pandemic.
It’s human nature to want to look for the positives in even the worst of situations, and I’ve noticed that in both my personal and my professional circles of late, people are talking about the things they hope we don’t lose when things go back to “normal.”
Chief among them, especially in my healthcare technology circles, is a level of humanity that our previously faster-paced lives, ways, and organizations had perhaps too often and too easily dismissed. Humans on the frontline of care delivery, for example. The effects of social isolation on healthy people, much less those who are sick. The struggle and juggle of modern work-life balance. Inequalities in healthcare access and delivery.
We’ve long talked about technology’s ability to make some of these things easier, to close some of these gaps, but now we know just how possible they are when people, politics, and policy unite in the face of a pandemic. We now know just how quickly even the largest and slowest-moving of health systems can change course and even course-correct.
Until now, it’s been far easier to talk about the promise of technology, telemedicine, and remote workforce scenarios than it was to actually deploy them. Because before, to deploy such solutions also meant loss; loss of control, loss of normalcy, loss of humanity. Until now.
Now, the very things that once seemed to threaten us are bringing us and our organizations closer together. They’re also shining a light on the hard facts about the real value (indeed, the necessity) of such soft skills as empathy, communication, and human insight; skills that have never been more important nor more obvious in the deployment of technology, applications, and people to deliver care.
Amid the COVID-19 recovery that we all hope is near, here are three things from which I hope we never recover:
1. Virtual Care Support and Delivery
Whether telemedicine, telehealth, or the remote workforce, we’ve not merely crossed the chasm but bridged it, and I predict we’re here to stay.
Prior to COVID-19, less than 10% of healthcare visits were conducted with telehealth and/or telemedicine. That number is now estimated at 40% to 50%, and it’s unlikely that the cat gets put back in the bag, nor should it.
Key enablers of this long-overdue trend have been changing reimbursement policies, the relaxing of regulations governing patient data, and the ability of doctors to treat patients across state lines and platforms thanks to various state and federal licensure waivers.
Necessity, too, has relaxed the barriers to working remotely, which until now was relatively unheard of for large health systems with equally large corporate and back-office staff and campuses.
Back in my CIO days, I too was a believer in the importance of physical office presence. I wanted to see the 50-plus people on my service desk. It provided a comfort level that people were doing their jobs and doing them at the levels that I and our patients expected.
Being on the consulting side, though, I’ve completely changed my mind. The flexibility of being able to work remotely is a phenomenal perk, and I dare say that the thousands now working from home would agree with me that you actually find yourself working more hours, not fewer, than in an office environment.
Countless IT Service and Support Desks, one of which I serve on the advisory board, has been working remotely throughout the pandemic, and they’re doing yeoman’s work in the face of huge increases in IT support for health systems across the country deploying more and new solutions for patients, physicians and staff alike.
For context, telehealth-related calls for one organization at which I serve on the advisory board have jumped 29% during COVID, accounting for more than 30% of calls compared to just 1% pre-COVID. EMR-related calls jumped 54% for one health system client, mostly due to telehealth appointments being conducted through patient portals such as MyChart. We also saw monthly call volume for that same client nearly triple during COVID, with more than 11,500 calls in April alone.
Overall, we saw a jump in average call duration of more than 60% for telehealth-related calls.
This is likely another trend that continues along with more and more teams working remotely, especially with tech giants like Facebook and Google once again setting precedent. Both recently announced they would let employees continue to work from home for the rest of the year. If that kind of flexibility holds, we’ll likely see unprecedented movement among the tech workforce who may now be freer to pick their employer without the prospect of having to pick up their lives and move.
This means pay, flexibility, and, yes, communication, become increasingly important in recruiting and retaining the best tech development and support teams.
2. Communication with Feeling and Facts
To be fair, communications were probably pretty good in most health systems prior to COVID-19, but it was likely more periodic and in the form of an email from HR rather than the constant communications with teams like we’re seeing now.
Every employer in the healthcare arena should continue to focus on employee and stakeholder communication as we see this pandemic through, and indeed well beyond it. According to research from McKinsey & Company, “The overwhelming effects of a crisis strip leadership back to its most fundamental element: making a positive difference in people’s lives. By turning inward to cultivate awareness, vulnerability, empathy, and compassion, and then turning outward to comfort and address the concerns of stakeholders, leaders can exhibit individual care, build resilience, and position their organizations to positively reimagine a postcrisis future.”
Most people are hungry for solid, factual information, and the more that can be disseminated to the organization the better. In fact, the latest Edelman Trust Barometer found that people have increasingly lost faith in traditional authority figures and institutions and have shifted their trust to the relationships within their control, most notably their employers.
When we demonstrate to our people and our patients that we understand their struggles and needs and that we trust them enough to share real, factual, meaningful information… as well as to work remotely and get the job done and done well… that’s when everyone wins.
3. Empathic HIT
There has been a dramatic shift in mentality about how and where people do their jobs as well as how and where they receive care. I’ve been heartened by the increased show of heart as we all navigate these uncharted waters.
I believe this uptick in empathy may, in fact, be COVID-19’s most meaningful consequence, and I believe empathic HIT has newfound intrinsic value. Here’s why.
Remember that dramatic increase in call volume and call duration that I mentioned earlier? Yeah, well guess why these calls are lasting longer. The Continuous Improvement Manager who supervises IT Support Desk teams at one organization I’m involved with tells me it’s because their people are focusing as much on the humans on the other end of the line and their holistic needs as they are on the reason they called in the first place.
Recently, one of the supervisor’s agents received a call from an elderly patient in her 80s whose husband had just passed away. To access his life insurance policy and cover funeral expenses, she needed to gather all sorts of health information, but she couldn’t access his medical records. Adding to her stress, she wasn’t particularly tech-savvy. The agent helping her knew the patient was already traumatized to have lost her husband, and she knew it had to be heightened by the pandemic, so she was determined to help ease some of her stress. Instead of transferring her to another department – billing, medical records, insurance – the Support Desk agent stayed on the line with her for two and a half hours, helping her through every phone conversation with all of the right people to ensure she received everything she needed.
While a lengthy phone call may sound like a relatively simple task for some, it meant the world to the human on the other end. These are the kinds of soft skills that make technology work for us. Empathic HIT Support understands that it’s not just a numbers game or getting to the next call. Rather, it’s about being a voice of comfort and reason and being curious enough to ask the questions that lead to the right answers, connecting people with technology in ways that lead to access to care and healing.
I’ve been both proud and impressed with how our healthcare providers have responded to the challenges we’ve been presented these past few weeks and months. We’ve probably grossly over-engineered as many solutions as we’ve simplified, but that’s ok. Healthcare people, in general, don’t wait for solutions, they usually create them. They’re creative people who want to do good for their patients and their people.
About Randy Carpenter
Randy Carpenter is currently the Senior Vice President of the Executive Advisory Board at HCTec. He has over 30 years of experience in all aspects of Healthcare Information Technology (HIT) and has held various leadership roles for healthcare and pharmaceutical services organizations throughout his career.
March 17, 2020, may well be remembered as the day the telemedicine revolution finally took off. Telemedicine and Telehealth‘s adoption, fast-tracked by Coronavirus/COVID, will create profound changes in how healthcare services are provided — while also spawning new healthcare marketing opportunities.
Earlier last month, in the interest of public safety, the federal government largely removed two huge and long-standing barriers to telemedicine adoption by easing reimbursement and HIPAA restrictions. Many private pay health plans followed suit. These changes open the door to exciting new ways to better serve patients today and to bolster, grow and sustain medical practices, medical offices, hospitals, and healthcare networks in the future.
Changes in healthcare and medical services delivery commenced almost instantly. For example, right around this time, we spoke with one of our multi-location oncology clients about our marketing teams‘ recommended changes to their marketing plans due to COVID-19. These discussions evolved to focus on their need to help cancer patients both safely and remotely, and their uncertainties regarding HIPAA. The new rules now allow the use of simple, practical, patient-friendly solutions like Apple FaceTime and Zoom, to communicate with homebound patients. True to their purpose, these new government proclamations have opened the door to safer, better, and more convenient care for cancer patients.
Our healthcare clients are not alone:
“With the coronavirus pandemic turning doctors’ offices into no-go zones, family physicians are now doing many of their consultations online or by telephone,” The New York Times reports. “In a matter of days, a revolution in telemedicine has arrived at the doorsteps of primary care doctors in the U.S. and in Europe. The virtual doctor visits, at first a matter of safety, are now a centerpiece of family doctors’ plans to treat everyday illnesses. We’re basically witnessing ten years of change in one week.”
Until now, operational challenges, internal politics, resistance from doctors, state law limitations, and HIPAA and reimbursement-related fears had stymied larger healthcare systems from embracing telemedicine. Due to COVID-19, these same players suddenly found ways to do the previously unimaginable – adopt telemedicine at scale in a matter of weeks.
According to Harvard Business Review, “Prior to this crisis, many major health care systems had begun to develop telemedicine services, and some, including Intermountain Healthcare in Utah, have been quite active in this regard. That said, nationwide use of telemedicine had been limited. John Brownstein, chief healthcare innovation officer of Boston Children’s Hospital, noted that his medical institution was doing more telemedicine visits during any given day in late March that it had during the entire previous year.”
During a recent webinar (COVID-19: Up to the Minute Learnings from Industry Experts on the Front Lines of the Coronavirus Pandemic), Ed Rafalski, Ph.D., Chief Strategy and Marketing Officer of BayCare Health said, “Necessity is the mother of innovation and invention here at Baycare. I have been trying to get the organization to get more providers stood up on our telehealth platform, and a crisis made it happen. So the good news is we’re adding capacity and getting providers trained that up until this point were either unwilling, or afraid, or too busy seeing patients. And so what’s happened is because people are canceling elective business, doctors have free time. So they’re saying, ‘Well heck, I’ll go ahead and get trained on telehealth.’ So we’re building our capacity exponentially, which is good news.”
Consumer and Doctor Acceptance of Telehealth: What Does the Data Shows?
With social and physical distancing, telemedicine has gained a greater consumer and provider appeal virtually overnight. Telemedicine is a new marketing opportunity, and now is the time to take full advantage of this shift. It’s likely to be a permanent change.
For their part, many consumers have been ripe for change for some time.
By 2019, American Well’s Telehealth Index: 2019 Consumer Survey, found 66% of consumers were willing to use telehealth, and 8% had tried it. As you might expect, attitudes toward telehealth varied by age. 74% of 18-34-year-olds and 72% of 35-44-year-olds said they were willing to use it, while 52% of seniors (65+) said they were open to telehealth. Of those who had used telemedicine, 54% were Millennials.
Speaking of Millennials, remember they were born into a tech-rich world. Millennials number over 75 million and 40 percent say telemedicine is an extremely or very important option. It’s in their digital DNA to expect and demand immediacy and convenience. What’s more, computers, laptops, mobile devices, and smartphones are ubiquitous, and virtually everyone is equipped for instant audio/video conferencing.
In response to COVID, Sykes TeleHealth Services just completed a survey to understand changing consumer perceptions and behaviors regarding telehealth in our new era. Interestingly, almost 42% of people initially screened were still not even aware of telemedicine, which disqualified them from taking the survey. Of the 2000 respondents (58% of the total) of people who ARE aware of telehealth:
When asked if their health insurance provider covers telemedicine, 52% said yes, 10% said no, and 35% weren’t sure.
When asked, “Have you ever considered trying a telehealth appointment?” 20% said they had already completed a telehealth appointment, 40% had considered it, but not yet made an appointment, 37% said they would consider it, and 3% said they wouldn’t consider it.
Importantly, people who try telehealth become satisfied enough to do it again. Of those who had tried a telehealth appointment, 59% said they’d already had more than one appointment, 37% said they’d consider scheduling another appointment, while 4% said they would not consider another appointment.
Most importantly, COVID-19 promises to be a game-changer. 73% of respondents said they’d be willing to use telehealth if they showed symptoms of COVID-19, while 60% said COVID-19 had increased their willingness to try telehealth in the future.
Meanwhile, even before COVID-19, physicians predicted a growing acceptance of telehealth. American Well’s 2019 Physician Survey reported that 69% of physicians were willing to have a video visit. The top reasons cited were increased access for patients, flexible work-life balance, to attract and retain patients, to improve outcomes, and to be on the leading edge of medicine.
What’s more, 22% of surveyed physicians said they had already used telehealth to see patients, a 340% increase from 2015 when only 5% had tried it. These doctors reported benefits, including increased access to care, more efficient use of time, reduced costs, high-quality communications with patients, and enhanced relationships with patients.
To make the data come alive for you, let me share two personal stories.
Last year, our family was enjoying Spring Break at our (currently closed) Airbnb vacation rental in Palm Springs. My daughter woke us up, worried about a bug bite with a growing ring around the site of the bite. Rather than taking a chance and spending time at unknown urgent care, we opened my laptop and requested a quick telemedicine conference. Presto, within mere minutes – and for less than I would have paid at the urgent care – our daughter’s minor-but-annoying irritation was solved. She was relieved, and we all sat down to enjoy a family morning with pancakes. Anecdote #2: Days after I alerted him to the new HIPAA and reimbursement changes, my primary care physician sent me an email proudly announcing, “Hey… I’ve now got telemedicine available.” Evidently, he now appreciates the opportunity that is knocking.
Google Trends shows the record rise in searches for “telehealth,” peaking March 20 due to COVID
The Telemedicine Marketing Opportunity
The coronavirus outbreak has been a tumultuous experience and a worldwide tragedy. At least we can take some solace that our nation’s healthcare system will almost inevitably improve as a result. Telemedicine specifically offers the promise of better care and, at the same time, provides a unique marketing opportunity.
As we’ve seen, the barriers to telemedicine adoption are disappearing rapidly. Regulations and reimbursement are improving. Meanwhile, most doctors and patients who have tried telemedicine continue to use it.
Virtual services provide a fresh (and often new) service line for hospital CEOs, medical practice administrators, doctors, nurse practitioners, behavioral health professionals, and other healthcare providers.
Potential benefits to your organization include:
Greater patient satisfaction
Operational efficiency, and
Many consumers have long been enthusiastic about the convenience of telemedicine. Changes on the provider side—partly due to the COVID-19 Nationwide Public Health Emergency—include:
Telemedicine reimbursement is more universally available, including many, if not most, private insurance plans
Some virtual doctor visits pay at the same rate as regular in-person visits
Our government has relaxed HIPAA have restrictions in favor of the greater good because of the COVID emergency
Medicare Part B provides for billing for non-face-to-face communications
The learning curve has become flat; providers and patients are familiar with communications technology (Zoom, Google Meet, FaceTime, etc.)
Patients and healthcare providers have computer equipment and use two-way communications nearly universally
Professional organizations, such as the American College of Physicians, encourage virtual visits, whenever appropriate, to limit potential coronavirus exposure
Here are some of the telemedicine marketing strategies to consider:
Email your patients to inform them that you now offer telemedicine. Reinforce the message with in-office signage and staff/provider conversations with patients
Feature your telemedicine option on your website
Promote a new level of convenience with universal consumer appeal
Start a paid search campaign that targets patients in your area who are already looking for a telemedicine provider
Present telemedicine as an offer, such as a telemedicine screening
It can also act as a gateway channel for an online second opinion
A low-cost, low-risk introductory channel for elective care
Telemedicine is an easy and natural initial gateway for urgent care
Offer telemedicine services through doctors, nurse practitioners, clinical psychologists, and many others
Remote patient monitoring, compliance, and follow-up
A telemedicine connection can be available at partner locations. (For example, generalists could provide telemedicine access to allied specialists when appropriate.)
In some medical marketplaces, your new telehealth marketing program coulds be a competitive advantage. In other areas, telemedicine is rapidly becoming “table stakes.”
Remember, whether you choose to embrace telemedicine or not, you are already competing with local providers AND well-funded telehealth service providers like Teladoc.
What are Some Telemedicine Options?
People still need healthcare, and healthcare still needs patients. Right now, the various telemedicine formats are an attractive and safe way to connect with new and existing patients. Some platforms also easily facilitate group meetings or collaboration among multiple participants, partners, or internal staff.
And, it’s now relatively easy to open a telemedicine window across the service spectrum. Health systems, medical practices, hospitals, urgent care centers, and other healthcare providers all can adopt telemedicine to benefit their community. For the most part, telemedicine platforms are scalable and can serve large multi-location providers, hospitals, and service line departments, as well as individual doctors and practices.
Right now, during the COVID-19 epidemic, smaller providers are necessarily relying on simple, ad hoc technologies like FaceTime, Zoom, or Skype.
Still, there are dozens of mature and stable software options available for both the enterprise level (e.g., EHR/HL7v2/FHIR integrations at Microsoft) and for the individual practice.
Just in case creating a telemedicine program is entirely new for you, or if you’re rolling it out as a more substantial part of your services, here is an unordered sampling of some of the telemedical services you might consider:
DOXY.ME – A simple, free, and secure telemedicine solution with unlimited message, voice, and video connections. It also has paid tiers with additional features. Doxy.me integrates with Electronic Health Records (EHR) or Practice Management software.
ALLSCRIPTS – Now offers telemedicine integration for health systems and practices to its EHR and practice management software offerings.
EVISIT – Claims an industry leadership position a virtual care provider favored by health systems, hospitals, clinics, and physician groups in the US.
AMC HEALTH – Provides various comprehensive services, including patient personalization and remote monitoring and tracking of patient devices. AMC Health includes clinical trial and research options.
SIMPLEVISIT – Manages telemedicine programs with HIPAA-compliant video visits compatible over Skype, FaceTime, or other communications platforms.
MEND – Described as full-featured and easy to use telemedicine suite. Mend includes voice and video calling, plus appointment reminders, online forms, and appointment self-scheduling.
MEDICI – A secure platform to connect doctors with patients using text, audio, and video. HIPAA compliant provides for billing, chat translate, and other features.
UPDOX – A secure, simple, HIPAA-compliant telemedicine tool. “During the COVID-19 crisis, telehealth is a critical channel for physicians to care for patients while minimizing risk to themselves and others and protecting the community.”
SPRUCE HEALTH – Describes itself as a powerful tool for patients, healthcare providers, and other partners in health to connect and communicate.
Remember, telemedicine and telehealth capabilities represent a significant marketing opportunity. The social distancing demands, plus the broad audience appeal and accessibility, will fundamentally change how patients are seen now and for the foreseeable future.
Note, while the terms are often used interchangeably by the public and even some of the sources cited in this post, technically speaking, TELEMEDICINE refers to remotely providing healthcare services, typically using a secure audio/video platform between provider and patient. Telemedicine is a subset of the larger TELEHEALTH, which also includes online medical education, training, administrative meetings, group sessions, and the like.