Transitioning from Traditional to E-Fax: How Healthcare Communications are Transforming Post-COVID

Telehealth After COVID-19: What's Next for the Healthcare Industry?
Michael Morgan, CEO of Updox

The majority of industries have decreased or eliminated their use of the traditional fax machine over the past decade, including aviation, retail, and even finance. While the healthcare industry is at the forefront of disease research and treatment, however, it is still heavily reliant on this aging technology. 

Traditional fax has become ubiquitous in healthcare. It worked for health systems for many years, but the overwhelming volume of patient data and paper documents the healthcare industry is now processing makes traditional faxing more challenging. In today’s environment, fax is no longer the most convenient, safe, or secure communications format but it is still an ingrained part of practice workflows. The good news is, there is no need to “axe the fax” in order to improve office communications and alleviate paper overload. By transitioning to electronic fax, healthcare providers can maintain their workflows and the benefits of fax, while incorporating it into their overall virtual communications strategy – further simplifying the business of healthcare. 

The Traditional Fax Challenge

The challenge with traditional fax isn’t new. In fact, in 2008 the Obama administration allocated nearly $30 billion to incentivize American hospitals and doctor offices to switch from paper to electronic systems. Since then, the industry has made small steps towards a more digitized system via fax servers and virtual patient communications such as secure text and broadcast messaging. While this solved part of the problem by making documents electronic and streamlining communications, it did not address the issue of inefficiency at its core, as practices are still printing, signing, and scanning paper documents. This inefficiency is causing a bottleneck when it comes to getting information transferred quickly, creates unnecessary costs for practices, and causes a lack of integration between health technologies across our healthcare system. 

A recent poll by the Medical Group Management Association (MGMA) found that 89% of healthcare organizations still use a fax machine, primarily to: 

  • Share patient records and lab and/or test results
  • Referrals
  • Payer communication
  • Pharmacy communication

This fragmented, outdated way of communication is not only inefficient and costly, it also impacts patient privacy and safety. At the onset of the COVID-19 pandemic, one Texas health department received so many test results via fax in one day that it simply couldn’t keep up with the amount of paper being spit out – resulting in hundreds of confidential results being dumped on the floor. In addition, the vast differences between old and new technology being blended together are making it difficult to keep track of patient records, share data between practices or report to the government, and more, including important racial, ethnic and geographic data that the Trump administration required for COVID tests. In addition to these challenges, traditional fax eats up staff time that could instead be spent on patient care.  

Addressing Outdated Systems and Driving Transformation 

While on the surface the solution seems simple, actually addressing this challenge at its core is not as easy as it seems. Many providers and large health systems face barriers when it comes to implementing this technology, such as: 

  • Compatibility between systems 
  • Fear of competition and/or losing patients to other health systems if e-fax enables patients to easily share data with other physicians
  • Cost considerations
  • Regulatory issues around the transfer of data between providers/EHRs through electronic fax

Despite these challenges, the pandemic has highlighted the delayed, disjointed communications that exist within our healthcare system – and underscored the need for practices and health systems to adopt electronic fax technology. For example, a CNBC survey found that due to COVID-19 tests results coming in via fax in such large amounts, almost 40% of Americans had to wait more than three days for their results, which was too late to be clinically meaningful.  

It’s time to address this challenge industry-wide. Last year’s MGMA 2020 virtual conference theme, Rise Above, focused on giving providers actionable tools to navigate through the challenges COVID-19 has presented. The importance of virtual care solutions, including communications tools like electronic fax and forms, are unprecedented. Electronic fax technology can help alleviate the bottlenecks and inefficiencies that currently exist in healthcare. These solutions can: 

  • Reduce costs spent on traditional fax hardware, such as paper, ink, toner, etc.
  • Increase accessibility, allowing providers to view documents via mobile, etc.  at their convenience 
  • Improve practice workflow and efficiency, allowing practices to edit, organize, assign and complete patient forms online

Additionally, electronic fax should integrate seamlessly with other patient management solutions that practices are leveraging, such as video chat, SMS text, electronic forms, and a virtual waiting room, ultimately streamlining the entire patient experience.

Healthcare has transformed dramatically this year and will continue to do so — there’s a new expectation of patient care post-COVID. In order to improve patient communications, practice efficiency, system interoperability, and data sharing, practices must adopt an entire virtual care strategy, including electronic fax. Offering telehealth but still communicating via traditional fax will hold your practice back. It’s time for our healthcare system to ditch outdated systems and go completely paperless. This is how we will tap into the true power of the inbox, drive practice profitability and efficiency, and better serve patients. 


About Michael Morgan, CEO of Updox
With a successful track record in helping organizations use technology to transform the way healthcare is delivered, Mike has more than 25 years of healthcare leadership within software, behavioral health, and HIT organizations. Updox was named to the Inc. 5000 list of fastest-growing companies in America for the past six consecutive years.


Xealth’s CEO Shares Impact of Digital Health in 2020 and What’s Ahead in 2021

Xealth’s CEO Shares Impact of Digital Health in 2020 and What’s Ahead in 2021
Mike McSherry, CEO & Co-founder of Xealth

HIT Consultant sat down with Mike McSherry, CEO, and co-founder of Seattle-based digital prescription platform Xealth to discuss digital health lessons learned in 2020 and what we can expect in 2021. As Xealth’s CEO, Mike also works with Duke Health, UPMC, Atrium Health, and The Froedtert & the Medical College of Wisconsin health network where he uses his background in digital health to connect patients and care teams outside of traditional care settings. 


HITC: In 2021, How can digital health reduce race and minority disparities in healthcare?

McSherry: The U.S. has struggled with health disparities, which this pandemic has widened. Many of these disparities can be linked to access, which digital health can assist with – telehealth makes care virtual from any location, clinical decision support can reduce human errors, remote patient monitoring helps keep patients home while linked to care. 

Digital health removes hurdles related to transportation, taking time off work, or finding childcare in order to travel in-person for an appointment. It brings care to the patient instead of the other way around, making access simpler. Care through these pathways is also more cost-efficient. 

There are still hurdles to overcome. Broadband is widespread but not everywhere and inclusive design of these tools should be considered. How digital tools, including wearables, are built should address differences in gender and ethnicity, especially as these tools are used more frequently in clinical trials, so as not to inadvertently perpetuate disparities.  

HITC: Why some hospitals are offering digital health tools to staff but not patients?

McSherry: There are a few factors at play when hospitals offer digital health tools to staff but not patients. One, most health systems are not currently deploying system-wide digital health initiatives, leaving the decisions to individual departments or providers. This can lead to inconsistent patient experiences and more data siloes as solutions are brought in as one-offs. 

The second issue is reimbursement. A hospital acting as an employer offering digital health tools as part of its benefits package is different than a patient, who must rely on their health insurance, whether it is a public or private plan. The fact healthcare organizations see digital health tools as a perk shows their value. Now, it is time for CMS and commercial payers to consistently enable their use to help providers care for patients and incorporate digital health as clinicians see fit. 

HITC: How hospitals can remain competitive in 2021, especially after tighter margins from COVID-19?

McSherry: Large tech companies, like Google and Amazon, and huge retailers, including Walmart and Best Buy, are looking to deliver the promise of health care that has so far eluded the industry. Venture capital money has been pouring in for funding innovation, with digital health funding hitting a new high in 2020. 

These initiatives are all racing to control health care’s front door and if hospitals don’t innovate as well, they run a very real risk of having patients turn elsewhere for care. Payers are also building digital front doors and telling members to go there. People have long expressed their desire to have the same consumer experience in health care that they receive in other industries. The technology is there. It needs to be incorporated with the correct care pathways. 

One silver lining during the COVID-19 pandemic is that it showed fast-moving innovation can happen in health care. We worked with hospitals to stand up workflows around telehealth in four days and remote patient monitoring in seven days – an amazing pace. The key is to keep this stride going once we are on the other side of this crisis. 

Providers are becoming more digitally savvy to engage patients and deliver holistic care. Hospitals should support this.  

HITC: What will be Biden’s impact on COVID-19, how hospital leaders should respond, and what it means that we have a divided congress?   

McSherry: Under the current administration, telehealth rules have been relaxed, at least temporarily, along with cross-state licensure so providers are better able to build a front door strategy, helping organizations roll out remote patient monitoring and chronic care management apps. Biden has been a proponent of digitalization in health care and will have a broader engagement. This could lead toward more funding and more covered lives. 

A divided Congress will not make much easy for the Biden administration, however, getting on the other side of this pandemic as quickly and as safely as possible is best for everyone. Biden has shown he will make fighting COVID-19 a top priority.  

HITC: Will remote patient monitoring become financially viable for hospital leaders in 2021?

McSherry: Why does a diabetic patient need to have every check-in be in-person or a healthy, pregnancy met every few weeks with an in-person visit as opposed to remote monitoring for key values and a telehealth check-in in place of a couple of those visits? Moving forward, hospitals will see the benefit of remote monitoring in terms of lower overhead, along with better patient engagement, outcomes and retention. 

To make this work, providers must share risk, and determine digital strategies around attracting patients and then manage them in a capitated way with more digital tools because of the cost efficiencies.   

HITC: How do we foster tighter physician-patient relationships?

McSherry: Patients trust their doctors, period. The struggle is going to be more obvious as more people do not have a PCP and turn to health care with a bandage approach to take care of an immediate concern.  That will lead to entire populations without that trusted bond who are sicker when they finally do seek care, due to the lack of continuity and engagement early on. 

By connecting with people now, where they are comfortable, there is a tighter physician-patient relationship by making it more accessible and reciprocal.  


M&A: EverCommerce Acquires Healthcare Communication Platform Updox

EverCommerce Acquires Healthcare Communication Platform Updox

What You Should Know:

– Service commerce platform EverCommerce acquires Dublin,
OH-based Updox, a healthcare communication platform for in-person and virtual
care.

–  The acquisition
expands EverCommerce’s health services portfolio and enables the companies to
further their shared goal of simplifying the business of healthcare and
facilitating the growth of healthcare practices.


Today, EverCommerce, a leading service commerce platform, completed the acquisition of Updox, a Dublin, OH-based complete healthcare communication platform for in-person and virtual care. The company will join EverCommerce’s portfolio of health services companies, enabling it to provide customers with faster access to more products, a broader suite of solutions, and more resources.

The acquisition comes on the heels of a breakout year for
virtual care. Digital health is on track to hit over $12 billion in investments
by the end of 2020 – the largest funding year for the sector yet – and over 60
acquisitions through the end of Q3, including other telehealth breakouts like
Teladoc, which recently completed its acquisition of Livongo in a deal valued
at over $18B.

Deliver the Best in Virtual & In-Person Care

Updox provides next-generation virtual care, patient engagement, and office productivity solutions that enable practices to reduce costs and drive revenue. Based on increasing demand for solutions that seamlessly work together to improve practice efficiency and provide an engaging patient experience, Updox has continuously brought new functionality to market. Additional solutions are planned for 2021. 

Updox serves more than 560,000 users across healthcare practices, health systems and pharmacies, and more than 210 million patients. Updox has experienced rapid growth and adoption this year, as healthcare providers sought to quickly implement telehealth and other patient engagement solutions that enabled them to acquire new patients, operate more efficiently, and engage their patients as a result of the COVID-19 pandemic. In fact, Updox facilitated over 3.5 million telehealth visits since March and continues to support more than 15,000 visits per day.

The EverCommerce health services portfolio includes a
diverse mix of solutions including cloud-based medical billing, specialty EHR,
practice management, RCM software, lead generation, marketing solutions and
retention services for healthcare practices. With this acquisition,
EverCommerce will advance its mission to provide end-to-end mission-critical
solutions that enable healthcare practices to accelerate growth, streamline
operations and increase patient retention.

“Now more than ever, healthcare providers need a one-stop-shop to acquire new patients, operate more efficiently and engage their patients. They also need one single place to communicate with patients where they are – on their mobile phones,” said Michael Morgan, president of Updox. “We’re thrilled to join the EverCommerce team, which shares our vision for advancing healthcare. We look forward to accelerating innovative solutions that enable healthcare practices to more effectively market to patients, simplify payments, and effectively interact with patients both in and outside the practice.”

Terms of the deal were not disclosed. 

Powered by Doctor on Demand, ArcBest Rolls Out Virtual Primary Care Health Plan to its 13k Employees

Powered by Doctor on Demand, ArcBest Rolls Out Virtual Primary Care Health Plan to its 13k Employees

What You Should Know:

– Publicly traded logistics company ArcBest announced its
deal with Doctor On Demand to introduce its virtual-first health plan to its
13,000 employees, who are largely “essential workers” as long-haul
truckers.

– Employees appreciated the convenience and safety of 24/7 virtual care – from their homes, from the road – and ArcBest is now doubling down on virtual care for 2021 – and offering a holistic, virtual-first primary care health plan – one where patients see the same PCP time and time again virtually and can receive many of the same services virtually that they’d typically receive in-person.


Doctor
On Demand
, the nation’s leading virtual care provider,
and ArcBest, a
multibillion-dollar leader in supply chain logistics, announced a partnership
to offer a new Virtual Primary Care health plan benefit to its employees and
their dependents nationwide. The partnership expands on the existing urgent
care and behavioral health services that Doctor On Demand has been providing to
ArcBest since 2017.

Virtual Primary Care Benefit

ArcBest is getting creative in how they deliver healthcare benefits to their thousands of field employees – many of whom are on the road or reside in rural areas throughout the country. As the pandemic hit, it became increasingly difficult or unsafe to seek in-person medical or mental health care, so ArcBest promoted the use of its telemedicine offering of urgent care and mental healthcare.

The new Virtual Primary Care benefit will be available to all 8,000 members who are covered under ArcBest’s medical plan starting December 1st. This benefit comes at a critical time as COVID-19 cases are spiking again, and as the country simultaneously heads into cold and flu season. As a provider of essential freight and logistics services, ArcBest has a large field employee population that operates 24/7, making it challenging to access routine in-person care.

Virtual Primary Care Improves Access to Care

ArcBest believes that investing in this new virtual health
plan upfront will have a major impact on employees’ health long term –
promoting preventative healthcare and driving down long-term costs associated
with employees waiting until their chronic back pain or chronic disease
warrants more costly interventions.

“At ArcBest, we have a unique set of healthcare benefit needs, and Doctor On Demand’s existing urgent and behavioral health care services have been invaluable, especially this year,” said Rich Krutsch, Vice President, People Services at ArcBest. “The pandemic has also prompted us to double-down on our investments in virtual care, and we’re excited to expand our program with Doctor On Demand to include much more holistic, integrated virtual care for our employees.” 

Employees Can Select Primary Care Doctor Through Doctor
on Demand

Eligible ArcBest employees and their dependents will now be able to select a primary care provider through Doctor On Demand and access a comprehensive set of services to support whole-person health, including preventive wellness check-ups, vaccination referrals, nutrition consultations, chronic condition management, and more. Additionally, members are able to continue to see the same physician over time, allowing them to build a consistent, trusted relationship via video.

Hospitals Hit with Low Volumes, High Expenses, Poor Margins as COVID-19 Cases Mount

Hospitals Hit with Low Volumes, High Expenses, Poor Margins as COVID-19 Cases Mount

What You Should Know:

– October was a challenging month for hospitals and
health systems nationwide amid ongoing instability spurred by the COVID-19
pandemic, according to Kaufman Hall’s latest Hospital Flash Report.

– Margins and volumes fell, revenues flattened, and
expenses rose as COVID metrics continued to climb and some states moved to
retighten social distancing guidelines.

– As of Oct. 31, the number of daily U.S. COVID cases
reached a high of more than 90,500 and related hospitalizations surpassed
47,400.


Instability spurred by the COVID-19 pandemic
continued to hit hospitals and health systems nationwide in October. Margins
fell, revenues flattened, and expenses rose as organizations saw an eighth
consecutive month of shrinking volumes, according to the November
issue of Kaufman Hall’s National Hospital Flash Report
.

Rising COVID-19 rates are expected to exacerbate volume
declines as many local and state governments reinstate stricter social
distancing policies, causing many to delay non-urgent procedures and outpatient
care. The result threatens to further destabilize hospitals financially in the
coming months.


Key Findings

– Eight months into the pandemic, the Kaufman Hall median
hospital Operating Margin Index was –1.6% for January through October, not
including federal funding from the Coronavirus Aid, Relief, and Economic
Security Act (CARES Act). With the funding, the median margin was 2.4%
year-to-date.

– Operating Margin fell 69.4% year-to-date (6.0 percentage
points) compared to the same period last year, and 9.2% year-over-year (1.4
percentage points) without CARES Act funding. With the federal aid, Operating
Margin fell 18.7% year-to-date (1.7 percentage points) and 8.5% (1.2 percentage
points) below October 2019 levels.

– Declining volumes and rising expenses contributed to the
month’s low margins. Adjusted Discharges fell 11.2% year-to-date and 9.3%
year-over-year, while Adjusted Patient Days dropped 7.7% year-to-date and 2.9%
year-over-year. Operating Room Minutes fell 11.7% year-to-date and 5.6%
compared to October 2019, as many patients opted to delay non-urgent
procedures.

– Emergency Department (ED) Visits remained the hardest hit,
falling 16% both year-to-date and year-over-year in October, but increased 1.9%
from September. The month-over-month increase was due in part to rising
COVID-19 infections, which also contributed to a 7.6% month-over-month increase
in Discharges, reflecting higher numbers of inpatients.       

– Gross Operating Revenue (not including CARES Act funding)
fell 4.8% from January to October compared to the same period in 2019, but was
flat compared to October 2019. Fewer outpatient visits were a major
contributor, driving Outpatient Revenue down 6.6% year-to-date and 2.6%
year-over-year. Inpatient Revenue declined 2.4% year-to-date but rose 2.6%
year-over-year.

– Expenses rose as hospitals continued to bring back
furloughed workers, and purchased drugs, personal protective equipment, and
other supplies needed to care for COVID-19 patients. Total Expense per Adjusted
Discharge rose 13.5% year-to-date and 12.2% year-over-year in October. Labor
Expense and Non-Labor Expense per Adjusted Discharge rose 15.2% and 13%
year-to-date, respectively. Such increases will put hospitals in a tenuous
situation if volumes continue to decline.

Why It Matters

“The next few months will be a grave period for our country, and for our nation’s hospitals and health systems,” said Jim Blake, a managing director at Kaufman Hall and publisher of the National Hospital Flash Report, which draws on data from more than 900 U.S. hospitals. “If unchecked, the virus is projected to continue its rapid spread through communities as families gather for the holidays, and as colder weather pushes more activities indoors. The potential public health implications and financial impacts for our hospitals could be dire.”

For more information, click here
to download the report.

Lean on Your Connected Community of Care in Times of Crisis

Is Your Community Ready to be Connected?
Dr. Keith Kosel, Vice President at Parkland Center for Clinical Innovation (PCCI)

We’ve all experienced crises in our lives. They may be personal in nature (e.g., involving our interpersonal relationships), organizational (e.g., relating to our employment or retirement income), or nature-made (e.g., floods, tornados, or the COVID-19 pandemic). When crises hit our communities, the impacts can be widespread and far-reaching. Healthcare providers and community-based organizations (CBOs) are called upon to provide more rapid and extensive care and support to the community than is otherwise the norm. A well-established and highly functioning Connected Community of Care (CCC), as is the case here in Dallas, Texas, can provide a tremendous strategic and tactical advantage over non-connected peers.

Since 2014, the Parkland Center for Clinical Innovation (PCCI) has led an effort to bring together several large healthcare systems and a number of regional social-service organizations such as food banks, homeless assistance associations, and transportation service vendors, along with over 100 smaller CBOs (i.e., neighborhood food pantries, crisis centers, utility assistance centers) and area faith-based organizations to form the Dallas CCC. Over time, civic organizations, such as the Community Council of Greater Dallas, Dallas County Health and Human Services (DCHHS), and select academic institutions have begun to participate in various community-wide projects under the Dallas CCC umbrella.

Central to the success of the Dallas CCC are the partnerships that have been formed between the CBOs and a number of local healthcare systems (Parkland Health & Hospital System [Parkland], Baylor Scott & White Health, Children’s Medical Center, Methodist Health System, and Metrocare Services), clinical practices, and other ancillary healthcare providers serving the Dallas metroplex. These partnerships have proved essential in building a truly comprehensive and functional network aimed at improving both the health and well-being of Dallas residents.

Connecting these various entities and forming a two-way communication pathway is an electronic information exchange platform termed Pieces™ Connect, which allows for real-time, two-way sharing of information pertaining to an individual’s social and healthcare needs, history, and preferences. The information exchange platform is the glue that holds the physical network together and provides one of the mechanisms to disseminate information from public health and healthcare entities to social service providers in the community. It allows the individual community resident, via the CBO, to become better informed about important health issues, such as routine vaccinations or preventive care, such as social distancing and proper mask usage during a pandemic.

Until recently, the primary mission of the Dallas CCC focused on addressing residents’ social determinants of health (SDOH) issues through providing community resources (e.g., food assistance, housing, transportation) to improve the lives of Dallas County residents. While this mission has become even more critical during the COVID-19 pandemic, the work of the Dallas CCChas also evolved to include identifying COVID-19 sites within the County and directing community outreach efforts to help stem the rapid spread of the virus.

The Dallas CCC has provided an innovative model of community governance and cooperation to impact the consequences of the COVID-19 outbreak. From the first days of the pandemic, PCCI has been working with Parkland and DCHHS to help reliably identify and quantify the geographic location and incidence rates of positive COVID-19 cases within Dallas County. This problem is especially challenging when considering vulnerable populations and the transitory nature of these residents in inner-city communities.

Working with data provided by DCHHS, the Dallas-Fort Worth Hospital Council, and CBOs, PCCI built a series of dynamic geo-maps that were able to identify, at the neighborhood and block level, the location of hotspots of positive COVID-19 cases as well as attendant mortality rates. In addition to flagging at-risk patients and populations, the model continues to be used by public health and civic leaders to establish locations for testing sites within the city of Dallas based on COVID-19 incidence and community needs.

With the establishment of the hot-spotting, the next step was to get that information, along with general infection prevention protocols, in the hands of local CBOs to help raise awareness and slow the spread of the virus.  With the aforementioned information in hand, public health workers have been able to develop targeted communications and tactical strategies to improve containment efforts through community-wide awareness and educational messaging.

By connecting local CBOs and faith-based organizations with public health workers and clinicians, the Dallas CCC is facilitating effective contact tracing and the implementation of care plans for high-risk individuals in a more efficient and scalable manner.

The value of the CCC communication network linking healthcare providers and CBOs cannot be underestimated, as it represents a highly effective and efficient mechanism to disseminate leading practice information aimed directly at high-risk populations. We have seen first-hand that communications delivered to community residents through familiar food pantries, homeless shelters, and places of worship are much more effective than community-wide public information campaigns broadcast via radio or television.

This increased effectiveness is based on the fact that many of these at-risk individuals frequent the CBOs on a regular basis for essential services and these individuals know and trust the CBO staff delivering the information. From one-on-one conversations to displaying infographic posters and take-away educational leaflets, CBOs provide a ready avenue to communicate with at-risk individuals in the communities they serve.

As mentioned, early work in Dallas County is beginning to demonstrate the value of CCC in facilitating contact tracing. In this case, the challenge is not simply identifying the location of positive COVID-19 cases but having the ability to connect those cases to other individuals within the neighborhood or community who may have come in contact with the infected individual, all while working in an environment where individuals frequently move from one location to another. Having a well-established communication system at the local neighborhood level can be extremely helpful in identifying contacts and potential contacts.

It is well-known that many individuals in impoverished, underserved neighborhoods are reluctant to speak with individuals they don’t know or trust, especially if those individuals are affiliated with government agencies, no matter how well-intentioned the agency personnel may be. Staff members at local faith-based organizations and CBOs frequented by these vulnerable residents are a highly effective resource for identifying inter-personal relationships and connecting with those individuals, which is something that has proved challenging for public health staff when working outside of a CCC environment. In Dallas, CBOs, public health, and civic staffers, as well as medical student volunteers have all been partnering to help facilitate the contact tracing process with positive results.

CCC’s can materially improve the health and well-being of a community’s residents, especially in times of crisis. The take-away lesson is clear. If you already have a CCC, lean on it to help you through crises impacting your community. If you don’t have a CCC, now is the time to begin the process of establishing one in your community. Even with the challenges that the current pandemic is generating, it is possible to begin building your CCC.  Start small and gradually increase the CCC’s scope and scale; don’t be in a rush to grow. The most important thing is to take the plunge and begin the journey!


About Dr. Keith Kosel

Dr. Keith Kosel is a Vice President at Parkland Center for Clinical Innovation (PCCI) and is the author of “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations,” a guide that brings together communities to support our most vulnerable. At PCCI, Keith is leveraging his passion for – and extensive experience in – patient safety, quality, and population health by focusing on understanding social determinants of health and the impact of community-based interventions in improving the health of vulnerable and underserved populations.

Rural Hospital Execs Can Beat COVID-19 By Shifting From Reactive to Proactive Care

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 Medicine affirms, 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.

Value-Based Reimbursement Contracts Now Account for 26% of Hospital Revenue, KLAS Finds

What You Should Know:

– Value-based reimbursement (VBR) contracts now account
for 26% of hospital revenue, according to a new report from KLAS research and
CHIME.

– Report reveals providers are looking first to their
electronic health record (EHR) systems to drive PHM, and are most interested in
investing in new healthcare information technology (HIT) when they know there
is a clear ROI. 


With value-based reimbursement (VBR) adoption slowing, healthcare providers are searching for ways to manage risk and achieve ROI on population health management (PHM) solutions adoption, according to a new report from KLAS Research and CHIME – the College of Healthcare Information Management Executives. The new report, issued, reveals that providers are looking first to their electronic health record (EHR) systems to drive population health management (PHM), and are most interested in investing in new healthcare information technology (HIT) when they know there is a clear ROI.  The findings were based on findings from KLAS Decision Insights, the KLAS 2019 Population Health Management Cornerstone Summit, and CHIME’s 2019 HealthCare’s Most Wired data.

Value-Based Reimbursement in 2020: How Far Have We Come?

VBR contracts now account for 26% of hospital revenue. Fee-for-service still outpaces VBR, and over time, the lack of significant progress toward VBR has eroded healthcare organizations’ confidence that the change will happen in the near future. The biggest factors limiting the adoption of VBR are uncertainty that an ROI will be achieved and a lack of needed infrastructure.

How Is Technology Being Used to Support VBR?

Once organizations decide to invest in technology to help
with VBR, they generally turn first to their EMR. Though provider organizations
may not ultimately choose their EMR for certain population health management
(PHM) needs, EMRs are almost always considered, due to (1) assumed integration
with EMR data; (2) anticipated cost savings; and (3) increased ease of access
to PHM data in the EMR.

EMRs are slightly less likely to be used for administrative
and financial reporting—EMRs have historically struggled to provide the nuanced
views needed in these areas, so organizations often opt for third-party
solutions that provide additional analysis, visualization, and ad hoc reporting.
Third-party solutions may be used on their own or in conjunction with EMR
functionality.

Organizations invest in HIT when there is a concrete ROI

Solutions that help organizations identify and act on care
gaps see some of the broadest adoption as they can be helpful with just about
any VBR contract. Once a gap is identified, organizations need to reach out to
the patient and close it, so patient engagement tools are also highly sought
after.

Functionality is a significant driver in PHM purchase
decisions

Healthcare organizations are looking for enterprise EMRs and
broad BI platforms capable of tackling a large swath of their PHM and
VBR-related functionality needs (e.g., root cause analysis, A/B testing, etc.).
In this quest for consolidation, organizations are seeking to eliminate ad hoc
interfaces and replace vendors who haven’t delivered on functionality or
quality.

“Providers are trying to find positive ROI on their population health management investments,” said Adam Gale, president of KLAS Research. “This report offers a useful roadmap for how they can meet that challenge.”

For more information about the report, visit https://klasresearch.com/report/value-based-reimbursement-2020/1705

Accounting for the Social Determinants of Health During the COVID-19 Pandemic

Accounting for the Social Determinants of Health During the COVID-19 Pandemic
Andy Aroditis, CEO, NextGate

The COVID-19 pandemic is not just a medical crisis.  Since the highly contagious disease hit American shores in early 2020, the virus has dramatically changed all sectors of society, negatively impacting everything from food supply chains and sporting events to the nation’s mental and behavioral health.

For some people, work-from-home plans and limited access to entertainment are manageable obstacles.  For others, the shuttered schools, lost wages, and social isolation spell disaster – especially for individuals already living with socioeconomic challenges.

The social determinants of health have always been important for understanding why some populations are more susceptible to increased rates of chronic conditions, reduced healthcare access, and shorter lifespans.  COVID-19 is throwing the issue into high relief.

Now more than ever, healthcare providers need to gain full visibility into their populations and the non-clinical challenges they face in order to help individuals maintain their health and keep their communities as safe as possible during the ongoing pandemic.

Exploring correlations between socioeconomic circumstances and COVID-19 vulnerability

Clinicians and researchers have worked quickly to identify patterns in the spread of COVID-19.  Early results have emphasized the danger posed by advanced age and preexisting chronic conditions such as obesity, diabetes, and heart disease. 

Further, data from the Johns Hopkins University and American Community Survey indicates that the infection rate in predominantly black counties is three times higher than in mostly white counties. The death rate is six-fold higher.

Data from the Centers for Medicare and Medicaid Services (CMS) confirms the trend: black Medicare beneficiaries are hospitalized at a rate of 465 per 100,000 compared to just 123 per 100,000 white beneficiaries. Hispanic Medicare beneficiaries had 258 hospitalizations per 100,000, more than double the white population’s hospitalization rate.

Researchers suggest that the social determinants of health may be largely responsible for these disconnects in infection and mortality rates.  Racial, ethnic, and economic factors are strongly correlated with increased health concerns, including longstanding disparities in access to care, higher rates of underlying chronic conditions, and differences in health literacy and patient education.

Leveraging data-driven tools to identify vulnerable patients

Healthcare providers will need to take a proactive role in identifying which of their patients may be at enhanced risk of contracting the virus and experiencing worse outcomes from the disease.  

They will also need to ensure that person gets adequate treatment and participate in contact tracing efforts after a positive test.  Lastly, providers will have to ensure their public health reporting data is accurate to inform local and regional efforts to contain the disease.

The process begins by developing confidence in the identity of each individual under the provider’s care.  Healthcare organizations often struggle with unifying multiple electronic health record (EHR) systems and other health IT infrastructure, resulting in medical records that are incomplete, inaccurately duplicated, or incorrectly merged.

Access to current and complete medical histories is key for highlighting at-risk patients.  An enterprise master patient index (EMPI) can provide the underlying technical foundation for initiating this type of population health management.  

EMPIs help organizations create and manage reliable unique patient identifiers to ensure that records are always associated with the correct individual as they move throughout the healthcare system.

When paired with claims data feeds, health information exchange (HIE) results, and interoperability connections with other healthcare partners, EMPIs can bring a patient’s complete healthcare status into focus.

This approach ensures that providers stay informed about past and present clinical issues and service utilization rates.  It can also support a deeper dive into the social determinants of health.

Combining EHR data with standardized data about socioeconomic needs can help providers develop more comprehensive and detailed portraits about their patients’ holistic health status.  

By including this information in EHRs and population health management tools, providers can develop condition-specific registries to guide outreach activities.  Providers can deploy improved care management strategies, close gaps in care, and connect individuals with the resources they need to stay healthy.

Healthcare organizations can acquire socio-economic data about their communities in a variety of ways, including integrating public data sources into their population health management tools and collecting individualized data using standardized questionnaires.

Once providers start to understand their patients’ non-clinical challenges, including the ability to avoid situations that may expose them to COVID-19, they can begin to prioritize patients for outreach and develop personalized care plans.

Conducting effective outreach and interventions for high-needs patients

COVID-19 has taken a staggering economic toll on many families, including those who may have been financially secure before the pandemic.  Routine healthcare, prescription medications, and even some urgent healthcare needs are often the first to fall by the wayside when finances get tight. 

Healthcare providers have gotten creative about staying connected to patients through telehealth, drive-in consults, and other contactless strategies.  But they must also ensure that their vulnerable patients are aware of these options – and that they are taking advantage of them.

Contacting a large number of patients can be challenging since phone numbers, emails, and home addresses change frequently and are prone to data entry errors during intake. Organizations with EMPIs can leverage their tools to ensure contact information is up to date, accurate, and associated with the correct individual.

Care managers should prioritize outreach to patients with complex medical histories and known clinical risks for vulnerability to COVID-19.  These conversations are a prime opportunity to collect social determinants of health information or refresh existing data profiles.

Looking to the future of healthcare in a COVID-19 world

Combining technology-driven strategies with targeted outreach will be essential for healthcare organizations aiming to provide holistic support for their populations during – and after – the COVID-19 pandemic.

By developing certainty about patient identities and synthesizing that information with data about the social determinants of health, providers can efficiently and effectively connect with their patients to offer much-needed resources.

Taking a proactive approach to addressing the social determinants of health during the outbreak will help providers maintain relationships with high-needs patients while building new connections with those facing unanticipated challenges.

With a combination of population health management strategies and innovative technology tools, healthcare providers and public health officials can begin to view the social determinants of health as a fundamental component of the fight against COVID-19


Andy Aroditis, is CEO of NextGate, the global leader in healthcare enterprise identification.

Why International Expansion Must Remain a Priority for Cerner, Epic, Allscripts, MEDITECH

What You Should Know:

Why International Expansion Must Remain a Priority for Cerner, Epic, Allscripts, MEDITECH

– How the top US acute EHR vendors, namely Cerner, Epic, Allscripts, and MEDITECH (+85% share of US acute market in terms of revenues), have progressed on international expansion.


As highlighted below, there is a significant variance amongst the big four in terms of revenue and share of business outside the US. Cerner has by far the highest revenue at more than $650M in 2019, representing 12% of its business. Whilst MEDITECH has considerably lower revenue than Cerner, its international revenue is broadly similar to a share of its total revenue.

By contrast, Allscripts and MEDITECH each has international business that is comparable in terms of revenues, but as a share of overall revenues, international is much less important for Allscripts.

Allscripts’ international revenue was lower than Epic, Cerner, and Meditech in 2018, however, its growth in 2019 enabled it to overtake MEDITECH and become the third largest of the four vendors in 2019.

Main Chart

Cerner

cerner

Cerner’s international revenues fell marginally as a proportion of its total business in 2019 (11.5%, down from 11.9% in 2018), although revenues grew in absolute terms by 3%. This growth was aided by success in Europe, particularly in the UK and Nordics where it won new contracts. Cerner’s overall revenue suffered a 3% decline in 1H 2020 (versus 1H 2019). Despite the impact of COVID-19, its international business witnessed marginal revenue growth (+1%) and rose as a share of its overall business (11.9%) during this period.

Cerner received a significant boost to its international business in 2015 when it acquired Siemens’ EHR business. This provided it with a broad footprint of deployments in DACH (Germany, Austria, Switzerland), Benelux, France, Norway, and Spain. Since this acquisition, the challenge for Cerner had been to migrate the customer base to Millennium. However, this has not happened to date, particularly in Germany and Spain.

Tough market conditions, especially in Germany which already had a highly competitive acute EHR market, was another factor impacting the market growth. The above challenges faced by Cerner were key drivers behind the deal to sell parts of Cerner’s Healthcare IT portfolio in Germany and Spain to CompuGroup Medical (CGM). Cerner will continue to maintain a presence in Spain and German acute markets via its i.s.h.med solution (originally contracted to SAP/Siemens), which was not included in the CGM agreement. i.s.h.med has also provided Cerner a footprint in several other European, African, and Asian countries such as Russia and South Africa.

In other European countries where Cerner has a Millennium footprint it has had more success, and the additional product support and development costs have been less.

Cerner has a substantial UK presence, in part owing to its legacy relationship with BT and the subsequent contracts given out under the largely failed NPfIT program. These customers do use Millennium and the company has grown this business in recent years. To date, Cerner has an installed base of 26 trusts in the UK, up from 22 in 2019, and has had success upscaling these contracts to include products such as HealtheIntent. It has also grown the number of acute trusts served. For example, in 2018 it won contracts with The Countess of Chester Hospital National Health Service Foundation Trust, previously using MEDITECH, and Sandwell and West Birmingham Hospitals. In 1Q 2020, Cerner was selected by two NHS Foundations Trusts (Ashford and St Peter’s Hospital and Royal Surrey) to implement a shared Millennium EHR system, which should support a more coordinated care approach between the two organizations.

Elsewhere in Europe, Cerner expanded its Nordic business recently with large contracts in Region Skäne and Västra Götalandsregionen (both in Sweden) during 2018 and 2019. Cerner was chosen as the preferred EMR supplier for Central Finland (four of 19 sote-areas) and will have the opportunity to expand the contract to other surrounding regions in the mid-long term. However, it lost its Norwegian footprint to Epic when it chose not to bid when the Helse Midt-Norge (Central region) contract was renewed in 2019.

The company has also seen success in the Middle East, particularly in the UAE, Qatar, and Saudi Arabia. However, growth has been more subdued over recent years. In the UAE, it has large contracts with the Ministry of Health and Prevention (MOHAP) and Abu Dhabi department of health (HAAD). Whilst Cerner already has a significant footprint in Saudi, e.g. King Faisal Hospital, the country is still relatively untapped in terms of deployment of digital solutions and offers Cerner a good future growth opportunity.

In Asia Cerner has been successful in Australia, winning state/territory-wide EHR contracts in both Queensland and New South Wales (the only vendor to win two state/territory-wide contracts), and also had success in other states/territories where procurement is decentralized.  Cerner was aiming to add a third centralized Australian contract to its customer base, namely ACT Health (Capital Territory), but was unsuccessful in a head-to-head with Epic, which was selected as the chosen partner in July 2020. Cerner aims to push its PHM solution (HealtheIntent) through its existing state-level contracts where it already has a presence with Millennium.

Most of Cerner’s non-US business in the Americas is in Canada where approximately 100 hospitals are estimated to be using its solution. Here it faces competition from the other leading US vendors such as MEDITECH, Epic, Allscripts, and also local vendor Telus.

In summary, Cerner has broadly made a success of its international business. It tops the market share table in several of its international geographies and it has done this while broadly maintaining the margins achieved with its US business. However, Cerner’s divestiture of the legacy Siemens business in Germany/Spain, and withdrawal from Norway (Central region), will reduce the size of its European business. Cerner also faces an increasing threat from EMEA competitor Dedalus, whose recent acquisitions of Agfa Health’s EHR and integrated care business, and DXC’s healthcare provider business (deal to close in March 2021), could impact Cerner’s position as acute EHR market leader in EMEA moving forwards.

Allscripts

Allscripts

Allscripts’ international revenues witnessed a substantial rise in real terms (up by 34% versus 2018) and as a share of overall business in 2019. This was partly due to a strong performance in the UK with existing customer sales, and new contract wins in New Zealand, Qatar, Philippines, and Saudi Arabia. The impact of COVID-19 on Allscripts’ total revenues was comparatively significant (versus Cerner and MEDITECH), with declines of 9% and 6% respectively in 2Q 2020 and 1H 2020. It is estimated that these declines predominantly impacted North American revenues, whereas international revenues suffered to a lesser extent.

Canada had historically been its largest market outside the US accounting for just under a third of its non-US business, however, its share fell by six percentage points from 2018 to 23% in 2019, largely owing to the growth of its business in the UK and Australia, which are estimated to now be broadly similar in size to Canada.

In Canada, it is a top-five player, but lagging someway behind MEDITECH, Cerner, and Epic in terms of hospital installations. Allscripts continues to steadily grow its Canadian business with a focus on selling added functionality/upgrades to long-standing customers in three provinces (Manitoba, Saskatchewan, and New Brunswick). It aims to expand its Canadian coverage by securing the contract with Nova Scotia province in 2H 2020.

Success in EMEA was mainly driven by wins in the UK, which included two Sunrise clinical wrap contracts along with several added-value solutions for existing client systems. In May 2019, Gloucestershire Hospitals NHS Foundation Trust selected Allscripts to provide a clinical wrap around InterSystems’ PAS. This was rolled out to the entire Trusts’ inpatient wards in March 2020 and represented the fifth clinical wrap around another vendor’s PAS in the UK. In the UK it serves 18 acute trusts (only Cerner, DXC, and SystemC are estimated to serve more).

Much of the company’s UK footprint was built from its acquisition of Oasis Medical Solutions six years ago. However, it has slowly built on this foundation adding new acute trust customers and upgrading many from the legacy Oasis PAS solution to Sunrise and other Allscripts’ solutions such as dbMotion – although perhaps at a slower rate than hoped. Besides the UK and Italy (where it has one Sunrise contract) Allscripts does not have immediate plans for Sunrise expansion in mainland Europe. However, countries that are attempting to implement integrated data-sharing programs (e.g. France, Germany, and Italy), offer Allscripts potential markets for its dbMotion solution.

Allscripts also achieved growth in the Middle East, fuelled by a contract win in March 2020 with Qatar’s Alfardan Medical / Northwestern Medicine for Sunrise. Allscripts has been working on opportunities across Saudi Arabia, UAE, Oman, Qatar, and Kuwait, with different strategies for each country. For example, Oman has a relatively low level of digital healthcare maturity and is being targeted with EMR solutions, whereas relatively mature health markets (e.g. UAE and Qatar) are being targeted with PHM/dbMotion.

Its entry into the Oceania market was also largely via acquisition (Core Medical Solutions in 2016). Core Medical Solutions was a leading player in the smaller hospital and private hospital markets in Australia. Allscripts has added to this legacy with a state-wide Sunrise EHR contract in South Australia (although deployment has not been without its challenges). Sunrise has been implemented in Royal Adelaide Hospital, South Australia Health and Medical Research Center, University of Adelaide, and the University of South Australia.

In 4Q 2019 Allscripts added South Australia’s largest regional hospital network, Mt Gambier, to its coverage. It also had success selling its Sunrise solution outside of this state-wide contract (e.g. Gippsland Health Alliance in Victoria in 2018) and in 2019 its footprint expanded into New Zealand.

In terms of its broader Asian strategy, the company recently split its Asian business into two sub-businesses, ASEAN and ANZ, indicating it sees opportunities beyond its existing Singapore footprint in South East Asia. This has been supported by 2019 wins in the Philippines. In less digitally mature countries, the BOSSNet EHR solution it obtained via the Core Medical Solutions acquisition offers a potential route to offering a more entry-level EHR solution compared to Sunrise.

At just 4.0% of revenues in 2019, international remains a relatively niche business for Allscripts. To some extent the company needs to decide where it wants to take this business. Relying on organic growth in the regions it currently serves is unlikely to move the dial far from this 4.0% figure over the next five years. A significant change is likely only via acquisition, something the company has not shied from in the past. However, should it focus on cementing its position in existing markets or expansion into new? Given it is not a top-two vendor in any of its current geographies outside the US, acquisition to cement its position in existing markets would make more sense than further expansion into new geographies.

Epic

Historically, there have been two major points of entry into new geography for EHR vendors; either through a partnership to gain expertise and ‘localize’ a solution or through the acquisition of a local vendor (as with Cerner and Allscripts earlier). Both have their challenges, with partnerships often being slow to progress and acquisition resulting in the long-term support, and in some instances a significant burden of a legacy solution (e.g. Cerner is still supporting several legacy Siemens EHR solutions nearly six years after announcing its acquisition plans and most of Allscripts’ UK customers are not using Sunrise).

Examples where vendors have taken on large regional projects without sufficient ‘localization’, have often resulted in projects not meeting expectations and negatively affecting both vendors and providers alike. To some extent, Epic has suffered from this with several of its non-US deployments, in particular in the UK (e.g. Cambridge University Hospitals in 2015) and more recently in Denmark (regional contracts in the Zealand region and Capital Region) and Finland (regional contract in the Apotti Region). 

Epic has not made acquisitions to enter its international markets and in all these examples EHR implementations have not met expectations and have either had to be scaled back, delayed, or required a significant amount of remedial action. The main criticism is often not enough ‘localization’ before deployment. That said Epic has had success elsewhere internationally, with less controversy surrounding its deployments in DACH, Netherlands, Middle East, and Singapore. In Canada, it is estimated to be the market leader in terms of revenues and second only to MEDITECH in terms of hospital deployments.

Epic has increased its focus on international expansion in recent years with incremental increases in revenue. However, it needs to improve on implementation/execution or future opportunities may be limited.  The fact it was the only vendor to hit the preselection criteria in Norway for the Helse Midt-Norge contract which it won in 1Q 2019 (replacing Cerner) suggests that progress has perhaps been made on this front.

Historically Epic has struggled to win any Australian state/territory-wide deployments where Cerner, Allscripts, and InterSystems have been successful. However, Epic strengthened its position by winning its first state contract in July 2020 – a $151m deal for the Australian Capital Territory (ACT Health). This was also significant due to it being the first time the Capital Territory had centralized contracting.

MEDITECH

Meditech

At 12% of 2019 revenue, MEDITECH had the highest proportion of non-US sales of all the vendors analyzed in this insight. However, the overwhelming majority of this was from Canada, where it is estimated to be the market leader in terms of the number of hospital installations (although in terms of revenues it is smaller than Epic, Cerner, and Allscripts). Of approximately $60M in non-US sales in 2019, nearly $50M is estimated to have been from Canada. Non-US revenue share was down marginally from 13% in 2018 and in absolute revenues (-7%) due to a fall in Canadian revenues (-8%), whereas revenue from other international markets was marginally up (+1%).

In early 2018 MEDITECH announced the release of its cloud-based EHR, Expanse. MEDITECH has since been rolling out its cloud-based EHR to new customers and replacing its legacy hosted Magic solution for existing customers. This will ease some of the costs and time associated with implementing the solution, which should make it more competitive. In addition, the data hosted on the cloud will make it easier to drive interoperability through a Health Information Exchange, further increasing its attractiveness for provider networks.

Implementation delays caused by COVID-19 contributed toward MEDITECH’s total revenue declining by 3% in 2Q 2020 (versus 2Q 2019). However, a strong international performance in 1Q 2020 (estimated revenue up by c.25%) was driven by new Expanse installations in Canada (including Ontario Mental Health Hospital), leading to 1H 2020 revenues rising by almost 10% (versus 1H 2019).

Approximately 2% of MEDITECH’s business comes from outside North America, a trend that has remained relatively unchanged for several years. As with Epic, Cerner and Allscripts, a significant proportion of its non-American business is in other English-speaking countries, such as the UK/Ireland (22 customers in the UK and 3 in Ireland – mainly public/private sector hospitals), South Africa (24 hospitals) and Australia (72 private hospitals). In the UK it is a second-tier vendor providing EHR solutions to a small number of NHS trusts (low double-digit). Despite a concerted push into the UK, with the acquisition of Centennial (its UK distributor and system integrator) and the official formation of MEDITECH UK in 2018, the number of trusts served decreased with Cerner taking Chester NHS Trust from MEDITECH in 2018.

The company has had considerable success in Africa, selling solutions in 12 countries including Botswana, Namibia, South Africa, Kenya, Nigeria, and Uganda. In September 2019, it partnered with Aga Khan University for a new 2020 deployment of Expanse in South African and Kenya, and subsequent deployment in Pakistan. Contracts in Kuwait and the UAE result in the whole MEA region accounting for a sizable share of its non-North American business.

MEDITECH’s international business mirrors its US business to some extent. It has one of the largest installed bases of hospitals worldwide, but predominantly small hospitals, and often in countries where spend per bed is low; it is also typically not upselling beyond core EHR, meaning that its international revenues, particularly when Canada is excluded, remain small.

Key Takeaways

In Signify Research’s latest global EHR analysis, it was estimated that the US accounted for nearly two-thirds of global EHR sales in 2019, so for these four vendors it must remain the key priority. However, the US is forecast to be one of the slowest growing EHR markets over the next five years as it approaches saturation, particularly for core-EHR products in the acute market. Further, the acute market in the US has now broadly consolidated around these four vendors meaning opportunities for gains in share through replacement is increasingly rare – the long tail has gone.

The geographic expansion offers a potential avenue to drive growth. However, it is not easy and there are plenty of pitfalls. Localizing solutions, acquiring local vendors, displacing local incumbents, aligning products to match government requirements and projects, and putting in place local implementation, project management, and support teams all require significant time and investment. Because of this, the global market remains highly fragmented and market share change is slow. However, for the big four discussed in this insight, ignoring the international opportunity will significantly limit long-term growth; so despite slow and sometimes painful progress, we expect it to remain a priority.


About Arun Gill, Senior Analyst at Signify View

Arun Gil is a Senior Market Analyst at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology, and telehealth. He brings with him 10 years’ experience as a Senior Market Analyst covering the consumer tech and imaging industry with Futuresource Consulting and NetGrowth Consultants.

Experity Acquires Reputation Management Platform Calibrater Health

Experity Acquires Reputation Management Platform Calibrater Health

What You Should Know:

– Experity, a provider of urgent care health IT, has
acquired feedback management solutions company- Calibrater Health.

– Through the acquisition, Experity will expand its patient engagement HIT platform by fully integrating Calibrater’s reputation management functionalities like AI-powered issue tracking, SMS patient surveys, and enhanced performance insights.


Experity, a provider
of clinical and practice management software to the urgent care space, today
announced that it has acquired Calibrater Health, a provider of feedback management
solutions. 
The acquisition enables Experity to strategically expand
its industry-leading patient engagement offering with reputation management
capabilities tailor-made to meet the needs and demands of the rapidly growing
urgent care industry.

Patient Experience Top Priority for Urgent Care

The patient experience is top priority for providers in the
urgent care space. While a positive experience largely depends on efficient and
seamless care delivery, equally important are clinics’ patient engagement and
reputation management capabilities designed specifically for the urgent care
industry.

“Delivering a positive patient experience is the lifeblood of the urgent care market, so joining forces with a leader in feedback management like Calibrater Health is the right step in Experity’s continued growth,” said David Stern, CEO of Experity. “The urgent care industry continues to redefine what the patient experience can look like. We are committed to evolving alongside our providers to ensure that we will always meet their needs.”

Calibrater Health’s feedback management technology contributes
to a seamless patient experience through:

– Reputation management

– AI-powered issue tracking

– Text-based patient surveys

– Net promoter score (NPS)

– Team scorecards and engagement

– Performance insights

Acquisition Expands Patient Engagement Platform

In combination with Experity’s intuitively designed
workflows and critical load-balance and reporting capabilities, the new
features will deliver a more robust patient engagement platform. As a result,
clinics can provide a smoother patient experience from the patient’s initial
online search, to post-visit follow-up, to their future urgent care visits.

A seamless patient experience
requires connected, integrated technology. However, urgent care clinics have
traditionally had to rely on multiple, disparate platforms to get all the
functionalities needed to manage the various elements of the business. This
acquisition fully integrates crucial technological functionalities and data
collected across all workflows within an urgent care business, including
patient feedback and clinical data. As a result, over 50% of US clinics that
use Experity and Calibrater solutions will now have all the capabilities and
insights they need in one interface to provide a truly seamless patient
experience.

“Joining two leaders with different areas of expertise in urgent care technology brings immense value to urgent care providers who are tired of having to work across disconnected technology platforms and vendors to get what they need,” said Tim Dybvig, CEO of Calibrater Health. “With this integration, clinics using Experity or Calibrater solutions now have all the capabilities and insights they need in one interface to provide a truly seamless patient experience.”

Bridge Connector Lands $25.5M to Expand Healthcare Integration Platform

Bridge Connector

What You Should Know:

– Bridge Connector raises $25.5 million in Series B funding to advance interoperability layer for healthcare organizations as demand for integrated health data intensifies during COVID-19 pandemic.

– The investment will support the growth of Destinations,
the company’s new integration-platform-as-a-service (iPaaS) that connects
health data systems using use-case-based interoperability blueprints to speed
integrations with major vendors.


Bridge Connector,
a Nashville, TN-based interoperability company changing the way health care
communicates, today announced it has raised $25.5 million in Series B funding led
by Axioma Ventures. The round was also joined by all existing investors,
including veteran investor Jeff Vinick, and brings Bridge Connector’s total
funding to over $45 million.

COVID-19 Underscores Growing Demand for Integrated Health
Data

The last decade has seen an explosion of digital health platforms and the U.S. health care system has taken incremental steps toward achieving interoperability between them. In March, the Department of Health and Human Services (HHS) issued new rules that force formerly closed vendor solutions to become interoperable.

However, the COVID-19 pandemic has exposed the urgent need for data liquidity as healthcare providers across the country have struggled to share essential patient information and provide comprehensive care via remote delivery methods such as telehealth. In the face of the pandemic’s disproportionate effect on minority communities, the industry has also recognized the critically important role that social determinants of health — the environments in which we are born, live and work — play in our overall well-being and the need to make this information available to health care providers.

A True Interoperability Layer for Healthcare

Founded in 2017, Bridge Connector provides a suite of vendor-agnostic integration solutions and a full-service delivery model, helping health care vendors, providers, and payers more easily share data between disparate systems, such as electronic health records (EHRs) or patient engagement solutions. The company’s technology is designed to democratize health care by allowing organizations of any size to equitably connect data systems and empower care teams with the most accurate patient data in real-time. Unlike other health care interoperability vendors, Bridge Connector’s unique approach does not lock customers into a forced data model or proprietary APIs, instead of employing a vendor-agnostic integration layer that works across data models without the need for standardization.

The investment will further support the company’s increasing
market share in healthcare interoperability and growth of Destinations, a new
integration-platform-as-a-service (iPaaS) that connects health data systems
using use-case-based interoperability blueprints to speed integrations with
major vendors.

Recent Integrations with Key HIT Stakeholders

The new funding comes shortly after Bridge Connector finalized various collaborations with some of the most influential stakeholders in health IT, including Epic, Allscripts, and Salesforce, as well as other system integrators such as MuleSoft. Those collaborations represent calculated steps toward creating a centralized hub of integration solutions for all data platforms that any health care provider or payer can access. The average hospital today uses approximately 16 disparate electronic health records platforms that limit data sharing within the walls of a single hospital, let alone between separate hospitals.

Analysis: July Health IT M&A Activity; Public Company Performance

– Healthcare Growth Partners’ (HGP) summary of Health IT/digital health mergers & acquisition (M&A) activity, and public company performance during the month of July 2020.


While a pandemic ravages the country, technology valuations are soaring.  The Nasdaq hit an all-time high during the month of July, sailing through the 10,000 mark to post YTD gains of nearly 20%, representing a 56% increase off the low water mark on March 23.  More notably, the Nasdaq has outperformed the S&P 500 (including the lift the S&P has received from FANMAG stocks – Facebook, Amazon, Netflix, Microsoft, Apple, Google) by nearly 20% YTD. 

At HGP, we focus on private company transactions, but there is a close connection between public company and private company valuations.  While the intuitive reaction is to feel that companies should be discounted due to COVID’s business disruption and associated economic hardships facing the country, the data and the markets tell a different story.

While technology is undoubtedly hot right now given the thesis that adoption and value will increase during these virtual times, the other more important factor lifting public markets is interest rates.  According to July 19 research from Goldman Sachs,

“Importantly, it is the very low level of interest rates that justifies current valuations. The S&P 500 is within 4% of the all-time high it reached on February 19th, yet since that time the level of S&P 500 earnings expected in 2021 has been pushed forward to 2022. The decline in interest rates bridges that gap.”

Additionally, Goldman Sachs analysts also estimate that equities will deliver an annual return of 6% over the next 10-years, lower than the long-term return of 8%.  Future value has been priced into present value, and returns are diminished because the relative return over interest rates is what ultimately matters, not the absolute return.  In short, equity valuations are high because interest rates are low. 

What happens in public equities usually finds its way into private equity.  To note, multiple large private health IT companies including WellSkyQGenda, and Edifecs, have achieved 20x+ EBITDA transactions based on this same phenomenon.  From the perspective of HGP, this should also translate to higher valuations for private companies at the lower end of the market.  As investors across all asset classes experience reduced returns requirements due to low interest rates, present values increase across both investment and M&A transactions. 

As with everything in the COVID environment, it is difficult to make predictions with certainty.  Because the stimulus has caused US debt as a percentage of GDP to explode, there is an extremely strong motivation to keep long-term interest rates low.  For this reason, we believe interest rates will remain low for the foreseeable future.  Time will tell whether this is sustainable, but early indications are positive.

Noteworthy News Headlines

Noteworthy Transactions

Noteworthy M&A transactions during the month include:

  • Workflow optimization software vendor HealthFinch was acquired by Health Catalyst for $40mm.
  • Sarnova completed simultaneous acquisition and merger of R1 EMS and Digitech.
  • Payment integrity vendor The Burgess Group acquired by HealthEdge Software.
  • Ciox acquired biomedical NLP vendor, Medal, to support its clinical data research initiatives.
  • Allscripts divests EPSi to Roper for $365mm, equaling 7.5x and 18.5x TTM revenue and EBITDA, respectively.

Noteworthy Buyout transactions during the month include:

  • HealthEZ, a vendor of TPA plans, was acquired by Abry Partners.
  • As part of a broader wave of blank check go-public transactions, MultiPlan will join the public markets as part of Churchill Capital Corp III.
  • Also as part of a wave of private equity club deals, WellSky partially recapped with TPG and Leonard Greenin a rumored $3B transaction valuing the company at 20x EBITDA.
  • Edifecs partnered with TA Associates and Francisco Partners in another club deal valuing the company at a rumored $1.4B (excluding $400mm earnout) at over 8x revenue and 18x EBITDA.
  • Madison Dearborn announced a $410mm take private of insurance technology vendor Benefytt.
  • Nuvem Health, a provider of pharmacy claims software, was acquired by Parthenon Capital.

Noteworthy Investments during the month include:

Public Company Performance

HGP tracks stock indices for publicly traded health IT companies within four different sectors – Health IT, Payers, Healthcare Services, and Health IT & Payer Services. Notably, primary care provider Oak Street Health filed for an IPO, offering 15.6 million shares at a target price of $21/ share. The chart below summarizes the performance of these sectors compared to the S&P 500 for the month of July:

The following table includes summary statistics on the four sectors tracked by HGP for July 2020:


About Healthcare Growth Partners (HGP)

Healthcare Growth Partners (HGP) is a Houston, TX-based Investment Banking & Strategic Advisory firm exclusively focused on the transformational Health IT market. The firm provides  Sell-Side AdvisoryBuy-Side AdvisoryCapital Advisory, and Pre-Transaction Growth Strategy services, functioning as the exclusive investment banking advisor to over 100 health IT transactions representing over $2 billion in value since 2007.

COVID-19 Underscores Why Certain Aspects of the American Healthcare System Should Change Forever

Medsphere CEO Talks Affordable Healthcare IT and Future of EHRs
Irv Lichtenwald, President & CEO of Medsphere Systems Corporation

In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity upending the basic functions of a civilized society. With that, the UK’s National Health Service (NHS) was born.

In 2020, all perspectives about quality and the time it takes to see a provider aside, the NHS remains quite popular among UK citizens and is an enduring source of national pride.

With the United States in the midst of its own upheaval, it’s for a related question: Might the current COVID-19 situation give rise to significant changes to the American healthcare system? 

Virtually no one thinks the correct answer is ‘No.’ Things will change. The question is how and to what extent. The healthcare system in place in the United States now is dramatically more complex than that in use by Britons after WW II. There are so many moving parts, so many things that can break. 

So, in which aspects of the current American healthcare system are we likely to see changes after COVID-19 is dealt with?

Telehealth: Someone always benefits in a catastrophe. In this case, that someone may be Zoom shareholders.

From 10 million daily users in December, Zoom rocketed to 200 million in March and nearly 300 million a month later. Much of that was healthcare related. 

Of course, Zoom is not the only direct beneficiary of coronavirus as venerable meeting platforms like WebEx and Skype, among others, have also experienced dramatic growth.

Hospitals and health systems were incrementally implementing telehealth services prior to the coronavirus outbreak, but there was no sense of urgency that accompanies a rapidly spreading virus. Since then, the federal government, states and insurance companies have allocated funds and rewritten regulation to expand the use of telehealth. 

But there are more telehealth related-issues to address, some of which have thorns. Service and payment parity across insurance companies is an issue. If telehealth is going to be a regular component of healthcare, technology gaps will have to be addressed, especially in rural areas. 

This is something the federal government recognizes. The White House recently drafted an executive order oriented around improving rural health by expanding technology access, developing new payment models and reducing regulatory burdens. The EO tasks the secretaries of health and human services and agriculture to work with the Federal Communications Commission to “develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.” But until Congress gets involved and provides funding for something like this, it will probably never get out of the proposal phase. 

In fact, there are enough concerns—parity, technology gaps, added costs—associated with telehealth to wonder if it will endure after coronavirus is in the rear view. Enough about telehealth benefits both providers and patients for it to stick and proliferate, but that could also be said about any number of healthcare initiatives that seem to languish for lack of coordination and political will. 

Health Insurance: This is where the NHS analogy is the most relevant. Many millions of workers are furloughed or simply laid off with the impact of COVID-19 on frontline jobs like restaurant worker, massage therapist and barista. Those who had insurance through work may not have it anymore, leaving them doubly vulnerable—no coverage, no income—to illness or accident. 

Mass unemployment episodes reveal, each time, the weakness in the patchwork employment-based healthcare insurance system we’ve sort of made peace with for decades. Sure, Medicaid exists to fill the gaps, but it may make sense to render Medicaid unnecessary, especially since its value is questionable in particular states.

“You notice the number of band-aids that Congress is having to apply to help people who have lost their jobs,” said former CMS Administrator Don Berwick, MD. “What we have now is a whole series of band-aids and special measures. What if instead, we just had universal health insurance?”

What if, indeed. Will COVID-19 be the straw that burns the bridge of employer-based health insurance, to mangle a metaphor? That may depend on how long the pandemic lasts, who is president sometime after November 3 and how much damage is done to the national fabric before economy and society start a process of repair.

Payment Models: For years now, hospitals have been in the middle of slow shift from fee-for-service care to value-based care and alternative payment models. That transition didn’t happen quickly enough to prevent most hospitals from falling into a financial chasm. If elective procedures are a big part of revenue, it follows that revenue will fall if those procedures disappear. 

To be fair, the hit to hospital finances has been catastrophic enough—more than $200 billion in losses over four months, according to the American Hospital Association—that federal government support would have been necessary even if a full pay-for-quality model had been in place.  

But the pandemic spotlights the downside of treating essential services like healthcare as though they are mere services one selects or rejects. And it exposes the folly of not making sure everyone has insurance coverage (a payer) when the individual costs for COVID-19-related hospital admission can range from $20,000 to $88,000. 

End-of-Life Care: According to one analysis, 42 percent of COVID-19 deaths have occurred in nursing homes or assisted living facilities. The families of those unfortunate souls who’ve died while in a facility have generally endured the agony of saying goodbye outside a window or over a video link. It’s hard to believe, after COVID-19, that the assisted living industry will continue as before. 

“The crisis surely will lead nursing home administrators to reconsider the way patients are cared for,” says Modern Healthcare. “Among the ideas Harvard’s [Professor David] Grabowski believes will get a longer look in the wake of the pandemic are using telemedicine services, creating specialized Medicare Advantage plans for the homes and pursuing smaller settings.”

Perhaps. And perhaps a son or daughter that remembers coronavirus will simply choose not to risk everything by putting their parent in a home. Could enough of them make such a decision that the industry contracts? Is forced to take quality care more seriously? Attracts more serious federal regulation? 

As the deaths mount, it’s hard not to give every option serious consideration. 

Supply Chain: These days we’re bickering in public and on social media (looking at you, maskless Karen throwing food in Trader Joes) about whether or not masks should be mandated. Look back with me  to February, however, and you’ll fondly recall concerns about there being enough masks at all. 

Back then we learned that the United States had exactly one mask manufacturer, and that all other masks are sourced from overseas. That it takes longer to get stuff from China than from Amarillo creates obvious potential problems when a crisis hits, but it also pits hospitals and government entities against one another and guarantees that the winner will pay more for supplies than they would in less-critical times. 

It also creates weird, unnecessary scenarios that could be avoided using coordination and leadership. The governor of Maryland, for example, used his wife’s connections to South Korea (her country of birth) to secure 500,000 coronavirus tests, which he then put in an undisclosed location and protected using national guard troops. 

What’s the remedy? 

Modern Healthcare has called for a national supply chain czar, which in other times may have just been the head of FEMA. The suggestion, however, highlights the need for a coordinated central clearing house where supplies can be ordered, managed and dispersed based on need. 

Individual hospitals, clinics and health systems can also help themselves by using a robust supply chain software system that keeps track in real time of available supplies, covers all ordering systems and methodologies, and reacts swiftly to certain thresholds. 

The uniquely unfortunate aspect of the American political system among western democracies is that, for the most part, it responds to the demands of special interests. Think about your local representative. Chances are good the shouts of specific business interests are ringing in his or her hears so loudly that little else is audible. 

As such, there is a significant danger that the American healthcare system will return, post-COVID-19, to the same dynamic it had when the virus arrived, which will be unfortunate. What we need post-pandemic is not necessarily specific changes to hospitals, clinics, insurance companies, etc., though they could be part of an overall solution. What will be necessary is an examination of where every aspect of the healthcare system overall, inasmuch as there is one, didn’t do its job.   

Disasters are social sodium pentothal that, while active, force groups of people to take an honest look at their failures. Once the disaster is passed, however, there is a danger that Upton Sinclair’s maxim—“It is difficult to get a man to understand something when his salary depends upon his not understanding it”—will rule the day. 

No one hopes for more dramatic damage to the American economy and social fabric, but the irony is that necessary change sometimes only comes when reality is undeniable, as in a shellshocked Britain instituting the NHS. If COVID-19 doesn’t shock us sufficiently into making substantial changes to the healthcare system, it’s a pretty safe bet the same disaster will occur again.

7 Day Moving Average for COVID-19 Cases Is Up 148% Nationwide

7 Day Moving Average for COVID-19 Cases Is Up 148% Nationwide

What You Should Know:

– Nationwide, the seven-day moving average for COVID-19
cases is up 148% from June 7th to July 7th. In many states across the country,
the “curve” never flattened. Since June there hasn’t been a flattening effect,
but rather a significant spike in the number of COVID-19 cases.

– States hit hardest with new waves of COVID-19 cases
like Arizona, California, Texas and Florida have the highest percentage of
hospital beds occupied by patients with COVID-19. If there are too many total
cases in a short period of time, it can overwhelm health care capacity to treat
people during a pandemic.

– Nationwide, there is an average of 2.96 physicians and
2.4 hospital beds per 1,000 people.


Coronavirus cases continue to rise across the United States and have the potential to overwhelm our healthcare system, by limiting the number of available hospital beds, according to QuoteWizard’s recent report. Nationwide, the seven-day moving average for COVID-19 cases is up 148% from June 7th to July 7th. In many states across the country, the “curve” never flattened. Since June there hasn’t been a flattening effect, but rather a significant spike in the number of COVID-19 cases.

Report Background/Methodology

The findings are based on Kaiser Family Foundation data on
hospital beds and physicians per 1,000 people. Associated with hospital
preparedness, QuoteWizard updated data from the CDC that shows the percentage
of inpatient beds occupied by COVID-19 patients (as of July 7, 2020). The data is
paired with New York Times’ seven-day moving average of new COVID-19 cases from
June to July to reflect the spikes in new cases experienced over the last
month. The analysis is intended to show where cases are spiking; there’s a
correlation between hospital capacity and how prepared states’ hospital systems
were before the pandemic.

Additional key findings include:

States hit hardest with new waves of COVID-19 cases like
Arizona, California, Texas and Florida have the highest percentage of hospital
beds occupied by patients with COVID-19. If there are too many total cases in a
short period of time, it can overwhelm health care capacity to treat people
during a pandemic.

Arizona, California, Texas and Florida were states that
already rated poorly for hospital capacity prior to the COVID-19 outbreak.
Given already low capacity in states combined with the easing of stay-at-home
orders is leading these states hospitals towards overcapacity.

Florida ranks 22nd-least prepared based on physicians and
hospital bed capacity. Florida has seen a 736% weekly moving average increase
of COVID-19 cases over the last month. This spike in cases amounts to 16.30% of
hospital beds occupied strictly by COVID-19 patients.

Twenty-three states saw a decrease in hospital beds per
1,000 people from 2014 to 2018. Many of these states seeing increases in cases
in June and July are experiencing cases growing two to four times more than
previous periods.

Nationwide, there is an average of 2.96 physicians and 2.4
hospital beds per 1,000 people. The capacity of the health care system to
handle COVID-19 is dependent on how many people have access to critical health
care components like hospital beds, nurses, doctors and equipment like
ventilators.

Ranking: State-by-State Ranking of Growth in 7 Day Moving
Average for COVID-19 Cases from June to July

Rank State Physicians per 1,000 people Beds per 1,000 people % COVID-19 cases occupying beds Growth in seven-day moving average from June to July

1

Utah

2.11

1.82

4.80%

70%

2

Idaho

1.69

1.98

3.30%

716%

3

Nevada

2.00

2.00

13.70%

405%

4

Arizona

2.45

1.96

28.40%

269%

5

Hawaii

2.58

1.86

0.70%

633%

6

Colorado

2.52

1.92

2.60%

24%

7

Texas

2.23

2.3

16.00%

378%

8

Oregon

2.88

1.66

3.20%

243%

9

New Mexico

2.78

1.82

6.00%

26%

10

Washington

2.89

1.70

3.60%

102%

11

California

2.86

1.82

10.80%

194%

12

Georgia

2.38

2.40

14.50%

280%

13

Alaska

2.60

2.26

1.90%

147%

14

South Carolina

2.50

2.50

13.60%

352%

15

North Carolina

2.71

2.14

5.30%

60%

16

Virginia

2.73

2.14

3.40%

-35%

17

Oklahoma

2.39

2.84

4.60%

438%

18

Wyoming

2.03

3.24

2.40%

433%

19

Indiana

2.50

2.62

4.60%

8%

20

Wisconsin

3.04

2.14

2.70%

62%

21

New Hampshire

3.12

2.10

2.40%

-68%

22

Florida

2.63

2.62

16.30%

736%

23

Montana

2.18

3.52

2.50%

1175%

24

Arkansas

2.37

3.18

6.90%

72%

25

Alabama

2.49

3.08

12.40%

204%

26

Vermont

3.75

1.98

0.80%

-42%

27

Mississippi

2.22

4.08

11.30%

180%

28

Maryland

4.08

1.94

8.10%

-45%

29

Delaware

3.23

2.20

3.40%

113%

30

South Dakota

2.31

4.76

3.60%

-11%

31

Iowa

2.70

3.04

2.70%

38%

32

Connecticut

4.38

2.06

2.90%

-71%

33

Tennessee

2.78

2.98

5.10%

147%

34

Rhode Island

4.71

2.10

3.20%

-33%

35

New Jersey

3.43

2.34

4.40%

-40%

36

Kentucky

2.67

3.20

6.00%

31%

37

Minnesota

3.22

2.58

3.80%

-7%

38

Illinois

3.42

2.50

4.20%

-27%

39

Kansas

2.72

3.38

2.80%

276%

40

North Dakota

2.64

4.28

1.90%

10%

41

Maine

3.51

2.54

1.80%

-23%

42

Michigan

3.89

2.50

2.80%

37%

43

Massachusetts

5.25

2.32

3.80%

-53%

44

Louisiana

2.97

3.16

7.80%

250%

45

Ohio

3.63

2.88

4.10%

140%

46

Missouri

3.30

3.08

4.30%

95%

47

Nebraska

2.91

3.54

3.00%

-34%

48

Pennsylvania

3.99

2.92

3.40%

26%

49

New York

4.60

2.7

4.00%

-34%

50

West Virginia

3.17

3.74

2.50%

353%

Post COVID-19: 3 Things I Hope Healthcare Won’t Recover From

Post COVID-19: 3 Things I Hope Healthcare Won’t Recover From
Randy Carpenter, SVP of the Executive Advisory Board at HCTec

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. 

The more we can learn from some of the best practices coming from these times of crisis and upheaval and continue to keep connected with our teams, the better. 

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.

Doctor On Demand Raises $75M to Expand Comprehensive Virtual Care Platform

Doctor On Demand Raises $75M to Expand Comprehensive Virtual Care Platform

What You Should Know

– Doctor On Demand raises $75M in Series D
funding led by General Atlantic to expand comprehensive virtual care.

– Doctor On Demand is seeing record usage
this year – up 139% – for COVID-19 screenings, routine health issues, chronic
conditions and behavioral health.

San Francisco, CA-based Doctor On Demand, today announced it
has raised $75 million in Series D funding led by General Atlantic, a leading
global growth equity firm, with participation from existing investors. The
funds will be used to accelerate Doctor On Demand’s investments in growth and
further expand access to high-quality, comprehensive virtual care for patients
nationwide.

Founded in 2012, Doctor On Demand offers immediate,
video-based access to top physicians and psychologists for just $40 per visit,
with no subscription fees for partners via the iPhone, iPad,Android and
desktop.  With over 98 million covered lives and a 4.9/5 patient
satisfaction rating, Doctor On Demand is the preferred
virtual care provider of consumers, health plans and employers. The company’s
unmatched technology platform and clinical model of fully employed providers
gives patients a continuum of care and the ability to build trusted, personal
relationships with their providers. 

Recent Traction/Milestones

Following robust growth in 2019, Doctor On Demand
experienced accelerated momentum in the first half of 2020, with the COVID-19
pandemic driving increased demand for the company’s integrated medical and
behavioral health services. The company more than doubled its covered lives in
the past six months, propelling Doctor On Demand to its 3 millionth virtual visit.
In response to the public health emergency, the company mobilized quickly to
roll out its critical virtual medical services to 33 million Medicare Part B
beneficiaries across all 50 states, just weeks after the Centers for Medicare
and Medicaid Services (CMS) expanded coverage to allow for the reimbursement of
telemedicine visits for this high-risk patient population.

While COVID-19 has driven a sharp increase in utilization of
Doctor On Demand’s urgent care and behavioral health services, more than half
of the company’s 2020 future growth is focused on the continued expansion of
its Virtual Primary Care offering. This service enables health plans and
employers to deliver cost-efficient, comprehensive virtual care inclusive of
integrated behavioral health, 24/7 everyday & urgent care, and chronic care
management to their populations while reducing costs.

“In April 2019, Humana and Doctor On Demand launched On
Hand™, a first-of-its-kind health plan that centered on comprehensive virtual
primary care,” said Chris Hunter, Segment President, Group and Military
Business at Humana. “This new plan design represented a paradigm shift in
healthcare, and demonstrated that our members can and will build long-term
relationships with primary care providers and care teams in a virtual-first
care setting.” 

“Even before the pandemic, we recognized the importance of
providing integrated, virtual medical and emotional health care for our
associates,” said Adam Stavisky, SVP, US Benefits at Walmart. “Our early
decision to partner with Doctor On Demand helped us respond quickly as the
crisis hit, allowing us to immediately meet the care needs of our associates
and their families where and when they need it.”