Assessing physician practices and expectations in the post-COVID era

The ongoing COVID-19 pandemic has affected the routines of many practicing physicians, including an impact on their prescribing decisions. New research from CRA shows that for many physician practices, prescribing has shifted based on route of administration. These changes, initially presumed to be temporary, may continue beyond the pandemic.

As several COVID-19 vaccine candidates progress to patients and with more than 150 other vaccines in clinical development, global communities look forward to returning to “normal life,” but it is also increasingly likely that what we return to will be a “new normal”.

For many practicing physicians, changes presumed to be temporary just a few months ago may in fact become part of more permanent changes to their practice structure. As the COVID-19 pandemic continues, personal protective equipment (PPE) requirements, social distancing, increased telehealth and fewer in-person doctor visits have become common.

Many physicians are also now reporting affordability issues among their patients. In this article, we focus in particular on how COVID-19 may be changing prescribing decisions using market research and claims data.

Together with research partner Dynata, Charles River Associates (CRA) conducted a recent survey of 140 physicians to better understand their perceptions of the pandemic’s effects on their daily practice, including current and potential future changes.

The survey focused on oncologists and neurologists, two specialties that regularly see immunocompromised patients receiving long-term treatment, and also surveyed pulmonologists and urologists to gauge the wider impact on prescribing habits. The findings (both self-reported by physicians and observed in claims) suggest that the pandemic is affecting the therapies that patients receive, as healthcare providers (HCPs) look to reduce the risk of their patients contracting COVID-19.

Analysis of prescribing changes

Based on the survey results, the majority of HCPs (61%), especially oncologists, report changing their prescribing decisions in some way as a result of COVID-19 (see Figure 1). The proportion of physicians who reported changing prescribing decisions varied, ranging from 77% for oncologists to 46% for urologists (pulmonologists and neurologists reported changing their prescribing decisions 54% and 65% of the time, respectively). Ways in which physicians changed their prescribing decisions include:

  • Shifting prescribing toward therapies with less frequent dosing (reported most often by oncologists [40%] followed by neurologists [26%])
  • Moving toward more established therapies (reported most often by neurologists [37%])
  • Moving toward therapies with fewer side effects (reported most often by pulmonologists [26%])
  • Most commonly, moving toward therapies that require less in-person contact, such as subcutaneous or oral medicines versus intravenous medicines (reported most often by oncologists [43%] and neurologists [37%])

Figure 1. Changes in Prescribing by Specialty

Source: CRA market research (conducted June 2020)

Each of these changes may offer potential benefits for both HCPs and patients. For example, prescribing more established therapies or therapies with more robust efficacy and safety data may make it easier for HCPs to titrate dosing or manage adverse events. Shifting prescribing toward therapies that require less frequent dosing and less in-person contact (such as moving from an intravenous therapy administered in an infusion centre to a subcutaneous therapy that can be administered conveniently at home) has clear potential benefits as a result of reducing interaction that may spread COVID-19.

There are also special considerations for immunocompromised patients including those with cancer or autoimmune disorders such as multiple sclerosis (MS) who are shown to be at increased risk of complications and death from COVID-19. Given their susceptibility to contracting COVID-19 and its associated complications, oncologists and neurologists may be especially motivated to look for opportunities to reduce the risk to immunocompromised patients, including reducing the amount of in-person contact and hands-on management. Switching to therapeutic options that involve less in-person contact may also be more amenable for patients who feel uncomfortable or have difficulty traveling to an infusion centre safely during the pandemic. Fewer patients coming in and out of an infusion centre may help infusion nurses and other staff to also reduce their potential exposure to COVID-19.

Overview of patient claims data

To further explore the impact of COVID-19 on prescribing decisions among neurologists and oncologists specifically, including the proportion of infused therapies prescribed, CRA worked with data from Compile to analyse claims data from patients with MS and HER2+ breast cancer (see Figure 2). These data cover about 30% of US pharmacy claims and about 50% of US medical claims for these conditions.

More than 100,000 MS patients were included in the data set, defined as patients with two or more MS-related medical claims or one or more MS-related medical claims plus a related pharmacy claim identified between January 2019 and June 2020. Focusing on the subset of MS patients shown to have received treatment from neurologists during this time period, infusion therapies (specifically Lemtrada, Ocrevus, and Tysabri) showed a decline of 19% in terms of the total number of claims from February to June 2020.

Our team also reviewed claims data for more than 280,000 HER2+ breast cancer patients during the same observation period (January 2019 to June 2020) and using the same parameters for claims data (two or more HER2+ breast cancer-related medical claims or one or more HER2+ breast cancer-related medical claims plus a related pharmacy claim). Similar to MS patient data, we observed a marked decrease in use of infusion therapies among the subset of HER2+ breast cancer patients shown to have received treatment from oncologists during the observation period. In fact, the claims data suggest that oncologists may be even more likely to shift away from infused therapies to other routes of administration (such as oral or subcutaneous) compared to neurologists. Among HER2+ breast cancer patients in this claims analysis, there was a significant decline of about 41% in terms of the total number of claims using infusion treatment (including Enhertu, Herceptin, Herzuma, Kadcyla, Ogivri, Perjeta, and Trazimera) from oncologists from February to June 2020.

Figure 2. Changes in Prescribing by Specialty

Source: CRA claims data analysis (using claims through June 2020)

Our analysis represents a preliminary review of the impact of COVID-19 on prescribing habits among physicians including specialists. Given the specialised focus in the analysis and the nature of the data, there are caveats associated with using this data source; these may include under-representation of in-patient claims, limited coverage of certain mail-order channels and specialty pharmacies, and the uncertainty of claims capturing for some patient populations.

Impact on patients

Physicians are also adjusting to the impact of COVID-19 on their patients, including patient anxiety and personal finances. More than half of the surveyed physicians in the market research data reported higher patient anxiety due to COVID-19, and most pulmonologists (77%) and oncologists (66%) also reported that patients often contact them with COVID-19-related concerns or questions. They indicate that financial anxiety is likely exacerbating patient anxiety. Many physicians also reported seeing an increase in issues related to financial difficulties among their patients, such as:

  • discontinuing or skipping medications due to cost (45% of physicians)
  • no longer being able to afford prescribed medications (41% of physicians)
  • losing insurance (e.g. through non-employment) (40% of physicians)
  • requesting cheaper medications such as generics (35% of physicians)

As the pandemic’s toll on the economy continues, physicians will likely see themselves having more difficult conversations with their patients surrounding medication management and affordability. Being aware of these trends can help physicians prepare their practices to better address such issues. For example, practices may collaborate with pharmaceutical companies to make it easier to help patients find and enroll in financial support programmes.

Taken together, all findings thus far indicate that COVID-19 may be affecting the way physicians prescribe medication and interact with patients, among other impacts. Based on our survey, physicians also cite likely trends such as increased virtual medical conferences and fewer visits with sales representatives, with both outlets possibly becoming less predominant sources of product development information.

In recognition of potential systemic changes in the delivery and access of healthcare services, physicians will continue to adapt their practices to the new environment to address both internal and patient concerns. This may require education from and communication with pharmaceutical companies and other industry stakeholders moving forward. Acknowledging that temporary changes including prescribing changes may become permanent and preparing for this shift can better position HCPs and their practices to succeed in the post-COVID-19 era.

About the authors

Kristen Backor, PhD, is director of the market research Center of Excellence at CRA, providing guidance and oversight for projects concerning customer insights and qualitative and quantitative research assessments.

Eddie Li is director of the Analytics Center of Excellence at CRA, where he specialises in market assessment, promotional response modelling, customer segmentation and patient finding.

Jing Li is a senior associate in the Analytics Center of Excellence at CRA with significant experience in analysis of pharmaceutical claims data.

Elizabeth Rountree is a vice president at CRA with 20+ years of customer insights experience (data analytics, primary market research) in biopharmaceuticals as well as in-depth expertise in neurology and oncology.

Billy Wang is an associate at CRA who has been helping clients define COVID-19 focused strategies since the beginning of the pandemic.

The views expressed herein are the authors’ and not those of Charles River Associates (CRA) or any of the organisations with which the authors are affiliated.

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M&A: Cerner to Acquire Health Division of Kantar for $375M in Cash

M&A: Cerner to Acquire Health Division of Kantar for $375M in Cash

What You Should Know:

 – Cerner announces it will acquire Kantar Health, a leading data, analytics, and real-world evidence and commercial research consultancy serving the life science and health care industry.

– This acquisition is expected to allow Cerner’s Learning
Health Network client consortium and health systems with more opportunities to
directly engage with life sciences for funded research studies. The acquisition
is expected to close during the first half of 2021.


Cerner today announced an agreement to acquire Kantar Health, a division of Kantar Group, a leading data, analytics, and real-world evidence and commercial research consultancy serving the life science industry for $375 million in cash, subject to adjustment.

Acquisition Will Create Leading Data Insights and Clinical
Research Platform

With this acquisition, Cerner plans to harness data to improve the safety, efficiency, and efficacy of clinical research across life sciences, pharmaceuticals, and health care at large. This acquisition is expected to allow Cerner’s Learning Health Network client consortium to more directly engage with life sciences for funded research studies.

The Cerner Learning Health Network offers health systems complimentary access to a network of bi-directional, de-identified data resources. This access helps advance research efforts and provides opportunities to generate revenue with funded research studies from life science companies. Kantar Health’s proprietary syndicated data products including CancerMPact, Claritis, National Health & Wellness Survey, and its broader oncology, rare disease, and multi-therapeutic expertise are used today by all of the top 20 life science companies to further their real-world evidence, commercial and clinical research efforts.

The combination of Cerner and Kantar Health is expected to
enable a two-sided collaboration between providers and the pharmaceutical
industry, where researchers can generate insights and use differentiated
real-world data assets and expertise to address the most complex clinical
research questions.

“Cerner launched the Learning Health Network with our provider clients to advance a shared vision: treat global diseases more effectively through an acceleration of clinical research,” said Donald Trigg, president, Cerner. “Kantar Health has incredible health economics and medical affairs expertise, differentiated real-world data assets and strong relationships with the world’s leading life science companies. It offers us an amazing opportunity to drive cross-industry collaboration that can change health outcomes around the world.”

Acquisition Reflects Cerner’s Strategic Focus on Clinical
Research

This is the second announcement in this month expanding upon
Cerner’s commitment to improving the safety and efficiency of clinical research
in life sciences and health care. Last week we announced a relationship with
Elligo which broadens the clinical trial resources available to rural and
community hospitals and physician practices. This is significant to help
broaden the diversity of individuals involved in clinical research, including
those in minority populations and rural communities.

The acquisition is anticipated to close in the first half of 2021, subject to regulatory approval, employee consultations, and other conditions, and is not expected to have a material impact on Cerner’s earnings in 2021.

Cerner Invests in Elligo to Make Clinical Trials Accessible for Health Systems of All Sizes

Cerner Invests in Elligo to Make Clinical Trials Accessible for Health Systems of All Sizes

What You Should Know:

– Cerner announced a strategic investment in Elligo
Health Research, a leading research organization that enables clinical trials
with nationwide community-based health care practices.

– Cerner plans to expand the data and tools available in
the Cerner Learning Health Network to offer additional clinical trial resources
to community and rural hospitals and physician practices.

– Financial terms of strategic investment were not disclosed.


Cerner Corporation today announced an undisclosed strategic investment in Elligo Health Research, a leading integrated research organization that enables clinical trials with nationwide community-based health care practices. As part of the strategic investment, Cerner will enter into a commercial agreement to expand the data and tools available in the Cerner Learning Health Network to offer additional clinical trial resources to community and rural hospitals and physician practices.

Single Platform to Accelerate Clinical Research

Founded by John Potthoff, Ph.D., and Chad Moore in 2016, Elligo
Health Research Since 2016, Elligo Health Research, founded by John Potthoff,
Ph.D., and Chad Moore, has accelerated the development of new pharmaceutical,
biotechnology, medical device, and diagnostic products using its novel clinical
technology and its Goes Direct® approach. As one of the largest health networks
for clinical research, Elligo works to bring research as a care option to as
many participants as possible by offering innovative, patient-centric solutions
within the practices of trusted physicians.

Collaboration Will Accelerate Clinical Research
Timeframes

Health systems face significant obstacles such as patient recruitment, costs, and access to clinical trial resources. Today, for example, the drug development process takes more than 17 years and costs approximately $2.5B. Cerner and Elligo will focus on helping reduce those obstacles health systems face to make clinical trials become more of a reality – no matter the size, location, or academic standing.

Additionally, most clinical trials are executed in large,
urban areas with homogenous trial populations, which offer insights that may
not be broadly applicable to all patients in need of the therapies. Clinical trial
resources can offer funded research opportunities for health care organizations
as well as access to trial therapies for patients who need it most, including
those in minority populations and rural communities. This could result in
outcomes that are more representative of diverse populations and a potential
increase in drug safety through post-market surveillance capabilities.

This collaboration is expected to help accelerate clinical
research timeframes, make clinical trials more broadly and easily accessible
and reduce the costs associated with bringing a therapy to market. In addition,
Cerner representatives will also join Elligo’s board of directors.

“At the beginning of the year, we launched a bold push with our provider clients to change the pace and cost of clinical trials. Today, 51 health systems are part of our Learning Health Network,” said Donald Trigg, president, Cerner. “Elligo shares our passion for making clinical trial opportunities accessible to every provider and patient. Our collaboration will accelerate that shared mission in the quarters ahead.”

M&A: CompuGroup Medical Acquires eMDs for $240M

M&A: CompuGroup Medical Acquires eMDs for $240M

What You Should Know:

– CompuGroup Medical (CGM) acquires eMDs, Inc. (eMDs), a
leading provider of healthcare IT with a focus on doctors’ practices in the US,
reaching an attractive size in the biggest healthcare market worldwide.

– CGM is building an attractive platform for future
growth through complementary product portfolios and the ability to provide
comprehensive solutions for doctors’ practices.


CompuGroup
Holding USA, Inc.,
a 100 % subsidiary of CompuGroup Medical SE &
Co. KGaA announced it has acquired
eMDs, an Austin, TX-based provider of electronic health records
(EHRs),
practice management software, revenue cycle
management
solutions, and credentialing services for physician practices
and enterprises. The acquisition is structured as a reverse triangular merger
under U.S. law. eMDs’ key products are Ambulatory Information Systems and
outsourcing services for medical accounting.

Financial Details

With this acquisition, the US subsidiary of CGM
significantly broadens its position and will become the top 4 providers in the
market for Ambulatory Information Systems in the US. The consideration to be
paid to the current shareholders of eMDs is based on an enterprise value of $240M
(equal to approx. EUR 203 million), which will be adjusted inter alia for
amounts of cash, financial debt and net working capital (compared to a
reference amount) as of the closing date. In the fiscal year 2019/2020 (ended
03/31/2020), eMDs had revenues of approximately EUR 81 million and an adjusted
EBITDA of approximately EUR 12 million with more than 60,000 healthcare
providers.

Founded by physicians, the company is an industry leader for
usable, connected software that enables physician productivity and a superior
clinical experience. eMDs’ customer base today consists of more than 60,000
providers in more than 70 disciplines. eMDs is operating in the highly
attractive US healthcare IT market that shows a high equipment rate with IT
solutions for healthcare professionals. eMDs has more than 1,400 employees at
locations in the United States and India.

“The fit with our existing product portfolio is perfect. We have established a solid foundation in the United States in recent years and are already number 2 in the important field of Laboratory Information Systems for Physician Owned Labs (POLs) and Reference Labs,” said Frank Gotthardt, founder and CEO of CompuGroup Medical SE & Co. KGaA. The Germany-based corporation is one of the leading providers for eHealth solutions worldwide. “We are firmly convinced that both CGM and eMDs customers will benefit from this transaction through complementary product strengths.”

CMS Direct Contracting Model Options for Value-Based Care

CMS Direct Contracting Model Options for Value-Based Care
Vanessa Kuhn, Director of Health Policy, PatientPing

The Centers for Medicare and Medicaid Innovation (CMMI) created the Direct Contracting Model to expand opportunities for more diverse providers and healthcare organizations to participate in value-based care arrangements for Medicare fee-for-service (FFS) beneficiaries.

The goal of the new model is to create the next generation of risk-sharing arrangements to improve outcomes for patients, lower costs, and ensure high-quality care. In developing the Direct Contracting model and associated payment options, CMMI decided to build on lessons learned from accountable care initiatives, in particular, the Next-Generation ACO (NGACO) Model, as well as Medicare Advantage and other innovative private payers. The new model specifically aims to attract providers new to Medicare FFS and Innovation Center models: “the payment model options appeal to a broad range of physician practices and other organizations because they are expected to reduce burden, support a focus on beneficiaries with complex, chronic conditions, and encourage participation from organizations that have not typically participated in Medicare FFS or CMS Innovation Center models.”

High risk equals high reward for the new Direct Contracting Entities (DCE). The payment model options that participants can choose from aim to (1) increase risk-sharing arrangements through capitated and partially capitated population-based payments, (2) include providers and organization new to Medicare FFS, (3) increase access and empower beneficiaries in their care, and (4) decrease provider burden by emphasizing only core quality metrics and making certain care delivery waivers available. Importantly, the model offers options for new entrant DCEs, meaning DCEs that have no or limited experience with Medicare FFS beneficiaries and associated Medicare risk-based contracts, as well as high needs DCEs that will focus specifically on high cost, high acuity beneficiaries.

The Direct Contracting model begins with an optional six-month implementation period on October 1, 2020, which is intended to support organizations that need additional time to align beneficiaries and optimize their care coordination and management functions. In light of COVID-19’s overwhelming impact on healthcare this year, CMMI announced the first Direct Contracting Model performance year will start April 1, 2021—a three-month delay from the original start date, with five performance years to follow. The second cohort of Direct Contracting participants will begin in January 2022.

Risk-Sharing Options:

The Innovation Center will initially test two risk-sharing options: 

  1. Professional – includes a 50% shared savings/shared losses provisions and Primary Care Capitation, a capitated, risk-adjusted monthly payment for enhanced primary care services that’s equal to seven percent of the total cost of care benchmark for enhanced primary care services
  2. Global – is 100% full risk option with either Primary Care Capitation or Total Care Capitation, which is a capitated, risk-adjusted monthly payment for all services provided by Direct Contracting Participants and preferred providers. 

CMS may test a third option, the Geographic Option, in the future, which would also be a 100% risk arrangement offering an opportunity for participants to assume the total cost of care risk for Medicare FFS beneficiaries in a defined region.

Achieving Success in the Direct Contracting Model:

Similar to existing accountable care models, critical elements to achieve success in the Direct Contracting model include a focus on workflows, systems, and partnerships that support care coordination activities, including connections to needed healthcare and wrap-around services, as well as supporting providers in attaining quality benchmarks while managing overall utilization. Underlying these capabilities is access to real-time actionable information to drive timely interventions and coordination activities.  

Real-time information through admission, discharge, and transfer (ADT) event notifications for Emergency Department, hospital, or post-acute encounters enable care coordination teams to deploy workflows and resources to more easily and quickly support patients. Knowing when and where patients are receiving care and understanding the clinical context for their care allows providers and care teams to more seamlessly work together to provide the right care at the right time without unnecessary or duplicative interventions. It also allows care teams to identify patients at high risk for complications, including readmissions and can prompt time-sensitive outreach and connection to additional resources.  

Having access to real-time information can not only improve patient outcomes and quality but will also help to maximize payment incentives for Direct Contracting participants. Coordinated care consistently leads to shorter lengths of stay, which not only has positive quality implications for patients but also financial benefits for Direct Contracting Entities. 

In addition, healthcare organizations can use real-time information to continuously strengthen and refine care network partnerships and collaborations.

Bottom Line:

To effectively manage Medicare FFS patients within the Direct Contracting Model, participants will need to coordinate with other providers across care settings and deploy timely interventions that support patients’ health and well-being. Real-time information, through ADT data, will provide participants with a new level of clinical intelligence to successfully prioritize and deploy care coordination services and ensure seamless transitions of care for patients while also creating optimal opportunities to achieve shared savings.  


About Vanessa Kuhn, Ph.D

Vanessa Kuhn, Ph.D., is the Director of Policy at PatientPing, a care collaboration platform that provides real-time visibility into patient care events across the continuum. PatinetPing works with hospitals, post-acutes, health plans, ACO’s and beyond, the platform connects providers across the nation to improve patient and organizational outcomes.

Best practices for physicians in adopting compliant and efficient data sharing

hand touching visual screen

By making responsible and strategic technology investments, practitioners will have access to robust data, be in a position to analyze and interpret trends and outcomes and provide health care informatics that ultimately will be the insights they need to be successful in a value-based health care environment.

Humana Taps Cohere Health to Modernize Prior Authorizations for Musculoskeletal Treatment

Cohere Health Launches with $10M to Increase Transparency Across Care Journey

What You Should Know:

– Cohere Health partners with health insurer Humana to modernize
the prior authorization process for musculoskeletal treatment across 12 states.

– In addition, the company has closed an additional $10M
in funding led by Flare Capital Partners and Define Venture, bringing the
company’s total funding to $20M.


Health insurer Humana has signed an agreement with healthcare collaboration company Cohere Health to improve the prior authorization process for musculoskeletal treatment across 12 states, starting Jan. 1, 2021. Cohere aligns physicians, patients, and health plans on a patient’s optimal healthcare experience—enabling access to higher quality care while at the same time minimizing administrative burden and siloed decision-making.

The partnership leverages CohereNext Platform’s prior authorization capability which grants authorizations across an entire episode of care, in effect pre-authorizing a complete treatment regimen from the initial diagnosis to treatment plan selection, and, ultimately, to the patient’s return to good health. Cohere’s approach aims to expedite evidence-based treatment plans to improve the healthcare experience for doctors and patients alike.

Humana to Leverage CohereNext Platform to Streamline
Prior Authorizations

As part of the partnership, Humana will employ the CohereNext Platform to streamline prior authorizations in musculoskeletal treatment in Alabama, Georgia, Indiana, Kentucky, Michigan, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, and West Virginia. The platform will initially serve approximately 2 million members and more than 3,500 physician practices.

This partnership supports Humana’s vision to reimagine and modernize processes for prior authorization by reducing approval times and improving the delivery of care, all while preserving important benefits such as safety, predictability, and cost containment.

Cohere’s solution will initially focus on prior
authorization; the company is developing additional use cases such as
value-based contract performance, improving physician and patient engagement,
and optimizing health plan clinical programs. By facilitating physician and
health plan collaboration, Cohere’s technology will help accelerate the
evolution to value-based care models.

“Through this strategic initiative and collaboration with Cohere Health, Humana is building on its commitment to reduce the complexity and friction of prior authorization for our physicians and members,” said William Shrank, MD, MSHS, Chief Medical Officer, Humana and Board Member, Cohere Health. “Cohere’s solution was co-designed with physicians and represents a major leap forward in improved physician experience and the adoption of evidence-based medicine.”


Cohere Health Closes Additional $10 Million in Funding to
Accelerate Delivery of Patient Journey Platform

In addition, the company announced it closed an additional
$10 million in funding led by Flare
Capital Partners
and Define Ventures,
bringing the company’s total funding to $20 million. The funding will be used
to enhance the company’s scalable CohereNext® platform that is built on
next-generation cloud and data technologies and provides interoperability to
existing healthcare infrastructure as well as the emerging digital health
economy.

This
Series A extension comes just two months after Cohere Health’s initial $10 million Series
A funding, which was also led by Flare
Capital Partners with Define Ventures contributing as an investor and partner,
as well as participation from a leading national strategic partner.

The CohereNext Platform improves the physician experience
and quality by:

– Authorizations that begin with diagnoses and not billing
codes

– Facilitating and auto-approving evidence-based treatment plans

– Delivering a peer review process with a true peer
specialist or sub-specialist

– Sharing quality performance relative to peers for specific
care paths and patient cohorts

– Providing tools, data and technology that optimizes
value-based payment

“The tragedy of COVID-19 has reinforced that the basic infrastructure supporting healthcare innovation is fundamentally broken. The shift from fee-for-service to value-based-care requires enabling interoperable capabilities to facilitate care around the interests of patients, and as a result, Cohere Health continues to rapidly grow and attract additional investments,” said Siva Namasivayam, CEO and founder of Cohere Health. “The additional funding will enable us to expand the CohereNext platform to impact more failure points across patient journeys so that physicians can deliver better outcomes and we can continue building our team, which has grown by more than 95 people this year.”

Is Your Community Ready for Connected Community of Care Model?

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

This question initially brings to mind many possibilities such as connection to the latest 5G cellular service, a new super-fast internet provider, or maybe one of the many new energy suppliers jockeying for market share from traditional utility companies. While all of these might represent legitimate opportunities to improve one’s community, here we are talking about a different concept; specifically, whether your community is ready to have a Connected Community of Care (CCC) to advance whole-person health.

The image of a CCC may seem obvious. After all, we all live in communities where we have some connections between hospitals, physician practices, ambulatory care centers, and pharmacies to name just a few. But here we are talking about a broader sense of connected community that includes not just health care organizations, but social service organizations, such as schools and civic organizations and community-based organizations (CBOs) like neighborhood food pantries and temporary housing facilities. A true CCC links together local healthcare providers along with a wide array of CBOs, faith-based organizations, and civic entities to help address those social factors, such as education, income security, food access, and behavioral support networks, which can influence a population’s risk for illness or disease. Addressing these factors in connection with traditional medical care can reduce disease risk and advance whole-person care. Such is the case in Dallas Texas, where the Dallas CCC information exchange platform has been operating since 2012. Designed to electronically bring together local healthcare systems, clinicians, and ancillary providers with over a hundred CBOs, the Dallas CCC provides a real-time referral and communication platform with a sophisticated care management system designed and built by the Parkland Center for Clinical Innovation (PCCI) and Pieces Technologies, Inc.

Long before this information exchange platform was implemented, the framers of the Dallas CCC came together to consider whether Dallas needed such a network and whether the potential partners in the community were truly ready to make the commitments needed to bring this idea to fruition. As more and more communities and healthcare provider entities realize the tremendous potential of addressing the social determinants of health by bringing together healthcare entities and CBOs and other social-service organizations, the question of community readiness for a CCC is being asked much more often. But how do you know what the right answer is?

Before looking at the details of how we might answer this, let’s remember that a CCC doesn’t don’t just happen in a vacuum. It requires belief, vision, commitment― and above all― alignment among the key stakeholders. Every CCC that has formed, including the Dallas CCC, begins with a vision for a healthier community and its citizens. This vision is typically shared by two or more large and influential key community stakeholders, such as a   large healthcare system, school district, civic entity, or social- service organization like the United Way or Salvation Army.

Leaders from these organizations often initially connect at informal social gatherings and advance the idea of what if? These informal exchanges soon lead to a more formal meeting where the topic is more fully discussed and each of the participants articulates their vision for a healthier community and what that might look like going forward. This stage in the evolution of a CCC is perhaps the key step in the transformation process, as while all stakeholders will have a vision, achieving alignment among those visions is no small feat. Many hopeful CCCs never pass this stage, as the stakeholders cannot come to an agreement on a common vision that each can support. For the fortunate few, intrinsic organizational differences can be successfully set aside to allow the CCC to move forward.

It’s at this point in the CCC’s evolution that details begin to matter in truthfully answering the question, “Is this community ready to be connected?” While there may be agreement among the key stakeholders on a vision, the details around readiness may still divert or delay the best-laid plans. It is safe to say that the key to understanding a community’s readiness to form a CCC lies in the completion of a formal, comprehensive, and transparent readiness assessment.

A readiness assessment is a process to collect, analyze, and evaluate critical information gathered from the community to help identify actual clinical and socio-economic needs, current capabilities and resources (including technology), and community interest and engagement. Taken together, a comprehensive readiness assessment can help identify a community’s strengths and weaknesses in preparation for establishing a CCC.

A readiness assessment is not a tactical plan for building a CCC, nor is it a governance document that provides how all members of the CCC will relate to each other. Instead, the readiness assessment provides communities interested in establishing a CCC with an honest and unbiased yardstick to measure preparedness. Conducting and using the results of the readiness assessment is one of the best ways to ensure a successful CCC deployment.

A typical CCC readiness assessment covers five areas: (1) community demographics; (2) clinical areas of need (including trends); (3) social areas of need (including trends); (4) technology competency (e.g., what percent of the potential network participants are computer literate?), availability (e.g., what percent of the potential network participants have internet access?), and suitability (e.g., is the internet access, high speed?); and (5) what are the needs of potential network participants and can these be modeled as use cases for the information exchange network? This information is essential to help key stakeholder decision-makers decide to move forward with establishing a CCC and to know what specific challenges may lie ahead.

The collection of this essential information can be done in a number of ways, such as making use of existing publicly reported data or conducting surveys, interviews, focus groups and town hall meetings with community leaders and residents and clinical and CBO leaders and staff. Experience conducting the readiness assessment that provided the foundation for the Dallas CCC showed that no single information-collection method was sufficient to collect the necessary level and robustness of the data. In Dallas, we utilized all five approaches but found that in addition to researching publicly available data, initial surveys, followed by interviews and focus groups, yielded the most voluminous and reliable information to chart the course ahead.

In addition to the various methods to collect this essential information, the key to obtaining useful and reliable information requires a sufficient number of respondents/participants who are drawn from various organizations and organizational levels. Simply put, you must have a large enough sample and you must have diversity within the sample. It’s not enough to just interview leaders of potential network participants, as their understanding of the needs, trends, and capabilities may look very different from that of frontline staff.

Similarly, surveying only one category of potential network participants may not provide enough information to fully understand the socio-economic needs in the community or even the perspectives surrounding the prevalence of chronic conditions. Beyond the qualitative methods involved, it is important to note that if done right, this process takes a lot of time to complete. Cutting corners by reducing the sample size, for example, or doing selective sampling to speed the readiness assessment process along will only cause problems later when this insufficient information results in erroneous decision-making.

Once the data has been collected, it is important to carefully analyze what the data is trying to tell you. Results of the readiness assessment must be shared openly and honestly with all key stakeholders, particularly those serving in a governance capacity. The governance group (a topic for another day) that has formed in parallel with the readiness assessment must be able to evaluate and understand the main messages from the readiness assessment to make an informed decision as to whether to move forward with establishing a CCC.

Like the need for alignment around the key stakeholder’s vision for the CCC, there must be universal agreement by the key stakeholders as to the message of the readiness assessment and its implications for the road ahead. As with the vision alignment stage, substantive disagreements among the group at this stage are a sign of trouble ahead unless differences can be resolved.

At this point, you might be thinking that this all seems very complicated and fraught with potential land mines waiting to derail your effort to answer the original question “Is your community ready to be connected?” Again, I would emphasize the importance of unwavering commitment and alignment to achieve the vision. But I would also offer advice gleaned from working in the CCC space for the last eight years, which is to get help early and don’t wait until the horse is out of the barn!

We have seen first-hand many communities and consultants approach the conduct of a readiness assessment with a cavalier attitude, often exemplified by the statement, “we already know all of this,” only later to have to backtrack their pronouncements at substantial additional cost in time and resources. Fortunately, today there are a number of excellent organizations, including PCCI, with the experience, credibility, and integrity in the CCC space to help you on this journey. Don’t be afraid to seek them out. It will be a wise investment that you will not regret, particularly when you begin to see the results of improved whole-person health and well-being in your community.           


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.

Designing A Digital Experience to Drive Revenue and Patient Engagement

 Designing A Digital Experience to Drive Revenue and Patient Engagement
Bill Krause, VP and GM, Digital Experience and Consumer Engagement at Change Healthcare

With the rise of healthcare consumerism, people are looking to hospitals, health systems, and physician practices to deliver the same user-friendly, digital experiences they receive from other industries. A recent survey found that more than 80% of consumers surveyed believe “shopping for healthcare should be as easy as shopping for other common services.” Specifically, they want streamlined access points online where they can shop for and purchase healthcare, easily make appointments, understand what they need to pay, make payments, and set up payment plans – or even obtain financing for care if the estimated costs exceed their budgets. 

These types of digital experiences help providers recruit new patients and keep them engaged, which leads to better outcomes for both the health of the patient and the financial health of the practice. Unfortunately, most healthcare organizations aren’t ready to provide this level of convenience. In part, this is because they have relied on patient portals as their main digital engagement tool to date.

The problem with portals

There are a few reasons why patient portals underdeliver. First, portals are only for patients that have an existing relationship with a provider. However, the patient experience begins when consumers start shopping for care. Relying on a portal alone is a missed opportunity to generate new patient business.  

Second, portals don’t mirror what consumers expect from digital solutions. The interfaces are clunky, the functionality is limited, and the technology only supports a pull strategy, meaning that it waits for the patient to come to it rather than periodically reaching out and prompting the individual to take action.

Third, a patient must be logged into a portal before they can do anything with it. This makes it harder to schedule appointments with new physicians because there is not an established connection. In these cases, the patient must pick up the phone, wait on hold, set up an account, possibly wade through insurance approval and pre-authorization, and then make the appointment. 

Finally, portals aren’t ideal for communicating costs. While some allow the patient to pay co-pays, they aren’t designed to give realistic cost estimates, offer payment plans, suggest alternative funding sources, and so on.

Taken together, these challenges result in low, inconsistent portal use. Even if a hospital indicates that 50% of its patients access the portal, one-time or limited use should not be viewed as patient engagement. Instead, to realize true engagement, organizations should be thinking about ways to foster two-way conversations to keep new and existing patients focused on their health and how the hospital, health system, or physician practice can meet their needs. This improves patients’ experience and builds loyalty, while also reducing leakage and growing revenue. 

What are the risks of poor digital engagement? 

Without a well-considered plan for providing a retail-like shopping experience that includes transparent cost information, healthcare organizations run the risk of losing patients. This is especially important as the marketplace becomes more competitive and focused on patient experience, and retail clinics continue to pop-up around the country. 

In addition to market changes, regulatory pressures are also making patient-centric financial communications a necessity. Several states are implementing price transparency regulations, and a federal requirement is right around the corner. To meet these standards, organizations will need effective tools that reliably determine and share prices with patients in advance of their appointments.

So where do organizations go from here? 

It’s clear that patient portals are not the answer. But how can organizations do a better job of giving patients the convenience they seek? Here are four best practices to consider.

1. Evaluate your organization’s digital tools.

The first step is to take a hard look at the digital solutions you currently provide and compare them to those available from other industries, such as travel, retail, and financial services. Consumers want a digital, retail-like shopping experience where they can search local providers, compare reviews and costs, schedule their treatment, and even pay – all in one intuitive place.

Don’t be fooled into thinking that only younger people want these tools. Research shows that more and more older adults are embracing mobile activities like online banking. In fact, The Harris Poll found that 80% of Baby Boomers (individuals between 56-76 years old) “wish there was a single place to shop for and purchase care.” 

Digital tools designed to improve access and transparency while making it easier to pay create more engaged consumers and provide a better patient experience. Achieving this dual dynamic requires digital tools are part of a comprehensive end-to-end solution.  

2. Streamline access to shoppable services

These are elective procedures and screening tests that an individual can schedule in advance and include things like planned joint replacements, colonoscopies, and mammograms. Healthcare organizations offer standardized pricing for these services, allowing patients to shop around for the best price, location, and experience. 

When patients are able to use a digital tool to research a service, set an appointment, and make a payment, it can drive patient satisfaction and increase the chances the individual will choose to have the procedure with the organization supplying the tool. With 67% of consumers stating they would “shop for healthcare entirely online, like any other products and services,” streamlining access to shoppable services will drive engagement and revenue. 

3. Adopt tools that help people understand their care costs.

More than half of consumers surveyed for The Harris Poll said they have “avoided seeking care because they weren’t sure what the price would be.” The biggest hurdle to accessing care is price transparency, resulting in patients not getting the treatment they need and in poor revenue management for a practice. 

Patients are more likely to pay their portion up front when they understand what they owe and feel confident that the cost information provided has taken into consideration their current insurance, deductibles, and co-pays. A key to accurate estimates is an automated solution that checks the patient’s insurance digitally, determines the benefits, reviews the amount of any deductible, and verifies whether the individual has already met their deductible. When a patient financial tool also offers the ability to make payments or set up a payment plan, it can increase patients’ propensity to pay, boost the amount of self-pay funds the organization collects, and substantially reduce the cost-to-collect.

4. Enable digital appointment scheduling

Consumers view scheduling and rescheduling appointments as a very difficult task.  Digital solutions can address this pain point. Mobile tools and apps that patients can use to schedule appointments monitor wait times, digitally complete forms, and check-in for appointments are essential to breaking down some of the barriers to patient access. 

Before onboarding a tool like this, organizations must think through the change management challenges in getting all stakeholders on board. Historically, physicians have been hesitant to open up their calendars to permit digital scheduling. However, transparency and standardization are becoming increasingly important to meet patient demand and are necessary to make these types of tools work smoothly.

Although digital tools are gaining popularity among all generations, there are still people who prefer to pick up the phone to price, schedule, and pay for care. In addition to digital solutions, organizations should have service-oriented call centers to work with these patients. Such centers should have well-trained professionals who are available during and outside of traditional business hours so patients can access the information they need when they need it.

Relying on the status quo is not wise

Healthcare is only going to become more consumer-driven as high-deductible health plans continue to disrupt the industry. Hospitals, health systems, and physician practices cannot afford to rely on outdated technologies that don’t facilitate two-way conversations or the digital experience patients expect. To compete today and in the future, organizations need a comprehensive, retail-like solution that offers a seamless user experience and spans the entire patient journey. Tools and technologies used in combination with putting the patient first will build loyalty while also improving an organization’s clinical and financial outcomes.


About Bill Krause

Bill Krause is the Vice President of Experience Solutions at Change Healthcare. Serving the healthcare industry for over 12 years, Bill leads innovation and solution development for patient experience management at Change Healthcare. In this role, he is responsible for the development and execution of strategies that enable healthcare organizations to realize value through leading-edge consumer engagement capabilities.

Previously, Bill provided insights and direction into new product and service strategies for McKesson and Change Healthcare. He also managed business development planning, partnerships, and corporate development across a variety of healthcare services and technology lines of business for those companies.

Prior to McKesson, Bill worked at McKinsey & Company as a strategy consultant, serving a variety of clients in healthcare and other industries.  He received his MBA from Harvard Business School and his undergraduate degree from the University of Virginia. He also served as a lieutenant in the United States Navy.

Sharecare Acquires WhiteHatAI to Enhance Healthcare Payment Integrity

Sharecare Acquires AI Company WhiteHatAI to Enhance Healthcare Payment Integrity

What You Should Know:

– Sharecare acquires WhiteHatAI to provide health plan
and provider clients with additional capabilities to ensure healthcare payment
integrity 

– WhiteHatAI’s ability to detect erroneous claims before
they are paid will help Sharecare’s health plan partners reduce costs
associated with FWA.

– Sharecare will integrate WhiteHatAI’s capabilities to
foster deeper engagement by enabling patients to both verify recent medical
procedures and report satisfaction.


Sharecare, the
digital health company that helps people manage all their health in one
place, today announced its acquisition
of WhiteHatAI, an innovator
in artificial
intelligence
(AI) healthcare payment integrity applications. WhiteHatAI
marks Sharecare’s 16th acquisition; financial terms of the
deal were not disclosed. 

WhiteHateAI Acquisition Benefits for Sharecare

Over the last several years, Sharecare
has introduced a range of capabilities and services to
support payers’ and providers’ workflows –
including digital clinical data solutions and medical
records management; quality, performance and risk-adjustment tools; and
billing contract compliance. Given traditional retrospective systems
fail to recover 99% of erroneously paid medical claims, WhiteHatAI’s
ability to detect erroneous claims before they are paid will help
Sharecare’s health plan partners reduce costs associated with FWA.
Additionally, these capabilities better position Sharecare’s provider
clients to succeed in value-based environments by enabling more timely
payments and fewer claim denials – resulting in cash flow generation
and better revenue
cycle management
.  

Impact of FWA in Healthcare

“Fraud, waste and abuse in our healthcare system is already a $900 billion problem, which – prior to the pandemic – was expected to increase 6.5% annually through 2024; but given the necessity to fast-track claims in the face of COVID-19, this challenge is likely to grow even bigger, faster,” said Jeff Arnold, founder, chairman and CEO of Sharecare. “By acquiring WhiteHatAI and integrating their suite of AI-driven capabilities across our portfolio, we are bringing industry leading innovation to our payer and provider client partners that will help them not simply detect FWA but do so before it occurs, thus increasing efficiency and accuracy throughout healthcare organizations.” 

WhiteHatAI Integration with Sharecare App

WhiteHatAI’s proprietary AI-driven platform also will
empower providers to extract unstructured clinical data from medical
charts – which can contain meaningful insights not available in the
structured record – and enable the identification and calculation of
CMS quality measures. Additionally, as the digital health company partners with physician practices to help
patients manage their own health day-to-day between office
visits with the Sharecare app, it will integrate WhiteHatAI’s
capabilities to foster deeper engagement by enabling patients to both
verify recent medical procedures and report satisfaction. Sharecare
can then message users based on the treatment or care plan addressed during the
medical visit, thereby improving outcomes and lowering the cost curve.  

“Sharecare has a track record of innovation and collaboration unlike any other digital health company, and we are excited to merge our expertise in AI and healthcare payment integrity with their ability to convene, rally and engage people, providers and payers in improving health and well-being,” said Pete Ransome, CEO of WhiteHatAI. “Joining the Sharecare family enables us to capitalize on our ability to combat the prolific and fast-growing problem of fraud, waste, and abuse in healthcare, which will save millions of dollars for our collective clients and, ultimately, advance patient care and satisfaction.”