How to Survive in the Healthcare Business

The short answer: Adapt...

The revolution happening in the healthcare system is creating challenges as well as opportunities for current healthcare players and new participants. If existing players do not adapt, they may soon be paced out of the competitive environment due to their inability to change.

Clinical Decision Support Systems: The Shift From Volume to Value

Since the days of Hippocrates, delivering safe and quality care has been the aim of all providers. With requirements shifting from volume to value based care (VBC), improvement in better patient outcomes is a necessity now for providers. To get paid adequately, healthcare providers need to demonstrate the delivery of quality care through clinical quality improvement.

Innovations and Calculated Risks in the EHR industry

For most of us, we have seen the computer grow from a simple soup of vacuum tubes and wires into a complex intelligent ecosystem that changes by the second. Technology vendors who do not adapt to the changes and will of the new ecosystem will be soon on the list of endangered species.

Clinical & RCM Integrated Data Exchange: Opportunity for Growth

When thinking of EHRs, we usually think solely about the clinicians or the clinical elements; we are not always considering the revenue cycle management process being integrated and working harmoniously in tandem through a mutual exchange of data.
In this perpetually evolving healthcare landscape, single and/or integrated platforms across ambulatory settings will be a necessity for clinical, financial, and operational data flows. In the value-based care model, payments will be now considered based on the accuracy and completeness of medical documentation of services rendered and managed by the providers.

EHR Reimagined: OmniMD adds artificial intelligence and machine learning to its EHR and RCM solutions

OmniMD, a leading provider of integrated Health IT platforms and services for medical practices incorporates AI and machine learning into its EHR and RCM solutions for medical practices. When thinking of EHRs, we usually think solely about the clinicians or the clinical elements; we are not always considering the revenue cycle management process being integrated and working harmoniously in tandem through a mutual exchange of data.
“OmniMD’s Advanced Data Science group has been working on AI and machine learning solutions for the past 3 years, “said Divan Da've, founder and CEO of OmniMD. “Our initial focus is specifically on machine learning-based clinical decision support systems, population management, predictive analytics, and financial.”
In this perpetually evolving healthcare landscape, single and/or integrated platforms across ambulatory settings will be a necessity for clinical, financial, and operational data flows. In the value-based care model, payments will be now considered based on the accuracy and completeness of medical documentation of services rendered and managed by the providers.

Improving The Urgent Care Process Through Technologies And Patient Experience

Urgent care plays a significant role in today’s healthcare industry. When a patient is in pain or in need of immediate medical care, an urgent care clinic is a great alternative to a hospital. It is imperative for these facilities to be current and updated with technologies and processes to better serve their patient populations.

Top 5 Reasons Why Your Claims Get Rejected

Payers are constantly changing their rules, regulations, and standards which leads to a complex billing process. These complexities are leading to the imminent decline in reimbursements and a rise in rejections.  Denied claims are one of the biggest reasons for loss of revenues across all medical specialties. Having trained and experienced billing staff is one of the best defenses against denied claims, however, understanding the different reasons for denial is fundamental to success. Here are the top 5 reasons why your claim got rejected:

The Importance of UX Design in HealthIT

UX (user experience) design in healthcare has been gaining quite a bit of traction throughout the years. In the healthcare industry, poor usability and design aren't just frustrating, it can lead to some serious damage and adverse patient outcomes. Poor design could quite possibly be contributing to medical errors, which has been estimated to be the third leading cause of death in the United States.

There is a myth that UX is all about creating user-friendly systems while in reality, it is so much more than that. UX is a concept connected with everything from your smartphones, websites, and even video games. UX is a state of mind; It is a perception that favors taking a human-centered approach to design applications.

There are some essential ideologies of UX design thinking, which focus on whether or not it is making an application interface more intuitive and conveying ease of use.

Patient Portals: An Open Door For Patient Engagement

The healthcare industry’s perspective towards patient engagement has changed drastically. Data compiled two years ago suggests that patient engagement through a portal was a big issue as there was very low portal utilization by both patients and practices. The study surveyed a random sample of 1,540 U.S. patients and resulted in the following information:

• Only a 1/3 of patients surveyed had access to a patient portal; whereas the remaining 2/3 either do not have access or are unsure.
• The most requested patient portal features are appointment scheduling, checking lab results, and requesting prescriptions/refills.
• The prominent items of frustration with patient portals are unresponsive staff (34%) and poor interfaces (33%).

In a more recent study in 2017, patient access to health data was more widespread across the industry, with 80% of patients using the patient portal and 90% of patients obtaining record copies free of charge. Patient portal and health technology use truly emerged in the industry following the 2009 HITECH Act. As per the survey, now 82% of patients agreed to the fact that they have logged into their patient portal at least once (a night and day difference compared to a similar survey in 2013 where only 5% of patients had access to their patient portal, and drastically improved from the previous year). The top requested features seem to be consistent throughout the years. Several EHR vendors offer the ability to request for an appointment, review labs, and request a refill in addition to attempting to improve the user interface and adapting to a more intuitive environment. As more practices tend to adopt an EHR solution that offers patient portals, the staff are becoming more responsive to the needs of their patients.

The studies show that the vast majority of patients demand access to their health information online. By raising awareness regarding patient portal use, a practice can increase patient engagement and reduce data entry and wait times. Patients are now accessing their patient portal to manage several tasks like scheduling an appointment, request a refill, and access their health data. The portal provides a platform for patients to be more engaged in their care while directly sharing information with their providers. Patient engagement provides several benefits for any practice and the best means to an end is by logging into your patient portal. It is essential for the success of the practice to evaluate their EHR vendor's current patient portal offering and if it aligns with their goals of patient engagement and overall efficiency. 

Source: http://blog.omnimd.com/blog/patient-portals-an-open-door-for-patient-engagement

Health Information Technology and the Shift to Value-Based Care

The US healthcare market is rapidly changing the way it compensates providers for medical services and this trend has significant consequences for healthcare information technology companies. In a study provided by the Health Care Payment Learning & Action Network in 2016, 29% of payments to providers used alternative payment models (APM), including shared savings and risk, bundled and population-based payments, and additional 28% of payments included pay-for-performance and care coordination bonuses on top of the legacy fee-for-service (FFS) compensation. Only 43% of 2016 payments were traditional fee-for-service plans which is a significant decline from the prior year when FFS accounted for 62% of provider payments. It is expected that APM payments will account for about 50% of the health care payment market in 2018 and traditional FFS plans will be reduced to well below 50% of the market. This dramatic and rapid shift has significant consequences for the health care information technology industry.

Revenue Cycle Management (RCM) systems used by providers are generally excellent at transaction processing and financial record keeping, but lack the ability to analyze practice, cost and efficiency trends throughout patient populations. This ability is necessary to have beneficial conversations with payers. Claim management systems have similar shortcomings and further lack a comprehensive view of the financial picture of the patient’s care. Both systems struggle to interact with the growing number of third parties, such as repricing or analytic entities that play critical roles in emerging value-based care and compensation models. In the near future, hybrids of combined RCM and claims management systems will likely emerge to improve efficiency and analytics and reduce costs. For example, a gated, network only plan (a micro-single payer) could provide a simple cloud-based platform with today’s technology for documentation and reimbursement. This solution would give the payer visibility in the care process and the provider certainty and ease of reimbursement.

In addition to converging provider/payer transaction systems, there are very powerful benefits in bringing electronic health record data into the value “conversation”. The patient’s condition and expected course are the most powerful determinants of cost. Harnessing this information in the analytic process makes value determinations possible. After all, spending nickels to save dollars still shows current costs against invisible financial benefits. Realizing these benefits will require far more integration of EHR and RCM systems as well as data analytics that bridge the clinical and financial dimensions.

Source URL: http://blog.omnimd.com/blog/health-information-technology-and-the-shift-to-value-based-care