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For leaders of employer-sponsored health, wellness, safety and workers' comp programs

Five Key Health Technology Trends for 2014

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Five Key Health Technology Trends
Indu Subaiya and Matthew Holt
Health 2.0 Conference

Mike Allen:  “Health 2.0 leaders provide an important perspective on the rapidly changing health and medical technology marketplace.”

Indu Subaiya and Matthew Holt, co-founders of the highly successful Health 2.0 conferences, have hosted more than 11,000 attendees and introduced over 500 technology companies to the world stage since 2006;  their sponsors include industry leaders Kaiser Permanente, The Robert Wood Johnson Foundation, Nokia, Walgreens, Cigna and United Healthcare.

Holt and Subaiya used their unique industry perspective as the basis for a keynote talk on Five Key Health Technology Trends at their flagship Health 2.0 Annual Conference held in Silicon Valley earlier this month.  Below is a summary of these trends and their implications for employers, health plans, insurers and brokers:

health-monitor-1501.      Self-tracking is going mainstream.  Smartphone Apps and tracking devices like FitBit, Jawbone and MyFitnessPal are rapidly expanding beyond their initial market of young, hip, tech savvy “quantified selfers”.    As mainstream Americans and physicians increasingly adopt these technologies, App developers are positioning their products to meet the needs of this broader market.  Some key developments include:

  • Well respected organizations like the Mayo Clinic are validating the clinical effectiveness of tracking devices which is speeding adoption in the medical community.  See Mayo’s recently published report  about the use of Fitbit to predict recovery from heart surgery.
  • App and device makers are consolidating to offer more comprehensive product lines.   For instance, Jawbone recently purchased BodyMedia and added 87 patents and a line of FDA Class II medical devices to its’ extensive line of trackers.
  • Developers are increasingly providing APIs (application programming interfaces) to facilitate integration with other platforms.  At the same time, insurers like Aetna have developed APIs to encourage interfaces with their health and wellness platforms.

As tracking goes mainstream, employers can increasingly find tracking solutions which improve medical outcomes, have a high level of medical credibility and provide the sophisticated technical and customer support required by corporate buyers.

GoogleGlass2.     New “augmented reality” tools such as Google Glass will change the delivery of medical services.    Like the Apple iPad before it, Holt believes that Google Glass will create a whole new ecosystem of medical apps and other software.   Physicians will use Glass to access checklists, instructional materials and images at the point-of-care, record patient conversations and consult with experts during surgery.  Equally important, software is being developed to analyze the vast quantities of data gathered by Glass to improve physician performance.

Another example of an augmented reality tool is Ellie, the emotion reading robot that analyzes facial expressions, gestures and voice inflections to help mental health practitioners interpret what patients are telling them.   Advances in motion sensors,  nano-devices, optical tools and big data analytics will provide savvy employers with many more new, reality enhancing tools that can be used at workplace clinics and as part of health and safety programs.

220px-The_Blue_Button_Logo,_April20123.      Clinical data sharing with patients will go to scale as years of work on Health Information Exchanges (HIE) begins to pay out.  Holt cited the HIE developed by the New York Health Collaborative which shares data among 200 hospitals and includes a well-designed patient portal.  In addition to the HIE projects underway in most American markets, the  government is expanding their Blue Button project   which provides medical records online for those covered by the Veterans Administration, and the departments of Defense and HHS.

As patient portals and electronic medical records become pervasive, employers will need to be prepared to provide interfaces with data from wellness and workers’ compensation programs to provide a more complete understanding of the patient and their health.

4.      Increasing transparency of medical prices – Data released this summer by CMS underscores the potential savings from improved price transparency.  According to the agency, the top 100 inpatient procedures at 3,400 hospitals showed “significant variation in average charge from hospital to hospital, including those within the same community locus.”

As noted in a previous post, employers are increasingly using medical price-shopping tools like those offered by Castlight, Pokitdok, GoodRx to help employees reduce medical costs.

5.      The definition of “health” will be expanded as the medical profession increasingly learns to improve population health by managing non-medical factors such as job stress, care-giving burden, financial worries, state-of-mind and even sex life.

indexEmployers like General Electric are already using aggregated data from employer-sponsored mobile Apps that track activity levels, sleep patterns and moods.  A demo of this system by MedHelp is available at the Health 2.0 site and is discussed at a previous Tech Talk post titled New Advances in Big Data Improve Healthcare.

Improved tools for self-tracking, augmented reality, clinical data sharing and medical price shopping provide many opportunities to re-define and re-engineer health, wellness and workers’ compensation programs.

If your organization has been standing on the sidelines wondering how to take advantage of these new technologies, the time has come to move ahead or be left behind.  A good starting point is this site’s App Directory which identifies 33 categories of  solutions for employer health, wellness, workers’ comp and safety programs.

 

October 21, 2013 |

New Medical Price Shopping Technologies Reduce Treatment Costs

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Santa Clara Conference Center
Venue for the 2013 Health 2.0 Conference

Mike Allen: “Employers looking to lower health expenses should help workers shop for medical treatment.” 

New technologies are rapidly evolving that engage employees in finding cost-effective health care, according to Lew Altman, a leading healthcare consultant and speaker at the 7th Annual Health 2.0 Conference held in the Silicon Valley.

The conference highlighted a number of new medical price shopping platforms that have entered the market since the well-funded debut of the Castlight in 2010. Let’s take a look at the companies which demonstrated at Health 2.0 plus several others to get a sense of the price shopping tools available for employers, health plans, insurers and brokers.

Change Healthcare targets health plans and self-insured employers and has recently received $15 million in funding.  They demonstrated their user-friendly online Healthcare University which teaches consumers the fundamentals of health insurance and price shopping.  This platform is being successfully used at BlueCross of Minnesota.     The “University” is part of a platform which also includes the  Transparency Messenger which provides consumers with personalized messages about savings opportunities based on their medical record.  For instance, the system can generate an email alert to patients using an expensive branded drug to let them know that a low-cost generic is now available. Change Healthcare touts a national client base of employers and health plans covering lives in all 50 states.

New entrant  PokitDok  was launched in 2012 to help patients solicit price proposals from multiple providers.   While PokitDok primarily focuses on signing up consumers, CEO Lisa Maki indicates that they have recently introduced functionality for business owners and have raised $4.0 million to begin national expansion.

Other new start-ups include HealthInReach  which offers scheduling and discounts for both medical and dental procedures in the Los Angeles area and MyDocTime which demoed a doctor and dentist scheduling service which finds a provider who can take you immediately.  Two other firms offer price shopping for dental services and both have special programs for employers.  Healthsouk currently covers a number of California markets; Brighter offers a similar service in Los Angeles and plans a national expansion backed by major venture capitalists Mayfield Fund and Benchmark Capital.

Several more established players that offer programs for employers and national coverage did not present or exhibit at Health 2.0.  These leaders include GoodRxFairHealth, and Castlight.  Detailed descriptions of these offerings can be found at their websites and at this site’s App Directory.

Should employers be jumping in and offering medical shopping platforms to workers?  Yes, but proceed carefully and consider the following factors as you develop your requirements.

1. Geography – Although all of the services noted above have expansion plans, many currently offer only limited geographic coverage.

2. Depth of provider coverage – a well-established Bay Area periodontist who has tested several of the dental platforms told me that “most of the dentists were either recent dental school grads or not people I would refer to.”   Make sure you understand the depth and quality of the network you offer your employees and manage their expectations accordingly.

3.  Go for the big savings – many offerings primarily help employees reduce “out-of-pocket” costs which account for only about 16% of total medical expenses according to a 2007 study.  This is a good place to help your employees get started with medical price shopping, but keep in mind that the larger savings will come from programs which engage employees in reducing the “over-the-deductible” costs which account for 84% of total medical spending. 

At this point, none of the firms noted above are promoting their ability to generate “over-the-deductible” savings although Castlight appears to be putting together the tools that will make this possible.  Take a look at their  recent study showing that a knee replacement in Los Angeles at a quality provider costs  $60,000 less than the same procedure at a lower quality provider!

Industry players including Lew Altman, Lisa Maki and many others believe that employees will increasingly play a more active role in managing their own health, including shopping for treatment.  Companies, health plans, insurers and brokers all have an opportunity to provide workers with the knowledge and tools they need to make this transition.

 

October 15, 2013 |

New Advances in Big Data Improve Healthcare Delivery

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H2N.10Mike Allen:  “The annual Health 2.0 Conference  highlights big data tools to improve healthcare delivery.”

Over 2,000 attendees met in the Silicon Valley for  this leading health tech conference which drew medical entrepreneurs, venture capitalists and representatives from health plans and employers including  Kaiser Permanente, Dignity Health, Cigna, United Healthcare and Safeway.   Over the next few weeks, we will review and discuss highlights of the event starting with the developments in big data tools which analyze data sets too large and complex for traditional data processing applications.

logo_mcFor employers, new analytic tools for  population management are particularly promising.    Ben Wolin, founder of  Everyday Health, the consumer medical website, discussed how his firm’s big data tools provide consumers with customized health  information based on past search patterns.   Everyday Health’s website and analytic capabilities are being used to increase consumer engagement at Mayo Clinic Health Living, a corporate wellness and population management program.

indexA different approach to population management was described by John De Souza, CEO of  MedHelp.  His firm uses information gathered from Smartphone and online tracking systems to help General Electric analyze employee activity levels, sleep patterns and moods.  MedHelp’s demo of GE data, which is available at the Health 2.0 site,  shows how their big data tools help GE  assess the impact of  wellness programs and gain insights into health management programs for specific conditions.

Employers should be aware of new data sources which can pinpoint health improvement opportunities when integrated with existing health information.  For instance, Bill Davenhall of  ESRI introduced his firm’s new database of environmental hazard sites.  A physician treating a patient for lung cancer can use this data to develop a “medical place history” which uses the patient’s past home and work addresses to identify past exposure to carcinogens.  Also, environmental health professionals can correlate the incidence of employee health conditions with hazard exposure at different company locations and use this information to mitigate risk.

For patients recovering from musculoskeletal disorders (MSD), Moving  Analytics has developed sophisticated algorithms which use patient movement data to determine if rehab plans are working.  Harsh Vathsangam’s start-up uses motion tracking capabilities of Smartphones to trigger status reports and reminders for both patients and their physical therapists.  With over 80% of workers’ comp claims resulting from MSD, Moving Analytics has great potential.

Finally, Silica Labs is developing Apps to harness the healthcare potential of Google Glass as commercial versions role out in the first half of 2014.   CEO Marvin Ammori is betting on “hands free” apps that let physicians record patient conversations, consult remotely during surgeries and access checklists, instructional materials and images at the point-of-care.  Health plans should be able to employ big data tools to analyze this massive new source of information and use it to improve physician effectiveness.

There are many initiatives underway to improve the interoperability of different data sets which will make it easier to create larger databases for analysis.  Phillipe Schwartz, CEO of App and device developer  Withings, described how his team is developing and refining API’s (application programming interfaces) to let customers integrate his firm’s data with other systems.   Most large mobile health developers have similar initiatives and employers should consider APIs and other evidence of interoperability as a requirement for Apps that they are considering for wellness and chronic disease management programs.

At a more global level,  Dr. Peter Tippett discussed Verizon’s three industry initiatives to improve the interoperability of health data.    Identity authentication technology will keep track of doctors and patients who are constantly moving, changing names, and locations.  Other Verizon tools will make it easier to to merge different types of data, and to keep data HIPAA compliant.

Employers are especially well situated to use big data because of their access to employee data from health, wellness, safety and workers’ comp programs as well as information from human resource information systems.   A good place to begin assessing the market for big data and other health technology services is the Health 2.0 website which provides archived presentations, a blog and other services.

Look for technology solutions that address your high payoff business issues and that are supported by organizations willing to dig in and understand your requirements.   For those who do this right, there can be a significant improvement in the health and wellness of your employees.

October 7, 2013 |

Stanford Research: Health IT That People Really Use

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Stanford Design Lab Solutions

Stanford Design Lab Solutions

Mike Allen:  “Stanford researchers address the chronically low engagement levels in health technology.”

The recent high profile failure of a WellPoint mobile App highlights the importance of developing or purchasing software that engages users.  (WellPoint Tries to Avoid Another Mobile ‘Crapplication’ – Wall Street Journal).

A recent presentation by a leading physician-researcher from the Stanford University Behavior Design Lab provided a number of insights into the characteristics of high engagement health technology  which will be helpful to both:

  • Healthcare executives responsible for transforming their IT infrastructure.
  • Software developers trying to create the next big breakthrough.

For more on this topic, see my write-up of the recent presentation by Stanford’s Kyra Bobinet, MD, MPH who previously served as the Medical Director for Wellness Programs at healthcare tech leader Aetna.

This presentation was sponsored by the Health Technology Forum, a San Francisco based meet-up group of healthcare executives, software engineers, entrepreneurs and venture capitalists which sponsors presentations, meet-ups and conferences in 13 cities around the world.

Captology.

 

October 3, 2013 |

Sedgwick, leading workers’ comp TPA, enters the mobile health market

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SedgwickWelcomeMike Allen on Sedgwick viaOne® Express Mobile:  “Very solid job with a first generation mobile tool for claimants.”

On August 5, 2013, Sedgwick, the nation’s largest workers’ comp third party administrator, released their first  mobile app –  viaOne® Express Mobile.   According to Sedgwick Executive VP Scott Rogers, viaOne is a first generation tool designed to improve communication between the claims examiner and the injured, ill or disabled employee.    Rogers believes that as Smartphones and tablets become the preferred means of communication for a rapidly growing segment of the workforce, the viaOne mobile app can help minimize communication gaps which cause unhappy customers and often precipitate  lawsuits.    Jarrod Magan, VP of Client Technology, indicated that Sedgwick’s plan is to carefully add other features based on reactions to this initial offering.

With this background, Sedgwick provided me with access rights and I logged into the viaOne test site on my iPad and found three claims listed, one each for workers’ comp, disability and employee medical.   For employers where Sedgwick administers several coverages this integrated platform reduces the time that benefit managers spend educating claimants.  Also, employees with several claims open can go to just one app for all of their claim information.   The user interface is clean, simple, all text.  Icons would be nice, but the text presentation is attractive.

I navigated first to a screen which listed issued and pending payments.  This is useful and should cut down on calls to examiners.  Another easy-to-use screen provided an opportunity to report a date for return to work to the claims examiner.    Unfortunately, when I got to the screen for general communication with the examiner,  viaOne required me to select a “message topic” from nine (9) wordy options.  This took time to figure out and seemed to be an unnecessary burden to put on the user.

Technical support was available through a prominently displayed button which brought up a text page with an email address.  Unlike communication with the claims examiner, this email could not be accessed from within the app.  I exited viaOne and sent a request for support from my personal email.  An automated response told me to either wait 72 hours for an email response or to call a support line for immediate help.  I did both.  First,  I called support, and in four minutes had worked through a four branch decision tree, a brief wait and was talking to live help.  Not bad.  As for the email response, I was informed that Sedgwick’s support team doesn’t monitor the demo environment so no real test was possible.

viaOne provides users with the opportunity to receive automated notifications via text or email at key points in the claims cycle such as when a check is issued.   This useful “push” feature can be configured by the users, including an option to turn off the notifications.   Unlike the very thorough privacy and security policies at Sedgwick’s main website, viaOne mobile has a only a brief paragraph.  For users like myself who are concerned about unauthorized access to personal financial and medical information I believe that this is inadequate.

Integration with case management, utilization review and other systems, which are available in the Sedgwick core system, have not been pushed out to the mobile app at this time.  This will be an important future capability as users come to expect a full range of services available on their Smartphones, tablets and other mobile devices.

The Sedgwick press release touts that they are “the first third-party administrator in the industry to provide this level of automated communications.”  While a review of the websites of the other top 5 workers’ comp TPAs indicates that this is probably true, we hope that Sedgwick will continue to set the bar higher and progressively add new features.

In the short run, more information available from the claim file might be useful such as confirmation  of bank transfers for indemnity payments, tracking of utilization review requests and approvals and information from case managers.

Longer term, Sedgwick may want to consider some of the medical management features offered at the mobile portals of major health plans.   These might include injury-specific educational information, access to medical reports and tests, 24×7 medical hotlines for selected cases, remote monitoring of vital signs and automated reminders for medication and physical therapy  regimens.

Sedgwick has done a very solid job with this first generation mobile tool.  They are smart to offer limited functionality as they implement this new technology across their extensive and varied client base.  We look forward to following future enhancements of viaOne.

August 22, 2013 |

Mobile Health and Medical apps – 10 Ways They Can Improve Workplace Health

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health-monitor-150As Smartphones and tablets become a preferred means of communication,  they are increasingly used to influence healthy outcomes by medical professionals, employers, employees, insurers and brokers.

To help you apply this new technology, we’ve provided the table below summarizing benefits experienced by other organizations.

As you review the table, remember that this is a new, wild and wooly industry.  As part of the evaluation of each app, be sure that you get answers to these three questions:

1. Is the information presented in the app credible?  Look for certifications or approvals by entities like the FDA, Happtique and URAC.  Other good signs include the existence of qualified medical or other professionals on management teams and advisory boards and the use of documented best practices.

2. What is the level of customer support?   Many app developers provide a contact form and a promise to respond in 72 hours.  Is this good enough or do you  require 24 x 7 phone support?

3. Do the privacy and security policies meet your requirements?  This is especially important if the app captures personal information or if you plan to integrate it with an EHR or claims system with confidential data.  Note that many personal health and wellness apps fall down in this area.

The “right” answers to these questions will depend on the your specific needs but be sure you know your requirements and how the developer’s solution matches up.


Key Result AreaMobile Health Benefits
Health and wellness programsSmartphone and tablet apps track diet, activity and mood which encourages healthy behaviors and lowers medical costs
Chronic disease managementSpecialized apps for diabetes, heart conditions, mental health, addictions, back pain and other debilitating conditions provide tools help physicians and patients improve treatment.
Patient communication Mobile portals empower patients by providing medical and claim information when and where the want want it. This enhances patient communication with medical teams, claims adjusters and employers.
Triage and emergenciesMedical hotlines using Smartphones and tablets provide immediate help and triage which improves treatment and lowers costs.
Remote medical monitoringMedical sensors imbedded in Smartphones or connected to them result in more complete tracking of vital signs and faster identification of problems or emergencies.
Tele-medicineDoctor visits using tablets result in better utilization of physician time, less patient travel and waiting time and lower costs.
Care coordinationSmartphone supported systems help families, caretakers and employers coordinate care resulting in improved adherence to medical regimens and better outcomes.
Patient engagement Tablet delivered educational videos and instructions improve patient understanding. Automated reminders increase compliance with medication, physical therapy & other treatment regimens.
Incident reportingSmartphones apps for accidents and first reports of injury provide fast, on-the-spot reporting with photographic documentation.
Safety and preventionOn-the-job OSHA, ergonomic and safety tools provide preventive information when and where needed.

Once you’ve identified potential high payoff areas for your organization, use our App Directory to find apps appropriate for your health, wellness, safety and workers’ comp programs.   It’s includes information for each app about credibility, customer support and privacy/security policies and it is a lot easier than sifting through the 20,000+ healthcare apps on the market!

August 2, 2013 |

Leading cardiologist discusses the mobile health revolution

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“I’m prescribing more Apps than medications.”  Dr. Eric Topol

Dr. Topol is a leading cardiologist, director of the Scripps Translational Science Institute and chief academic officer of San Diego-based Scripps Health.  He is also the foremost evangelist for digital health and author of  The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care.

For a quick overview of his vision for the future of medicine, take a few minutes to view this well-done segment at NBC news.   Dr. Topol demonstrates and discusses a number of devices which illustrate the power of the new technologies and how they can lower costs and improve outcomes.    

For specifics on how the mobile revolution may impact workers’ compensation, safety and employer health programs, take a look at Peter Rousmaniere’s Risk & Insurance article A Workers’ Comp App Store?  and a previous Tech Talk post –  40 Apps for your workers’ comp team.

July 18, 2013 |

New software for First Report of Injury (FROI) reduces workers’ compensation costs

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imagesRed Hollingsworth had a problem.  When several of his customers were hit with unexpected rate increases, the Salt Lake City workers’ comp specialist dug into the case files and found a common root cause.  When workplace injuries occurred, the employer’s busy administrative staff would hastily notify the insurance carrier and consider their job done.  With no one from the employer or broker involved, treatment was getting sidetracked and no one knew until the higher claims costs forced the insurer to deliver a big rate increase at renewal.

When industry sources told Hollingsworth this was a common problem, he developed COMPMinder a technology platform designed to get the employer, broker and insurer working as a team right from the start to implement best practices for FROI. 

The results so far have been impressive.    After implementation of COMPMinder, a skilled nursing facility with 2,000 employees in Utah, Idaho, Nevada and California cut insurance premiums almost 25% over three years due to better claims experience.   A large ski resort cut premiums in half over two years.  In both cases, a large part of the improved claims experience can attributed to early intervention which likely would not have occurred prior to use of the software.

So how does the software work?  When the employer learns of an injury, an administrator logs into COMPMinder to pull up the state-specific FROI form built into the system.  The software prompts them to make sure that the accident scene is photographed,  the accident cause documented, witnesses identified, first aid actions noted and other required information.  When completed, the FROI is automatically filed with the insurer and immediate notification is emailed to a configurable list which generally includes a non-clerical member of the employer’s HR staff and the broker.

At 24 hours a more detailed reminder is sent to the administrator prompting them to contact the doctor’s office,  the injured employee and company personnel to gather key information and coordinate return to work. Similar emails are sent at 72 hours and then weekly until the employee returns to work or the employer terminates the COMPMinder process.  This automated system keeps everybody in the loop and insures that the employer, broker and carrier cover all their bases such as:

  • Was a copy of the injury report secured ASAP?
  • Who has contacted the physician and what did they say?
  • Was a drug screen administered or narcotics prescribed.
  • If applicable, was the physician notified that light duty or alternative arrangements are available?
  • Has the employee returned to work?  If not, why not?
  • What are the employee and the doctor saying about their ability to return?
  • Are there any red flags noted – Height & weight? Previous injuries? Comorbidities?

How does this work for employers?  At the ski resort noted above, an employee was horsing around on his free time and had a serious accident.  Because of the detailed questions prompted by the software, the employer determined that the injured worker’s accident had occurred on break and on a part of the slope where they were not supposed to be and denied the claim.

COMPMinder does what many good software solutions do – it uses technology to enforce disciplined application of best practices for critical processes.   Take a look at your FROI process and see if an automated solution might help.

May 30, 2013 |

MAXIMUS brings needed health technology skills to workers’ comp

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Maximus.logo In a press release earlier this week, MAXIMUS announced that it has finalized its agreement with the California Division of Workers’ Compensation to provide Independent Bill Review (IBR) and Independent Medical Review (IMR)  services as part of  a $40 million two year contract.  They also recently announced a business process re-design assignment with the Texas Workers’ Compensation Commission.

According to analyst presentations, revenues at publicly traded MAXIMUS (MMS – NYSE)  have grown rapidly and profitably to the $1.0 billion level with the anticipation of continued strong growth.   A large segment of their business comes from services which should appeal to larger workers’ compensation players including:

  • Healthcare technology
  • Re-engineering
  • Case management
  • IMR/IBR services

Most of their work is with government health plans including Medicare, Medicaid, the VA and 44 other government entities including a large contract for group health IMR services with the State of California.

According to MAXIMUS CEO Richard Montoni, who was recently selected as Executive of the Year among government contractors, “This latest contract allows MAXIMUS to grow our independent review business while securing a foothold in a new, adjacent market, which is part of our larger strategy to extend our core capabilities to new programs and agencies.”

No doubt MAXIMUS sees an opportunity to help workers’ comp players rethink and replace aging systems.  As noted in a previous Tech Talk post, the Affordable Care Act and HITECH Act will force  workers comp organizations and group health plans to share medical files and coordinate care to a much greater extent.  MAXIMUS has the know-how, technology and re-engineering talent needed to do this.

Expect MAXIMUS to go after new business at those state funds with high combined ratios and  large counties and municipalities with high comp expenses.  In a recent article in Work Comp World, industry expert David DePaolo observed that this is part of trend of  “big government (relying) on big business to resolve big issues.”

The workers’ comp market is ripe for a fresh look at business processes and technology.  MAXIMUS should help the industry by raising the level of the competition for technology solutions providers.

May 22, 2013 |

Is your workers’ compensation technology platform ready for healthcare reform?

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The Affordable Care Act initiates a new model for healthcare delivery – are you ready?

Big changes are under way in the medical world surrounding workers’ compensation.    Hospitals, physician groups, pharmacies and ancillary services will be using vastly improved technology platforms and adopting  a new, outcomes-focused business model.

What are the technology implications for the workers’ compensation industry?  Are you ready to face and take advantage of this disruptive change?

Let’s start with a quick overview of the legislation, then take a look at examples of changes being made in the medical world surrounding the workers’ compensation industry.    Finally,  we will identify possible implications for workers’ compensation technology platforms.

Two separate initiatives are driving healthcare reform – the Health Information Technology for Economic and Clinical Health Act (HITECH)  and the Patient Protection & Affordable Care Act (PPACA). These initiatives are rolling out at the same time and share a common vision of technology-enabled, patient-centered treatment teams with incentives based on improving outcomes and lowering costs.

HITECH provides physicians and hospitals with incentives (or penalties) to demonstrate  “meaningful use” of electronic health records (EHR) and related technology.   HITECH is rolling out in three phases targeted for completion in 2016.  At that point, the healthcare technology platform will include:

  • Health Information Exchanges (HIE) which are local electronic hubs that enable hospitals, physicians, clinics, labs, pharmacies and other organizations in a geographic area to securely share patient medical records.   HITECH funding will accelerate the development of  HIEs, which have been under construction in many regions prior to the legislation.
  • Computerized clinical decision support systems that use evidence-based guidelines to insure effective care.
  • Tools which enable patients and their care teams to work together to improve health.
  • Automated ordering and tracking of medications, lab work and radiology tests.
  • Patients will receive electronic copies of their medical records which they can share vie the Internet with families and others.
  • Use of SNOMED CT for diagnoses instead of ICD-9 codes.
  • Support for reimbursement  based on improving outcomes instead of procedures.

More information on HITECH can be found at the HealthIT.gov site.   

PPACA builds on the HITECH foundation.  Through regulations and incentives it creates a  new patient-centered healthcare model.  Key provisions include:

  • Expansion of benefits including free preventative health, elimination of  lifetime maximums, limiting annual out-of-pockets expenses and more.
  • Increasing the pool of insureds through  a combination of mandated coverage, increased Medicare eligibility and subsidies.
  • Establishment of competitive online health insurance marketplaces (the “Exchanges”).
  • Encouraging insurers to set up HMO-like Accountable Care Organizations (ACO) to manage Medicare recipients.  The insurers partner with local hospitals and medical groups to manage a patient population and earn incentives for improved outcomes and lower costs.
  • Medicaid primary care delivered through a new model called the Patient Centered Medical Home.  This approach provides each person with a clinical “home” for basic care, screening and  referrals to specialists.
  • Incentives for company wellness programs meeting certain standards.
  • Although P & C insurers will not initially be required to comply with HIPAA standards,  PPACA requires that this policy be reviewed every three years.  A white paper by EK Health’s Todd Brown provides background.

The American Public Health Association provides a brief outline in a 2-page APHA fact sheet.  More extensive summaries of PPACA provisions are available at the Kaiser Family Foundation and Healthcare.gov.

Below are examples of some of the extensive changes being made to adapt to HITECH and PPACA in the healthcare community surrounding the workers’ compensation industry:

  1. In California’s Santa Cruz County, the local Santa Cruz Health Information Exchange electronically connects two local hospitals, physician groups, County Health Clinics, County Detention, Mental Health, seven national and local reference labs, five imaging centers and safety net clinics.   Also, the California Blue Shield ACO program  is being set up with a large hospital and a major physician group to manage the health of about 8,000 public employees. Finally, a coalition of hospitals, medical groups and public clinics called the Patient-Centered Medical Home Initiative is working to implement this model of primary care for Medicaid recipients.  You will want to be familiar with similar initiatives taking place in the markets where you provide workers’ comp coverage.
  2. The UCSF Medical Center, ranked in the top 10 hospitals nationally, provides a good illustration of the difficulties involved in the implementation of HITECH.   At the recent HTF Conference, CIO Kent Soo Hoo reported that the difficult  installation of the Epic EHR system in 2011 has resulted in a new set of issues.  First, the volume of new data is creating information overload which needs to be filtered to create actionable information.  Second, new automated devices connected to the EHR began sending out so many messages that staff developed “alert fatigue” and began to tune out the system.  Finally, poor usability of many home health medical devices has been compounded by interoperability failures between these devices, the EHR and other IT systems.  These issues are being resolved, but the extra work has been significant.
  3. At the HTF Conference, the  Alameda Alliance for Health provided a detailed look at the extensive  re-tooling that they needed to prepare for the new legislation.   The Alliance manages  200,000 insureds covered primarily by by Medi-Cal through a network of 3,200 providers and dozens of hospitals and clinics.  New software installations included:
  • New claims software from  Healthsuite  to improve efficiency.
  • An EHR system that connects via HIE with Alliance providers who use 16 different EHR systems.
  • Clinical decision support will be provided by CareAnalyzer software that uses the Johns Hopkins ACGSystem to predict which patients will  benefit from from care management programs.
  • Case management and utilization review will be improved with the Casenet TruCare platform.
  • Patient Medical Home and patient engagement support enhancement with the HealthX  Patient Portal.
  • Reporting, analysis and population health management support by MedeAnlytics and Alere. 

 

According to Zina Glover, the Alliance’s Chief Operations Officer, these new systems will enable the Alliance to meet PPACA and HITECH requirements and transform the way they do business.

We’ve looked at the HITECH and PPACA legislation and examples of how the broader medical marketplace is adopting new technologies in response.  Now,  let’s consider possible implications for workers’ compensation (WC) technology platforms.  Specifically:

  • How will WC medical teams get access to the complete medical history contained in EHRs and use this information to improve treatment?
  • How will WC treatment information be incorporated into the patient’s EHR?
  • Can HITECH’s automated ordering and tracking of medications make it easier for WC organizations to get the full picture of the patient’s medication use?
  • Will WC organizations share information through HIEs?  If so, how?
  • Will new security provisions be needed to access HIPAA protected information?
  • As physicians increasingly are paid for performance, will WC insurers still pay based on procedures and fee schedules?   If so, what changes will need to be made in bill review systems to prevent cost-shifting?
  • As physicians rely more on evidence-based guidelines outside of occupational medicine, will this change the use of  comp-specific guidelines – ACOEM, ODG and Reed Group?
  • How will the HITECH requirement that physicians use SNOMED CT for diagnoses beginning in 2015 impact analytic and analysis systems built on ICD-9 codes?
  • Can some of the new technologies developed for the broader healthcare market (some listed above) be used to improve treatment of injured workers?

No doubt there are many opportunities to leverage the technologies implemented as part of new American medical model to  improve treatment of  injured workers.  What steps are you taking to make this happen?

May 7, 2013 |

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