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12 Things You Need to Know About Value-based Reimbursement
Chet Van Wert | Apr 13, 2016
Title: Writer
Topic category: Healthcare/Wellness
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Institute for Health Technology Transformation

The Institute for Health Technology Transformation (iHT2) released a report recently that beautifully summarizes the IT challenges of value-based healthcare reimbursement. Sub-titled “Building an Infrastructure for Financial Risk,” the report calmly outlines the enormous transformations that are needed in healthcare IT to support a reimbursement framework that transfers financial risk from the payer to the healthcare provider.

The bad news: healthcare IT is no longer just about record-keeping. It demands all kinds of capabilities that are new to the industry. Managing the financial risks to a healthcare organization and providing a high level of patient care requires (among other capabilities) predictive analytics, effective customer communications, financial modeling, and a delicate balance between automation and human contact.

The good news: many of these techniques and technologies exist in other industries and can be adapted to the healthcare care. Of course, those adaptations won’t all be straightforward.

Twelve key take-aways from the report (read more here):

  1. Make sure you have enough primary care physicians and other clinicians to provide comprehensive preventive and chronic care
  2. Restructure physician comp to align provider incentives with value-based care.
  3. Create patient centered medical homes or use existing PCMHs as building blocks for your ACO.
  4. Focus on care management for high-risk patients as well as other segments of the population that could become high risk in the future.
  5. Automate as much of population health management as you can while emphasizing human contact for high-risk patients
  6. Embed care managers in practices wherever possible to create close relationships with patients.
  7. Don’t try to manage population health with your EHR alone, but use applications built for population health to help accomplish your goals.
  8. Integrate claims data with clinical data to provide breadth, timeliness, and adequate detail for analytic purposes.
  9. Find ways to obtain timely information from hospitals and health plans about admissions, discharges, and procedures
  10. Use predictive modeling to intervene with patients who are likely to get sick in the coming year.
  11. Use registries to track patients’ health status and make sure they get the services they need.
  12. Apply financial analytics to budgeting, using historical data on costs and, if possible, activity-based cost accounting.
SOURCE:
Jasmine Pennic |Apr 28, 2015
Tags: value-based reimbursement, outcome-based reimbursement, healthcare IT
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The Internet of Things holds great promise to improve our health and wellbeing, from connected medical devices to instant and automatic data sharing, to more complete record keeping.

Hackers continue to dominate the headlines. Healthcare providers hold some of the world’s most sensitive information, making them a particularly high-value target.

Reporters at Computerworld recently demonstrated the risk of “medjacking,” where hackers were able to exploit Internet-connected medical devices, such as infusion pumps, to administer deadly levels of an otherwise helpful drug into an unsuspecting patient, without triggering an alarm to medical professionals.

The network represents one of the largest avenues of attack, and every possible effort should be made to secure it.

Software-defined networking represents a crucial layer in a multi-layered security plan. The network can be easily segmented into areas that remain invisible to devices on the edge. One physical network can create numerous virtual networks on the fly. Network connections open as approved devices connect, and dynamically close as those devices are disconnected. Getting a complete picture of every device on the network at that moment is a single click away.

In a healthcare setting, does the network that transports data from the MRI machine to the electronic health record system need to share the same path options as the payment card system? No. By segmenting the network and isolating various systems, you create additional protections against a single intrusion infecting multiple systems.

To quote the lead hacker at the NSA, who recently gave a presentation on how companies can protect themselves from the NSA: “Segment networks and important data to make it harder for hackers to reach your jewels.”

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The advent of value-based and outcome-based reimbursement makes healthcare more of a “business” than ever before and, at the same time, more challenging than ever to run a health care organization in the black. Costs escalate so easily and patient interaction times are not always controllable. How does a health care organization stay fiscally healthy?

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  • Sharing electronic health records between different remote locations and with remote health care agents allows for more efficient management of time and better recording of time spent on patients.
  • Call centers that can respond right away without call waiting time make for quicker resolutions and better time management.

Avaya’s IP Office Contact Center Server Edition has proven delivery on these important needs for both patients and insurers/doctors. As an example, CET Home Emergency contact center in the UK was inundated with call volumes reaching 150% of normal levels one day but, with Avaya’s product, only used about 60% of their maximum capacity.

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Avaya’s IP Office Contact Center Server Edition provides “so much of the required customer data that we no longer have to waste time asking callers for it. It gives us more lines which is obviously key, but also helps us manage calls better. We now have an extensive interactive voice response system, and our wallboards show how far a call is through that.”

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The networks currently found in most healthcare organizations were designed for an era when application and compute resources were static and “best effort” service delivery was the norm. The networks were built on multiple tiers, were highly complicated and had long troubleshooting and repair times.

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Network segmentation: This feature of SDNs, which is known as clinical segmentation, isolates specific departments and/or devices in their own virtual, private networks. The primary benefit to the IT department is that it is much easier to secure connected endpoints because each group of devices will be completely isolated from other devices. If there is a breach on a network segment, it will not impact devices on other segments.

Flow control: A software-defined network allows IT to monitor and control flows between devices with a high degree of granularity and apply them either by group or according to specific device policies. This enables IT to optimize the performance of specific flows, ensuring the performance of mission-critical systems—such as MRI and electronic records—aren’t affected by other applications.

Edge automation: As mentioned previously, the complexity of healthcare IT has increased over the past decade. The fact that the infrastructure now must support a large number of mobile devices only adds to the complexity. Many IT services require the network to be provisioned at the edge, often on a port-by-port basis. This was a challenge with static endpoints, but when the devices are mobile, network managers face the constant reconfiguration of every point in the network between the edge and the core. An SDN enables edge automation to ensure that each Ethernet port at every location can provide any service to authorized devices. In this scenario, all the intelligence is at the edge, and the network services are transparent to the core (Exhibit 2). This arrangement obviates the need for edge port provisioning, which can be costly and time consuming for the IT department. With an SDN, policies dictate which devices can be automatically added to the network, providing an additional level of security while allowing the medical staff to perform their required activities without IT support. This removes all human latency and speeds up processes, which can be the difference between patients receiving the medical attention required and being put at risk.

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