Care Management blog series Archives

September 12, 2022 by Lori Clark

Security is an imperative for every industry and company—and in the healthcare industry it is especially critical.

In addition to the same security concerns every industry has about information and data privacy, the healthcare industry also has enhanced regulatory and ethical requirements related to the privacy of healthcare information.

According to some sources, about 30% of the world’s data volume is being generated by the healthcare industry.¹ This data includes information that is particularly vulnerable to security breaches such as Personal Health Information (PHI), Personally Identifiable Information (PII), and patients’ financial information. For decades, there has been an attempt to consolidate all of these sources of personal information through efforts like statewide Health Information Exchanges (HIEs), that would make it easier for patients and their various healthcare providers to have all of the patients’ information in one shared location. By sharing patient information with other healthcare organizations, however, patients’ personal information and data becomes extremely vulnerable–and extremely valuable–for those wishing to profit from its acquisition.

¹Wiederrecht, G., Darwish S., Callaway A., The Convergence of Healthcare and Technology. RBC Capital Markets.

What is the current state of security in the healthcare industry?

Right now, the healthcare industry is a unique combination of cutting-edge technology and aging legacy systems like spreadsheets and manual data input. While patients are embracing technology like health apps and demanding easier access to their personal health information, healthcare organizations are being pushed to up their own technology game.

As technology advances, however, so do the security concerns that span all industries—the threats of hackers and those with ill intentions trying to gain access to entire networks of information illegally. Connecting networks of data creates better access for healthcare organizations and patients, yes, but it also creates the opportunity for hackers to gain that same access to valuable information. Healthcare organizations have been experiencing escalated costs related to data breaches. In 2020 alone, healthcare data breaches cost $13.2 billion, which is over double the amount of the annual data breach cost of $6.2 billion in 2017. In response to these breaches, regulators are increasing pressure on healthcare organizations to improve security and compliance–but they aren’t providing the funding for the healthcare organizations to do so.

The healthcare industry is also facing the challenge of every healthcare organization having different security protocols and processes. With various degrees of security measures in place, healthcare organizations lose the ability to effectively secure and manage their data widely. A prime example of this is the HIEs and the security situations they create by trying to consolidate patient information. The HIEs bring patient information together so that patients, providers, and payers can interact with the information directly and share it between cooperating and competing organizations. In doing so, however, the patients’ information is now at the discretion of many organizations who may or may not be as secure and compliant as the organization that originally gathered the patient information, which could then compromise how secure the data remains.

So, how can healthcare organizations prepare for future security risks and threats?

To protect their patients’ vulnerable information, healthcare organizations must invest in technology and processes that bolster the security of that information.
In addition to increasing their own security maturity, healthcare organizations must enhance regulations that enforce security and compliance standards to resolve the issues of when patient data is shared.

The Neudesic Care Management Platform helps healthcare organizations meet their security challenges and protects patient information from future security threats. Built on Microsoft Cloud for Healthcare, Neudesic’s Care Management Platform incorporates security best practices to protect information. It uses a rich security model to protect the data integrity and privacy of users while promoting efficient data access and collaboration.

The platform is ideally suited to strengthen and improve healthcare ecosystems and promotes sharing patient information securely. It combines business units, role-based security, row-based security, and column-based security to define the overall access to information, while also meeting the healthcare industry’s compliance and regulatory requirements.

A platform built for better outcomes

Neudesic’s Care Management Platform is already improving patient care and business outcomes for healthcare organizations. The platform is helping increase security and building confidence in healthcare providers, payers, and patients by:

Reducing risk by 70% through improved case management and elimination of information gaps.
Reducing payment errors and missed payments by more than 90% through batch generation.
Reducing process overhead by 30% by streamlining processes and eliminating data re-entry.

Information security is an ever-present threat to all industries. For healthcare organizations, the Neudesic Care Management Platform is helping secure vital patient data and improve healthcare delivery.

About Neudesic

Neudesic is the trusted technology partner in business innovation, delivering impactful business results to clients through digital modernization and evolution. Our consultants bring business and technology expertise together, offering a wide range of cloud and data-driven solutions, including custom application development, data and artificial intelligence, and comprehensive managed services. Founded in 2002, Neudesic is headquartered in Irvine, California.

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September 12, 2022 by Nayan Patel

Health systems today are seeking ways to diversify risk-based payments. To have a greater role in their risk-management, providers and payers are seeking to align more, and they are becoming what’s called a “Payvider.” Payviders are exactly what they sound like: payers and providers combined.

So, who are payviders?

A payvider is a mutually beneficial partnership between a healthcare payer (often a health insurance plan) and a provider (usually a healthcare system).

By having a contractual or joint ownership arrangement between a payer and a provider, the new payvider is able to deliver cost-effective health services by having full management over how their members receive care.

Payviders have grown in number due to the Centers for Medicare and Medicaid Services (CMS) placing an emphasis on Accountable Care Organizations (ACOs). In ACOs, all of the providers who treat a patient during the year receive a single payment that they then divide amongst themselves. This requires each entity to maximize the efficiency of their care delivery to maintain margins.

Payviders are also growing in number due to the shift in healthcare systems focusing on quality instead of quantity of services. In this “value-based” healthcare system, the amount of money hospitals and physicians receive is based upon patient outcomes, service quality and cost containment. Providers are incentivized to help patients improve their overall health, reduce the incidence and effects of chronic disease and live healthier lives, and in turn the providers are rewarded for these efforts. This differs from the traditional fee-for-service approach in which providers are paid for each service they perform, making their focus the quantity of services rather than quality.

Why become a payvider?

Typically, when providers and payers take on more risk, they can reduce their own financial risk, improve health outcomes and increase their profitability.

While a system based on the quality of care is riskier for providers, payers also have a stake in the form of premium costs so by combining forces and becoming a payvider, both the provider’s and payer’s interests align.

There are currently three payvider models:

Insurance companies become providers: A payer (insurance company) transitions to providing healthcare and offering insurance. Instead of being an insurance company with healthcare elements, they become a healthcare company with insurance elements.
Healthcare providers creating their own insurance plans: A provider controls premiums and doesn’t need to share any savings created-from improving the quality and operational efficiency of their health services-with insurance companies.
Joint ventures between payers and providers: Payers and providers partner to design healthcare plans with the shared goals of improving patient care and bringing in additional insured individuals.

These three models may develop over time and will adjust based on economic conditions and the needs of a particular market, location, payer mix or provider type.

Benefits of payviders for payers, providers and patients

With more payviders, the healthcare industry has seen key benefits to the market including improved health outcomes, strong provider relationships and better patient engagement. These benefits will lead to lower costs for patients in the long run.

A recent survey of 120 payers by Change Healthcare showed that increased use of value-based care has helped improve quality of care, it has increased patient engagement and reduced costs. The survey found that under value-based care:

The cost of unnecessary medical expenses was reduced by 5.6% on average
80% of payers reported increases in the quality of medical care
64% of payers reported improved relationships with providers
73% of payers said that patient engagement had improved

When done right, payvider models can turn organizations into growth engines that support sustainable margins and better health for all-which is a win-win scenario for the industry and patients.

Payviders are on the rise, and need the right platforms to support their success

Successful payviders put their members first with a focus on member enrollment, point of care transitions and payment coordination. To ensure that goals and interests align, communication between payers, providers and patients is key.

With Neudesic’s Care Management Platform, organizations are able to provide care coordination that bridges information and communication, and it monitors for gaps in patient care. It’s an interactive platform for shared communication between consumers, vendors and community care providers that increases overall customer satisfaction while benefiting payers and providers.
As payvider partnerships continue to rise, the use of technology to share data with efficiency is likely to inspire innovative strategies to better connect with consumers and ultimately provide better care. Moving forward, the payvider should cultivate a strong culture, prioritize innovation and keep focusing on cost-saving measures.

About Neudesic

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September 12, 2022 by Riaan Van Der Merwe

Health systems are experiencing a shift right now. Moving from a focus on the quantity of services to the quality of those services, health systems are promoting a higher quality of care for patients. And one way they’re doing so is by forming Accountable Care Organizations (ACOs).

What are ACOs?

ACOs are groups of doctors, hospitals, and other health care providers who voluntarily contract to share responsibility for the quality, cost, and coordination of care for a defined population of patients.

To share a patient’s care across all of the members of an ACO, communication and coordination are essential. Seamless communication not only ensures that every doctor, hospital, and health care provider knows exactly what’s going on with the patient and the services the patient needs, but strong communication creates efficiency within the health system itself and ultimately creates a better outcome for the patient by giving them the right care, at the right time.

Strong communication that leads to better care coordination amongst an ACO is also helping to address gaps in patient care. These “care gaps” currently exist when there are multiple services being used to manage a patient’s care and connections are missing between the services themselves. Take, for example, a patient going into a hospital for a procedure, and though they are planning to be an inpatient for three days, they get released one day early. Without interconnected care coordination services, there may not be transportation booked for the patient to move to their living arrangements or an outpatient rehabilitation center, creating a gap in their care. Now the patient and their health care providers must scramble to get the patient to where they need to go next for proper recovery, impacting the patient’s outcome and their overall healthcare experience.

Where else do these care gaps happen?

As ACOs require each entity to maximize the efficiency of their care delivery to maintain margins, the individual parties who make up an ACO are motivated to communicate and coordinate with one another as much as possible.

When an ACO is successful, it creates better patient care coordination, which in turn bridges information and communications, and monitors the gaps in care to minimize them as much as possible. Successful ACOs deliver high-quality care and spend healthcare dollars more wisely, thus sharing in the savings it achieves for the payor, such as Medicare or private insurers.

Creating a holistic patient view to close care gaps

To help ACOs fulfill their purpose and create seamless patient care coordination, Neudesic’s Care Management Platform combines patient data across multiple platforms and allows ACOs to get a holistic view of their patients and their care journeys.

The Care Management Platform allows ACOs to understand how their specific patient outcomes can be tied back to behavioral health, and allows them to see how plans can be created and predicted to allow for better patient outcomes and satisfaction.

Along with minimizing care gaps in the patient journey, the Care Management Platform enables ACOs to work toward their ultimate goal: ensuring patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

About Neudesic

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September 12, 2022 by Navin Parmar

For years now, healthcare providers have been searching for a single, comprehensive patient record, or what has been termed “The Golden Record.” The Golden Record is a desired state, it’s a term that doesn’t capture the full importance and impact of a comprehensive record, and at the moment, it’s an elusive goal.

Patients often have multiple medical records for a variety of reasons including regulatory requirements that need the system of record to be the same as the source system. Sometimes, patient data is entered in the place of service for localized use only, and those entering the data may not have a central Electronic Medical Record (EMR) system. And there are scenarios when patients are authorized caretakers of family members and friends, which requires an additional record that’s not the patient’s own to now be part of their file. The “golden record” attempts to create single record for patient but does not provide comprehensive view.

The goal behind the comprehensive patient record is to collect these duplicates of a patient’s record, and bring them into a single, all-encompassing record that houses their data in one spot. Additionally, the Golden record just provides partial truth around the patient. The patient care is from variety of sources beyond the EMR record. The data may exist from in-home, nursing facilities, wellness centers that are part of the care management, but information are not usually connected due to nature.

So, what’s stopping a comprehensive patient record from happening?

Creating a single comprehensive patient record is challenge when the EMR captures the encounters that are within the provider locations (assuming provider has single EMR system across its network).

The build of analytics and datawarehouse system has provided some initial foundation on building comprehensive patient record but that can be time consuming and may be limited for more long-term care.

We’ve seen that Master Patient Indexes (MPIs) within EMRs are exceedingly limited in their ability to compare records from disparate sources. And as some EMR systems inadvertently duplicate patients’ information, multiple individual records are created when the EMRs lack the sophisticated algorithms that compare and link records across different data sources and locations.

Despite these challenges, though, healthcare providers are making progress toward the comprehensive patient record by using Continuum of Care records. These Consolidated Clinical Document Architecture (C-CDA / HL7 v3) has provided the clinical documents that providers can ingest into its EMR systems for building comprehensive patient record. However, this data is restricted to either digital scan documents (some providers get faxes) or structured encounter data that was provided via interoperability. The challenges still continue on bringing encounter data that is not EMR, for example, at-home care, wellness centers, outdated medication (Over the counter (OTC) and/or Prescription).

The promise of a comprehensive patient record

With a comprehensive record, all healthcare service providers have a common, shared dataset and patient profile.

The comprehensive patient record can also alleviate the inconveniences, frustration and stress patients feel when their records aren’t able to be found at a location, and they’re forced to re-register. When their information can be easily accessed, and they do not need to fill out the same paperwork multiple times. The comprehensive patient record also helps eliminate multiple unnecessary tests, misdiagnosis. The longitudinal view of patient is available for providers to better patient care, patients have improved experiences and better outcomes overall when it comes to healthcare.

There are many benefits for healthcare providers as well. With a comprehensive patient record in hand, healthcare providers have the capability to understand their patients completely, and thus provide better services. Providers can also answer questions such as:

What are the Social Determinants of Health (SDOH) for the consumer?
What are the factors that help deliver better quality services and reduce the risks for pre- and post-care?
Where do gaps exist in services that are being offered?

How can we make the promise of a comprehensive patient record a reality?

Artificial Intelligence-based algorithms can help make progress toward a comprehensive patient record by matching criteria used in multiple systems.

There are algorithms that can provide matching capabilities using deterministic and probabilistic methods, and these algorithms are built into modern tools that can help combine data from multiple sources into a “belly button” patient record. Building out these algorithms to include external social data and automate processes that reduce the need for manual intervention will be huge steps toward the comprehensive patient record becoming reality. Using, FHIR API capability to ingest data from external compatible system provides building complete comprehensive record on the platform. The data from non-encounter transactions, outreach calls, medication follow-ups would help clinicians and care providers improve overall healthcare delivery.

Neudesic’s Care Management Platform is further helping realize the promise of a single, comprehensive patient record as an interactive platform that enables shared communications between consumers, vendors and community care providers. Built on the Dynamics Cloud for Healthcare, the Neudesic Patient Reactivation Solutions are helping providers and healthcare organizations to:

Identify patients for Care Management based on consolidated patient data and segmentation
Target outreach to engage patients with care journey management tools
Optimize scheduling via self-service portals, virtual agents, email and text
Track data to calculate ROI generated by new appointments

This work to bring together fragmented and duplicated patient information into a single, comprehensive record is the ultimate goal because the better the patient record is, the better the care the patient receives.

About Neudesic

Read our full Blog to learn more.