All about the new interoperability rules with Michael Michela

Latest From Data Book

Neal Singh explains why healthcare organizations are turning to this strategy

Contract Lifecycle Management

Healthcare groups react to the updated CDC guidance

The New Mask Rules

The wave of health system retirements continues, with Baptist Health South Florida CEO Brian Keeley announcing plans to retire Wednesday after nearly 50 years of service, according 

 from the health system based in Coral Gables, Florida. Keeley will retire next year and will be succeeded by Albert “Bo” Boulenger, the current executive vice president and chief operating officer (COO), who now assumes the title of president. Keeley began his career at Baptist Hospital in 1969 as an administrative resident and was named assistant administrator in 1973, following four years in the U.S. Navy Medical Service Corp. Keeley became chief operating officer of Baptist Hospital in 1979 and CEO in 1986, and has led the multihospital system since the merger of Baptist Hospital with South Miami Hospital and Homestead Hospital in 1995. Keeley is credited with leading the health system’s digital transformation efforts, which aimed to make the Baptist Health South Florida the “Amazon Prime of healthcare.” The 11-hospital system now has nearly 24,000 employees.

Vice President for Government and Community Affairs Tom Lewis will retire from Johns Hopkins University and Medicine will retire after 16 years at the institution, where he is credited with strengthening relationships with surrounding communities. Lewis came to Johns Hopkins in 2005 as director of State Affairs in a newly consolidated office spanning Johns Hopkins University and Medicine, and he became vice president four years later. According 

, Lewis made an immediate impact in garnering state support for capital projects at Johns Hopkins as part of a broader strategy to boost Maryland's economic development and intellectual capital, including projects in technology and cell therapy. Lewis, who had previously served as chief of staff for two speakers of the Maryland House of Delegates, secured state funding for new clinical buildings in East Baltimore; gaining funding support for the Maryland Advanced Research Computing Center, which vastly increased the capacity for researchers at Johns Hopkins and the University of Maryland, College Park to pursue big data projects; and partnering with Johns Hopkins Tech Ventures to win state support for the Maryland Center for Cell Therapy Manufacturing in East Baltimore.

Articles

The wave of post-pandemic retirements continues.

MED MOVES: Retirements at Baptist Health South Florida, Johns Hopkins

Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include 

The Supreme Court on Thursday tossed a lawsuit that once again threatened the Affordable Care Act (ACA), ruling 7-2 that Republican-led states who brought the case lacked legal standing to challenge the law.

For the third time, an increasingly conservative court left intact the law’s protections that require coverage for preexisting conditions, created Medicaid expansion, promote health screenings and preventive care, and launched novel, value-based payment strategies within the agency that manages Medicare and Medicaid.

The ruling comes as President Joe Biden has tried to build on the ACA and create new incentives for states that have not expanded Medicaid to do so, amid mounting evidence that having health coverage reduces mortality.

 and was joined by Justices Elana Kagan and Sonia Sotomayor, as well Chief Justice John Roberts and two appointees of President Donald Trump, Justices Brett Kavanaugh and Amy Coney Barrett. The opinion focused on the fact that individual states governed by Republicans, along with individual plaintiffs, had failed to show “a concrete, particularized injury fairly traceable to the defendants,” and thus could not challenge the law on constitutional merits.

The latest challenge, led by Texas, began after Trump’s 2017 tax law eliminated the enforcement mechanism for the ACA’s individual mandate. On those grounds, the Republican-led states tried to assert that the entire law must fall, even provisions unrelated to the requirement that all Americans have health insurance.

Today, the Supreme Court’s majority found that the states failed to make their case that the de facto end of the mandate would cause them harm, which would create grounds to challenge the entire ACA.

“Unsurprisingly, the States have not demonstrated that an unenforceable mandate will cause their residents to enroll in valuable benefits programs that they would otherwise forgo. It would require far stronger evidence than the States have offered here to support their counterintuitive theory of standing, which rests on a ‘highly attenuated chain of possibilities.’”

Justice Clarence Thomas wrote a concurring opinion, stating, "Although this Court has erred twice before in cases involving the Affordable Care Act, it does not err today."

An estimated 20 million people had gained coverage under the law at a peak in 2017, but there was some loss of coverage during the Trump administration. More recently, more than 1 million people signed up for coverage through the ACA under a 

 authorized by the Biden administration due to the COVID-19 pandemic. The American Rescue Plan reduced premiums, and additional proposals would make those premium cuts permanent.

While many legal experts had questioned the merits of the Republican states’ challenge, the addition of Justices Neil Gorsuch, Kavanaugh, and Barrett to the court raised concerns among the law’s supporters about what would happen once the case reached the highest court. Gorsuch and Justice Samuel Alito dissented, but the other Trump appointees ruled with majority on the narrower question of standing.

The latest challenge was argued in November, just after Barrett joined the court, and the defense was organized by a group of officials from Democrat-led states. Their leader was former California Attorney General Xavier Becerra, recently confirmed as Biden's HHS secretary.

The ACA is now one of the most litigated pieces of legislation in history. It survived an initial challenge after its passage in 2010, although the court did reshape the law by allowing states to opt out of Medicaid expansion.

However, that decision ended up creating an environment for research comparing health outcomes between expansion and non-expansion states, and now data are pouring in that show how populations with health coverage benefit in multiple ways—those 

 who are able to manage their disease suffer fewer complications.

Veterans of the Obama administration who helped write and implement the ACA were surprised and pleased this morning, and said the decision opens the door for the Biden administration to improve the law.

“Bottom line—this is incredible,” former Obama administration policy official Kavita Patel, MD, told MSNBC. “It’s a chance for the Biden Administration to try to take back some of what the country lost when the individual mandate was taken away. … Not being a lawyer, I don’t think you could have a clearer path saying, ‘this is it.’”

“It’s not a close call in terms of the law, and not a close call in terms of who we are as a country,” said former Acting CMS Administrator Andy Slavitt.

Chiquita Brooks-LaSure, now CMS Administrator with chief responsibility for implementing the law, recalled her work on its passage during her tenure with the House Ways and Means Committee. 

"Millions of Americans can breathe a sigh of relief following today’s Supreme Court 7-2 ruling upholding the Affordable Care Act," she said. "This victory assures access to affordable and comprehensive health insurance for patients and families across the country."

She pointed to the fact that 12 states have still not expanded Medicaid, but the Biden administration hopes that will now change.  "Through the ACA, and hand-in-hand with CMS, dozens of states have expanded Medicaid – bringing quality coverage to our family and neighbors who need it most. We will continue to partner with states because we know 4 million more Americans stand to gain access to quality health coverage in the remaining states."

Other supporters of the ACA also called for working to improve the law.

"CareFirst is pleased that the key provisions of the Affordable Care Act remain in effect and will continue to promote access to affordable health insurance for the individuals we serve and all Americans,” said Brian D. Pieninck, president and CEO of CareFirst BlueCross BlueShield. “CareFirst looks forward to continuing our work with federal and state policymakers to maintain and improve access to healthcare throughout our region."

Officials from the Robert Wood Johnson Foundation called for an end of “meritless attacks against a milestone law. … It is time now for our nation to resume its path toward achieving universal health care coverage.”

Supreme Court Upholds ACA, Says States Lacked Standing

COVID-19 accelerated digital innovation in healthcare, but it takes more than a smartphone app to deliver the interactions and empowerment that consumers now expect in a post-pandemic world. To provide value, health systems must deploy a tightly integrated, mobile-friendly platform that anticipates consumers’ needs, engages them in their care and strengthens their overall care experience.

Today, 62% of consumers would rely on digital health for health and wellness advisory services, a recent 

 found, and 54% of consumers are open to receiving virtual care from their providers. But health systems are quickly learning that applying just any “build it and they will come” mindset to digital front door offerings results in lackluster engagement. Notably, half of consumers who responded to the Accenture survey say a bad digital experience can ruin their entire experience with a provider, while two out of five say a good digital experience has a major influence on their perception of a provider.

Achieving a value-driven mobile strategy that speaks to the future of consumer engagement requires that healthcare leaders incorporate three essential elements.

. Even before the pandemic, digital wayfinding was evolving from a “nice to have” to a “must have” feature, given the need to create a more seamless patient care experience. Platforms that include mobile wayfinding are able to serve as a digital companion throughout the patient’s journey, from the patient’s home to a convenient parking spot to the point of care. Today, the emergence of COVID-19 demands that patients know how to reach care access points quickly to protect themselves and others from the spread of infection. As a result, more hospitals and health systems are investing not just in wayfinding, but 

, with the ability to redirect traffic when circumstances change, update maps in real time, keep patients apprised of wait times and even help them remember where they parked. The best systems also provide location-aware analytics that hospitals use to gain insight into consumer behavior. These insights inform and empower operational adjustments that enhance the patient experience.

Digital Element No. 2: Targeted push notifications

. When breaking news develops, targeted push notifications empower healthcare organizations to reach consumers in the surrounding area quickly. During the first months of the pandemic, hospitals used these geofenced communication tools to issue real-time alerts to individuals in their catchment area informing them of protocols for triage, updated visitation rules, facility access and more. As the vaccine has become available, leading healthcare facilities are using targeted push notifications to inform local residents when vaccines become available and enable residents to digitally schedule an appointment.

For example, at University Health System in San Antonio, leaders sent geo-targeted push notifications to specific ZIP codes enabling an equitable and efficient vaccine distribution. The ability to maintain a full vaccination schedule has enabled the health system to use all its vaccine supply—a notable achievement, given that 

 because they aren’t used in time. The ability to communicate with residents in real-time not only gives individuals peace of mind, but also strengthens the health system’s ability to target vulnerable and underserved populations, helping to eliminate health disparities. Since promoting push notifications to support vaccine scheduling, more than 160,000 people have downloaded University Health System’s digital app.

Digital Element No. 3: Support for a seamless patient experience

. It’s clear that consumers want virtual options for a variety of healthcare services. But whether consumers rely on a health system’s mobile platform to connect with these services depends in large part on the platform’s ability to provide a seamless, convenient digital experience. To get there, healthcare organizations must give consumers the ability to access their medical information, schedule appointments and pay for care directly from their mobile device. Best-in-class mobile apps also incorporate chatbots that help answer individuals’ questions and, when live support is needed, direct them to the right team members for assistance.

For example, imagine that your child is running a fever of 102 degrees on a Saturday morning. The situation doesn’t require a trip to the emergency department, but it may necessitate an urgent care visit. The ability to check the nearest urgent care center's wait times with the touch of a smartphone, reserve your place in line, drive to the center at the appropriate time and walk in without a wait is a powerful differentiator for the patient experience. This level of digital service reduces friction between the patient and hospital while leaving a positive impression that boosts an organization’s ability to attract and retain patients especially in a competitive market.

Distinguishing Your Organization—Digitally

COVID-19 accelerated digital engagement among healthcare consumers, but providers will struggle to sustain gains in engagement unless they pay careful attention to the quality of the digital experience they provide. By investing in tools and support that anticipate customers’ needs, amplify convenience and support highly coordinated, seamless care, healthcare organizations will strengthen their digital value proposition and provide memorable experiences that keep patients coming back.

Joshua Titus is CEO, Gozio Health, a company that specializes in end-to-end, customizable mobile platforms for health systems. Titus is passionate about creating mobile technology that informs and delights users.

Half of consumers say a bad digital experience can ruin their entire experience with a provider, while two out of five say a good digital experience has a major influence on their perception of a provider. 

Launching the Right Mobile Strategy for a Post-COVID Environment

Leslie Trigg, CEO of Outset, the creator of Tablo, a home-based dialysis machine that incorporates cloud-computing technology. We discussed how these machines work, why they would be attractive to patients, and how the COVID-19 pandemic has affected the demand for these machines. We also talked about the potential for home dialysis machines to be eligible for reimbursement and what the future looks like for this technology.

Podcasts

Leslie Trigg, CEO of Outset, discusses how imbedded cloud-computing technology in home dialysis machines can improve quality of care for patients, and how the pandemic has boosted demand for these machines.

Podcast: Home Dialysis Machines and Cloud-Computing with Leslie Trigg

Clark Lagemann is the co-CEO of Avidon Health.

Now more than ever, health systems and providers recognize that healthcare is not one-size-fits-all. Patients face multifaceted challenges including COVID-19, disparities regarding access to care, financial strain, and a range of other complex issues while they navigate the healthcare landscape. Many of them also manage chronic conditions, which can be exacerbated—or entirely caused—by unhealthy behaviors over a prolonged period. So, even when patients overcome environmental barriers to receiving effective care, there is an added challenge of engaging them in the behavior change process to help them transcend the psychological barriers preventing them from achieving the long-term results they want—and need.

In an era when patient communication channels have moved online, how can providers ensure that digital health and behavior modification tools drive healthcare engagement in a way that promotes meaningful, long-lasting, and positive outcomes? It starts with strategic onboarding, persuasive technology that speaks to the individual, and implementing cognitive behavioral interventions so patients are motivated to take quick, focused action and see results that motivate future achievement.

Because patients are more likely to act on behavior modification when interventions align with their values and goals, it’s absolutely crucial to deploy an automated and effective onboarding patient experience from the start that quickly identifies any potential barriers to care to target later. As such, the recruiting and onboarding stage is critical to ensure lasting success.

It’s here at the initial touch point of enrollment that offers tremendous opportunity to guide patients towards self-identified care paths. By self-selecting interventions, patients practice advocating for their wants, needs, and goals rather than being “directed” to a care path that may not fit their vision. Again, this speaks to the overall philosophy of personalized and persuasive digital health communication – one that encourages patients to advocate for themselves and their care by choosing the behavior interventions that align with their unique health and wellness goals.

An enrollment and onboarding process indicative of successful outcomes need not include real-time interactions with a live coach. In fact, a fully automated process can boost enrollment rates because it eliminates friction points, such as scheduling a phone interaction with a health coach, that may delay progress. In this way, a digital-first enrollment and onboarding process can truly meet patients not only where they are, but when they’re available, maximizing the likelihood for lasting success.

Health industry innovators have designed digital platforms that leverage the efficiencies of technology while honoring each individual patient via personalized communication. Platforms that deploy technology that patients use already—such as SMS/text and email—offer more promising outcomes than those that introduce new technology to patients that they must then learn. What methods of communication patients may prefer? Herein lies yet another opportunity for personalization—ask the patient to self-select in the enrollment stage their preferred communication method and frequency.

Although the method of communication matters, it’s the way in which communication is personalized that is most interesting. Some of the most customizable digital-first health platforms have developed technology to deliver automated responses and prompts that invite two-way communication with the patient. These “adaptive conversation engines,” sit at the intersection of healthcare, innovation, and artificial intelligence to power highly personalized and interactive dialogue that is specific to each patient.The technology not only fosters interpersonal communication, but also has the ability to vary responses to reflect the dialect and language preference of the individual. In this way, patients feel listened to and understood.

Additionally, cognitive behavioral training is particularly effective at driving participation and outcomes. Cognitive behavioral training is a method born out of communication. A free flow of communication over the digital platform via text allows patients to become more aware of the false beliefs and negative thoughts that may influence their behaviors. This strategy lends itself to automated conversations, where the technology identifies the thought processes, inaccurate beliefs, and the situations that may challenge the patient to move towards more positive thoughts and behaviors that improve health.

While a one-size-fits-all methodology may be appropriate in certain cases, yielding small improvements in behavioral change, it’s unlikely to be long lasting. Why? Because to empower and engage diverse health populations, healthcare leaders must deliver care that is focused on the person, not just their condition, and drive engagement.

This shift in orientation from one that is condition-based to behavioral-based need not be complicated. The will exists. Healthcare systems are moving away from “directive” care to “person-centered” care. The technology exists. Automated conversations driven by tailored technology have the power to provide personalized insight, support, and feedback that addresses the individual patient’s needs and improves healthcare engagement. It’s these components that are key in the most promising behavioral change programs.

We live in uncertain times, but exciting times as well. With technology, healthcare stakeholders can empower patients, both in the office and remote, to learn effective behavioral strategies that work for them, so that they are empowered and see better health and long-term success.

In an era when patient communication channels have moved online, how can providers ensure that digital health and behavior modification tools drive healthcare engagement in a way that promotes meaningful, long-lasting, and positive outcomes? 

Key Factors to Drive Healthcare Engagement for Lasting Behavioral Change

Cynthia Horner, MD, is the medical director for Amwell and has been a board-certified family physician for 25 years.

For three out of five consumers who experienced a virtual visit last year, COVID-19 prompted their first foray into telehealth, according to a 

. But while urgent care was once the biggest draw for telehealth consumption, that trend flipped during the pandemic, when scheduled visits—especially with specialty and primary care physicians—took center stage.

Now, as healthcare leaders consider where and how to embed telehealth into their member or patient experience for the long haul, it’s critical to examine how virtual care can lead to better health outcomes.

The following use cases provide insight into why virtual primary care (VPC) is quickly becoming the new house call and what it takes to provide optimal value with a VPC program from a physician’s perspective.

Case Number 1: Jumpstarting A Relationship With a Primary Care Provider

Lisa*, 26, a newly diagnosed, insulin-dependent person with diabetes, recently moved to the East Coast. She graduated law school, started a job, and acquired new insurance, yet she did not have a primary care physician in her newly established community. When it came time to refill her medication, Lisa chose telehealth for its convenience—as an attorney, she works 65 to 70 hours a week—and to establish a new relationship with a primary care provider.

It quickly became clear that Lisa’s health needs went beyond the request for a prescription refill. Lisa had not been seen by a clinician in six months, and her blood sugar levels had skyrocketed to 250, even while taking medication. Because of her struggles with keeping her diabetes under control, Lisa showed signs of retinal inflammation, a condition that is typically accompanied by kidney damage and, if left unchecked, could quadruple her risk of heart disease and triple her risk of stroke.

Lisa’s virtual primary care provider assessed her condition with the help of a home glucometer, digital blood pressure cuff, and a scale. She also used video to examine Lisa’s overall physical condition, looked for swelling in Lisa’s feet and ankles and worked with Lisa to determine whether she had lost any sensation in her feet. With these tools, Lisa’s virtual primary care provider could perform 90% of the exam that otherwise would have been conducted in person.

The virtual primary care provider adjusted Lisa’s medication and ordered laboratory tests to dig deeper. She also referred Lisa to an ophthalmologist for a retinal screening and to a diabetes educator and an endocrinologist. When Lisa expressed concern regarding how she would find an ophthalmologist in a new city, her virtual primary care physician worked with her to find a close-to-home option and sent an electronic referral. Today, Lisa’s blood sugar levels are at non-diabetic levels, the strain on her retina and kidneys has been resolved, she’s exercising regularly, and she feels great.

Key to success: digital reminders for follow-up care

. So many patients with chronic disease become lost in the follow-up process, primarily due to difficulties in accessing care. While telehealth helps eliminate access-to-care challenges, digital reminders ensure that patients stay on top of follow-up appointments.

Case Number 2: Providing More Personalized Care Intervention

Gerald*, 54, suffered from chronic obstructive pulmonary disease (COPD) after a long history of smoking. He had recently changed insurance and did not have a primary care provider. He was also afraid to leave his house to receive in-person care, given his increased risk for developing a severe case of COVID-19. When Gerald learned that his health plan offered virtual primary care visits, he sought treatment for an increasingly productive cough.

It did not take long for the virtual primary care physician to discover that Gerald faced significant challenges controlling his COPD. Gerald used his steroid inhaler at twice the maximum dose to help with his cough, and he relied on his rescue nebulizer every four hours. His overuse of these medications was causing heart palpitations—a concern if left unchecked.

Often, patients with chronic disease purchase personal biometric monitors to keep track of their vital signs at home, so Gerald’s physician incorporated tools such as a pulse oximeter into his exam. She could also tell by listening to Gerald’s cough that he was wheezing. She prescribed medications that would help Gerald with his breathing and help prevent pneumonia from mucus buildup. She also changed the type of medication Gerald used in his inhaler to decrease the impact on his heart. Today, Gerald not only feels much better, but he’s also reduced his risk of heart failure, stroke and other complications, while avoiding having to seek care in the hospital.

Key to success: getting a glimpse into a patient’s home life.

One of the benefits of meeting with Gerald via video is that the virtual physician could ask Gerald to demonstrate how he used his inhaler and could take a look at Gerald’s nebulizer machine. The physician discovered that Gerald used his inhaler incorrectly, while the tubing on the nebulizer machine, which was 10 years old, was cracked. Gerald’s physician taught him a better technique for using his inhaler during that first video session and ordered new tubing for his machine—small changes that ensured he would receive the full benefit of his medications.

It’s important to note that patients do not need to have chronic health problems to benefit from virtual primary care. The experience of Isabella*, 34, is one example. Isabella chose virtual primary care for a mild residual cough that she developed after recovering from COVID-19.

Prior to her virtual primary care appointment, Isabella hadn’t seen a primary care physician in three years. A close look at her medical history indicated that Isabella underwent a pap smear a few years earlier that came back with mildly abnormal results, but Isabella never scheduled a follow-up appointment

The primary care provider discussed the need for further testing with Isabella and connected her with an OB/GYN who could meet Isabella’s needs.

Key to success: paying attention to patients’ care needs beyond the stated reason for the visit

 In Isabella’s case, the convenience of telehealth prompted her to schedule a virtual primary care visit, but the careful eye of her virtual provider enabled Isabella to avoid delayed care, reducing the potential for worrisome health risks. This approach also can help to improve Healthcare Effectiveness Data and Information Set (HEDIS) measure performance.

COVID-19 demanded that providers find creative ways to safely interact with patients, catapulting telehealth into the mainstream. As leaders continue to look for ways to leverage telehealth to provide affordable, evidence-based care that result in better outcomes, virtual primary care should be a top-of-mind consideration in 2021 and beyond.

Cynthia Horner, MD, is the medical director for Amwell and has been a board-certified family physician for 25 years. She has conducted more than 22,000 telehealth visits, having served as a full-time telehealth provider since 2016.

* Names have been changed to protect patients’ privacy.

As healthcare leaders consider how to embed telehealth into their member or patient experience for the long haul, it’s critical to examine how virtual care can lead to better health outcomes.

Is Virtual Primary Care the New House Call? Three Real-World Examples

Press Ganey was recently granted authorization by CMS to deploy the Primary Care First Patient Experience of Care Survey (PCF PECS).

The program comes as part of CMS’s five-year plan to improve quality and patient experiences while keeping costs low for patients receiving primary care. Press Ganey will begin administering surveys during the inaugural PECS administration period starting Sept. 28 and ending Dec. 21, 2021. The surveying firm will continue to administer surveys throughout the rest of the five-year program.

The CMS intends to measure the impact of the Primary Care First Model, a payment model that supports the delivery of value-based care, by using a targeted set of patient experience assessments. These assessments include CG-CAHPS 3.0 and PFC-centric questions focused on five domains:

The delivery of timely care, appointments, and information.

The quality of communication carried out by providers to patients.

The degree of attention to care by other providers.

The support received by patients taking care of their own health.

Press Ganey’s real-time digital surveys, those of which have already been in circulation, will be supplemented by the new in-person survey methods. Gathering patient experience insights from the use of both digital and in-person data collection methods will optimize PCF program performance.

The approval of the PCF PECS program paired with a recent SPH Analytics acquisition makes Press Ganey the only firm certified to conduct all CMS and NCQA-mandated experience surveys. Survey feedback will gather data necessary to improve the experience of patients with complex and chronic conditions.

“We are proud to receive CMS approval to provide a solution to help drive and sustain improvement in the primary care setting,” said Daniel Litwer, Chief Client Officer at Press Ganey, 

. “Feedback from patients will produce critical insight into how this model impacts and reshapes the experience for those with complex and chronic conditions.”

Following authorization from the CMS, the healthcare survey specialist will create methods to gauge patient experience.

CMS Authorizes Press Ganey to Administer Primary Care First Patient Experience of Care Surveys

Josh Hetler is the executive vice president for Business Intelligence, DataLink.

In the wake of revenue loss related to COVID-19, smaller hospitals, public hospitals and rural hospitals are among those most likely to face 

 and may be at risk of closing or merging. If patients don’t receive non-emergent care, health outcomes will decline. This will impact patient 

 and performance, which are increasingly tied to financial incentives by private payers and CMS.

 have seen an overall reduction in claim volume, particularly in commercial lines of business, as members lose employer-sponsored coverage. Additionally, there has been a drop in emergency department, inpatient and office visit claims across all plan types.

In this uncertain environment, healthcare leaders must take proactive steps to close care gaps and ensure patients can access the level of care they need to prevent disease and control chronic conditions. This means finding new ways to tap into operational efficiencies and adopt tools that deliver a 360-degree view of the patient and intelligent analytics to identify care gaps and closure opportunities for quality and risk adjustment.

During the COVID-19 pandemic, primary care visits dropped

with many Americans temporarily putting off going to the doctor. Experts speculate that this will lead to a decline in health 

 and a rise in potentially negative consequences for those who delayed preventive screenings and treatments. The decrease in doctor visits has also led to unaddressed care gaps and strained revenue for many health systems. In fact, providers averaged a

 in visits remains largest among surgical and procedural specialties and pediatrics. 

 show smaller decline for more severe conditions, such as stroke and acute myocardial infarction, compared to visits related to less severe conditions, such as dermatitis and conjunctivitis. Analysis of electronic health record (EHR) data for breast, cervical and colon cancer screenings showed an even sharper decline beginning in early March of 2020 followed by an increase in screenings, although screening rates have remained far below 2019 levels. By mid-June of 2020, weekly volumes for cancer screenings remained roughly 30% to 35% lower than their pre-COVID-19 levels.

 that the COVID-19 pandemic has accelerated the move toward value-based payment, which could disrupt traditional utilization patterns and fee-for-service payment. Such a shift requires more intense focus around data-sharing to support improved outcomes.

Payers should look for opportunities to alleviate provider administrative burden, including increasing access to 

 and adjusting value-based payment programs to focus on outcome improvements that are within provider control. Success for providers and payers will depend upon leveraging data to highlight opportunities for quality improvement and sharing data to aid identification of at-risk members.

 around member diagnoses, procedures and outcomes, they should expect the majority of information for risk analyses to reflect pre-COVID periods. This means that they will not yet see drastic changes in risk scores that are proportional to member changes in utilization for several months.

 will be key to understanding the pandemic’s effect on cost-of-care trends and member risk profiles, and how to manage and triage care in ways that most effectively add value.

To turn this crisis into opportunity, payers can implement 

 to close care gaps, while simultaneously aligning with ongoing quality improvement initiatives:

Identify highest-risk individuals with claims data 

other tools that also enable providers to prioritize patients for outreach and face-to-face visits.

Ensure messages reach their target demographic

 and identify member preferences for engagement, such as texting versus a phone call.

Help members better understand their virtual care

 visit opportunities and encourage its use for ongoing healthcare management needs, especially for behavioral health counseling.

Support follow-up with patients to not only assess 

the effectiveness of outreach and engagement tactics, but also understand strategies that don’t work.

It will be equally important to partner with a population health management solution that offers data analytics and the highest level of data connectivity. These solutions enable payers and providers to better address member healthcare needs, monitor vulnerable populations and take steps to enhance health and reduce risk. The goal is to improve outcomes and strengthen payer performance—for now and beyond the pandemic.

Data connectivity for members, payers and providers has become increasingly important since the passing of the 21st Century Cures Act—which is intended to help accelerate medical product development and bring new innovations and advances to patients who need them faster and more efficiently. The right population health management solution offers connectivity with EHRs, health information exchanges (HIEs) and the bi-directional data feeds between these systems to extract continuity of care document (CCD) data.

 Real-time reporting and drill-down dashboards forvisibility into membership health metrics and utilization.

. Improves value-based contract performance andprovider engagement, educates and assists the care team on using the technology solution to enhance focus on the appropriate member care key performance indicators (KPIs) and documentation.

 Increases quality care gap closures and leverages data from multiple sources to proactively close gaps in care.

 Improves hierarchical condition category codes (HCCs) recapture documentation to ensureaccurate diagnoses of chronic conditions and risk adjustment accuracy.

 Improves clinical outcomes andalleviates the provider administrative burden of using multiple platforms for care coordination—with proven high provider utilization rate.

 Manages and housesmember data from multiple payers for provider office visits, lab test results, medication adherence and hospitalizations.

. Promotes team collaboration across the care continuum, providing a holistic, real-time view of the entire spectrum of patient care, improving patient care delivery and driving value by reducing operational costs.

An innovative and advanced value-based care enablement solution gives providers more time to spend caring for patients and access to data from multiple payers, with real-time reporting and dashboards at the point of care. This level of data capture enhances patient engagement, improves clinical outcomes, increases quality care gap closures and improves value-based contract performance for a more sustainable healthcare system.

Following a checklist improves data capture, enhances patient engagement, and increases access to care.

 Efficient Data Connectivity Mitigates Economic Impact of Pandemic

Alan Payne, chief information officer at Sensyne Health. We discussed some of the major ethical concerns experts have regarding the use of artificial intelligence (AI) in healthcare. We also talked about how these issues can impact quality of care and what healthcare organizations can do to help avoid them.

Alan Payne, chief information officer at Sensyne Health, discusses some of the ethical concerns regarding the use of artificial intelligence (AI) in healthcare and what organizations should do to mitigate potential data security and bias issues.

Podcast: AI Ethical Concerns and How to Mitigate Them With Alan Payne

Jim Yuhas serves as chief financial officer for Legacy Data Access and operating partner for Cadrillion Capital.

Healthcare technology teams worry about managing data that’s right in front of them—in whatever server, electronic health record (EHR), radiology, financial or billing system the organization is using. With a primary focus on daily operations, conversions, integrations and system optimization, IT resources are always strained. With plenty of priorities, it’s likely they’re 

 thinking about legacy data, a lifetime of disparate information systems with protected health information (PHI) quietly operating in the basement.

But then, a mainframe starts overheating. Or a hard drive starts clicking. Or a lawyer subpoenas patient records for a malpractice case—and there’s a tight deadline for turnaround. In 2021, these types of data emergencies are becoming increasingly more common as legacy systems age, which is why data archiving is such a critical component to a health system’s overall data and risk management strategy.

Health Information Technology for Economic and Clinical Health (HITECH) Act,

 which sped up the healthcare information age, healthcare data has grown exponentially. According to 

, by 2025, there will be 463 exabytes of data created each day worldwide, which is the equivalent to 2.13 million movies. Researchers estimated in 2019 that as much as 

 is health-related (based on the yottabyte scale).

The more data we have, the greater our burden to manage it properly; or the wide range of devastating legal, clinical and financial consequences of poor legacy data management will escalate. 

Legacy Data: Understanding the Costs of Mismanagement

The mere thought of archiving data in a sensible, sustainable way — before waiting until a data emergency — is about as exciting as the idea of engaging with a legacy email account. 

Imagine logging into the email account you created in 2005, which you’ve since abandoned, in order to find an old message sent by a former colleague in 2010. The big difference is that information contained within legacy servers is likely far more critical to protect than an email thread with former colleagues sent to a legacy POP address. It’s also far more costly to protect PHI too: maintaining an operating license on a legacy system is a six-figure monthly expense for large organizations, before the consideration of indirect costs of hardware, support teams. And the consequences of abandoning that data are more severe than losing access to a 20% off Bed Bath Beyond coupon.

The data held by a healthcare system’s machines carries monetary and security risks. If a healthcare system can’t produce data within a given timeframe, it could be asked to pay steep penalties, either in the form of fines or legal settlement fees. For example: If the healthcare system’s legacy data is somehow exposed or compromised (for example, via a ransomware attack) the organization faces civil monetary fines for violating HIPAA plus significant reputational damage.

These potential consequences don’t include the avoidable duplicative costs an organization incurs every month for maintaining and licensing two or more HIPAA-complaint record sets (the old and the new).

Moreover, no financial figure can touch the clinical significance of improper data management: If a patient needs an operation, and the healthcare system can’t access critical, but dated, patient medical information, physicians could miss something big that could change the patient’s care plan—and outcomes.

For these and other reasons, healthcare organizations shouldn’t wait until a physical, legal, or clinical “fire” before considering a better approach for managing data.

Here are four considerations when updating your data archiving strategy:

 A smart data archival strategy will include extraction, backup, access, reporting, migration, streamlining, and active archiving. It’s a lot. But the right partner will simply take the reins and should put negligible weight on the healthcare IT department. For example, you should never be asked to convert or standardize your own data. Not only will this place a massive burden on your team, but the whole archival process will take weeks, if not months, longer than it should. Experience matters.

. Saving on high monthly maintenance fees is great, but almost nothing comes close to the cost of a security breach—both from fines and reputation damage. Between 2009 and 2020, there were 3,705 healthcare data breaches of 500 or more records reported to the (HHS Office for Civil Rights. When working with a prospective vendor, healthcare leaders should always inquire about an organization’s approach to protecting health information at every step of the archival process.

 Expertise is particularly useful when it comes to data archival. Every healthcare IT department knows that the dynamics of a revenue cycle management vendor system is dramatically different from a mainframe-based system, as are the variety of internally created systems. When it comes to speed of archival, it’s smart to find a partner that’s already navigated hundreds of computing languages, not to mention departmental, operational and technical specifications. This matters when it comes to turnaround time and accuracy. If a data vendor has to subcontract with a consultant, that could cause delay and impacts the ability of an organization to quickly and efficiently shuttle their data from a legacy system to a new archival solution.

User experience is often one of the more confusing areas of data archival. Many systems, such as EHRs and practice management systems, leverage sleek, artificial intelligence (AI)-driven portal designs to minimalize administrative burden on staff. Archival strategy is a bit different. The objective is to lower cost and risk with as little disruption as possible, often most efficiently done by mimicking the previous system, but specifically for archival use. This minimizes training and unnecessary workflow delays, as your teams enter into familiar replicas of old systems with one access point for all archived systems.

These are all things healthcare organizations should consider as they head into spring-cleaning mode and look for ways to ease operations, archive old data, and protect themselves for when a data emergency does arrive. With awareness and consideration of all the avoidable risks and costs maintaining legacy systems, organizations must prioritize their archival planning. This creates the opportunity for healthcare organizations free to focus on managing the data that’s right in front of them, instead of worrying whether a hazardous situation or PHI catastrophe will leave them scrambling.

Jim Yuhas serves as chief financial officer for 

 and operating partner for Cadrillion Capital. Prior to joining Cadrillion, Yuhas was at Banc of America Securities as a syndicate member on the Special Situations desk within the Global Debt platform. He has more than a decade of LBO, recapitalization and leveraged finance experience. Previously, he was a CPA with KPMG.

Unless health IT teams become more proactive, a wide range of legal, clinical and financial consequences resulting from poor legacy data management will escalate.   

Your Legacy EHR Data is at Risk: The Case for Proactive Information Archival

The health system Houston Methodist has confirmed that 153 employees have quit or were fired because they did not meet Monday’s deadline to receive the COVID-19 vaccine to keep their jobs.

Houston Methodist spokeswoman Patti Muck told the 

 that the 153 people are no longer employed by the health system, although there was no breakdown how many were fired and how many resigned. Earlier this month, the health system reported that 178 of the nearly 25,000 employees had not been vaccinated, so a small number complied with the order to be vaccinated or be out of a job.

 in late May after it was one of the first large health systems to announce a mandatory vaccination policy in April. However, a federal judge dismissed the lawsuit, calling it frivolous, which paved the way for the dismissals. Some employees staged protests over the vaccination order and more are planned.

"We can now put this behind us and continue our focus on unparalleled safety, quality, service and innovation," hospital president and CEO Marc Boom said in a statement at the time of the lawsuit’s dismissal. "All our employees have now met the requirements of the vaccine policy and I couldn't be prouder of them."

A guidance from the Equal Employment Opportunity Commission states that employers can require staff to be vaccinated to enter a workplace as long as 

 are made for those with religious or health exemptions. 

Polling has revealed a divide between physicians and frontline workers over willingness to receive a COVID-19 vaccine. A 

 by the American Medical Association found 96% of physicians had been vaccinated. However, in March, a 

 found only 52% of frontline workers said they had been vaccinated, despite availability of the vaccine for that group. Reasons for reluctance to be vaccinated included concern about side effects and the speed with which the vaccines had been developed. 

All three vaccines being offered in the United States are under an FDA emergency use authorization, and two have filed for full approval. 

A few dozen employees had sued but a federal judge dismissed the suit as frivolous.

153 Houston Methodist Employees Who Refused COVID-19 Vaccine Resign or Are Fired

The Federal Communications Commission (Commission) recently 

 of how the integration of the Hospital Robocall Protection Group’s (HRPG) Best Practices can protect hospitals and similar institutions from unlawful robocalls, which interfere with the delivery of critical patient care.

The HRPG Best Practices assessment, released June 11, 2021, reflects the unanimous view of the committee’s members on the recommended actions voice service providers, hospitals, and federal and state government agencies can take to prevent or lessen the amount of unlawful robocalls to hospitals. The practices outline measures stakeholders can take to prevent unlawful robocalls and to appropriately acknowledge and reduce robocall events after they occur.

The commission’s assessment concludes that the best way to promote voluntary adoption of the HRPG Best Practices is to raise awareness among all stakeholders, especially hospitals, and to create effective forums to expand their adoption and implementation. The commission also recommends that groups dedicated to hospital risk management and security, such as the American Hospital Association (AHA), the American Society for Health Care Risk Management (ASHRM), and the College of Healthcare Information Management Executives (CHIME) develop and distribute educational materials, expand outreach to their constituencies, and provide training for hospitals and staff regarding robocalls.

The FCC suggests that a website hosted by organizations such as AHA, ASHRM, and CHIME could streamline navigation of robocall resources including the Best Practices, training materials, or links to webinars, which would help amplify hospital outreach. Stakeholders such as voice service providers and governmental entities would be encouraged to contribute to the website.

FCC issues recommendations for stakeholders to combat issue of unlawful robocalls to hospitals, which threaten public health and safety.

153 Houston Methodist Employees Who Refused COVID-19 Vaccine Resign or Are Fired

FCC Releases Assessment of Best Practices to Address Illegal Robocalls to Hospitals

Podcast: Adoption of Healthcare Tech in the Age of COVID-19 with Dr Kaveh Safavi

The Rapidly Shifting Patient Financial Journey and Key Considerations for Health Systems

Hospital Differences Explain Higher Mortality Among Black Patients With COVID-19, Study Finds

Featured Content

Latest From Data Book

Contract Lifecycle Management

The New Mask Rules