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healthcare, healthcare IT, HIT, wearables, digital health

By Nathan Schnell

4 Healthcare IT Trends to Watch in 2018

4 Healthcare IT Trends to Watch in 2018

As we head full steam into another year sure to be full of change for healthcare, we thought we’d offer a roundup of healthcare IT trends predicted for 2018 by health IT writers, editors and analysts. Ready? Here we go…

Artificial Intelligence

While artificial intelligence (AI) is currently used to automate simple tasks, 2018 is predicted to be the year where it will make its way into clinical support and decision making. Currently many healthcare organizations already use AI for clinical decision support, population health, disease management, readmission and claims processing. But experts believe 2018 will be the year AI will make inroads into cancer diagnostics, pathology and image recognition, according to a recent SearchHealthIT article.

Health Data Management predicts that by 2021, 20 percent of healthcare and 40 percent of life science organizations will have recognized a 15 to 20 percent in productivity gains by adopting AI technology, noting that adoption resides mostly in large academic medical centers at present. Industry analyst Forrester predicts that AI as well as the Internet of Things (IoT) will be part of the disruption of siloed healthcare ecosystems in 2018.

Digital Health

According to seed fund Rock Health, a record-breaking $3.5 billion was invested in 188 digital health companies in the first half of 2017, with the number of wearables is set to hit 34 million by 2022.

Digital health has been gaining momentum for many years with the wearable trend. According to a Forbes article, the most frequent users of wearables are the least likely to be hospitalized.

Additionally, the Food and Drug Administration (FDA) recently issued new guidelines that loosen regulations for some mobile health technologies, recognizing that clinical evidence supports better health outcomes with mobile device usage. This change will likely encourage healthcare organizations to better embrace the integration of consumer digital health device data.

Telehealth and telemedicine are predicted to grow as more states update laws to expand access to these services. With one in five U.S. adults suffering from mental illness, a noteworthy predicted area of expansion is telemental and telebehavioral health services, according an article by SearchHealthIT.

Blockchain

The promise of blockchain, the technology invented to power Bitcoin, has been around since 2008. However, this year may be the year its value starts to be recognized and leveraged within healthcare. HealthDataManagement predicts that by 2020, 20 percent of healthcare organizations will be using blockchain for operations management and patient identity.

However, as noted by SearchHealthIT, blockchain has “yet to prove itself in the demanding crucible of health IT systems and clinical healthcare settings,” but notes that “IBM, Intel, Google, Microsoft  and others have units dedicated to development of blockchain products, including for healthcare.” Federal health IT officials are promoting it heavily as well.

Electronic Health Record Analytics

To be successful, EHRs will need to move into providing analytics that support population health initiatives and value-based healthcare – and many predict 2018 will be the year where headway will be made by EHRs in analytics. The big players like Cerner and Epic already have population health products and other smaller vendors like cloud-based AthenaHealth do as well. More are predicted to join and more healthcare organizations will likely take advantage of these products.

Nathan Schnell is Vice President of Service Delivery at Intellimed. 

By Jennifer Zweifel

Congress’ Tax Bills: The Impact on Healthcare and the Affordable Care Act

The House and Senate have now passed versions of the biggest rewrite of tax law in decades.

Since the bills are not identical, the final legislation must be negotiated in a conference committee. While not all provisions will survive, it is predicted that the final bill will most closely resemble the Senate version, which includes repealing the Affordable Care Act’s individual mandate, according to an article by the Association of Health Care Journalists (AHCJ).

Our team at Intellimed wanted to know the impact on healthcare of Congress’ bills. Here’s what we learned…

Impact on the Affordable Care Act (ACA)

Both bills as they stand now would significantly impact ACA/Obamacare. The biggest changes include:

  • Abolishment of Mandatory Insurance Coverage: The Senate tax bill would eliminate the government’s enforcement of the ACA requirement that most Americans carry insurance coverage. According to a recent Chicago Tribune article on the bill’s impact, abolishment of the coverage mandate would result in government savings from fewer consumers applying for taxpayer-subsidized coverage, giving GOP tax writers nearly $320 billion over 10 years to help pay for tax cuts. With healthier people opting out of insurance and foregoing a penalty, it is speculated that premiums would continue to rise for those maintaining coverage. The Washington Post concurs in its coverage, stating “The result could cause an extra 13 million people to become uninsured and drive up insurance premiums in marketplaces created under the law, according to anestimate by Congress’s nonpartisan budget analysts.

The House bill would not end penalties for Americans who fail to carry insurance. However, House Republicans have been sympathetic to the idea, which was part of legislation the House adopted this year to dismantle much of the ACA.

  • Impact on Medicare: The impact on Medicare is somewhat unclear. However, the impact of both chambers’ bills is predicted to increase federal deficits by about $1 trillion over 10 years, even after accounting for stronger economic growth expected from tax cuts. More red ink means higher borrowing costs for the government, and that would reduce the options for policymakers when Medicare’s long-postponed financial reckoning comes due, although GOP leaders House Speaker Paul Ryan, R-Wisc., and Senate Majority Leader Mitch McConnell, R-Ky. said in a joint statement that speculation about the tax bill’s cuts to Medicare are unfounded, according to the Chicago Tribune.

    The Washington Post
    notes, “Cuts, if they happen, would decrease federal spending on Medicare by 4 percent — amounting to about $25 billion next year, the Congressional Budget Office forecast. Because paygo rules do not allow Medicare benefits to be touched, the funding loss would be spread among payments to doctors, hospitals and others that provide care to the program’s 56 million older and disabled Americans.
  • Impacts to Federal Programs for Low-Income Americans & CDC: The bills would leave untouched some health-care programs that provide help to low-income Americans, including Medicaid and the Children’s Health Insurance Program (CHIP). Nearly $1 billion a year would be eliminated for a Prevention and Public Health Fund, created under the ACA that now represents 12 percent of the Centers for Disease Control and Prevention’s (CDC) budget, according to The Washington Post.
  • Tax Deduction for High Medical Expenses: The House bill repeals the tax deduction for people with high medical expenses not covered by insurance. The Senate bill would make the deduction more generous than what’s currently allowed. People could deduct amounts that exceed 7.5 percent of their income. The differences would have to be resolved in conference.
  • Tax Credit to Drug Companies: In an effort to raise money to pay for lower tax rates, the House bill eliminates a current tax credit available to drug companies that develop medications for people with rare diseases; the Senate bill scales back the tax credit.

Health Associations’ Take on the Republican Tax Bill
In a joint statement this month, the American Psychiatric Association, American College of Physicians, American Congress of Obstetricians and Gynecologists, and American Academy of Pediatrics, among others, voiced opposition to the Republican tax proposal. The main concern of these groups was around repeal of the individual insurance mandate, which would leave millions more people uninsured by 2027, according to the Congressional Budget Office (CBO), with speculation that individual and small-group marketplaces would be destabilized and rates of medical bankruptcy would skyrocket.

And the Story Continues…

The tax bill story is certainly not over and we’ll all get to watch it unfold over the coming weeks and months as we head into the New Year. We hope this quick overview of the House and Senate bills’ impact on healthcare has been informative. Please add your comments and let us know if we’ve missed any key points.

Jennifer Zweifel serves as Chief Financial Officer of Intellimed, a leader in healthcare data analytics software and analysis based in Phoenix, AZ. 

By Kim Carlson

8 Ways Claims Data Supports Population Health

8 Ways Claims Data Supports Population Health

Effective population health initiatives implemented by hospitals, large physician groups, payers, self-funded employers, among others require data analytics to be successful. The right data can inform population health strategy, goals and outcomes. While healthcare claims data is not the only data required for population health, it is a big factor in driving improvements in population health programs.

Here are eight ways we believe healthcare claims data can inform population health initiatives:

  1. Managing Overall Costs: Claims data can shed light on the disparate prices doctors and hospitals charge for the same procedures. The data can show total spending within an institution by procedure as well. Claims data can reveal which service lines are performing well and which are struggling with cost-containment.
  2. Physician Performance: Claims data can help to determine the performance of individual physicians through analysis of the services provided by diagnostic code. Data can reveal if physicians are following nationally recognized medical protocols. An example is diabetes care: According to the Pew Charitable Trusts, claims data can reveal whether a doctor followed nationally recommended protocols for treating patients diagnosed with diabetes. How many received quarterly exams? Did they receive an eye exam? How many were admitted to a hospital?
  3. Empowered Consumers: Some states through all-payer claims databases (APCDs) are making claims data available to healthcare consumers, with the idea that when consumers can compare prices across physicians and hospitals, they will make better and more informed decisions regarding both quality and cost.
  4. Improving Quality and Outcomes: When combined with clinical data, healthcare claims data can provide a very broad view at both the patient-level and population-level of interactions across the continuum of care within a healthcare system.
  5. Reduce Hospital Readmissions: Claims data can help to reduce costly hospital readmissions by uncovering areas by service line and/or at the physician-level where readmissions are occurring most frequently.
  6. Patient Engagement: Patient engagement is a key to successful population health. Claims data can help reveal when to reach out to patients as well as whether patients are filling prescriptions or following-up with recommended lab tests. In the past, technology lagged when using claims data to reveal patient patterns. However, newer analytics allow for as little as 15 days to reveal patterns such a prescription refills or follow-up tests, providing healthcare clinical teams a reasonable window to follow-up with patient outreach.
  7. Strengthen Coordination of Care: Claims data, notably when coupled with clinical data, can inform the actions of care teams that can include physicians, care managers, health coaches, caregivers and even the patients. Creating data transparency through patient portals and other tools that aggregate data into usable information allows for care plans to be adjusted to the patient’s needs.
  8. Amp Up Reporting: The best reporting reveals where there are opportunities to improve and where health systems have effectively made changes. Claims data when coupled with clinical and other data can reveal these insights. Such insights can improve population health initiatives that help to contains costs and improve healthcare quality resulting in healthier populations and healthcare systems.

By Trisha Young

SHSMD 2017 Highlights and Key Takeaways

SHSMD 2017 Highlights and Key Takeaways

Intellimed recently attend the American Hospital Association’s Society for Healthcare Strategy & Market Development (SHSMD) annual conference – SHSMD Connections – in Orlando on September 24-27, 2017.

The event provides a fantastic opportunity for healthcare marketing, public relations and communications and strategic planning professionals to come together to exchange ideas, learn about new product innovations and network.

Many of Intellimed’s clients attend this event and are the individuals within their organizations who use our healthcare data analytics solutions daily, notably our IntelliClient.

In this day-and-age of fast and furious email communication, social media and information abundance via the Internet, attending an event like SHSMD is a breath of fresh air. It allows us to:

  • Share our product improvements with our current and prospective clients.
  • Hear about customer and prospect challenges and how we may be able to help address them with our tools.
  • Gain insights into how we can make improvements to our solutions to meet changing market needs.
  • Reinforce Intellimed’s commitment to a high-quality, high-touch approach to healthcare data analytics solutions.
  • Learn about other products and services in the healthcare data analytics market.

Here are some highlights and key takeaways from the SHSMD event:

  • Intellimed enjoyed participating with 140 other exhibitors, providing conference attendees with industry-leading services and solutions.
  • Lots of fun pictures over on SHSMD’s conference Facebook page.
  • Cocktails before the opening keynote along with the crowd being serenaded by local a cappella group reVoiced – a nice change from the standard conference kick-off activities.
  • Opening keynote speaker, Ceci Connolly, President and CEO at theAlliance of Community Health Plans, who discussed healthcare’s biggest challenges – from high-deductible plans to rising drug prices to payer consolidation. Ceci offered many new and insightful perspectives on these challenging issues.
  • Some reoccurring themes throughout the event:
    • Accountability matters among providers and patients with focus on design thinking, population health, appointment follow-up communications, digital tools and more personalization
    • Consumers continue to expect experiences in healthcare on par with what they’ve come to expect from other industries and healthcare must rise to the occasion.
    • Marketers must measure ROI – a common healthcare pain point – with emphasis on marketing as a profit versus cost center.
    • Marketing must continue to move toward digital with emphasis on using technology to measure outcomes and track data, which the C-suite demands.
    • Mobile matters and patient experiences must be tailored to it from search to the experience a patient has on a hospital’s website.

Kudos to SHSMD for another great event!

Intellimed looks forward to attending next year, which given the fast-paced changes happening in healthcare, will again prove to be enjoyable and insightful.

By Nathan Schnell

Predictive Analytics in Healthcare: Trends, Challenges and Why We Need It

Predictive Analytics in Healthcare: Trends, Challenges and Why We Need It

Data from the National Academy of Medicine shows that the U.S. healthcare system spends $750 billion annually – almost a third of its resources – on unnecessary services and inefficient care.

Predictive analytics tools, long used in other industries like retail to forecast the likelihood of an event, are one of the critical tools for reducing healthcare waste and improving patient care and outcomes.

A 2017 survey by the Society of Actuaries looked at the trends in use and future use of predictive analytics in healthcare:

  • 57% of executives (providers and payers) forecast predictive analytics will save their organization 15% or more over the next 5 years, with 26% forecasting saving 25% or more over the next five years.
  • 47% of providers currently use predictive analytics.
  • 93% say predictive analytics is important to the future of their business.
  • Providers cite patient satisfaction as the most valuable outcome for using predictive analytics.
  • Payers cite controlling costs as the most valuable outcome for use of predictive analytics.

Despite what seems like strong support from this data, there are major barriers to the adoption of predictive analytics in healthcare.

Challenges to Using Predictive Analytics in Healthcare

The top 5 challenges for implementing predictive analytics from the Society of Actuaries study are:

  • Lack of budget – 16%
  • Regulatory issues (e.g. HIPAA) – 13%
  • Incomplete data – 12%
  • Lack of skilled employees – 11%
  • Lack of sufficient technology – 10%

In addition, a recent Harvard Business Review article notes that the success of predictive analytics in healthcare depends less on the tool used and more on the buy-in at all levels of an organization from the start. The authors cite the following major challenges:

  • Engaging the right people from the outset – Whether the tool is developed in-house or purchased off-the-shelf, the right people should be involved in the process, with a multi-disciplinary team comprised of clinical, analytics, data science, information technology and behavior change skill sets.
  • Change agents and clinical champions – Change agents are essential to successfully implementing predictive analytics, particularly for sustaining its usage. These individuals often work alongside clinicians to map workflows and identify changes and new processes. In addition, clinical champions are a must to promote the tool among their clinical peers.
  • C-suite commitment – Frontline buy-in is essential, but without the full commitment of the C-suite, predictive analytics won’t take off or be fully utilized. Identifying measures that resonate with management is important, such as financial penalties associated with hospitals readmissions.

Why Implement Predictive Analytics in Healthcare?

As noted in the HBR article, “Implementing predictive analytics is a means to an end – where the end should represent an improvement in health or health care outcomes, including lower costs.”

Additional major reasons as noted in Hospitals & Health Networks include:

  • Success in the shift from fee-for-service to value-based care, which may be impossible without the use of predictive analytics, along with data warehousing and integration.
  • Being able to understand a healthcare system’s current state is a must for being able to forecast a desired future state and associated plan to get there.
  • The ability to get in front of healthcare consumer trends.
  • Supporting population health initiatives.
  • Improving patient care: reducing hospital readmissions, reducing hospital stays, anticipate staff needs and more.

Ultimately, predictive analytics in healthcare is about translating data and science into practical applications to solve complex clinical and business problems that improve care and control costs. The end game? Strategic, cost-effective high-value care.

By Gene Koch

Integrating Data Silos: 7 Key Benefits for Healthcare

In our article, Healthcare Data Silos: From Medical Tragedy to Opportunity of Accelerating Returns, we discussed the challenges and tremendous opportunities for integrating data silos.

In healthcare, too many silos result in health systems that operate on assumptions – not a good thing for patient safety and when billions of dollars are in play.

We discussed in our article how data silo coordination is key to managing big data and using it for many of the strategic areas healthcare organizations are currently pursuing:

  • Evolving accountable care initiatives and organizations.
  • Creating more coordinated care among providers, health systems and patients.
  • Managing population health initiatives.
  • Implementing and succeeding in new healthcare payments models.
  • Communicating with and marketing to patients as well as providing them with access to their health data for active engagement and healthcare decision-making.

In this article, we’d like to follow up on the topic of data silos and provide some practical thoughts about integration that lead to meaningful big data usage.

  1. Next Generation Technologies: Shifting a healthcare system’s IT infrastructure is no easy task. Yet, implementation of next generation technologies in cloud, remote tele-monitoring and wearables – among others – are designed to distribute data securely and with greater agility.
  2. Clinical Data Warehouse: The first-generation of clinical data warehouses pretty much crashed and burned, but not before spawning the extract/transform/load (ETL) industry. Today’s data warehouses for healthcare are more sophisticated and able to deliver the analytics healthcare executives need. According to leading clinical data warehouse provider Health Catalyst, a data warehouse solutions should deliver analytics that combine clinical, financial, quality, cost and patient experience data.
  3. Governance, Policies & Standards: In addition to the right technologies and tools, a healthcare system must have governance in place as well as policies and standards to ensure usable data sets are available to solve problems, answer questions and uncover opportunities.
  4. Business Strategy: Oftentimes the integration of new data is an afterthought. Making data integration part of business strategy with activities such as mergers and acquisitions, expansions into new markets and IT and other infrastructure and capital investments, provides a better chance that data integration will occur on the frontend rather than the backend of such key activities.
  5. Big Data & Healthcare Providers: Healthcare executives need access to integrated data for business strategy and decision making, but healthcare providers need it as well. The ability to break down data silos to inform clinical care, workflows and the art of practicing medicine will be essential in achieving quality goals within healthcare.
  6. Advancing Medicine: Advancements in medicine require new data in areas such as genomics. Emerging data sources like genomics – which often end up on their own silos – will require integration with other forms of data to recognize their full potential.
  7. Asset Management: Managing a hospital’s assets in no easy task. Breaking down data silos can help healthcare organizations consolidate assets. With reliable data, predictive maintenance and capital equipment replacement forecasting (CERF) can help a system save significant dollars.
Gene Koch is Chief Operating Officer for Intellimed. 

 

 

 

 

By Gene Koch

Is a Marriage of Clinical and Claims Data the Linchpin for Value-Based Healthcare?

Is a Marriage of Clinical and Claims Data the Linchpin for Value-Based Healthcare?

As Walter Cronkite once said, “America’s healthcare system is neither healthy, caring, nor a system.” A bit harsh? Probably. Yet, as our healthcare system continues to march toward value-based care amidst political uncertainties around it, it’s a pretty easy to see there are opportunities for improvement.

Many healthcare systems and providers have payment models that are still dependent on fee-for-service (FFS) revenues, and making the transition has not been easy. According to a survey conducted by analytics vendor Health Catalyst, only 23 percent of healthcare systems said they would meet HHS’ goal to tie 30 percent of traditional FFS Medicare payments to quality through alternative payments models such as Accountable Care Organizations (ACOs).

Many believe this shift, despite what happens with national healthcare policy, is inevitable. With the U.S. spending nearly 18 percent of its gross domestic product (GDP) on healthcare and fee-for-service being a major driver for it, it’s hard to argue that a different model isn’t needed.

As the focus continues to be on reducing volume and increasing value, data will remain at the heart of this process. While there are many forms of data that play a role in value-based care, we believe that these three are the most critical forms of data and the linchpin for success:

  • Clinical Data
  • Claims Data
  • Demographic Data

The Two Major Players: Providers & Payers

According to healthcare leader Emad Rizk, M.D., the shift from fee-for-service to value-based care can’t be administered by providers alone. A huge player and administrator of it must be payers, he said in a recent Healthcare Informatics article, adding that payers do not yet have the systems in place to be able to pay for a bundled payment.

With providers as the keepers of the clinical data and payers as the keepers of the claims data, it only seems logical that these two entities will need to work closely together in value-based care.

Providers and Risk-Based Contracts

For providers working in environments with value-based care models where payment is dependent on outcomes and quality, claims data will offer a much more complete picture, when combined with clinical data, of a patient’s health. While claims data has a lag time, taking weeks or more to process, it can effectively be used for predictive modeling for future care and cost management. Combined with clinical data, success or failure can be better demonstrated.

System Redundancies

Redundancies within healthcare are notorious. Claims data can reveal redundant, misused and overused tests and services. Adding clinical data to the mix can help to inform care plans and create greater efficiencies within a healthcare system, with the goal to avoid waste and redundancies.

Interoperability

In the early days of health IT, the goal was to get healthcare data from paper to an electronic format. We’ve sure come a long way. Now, interoperability has replaced electronification of healthcare data as the next big step. Unfortunately, the healthcare system offers little incentive to commercial electronic medical record (EMR) vendors to be interoperable with one another. At minimum within a system, marrying a system’s clinical data with claims data can provide a more holistic picture for care, strategy and risk management.

Our Clients

At Intellimed, a healthcare data analytics company, we don’t pretend to have all the answers to success in value-based healthcare. However, in working with our clients, we see that the ones leading the way and doing it with the least amount of pain are marrying clinical, claims and demographic data to inform their value-based strategies.

By Shelly Cutrer

The Role of Claims Data in Evolving Telehealth in Healthcare

In a 2017 study published by Health Affairs, commercial claims data on over 300,000 patients from three years (2011-2013) was analyzed to explore patterns of utilization and spending for acute respiratory illnesses.

The study found that while direct-to-consumer telehealth may increase access by making care more available and convenient, it may also increase utilization and healthcare spending.

According to the American Telehealth Association telemedicine offers these four primary benefits:

  • Improving Access: Telehealth brings care to patients in remote areas. It expands the reach for providers to offer care beyond their facilities.
  • Cost Efficiencies: Keeps costs down through better chronic disease management, shared healthcare staffing, reduced travel times and fewer/shorter hospital stays.
  • Improved Quality: Telehealth has come a long way and the quality of telehealth care often equals that on in-person care in many situations.
  • Answers Patients’ Need: Consumers like telemedicine, and it provides both access and answers when and where they need them.

Given these goals and the recent Health Affairs study showing telehealth may not actually reduce costs, how can claims data be of value in both improving access and lowering costs through telehealth?

Patient Outreach & Engagement: Claims data can be used to analyze utilization, physician patterns, geographic trends and more. This can be valuable in creating and informing patient outreach and engagement programs to encourage patients to take a more active role in their healthcare, including proper usage of telehealth programs. While patient engagement is still in its beginning stages, early evidence shows it has huge potential to lower the cost burden on the healthcare system.

Support Value-Based Healthcare: Regardless of what happens with healthcare legislation, the train has left the station when it comes to value-based care. Value-based care focuses on managing rising costs, reducing inefficiencies and redundancies in the system and rewarding providers and healthcare systems on quality over quantity. Claims data has great potential to be leveraged to inform when and where telehealth services should be utilized to support value-based care initiatives.

Big Data: Big data must not only include clinical data, but also claims data along with lab and other data to be truly meaningful for strategic decision making. As hospitals and healthcare systems become more and more advanced in data analytics, big data will be better positioned to inform the proper usage of telehealth to both achieve cost savings and improve access to care.

Given the aging population, physician shortages in many areas and the growing need to manage chronic diseases, telehealth has a lasting role to play in healthcare. However, utilizing it effectively to meet the goals for telehealth and the emerging value-based care environment will be critical and data – including claims data – will be needed.

At Intellimed, we offer claims data analytics solutions that can help inform strategic decisions for telehealth as well as many other areas. To learn more about our solutions or to schedule a demo, please contact us.

healthcare reform, BCRA, Senate Healthcare bill, healthcare senate bill, trump care, ACA, affordable care act, obamacare

By Bill Goodwin

U.S. Hospital and Medical Associations’ Positions on the Better Care Reconciliation Act (BCRA), Healthcare Senate Bill

U.S. Hospital and Medical Associations’ Positions on the Better Care Reconciliation Act (BCRA), Healthcare Senate Bill

In my effort to stay current this week on the ever-moving Senate healthcare bill reform effort – the Better Care Reconciliation Act (BRCA) – I’ve been tracking the opinions coming from the major U.S. healthcare associations, notably the hospital and medical groups.

Just shortly before and after the much-anticipated analysis from the nonpartisan Congressional Budget Office (CBO) on Monday, letters to the Senate, press releases and other statements began pouring in regarding the BRCA.

CBO analysis on Monday found that:

  • The Senate bill would increase the number of people who are uninsured by 22 million in 2026 relative to the number under current law, slightly fewer than the increase in the number of uninsured estimated for the House-passed legislation.
  • By 2026, an estimated 49 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.
  • CBO and the Joint Committee on Taxation (JCT) estimate that, over the 2017-2026 period, enacting this legislation would reduce direct spending by $1,022 billion and reduce revenues by $701 billion, for a net reduction of $321 billion in the deficit over that period

The full CBO analysis can be found here.

As of today, here’s a roundup of where the various groups stand. Our intent is not to take a political position in this article, but rather to provide a roundup of hospital and medical association’s stance on the BRCA at this time.

Hospital Associations’ Positions on BCRA, Senate Healthcare Bill

American Hospital Association

In a public statement issued by Rick Pollack, President and CEO of the American Hospital Association, he stated:

Unfortunately, the draft bill under discussion in the Senate moves in the opposite direction, particularly for our most vulnerable patients. The Senate proposal would likely trigger deep cuts to the Medicaid program that covers millions of Americans with chronic conditions such as cancer, along with the elderly and individuals with disabilities who need long-term services and support. Medicaid cuts of this magnitude are unsustainable and will increase costs to individuals with private insurance. We urge the Senate to go back to the drawing board and develop legislation that continues to provide coverage to all Americans who currently have it.

National Rural Health Association

Alan Morgan, CEO of the National Rural Health Association (NRHA), said, “Members of Congress seem to be working toward a solution that perhaps makes things even worse.” NRHA has acknowledged that while the goals of the ACA were laudable, the legislation has failed in part to provide for the needs of health care in rural America.

A statement issued by Erin Mahn Zumbrun, NRHA’s Government Affairs & Policy Manager further expanded on NRHA’s position of the Senate bill:

While the bill appears to have some changes from the House version, the bill maintains some of the provisions that led to NRHA’s opposition. NRHA is disappointed that the bill includes deep Medicaid cuts that change the program from an open-ended federal commitment to a capped federal payment that limits federal spending, leaving either states, patients, or providers to struggle with the loss of funds.

The Medicaid expansion is also eliminated, being phased out over a four-year period from 2020 to 2024. Tax credits to assist individuals in purchasing insurance remain but are substantially reduced, likely leading to many more individuals unable to afford health insurance. The bill also repeals billions of taxes included in the Affordable Care Act (ACA) to pay for the coverage expansion, as well as eliminating the individual and employer mandates.

Federation of American Hospitals

On the Federation of American Hospitals (FAH) blog on June 22, the association stated its position on the BCRA:

Most providers and clinicians, including FAH, are deeply concerned by the Better Care Reconciliation Act (BCRA) discussion draft released today.  The opportunity is still there for the Senate to make critical revisions to keep the promise of accessible, affordable health care coverage and ensure Medicaid remains a viable program because it is essential to our most vulnerable neighbors. FAH has been explicit about our health reform core principles: maintain coverage levels, reasonable Medicaid structural reforms, sustain affordable, high quality individual coverage, protect employer-sponsored insurance and roll back untenable cuts to hospital reimbursement.  At this time, the BCRA draft does not sufficiently meet those principles which are so important to those Americans our community hospitals serve and our employees who care for those patients every day. Now is the time for the Senate to hit reset and make key improvements to this legislation. 

America’s Essential Hospitals

A press release issued on June 22 by America’s Essential Hospitals on BRCA stated:

Senate leaders today have put ideology ahead of lives with a plan that puts health and home at risk for millions of working Americans and that would badly weaken essential services for everyone in communities across the country.

Today’s Senate bill makes few material improvements to the deeply damaging House legislation, and might be worse overall. For the hospitals that protect millions of Americans and their communities — our essential hospitals — this bill might even accelerate decisions by some to reduce services or close their doors.

This could leave many people without local sources of lifesaving services, such as trauma, burn, and neonatal intensive care.

America’s Essential Hospitals stands by two guiding principles: affordable health care coverage for all Americans and sufficient resources for essential hospitals to meet their vital community mission. The Senate plan violates both principles and will make our nation sicker, less productive, and less secure.

We oppose this plan and appeal to senators to consider the needs of all Americans and work with us and other stakeholders — in an open and transparent process — to fix what’s wrong with our health care system while preserving progress made toward coverage and stability for all.

Medical Associations’ Positions on BCRA, Senate Healthcare Bill

American Medical Association

In a letter issued by the AMA CEO James Madara to Senate Majority Leader Mitch McConnell on the BCRA on June 26, Madara wrote:

On behalf of the physician and medical student members of the American Medical Association (AMA), I am writing to express our opposition to the discussion draft of the “Better Care Reconciliation Act” released on June 22, 2017. Medicine has long operated under the precept of Primum non nocere, or “first, do no harm.” The draft legislation violates that standard on many levels. We believe that Congress should be working to increase the number of Americans with access to quality, affordable health insurance instead of pursuing policies that have the opposite effect.

The full letter can be read here.

American Congress of Obstetricians and Gynecologists, American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association and the American Psychiatric Association

In a joint press release on BRCA issued June 22 by the above six major medical groups stated:

The physician leaders of six organizations representing more than half a million of America’s frontline physicians are strongly opposed to the Better Care Reconciliation Act. The U.S. Senate’s proposed health reform bill contains provisions that would do great harm to patients by repealing and undermining essential coverage and key patient protections established by the Affordable Care Act and make health care unaffordable for millions of Americans.

Given the broad impact of this bill and the magnitude of the changes made, including to the Medicaid program, our organizations are deeply concerned with the hidden and hurried manner with which this bill was drafted. We are concerned that no public hearings were held and no physician or patient expertise was sought during the bill’s development.

Payer Perspectives on BRCA

A spokesperson for America’s Health Insurance Plans told The Hill in a recent article, “We are not taking a support or oppose position.”

The Blue Cross Blue Shield Association, which represents insurers covering more than 100 million Americans stated in the same article, “We are encouraged that the draft Senate legislation funds cost-sharing reductions.”

Bill Goodwin is CEO of INTELLIMED, a leading healthcare analytics company.

measuring hospital competition

By Kim Carlson

Measuring Hospital Competition: Vital in Value-Based Healthcare

Measuring Hospital Competition: Vital in Value-Based Healthcare

For the last two decades, competition has been front-and-center in our market-driven system. Hospitals must increasingly make measuring hospital competition a priority to make the right decisions around their markets. However, measuring the competition is complex and having the right data matters as much as pairing it with meaningful methodology and analytics.

Changes in healthcare toward a value-based care model are forcing hospitals to take a broader view of data and competitive analysis. Indeed, clinical, operational and financial measures around quality intersect, making analysis challenging.

Measuring the competition is critical for making decisions around:

  • Service lines expansions, additions and closures
  • Mergers and acquisitions
  • Integrating new service lines post-acquisition
  • Physician outreach, engagement and retention

It’s no secret that with value-based care, hospitals and health systems that provide high-quality care and stellar outcomes will rise above the rest and grow their market share. Market intelligence is critical to achieve the goals of value-based care with its quality, efficiency and outcomes measures.

Furthermore, as we continue to see both horizontal and vertical consolidation within the healthcare market, the number of healthcare systems may continue to become smaller within a geographic region, changing the nature of how competition is measured.

According to data reported on the U.S. hospital industry in a 2013 JAMA article (n = 4973):

  • 60% of hospitals are part of a health system
  • There were 3.2 hospitals within a system on average
  • In 2011, there were 432 merger and acquisition deals
  • 49% of hospitals owned physician practices
  • 41% of physician practices were physician-owned

And… things continue to change, as those of us in healthcare know!

Approaches to Hospital Competitive Measurement

The Herfindahl-Hirschman Index

The HHI is a commonly-used measure of market concentration calculated by squaring the market share of each entity competing in a market and summing the resulting numbers. The Healthy Marketplace Index (HMI), created by the Health Care Cost Institute (HCCI) uses the HHI Index in its methodology. The HMI was developed as a series of metrics to assess the economic performance of health care markets, both across markets and within markets over time. The metrics are related to three aspects of the economic environments of healthcare markets, including price, productivity and competition.

A Relational Approach

An interesting approach to measuring hospital competition was put forth in 2002 by Min-Woong Sohn in 2002 called “A Relational Approach.” The approach conceptualizes competition as an attribute of a relationship between two hospitals and measures competition at the level of each pair of hospitals, the smallest unit at which competition can be measured. This approach can be used to identify the strongest competitor in a market and to estimate the strength of competition received from that competitor. This methodology can produce a ranked list of competitor’s strength and competition and how much competitive pressure a hospital receives from its local competitors.

Data Sources for Measuring Hospital Competition

The primary data sources for measuring hospital competition are:

  • Discharge data
  • Claims data
  • Emergency room data
  • Outpatient data
  • Demographic data

At INTELLIMED, we have provided highest quality claims data for over 30 years to U.S. hospitals. We are known for our stellar customer service and speed of data and analytics. We hope you enjoyed this article. Learn more about our healthcare data analytics services.

 

Kim Carlson is Regional Vice President of Business Development at INTELLIMED.

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