What You Should Know:

– Edward-Elmhurst Health (NS-EEH) has announced a significant, long-term partnership with Lumeris, a pioneer in value-based care (VBC). This partnership is a major development in the healthcare industry, representing the largest VBC provider deal since 2018.

– With rising expenses outpacing reimbursement rates, health systems and physician organizations are increasingly turning to value-based care to avoid layoffs and service cuts. NS-EEH, the third largest healthcare delivery system in Illinois, comprises nine hospitals, 25,000 team members, and 300 local offices, serving over 4.2 million residents.

Collaboration aims to drive coordinated care and improve quality while reducing costs

NS-EEH will strengthen its clinically integrated network (CIN) by incorporating Lumeris’ population health data platform into its value-based care strategy. The two organizations also plan to deliver joint services, supporting the CIN’s healthcare providers in care management, pharmacy management, patient engagement and other key areas. NS-EEH’s CIN includes more than 3,000 system-employed physicians, affiliated physicians and advanced practice providers, and nine hospitals across Chicagoland.

In collaboration with Lumeris, the organizations will manage joint risk arrangements, leveraging AI as a central component of their technology and approach. Lumeris stands out as the only value-based care enablement company with experience working across various patient populations, including those covered by Medicare Advantage, CMMI programs, commercial insurance, and Medicaid. This partnership aims to enhance collaboration among patients, physicians, and care teams, ultimately leading to improved clinical outcomes, a better experience for both patients and providers, and more efficient management of healthcare costs.

Formation of New ACO Models

Furthermore, NS-EEH and Lumeris will work together to address healthcare disparities in underserved communities by establishing new models of care under the accountable care organization (ACO) framework. Initially, NS-EEH and Lumeris will focus on the opportunity to participate in the Centers for Medicare & Medicaid Services’ (CMS) ACO Realizing Equity, Access, and Community Health (ACO REACH) model. This advanced value-based care model seeks to streamline care coordination and improve health outcomes for traditional Medicare patients. In the future, the partner organizations will expand their focus to include other types of accountable care and population health models to serve our diverse communities.

What You Should Know: 

– UnitedHealthcare and RUSH Health announced a new relationship that will give UnitedHealthcare Medicare Advantage plan members network access to all RUSH Health locations in Illinois for the first time, effective immediately. 

– The multi-year agreement, effective Oct. 1, provides UnitedHealthcare Medicare Advantage plan members with enhanced access to quality care and provides a new option as they choose which health plan best meets their healthcare needs during the current Medicare Annual Enrollment Period.

– The new agreement covers nearly all UnitedHealthcare Medicare Advantage plan types, with the exception of Medicare Advantage Access plans.

RUSH Health Background

RUSH Health is a clinically integrated network of physicians and hospitals that work together to provide high-quality, efficient health services. The health system covers the spectrum of patient care from wellness and prevention to disease and care management. At the system level, RUSH Health includes RUSH University Medical Center, RUSH Copley Medical Center, RUSH Oak Park Hospital, Riverside Medical Center and more than 140 physician practices.

In Illinois, UnitedHealthcare serves more than 186,000 people enrolled in Medicare Advantage plans with a network of thousands of physicians and other care providers statewide. 

“This new relationship will create greater access to the very best health care for more patients across the Chicago area and Northwest Indiana,” said Lisa Wagamon, president of RUSH Health. “We are pleased to be able to extend the reach of academic medicine to more patients and families, especially those who need care for serious and complex conditions.”

Given Artificial Intelligence’s potential to improve patient care and reduce costs, it’s no surprise that AI applications are gaining momentum in health care. As your organization explores the benefits of AI in your journey towards Value-Based Care, however, you need to carefully assess the implications, for better and worse.

Evaluating AI implications can be tricky. Healthcare AI varies widely, with clinical technology paving the way for advancements in diagnostics and treatment. But pressure on ACOs to achieve savings is spurring consideration of machine assistants for customary clinician services. That’s the message of one recent study suggesting that AI chatbots may outperform physicians in communicating with patients, offering higher-quality responses and displaying greater empathy. The study evaluated how chatbots versus physicians responded to 195 patient questions from Reddit’s r/AskDocs. Surprisingly, healthcare professionals who reviewed the responses favored chatbot answers over those from physicians in terms of quality (78.5 to 22.1 percent) and empathy (45.1 to 4.6 percent). Not a great report card for physicians!

But before planning to use chatbots in patient education, navigation, and coaching – especially given staffing shortages in health care – ACOs should closely examine the underlying assumptions. Consider these very human factors: How do patients feel about discussing treatment plans with chatbots? Was the study validated and reviewed by peers?  What were the study’s limitations and biases? Did physicians couch their responses with caution due to liability or clinical concerns? Either could have negatively affected the tone of physician communications.

The rapid adoption of AI technology risks incorporating human biases into algorithms, perpetuating gender and race biases through AI healthcare recommendations. Before jumping on the AI bandwagon, we need a better understanding of the effects on physicians and patients, as well as a thorough evaluation of potential unintended consequences.

There may be an advantage in time and money to using chatbots to assist in patient education and to support—not replace–human roles in medicine. We still need to preserve essential conversations between patients and physicians to maintain trust. Ceding that direct communication to technology could erode the patient-physician relationship. It would also undermine efforts to recruit talent into the healthcare profession, where shortages of skilled clinicians is already a significant issue, especially in rural and poorer communities.

Under pressure to adapt to Risk, many ACO stakeholders may be eager to deploy AI solutions. To resist being swept up by the momentum, carefully consider your options, support your participating clinicians in their clinical AI applications, and explore how you might collaborate.

Here are three guidelines for leveraging AI to strengthen your organization while recognizing potential weaknesses of machine-based systems:

1. Use AI to analyze complex data for risk identification, patterns, and variations in healthcare services and costs. AI’s ability to efficiently analyze diverse datasets aligns well with Value-Based Care. Personalized treatment plans based on multiple patient data points can be developed using AI analysis. For instance, AI algorithms can drive episodes of care, enabling ACOs to compare procedure costs, reduce variations, target patients for clinical review, and identify opportunities for improvement. However, be sure to exercise caution and scrutinize algorithms for potential biases that may impact population groups and health equity.
   
2. Evaluate the use of AI in creating patient materials for review by clinicians. ACOs have a responsibility to provide patients with factual information, support medical decision-making, promote cost transparency, and engage patients and their families in the process. Chatbot-generated communications, subject to clinical review, can be an efficient way to develop the necessary tools.
3. Defer replacement of direct communications with patients with AI and test the programs first. Pilot AI-driven communication and education tools, such as patient check-ins and self-management programs, with evaluation of changes in outcomes and patient acceptance. The urgency to utilize data wisely will drive ACOs toward AI solutions. Remember that technology is never neutral. Plan carefully for human and non-human resources to ensure that any AI applications benefit your organization and avoid potential, significant harm.
   

About Theresa Hush

As CEO and Co-founder of Roji Health Intelligence, Theresa Hush is a healthcare strategist and change expert with experience across the health care spectrum, including public, non-profit and private sectors. Her accomplishments include leading the transformation of Blue Cross Blue Shield regulations in Illinois, improving access to care as Director of the Illinois Medicaid program, and serving in executive leadership for both private payers and physician organizations. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs.

Today, more than 131 million Americans – 66 percent of all adults in the U.S. – use prescription drugs, and one in four use three or more, according to the Health Policy Institute. Not only are we being prescribed more drugs than ever before, but we’re paying more for them too: the U.S. has the highest per-capita pharmaceutical spending among the developed countries. In 2021, the U.S. healthcare system spent $603 billion on prescription drugs.

But even as we’re being prescribed more drugs, we’re failing to take them. Lapses in medication adherence are worrisomely common, with studies showing that 20%-30% of medication prescriptions are never filled, and a staggering 50% of medications for chronic disease are not taken as prescribed. 

This lack of medication adherence has serious repercussions for both our physical and financial health. Statistics show that each year in the U.S., non-adherence to prescribed treatments can be attributed to at least 125,000 preventable deaths, up to 25 percent of hospitalizations, and $500 billion in preventable medical costs.  

The Causes of Non-Compliance 

Patients themselves are not always the cause of medication non-compliance. People generally want to do what’s best for their health, but there are several potential factors that may keep them from taking their medications as prescribed, including financial limitations and logistical issues. Some patients, especially those from more vulnerable populations, take less medication than prescribed because of the cost. Other patients may face logistical barriers such as lack of transportation, which makes it difficult to stay on track with medications because the patients have no way to pick them up. 

But there are also other, more controllable factors that impact patients’ medication adherence, including:

• Insufficient patient education. Patients may not take medications because they don’t understand the benefits of the therapy or potential consequences of non-adherence, or because they are afraid of the side effects. 
• Health literacy. patients’ health literacy is central to their ability to adhere to their treatments.  Studies show that the risk of non-adherence is very high when patients cannot read and understand basic written medical instructions. Misunderstanding of this type is not as uncommon as one might imagine, with one large study of 2,500 patients finding that nearly one-third had marginal or inadequate health literacy. 
• Complex treatment regimens. Patients may have trouble remembering what their doctor told them and may require extra support to remember what medications to take and when to take them.
• Lack of trust in the healthcare provider. The interpersonal dynamics of the physician–patient relationship play an important role in patient’s adherence to their treatments.  Patients who believe that their physician is someone who can understand their unique experience of being a patient, and can provide them with reliable and honest advice, are more likely to take their medications as prescribed.

Personalized Patient Engagement is Critical to Getting Patients to Adhere to Treatments 

Many of the barriers described above can be overcome with better patient engagement and communication. For example, while clinicians don’t have control over drug pricing, they could offer lower-cost options if they recognize that price is an issue for a particular patient. Clearer patient education about the risks for side effects and the realistic result of therapy is essential for patients who don’t fully understand their treatments.  

But to achieve effective engagement, in which the patient understands and internalizes information, is motivated to act upon it, and provides reciprocal information, requires true personalization. Until recently, personalization in digital communications simply meant adding the recipient’s name in the introduction of an email or calling out a health condition s/he may be managing. Such mass approaches to patient engagement (whether for education or marketing) have proven insufficient. What’s needed is a new approach that leverages patient data to gain insights into what motivates them. Patients provide a significant amount of historical health and other personal information about themselves; finding a way to use this data to create hyper-personalized communications through preferred channels is central to achieving real patient engagement.

Leveraging Psychographics to Create Personalized Communications 

Psychographic segmentation (dividing people into groups using psychological characteristics including personality, lifestyle, social status, activities, interests, opinions, and attitudes) has been used for decades by the world’s most successful consumer products and retail companies to influence decisions, behaviors and user experience. However, psychographic segmentation is relatively new to healthcare and represents a way for consumer science to augment and support the delivery of care, as well as help healthcare providers achieve their business goals.

Healthcare has historically taken a “one size fits all” approach to patient engagement, using the same message and channel mix with every person who shares or seeks to prevent, a given health condition. Patients are people first, who happen to have a health issue but do not define themselves solely by that issue. They have distinct personalities and motivations that influence their choices and behaviors. Psychographic segmentation helps classify people according to their motivations and communication preferences to optimize targeting, messaging and the engagement experience. 

Today, there are advanced patient engagement technologies that leverage psychographic profiles to understand patients’ lifestyles, motivations, and engagement preferences to deliver hyper-relevant messages designed to trigger action. These solutions enable healthcare organizations to provide personalized care without increasing staff workload and serve as a valuable tool in addressing medication non-adherence. 

The reasons patients fail to adhere to their drug treatments are highly personal – engaging these patients in an equally personal way is the key to solving the problem.

About Carrie Kozlowsk
Carrie Kozlowski, OT, MBA, is the COO and co-founder at Upfront Healthcare. Over a career spanning 25 years, Carrie has combined real-world clinical experience with strategic thinking and an entrepreneurial drive to lead strategy, operations, and talent development at forward-thinking organizations focused on population health. Carrie’s clinical background includes providing direct care, training, and management services as a practicing occupational therapist. She holds an MBA in Management and Entrepreneurship from the University of Illinois Chicago, and a bachelor’s degree in occupational therapy from the University of Hartford.

What You Should Know: 

• LG Business Solutions USA launches a new line of “Patient Engagement Boards” that empowers hospitals to outfit patient rooms with crisp high-definition screens for displaying patient information such as their name, schedule, a list of caregivers, native language and more. 
• The new Patient Engagement Boards are now available in a 43-inch UHD model and 32-inch FHD model, featuring Power over Ethernet (PoE) capability, offering optimized solutions and simplified installation for diverse patient room needs.

LG Patient Engagement Board Overview

The LG Patient Engagement Boards (ML5K-B Series) are designed to improve experiences for patients and caregivers while simplifying operations for administrators and IT staff. The 32-inch model can be rapidly deployed utilizing POE without the exhaustive approval process commonly associated with modifying a room’s electrical components. Convenience is further enhanced by each display’s automatic brightness sensor, which ensures viewing comfort by matching ambient light levels throughout the day.

Both models can be wall-mounted vertically or horizontally using 200×200 VESA mounts. And both displays feature LG IPS panels and offer up to 50,000 hours of life, making them ideal for 24/7 use. Integrated stereo speakers further simplify deployment and provide flexibility to host a variety of content. The 43-inch 43ML5K-B offers a typical brightness of 500 nits and has a 25 percent haze treatment that reduces glare, while the 32-inch 32ML5K-B provides 400 nits through standard power and 200 nits through PoE. 

“As hospitals continue to digitize more and more of their operations, in-room displays provide patients and caregivers with greater legibility and infinitely more flexibility than analog white boards,” said Tom Mottlau, LG Business Solutions USA Healthcare Director. “Our patient engagement development partners have utilized the powerful LG webOS 6.0 platform to develop intuitive applications that can allow hospitals to eliminate handwritten notes and the difficulties that can arise from illegible writing or unclear instructions. These enhancements can improve communications and patient trust, resulting in better overall experiences.”

Given Artificial Intelligence’s potential to improve patient care and reduce costs, it’s no surprise that AI applications are gaining momentum in health care. As your organization explores the benefits of AI in your journey towards Value-Based Care, however, you need to carefully assess the implications, for better and worse.

Evaluating AI implications can be tricky. Healthcare AI varies widely, with clinical technology paving the way for advancements in diagnostics and treatment. But pressure on ACOs to achieve savings is spurring consideration of machine assistants for customary clinician services. That’s the message of one recent study suggesting that AI chatbots may outperform physicians in communicating with patients, offering higher-quality responses and displaying greater empathy. The study evaluated how chatbots versus physicians responded to 195 patient questions from Reddit’s r/AskDocs. Surprisingly, healthcare professionals who reviewed the responses favored chatbot answers over those from physicians in terms of quality (78.5 to 22.1 percent) and empathy (45.1 to 4.6 percent). Not a great report card for physicians!

But before planning to use chatbots in patient education, navigation, and coaching – especially given staffing shortages in health care – ACOs should closely examine the underlying assumptions. Consider these very human factors: How do patients feel about discussing treatment plans with chatbots? Was the study validated and reviewed by peers?  What were the study’s limitations and biases? Did physicians couch their responses with caution due to liability or clinical concerns? Either could have negatively affected the tone of physician communications.

The rapid adoption of AI technology risks incorporating human biases into algorithms, perpetuating gender and race biases through AI healthcare recommendations. Before jumping on the AI bandwagon, we need a better understanding of the effects on physicians and patients, as well as a thorough evaluation of potential unintended consequences.

There may be an advantage in time and money to using chatbots to assist in patient education and to support—not replace–human roles in medicine. We still need to preserve essential conversations between patients and physicians to maintain trust. Ceding that direct communication to technology could erode the patient-physician relationship. It would also undermine efforts to recruit talent into the healthcare profession, where shortages of skilled clinicians is already a significant issue, especially in rural and poorer communities.

Under pressure to adapt to Risk, many ACO stakeholders may be eager to deploy AI solutions. To resist being swept up by the momentum, carefully consider your options, support your participating clinicians in their clinical AI applications, and explore how you might collaborate.

Here are three guidelines for leveraging AI to strengthen your organization while recognizing potential weaknesses of machine-based systems:

1. Use AI to analyze complex data for risk identification, patterns, and variations in healthcare services and costs. AI’s ability to efficiently analyze diverse datasets aligns well with Value-Based Care. Personalized treatment plans based on multiple patient data points can be developed using AI analysis. For instance, AI algorithms can drive episodes of care, enabling ACOs to compare procedure costs, reduce variations, target patients for clinical review, and identify opportunities for improvement. However, be sure to exercise caution and scrutinize algorithms for potential biases that may impact population groups and health equity.
   
2. Evaluate the use of AI in creating patient materials for review by clinicians. ACOs have a responsibility to provide patients with factual information, support medical decision-making, promote cost transparency, and engage patients and their families in the process. Chatbot-generated communications, subject to clinical review, can be an efficient way to develop the necessary tools.
3. Defer replacement of direct communications with patients with AI and test the programs first. Pilot AI-driven communication and education tools, such as patient check-ins and self-management programs, with evaluation of changes in outcomes and patient acceptance. The urgency to utilize data wisely will drive ACOs toward AI solutions. Remember that technology is never neutral. Plan carefully for human and non-human resources to ensure that any AI applications benefit your organization and avoid potential, significant harm.
   

About Theresa Hush

As CEO and Co-founder of Roji Health Intelligence, Theresa Hush is a healthcare strategist and change expert with experience across the healthcare spectrum, including public, non-profit and private sectors. Her accomplishments include leading the transformation of Blue Cross Blue Shield regulations in Illinois, improving access to care as Director of the Illinois Medicaid program, and serving in executive leadership for both private payers and physician organizations. An expert at creating consensus for desired change through education and collaboration, Terry helps organizations take actions that will direct their future through meaningful technology and programs.

The VBC delivery model encompasses various approaches with the most common being Accountable Care Organisations (ACOs) and Integrated Delivery Networks (IDNs) in the US and  Integrated Care Systems (ICS) in the UK.  Both countries’ approaches are networks of healthcare providers (hospitals and physicians) who work together to deliver high-quality coordinated care to beneficiaries while controlling costs.  The benefits of VBC models include better patient health outcomes at a lower cost, streamline delivery via coordinated care teams, focused preventative care and treatment plans for patients, less physician burnout, lower costs for payers, and a healthier patient population due to better adherence to treatment.  

While there are many benefits to VBC, there are also some significant obstacles that must be overcome for this type of healthcare delivery model to be a success.  This includes dealing with disparate IT and health records systems, outdated workflows, and lack of internal resources which is a consequence of patients seeing multiple physicians, specialists, etc. who are using different data handling platforms throughout the course of treatment.

When it comes to VBC IT solutions, there are six tools that are essential for tracking, monitoring, and measuring patient outcomes.  These include IT tools to identify patient cohorts, segment patients by risk, aid clinical decision-making, manage care coordination, carry out patient activation, and finally, measure performance and report outcomes.  

Over the years, Signify Research has had the opportunity to speak to 100s of VBC decision-makers and buyers from ACOs and IDNs in the US and similar organizations internationally about their healthcare IT needs.  Our conversations with these organizations have provided greater insights into the current drawbacks of utilizing these technologies as well as what needs to change to improve these IT tools for the better. 

Tools to Identify Patient Cohorts

Our research has highlighted that electronic health record (EHR) systems are the main sources of patient information that are used to identify specific patient cohorts to target as part of VBC, coupled with manual data handling processes.  EHR systems can vary across providers’ settings, with some being more basic with limited clinical decision support (CDS) on offer including minimal highlighting of care gaps and no priority ranking of patients or insights on the financial impacts of closing these care gaps.  EHR systems that are more advanced tend to provide modules that have robust CDS that highlight actions to prioritize patients and provide some input on the cost impact of closing care gaps.  

However, gathering this information to identify patient cohorts to target for VBC is not always a straightforward process.  A majority of ACOs and IDNs that leverage EHR systems to identify patients use a mixture of DIY business intelligence tools such as Tableau, PowerBI, and Excel, for example, combined with some form of a dedicated commercial health insights solution drawing on EHR data.  This process is not straightforward and involves interrogating multiple data sources in various locations to develop a fuller patient view that includes manually pulling data from EHRs/Data Warehouses, claims portals (US-only), self-developed DIY tools, and social determinants of health (SDoH) tools.  Having to pull in data from multiple sources manually does not always display in a way that can help these organizations clinically, especially when some of the data is insignificant or inaccurate.    

When identifying patients to target for VBC, key things that care management teams look at include frequency of hospital admissions/readmissions, frequency of ED visits, type and number of chronic conditions, social needs data, medication spending, and screening tests.  As VBC organizations continue to grow and mature, the demand for more data points beyond EHRs is becoming increasingly important to help accurately identify patients to close care gaps.  With this comes growing interest in the need for sophisticated IT tools that automate processes and improve current workflows. 

Tools to Risk Stratify Patient Cohorts

The VBC providers we have spoken to have highlighted a reliance on several off-the-shelf algorithms that are used to segment patient cohorts identified from EHRs into high-risk/low-risk categories as a way of prioritizing who needs immediate interventions and care plans.  The algorithms in use include, for example, Milliman RX, Hierarchical Condition Category (HCC), Charlson Comorbidity Index, QAdmission Risk Algorithm (UK), Electronic Frailty Index (UK), and Kaiser Triangle.

The reliance on these algorithms once again requires care management teams to utilize manual data handling processes that include a mix of self-developed business intelligence tools combined with some health insights software.  As risk stratification is an important part of VBC, most organizations are currently not using sophisticated tools for various reasons related to issues of cost and lack of internal resources.  But the interest and need are there to look at IT tools that can improve workflows and help to focus on high-risk, high-cost patients in a more efficient and less laborious manner.

Clinical Decision Support Tools

Across VBC organizations we have engaged with, there is a wide variety of CDS software tools in use depending on where the ACO, IDN or other organization is based on their IT set-up journey.  Some have minimal or no CDS tools for closing gaps in care and rely entirely on manual processes to find and prioritize patients for care plans.  Other organizations have CDS support in the form of limited actionability that provides some software assistance with identifying cohorts but still requires manual work to input/extract relevant patient data.  The most advanced VBC organizations have developed integrated tools/dashboards that are combined with cohort identification and risk stratification IT tools and CDS modules providing care gap closure recommendations. 

While advanced CDS setup is what most organizations aspire to, the system is still not perfected as many CDS options are not integrated with care coordination team workflows requiring timely manual processes and additional staff resources.  There is a growing demand for the use of mature, integrated tools that mirror the VBC journey and bundle cohort identification, risk stratification, and CDS in health insights into one seamless end-to-end workflow.  

Population Health Management Tools

Another health IT needs includes improvements to current population health management (PHM) tools on the market.  Many organizations currently use broader dedicated PHM tools that enable care management teams to view cohorts based on risk and then drill down into specific patients to receive input and advice on what actions are needed to close gaps in care.  This specialized software allows for data visualization of common actions across cohorts that would lead to the greatest impact from a financial and clinical perspective.  

While dedicated PHM software is mostly used in medium to large-scale VBC organizations, many of the buyers we have spoken to have highlighted the dissatisfaction that cohort ID is mostly from siloed data sources that are not always accurate or up to date which increases the potential for patients to be incorrectly prioritized.  Also, many of the tools are not as user-friendly and require dedicated support from the IT/informatics team to manipulate data.  The demand is for solutions that not only provide a holistic patient view but also can be easily manipulated by care management teams without having to rely on technical or informatics expertise.  

Patient Activation and Outreach Tools

Our conversations with VBC decision-makers and buyers have also illustrated that despite the demand and use of IT tools for PHM, the telephone remains the primary method of contacting patients and enrolling them into VBC.  Enrollment success varies greatly across organizations, with some leveraging additional outreach tools such as texting tools and various patient apps and portals to contact patients.  

Patient communication is initiated and managed via workflows that once again originate from the EHR which houses patient contact information.  Organizations that have smaller, less diverse populations and those who have either invested in specific PHM IT tools to manage the process or who have developed their own in-house IT tend to experience higher patient enrollment in VBC.

However, while not high on the IT improvement wish list, many VBC buyers have expressed a desire to access outreach tools that better integrate with other care coordination workflows to streamline and expedite patient outreach activities and generate engagement.  

Reporting and Performance Tracking Tools 

To judge the eligibility of ACOs and IDNs for reimbursement payments and shared cost-savings, these organizations are required to participate in annual audits that measure performance and track outcomes.  Analyzing data for these audits is extremely valuable, but it tends to be a labor-intensive process and many healthcare organizations lack adequate resources and skill sets to create these reports.

Currently, most organizations use some form of DIY BI tools created by internal staff to track various program success metrics and KPIs around strategy, operational, and process improvements.  Most medium-to-large scale organizations rely on internal data analytics/informatics teams to develop IT tools via Tableau, Excel, Qlik that provide details on specific performance measures. 

This method of reporting again requires an abundance of manual tracking/reporting activities with automated tools used less commonly.  And this reliance on specific data analyst teams creates a backlog of reporting which makes it impossible to monitor performance in real time so strategies can be implemented to correct or improve outcomes before year-end.   

What PHM solutions are truly needed?

In summary, the six types of health insights IT tools that are essential for VBC organizations are not without significant drawbacks.  What is clearly not working is the lack of a holistic 360-degree patient view, and data limitations in terms of latency and access with multiple data feeds leading to missing and outdated patient information.  With the variety of vendor PHM IT tools in use that are falling short and still need to rely on manual processes, there are growing challenges in creating clear, coordinated workflows that share information back and forth between care management teams and frontline providers.  

Our conversations with VBC healthcare leaders have illuminated three key purchase drivers for any PHM IT tool which includes examining how these tools improve patient care, improve clinical staff workflow/efficiency, and reduce data fragmentation/data siloes.  What is needed for VBC are IT tools that ensure actions recommended by dedicated care management teams are visible and front-facing for providers to act upon as they interact with patients.   Also, having real-time data feeds and tools to inform care management would be extremely beneficial to VBC organizations in terms of monitoring and improving healthcare outcomes.

About Rohinee Lal 

Rohinee Lal is the Principal Analyst at Signify Research, a research advisory company providing healthtech marketing intelligence powered by data. Rohinee joined Signify Research’s Custom Research & Consultancy team in early 2022. She brings over 24 years of experience collecting, analyzing, & presenting market intelligence across various industries including pharmaceuticals, medical devices & digital health.

What You Should Know:

– Aledade is continuing its strong momentum today, announcing that Cigna Healthcare Medicare Advantage customers can now receive value-based care from Aledade’s network of independent primary care practices.

– Participating practices can access Aledade’s cutting-edge data analytics, user-friendly guided workflows, and health care policy expertise, as well as integrated care services supported by AledadeCare Solutions.

– This news comes shortly after Aledade announced a 10-year collaboration with Humana, and a partnership with CareFirst Blue Cross and Blue Shield to advance value-based care to more independent physicians. 

Doctors and other healthcare professionals are entrusted with the responsibility of safeguarding the health and well-being of their patients, ensuring they receive the highest quality of care. While healthcare professionals are expected to provide a certain standard of care, any deviation from that standard that results in harm or injury to a patient may leave them exposed to a medical malpractice claim.

The consequences of medical malpractice can be severe, and in some cases, can result in permanent injury, disability, or even death. Patients harmed by medical malpractice may suffer from physical and emotional pain, financial loss, and other damages that severely impact their quality of life. This article will examine some of the causes of medical malpractice and outline steps to prevent its occurrence.

Causes of Medical Malpractice
There are many scenarios that can lead to a medical malpractice claim. Among the most common causes of malpractice are:

– Diagnostic errors: Misdiagnosis occurs when a medical professional fails to correctly identify a patient’s medical condition, resulting in the wrong treatment being administered or no treatment being provided at all. 

– Surgical errors: There are many types of surgical errors, such as damage to internal organs, incorrect incisions, operating on the wrong area, or leaving foreign objects behind after surgery.

– A failure to treat patients: A failure to provide adequate treatment to patients can encompass a range of issues, such as neglecting to administer necessary medical tests or failing to address a medical condition in a timely or appropriate manner.

– Birth injuries: These can result from various causes, such as the misuse of delivery tools, failure to perform a timely cesarean section, or inadequate prenatal care.

Medication errors: This may occur when a medical professional prescribes or administers the wrong medication or dosage.

If you have undergone a failed tubal ligation procedure you may be entitled to compensation for your injuries. You can speak with a specialist attorney such as those at The Tinker Law Firm PLLC to see if you have a claim.

Preventing Medical Malpractice 

The prevention of medical malpractice is critical to ensure patient safety and reduce the risk of injury or harm. The following steps can help in achieving this goal.

Effective Communication 

Medical professionals should communicate clearly with patients about their medical conditions, treatment options, and the potential risks and benefits. Patients should also be encouraged to ask questions and express their concerns about their treatment. 

Electronic Health Records 

Another vital way to prevent medical malpractice is through technology. EHRs can help to reduce the risk of medical errors by providing medical professionals with accurate and up-to-date information about a patient’s medical history, allergies, and medication use. EHRs can also help to ensure that medical professionals are following the correct guidelines and protocols for patient care.

Staying Current

Medical professionals can prevent medical malpractice by staying up to date with the latest research, information, and guidelines in their field. By participating in ongoing education and training programs they can ensure they are providing the most effective and safe treatments to their patients.

The steps outlined above can help to prevent medical errors and ensure that patients receive the appropriate care and treatment.

What You Should Know:

– CRISP, the nonprofit state-designated health information exchange (HIE) of Maryland, announced plans to expand its Medicaid Redetermination Notification project across the state to support care teams as they navigate redetermination for 1.6 million Medicaid enrollees.

– The project is a collaboration across state agencies and began as a pilot supporting federally qualified health centers who expressed concerns about lacking resources that would contribute to vulnerable patients slipping through the cracks and loosing coverage.

Medicaid Redetermination Notification Project Background

In partnership with Maryland Medicaid (MDH), the project provides healthcare delivery organizations with a secure report of all their patients who will face redetermination within the next 90 days. The program breaks down data siloes, ensuring healthcare centers have access to timely and accurate patient information, so care teams can perform outreach and navigate patients through the redetermination process. The notification project is currently available to Federally Qualified Healthcare Centers (FQHCs) and will expand to all CRISP-participating organizations by May 2023. CRISP will conduct outreach with more information to all eligible organizations as the project expands.

Medicaid Redetermination is a nationwide concern as all states will enter redetermination for 91.3 million people across the country. Behm emphasized the critical role HIEs can provide during redetermination: “By leveraging the infrastructure and technology already in place, HIEs can modernize the process and significantly reduce the burden on providers, clinics and state Medicaid agencies so they can instead focus on supporting patients.”

When it comes to consumer engagement, other industries have had a significant head start. For years, retailers, banks, and other customer-centric organizations have been working hard on curating digital experiences that simplify, personalize, and secure interactions and transactions with their consumer base.

Accessing your savings account through an app is now the standard for millions of people. It’s second nature to use the chat feature on a clothing retailer’s website to get information about an order or schedule a return. And even utilities companies now offer extensive online dashboards to help consumers manage their energy usage.

This is all creating an expectation among consumers—when interactions are quick, easy, and successful within one industry, it encourages them to look for similar high-quality experiences within others. Now, that’s starting to influence how patients expect to interact with their healthcare providers.

Patients want the experiences they get as consumers

It’s often difficult to prioritize spending on a patient engagement strategy when there’s life-saving equipment and everyday care delivery to worry about. But recent figures show that 61% of US patients are now demanding better experiences from their care providers. They want to be proactive about their health, but often the tools simply aren’t there to support them.

In many cases, patients need to navigate complicated and outdated phone systems to contact their providers, while administrative staff have to field inquiries, manage appointments, and ensure clinicians have the information they need for consultations.

Some healthcare providers have been making tentative steps toward technology that creates a “digital front door” where patients can access some information and do basic tasks relating to their care. 

It’s time to expand beyond the digital front door 

During the pandemic, the patient access centers of thousands of healthcare organizations were put under immense pressure. Patients are getting more involved with managing their health—and many are now approaching their providers with concerns they kept to themselves at the height of COVID-19.

As demand grows, healthcare organizations need to evolve their systems to provide more convenient routes for patients to book appointments, order prescriptions, check on test results, or view their medical history. By matching the experience more closely to those patients get from brands in other sectors, organizations can encourage patients to take more ownership of their health too.

With the ability to choose their own appointment slot through an online booking system, for example, patients are far less likely to no-show on the day. Plus, making notes and clinicians’ recommendations available through a web portal will help patients manage their ongoing care.

Proactive contact gets patients involved with their care

Increasing compliance with treatment plans is the key to better outcomes. But whether a patient schedules a follow-up appointment, remembers to take their medication on time, or makes recommended lifestyle changes can be out of the clinician’s hands as soon as the consultation is over.

Clinicians often won’t have time to call and check in on their patients regularly, and busy desk staff don’t have the medical expertise needed to guide those conversations. However, an automated, proactive outreach program—through SMS or voice calls, for example—can help keep people on track in their wellness journey before and after their appointment, like this:

– An SMS the day before the appointment reminds the patient to arrive on time with any documentation they need—such as a list of existing medications—and prepared for any tests. 

– A push notification to their healthcare app can let them know when their new prescription is ready to pick up.

– The web portal can collate all the relevant literature for managing their condition into a central repository, so patients don’t rely on internet sources.

– And then, a personalized follow-up call a couple of weeks after the appointment can prompt them to give feedback on any side effects and schedule a check-in at a time that’s convenient.

Close the experience gap in healthcare

Many organizations in other sectors have stepped up their digital strategies to close the experience gaps they identified when brick-and-mortar locations closed. It’s time for healthcare providers to do the same—and there are plenty of excellent examples to draw from.

As well as meeting patients’ growing expectations for the healthcare experience, investing in technology will help streamline the journey through care pathways, from the moment a patient gets in contact to when they’re discharged completely.

Frequent, personalized contact builds trust between patients and their clinicians, so they’re more likely to be honest about their symptoms and follow advice closely. In the long term, that leads to better outcomes and helps take pressure off clinical staff and those who support them.

Engagement is just one piece of the patient experience puzzle—and proactive engagement tools are just part of the solution. Expanding the digital front door into a fully digitally-enabled healthcare environment will also require careful consideration of clinician workloads and support staff processes to ensure the benefits are felt across the care continuum.

About Diana Nole

Diana joined Nuance in June 2020 as the executive vice president and general manager of Nuance’s healthcare division, which is focused on improving the overall physician-patient experience through cutting-edge AI technology applications.

She is responsible for all business operations, growth and innovation strategy, product development, and partner and customer relationships. Over the course of her career, Diana has held numerous executive and leadership roles, serving as the CEO of Wolter Kluwers’ healthcare division, president of Carestream’s digital medical solutions business, and vice president of strategy, product management, and marketing for Eastman Kodak’s healthcare information technology solutions business.

As a patient engagement product director, there’s nothing that I love to hear more from customers than they live and breathe in the systems we’ve created. We’ve thought long and hard about UI; about the rich dashboards we build; about new ways to expand functionality within the parameters of our applications and programs. 

But there’s a hard truth that I—and the healthtech community at large—need to learn, or have already: 

Most of the people who use our software aren’t focused on actually using our software. 

I don’t mean that no one is thinking about patient engagement, of course. On the contrary, patient engagement is becoming a c-level imperative at healthcare systems across the country. And that’s happening for good reason. Effective engagement has emerged as a leading tool on two fronts: 

– Counteracting the labor crisis in healthcare by improving job satisfaction through the streamlining of intensive manual outreach and rounding

– Helping healthcare leaders create new dynamic experiences for patients and competing in an industry increasingly defined by consumerism

But on the healthcare front lines, everyday users of engagement products are focused on performing extremely demanding jobs in the most efficient way possible while doing right by every patient that comes through the door. That means that the tech center of their daily universe isn’t patient engagement, but rather the program they use most in their daily duties: The EHR. 

And that means that patient engagement solutions, while still critically important, can’t distract from patient care or complicate workflows. Interoperability is paramount, and patient engagement should in essence become as visible or invisible as each user wants it to be.

The Electronic Health Record, or EHR, is almost universally treated as the single—or at least most important—source of truth for healthcare systems. And while it’s a central hub for clinical patient records, non-clinical—but still contextually important—data must be pulled in from elsewhere. 

A proliferation of point solutions add value in terms of data collection, but many are tacked onto IT architectures and siloed, resulting in data gaps or cumbersome manual data processing and integration, preventing timely and nuanced data analysis. 

Where does patient engagement fit? 

In short, patient engagement should exist wherever a user wants to leverage its functionality, whether that be within a patient engagement software program, or through data-sharing-enabled functionality within the EHR. The future of patient engagement is omni-channel—not only from a patient perspective, but a hospital caregiver perspective as well. 

Tight and immediate data integration has become table stakes. The new basis of competition for healthcare IT vendors will come through integration of experience. The modern paradigm in patient engagement allows super users rich functionality within patient engagement apps, but also seamlessly integrates insights in real-time into the EHR. 

So what happens when patient engagement data, functionality, and insights are ported into the EHR in near real-time? For starters, providers have single-point access to longitudinal health histories, enabling informed care decisions. Health systems are also empowered, meanwhile, to glean population-level health insights and digest macro trends to improve care and operations. Additionally, providers are better able to: 

– Coordinate care: Using an EHR system that’s tightly integrated with patient engagement and other tools like scheduling, data can follow patients across the entire continuum, shared among providers everywhere to enable the best, most-informed care. For example, real-time integration enables use cases like alerting physicians when a patient checks into an emergency room, or seamless care transitions between settings, facilities, and providers

– Tap into analytics: Whether it takes place inside the EHR or elsewhere, automation and analytics are key to improving operations and care. Data availability—as well as the proper tagging systems and training—is the foundation to enabling the digital transformation needed in healthcare. Through real-time data availability in the EHR, providers can overlay engagement data with clinical data to identify trends and areas for improvement. 

– Enhance workflows: If engagement data is mapped directly to the EHR in discrete fields, the cumbersome work of reconciling information across systems is negated. Additionally, functions like intake, post-discharge outreach, and point-of-care surveys can be automated and operationalized directly into the system of record. 

– Improve patient experience: Interoperability flows directly into patient experience. When frontline staff have contextual, non-clinical data at their fingertips, they’re better able to understand and adapt to patient preferences and historical data. Simply put, they are able to provide care in a way that shows patients they understand their unique situations and have catered care accordingly. 

– Increase staff satisfaction: Providers have the opportunity to resolve a major clinical pain point: by funneling engagement data to the EHR, they can cut down on the endless toggling associated with accessing and inputting data across systems. 

– Improve patient outcomes: Real-time data availability simply boils down to faster, better-informed clinical decisions. Actions can be taken before conditions escalate, decisions are made in light of the full clinical and contextual picture, and patient health is improved. 

Ultimately, in healthcare as well as everywhere else, true value comes in meeting your customers where they are. And for healthcare providers, that means meeting them in the EHR. It’s an important evolution in the healthcare interoperability revolution—and it’s one that not only better serves the frontline providers accessing the systems, but most importantly the patients themselves, through enhanced experience and better clinical outcomes. 

About James Rachlin
James Rachlin is the Director of Product, Interoperability at CipherHealth, driving product management and platform strategy with a focus on integrations and interoperability. James has spent over 10 years leading healthcare interoperability efforts at national and state-level health information exchanges and several technology vendors.

What You Should Know:

– Lumeris is launching Tribus, a value-based care accelerator for practices to convert from fee-for-service to value-based care using a community based-model.

– Under the direction of Dr. Chuck Willey, CEO of Tribus, who is a practicing internal medical physician in St. Louis, doctors will participate in physician-to-physician training and mentorship for anyone looking for a better way to deliver at-risk care for senior populations.

Why It Matters

The Medicare population is projected to be nearly a quarter of the U.S. population in the next ten years. With health systems influencing the vast majority of expenditures for healthcare delivery in the United States, Tribus supports coordinating the experience of care across all venues of delivery. This is accomplished in a shared risk partnership structure where Lumeris is aligned around driving performance outcomes with the participating physician partners.

“It’s an accelerated, community-based approach for practices to convert from fee-for-service to value-based care by learning directly from doctors who have operated in this model for decades,” said John Fryer, President of Tribus and SVP of National Markets at Lumeris. “For practices that want to convert to total cost of care arrangements and are ready to make the leap, this is hand-to-hand work that drives quality patient outcomes, satisfied consumers and solid financials for physicians, payer partners and ultimately patients.”

What You Should Know:

– Providers believe 96% of payment is now value-based in some capacity, and 58% believe their EHR vendor won’t be able to support the data strategies required to thrive under value-based care, according to a new study conducted by Morning Consult and Innovaccer.

– The 37-page national research study uncovers key IT infrastructure issues healthcare leaders said are impeding or essential for progress towards accelerating their transformation to value-based care.

The State and Science of Value Based Care

Only 4% of providers today report using pure FFS with no links to quality and value, and that plummets to 1% by 2025. Providers believe the payment model that’s historically dominated in healthcare has flamed out, and that 96% of healthcare payment today has connections to care quality, cost reductions and, in some cases, patient experience. That leaps to 99% by 2025.

Moreover, while providers report they have moved 96% of their revenue into some form of performance risk, 80% of those programs operate on a FFS architecture, where claims submission (as opposed to population-based payment) remains the driving force for value-based analysis and payment. The FFS architecture is even present in Shared Savings models, according to respondents, where healthcare costs are compared with a goal, and providers and payers share in the savings or losses.

– 58% said they didn’t believe their EHR vendor could support their enterprise data strategy.

– 42% said their data is highly fragmented and siloed, a blind spot for insights, workflows, actions, and reporting essential for value-based care delivery.

– 48% said they’re not confident their organization has the infrastructure to capture and use the full range of patient data.

– 41% said their organization needs population health analytics to advance their enterprise data/information strategy, making it the #1 capability sought among ten priorities offered.

– 68% said their organization doesn’t have the AI capabilities to drive digital transformation essential for value-based care.

– 69% of healthcare leaders said they aren’t using technology to identify at-risk patients.

– Despite a 94% increase in the number of executives who expect consumer-generated data to have a high impact on SDoH by 2025, 72% of respondents aren’t integrating medical and social determinants data.

In addition to presenting key findings on providers’ outlook on value-based care, the State and Science of Value-Based Care report covers value-based care challenges and opportunities reported by respondents; addresses the people, process, and technology gaps respondents said must be bridged; and provides expert commentary and guidance to help providers to put their data to work to accelerate their transition to value.

“The research shows a strong relationship between an organization’s investment in modern digital infrastructure and their ability to succeed with value-based payment models,” Stevens said. “Digital investments will be the deciding factor for more mature risk-bearing organizations. The key to value-based care is the ability to integrate data from EHRs and other IT silos—clinical, claims, labs, pharmacy, telehealth, remote monitoring, social determinants, consumer-generated, you name it—into a unified patient record that lets providers drive the analytics-driven workflows, care management, risk stratification, and patient engagement strategies to drive better outcomes at a lower cost.”

For more information, download the State and Science of Value-Based Care

For the better part of a decade, the shift toward value-based care in the U.S. has been driven by the establishment of the Center for Medicare and Medicaid Innovation (CMMI). Working to develop, test and evaluate new payment and delivery models in Medicare, Medicaid and the Children’s Health Insurance Program, CMMI has taken aim at improving the provider experience, generating better patient outcomes and reducing the overall cost of care.

Recently, CMMI stated that by 2030 every Medicare beneficiary should be in a value-based relationship – either an ACO or ACO-like model or Medicare Advantage – with a significant emphasis on health equity. 

Historically, CMS models have focused on enabling providers to increase accountability for patients’ health through ACO condition-specific models and payer-supported models like Medicare Advantage. However, with approximately 13 active models, CMS has been consolidating and simplifying their models, resulting in fewer disease-specific models and a focus on making provider and patient enrollment easier. 

To succeed across the spectrum of risk, especially as provider enterprises assume more risk and accountability for holistic patient care, they must invest in the right infrastructure that delivers differentiated patient and provider experiences, while producing better clinical, financial and operational outcomes. For this to happen, provider enterprises must focus on the following key strategies:

1. A primary care-led delivery model with enhanced virtual care and clinician access, supported by high-risk clinics. In this model, primary care physicians are supported by a robust infrastructure and given tools to focus on their overall panel, while the patients requiring the most attention are provided with focused support by high-risk clinics. With aligned incentives, primary care physicians can keep expanding their managed care panels, thereby reducing access issues, while thriving in value-based contracts. 

2. Robust medical management infrastructure to meet patient needs for specialty, acute, facility, home and post-acute care needs. This approach brings specialists and facilities in with the right capitation models and incentivizes them to improve care outcomes while optimizing utilization. 

3. Differentiated patient experience to improve satisfaction, clinical outcomes and loyalty. Ensuring that patients can navigate the complex healthcare system with the right blend of technology and staff increases the likelihood of the best outcomes for patients. To do so, care teams and primary care physicians should focus on ensuring patients have the most possible choices, potentially through on-demand access. 

4. Leveraging data and analytics. While there are an increasing number of data sources, the lack of interoperability and data silos still make it difficult to build the full picture of a patient’s health and overall well-being (including SDoH), which sub-optimizes outcomes. Investing in solutions that enable the unification of all data into a single platform, drawing correlations and proactively identifying at-risk and emerging-risk patients at each step of the journey is invaluable in intervening at the right time. 

5. Designing programs and infrastructure with health equity in mind. The need to drive improved health in our communities is critical and is being propelled by CMS’ 2030 objective. Moving forward, organizations will have to build infrastructure that can collect health equity data, report on it and service all Medicare beneficiaries. Without timely investments now, practice operations, reimbursement and ultimately patient care will fall behind.

6. Building a cost-efficient and scalable infrastructure. To succeed in the ever-evolving and dynamic reimbursement environment, provider enterprises need to figure out the best way to structure their care delivery operations and focus on their core strengths, while mission-supportive chores are delegated to effectively create a scalable, asset-light infrastructure that adapts to their changing needs. 

The underlying theme across all these efforts is an acceleration toward value-based payment models that focus on driving more accountability for providers and improving health outcomes for patients. Provider organizations must be cognizant of the 2030 goals as they build patient-centric and physician-led models that help them succeed across the spectrum of risk. 

About Siddharth Thakkar 

Siddharth Thakkar is Vice President, Product and Marketing at IKS Health, a scalable, proven, cloud-based physician enablement platform that enables provider enterprises to deliver better, safer and more efficient care through a strategic blend of technology and expertise.