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SHSMD17 Opening Keynote, Ceci Connolly, Delivers Refreshing Dose of Perspective

Posted on September 25, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

On a hot and muggy day in Orlando, Ceci Connolly, President and CEO at the Alliance of Community Health Plans, delivered an opening keynote that felt like a splash of refreshing cool water at the 2017 Society for Healthcare Strategy & Marketing Development Conference (SHSMD17).

It would have been easy for Connolly, a former Washington Post national health correspondent, to focus her keynote on the impact Capitol Hill has had on US Healthcare. Instead, Connolly used her 60 minute talk to provide the SHSMD17 audience with repeated doses of perspective. You could almost hear the gears turning in people’s heads as she dispelled common healthcare misconceptions and reframed daunting challenges.

Connolly started by highlighting the problem of the rising cost of healthcare. In 1960 US healthcare spending as a percentage of US Gross Domestic Product (GDP) was just above 5%. By 2010 it was almost 18%.

According to the Centers for Medicare & Medicaid Services (CMS), national health spending is projected to grow 1.2% FASTER than GDP per year until 2025. This means that by 2025, US healthcare spending as a percentage of GDP would reach a whopping 19.9%.

This in and of itself is not news, but what Connolly did was expertly re-frame these statistics:

The more that healthcare consumes our GDP, we will have less and less money for things like building national infrastructure, fueling economic growth and oh, helping people recover from devastating hurricanes. Those priorities will suffer because healthcare will dominate our GDP spending.

Connolly’s statement was especially poignant given SHSMD President Ruth Portacci’s early comments about the heroic efforts of healthcare workers in Florida, Texas, Louisiana, Puerto Rico and the Caribbean to help those areas recover from devastating hurricanes.

From there Connolly proceeded to cast a new light on the wave of healthcare provider consolidation, payer mega-mergers, patient consumerism, aging populations, millennial expectations and retail health. Particularly noteworthy was Connolly’s take on rising drug prices and high deductible health plans (HDHPs).

According to Connolly, drug prices go up when new drugs are introduced for specific conditions. These new drugs, often with fancy names, are brought to market at prices higher than existing alternatives. The companies that own those existing drugs then raise their prices to match the new entrant and justify the increase with a mountain of evidence that their drug is every bit as good as the new one.

Connolly also took aim at HDHPs. During the industrial boom, US employers offered to pay for employee healthcare as way to entice workers to join their ranks. In short order, employer-sponsored health became the standard. Fast forward to 2017 and employers can’t shed healthcare costs fast enough. Instead of offering more health coverage, employers are offering HDHPs and transferring the burden to employees. According to Connolly the era of employer-sponsored healthcare is ending and that will have enormous consequences for US Healthcare where almost 50% of Americans still receive their health coverage through their employer.

It certainly was not your typical rah-rah opening keynote, but in these challenging times, it was courageous and refreshing to have someone stand up in front of 1,500 healthcare insiders and get us to think differently.

Against Medical Advice – ZDoggMD’s New Show

Posted on March 17, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those of you reading this that don’t know ZDoggMD, what’s wrong with you? Seriously though, check out some ZDoggMD’s parody videos to see what I mean. Along with making “dope parody videos”, he has just started live streaming a new show he called Against Medical Advice which he streams live each week on the ZDoggMD Facebook page.

Check out the trailer for Against Medical Advice:

I love the goals that ZDoggMD has for the show and he’s such a unique talent so check it out. Against Medical Advice episode 1 and episode 2 are out if you want to see something you’ve never seen in healthcare.

If you’re not a fan of his new show, you’ll probably enjoy this heartfelt parody of 7 Years (A Life in Medicine). It’s a good reminder of the importance of the work we’re doing in healthcare.

Bad Handwriting Could Cost a Doctor His License

Posted on September 16, 2016 I Written By

For the past twenty years, I have been working with healthcare organizations to implement technologies and improve business processes. During that time, I have had the opportunity to lead major transformation initiatives including implementation of EHR and ERP systems as well as design and build of shared service centers. I have worked with many of the largest healthcare providers in the United States as well as many academic and children’s hospitals. In this blog, I will be discussing my experiences and ideas and encourage everyone to share your own as well in the comments.

I admit that I don’t have very good handwriting. My signature is no better, and often leads people to ask if I am a doctor. Because it is commonly known that doctors don’t excel at handwriting skills. Thankfully, I rarely hand-write anything anymore. With computers, I can write quickly while still producing a result that is easy to read.

One benefit of an EHR solution is that we don’t have to worry about deciphering handwritting! But for one Nevada doctor, poor penmanship may lead to the loss of his medical license!

Read this story in the Review Journal for more information or this excerpt of the situation below:

The Nevada State Medical Board has formally threatened to revoke the medical license of Dr. James Gabroy, a 69-year-old Henderson internist who has never had malpractice or professional incompetence problems, nor has he ever had sexual misconduct, patient abandonment or fraudulent billing issues.

why is the board taking action against Gabroy — punishment ranges from a $5,000 fine to license revocation — with a Sept. 28 hearing scheduled in Reno?

His handwriting.

Citing confidentiality, Ed Cousineau, the board’s executive director, won’t stray far from the Oct. 23, 2015, board complaint that alleges the medical records of three unnamed patients were illegible, inaccurate and incomplete.

Are we heading for an environment where you’ll have to have an EHR in order to have a medical license?

If you’d like to receive future posts by Brian in your inbox, you can subscribe to future Healthcare Optimization Scene posts here. Be sure to also read the archive of previous Healthcare Optimization Scene posts.

Value Based Reimbursement: Another Challenge for HIM Professionals

Posted on August 3, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin’s latest HIM Scene posts here.

How many times have you heard something along these lines: “HIM professionals must stay relevant and current with the continuous healthcare changes.” I must sound like a broken record to my team but it is absolutely true! HIM professionals provide the bridge between clinical data and reimbursement methodologies through CDI, coding, documentation integrity, and health data analytics to name a few. It has been proven time and time again that these HIM skills are vital to healthcare organizations but these skills must also be adapted and be put to good use each time a new guideline or rule is introduced.

Value-Based Reimbursement is an area that continues to grow with the push for quality patient outcomes and healthcare savings with potential penalties for excessive costs and poor quality of care. Reimbursement incentives that are tied to quality of care make perfect sense and HIM professionals need to take the plunge into these initiatives. By marrying departments and cross-functioning teams, we are able to generate proactive data and improve performance.

At my facility, I oversee the HIM department as well as the Quality department because we work closely together and will continue to have an even closer relationship throughout healthcare reform. This is becoming very common in the industry.

In this roundtable article for the Journal of AHIMA, we each outlined how we are bringing HIM to the table for Value Based Reimbursement initiatives and maximizing the tried and true skills of HIM professionals.

I have said it before and I will continue to say it: Always keep your finger on the pulse of healthcare and stay relevant by taking on these new challenges!

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

A Primer on Medicaid/CHIP Managed Care Reform

Posted on May 27, 2016 I Written By

The following is a guest blog post by Megan Renfrew, Director in the Cognosante Solutions Lab.
Megan Renfrew - Cognosante
On May 6, 2016, the Centers for Medicare and Medicaid Services (CMS) published a final regulation in the Federal Register concerning managed care in Medicaid and the Children’s Health Insurance Program (CHIP).  The first overhaul of Medicaid and CHIP managed care regulations in more than a decade, the rule “updates how Medicaid works for the nearly two-thirds of beneficiaries who get coverage through private managed care plans,” wrote CMS Acting Administrator Andy Slavitt and Vikki Wachino, CMS Deputy Administrator and Director for the Center for Medicaid and CHIP Services, in a CMS blog post.

Approximately 72 percent of Medicaid enrollees in 39 states and the District of Columbia are served through managed care plans, up 14 percent since 2013.  Combined Federal and state spending on Medicaid managed care exceeds $150 billion annually.  Those figures will grow steadily as states continue to expand Medicaid managed care coverage to include larger geographic areas, additional populations, and services previously covered through fee-for-service Medicaid, such as inpatient and Long-Term Services and Support (LTSS).

While the medical loss ratio and other financial requirements received the lion’s share of attention throughout the rule-making process, the rule’s focus on improving the beneficiary experience and increased reporting and data requirements are equally important.  Beneficiaries will benefit from quality improvement requirements, stricter provider access requirements, and stronger care management programs.  Plans and states will need to adjust contracts and IT systems to meet new data, reporting, and analytics requirements that support CMS’s goals of increased program integrity and transparency.

Beneficiary Experience & Protections

To strengthen the experience of beneficiaries, the rule requires states to address disparities and individuals who need long term care or have special health needs in their quality plans for the Medicaid managed care rule.  The final rule, which will be phased in over several years, also creates the first quality rating system for Medicaid managed care plans, aligning Medicaid with Medicare Advantage and Qualified Health Plans rules.  This will allow beneficiaries to better compare plans before enrollment.

On the care management front, the rule includes standards for care coordination, health assessments for new plan enrollees, and treatment plans for enrollees with special healthcare needs or who receive LTSS.  These rules are designed to make sure that beneficiaries receive appropriate care in the appropriate setting, and are assisted in navigating the complex healthcare system.

The rule helps ensure that beneficiaries have sufficient access to providers by strengthening provider network adequacy requirements.  States must add time and distance standards to their state network adequacy rule (31 states already have time and distance standards in place for primary care providers).  Under the final rule, however, CMS spells out the provider types subject to network adequacy requirements in greater detail.  As a result, states must now create standards for more than seven different provider types.  Plans must also report provider network data at least annually, and maintain an up-to-date provider directory for plan members.

Additional changes focus on targeted beneficiary education and outreach.  States must implement systems that support beneficiaries prior to and after enrollment, a role that will likely be played by enrollment brokers.  Under these systems, beneficiaries are educated about managed care, including benefits covered and choice of plans, and their rights and responsibilities under Medicaid.  The beneficiary support system also provides a venue for current managed care enrollees, including assistance navigating the grievance and appeals process.

Enhanced Data and Systems Needs

Under the final rule, states and plans are required to meet stronger data submission and reporting requirements to support program oversight, program integrity, and increased transparency.  To meet these requirements, states and plans must have adequate IT systems to ensure accurate and timely data delivery and reporting.  Some states and managed care plans will likely need to increase their data collection and analytics capabilities to comply with the new rule.

The most important change is that federal payment for Medicaid managed care is tied to the submission of accurate, complete, and timely encounter data to CMS in a CMS-specified format, likely TMSIS.  Historically, some states have struggled to collect complete and accurate encounter data from managed care plans, and to manage that data in legacy systems designed for fee-for-service claims.  Both states and plans will need to examine their current IT systems, data collection and submission processes, and contract language to ensure that they are well positioned to meet these requirements.

In addition to the encounter data requirements, CMS is requiring that states post information on their Medicaid managed care plans on a public website, including enrollee handbooks, provider directories, and plan contracts.  Also required is information about plan performance, including finances, operational performance, quality indicators, measures of customer satisfaction, and the results of program integrity audits.

To meet the stricter provider network adequacy requirements, plans will need to have, at a minimum, accurate data on their provider network.  As states revise their network adequacy rules to meet the CMS requirements and monitor their plans for compliance, they may benefit from using GIS-based tools that automate network adequacy analysis and allow for easy evaluation of policy options and plan performance.

To support program integrity goals, the CMS rule requires all providers in Medicaid managed care plan networks to enroll with the state Medicaid agency.  Enrollment in Medicaid was previously required only of those providers participating in the Medicaid fee-for-service program.  States may find that they need more automated provider enrollment and verification systems to handle the increased workload that this requirement will generate for state Medicaid agencies.  Luckily, provider enrollment solutions are available in the market.

To help ease the burden of implementing the systems necessary to manage the robust data collection, analysis, exchange, and reporting necessary under Medicaid managed care reform, states can leverage CMS’s previously issued final rule extending 90 percent federal matching funds for Medicaid enterprise system development.  In addition to ensuring the permanent availability of this funding, that rule extends its use to commercial-off-the-shelf and software-as-a-service solutions.  This allows states to take advantage of previously developed and tested products in the marketplace.

21st Century Medicaid

CMS and its stakeholders devoted thousands of hours to crafting sweeping reform that brings Medicaid manage care into the 21st Century, including supporting data-driven decision-making and oversight, and allowing for state innovation in delivery system and payment reform. Doing so solidifies Medicaid’s place as a key driver of health innovation and plans’ roles supporting and implementing that innovation.

About Megan Renfrew
Megan Renfrew is a Director in the Cognosante Solutions Lab.  An accomplished health policy expert who spent more than five years drafting healthcare bills for the U.S. House of Representatives, she previously served as the technical director at CMS responsible for collecting and analyzing Medicaid and CHIP eligibility and enrollment data from states.