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Interview with Dana Sellers: Encore Pay for Perfomance (P4P) Managed Services

The following is an interview with Dana Sellers, CEO of Encore Health Resources about their new Pay for Performance Managed Services offering which they’ll be sharing at HIMSS 2014.
Dana Sellers
Tell us your vision for how your new P4P Managed Services will work.
Our vision is to help our clients manage performance and data components against payer contracts to maximize quality, obtain incentives, and avoid penalties. Our offering uses a combination of Encore subject-matter experts (SMEs), software tools, and methodologies that we’ve already tested and proven in large healthcare systems. P4P Managed Services lifts the burden of meeting these value-based demands off our clients’ shoulders and into Encore’s hands. As part of this innovative offering, we also share risks and rewards via multi-year partnerships. We work with clients to ensure that they have the trusted data they need to support performance improvement and obtain incentives.

Our service begins with the P4P Value-driven Roadmap, which identifies the dollars and associated measures at stake in clients’ at-risk, value-based contracts — including projections for the next few years. As input for the roadmap, we perform a data assessment of a client’s EHR and other source systems to determine if they are capturing the right data for the targeted measures. The roadmap defines the multi-year data and process program required to obtain the desired incentives.

Next, we establish this required program along with data governance, technology, and data tools. We also build the value components of the program, including EHR remediation, workflow redesign, change management, data profiling, ETL, and dashboards required to monitor performance.

Once the program foundation is established, the value-management cycle begins. Encore monitors each client’s performance, providing insight through performance analysis and suggesting needed performance improvements to meet all targeted incentives and enhance the quality of care. Also, as new contracts emerge, we work with clients to incorporate new eMeasures into the program.

By creating trusted, transparent data, Encore helps health systems transform and meet new payment-model requirements by using eMeasures to adhere to evidence-based standards. The result is better patient care and an improved bottom line. We provide the consulting expertise, unique methodologies, and our own, in-house developed software tools to help our clients succeed — as we’ve proven by our results in helping other large clients accelerate their achievements through eMeasures.

Why did you choose to offer a service like this?
We know EHR data! Our methodologies and software tools are built around EHR data and eMeasures.

Encore was founded to provide consulting services with a focus on analytics fueled by clinical data. In the broad spectrum of consulting services that we provide – from HIT and clinical advisory to implementation, go-live services, and analytics — our focus is trained on identifying and gathering the data that our clients need to improve healthcare and operational performance. Therefore, our P4P Managed Services offering is a natural extension of our mission. At-risk contracts require the ability to track eMeasures, which has been an Encore strength – and differentiator — since our founding five years ago.

Our vision for P4P Managed Services is also supported by our clients – especially CIOs and CFOs. They have told us that they need assistance with all aspects of data capture, analytics, and performance improvement. When we lift that burden from our clients’ shoulders, it frees them to focus on other critical issues, such as cost reduction, while we leverage our unique expertise and proven experience to manage the value side of the equation.

Which P4P programs do you see Encore supporting?
We support measures — quality measures that go back to incentives. These include Medicare, Medicaid, commercial P4P/Fee-for-Value type contracts, IQR, PQRS, ACO, ACAs, ACCs, NQF/CQMs, PCMH, PCQUS, clinically integrated networks, and the like.

Our methodology and tools tie the eMeasures directly to workflow, so we know how to change each client’s workflow to get better results. Our knowledge bases include over 350 eMeasures.

How much of this offering is technical and how much of it is services.
This is an important question. Encore is first and foremost a services company – a services company that is strongly differentiated by unmatched, in-house-developed software solutions that are uniquely designed to support the services we provide. So our new offering is precisely that: services supported by innovative technology and processes on a flexible, as-needed basis.

What does the cost structure look like for this service?
As described earlier, the P4P Managed Services cost structure is based upon a roadmap we define with each client to quantify the value-based, at-risk dollars and the client’s capabilities to manage the quality-performance components of their at-risk contracts. Contract details, therefore, will vary with each client’s situation. The bottom line is that Encore is willing to manage our P4P Managed Services contracts while working with clients to define a risk-sharing arrangement that incents everyone to achieve.

Why would an organization choose to outsource the P4P to Encore as opposed to doing it in-house?
The process of managing performance against eMeasures across a health system is complex, and many clients have not put together a disciplined approach to performance improvement. Further, many of our clients are telling us that they simply do not have the full complement of expertise, resources, technology, and program-management disciplines available to move fast enough against a dizzying array of government and commercial at-risk contracts. But we do, and we – especially our skilled eMeasures experts — have a track record that proves it.

Also, an increasing number of health systems are recognizing that they’ll have to enter a world of eMeasures that is growing every year. With P4P Managed Services, we bring the expertise, skills, tools, and methodology that can take this eMeasure world and our clients under our wing. Our new service provides clients the breathing room to focus on multiple fronts simultaneously – and not leave any dollars on the table as a result.

A third reason for choosing our new offering is because it’s a cost-conscious solution. We eliminate the need for clients to hire more architects, eMeasures specialists, analysts, and report builders.

Finally, P4P Managed Services can preserve endangered species. That is, we supplement our clients’ existing IT department with some of the hardest resources to find: clinicians and operational SMEs with an understanding of data; eMeasures experts; and, technical SMEs with an understanding of the clinical and the operational worlds.

How much accountability is Encore taking on with these P4P Managed Services? Where do you draw the line?
Our new offering is a full life-cycle solution that we approach as a partnership. We nail down the amount of accountability – the risk that we’re able to share – on a case-by-case basis through the roadmap. Depending upon what we learn, we then determine the degree of accountability that both we and our clients can share to incent the highest levels of achievement.

Is there some risk on Encore’s part that the client will fall short on what they need to accomplish for Encore to provide the P4P services? Encore can’t go in and do the documentation for the doctor.
This is precisely what our new service is in place to define. As with every engagement, we use a thorough, careful assessment process to ascertain the nature of the challenges involved. With P4P Managed Services, that means understanding:
• The incentives involved
• The risk involved if our clients can’t achieve optimal revenue reimbursement – say with Medicare and Medicaid contracts
• The risk involved for Encore if those contractual incentives are not earned
Bottom line: we both win, or we both lose. With P4P managed services, we are convinced that we can define on a case-by-case basis the mix of Encore services, solutions, and client resources that Encore will manage to produce a win or multiple wins for both sides.

This feels similar to revenue cycle management (RCM) applied to P4P programs. Can you apply some of the RCM learnings to this type of offering?
Yes, similarities do exist between RCM and the management of quality performance components of at-risk contracts. The way we see it, RCM has been responsible for collecting patient data and getting claims ready for a long time. It remains fairly unchanged and encompasses the management of people, processes, and technology across health systems to improve revenue collection. By tying eMeasures to clinical rather than latent claims data, performance issues can be corrected within a few days. That is because the use of EHR data literally “moves the needle” in real time. Beyond claims data, we use EHR clinical data to affect change that meets the required quality measures thresholds.

At present, there is an increased focus on traditional cost monitoring, which informs RCM. This typically happens at the service line and department level; not at the episode-of-care level. Although direct, indirect, fixed, and ad-hoc costs are certainly important and are included, value-based cost control and reduction efforts must focus on the clinical processes, just like the quality performance components. Both will require tracking the costs and quality across the entire continuum of care, constantly analyzing performance and applying adjustments. And the revenue cycle is a significant piece of this. So the discipline and techniques needed for RCM can certainly inform a health system’s approach to fee-for-value focused management.

Do you see this as the start of offering even more Managed Services offerings?
Yes. We are now working on another offering – it’s in the packaging stages – around Meta-Data Management. Stay tuned for more details later this year.

February 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospital IT Executives Versus Doctors

I just got sent a thread from a physician forum that reminded me of the often deep divide that exists between hospital IT executives and the doctors that work at those hospitals. Obviously there are a wide range of hospital governance structures. Some where the doctors own the hospital and so this dynamic isn’t always the same. However, I’ve found that it’s often the case that doctors don’t feel like the IT executives at the hospital listen to their needs and the IT executives feel like the doctors get everything that they want.

The reality is usually somewhere in between. However, perception is an individual’s reality. Changing either groups perception is really difficult.

There isn’t any simple way to solve this problem and to be quite frank you can’t ever completely solve it. The best you can do is for both sides of the equation to involve and understand the other side’s perspective. The problem is that it’s really easy for either side of the equation to basically give up trying. When one side stops, the other side often retaliates and then you’re in for real trouble.

Here’s the reality for doctors. A whole slew of government mandates are being heaped upon healthcare IT and this is going to change the way they practice medicine. Some of it will be good and some of it will be bad. As one doctor recently told me, he’s had to change the way he’s practiced medicine every decade. Some change is inevitable. Most hospital IT executives don’t like it any more than you do, but it’s just the reality of the current environment.

Here’s the reality for executives. We can do a much better job of implementing healthcare IT. This will require extra planning. It will require the proper staff, but done well you can minimize the impact on doctors. No doctor wants to be a data entry clerk and you don’t want your highest paid people being one either. Fight against irrational timelines that aren’t reasonable and be an advocate for well done plans and not just ones that meet the deadline.

From my vantage point, both sides of the equation can do better. If we’d all just take a little time and walk in the other person’s shoes we’d likely do better. If we don’t, it’s going to get really ugly really quickly. In some cases, it’s already started.

February 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Hospitals Using Tablets to Improve EMR Access

Some high profile hospitals are turning to tablets as a way to give physicians better access to EMRs when they’re walking the halls.  Using tablets is seen as a way of working around desktops’ limitations in making better use of EMRs’ capabilities, according to MedPageToday.

For example, back in 2010, the University of Chicago School of Medicine issued tablets to all hundred 15 internal medicine residents. After a year, three quarters of residents reported tablets help them finish tasks more quickly and spend more time on direct patient care.

In another example, the Cleveland Clinic is pilot testing the use of tablets with a few sectors of its workforce, such as its rapid response teams. Using tablets, clinicians can look up patient data on the way to the patient was crashing and be better prepared when they arrive.

In yet another instance, the University Of Pittsburgh Medical Center is testing the use of Windows tablets with cardiologists. The medical center has developed special software allowing physicians to jump between different mobile apps without having to reenter patient information to do their work.

These are just examples of how hospitals can turn mobile devices into effective extensions of the EMR, said David Collins, senior director of mHIMSS, the mobile wing of HIMSS. “If you can spend $300 on a tablet and issue these to providers so that they’re more mobile, it’s really a minimal cost for the payoff,” Collins told MedPageToday. Although, John Lynn makes a pretty good counter argument for why IT admins prefer the more expensive Windows 8 tablets over iPads or Android tablets.

These are just a few early examples of how hospitals can use tablets to make access to patient data simpler. Over the next year or two expect to see far more examples of tablet use in hospitals, as it’s become increasingly clear that they can help enhance the use of clinical data, on the spot when clinicians need it.

February 18, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Hospitals Don’t Prepare For Full Costs of EMR Installs

A new study published in Medical News Today concludes that UK hospitals aren’t always taking into account the full costs of implementing new EMRs, and as a result, are not receiving the full benefits of these systems.

The study, which was published in the Journal of the American Medical Informatics Association, evaluated the implementation of three EMRs — iSOFT’s Lorenzo Regional Care, Cerner’s Millenium and CSE’s RIO — across 12 diverse healthcare organizations in three regions of the UK and at different stages of implementing the systems.

Researchers also conducted 41 semi structured interviews with 36 hospital staff, members of the respective implementation teams, and those spearheading the implementation at a national level.

The research team found four overarching cost categories associated with implementing EMR system: infrastructure, personnel, facilities and other (such as training materials).

As might be expected, the hospitals involved spent their EMR budget in significantly different ways. For example some hospitals spend big on testing the software, while others spent large sums training clinicians and administrative staff to use the new system.

The hospitals also made significantly different decisions when it came to hiring new staff to cover for those who were in training. One hospital spent over $1.1 million to provide covering staff, while another spent no money at all to cover from for staff and training.

When all was said and done, hospitals were most likely to cut back on training and implementation costs. Meanwhile, hospitals were also likely to under budget for factors such as the need to back fill staff to the lost productivity, and the need to test the system due to inadequate vendor testing.

February 17, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Five EMR Rollout Lessons Gleaned from EMR Adoption Stage 7 Hospitals

Since 2006, HIMSS Analytics has named only 160 hospitals as reaching stage 7 in its EMR adoption model, 30 of which reached paperless status into their 2013, HIMSS reports.  To help other hospitals in their journey, HIMSS has queried some of these hospitals, and come up five methods which help hospitals in their EMR adoption process. They include the following:

1. Use the Big Bang Method

Health IT leaders who have been through the EMR rollout process and reached Stage 7 told HIMSS that “Big Bang” implementation, rather than gradual phase-in, worked well for their institutions and provided better patient experiences.

2. Universal Training

Hospitals at the top of the EMR adoption food chain say that part of how they succeed was to train everyone — the entire care delivery team rather than specific types of providers. It’s also helpful to find a core group of champions within nursing, physicians and leadership to champion the process and support their peers.

3. Respect Your Organization’s Culture

When deploying software of such a cost and complexity, it’s easy to lose sight of what makes your organization unique. Make sure your change leadership process addresses the realities of local environments, and leverages unique strengths of your staff.

4. Involve Your Whole Team

These high-performing adopters stressed that it’s important to involve operational leaders from the outset and to make the EMR a corporate strategic initiative on by clinicians, not an information systems initiative.

5. Use All of Your Resources

No matter how you do it — via peer to peer best practices discussions with other hospitals, partnering with the vendor or other strategies — take advantage of the resources you have to improve, streamline and speed up the EMR installation process.

Of course, no two hospitals are exactly alike, and some of these ideas may not fit with your culture or organizational status. But given the success hospitals have had with these approaches, they’re certainly worth a look

February 14, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Hospital Chief Accused of $800,000 in Meaningful Use Fraud

Now here’s a case of the type I’ve never seen before, but expect to see more of it going forward given the temptations involved. According to the Dallas Morning News, the top administrator and CFO of a now closed chain of hospitals is facing charges that he defrauded the government of nearly $800,000 in EMR stimulus funds.

The administrator, Joe White, and the doctor who owned the hospitals, Tariq Mahmood, are accused of identity theft and stealing government healthcare funds. Meanwhile, it’s alleged that White falsely certified that Shelby Regional Medical Center in East Texas has met the requirements to receive Meaningful Use funds. Federal authorities assert that White used a computer ID and Social Security number belonging to another employee who had refused to attest at the hospital.

White is also accused of demanding that data be manually inserted from paper records into the incomplete EMR, in an effort to meet Meaningful Use qualifications.

This comes as a follow-up to the catastrophic failure of Mahmood’s six-hospital chain, which came after years of increasing financial chaos, with the hospitals mounting up millions of dollars in debts to vendors and landlords. As the hospitals fell apart financially, inspectors were documenting hundreds of patient care failures, the Dallas Morning News reports.

This came amid questions as to whether White was qualified to run a medical center, given his past record as a RadioShack salesman and a maintenance man.

February 12, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Meaningful Use Drove the Data Gathering

I recently heard an interesting comment that “meaningful use drove the data gathering.” As you look at meaningful use, it has been the driver of data gathering in healthcare. I’m not sure any other technology has gathered more healthcare data than EHR software (I guess the health plans might have a case here, but it’s different healthcare data). Much of the EHR adoption is attributed to meaningful use.

While it’s great that we’re gathering all of this healthcare data, it’s worth asking the question of what’s being done with this data. Are we meaningfully using the data we’ve gathered? Is the data in a format that we can use the data?

The past 3-5 years of EHR has been defined by EHR systems that converted the paper chart world into an electronic chart world. I believe this is a great step forward, but it’s only a step. The next 5 years we’re going to start using the data that’s been gathered into EHR software and that will change healthcare.

One challenge we face is that many EHR vendors are locking in the data. They’ve gathered the data, but they haven’t set it free so it can be used for good. I believe locking in the data is bad for healthcare, but I also believe that it’s a bad business decision by EHR vendors.

In the future, EHR vendors will be differentiated more on the marketplace of third party applications they support than on their own in house developed apps.

I think we can barely imagine what benefits will come from the proper use of the data we’ve collected in EHR software. EHR data is a treasure trove of opportunity. We just need EHR vendors to start acting like the database of healthcare and stop trying to be the end all be all solution. Then, we’ll see innovation that we haven’t even imagined come into view.

February 5, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

ED Alerts Help Health Plans Cut Costs

As readers of this publication know, many hospitals are interested in participating in HIEs, but are buried in projects already and not so sure the investment will pay off.  But here’s an instance where a very modest HIE application helped a health plan save real money in just six months without having to do an expensive buildout.

According to iHealthBeat, a new study by the Agency for Healthcare Research and Quality has found that simply sending near real-time alerts to health plans when a member is admitted to the hospital ED could help the health plan save money and get patients into primary care.

To do the study, Indiana Health Information Exchange programmers developed an application which sent daily alerts about health plan members who visited EDs at nine Central Indiana hospitals. As part of the pilot, the alerts were sent to the participating health plan within 24 hours. The health plan then used this data to replace non-urgent ED visits with primary care visits, iHealthBeat reports.

During the six-month pilot, the health plan was able to reduce nonemergency ED visits at participating hospitals by 53 percent; the same time primary care visits among plan members jumped to 68 percent during the pilot period.

The bottom line in all of this was that after using the daily updates to guide patient behavior, the health plan was able to save $2 million to $4 million over six months. While I could be wrong, I don’t believe there are many test cases out there that can demonstrate the effectiveness of hospital to plan communication and brag of this much success.  While this isn’t exactly an argument for all hospitals to have HIEs, this does suggest that shared, timely information on important patient behaviors can be extremely valuable.

February 4, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

NYC Health Systems Get $7M To Share Data

Seven New York City health systems have gotten a delayed Christmas present — a $7 million grant designed to encourage data sharing initiatives and improve patient recruitment for clinical trials. The primary goal of the project is to use evidence-based research to help patients make good decisions about their healthcare.

The funding comes from a group known as the Patient-Centered Outcomes Research Institute, or PCORI. PCORI, which will create a clinical data research network in NYC, has already created 29 such networks across the nation, according to Healthcare IT News.

These networks, collectively, will form PCORnet, a $93.5 million patient-centered research initiative. The New York City Clinical Data Research Network (NYC-CDRN), a  consortium of 22 regional organizations, will work together to develop systems supporting data networking efforts and advance patient-centered research, Healthcare IT News reports.

NYC-CDRN will kick off their efforts by identifying patients with diabetes, obesity and cystic fibrosis. It will then partner with patients and clinicians by creating disease-specific community groups.

The NYC-CDRN network will connect medical records for 6 million New York City residents, then anonymize the records, and over the next 18 months, will work to standardize the data. Ultimately, the goal is to allow patients and providers to have access to evidence-based information they can use to make smart healthcare choices.

This should be an interesting project to watch over the next year and a half. PCORI is doing a lot of forward-thinking work with its money, including $5 million to the NIH for a tool called PROMIS designed to help with comparative effectiveness research. PROMIS has existed since 2004, but PCORI is now helping it move forward, making the $5 million in funds available  in research grants up to $500,000 for projects up to two years in length.

January 29, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies.

Two Pillars: Cost Containment or Revenue Generation

Far too often we try to make simple things really complex. Healthcare is replete with examples of really simple things that are made much harder than they need to be. For a hospital executive, I recently heard a really simple way to look at the revenue situation of a hospital.

It’s all about Cost Containment or Revenue Generation.

Turns out, these principles apply to any business. Those are the only two ways you can improve the cash flow of a hospital organization. Feels pretty simple, but no doubt there’s a lot of nuance to each category.

As I noted in my post Expense Growth vs Revenue Growth in hospitals, we’re entering a new era in healthcare where a hospitals revenue is decreasing. There are enormous pressures right now to lower the costs of healthcare and that directly relates to decreased revenue for a hospital.

In theory, new ACO models should present some new revenue opportunities to hospitals. Will they completely offset their revenue loss? I don’t think so, but they could provide some relief to the decreased revenue parade. Are you ready for an ACO model of reimbursement?

The EHR is likely to be the foundation of any ACO participation. However, even more than the EHR, the analytics platforms built on top of those EHR are going to really drive a hospital’s success in an ACO. This is why I think so much investment is happening in analytics programs. Watch for even more of it to happen in 2014.

Using our simple explanation, an investment in analytics can make a hospital’s ACO work possible and become a nice revenue generator. Plus, if done right, the analytics can also provide a hospital with cost containment. On face, analytics sounds like a great investment. The problem is that most analytics investments like to talk the talk of cost containment and revenue generation, but in actual implementation they fall well short.

Thanks to government stimulus money, the EHR didn’t have to go through the analysis of EHR as a cost containment or revenue generation mechanism. However, I bet over the next couple years, we’re going to see a lot of questions about how EHR can help in either of these two categories and where it’s hurting these two categories as well.

Where do you think EHR can help with cost containment or revenue generation? Where is EHR having a bad impact on these two areas?

January 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.