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Pricing Transparency and Provider Quality: Insights from Utah HIMSS

Posted on September 10, 2018 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

Working to improve Health IT has been a major focus of Utah HIMSS this year. I am honored to serve as part of the Utah HIMSS Board. Utah HIMSS hosts educational events and luncheons for members. On August 29, 2018  the meeting focused on Pricing Transparency and Provider Quality. Health Informatics is positioned to help reduce waste in healthcare and providing better care for patients.

Bob White works with Select Health, one of the major insurance providers in the state, which is a subsidiary of Intermountain Healthcare. He was able to talk about payment models and value based care work within the Select Health group. Providing more visibility into the cost for patients and physicians has been a major focus on Select Health and payer provider entities have a unique market position. They want the cost of care delivery to be lower since they are paying the cost. Point of service adjudication requires that a lot of workflows need to be coordinated before the patient leaves the office.

Bob asked: How often do we feel like we don’t have complete information to know what is going on and what your options are?

One of the most notable things that he spoke about was the lack of adoption. They have great visibility but not everyone knows where to find that information. Some of the employees at Selecthealth have high deductible plans and in effect, become self-pay members. Becoming more educated consumers is a huge part of what Select Health has done with their pricing transparency.

Katie Harwood from the University Of Utah discussed their pricing transparency tool. The University of Utah is one of the first systems in the country to create an online interactive tool to help predict cost to patients. Patients can look up what a procedure might cost and enter information about their copay and caps. Most importantly, the cost estimator included the cost of facility and cost of provider, so patients don’t get stuck with unexpected out of network bills.

The most common search? Vaginal delivery without complications. I was thrilled to hear them speak because I’m pregnant and my provider is with the University of Utah Health. I got a cost estimate on my second visit to the OB and I was pleasantly surprised that they gave that information.  I was able to pay for what (might be) the cost of my maternity care. Being able to plan ahead is very valuable. The University of Utah has invested in creating bundled payment models to improve care coordination and as a patient, having that information has improved my healthcare experience.

While in development, the University of Utah wanted to add appointment scheduling for patients. Harwood mentioned this created a larger data matching challenge, as it was difficult to match exact providers with procedures. Insurance companies are trying to make it easier for patients to schedule and understand what their costs will be, and physician directories create unique challenges. What if you were a surgeon who performed a total knee replacement but you didn’t have the information connected with the correct insurance company for you to appear in the online scheduling tool?

Interestingly, many people go to the cost estimator tool enter “I don’t know” for some of their search criteria such as deductible and copay. Bridging the consumer gap to give even better information and creating the most accurate scheduling possible starts with efforts to create great health IT tools and adjusting them according to user behavior.

Holly Rimmasch from Health Catalyst was able to ask great questions and mentioned a program that Health Catalyst is doing to promote women in health IT. She served as a moderator and has an extensive background with pricing. They have promoted women in Health IT in the Utah area, including providing student scholarships for their Healthcare Analytics Summit in September.  A key question that Holly has focused on is “Are we making a difference in both quality and costs?”  “Does it translate into cost savings for those that are paying?” Part of her work involves bringing data sources together (clinical, financial, claims, etc.) to create transparency to services and care being provided and at what cost.  Over the last 6 years, Holly has been involved in developing a more accurate activity-based costing system. Accurate costing leads to more accurate pricing and more accurate pricing leads to improved price transparency. I am looking forward to learning more about what Health Catalyst does for improving Healthcare IT in Utah.

Norm Thurston is a Utah State Representative and I was surprised how much I enjoyed his presentation and I will tell you why. Norm Thurston has a background in statistics and I felt confident that the Utah legislature was getting good information about improving healthcare. Representative Thurston spoke about the availability of state data to see things like prescribing trends and billing trends among physicians. He asked Bob White about upcoding- and how the government of Utah looks at billing data to make that information more transparent for payers and providers. The checks and balances of legislators asking about trends based on data aren’t something I see every day in healthcare. Data backed inquiry can improve prescribing. Utah has had a decrease in opioid deaths in the last year, and the healthcare system and state efforts have actively used data to improve the numbers. Utah has historically been a state with a problem and has actively worked to improve rates of opioid deaths. One of the audience comments that I enjoyed was a question from Todd Allen, MD about how they evaluate the statistical significance of prescribing and billing differences. How do we know if using this drug or billing code 75% of the time has better outcomes that in the hospital where it is used less than 65% of the time? Having visibility and data is part of the equation for improving healthcare outcomes, and another part is interpreting the data and deciding best practices.

What Happened to Care Pricing and Provider Quality Transparency?

Posted on August 21, 2018 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

I’m on the Utah HIMSS board and we’re hosting an event called “Full Disclosure- Price Transparency & Provider Ratings in Healthcare.”

At the event on August 29, 2018, we’ll be talking about pricing transparency and physician outcomes. The Pricing Transparency question has multiple goals and remains a complex problem in healthcare IT and other areas. Leaders in Utah Health IT will come together to discuss resources and experiences from Utah.

Pricing in healthcare remains the number one concern for many different stakeholders. Informatics departments are still concerned with denials and claims administration. Patients are unsure of price of care. Physicians’ practices are not clearly aligned with billing codes and claims can account for up to 30% of healthcare spending waste. In April of this year, Seema Verma announced that requirements for hospitals to post standard pricing would be the start of a broad initiative to increase transparency about healthcare prices.

Can price transparency & provider ratings help manage the costs of healthcare?

Price transparency might have the single biggest effect in informing the public about healthcare costs and could support a more efficient health care delivery system in the United States. Utah HIMSS members and others are invited to submit questions for panelists.  

Please register for the event and follow the Utah HIMSS pages Linkedin and Twitter.

Here’s a look at the panel members that will be involved:

Moderator: Holly Rimmasch- Health Catalyst

Holly Rimmasch is an Executive VP/Chief Clinical Officer of Health Catalyst.  She currently leads population health, patient safety and improvement services.  Ms. Rimmasch has over 30 years of experience in clinical and operational healthcare management. She has spent the last 20 years dedicated to improving clinical care and better understanding how to sustain and achieve better value.

Holly has extensive healthcare and operational experience.  Prior to joining Health Catalyst, she was an Assistant VP at Intermountain Healthcare responsible for Clinical Services.  While at Intermountain, she also served as the system Clinical Operations Director for Cardiovascular and Intensive Medicine.  Holly co-founded and was a Principal in HMS, Inc, a healthcare consulting firm focusing on population health.

Ms. Rimmasch holds a Master of Science in Adult Physiology from the University of Utah and a Bachelor of Science in Nursing from Brigham Young University.

Price Transparency

A key question that Holly has focused on is “Are we making a difference in both quality and costs?”  “Does it translate into cost savings for those that are paying?” Part of her work involves bringing data sources together (clinical, financial, claims, etc.) to create transparency to services and care being provided and at what cost.  Over the last 6 years, Holly has been involved in developing a more accurate activity-based costing system. Accurate costing leads to more accurate pricing and more accurate pricing leads improved price transparency.

Panelist: Rep. Norm Thurston- Utah State Legislature

Personal & Professional

Dr. Thurston has a Masters and Ph.D. in economics from Princeton University, and an undergraduate degree in Spanish and Agribusiness Management from Brigham Young University.  His areas of specialty include insurance markets, health care provider markets, labor markets, and public finance/economics. 

Dr. Thurston has been a policy analyst and health economist for the Utah Department of Health since 2003. Currently, he is the Director of the Office of Health Care Statistics which is responsible for the collection, analysis, and dissemination of data related to health care cost and quality for the State of Utah.  In previous roles he has served as policy adviser and executive staff for health system reform efforts in the State of Utah. 

Before joining the state, Dr. Thurston worked for eight years as an assistant professor of economics at Brigham Young University.  He has published several articles on health care markets in nationally recognized economics journals.  He is a life-long resident of Utah, growing up in Morgan County.  He has native-level fluency in Spanish and was a Fulbright Scholar teaching economics in Argentina in 2001. He and his wife Maria have three children and two grandchildren.

Legislative

Rep. Thurston was elected to the Utah House of Representatives in 2014 from District 64 (Provo, Springville).  Currently, he is a member of the Government Operations Committee, the Economic Development and Workforce Services Committee, and the Social Services Appropriations Subcommittee.

Price Transparency:

“Norm Thurston is the director of the Office of Health Care Statistics (OHCS). The office collects, analyzes and disseminates data on health care utilization and costs for the State of Utah. Their two main data efforts include collecting information about patient encounters at hospitals and emergency rooms into the Healthcare Facilities Database and information about claims paid by health plans for all types of services into the All Payer Claims Database.

These data are used by a variety of entities, including healthcare facilities, plans, researchers, and public health programs.”

Panelist: Bob White- Intermountain Healthcare

Bob White, Vice President and Chief Operating Officer

Bob has over 27 years of experience in the Information Technology industry. He has been with SelectHealth for 20 years and currently leads member services, business systems support, program management, process improvement, business continuity, and information technology.

Previously, Bob was employed by the IBM Consulting Group. He attended Brigham Young University and holds a bachelor’s degree from DeVry University. He currently serves on the board of Trizetto Customer Group

Panelist: Katie Harwood- University of Utah Hospitals and Clinics

Patient and Financial Services Manager at the University of Utah Hospitals and Clinics

Katie Harwood is a Revenue Cycle Manager with University of Utah Health. She has been with the organization since 1995, most recently responsible for the admissions and financial counseling  teams. She is currently serving as the president of the American Association of Healthcare Administrative Management Utah Mountainwest chapter (AAHAM). She also participates with the National Association of Healthcare Access Management on the Certification Commission and is  a Certified Healthcare Access Manager. Outside of work she enjoys her two sons, dog, and Zumba.

Katie had the opportunity to participate in the development of the pricing transparency tool University of Utah Health. The goal was to create a tool that would have full care pricing available for consumers. She is excited to share what our experience in pricing transparency has been and how the consumer benefits from the use of it .

Health Leaders Go Beyond EHRs To Tackle Value-Based Care

Posted on March 30, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In the broadest sense, EHRs were built to manage patient populations — but largely one patient at a time. As a result, it’s little wonder that they aren’t offering much support for value-based care as is, as a recent report from Sage Growth Partners suggests.

Sage spoke with 100 healthcare executives to find out what they saw as their value-based care capabilities and obstacles. Participants included leaders from a wide range of entities, including an ACO, several large physician practices and a midsize integrated delivery network.

The overall sense Sage seems to have gotten from its research was that while value-based care contracts are beginning to pay off, health execs are finding it difficult support these contacts using the EHRs they have in place. While their EHRs can produce quality reports, most don’t offer data aggregation and analytics, risk stratification, care coordination or tools to foster patient and clinician engagement, the report notes.

To get the capabilities they need for value-based contracting, health organizations are layering population health management solutions on top of their EHRs. Though these additional PHM tools may not be fully mature, health executives told Sage that there already seeing a return on such investments.

This is not necessarily because these organizations aren’t comfortable with their existing EHR. The Sage study found that 65% of respondents were somewhat or highly unlikely to replace their EHR in the next three years.

However, roughly half of the 70% of providers who had EHRs for at least three years also have third-party PHM tools in place as well. Also, 64% of providers said that EHRs haven’t delivered many important value-based contracting tools.

Meanwhile, 60% to 75% of respondents are seeking value-based care solutions outside their EHR platform. And they are liking the results. Forty-six percent of the roughly three-quarters of respondents who were seeing ROI with value-based care felt that their third-party population PHM solution was essential to their success.

Despite their concerns, healthcare organizations may not feel impelled to invest in value-based care tools immediately. Right now, just 5% of respondents said that value-based care accounted for over 50% of their revenues, while 62% said that such contracts represented just 0 to 10% of their revenues. Arguably, while the growth in value-based contracting is continuing apace, it may not be at a tipping point just yet.

Still, traditional EHR vendors may need to do a better job of supporting value-based contracting (not that they’re not trying). The situation may change, but in the near term, health executives are going elsewhere when they look at building their value-based contracting capabilities. It’s hard to predict how this will turn out, but if I were an enterprise EHR vendor, I’d take competition with population health management specialist vendors very seriously.

EHR Data Migration – Tackling EHR & EMR Transition Series

Posted on August 10, 2016 I Written By

EHR Data Migration
(See Full EHR Data Migration Infographic)

In this infographic, Galen Healthcare Solutions provides critical information and statistics pertaining to EHR data migration including:

  • Healthcare Data Growth
  • EHR Data Migration Drivers
    • Mergers & Acquisitions
    • System Consolidation
  • EHR Data Migration Challenges
  • Industry Leading EHR Migration Solution

The demand for data migration within the U.S. healthcare market is growing exponentially. The increase in mergers and acquisitions is driving system consolidation as is the increasing number of HCOs seeking EHR replacements to address usability and productivity concerns. A recent survey by Black Book Rankings found that nearly one-fifth of large practices and clinics intend to undergo an EHR replacement by the end of 2016. In addition, a 2015 Kalaroma report shows that the EHR replacement market will grow at an annual rate of 7-8% over the next five years.

EHR Data Migration Process

The process of migrating from one EHR to another is among the most difficult technical and functional projects a healthcare organization will ever confront. The EHR transition requires vendor selection, assessment and scoping, legacy system optimization, data migration, legacy application support, data archival, and new system implementation. If organizations fail to address any of these components properly, their migration could leave healthcare providers without the information needed to make the best patient care decisions, and organizations without easy access to the historical data necessary for participating in quality reporting initiatives and other current and emerging value based care reimbursement methodologies.

Learn more about EHR transition, replacement and migration strategies, methodologies, tips & tricks, and best practices by downloading our EHR Migration Whitepaper.

About Justin Campbell
Justin is Vice President, Strategy, at Galen Healthcare Solutions. He is responsible for market intelligence, segmentation, business and market development and competitive strategy. Justin has been consulting in Health IT for over 10 years, guiding clients in the implementation, integration and optimization of clinical systems. He has been on the front lines of system replacement and data migration and is passionate about advancing interoperability in healthcare and harnessing analytical insights to realize improvements in patient care. Justin can be found on Twitter at @TJustinCampbell

About Galen Healthcare Solutions

Galen Healthcare Solutions is an award-winning, #1 in KLAS healthcare IT technical & professional services and solutions company providing high-skilled, cross-platform expertise and proud sponsor of the Tackling EHR & EMR Transition Series. For over a decade, Galen has partnered with more than 300 specialty practices, hospitals, health information exchanges, health systems and integrated delivery networks to provide high-quality, expert level IT consulting services including strategy, optimization, data migration, project management, and interoperability. Galen also delivers a suite of fully integrated products that enhance, automate, and simplify the access and use of clinical patient data within those systems to improve cost-efficiency and quality outcomes. For more information, visit www.galenhealthcare.com. Connect with us on Twitter, Facebook and LinkedIn.

Overcapacity in Inpatient Business

Posted on April 28, 2015 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.

In a recent conversation I had with Bill Anderson, Chairman and CEO of Medhost, he made this really insightful observation, “We have overcapacity in the inpatient business.”

I’m sure there are some exceptions in certain areas, but I believe that Bill is right about the healthcare system on the whole. We have overcapacity in the inpatient business. Unlike other businesses, where you want to drive more demand for a product or service, healthcare is somewhat unique in that we want to try and continue to decrease demand for healthcare services that a hospital provides.

This reminds me of all the people that say, “we need to cut costs in healthcare.” The numbers are clear that the US pays too much for the results we’re getting and that the costs of healthcare are a major problem for the US budget and for many large corporations budgets as well. It’s clear why we need to drive healthcare costs down. However, what they don’t say is that lower cost healthcare means that someone is getting paid less. This someone is often the hospitals.

One way you could look at all these efforts to decrease the cost of healthcare is that they are decreasing the demand for the inpatient business. If we have an overcapacity in inpatient healthcare already, these cost cutting measures will likely increase the overcapacity problem even more.

Those aren’t the only things that are driving down the demand for inpatient services. ACOs and value based care will drive the demand for inpatient services down even farther. High deductible plans will force patients to not do inpatient services that they would have done in the past. All of this will work to accentuate the overcapacity problem in inpatient healthcare.

How does a hospital combat the overcapacity problem? One idea is through digital differentiation. In some areas hospitals have a monopoly on services, but even they are competing with the hospital the next town over (even if it’s a 3 hour drive). However, the majority of healthcare organizations work in an environment that is incredibly competitive. Could unique digital services help a hospital be in more demand from patients than their competitors?

Hospitals are going to be around for as long as I’m alive. There’s certain services they offer that you can’t get other places. However, the demand for the services they offer is going to drastically change. How are you approaching this change in demand? Do digital services offer one solution to this problem?

Will Health Systems Own Healthcare?

Posted on April 20, 2015 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.

In all of my many conversations this past week, there was an underlying understanding that health systems are getting bigger and bigger. The trends of hospitals acquiring other hospitals is having a major impact on healthcare. Hospitals acquiring ambulatory clinics is probably having an even bigger impact.

As I ponder on this trend, I really can’t imagine a way that we return to the previous status quo. Certainly some doctors will tire of being employed by health systems, but I’m sad to say that once they’re ready to leave they may not find many doors available for them to take.

Aside from a limited number of direct primary care doctors in affluent areas, I believe it’s going to become extremely difficult for a doctor to leave a health system. In some areas, this is already the case. However, value based reimbursement is going to make this an impossibility for many.

I don’t think we know all the unintended consequences of this change in healthcare. As a capitalist, I love economies of scale and you can see how healthcare could benefit from some of these economies. However, what isn’t clear to me is that health systems do a great job capitalizing on economies of scale. In fact, I bet if you studied it you’d probably find that small physician practices run much cheaper than a large health system. If someone knows of a study that looks at this, I’d love to see it.

I do think that some specialists are bonding together in some areas to create super groups in order to combat this trend. In many ways they essentially create a monopoly of sorts around a certain specialty physician service in a local area. I’ll be interested to see how this plays out. Might be a short term win, but I’m not sure they can survive long term.

I’m still chewing on all the ways that we’ll benefit and suffer in a health system owned healthcare system. I’d love to hear your thoughts in the comments on these trends and the impact for good and bad of these changes.