Not an ideal beginning for Health Insurance Exchanges

The response provided to the much awaited health insurance exchanges seems to have been overwhelming with a large number of consumers showing interest in registering themselves and searching for best available plans. The unfortunate part has been that the info systems expected to handle the transactions have failed to deliver. The opening day of health insurance marketplace was marked with delays and server crashes. Technical issues have resulted in preventing consumers from signing up online and looking up for plan information. One obvious cause has been the inability of these sites to handle such large number of parallel transactions. In most cases the platforms are not robustly built to handle online traffic as huge as is coming their way. Consumers, in the meantime, have been urged to follow the old fashioned way of buying plans either over telephone or in person. Only the waiting time is expected to go up till the online registration part is not handled.

The insurers on their part have been caught in a web of uncertainty. They do not have much information about how many enrollments will they have to deal with eventually. Insurers are used to handling batches of electronic data sent across to them. But it becomes difficult to handle them when they are corrupt or incomplete. This is precisely what is happening right now. Technical issues having been dogging the federal run health exchanges. This has resulted in faulty or incomplete data being shared from their end with insurers. In some cases, the files shared do not open or are in a state where they cannot be used further. As a quick fix, they have resorted to manually correcting the errors and processing them. But such a thing will not be possible as one approaches the enrollment deadline - which was earlier scheduled on 15^th of Dec 2013. With millions of people expected to sign up for the program, handling all the incorrect files will be next to impossible. The problem is not only with the federal run exchanges but with the state run ones too.

All this has resulted in the exchanges unable to share exact enrollment statistics as of date. Inspite of all the chaos which exists, the insurers do not want miss out on the opportunity and have taken it upon themselves to market their offerings to the people. They clearly see a lot of scope for generating business from the population which would be taking up insurance coverage for the first time. Thus they are not waiting for the states to educate people and are launching their own marketing campaigns. Since it has started to sink in that that the systems will take a bit to time to start running optimally, they are actively pursuing channels by which they can reach out to consumers’ offline. For example one such channel successfully deployed is to send out emails to small business concerns which can provide multiple pools of subscribers at one go and urge them to ahead with the traditional method.

In the meantime, the government is trying its best to solve the technical problems which have caused this clutter. It has put together a team comprising of people of very high repute to look into the matter with outmost urgency. But the unfortunate part has been that, inspite of working 24x7, new issues have cropped up on an ongoing basis and have resulted in preventing consumers from accessing the market places online. Overall, the federal website HealthCare.gov seems to have the following major problems:

• Confusing prompts
• Overwhelming amount of information provided out of context
• Forms taking too much of time load
• Design Flaws in architecture

As per the earlier mandate, consumers had to apply for insurance coverage by 15^th of Dec 2013 and start getting covered by the 1^st of Jan 2014. But the unexpected turn of events; driven by technical issues of gigantic proportions has compelled the deadline to be pushed to Mar 31^st 2014. This will serve as a breather for people and ease out the process of registration.

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What will be the future of Physician-Owned Practices?

The Healthcare Landscape is in the process of undergoing a major change courtesy reforms which have either been brought in or are scheduled in the near future. These reforms are expected to pose huge challenges for providers as they grapple with ICD-10 coding standards, payment and reimbursement reforms, new healthcare models like Accountable Care Organizations etc. They are expected to also make huge investments in meaningfully adopting EHRs or face penalty. All this is taking a toll on the revenue stream. Physicians who are otherwise expected to focus on providing care to their patients in the best possible way are now required to devout a considerable amount of their valuable time in understanding the mandates and adapting to them. Does it mean the moving forward we are unlikely to come across independents physicians? Well, the Federal push to adopt Health IT has kind of compelled many physicians to join hospitals or similar such setups in order to ensure exemption from the additional burden to investing in IT and having to keep up the multitude of technological and regulatory requirements .

The financial and administrative strain on these private practices has resulted in physicians actively looking out for opportunities for affiliation. The move seems quite logical also; to let existing setups deal with all matters not directly related to patient care while the physicians can channelize your energies into it. As early as 2005, the percentage of physician–owned practices was at 66% but has reduced considerably to 33% by 2013. Also, the new physicians entering the industry do not seem too keen to own an independent practice; concerned mainly by the administrative hassles involved in holding one and the resultant squeeze in the profitability levels. For the hospitals also, acquiring Physicians goes a long way in ensuring an increase in the cash flow. At the end of the day hospitals are business entities which have to operate profitably to serve their patients better and also in a larger sense project the industry as lucrative to young people looking at taking up the medical profession. Since adoption of IT mandates has increased the financial pressure on the independent establishments, long term sustainability efforts seem to be channelized towards their affiliation to hospitals.

Inspite of all these developments, there are quite a number of physicians who still want to operate in an independent manner. To make it a reality they need to have an upgraded and integrated software revenue cycle management, practice management and electronic health records. This was revealed by a survey which was conducted amongst Practices which are Meaningful Stage 1 attested. This is where cloud based EHRs and RCMs have innovated and come up with solutions that meet all regulatory requirements. Cloud Based EMR requires a user to pay a subscription fees rather than purchase it. The fees generally need to be paid on a monthly basis. Users, i.e. physicians in this case, are not required to make any investment on associated hardware and software. It is reckoned as cloud because the storing of data is done across a network of data storage centers and not in any one particular location.

The major reasons for physicians to want to adopt this model, so as to enable them to have an independent existence, are:

• They do not have to bother about meeting the HIPPA regulation
• The onus to meet Meaningful Use also lies with Vendor
• The model offers exceptional flexibility for Physicians on the move
• There is High focus on data security and protection
• It is highly cost effective

There are also some drawbacks of using Cloud based EHRs. The major ones are:

• High dependence on vendors for data backups and security
• Setup likely to suffer if the vendor closes down

If a physician is looking at the possibility of entering into a long-term relationship with a vendor, then it would be cost effective to buy the software. However, in the given circumstances when a lot of consolidation is taking place in the EHR marketplace, licensing is a better option. Physicians looking for getting software developed can hire developers from healthcare software development companies in India who can help build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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How is mHealth metamorphosing Healthcare delivery?

Various researches have indicated the various benefits which implementation of mHealth is to bring forth in the healthcare industry. Although there is an inclination to quantify the benefits in monetary terms, the real focus should be on identifying the major changes in healthcare delivery which mHealth is going to bring about. The accuracy of monetary benefits is always going to be debatable but not the tangible benefits drawn from mHealth adoption. Of the many benefits predicted two areas which are going to see some real changes are remote patient monitoring and chronic disease management. In the event of the first, it will result in patients spending less time in hospitals and in outpatient visits. What has been really exciting is to have mHealth hardware getting directly linked to companion apps.

However, mHealth is expected to grow more so as Smartphone-based rather than being delivered through bespoke devices. As far as chronic disease management is concerned, from addressing high healthcare costs, inequality of care and medicinal waste, mHealth can actually bring about some serious positive change in lifestyle. Plus, it allows patients in some capacity to manage their health independently. For a chronic disease like diabetes, triggered mainly by incorrect lifestyle, mHealth can prove a really meaningful contribution in managing it well. For e.g. patients can use the proven apps to adhere to treatment regimes. Physicians can use make use of Patient portals to communicate directly with patients and provide information on disease management. All these and many more channels can be used to get patients to manage their blood glucose levels and reduce instances of emergency room visits and readmissions. Studies done have also indicated that with the younger lot, who unfortunately suffer from the disease, there are apps specially designed which use pictures and text messages which engage them to improve their compliance to care process at home. Also, it helps to get responses to queries from physicians in quick time. The texting program has seems to be gaining in popularity with text reminders ensuring better adherence.

Overall, these are early stages for adoption of mHealth apps. Most of the ones available currently do not have a high degree of sophistication, and are underutilized. However, it is laying the foundation for the next level of innovation to follow where the apps developed will be more suited to the changing healthcare landscape. Since a lot of changes related to healthcare IT are scheduled in the next few years, with some mandated by the federal government, the mobiles apps in the future will have to take into account the regulatory compliances to pervade into the lives of all stakeholders in the industry. The mHealth market is entirely in sync with the smartphone application market. Hence, the adoption is sure to pick from developed countries before it moves to others. In absolute terms, mHealth will see a exponential adoption since the number of people using smartphones and tablets is expected to be in billions in the next 5 years. That is also the time when it is expected to have entered the commercialization phase. But between then and now some major changes will also have to be done. For instance the regulations will have to be modified and defined in clear terms and the solutions have to handle more complex situations. The changes currently taking place in the operational models in the industry will create a an environment conducive to mHealth adoption. One of the studies done to identify the trends which will shape the market for mHealth had the following points to share

• The main driver for the mHealth usage will be the penetration of Smartphones
• There will customized mHealth applications available for smartphones or tablets
• Most of the applications will be native
• There are likely to be niche stores for mHealth apps
• The commercialization phase will require better regulations to be in place
• The market will be driven by the buyers
• The traditional health distribution channels will start adopting mHealth apps
• Countries with high smartphone penetration and healthcare budgets will be the main benefactors
• The chronic diseases will draw special focus
• New business models will come into play

With the adoption rate for mHealth apps on the rise, healthcare software testing also starts assuming increasing importance. It becomes vital and hence imperative to use app testers to test the robustness and security of the apps before they are rolled out to the patients and users.

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Major hurdles to Healthcare IT adoption

The Healthcare industry is currently undergoing a metamorphosis which is unprecedented. All the efforts being put in to digitize data is expected to bring in significant changes to the manner in which care is provided. Health Information Technology for Economic and Clinical Health Act was enacted under the American Recovery and Reinvestment Act of 2009, has pushed for the adoption of electronic health records. This has resulted in efforts directed towards innovation in this industry. The intent is to move towards using more evidence-based tools in helping physicians provide better services to their patients. All this is finally expected to result in a smarter healthcare model. However, the entire story looks pretty promising till the issues at hand are considered. The biggest hurdle at this moment, which has the capacity to undermine the entire initiative, is the pace at which the adoption is taking place. The changes in approach which need to be brought in require acceptance and widespread use to ensure that the real benefits are passed on to the patients. Unfortunately there is a lot of inertia amongst physicians against adoption of information technology in their operations. Government is doing its bit by trying to enforce them, through incentives first and planned penalty later, to accept the change. But the real benefits can only be derived if there is a change of heart in the present generation of physicians and the various tools made available at their disposal are used to their fullest extent. The medical schools are doing their bit in making it mandatory for the students to use software tools and devices as part of their curriculum. This will automatically make it possible for them to extend it to their practices because of the familiarity which would have developed. The problem here is that such a phenomena will have a lag time. To ensure that the current population is not denied the benefits or is not made to wait for decade, it is the unwilling bunch of experienced practicing physicians who have to change.

In the current healthcare model the focus is on quantity. Physicians, to run their setups profitably, have to see a large number of patients on a daily basis. They are also badgered by the continual interference of payers who want to call the shots on how patients should be treated. All this has rendered the model effective and unyielding from both the physician as well as the patient perspective. Accountable care Organization is one of the new models which is taking shape as a consequence of these developments. This ties the provider payment to the quality of care and reduction of care cost for an identified population. They are responsible to the patients as well as the payer for the appropriateness, quality and efficiency of care that they provide. They are driven by 3 primary objectives:

• Improved Care
• Improved Health
• Lower per-capita Cost

However, setting up an ACO involves a considerable amount of startup cost and large annual expenses for maintenance. This is where implementation of info systems can be of tremendous benefit – both in terms of reducing the cost as well as improving the quality of care. It is effective IT solutions which can ensure that the physicians receive the best possible information at the right time to enable them to achieve their goals. All this can be done ensuring confidentiality of patient information throughout the processes. But implementation of IT has also had its fair share of challenges which are not completely removed yet. For e.g. an ACO generally has a large number of Primary Care physicians under its wing. each of the setups generally have their home grown EMRs which generally are seen to lack all the functionalities needed to make them comply with Meaningful Use mandates . On handling this issue the next one to surface is generally that of lack of interoperability. As more and more physicians start joining the group ensuring both the above factors is a must. Another issue which came to the forefront was the differing speed of communication at healthcare setups which indirectly affected how fast physicians driven by need could communicate. Clinical software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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Measures to handle Health IT hazards

Implementation of the Medicare and Medicaid EHR incentive programs has led to widespread adoption of EHRs everywhere. The trigger to all this was with the Obama government encouraging the adoption of Health IT by passing the Recovery Act in 2009. In the year 2011, the Medicare and Medicaid EHR incentive programs made it possible for physicians, hospitals, and other eligible providers to draw incentives for adopting and meaningfully using certified electronic health records. Health IT, besides all the benefits that it is supposed to bring forth, also needs to ensure safety of patients. Understanding the relevance of this area, the federal government has established a communications infrastructure to capture data about IT-related patient safety events. This is expected to hugely benefit the providers since it will result in the right intervention to handle issues when they arise. Thus new systems, when they get implemented, should without fail take into account the safety of patients. Two things hold the key to achieve this; more engagement from the Patient’s end and provision for exchange of patient information among providers. Surveys conducted have indicated some common occurrences of problems which can broadly be categorized to fall under the following heads:

• Information that is very coarse : generic statements
• Information that's too fine : being very specific reduces chances of considering alternatives
• Missing reality : only reports and numbers do not necessarily indicate the actual situation
• Multiplicity : results / analysis from various sources suggesting conflicting information

These are problems which physicians encounter when they deal with Information systems in real time. What needs to be done here is to have a provision for giving feedback to system developers on a regular basis to close the loopholes. Physicians need to be empowered to suggest improvements when they observe problems. Not providing feedback and being operationally efficient in following what the systems prompt can in the long run prove to be a big pitfall for the industry.

Health IT is expected to bring about tremendous benefits to patients care. However since it involves complex technologies, there are high chances of mistakes occurring in its roll out. Information errors comprise a major chunk of the potential hazards of Health IT. From data mismatches to interoperability failures between devices and systems to distractions caused by smartphones and devices, all these have the potential to undo or spoil a lot of the positives of health IT implementation. If we take the last point into account, the event does not seem to be as fatal as the effect it ends up having. In today’s world of BYOD culture, physicians carry their own smartphones and tablets to work. It is quite obvious to have a lot of apps available in these devices in addition to the ones which are required to work with. Since a lot of these apps have live updates etc. it is quite normal to get distracted by them if one were using the device during patient visits with the apps switched on. Apart from the fact that it may lead to mistakes and missing out on relevant information, focusing more on the device might lead to not noticing vital clues in patients affecting the quality of care. The medical schools are trying to address the matted by devising special courses to help the future physicians learn about ways to integrate technology into their workflow without getting distracted or affected in ways which might prove to be detrimental.

Experts in the industry are suggesting ways by which the concern of safety in Health IT can be addressed. One such recommendations is to device a framework which can be rolled out in three phases and get combined with EHR implementation and related Meaningful Use requirements. The important thing to keep in mind is to incorporate safety into training of Healthcare providers and also into certification of software products. The software developers involved in developing these complex systems also need to be involved and explained their need to share responsibility for the safety. Finally measures should be taken to ensure that physicians find it easy and convenient to share their feedback and concerns whenever they want to. Nothing can be more vital than their feedback. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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Can Big Data live upto Healthcare expectations?

Based on the analysis made so far on the effect Big data on restraining healthcare cost, it is being suggested that the industry stands to save an approximate amount to the tune of $450 bn. Further improvements and suggestions which are bound to come by as more research is done in this field will only result in more savings. Important suggestions made so far include doing away with the fee-for –service as a method of payment and change in the mindset of the providers and patients to accept the benefits of making use of data. The second point is highly critical. Unless there is a change in the approach on the part of the stakeholders in terms of their willingness to use the recommendations suggested by the analysis which comes with the sue of data , it will be next to impossible to actually start realizing the benefits of the approach. A case in point could be as simple as the following. No matter how much of investment and research is done in the field of fitness and exercise, the true benefit can never be passed on to people if they continue with the sedentary lifestyles as they have been for all this while . What big data analysis might provide as an input is the importance of exercising and some metrics to prove how it can possibly help people with a better lifestyle. But no matter how many new exercising techniques are suggested, the benefits can never be realized unless people actually start devoting time to fitness. Experiments done in controlled conditions have indicated that even if simple interventions were made successfully, on the large the results will lead to huge savings. This however will require physicians to combine their treatment methodologies with bog data. Although one of the major factors to distinguish one physician from another is their ability of judgment for treatment decisions, there is no harm if they were to combine it with big data usage and multiply the benefits. This however requires a paradigm shift in their openness to this field and a willingness to apply the recommendations.

Various developments over the last two decades in healthcare have resulted in the industry reaching this juncture at which the benefits of harvesting on the data available seem to have a lot of potential. Providers and Payers have digitized their medical records, Pharmaceutical companies have been supplying huge amount of information related to research and development into medical databases. Information from clinical trials and insurance programs are available and most importantly it is possible now to collect and analyze data from multiple sources. However the major factor which is responsible for driving up the demand is that of rising fiscal costs. There is now a huge need among healthcare stakeholders to compile and exchange information. This has been the result of a shift in healthcare delivery approach which is taking place. The tradition method of delivery where the payment was based on treatment volume resulted in high cost escalation which has compelled adoption of models where payment is related to the outcome and just not on the delivery of service. Since it is now the outcome which is of importance the stakeholders have started realizing that the costs can be brought down and results better achieved if there is more cohesion in their approaches and there is avoidance of repetition of processes. For this to happen it is imperative that they have access to common data and systems which make it possible to exchange information. Thus the need for availability of data and its harvesting has never been more.

Physicians who till now have relied on their judgment to take treatment related decisions have also started noticing the benefits of more evidence-based decision making. The process is based on taking inputs from systematic reviewing of clinical data and letting the best available information impact treatment decision. The important point here is that, surveys have indicated that the early adopters of this new approach have already started drawing the benefits. This is not only encouraging but could mean the beginning of a new era in the healthcare industry which till now has not been banking on use of big data compared to others like the retail and banking. There are bound to be roadblocks ahead but the journey nevertheless seems to have started already. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

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How Ethical is Concierge Medical System?

For patients, the much-touted benefit of concierge medicine is that the doctor has more time and can provide them greater access. Email consultations, preventive tests and extensive exams are some of the additional services provided which otherwise are not covered by insurance. In the middle of all this, there are a lot of people questioning the credibility of this model. Infact many states are putting forth the question whether concierge medicine is not against the existing insurance laws. There are admonitions being sent out to the doctors that charging Medicare patients an 'access fee' is similar to double billing. In addition to this, it will also worsen the physician shortage system as there will be very few left to address the needs of non-concierge patients. Also, will this model be able to solve the healthcare issues at the national level is a big question mark. How many people will also be willing to pay an additional amount after paying the premium for health insurance ?

Medicare system, for whatever benefits it has to offer, is in financial trouble as it reduces payments to physicians, thus making patients covered under Medicare less desirable. The model is making the lives of physicians tougher not just financially but in an operational sense as well. Mounting paperwork and low rate of payment is making the whole system untenable. Thus for physicians the concierge model is not necessarily about less work. On the contrary, it makes it more satisfying for them as professionals and allows them to build a more profitable practice. Their income is based on contracts that they enter into with the patients and their satisfaction is derived from the amount of control that they have in running their medical setup. They are no more at the mercy of the insurance companies who otherwise pull the strings and decide the course of treatment in most cases. So overall they feel they are in more control of their destiny. The physicians who are actively advocating this new model are going to the extent of saying that its adoption will potentially solve the current problem of, which is expected to get worse in the future, shortage of Primary Care Physicians. The logic that they put across is that there has to be enough incentive in the field of medical science to draw bright and young people to take it up as a profession. They have to have a justification to make an investment in a career which looks promising.

Many are looking at Concierge Care as an effect of demand and supply. Physicians are considering this option only because they see a lot of willingness among patients to get the kind of access and services it offers. This model started about a decade ago and ended up being accessible only to the rich masses. However proponents of the model realized that for it to get a wider acceptance, variants had to be devised to include people who are not necessarily rich. There is a hybrid model which is being looked upon as well. In this, the physician continues to operate in the traditional way but shift a group of patients, who are willing to go ahead, to a concierge model and charge them an additional amount on a monthly basis to avail the additional benefits. They also have the prerogative to stop the payment if they are either unable to pay or don’t want the services. However critics of the hybrid model are not convinced if on a practical basis, physicians will actually be able to provide additional care and time to the upgraded patients when the number of patients mapped to them will not have gone down. In the meantime, there are reports of one concierge practice having gone bankrupt because of the physicians turned dissident and convinced a large number of patients to not renew their contract and instead pulled them along to another concern. Although the practice has sought legal help to resolve the issue, it kind of opens up possibilities of issues which practices adopting the new model are likely to face. Healthcare software development teams can help you build clinical and EHR/EMR software projects within allocated budgets and time schedules.

We provide healthcare software maintenance services. If you would like to know more about our certified healthcare app developers, please get in touch with us at Mindfire Solutions.