Health Plans’ Survival Could Depend on Customer Service

Insurers are facing more pressure than ever to meet customer demands or lose those customers to competitors.

A recent survey, conducted by HealthEdge and Porter Research, of 2,500 health plan members across the U.S. indicated that health plans must quickly tune their offerings and provide service levels that match or exceed members’ expectations.

Consumers expect organizations in their healthcare ecosystem to more effectively communicate with them and supply information and services in a way that is as convenient as their experience in other industries.  For example, 88% of survey respondents said their health plan could be doing a better job of communicating their total financial responsibility.

Additionally, survey respondents indicate that members care in their health plans lag in “tech-savviness”.  More than half, 57%, said their confidence in the health plan’s ability to provide effective coverage and benefits would be adversely affected by the knowledge that outdated technology is being used.

To read the full article, click here at Health Plans’ Survival.

Source:  HealthLeaders Media, October 21, 2016

HIT Workforce Needs for Georgia Hospitals, Healthcare Systems

The Institute for Healthcare Information Technology (IHIT) commissioned Porter Research to conduct a study to get insight from Georgia hospitals and healthcare systems about IT workforce readiness and their unique challenges related to IT job fulfillment.  This most recent study continues to build onto the research performed in 2014:  Georgia Healthcare IT Workforce Readiness Survey and Georgia Healthcare IT & Education Working Together.

This year’s study included reaching out to more than 3,000 key professionals employed at healthcare providers located throughout the State of Georgia to participate in an online survey.  Participants — mainly comprised of C-level executives, administrators/directors and managers — had the opportunity to share information about their organization’s IT budgetary spending & priorities, as well as about their current and future job fulfillment needs, the required education and skills that are sought after, and their job recruitment strategies and challenges.

A couple of the key survey findings include:

•   More than 80% of respondents stated their IT budget will increase over the next five years, with the top priority areas for IT spending being:
– Electronic Medical Records (EMRs)
– Cyber Security
– Medical Device Integration

•   72% of survey participants stated they have up to 50 healthcare IT jobs currently open.  And the overwhelming majority (94%) indicated that they expect to have healthcare IT jobs available in the next one to five years.

•   The most mentioned jobs that are expected to be difficult to fill over the next five years were:
– Informatics
– Security
– Clinical

•   In response to, “How confident are you that your organization will be able to fill your healthcare IT jobs over the next five years?”  Here are the perceptions of the surveyed hospitals and healthcare systems…

Confidence of Filling IT Jobs in Future
42% of respondents have doubts that they will be able to fill these
projected IT positions over the next five years..

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The surveyed hospitals and healthcare systems also had the chance to submit any recommendations that they had about changes the education systems in Georgia need to implement to improve training for the healthcare IT workforce.  To find out what the top workforce recommendations were and to review the complete survey findings, look for the Georgia Healthcare IT Workforce Needs for Healthcare Providers whitepaper that will be available soon on the IHIT website at www.InstituteforHealthcareIT.org

HHS’ ICD-10 Code Deadline Arrives

With the arrival of October 2015 come changes beyond the color of the leaves, as it signifies the U.S. Department of Health and Human Services’ (HHS) deadline for hospitals, physician practices, other healthcare providers and payers to have completed the transition from ICD-9 to ICD-10 (International Classification of Diseases, Revision 10) coding systems.  ICD-10 provides more granular coding during a patient’s medical treatment, generating specific data that is expected to improve healthcare delivery.  Benefits of the more advanced coding include the ability to:

  • Develop a more detailed patient history
  • Better coordinate patient care across providers and over time
  • Improve quality measurement and reporting
  • Detect and prevent fraud, waste, and abuse
  • Gain more accurate metrics for Federal or private insurance reimbursement

Additionally, since ICD-10 coding includes more complete information on the medical conditions that providers treat, the level of data capture and analytics is expected to allow for more advanced surveillance of public health and quality reporting on a national scope.

For all of these benefits of implementing a more complete medical coding system, it has been a process fraught with difficulties…particularly for healthcare providers and insurers.  They have had to shoulder most of the financial responsibility for the operational upgrades necessary to be able to track, code, store and share the data-heavy ICD-10 coding system that is required to participate in reimbursement programs.

Porter Research – a Billian Company – has been working with many healthcare organizations over the past few years leading up to the ICD-10 deadline to develop research programs that would provide key metrics of what was taking place in the healthcare marketplace, as providers scrambled to fund and implement these changes within their business model to achieve regulatory compliance.

“I recently attended the AHIMA [American Health Information Management Association]trade show, and there was a lot of optimism going around about the kickoff for ICD-10, and how well things were going,” said Cynthia Porter, president of Porter Research.  “But there’s also the lingering question about what happens if claims don’t get paid in 30 days-time.  I think there is an undercurrent of nervousness about the potential for claims to be denied for some unexpected reason.  In the end, only paid claims will start alleviating the concerns held by healthcare providers and payers.  Training and workflow challenges associated with the ICD-10 transition will continue well past October.”

Navicure, a provider of cloud-based healthcare billing and payment solutions, commissioned Porter Research to conduct a recent national survey of healthcare organizations to gauge their preparedness for the ICD-10 transition.  The August 2015 Healthcare Organization ICD-10 Readiness Survey revealed a mixture of confidence along with apprehension from survey participants, the majority (58%) of whom serve as physician practice administrators or billing managers.  Some key survey findings include:

  • 85% of respondents stated that they are optimistic about ICD-10 preparedness
  • 94% of respondents anticipate an increase in their claims denial rate
  • Over 50% of respondents anticipate a negative impact on their organization’s finances, operations and staff morale as a result of the transition to ICD-10.

“The ICD-10 Readiness Survey that Porter Research conducted helped Navicure understand what was important and needed in the marketplace to meet the HHS deadline.  This insight from key healthcare industry stakeholders allows Navicure to better understand the market realities of what is actually taking place during the transition,” stated Phil Dolan, Navicure’s Chief Marketing Officer.  “Thankfully, it appears that the ICD-10 deadline arrival has been uneventful so far, as we enter into October.  I think this level of preparedness indicates how hard providers and vendors have worked together over the past few years in order to reach this point.”  To view the complete survey key findings and action items, visit survey results

Navicure has been working with healthcare providers to assist them through the ICD-10 transition process, to ensure that their day-to-day business operations avoid unnecessary disruption.  The IT solution company even offers free access to ICD-10 transition tools that include online correction of rejected claims, expanded claim tracking, and ICD-9 to -10 mapping for any payers that turn out to be unprepared for the change.  Navicure’s ICD-10 resource webpage is available at click here

The Centers for Medicare & Medicaid Services (CMS) announced earlier this year that non-compliant ICD-10 Medicare claims would be accepted during the 12-month period past the deadline date.  However, this does not extend to Medicaid, BCBS and commercial plans. Additionally, the CMS is working with the American Medical Association (AMA) on a series of proactive initiatives [ For more details, click initiative ] to help physicians and other healthcare providers that are struggling to achieve regulatory compliance.  The two agencies – representing governance and the medical community – realize the need for addressing the individual challenges faced by healthcare providers beyond an inflexible deadline date as the healthcare industry modernizes its coding system nationwide.

Practical Applications of NLP in Healthcare: Enhancing the Value of Electronic Data

Approximately 65 percent of hospitals plan to spend an average of $1.9 million on analytics in 2015, according to a survey conducted by CDW Healthcare. By applying complex algorithms to massive volumes of electronic data, analytics work to lower costs, improve care, predict outcomes, and manage population health. Many experts believe analytics drive the true return on investment of EHR technology.

However, 80 percent of the data that resides in EHRs remains in an unstructured narrative format, making it virtually inaccessible for analytics purposes. Furthermore, healthcare data is spread across multiple hospital systems—disjointed and unintegrated. Disparate systems capture the same information, but in different formats, nomenclatures and terminologies. One multi-hospital health system reported 67 different ways to identify patient gender during a recent data clean-up project.

Faulty, redundant and unstructured information within hospital systems impede the healthcare industry’s progress toward effective, data-driven decision making. This article explores how natural language processing (NLP) is being used to address one of these data disparity issues: unstructured data.

NLP Provides Antidote for Unstructured Data

NLP technology taps into the power of unstructured data. NLP is used within and atop existing systems and technology applications to support better data-driven decision making in five key operational areas: ICD-10 coding, speech recognition, core measure reporting, research/clinical trials, and clinical documentation improvement.

NLP generates key data points from electronic, text-based documents. Once identified by the NLP rules engine, the data points can be analyzed and manipulated in a variety of ways. NLP allows organizations to perform tasks such as case identification, real-time patient monitoring, and data gathering for national quality reporting. Without NLP, traditional data analytics tools simply wouldn’t work with unstructured data.

NLP is also often in the background of more visible technologies that make work easier for physicians, coders, case managers, and many others who rely on clinical data within an organization. For example, computer-assisted coding (CAC) and speech recognition vendors use NLP’s rules and engines as the underpinnings for their applications. Without NLP, these technologies wouldn’t be nearly as effective.

Four Specific Use Cases for NLP

Let’s take a closer look at how organizations are using NLP to get at the heart of clinical data in the EHR.

    1. Create opportunities for clinical documentation improvement (CDI) efficiencies. NLP helps CDI specialists perform comprehensive data mining in a matter of seconds. Instead of reviewing hundreds of cases, CDI specialists use the NLP-generated work list to focus exclusively on cases with identified documentation gaps and improvement opportunities. The ability to automate case finding will become even more critical as organizations improve the granularity of clinical documentation for accurate coding and billing under ICD-10.This data-driven workflow improves query rates and overall efficiency, and it allows CDI specialists to focus on fixing documentation rather than searching for certain diagnoses. Greater efficiency, in turn, improves financial outcomes through increased review rates.

 

    1. Expedite patient identification for clinical trial enrollment. NLP helps organizations quickly identify patients who may be eligible for immunotherapies, clinical trials and medical research. Automated case finding ensures patients are informed about all possible care options early in the disease process versus post discharge thereby making clinical trials more efficient and effective.

 

    1. Comply with core measures. Using NLP, organizations assess documentation immediately upon admission so close monitoring can occur. Quality reviewers spend more time reviewing cases instead of sifting through charts. NLP also allows for faster review of progress notes and problem lists, helping quality reviewers identify patients as soon as they fail criteria in the ED so prompt action can be taken.

 

  1. Provide real-time data about patients. Hospitals use NLP concurrently to monitor patients while they are in the hospital receiving treatment. For example, as physicians document certain diagnoses or procedures (e.g., insertion of urinary catheter), NLP generates alerts and reminders so providers monitor these patients frequently to mitigate the risk of urinary tract infection—one of many hospital-acquired conditions identified by CMS.Another example is using NLP to track sepsis patients. NLP helps uncover the symptoms immediately rather than retrospectively. Physicians can then direct their attention toward these patients and reduce the likelihood that they will be readmitted.

HIT Vendors Successfully Leverage NLP

Vendors (i.e., overlaying applications) are also using NLP in a variety of ways. Consider the three most common applications of NLP in healthcare: coding, EHRs and speech recognition/dictation.

Computer-assisted coding (CAC)
CAC instructs the underlying NLP engine to find clinical problems and procedures within terms and phrases of documentation. It also delineates the current from the past as well as personal from familial. In addition, NLP associates certain descriptors with the appropriate nouns/diagnoses, such as associating “exacerbation of” or “acute diastolic” with the term “heart failure.” Once CAC has obtained this structured data, it can apply unique clinical ICD-9 and ICD-10 codes that a medical coder subsequently reviews and validates.EHR systems
When embedded directly within the EHR, NLP automatically converts a physician’s free-text comments as well as digital narrative text-based content into discrete data. Some vendors combine speech recognition technology with NLP to prompt physicians to elaborate on or clarify certain documentation elements as they dictate – known as Computer-Aided Physician Documentation (CAPD).

Speech recognition/dictation
Unlike speech recognition, which simply converts spoken word into digital text, NLP infers meaning behind the words. Physicians continue to dictate and/or speak their reports while NLP engines convert this information into work lists for CDI professionals, discrete data for the EHR, or quality measure compliance reports.

It’s All About the Data

NLP will continue to play an important role in data analytics and population health management. As more organizations implement EHRs, NLP will be the foundation for abstracting valuable narrative information and turning it into actionable data that can make a big difference in terms of healthcare outcomes and efficiency.

Faulty and redundant data issues will remain a problem in healthcare and must be addressed through stronger information governance programs. In the interim, organizations and technology vendors should use NLP to eliminate one major electronic information hurdle—unstructured data.


About the Author:
Steve is responsible for business development and product strategy at RecordsOne. Since joining in 2007, he has guided the company from a dictation and transcription technology vendor to a complete clinical documentation solutions provider. He has worked with multiple hospital and clinic organizations to assess, improve and automate revenue cycle processes and workflows through technology.

Steve is a national author and speaker on the use of natural language processing technology in healthcare. He works hand in hand with hospitals to identify new and innovative uses for NLP within coding, clinical documentation improvement, quality reporting and reimbursement. Steve is an active member of AHIMA, ACDIS, HIMSS and WEDI with most recent speaking sessions at AHIMA’s National Data and CDI Summits in late 2015 as well as the AHIMA national convention.

Survey Gauges Medical Practices’ Attitudes toward ICD-10

NueMD recently released findings from their April 2015 survey exploring small and mid-sized medical practices’ attitudes towards the pending transition to ICD-10, a more granular disease and diagnosis classification system.

With the October implementation deadline fast approaching, NueMD surveyed 1,000 medical practice professionals and billers about their stress levels, areas of concern, the general sense of preparedness regarding switching to the new coding standards.

When asked how confident they are that their employees will be trained by the ICD-10 deadline, only 11.4% of survey respondents indicated feeling “highly confident,” with the most common response being “Not at all confident” (35%).

nuemd_icd-10_survey

View NueMD’s ICD-10 survey findings report to learn more about survey participants’ attitudes, concerns, expectations and preparedness related to ICD-10 adoption.

About NueMD
NueMD is the leading provider of cloud-based medical practice management software for small practices. Powered by Nuesoft Technologies, Inc., NueMD offers practice management, electronic health record and medical billing software and services to help physicians maintain the clinical and financial well-being of their practice. For more information please visit www.nuemd.com.

Georgia Healthcare IT & Education Working Together

The Institute for Healthcare Information Technology (IHIT) commissioned Porter Research to perform a follow-up project stemming from last year’s “Georgia Healthcare IT Workforce Readiness Survey”, which involved a statewide survey of healthcare IT service providers (vendors) and practitioners (hospitals, clinicians) to gauge the status of their plans to expand and hire from within the state, as well as their perceptions of how well-equipped Georgia’s educational institutions are to provide qualified healthcare IT job candidates.  The Workforce Readiness project produced a whitepaper, highlighting the research findings, that IHIT shared with state leaders and educational representatives.  It was decided that follow-up research was needed to collect more granular insight about specific areas of industry perceptions as it relates to the state’s educational system.

Consequently, IHIT in collaboration with the Technical College System of Georgia, the University System of Georgia, and Emory Continuing Education conducted a series of interviews and discussions with top executives from a random selection of 10 healthcare IT companies, of varying sizes, located in the Metro Atlanta area.  Unlike the earlier, larger-scope statewide research project, this follow-up effort was designed as a face-to-face meeting with industry leaders in order to get feedback beyond a Q&A session.  The in-person format allowed for every company to be presented with the same set of open-ended discussion topics in the hopes of starting a dialogue between all parties.  The meetings were also held to help evaluate current educational offerings as well as proposed future initiatives that could be developed to “bridge any gaps” that may exist between the job demand and the educational supply to foster growth for Georgia’s healthcare IT industry.

The newly-released “Georgia Healthcare IT & Education Working Together” whitepaper covers the interviews with healthcare IT executives, their suggestions for developing an educational “orientation” curriculum to better prepare students, and the responses from healthcare IT educators.  The Working Together whitepaper, along with the earlier Workforce Readiness whitepaper, can be downloaded here.

IHIT is an Atlanta-based non-profit organization founded for the purpose of connecting resources and leveraging strengths of the healthcare IT industry within Georgia and the Southeastern U.S. to expand technology throughout the nation’s healthcare system.

On-Demand Webinar Resources: Redefining ROI in Healthcare Sales

Porter Research and Maestro Strategies recently co-hosted the webinar “Using ROI to Build Trust and Differentiate in Today’s Healthcare Marketplace.”

Cynthia Porter (President, Porter Research) and Susan Irby (Business Intelligence Practice Leader, Maestro Strategies), who collectively boast more than fifty years of experience serving and consulting in the healthcare industry, addressed the ways healthcare vendors and suppliers are redefining their ROI positioning to better demonstrate the far-reaching value of increasingly complex healthcare solutions to potential provider and payer buyers.

Guest speaker and HealthEdge Vice President of Marketing Brian Bogie shared details on his experience working with Porter and Maestro to quantify the value of HealthEdge solution components that may have a huge impact on healthcare organizations without the benefit of being quantified financially, and to validate those perceived benefits through objective client research.

Hear more about Brian’s success developing an ROI took kit to help his company articulate full solution value and build trust with healthcare buyers by accessing the webinar event recording here. Slides from the presentation are also included below.

If you would like to learn more about developing an ROI tool kit for your company, conducting benefit validation research with your clients, or procuring health market data to help facilitate engagement, contact Porter Research.

Education, Funding on HIT Industry Stakeholders’ Minds at First Annual Georgia HIT Day

Georgia CapitolGeorgia Lieutenant Governor Casey Cagle proclaimed February 24th as “Georgia HIT Day” at a state capitol gathering held earlier this week where local officials and healthcare technology firms convened to discuss the economic impact healthcare IT is having in the region.

Tag Health, in partnership with Georgia HIMSS and the Metro Atlanta Chamber, hosted speakers from local HIT companies McKesson Technology Solutions, HealthPort Technologies, and Navicure, Inc. for a panel discussion primarily focused on job opportunity the HIT market has brought to Georgia.

Recent HIT market research from the Institute for Healthcare Information Technology (IHIT) suggests that more than 4,700 healthcare IT jobs are available in the state of Georgia, but research participants report difficulties filling positions. Georgia HIT Day panelists pointed to a need for more individuals with cross-industry experience (i.e. provider, health plan, pharmacy, technology) to help build a qualified HIT workforce.

A noticeable portion of event attendees appeared to be professional students in local HIT continuing education programs interested in filling that workforce deficit, and actively seeking employment.

Porter Research President Cynthia Porter, who was involved in fielding the recent Georgia HIT workforce research and was in attendance at the event, observed an emphasis on HIT education needs. Porter elaborates: “There is some concern that job candidates in the region may be tempted to migrate to more fertile markets if Georgia’s academic push for HIT advancement isn’t coupled with increased business investment in the area.”

GA Capitol

State officials and organizational representatives addressed the need to better brand the city’s strengths in healthcare IT (including an educated workforce) to attract more venture funding to the Atlanta market. The city was presented with the HIStalk.com Reader’s Choice Award for recently being voted the “Nation’s Capital of Health IT” at Tuesday’s event.

Porter Research Information Services Director David Himes, also on hand at the event, found promise in the state’s collective approach to promoting Georgia HIT, observing that “As the state maneuvers to coordinate the education efforts to staff these jobs, a forum that brings healthcare IT firms, healthcare staffing and recruiting companies, and the Board of Regents to the table could yield promising results.”

Local healthcare providers and HIT end-users were also in attendance and some aired concerns regarding HIT’s impact on provider productivity. Other provider attendees championed patient safety as HIT’s primary objective, while others voiced the need to bring a wider variety of HIT end-users (i.e. nurses) to the product development table.

To date, roughly two-thirds of Georgia hospitals have received funds for successfully demonstrating meaningful use of an Electronic Health Record (EHR) system as part of CMS’s Medicare EHR Incentive Program. You can read more about Georgia healthcare benchmarks here.

Navicure Survey Reveals ICD-10 Optimism despite Minimal Preparation

Navicure, a provider of cloud-based healthcare billing and payment solutions, today announced key findings from its third ICD-10 readiness survey, deployed in January 2015 in conjunction with Porter Research. The findings revealed physician practices are generally optimistic about being ready for the October 1, 2015, transition date, although only 21 percent feel they are currently on track with preparation efforts.

As with Navicure’s first two surveys, the majority of participants (57 percent) were practice administrators or billing managers from practices with one to 10 providers. The next largest group was billers and coders who made up 14 percent, followed by practice executives (13 percent).

The survey found physician practices’ state of ICD-10 preparedness varies widely. The majority (81 percent) are still optimistic they will be ready when the transition happens, and overall optimism toward ICD-10 readiness generally remained high. The findings were centralized around the themes of timing, readiness and challenges, including:

  • Physician practices don’t think ICD-10 will be delayed again. The majority of respondents (67 percent) believe the ICD-10 transition will take place on the October 1, 2015, implementation deadline.
  • Potential impact on revenue and cash flow is the greatest concern. Fifty-nine percent of respondents noted cash flow was a concern, while 12 percent indicated their greatest concern is staff productivity, followed by 11 percent who are most concerned the transition will be delayed again.
  • Respondents feel the biggest challenge will be dealing with unprepared payers. Forty-one percent of respondents cite lack of payer readiness as the most challenging aspect of the transition. End-to-end testing with payers remains a priority for practices, though the percent of those opting out of testing opportunities is increasing.

“Since 2013, Navicure has been conducting ICD-10 readiness surveys, which have allowed us to gain broad perspective on how we can best help healthcare organizations prepare for the transition,” said Jim Denny, founder and CEO of Navicure. “We remain committed to providing ICD-10 education and training resources for both clients and prospective clients, and we are eager to help them through a successful transition so they can maintain healthy revenue cycles and efficient workflows.”

This survey was a follow up to surveys conducted in April and November 2013. Navicure will sponsor additional surveys in 2015 to continue monitoring changes in attitudes and transition activities as the implementation deadline draws near. To view the complete, current survey results and analysis, visit www.navicure.com/surveythree.

About Navicure
Navicure’s cloud-based healthcare billing and payment solutions help healthcare organizations of all sizes increase revenue, accelerate cash flow, and reduce the cost of managing insurance claims and patient payments. Serving more than 50,000 healthcare providers nationwide, Navicure’s technology solutions automate account receivables processes, including claims management; patient eligibility verification; remittance and denial management, including automated secondary claims filing, appeals, and posting; reporting and analysis; and patient payment collections at and near the time of service. Navicure’s solutions are supported by its unique 3-Ring® Client Service which guarantees that a client service representative will answer every client call in three rings or less, even during times of transition such as 5010 and ICD-10.

Navicure is the exclusive billing and payment solution of the MGMA AdminiServe® Partner Network and an MGMA Executive Partner. In the past seven years, Navicure has been included among the top three clearinghouses in a field of more than a dozen solutions ranked by KLAS® (www.klasresearch.com), winning “Best in KLAS” distinctions in 2008, 2010 and 2012. Navicure also received the 2013 Gold Stevie Award for Healthcare Customer Service Team of the Year as part of the 2013 Stevie Awards for Sales and Customer Service. Navicure continues to be ranked among the fastest growing companies nationally in the Inc. 5000 and Deloitte Fast 500 rankings. For more information, please visit www.navicure.com.

About Porter Research
Porter Research – a Billian Inc. company – has for over 20 years worked diligently to understand and assess each client’s unique needs and to build a customized business-to business research program to achieve desired goals.

The company has worked with over 300 healthcare IT companies, providing many with Goto-Market Strategies based on its unparalleled experience, proven methodologies and knowledge-based analysis. Porter Research enables its clients to operate in a fast-changing market of new, emerging technologies and health reform issues such as ICD-10. It provides the unbiased results that healthcare clients need to make informed, strategic business decisions.

For more information, visit www.PorterResearch.com, follow @PorterResearch on Twitter, or call 678-282-1033.