Focus on Reducing the Cost of Care

Reducing the cost of care requires aligning incentives of providers, payers and patients

Congress, government agencies, presidential candidates, consumers and the industry itself talk about the need to lower healthcare costs, but what does this entail? Many want to target drug costs and the Centers for Medicare and Medicaid Services has mandated hospitals to post a list of their standard charges by diagnostic-related group, in an effort for consumers to have transparent cost options. And providers need to collect every penny owed them and combat revenue leakage. This month, Healthcare IT News, MobiHealthNews and Healthcare Finance News take a look at what all of this means and how technology, as always, is spurring innovative solutions.

-- Susan Morse, senior editor, Healthcare Finance News

What you need to know

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Self-insured employers are playing an increasing role in taking on the status quo to lower costs

by Susan Morse

The insurance industry will remain but the traditional PPO is beginning to come to an end as costs are outstripping inflation and wages, CEO says.

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Financial incentives plus information decrease patient preference for potentially wasteful diagnostic testing

by Jeff Lagasse

Discussing benefits and risks of low-value diagnostic testing via head CT scan with patients can reduce the prevalence of such testing.

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Reducing wasteful spending in healthcare by curbing administrative complexity

by Jeff Lagasse

Wasteful spending is an increasingly thorny problem in healthcare, especially with the industry comprising an ever-larger portion of GDP.

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Operational efficiencies saved hospitals from further earnings decline

by Max Sullivan

Mergers and acquisitions helped grow revenue but it's taking health systems longer to realize expected synergies.

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LCMC Health uses pop health tech to attack value-based care head on

by Bill Siwicki

Among other successes, the health system surpassed its first-year revenue goals ($3.6 million versus $3.1 million) through a combination of quality improvements and shared savings.

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Cerner teams up with Uber to help patients get to appointments

by Mike Miliard

As the most recent health IT vendor to partner with a rideshare company, Cerner will embed access to Uber's non-emergency transport within the EHR workflow.

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'Telehealth titans' discuss cost-savings of virtual care, describe the hospital of the future

by Mike Miliard

Longtime telemedicine pioneers from the provider and vendor sides see a near-term future of more efficient care, and describe a longer-term view of "virtualist centers in what were formerly known as hospitals."

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New tool helps promote ICD-10 codes for social determinants of health data

by Mike Miliard

eHI's collaborative includes Humana, United HealthCare, American Hospital Association and others who are working to encourage use of existing ICD-10-CM Z codes and develop new ones.

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Healthcare costs projected to rise 5% in 2020 as employers look to control costs

by Jeff Lagasse

Despite this cost increase, 95% of employers are very confident their organization will continue to sponsor healthcare benefits to active employees.

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Hospital replaces manual Rx process with e-filling, achieves error rate of just .006%

by Bill Siwicki

LIFE St. Mary hospital uses Tabula Rasa HealthCare’s pharmacy platform, which has helped lead to a 16% decrease in ER use and a 27% decrease in total hospitalization.

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VA, UL collaboration advances case for medical device security standards

by Benjamin Harris

The agency worked for two years with the certification company on a cooperative research project that highlights the value of standards for connected devices and IoMT.

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FDA approves record number of generic drugs, claiming savings to the healthcare system

by Jeff Lagasse

The FDA is also approving greater numbers of complex generic drugs, which are more difficult to replicate and traditionally lack competition.

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Hospital bottom lines could benefit from more clinical integration in the supply chain

by Jeff Lagasse

A tiny fraction of healthcare executives, 5%, said clinical integration is their supply chain't top priority.

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Physician-led accountable care organizations outperform hospital-led counterparts

by Jeff Lagasse

On average, physician-led ACOs produced almost 7 times the amount of Medicare savings per beneficiary than hospital-led ACOs.

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Telehealth eliminates time and distance to save money

by Susan Morse

In the age of consumerism, virtual visits meet consumers where they are, says Anthem executive.

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Expanding biosimilars market holds potential for significant savings to state Medicaid programs

by Jeff Lagasse

The anticipated savings would increase in a scenario in which biosimilars made up a larger portion of the total market share.

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Poor digital billing process associated with uncollected payments

by Max Sullivan

Younger consumers are especially are willing to switch providers over a bad billing experience.

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For one clinic, referral authorization tech cuts process from 5 minutes to 25 seconds

by Bill Siwicki

Automation changed the payer administrative tasks landscape at Primary Care Offices. For example, the clinic has gone from one referral coordinator per physician to one per three.

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Smoking cessation efforts may reduce avoidable hospital readmissions

by Jeff Lagasse

Smoking cessation efforts could ultimately be a strong investment that allows the hospital to retain more reimbursement dollars.

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UnitedHealthcare app gives members on-demand access to telehealth services

by Max Sullivan

The app also allows users to manage prescriptions, see information on deductibles and out-of-pocket spending, and locate physicians and hospitals using GPS technology. 

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Pressure ulcers cost the health system $26.8 billion a year

by Susan Morse

UCLA researchers have found that pressure ulcers first form on the inside of the body at a cellular level, says researcher and CEO Martin Burns.

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Health leaders ramp up AI investments as confidence in the technology grows

by Nathan Eddy

Administrative process improvements top the list of investment priorities, led by technologies to help automate business processes like administrative tasks or customer service.

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AMA Board Chair on AI's opportunities for optimizing healthcare operations

by Mike Miliard

Dr. Jesse Ehrenfeld explores the practical implications of artificial intelligence and its impacts on quality, safety, cost reduction, patient engagement and more ahead of his roundtable session at the Connected Health Conference in Boston Oct. 16.

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HHS and CMS are offering safe harbor to Stark Law to promote value-based, coordinated care

by Susan Morse

Example of change is allowing a hospital to donate free cybersecurity software to each physician that refers patients to its hospital.

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Go365 wellness program reduces healthcare costs, Humana says

by Susan Morse

Members are given financial and other rewards for participating.

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Atrium Health merges SDOH data into its Cerner EHR to improve care, trim costs

by Bill Siwicki

The North Carolina health system expects to see a decrease in emergency department utilization and readmission rates.

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A quarter of total U.S. health spending estimated to be waste

by Jeff Lagasse

Administrative complexity accounted for the most waste, estimated at $256.6 billion, and pricing failure was a close second.

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InterSystems unveils Clean Data as a Solution, helping normalize datasets for analytics ROI

by Mike Miliard

The new offering, which includes patient matching, aggregation, normalization, deduplication and more, can help health systems launch more effective AI and machine learning projects, the company says.

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Cerner teams with i2i for Medicaid cost savings tools

by Nathan Eddy

The integration between Cerner's HealtheIntent and i2i’s analytics products will offer clients a broader set of pop health management capabilities, the companies say, enabling more data-driven insights for Medicaid populations.

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Some ICU admissions may be preventable, saving money and improving care

by Jeff Lagasse

While there's no universal standard for what constitutes a preventable ICU admission, those with chronic medical conditions may be good candidates.

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Aledade touts cost saving successes of its ACOs

by Nathan Eddy

The company, founded by former National Coordinator for Health IT Dr. Farzad Mostashari, says advanced analytics are helping its accountable care organizations drive big efficiencies.

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Rising animosity toward healthcare costs means ripe opportunity for insurtech startups

by Dave Muoio

As politicians and their constituents grapple over Medicare for All, these well-funded startups hope to capitalize on the public’s appetite for new, consumer-friendly approaches to health insurance.

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Revenue cycle, billing improvements trump lawsuits when it comes to collecting

by Jeff Lagasse

Making the process more palatable for consumers can help to avoid revenue leakage and lawsuits.

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Vim's platform raises $24M to guide patients toward high-quality, low-cost care

by Dave Muoio

Optum Ventures and Premera Blue Cross led the Series B round.

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CMS unveils new rules aimed at clinician burden, patient experience

by Mike Miliard

The Omnibus Burden Reduction and Discharge Planning rules both aim to reduce red tape and enable transparency, says Centers for Medicare & Medicaid Services Administrator Seema Verma.

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3M and M*Modal launch new AI-powered CDI tool

by Mike Miliard
For their first new post-acquisition technology, 3M Health Information Systems and M*Modal have unve
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Health 2.0: Providers must reinvent themselves to achieve quadruple aim

by Mike Miliard

Dr. Albert Chan, chief of digital patient experience at Sutter Health, says health systems have to get better at interpreting data in novel ways to make good on their promise to patients.

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How should your organization assess telehealth ROI?

by Mike Miliard

A new report from Manatt Health Strategies points to big differences in how return on investment should be gauged, depending most importantly on provider type – but also on acuity mix, IT infrastructure, staffing and other considerations.

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How merging financial and clinical data saved Yale New Haven Health $150 million

by Bill Siwicki

The massive undertaking, based around a new cost accounting system, is all part of a strategy to prepare for value-based reimbursement.

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How asynchronous telemedicine saved SSM Health 18 minutes per visit

by Bill Siwicki

The health system is averaging 600 virtual visits per month with its new telehealth offering, gaining efficiencies for caregivers and boosting patient satisfaction.

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How mobile RFID communications and OR workflow tech saved one hospital $1M annually

by Bill Siwicki

At Adventist Health White Memorial, reducing OR turnaround time by just three minutes may seem small – but at five turnarounds per day, multiplied by six operating rooms, it adds up to $974,160 per year.

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How University of Rochester uses AI to reduce risk of failed follow-up

by Bill Siwicki

The University of Rochester Medical Center uses analytics with natural language processing to support the organization’s Backstop tracking program at six of its hospitals. It has seen a 29% increase in the recommended examination completion rate.

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Cerner partners with Simplee on price transparency

by Nathan Eddy

Cerner will add Simplee's financial engagement platform to its revenue cycle portfolio and incorporate its billing tools into its consumer-facing technology

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Physician pay increased in 2018 while productivity remained stagnant

by Jeff Lagasse

Physician compensation rebounded from a stagnant 2017, but the increase in productivity was negligible.

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NantHealth using partnerships to provide better patient outcomes

by HIMSS TV

Mark Jackson of precision medicine company NantHealth was at Health 2.0 looking for new opportunities to bring valuable cloud-based data to physicians at the point of care.

Video

Integrating cost into the care conversation

by HIMSS TV

There are ways patients and providers can more effectively navigate the complexity of healthcare costs, says Rebekah Angove, vice president at the Patient Advocate Foundation.

Video

Putting AI to work for better care at lower cost

by HIMSS TV

Leonard D'Avolio, founder and CEO of Cyft, says machine learning is only a means to an end, helping organizations learn from data more quickly and intuitively.

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Healthcare is transforming to take on challenge of value-based care

by HIMSS TV

This is the year that health tech ideas are coalescing toward a real sea change, says Dr. Charles Alessi, chief clinical officer at HIMSS International.