Monday, September 26, 2016

Optimizing Payer and Provider Communications: A Necessary Burden or Strategic Advantage?

Exchanging data between healthcare providers and health plans/payers has been a contentious subject throughout the 23 years I’ve been working in healthcare IT. Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. And all the federal and state mandates laid on providers and health plans over the past decade have not improved matters.

This Friday, September 30th, a tweetchat will be held at 10:00am PT/1:00pm ET to discuss “Optimizing Payer and Provider Communications.” The chat is being sponsored by Availity and will be co-hosted by Mark Martin, Director of Product Management for Availity, and me, Steve Sisko. The chat will explore the communication challenges between providers and payers and the ways in which communications and data sharing between healthcare providers and health plan payers can be improved and optimized.

What are the Topics?

For the list of topics that will be discussed, see this page at Availity’s web site.

Which Providers & Health Plans Exchange Data?

The short answer? ALL OF THEM! But several factors do influence the types, volumes and frequencies of data exchanged between health plans and physician practices. These include:

1. Type of Health Plan: Medicare, Medicaid, Commercial, ASO, etc.

2. Product Type: PPO, HMO, POS, HDHP, FFS, etc.

3. Provider Type: Primary Care, Specialist, Imaging Provider, Pharmacy, Lab, etc.

What Type of Data Do Providers & Health Plan Payers Exchange?

The following types of business transactions demand the exchange of data between healthcare providers and health plan payers:

1. Eligibility & Benefit Inquiry
2. Prior Authorizations
3. Contracting including Practice and Provider Directory
4. Pharmaceutical Formularies
5. Billing/Claims
6. Credentialing
7. Treatment Plan Compliance Monitoring
8. Quality Measures

These data may be exchanged at different times – at time of contracting with the provider, pre-patient visit, upon patient check-in, during the encounter, upon checkout, or retrospectively, irrespective of the patient. In addition, certain transactions may not even apply based on the health plan type, product type and provider type.

As Mark Martin notes in Leveraging Technology to Enhance Payer-Provider Relationships, "the key is to forge pathways where these two spheres of data (provider and payer) can overlap and be leveraged to benefit both stakeholders."

Some Background Materials

The following studies, blog posts, articles and white papers provide additional information about data exchanges between medical practices, providers and health plan payers.

"Provider Data Management"

But Wait! There's More!

For more information on healthcare data, technology and services, consider following me and Mark Martin on Twitter.

Sunday, September 25, 2016

Healthcare Innovation: The X Factors, SMS Nudges & The Three C’s: Cost, Compression and Consequence

This past week, Eric Grossman, CEO of NextHealth Technologies was interviewed in the GuideWell Insights Lounge at the 2016 Oliver Wyman Health Innovation Summit. Kate Warnock, GuideWell Social Media Manager and healthcare innovation inquisitor, teed up several topics for Eric to share his insight and thoughts on:

1. The X Factors driving health plans to exit from the ACA marketplace,

2. Effecting consumer behavioral change via artificial intelligence and SMS messaging,

3. The 3 C’s driving change in the health industry: Cost, Compression and Consequence,

4. "Exponential trends' worth watching for.

The GuideWell Insight Lounge on YouTube!

You can see the entire interview here and all the other great interviews Kate gave during the #OWHIC summit at GuideWell's YouTube channel here. Note: the following questions from Kate and responses from Eric were pulled verbatim from the interview recording. I’ve recently discovered that many YouTube recordings are transcribed and that it’s easy to pull the transcribed text. So while  you may be thinking, "that guy Steve sure does have a lot of time on his hands," this entire post - start to finish - took me about 20 minutes. Hopefully you, my reader, gets as ,much value out of it as I did. 

Kate Warnock Interviews Eric Grossman

Could you have predicted the exit of so many health plans from the ACA marketplace? Could these exits have been avoided?

“You know I think it’s a great question. Hindsight’s 2020 and it’s easy to be a Monday morning, armchair quarterback. Yeah but I think sort of is my answer, you know, I’m first of all I’m a big proponent of market forces versus public policy, sort of driving the market. But we sort of had an untenable situation with all these uninsured Americans."

Two X-Factors

"But I think there were really two X factors that you can I saw as sort of what may drive exit. I think the first is public policy around individual mandate and, unfortunately, it hasn’t been strong enough to keep the healthy people in to drive sort of the fundamentals of insurance which is you’ve got to have a balance risk pool. So without that we, you know health plans, have been left with a lot of expensive risk. And that kind of comes to the second X Factor which is market forces and unfortunately a lot of these smaller health plans, in my opinion, sort of followed the bigger ones in terms of their pricing. And a lot of the bigger ones kinda came in with a low-cost narrow network plan design and unfortunately because of the prior X Factor it created an environment with a lot of losses that little health plans couldn’t sustain so they had to exit."

"So in hindsight those were X-Factors. We didn’t know how they would play out and it’s led to a lot of shake out but you know, as Obama says, I think they’re things that we can improve upon and and correct given that we have so many more people in the system there’s gotta be some benefits."

You [NextHealth] are pros at doing [behavioral analytics] so you give the consumer some nudges to help change behaviors. Could you give us some scenarios where those nudges just might take place for and how they impact behavior?

"The first thing that that we do in in driving consumer behavior changes is find someone among millions of members who the analytics thinks that we can be successful in changing behaviors. You know a lot of people don’t want to change so or they’re too acute, too sick to change. So let’s take out of network usage: so we talked about narrow networks. That’s when you leave the health plans Network and get a higher deductible, a higher copay and higher negotiated rates. Not a good thing but the majority people when they go out a network they don’t know they go out-of-network and it’s could be thousands of dollars to any consumer, a health plan.

Sarah and SMS Nudges

Eric told the story of using analytics and SMS text messaging to help 25 year-old mother Sarah Gomez make better decisions about obtaining care for her two kids.

Listen to Eric tell the story at 3:30 –6:50 in the recording.

Let’s take a little bit look down the road. Okay so there’s some other trends that might disrupt the health industry and, from your perspective, what are some of those things that you think can really help change the way we’re doing business in the health industry?

“I think a block chain is a good example of how sharing data in an open-source, cloud-based environment has helped other industries like Bitcoin and others. I think one of the presenters here Chris K from Humana talked about block chain. But I don’t think there’s a silver bullet around, you know, some sort of sea change events. I do think that the sea change is large enough to drive major change in industry and I I think I like and I like the 3 c’s. So The Three C’s are the first one is cost obviously paying out $8 in claims costs for every one dollar in premium isn’t viable for any health plan regardless of your reserves. So that’s led to the second C which is compression. And you mentioned some of the sort of what’s going on in the market with ACA and then the last C is consequence: whether companies are going out of business or policy change in Washington so I think those three C’s breed innovation and there’s no better drive of innovation than desperation.”

One last question maybe a little bit closer to home. Any other trends worth watching for exponential growth in the efficacy of prescriptive analytics?

"So those are some big words. I’ll tackle those one at a time I typically don’t understand more than three syllables. I would say that the biggest trend is the continued losses stemming from the Affordable Care Act is driving health plans and hospitals to absolutely focus on solutions that are presented at this conference, that drive attributable medical cost savings and consumer behavior change. The word is attributable. How do we know that when I reach in with a screwdriver that it truly was my screwdriver that turned the screw? So that’s attribution. And I frankly don’t think health plan executives really care about the sausage machine; they need outcomes.

And it just so happens that prescriptive analytics or what to do next; the what and how well. And randomized control trials and machine learning are just absolutely no regret investments that you can make in the wake of all the market forces and all the headwind we’re up against."

Check back for more insight on healthcare data, technology and services. And consider following me on Twitter.

Thursday, September 22, 2016

Healthcare’s Transition from a B2B to B2C Business Model

The 2016 Health Innovation Summit hosted by Oliver Wyman Health & Life Sciences unit kicked off yesterday in Chicago with the theme of this year’s event being “The Consumer Imperative: Transforming Healthcare From The Outside In.” 

On day one, my friend Kate Warnock – Social Media Manager at GuideWell Health - was at the summit interviewing key individuals at the GuideWell Insights Lounge. This is the 2nd year that the GuideWell Insights Lounge has stationed itself at the OW Summit; the GW Insights Lounge is apparently a new fixture at major healthcare conferences. I gotta say I like how Kate and GuideWell capture, curate and share valuable information about healthcare innovation, thought leadership and trends. 

One of Kate’s first interviews of the event was with Terry Stone - Global Managing Partner for the Health and Life Sciences Practice - at Oliver Wyman. Terry shared with Kate some insight into the difficulty healthcare payers are having with their transition from a business-to-business (B2B) to a business-to-consumer (B2C) business model. Terry also shared how innovators must understand the entire healthcare ecosystem and outlined the 'category' of those who might be in the best position to really disrupt the health market.

Thank's YouTube for Poor Man's Transcription

The following is a transcription I pulled off of the YouTube recording created by the GuideWell Insights Lounge. You can see the entire interview here. You may also want to check out tweets from the summit tagged with #OWHIC.

We've been talking about the consumer in the health industry for a long time yet we still seem to lag behind behind other industries. Why is that and what can we do to fix it now?

"That's a great question. I think in the last three years, in some way shape or form, we've touched on this each year: about where are we and why are we kind of stuck? That actually is a key part of why we focused the conference on what we have this year. Because healthcare does seem to be a little bit stuck. 

B2B-B2B2C-B2C (Chromosomal Language of Biz Models)

And I think it's a great question. We've given a lot of thought to it. I'll start by the first, most basic premise being: healthcare has always been a B2B industry versus a real business-to-consumer industry. So in B2B businesses, health plans were selling to large employers. Right? Quite frankly, provider systems were negotiating with health plans and quite frankly the consumer, in some ways, was an afterthought. Okay. But that sounds a little overly simplistic. Like okay. So it's B2B now we have to be B2C. But I think it's really important that people understand what happens when you're in B2B market versus B2C and why does that make it so difficult to change?

Complexity of B2B Market Must Be Turned Upside Down

“So first of all, in a business-to-business market, your buyers are often buying for a lot more like rational logical reasons. You also have very sophisticated buyers buying a complicated service and, in some ways unintentionally I would argue, the product gets more complicated as each side tries to prove to one another that they're adding more value. Right? It's almost the antithesis of what you need for the consumer and that's a really hard paradigm to break and that actually is most pervasive through most of healthcare.

Pharma has Apparently Made the Transition

I'd argue the drug industry is probably the closest to having found its way once they had access to direct-to-consumer advertising, which gets a lot of backlash for a lot of reasons but they're one of the first parts of healthcare that's really started to have to embrace what it is about the consumer and what they need and how do I meet them where they are?”

How important is it for organizations to really understand the full ecosystem and to be able to connect the dots - another theme here at the summit?

“Sure I'm we talked a lot about the ecosystem and healthcare and it's funny we talk about the healthcare system in the US and I think what someone said it great ones where they commented that we don't have a system what we have is a bunch of parts and pieces that are all stuck together and you get this sort of random ecosystem, if you will."

Carve Out a Spot for Yourself that's Sustainable 

"I think it's really really important that players in the space understand where they sit in the ecosystem and have a consumer view set and how the consumer thinks about interacting with the parts and pieces and how you stitched together in order to add value to the consumer and simplify their life while also making sure you carve out a spot for yourself that's sustainable where you can make money because many of these are going commercial enterprises.”

Who do you think is in the best position to really disrupt the health market?

“It’s sort of the 10 million dollar question. I think if I knew specifically I probably wouldn't be sitting here and I'd be betting my money on someone else. But I will speak kind of categorically that, in my role, I see lots of players in healthcare. I cut across payers, providers, life science companies, health services and tech innovators. And what I have kind of strongly come to believe is that most likely the disruption that really changes things going to come from the outside."

Get Traction with People You Frequently Touch 

"So that healthcare is in some capacity going to be airBNB’d or uber-ized. And by that I don't mean ‘Uber for Health,’ I mean somebody out of left field takes an industry that's kind of not delighting the stakeholders and has excess waste and it's going to kind of disrupt it and shake it out. And that could be in the form of the Apple’s or the Google’s of the world. Right? It could be the Walmart’s of the world. You know that the average Walmart consumer, I believe, goes in more than twice a week, over a hundred times a year. If you start getting traction with people who have that much of a frequent touch with you there's a lot you wind up doing. And I think when I advise my clients I say: “You should be watching for the people on the fringe - not your competitor down the street.”

What do you hope is achieved at this year’s summit?

“So what we're hoping to achieve this year is going beyond the basic part of innovation; which is ‘Oh, what's that company do? Or what's that technology? Or that seems really neat. And actually what we've been striving to do for the last couple years is get underneath “what's the magic in what makes that company special? What is it that makes it stick? Why are consumers delighted? And how did we get beyond the basics of the functions and the features and figure out what it is that really makes it sing and what really makes it kind of win. And I think that's a lot of what will be sharing."

It's About Culture, Mindset, and Behavioral Change. Oh My!

"So we'll be talking not only about innovative companies but about culture; about mindset; about how do you drive behavioral change in consumers. So it's just the cut all across the board and we're really excited about how we think it will help our clients, help other stakeholders in the healthcare industry actually have more impact and delight their customers.”

Tuesday, September 20, 2016

What are Healthcare Executives Focusing on for 2017?

The Healthcare Executive Group is a members-only network of C-suite health plan and health system executives that collaborate with each other and certain other healthcare industry vendors and thought leaders to identify and promote innovation and transformation within the healthcare industry.

Every year for the past six years, the HCEG developed a ‘Top 10 List’ of the priorities and challenges considered "top of mind" for its members and their healthcare organization. The 2017 Top 10 list was recently developed during the group’s Annual Forum held in New York City last week. The HCEG news release announcing the 2017 Top 10 list can be found here.

What's On the HCEG Top 10 List?

My quick take on the Top 10 list reveals five main themes that HCEG members identified as critical to the healthcare industry:

1. Value-based Reimbursement
2. ACO’s and Analytics
3. Consumer Health & Transparency
4. Mobile Health
5. Retail Health and Care Redesign

Another Top 10 List? So What?

While a Top 10 list developed by a group of healthcare executives is certainly interesting, if taken alone it may not be perceived as having huge value. But according to HCEG’s news release today, their Top 10 list forms the basis for “examining critical issues, priorities and challenges for health plans in the post-reform era and will be complimented by a 7th annual national industry-wide survey with executive-level support from HCEG sponsors.

So, depending on how these Top 10 items are fleshed out by HCEG, its sponsors and healthcare industry thought-leaders over the next few weeks, these Top 10 items and the supporting information provided by the HCEG may very well provide unique and valuable insight to those of us working in this era of rapidly changing and advancing healthcare reform.

Check Back for More

As 2016 advances toward 2017, I’ll keep an eye on this Top 10 list and similar industry news; and I’ll be sure to share with the readers of this blog and those who follow me on Twitter. You can also follow the HCEG on Twitter.

Monday, September 12, 2016

Tips for Promoting and Hosting Tweetchats

I consider tweetchats one of the most powerful uses of Twitter since they are a way of learning from crowd-sourced information and ideas about very specific topics. Over the last few years I’ve participated in dozens – probably hundreds – of ‘tweetchats.’ And I’ve hosted more than a few chats.

Recently, several people have reached out to me inquiring about tweetchats: how to promote them, how to host them, and other practical tips about tweetchats. I’ve also reached out to a few people (including @AleishaBrooke) who hosted tweetchats I've participated in. This blog post is for the above referenced individuals.

Promoting the Tweetchat
1. Invite Relevant Guests and Influencers to Participate

Getting an influencer in on the chat can really boost its visibility and authority. Many influencers have large audiences that they will involve in the chat too.

Invite your biggest fans to the chat. Tweeting is the best way to promote a chat to your fans. Typically you should do it 12 to 24 hours before the chat, as people tend to be busy and are likely to forget.

2. Invite People Personally

If you’re certain that a friend, role model, or follower would be the perfect fit for your Tweet chat community, take the time to invite them personally. Make it easy for them to know when the chat will occur and provide them the topics in advance so they can best participate.

3. Promote the Chat Via Channels Other Than Twitter.

If you have a Facebook, LinkedIn and/or other social media account, share information about the tweetchat via those channels

4. Define and register a hashtag

A unique hashtag is a prerequisite for a tweetchat. You can have one without a hashtag. So select a hashtag that is short, unique and easily remembered. And make sure to ‘register’ the hashtag at sites like Symplur

Graphics and Images
1. Incorporate Eye-Catching Visuals at Every Opportunity

There are several ways you can incorporate visuals into your Twitter chats. You can use images to promote your upcoming chats, to convey the questions/topics of the chat, and to provide certain ‘logistical’ reminders before and during the chat.

2. Use Images to Advertise the Chat and for Each Topic/Question

Images are effective ways to convey reminders like being sure to include the hashtag in every tweet, tagging responses to specific topics/questions with the id number (T2, A2, etc.).

1. Provide 'logistical’ messages before, during and after the chat.

Tweets like the following can be prepared in advance and then easily copied and tweeted during the chat. You might also consider scheduling certain tweets.

60, 30 and 5 Minutes before the Chat
The <#chatname> will start in <number> minutes. See here: <link to topics or info on the chat>.

Start of the Chat
Tweet: “It’s time for our chat on <chat theme.>”

Tweet: “We’ll use a T1:A1 format: for each Topic 1 thru 6, begin your response w/ T1-T6. Please include <#chatname> in all tweets”

Tweet a hello/welcome to as many attendees as you can – especially any influencers or ‘special guests.’

During the Chat

1. Use a tool to help identify and manage your tweets.

Consider using a tool like Tweetdeck to provide several channels or streams that can be used to monitor each topic of the chat. For instance, I use Tweetdeck as follows:

2. Welcome the Newbies And Lurkers

Take time to acknowledge newcomers and lurkers. A small effort to help them feel welcome can go a long way to encourage their participation and to help ensure they return for future chats. Many of the “newbies” may someday be your biggest evangelists if you treat them right!

3. Respond to Every Question or Comment Directed to Your Account

Tweetchats are all about engagement. Don’t fail to acknowledge those that tweet at your account.

4. Warn/remind about of upcoming topics:

Get ready for Topic #1 coming up soon! <#chatname>
Topic #2 on its way shortly! <#chatname>
Get ready for Topic #3 coming up soon! <#chatname>
Topic #4 coming in a minute <#chatname>
Get ready for Topic #5 coming up soon! <#chatname>

5. Periodically remind people to include hashtag by tweeting:

“Remember to include the <#chatname> hashtag in each of your tweets.”

6. Periodically remind people of format for responding:

“Remember to begin your response w/ the topic number and include <#chatname> in all your tweets”
7. Two to Three Minutes Before the Chat Ends

"Everyone, please thank @_____ from _____ for adding so much value to our [#chatname]."

At the end of the chat
Tweet: “Thank you all for attending the <#chatname> today!

Thank all the people you can. A group thank you listing multiple participants is good.

After the Chat is Over
1. Recap the Chat

A tweetchat is a great source of information. Information that should be shared with participants who may have missed tweets during the frenzy of the chat. And for others who may have missed the the chat. A tool like Storify can help with this. You can also curate tweets in a blog post; which is my favorite approach.

2. Create a blog post that summarizes and comments on the best tweets on the chat.

3. Share the stats on the chat

If you’ve had a good chat, you may want to share the stats of the chat. If you’ve registered the hashtag for the chat on Symplur, you can pull the stats from there and share.

General Tips
1. Prepare all your tweets in advance so you can just copy and tweet them. This saves you time to address other needs.

In particular you can prepare some tweets that contain links to supporting materials.

2. Understand how others participate in tweetchats

See this post I wrote a while ago about participating in tweetchats:

That’s All Folks!

For more information like the above and to learn more about healthcare data, technology, and services -including the use of social media  - consider following me on Twitter.