Thursday, February 21, 2013

5 Important Considerations When Reviewing Products at HIMSS 2013

The majority of people meeting with HIMSS exhibitors are probably looking for products to meet a specific business need; like a computer-assisted coding tool to assist with their ICD-10 project.  Or perhaps a revenue cycle management application to improve cash flow.  As you view the hundreds of companies exhibiting at HIMSS, I suggest keeping these five considerations in mind:
                                                
Built with Open Components
Is the vendor software built with any “open component technologies?” An “open platform” design is no longer enough. Healthcare platforms built with “open component technologies” can be layered together and achieve greater value from the sum of their individual parts.

Utilizes an “As-a-Service” Business Model
Service-oriented business models are key to taming technical and financial challenges associated with modern software products. Look for vendors with SaaS (software), PaaS (platform) and/or IaaS. (infrastructure) business models.

Uses “Vendor-Agnostic” Standard(s)
Being locked into any specific “standard” – especially a standard developed and perpetuated by a vendor or small group of vendors - is not a good thing. Look for products that use the most open and accessible development languages, file systems and operating software available.

Allows Easy Entry and Exit of Your Data
Does the product include the ability to integrate, exchange, translate and manage data securely and on a bi-directional basis?  Ideally, the architecture of the product would allow "interface enabling" on a realistic and cost-effective basis.

Available Expertise, Guidance & Tools
What degree and combination of business, technical and operational expertise will be needed to get up and running on the product? Will a lot of expensive and potentially hard to find consulting services be needed to implement, configure and operate the product?  Can the vendor provide education, training and knowledge transfer supported via best practices and on a collaborative basis?

So while you walk the exhibitor halls of HIMSS 2013 looking for new products to enable your healthcare mission, consider how the above may impact the overall value and longevity of the product(s) you eventually select.

Wednesday, February 6, 2013

ICD-10 Topics at the Healthcare Mandate Summit


On Tuesday and Wednesday of this week, Edifecs sponsored the Healthcare Mandate Summit to bring together some of the top payers, providers and industry experts in the country to discuss compliance with multiple healthcare mandates.  Here’s some info on the ICD-10 mandate that I gleaned from the #MandateSummit hashtag 

Best Practices and Observations

1. Assess and quantify financial risk, use ROI to allocate budget and resources for...
2. Recommends holding contingency $$ at program level vs. project. Speeds reallocation
3. Budget is "lean and mean" hired a full-time project controller to manage
4. Highly disciplined schedule risk management. Deliver early & often vs. big-bang
5. ICD-10 is one of the biggest resource constraints is domain knowledge. Staff turnover and wage jumps are increasing.
6. Payer-provider collaborative’s – particularly with testing and communication - are key to success.

What happens after 2014?

Dennis Winkler from @BCBSM discussed how the effects of the transition to ICD-10 will be felt for years to come. Post 2014 is a question not many have focused on yet. That's changing.

1. Year 1-2 after ICD-10 - Stabilization phase
2. Year 3-5 after ICD-10 - Need to assess and monitor the data to ensure it's correct
3. Year 5 and beyond after ICD-10 - The time to use the data to revise fraud & abuse rules, etc.

Note: In my estimation, some organizations will start to leverage ICD-10's specificity and the information they glean from the ICD-10 data they collect starting in Year 3.  Medical policies, benefit plan designs, and provider contracting configurations - particularly in regards to quality and performance based contracts - are all areas that can be improved using ICD-10.

Prediction:

By Q3/Q4 of this year/2013, plans will start to see gaps in approach and remediation, esp. in managing legacy systems

Audience Polls

1. Only 45% have a tool/process for submitting/accepting test claims in an end-to-end test.
2. If partners aren't ready, 43% will only accept ICD-10 after a certain date; 33% will dual process

Monday, February 4, 2013

It’s Half-Time in the ICD-10 Super Bowl


Given the recent one year delay in the ICD-10 implementation date, I’d say we are right at half-time in the ICD-10 Super Bowl. Regardless as to whether you’re on a team that worked hard, focused on basic blocking and tackling, and gained some points in the first half or you’re on a team that made excuses for not trying, hoped ICD-10 would go away and that the lights will not come back on, this half-way point should be used as a time of reflection on how to best to return your team to battle and win the ICD-10 implementation game.

Take a short break

Use this time to gather your thoughts, think about what you’ve accomplished, and discuss matters with your assistants, coordinators and special team leads.

(Pretend) to be a raging bull

Half-time is emote-time. Recap what your team did well and not so well in the first half. Share your successes but also address your weak spots and/or failures.  Deliver criticism to the team as a group first and, if individual players warrant attention, consider how best to motivate them publically and/or privately on using the second half to turn things around.

Confirm your strategy and make adjustments if necessary

While you have your player’s attention, revisit goals and objectives that must be achieved in the second half leading up to October of 2014. Besides ensuring everyone understands their individual role and responsibilities, it’s important that all your players understand what’s needed to win the game. Spend a little time to reflect on what's working and what isn’t – and make changes accordingly.

Keep the Drive Alive and Avoid the Hail Mary Pass

There are all kinds of testosterone-laced clich├ęs one could invoke at half-time to inspire the brute strength many think is needed to pull off a convincing ICD-10 Super Bowl victory.  Just don’t forget that finesse, agility, team work and strategy are also requisites for success; teams often live and die solely on how well they work together.