Health care startup aims to eliminate hospital and doctor bills

https://www.axios.com/startup-ooda-health-aims-to-eliminate-hospital-doctor-bills-e1fc6bdc-6755-4627-b954-59fc35326d3e.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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New payment startup Ooda Health has raised $40.5 million on the premise that its technology will make sure patients never get another bill from a hospital or doctor.

Why it matters: Ooda Health not only has big-name venture capitalists on board (Oak HC/FT and DFJ led the funding round), but also has large health insurers and providers as investors. However, while the company attempts to cut administrative waste, it won’t address the health care system’s underlying pricing and spending habits.

The details: Anthem, Blue Cross Blue Shield of Arizona, Blue Shield of California, Blue Cross Blue Shield of Massachusetts, Dignity Health and Hill Physicians are the initial industry investors.

  • Ooda Health would not disclose their investments. Seth Cohen, Ooda Health’s co-founder and president, said the company got its start after Blue Shield of California CEO Paul Markovich recommended a meeting with Dignity Health CEO Lloyd Dean.

How it works: Health insurance companies pay Ooda Health an administrative fee and a risk-sharing payment. Ooda Health then connects with hospitals and doctors and pays them instantly based on what is in the electronic health record instead of a traditional medical claim. Any outstanding payment issues would be handled through the insurance company, rather than directly by providers.

  • Cohen made this analogy: If you’re at a restaurant and you use your credit card for the meal, the restaurant gets paid immediately. The credit card company, not the restaurant, then follows up with you about how to pay off what you owe.
  • Health insurers would avoid late fees and penalties for missing payment deadlines, patients who are encountering higher deductibles and out-of-pocket costs wouldn’t have to pay providers directly, hospitals wouldn’t have to chase outstanding balances, and providers would get paid quickly.
  • “It is a bad model for providers to collect from patients,” Cohen said, noting that collection agencies are cut out in this scenario.

Yes, but: Out-of-network hospitals and doctors would still charge exorbitant fees on their own, and administrative work wouldn’t be completely eradicated. This also makes the electronic health record a de facto tool for billing instead of solely a repository for patient medical information.

 

CHS faces investigation related to EHR incentive program

https://www.beckershospitalreview.com/legal-regulatory-issues/chs-faces-investigation-related-to-ehr-incentive-program.html

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Franklin, Tenn.-based Community Health Systems has received a civil investigative demand related to the company’s adoption of EHRs and adherence to the meaningful use program, according to CHS’ latest financial filing.

Under the meaningful use program, now called the promoting interoperability program, CMS distributed incentive payments to eligible providers for installing EHR systems and using them to engage patients and families and to improve care coordination.

In its financial filing, CHS said it is responding to a civil investigative demand related to its “adoption of electronic health records technology and the meaningful use program.”

Federal and state authorities issue these types of demands to collect records and information related to ongoing civil investigations, including False Claims Act cases.

CHS declined to comment on the investigative demand beyond what is included in the financial filing.

EHR incentive payments grabbed the attention of federal regulators after HHS’ Office of Inspector General released a report in 2017 that revealed Medicare made approximately $729.4 million in EHR incentive payments to medical providers who did not comply with federal requirements.

 

Trinity Health chooses Epic for integrated EHR, revenue cycle management

http://www.healthcarefinancenews.com/news/trinity-health-chooses-epic-integrated-ehr-revenue-cycle-management?mkt_tok=eyJpIjoiTXpGak1qTmhNbVUxWVRsaSIsInQiOiJwQlwvU1ZxcTU2bExreng4NXpEZ0Q2WkRYeldUbzlNM3kwWlJFeER5WlwvS3NqQ0lvMFwveHVNRExjdmVkdkRNMTBOb3FlZlwvOUJIMTYzR0tVWlNlcDJWMlRkMVM4TzZCK1I3XC9NSkFkc1U5QjhYaTZXKzhaUnY0M2RKNGNubTR5dk84In0%3D

St. Joseph Oakland is part of the Trinity Health system in Pontiac, Michigan. Credit: <a href="https://twitter.com/sjmo_hospital/status/988871404237086721" target="_blank">Twitter</a>

 

The Michigan health system, one of the largest in the U.S., says it wants to roll out a single, enterprise platform to deliver “people-centered care.

It’s a big week for Epic implementations in the Upper Midwest. The world-class Mayo Clinic is ready to go live with its newly-minted system on May 5, after more than three years of work. And today comes news that sprawling Trinity Health, based in Livonia, Michigan, has selected Epic to build out its own enterprise-wide electronic health record and revenue cycle management system.

It’s a process the Catholic health system expects will take four years to implement across its 94 hospitals and 109 continuing care locations. The expected cost of the deal was not disclosed.

Trinity officials said the integrated Epic platform will allow the health system to improve experiences for patients and clinicians across the board.

“People deserve customized and convenient healthcare experiences, including simple access to a complete health and billing record,” said Mike Slubowski, president and chief operating officer of Trinity Health.

“At the same time, physicians and clinicians need tools that make it easier to practice medicine,” he said. “We look forward to implementing a single, enterprise solution enabling us to deliver excellent, people-centered care.”

It’s the same appetite for a seamless and enterprise-wide system, across all locations and functionalities, that Mayo Clinic CIO Christopher Ross said was a factor in its choice of Epic back in 2015. That health system had been “steadily working toward a convergence of its practice” for several years, he said at the time, and best-of-breed would no longer suffice for achieving those goals.

At Trinity Health, the plan is to leverage Epic as a fully-integrated system for a single, comprehensive health record for every patient.

Trinity tapped Epic on the strength of the different products offered on that single, unified platform, officials said – not just enterprise EHR and revenue cycle, which will eventually go live at all of its hospitals, ambulatory centers, physician offices and continuing care programs, used by some 100,000 employee – but also online scheduling, e-visits and  online bill pay.

“We are confident a single platform will enable new levels of innovation, consumer focus, clinical and business integration and efficiency to help us build our people-centered health system,” said Slubowski. “It will also help align people, process and technology to create a culture in which people-centered care becomes the standard way we care for the communities we serve.”

Epic President says EHRs are not walled off, integrations are just hard

https://medcitynews.com/2018/03/epic-president-says-ehrs-not-walled-off-integrations-just-hard/?utm_campaign=MCN%20Daily%20Top%20Stories&utm_source=hs_email&utm_medium=email&utm_content=61259603&_hsenc=p2ANqtz-9KZbK2I0aYCjcH-L8_oANZXZSsq2K8jondsl8vHF0rHfcb8_zR65kRtQV-cDsnd_VomLuc-G2in5Y4wJcsFWrR8zgKJg

 

 

18k Kaiser nurses vote for option to strike at California facilities

https://www.beckershospitalreview.com/human-capital-and-risk/18k-kaiser-nurses-vote-for-option-to-strike-at-california-facilities.html

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Tens of thousands unionized registered nurses at facilities owned by Oakland, Calif.-based Kaiser Permanente voted for the option to call a strike if an agreement is not reached on issues such as staffing and patient care, according to a California Nurses Association news release.

The CNA — which represents 18,000 RNs who work at more than 20 Kaiser Permanente medical centers and dozens of medical clinics and office buildings in California — said nurses are calling on the healthcare giant to improve patient care standards.

“With this vote nurses are making it absolutely clear: We are ready to strike to make sure our patients get safe care,” said Zenei Cortez, a South San Francisco Kaiser Permanente RN and co-president of CNA.

Union officials said nurses specifically are calling on Kaiser Permanente to support their proposals regarding staffing and patient care standards. These include bringing in a charge nurse on each unit, as well as resource nurses to assist other nurses so they are able to take breaks. The union said nurses also propose “interventions with pharmacy to expedite patients receiving correct medications,” and “increased staffing when needed due to emergent conditions and heightened patient volume.”

Additionally, the CNA said nurses are opposed to Kaiser Permanente’s proposal to move from the existing GRASP patient classification system to Epic Acuity, which nurses contend is less transparent. Nurses are also opposed to what they said are Kaiser Permanente’s plans to cut pay for new hires by 10 percent in the Sacramento region, and 20 percent in Fresno and the Central Valley.

Regarding the union’s claims about staffing, Debora Catsavas, senior vice president of human resources for Kaiser Permanente Northern California, said in a statement: “Our nurse staffing meets, and often exceeds, state-mandated staffing as necessary for patients, based on the complexity of their medical conditions. We employ more than 18,000 nurses, and have hired more than 2,000 nurses in multiple key specialty areas over the last three years, and continue to hire more as needed.”

As far as the move to Epic Acuity, Ms. Catsavas said the move addresses various issues nurses have raised about the existing GRASP patient classification system.

“GRASP is a system from the 1980s based on studies of nursing work flows conducted nearly 50 years ago. Epic Acuity is an up-to-date, comprehensive system that directly reflects the care provided and allows nurses to spend more time at the bedside,” her statement reads. “Epic Acuity uses clinical information directly inputted by the nurses into our electronic medical record.”

She said Kaiser Permanente also offered nurse representatives paid time to talk about and review Epic Acuity’s implementation.

Furthermore, Ms. Catsavas said there are no proposed wage cuts or wage reductions for current nurses. However, she said Kaiser Permanente last October proposed a new wage scale for new nurses hired in the Sacramento, Central Valley and Fresno areas on or after Jan. 1, 2019, “to more closely align with the lower cost of living in these markets.”

She noted Kaiser Permanente nurses in Sacramento, the Central Valley and Fresno earn 24 percent, 37 percent and 45 percent more than non-Kaiser Permanente nurses, respectively.

While the Kaiser Permanente nurses have authorized a potential strike, no strike date is set. For a strike to occur, nurses would have to provide at least 10 days notice.

Ms. Catsavas said Kaiser Permanente anticipated a strike authorization might occur but believes an agreement is within reach.

 

 

Healthcare execs say EHRs don’t do enough to manage value-based contracts

https://www.healthcaredive.com/news/healthcare-execs-say-ehrs-dont-do-enough-to-manage-value-based-contracts/518330/

Dive Brief:

  • A survey of 100 healthcare executives found that most of them are seeing ROI on value-based contracts, but investments in EHRs are not sufficient to manage those contracts.
  • The Sage Growth Partners study found most respondents were not satisfied with their EHRs’ “ability to help them manage core functions necessary to succeed in (value-based care) — such as care coordination, risk stratification, decision support and patient engagement.”
  • About two-thirds of respondents said EHRs are not delivering promises concerning lower costs, better population health management and improved patient and physician satisfaction.

Healthcare providers are increasingly looking to EHRs and third-party population health management solutions to help them with value-based care.

A recent Healthcare Financial Management Association (HFMA) survey found that value-based payment programs doubled since 2015. Nearly three-quarters of executives in the HFMA survey said their organizations achieved positive financial results, including return on investment, from value-based payment programs.

Although providers expect value-based programs to continue to increase, the new Sage Growth Partners survey found dissatisfaction with EHRs and concern they are not helping enough in value-based care. The report found 64% of respondents said EHRs haven’t delivered many critical value-based tools. At least 60% of respondents said they are looking for value-based solutions beyond EHRs.

The survey included a finding that will likely get the attention of EHR and population health management vendors — half of respondents said they are somewhat or highly likely to switch population health management vendors over the next three years.

Nearly three-quarters of survey respondents have had an EHR for at least three years. About half also have third-party population health management solutions. These findings offer a glimpse into the dissatisfaction as well as opportunity in population health management.

The executives surveyed said there are issues with interoperability, addressing social determinants of health, patient engagement, stakeholder coordination and risk analytics. They also spoke of health systems having trouble aggregating and using data from numerous EHR systems and other data sources.

These issues have led half to two-thirds of healthcare executives turning to population health management or do-it-yourself solutions beyond EHRs “to compensate for the lack of these capabilities within their EHRs.” Many of those executives said population health management solutions enabled their value-based success. Those successes are also coming at a lower cost than the investments in EHRs.

The study authors predicted more healthcare executives will look beyond EHRs in the coming years to help with value-based contracting. They said “suboptimal tools” that manage care and costs for populations won’t be enough in coming years.

“As (value-based care) reaches the tipping point, and as they take on programs with greater risk and greater complexity, they will need to continue looking beyond their EHRs to get the functionality they need,” the authors wrote.

 

Can Amazon do to health care what it did to books?

http://money.cnn.com/2018/02/01/news/economy/amazon-health-care/index.html

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First books. Then groceries. Now health care?

Amazon shook up the health care world on Tuesday, announcing it was partnering with fellow heavy hitters Berkshire Hathaway (BRKA) and JPMorgan Chase (JPM) to address soaring costs.

Amazon (AMZN), which has advanced light years from its origins as an online bookseller, has had a dramatic impact on many of the industries it’s touched. When it moved into cloud services and streaming shows, it left rivals scrambling to catch up. Last year, it bought Whole Foods, shaking up the grocery space.

The company is now one of the most valuable in the U.S. and its founder, Jeff Bezos, one of the richest people in the world.

But Bezos and his peers, Warren Buffett and Jamie Dimon, are taking on one of the nation’s thorniest challenges. Making health care more affordable has bested savvy business leaders in many industries. The announcement was met with cautious optimism and lots of skepticism.

Related: Jeff Bezos, Warren Buffett and Jamie Dimon want to fix health care

Not much is known about the threesome’s venture — a yet-to-be-named company that will give the firms’ U.S. employees and their families a better option on health insurance and will not be motivated by profit. Experts, are betting that the firm will eventually expand its services to other companies if the effort proves successful.

Health care costs have soared for both employers and their workers over the past decade. Premiums have jumped nearly 50% for family coverage since 2008 and more than tripled since 1999. Meanwhile, employees are shouldering more of the cost when they actually get medical care because their deductibles and co-pays are going up.

Amazon, however, is a master at wringing out inefficiencies in the supply chain. This could prove particularly useful in the health care arena, which is known for its bloat.

“One thing we know for sure is there’s a lot of overhead costs in health care,” said Frederick Isasi, executive director of FamiliesUSA, a health care advocacy group.

While many employers have tried to tackle health insurance costs in the past, they often didn’t have the bandwidth or resources to devote to the issue, Isasi said. The new venture, however, will be focused on its mission and will have the financial backing of three strong firms.

Some of the ways Amazon could use its know-how to make a dent in prices: Negotiate rates directly with health care providers and drug manufacturers, use technology to ease consumers’ ability to make appointments or consult with doctors outside of the office and improve access to price and quality information about physicians, procedures and prescriptions to allow consumers to shop around, Isasi said.

Amazon could also improve Americans’ interaction with their insurance companies and providers, which all-too-often involves ancient technologies such as faxing, said Bob Kocher, a partner who specializes in health care information technology at Venrock, a venture capital firm. After all, Amazon invented one-click ordering on its retail site. It could develop a similar process for paying medical bills, even grouping invoices for doctors, facilities and labs for care that takes place in a hospital, for instance.

And Amazon could make it easier for patients and providers to access their medical records, which would also reduce costs. The new venture could store all that information in the cloud, said Michael Pachter, managing director for equity research at Wedbush Securities.

That way “everything is all together in one place,” he said.