Tag: Health iT
The healthcare industry hasn’t lost interest in consolidation, but the value of deals has taken a dip, according to a new report.
PricewaterhouseCoopers released its quarterly look at healthcare deal-making and found 261 deals in total were announced in the third quarter of 2018. That’s on par with recent quarters; the number of deals has exceeded 250 in the past five, and there have been 200 or more since the fourth quarter of 2014.
The value of those deals, however—$15.9 billion in total—reached its lowest level since the first quarter of 2017 and represented a 35.8% decrease from the second quarter of this year and a 10.1% decrease from a year prior.
There was just one megadeal reported last quarter, PwC said: RCCH HealthCare Partners’ $5.6 billion purchase of LifePoint Health.
Thad Kresho, U.S. health services deals leader at PwC, told FierceHealthcare the industry’s interest in consolidation isn’t likely to slow down even if the overall value of deals ticks down a bill. He said that in a number of deals his team monitors, an asset they pegged as low-value sold at a far higher-than-expected price.
“I think there’s still a good bit of runway to go,” Kresho said, “but you’re going to run out of good assets eventually.”
A trend that could be playing a role in the decrease in value is the rise of more nontraditional partnerships and affiliations, Kresho said. Providers are growing more interested in teaming up with other stakeholders, such as retail networks, instead of fully integrating.
These partnerships can be a less-costly and time-consuming way for stakeholders to expand their service offerings and continue the drive to “be all things to all people,” he said. For example, Bon Secours Virginia and VCU Health continue to treat one another as rivals in some areas, but decided earlier this year to begin collaborating when it came to filling a need for thoracic surgery services in their area.
Private equity firms are also still in the driver’s seat in healthcare deal-making, Kresho said. Their growing interest in this sector was a trend PwC flagged in its previous report, noting that these firms have invested heavily in learning more about how healthcare works because they see so much value in the industry.
They also play a role in driving up the value of deals, Kresho said.
The Department of Justice’s approval in two headline-grabbing megadeals, the planned mergers between CVS Health and Aetna and Cigna and Express Scripts, also colors the deal-making landscape significantly, according to the report. That’s especially true as DOJ spiked the Anthem-Cigna and Aetna-Humana mergers.
- The American Medical Association launched an improved version of its Health Workforce Mapper that the group says could improve patient access to care.
- The tool provides population health data by geographic location, including factors like care quality, access to care, health behaviors and social environment factors.
- AMA President Barbara McAneny said the updated tool will let providers pinpoint areas and populations that “could benefit most from their skills and services.”
AMA said the population health portion of the tool lets providers view physicians in a county and overlay the patients and factors that influence health and access to care. The group enhanced its free tool with the help of the American Academy of Family Physicians’ Robert Graham Center and HealthLandscape.
“Providers can use this information to help them determine where to locate or expand their practices to reach patients in greatest need of access to care,” McAneny said.
The mapper tool uses AMA, CDC and CMS data to figure out health professional shortage areas, hospital locations and workforce trends. The tool also helps new doctors figure out gaps in patient care to see where their services are most needed.
It could also help with an expected physician shortage in the coming years. A recent Doctors Company report found that half of physicians may soon retire.
Health systems could also use the tool to figure out what areas need services, including whether to invest more in outpatient services in certain areas. It could additionally help payers and payer/provider collaborations improve population health efforts. That includes Medicare Advantage payers, which will now have the ability to customize plans with supplement benefits, including population health efforts.
Numerous studies have shown the influence social determinants of health play on someone’s health status. U.S. News and the Aetna Foundation recently released a series of reports that found that socioeconomics play a bigger role in health outcomes than a person’s race and ethnicity.
Providers, payers and community groups have looked for ways to bridge the wellness disparities. Being able to target areas with social needs and provider shortages are one way that this updated AMA tool may be able to help resolve some of those population health and access to care problems.
- Teaching patients how to access a patient portal and its role in their post-discharge care increases engagement during and after hospitalization. It also improves patient experience, a new JAMIA study finds.
- Researchers gave digital tablets to 97 patients for one day, showing them how to register and log in to the patient portal. Of those, 50 also received a bedside tutorial on key functions of the portal and the importance of those functions in their transition to follow-up care.
- Patients in the intervention group had a higher mean number of logins (3.48 versus 2.94) than controls. They also had a higher mean number of specific portal tasks than controls, though no individual comparison was statistically significant. Those in the test group had an easier time logging in and navigating the portal and were generally happy with the tablet approach — 88% reported being satisfied or very satisfied.
As MACRA and the Quality Payment Program place more emphasis on patient access to information, patient portals provide an effective means of engaging patients and improving outcomes.
And patients have indicated they want more communication from their doctors. In a recent Aetna report, 77% of consumers said it is very important for them to speak to them in easy-to-understand language and 59% would like access to other healthcare professionals to coordinate care. Younger consumers also expressed a high interest in digital tools to improve communication with providers.
While previous interventions have focused on engaging providers to improve completion of key tasks during transitions of care, this is the first randomized clinical trial to assess patient engagement as a way to increase portal use in and outside the hospital, the authors note.
The fact that the intervention took just 15 minutes to deliver made it “highly feasible and consistent to patients,” they say.
Still, while use of the hospital’s tablets increased engagement, the uptick was not significant in most instances, perhaps due to unfamiliarity with the devices, they suggest. Teaching patients to access the portal on their own devices could perhaps boost efficacy even more.
“As the movement towards ‘bring your own device’ (BYOD) gains momentum for patient engagement with the EHR and other health-related platforms (eg, diet, activity, and medication logs or other health-related apps), there is tremendous opportunity for patient in acute and post-acute phases of care,” the authors write.
Future research should explore use of BYOD, such as whether personal devices could facilitate stored credentials and use of biometrics to log in to patient portals, they say. More research on portal use in hospitals is also needed, “especially given that most hospitals have not yet deployed this feature of EHR, and Meaningful Use will require higher use in the near future, suggesting an impending implementation boom — more evidence is needed to guide this process,” they write.
Also needed is research on the ability to share data among disparate systems and how that affects use of portals when patients receive care at multiple institutions.
- Many American doctors are pessimistic about the practice of medicine. This unease includes concern about their practice’s financial stability and administrative management, as well as use of EHRs, according to a new Leavitt Partners white paper.
- Leavitt Partners, which conducted a national survey of 621 physicians between June 2017 and July 2017, found that 38% of doctors surveyed had an overall pessimistic outlook on the practice of medicine today. That feeling was evident among all types of physicians, though some doctors were more negative than others.
- The survey found that long-time doctors and solo practitioners were more likely to be pessimistic than other doctors.
Physician satisfaction can influence patient safety and quality. Low morale can also lead to health problems, burnout and high turnover.
David Muhlestein, one of the authors of the paper, told Healthcare Dive in a statement that one key to the survey results is that there isn’t one specific type of physician who is pessimistic.
“If there were, we could focus on those physicians and how we could improve their circumstances. Instead, we found that a pessimistic outlook can affect any physician and that a lot of factors associated with pessimism are on the practice-level,” said Muhlestein, a chief research officer at Leavitt Partners.
The survey found that 41% were either very optimistic or somewhat optimistic, 21% were neutral and 38% were somewhat pessimistic or very pessimistic.
Muhlestein said one strong trend was that older physicians were more likely to be pessimistic. Nearly half of doctors surveyed with at least 20 years practicing medicine said they have a negative view. That’s compared to one-third of pessimistic physicians with less experience.
Other survey results include:
- Nearly two-thirds of physicians said they’re not confident in their practice’s financial stability.
- Slightly more than half aren’t confident about their practice management.
- A little more than half believe their EHRs hurt the ability to provide quality patient care and a similar amount aren’t satisfied with their EHR system.
Doctors not happy with their EHR were significantly more likely to be pessimistic.
The study authors warned that pessimistic providers are also cool to the idea of value-based payment models. Most pessimistic physicians don’t plan to transition to global or bundled payments and are also less likely to want to change care delivery. Nearly half of those physicians said they’re not expanding the role of non-physicians to deliver care. Only about one-quarter of optimistic doctors were resistant to the change.
The study authors suggested some ways to reverse pessimism, including strengthening organizations (such as dissatisfied solo practitioners merging with small group practices) and improving EHRs, so they’re more user-friendly and fit into a doctor’s daily workflow.
They also suggested that policymakers and stakeholders must keep in mind how value-based payments may affect physician satisfaction. “Empowering a variety of physicians to help shape new programs and initiatives may help to improve physician satisfaction, thereby hastening the move toward value,” they wrote.
The results are the latest to show morale issues for physicians. A recent study by JAMA found that physician burnout starts as early as medical school and residency.
A recent Doctors Company National Survey of Physicians found that seven out of 10 doctors wouldn’t recommend healthcare as a profession. Respondents to that survey blamed EHRs and regulations for causing burnout. That survey also found little interest in bundled payment programs.
The recent Medical Group Management Association 2018 Regulatory Burden Survey also cited concerns about regulations and EHRs. That survey found that 86% of 426 medical group practices surveyed said regulatory burdens increased for their medical practice over the past year. The MGMA survey respondents also said Medicare and Medicaid value-based programs increased regulations. More than three-quarters added that those value-based payment initiatives didn’t improve quality of care.
All of these studies point to not just physician wellness and quality of care problems, but burnout also costing health systems and hospitals as much as $1.7 billion a year. This problem goes beyond morale and patient safety. It can also hurt a hospital’s bottom line.
- America’s largest commercial healthcare insurer is expanding into EHRs. UnitedHealth Group will launch an integrated and portable system for its 50 million fully benefited members by the end of next year, CEO David Wichmann said on the company’s third quarter earnings call Tuesday morning.
- Though details remain sparse, Wichmann said UnitedHealth plans to launch a “fully individualized, fully portable” EHR in 2019 leveraged off its existing mobile wellness platform Rally. The mobile platform currently allows its 20 million registered users to find savings for and get rewarded for maintaining wellness.
- UnitedHealth is coming off a strong Q3, reporting better-than-expected earnings and revenue. Wichmann emphasized the payer’s digital capabilities as a linchpin for its long-term growth, along with dual strategies of reining in costs and expanding its medical services group.
As tech giants like Amazon increasingly move into healthcare, traditional companies are feeling the pressure to innovate — or risk falling by the wayside.
EHRs are a point of contention for many healthcare organizations and physicians. They’re expensive to implement, costly and time-consuming to train physicians and nurses on, highly variable between systems, prone to human errors, usually restrict interoperability between different companies and can even result in worse care for patients.
In a market dominated by two strong competitors, Epic and Cerner, it’s also unclear how UnitedHealth’s offering will stack up or interact with existing EHR platforms.
What we know: the health record will be a “deeply personal” tool that identifies gaps in care for consumers and suggests next “best actions” driven by the patient’s medical data, Wichmann said. UnitedHealth is trying to position itself at the center of patient and doctor interactions. The EHR will also be available to providers in a model that looks similar to that used by patients but provides an element of predictive analytics “in the workflow of the physician’s office.”
It will build off Rally, a consumer digital health platform, to outline a customer’s health record and determine whether there have been gaps in care. Rally, which provides information and tech-enabled services under UnitedHealth’s umbrella, is a part of Optum: a UnitedHealth venture combining data analytics, a PBM and doctors.
“You might imagine what that could ultimately lead to in terms of continuing to develop a transaction flow between physicians and us and the consumer and us,” Wichmann said on the call.
The payer wants to “set the health system around responding to those deeply personal circumstances and situations,” Wichmann said, and act as the “custodian to try and drive better outcomes” while ensuring quality.
- Industry groups are urging the Office of the National Coordinator for Health IT to consolidate existing health IT comparison resources in a centralized clearinghouse as part of the EHR Reporting Program mandated in the 21st Century Cures Act.
- Doing so would create a one-stop shop where end users could quickly access comparative information on a variety of certified health IT products, the American Health Information Management Association and National Rural Health Association wrote in separate comments on a request for information on the reporting program.
- Comparative information provided under the program should be user-friendly and presented in every-day language, the groups said. ‘We recognize that the CHPL [Certified Health IT Product List] contains critical information designed to enhance transparency and accountability,” AHIMA said. “However, end users may sometimes lack the technical background and expertise to fully comprehend the information presented on the CHPL, even though they play a critical role in the decision-making process around the acquisition, upgrade, or customization of a certified health IT product.”
The Cures act tasks ONC with developing a reporting program that assesses characteristics of EHRs, including security, interoperability, usability and user-centered design, and conformance to certification testing. Yet more than 600 days since the law was enacted, industry is still awaiting details about the program and how it will work.
ONC issued the request for information amid growing pressure from lawmakers, including an amendment requiring the Trump administration to update Congress on progress being made around the information blocking provisions of the Cures Act. The amendment was adopted as part of the Senate fiscal year 2019 Labor-HHS appropriations bill.
While AHIMA supports development of the EHR Reporting Program, it recommends a step-wise approach that focuses initially on the mandatory reporting categories laid out in Cures. “AHIMA believes that a focused, incremental approach will help ensure that the comparative information developed under the program is usable and meets the needs of end users,” according to its comments.
AHIMA also urged ONC to adopt naming convention strategies to ensure consistent terminology across all stakeholders, so that certified health IT products can be fairly compared. And comparative information made available via the reporting program should capture the full lifecycle of the product — from acquisition and implementation to maintenance, upgrades and replacement, the group said.
The American Hospital Association called for ONC to include reporting criteria that reflect a system’s real workaday strengths and weaknesses. “Given the high adoption rate of certified EHRs, the EHR Reporting Program should emphasize reporting criteria that indicate how certified EHRs support the safe, efficient and effective collection, exchange and use of electronic health information rather than static certification criteria on collection of health information,” the group said.
To do that, ONC could redirect reporting toward ways EHR performance supports clinical care, including new care models and patient engagement, AHA said.
Stakeholders also called for transparency both in the way reporting criteria are calculated and data obtained and regarding EHR costs. “While the methodologies used should be transparent, ONC should also ensure that the reporting criteria are not easily gamed — where submitting organizations curate data to derive a positive assessment that may not necessarily reflect the actual usability or safety of the system,” NRHA wrote.
AHIMA and NHRA also suggested cost be a reporting category under the program. That would allow end users to compare not just initial costs of purchasing a health IT product, but subsequent costs associated with implementation, training, workflow design, upgrades, maintenance and transaction fees.
Commenters also urged ONC to adopt a least burdensome approach to the EHR Reporting Program, including using data collected from existing state and federal programs, where appropriate.
NRHA pushed for a “collect once, share many” policy of data collection.
In its comments, Cigna said it supports efforts to describe EHR functionality in terms of its setting, such as ambulatory care or outpatient surgery.
“We specifically support efforts to categorize platforms by their ability to provide needed data to support patient centered medical homes and support the provider’s efforts to demonstrate compliance with requirements for documentation and data production imposed by various accrediting bodies,” the health insurer said.
Comparative information should also include system stability issues with upgrades and patches, including stability of customization processes and how customization affects reporting capabilities, Cigna said. “Projected or known frequencies or upgrades and total cost of ownership for a given IT solution would be optimal,” the company said.