By Justin Barnes and Mason Beard


The transition to value-based care is not an easy one. Organizations will face numerous challenges on their journey towards population health management.


We believe there are five key elements and best practices to consider when transitioning from volume to value-based care:  managing multiple quality programs; supporting both employed and affiliated physicians and effectively managing your network and referrals; managing organizational risk and utilization patterns; implementing care management programs; and ensuring success with value-based reimbursement.


When considering the best way to proactively and concurrently manage multiple quality programs, such as pay for performance, accountable care and/ or patient-centered medical home initiatives, you must rally your organization around a wide variety of outcomes-based programs. This requires a solution that supports quality program automation. Your platform must aggregate data from disparate sources, analyze that data through the lens of a program’s specific measures, and effectively enable the actions required to make improvements. Although this is a highly technical and complicated process, when done well it enables care teams to utilize real-time dashboards to monitor progress and identify focus areas for improving outcomes.


In order to provide support to both employed and affiliated physicians, and effectively manage your network and referrals, an organization must demonstrate its value to healthcare providers. Organizations that do this successfully are best positioned to engage and align with their healthcare providers. This means providing community-wide solutions for value-based care delivery. This must include technology and innovation, transformation services and support, care coordination processes, referral management, and savvy representation with employers and payers based on experience and accurate insight into population health management as well as risk.


To effectively manage organization risk and utilization patterns, it is imperative to optimize episodic and longitudinal risk, which requires the application of vetted algorithms to your patient populations using a high quality data set. In order to understand the difference in risk and utilization patterns you need to aggregate and normalize data from various clinical and administrative sources, and then ensure that the data quality is as high as possible. You must own your data and processes to be successful. And importantly, do not rely entirely on data received from payers.


It is also important to consider the implementation of care management programs to improve individual patient outcomes. More and more organizations are creating care management initiatives for improving outcomes during transitions of care and for complicated, chronically ill patients. These initiatives can be very effective.  It is important to leverage technology, innovation and processes across the continuum of care, while encompassing both primary and specialty care providers and care teams in the workflows. Accurate insight into your risk helps define your areas of focus. A scheduled, trended outcomes report can effectively identify what’s working and where areas of improvement remain.


Finally, your organization can ensure success with value-based reimbursement when the transition is navigated correctly. The shift to value-based reimbursement is a critical and complicated transformation—oftentimes a reinvention—of an organization. Ultimately, it boils down to leadership, experience, technology and commitment. The key to success is working with team members, consultants and vendor partners who understand the myriad details and programs, and who thrive in a culture of communication, collaboration, execution and accountability.


Whether it’s PCMH or PCMH-N, PQRS or GPRO, CIN or ACO, PFP or DSRIP, TCM or CCM, HEDIS or NQF, ACG’s or HCC’s, care management or provider engagement, governance or network tiering, or payer or employer contracting, you can find partners with the right experience to match your organizations unique needs. Because much is at stake, it is necessary to ensure that you partner with the very best to help navigate your transition to value-based care.


Justin Barnes is a corporate, board and policy advisor who regularly appears in journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT. Barnes is also host of the weekly syndicated radio show, “This Just In.”


Mason Beard is Co-Founder and Chief Product Officer for Wellcentive. Wellcentive delivers population health solutions that enable healthcare organizations to focus on high quality care, while maximizing revenue and transforming to support value-based models.

In my last blog post, we looked at the first two significant policy issues that will shape the future of health IT this year and beyond—EHR meaningful use and interoperability. Today, we focus on alternative payments, telehealth care delivery models, and ICD-10 (briefly)


Alternative Payment and Care Delivery Models

A newly-proposed CMS Shared Savings Program Rule focuses on more ACO flexibility, greater performance-based risk and reward as well as the use of innovative care coordination and telehealth tools. While I am still holding out for passage of bipartisan, bicameral SGR/ FFS reform legislation, there has been real progress out of the Department of Health and Human Services (HHS) as it has proposed phasing in an alternative payment models that leverage outcomes and quality-based payments with a smaller fee-for-service reimbursement. Basically, paying providers for value, not volume.


Through this January announcement:


  • HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as ACO, PCMH or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018


  • HHS also set a goal of tying 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value Based Purchasing and the Hospital Readmissions Reduction Programs


Note: In 2011, Medicare made almost no payments to providers through alternative payment models, but today such payments represent approximately 20 percent of Medicare payments. The goals announced in January represent a 50 percent increase by 2016.


  • To put this in perspective, in 2014, Medicare fee-for-service payments were $362 billion so a significant amount of payments will be shifting quickly into alternative payment models and this trend will not be tied to just Medicare but rather all insurers including Medicaid will be briskly moving in this direction


HHS has adopted a framework that categorizes health care payment according to how providers receive payment to provide care:


  • Category 1—fee-for-service with no link of payment to quality
  • Category 2—fee-for-service with a link of payment to quality
  • Category 3—alternative payment models built on fee-for-service architecture
  • Category 4—population-based payment


Medicare telehealth expansion includes use of health IT for chronic care

Medicare has expanded its covered telehealth services to include wellness (HCPCS code G0438) as well as several behavioral health visits. Beginning in January 2015, Medicare will reimburse physicians $40-$42/patient/month for chronic care management services for patients with more than one chronic condition

  • Physicians must use EHR systems that meet 2011 or 2014 certification criteria for meaningful use and a scope of service
  • Chronic care management is expected be provided by clinical staff directed by a physician or other qualified health professional. The level of service is expected to be 20 minutes per patient per month



Oh, and let’s not forget about our decade-long transition to ICD-10 on October 1, 2015.


So as you can see and are probably well aware, 2015 has already started off with seismic shifts in public policy in an attempt to stabilize the rate of growth of our annual healthcare costs. I don’t believe anyone can kid themselves and think that we will ever reduce our nation’s healthcare expenses, but what many of us are passionately working towards is creating a smarter and sustainable healthcare system that will at least reduce the rate in which our costs are increasing and truly create a healthcare system where we see intrinsic value and the patient becomes an informed and accountable consumer. We can all dream can’t we?


What questions do you have?


As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Institute of Technology’s Advanced Technology Development Center (ATDC). In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. Barnes has appeared in more than 1,000 journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT. Barnes also recently launched the weekly radio show, “This Just In.”

As we head toward HIMSS in Chicago next month, it’s a good time to take a look at the significant policy issues that will shape the future of health IT. While we will see tweaks to important legislation and regulation, the major public policy impacts that I envision for 2015 and even 2016 will revolve around EHR meaningful use, interoperability and most importantly in my book and strategy, alternative payment and care delivery models. Yes, ICD-10 is in there too but literally for how many years can we talk about that?


In this two-part blog series, I’ll look at the five issues that I see as priorities. Today’s topics: meaningful use and interoperability.


EHR Meaningful Use
EHR meaningful use will almost certainly grab the biggest headlines throughout the year as we just saw with the popular CMS announcement of the delay in the Medicare EHR meaningful use attestation for the 2014 reporting year, whereas eligible professionals now have until March 20, 2015.


There is also a new EHR meaningful use rule expected this spring that is intended to be responsive to provider concerns about software implementation, information exchange readiness as well as be reflective of developments in the industry and progress toward program goals achieved since the program began in 2011.


Here are a few highlights:


  • Shorten the EHR reporting period in 2015 to 90 days to accommodate these changes
  • Realign hospital EHR reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other CMS quality programs
  • Modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens


Interoperability and Data Exchange

The Office of the National Coordinator for Health Information Technology (ONC) released its shared interoperability Roadmap on January 30.


The ONC sees health IT as an important contributor to improving health outcomes, improving health care quality and lowering health care costs. They further state that health IT should facilitate the secure, efficient and effective sharing and use of electronic health information when and where it is needed.


Here are a few highlights:


  • ONC suggests that the community must expand its focus beyond institutional care delivery and health care providers, to a broad view of person-centered health
  • Healthcare is being transformed to deliver care and services in a person-centered manner and is increasingly provided through community and home-based services that are less costly and more convenient for individuals and caregivers
  • The Roadmap Identifies Four Critical Near-Term Actions for Enabling Interoperability
    • Establish a coordinated governance framework and process for nationwide health IT interoperability
    • Improve technical standards and implementation guidance for sharing and using a common clinical data set
    • Enhance incentives for sharing electronic health information according to common technical standards, starting with a common clinical data set
    • Clarify privacy and security requirements that enable interoperability


A personal favorite inside the Roadmap is the call for alignment of private payer efforts with CMS policies and programs, including incentives for health information exchange and e-clinical quality measures that will enable the three- and six-year goals in the Roadmap. This is a key component that will garner a lot of broad stakeholder support including the critical support of caregivers and IT professionals who struggle to participate in quality and incentive programs due to their lack of coordination and ability to report on measures.


The ONC did create a terrific infographic that details this journey as well. Public comments on the ONC Interoperability Roadmap are open until April 3, 2015.


What questions about EHR or interoperability do you have?


Watch for the second part of this blog series to be posted soon.       


As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Institute of Technology’s Advanced Technology Development Center (ATDC). In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. Barnes has appeared in more than 1,000 journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT. Barnes also recently launched the weekly radio show, “This Just In.”

In my last post, we looked at two of the top five health IT trends I’m seeing for 2015. In this blog, we’ll conclude with a more in-depth look at the remaining three trends.


To recap, the five areas that I strategically see growing rapidly in 2015 are focused on the consumerism of healthcare, personalization of medicine, consumer-facing mobile strategies, advancements in health information interoperability including consumer-directed data exchange and finally, innovation focused on tele-health and virtual care.


While all of these trends can be independent of each other and will respectively grow separately, I see the fastest growth occurring where they are combined or integrated because they improve each other.


Here’s my take on the three remaining trends:


  1. Consumer-facing mobile strategies: To control spiraling healthcare costs related to managing patients with chronic conditions as well as to navigate new policy regulations, 70 percent of healthcare organizations worldwide will invest in consumer-facing mobile applications, wearables, remote health monitoring and virtual care by 2018. This will create more demand for big data and analytics capability to support population health management initiatives. And to further my earlier points, the personalization of medicine relies on additional quality and population health management initiatives so these innovations and trends will fuel each other at faster rates as they become more integrated and mature.

  2. Consumer-directed interoperability: Along with the evolution of the consumerism of healthcare, you will see the convergence of health information exchange with consumer-directed data exchange. While this has been on the proverbial roadmap for many years, consumers are getting savvier as they engage their healthcare and look to manage their increasing healthcare costs better along with their families’ costs. Meaningful use regulations for stage 3 will drive this strategy this year but also just the shear demand by consumers will be a force as well. I am personally seeing a lot of exciting innovation in this area today.

  3. Virtual care: Last but certainly not least, tele-health, tele-medicine and virtual care will be top-of-mind in 2015. The progression of tele-health in recent years is perhaps best demonstrated by a recent report finding that the number of patients worldwide using tele-health services is expected to grow from 350,000 in 2013 to approximately 7 million by 2018. Moreover, three-fourths of the 100 million electronic visits expected to occur in 2015 will occur in North America. We are seeing progress not only on the innovation and provider adoption side but slowly public policy is starting to evolve. While the policy evolution should have occurred much sooner, last Congressional session we saw 57 bills introduced and as of June 2013, 40 out of 50 states had introduced legislation addressing tele-health policy. I see in every corner of the country that care providers want to use this type of technology and innovation to improve care coordination, increase access and efficiency, increase quality and decrease costs. Patients do as well so let’s keep pushing policy and regulation to catch up with reality.


While the headlines this year will be dominated by meaningful use (good and bad stories), ICD-10, interoperability (or data-blocking), and other sensational as well as eye-catching topics, I am extremely encouraged by the innovations emerging across this country. We are starting to bend the cost curve by implementing advanced payment and care delivery models. While change and evolution are never easy, we are surrounded by clinicians, patients, consumers, administrators, innovators and even legislators and regulators who are all thinking and acting in similar directions with respects to healthcare. This is fueling these changes “on the ground” in all of our communities. This year will be as tough as ever in the industry but also, a great opportunity to be a part of history.


What do you think? Agree or disagree with these trends?


As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Institute of Technology’s Advanced Technology Development Center (ATDC). In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. Barnes has appeared in more than 800 journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT. He recently launched a weekly radio show, “This Just In.”

While I know meaningful use (stages 2 and 3), electronic health record (EHR) interoperability, ICD-10 readiness, patient safety and mobile health will all continue to trend upwards with great importance, the five areas that I strategically see growing rapidly in 2015 are focused on the consumerism of healthcare, personalization of medicine, consumer-facing mobile strategies, advancements in health information interoperability including consumer-directed data exchange and finally, innovation focused on tele-health and virtual care.


While all of these trends can be independent of each other and will respectively grow separately, I see the fastest growth occurring where they are combined or integrated because they improve each other. It’s like a great marriage where the spouses make each other better and usually more successful because of their unity. I see the same occurring in 2015 and why I am so bullish on these integrated opportunities and innovations.


In this first part of my 2015 outlook blog, we’ll look at two of the top trends:


  1. Treating the patient as a consumer: This is due to numerous factors but a significant driver is the shift in various CMS regulations and incentives that have care providers and healthcare organizations focused on increased patient engagement as well as patient empowerment to improve communication, care coordination, patient satisfaction and even discharge management with hospitals. As a result of an increased focus on improving the patient/consumer experience, 65 percent of consumer transactions with healthcare organizations will be mobile by 2018, thus requiring healthcare organizations to develop omni-channel strategies to provide a consistent experience across the web, mobile and telephonic channels. I have already begun to see this in hundreds of area hospitals and practices in Georgia and know it is occurring across the country.

  2. Personalized medicine: While this concept is not new, the actual care plan implementation as well as technology and services innovations supporting this implementation is being driven quickly by the increased pressure for all care providers to improve quality and manage costs. You will see this increase dramatically once Congress passes SGR Reform that received bipartisan and bicameral support last Congressional Session and Congressional leaders are poised to take up this legislation again in the next month. The latest statistics show that 15 percent of hospitals will create a comprehensive patient profile by 2016 that will allow them to deliver personalized treatment plans.


Tomorrow we’ll look closely at the other three 2015 trends in health IT.


What questions do you have? What are the trends you are seeing in the marketplace?


As a healthcare innovation executive and strategist, Justin is a corporate, board and policy advisor who also serves as an Entrepreneur-in-Residence with the Georgia Institute of Technology’s Advanced Technology Development Center (ATDC). In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice. Barnes has appeared in more than 800 journals, magazines and broadcast media outlets relating to national leadership of healthcare and health IT. He recently launched a weekly radio show, “This Just In.”

There is talk in the medical industry of helping providers practice at the maximum of their licensure. One reason for this is that we don't have enough primary care physicians, and, in part, can address this gap with physician assistants, nurse practitioners, registered nurses, and a myriad of non-traditional team members like pharmacists and health coaches. It so happens that all of these individuals can be more cost-effective than physicians.


Medical assistants can do more than escort patients to an exam room and take vital signs. Nurse practitioners have the training and ability to move beyond acute illness diagnosis & treatment to engage in chronic disease management. Collaborative practice agreements allow pharmacists to manage complex patients on complicated medication regimens, assisting the healthcare team with their unique expertise in drug effects and interactions. As for doctors, the highest paid part of that pyramid, how do we make sure they are doing the things that only doctors can do while engaging their team to help with the rest?


Elevating the Patient Role


There's one team member who is often left out of this conversation -- the patient. How do we engage patients at the maximum of their ability? Patients are capable of doing a lot of more to manage their health if we would just give them the proper training and tools. By the way, patients are free. We don’t have to pay them to take care of themselves.


mHealth is the platform on which healthcare will move forward. What role can and should the users of mHealth technologies play? How do we maximize the impact that each user group can have on the health outcomes we are all working towards? How does everyone practice at the maximum of his or her licensure in a mhealth world?


It's important to remember the simple goal we are all working towards. We are trying to help people live healthier lives and trying to do it cost effectively. Patients are indispensable in working towards this goal. Patients have access to themselves all day, every day. They are on the front lines of healthcare, and they don’t cost anything.


Merging Patients and mHealth


In fact, according to an ONC-funded pilot project at Geisinger Health System, patients help to spot errors such as outdated information and omissions such as medications prescribed by another provider. Personal health records can drive these efforts.


  • Patients are eager to provide feedback on their medication list – 30 percent of patient feedback forms were completed and in 89 percent of cases, patients requested changes to their medication record.


  • Patient feedback is accurate and useful – on average, patients had 10.7 medications listed, with 2.4 requested changes. In 68 percent of cases, the pharmacist made changes to the medication list in the electronic health record based on the patient’s feedback.


ONC officials also write that the Open Notes Project, launched in 2010 by Geisinger, the University of Washington's Harborview Medical Center, Beth Israel Deaconess Medical Center and the Robert Wood Johnson Foundation, “found that patients who were given access to their doctors' notes reported they do better in taking their meds.”


If patients are going to become effective team members, we need to maximize their potential. mHealth solutions can help remove barriers by providing effective education, the necessary tools for tracking health and the right connectivity with other members of their healthcare team. This would allow the rest of the team to focus on the aspects of care they are uniquely qualified to address.


What questions do you have?


Lucienne Ide, co-author of this blog post, is CEO of and Justin Barnes is a Managing Director at Justin Barnes Advisors.

Doctors and surgeons are some of the brightest individuals in the world. However, no one is immune to mistakes and simple oversights. Unintentional errors occur in any industry; what makes healthcare different is that a single misstep could cost a life. 


In, The Checklist Manifesto by Dr. Atul Gawande, he cites a fellow surgeon’s story of a seemingly routine stab wound.  The patient was at a costume party when he got into an altercation that led to the stabbing.  As the team prepared to treat the wound, the patient’s vitals began dropping rapidly. The surgeon and his team were unaware that the weapon was a bayonet that went more than a foot through the man, piecing his aorta.


After regaining control of the situation, the man recovered after a few days. This experience presented complications that no one could possibly predict unless the doctors had full knowledge of the situation.  Gawande states, “everyone involved got almost every step right […] except no one remembered to ask the patient or the medical technicians what the weapon was” (Gawande 3). There are many independent variables to account for; a standard checklist for incoming stab wound patients could ensure that episodes like this are avoided and that other red flags would be accounted for. 


Miscommunication between clinicians and patients annually accounts for roughly 800,000 deaths in the US, more than heart disease and more than cancer.  The healthcare industry spends roughly $8 billion on extended care as a result of clinical error every year. As accountable care continues to make progress, the healthcare industry is moving more towards evidence based medicine and best practices. This is certainly the case for care providers, but also for patients as well. 


Implementing checklists in all aspects of healthcare can eliminate simple mistakes and common oversights by medical professionals and empower patients to become more educated and informed. Studies by the Journal of the American Medical Association (JAMA) as well as the New England Journal of Medicine (NEJM) have concluded that implementing checklists in various facets of care can reduce errors by up to half. Certain implementations of checklists in Intensive Care Units for infection mitigation resulted in reducing infections by 100 percent.


Compelling evidence of the need for checklisting can be found in the preparation process for a colonoscopy.  Colonoscopy preparation is a rigorous process that requires patients to be watching their diet and the clock for two days before procedure.  It is not uncommon for a colonoscopy to fail due to inadequate patient preparation. Before the procedure, the patient must pay attention to an arsenal of instructions regarding food, liquid, and medication. A detailed checklist that guides each patient through the process would practically eliminate any errors and failures due to inadequate patient preparation. 


From the patient’s perspective, checklisting everything from pre-surgery preparation to a routine checkup should be a priority.   At the end of the day, the patient has the most at stake and should be entitled to a clear, user-friendly system to understand every last detail of any procedure or treatment.


A couple of companies are making waves in the area of patient safety checklists, most notably of which are BluMenlo and Parallax.


BluMenlo is a mobile patient safety firm founded in 2012. Its desktop, tablet, and mobile solution drives utilization of checklists for patient handoffs, infection mitigation, and Radiation Oncology Machine QA. Although initial focus is in the areas mentioned, BluMenlo is expanding into standardizing best practices hospital and ACO-wide.


Parallax specializes in operating room patient safety. Its CHaRM offering incorporates a Heads Up Display to leverage checklists in the Operating Room. The software learns a surgeon’s habits and techniques to accurately predict how long an operation may take as well as predict possible errors.


Electronic checklists will certainly take hold as health systems, ACOs and accountable care networks continue to focus on increased patient safety, improved provider communications and best practices for reducing costs across their organizations. We will even see these best practices expedited if we begin to inquire with our care providers as informed and engaged patients.


What questions about checklists do you have?


As a healthcare executive and strategist, Justin Barnes is an industry and technology advisor who also serves as an Entrepreneur-in-Residence at Georgia Tech’s Advanced Technology Development Center. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice.

Living in Atlanta and working within the healthcare delivery innovation community, the mounting Ebola outbreak taught us all how quickly the “global” can become local.


For a healthcare system threatened by infectious disease, complex chronic illness, environmental and population management issues, the outbreak also reinforces how new technologies are advancing patient and caregiver safety, prevention, patient monitoring, diagnosis and even treatment.


The answer, through non-contact medicine, is literally in the airwaves.


Researchers at Stanford are pursuing the combined use of laser and carbon nanotubes to provide a more detailed view of blood flow in the brain – down to single capillaries – to increase the understanding of cerebral-vascular disease beyond the imaging provided by CT scan or MRI.


Other researchers are utilizing laser and sound waves to approach skin disorders through light absorption to better gauge tumor depth.


Similar to research at Stanford, the expanded use of infra-red and near-infrared light is being pursued to measure oxygen levels in human tissue for tumor detection, and non-contact infra-red thermometers are becoming available to caregivers.


An ultra-wideband radar sensor developed in Atlanta can see through solid objects and human tissue to continuously monitor cardio-respiratory rate, patient movement, bed presence and other clinically important motion.


And in many of these instances, the future is now, based on published data demonstrating outcomes.


A comparative study appearing in the March 14 edition of the Journal of American Medicine found a range of benefits from non-contact sensors tracking biomotion. Produced in a hospital setting, the study found that over nine months, the utilization of sensors decreased code blue instances dramatically by 86 percent. Days in ICU after surgical transfer, for example, decreased 45 percent and overall length of stay by nine percent.


These types of non-contact biosensors provide continuous and real-time actionable and sharable data scalable to ubiquitous applications. Their use for chronic conditions or within emergency situations such as burn units and the potential to aid differing patient populations continues to expand. In cases of presently non-curable or highly infectious disease states, advances in non-contact medicine could provide equal benefits.


Many Americans are using or are aware of the wearable sensors embedded into clothing or the light-contact wrist bands that provide basic vitals or lifestyle data. Even bathroom scales are generating data that can be captured or shared, all within the realm of passive or compliant patient-generated data.


This consumer market approach, though, is giving way to increased attention and research in the more critical arena of clinical, in-patient and point-of-care solutions, where efficiencies and costs are also important to an advanced and egalitarian healthcare system striving for greater care coordination.


Invited to September’s annual TEDMED conference on health and medicine as part of its innovation and collaboration sessions known as “The Hive,” we expect to learn more about and share information on these and many other breakthroughs in patient care that will likely impact all of our lives or our communities in an increasingly connected world where the future should always be now.


Robert Arkin and Dr. Jiten Chhabra collaborated on this blog post. Robert Arkin is CEO, and Dr. Jiten Chhabra is Medical Director, at Sensiotec. Justin Barnes is an Entrepreneur-in-Residence with the GA Tech Advanced Technology Development Center.

As I continue to travel around the country and speak to healthcare practitioners, it's becoming clear that the realities of patient consumerist behavior coupled with engagement incentives are leading caregivers to more actively pursue innovative solutions and long-term strategies.


And one main point I continue to make is that it is increasingly important to understand that the empowered patient is a benefit to your practice and not a hindrance, especially when market forces are leading patients in that direction.


At a recent presentation before practice administrators, payers and health IT executives during a regional MGMA conference, I found a ready audience looking for best practices.


By now it is – or should be - largely understood that high-deductible health plans and alternative care sites such as retail clinics are leading patients to be more cost conscious than ever before. This has led to “doctor shopping” and the growth of websites rating the overall patient experience along with costs and the history of a practitioner’s procedural, certification and work history.


All of this is of course fueled by informational consumer technologies and mobile applications along with those empowering patients to self-measure, self-monitor and self-manage aspects of their healthcare.


It is estimated that globally some 500 million people are expected to access a mobile health application by 2016.


And even within the industry, new transparencies such as the CMS Physician Compare website, is adding to the consumerism of healthcare.


Embracing Transparency and Patient Collaboration


Adopting the mindset that an empowered patient is a loyal patient – and a more compliant patient – is a sound strategy backed by recent studies.


A pilot project by Geisinger Health System opening up medication records to patients for their review found that patients were eager to provide input toward reconciling and updating medication lists and offering changes that could be entered into EHRs.


A similar program by a consortium of health systems known as the Open Notes Project found that patients given access to provider notes were more compliant in their medication regimens.


Therefore transparency itself is a patient engagement strategy.


What to do with Patient-Generated Data


The next frontier for caregivers in any setting is how to absorb, share and in general prepare for the emergence of Patient-Generated Health Data.


The growth of mobile and consumer-directed monitors and devices is a big part of the healthcare applications marketplace.


And by now you should be aware that agencies such as ONC are calling for practitioners to be able to accept these types of data into the EHR, and that doing so is among the criteria proposals within Stage 3 of meaningful use.


If you are equipped with a patient portal and in addition the ability to integrate it with a personal health record (PHR) then you have reached some technological engagement foundations.


New technologies are making it so easy for the patient-consumer to create health data – via everything from a bathroom scale to wearables – that old-fashioned notions of patient compliance or regular checkups is being replaced by strategies to understand how to accept and coordinate this data into an alert-driven or actionable technology.


It is important to stay abreast of consumer-driven care coordination technologies emerging in the market. I came across a technology called OneCare, a data hub free to consumers that merges health data from the provider, PHR or other personal sources and collaborates with health plans to track health metrics matched to patient financial incentives.


There are even solutions such as Gozio Health’s smartphone wayfinding platform that uses sensor fusion technology to provide better “customer service” during a visit.


This isn’t high-tech benevolence – engaged visitors translate into fewer missed and late appointments, higher HCACHPS scores and more easily met MU-2 objectives.


Strategic Foundations


To meet the demands of the new consumerist and patient-generated data horizons of quality-driven healthcare and payment models, adopt a collaborative and proactive approach to patient populations.


It’s important to survey this population to understand their expectations and their own levels of technological abilities and the importance they place upon it.


Turning this information into analytics and then a sound strategy – for both incentive program requirements and realistic patient engagement as well as empowerment programs – are keys to putting theory into practice.


What questions do you have?


As a healthcare executive and strategist, Justin Barnes is an industry and technology advisor who also serves as an Entrepreneur-in-Residence at Georgia Tech’s Advanced Technology Development Center. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice.

I’ve been fortunate enough to share a lot of podiums with great minds and innovators, from last year’s White House economic summit to annual health IT gatherings like the HIMSS annual conference, but I don’t think I’ve ever been as energized about our country’s technology community as from what I’m experiencing on the ground floor.


Named by Forbes as one of the Top 12 Business Incubators Changing the World, the Advanced Technology Development Center (ATDC) at Georgia Tech in Atlanta is a hub for technology startups with national reach and attention from investment groups to established companies like Intel and many more.


As a new ATDC entrepreneur-in-residence, I primarily focus on mentoring healthcare and health IT executives from startup firms to young high-growth companies but I’m also afforded the opportunity to collaborate on current and future ATDC community-enhancing programs. Over the last few decades the Center has nurtured more than 150 successful startups into the marketplace and at any given time has another 40 in the pipeline.  It is certainly an exciting and rewarding time at a multitude of levels.


ATDC's affiliation with the Georgia Institute of Technology, alignment with the university’s Enterprise Innovation Institute, VentureLab’s center for technology commercialization and the Flashpoint startup accelerator program probably speaks for itself as to what kind of resources can be combined in technology hubs around the country.


The ATDC’s renown led to a visit by the United States’ first Chief Technology Officer Aneesh Chopra on July 9 on the potential for transformative public-private technology initiatives was as inspiring as it was educational. I was fortunate enough to work with Aneesh while he was in the White House and it was great to hear about his current healthcare and open-skills data initiative projects as well as his new insightful book, Innovative State.


Whether it’s health IT or big data or financial technology firms being developed at ATDC, what’s been most inspiring is not so much an open-source technology as the open-source mindset of sharing and collaboration that is fostered.


In healthcare, the ATDC is nurturing firms like Rimidi Diabetes, Inc., which was officially launched in Washington, D.C. at the mHealth Summit and went on to test its cloud-based platform with a California-based accountable care organization. This algorithm-based technology merging blood glucose levels with fitness and behavioral metrics is a positive gain for the much-needed advancement in quality and outcomes-based healthcare.


Another community success story, BluMenlo, provides physicians and clinicians with a mobile application providing live procedural checklists of proper clinical care that is leading to increased patient safety and decreased preventable medical errors that contribute to about 800,000 annual deaths and cost hospitals roughly $7 billion a year. These are staggering numbers and it’s encouraging that startup brain trusts are tackling real issues, which does not go unnoticed by the growth capital community.


As you can tell, I am highly energetic and optimistic about our Atlanta-based technology innovations, but more so about our nation’s renewed entrepreneurial spirit and blessed opportunities in many important markets and sectors that our country and global economies are thirsting for.


I would encourage everyone in the corporate sector and certainly the health and care provider community to welcome or become involved with the startup or incubation community in your part of the country. There are exciting innovations that your organizations could pilot or implement that will positively affect your bottom-line in every way. In my healthcare realm, I see powerful cost-effective and efficient innovations that dramatically increase patient safety, improve care quality, advance patient engagement, save millions of dollars and best of all, save lives.


What questions about health IT innovation do you have?


As a healthcare executive and strategist, Justin Barnes is an industry and technology advisor and also serves as an Entrepreneur-in-Residence at Georgia Tech’s Advanced Technology Development Center. In addition, Mr. Barnes is Chairman Emeritus of the HIMSS EHR Association as well as Co-Chairman of the Accountable Care Community of Practice.


Follow him on Twitter (@HITAdvisor)

See his other posts here

Whether the ICD-10 delay and Medicare payment fluctuations bring relief or frustration, there are still many ways to position your organization for a successful future.


In fact, despite the recent disposition toward delay, now is actually the time to energize or re-energize your focus on existing programs that create a strong foundation for evolving and future value-based and alternative payment incentive models, such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).


As you may know, the congressional stalemate on how to pay for long-term Medicare payment stability — coupled with the phasing out of fee-for-service (FFS) — brought ICD-10 into pre-midterm election politics. The result? A one-year delay of the advent of ICD-10 in the U.S. until Oct. 1, 2015. In addition, a one-year Medicare payment patch averted a 24-percent cut, instead increasing Medicare payments by 0.5 percent for the next 12 months.


Both actions temporarily slowed the momentum of the SGR Repeal and Medicare Provider Payment Modernization Act (SGR Repeal), which proposed to stabilize Medicare payments through 2018 and that same year institute a value-based purchasing program similar to accountable care structures while phasing out FFS.


Moving your healthcare organization forward

Keep in mind that throughout this process, congressional leaders said they will still work hard to resurrect the bipartisan SGR Repeal Act widely supported by Capitol Hill, provider groups and the health IT industry. This is the right thing to do to advance preventive, coordinated care and move toward a sustainable healthcare system.


In the case of ICD-10, many organizations were readying for the conversion this fall, respecting its merits toward advancing quality reporting, expanding performance measures and improving overall population health.


You can make the most of these changes by staying focused on creating strategies for implementing the value-based and alternative payment incentive models the SGR Repeal Act proposes:


Accountable care organizations — With more than 600 voluntary structures currently operational, many of your peers have moved into coordinated care programs based on quality incentives. Don’t be left behind. These programs are another example of how private payers and healthcare organizations have followed the lead of the original Medicare Shared Savings Programs.


Patient-centered medical homes — This equally successful program has been expanded to include specialty medicine, with the March 2013 launch of the Patient-Centered Specialty Practice (PCSP) program by the National Committee for Quality Assurance (NCQA).


Meaningful use Stage 2 — Stage 2 is an example of how quality measure incentive programs will come to pass. Keep in mind that for the 2014 reporting year, any 90-day or fixed-quarter attestation can be pursued, so there’s plenty of time to capitalize and ready your organization for success. There are incentive funds still on the table.


With aspects of healthcare coverage, payment and sustainability such a paramount issue for our country — intertwined with health IT adoption and improved population health goals — it’s essential to continually assess what programs are best for your organization and your patients.


It’s safe to say you will need to engage these programs despite periods of fluctuation to successfully compete in a future of healthcare dominated by accountable care, value-based purchasing and alternative payment models.


Justin Barnes is a vice president at Greenway Health, chairman emeritus of the Electronic Health Record Association (EHR Association) and co-chair of the Accountable Care Community of Practice (ACCoP).


Follow Justin on Twitter (@HITAdvisor)

See his other posts here

I recently joined a panel of learned colleagues working in public health, telemedicine and acute care at an Institute of Medicine (IOM) forum focusing on the state of our nation’s healthcare system relating to population health and emergency preparedness and response due to natural disaster or other factors.


Along with seeking programmatic opportunities within the Affordable Care Act (ACA), I was asked to represent the view of the healthcare information technology sector on ways to advance resilience through technology that keeps the focus on the patient.


Doing so means establishing an infrastructure around current national standards (such as Direct & C-CDA) for data exchange and readable content, as well as increasingly open architectures around application programming interfaces (APIs) that expand integration with emergency response departments, responders, hospital EDs and HIEs, along with the current integration of electronic health records.


The expansion of patient portals, personal health records and cloud technology must also keep pace with available standards such as Blue Button, along with the ability for providers to utilize mobile EHR innovations to access these standard and readable patient records. After all, hospitals and practices are not immune to disaster, as the nation experienced certainly with Hurricane Katrina and most recently during Hurricane Sandy.


Also, a national patient identifier strategy is equally crucial to develop, one that can link the needed clinical information to the right displaced patient.


Both the American Recovery and Reinvestment Act (ARRA, 2009) and ACA provide the means to put this infrastructure in place, and in fact such networks are already taking shape. The ACA’s Health Center Controlled Networks fund was primarily focused on EHR and meaningful use adoption in the front lines, and provides the opportunity for resiliency expansion.


ARRA’s HIE Cooperative Agreement Program seeded state and regional HIEs, from which a debut collaboration this year of 10 HIEs has formed under the name SERCH, specifically to manage emergency response using vetted exchange standards, all while some individual state HIEs are expanding linkage to include EMS and fire departments.


And yes, taking a measured, national and analytical approach to resilient, technology-driven strategies is a best practice for achieving best practices in the field. Here too, ACA can be leveraged through a pair of well-funded and important programs, the Patient Centered Outcomes Research Institute (PCORI) and the Prevention and Public Health Fund, where respectively analysis and additional research options for emergency healthcare and IT exist, and where implementation can follow.


And finally, it’s again not just emergency response, but also preparedness, where for example outbreak surveillance, immunizations and registries have long been a national goal. Here there are new and existing collaborations between ONC, CDC and EHR developers that can be further integrated.


Right now the opportunities far outweigh the barriers toward establishing a coordinated national approach to population health when we may need it most, and it’s important to continue this discussion as the health IT industry itself continues to mature.


See the IOM panel presentation slides here.


Justin Barnes is a vice president with Greenway Medical Technologies, chairman emeritus of the national Electronic Health Record Association (EHR Association), co-chair of the Accountable Care Community of Practice (ACCoP) and a board member of the CommonWell Health Alliance.

Below is a guest blog post from Tee Green, president and chief executive officer of Greenway Medical Technologies, Inc.


Should every health system, hospital or group practice CIO know that to do interoperability right they need to consider XDS or PIX at the core of functionality? That these cross enterprise document sharing and patient identifier cross reference protocols can reach into another EHR?


Health IT solution providers should, and it’s clear from a survey of CIOs commissioned by Greenway that CIOs want leaders who will partner in their pursuit of the data liquidity that fits their needs. Right now education outranks selling, as interoperability is arguably the most important factor in addressing the range of care coordination programs every healthcare entity is facing. Tee Green new headshot.jpg


It’s also clear that the growing EHR replacement market is being fueled by a reassessment of original platforms lacking in comprehensive data exchange at a point when the improvement of population health should not take any backward steps.


The survey specifically found that the primary concern CIOs have about utilizing technology in their healthcare system is of course interoperability. Twenty-six percent voiced it in basic terms, and another 18 percent specifically in terms of medical staff alignment, which is itself a function of interoperability through the alignment of hospitals and clinics on EHR platforms capable of seamlessly exchanging data. That’s 44 percent overall, which outweighed cost at 22 percent.


Who should carry the burden of interoperability? Forty-nine percent chose a shared process between health IT solution providers and the healthcare system. Thirty-three percent chose a shared approach additionally led by health IT. Taken together that’s 82 percent voicing the need for a shared partnership. That’s an overwhelming result the industry needs to listen to.


And don’t think that today’s patient-consumers are not aware that technology matters. We surveyed them too, and 56 percent notice when technology is used at the point of care, and believe it helps their doctors do a better job. They also realize, by a 3-to-1 margin, that technology beats paper when it comes to sharing data.


Where do we go from here?


National organizations like the EHR/HIE Interoperability Workgroup - a coalition of state agencies, EHR companies, HIEs and certification experts - are solidifying standards, from PIX to C-CDA, and must also foster and project a sense of selfless collaboration with CIOs and doctors and nurses.


This is a key example of how together health IT leaders can create a smarter and sustainable healthcare system, and takes away any skepticism that the industry is not in it for population health. And the movement to national interoperability must be led by the industry, not by external policy, to further assure CIOs that motivations are in the right place.


Our survey did not reflect an overly negative attitude, and that’s because health IT leaders are already showing the willingness to partner with each other.


Development agreements and data exchange pilots by perceived market competitors are starting to emerge that align hospitals and clinics and integrate with HIEs, and select EHR-to-EHR exchange has become a staple of an interoperability showcase near you.


I predict that by the time meaningful use Stage 2 gets underway in 2014, the thresholds for data exchange being tied to incentives - electronically transmitting 10 percent of care transitions, at least one to a different EHR platform - will be eclipsed. The healthcare industry expects it. It’s the primary concern, the primary need for partnership, and the primary way for health IT to deliver.


What do you think?


View the entire survey, “Healthcare Information Technology: Trends and Transformations,” at

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