Transforming Healthcare by Increasingly Making IT Invisible

Transcript of a discussion on how healthcare providers employ new breeds of intelligent digital workspace technologies to improve doctor and patient experiences, make technology easier to use, and assist in bringing actionable knowledge resources to the integrated healthcare environment.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: Citrix Systems.

Dana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and you’re listening to BriefingsDirect. Our next discussion explores how healthcare organizations are using the latest digital technologies to transform patient care and experiences.

Gardner

When it comes to healthcare, time is of the essence and every second counts, but healthcare is a different game today. Doctors and clinicians, once able to focus exclusively on patients, are now being pulled into administrative tasks that can eat into their capability to deliver care.

To give them back their precious time, innovative healthcare organizations are turning to a new breed of intelligent digital workspace technologies. I’m pleased to be joined by two leaders in this area who will share their thoughts on how these solutions change the game and help transform healthcare as we know it.

We are here with Mick Murphy, Vice President and Chief Technology Officer at WellSpan Health. An integrated healthcare system with more than 19,000 employees serving Central Pennsylvania and Northern Maryland, WellSpan Health consists of 1,500 physicians and clinicians, a regional behavioral health organization, a homecare organization, eight respected hospitals and more than 170 patient care locations.

Welcome to BriefingsDirect, Mick.

Murphy: Thank you.

Gardner: We are also joined by Christian Boucher, Director and Strategist-Evangelist for Healthcare Solutions at Citrix. Welcome, Christian.

Boucher: Thank you for having me.

Gardner: Christian, precision medicine is but one example of emerging trends that target improved patient care, in this case to specifically to treat illnesses with more specialized and direct knowledge. What is it about intelligent workspace solutions that help new approaches, such as precision medicine, deliver more successful outcomes?

Boucher: We investigated precision medicine to better understand how such intricate care was being delivered. Because every individual is different -- they have their own needs, whether on the medication side, the support side, or the genomic side -- physicians and healthcare are beginning to identify better ways to treat patients as a customized experience. This comes not only in the clinical setting, but also when the patients get home. Knowing this helped us formulate our concept of the intelligent workspace.

Boucher

So, we decided to look at how users consume resources. As an IT organization -- and I supported a healthcare organization for 12 years before joining Citrix -- it was always our role to deliver resources to our users and anticipate how they needed to consume them. It’s not enough to define how they utilize those resources, but to identify how and when they need to access them, and then to make it as simple and seamless as possible.

With the intelligent workspace we are looking to deliver that customized experience to not only the organizations that deploy our solutions, but also to the users who are consuming them. That means being able to understand how and where the doctors and nurses are consuming resources and being able to customize that experience in real-time using our analytics engines and machine learning (ML). This allows us to preemptively deliver computing resources, applications, and data in real-time.

For example, when it comes to walking into a clinic, I can understand through our analytics engine that we will need for this specific clinic to utilize three applications. So before that patient walks in, we can have those apps spinning up in the background. That helps minimize the time to actual access.

Every minute we can subtract from a technology interaction is another minute we can give back to our clinicians to work with the patients and spend direct healthcare time with them.

Gardner: Understanding the context and the specific patient in more detail requires bringing together a lot of assets and resources on the back end. But doing so proactively can be powerful and ultimately reduces the complexity for the people on the front lines.

Mick, WellSpan Health has been out front on seeking digital workspace technology for such better patient outcomes. What were some of the challenges you faced? Why did you need to change the way things were?

IT increases doctor-patient interaction

Murphy

Murphy: There are a couple of things that drive us. One is productivity and giving time back to clinicians so that they can focus on patients. There is a lot of value in bringing more information to the clinical space. The challenge is that the physicians and nurses can end up interacting more with computers than with the patients.

We don’t think about this in minutes, but in 9-second increments. That may sound a little crazy, but when we talk about a 15-minute visit with a primary care doctor, that’s 900 seconds. And if you think about 9 seconds, that’s 1 percent of that visit.

We are looking to give back multiple percentage points of such a visit so that the physician is not interacting with the computer, they are interacting directly with the patient. They should be able to quickly get the information they need from the medical record and then swivel back and focus directly on the patient.

Gardner: It’s ironic that you have to rely on digital technology and integration -- pulling together disparate resources and assets -- in order to then move past interacting with the computers.

Murphy: Optimally the technology fades into the background. Many of us in technology may like to have the attention, but at the end of the day if the technology just works, that's really what we are striving for.

We want to make sure that as soon as a physician wants something -- they get it. Part of that requires the ability to quickly get into the medical record, for example. With the digital workspace, an emphasis for us was improve on our old systems. We were at 38 seconds to get to the medical records, but we have been able to cut that to under 4 seconds.

How the Right Technology
Improves Patient Care and
Helps Save Lives

This gets back to what Christian was talking about. We know when a physician walks into an exam room that they are going to need to get into the medical records. So we spin up a Citrix session in advance. We have already connected to the electronic health records (EHRs). All we are waiting for is the person to walk in the door. And as soon as they drop their ID badge onto a reader they are quickly and securely into that electronic medical record. They don’t spend any time doing searches, and whatever applications are needed to run are ready for them.

Gardner: Christian, having technology in the background, anticipating needs, operating in the context of a process -- this is all complex. But the better you do it, the better the outcome in terms of the speed and the access to the right information at the right time.

What goes on in the background to make these outcomes better for the interactions between the physicians, clinicians, and patients?

Boucher: For years, IT has worked with physicians and clinicians to identify ways to increase productivity and give time back to focus more on patient care. What we do is leverage newer technologies. We use artificial intelligence (AI),  ML, and analytics and drill down deeper into what is happening -- and not only on a generic physician workflow.

It can’t just be generic. There may be 20 doctors at a hospital, but they all work differently. They all have preferences in how they consume information, and they perform at different levels, depending on the technology they interact with. Some doctors want to work with tablets and jump from one screen to the next depending upon their specific workflow. Others are more comfortable working with full-on laptops or working on a desktop.

We have to understand that and deliver an experience that each clinician can decide is best-suited for their specific work style. This is really key. If you go from one floor to another in a hospital and watch how nurses work differently -- from the emergency room to the neonatal intensive care unit (NICU) -- the workflows are considerably different.

Not only do we have to deliver those key applications, we have to be mindful of how each of those different groups interacts with the technologies. It's not just applications. It's not just accessing the health record. It's hardware, software, and location.

We have to be able to not only deliver those experiences but predict in real-time how they will be consumed to expedite the processes for them to get back into the patient-focused arena.

Work outside the walls

Murphy: That’s a great point. You mentioned tablets. I don’t know what it is about physicians, but a lot of their kids seem to swim. So a lot of our doctors spend time at swim meets. And if you are on-call and are at a swim meet, you have a lot of time when your child is not in the pool. We wanted to give them secure access [to work while at such a location].

It's really important, of course, that we make sure that medical records are private and secure. We are now able to say to our physicians, “Hey, grab your tablet, take it with you to the swim meet. You will be able to stay at the swim meet if you get a call or you get paged. You will be able to pop out that tablet, access the medical records – and all of that access stays inside of our data center.”

All they are looking at is a pretty picture of what's going on inside the data center at that point. And so that prescription refill that’s urgent, they are able to handle that there without having to leave and take time away from their kids.

We are able to improve the quality of life for our physicians because they are under intense pressure with healthcare the way it is today.

Boucher: I agree with that. As we look at how work is being done, there is no predefined workspace anymore -- especially in healthcare where you have these on-call physicians.

Look at business operations. We are able to offset internal resources for billing. The work does not just get done in the hospital anymore. We are looking at ways to extend that same secure delivery of apps and data outside the four walls.

Just look at business operations as well. We are able to offset internal resources for billing. The work does not just get done in the hospital anymore. We are looking for ways to extend that same secure delivery of applications and data outside the four walls, especially if you have 19 hospitals.

As you find leverage points for organizations to be able to attract resources that may not fall inside the hospital walls, it’s key for us to be more flexible in how we can allow organizations to deliver those resources outside those walls.

Gardner: Christian, you nailed it when you talked about how adoption is essential. Mick, how have digital workspace solutions helped people use these apps? What are the adoption patterns now that you can give flexibility and customize the experience?

Faster workflow equals healthier data

Murphy: Our adoptions are pretty strong. I will be clear, it's required that you interact with electronic health records. There isn't really an option to opt out. But what we have seen is that by making this more effective and faster, we have seen better compliance with things like securing workstations. Going back to privacy, we want to make sure that that electronic health data is protected.

And if it takes me too long to get back into a work context, well, then I may be tempted to not lock that workstation when I step away for just a moment. And then that moment can become an extended period and that would be dangerous for us. Knowing that I am going to get back to where I was in less than four seconds -- and I am not even going to have to do anything other than touch my badge to get there, -- means we see that folks secure their workstations with great frequency. So we feel like we are safer than we were. That’s a major improvement.

Gardner: Mick, tell us more about the way you use workspaces to allow people to authenticate easily regardless of where they are.

Murphy: We have combined a couple of technologies. We use smart badges with a localized reader, with the readers scattered about for the folks who need to touch multiple workstations.

So myself as an executive, for example, I can log into one machine by typing in my password. But for clinicians going from place to place, we have them login once a day and then as long as they are retaining their badge and they are getting back in. All they have to do is touch their badge to a reader and it drops them right back into their workspace.

Gardner: We began our conversation talking about precision medicine, but there are some other healthcare trends afoot now, too. Transparency about the financial side of healthcare interactions is increasingly coming into play, for example.

We have new kinds of copays and coinsurance, and it’s complex. Physicians and clinicians are being asked more to be part of the financial discussion with patients. That requires a whole new level of integration and back-end work to make that information available in these useful tools.

Taking care of business

Murphy: That is a big challenge. It's something we are investing in. Already we are extending our website to allow patients to get on and say, “Hey, what’s this going to cost?” What the person really wants to know is, “What are my out-of-pocket costs going to be?” And that depends on that individual.

We haven’t automated that yet end-to-end, but we have created a place where a patient can come on and say, “Hey, this is what I am going to need to have done. Can you tell me what it's going to cost?”

We actually can turn that back around [with answers]. We have to get a human being involved, but we make that available either by phone or through our website.

Gardner: Christian, we are seeing that the digital experience and the workspace experience in the healthcare process are now being directed back to the patient, for patient experience and digital experience benefits. Is the intelligent workspace approach that provider organizations like WellSpan are using putting them in an advantageous position to extend the digital experience to the patient -- wherever they are -- as well as to clinicians and physicians?

Boucher: In some scenarios we have seen some of our customers extend some of Citrix’s resources outside to customers. A lot of electronic health records now include patient portals as part of their ecosystem. We see a lot of customers leveraging that side of the house for electronic health records.

We understand that regardless of the industry, the finance side and he back-office side play a major role in any organization's offerings. It's just as important to be able to get paid for something as it is to deliver care or any resource.

We understand that regardless of the industry, the finance side and the back-office side play a major role in any organization’s offerings. It's just as important to be able to get paid for something as it is to deliver care or deliver any resources that your organization may deliver.

So one of the key aspects for us was understanding how the workspace approach transforms over the next year. Some of the things we are doing on our end is to look at those extended workflows.

We made an acquisition in the last six months, a software company, [Sapho], that essentially creates micro apps. What that really means is we may have processes on ancillary systems, they could be Software as a service (SaaS) -based, they could be web-based applications, they could be on-premises installations of old client/server technologies. But this technology allows us to create micro experiences within the application.

So just say a process for verifying billing takes seven steps, and you have to login to a system, and you have to navigate through menus, and then you get to the point where you can hit a button to say, “Okay, this is going to work.”

What we have done is take that entire workflow -- maybe it’s 10 clicks, plus a password -- and create a micro app that goes through that entire process and gives you a prompt to do it all in one or two steps.

So every application that we can integrate to -- and there are 150 or so – we can take those workflows, which in some cases can take five minutes to walk-through and turn it into a 30-second interaction with [the Sapho] technology. Our goal is to look beyond just general workflows and be able to extend that out into these ancillary programs, where you may have these kinds of normal everyday activities that don't need to take as long as they do and simplify that process for our end users to really optimize their workflows during the day.

Gardner: This sounds like moving in a direction of simplifying process, using software robots and as a way of automating things, taking the time and compressing it, and simplifying things -- all at the same time.

Murphy: It’s fascinating. It sounds like a great direction. We are completely transparent, and that’s a future for us. It sounds like I need to get together with Christian after this interview.

Gardner: Let’s revisit the idea of security and compliance. Regulations are always there, data sharing is paramount, but protecting that data can be a guard rail or a limiter in how well you can share information.

Mick, how are you able to take that patient experience with the clinician and enrich it with all the data and resources you can regardless of whether they are at the pool, at home, on the road, and yet at the same time have compliance and feel confident about your posture when it comes to risk?

Access control brings security, compliance

Murphy: We feel pretty good about this for a couple of reasons. One is, as I mentioned, the application is still running in our data center. The the next question is, “Well, who can get access to that?”

One way is strong passwords, but as we all know with phishing those can be compromised. So we have gone with multifactor authentication. We feel pretty good about remote access, and once you have access we are not letting you pull stuff down onto your local device. You are just seeing what’s on the screen, but you are not pulling files down or anything of that nature. So, we have a lot of confidence in that approach.

Boucher: Security is always a moving target, and there may be certain situations when I access technology and I have full access to do what I please. I can copy and paste out of applications, I can screenshot, and I may be able to print specific records. But there may be times within that same workflow -- but a different work style -- where I may be remote-accessing technologies and those security parameters change in real-time.

As an organization, I don’t feel comfortable allowing user X to be able to print patient records when they are not on a trusted network, or they are working from home, or on an unknown device.

So we at Citrix understand those changing factors and understanding that our border now is the Internet. If we are allowing access from home, we are now extending our resources out to that, out to the Internet. So it really gives us a lot more to think about.

We have built into our solutions granular control that uses ML and analytics solutions. When you access something from inside the office, you have a certain amount of privileges as the end user. But as soon as you extend out that same access outside of the organization, in real-time we can flip those permissions and stop allowing users to print or screenshot or copy and paste between applications.

Digitally Enhanced Precision Medicine
Delivers Patient-Specific Care to
Treat Illness and Cure Diseases

And that’s invisible to the end-user. It all happens in the back-end in real-time. Security is something that we take extremely seriously at Citrix, and we understand that our customers do as well. So, giving them those controls allows them to be a lot more nimble in how they deploy solutions.

Murphy: I agree with that. Another thing that we like to do is have technology control and help people be safe. A lot of this isn’t about the bad actor, it’s about somebody who’s just trying to do the right thing -- but they don’t realize the risk that they are taking. We like to put in technology safeguards. For example, if you are working at home, you are going to have some guardrails around you that are tighter than the guardrails when you are standing in our hospital.

Gardner: Let’s revisit one of our core premises, which is the notion of giving time back to the clinicians, to the physicians, to improve the patient experience and outcomes. Do you have other examples of intelligent and digital workspace solutions that help give time back? Are there other ways that you’re seeing the improvement in the quality of care and the attention span that can be directed at that patient and their situation?

The top of your license

Murphy: We talk a lot in healthcare about working at the top of your license. We try and push tasks to the least skill level needed in order to do something.

When you come in for a visit, rather than having the physician look up your record, we have the medical assistant that rooms you and asks why you are there. They open the record, they ask you a few questions. They get all that in place. Then they secure the workstation. So it’s locked when the physician walks in and they drop their badge and get right in to the electronic medical record in four seconds.

That doctor can then immediately turn to you and say, “Hey, how are you doing today? What brings you in?” And they can just go right into the care conversation. The technology tees everything up so that the focus is on the patient.

Gardner: I appreciate that because the last thing I want to do is fill out another blank clipboard, telling them my name, my age, date of birth, and the fact that I had my appendix out in 1984. I don’t want to do that four times in a day. It’s so great to know that the information is going to follow me across the process.

Murphy: And, Dana, you are better than me, because I had a tonsillectomy in ‘82, ‘83, ‘84? It depends on which time I answered the survey correctly, right?

All systems go with spatial computing 

Boucher: As we look forward a few years, that tighter integration between the technologies and our clinicians is going to become more intertwined. We will start talking about spatial computing and these new [augmented reality] interfaces between doctors and health records systems or ambulatory systems. Spatial computing can become more of a real-time factor in how care is delivered.

And these are just some of the things we are talking about in our labs, in better understanding how workflows are created. But imagine being able to walk into a room with no more than a smart watch on my wrist that’s essentially carrying my passport and being able to utilize proximity-based authentication into those systems and interact with technology without having to login and do all the multifactor authentications.

And then take a step further by having these interfaces between the technology in the room, the electronic records, and your bed-flow systems. So as soon as I walk into a room, I no longer have to navigate within the EHR to find out which patient is in the room. By them being in the room and interfacing with bed flow, or having a smart patient ID badge, I can automatically navigate to that patient in real-time.

As soon as I walk into the room, I no longer have to navigate within the EHR to find out which patient is in the room. By them being in the room and interfacing with the bed flow, or having a smart ID badge, I can navigate to the patient in real time.

In reality, I am removing all of the administrative tasks from a clinician workflow. Whether it’s Internet of things (IoT)-based devices, or smart devices in rooms, they will help complete half of that workflow for you before you even step in.

Those are some of the things we look at for our intelligent workspace in our micro app design and our interfaces across different applications. Those are the kind of ways that we see our solutions being able to help clinicians and organizations deliver better care.

Gardner: And there is going to be ever-more data. It’s always increasing, whether it’s genomic information, a smart device that picks up tracking information about an individual’s health, or more from population information across different types of diseases and the protocols for addressing them.

Mick, we are facing more complexity, more data, and more information. That’s great because it can help us do better things in medicine. But it also needs to be managed because it can be overwhelming.

What steps should we be taking along the way so that information becomes useful and actionable rather than overwhelming?

AI as medical assistant

Murphy: This is a real opportunity for AI around an actual smart clinical assistant. So something that’s helping comb through all the data. There’s genomic data, drug-drug interaction data, and we need to identify what’s most important to get that human judgment teed up.

These are the things that I think you should look at versus, “Oh, here is all the possible things you could look at.” Instead we want, “Here are the things that you should really focus on,” or that seem most relevant. So really using computing to assist clinicians rather than tell them what to do. But at least help them with where to focus.

Gardner: Christian, where would that AI exist? Is that something we’re going to be putting into the doctor’s office, or is that going to be something in a cloud or data center? How does AI manifest itself to accomplish what Mick just described?

Boucher: AI leverages intense computing power, so we are talking about significant IT resources internally. While we do see some organizations trying to bring quantum computing-based solutions into their organization and leveraging that, what I see is probably more of a hosted solution at this point. That’s because of the expense but also because of the technology, of when you start talking about distributed computing and being able to leverage multiple input solutions.

If you talk about an Epic or Cerner, I’m sure that they are working on technologies like that within their own solutions -- or at least that allow their information to be shared within that.

I think we’re in the infancy of that AI trend. But we will see more-and-more technology play a factor in that. We could see some organizations partnering together to build out solutions. It’s hard to say at this point, but we know there is a lot of traction right now and unfortunately, they are mostly high-tech companies trying to leverage their algorithms and their solutions to deliver that, which at some point, I would guarantee that they’ll be mass produced and ready for purchase.

Murphy: AI could be everything from learning to just applying rules. I might not classify applying rules as AI, but I would say it’s rudimentary AI. For example, we have a rule set, an algorithm for sepsis. It enables us to monitor a variety of things about a patient -- vital signs, lab results, and various data points that are difficult for any one human to be looking at across the entire set of patients in our hospitals at any given time.

Learn How to Build
An Intelligent Workspace
Infrastructure and Culture

So we have a computer watching that. And when certain criteria are met in this algorithm, it reports to a centralized team staffed with nurses. The nurses can then look at that individual patient and say, “Does this look like a false alarm or does this look like something that we really need to pursue?” And based off of that, they send someone to the bedside.

We’ve had dramatic improvements with sepsis. So there are some really easy technical things to do -- but you have to engage with them, with human beings, to get the team involved and make that happen.

Gardner: The intelligent digital workspaces aren’t just helping cut time, they are going to be the front end to help coordinate some of these advanced services that are coming down that can have a really significant impact on the quality of care and also the cost of case, so that’s very exciting.

I’m afraid we will have to leave it there. We have been listening to a sponsored BriefingsDirect discussion on how leading health organizations are using the latest digital technologies to transform patient care and experiences. And we’ve learned how doctors and clinicians are turning to a new breed of intelligent digital workspace to gain a consistent and contextual user experience and therefore better healthcare outcomes.

So, a big thank you to our guests, Mick Murphy, Vice President and Chief Technology Officer at WellSpan Health in Pennsylvania, and Christian Boucher, Director and Strategist-Evangelist for Healthcare Solutions at Citrix Systems.

And a big thank you as well to our audience for joining this BriefingsDirect intelligent workspaces discussion. I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host throughout this series of Citrix-sponsored BriefingsDirect discussions.

Thanks again for listening and do come back next time.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: Citrix Systems.

Transcript of a discussion on how healthcare providers are employing a new breed of intelligent digital workspace technologies to improve doctor and patient experiences, make technology easier to use, and assist in bringing actionable knowledge resources to the integrated healthcare environment. Copyright Interarbor Solutions, LLC, 2005-2019. All rights reserved.

You may also be interested in:

• How The Open Group Healthcare Forum and Health Enterprise Reference Architecture cures process and IT ills
• The next line of defense—How new security leverages virtualization to counter sophisticated threats
• Expert Panel Explores the New Reality for Cloud Security and Trusted Mobile Apps Delivery
• Philips teams with HPE on ecosystem approach to improve healthcare informatics-driven outcomes
• A tale of two hospitals—How healthcare economics in Belgium hastens need for new IT buying schemes
• How IT innovators turn digital disruption into a business productivity force multiplier
• How the Citrix Technology Professionals Program produces user experience benefits from greater ecosystem collaboration
• HPE and Citrix team up to make hybrid cloud-enabled workspaces simpler to deploy
• Citrix and HPE team to bring simplicity to the hybrid core-cloud-edge architecture

Price Transparency in Healthcare Requires Higher Accuracy and Technology Adoption to Regain Patient Trust

Transcript of a discussion on how new transparency on costs in healthcare provides both a step toward more educated choices as well as an opportunity to use technology to inform and instruct throughout increasingly complex payer-provider-patient processes.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.

Dana Gardner: Hi, this is Dana Gardner, Principal Analyst at Interarbor Solutions, and you’re listening to BriefingsDirect. Our next healthcare finance insights discussion explores the impacts from increased cost transparency for medical services.

Gardner

The recent required publishing of hospital charges for medical procedures is but one example of rapid regulatory and market changes. The emergence of more data about costs across the health provider marketplace could be a major step toward educated choices – and ultimately more efficiency and lower total expenditures.

But early-stage cost transparency also runs the risk of out-of-context information that offers little actionable insight into actual consumer costs and obligations. And unfiltered information requirements also place new burdens on physicians, caregivers, and providers – in areas that have more to do with economics than healthcare.

To learn more about the pluses and minuses of increased costs transparency in the healthcare sector, we are joined by our expert panel:

• Heather Kawamoto, Chief Product Officer at Recondo Technology in Denver.
• Joann Barnes-Lague, Revenue Cycle Director at Shields Health Care Group in Quincy, Mass.
• Julie Gerdeman, President at HealthPay24 in Mechanicsburg, Penn.
• Beth Jones Sanborn, Managing Editor at Healthcare Finance News/HIMSS Media in Portland, Maine.
• Alena Harrison, Senior Director of PBM Innovation at CVS Health in Woonsocket, RI.

Welcome to you all. For better or worse, we are well into an era of new transparency about medical costs. Heather, why is transparency such a hot issue right now?

Kawamoto

Kawamoto: It’s largely due to a cost shift. Insurance companies are having patients owe more of a payment’s portion. With that there has been a significant rise in the high-deductible health plans -- not only in the amount of the deductible, but also in the number of patients on high-deductible plans.

And when patients get, sadly, more surprise bills, we start to hear about it in the media. We also have the onset this month of the IPPS/LTCH PPS final rule from the Centers for Medicare and Medicaid Services (CMS) [part of the U.S. Department of Health and Human Services].

The New York Times did a recent story about this, and that’s created buzz. And then people start saying, “Hey, I know I have a medical service coming up, I probably need to call in and actually find out how much my service is going to be.”

Gardner: It seems like the consumer, the patient, needs to be far more proactive in thinking about their care, not just in terms of, “Oh, how do I get better? Or how do I stay as healthy as I can?” But in asking, “How do I pay for this in the best possible way?”

That economic component wasn't the case that long ago. You would get care and you didn't give much thought to price or how it was billed.

Joann, as somebody who provides care, what’s changed that makes it necessary for patients to be proactive about their health economics?

Know before you owe

Barnes-Lague

Barnes-Lague: It’s the consumer-driven health plans, where patients are now responsible for more. They have to make a decision – “Do I buy my groceries, or do I have an MRI.”

The shift in healthcare makes us go after the patient before insurance is paid 100 percent. Patients now have a lot of skin in the game. And they have to start thinking, “Do I really need this procedure, or can it wait?”

Gardner: And we get this information-rush from other parts of our lives. We have so much more information available to us when we buy groceries. If we do it online, we can compare and contrast, we can comparison shop, we can even get analysis brought to the table. It can be a good thing.

Julie, you are trying to help people make better paying decisions. If we have to live with more cost transparency, how can technology be a constructive part of it?

Gerdeman

Gerdeman: It's actually a tremendous opportunity for technology to help patients and providers. We live in an experience economy, and in that economy everyone is used to having full transparency. We’re willing to pay for faster service, faster delivery.

We have highly personalized experiences. And all of that should be the same in our healthcare experiences. This is what people have come to expect. And that's why, for us, it’s so important to provide personalized, consumer-friendly digital payment options.

Sanborn: As someone who has been watching these high-deductible health plans unfold, data has come out saying the average American household can't afford a $500 medical bill, that an unexpected $500 medical bill would drastically impact that household’s finances for months. So people are looking to understand upfront what they are going to owe.

At the same time, patients are growing tired of the back-and-forth between the provider and the payer, with everyone kicking the can back and forth between then saying, “Well, I don’t know that. Your provider should know that.” And the provider says, “Well, your health plan is the one that arbitrates the price of your care. Why don't you go ask them?” Patients are getting really, really tired of that.

Learn How to Meet Patient Demands
for Convenient Payment Options
for Healthcare Services

Now the patients have the bullhorn, and they are saying, “I don't care whose responsibility it is to inform me. Someone needs to inform me, and I want it now.” And in a consumer-driven healthcare space, which is what’s evolving now, consumers are going to go where they get that retail-like experience.

That’s why we are seeing the rise in urgent care centers, walk-in clinics, and places where they don’t have to wait. They can instead book an appointment on their phone and go to the appointment 20 minutes later. Patients have the opportunity to pick where they get their care and they know it. At the same time, they know they can demand transparency because it's time.

Gardner: So transparency can be a force for good. It can help people make better decisions, be more efficient, and as a result drive their cost down. But transparency can put too much information in front of people, perhaps at a time when they are not really in a mindset to absorb it.

What are you doing at CVS, Alena, to help people make better decisions, but not overload them?

Clear information increases options

Harrison

Harrison: The key to good transparency tools is that they have to be a 100 percent accurate. Secondly, the information has to be clear, actionable, and relevant to the patient.

If we gave patients 10 data points about the price of a drug -- and sometimes there are 10 prices depending on how you look at it -- it would overwhelm folks. It would confuse them, and we could lose that engagement. Providing simple, clear data that is accurate and actionable shows them the options specific to their benefit plan. That is what we can do to help consumers navigate through this very complex web in our healthcare system.

Gardner: Recondo helps people create and deliver estimates throughout this process. How does that help in providing the right information, at the right time, in the right context?

Kawamoto: It's critical to provide [estimate information] when a patient schedules their service, because that gives them the opportunity -- if there is a financial question or concern -- to say, “Okay, I don’t know that I can pay for that. Is there another location where the price might be different? What are my financial options in terms of the payment plan or some sort of assistance?”

Enabling providers to proactively communicate that information to patients as they schedule a service or in advance gives patients an opportunity to shop. They know they are going to be meeting with an orthopedic surgeon because they need knee arthroscopy.

In advance of that, they should be able to get some idea of what they are going to owe, relative to their specific benefit information. It puts them in that position to engage with the orthopedic surgeon to say, “I looked at the facility and it's actually going to be $3,000. What are my options?” Now, that provider can be a part of the cost discussion. I think that is critical.

Barnes-Lague: As providers we have to be okay with patients making that decision, of saying, “Maybe I won’t have that service now.” That’s consumer-driven. And sometimes that hurts our volume.

We may have had a hard time understanding that in the beginning, when we shared estimates and feared that the patients wouldn't come. Well, would you rather trick them and then have bad debt?

As providers we have to be okay with patients making that decision, of saying, "Maybe I won't have that service right now." That's consumer-driven. ... It's about being comfortable with the patient making educated decisions.

It’s about being comfortable with the patient making educated decisions. Perhaps they will come back for your MRI in December when their deductibles are met, and they can better afford it.

Gardner: Part of this solution requires the physician or practitioner to be educated enough to help the patient sort out the finances, as well as the care and medical treatments. As someone who has a lot of clinicians, technicians, and physicians, are they not the primary point for more transparency to the patient?

Barnes-Lague: That would be the ideal solution, to have the physicians who are referring these very expensive services to begin having those conversations. Often patients are kind of robotic with what their doctors tell them.

We have to tell them, “You have a choice. You have a choice to make some phone calls. You have a choice to do your own price shopping.” We would love it if the referring physicians began having those price-transparency conversations early, right in their offices.

Gardner: So the new dual-major: Economics and pre-med?

Julie, your background is in technology. You and I both know there are lots of occupations where people have complex decisions to make. And they have to be provided trust and accommodation to make well-informed decisions.

Whether you are a purchasing agent, chief executive, or chief marketing officer, there are tools and data to help you. There have been great strides made in solving some of these problems. Is that what we are going to see applied to these medical decisions across the spectrum of payer, provider, and patient?

Easy-to-access, secure data builds trust

Gerdeman: This field is ripe for disruption. And technology, particularly emerging technology, can make a big difference in providing transparency.

A lot of my colleagues here have talked about trust. To me, the reason everybody is requiring transparency is to build trust. It goes back to that trusted relationship between the provider and the patient.

The data should be available to everyone. It’s now time to present the data in a very clear, simple, and actionable way for them to make decisions. The consumer can make an informed decision, and the provider can know what the consumer is facing.

Gardner: Yet to work, that data needs to be protected. It needs to adhere to multiple regulations in multiple jurisdictions, and compliance is a moving target because the regulations change so often.

Beth, what do we do to solve the data availability problem? Everybody knows data is how to solve it. It’s about more data. But nobody wants to own and control that data.

Sanborn: Yes, it’s the $64,000 question. How do you own all that data and protect it at the same time? We know that healthcare is one of the most attacked industries when it comes to cyber criminals, ransomware, and phishing.

Sanborn

I hear all the time from experts that as much as the human element drives healthcare, as far as data and its protection [the human element] is also the greatest vulnerability. Most of the attacks you hear about happen because someone clicked on a link in an email or left their laptop somewhere. These are basic human errors that can have catastrophic consequences depending on who is on the receiving end of that error.

Technology is, of course, a huge part of the future, but you can't let technology develop faster than the protections that have to go with it. And so any developer, any innovator who is trying to help move this space forward has to make cybersecurity a grassroots foundational part of anything that they innovate.

It’s not enough to say, “My tool can help you do this, this, and this.” You have to be able to say, “Well, my tool will help you do this, this, and this, and this is how we are going to protect you along the way.” That has to be part of, not just the conversation, but every single solution.

Gardner: Alena, at CVS, do you see that data solution as a major hurdle to overcome? Meaning the controlling, managing, and protection of the data -- but also making it available to every nook and cranny that it needs to get to?

Harrison: That’s always a key focus for us, and it’s frankly ingrained in every single thing we do. To give a sense of what we are putting out there, the price transparency tools that we have developed are all directly connected to our claims system. It’s the only way we can make sure that the patient out-of-pocket costs we provide are 100 percent accurate. They must reflect what that patient would pay as they go to their local pharmacy.

See the New Best Practice
of  Driving Patient Loyalty
Through Estimation

But making sure that our vendor partners have a robust and very rigorous process around security is paramount. It takes time to do that, and that’s one of the challenges we all face.

Gardner: So we have a lot going on with new transparency regulations, and more information coming out. We know that we have to make it secure, and we are going to have to overcome that. So it’s early still.

It seems to me, though, there are examples of the tools already developed and how they can be impactful; they can work.

Joann at Shields, do you have any examples of what benefits can happen when you bring in the right tools for transparency and for making good decisions?

Transparency upfront benefits bottom line

Barnes-Lague: Yes, we bring in more revenue and we bring it in timely. We used to be at about 60 percent collected from the patient’s side overall. Since we implemented tools, we are at 85 percent collected, a 400 percent increase in our overall revenue.

We have saved $4.5 million in [advance procedure] denials, just based on eligibility, authorization, and things like that. We are bringing in more money and we don’t require as much labor because of the automation. We are staffed around the automation now.

Gardner: Julie, how does it work? How do better tools and more information in advance help collect more money for a medical transaction?

Gerdeman: It works in a couple of ways. First, from a patient-facing perspective, they have the access to pay whenever and wherever they are. Having that access and availability is critical.

We have saved $4.5 million in [advance procedure] denials -- just based on eligibility, authorization, and things like that. We are bringing in more money and we don't require as much labor because of the automation.

Also they need to be connected. An estimate – like Heather talked about, to be able to make a decision from that -- has to be available from the very beginning.

And then finally, it's about options. All of these things help drive adoption if you give a patient options and clarity upfront. They have a choice of how to pay and they have the knowledge about costs. That adoption drives success.

So if you implement the tools appropriately you will see immediate impact. The patients adopt it, the staff adopts it, and then it drives up the collections that Joann is talking about.

Gardner: Heather, we have seen in other industries that tracking decision processes and behaviors leads to understanding use patterns. From them, incentivization can come into play. Have you seen that? How can incentives and transparency improve the overall economic benefits?

Incentivization improves savings

Kawamoto: Being able to communicate to patients what their anticipated out-of-pocket costs will be is powerful. A lot of organizations have created the means where they say to the patient, “If you pay this amount in advance of your service, you will actually get a discount.” That puts the patient in a position to say, “I could save $200 if I decide to pay this today.” That's a key component of it. They know they are going to get a better cost if they pay sooner, and then many of them are incented to do that.

Gardner: Any other thoughts about incentives, Alena?

Harrison: Yes. An indirect incentive, but still quite relevant, is that our price transparency tools are available to all of our CVS Caremark members. We are seeing about 230,000 searches a month on our website.

When members search for the drugs they are taking, if there are lower-cost alternative options, we see members in their next refill order one of those lower cost drugs 20 percent of the time. That results in an average savings of $120 per prescription fill for those patients. As you can imagine, over the course of several months, that savings really starts to add up.

Gardner: We have come back to the idea of the out-of-pocket costs. The higher the deductible, the lower the premiums. People are incentivized therefore to go to lower premiums. But then, heaven forbid, they have an illness, and then they have to start thinking about, “Oh my gosh, how do I best manage that out-of-pocket deductible?”

Nowadays, with technologies like machine learning (ML), artificial intelligence (AI), and big data analytics, we are seeing prescriptive or even recommendation types of technologies. How far do we need to go before we can start to bring some of those technologies about making good recommendations based on data -- rather than intuition or even a lack of informed decision making — to medical finance decisions? How do we get to that point where we can be proscriptive in automated recommendations, rather than people slogging through this by themselves?

Automated advice advances

Gerdeman: At HealthPay24 we are looking at predictive analytics and what role the predictive capability can play in helping make recommendations for patients. That’s not necessarily on the clinical or pharmaceutical side, but we know when a patient makes an appointment and gets an estimate what their propensity to pay will be.

Proactively we can offer them options based on what we know ahead of time. They don't even have to worry about it. They can just say, “Okay, here are my choices. I have only saved up $500; therefore, I am going to take advantage of a loan or a payment plan.” And I do believe that technology will help.

On the AI side, it’s already starting. As you talk to providers, they are using it for repetitive processes. But I think there is even more opportunity on the cognitive side of AI to play [a role] in hospitals. So there is a big opportunity.

Gardner: We already see this in financial markets. People get more information, they get recommendations, and there is arbitrage. It’s not either/or. It’s what are the circumstances? What’s the credit we can offer? How do we make the most efficient transaction for all parties?

So, as in other transactions, we have to gain more comfort with the combination economics and medical procedures. Is that part of the culture shift? You have to be a crass consumer and you have to be looking out for your health.

Any thoughts about the need to be both a savvy consumer as well as a patient?

Kawamoto: It's critical. To Julie’s point, we are now looking through our data and finding legitimate savings opportunities for patients, and we’re proactively outreaching to those patients. Of course, at the end of the day, the decision is always in the provider’s hands -- and it should be, because not all of us are clinicians. I certainly am not. But to allow patients to prompt that fuller conversation helps drive the process, so the burden isn't just on the provider. This is critical.

Gardner: Before we close out, any recommendations? How should the industry best prepare for more transparency around procedures and payments in medical environments? Joann, what do you think people should be thinking about to better prepare themselves as providers for this new era of transparency?

Lead with clear communication

Barnes-Lague: Culture is very important within the organization. You need to continue to talk. It’s shifting. Let’s talk about the burden to the provider, now that the patients are responsible for more. There is no other product that you can purchase without paying upfront. But you can walk away from healthcare without paying for it.

The more technology you implement, the more transparency you can provide, the more conversations you can have with those patients – these not only help the patients. You as providers are in business for revenue. This helps bring in the revenue that you have lost with the shift to consumer-driven health plans.

Gardner: Heather, as someone who provides tools to providers, what should they be thinking about when it comes to a new era of transparency?

View a Webinar on How Accurate 
Financial Data Helps Providers
make Informed Decisions

Kawamoto: While there have been tools available to providers, now we have to make those tools available to patients. Providers are, in many cases, the first line of communication to patients. But before that patient even schedules, if they are in a position to know they need a service, they can go out and self-shop.

That’s what providers need to be thinking about. How do I get even further out into the decision-making process? How do we engage with that patient at that early point, which is going to build trust, as well as ensure that revenue is coming to your particular facility?

Gardner: Beth, what advice do you have for consumers, the patients? What should they be thinking about to take advantage of transparency?

Take care of physicians and finances

Sanborn: First, I want to advocate for the physicians. We hear all the time about change fatigue, burnout; burnout is as hot a topic as transparency. If providers are going to be put in the position of having to have financial conversations with patients, I think health system leaders need to be aware of that and make sure that providers are properly educated. What do they need to know so that they can accurately communicate with patients? And they need to understand how that's going to affect the workload -- that is already onerous and at times damaging -- to physicians. So along Joann’s comments about culture, there needs to be a culture around ushering in physicians into that role.

From a consumer standpoint, when we look at the law that just went into effect, patients need to understand what are they looking at. The price list that the hospital is publishing is a chargemaster. It’s a naked price from a hospital. It's not what they are going to pay, and so we need to eradicate the sticker shock that I am sure is happening at first glance.

Gardner: The patient needs to self-educate about what’s net-net and what’s gross when it comes to these prices?

Patients need to be educated on what they are looking at, and then understand the options available to them as far as what they are actually going to pay. Payers need to make sure they are reaching out and make sure their consumers understand how the benefits work.

Sanborn: Right. You can put these prices in plain terms. The chargemaster is what a hospital charges. But remember you have insurance. There are discounts for self-pay. There could be other incentives or subsidies that you are eligible for.

So please don't have a heart attack, literally, when you look at this price and go, “Oh, my gosh, is that what I am responsible for?” Patients need to be educated on what they are looking at, and then understand the options available to them as far as what you are actually going to pay.

And the other thing is benefits literacy. Payers need to make sure they are reaching out to their consumers and making sure their consumers understand how the benefits work so that they can advocate for themselves.

Gardner: Alena at CVS, as a provider of pharmaceutical services and goods, what advice do you have about making the best of transparency?

Harrison: Beth hit the nail on the head with a lot of her points. We see similar brute-force regulation happening in the prescription drug space. So pharmaceutical manufacturers now need to publish their “sticker” prices.

Little do most people know, the sticker price is something no one pays. Payers don't pay it. Patients certainly don't pay it. The pharmacy doesn’t pay it. And so it is so critical as this information becomes available to make sure that your customers, consumers, and members understand what they are looking at. You as an organization should be prepared to support them through the process of navigating this additional information.

Gardner: Julie, what should people be thinking about on the vendor side, the people providing these tools, now that transparency is a necessary part of the process? What should the tool providers be thinking about to help people navigate this?

Gerdeman: It comes back to the user experience -- providing a simple, clear, and consumer friendly experience through the tools. That is what’s going to drive usage, adoption, and loyalty.

View Provider Success Stories
on Driving Usage, Adoption,
and Loyalty Among Patients

Technology is a great way for providers to drive patient loyalty, and that is where it’s going to make a difference. That’s where you are going to engage them. You are going to win hearts and minds. They are going to want to come back because they had a great clinical experience. They feel better, they are healthier now, and you want the rest of their experience financially to match that great clinical experience.

Anything we can do in the tools themselves to be predictive, clear, beautiful, and simple will make all the difference.

Gardner: I am afraid that we will have to leave it there. You have been listening to a sponsored BriefingsDirect digital business innovation podcast on the emergence of more data about costs across the health provider marketplace.

And we have learned about the pluses and minuses of increased costs transparency in the healthcare sector and ways to reduce the risk of out-of-context information that offers little actionable insight into actual consumer costs and obligations.

So please join me now in thanking our guests, Heather Kawamoto, Chief Product Officer at Recondo Technology in Denver; Joann Barnes-Lague, Revenue Cycle Director at Shields Health Care Group in Quincy, Mass.; Julie Gerdeman, President at HealthPay24 in Mechanicsburg, Penn.; Beth Jones Sanborn, Managing Editor at Healthcare Finance News/HIMSS Media in Portland, Maine, and Alena Harrison, Senior Director of PBM Innovation at CVS Health in Woonsocket, RI.

And a big thanks to our audience for joining this HealthPay24-sponsored thought leadership discussion. I’m Dana Gardner, Principal Analyst at Interarbor Solutions, your host and moderator. Thanks again for listening, and do come back next time.

Listen to the podcast. Find it on iTunes. Download the transcript. Sponsor: HealthPay24.

Transcript of a discussion on how new transparency on costs in healthcare provides both a step toward more educated choices as well as an opportunity to use technology to inform and instruct throughout increasingly complex payer-provider-patient processes. Copyright Interarbor Solutions, LLC, 2005-2019. All rights reserved.

You may also be interested in:

• How The Open Group Healthcare Forum and Health Enterprise Reference Architecture cures process and IT ills
• Philips teams with HPE on ecosystem approach to improve healthcare informatics-driven outcomes
• A tale of two hospitals—How healthcare economics in Belgium hastens need for new IT buying schemes
• IT kit sustainability: A business advantage and balm for the planet
• How global HCM provider ADP mines an ocean of employee data for improved talent management
• The Open Group panel explores ways to help smart cities initiatives overcome public sector obstacles
• Regional dental firm Great Expressions protects distributed data with lower complexity thanks to amalgam of Nutanix HCI and Bitdefender security
• Balancing costs with conscience--How new tools help any business build ethical and sustainable supply chains