Telehealth for Chronic Disease Management

Diabetes, arthritis, hypertension, lung disease, and other chronic diseases can make life difficult to manage for millions of older adults, often forcing them to give up their independence.  Telehealth has proven to increase access to care and reduce costs via teleconsultations and remote patient monitoring.  Evidence shows that telehealth can effectively improve care with patients with chronic conditions, such as was demonstrated in a fourteen year study published in 2014.  Telehealth platforms can be used to more effectively educate patients and their families, develop and share care plans, monitor symptoms, and manage medications.  West Corporation, a global provider of communication and network infrastructure services, recently conducted a survey of nearly 1,000 patients and healthcare providers in the United States.  The survey (Strengthening Chronic Care) specifically targeted patients that have at least one chronic health condition and have been hospitalized as a result of a chronic illness.  Their goal was to identify some of the problems surrounding chronic care, and what it will take to address those issues.  Here is an overview of some of their findings:

91% of patients reported needing help managing their disease.

70% of patients reported wanting more resources or clarity to help manage their chronic health condition.

66% of the patients surveyed claim they do not get valuable personalized information from their provider, but rather they receive very general information.

60% of patients feel they spend more time discussing their symptoms with healthcare providers than ways to manage their condition.

58% of patients believe two-way, at-home monitoring devices are very useful to interact with their healthcare provider, rather than a more basic one-way at-home device.

54% of patients feel a weekly or twice weekly check-in from their provider would be valuable.

50% of patients feel an at-home medical device that measures their health using sensors and sends information back to providers for an evaluation would be extremely beneficial.

39% of patients need the most help managing their condition at home and in daily life.

21% of patients feel they need 24-hour assistance managing their chronic condition.

16% of patients reported feeling motivated to make changes to improve their health after being admitted to the hospital because of chronic medical condition.

12% of patients insist their provider is doing a good job of delivering information tailored to their specific needs and condition. (Only 12% in this survey!)

There is no such thing as a standard telehealth program.  Consequently, it is extremely important to take the time to develop a telehealth strategic plan first, as there are many nuances to consider as they relate to your particular business.  Interested in in advancing your global telehealth initiatives?  Visit www.StrategicTelehealth.com.

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Contact ABISA for healthcare consultancy support or speaking engagements.

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The Components of Your Medical Practice Plan

When creating a medical practice plan, all planning must be based with sensitivity to the time available you have to enact the plan.  If sufficient time is available and there is no advantage to be gained by acting more quickly, you must be deliberate.  Deliberate planning is performed well in advance of expected execution and relies heavily on assumptions about circumstances that will exist when the plan is implemented.

If your time is short, or there is an incentive to act quickly, you must enact rapid planning.  Whereas deliberate planning relies on significant assumptions about the future, rapid planning is generally based on current conditions and is therefore more responsive to changing events.  Rapid planning tends to be less formal than deliberate planning.  While distinct in concept, deliberate and rapid planning form a continuum and complement each other in practice.  Early in the planning process, if appropriate, we may perform deliberate planning.  As we near the day of execution, we move into rapid planning.  Deliberate planning thus forms the basis for rapid planning, while rapid planning often amounts to the revision of earlier deliberate plans.

Regardless of other characteristics, every medical practice’s plan usually contains several basic categories of information.  Each plan should have a desired outcome, which includes the intent for achieving that outcome.  The desired outcome often includes a time by which the mission must be accomplished.  This element of a plan is essential because it forms the basis for the other components of the plan.  Goals and objectives may be general, in which case they are defined by relatively few criteria and offer broad latitude in their manner of accomplishment, or they may be more specific, in which case they are defined by numerous criteria and are more narrowly bounded.

We should recognize there is a critical distinction between general goals, which may be good and vague ones, which are not.  While general goals have relatively few defining criteria, vague goals lack any usable criteria by which we can measure success.  In an industry that’s as complex as healthcare, few things are as important or as difficult as setting clear and useful goals.  This is a skill requiring judgment and vision.  The reality is that, given the nature of healthcare reform, we will often have to act with unclear goals.  Unclear goals are generally better than no goals, and waiting for clear goals before acting can paralyze a medical practice.

Every medical practice’s plan includes the actions intended to achieve the desired outcome.  Most plans include several actions, arranged in both time and space.  These actions are usually tasks assigned to subordinate elements.  Depending on circumstances, these tasks may be described in greater or lesser detail over farther or nearer planning horizons.  Every plan should also describe the resources to be used in executing those actions, to include the type, amount, and allocation of resources as well as how, when, and where those resources are to be provided.  Resource planning covers the personnel assigned to different tasks and other resources such as supplies or funding.

Finally, a medical practice’s plan should include some control process by which practice managers can supervise execution.  This control process includes necessary coordination measures as well as some feedback mechanism to identify shortcomings in the plan and make necessary adjustments.  The control process is a design for anticipating the need for change and for making decisions during execution.  In other words, the plan itself should contain the means for changing the plan.  Some plans are less adjustable than others, but nearly every plan requires some mechanism for making adjustments.  This is a component of plans which often does not receive adequate consideration.  Many plans stop short of identifying the signals, conditions, and feedback mechanisms that will indicate successful or dysfunctional execution.

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Contact ABISA for healthcare consultancy support or speaking engagements.

Last Year’s Healthcare Breaches

Hacking healthcare is trend that is likely to continue for the foreseeable future, so no one should be surprised about patient data breaches.  And despite the often valiant efforts of healthcare organizations to protect patient data, IT security vulnerabilities have existed as is evidenced by the healthcare data breaches that came to light in 2016.  A report by TrapX Security shows that healthcare cyberattacks in the United States increased 63% from 2015 to 2016 and that such attacks now account for 31% of all major HIPAA data breaches (which is a 300% increase in just three years!).  Here are the top ten healthcare cyberattack breaches in the U.S. last year:

  1. Alliance Health Networks had one of its patient databases accessible to the Internet, resulting in 42,372 patients’ protected health information being exposed for 30 months.
  1. Urgent Care Clinic of Oxford had its systems breached, impacting 64,000 patients.
  1. Medical Colleagues of Texas had its systems breached, impacting 68,631 patients.
  1. Southeast Eye Institute, P.A. dba Eye Associates of Pinellas had its systems breached, impacting 87,314 patients.
  1. Central Ohio Urology Group suffered a cyberattack impacting 300,000 patients.
  1. Peachtree Orthopedic Clinic had its systems hacked, resulting in 531,000 patients’ protected health information being compromised.
  1. Valley Anesthesiology Consultants reported they suffered a cyberattack which possibly impacted 882,590 patient records.
  1. 21st Century Oncology had its systems breached, impacting 2,213,597 patient records.
  1. Newkirk Products (a service provider that issues healthcare ID cards for health insurance plans) suffered a cyberattack which possibly impacted 3,446,120 patient records.
  1. Banner Health had its systems breached, impacting 3,620,000 patients.

The full report from TrapX Security can be accessed here.  (Although, after reading through all of the above, you may be a little leery about clicking on this link, right?)

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Contact ABISA for healthcare consultancy support or speaking engagements.

Medical Administrator Recruitment

Undoubtedly a talented administrator will help to ensure a medical practice operates efficiently, is profitable, and has great employees.  Finding such an administrator, however, can sometimes be challenging since your practice is not the only one attempting to recruit that stellar candidate.  So, if you like gambling in casinos and/or have plenty of time to spend interviewing countless candidates, then you should put an advertisement in your local paper or online.  Otherwise, your time and money would be better spent using a recruiter to find an experienced administrator who you will value for years to come.

A good recruiter will weed through the candidates and give you just a few (no more than three) who appear to be a good fit for you and your practice.  Of course, when it comes time to interview, there are several items you need to ensure are covered.

Top Characteristics

Here a few things that you should ensure the candidates have when you are conducting your interview:

  • Appropriate education level (Do they need a high school diploma? Specific type of college degree? Master’s degree?)
  • Business acumen (This is your business person, so don’t skimp on this criteria. You are not hiring them to perform surgery; you are hiring them to keep the practice in order.)
  • Leadership capabilities (Are they motivating? Can they delegate?)
  • Healthcare administrator qualities (Do they communicate well? Are they empathetic?  Do they have a sense of attention to detail?)

Warning Characteristics

Recruiters should be interviewing candidates in great detail before they ever send them your way.  It is their job to be acute and to have a thorough selective process.  Even the best of recruiters may miss something when they screen candidates, so here are a few red flags you should be on the lookout for when conducting your interviews:

  • Did the candidate ask about salary upfront? (Actually, when using a recruiter, the candidate should not even bring it up since the recruiter should have already covered the salary range, benefits, etc.)
  • Did the candidate ask about long hours?
  • Did the candidate slam their former co-workers?
  • Does the candidate appear to have poor people skills?
  • Does the candidate appear to miss the point about patient care? (This can sometimes be the case if this will be the first job they have in a medical practice.  Obviously, patient care is a priority.  The candidate that does not get that, will not do a job well since they will be unable to relate to the tasks the clinical staff perform on a daily basis.  The candidate does NOT have to have clinical experience to do a great job as an administrator.)

This position is crucial member of your staff and critical to the success of your practice.  Finding the right administrator is not easy, but being open about your needs to a recruiter can help to facilitate the search for a perfect fit.

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Contact ABISA for healthcare consultancy support or speaking engagements.

Market Assessment for Medical Practice Competition

For healthcare organizations, a competitive analysis is a means to assess who your competitors are, what value they provide, understanding their (and your) strengths and weaknesses, and where your practice fits in. A good competitive analysis is a scouting report of the actual market terrain that your practice must navigate in order to be successful. While analyzing the competition is an essential component of your strategy, most medical practices don’t conduct this type of analysis systematically enough. However, a thorough competitive analysis is indispensable.

  • First, begin by compiling a list of your practice’s competitors. Most of the time, such a list is comprised of who your practice considers to be its chief competitors. However, there may be other healthcare organizations that indirectly compete with yours, perhaps ones outside of your catchment area that offer services such as telemedicine or niche treatment modalities that are aiming for the same patients. You will also want to include information on healthcare entities that may be entering your market in the coming year. Once you have compiled the list, you can highlight those practices that will be the greatest challenge.
  • Second, analyze the competition’s services in terms of features, value, and target patients. How do they market them? How do patients see your competition? How do referring physicians view your competition? Take an honest look at their offerings. Is your quality commensurate? Do you have similar offerings? What is the unique value you provide that competitors don’t or can’t? Emphasize these benefits in your marketing.
  • Third, compile a list of competitor strengths and weaknesses and remember to be objective. You’ll do your practice no good if you allow bias toward your own physicians, staff, and services to cloud your judgment. Try to see the competition’s practice as though you were them. What makes their practice so great? If they are growing rapidly, what is it about their practice that’s promoting that growth?
  • Fourth, observe how your competitors market themselves through advertising, collateral material, and perhaps the use of physician liaisons. You will have to go to many different sources to get a complete picture. It takes practice and a little shrewdness on your part to piece together a complete picture of strategies and objectives, so the use of a qualified consultant may be to your benefit. Focus on the facts, be persistent, and trust your intuition to help you.
  • Fifth, what are the market demographics for your practice like now? Is it growing? If so, then there are likely quite a few patients left to go around. If on the other hand the market is flat, then the competition for patients is likely to be fierce. Your practice will find itself scrambling to win market share. The outlook portion of your analysis may seem like forecasting, but it’s really a measure of trends. By the time you’ve done most of your research, you’ll have enough information to determine what the outlook really is.

By evaluating yourself against your competition, you’ll likely find new ideas for your practice. While compiling a competitive analysis is an interesting piece of work, it can indeed be challenging. Consequently, you may want to seek the help of a healthcare consultant to guide you through this process. You’ll learn a lot about your market and in the process become a more valuable resource for your patients and referring physicians.

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Contact ABISA for healthcare consultancy support or speaking engagements.

Outlook on Digital Health Data

Digital health tools can improve consumers’ direct visibility into and control over their vital health metrics and ongoing healthcare needs.  Millions of Americans report that smartphones and apps have changed the way they manage their health and wellness.  As Americans begin to use wearable devices to track and collect their personal health data, we will see more of a willingness to share that data with healthcare providers and intermediaries.  Consequently patients’ expectations for care and care delivery are changing, and will force the healthcare industry to change.  Providers, however, are having to tackle long-standing interoperability and data access challenges.  So, while many would agree that the future of digital health data is bright, there’s much work to be done.

The 2015 Digital Impact Survey surveyed 1,000 smartphone owners over the age of 18 and found a 70% increase (over its 2013 survey) in adoption of smartphone and apps to manage health and wellness.  Meanwhile another report has been published which analyzes consumer attitudes and preferences about making care choices and decisions and provides guidance to healthcare stakeholders regarding how to communicate and engage with consumers for self-care and support.  The report shows the increased adoption of connected health devices which includes items such as blood pressure meters, connected treadmills, digital fitness trackers, and networked weight scales.  Now, a research study conducted in the fourth quarter of 2016 reported results of its findings of patient evaluations on of technology.  The study polled over 12,000 adult patients and here is just a snapshot of some of the findings:

96% of respondents said they left their physician office visit with poorly communicated or miscommunicated instructions on patient portal use.

94% of patients with fitness trackers reported that their physician informed them the practice had no capability or interest in coordinating their outcomes currently via their electronic health record (EHR).

93% expressed concerns over the security of their personal financial information being used by healthcare providers; 70% of Americans reportedly distrust health technology.

91% of respondents noted feeling slighted by their providers who would not accommodate their personal data and believe their physician practice’s EHR should store any health-related data they request.

87% of patients are unwilling to comprehensively divulge all of their medical information.

84% of patients said their trust in their provider is influenced by how the provider used health technology; 69% of patients stated they believe their current primary care physician does not demonstrate enough technology prowess for them to trust divulging all their personal information.

On the physician side of things, the study states that 94% of physicians find the volume of digital health data to be overwhelming, redundant, and unlikely to make a clinical difference.  Additionally, 85% of physicians reported that the addition of EHRs has made patient care too impersonal.

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Contact ABISA for healthcare consultancy support or speaking engagements.

Physician Employment ≠ Quality of Care

As previously mentioned regarding physician practice acquisitions, many hospitals around the country have sought in recent years to increase their number of employed physicians.  Their goal of doing so is to be better prepared with healthcare reform that reimburses based on quality of care, outcomes and cost control rather than the traditional fee-for-service system.  The belief by many hospitals has been that employment of physicians will lead to greater care coordination, more closely aligned incentives, and ultimately better patient care.  However, a new study in the Annals of Internal Medicine demonstrates that “no association was found between switching to an employment model and improvement in any of 4 primary composite quality metrics.”  Specifically, there were no resultant changes in mortality rates, 30-day readmissions, length of stay or patient satisfaction rates.  Researchers noted:

“Although some of these improvements certainly are taking place as hospitals increasingly employ physicians, on the basis of the hospital performance metrics we examined, we found no national-level evidence that these changes have translated into better patient care.”

In the study, 803 acute care hospitals in the U.S. that switched to an employee relationship with their physicians were compared with 2,085 hospitals that maintained unaffiliated or contractual relationships with their physicians.  The researchers’ summed up their study by stating:

“During the past decade, hospitals have increasingly become employers of physicians. The study’s findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care.”

Consequently, the study recommends hospitals should instead focus on ways to boost clinical integration and improve patient care instead of hoping those goals will be accomplished solely by employing more physicians.  The study that was recently published in the Annals of Internal Medicine can be found here.

On a related noted, other data proving that financial integration between physicians and hospitals has been associated with higher commercial prices and spending for outpatient care, can be found in my Consolidation ≠ Efficiency article.

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Contact ABISA for healthcare consultancy support or speaking engagements.