Developments from the past month highlight progress and opportunities for improvement within the health care industry. Here's our take on what you need to know to maintain and create business value.

Digital Health

Nearly $10 Billion could be shaved off the nation's annual health care bill by virtual health

That's according to an exhaustive analysis of the potential of virtual health released by Accenture at the U.S. News & World Report's Hospital of Tomorrow Forum. Most of the savings --some $7 billion --would come from using virtual health technologies to “streamline” patient visits with primary care providers. Providers could collect patient information and discuss treatment options “virtually” with patients prior to face-to-face office visits, Accenture said. Another $2 billion could come from patients using virtual health technologies to manage their chronic medical conditions rather than seeking care from providers in physical settings, the analysis said. The health care industry is on the front end of tapping into the potential of digital health to improve health outcomes and lower health care spending. The time to think about how it could positively affect your health care business is now.

80% of consumers have used at least one digital health technology

According to a new report from Rock Health based on a comprehensive survey of more than 4,000 consumers on their digital health habits. According to the report, 80 percent of the surveyed consumers said they used a digital health technology at least once in one of six categories:

  • Online health information
  • Online health reviews
  • Mobile health tracking
  • Wearables
  • Genetic services
  • Telemedicine

Yet, only 2 percent of the respondents were digital health “super adopters,” which Rock Health defined as people who used at least five of the six technologies. The report is essential reading for health care providers, payers and suppliers that want to know where they should target their resources.

Primary Care

52,550 first-time applicants to medical school this year --all-time high per AAMC

The number of first-time applicants and number of students enrolled in U.S. medical schools both hit all-time highs this year, according to data released by the Association of American Medical Colleges. The number of applicants is 52,550, and the number enrolled is 20,630. The AAMC credited medical schools for “…creating innovative education and training programs to prepare tomorrow's doctors to meet the challenges of the changing health care environment.”

167 advanced practice providers in 41 cardiology practices who cared for 459,669 heart patients

That's the number of nurse practitioners and physician assistants who were just as effective in providing outpatient cardiac care services to heart patients as 716 physicians in the same practices, according to a study published in the Journal of the American College of Cardiology. The study concluded that a collaborative care model supported by a mix of primary care providers is capable of providing care comparable to that provided by physician-only models and presumably for less.

Revenue Cycle Management

10.1% of Medicare claims denied during first four weeks after switch to ICD-10

That's a negligible increase from the 10 percent of Medicare claims denied historically from Oct. 1 through Oct. 27, according to data released by CMS. The results indicate that health care providers and Medicare were well prepared for the transition to the ICD-10 code set on Oct. 1 and that the much-feared hit to accounts receivable from rejected or denied claims has yet to materialize. In fact, Medicare rejected only .09 percent of the claims during the first four weeks of the transition because of invalid ICD-10 codes compared with 0.17% of claims historically rejected during the same period because of bad ICD-9 codes. A testament to the education, training, practice and testing efforts.

$9.7 Billion projected size of the health care outsourced revenue cycle management market by 2018

That's according to Black Book Market Research in its annual report on the state of the health care revenue cycle outsourcing and technology. That eye-popping $9.7 billion figure will be fueled by a nearly 27 percent annual growth rate in the market over the next three years, the firm said. Driving the market is the need for health care providers to upgrade their billing and collection skills to handle new reimbursement models and millions of newly insured patients because of the health insurance mandates of the ACA. The report said 83 percent of hospitals now outsource some accounts receivable and collections. The new health care environment requires new levels of expertise, including revenue cycle management that may not be available in-house.

Value Based Reimbursement

$145 Billion paid out in medical claims by 36 Blues plans through value-based care programs 

That's the amount of value-based payments made by three dozen independent Blue Cross and Blue Shield plans to health care providers from July 1, 2014, through June 30, 2015, according to figures released by the national Blue Cross Blue Shield Association. The $145 billion represents more than one-third of the total claims paid by the plans during that 12-month period. The data support the belief that value-based reimbursement is well on its way to becoming the dominant health care financing mechanism of the future. Providers should be preparing for that future now with value-driven care models supported by robust quality, outcome and cost data infrastructures.

64% of surveyed hospital executives rank transition to value-based reimbursement as top challenge

Not surprisingly, “managing the switch to value-based reimbursement models” ranked No. 1 on a list of challenges that need to be addressed by hospitals. That's based on a new survey of 320 c-suite hospital executives by Peer60. The ways to effectively manage the transition to VBR also are on the list at No. 2, No. 3 and No. 4. Respectively, they are: Coordinating care, managing patient populations and patient engagement. Hospitals and other providers that excel at those three competencies will have no problem coping with the top concern on their list.

About 1,800 hospitals will receive bonuses under Medicare's VBP Program in fiscal 2016

That's a 50 percent increase in the number of hospitals that received bonuses from Medicare in fiscal 2015 under the program's Value-Based Purchasing Program, according to figures released by CMS. The VBP Program rewards or penalizes hospitals based on how well they score on measures in four quality domains: Outcomes, patient experience, efficiency and clinical process of care. Based on their individual performance, each of the 1,800 hospitals will receive their proportionate share of $1.5 billion in bonuses. The results show two things: Better care and better financial health go hand in hand; and, hospitals with the right tools and competencies can improve their performance in just one year.

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McKesson editorial staff is committed to sharing innovative approaches and insights so our customers can get the most out of their business solutions and identify areas for operational improvement and revenue growth.

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