CEO Dr. Mansoor Khan observations about Population Health, Care Management & Clinical Surveillance

CEO Mansoor Khan
CEO Mansoor Khan

Q: What did you take away as the biggest changes ahead for the healthcare industry in 2015?

A: Population health management and how providers and clinicians can more effectively manage patients, and their data, were some of the main issues that I had addressed at the show. In the past, we had focused on the provider data, which essentially was “dirty data” that needed better ways to be captured, normalized and then inter operate across healthcare systems and into clinical workflows. But on the horizon, the biggest challenge will be around consumer data, where cognitive computing and machine learning will play a big role in aggregating and incorporating these new, and vast, consumer-driven data.

Also a big healthcare change that was discussed was managing patients with two or more chronic conditions. Under a new rule published by CMS, which went into effect on January 1, 2015, clinicians who dedicate at least 20 minutes to care management services during a 30-day period will be paid $41.92 a month, including non-face-to-face care.  This new regulation was a huge topic during the show. Especially with new health care models shifting from inpatient to more outpatient services, home-based chronic care management is a natural evolution for the healthcare industry. By allowing for non-face-to-face care, this will keep patients in their homes and with their caregivers, and will be a tremendous leap forward in the way that patients and their clinicians communicate and collaborate on chronic care treatment.

Q: What are the major hurdles that were discussed on advising providers concerned about satisfying the new CMS regulations for chronic care management?

A: We talked to a lot of ACOs and hospital systems about the challenges that will come with tracking billable time, handling the billing process and reimbursements, to even locating, and providing clinician resources for the required monthly care management and patient interaction. Technology will continue to be the linchpin to the success of these chronic care programs. Having the right population health platform is also key. It has to be comprehensive, accessible and meaningful. Providers need to easily identify eligible beneficiaries for enrollment, have access to disease registries for advanced tracking and deploy real-time evidence-based alerts to close crucial care gaps. Few products on the market today are able to capitalize on this opportunity, and those that can, will have a great competitive advantage.

Q: What were some additional trends emerging from the show?

A:  It seems that the biggest change from the providers point of view is this dramatic shift from in-patient services to ambulatory services. Hospitals that do not have a solid plan on how to shift their models accordingly will face big challenges. CMS is already promulgating new regulations that will both force and enable these changes. Additional CMS regulations are coming to infection control and managing antimicrobial stewardship.  I talked to many hospitals that are considering implementing a real-time clinical surveillance solution to help prevent and contain hospital-acquired infections (HAIs) to avoid escalating CMS penalties. This is a huge concern, and these penalties have just increased from 2% to 3% this past year. In 2015, CMS had also expanded the scope of reporting HAIs from not just the ICU but hospital-wide. It will become ever more critical to implement automated real-time monitoring tools that will mitigate these risks by quickly identifying HAIs, which in turn, will significantly cut down on the instances of re-admissions.

Q: Any final thoughts from HIMSS 2015?

A: The health care industry continues to evolve around patient-centric solutions as we transition from fee-for-service to value-based care. Meaningful Use regulations have made great strides, and will continue to become even more important with the coming of Meaningful Use Stage 3. Making all health records digital is positive progress, but interoperability and managing this vast amount of patient data remains problematic. This is where Big Data and cognitive computing will play an active role in shaping this next stage of Meaningful Use. On the whole, and despite some familiar HealthIT challenges, there have been great gains made in the last few years, and patient outcomes should remain a top priority for providers. By focusing on improving the patient experience and better chronic care management, I think 2015 will be a truly transformative year in healthcare.