Archive for December, 2010

A December interview in The Economist with IBM’s Global Director of Healthcare Marketing, Andrea Cotter, highlighted the pivotal role of EHR’s in transforming healthcare. This comes simultaneous with a study this month showing better financial performance for providers using EHRs

 

Ms. Cotter explains: “…access to critical health information must be simplified, streamlined and automated to reduce costs and improve service. Electronic health records are the foundationof this transformation, the basic building blocks of health-care efficiency. When standardised and shared, EHRs provide a powerful means of increasing accuracy and speeding the delivery of patient information to the point of care. They enable stronger collaboration, more complete records and better service. And they serve as the enabler of other health-care IT, such as analytics and predictive modeling…”

 

The current healthcare structure is debilitated by fragmented data residing in uncoordinated and inefficient systems. These systems cannot integrate to assist caregivers in their efforts to deliver improved treatment or more efficient cost management. Instead, these disconnected segments in the present structure can become breeding grounds for fraudulent billing schemes, waste, duplication and error at multiple levels.

The good news is that collecting, storing and analyzing high quality patient data is now a fully achievable task and the crucial process of developing/deploying a unified system for sharing the data is well underway. Connected medicine, an impossibility a decade ago, is now healthcare’s imminent destination. To get there the system needs to:

  • Fully digitize patient data and create the EHR’s
  • Develop a universal vocabulary for data exchange
  • Standardize methods for sharing & protecting the data
  • Apply state of the art analytics for interpreting data

As digitizing of patient data comes together in detailed EHRs and a common language for health information exchange is developed a new and encouraging view of healthcare comes into focus.

More and more significant collaborative efforts are following examples like that of UPMC’s $8 billion global health enterprise and its Center for Connected Medicine. The corrective potential of a fully integrated healthcare system is enormous. With patient-care at its core, connected medicine holds the promise of redefining how treatment is managed, delivered & advanced, all within a cost efficient structure.

It’s been a year of steady and encouraging progress in the fight against fraud and waste in the healthcare sector. The Inspector General’s office reports an expectation of significant total savings in many sectors for fiscal 2010, with a noteworthy $3.8 billion coming from investigative receivables.

 

“…We are particularly encouraged by the success of our partnerships with HHS and the Department of Justice through the Health Care Fraud Prevention and Enforcement Action Team (HEAT),” Inspector General Daniel Levinson said in a news release.

 

Use of advanced predictive analytics in preventing fraud & waste is gaining a prominent role in the battle. At a recent healthcare fraud prevention summit HHS Secretary Kathleen Sebelius and Attorney General Eric Holder announced that the CMS will be acquiring new analytic tools. The CMS is soliciting for “state of the art, fraud-fighting analytic tools to help the agency predict and prevent potentially wasteful, abusive, or fraudulent payments before they occur.” It’s the “before they occur” aspect of the analytics that brings the greatest potential for arresting and reducing the sharply rising costs in the current healthcare system.

The CMS, with new and expanded authority,
Will be able to take anti-fraud action before a claim is paid.

 

“By using new predictive modeling analytic tools we are better able to expand our efforts to save the millions – and possibly billions – of dollars wasted on waste, fraud and abuse.” said CMS Administrator Donald Berwick, M.D.

 

Customizable analytics software & services such as IBM’s Fraud and Abuse Management System is providing the state of the art solutions now needed. ‘FAMS’ is capable of sorting through information on tens of thousands of providers and tens of millions of claims in a matter of minutes…creating suspicion indices using almost 1,000 behavioral patterns in a wide range of specialties. The highly customizable system yields rapid results as the analytic modeling tools reveal potentially fraudulent activity, waste, mis-management of funds and other sources of loss. The software, tools and services needed to combat fraud and plug many other fiscal leaks in our ailing healthcare system are ready for frontline deployment.