Healthtech Security
Article | November 29, 2023
With consumers’ share of healthcare costs expanding, we need to do a better job making charges more transparent and more predictable
My husband recently stubbed his toe. Badly. Badly enough that I encouraged him to go see a doctor. He was reluctant. While I suspected he’d rather just garner sympathy by complaining to me while limping around the house (just kidding, honey), his stated reason was all too familiar: “I have no idea what we’ll have to pay. They’ll want to do anX-ray,it might need surgery, and I have no idea what it’ll cost.” All true. We have good health insurance; but like most Americans, when we go to the doctor or have a procedure, what we will actuallyhave topay out of pocket remains a mystery.This is something that we can and should change.
As consumers we are shouldering more and more of the cost of healthcare. And the biggest increases are for those of us with employer-sponsored plans. According to an analysis of federal data by the Commonwealth Fund,deductibles in employer plans more than doubled between 2008 and 2017, from $869 to $1,808. Especially troubling, an accompanyingCommonwealth Fund survey revealed that only 62% of adults were very or somewhat confident in their ability to afford healthcare.
This increasing burden is also evident when you look at the crushing levels of medical debt in the United States. According to a new studyby JAMA, medical debt is now the largest contributor to personal debt. And the data for this study was collectedbeforethe COVID-19 pandemic.
Some of this debt is driven by unpredictability—if the heart procedure you needed costs several thousand dollars more out of pocketthan you thought it would, you may not be prepared, emotionally or financially, to pay it. This is a bad outcome, obviously. The risk of nonpayment rises for the provider; and a recuperating patient is burdened with the stress of a large,unexpected bill.
More skin in the game
Soas consumers are paying more out of pocket, some may become reluctant to seek care (like my husband) or seek more information about what they willhaveto pay for the care they receive. Consumers are also armed with incredible levels of price transparency with other products—everything from hotel rooms to clothing to household items. With so much skin in the game, and the internet providing so much information, consumers’ expectations are changing when it comes to healthcare.
State and federal regulators are also beginning to take action, a trend that will likely accelerate. Most hospitals are now required to publicly disclose the prices they charge. This does not, however, solve the issue for consumers. While it provides a measure of visibility into pricing for insurance companies, Medicare, and Medicaid, it doesn’t show what share the patient will ultimately pay.
Making the complicated simple
The complexity of pricing in healthcare is well documented. Niall Brennan, CEO of the Health Care Cost Institute, a nonprofit that analyzes medical costs, suggests that healthcare costs are too high.As a recent Wall Street Journal article reported, a price of a C-section varied from $6,241 to$60,584 at one hospital. This all has to do with the vagaries of the agreements that hospitals sign with multiple insurance companies and government payers. In turn, each insurance company will have its own deductible and out-of-pocket schedules, which providers don’t have access to.
We are seeking to change this at Change Healthcare. We are piloting our Care Cost Estimator with a few innovative providers. With the Care Cost Estimator, weleverage our unique dataset, and the largest eligibility network in the industry, to make the unpredictable, predictable.Because we’ve managed 15 billion healthcare transactions—and our network covers 1 million physicians, 6,000 hospitals, and 2,400 payers—we have an unmatched ability to analyze what real-world patients are paying for practically any procedure, performed at almost any hospital or clinic.
With a cloud-based transaction engine, providers will now be able to tell their patients how much they will have to pay out of pocket for a given procedure.And this analysis takes place in real time.
Removing unpredictability in pricing
This gives providers the opportunity to offer added value for their patients, taking some unpredictability out of whatis often a stressful transaction. In addition, it accelerates patient payment cycles which, as the patient’s share of the cost burden increases, is becoming more and more important. We’re not talking $50 co-pays anymore; it’s thousands of dollars per transaction. If necessary, providers can also help the patient plan for the expense, offering financing options, thus reducing unpaid bills. For the patient, it allows more informed decision-making and peace of mind.
Testing the beta version of our Care Cost Estimator with our partners will allow us to receive real-world feedback and collaborate with customers on how to continuously improve the product as we scale it. We expect the ROI for providers, in addition to the payment-cycle improvements, will include greater patient satisfaction and loyalty. For the patient, it provides information necessary to help make proper decisions and plan emotionally and financially; in other words, giving the consumer the same information for vital healthcare transactions that’s available to them for practically any other purchase.
This kind of win-win solution is at the core of Change Healthcare’s mission to improve the healthcare experience for everyone—including my husband and his broken toe!
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Healthtech Security
Article | August 31, 2023
In the ever-evolving healthcare landscape, transparency in pharmacy benefit management (PBM) has emerged as a critical issue. The discussion surrounding driving down prescription drug costs and increasing access to affordable medications has brought attention to the practices of PBMs. However, achieving true transparency requires more than just buzzwords; it necessitates access to real-time data that empowers consumers to make informed decisions about their healthcare. In this piece, we will explore the importance of real-time transparency in PBMs and highlight how Xevant, a leading platform, is revolutionizing the industry.
The Current State of PBM Legislation
With over 100 bills to reform PBM practices, legislative efforts are intensifying to address the business practices associated with PBMs. However, one common concern is the absence of language surrounding real-time automation in many of these bills. The lack of such provisions threatens to undermine the effectiveness of the proposed reforms. It is crucial to examine the available resources and insights to gain a comprehensive understanding of the issue. The current state of PBM legislation and the efforts to reform PBM practices highlight the pressing need for transparency and accountability in the pharmaceutical industry. PBMs play a critical role in the drug pricing ecosystem. Still, concerns about “traditional” PBM business practices, such as lack of transparency and opaque rebate systems, have raised questions about their impact on drug prices and patient access to affordable medications.
Xevant's Groundbreaking Solution
Xevant, led by CEO Brandon Newman, stands at the forefront of the drive for transparency in PBM practices. As the only platform capable of providing PBMs and consumers with real-time, automated, and completely transparent data from the entire pharmacy benefits ecosystem, Xevant is poised to revolutionize the industry against the backdrop of the political landscape.
The absence of language surrounding transparency and real-time automation in many proposed bills threatens the effectiveness of the reforms. Yet, innovative companies like Xevant are leading the charge for openness in PBM practices. Xevant's real-time data automation and optimization capabilities empower consumers with timely, comprehensive, and transparent information, enabling them to make informed decisions about their healthcare and potentially save money.
With the potential passage of these bills, the pharmaceutical industry could see a shift towards greater accountability, fairer pricing practices, and improved access to affordable medications. The reforms could also create a more level playing field for generic drug manufacturers, fostering competition and lowering prices.
Real-Time Data Automation and Optimization
Newman emphasizes that transparency cannot be achieved without access to real-time data automation and optimization. This real-time, customized data enables individuals to compare prices, explore alternatives, and understand the specific cost components related to their medications. By bringing together various parts of lowering drug costs, such as drug rebates, 340B contracts, sell-side discounts, copay assistance, and employer negotiations, Xevant offers a solution that empowers consumers with the information they need when required.
The Implications of Timely Access to Data
The scarcity of timely access to data among many traditional PBMs is a significant challenge in achieving transparency in the pharmaceutical industry. These PBMs typically collect data annually, which leaves a substantial margin of error and can result in millions of dollars lost from consumers' pockets. In contrast, Xevant's capabilities offer a game-changing solution.
With Xevant's platform, consumers gain immediate access to critical information regarding drug rebates, markups during spread pricing, competitive alternatives, and the vast landscape of the pharmaceutical ecosystem. Having these complete datasets available in real-time allows individuals to make informed decisions about their healthcare and potentially save lives. The significance of timely access to data cannot be overstated, as transparency becomes meaningful only when it happens in the present rather than months, or even a year, later than when the impact has already occurred.
Navigating Proposed Legislation and Questionable Business Practices
Another critical aspect of the PBM landscape that Xevant addresses is the moral implications associated with cost-sharing, clawbacks, spread pricing, and the pass-through of rebates. These practices have long been criticized for their opacity and their negative consequences on patients' access to affordable medications. Xevant's transparency-focused approach highlights these practices, allowing stakeholders to evaluate their ethical implications and work towards fairer alternatives.
Xevant recognizes that proposed legislation may have potential cracks that allow for slip-through and the continuation of questionable business practices. Delayed and inaccurate reporting are loopholes that can hinder the effectiveness of reform efforts. By actively engaging with legislators and industry stakeholders, Xevant aims to identify these potential shortcomings and advocate for comprehensive robust legislation that leaves no room for exlploitation
The Future of Healthcare and the Role of Real-Time Automation
As the discussion surrounding PBM reform gains momentum, the future of healthcare in America hangs in the balance. Xevant sets a new standard for efficiency and consumer empowerment in healthcare decision-making by employing AI-driven technology. Xevant's visionary approach to real-time data automation and optimization paves the way for greater transparency and cost savings in the pharmaceutical industry.
Wrapping Up
Transparency in pharmacy benefit management is crucial to addressing the soaring costs of prescription drugs and enhancing access to affordable medications. Without access to real-time data and automation, the pursuit of transparency remains elusive. Xevant's groundbreaking platform solves this pressing challenge, enabling PBMs and consumers to access complete, transparent data in real-time.
As legislative efforts progress, the need for real-time transparency becomes increasingly evident, and Xevant emerges as the leading legal solution for PBMs. When harnessing the power of real-time data automation, the vision of affordable healthcare can be transformed into a reality, benefiting individuals and the entire healthcare ecosystem.
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Health Technology, Digital Healthcare
Article | September 7, 2023
It’s no secret that the working world has changed these past few years, but employees have also undergone a lot of personal transformation due to these shifts. Struggles with health, home life, or personal issues can make it hard for them to work. Burnout is increasing worldwide, with 40% of desk-job workers feeling mentally distanced from work, depleted of energy, and increased negativity. Younger workers are already becoming drained by work life, which could spell trouble for future generations of employees.
Despite these challenges, the workplace is the best place to help staff improve their wellness, especially since they spend most of their time working or in the office. Wellness programs can be implemented to help employees feel rejuvenated and respected, which will boost their performance at work. Here are some examples of programs your workers might enjoy
Weight Management Programs
The idea of a weight management program at work may seem like something employees could be offended by, but it can help workers build healthy habits and assess their lifestyle to help them achieve better health. Employees can learn to manage their diet better, leading to weight loss and a lowered risk of certain health conditions.
These programs can also identify the need for medical weight loss strategies. For employees struggling with pre-obesity—a complex disease influenced by several factors often out of an individual’s control—personalized lifestyle changes and FDA-approved medications can be recommended. With chronic weight issues, doctors can prescribe medications that can help produce an average of 15% weight loss, especially when individual biology makes doing so harder. Employees can look for the help they need for wellness and weight loss, which can help them feel cared for by the company. When workers are at their peak physically, they can enjoy a healthier lifestyle and will be more efficient at work.
Quit Smoking Programs
Smoking is usually a means for employees to reduce stress, but it can greatly impact their personal and professional lives. Smokers tend to be more absent or disengaged at work than non-smokers. Presenteeism at work is also associated with heavy smoking. Employees coming to work despite health issues can lead to subpar performances. This can cost workplaces a lot of money in lost productivity, and workers will also suffer from health consequences.
Smoking cessation programs can help employees reduce their tobacco consumption and quit smoking for better health and productivity. These programs can include counseling, suggesting smoking cessation products or nicotine replacement therapy, or other initiatives tailored to individuals. Your staff may need more motivation when trying to quit, so having more support and a community to confide in can help.
Mental Health Programs
Mental health in the workplace was largely ignored for many years, as many saw it as a personal issue. However, work can contribute significantly to employees’ mental health problems or exacerbate mental illnesses like anxiety and depression. Improving these conditions is vital to improving many aspects of life for employees. Workers will better enjoy work and perform well when they know they’re being supported. Mental health is also paramount to sustainable development and plays a significant role in transforming the world as a whole. Treating and monitoring mental wellness should be prioritized at work and beyond.
Though companies may not have the means to properly diagnose or treat workers’ mental illnesses, mental health programs can help give employees and managers the education and resources to help improve mental wellness. Education and training on mental health can aid people in spotting issues and having them addressed or equip people with the ability to provide proper support or encouragement. These programs can also help the business take the initiative and offer other resources to improve mental health. That can be through mental health sick leaves, adding napping or gaming areas to the office, or offering mental health apps or counseling in benefits packages. When your staff is appreciated and taken care of, it’ll improve their overall well-being and life at work and home.
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AI
Article | December 21, 2021
COVID-19 has been a catalyst for change, with the diagnostics industry taking centre stage and rising to the challenge of a global pandemic. One of the silver linings of this mammoth task has been the unprecedented time and focus dedicated to finding new technologies and solutions within the sector.
The lessons learned from the pandemic now need to be taken forward to improve breast and cervical cancer detection, prevention and treatment across the UK over the coming years.
In the more immediate term, the diagnostics industry, alongside public health leaders, faces a daunting backlog as screening programmes for breast and cervical cancer were put on pause for months. These two life-saving tests have been some of the most overlooked during the pandemic and getting back on track with screening is critical as we start to turn the corner. We believe innovation in diagnostics, particularly artificial intelligence guided imaging, is a key tool to tackle delays in breast and cervical cancer diagnosis.
The scale of the backlog in missed appointments is vast. In the UK, an estimated 600,000 cervical screening appointments were missed in April and May 2020. And an estimated 986,000 women missed their mammograms, of which an estimated 10,700 could be living with undiagnosed breast cancer. It is clear that hundreds of thousands of women have been affected as COVID-19 resulted in the reprioritisation of healthcare systems and resource allocation.
Both cervical and breast cancer screening are well suited for digital technologies and the application of AI, given both require highly trained medical professionals to identify rare, subtle changes visually –a process that can be tedious, time-consuming and error prone. Artificial intelligence and computer vision are technologies which could help to significantly improve this.
What does AI mean in this context?
Before examining the three specific areas where digitisation and AI can help, it is important to define what we mean by AI. It is the application of AI to medical imaging to help accelerate detection and diagnosis. Digitisation is the vital first step in implementing an AI-driven solution – high quality images demand advanced cloud storage solutions and high resolution. The better the quality of the input, the more effectively trained an AI system will be.
The first area where AI-guided imaging can play a role is workflow prioritisation. AI, along with increased screening units and mammographers, has the potential to increase breast cancer screening capacity, by removing the need for review by two radiologists. When used as part of a screening programme, AI could effectively and efficiently highlight the areas that are of particular interest for the reader, in the case of breast screening, or cytotechnologist when considering cervical screening.
Based on a comparison with the average time taken to read a breast screening image, with AI 13% less time is needed to read mammogram images, improving the efficiency with which images are reviewed. This time saving could mean that radiologists could read more cases a day and potentially clear the backlog more quickly.
For digital cytology for cervical cancer screening, the system is able to evaluate tens of thousands of cells from a single patient in a matter of seconds and present the most relevant diagnostic material to a trained medical professional for the final diagnosis. The job of a cytotechnologist is to build a case based on the cells they see. Utilising these tools, we are finding that cytotechnologists and pathologists are significantly increasing their efficiency without sacrificing accuracy to help alleviate the backlog of cervical screening we are seeing in many countries.
Prioritising the most vulnerable patients
Another key opportunity is applying AI to risk stratification, as it could help to identify women who are particularly at risk and push them further up the queue for regular screening. Conversely, it would also allow the screening interval for those women at lower risk to be extended, creating a more efficient and targeted breast screening programme.
For example, women with dense breast tissue have a greater risk factor than having two immediate family members who have suffered from breast cancer. What’s more, dense breasts make it more difficult to identify cancerous cells in standard mammograms. This means that in some cases cancers will be missed, and in others, women will be unnecessarily recalled for further investigation.
A simple way to ensure that those most at risk of developing breast cancer are prioritised for screening and seen more regularly would be to analyse all women on the waiting list with AI-guided breast density software. This would allow clinicians to retrospectively identify those women most at risk and move them to the top of the waiting list for mammograms.
In the short term, to help tackle the screening backlog, prior mammograms of women on the waiting list could be analysed using the breast density software, so that women at highest risk could be seen first.
Finding new workforce models
Being able to pool resources will allow resource to be matched to demand beyond borders. Globally, more than half a million women are diagnosed with cervical cancer each year and the majority of these occur where there is a lack of guidance to conduct the screening programme. The digital transformation of cervical screening can connect populations that desperately need screening to resources where that expertise exists. For example, developing countries in Africa could collect samples from patients and image these locally, but rely on resources in the UK to support the interpretation of the images and diagnoses. Digital diagnostics brings the promise of a ‘taxi-hailing’ type model to cervical cancer screening – connecting groups with resources (drivers with cars) to those who are in need (passengers): this is an efficient way of connecting laboratory professionals to doctors and patients around the world.
It’s going to take many months to get cancer screening programmes up and running at normal levels again, with continued social distancing measures and additional infection control impacting turnaround times. But diagnostic innovation is on a trajectory that we cannot ignore. It will be key to getting cancer screening programmes get back on track. AI is a fundamental piece of the innovation puzzle and we are proud to be at the forefront of AI solutions for our customers and partners.
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