Physician Training Needs to be Modernized

Health Technology, Digital Healthcare

Article | August 21, 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.

Health Technology, Digital Healthcare

Article | July 14, 2023

As competition for patients intensifies, more hospitals and health systems are embracing a consolidated, single-bill approach for services rendered. Creating a single bill for the patient’s portion of inpatient or outpatient services can help eliminate confusion and reduce the ill will that frequently results when patients receive multiple invoices for a single care event. Yet incorporating anesthesia charges into a consolidated invoice is often problematic due to the unique nature of the anesthesia billing compliance. Anesthesia Billing Service Hurdles A few weeks ago, I met with the CEO of a 300-bed hospital. We discussed anesthesia billing, and he explained that his hospital traditionally outsourced this portion of its billing due to the more complex nature of anesthesia coding and the need to collect anesthesia minutes for billing. Unlike most inpatient services, anesthesia charges are not directly derived from CPT codes but instead utilize minutes and modifiers unique to the specialty. That means coders must use a CPT crosswalk to account for ASA codes, base and time units, emergency- and physical-status monitors, split anesthesia units reflecting CRNA involvement, and other specialty-specific nuances. Most coders and hospital billing staff are not trained in these complexities, and hiring and retaining capable staff in today’s competitive market can be difficult. Moreover, many billing platforms are simply not equipped to incorporate all the variables necessary to produce an accurate anesthesia bill. As a result, producing a consolidated patient bill that includes anesthesia is tricky. Yet leaving anesthesia off a single bill can undercut its value since, after facility and surgical charges, anesthesia often is one of the largest cost items patients incur. Fortunately, we at Change Healthcare know how to roll anesthesia charges into existing hospital billing systems to produce an accurate and timely single patient bill. Helping to Reduce Costs The benefits of consolidated billing extend beyond an improved patient experience. Producing just one bill reduces costs and repetition at both the front and back end of the revenue cycle management process. It can also ease staff burden when collecting on self-pay accounts, since there’s only one bill per patient. Finally, consolidated bills can help increase revenue by simplifying collections when patients present for follow-up care. Here’s an example: When the patient comes back for post-surgery physical therapy, a hospital employee at the registration desk can remind them that they still owe $150 for anesthesia and ask if they’d like to take care of that now. In my experience, patients usually hand over their credit card and settle their bill on the spot when asked at the time of care about a balance due. System-Agnostic Billing Across Hospital Platforms Change Healthcare has a long history of providing full-service, outsourced anesthesia-billing services to hospital and health-system clients. Unlike most other billing vendors, we’ve developed what we call a system-agnostic approach. That means we’ll provide billing services on our proprietary system or on the hospital’s existing billing platform, regardless of type, to generate accurate anesthesia-billing results. In practical terms, we’ll function as part of your billing team and use the same system your coders and billing staff rely on to generate anesthesia charges that can be included in a single patient bill. System-agnostic billing also allows us to provide clients with custom anesthesia reporting that wouldn’t otherwise be available with an outsourced billing solution. This helps clients gain far greater visibility and insight into anesthesia-billing charges. And by incorporating our anesthesia coding and billing capabilities into your existing billing system, you’ll be spreading the platform’s fixed costs across a greater number of departments. The bottom line? It’s not a heavy lift for us to virtually embed our trained anesthesia coders and billing professionals into your system. Our specialists will review your existing platform and provide, at no obligation, a return-on-investment analysis that can help you determine whether outsourcing anesthesia billing to capture claims on a single hospital bill makes sense for you. We expect the answer will be yes. Not only will you enjoy greater system efficiencies, but you’ll be in a position to produce a single bill that truly reflects the entire episode of care.

Health Technology, Digital Healthcare

Article | August 16, 2023

Affordable healthcare is the need of the hour and interoperability is the means to that end. The healthcare ecosystem is looking into ways they can enable this affordability as soon as possible, and that is where FHIR comes in. FHR promises an on-demand exchange of secure healthcare information. It has become an increasingly popular protocol, thanks to its commitment to ensuring interoperability in the app economy, via apps. The privilege enjoyed by consumers and participants in most industries is the ease of accessibility of information. With most of it being on the cloud, a URL ensures access to the same information regardless of where it is being accessed from or which internet enable device. This is the privilege FHIR aims to introduce in healthcare, over the current document-based approach where forms are either faxed, emailed, or electronically exchanged. FHIR is for Building new healthcare apps Develop cloud-based health apps that integrate with social networks Providing a simple to use standards-based API for cloud-based health integration services The government looking to implement a national EHR FHIR Aims to Reduce Cost The medical expenses of an average American in a year are north of $12k and rising. The reasons are the unnecessary complications in the healthcare IT infrastructure. With FHIR, HL7 aims to reduce the burden on providers in sharing and accessing healthcare data at the point of care, thereby reducing the administrative expenses spent on moving data back and forth. It also promises to grant on-demand access to patients – enabling them to make better-informed healthcare decisions. What is part of FHIR? Pre-defined Resources and API A common way to represent data as building blocks and rules for connecting them Target support for common scenarios Implementer Friendly Familiar tooling and technologies using web standards Multiple Libraries available for faster implementations Mobile Friendly Concise and easily understood specifications, RESTful API and JSON Leverages cross-industry web technologies Multi-paradigm Thick client, browser, or mobile devices Supports human readability as the base level of interoperability Large Community for Support Heaps of open-source software and training events, webinars, and connectathons Specification feedback welcomed, including update requests-tracker Out-of-the-box Interoperability Base resources can be used as it is, can also be adapted for local requirements Seamless exchange of information using messages or document Start The FHIR Health plans are jumping on the FHIR bandwagon faster than ever thanks to the Interoperability and Patient Access rule as well as the latest proposals. Do not get left behind or sustain the ramifications of non-compliance with CMS regulations.

Article | August 27, 2021

Do you know a friend or loved one who suffers from fear, anxiety, and depression and do not know what to do to help them? It can be frustrating to watch someone you know struggle with their mental health and not be able to do anything to relieve their suffering. With this in mind, here are seven ways to help the person cope in these kinds of situations. 1. Learn as much as you can in managing anxiety and depression: There are many books and information that will educate you on how to successfully overcome fear and anxiety. Share this information with the individual who is struggling with their fears. The key is to get your friend to understand how important it is to seek some guidance when it comes to their mental health. 2. Be understanding and patient with the person struggling with their fears: Maintaining depression and anxiety can be difficult for the individual so do not add more problems than what is already there. Do not get into arguments with your friend who may be having a difficult time with their anxieties. Make an effort to listen to the person rather than making judgements. 3. Talk to the person instead of talking at them: It is important not to lecture the individual who’s having a hard time with anxiety and depression. Talk to the person about their issues without being rude. Most people will listen if you approach them in a proper manner. Remember to treat others the way you would want to be treated if you were the one who was struggling. 4. Ask for some ideas: Seek advice from a professional who can assist the person you know with their mental health issues. A counsellor can give you some ideas on how to overcome anxiety, fear, and depression. Getting help from a therapist is the number one priority in getting the individual to do something about their problems. 5. Find out why the person won’t get assistance: Address the issues on why he or she will not seek treatment. Many people who are struggling are fearful and frustrated. Try to find out the reasons why your friend won’t get the help they need and then try to find the ways that will overcome their resistance of seeking some guidance. 6. Remind the person on the consequences of not getting help: Another way to convince the individual who is struggling with fear and depression is to tell them what may happen if they don’t get some counselling. Anxiety and depression can make things worse and usually won’t go away by themselves. 7. You can’t manage your mental health all by yourself: A person’s fears and anxieties can be difficult to manage and more than likely he or she will need some help. Many people think that they can overcome their mental health problems on their own. This is a mistake. The individual should admit they have a problem and then seek treatment to get their life back on track.