Health Technology, Digital Healthcare
Article | August 16, 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.
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Health Technology, Digital Healthcare
Article | September 7, 2023
“Health care is different, the data here is emotional! If you tell me you were buying a fishing rod online and were emotional about it, I’d say you are lying. But I do frequently see people helpless and confused when it comes to receiving health care, managing its costs, making sense of its data.”
- Senior Product Leader inOptum Global Solutions Pvt. Ltd.
Yes, health care is different, and so is product management in it. This piece highlights the top 4 product management trends that are specific to health care and serve beyond being just a list of technologies making their way into health care.
Health care consumerism
Lance broke his ankle in a bicycle accident and is now in hospital waiting for surgery. Which of these words would describe him more aptly— a ‘patient’ or a ‘health care consumer’? The fact that Lance holds a high-deductible health plan, manages an interactive relationship with his primary doctor, keenly monitors his fitness through his smartwatch, and learns about healthier diet plans and recipes online — I can say he isn’t just receiving health care, but making active choices on how to pay for and manage his health. This choice and responsibility that people demand, is ‘health care consumerism’. This trend has been growing since 2015 when value-based care started picking up in the US.
What does this imply for products/PMs?
These are challenging and exciting times to be a product manager (PM) in health tech. This is because people are now demanding an experience equivalent to what they’re used to from other products in their lives, such as e-commerce, streaming platforms, and digital payments, to name a few. Any consumer-facing product (a mobile app, a web-based patient portal, a tech-enabled service) needs to meet high expectations. Flexible employer-sponsored health plans options, health reimbursement arrangements, price transparency products for drugs and medical expenses, remote health care services, and government's push to strengthen data and privacy rights — all point to opportunities for building innovative products with ‘health care consumerism’ as a key product philosophy.
Wellness
COVID-19 has tested health care systems to their limits. In most countries, these systems failed disastrously in providing adequate, timely medical assistance to many infected people. Prevention is of course better than cure, but people were now forced to learn it the hard way when cure became both inaccessible and uncertain. With lockdowns and social isolation, prevention, fitness, diet, and mental wellbeing all took center stage.
Wellness means taking a ‘whole-person approach’ to health care — one where people recognize the need to improve and sustain health, not only when they are unwell, but also when they’re making health care decisions that concern their long-term physical and mental health. A McKinsey study notes that consumers look at wellness from 6 dimensions beyond sick-care— health, fitness, nutrition, appearance, sleep, and mindfulness. Most countries in the study show that wellness has gained priority by at least 35% in the last 2–3 years. And wellness services like nutritionists, care managers, fitness training, psychotherapy consultants contribute 30% of the overall wellness spend.
So, what do health-tech PMs need to remember about wellness?
The first principle is, “Move to care out of the hospital, and into people’s homes”. A patient discharged after knee surgery has high chance of getting readmitted if he/she has high risk of falling in his/her house, or is unable to afford post-discharge at-home care with a physiotherapist. This leads us PMs to build products that recognize every person’s social determinants of health and create support systems that consider care at the hospital and care at home as a continuum.
The second principle is, “Don’t be limited by a narrow view of ‘what business we are in’, as wellness is broad, and as a health tech company, we are in health-care, not sick-care”. Wellness products and services include — fitness and nutrition apps, medical devices, telemedicine, sleep trackers, wellness-oriented apparel, beauty products, and meditation-oriented offerings, to name just a few. Recent regulations in many countries require health care providers to treat behavioural health services at par with treating for physical conditions, and this is just a start.
Equitable AI
Last month, WHO released a report titled “Ethics and Governance of Artificial Intelligence for Health”. The report cautions researchers and health tech companies to never design AI algorithms with a single population in mind. One example I read was, “AI systems that are primarily trained on data collected from patients in high-income settings will not perform as effectively for individuals in low or middle-income communities.” During COVID-19, we came across countless studies that talked about the disproportionate impact on minorities in terms of infections, hospitalizations, and mortality. A student at MIT discovered that a popular out-of-the-box AI algorithm that projects patient mortality for those admitted in hospitals, makes significantly different predictions based on race — and this may have adversely moved hospital resources away from some patients who had higher risks of mortality.
How should I think about health equity as an AI health-tech PM?
Health equity means that everyone should have a fair chance at being healthy. As a PM, it’s my job to make sure that every AI-assisted feature in my product is crafted to be re-iterative and inclusive, to serve any community or subpopulation, and is validated across many geographies. To prevent any inequitable AI from getting shipped, it is important to ensure that the underlying AI model is transparent and intelligible. This means knowing what data goes into it, how it learns, which features does it weigh over others, and how does the model handles unique features that characterize minorities.
Integrated and interoperable
In every article that I read on topics such as digital platforms, SaaS, or connectivity with EMRs, I always find the words: ‘integrated’ and ‘interoperable’ therein. Most large and conventional health tech companies started by offering point-solutions that were often inextensible, monolithic, and worked with isolated on-prem servers and databases. To give a consistent user experience, leverage economies of scope, and scale products to meet other needs of their customers, started an exodus from fragmented point-solutions to interoperable, integrated solutions. The popularization of service-oriented architectures (SOAs) and cloud vendors like AWS, Azure, and GCP has also helped.
The what and how of integrated-interoperable solutions for PMs:
Integrated solutions (IS), as I see them, are of two kinds — one, in which as a health tech company, we help our customers (health systems, insurance companies, direct to consumers) accomplish not just one, but most/all tasks in a business process. For example, a B2B IS in value-based care contract management would mean that we help our customers and health systems by giving an end-to-end solution that helps them enter into, negotiate, plan for, manage, get payments for their value-based contracts with health plans.
In the second type of IS, we offer products that can be easily customized to different types of customers. For example, a health management app that people can subscribe to for different programs such as obesity, diabetes, hypertension, cholesterol management, as needed. The app works with different datasets for these programs and uses different analyses and clinical repositories in its backend, but still delivers a consistent user experience across programs to a user who enrolled in multiple programs, say diabetes and weight management.
‘Interoperable’ simply means that one product should be able to talk to other products both in and out of the company. For example, if product-A can alert a doctor about any drug-drug interactions or allergies a patient might have, while she is writing prescriptions for the patient in product-B (an EMR), then product-A does talk to product-B, and hence, is interoperable. This trend is picking up further with the growth of IoT devices, and industry-wide participation in adopting common standards for data exchange.
Conclusion
Though the article derives much of its context from US health care, I have tried to keep a global lens while choosing these topics. For developing economies like India, digitization is the number one trend as much of the health system is still moving from manual records to digitally store patient and medical data in EMRs. The good news is that India is booming with health-tech innovation and that is where consumerism, wellness, and equitable AI make sense. Once companies develop enough point-solutions for different health system needs and use-cases, Indian health tech will see a move towards creating integrated, interoperable (IGIO) systems as well.
There are some other trends such as — use of non-AI emerging tech such as Blockchain in health information management, cloud infrastructure for health tech innovation, big data and analytics to improve operational efficiency in areas such as claims management and compliance reporting, Agile product management for co-developing with and continuously delivering to clients etc. — but I see them either as too nascent, or too old to feature in this list.
Finally, as a health tech product manager, you can use the following questions to assess your products against the above trends — (Consumerism) do the products that I manage, empower consumers with choice, information, and actionability? (Wellness) Does my product emphasize keeping them out-of-hospitals and healthy in the first place? (Equitable AI) Am I sure that my product doesn’t discriminate against individuals belonging to underserved populations? (IGIO) And finally, is my product scalable, integrated and interoperable to expand to a platform, in the true sense?
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Health Technology, AI
Article | July 18, 2023
Everybody deals with stress and anxiety, however the key is to know what to do when you’re stressed out. It is not always easy to keep your feelings from getting the best of you.
With this in mind, here are seven tips that a person can use to help manage their daily stresses and anxieties before they get out of control.
1. Get all of the facts of the situation: Gathering the facts of a certain event can prevent us from relying on exaggerated and fearful assumptions. By focusing on the facts, a person can rely on what is reality and what is not. Most importantly, do not focus on your fearful thoughts when you’re stressed out.
2. Take a break: Sometimes, we get stressed out when everything happens all at once. When this happens, a person should take a deep breath and try to find something to do for a few minutes to get their mind off of the problem. A person could take a walk, listen to some music, read the newspaper, or do an activity that will give them a fresh perspective on things.
3. Carry a small notebook of positive statements with you: Another technique that is very helpful in managing fear is to have a small notebook of positive statements that makes you feel good. Whenever you come across an affirmation that relaxes you, write it down in a small notebook that you can carry around with you in your pocket. Whenever you feel depressed, open up your small notebook and read those statements.
4. You can’t predict the future: While the consequences of a particular fear may seem real, there are usually other factors that cannot be anticipated and can affect the results of any situation. We may be ninety-nine percent correct in predicting the future, but all it takes is for that one percent to make a world of difference.
5. Challenge your negative thinking with positive statements and realistic thinking: When encountering thoughts that make you fearful or depressed, challenge those thoughts by asking yourself questions that will maintain objectivity and common sense. Focus on the reality of your situation and not on your thoughts. Your fearful thoughts can make things worse so try to focus on something positive when you get anxious.
6. Divide your activities into separate steps: When facing a current or upcoming task that overwhelms you with a lot of anxiety, divide the task into a series of smaller steps and then complete each of the smaller tasks one step at a time. Completing these smaller activities will make the stress more manageable and increases your chances of success.
7. Take advantage of the help that is available around you: There are many individuals who have been expertly trained in the field of psychology to help you find ways to manage fear and anxiety. Seek out someone whom you trust to provide sound advice and guidance. This same professional can also help you create an action plan for dealing with your fears and anxieties in the future.
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Health Technology, AI
Article | July 18, 2023
Embracing the AI Revolution: Transforming Digital Healthcare Software through AI-Enhanced UX Testing
The wave of demographic change sweeping the United States presents an urgent call to action for healthcare providers. According to the US Census Bureau, adults over 65 will account for a quarter of the US population by 2060, signaling a drastic shift in healthcare delivery needs. More than half a million of this demographic will be centenarians, accentuating the need for digital experiences tailored to seniors' unique needs.
Despite the rapid advancement of digital health technologies, research indicates that many senior citizens struggle to adapt. A recent study reported that 40% of adults over 65 believe their telemedicine visit was inferior to traditional in-person care, with a meager 5% finding it superior. The promise of convenience delivered by digital health is often overshadowed by the frustration associated with technical difficulties. An astounding 75% of senior citizens admit they need assistance when using new electronic devices.
Let's consider the patient portal app, a common touchpoint in the digital health journey. Despite its apparent simplicity, seniors find processes like logging in troublesome due to issues like forgotten passwords, technical bugs, or content readability. This scenario underlines the crucial need for comprehensive User Experience (UX) testing to eliminate these barriers and provide a seamless digital health experience.
The Complex Landscape of Healthcare UX Testing
The complexity of UX testing in healthcare has been exacerbated by the interplay of multiple modules, services, platforms, and vendors. Take Electronic Medical Record (EMR) systems, for instance, which undergo frequent updates, each one potentially impacting the system as a whole. Traditional manual testing methodologies are proving to be time-consuming and costly.
Though automation has revolutionized sectors from automotive to finance, the healthcare industry appears to be lagging. A study by the Health Information and Management Systems Society (HIMSS) reveals that a mere 15% of healthcare providers have adopted modern test automation platforms. Meanwhile, a significant 41% still rely on manual testing. As EMR systems grow increasingly complex and customized, this over-reliance on manual testing poses daunting challenges.
The gravity of this issue is amplified by a startling revelation from the HIMSS study - only 6% of healthcare executive leaders express confidence in their organizations' testing practices. In an increasingly digitized healthcare environment, such a low level of assurance raises substantial concerns about patient safety. Although 75% of the surveyed providers have invested in software testing to safeguard their bottom lines, nearly two-thirds confess feeling inadequately resourced in terms of time, money, and talent to meet future testing requirements. As the list of testing demands grows, QA teams are frequently stretched thin, leaving many potential user journey scenarios untested.
The Power of AI in UX Testing for Better Patient Outcomes
AI technologies hold the potential to revolutionize UX testing in healthcare.
The modern healthcare application is a labyrinth of potential user journeys - a typical mobile application model can yield over 9 billion separate scenarios. To effectively navigate this colossal testing landscape, test automation tools employing Machine Learning (ML) algorithms are critical.
By analyzing historical patterns, prioritized cases, and real-user insights, ML algorithms can auto-generate test cases and meticulously scrutinize each user interaction. This approach ensures an optimal digital experience and robust coverage of potential issues.
The HIMSS study also provides a glimmer of hope, revealing that nearly 80% of healthcare providers plan to adopt real-time testing analytics for quality assurance. AI's role becomes pivotal in augmenting the capacity of software testing teams in this scenario.
By leveraging historical patterns and prioritizing test cases, ML-powered testing tools can automate crucial tests across various platforms, devices, and operating systems. This symbiosis of human expertise and AI not only bolsters productivity but enables comprehensive testing coverage within tight time constraints.
The Future of Healthcare Software UX Testing
The path to perfecting a patient’s digital journey is fraught with challenges.
Healthcare organizations venturing into automated software testing or contemplating in-house tool replacement must stay abreast of evolving healthcare testing requirements. This understanding is key when evaluating automation vendors against the backdrop of regulatory standards. Opting for a technology-agnostic solution ensures extensive test coverage, boosts efficiency, and guarantees longevity as technologies advance. Introducing your software QA teams to user-friendly, low/no-code test automation tools can simplify the onboarding process and fosters better collaboration with Dev teams and business testers.
As we stand at the precipice of this transformative period in healthcare, it's clear that the AI revolution holds the key to unlocking the future of digital healthcare UX testing. By harnessing AI's potential, healthcare providers can ensure a user-friendly, seamless digital experience for the fastest-growing demographic, setting new industry standards in the process.
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