Pharmacy Benefit Management Companies Deliver Questionable Value Pharmacy Benefit Manager (PBM) companies participate in the drug distribution channels as middlemen. Their purpose is to manage prescription drug benefits on behalf of health insurers, Medicare Part D drug plans, large employers, and other payers. They provide the following services: Develop and maintain drug formularies for the payers they support. Use their purchasing power to drive lower drug prices and rebates for th...

AI Must Supplement and Not Drive Patient Care Decisions At the recently concluded 2021 KLAS Digital Health Investment Symposium, Dr. Robert Bart, M.D., Chief Medical Information Officer of UPMC stated that AI should be referred to as augmented intelligence versus artificial intelligence in healthcare. His reasoning is that no physician should trust or rely entirely on the output of an AI solution to dictate their course of treatment for a patient. Rather, AI should be used to augment the phys...

Resources to Monitor the Elderly are Expensive and Serial If you have an elderly relative or friend, you are likely concerned about how well their health is being monitored to ensure the highest quality of life. In some cases, a care provider service may be hired to look in on the person several times a week and to assist with cleaning, meals, and healthcare activities (e.g., medication refills and attending scheduled physician visits). The challenge with elder care home services is that, ...

The Problem: Digital Transformation Adoption May Create Provider Disruption Challenges COVID-19 drove provider organizations to adopt new care delivery strategies based on digital technologies. Telehealth became a core environment for providing care services to patients. Organizations also realized that front-door mobile applications that connected to the organization’s web portal were becoming a critical feature to improving patient satisfaction. Remote patient monitoring strategies...

The Problem: Efficiently Capturing Healthcare Data from Disparate Sources US healthcare has been plagued by the inability to efficiently capture data from disparate sources. Having this ability could provide a more complete medical record for patients, and it could also support analytics and emerging artificial intelligence (AI) programs. The industry initially used HL7 2.X standards to format data sharing between disparate systems. These standards provided a framework but not the d...

The Problem: Easily Accessing Useful Oncology Treatment Information Oncology treatment information may reside in many disparate cancer registries. Cancer registries collect information on patient demographics, types of cancer, screen mechanisms used, medication regime approaches, and treatment outcomes. Once a year, most state central cancer registries send information to CDC’s National Program of Cancer Registries (NPCR). Therefore, cancer registry data may be at least a year old and s...

The Problem: Current Neural Network Models are Confining and Expensive What is a neural network or deep learning? Simply put, these are networks that can support machine learning and natural language processing. MIT’s definition of neural networks is the following: “Neural nets are a means of doing machine learning, in which a computer learns to perform some task by analyzing training examples. Usually, the examples have been hand-labeled in advance. An object rec...

The Problem: Improving AI Chatbot Interactions AI chatbots can be helpful or discouraging to patients. Some people are used to chatbot interactions from web portals and have no problem interacting with these services. Other people would like to have a real person interacting with them during a health portal session and are annoyed when chatbots pop up. Chatbots can also be annoying if the person moderating the chat is trying to accommodate too many conversations at one time or the response...

Personal Health Information Regulations Can Slow Clinical Research The U.S. government enacted the Privacy Rule* to protect individually identifiable health information, known as Protected Health Information (PHI). The protected information consists of “the individual’s past, present, or future physical or mental health condition, the provision of health care to the individual, or the past, present, or future payment for the provision of health care to the individual, [and] any inf...

Big Data Environments Using Hadoop Have Peaked Apache Hadoop is an open-source software framework for storing data and running applications on clusters of commodity hardware. It provides massive storage for any kind of data (e.g., structured and unstructured), enormous processing power, and the ability to handle virtually limitless concurrent tasks or jobs. Hadoop automatically creates data backups, so you lose nothing in the case of a cloud failure. Much of the cloud environment fo...

Emerging Digital Appliances Often Lack Standards for Interoperability Many emerging technology environments end up with disjointed capabilities for connections with IT environments or other devices. This results in tremendous waste for consumers as these solutions may be more prone to technical obsolescence and replacement costs. In many cases, the rush to get a digital appliance to market with a minimum viable market design results in early versions of solutions that may not support future u...

Timely Identification of High-Risk Patients to Minimize Healthcare Costs As the healthcare reimbursement model moves to value-based reimbursement, it is imperative that healthcare organizations identify high-risk patients for appropriate care services. CMS has implemented a star rating system to drive Hospital Compare, which focuses on the provider’s ability to deliver on outcomes, benchmarks, and quality indicators for reported services. These ratings are provided to consumers to ...

Inexpensive, Readily Available Biomarkers for Disease Identification COVID-19 became a catalyst for providing virtual healthcare delivery services. As the pandemic raged across the country, providers began to immediately implement the use of telemedicine solutions to connect with patients who needed care but were also at high risk for virus infections. One challenge for the early telemedicine sessions is that providers were, in most cases, not able to have the most recent patient vital signs ...

Balancing Emerging Technology Solution Innovations Against Risk CIOs and CMIOs are bombarded daily with emails and texts from emerging technology vendors that are desperate to find healthcare provider clients that are more likely to take on higher risk levels for new technologies that address critical healthcare delivery needs. Healthcare organizations may consider new innovative technology products if the associated risk factors are within the benchmarks set by executive management. Risk fac...

Reliable and Safe Robotic Disinfection Processes for Healthcare Facilities Hospital-acquired infections and patients with highly infectious diseases have always been a challenge for healthcare systems to manage. COVID-19 elevated the need to develop a higher level of cleaning and sanitization processes to protect staff and patients. Healthcare executives acquired a new awareness of the needs for different housecleaning approaches that would be needed to provide safer, faster, and less costly ...

Telehealth Version 1.0–Lots of Players, Little Differentiation COVID-19 has forever changed primary healthcare delivery. To survive financially, physicians have had to quickly learn and implement telehealth solutions to deliver virtual care. The catalyst for implementing telehealth services was the Medicare 1135 waiver that reimbursed telehealth visits at the same rate as office visits[1]. This waiver was created to ensure patients would not be needlessly exposed to COVID-19 during an o...

Now more than ever, the partnerships between healthcare providers and vendors are crucial to the success of the industry and patient well-being. Now months into the COVID-19 crisis, we have been able to reach out to our provider friends to see how well their vendor partners have supported them throughout the pandemic. We are excited to share these findings with you in our Vendor Performance in Response to the COVID-19 Crisis report. There’s so much to share on this topic...

As healthcare providers, the social determinants of health (SDOH) can feel unwieldy and frustrating. How can you make sure your patient has a friend, enough food, and the counselling services they need? There are so many questions surrounding SDOH, but what many providers don’t know is that there is a growing number of technology solutions they could potentially rely on to help them with these problems. In the last few years, there has been growing interest in SDOH, and a lot of prov...

Robotic process automation (RPA) has been around for quite a while, but now, amidst growing economic pressures, its adoption in healthcare is starting to heat up. RPA solutions have been showing a strong ROI and cost reduction for providers recently, and there are now many more providers who want to know which vendors can help them access these benefits. In KLAS’ new report, we take a look at a vendor that has been garnering high marks and attracting a lot of attention in this market: Colburn...

Let’s say that you are experiencing heartburn. You go to the doctor, who prescribes medication and a healthy diet. The problem is that the co-pay for the medication is expensive, and you can’t afford the diet the doctor ordered.

Creating a Big Data Environment for Improved Analytics and AI Healthcare providers are keenly aware of the need to allow their data to be used by cohort organizations and technology companies to establish big data repositories that provide more accurate analyses and more sophisticated AI algorithms. Organizations such as Mayo Clinic sell their data to technology companies to facilitate advancements in AI[1]. Patient advocates are concerned that the data may not be deidentified to the extent n...

The Problem: Managing a Learning and Training Environment for Fast Paced Telehealth Provider organizations have been using eLearning environments for several years. In many cases, the organizations have not fully supported these environments or the education staff that supports and maintains these systems. COVID-19 will force healthcare organizations to focus their attention on expanding virtual and digital healthcare services. Telehealth will become a much more prominent and robust service o...

The Problem: Legacy Architectures and Proprietary Data Sets Can Impede Innovation Those of us who have been in the healthcare IT business for several decades can attest to the fierce competitive environment that exists between vendors in the same market segment. Historically, Epic and Cerner are the most recognized competitors in the enterprise healthcare IT market. These two vendors have disparate architectures and data sets that drive two different approaches for data interoperability. The ...

The Problem: Software Programming is Expensive and Slow to Deliver Needed Solutions Just 2% of the worldwide population knows how to code, and the need for software developers is estimated to grow by 24% over the next seven years.[1] Software programming is expensive and, in many cases, delivered later than needed. Because of a lack of women and racially diverse people currently working in the space, the knowledge transfer between what users of those groups need and what software developers d...