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Forecast Roundup


Industry insiders weigh in on the year ahead in healthcare technology.

Editor’s note: Because we received so many responses, the forecasts were split into two parts; part I was featured in the January 2012 edition of HMT.

Emergence of the individual network-exchange model

By Robert Connely, SVP, Medicity In the past few years we have seen a

tremendous shift in the way technology is used to connect people, and in 2012 we will see the emergence of a new model in healthcare, the individual network exchange. In healthcare, as in other industries, software technology is advancing to the point that it can adapt to how people work, rather than requiring people to adapt to the technology. Just as Facebook and smartphone apps have transformed the way people share information and use technology, a grassroots model that enables physician practices to own and control how they use technology to interact with each other and with health information exchanges (HIEs) will ease the adoption curve for practices and grease the skids for improving healthcare quality and costs. The individual network-exchange model enables physician practices to establish and control their own secure health information-exchange network. Its success will lie in several factors. First, it plays on the dynamics that form the reality of healthcare. Security, trust and understanding of terms and meaning can be greatly simplifi ed in a small exchange community, such as one created around a single patient. And by building the networks themselves, ownership and use of the system stands a high likelihood of success.

The individual network-exchange model will fi t well in

For more on Medicity: www.

the current healthcare technology landscape. Practices fully engaged in electronic collaboration in their immediate community can connect their individual exchange to larger HIE initiatives, enriching collaboration throughout regions and states. And on the broader scale, the individual network-exchange model complements existing approaches and emerging standards, such as the Direct Project and the continued advance of Internet, platform and cloud technologies.

Physician practices establishing their own

secure exchange networks with other practices will be key to driving forward effective care collaboration. This new model will make it easier for physicians to share information, collaborate with other care team members and deliver high-quality care.

30 February 2012

The pressures of healthcare reform – not to mention the looming ICD-10 transition and industry shift toward accountable care – are requiring major changes in hospitals’ fi nancial and clinical operations. Changes in payment structures and ICD-10 will topple revenue cycle management if organizations are not ready for them. Two key issues should be top priority: end-to- end management of revenue cycles and ensuring they can support accountable care. Major challenges are mounting for hospitals’ revenue

For more on OptumInsight: www.

streams: increasing numbers of outpatient visits and self- pay patients, rising costs and regulatory challenges, such as Medicare cuts, ICD-10 and payment reform. For hospitals to successfully adapt to these pressures, they must examine their revenue cycle holistically – starting with scheduling on the front end and extending to billing and accounts receivable on the back end. This will be especially important for ICD-10 readiness, which will wreak havoc on revenue processes and productivity levels. Hospitals must arm themselves with the technology and training necessary to prepare staff for the transition, while mitigating the disruption to their revenue. Hospitals need to understand denials, prevent audits and fi x revenue cycle issues, while aligning with government reimbursement changes for the future.

A sharper focus

on the revenue cycle brings the added benefi t of preparing for the move from fee for service to pay for performance, and all the changes that will bring. In 2012, we’ll see some hospitals completing the implementation of their EMRs and HIEs, while others will take advantage of population analytics and care-management technologies. Hospitals can take cues from the payer market with many of these, but will need to customize them to be provider friendly. Once up and running, these solutions will be the backbone of a sustainable health community – a clinically integrated, fi nancially viable health system that increases the quality of care, improves the patient experience and lowers overall healthcare costs.

Continued on page 32 Continued on page 32 HEALTH MANAGEMENT TECHNOLOGY

Manage revenue cycle to support accountable care

By Ron Jones, SVP of hospital solutions, OptumInsight

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