The Importance of Addressing Social Determinants in Healthcare

Dr. Joseph Webb, Nashville General Hospital CEO and author of the hub and spoke health equity model, discusses the science of healthcare delivery. “This evidence-based approach to care is statistically, scientifically, and empirically proven to produce desired outcomes.” Webb shares how Nashville General used an evidence-based approach to create innovative initiatives like food pharmacies and faith-based community partnerships to improve health literacy—an essential element in addressing social determinants and barriers to care.  

 

 

 

Healthcare’s Data Exchange Evolution

Bob Gross, Executive Director of Financial Decision Support and Analysis at Cleveland Clinic, and Krista Matlock, Senior Director of Operations and Market Network Services at Cleveland Clinic, discuss what puts the value in value-based care and how close we are to success. “The beautiful thing is that the technology, FHIR standards, and the data are here today.” Stakeholders are now coming to the table to discuss ways to create mutually aligned incentives that alleviate friction, reduce risk, and create a harmonious member-centric experience. “We are in a unique industry in that we literally give people the most valuable end result, which is quality of life and health. 

 

 

What Startups Need to Understand Before Pitching Their Disruptive Solutions

This month, two of our guests on The Spark, Dr. John Chelico, Chief Medical Information Officer for CommonSpirit Health and Jeremy Bikman, President of Reaction Data both have advice for startups looking to disrupt the healthcare industry.

In This Issue

From the Avaneer Podcast

What Startups Need to Understand Before Pitching to Hospital Leaders
Avaneer Health 

In this engaging podcast, Dr. John Chelico, Chief Medical Information Officer for CommonSpirit Health, discusses why startups need to embrace humility and patience before setting out to disrupt the industry. He suggests they start by having deeper conversations with health system leaders to gain a better understanding of the unique and complex challenges they face and the solutions they genuinely need and want. 

Listen to the podcast 

What it Takes to be a Successful Healthcare Startup
Avaneer Health 

The healthcare startup environment is notoriously difficult to navigate and requires a great deal of grit to succeed. Learn what Reaction Data President Jeremy Bikman says separates those who succeed from those who don’t, and the two questions every startup needs to answer before entering the market. 

Listen to the podcast 

5 Takeaways for a more connected and efficient healthcare landscape
Lyric 

Lyric Marketing and Communications Director Steve Ambrose caught up with Avaneer CEO Stuart Hanson at ViVE recently to share thought-provoking ideas on creating a frictionless healthcare environment. In this lively conversation, they delve into four key areas ripe for reinvention. What does Harrison Ford have to do with it? Listen to find out! 

Listen to the interview 

Industry Highlights

Top Trends in Automation, AI Adoption in Revenue Cycle
Revcycle Intelligence 

Revenue cycle leaders understand the critical role AI can play in automating the revenue cycle, but many are taking a “wait and see” approach. One key challenge is identifying the processes most in need of automation and then finding the right technology at the right price that will drive operational optimization and the best return on investment. Plus, revenue cycle use cases are simply lacking at this time, and many organizations don’t have the budget or the resources to implement the technology. 

Read the blog 

Usual approach ‘not enough’: 8 healthcare execs rethinking financial health
Becker’s Hospital CFO Report 

Traditional approaches to reducing expenses won’t work for today’s post-pandemic financial reality. Project delays and value-added solutions simply are “not enough or not effective” for many organizations. In this thought-provoking blog, healthcare leaders share their out-of-the-box approaches to today’s most significant financial challenges. 

Read the blog 

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From 72-Hour Waits to Real-Time Rides To Save Patients’ Lives

Non-emergency medical transportation (NEMT) helps hundreds of millions of patients get to their medical appointments each year, often for critical life-saving treatments like dialysis and chemotherapy. The decades-old NEMT service industry traditionally relies on highly manual, paper-based processes that often inhibit a patient’s ability to receive the care they need and for NEMT businesses to get paid. Kinetik founder and CEO Sufian Chowdhury saw an opportunity to reinvent how this industry functions through digital innovation. Hear him talk about the obstacles he faced, the lessons learned, and what it means to be a startup in today’s complex healthcare industry.

 

 

 

 

What is Interoperability in Healthcare?

The official definition of interoperability, as put forth by the ONC (Office of the National Coordinator for Health Information Technology), is “the ability of two or more systems to exchange health information and use the information once it is received.” However, if you google the term you’ll find dozens of different definitions, each with a slightly different slant. At the core of all these definitions, however, is the sharing and accessing of data.

According to HIMSS (Healthcare Information and Management Systems Society), there are four levels of interoperability.

Why do we need interoperability in healthcare?

In addition to the numerous clinical reasons to achieve interoperability, there is opportunity for the back-office administration of healthcare—which includes processes such as eligibility verification, prior authorization, claims submission, and charge capture. These processes are often fragmented, full of manual and error-prone workflows, and so inefficient that they cost the U.S. nearly half a trillion dollars each year, with billing, coding, physician administrative duties, and insurance administration being the primary drivers.

The current ways to connect for administrative transactions rely on a web of single-use, point-to-point connections and batch or call and response processes that lack data control and traceability. Payers and providers have invested millions in multiple platforms to modernize, but still lack full integration and interoperable functionality.

How does the lack of interoperability affect payers and providers?

One of the most significant issues caused by a lack of interoperability is friction between payers and providers. It’s understandable why a lack of transparency has created such high levels of distrust. Fraud, waste, and abuse cost payers billions each year, which is why they now use more sophisticated technology to identify potential claim issues. While this may help reduce fraud and overpayments, it has also caused more work for providers via increasingly complex payer requirements that are hard to keep up with.

The bottom line is that payers want to reduce their financial risk by ensuring that members receive the most cost-effective, appropriate level of care. At the same time, providers want autonomy around the decisions they make when caring for their patients, and they expect fair, timely compensation for that care. Both want to simplify the extreme administrative complexities caused by a lack of interoperability and data fluidity.

How does the lack of interoperability affect patients?

Administrative inefficiencies caused by a lack of interoperability can impact both a patient’s health and wallet. Prior authorization is a great example. In a 2022 survey by the American Medical Association, 94% of providers said the prior authorization process had caused delays in patient care, and 33% said those delays in care have caused a serious adverse event for patients.

The lack of financial transparency is another issue that impacts patients. When providers can’t tell patients with certainty what they will owe, it limits those patients’ ability to make informed decisions about when and where to get care and how to pay for it. This lack of transparency can negatively impact the entire patient experience, even offsetting a positive clinical experience. While the No Surprises Act has pushed the industry forward, there is much room for improvement.

Why is interoperability in healthcare so difficult to achieve?

The banking industry seems to have interoperability figured out. Consumers can easily send money to other people with no more than an email address or phone number, even outside their own banking system. And they can go to virtually any ATM anywhere in the world, see their account balance, and withdraw funds.

The primary reason interoperability in healthcare is so challenging is that payers and providers use multiple methods to exchange information, including:

All these methods deliver some level of interoperability but require the implementation and maintenance of point-to-point connections with each trading partner. And most of these connections use request-response workflows that delay data and require the aggregation and storage of data by third parties.

Another challenge is a lack of standardization. While Fast Healthcare Interoperability Resource (FHIR) has given us a common set of protocols and standards for a payload of transactions on a network, FHIR alone does not translate into interoperability and data fluidity. It is still a highly complex system of multiple data gateways.

Are there any solutions that help solve interoperability challenges in healthcare?

The answer is “Yes!” In a truly interoperable healthcare ecosystem, data would not need to be requested, aggregated, and validated each time it is needed. Instead, it would be continuously refreshed, always current, and accessible in real time via a single network to those who are permissioned to access it. It’s a new way of conducting the business of healthcare and it’s here today via the Avaneer Health Network™.

The Avaneer Health Network™ is a secure, permissioned, decentralized network and platform built on a data fabric infrastructure. Once a participant—payer, provider, or innovator—connects to the network, there is not a need to build a direct connection to any other participant. Data remains decentralized, and participants can control how and with whom they collaborate. Through a permissioned process, their data can be shared with anyone on the network whom they have approved to receive it. Once the connection is established, data can flow freely in real time, eliminating interoperability barriers and allowing genuine data fluidity.

How the Avaneer Health Network™ connects healthcare

Each participant receives an Avaneer SparkZone™, a dedicated, private, secure, cloud-hosted environment. The SparkZone is the connection between the participant’s internal system and the network, facilitating direct peer-to-peer data access with a suite of utilities and services for FHIR transformation. In addition, subscribed solution apps are loaded into the SparkZone.

Another important component of the Avaneer Network is Avaneer Collaboration Services™, which includes multiple tools and resources to facilitate interconnectivity. These services include a person-centric identity service that links person identities across network participants so that there is a shared context. Then, the Collaboration Service enable fluid and direct data exchange across the Avaneer Network. Governance of more than 20 autonomously administered security controls enforces authentication, authorization, access controls and audit controls to ensure data access is fully permissioned, auditable, and decentralized.

The Avaneer Network also provides a digital marketplace, the Avaneer Solution Exchange™, where participants can discover, offer, and source other solutions on the Avaneer Network. It’s a shared resource for the entire community of participants.

What’s next for interoperability in healthcare?

With each new technology that launches, the potential for innovation in healthcare increases exponentially. To successfully leverage and deploy innovative solutions requires a level of interoperability that supports collaboration and connectivity in a new way. With Avaneer Health, many of  healthcare’s biggest challenges, both administrative and clinical, are resolved.

We invite you to join Avaneer Health on our journey to reinvent the business of healthcare.

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