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Feb 18

Three Digital Healthcare Takeaways from HIMSS 2019 | Blog

By | Blog, Healthcare & Life Sciences

I experienced three pleasant surprises at last week’s Healthcare Information and Management System Society (HIMSS) conference. They were all about a perfect storm that is building to correct all that has been wrong in the digital healthcare space all these years.

Healthcare Companies are Exploring Cures for Their #DigitalHeadache

Payers and providers alike are growing increasingly disillusioned with the outcomes of their digital programs. In fact, 78 percent of the healthcare leaders we surveyed in late 2018 indicated some sort of failure with their digital initiatives, whether big or small. The good news here is that most forward-thinking leaders are going back to the drawing board to redefine their digital strategy. Anthem, Intermountain Healthcare, and New York Presbyterian are great examples of organizations that have taken up the cudgels to fix digital healthcare where it fails – organization and culture.

There’s Increased Focus on “Enabling” the Patient Experience

To make the “patient experience” successful, enterprise leaders are taking a step back and focusing their attention on creating experiences for their workforce, clinicians, and partners (e.g., physician group, CMS, government agencies.) Don’t get me wrong, patients still need to be at the center of our universe. However, the personas that enable and deliver experience for patients need a fix first.

Innovation is Coming from Unexpected Sources

It was heartening to see the likes of Amazon, Google, Microsoft, and Salesforce steal the march from the big boys in the healthcare tech space – i.e., Cerner and EPIC – in asserting themselves as the technology visionaries in healthcare. Their focus on healthcare microservices is a relief for healthcare executives trying to navigate the “all or nothing” approach of the EMRs.

There is one player that seems keen on reinventing itself: Optum. Through a nimble product and services strategy, Optum is touching upon on all the hot buttons – MLR, analytics, PBM, and claims. Optum is the specialist vendor to watch out for when it comes to healthcare.

Last, but not least, what really took the cake were the innovative and exciting POCs related to clinical AI and visualization that Israel and Ireland – yes, the countries – showcased in their booths. These were some of the most fully baked solutions that I have seen in my 10 years attending HIMSS.

Hence, it’s with good reason that I left fairly impressed with the developing ecosystem knocking on the doors of healthcare organizations that are hungry for outcomes.

I will sign off by sharing an illustration from our recent study that analyzed the investments 27 of the leading healthcare payers and providers have made in artificial intelligence (AI), a key marker in the world of digital healthcare. This study objectively analyzed these investments from the perspective of ROI achieved.

Assessing 27 healthcare players (payers and providers) on their Artificial Intelligence investments

As you can see, there is a wide variance even within such a small sample set of healthcare organizations. FOMO (Fear Of Missing Out) pushed a lot of organizations to invest in the flashy new toy called AI. However, not all of them embarked on their investment journey by first enabling the core components of capability.

The difference between the best and the rest in healthcare is simply this: the ones to get the best ROI – those on the top right – are taking their journey through step functions that enable not only technology but also an organizational culture of innovation.

Please contact me at [email protected] if you’d like to hear more about my take-aways from the HIMMS conference or our study, named “Dr. Robot Will See You Now: Unpacking the State of Artificial Intelligence in Healthcare – 2019.”

 

Nov 20

Investments in Healthcare AI Will Quadruple by 2020, According to Everest Group | Press Release

By | Press Releases

New research predicts US$6 billion investment will drive innovations in patient identity verification, opioid abuse detection and individually tailored healthcare.

Healthcare organizations are pouring billions into embedded AI across the value chain, driving an estimated quadrupling of AI investments in the next three years, according to Everest Group. The firm predicts that healthcare AI investments will grow from US$1.5 billion in 2017 to exceed US$6 billion by 2020, representing a compound annual growth rate of 34 percent.

While AI is a relatively new area in the healthcare space and its adoption is in the nascent stage, digitalization of healthcare is accelerating healthcare enterprises’ interest in AI. AI has the potential to transform healthcare processes and dramatically reduce costs and improve efficiencies.

For example, healthcare payers are leveraging AI for product development, policy servicing, network management and claims management. Examples include:

  • Use of fingerprints, eye texture, voice, hand patterns and facial recognition to reduce the time taken for customer verification
  • Leveraging of machine learning with integrated claims data and analytics to detect opioid use patterns that suggest misuse
  • AI-powered wearable devices and mobile applications to help customers with personalized advice
  • Chatbots and virtual assistants to predict the right answer to standard customer inquiries and assist customers in navigating through the insurance plan selection process.

Currently, the area where payers are adopting AI to the greatest extent is in care management.

Likewise, the highest adoption of AI by healthcare providers is for care and case management. Providers also are employing AI tools to:

  • collaborate more effectively with patients
  • reduce the time required for aggregating, storing, and analyzing patients’ data
  • streamline workflows
  • monitor patients remotely
  • detect diseases faster and more accurately
  • come up with better treatments.

These findings and more are discussed in Everest Group’s recently published report, “Dr. Robot Will See You Now: Unpacking the State of Artificial Intelligence in Healthcare – 2019.” The firm has analyzed the market from the vantage point of 27 leading healthcare enterprises and closely examined the distinctive attributes of the leaders, who are far ahead of the other industry participants in terms of AI capability maturity. The report identifies best practices, illustrates the impact generated, and offers proposed a roadmap for market stakeholders.

***Download a complimentary abstract of this report here. ***

“While healthcare enterprises are still in the nascent stages of AI adoption, the scale of opportunity in AI demands C-level vision,” said Abhishek Singh, vice president of Information Technology Services at Everest Group. “AI presents unique opportunities for healthcare enterprises – allowing them to improve customer experience, achieve operational efficiency, enhance employee productivity, cut costs, accelerate speed-to-market, and develop more personalized products. In the case of the leading healthcare organizations, their CEOs and CIOs are acknowledging the transformative power of AI, rapidly building appropriate AI strategies, and building a robust, overarching business plan to harness its benefits.”

Additional key findings:

  1. Nearly two-thirds of spending on AI in healthcare is driven by North America. The North American market is also expected to be the fastest growing during the next five years, driven by regulatory mandates for use of electronic health records, increasing focus on precision medicine and a strong presence of service providers engaged in developing AI solutions for healthcare.
  2. Around 75 percent of all AI initiatives in healthcare are still driven by large enterprises as most mid- and small-sized firms are taking a wait-and-see approach.
  3. With a boom in enterprise AI, talent scarcity has become one of the biggest leadership challenges in implementing and evolving AI capabilities.
  4. Application of machine learning (ML) for structured data and natural language processing (NLP) for unstructured information have become mainstream in the healthcare industry.
  5. Cognitive technologies are expected to play an important part in health plans’ technology strategies going forward. Also, providers are looking to increasingly leverage deep learning to explore more complex, non-linear patterns in data, such as that found in research papers, doctors’ notes, textbooks, clinical reports, health histories, X-rays and CT and MRI scans.
Nov 09

Wipro has to Think beyond Enrolment to Keep HPS Healthy, Feel Analysts | In the News

By | In The News

Indian IT services major Wipro may have to look at building solutions beyond healthcare enrolment-based services for its Health Plan Services unit to remain competitive amid legislative changes in the US, say analysts.

The Donald Trump-led US administration has pushed consistently to repeal Obamacare, which extended health insurance benefits to a large chunk of low-income people in the US.

At this juncture, Wipro should look “to double down quickly (to) address the re-pivot issues,” Peter Bendor-Samuel, chief executive of global IT advisory firm Everest Group, told ET.

Sep 19

Becker’s Hospital Review 4th Annual Health IT + Revenue Cycle Conference — September 19-22 | Event

By | Events

Research Vice President Abhishek Singh will be a speaker at Becker’s Hospital Review Health IT + Clinical Leadership held on  September 19-22 in Chicago. Abhishek will speak on the growing importance of blockchain technology on September 22 during Track F of the Blockchain Summit portion of the event.

Event Description
Join the brightest minds in Health IT and the Revenue Cycle – great networking – learn more in 48 hours than you can all year! This exclusive conference brings together hospital and health system CIO and IT executives to discuss the Role of the CIO, Social Media, Data Analytics, Blockchain, Mobile Health, EMR Issues and Health IT Issues.

Come listen and network with Hospital Executives as speakers discuss their biggest concerns and how they are addressing them.

When
September 19-22, 2018

Where
Hyatt Regency
Chicago

Speaker
Abhishek Singh, Research Vice President, Everest Group

Learn more and register

Apr 23

For US Healthcare Providers, Hope for Rescue From Shrinking Margins Lies in ‘People, Process, Technology’—But With Bolder and Smarter Partnerships This Time: Everest Group | Press Release

By | Press Releases

Everest Group offers solutions to help healthcare providers combat margin-crushing regulations, expenses, and risks in turbulent marketplace

A majority of healthcare providers in the United States suffered financial decline in 2017 amid the industry shift toward a value-based care system. Although many healthcare providers espouse a sound and logical strategy that focuses on people, process, and technology, few have been singing that song correctly, according to Everest Group.

In Everest Group’s recently published report, “Healthcare Provider Market: Addressing Issues Beyond Value-Based Care | What Healthcare Providers Need to Do to Address Myriad of Challenges,” the firm presents the challenges faced by healthcare providers in the market today and explains how most healthcare providers’ efforts to overcome those challenges have fallen short.

The key challenges facing healthcare providers include the following:

  • Not only Obama-era regulations, such as MACRA, but also some GOP-proposed / -passed regulations such as Tax Cuts and Jobs Act (TCJA) are putting pressure on hospital margins. MACRA alone is likely to cause a decline in hospital Medicare reimbursement by at least US$250 billion by 2030.
  • Massive investments into extremely expensive electronic health record (EHR) systems with little or no preparedness and vision have led to poor financial performance.
  • Continuing fraud, lack of education, and the inability of the Centers for Medicare & Medicaid Services (CMS) to address these issues have resulted in doubling of improper payments in the past five years, with improper payments in 2016 reaching approximately US$102 billion.
  • Claims denials totaled more than US$250 billion in 2016, highlighting the significance of payment risk for hospitals.
  • Talent shortages, escalating training costs and a lack of collaboration are also among the key issues affecting health systems’ workforces.

To engineer a turnaround in this bleak trend, U.S. healthcare providers still need to focus their investments on people management, process improvement and technology enhancement—but in smarter ways than ever before, according to Everest Group. In particular, healthcare providers need to be more targeted in their digital transformation investments and bolder in their ecosystem development endeavors, relying heavily on partnerships to effect greater change.

“One very real and pressing concern of many providers is the large investment they have already made in large-scale EHR implementations and the limited resources remaining for new investments,” said Manu Aggarwal, practice director at Everest Group. “To identify the path forward, providers need to outline a targeted set of investments instead of another round of large ones. Specifically, investments in automation and analytics can yield solid, quick wins and pave the way for future engagements without the need for high capital outlay.”

“Another ‘must’ for providers is ushering in a much more collaborative culture,” added Aggarwal. “For example, providers need real-time data sharing with payers in order to provide enhanced patient experience. Providers also need strong partnerships with technology vendors and business process service providers to deliver the modern, technology-driven services that patients demand. And, finally, broader collaboration among the health network is required for improving patient outcomes and maximizing reimbursements.”

Additional examples of the solutions recommended by Everest Group in the report include the following:

  • To address the talent shortage, hospitals should hire visiting physicians and nurses, link incentives with performance, and collaborate with specialists for training purposes to enhance people management.
  • Technology investment is a must; however, hospitals also need to sort out issues regarding technology illiteracy and improper implementation in order to achieve a positive return on investment.
  • Digital transformation does not end with EHR implementation; rather it involves continuous investments in other systems such as revenue cycle management (RCM) as well as tools for analytics and automation. Providers should set their sights on the ultimate objective: interoperable systems with end-to-end patient engagement.
  • The uninsured population is expected to increase with the removal of the Individual Mandate; hence, healthcare providers need to strengthen front-end processes such as eligibility verification and pre-authorization to avoid claims denial at later stages.

 ***Download a complimentary abstract of the report. ***

Apr 11

Urgent Digital Action Items for Healthcare Payers: Systems Integration, Data Standardization & Homogenized Processes—Everest Group | Press Release

By | Press Releases

ITO and BPO to grow steadily as healthcare payers play catch-up on digital solutions to navigate industry convergence and a shift in focus from B2B to B2C

Healthcare is lagging behind other industries in adopting digital strategies, but radical changes in the marketplace—such as the advent of Walmart and Amazon as players in the space and the disintermediation of Pharmacy Benefit Managers (PBMs) like Express Scripts and CVS—are cultivating a fertile field for digital solutions.

Everest Group describes the current healthcare market as a shape-shifting industry, with once disparate players in the market—payers, providers, PBMs and pharmaceutical companies—converging, and the focus of healthcare payers shifting from business-to-business (B2B) to business-to-consumer (B2C). To successfully navigate these industry shifts, healthcare payers must adopt radically different, technology-based approaches to the way they serve members, reimburse providers, operate their internal systems, and adapt to changes in government regulations and programs, according to Everest Group.

“Take the typical healthcare payer’s internal IT systems and processes, as just one example,” said Abhishek Singh, practice director at Everest Group. “They are plagued with disparate information systems, fragmented member information, legacy IT burdens, insufficient transparency in financial records, and inflexible, manual processes. The need of the hour in this regard is systems integration, data standardization and homogenized processes. For this reason, we expect the healthcare payer IT-BPS market to grow 8 percent by 2020.”

In its recently published report, Healthcare Payer Annual Report: Payers Look at Digital to Reinvent in a Turbulent Healthcare Market, Everest Group examines in detail the myriad changes impacting the healthcare and life sciences market and describes specific steps healthcare payers need to take in four key areas to be future ready.

  1. Members: In the past, a “one-size-fits-all” approach sufficed. Those days are over. Payers must now focus on enhancing the customer experience by providing customized and tailored services, offerings and solutions to individuals. Web-based insurance channels, interoperable databases, cloud-based platforms and predictive analytics are digital tools that payers can use to overcome current challenges.
  1. Providers: Transaction- or volume-based payment approaches are being replaced by outcome-based approaches. As an increasing share of payments to providers is linked to value, payers must focus on both business and patient metrics. Access to a large amount of accurate data is a key asset in solving business challenges and mitigating pain points. Payers must focus on integrating systems to ensure seamless data flow, data management and analytics. Of particular importance is implementing a common analytical framework that continuously derives meaningful insights from the shared information.
  1. Internal systems: In general, payers’ internal systems can be described today as disjointed and fragmented. Payers must transition towards internal systems that provide a unified view of members, technology assets and resources. Currently, payers are struggling with the burden of legacy systems, manual processes and system inefficiencies. Payers must focus on data interoperability, process reengineering, change management and platform modernization.
  1. Government: Whereas our healthcare system has focused on volume rather than outcome in the past, going forward the focus will be on outcomes with lower cost. With a focus on cost-reduction initiatives, payers should focus on seamless data flow and system architecture to gain traction.

“We will see payers relying on sourcing partners to address data flow and integration; the adoption of digital levers such as mobility, cloud automation and analytics; and process standardization and reengineering,” said Singh. “These technology and operations mandates will be the key factors that determine whether payers’ are able to successfully transition to a future-ready state.”

***Download a complimentary abstract of “Healthcare Payer Annual Report: Payers Look at Digital to Reinvent in a Turbulent Healthcare Market” here.***