Best Practices in Provider Enrollment & Trends in 2018 Dawn Anderson What s On The Horizon For 2018? 1. Credentialing and Provider Enrollment are Collaborating 2. Artificial intelligence and Internet of Things are taking a central 3. Payer-Provider Collaboration 4. Blockchain based systems 5. Single, Accurate Provider Database 1
Trend # 1 Credentialing And Provider Enrollment Collaboration Credentialing and Provider Enrollment Collaboration The biggest challenges in healthcare cannot be solved by working in siloes Trend in the industry to combine these departments under one working structure Credentialing and Provider Enrollment Collaboration In order to tackle complex challenges, industry stakeholders must break down barriers and work together with an eye on what s best for the ultimate end users: the providers and the patients. 2
Credentialing and Provider Enrollment Collaboration One fifth of Health Care Organizations have merged credentialing and provider enrollment operations in the last 24 months. Many are implementing plans to have these departments report up to the same director and/or reporting structure. What is next for your Organization? Trend # 2 AI And IoT Are Taking A Central Role AI And IoT Taking A Central Role Artificial Intelligence and Internet of Things are receiving a good amount of investment from healthcare leaders. There is going to be a considerable advancement in technology, making it crucial in healthcare to assist an already unbalanced workforce. AI and IoT will not only prove instrumental in enhancing accuracy in clinical insights, and security, but could also be fruitful in reducing manual redundancy and ensuring fewer errors as we transition to a world of quality in care. 3
Internet of Things The interconnection via the Internet of computing devices embedded in everyday objects, enabling them to send and receive data. The IoT is a giant network of connected "things" (which also includes people). Internet of Things If one thing can prevent the Internet of things from transforming the way we live and work, it will be a breakdown in security Of all the technology trends that are taking place right now, perhaps the biggest one is the Internet of Things; it s the one that s going to give us the most disruption as well as the most opportunity over the next five years. --Daniel Burrus Founder and CEO of Burrus Research AI is Disrupting The Healthcare Industry Amazon, Apple, Google, IBM, Microsoft, and many others are eyeing the $2.7 trillion healthcare market as fertile ground for technological disruption. Augmedix is working to minimize the time doctors spend on a computer during patient visits by leveraging Google Glass to automate scribing and collect audio, video and written notes then use natural language processing to help clinicians make sense of that information. BrainQ is concentrating on taking advances in neural networks to develop customized treatment protocols for people who cannot walk anymore, whether because of a stroke, spinal or brain injuries. 4
AI is Disrupting The Healthcare Industry Cytovale s computer vision technology looks at how a cell transforms when a patient gets infected with sepsis to apply technologies that can detect sepsis earlier. By combining attributes from the patient s file with clinical expertise, external research, and data, an IBM Watson program identifies potential treatment plans for oncology patients. IBM s cognitive health assistant is able to analyze radiology images to spot and detect problems faster and more reliably than humans. Radiologists in the future should only look at the most complicated cases where human supervision is useful. Healthcare IT News, Nov. 1, 2017 and The Medical Futurist, 2018. I have no doubt that sophisticated learning and AI algorithms will find a place in healthcare over the coming years. I don t know if it s two years or ten but it s coming. --Andy Schuetz, senior data scientist, Sutter Health 3 Reasons Healthcare Is Ready For AI Physicians and patients are frustrated with legacy medical systems. Smart devices that collect informative data are ubiquitous in American society. Physicians and patients are comfortable with at-home AI services provided by consumer technology companies. --Jessica Kim Cohen, Becker s Health IT and CIO Review, Jan. 18, 2018 5
Consumers getting first exposure to AI Narrow AI is already in our cars and homes. Wall Street Bank Cowen, "We think a natural fit for Amazon could be incorporating its Alexa voice assistant for some health care needs." They suggest a possible application for Alexa could be helping book a telemedicine appointment. Teladoc is currently compatible with Alexa and will allow you to schedule a televisit with Teladoc. https://youtu.be/emwz487yg9i SNL Amazon Silver Trend # 3 Payer-Provider Collaboration Payer-Provider Collaborations The transition to value-based care required that payers and providers work together to jointly manage risk, streamline risk adjustment and ensure data accuracy to improve compliance and reduce audit risk. Tufts Health Plan and Hartford HealthCare will join forces to launch a payer-provider collaborative health plan, the first of its kind in Connecticut. * *http://carepartnersct.com/news/hartford-healthcare-and-tufts-healthplan-join-forces-create-connecticut%e2%80%99s-first-provider-payer 6
Payer-Provider Collaborations When payers and providers collaborate on risk-based contracts, they must agree up front on metrics Payers and providers need a plan for ensuring transparency Payer-Provider Collaborations Once payers and providers have aggregated data, they can visualize trends in the data and establish informed objectives for their population. Payers and providers both want to improve patient care and lower cost! Trend # 4 Blockchain Based Systems 7
Blockchain-based systems Blockchain could arguably be one of the most disruptive technologies in healthcare. It is already being considered as a solution to healthcare s longstanding challenge of interoperability and data exchange. Blockchain-based systems will definitely require some changes from the ground up, but 2018 will have a glimpse of innovation centered around blockchain and how it can enhance healthcare data exchange and ensure security. What Is Blockchain? Write once, read only record of digital events in a chronological order that is shared in a peer-to-peer network. It records exchanges and transactions in a database that can be distributed and shared across authorized users that can add to it, when needed. Possible Uses for Blockchain Verified Resume s or CV s Verified provider data submitted to Credentialing and Enrollment Verifications conducted through blockchain 8
Possible Uses for Blockchain Enrollments submitted to payers Claims adjudicated through blockchain The possibilities are endless Trend # 5 The Quest Is On For A Single, Accurate Provider Database Single, Accurate Provider Database The industry is seeing a need for major improvement in medical staff credentialing and privileging processes, beginning with the need for thorough, accurate provider data. Provider directories must contain relevant and accurate provider information. 9
Single, Accurate Provider Database Directory maintenance will be implemented through monthly updates of provider information and quarterly touch points with providers within a Qualified Health Plan network. CMS is currently auditing healthcare organizations for accuracy Penalties may be forthcoming Thank You Dawn.Anderson@healthstream.com Questions? 10