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Author: eric

Adopting a HealthOps Mindset to Pull Healthcare Out of the Past

Author: Shilen Patel, CEO

HealthOps Philosophy is how HealthAxis conducts business and our standard of operation when combining services, technology, and data integration into practice. 

Nearly 20 years of leading healthcare technology companies have convinced me that the challenge of modernizing most dimensions of health care is not a matter of innovation, but typically, a matter of integration. Our field has an opportunity to improve access to care, patient experience, product design, and attain operational excellence. Unfortunately, we are not on par with other growing industries. Healthcare lifers, like myself, have seen rapid progression in mobile banking, the wide acceptance of e-commerce, and the ascent of business philosophies like Agile and DevOps in software development. Fragmentation of work and information, the absence of aligned incentives, and the inertia of complex legacy technology in mission-critical areas generate a frustrating lag to success. Quite frankly, we are alarmed at the absence of this continuous and holistic improvement concept within the industry.   

We formed HealthAxis Group to overcome these innovation killers and to enact our mission to ceaselessly improve the speed and quality of information and healthcare decisions. We visualize “Healthcare Rebooted” as a completely efficient, collaborative, and information-driven institution. 

For years, we pushed to design solutions that unify processes and data, catalyze coordinated and value-based care, and leverage modern technology. We saw a need to define how our team operates in this dynamic and growing industry. From a culmination of our Mission, Vision, and Values and a lack of industry best practices surrounding continuous holistic and improvements, we devised our philosophy, HealthOps. 

 Nowhere is HealthOps more evident than with HxOne, our end-to-end, fully integrated healthcare operations solution. Our data solutions, HxLogic, joins our technology, HxPro, and the experience and insights of our HxOps personnel. 

What is HealthOps 

The HealthOps mindset parallels concepts like Lean, Six Sigma, Agile\Scrum, and DevOps that require collective will and motivation. HealthOps reduces fragmentation through transparent, intentional, and effective interaction across the components. Everyone can see and reflect on the parts that make up the whole. Lessons learned to determine future priorities to make healthcare more efficient, coordinated, and information-driven. 

How to be a HealthOps Organization 
  • Provide more integration and cohesion among the critical parts at the top to accelerate healthcare innovation. 
  • Perpetually refine approaches through continuous improvement principles that render better benefits and access to care, optimize software and business processes, and actionable insights to improve quality of life and care. 
  • Commit to routine reflection on what each line of focus (tech, data, and people\process) can teach us about the others and have an agile organization to place it into action. 
  • Focus ownership\stewardship mentality of a team around each product combined with robust communication, total candor, and a dynamic process for implementing improvement. 

Living the HealthOps Philosophy has strengthened our team and produced tremendous value for our partners and customers. We will be sharing examples of HealthOps wins throughout the year as we work internally and in the field with clients to improve quality of life and quality of care through better technology, information, and operations at the top of the healthcare pyramid. 

 

 

 

 

 

HealthAxis Participating in the Rise National 2021

HealthAxis is exhibiting and speaking at Rise National 2021.

Date: March 26,29, & 30

HealthAxis will be sharing the benefits of our advanced all-in-one HxOne solution that encompasses next-generation technology, comprehensive third-party services, and advanced analytics to help health plans thrive in a growing and challenging environment. We look forward to making virtual connections, talking with those wanting to enhance their operations, and gaining additional education. Visit us at our booth or join us on Tuesday, March 30th at 1 pm during our roundtable sessions.

Candace Aguirre, Lead Scan Operator Shares Experiences

This month, we speak to Candace Aguirre, Lead Scan Operator about our mailroom operations, Covid-19 business impacts, and working on an inclusive team. 

 What does a day in the Lubbock Mailroom look like?  

Most days are busy. On average, we scan approximately 13,000 claims, and we send out about ten deliveries for returning checks and outgoing mail. My team is very hardworking and dedicated. I appreciate their reliability and admire their dedication. One of our stars is Kiemodrick Matthews. He is always punctual, conducts his day with efficiency, and arrives with a ready-to-work attitude. In the ongoing pandemic, they have continued to be dedicated to their work-family by exemplifying one of our company’s core values, trust in team.   

Has your department experienced any recent challenges?   

One challenge that has impacted many teams globally is the Covid-19 pandemic. We do our best to keep a clean and safe work environment. Our company provides supplies including disinfecting spray and wipes, hand sanitizer, gloves, face masks, and face shields. We also maintain social distancing in the workplace.   

Even with these precautions, our group has felt the effects of the virus. We have experienced some positive testing. Our impacted members were able to take recovery times as needed and return to good health.  

While this put us behind in some areas, we are maintaining productivity by being extremely dedicated and our operations have been continuous. We utilized healthy team members and some temporary workers to maintain steady production and catch up where we needed the extra support.    

What would you like to share about working at HealthAxis?  

The thing I value most about the culture at HealthAxis is that we are very inclusive. We operate with high values and consider objectives from all perspectives. These efforts allow our team to feel heard and considered in leadership decisions. An example of this is our floating holidays. The employee selected days off permit our team members to celebrate their community backgrounds and cultures.   

Even though some offices are states apart, we have managers virtually supporting one another and working together to keep strong company communication. As needed, we have managers traveling throughout the organization to help each other with a hands-on approach. This dynamic has been extremely helpful in critical situations. 

Evolution of Healthcare Analytics 

Healthcare analytics is the process of aggregating and evaluating current and historical industry data to predict trends, improve outreach, and better manage business practices and the spread of diseases. Analytics in healthcare is making a significant difference in today’s treatments and facility management.  

Benefits of Healthcare Analytics 

The healthcare industry has generated large amounts of data, driven by record keeping, compliance and regulatory requirements, and patient care. Historically, data was stored in hard copy form, but many healthcare organizations are becoming more efficient and effective through incorporating software and technology.  

Healthcare analytics derives insights at both the macro and micro levels for systemic wastes of resources. Analytics track individual practitioner performance, record the health of populations and identify the risk of chronic diseases. With all this information, health systems can efficiently allocate resources to maximize population health, revenue, and patient care.  

History of Healthcare Analytics 

Traditionally, health records were written on paper, maintained in folders divided into sections based on the type of note, and only one copy was available. Technological innovations, such as the computer, led to new health information approaches starting in the 1960s and laid the foundation for developing the Electronic Health Record (EHR).  

The first EHR appeared in the 1960s, and by 1965, approximately 73 hospitals and clinical information projects and 28 efforts for the storage and retrieval of medical documents and other clinical information were underway, according to HIMSS. The adoption and effective use of EHRs not only enabled better documentation and file organization but shifted the format of health records, and thus changed health care. 

In 1970, as computers became more accessible in academic research centers, there was a growing interest in developing Medical Diagnosis Decision Support Systems (MDDS). These systems are all-in-one computer programs that pinpoint medical diagnoses when patient information enters the system. Such developments, particularly in diagnosis decision support, have high complexity. While these efforts were novel at the time, they did not employ a formal knowledge model. Instead, they relied on the characteristics of the data. Therefore, it was difficult to generate a clear explanation for a decision made by the system. 

By 1990, innovators within the industry pushed for more education around the introduction of healthcare analytics. During this time, there was a recognition by researchers and developers that Artificial Intelligence systems in healthcare had to be designed to build on the expertise of physicians and accommodate the absence of perfect data. Approaches involving Bayesian networks and artificial neural networks were applied to intelligent computing systems in healthcare.  

Healthcare Analytics Today 

Before the 2000s, almost all medical data was on paper, and physicians spent hours manually entering information. Today, healthcare analytics is changing how medical professionals can work with patient data to execute a better experience. Our modern neural networks can outperform humans in tasks that are more complex than EKG interpretation. Doctors and nurses now use handheld devices to record patients’ real-time data and instantly update their medical history. With these digital advancements, better and more accessible treatments are available for a wide variety of diseases, making healthcare more efficient, providing advanced care, and supporting a higher rate of disease control. 

HealthAxis’ Role in Healthcare Analytics 

Our HxLogic solution is a comprehensive, integrable system enabling full lifecycle analysis. It effectively consolidates and analyzes data into usable and easily consumable information that pinpoints areas for action. Our system provides hundreds of dynamic metrics with alerts and reports to healthcare professionals through our pre-built healthcare data model, data marts, intelligence dashboards, reports, and analytics.  

Using HxLogic you can manage healthcare costs, adapt and become more compliant with new healthcare regulations, improve quality of care, detect fraud, and streamline processes.  

Our dedicated healthcare team at HealthAxis provides consulting and implementation services from strategy and planning through end-user training and personalized support. Let us help you identify and meet your analytic goals. Get started today with HealthAxis. 

 

Jesus Mendoza, Insight and Sales Operations Manager Shares Experiences

This month, we speak to Jesus Mendoza, Insight and Sales Operations Manager about upgrading systems, learning from partners, and his variety of experiences with HealthAxis.

What new implementation are you looking forward to?

I am looking forward to transitioning our current clients that are using our legacy system to the newest version of HxPro technology. I cannot wait to see their reactions to this faster, more efficient experience with additional options and features.

 

The latest version is enhanced with real-time upfront customization and immediate authorization or approvals for providers or members. These features combined with the ability to link providers to multiple locations with varying pay rates will fully automate systems and work cues for a faster overall process.

What have you learned from a client, partner, or coworker that has made an impact on your performance?

A client once said to me, “no matter how hard or difficult the situation becomes, you can choose to react to it positively or negatively.” This is to say that your reaction will influence others to react similarly. They also noted, “choose wisely because you never know who is watching.” I think about this often when approaching a challenge or presenting in a group setting. I know that my reaction to the task or opportunity can be a driving force for our team, and I choose to project positive energy and enthusiasm to all opportunities.

Tell us about your roles within HealthAxis.

I have worn multiple hats being a trainer, researcher, and account manager. As a trainer, I was responsible for coaching new clients on our systems and assisted in providing demonstrations for potential clients. Insights and sales allowed me to research and compare our system to others in the market and offer feedback to our development teams. In my current role as an account manager, I handle everything from tickets and release stories to testing and coordination with production sites for our clients.

CMS Changes to 2021 & 2022 Star Ratings Data Calculations

The Centers for Medicare & Medicaid Services (CMS) announced it will “put patients over paperwork to provide temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage, and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.”

 

 

Summary of  Changes

  • In light of the public safety issues in continuing to require the collection, validation, and submission of data for the 2019 measurement year, the first Interim Final rule removed the requirement for Medicare health plans to submit Healthcare Effectiveness Data and Information Set (HEDIS) 2020 data covering the 2019 measurement year for the Medicare program.

  • CMS is removing the requirement for submission of 2020 Consumer Assessment of Healthcare Providers & Systems (CAPHS) survey data for Medicare health and drug plans. Part C and D plans may use any CAHPS survey data collected for their internal quality improvement efforts.
  • Lastly, the 2020 Health Outcomes Survey administered by NCQA in partnership with CMS as a component of HEDIS data collection is postponed to late summer.

Changes to 2021 Star Ratings Calculations

CMS will also be taking the following actions with respect to 2021 Star Rating calculations:

  • CMS will use last year’s HEDIS measures scores and ratings from the 2020 Star Ratings for the 2021 Star Ratings. 
  • If the COVID-19 outbreak prevents the agency from having validated data or results in systemic data integrity issues for any other measures, CMS will replace the 2019 data that has any quality issues due to COVID-19 with the measure-level Star rating and score from the 2020 Star ratings. 
  • For newer contracts where the 2021 Star Ratings would be the first year that they would receive a Star Rating, CMS will treat them as new for an additional year since CMS would not have enough data to assign a rating.

Changes to 2022 Star Ratings Calculations

For 2022 Star Ratings, CMS expects Medicare Advantage contracts to submit HEDIS data in June of 2021, and Medicare Advantage and Prescription Drug Plan (Part D) contracts to administer the CAHPS survey in 2021.

To address any concerns about overall performance in 2020, the agency is changing the applicability date of the guardrails policy from January 1, 2020, to January 1, 2021. This will delay the implementation of the 5% point cap so that cut points for the 2022 Star Ratings can change by more than 5% points if national performance declines overall as a result of the COVID-19 outbreak.

CMS says it will calculate the Part C and D improvement measure scores for the 2022 Star Ratings as codified, but “recognizes that the COVID-19 outbreak may result in a decline in industry performance, therefore expanding the “hold harmless rule” to include all contracts at the overall and summary rating levels.”

Let HealthAxis’ knowledgeable team and cutting edge services keep your business on track and help you navigate change.

 

 

Andy Parker, Director of Administration Services Talks Progress

This month, we are connecting with Andy Parker, Director of Administration Services about his department projects, team, and client relations. 

What have you learned from a partner that has made a positive impact on our clients?  

For years, I managed a relationship with a partner for software that facilitated the processing of inpatient hospital claims. Working with them, we have expanded our offerings to incorporate additional software that facilitates the processing of outpatient hospital claims. This has made a positive impact for our clients by enabling them to combine pricing and process both types of claims. As we continue to grow our partnerships, we are reviewing additional opportunities to determine their advantages in use with our technology, HxPro.   

What wins has your department had recently?   

We’ve been very successful at making clients extremely efficient when it comes to adjusting large volumes of claims. It is not uncommon for Centers for Medicare & Medicaid Services (CMS) to publish a revision to a fee schedule, which can require a client to adjust claims. To streamline this process, we import and maintain Medicare fee schedules in our claims system that are published by CMS. We have also implemented CMS’ Merit-based Incentive Payment System (MIPS) program for a client, this program can increase or decrease payment based on a practitioner’s performance rating which previously required the client to adjust claims.  

Within the last six months, we have adjusted over 650K claims for a client for these reasons. Our automation has lessened the staff required by our clients to handle adjustments and has drastically improved the turnaround time.  

What should we know about your department?   

My team of six, consisting of developers and business analysts, is a unique team in that we provide dedicated full-time support to one client. This client is an administrator of Medicare Part B benefits on behalf of CMS. Much of the team’s activities involve implementations to make our claims system consistent with CMS. However, there are projects not specific to CMS programs that we design and implement for this client. My team always considers whether a project we’re working on would provide benefit to any other client within our claims system. When it can, the project is designed to function for all applicable clients. While this team provides dedicated support to one client, we always have all clients in mind when designing enhancements. 

 What are some of the new developments in your department?  

We are currently enhancing our legacy claims system for a client to perform Medicare Secondary Payer (MSP) functionality per CMS guidelines. This covers specific calculation rules to determine the secondary payment amount, enhancements to the Remittance Advice and Explanation of Benefits, as well as electronic reporting of secondary payments back to CMS via Encounter Data.    

For our clients that utilize claims editing services, we are scheduled to begin our annual optimization study. This process enables us, and our clients, to recognize potential savings. This optimization study is performed for each client and the results are packaged and shared with clients.

2020 Blog Highlights

2020 was a year of new challenges, transitions, and exciting developments in the healthcare field. HealthAxis has kept a constant eye on the industry, evolved, and adjusted. Together we have made technological advances and streamlined operations to thrive in a new climate.  

We are highlighting our most popular blogs on work from home, the HxOne product launch, and improving care management through analytic advancement.  

[icon name=”users” class=”” unprefixed_class=””]  Tips for Working in a Hybrid Model
Our team has found the following tips helpful while we continue to work in different locations and from home.

[icon name=”bullhorn” class=”” unprefixed_class=””]  A new Approach to Healthcare Operations
HealthAxis released an advanced all-in-one solution to administer claims, third-party services, and data analytics for Health Plans.

[icon name=”user-md” class=”” unprefixed_class=””]  Improving Care Management Programs through the Use of Targeted Analytics
In today’s healthcare climate, where pay for performance and shared savings models are becoming the new norm, using analytics to effectively design your care management program can hold the keys to your success.

What is HxLogic?

HxLogic is a powerful pre-built data warehouse and analytics solution that provides healthcare organizations with near real-time information to fundamental subjects like claims, members, providers, product, medical informatics, general ledger and standardized code sets. Helping organizations integrate both structured and unstructured data, including medical, pharmacy, and dental claims, as well as information about member eligibility, benefit design, providers, enrollment, public databases, demographics, websites and member experience outlets.  

How does HxLogic make an impact?  

Today’s business challenges demand timely Healthcare expense information that enables executives, managers and front-line employees to make better decisions, take action and correct problems before they effect quality of care.  

Achieving better business performance requires more than just improving process efficiency or enhancing healthcare expense reporting.  Rather, it requires improving effectiveness by leveraging advanced analytics that integrate data from across the organization and provide insight to the people who can impact the quality of care and cost management. 

HxLogic integrates critical data from across the enterprise value chain and transforms it into timely, actionable information so organizations can make the right decisions at the right time. 

What are the key features?
  • Over 175 Reports Measuring 750+ Metrics 
  • Pre-built Data Warehouse, Data Models, ETL Workflows and Analytics 
  • Automatically Integrate Data from Multiple Sources 
  • Pre-built, Self Service and Customizable Analytics 
  • Timely and in-context healthcare and cost information to improve decision-making 
  • Predictive Analytics for ER Admission and Hospital Readmission  
Out of the Box Dashboards: 
  • Executive Overview 
  • Medical Cost Overview 
  • Inpatient 
  • Outpatient 
  • ER 
  • Enrollment 
  • Membership 
  • Readmission Analysis 
  • High-Cost Members 
  • Professional 
  • Provider Peer Review 
  • Pharmacy 
  • Actuarial 

 What are the HxLogic modules?  

Modules include medical cost, self-funded, accountable care, care manager, and all-payer claims database. 

What can HxLogic do for you?  

HxLogic accelerates the deployment of your healthcare data warehouse with prebuilt rules and data models revealing the insights hidden in your data in the shortest time frame possible.  By integrating siloed data sources, your business users have a complete view of the customer, business costs, and operations.  

Where can I learn more?  

Contact us today to talk to an industry expert or request a demo to learn more about HxLogic and how our data warehouse and analytics solution can fully integrate with claims processing technology, HxPro, and third-party administration services, HxOps.