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The electronic prior authorization tipping point

Today’s prior authorization (PA) process for certain high-cost medications is often a lengthy, manual back-and-forth process among the doctor, payer, pharmacy and patient. But times are changing, and about 20 states have legislation proposed or in place to improve the process with electronic prior authorizations (ePA). The industry is at a tipping point and ready for change. Health IT partnerships with payers and life sciences companies can enable physicians to obtain PA electronically, leading to faster patient access to medications and reduced rates of prescription abandonment. Manual prior authorizations aren’t working According to Frost and Sullivan, about 70% of patients who encounter a manual, paper-based PA do not receive the original prescription, and patients abandon about 40% of manual PAs. With 180 million PAs each year, we can estimate that about 72 million prescriptions are abandoned each year. Manual PA […]

Recognized as an industry leader in interoperability, UPMC is a healthcare provider and insurer that operates more than 20 hospitals and 500 outpatient sites. A talented UPMC Interoperability team drives the organization’s efforts toward excellence in connectivity. We recently gleaned some valuable insights from two members of this team, Diane Michalec, RN, MSN, director of interoperability and Amy Urban, DO, MPH , clinical director of interoperability. They shared career advice and their perspectives on population health management: Tell me a little about your current role and the path you took to get there. Diane: I am currently the Director of Interoperability at UPMC and have responsibilities for managing the enterprise wide point of care application along with strategic planning and oversight of the interoperability program. I came into my first IT role from a critical care nurse background and have […]

To provide the best quality care, clinicians need detailed information about a patient’s medical history and status. They need to know existing information is correct, and also about new details in patients’ lives that could affect their care. Some days, I’m organized and build in time to prepare for upcoming appointments. I may be able to go to an online site and complete the updates and information necessary for my visit in advance. During busy days and weeks, it might be all I can do to get to the appointment on time, and having an onsite option like a kiosk in the waiting room to update my medical history becomes vital to making sure my doctor has all the best data about me. As a person and a patient, I like options. I want to engage with practices who use […]

Editor’s Note: Health Data Management recently named the 2016 Most Powerful Women in Healthcare IT, including Allscripts Analytics Chief Medical Officer Fatima Paruk. This post is one in a series that features insights from some of these women leaders, including Kara Marx , Kate Pavlovich and Dr. Carol Steltenkamp. Few people in the industry have achieved as much as Carol Steltenkamp, M.D., MBA, FAAP, FHIMSS. She is the chief medical information officer at UK HealthCare, which is the hospitals and clinics of the University of Kentucky (Lexington, Kentucky, U.S.A.), serves as chair for the HIMSS International Board of Directors, and is a professor of pediatrics at the UK College of Medicine. Even with all of these responsibilities, she still finds time to see pediatric patients. Her passion for helping others is inspiring, as is the advice she shared in a recent interview. Highlights […]

At the 2016 Pop Health Forum, healthcare providers delved into one of the industry’s most pressing issues: How do we meet demand on the fee-for-service side while simultaneously controlling risk on the value-based-care side? Allscripts Vice President of Solutions Management Jim Bresee helped address that question in this video: Delivering the complete patient record at the point of care Today, patient data resides in many different places. For clinicians to have a complete view of their patients, they need technology that can bring this data together in a way that is accurate and useful. First and foremost, it’s critical to know the record is aggregating the data for the right patient. When you bring information together from inside and outside the organization, you have to know with absolute certainty you have the right patient. Technology must use reliable patient identification […]

Editor’s Note: Health Data Management recently named the 2016 Most Powerful Women in Healthcare IT, including Allscripts Analytics Chief Medical Officer Fatima Paruk. This post is one in a series that features insights from some of these women leaders, including Kara Marx , Kate Pavlovich and Dr. Carol Steltenkamp. A fellow honoree from the 2016 Most Powerful Women in Healthcare IT awards reminded me that with recognition comes a responsibility to share knowledge and experience with others. It’s a principle that’s especially true in health care, which is by nature is a collaborative field. From Sharp Healthcare (San Diego, California, U.S.A.), Vice President Information Technology Applications Kara Marx recently shared some of her insights with us. Here are highlights from that conversation: Describe your current role and the path you took to get there. In my current role at Sharp, I manage a team […]

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A beginner’s guide to MACRA

MACRA is perhaps the most significant piece of proposed healthcare regulation I’ve ever seen. We’ve had a series of webinars to help clients understand the key points, and distilled them here in a Q&A format. What is MACRA? MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. It is Medicare payment reform designed to help lower the cost of health care, while delivering better quality and improving health outcomes. It creates a more comprehensive value-based framework for payment and combines different quality-based measures into one system. Is MACRA final? No. MACRA was enacted in April 2015, but a public comment period has been open from April through June 27, 2016. The government is estimating the final rule will be available in October 2016. If it’s not final, why should I worry about this now? MACRA includes many changes, […]

When there’s a customer support issue – with our cell phones, cars, banking or online shopping – the answers are not always on a website or app. Sometimes we want or need to call. The experience can quickly get exasperating if we’re transferred multiple times, repeating account information, security questions or other information. Based on previous experiences, there are companies I don’t mind calling for an issue, and those I never want to speak to again. Healthcare providers want to create an environment where patients have a great experience. It doesn’t matter if they are a new patient calling to get information on the practice, or an established patient calling to schedule an appointment, ask a question about a health-related issue or follow up on results.  Whatever the reason for the call, providers want their patients to avoid the pitfalls […]

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HIT Leader Q&A: Lessons learned from systems and Starbucks

  • Fatima Paruk, M.D., MPH
  • 06/21/2016

Editor’s Note: Health Data Management recently named the 2016 Most Powerful Women in Healthcare IT, including Allscripts Analytics Chief Medical Officer Fatima Paruk. This post is one in a series that features insights from some of these women leaders, including Kara Marx , Kate Pavlovich and Dr. Carol Steltenkamp. When great minds come together, great things happen. At the Most Powerful Women in Healthcare IT conference, leaders from across the industry addressed some of today’s most pressing issues. Kate Pavlovich, director of strategy and data analytics at NewYork-Presbyterian Hospital (New York City, New York, U.S.A.), participated and shared insights in a follow-up interview, including what she learned from working at a hectic espresso bar. Here are highlights from that conversation: Describe your current role and the path you took to get there. I’m focused on data governance, which sits in the office of strategy, […]

Editor’s note: On June 7, 2016, Allscripts client Stephen Nuckolls, CEO of Coastal Carolina Health Care (New Bern, North Carolina, U.S.A.), was a panelist at a Congressional briefing on interoperability hosted by the EHR Association. This blog post shares some of his comments at the briefing, which covered successes and areas for improvement with health information technology. It’s an honor to share with Congress a first-hand account of how we’ve used electronic health records (EHRs) to reduce spending and improve quality. Our medical group, a practice with 45 physicians mostly specializing in primary care, operates a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) that has about 11,000 attributed beneficiaries. Our ACO has accomplished several positive outcomes since being accepted into the program in 2012, including: Earned recognition as the top performer in the program for cancer screening rates […]