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Entries in Thayer, Claire (268)

Thursday
Jul252019

Four Questions for Erin Benson and Courtney Timmons with LexisNexis Health Care: Post-Webinar Interview

By Claire Thayer

Erin Benson, Director Market Planning and Courtney Timmons, Market Planning Specialist, LexisNexis Health Care, participated in a Healthcare Web Summit webinar discussion on ways for health plans to reduce the risk of a data breach, the necessary steps to validate and verify member information, and ingredients for a strong multi-factor authentication strategy.  If you missed this engaging webinar presentation, you’ll want to be sure to watch the Webinar Video. After the webinar, we interviewed Erin and Courtney on four key takeaways:  

1. What are some of the key ways health plan members are using their member portals? 

Erin Benson and Courtney Timmons: Health plan members are increasingly using their member portals as a tool to View and get answers to coverage questions

  •  Track claims and account activity
  •  Locate providers and services
  •  Find health advice
  •  Manage their member profile
  •  Pay bills

2. With the rise of digital healthcare, there's also a rise in online fraud. Tell us more about how this impacts healthcare firms?

Erin Benson and Courtney Timmons: 

As the ways in which members access their data becomes more sophisticated, so too do the ways in which hackers are finding ways to commit fraud:

  • More than 1 in 10 new account openings are fraudulent with 60% of those accounts being created using a mobile device
  • Call center fraud is up 113%
  • A record 1 Billion BOT attacks were seen in Q1 of 2018
  • There has been a 202% growth in login attacks since 2016
  • And 88% of all ransomware attacks were against healthcare organizations in 2017 –healthcare organizations are known on the black market to pay      

When fraudsters are successful it compromises patients’ trust in the healthcare organization, increases costs if they have to remediate a breach, and potentially leads to member safety risks if any of the patient’s health data is altered and care givers then act on bad information. Not to mention members will go somewhere else if they don’t trust that you can take care of their data.

3. You've mentioned that identity is the key to solving the challenge of balancing member engagement and data security. How do these interact together?

Erin Benson and Courtney Timmons: The healthcare organization should determine when and how to communicate with the member, ensuring updated contact information is maintained to best engage them. The member’s information should be protected from fraudster access. A foundational step is for healthcare organizations to aggregate the many data points about each member into one location linked together by a unique, persistent member-level identifier to create the one golden record about the individual.

Identity management and proofing, in tandem with new technological innovation, allows organizations to:

  •  Perform intuitive linking of data points to the accurate identity
  •  Leverage cross-industry analytics that allow organizations to determine if an identity enrolling in   your plan actually exists and if all of the identity information is accurate and belongs together, and 
  •  Monitor transaction activity across a diverse array of industries from financial, retail, insurance and   government, using machine learning to build analytics, provide fraud intelligence and track   fraudulent behaviors and schemes.
     

In order to protect their data, you have to know who to grant access to and be able to verify their identities. Knowing your members will allow you to validate that the right users get access to their information, while keeping fraudsters out, and providing insight into who is accessing your site, mobile application and/or portal no matter where in the medical journey a member… or fraudster… is trying to gain access. 

4. Identity verification is complex. What are a few key considerations in selecting identity verification layers? 

Erin Benson and Courtney Timmons:  Various types of authentication methods should be used to cover different types of security vulnerabilities.  It is important to implement solutions that serve different purposes, targeting different types of fraud.

Some questions to ask as you develop your strategy are:

  • Do we have a way of preventing fraud such as BOT attacks or ransomware by scanning devices trying to gain access to our portal?
  • Can we confirm that the user requesting access to the data is the owner of that identity?
  • Does the input identity exist and do all of those data elements belong together?

We recommend putting the no to low friction solutions up front in the process and introducing solutions with increasing levels of friction later in the process so only suspicious identities are facing additional scrutiny before logging in or completing a high risk transaction. 

Monday
Jul152019

Speaker Panel Answers My Accreditation Questions

By Claire Thayer, July 15, 2019

In June, Iris J. Lundy of Sentara Healthcare, Lorie Gillette and Dr. Robert C. Pendleton of the University of Utah Health, Lori Flies of Houston Methodist, and Patrick Horine, Chief Executive Officer at DNV GL Healthcare participated in a Healthcare Web Summit webinar discussion on how accreditation can be a catalyst for improvement in care quality, patient outcomes and overall operational efficiency. If you missed this lively presentation, you'll want to be sure to watch the Webinar Video. After the webinar, we interviewed our speakers on four key takeaways: 

1. Can you describe some of the quality improvement benefits within your system that have been implemented since contracting with DNV GL Healthcare? 

Lori Flies: At Houston Methodist, a few of the many quality improvement benefits included:

Implementation of ISO 9001 internal survey/internal audit using a process-based approach has improved identification of variations in quality and safety so that we can take corrective actions and evaluate improvement. Another benefit that we implemented was structured management review to quality and safety variations has resulted in leader decisions that drive improvements, such as ED throughput. Lastly, since contracting with DNV GL Healthcare, we’ve experienced stronger integration of clinical and non-clinical aspects of patient care; for example, last year working with both clinical and facility aspects of assessing ligature risk. 

2. You've talked about process owners within each of your hospitals, can you tell us more here? 

Iris Lundy: Each NIAHO standard or an identified process has an owner within the hospital (process owner) and a system lead who serves as the subject matter expert.  These individuals assist with developing educational material and other tools to assist their hospital with successfully implementing.  The system person assists to ensure we are standardizing as much as appropriate across our system.  There is also a VP sponsor for each of these groups to assist with removing barriers when they are identified. 

3. As an academic health system, you've mentioned historic silos within organization structure and clinical specialties. How did implementing management to support ISO 9001 force you to break down these silos? 

Bob Pendleton and Lorie Gillette: At the University of Utah Health, when we implemented a management system as per the ISO 9001 standards, silos were broken down due to the new reporting structure for management review which included adding key directors as well as executive leaders. The goal was to spread system information requiring process improvement and in turn, agree upon shared system goals collaboratively. Providing training and aligning goals on a system level provided the impetus to break down silos.  

4. Can you tell us how DNV GL approaches accreditation and give us a few examples of how you work more collaboratively with hospitals and why this approach is advantageous for the hospital? 

Patrick Horine: We think of our hospitals as partners. This process should be meaningful to the hospital leadership and staff. It is not just about noting a finding, but you want to understand how an organization applies a standard and their process. Doing so enables us to share insight, share ideas on how other organizations meet the requirements, and what they may consider for making improvements. We learn from the hospitals as well that we can improve our process and use to help others. We still hold the hospitals accountable for compliance, we just take a different approach in doing so. This is advantageous because the hospital staff get more from the survey experience. They see the practical application and understanding of the requirements and appreciate this being more than just passing the survey for the certification and about improving for their patients.   

Friday
Jul122019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week: 

‘Cadillac Tax’ on High-Cost Health Plans Could Affect 1 in 5 Employers in 2022

A new KFF analysis estimates that the Affordable Care Act’s tax on high-cost health plans would affect one in five (21%) employers offering health benefits when it takes effect in 2022 unless employers change their health plans.

Kaiser Health News

Friday, July 12, 2019 

Reckitt Benckiser Agrees to Pay $1.4 Billion In Opioid Settlement

British company Reckitt Benckiser has agreed to pay $1.4 billion to resolve all U.S. government investigations and claims in what is the biggest drug industry settlement to date stemming from the nation's deadly opioid epidemic.

NPR

Thursday, July 11, 2019 

As Its Drug Pricing Plans Fall Through, Trump Administration Turns To Congress To Act

The Trump administration has dropped one of the meatiest portions of its plan to reduce drug prices.

NPR

Friday, July 12, 2019 

California Effort to Stop Surprise Hospital Bills Stalls

A California proposal aimed at limiting high medical bills from emergency room visits has stalled for the year.

Associated Press

Thursday, July 11, 2019 

Congress has ambitious agenda tackling health care costs

Lawmakers are trying to set aside their irreconcilable differences over the Obama-era Affordable Care Act and work to reach bipartisan agreement on a more immediate health care issue, lowering costs for people who already have coverage.

Associated Press

Monday, July 8, 2019 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Jun282019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

Scott Gottlieb walks through the revolving door to the Pfizer board

After a two-year stint running the Food and Drug Administration, Scott Gottlieb has joined the board of directors at Pfizer, giving the world’s largest drug maker crucial insights into the inner workings of the Trump administration as it attempts to contain national angst over the rising cost of medicines.

Stat News

Friday, June 28, 2019

Five Things We Found In The FDA’s Hidden Device Database

After two decades of keeping the public in the dark about millions of medical device malfunctions and injuries, the Food and Drug Administration has published the once hidden database online, revealing 5.7 million incidents publicly for the first time.

Kaiser Health News

Thursday, June 27, 2019

Senate health committee may change surprise billing proposals ahead of floor vote

The Senate health committee approved its major healthcare package on Wednesday, but with one change to the proposed ban on surprise medical billing and potentially more to come ahead of a full Senate vote expected later this month.

Modern Healthcare

Thursday, June 27, 2019

In first 2020 debate, Democrats escalate their attacks on pharma and its high prices

Democrats demonized the pharmaceutical industry throughout the first primary debate of the 2020 presidential election, racing to prove their status as the candidate most willing to “take on pharma.”

Stat News

Thursday, June 27, 2019

At AHIP19, a call to 'break glass' to survive fast-changing industry

A panel of top executives, including a major provider, payer and former CMS chief opened America's Health Insurance Plan's annual meeting with some soul searching and a call for the industry to disrupt itself.

Healthcare Dive

Monday, June 24, 2019

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.

Friday
Jun212019

Friday Five: Top 5 healthcare business news items from the MCOL Weekend edition

Every business day, MCOL posts feature stories making news on the business of health care. Here are five we think are particularly important for this week:

 

Surgeons’ Opioid-Prescribing Habits Are Hard To Kick

As opioid addiction and deadly overdoses escalated into an epidemic across the U.S., thousands of surgeons continued to hand out far more pills than needed for postoperative pain relief, according to a KHN-Johns Hopkins analysis of Medicare data.

Kaiser Health News

Friday, June 21, 2019

 

Health Insurance Providers Launch Project Link to Address Social Barriers to Health

Not every health care problem can – or should – be addressed with a prescription pad. That’s why America’s Health Insurance Plans (AHIP) is launching Project Link – a new initiative that brings together the best thinking on how to effectively address social barriers to health and long-term well-being.

AHIP

Thursday, June 20, 2019

 

1 In 6 Insured Hospital Patients Get A Surprise Bill For Out-Of-Network Care

About 1 in 6 Americans were surprised by a medical bill after treatment in a hospital in 2017 despite having insurance, according to a study published Thursday.

Kaiser Health News

Thursday, June 20, 2019

 

Private Medicare Advantage Could Hit 70% Market Share

Enrollment of seniors in private Medicare Advantage plans could reach 70% of those eligible for federal health benefits for the elderly between 2030 and 2040, a new report shows.

Forbes

Tuesday, June 18, 2019

 

Trump says he will roll out new health care plan in next couple of months

President Trump said he'll be rolling out a new health care plan in a couple of months, saying it will be a key focus in his 2020 reelection campaign.

The Hill

Monday, June 17, 2019

 

These and more weekly news items on the business of healthcare are featured in the MCOL Weekend edition, along with the MCOL Tidbits, and more, for MCOL Premium level members.