Why Updating Healthcare Technology is Integral for the Future

By Faride Beaubien,

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In a previous post Healthcare Transactions: Simple?... Not yet, we talked about how healthcare technology and the process of transferring information needs to be updated. We will discuss how updating this technology in the benefit administration industry can help fix this problem, change the industry, and empower the consumer.

Imagine if a patient (not a benefits administrator) were able to make changes to his or her health insurance policy more than once a year or when a ‘life event’ takes place? Currently, this is not possible. Why not? Read on...

Health insurance data has to go through multiple company systems to make even the most minor changes. Further, there are a lot of cooks in the kitchen! Let’s use PokitDok as an example. We currently offer Aetna to our employees and Zenefits serves as our benefit administrator. For us to add a new employee to our small group (less than 50 employees), we would make the request to Zenefits via their web portal. Simple? Not so fast. The new employee request must be routed from the Zenefits platform to BenefitFocus (a benefit administration platform contracted by Aetna) and then, ultimately transferred to Aetna.

Current Example:

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Why does it work this way? Because many carriers still accept faxing, scanning or emailing as the only way to transmit health insurance documents. They are built on legacy systems and processes that desperately need an organizational and technological makeover. Though many carriers are switching to electronic data interchange (EDI) transmissions or machine to machine submissions, there will still be some left behind. Aetna, for instance, does not accept direct EDI enrollment files for small groups, perhaps because it is difficult for small groups to securely transmit their data in such a required format securely. To offer a workaround solution, Zenefits has two options to submit small group benefit changes to Aetna: changes can be submitted via the Aetna web portal manually or submitted via a slightly more automated access through BenefitFocus. It can take weeks before the submitter of the health insurance receives confirmation. These manual methods of transmitting information are time consuming and have a high probability of errors due to manual input.

Where the industry is going:

A federal mandate for benefits enrollment scheduled to be in effect by January 2016 states that the ACA …establishes new requirements for administrative transactions that will improve the utility of the existing HIPAA transactions and reduce administrative costs.” Companies such as BenefitFocus, GroupHub, Zipari and FormFire are paving the way to help manage this data, improve benefit administration and streamline the file transfer process to ultimately:

  • Cutting out third party administrators
  • Eliminate paper and fax submissions
  • Reduce administration costs
  • Enable the consumer to manage their own information electronically

Where PokitDok comes in:

PokitDok’s X12 APIs follow the standard ASC X12 format, allowing businesses of any size access to essential health transactions, such as the 834 Benefit Enrollment and Maintenance file. PokitDok manages carrier connectivity, file validation, encryption and transmission in a secure and HIPAA compliant way. In addition, we have automated the file transfer process so files can be tracked along the way and we’re able to notify submitters when as soon as a response from the carrier is available. We also allow companies to connect and transmit benefit enrollment files to health insurance carriers without having to manually integrate with every carrier out there. That way benefit administrators can focus more on managing the benefits of their members and not the many business rules that are currently hampering the process.

It may be a slow move but with the federal mandate and consumer push towards healthcare price transparency and access, members will ultimately be able to win. 2016 will be a great year for healthcare technology companies as carriers prepare and continue to revamp their processes ultimately making updating your benefits a much smoother, easier process.

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Enterprise, Provider

How Telehealth is Revolutionizing Child Care and Helping Parents

By PokitDok Team,

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Few areas of healthcare are poised to be more impacted by telehealth technology than pediatric care.

Consider the numbers: The population of children in the United States will hover around 74 million through 2020, according to government projections. Most of those children rely on someone to help them when they get sick — to drive them to a doctor's office, to fill a prescription, or simply to stay home with them. A sick day doesn't just mean a day away from school; for many parents, that's a missed day of work.

Being able to access quality healthcare remotely can save parents a lot of time — and money, whether that's by getting immediate treatment for an ear infection, or making regular visits to a specialist. Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Consumer, Enterprise

EMRs, EHRs & PHRs: What They Are & What to Know

By Nicole Fletcher,

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From CCDs and EMPIs, to MOOP and HDHPs, acronyms are tossed around constantly in healthcare. Some are specific to certain systems, while others are used interchangeably, sometimes meaning the same thing - and sometimes... not. At PokitDok, as we continue to offer interoperability solutions to hospital systems nationwide, we have come across a few of those acronyms - and thought we’d share the subtle, though notable, differences between three popular ones: EMR, EHR and PHR - along with how we fit into the equation.

EMR - Electronic Medical Records

Definition and Use

EMRs are digital versions of the paper charts in doctor’s offices, clinics, and hospitals. They house information collected by and for clinicians in that office, clinic or hospital and are primarily used for diagnostic purposes. The transition from paper health records to EMRs was part of the Affordable Care Act and is governmentally mandated to be complete by the end of 2015. EMRs are a vital step in the evolution of healthcare technology because they allow providers to track health data over time, identify patients for preventive visits and screenings, monitor them, and ultimately improve the quality of their health. Patients generally do not have access to the data that exists in EMRs (nor EHRs - to follow).

Issues

EMRs, though an important step in the future of health, are often disconnected from other health systems, past and present. Say for example, an adult patient’s childhood immunization records have been translated into EMRs. While electronic, they are not connected to that person’s present health records and, in most cases, there is no efficient way to get them there.

EHR - Electronic Health Records

Definition and Use

EHRs are built to go beyond the standard health data collected in a provider’s office, meaning that their goal is to offer a larger, all-encompassing view of a patient’s care history. EHRs include a lot of patient information from various doctors and clinicians and, to that point, these authorities can access that information to care for their patients. EHRs also share information with other healthcare providers, including specialists and labs. They were designed to follow patients – from their past, into their present and through their future. Leading EHR companies include names like EPIC, AllScripts, Dr. Chrono, and Greenway. EMR and EHR, as acronyms, are often used interchangeably but really, EHRs tend to encompass the information in EMRs, plus additional patient information.

Issues

EHRs house millions of electronic health records to offer a more inclusive view of patient health. They have issues though with their ability to technologically communicate with one another, meaning that, although their goal is to achieve a more complete view of a patient’s health, their technology does not support the connections required to do so. For example, if a patient has records stored in one hospital’s EHR, that system cannot easily send that data to another hospital on another system. To top it off, some hospitals use more than one EHR internally. The ability for multiple systems to communicate is called interoperability - this is what’s lacking in healthcare today.

PHR - Personal Health Records

Definition and Use

PHRs generally contain the same types of information as EHRs; anything from diagnoses and medications, to immunization records and family medical histories. The main difference though, is that they are intended to be set up, accessed, and managed by patients. Patients can use PHRs to manage their health information in a secure, private environment and give their providers access to it, rather than the other way around. They are a major power-in-the-hands-of-the-patient step toward healthcare consumerism.  

Issues

Similar to issues associated with EHRs, systems wide communication is a key element in allowing PHRs to function as intended. Further, price and process transparency is a vital piece of the puzzle in order for patients to truly ‘own’ their health. We aren’t there yet but if Dr. Eric Topol, author of the Patient Will See You Now, has anything to say about it, we have to get there soon.

What We’re Doing

The lack of communication and connectivity among disparate health systems is the inspiration for our work toward achieving interoperability in healthcare. EHRs today have solved countless problems for healthcare but their limitations and what they mean for patients can surely be improved. Two of our APIs specifically speak to this issue: Identity Management and Scheduling. The Identity Management piece helps EHRs manage patient identities within and across their systems. It cleanses duplicate data (of which there is a lot) and helps hospitals with EHRs - and eventually people with their PHRs - keep track of their health data past and present. Scheduling allows for multiple EHRs to connect so that, for example, doctors working in hospitals using more than one system, can be scheduled accurately, in real-time through a single interface.

Take a look at the links above for more information about our Interoperability Solutions and feel free to Contact Us with any questions.

 

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise, Provider

Exciting News from PokitDok!

By Lisa Maki,

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At PokitDok, our mission is clear: we want to make access to healthcare easy, informative, transparent and affordable for our customers, partners and ultimately, for you. To that end, we have been working diligently to improve healthcare interoperability via our API platform. Today, we’re honored to announce our Series B Funding, which will propel us on our journey towards realizing this mission.

PokitDok was born a little over four years ago, after I spent six frustrating months navigating the road to treatment for a spinal injury. From poor communication and inefficient processes, to interoperability issues and a complete lack of price transparency, I knew there had to be a better way.

Since then, along with my co-founder, Ted Tanner Jr., our amazingly talented team has built connections between fragmented healthcare operating systems, where they never existed before. We have established direct relationships with more than 300 insurance carriers, the top EHRs nationwide, hospital systems, benefits enrollment companies, and have made these available to scale and speed time to market for the apps and services created by countless developers - all looking to change the face of healthcare.

This round of funding, led by Lemhi Ventures, is the first step in the next phase of our adventure. Our investors and entire team passionately believe in disruptive innovation, and in powering an integrated health experience via common cloud-based web services enjoyed by every other industry. By removing legacy data silos, fluid data delivery in health becomes possible. This inspires more efficient processes, cost savings, and improved quality of care.

Thank you so much to everyone who has supported us along the way. It’s an honor to work with a team of absolute rockstars and we look forward to changing the future of health, one API call at a time.

Share the health,

Lisa Maki

CEO of PokitDok

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Enterprise

The Benefits & Challenges of Using Telehealth Solutions On Vacation

By PokitDok Team,

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When medical attention is called for and patients are away from home, it's not always easy to know where to go or who to call. A local Urgent Care center? An unfamiliar family practice that accepts walk-ins? Do you google it? Look in the white pages? In fact, telehealth solutions are an excellent, new resource that travelers and stay-at-homers alike can use to save time, money and hassle.

While the evidence at this point is largely anecdotal, telehealth technologies are emerging as convenient and effective solutions for sick travelers. Easy access to medical care anywhere, even while traveling, emerges as a key benefit to Telehealth.

"By accessing a doctor directly from your computer, you can get diagnosed and have your prescription sent to your local pharmacy," telehealth startup eVisit writes. "You could either go and pick it up from there in person, or you could ask a friend or a neighbor to stop by and pick it up for you. This method is not only a time saver, but also a way of getting medical attention whenever needed, even if it's 3 AM and you are on vacation in a remote area." Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Consumer, Enterprise

How to Hire & Scale a Team of Tech Superheroes

By Natalie Cann,

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PokitDok is embarking on a new inflection point in growth, and we’re hiring a team of talented newcomers to help us “crush it” through this next phase. As we like to say, we’re where Southern Charm and Valley Brilliance meet to make PokitDomination babies - do you think you have what it takes? Here are some cliff notes on our approach to hiring and what we look for in a candidate:

 

The Network Effect

Average tenure at any one position in Silicon Valley last I checked is between 18-24 months. According to the Chief Economist of the CEA, graduates today are predicted to have 10 different jobs by the time they are 40 (I’ve already surpassed that and I’m only 38). What does that mean? From my experience, it means you never know when you’ll run into someone from your past, especially in the startup world. I’m at PokitDok today because of a work friendship I maintained from 15 years ago. Over the years, I’ve even seen people go to work for someone that had previously worked for them 10 years earlier. YOU NEVER KNOW. We believe tapping into networks for hiring is critical, and what goes around eventually comes around.

  Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev

Introducing The PokitDok Eligibility App

By Nicole Fletcher,

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PokitDok’s X12 API gives developers direct access to patient eligibility via our connection to more than 300 insurance companies. To demonstrate the power of these connections, we created a clean, user-friendly application that checks eligibility with patient information, in real-time. By solving eligibility associated issues for provider groups with limited access to developers, this product can achieve exponential cost and labor savings and make the jobs of those responsible for eligibility easier. We are excited to offer the PokitDok Eligibility App as the first of a number of health insurance connectivity applications to come.

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PokitDok's Eligibility App connects users with all major insurance carriers (who are responsible for more than 80% of covered lives across the U.S.) through one simple online interface. There is no longer the need for front office staff to visit multiple carrier websites or call individual insurance carriers to verify eligibility, which can take up to 30 minutes for each patient. The PokitDok Eligibility App streamlines patient intake and reduces office overhead. Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Dev, Enterprise

High Deductible Health Plans: What do they mean and what will the future hold?

By Nicole Fletcher,

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Year-of-the-high-deductible-health-plan

The recent Supreme Court decision in favor of high deductible health plans will, according to David Goldhill and Paul Howard of the Wall Street Journal, "help put market forces back into medicine."

Twenty two million Americans were projected to enroll in high deductible health plans (HDHPs) by 2025, according to the CDC. Recent numbers show that to date, there are more than 37 million people enrolled in such plans ten years earlier than projected. High deductible health plans are on the rise (as discussed in a recent post), and much sooner than everyone thought.

How then will American healthcare consumerism change in the months and years to come? Typically, in HDHPs, patients pay out-of-pocket for nearly every medical service. Since mom and pop insurace companies are no longer footing the bill, patients, aka consumers, will - and are -  demanding change. Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Enterprise

High Deductible Health Plans: Are They Right For You?

By Nicole Fletcher,

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medical cost

By now, most people have at least heard of high deductible health plans (HDHPs), especially if they have one. A major gap though, exists between understanding what these plans are, what they mean, and who should have them. When it comes to personal health, it’s important to be aware of the opportunities and limitations of these health plans to ensure realistic expectations.

In this post, we will share some context and explore the history of high deductible health plans, why they came to be, and what patients should be aware of when using them. Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Enterprise

PokitDok Marketplace Launches New Features

By Nicole Fletcher,

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We’re excited to announce that new features have been added to the PokitDok Marketplace!

With an increasing focus on improving consumer experience in healthcare, the PokitDok Marketplace is an excellent, working resource to see how our APIs can be implemented easily and quickly for any health application or system. Continue reading…

The opinions expressed in this blog are of the authors and not of PokitDok's. The posts on this blog are for information only, and are not intended to substitute for a doctor-patient or other healthcare professional-patient relationship nor do they constitute medical or healthcare advice.
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  Tags: Consumer, Dev, Enterprise, Provider