FinDEVr NYC 2016 - Why Are You Here, Exactly?

By John Riney,

FinDEVr NYC 2016

When we're out at conferences, it seems like PokitDok always has some explaining to do. What do you do? How are you different? What's an API? How do you make money? How do you pronounce your company name?

For the record, it sounds like "pocket dock".

Even so, if you go to enough healthcare conferences, you tend to hear the same questions. So going to FinDEVr in NYC, a financial technology show, was particularly interesting. What does a little old health company have to do with finance? It's a good question. Might even be interesting to answer here, so here goes.

The world of finance has always cared about health. Giant hospital buildings full of modern equipment don't pay for themselves. But the story is getting more complex. In 2014 (the last year for which I could get numbers), hospital systems had to write off $42.8 billion in lost revenue, either from bad debt or charity care1. That's almost real money we're talking about, there.

The consumer side is just as gruesome. Health expenditures are now the number one cause of personal bankruptcy in the United States2.

Sometimes it's not good to be #1.

So with the situation becoming increasingly dire on the provider and on the consumer sides, the finance industry is taking a hard look at how to stop the bleeding. And it turns out that PokitDok is in a fairly unique position to help. We process tons of healthcare transactions via our APIs, and we can look at them holistically, instead of as a disparate collection of unrelated verticals. We put everything into a graph model, and have alarmingly smart data scientists that can analyze that graph to create data products and analysis that you couldn't extract from a mass of unrelated relational tables. What's really neat is that these data products have applications outside of the traditional health space. For example - and here's the point - finance.

One way financial institutions are trying to stem the tide of bad debt is by offering health-specific lending options. In the same way that your local bank or credit union encourages you to check with them first for financing options for buying a new car, they're looking at doing the same for major medical procedures. But what they've found is that people often manage their financial and medical lives very differently. You might be bad at paying your credit card bills on time, but if your doctor prescribes a medication or a follow-up visit, you're on top of it. And when they're trying to decide whether to extend credit for a medical procedure, a purely financially-based credit score often doesn't tell the whole story. That's where PokitDok's Health Credit Outcome (HCO) comes in. HCO is a rating product which, with the customer's permission, creates a measure of a person's propensity to pay, informed with data from their health history. This allows financial institutions to have, essentially, an entirely new axis of rating and qualification when deciding to extend credit for medical procedures.

There's more information about HCO on PokitDok.com. We're doing pilots with a few un-nameable but gigantic financial institutions, and shaping exactly what the product looks like. Obviously, there are a whole stream of interesting operational, regulatory, and ethical questions that have to be considered when moving data, even a computed score devoid of personal identification, from a medical to a financial context.

At the very least, it gives me an interesting answer to the question of "Why are you here, exactly?"

References:
1. "American Hospital Association Uncompensated Hospital Care Cost Fact Sheet, 2016 Update", http://www.aha.org/content/16/uncompensatedcarefactsheet.pdf

2. "NerdWallet Health Finds Medical Bankruptcy Accounts for Majority of Personal Bankruptcies", https://www.nerdwallet.com/blog/health/medical-bankruptcy/

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 Public Perspective on Healthcare: Innovation and Empowering Patients to be Healthcare Consumers

By PokitDok Team,

For those of us building the infrastructure required to power a consumer driven healthcare experience, it’s easy to get caught up in our own enthusiasm. But what about everyone else? How we talk about these patients or ‘consumers’ and their health will directly affect the future of this adoption, so it’s important to get a feel for how those conversations are already playing out.

Considering that notion, we thought we’d take to the media re: how Americans feel about technologies like telehealth, health IT innovations, and personal health records (PHRs) to name a few. The following outlines a snapshot of what we found.

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

How Most Patients Find a Doctor — And How That’s Changing

By PokitDok Team,

Lead

The inspiration for this post came from a pretty straightforward question: How does the average American find a doctor? That question has more layers than you might think. If you move to a new city for work, how do you choose a primary physician? If you need to have a specific procedure done, how do you find a surgeon you can trust? How do you assess the care provision of the local doctors available to you?

When we began to dig through the research, two things jumped out immediately:

  • There are far more articles by doctors teaching patients how to find a physician than there is available research on how real-life patients behave.
  • There is a noticeable generation gap in the way patients shop for doctors.

Here is a snapshot of how patients are shopping for healthcare professionals in 2016, and how we can expect that to continue to change in the months and years to come.

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, Provider

HiMSS 2016: A PokitRecap

By PokitDok Team,

From PokitColored lights, technical deep dives, and a shiny new booth, to several hundred amazing conversations, countless demos, and of course, squirrels with lasers* (a real-time representation of the PokitDok API calls taking place nationwide), HiMSS 2016 was a total success for the PokitDok Team.

left_alone_in_the_booth_hop_i_don_t_screw_it_up..._1024

We proudly showcased a number of demos including: real-time eligibility, cross-EMR scheduling, and our private label marketplace, which incorporates the functionality of any number of our APIs to power a branded, end to end, consumer-driven healthcare e-commerce experience.

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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Donut Hole : Medicare Drug Coverage Explained

By Mallory Nelson,

Although donut holes have been enjoyed by people for centuries, when it comes to donut holes in Medicare, a glazed ball of doughy goodness is not what comes to mind.

You can think of Medicare prescription drug coverage kind of like a donut. On either side of the hole, coverage is pretty good. But once you hit the middle, there’s nothing but empty space to enjoy. The donut hole is officially called the coverage gap. In the gap, there is a temporary limit on what the drug plan will cover for a member’s medication. Most members will never reach the donut hole, but for others that are headed straight there, some strategic planning can help them avoid the added costs associated with reduced drug coverage.

The coverage gap starts when the total drug cost has reached a certain limit for the year, around $3,310 for 2016. The total drug cost is defined as a combination of what the plan has paid in addition to what the member has paid out of pocket. This is an important distinction. Most members only see or care about their out of pocket cost (copay or coinsurance) for the medication. If, for example, a member pays $35/month for an expensive brand name drug, the actual cost of the medication might be in the thousands. Boom, that member hits the donut hole. He or she may not realize that there is an equally effective - and less expensive medication. By checking the member’s formulary and having a discussion with a pharmacist or doctor, a member can find out if such drug exists.

So, what happens if a member falls into the donut hole? In the past, this meant the member would have to pay the full cost of their drugs. This is no longer the case, but it’s still very expensive to be stuck in the hole. Instead of paying a reasonable copay, the plan switches to a discount model, meaning the member pays the entire cost of the drug minus discounts from the manufacturer / government. For brand-name drugs on the member’s formulary, the manufacturer plus the federal government covers 55% of the drug cost. This leaves the member to pay  45% of the remainder. Similarly, for generics, the government pays 42% and the member pays 58%.

Help, I’m stuck in the donut hole.. how do I get out?

The coverage gap ends when the member has paid $4,850 out of pocket for medication since the beginning of the year. Once you get out of the emptiness at the center of the donut, you finally reach the glazed goodness again. Things are even better on the other side of the donut. Although you never want to see this side, once you're there, you sure can enjoy it. This side of the glazed plain is called catastrophic coverage. Here, the member either pays $2.95 for generics and $7.40 for covered brand name drugs OR 5% coinsurance, whichever is greater.

The main point of the donut hole story, is- don’t fall in. Make sure you keep track of the total cost of your medications and find out if there are less expensive or preferred alternatives. Just because a medication is more expensive, doesn’t mean it’s better. Ask your pharmacist if there is a comparable option to your existing prescription and check your formulary to make sure you’re on a preferred drug.

Enjoy the donut, not the hole!

donut4fixed

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

How to Get the Most out of your Health Insurance Benefits in 2016

By PokitDok Team,

Controversial as the Affordable Care Act has been, it has helped turn millions of Americans into smart healthcare shoppers. Nearly 90% of Americans have health insurance, according to the U.S. Census Bureau, with high-deductible plans being the fastest-growing category of coverage. That means a significant part of the country is looking to maximize the benefits of their coverage.

Here are six ways to make health insurance benefits go further in 2016 — and a few ways we can help healthcare companies offer these experiences to the consumers with whom they engage.

 

Use Insurance Provider Intel and Bargaining Power

Healthcare providers charge different rates, depending on the insurance company and plan, according to Consumer Reports. Sometimes, the difference in price can be dramatic - hundreds or even thousands of dollars. If a patient hasn’t met his or her deductible for the year, the recommendation is to shop around, which is a pretty new concept for many. Considering this, consumers should have direct access to their eligibility and the proper tools to best take advantage of their benefits. While many patients, as of now, have no option but to call their insurance companies directly, what if they could immediately access this information as easily as say, searching for a flight on PriceLine? With PokitDok’s free of charge X12 APIs, specifically our eligibility endpoint, businesses can offer their consumers direct access to their eligibility information in a clean, easy to understand way. Try it out by signing up for our Platform or check out a past post for more on X12.

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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McKesson Ventures Makes Strategic Investment in PokitDok

By Lisa Maki,

Today, I’m proud to share that McKesson Ventures has made a strategic investment in PokitDok. As the venture capital arm of McKesson Corporation, currently ranked 11th on the Fortune 500, McKesson Ventures operates independently of McKesson Corporation and has a team dedicated to helping facilitate accelerated growth in strategically relevant healthcare businesses like ours. They join our strong group of investors who recognize the fundamental shift taking place in the $3T US healthcare industry, which, as I recently pointed out, is going global.

Last month, the NVCA reported that Corporate Venture investment in the entrepreneur ecosystem hit a 15-year high in 2015. Traditionally, these investors are focused on near–term, tactical investments that are tightly interfaced with their traditional business development efforts.  However, a subset of these investors – including McKesson Ventures – are thinking longer–term, looking at emerging markets and companies that will shift the landscape around their company and their customers.  These types of relationships can better prepare companies for the disruptions brewing around the corner, and even help them get ahead of the trend by introducing new technologies to their enterprise customer engagements to gain competitive advantage. Our new relationship with McKesson Ventures will encourage productive innovation around certain critical issues in healthcare, including interoperability and technology changes to the underlying system that legislation continues to drive.

Tom Rodgers, Senior Vice President and Managing Director at McKesson Ventures will join as a board observer. Here’s what he had to say about the recent investment:

“McKesson is an established provider of enterprise-level healthcare data solutions, and our technology is the backbone to many of the critical healthcare transactions taking place every day. PokitDok connects robust data streams like ours through an open platform for software engineers, health systems and their partners to build new and nimble products for patients and providers, giving them the consumer-centric offerings that today’s consumers demand. Easy-to-use tools such as price transparency, scheduling, and one-click payments are just the beginning of what’s possible with PokitDok’s underlying technology.”

PokitDok streamlines the business of health, by providing a development platform of Application Programming Interfaces (APIs) to process eligibility checks, claims, scheduling, payments, identity management and other business transactions. Our transaction volume is triple what it was last month and we expect it to grow exponentially in the months to come.

One of McKesson’s core customer segments is hospitals and health systems. As an example of how PokitDok can help serve that market, picture a large hospital system that operates a spectrum of departments and services. Our APIs could help that hospital run its non-acute lines of business, such as imaging and urgent care, on business models aimed at the increasingly engaged consumer – to attract patients, on boarding with eligibility and other benefit information and driving greater asset utilization through flexible scheduling and payments. Imagine giving patients the ability to shop, schedule and pay for an MRI, or other such service, online. Early adopters already have this underway. Our technology can be easily integrated with back office systems to improve efficiency, margins and ultimately, drive the cost curve down. PokitDok can give health systems the ability to build new patient-centered experiences like this - and beyond.

McKesson Ventures and our entire team believe wholly in powering an easily navigable, effective and efficient healthcare industry. It is a privilege to take this next step with them.

Share the health,

Lisa Maki

 

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

Three Big Ideas Shaping the Future of Health Informatics

By PokitDok Team,

Lead Image

Long relegated to the back office, health informatics has assumed a new role at the forefront of American healthcare. Hallelujah. Data, record-sharing and having systems that can actually talk to one another, #interoperability, are the keys to unlocking healthcare data and redefining the future of healthcare.

Dr. William Hersh, a professor of health informatics at the Oregon Health & Science University noted last year on his blog, The Informatics Professor, about how this shift seemed obvious to him and others in the field. He also made a point to say, not surprisingly, that much of the industry is still playing catchup. "Informatics is in the mainstream of healthcare now, and healthcare recognizes that using data and information to improve processes and outcomes while reducing costs is an essential part of doing business," he said. "Clearly there is room for improvement in how operational informatics is being done, but there is no turning back. This means that the priorities for our field are now driven largely by forces external to it. This is not necessarily a bad thing, as we must adapt to play our role optimally for the greater benefit to healthcare."

We couldn't agree more, Dr. Hersh — and our data science team indeed dreams about such validating sentiments. In the spirit of health informatics and data science, we thought we'd take you through a few external forces driving the field and offer a few techie deeper dives brought to your straight from our dev blog, Full Metal Health. We will explore:

  • The still-unmet need for health systems to work together and to share records seamlessly
  • Emerging applications for health records themselves
  • Patient empowerment through consumer-grade technology (and occasionally homemade tech)

Here is a look into how those forces are shaping the future of informatics.

 

Transparency & Interoperability

Billions of taxpayer dollars have been spent to ensure the digitalization of health records. Issues arise, however, in the movement of said records from and across multiple systems. What happens in turn is that most EHRs or PMS in use today function as walled gardens, from which those records cannot escape or move. Our platform is built to ensure interoperability across all of those systems, thereby freeing the data for transfer, free use and analysis. We did a little digging to see what other people thought:

Patrick Caldwell reported in MotherJones why the vendors of these systems have such an incentive to keep health records within their proprietary silos. These walled gardens are a great way to lock healthcare providers into expensive data ecosystems. This lack of interoperability also causes problems for patients, who cannot easily send their health records from their primary care doctor to their local hospital in an emergency. Why, you ask? It's simple: Because the technologies don't speak the same languages.

"Working in data silos will not improve the exchange of health data; rather, it will create friction in the industry," said Jitin Asnaani, Executive Director of CommonWell Health Alliance, in the Electronic Health Reporter. "Patients expect their doctors to have the information they need to provide them with the best treatment. Doctors struggle to access this important data outside their four walls. The industry has an opportunity to step up and make it possible for providers to access a three-dimensional view of the patient's health history, and in turn, create a new wave of opportunities for the health IT industry."

Infosys EVP of Healthcare, Insurance and Life Sciences Dr. Manish Tandon argues in Healthcare IT News that overcoming this hurdle would be nothing short of revolutionary. He paints a picture of a connected care system in which a diabetic patient showing hypoglycemic symptoms could count on paramedics to respond within minutes thanks to a biometric wearable that communicates with the paramedics' own system.

That reality, however, is still some way off. Tandon writes: "While it is important to adopt the right technology, it is equally essential to build an ecosystem that can enable a connection among all these elements. With a strong infrastructure, this Connected Care approach will take root and have the foundation on which physicians, pharmaceutical and medical companies and payers can connect and leverage the data the devices generate and collect."

Lights

 

New Approaches to Health Data

Patients are discovering quickly that having their health records siloed and accessible only to select providers limits their healthcare options. This is precisely why we have built our API platform. APIs facilitate interoperability through technologies most people are already familiar with, which makes record sharing both user-friendly and relatively easy to secure. Elsewhere, health informatics professionals are re-imagining how they work with patients' health records.

Consider the personal health record (PHR), which patients have access to, unlike the EHR, which only providers can access. Letting patients be the stewards of their own health records could open the doors to many more consumer-friendly models of healthcare delivery.

One example is local SF startup Gliimpse, which has a built platform allowing anyone (in the US for now) to "collect, personalize and share a picture of their health data." A patient then would not need to rely on third parties — and the regulations to which they're subject — to store and share their data. Another interesting application features HydroAssist, an app that allows patients with hydrocephalus — a cerebrospinal fluid condition — to record, track and share their treatment histories.

These among countless other healthcare informatics companies are working to build interoperability into the entire healthcare system — several of which made our list of innovative healthcare startups to watch this year.

SUP

 

The Empowered Patient

So far, we've only touched on what may be the biggest factor shaping the future of health informatics: That technology is now sophisticated enough to allow patients to play a greater and more proactive role in their health.

Just this past fall, the team at Open mHealth released their newest open-source app, Shimmer, which weaves things such as nutrition and fitness data into a person's health record. By integrating with consumer devices and services already tracking this information — Fitbit, Jawbone UP, FatSecret, RunKeeper, among others — Shimmer is able to connect all of that data for free. Open mHealth understand the same thing we do: consumers won't wait for a plodding industry to catch up to their demands, and the companies poised to succeed today understand we — ahem, they — need data healthcare informatics to meet these fervent, albeit reasonable, consumer demands.

In fact, a recent example proves such a statement. British citizen hacker Tim Omer, a diabetic frustrated by the expensive glucose monitors on the market, took matters into his own hands and built his own. He has since partnered with a charity, Great Britain Online Diabetes Community, to share his device nationwide — well played, Tim.

As in nearly every other industry, power in healthcare has shifted to the hands of the consumer. This, and only this, is the way of the future, writes healthcare business advisor and PokitPal Lisa Suennen. "Those companies who will end the game with the biggest prizes will be those that have embraced the idea of engaging with patients in product conceptualization, clinical trial design and, especially, through creating a continuous feedback loop with consumers/patients through monitoring, personalization and responsiveness to patient-reported outcomes," she said, and we couldn't agree more.

She went onto note, "The ones sitting on piles of gold at the end of this race will be those who have risen to the leadership challenge of partnering with their customers in a deep and meaningful way" — and we plan to do just that.

images by:
Ian Schneider, Jimmy Mutso, Guillaume de Germain

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

How Telehealth Can Help Fix America’s Mental Health System

By PokitDok Team,

Road

Many people with mental illness in America struggle, and have struggled, to get the care they need for any number of reasons. Through the last decade though, telehealth has proven its potential to help by providing affordable, convenient, and private care all through video chat. There is, of course, a long way to go before therapists are able to consult with and deliver care anywhere to anyone, but growth in the future of this rapidly growing field looks bright, to say the least.

Here is a snapshot of a few obstacles facing the mental health industry and how telehealth is poised to reach millions in the years to come. 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, Provider

20 of America’s Best Healthcare Informatics Researchers, Professors and Minds

By PokitDok Team,

Lead Image

 
Health informatics, a fast-growing field which focuses on using information technology to improve healthcare delivery, has countless professional opportunities for the future. From data scientists and out of the box thinking software engineers, to informatics researchers and professors, the future of the wide world of health is an exciting new land of opportunity.

The Affordable Care Act requires that healthcare providers digitize health records by the end of last year and has subsequently, created a tremendous demand for people, with the proper skillsets, to help hospitals, clinics, and practices manage their medical data. "This field is exploding," Charles Friedman, the director of the health informatics program at the University of Michigan, noted in the U.S. News & World Report. "Access to health information on the web is taking off at a meteoric pace. It's creating enormous employment opportunities." Well said, Charles. We agree.
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