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Patients with complex cases don’t want multiple provider portals, Rady CIO says

How about some real, original content for a change? Yeah, that’s why you started coming to my blog in the first place, isn’t it? You’re tired of nothing but video embeds from others and short, offbeat attempts at humor.

I recently interviewed Albert Oriol, CIO of Rady Children’s Hospital-San Diego, for a story that will appear elsewhere (read: a paying client) soon, but I had a lot of material I left out of that story. I get to use some of the rest here in a little experiment to see what it does to this site’s traffic.

Obviously, pediatric hospitals aren’t eligible for the Medicare side of meaningful use, which is why the threshold is lower for qualifying for Medicaid bonuses. Pediatricians and children’s hospitals only need to have 20 percent of their visits with Medicaid patients, compared to 3o percent for other providers. Rady meets that standard and already has attested to Stage 1.

Oriol, however, does not like the way the rules are written, calling some of them “well-intentioned mandates with unintended consequences.” For example, providers must offer portals for some of their patients – 10% in Stage 1, rising to 50% in Stage 2. But patients with complex conditions go to multiple providers, each of which may have unique portals. “It’s inconvenient for them to go to many different portals,” he says.

He also is frustrated with having to build reports knowing that many of the items will not apply to pediatric subspecialties. “It’s not the best use of resources,” Oriol says.

The two things at the top of mind for Oriol these days are telemedicine and advanced analytics. Rady is expanding its telemedicine program to support rural areas in Imperial County, a poor, isolated jurisdiction east of San Diego County along the Mexican border. He believes this will provide value and convenience to primary care physicians and patients alike.

On the analytics front, Rady is working on a demonstration project with California Children’s Services (CCS), a managed care program for children in the state’s MediCal system with certain diseases. “We’re going to bring in data from other providers,” Oriol says.

The hospital also is “taking a big step forward” in innovation and discovery by partnering with industry to research technology and the analytics of technology, according to Oriol.

 

April 28, 2013 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.

Anthem’s California plan turns to Google Maps to reduce ER costs

Remember back in February when I cut my face open at the HIMSS conference and needed medical assistance while 1,000 miles from home? I blogged then about how I used Google Maps to find an urgent care clinic close to the convention center instead of riding to a hospital emergency room in an ambulance? I’m guessing that course of action saved me at least $1,500, money that would have come out of my pocket because, as a self-employed individual, I was only able to qualify for an afford an insurance policy with a high deductible.

Though most Americans still aren’t engaged as consumers when they seek healthcare services, there are tens of millions of uninsured people and a smaller number of people like me with high-deductible plans that would face the same conundrum when they have a non-life-threatening condition: go for “traditional” ER care and pay through the nose, or take a few minutes to seek out lower-cost alternatives.

Now, insurers are trying to encourage the same kind of behavior, because they usually are the ones on the hook for high-dollar ambulance transport and emergency care, even if the condition isn’t a true emergency. Last week, Anthem Blue Cross in California announced a new program to encourage members to seek out non-emergency care—walk-in retail clinics and urgent care centers—when their regular physicians are not available.

“When your five-year-old is crying with a fever at 7 p.m. on a Friday because she has a sore throat or an ear ache, what do you do?” Anthem Medical Director Kurt Tamaru, M.D., said in a press release. “It’s important people know that they have options for less serious ailments other than an ER, such as retail health clinics and urgent care centers that provide quality care and cost them significantly less.”

According to Anthem Blue Cross, an ER charges an average of $641 treat strep throat, something that would cost about $70 at an urgent care center and just $27 at a retail health clinic. This does effect patients directly, too, because Anthem requires a $150 co-pay on average for a ER visit, but just $10 to $40 for care delivered at a walk-in clinic or urgent care center.

The technology driving this program? Google Maps and its brethren.

Just go to Google, Yahoo or Bing and type in “Anthem and urgent care,” and you will be directed to an Anthem educational site (or visit the site directly at http://www.anthem.com/ca/eralt). There, you will find a Google map showing ER alternatives within Anthem’s California network.

Members can sign up for educational e-mails explaining the types of conditions that don’t usually require emergency care, and the potential costs savings by seeking an alternative. Anthem also will make automated phone calls to members who recently had a costly ER visit that could have been avoided.

Anthem cited a study that proved the efficacy of such as an approach. Hopefully, the statistics are accurate and Anthem has success with its program. It worked for me because a lot of money was on the line. Likewise, Anthem members now face higher out-of-pocket expenses if they choose the expensive option rather than the right option. And all it takes is a simple, proven piece of technology called Google Maps.

 

July 15, 2011 I Written By

I'm a freelance healthcare journalist, specializing in health IT, mobile health, healthcare quality, hospital/physician practice management and healthcare finance.