The healthcare industry is different from any other field, especially when it comes to organizing, aggregating and sharing data. Most hospitals and health systems are located between fax machines and traditional systems and digital innovations. Megan Zakrewsky's background is full of healthcare innovations, especially the transition from paper to digital medical records, and her career has focused on interoperability for nearly 20 years. The challenges of health technology adoption and implementation are nothing new to her. She serves as an adjunct professor at Thomas Jefferson University in Philadelphia, and serves as Vice President of Products at Veradigm, allowing her to balance the service of healthcare technology providers while interacting with a variety of stakeholders in the healthcare ecosystem.
In an interview, Zachrusky talked about Veradigm’s role in reducing the administrative burden on providers by simplifying fragmented approaches and eliminating the “crowded desktop” experience in Electronic Health Records (EHRS). Veradigm works with payers and providers to strengthen and simplify workflows to reduce multiple care gaps.
Zachrusky said she joined Veradigm and had the opportunity to bridge the connection between providers and payers. At the time, from a data adoption perspective, the payer lagged far behind the provider, which presented her with an exciting challenge.
“It feels like the blueprint of work we’ve done in laying these foundations and pathways so that we can really bridge connectivity because payers are already starting to accumulate their ability to consume a lot of clinical data and use it to do something. The converged claims and clinical data provide the payers with meaningful intelligence, especially for paid payments.
Veradigm’s payer insights solution aims to simplify clinical workflow by reducing the time it takes to open third-party applications outside of EHR, improve care gaps, improve care quality and improve patient outcomes.
When asked if there is an 80:20 rule that can be applied to the administrative burden of health technology, Zachrusky acknowledged that 80% of the burden comes from managing a small fraction of the care gap.
“Since it’s hard to reach data, many gaps are created. Interoperability remains a struggle, especially for community providers that don’t necessarily have the technology and resources to connect with all the different places that need to get data,” Zakrewsky said. “If we can use Veradigm to try to do most of the gaps in solutions that are done within our own EHR and other EHR vendors, we can have a real impact in reducing this administrative burden.”
Through an intuitive workflow for clinicians during the care period, health technology companies can help payers and providers reduce their efforts to navigate across different systems.
However, some factors come entirely from the hands of the payer and the provider. When patients miss annual screening, immunizations, and other regular medical appointments, the risk is that their health status will not be detected early, but will worsen and increase the risk of hospitalization and higher medical expenses, thus bearing the health system.
“Payers have a more comprehensive view of patients because they are receiving information from various clinicians from which patients can seek care. In some ways, payers can connect points faster than clinicians,” Zachrusky said. “We are also able to remind healthcare providers of chronic disease data that needs to be recaptured annually and recorded from the perspective of CMS.”
Zakrewsky acknowledges that there is a lot of administrative burden and pressure on the care point, but that its payer insight solutions can provide clinicians with a more comprehensive patient situation. Payers can sometimes infer from health plan member data that may have other conditions that primary care providers are not aware of. With Veradigm, payers can determine a “suspicious condition” based on clinical data and other information in the patient’s medical history – whether the patient is taking or the medication for the surgery that may be used. Payers can view data from financial and clinical settings, and they can view the source of the claim data. They can use these opportunities to stimulate communication with providers and determine whether follow-up care is necessary outside of preventive health care.
“We really want to make sure that when the patient is face-to-face with the provider, there are many open conditions that can be addressed as much as possible because you don’t know when that patient will come back in. We want to make sure that all three stakeholders (payers, providers and patients) (again at the table and can promote better patients),” Zakrewskeky said. “I think it’s exciting now to link the data to reduce disconnection between these different parties.”
Just like not having enough data to create a care gap, having too much data can also cause problems. Multiple payers are trying to generate insights at the care point, with only an increasing number of garbage providers, an increasing number of applications and workflows remembering to spend your day. A survey of 250 U.S. clinicians in the report, “How the EHR workflow affects clinician experience, patient care, and profitability,” found that 91% of respondents said they had six or more external decision support tools on their computers. About 80% of clinicians in the report said they avoided the tools of payer insights provided outside of EHR.
These statistics illustrate the interest in implementing tools that provide clinicians with helpful insights that are also needed to be easily accessible in clinical workflows. Zakrewsky notes that payers need to have some ways to easily pass information and insights to providers who are sharing claims and clinical data with them. Because Veradigm is located between payers and providers, it is uniquely positioned to create solutions that simplify collaboration among these groups.
These two-way features support data trends and flows between payers and providers. Although providers are able to communicate data to payers for quite some time, it is not common for payers to make information to providers outside of prior authorization.
“This is crucial for real collaboration, right?” Zakrewsky said. “Payers need to have some ways to return information and insights to providers that provide claims and clinical data. ”
EHR suppliers can’t be everything for everyone in the healthcare ecosystem. There are always new emerging technologies that enhance the provider’s user experience. For example, artificial intelligence reduces administrative burdens by helping to automate tasks through machine learning and predictive texts to reduce administrative burdens that clinicians face.
“If we can automate the task of helping clinicians capture patient data accurately, that could have a positive impact on patient care,” Zachrusky said.
Trust and transparency are crucial to strong collaboration. Provider's health technology adoption is based on some constants: usefulness, ease of use, ease of fit for workflows, and the ability to transfer data firmly and effectively. But trust is crucial for the relationship between providers, payers and health technology providers. Zakrewsky mentioned the “trust factor”, which is crucial for health technology providers to maintain the highest standards of quality and safety.
Common incentives are also important characteristics of successful cooperation. Zachrusky noted that the industry’s shift from paying fees to value-based, risk-based care, where payers and providers are equally motivated to improve patient care and patient outcomes in meaningful ways. Consistency incentives for better patient outcomes are also important.
“Having mastered all these great techniques, a huge responsibility. We want to make sure we do it right and that the information surfaces and facilitate the cooperation of payer providers is accurate because honestly, once we start to emerge to clinicians, once we start giving clinicians 100% accurate clinicians, if that’s inaccurate, or will be paid immediately, then the amount of paid can be paid within the range of smart care. This is the shift that defines the next chapter of healthcare.
photo: Good Travel, Getty Images
