Best Practices

By Manolito Jones

In the ever-growing technology associated with hospitals and healthcare, no healthcare organization does it alone. More and more healthcare entities are enlisting the help of third parties to gain efficiencies and reduce their operating costs. Although outsourcing services can provide significant benefits, it can also introduce significant risks if information and data are not properly governed. In healthcare, it is more than money at risk; there is also protected health information (PHI).  

Data breaches involving third parties that result in exposure or loss of PHI are on the rise. In fact, four of the top 10 breaches in the last few years have involved business associates. A recent example is the bill collection service provider, American Medical Collection Agency (AMCA). The breach potentially exposed the data of 20 million patients of Quest Diagnostics Inc., Laboratory Corporation of America Holdings, and OPKO Health, Inc.   

The AMCA breach highlights the importance of third-party risk management when sharing patient information with external parties. It also reinforces the importance of risk management and due diligence. While outsourcing can provide many benefits, it can also make an organization more vulnerable if a third party isn’t taking the appropriate steps to protect PHI. 

[Read more…] about Why Healthcare Organizations Should Make Third-Party Risk Management A Priority

By Evan Osborne, MPH, RT(T)

Communities are facing a crisis in healthcare. Patients are choosing to feed their families over purchasing essential prescriptions for chronic diseases. Due to a lack of transportation, vulnerable and underprivileged demographics are purchasing cheap, unhealthy non-perishables at convenience stores rather than health-conscious options at grocers just a few miles away. Non-English-speaking patients are being discharged from hospitals only to return because they did not understand the post-discharge instructions. These are just a few challenges faced daily in communities suffering from low health equity.

In 2014, evidence-based research ranked the U.S. as last overall in comparison to 11 industrialized nations measured in quality, efficiency, access to care, equity and healthy living (Mahon, 2014). In September 2015, the Centers for Medicare and Medicaid (CMS) Office of Minority Health released their equity plan for improving quality in Medicare. The mission of this plan strategized the benefits of advancing health equity by improving quality of care within minority and other underserved Medicare beneficiaries (CMS.gov, 2015). This proposal was catalyzed by the Affordable Care Act, Healthy People 2020 and other leading federal agencies driving nationwide health initiatives. Furthermore, Medicare spending grew 4.2% to $705.9 billion in 2018 (CMS.gov, 2019). This historical data coincides with other trends highlighting the use of excess funds and care being directed towards disparities within specific populations and demographics. Influenced by modern healthcare’s transition from fee-for-service to value-based purchasing reimbursement models, the risk in caring for populations suffering from health disparities has grown exponentially. 

[Read more…] about Addressing Health Equity & The Risk In Providing Care

By Tony Cowan

Regardless of a patient’s insurance provider or deductible, the most expensive way to begin a medical treatment is by starting it in the emergency room. Tragically, the number of people who are using emergency rooms as their primary care provider is growing as nearly half of all U.S. medical care is delivered by emergency departments, according to a study by researchers at the University of Maryland School of Medicine. 

This is leading to complications, including crippling volumes in emergency rooms, extraordinarily high Medicare fines for readmittance, and challenges for independent practices protecting their parts in the community’s health care infrastructure. 

A critical step in decreasing the need for people to turn to emergency rooms is the use of mobile medical units, which can help hospitals and physician groups reduce costs and increase patient volume while still providing a superior level of service to the patient.

[Read more…] about Mobile Clinics Prevent ER Visits and Promote Equivalency of Care

By Brian Parks

Data breaches are on the minds of every C-suite executive in healthcare. Third parties (i.e., vendors) with access to organizations’ protected health information (PHI) and/or personally identifiable information (PII) represent a significant risk for data breaches to the organization.

The Information Systems Audit and Control Association (ISACA) defines TPRM as “The process of analyzing and controlling risks presented to your company, your data, your operations and your finances by parties OTHER than your own company.” 

Data breaches in healthcare organizations continues to make the front page and the struggles of organizations to get a handle on their third-party risk are well documented. A study conducted by the Ponemon Institute notes, “Despite the number of publicized data breaches throughout the U.S., there continues to be a significant lack of confidence and understanding within companies as to whether their security posture is sufficient to respond to a data breach or cyberattack … Companies also need to do more than depend on business associate agreements to ensure that consumer information is being protected. Business should perform audits and assessments with vendors.”

Most organizations are aware of the information security risk posed by third parties. They also admit their current vetting process is ineffective or non-existent. 

[Read more…] about Take Control of Your Third-Party Risk

By Michael Corbett, AVP

The priority to succeed in value-based programs is not new but with continued advancements in approaches, moving the needle year over year, is becoming increasingly difficult.  Continually moving the needle in the management and prevention of readmissions, it one of these examples. In order for health systems to sustain their performance and be seen as a top-tier system, a systematic, structured approach much be in place.  An outline of key approaches to succeed in this area is below:

[Read more…] about What are the best ways to predict and prevent readmissions in value-based programs?