International Data Group, Inc.

None In a recent webinar, Kendra Obrist, a Senior Consultant with Point of Care Partners (POCP), shared a framework she uses to categorize the way organizations approach regulatory compliance. She groups them into one of four buckets: Box Checker Cautious Follower Strategic Positioner Leader and Innovator   That last group is one that Obrist knows well. Her employer, POCP, supplies the program management for the HL7 Da Vinci Project, a multi-stakeholder collaborative to support the information sharing needed for value-based care. Which means that POCP works with many of the most innovative payer, provider, and vendor organizations in US healthcare. Those are the organizations paving the way for everyone else, and the US Center for Medicare and Medicaid Services (CMS) is so confident in their work that it has been enshrined in recent regulations.   The CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) requires that “impacted payers” deploy technology and numerous operational changes to facilitate information sharing and streamline prior authorization processes. The impacted payers are basically those federally funded plans operating under managed care models, for example, Medicare Advantage plans.   Interestingly, the rule requires the use of HL7 FHIR Application Programming Interfaces (APIs) but avoids most of the specifics, instead strongly encouraging payers to adopt the Implementation Guides (IGs) developed by the Da Vinci project and piloted by its members – the leaders and innovators.   Jeff Rivkin, Research Director for Payer IT Strategies at analyst firm IDC, points out that many payers continue to take a one-year, tactical approach to each regulatory mandate project. In other words, they are Kendra’s box checkers. He goes on to suggest that in order to “ensure operational excellence for members, providers, and internal constituents, payers instead need to evaluate individual mandates in the context of an overall vision.”   I have my own slightly different set of buckets inspired by Kendra, Jeff, and our experience with the CMS Interoperability and Patient Access rule (CMS-9115-F), an earlier mandate: Check the box Modernize incrementally Invest strategically   The earlier rule put in place a foundation on which to build. It required that claims and clinical data held by the payer be shared with members using FHIR APIs. And it established a rudimentary process for payer-to-payer information sharing. We spoke with plenty of “check the box” organizations. But most of the ones that went on to partner with InterSystems were those that saw the inherent value of integrating clinical and claims data as a strategic information asset. IDC refers to this as a “Member-360” record.   A Member-360 record allows customer service, enrollment, claims, and care coordination teams to access and use the same information base to profile members and provide the level of service members require in today's consumerization of healthcare and health insurance. But to achieve these goals effectively, the implementation strategies used by a payer for regulatory mandates also need to optimize this data asset.   Rivkin recommends developing a long-term architectural vision that includes compliance with regulatory mandates. This approach accommodates both my second and third buckets. One might, for example, deploy a Member-360 longitudinal health record to support the three “access APIs” mandated by the new CMS rule, but plan for a full-blown modernization of prior authorization in a second phase of that vision.   Regardless of which bucket your organization falls into, you’ll need a partner to help you meet both your immediate, and long-term compliance and information management goals. Consider: Current CMS mandates depend heavily on the work of the Da Vinci project and require deep knowledge of HL7 FHIR. You need a partner with experience in both.   New rules for payer-to-payer information sharing require payers to integrate the data they receive – including clinical data - with other data they hold. Gartner states that: “Healthcare payer CIOs and executives routinely underestimate the complexities involved in clinical data integration initiatives, leading to subpar business outcomes.” Does your proposed partner have the specialized expertise to assist you with this complex effort?   As information sharing gains traction, data volumes are expected to grow dramatically. Can your proposed partner deliver consistently at scale and have they proved this over time at multiple organizations?   Does your proposed partner have a path forward for you, regardless of where you are starting from? And does that path go beyond mere regulatory compliance? For example, to helping you manage complex provider network data? Or to deliver digital front door services and robust identity management for multi-source data?   Even if your organization is already stretched too far to take on one more thing beyond the bare minimum of “checking the box,” you can achieve regulatory compliance in the context of an overall vision for the long term. And for 0057, we all get to benefit from the leaders and innovators helping to make that vision a reality through the Da Vinci Project.

Oracle today at HIMSS24 announced significant enhancements to Oracle Health Data Intelligence, including a new generative AI service to help increase care management efficiency. Oracle Health Data Intelligence, formerly HealtheIntent, is a modular suite of cloud applications, services and analytics. The suite is designed to enable a broad range of healthcare and government stakeholders to use data from across the healthcare ecosystem to help advance patient health, improve care delivery and drive operational efficiency. Increase reimbursements and enhance care Additional new capabilities include system performance improvements, pre-built clinical quality analytics, and automated alerts that can help increase reimbursements and enhance care. Powered by Oracle Cloud Infrastructure, the updated suite offers organizations access to the same mission-critical security, performance, reliability and other cloud capabilities that Fortune 100 customers in highly regulated industries rely on today, the company said. The platform integrates, secures and analyzes data from a broad range of sources, including electronic health records , enterprise applications, insurance claims and demographic records, to provide a more comprehensive view of individual patients and overall population health. This EHR-agnostic technology is designed to enable organizations to eliminate the cost and complexity of trying to integrate disparate data and systems on their own, which risks an uncertain ROI and can take years to accomplish. "Turning data into insights is critical to solving the problems facing modern healthcare," said Seema Verma, executive vice president and general manager, Oracle Health and Life Sciences. "The new capabilities embedded within Oracle Health Data Intelligence can dramatically simplify customer efforts to address their regulatory goals, engage more patients , close care gaps and lower cost of care delivery. "With thousands of engineers and data scientists focused on platform enhancements, Oracle Health Data Intelligence is rapidly becoming an engine of innovation to control costs, enable breakthroughs and drive industry transformation." Results are coming in Already, customers using Oracle Health Data Intelligence have achieved results, including an average of 9-12% in cost reductions per member, per month (for commercial customers); a 5X increase in care gaps closed over three years through increased breast cancer screenings; and an average of 40-60% increase in annual wellness visits per provider, per year, the company reported. "Oracle Health Data Intelligence platform has been a critical strategic asset throughout our organization, delivering actionable insights across multiple lines of business and empowering our providers to make more informed, precise decisions at the point of care," said April Feld, DNP, RN, director of care management at Stony Brook Medicine. "Moving forward, we view Oracle Health Data Intelligence not just as a tool but as a catalyst for transformation," she continued. "Leveraging recent updates, including the power of Oracle Cloud Infrastructure and generative AI, we believe Oracle Health Data Intelligence will shape the future of data-driven healthcare – helping us to better understand and manage complex patient information to more effectively and efficiently deliver care at an individual and population level." Oracle Health has demonstrated its ability to aggregate data from multiple sources, including non-Oracle Health EHRs, health information exchanges and payers, said Jennifer Eaton, research director, value-based healthcare digital strategies at research and consulting firm IDC. "With its continued enhancements to Oracle Health Data Intelligence, Oracle is well positioned to help customers get the full value out of their data to drive meaningful change that can positively impact their organization and patients," she added. Oracle Health is at HIMSS24 in Orlando March 11-15 in Booth 2761. Follow Bill's HIT coverage on LinkedIn: Bill Siwicki Email him: bsiwicki@himss.org Healthcare IT News is a HIMSS Media publication.

Palantir has been expanding deeper into healthcare and adding new health systems and provider partners. Option Care Health, a provider of post-acute care and infusion services, inked a multi-year partnership with analytics company Palantir Technologies to use its artificial intelligence platform across its operations. The provider of home and alternate site infusion services will use Palantir's Artificial Intelligence Platform (AIP), which incorporates AI and large language models, to optimize nurse scheduling, patient onboarding, purchasing and supply chain execution, among other use cases, the company announced Monday morning at the J. P. Morgan Healthcare Conference. “Utilizing Palantir’s Foundry and AIP will allow us to innovate rapidly, build on best practices and ensure our approach to AI and machine learning adheres to the highest standards, incorporates the strongest foundations and provides the best protections and integrity," John Rademacher, president and CEO of Option Care Health. Foundry is an operations platform that brings together data and analytics. Follow the Fierce team's coverage of the 2024 J.P. Morgan Healthcare Conference here. Palantir has been expanding deeper into healthcare and adding new health systems and provider partners. The company has inked eight contracts with health systems to use its AI-based software AIP to improve patient flows and staffing, the Denver Business Journal reported. Its partners include Cleveland Clinic, Tampa General Hospital, HCA Healthcare, Lifepoint Health and Hone Health. The company has signed three other partnerships with health systems that have not yet been publicly announced, the publication reported. A year ago, Cardinal Health announced a strategic collaboration with Palantir Technologies to design a clinically integrated supply chain solution for live purchasing decision support of pharmaceuticals for health systems and hospitals. The company told CNBC that Palantir for Hospital Operations accounts for 10% of its commercial revenue in the U.S. Palantir’s software is also used across a number of government health organizations, including the National Institutes of Health and the U.K.‘s National Health Service, according to the company. Palantir's AIP enables organizations to bring the power of large-language models, and other AI technology, to their enterprise networks, private data and core operations, according to the software company. The platform is designed to bring in siloed and disconnected data sources, logic assets and systems of action into a single common operating picture, enabling users to optimize their decision-making. "Option Care Health is at the leading edge of deploying artificial intelligence across the healthcare sector," said Alex Karp, co-founder and chief executive officer of Palantir Technologies in a statement. "We are proud to support this effort, which builds on our expanding presence in and commitment to the medical sector and will expedite and improve services to patients across the country." Option Care Health said its use of Palantir’s software will help optimize visits per day and increase patient’s face time with clinicians, reduce administrative burden and ensure stockage of drugs and medical supplies while preventing overstocking. The company says it serves more than 220,000 patients a year across all 50 states with 7,500 team members including more than 4,500 clinicians. Back in May, Option Care Health was poised to become a massive provider of post-acute care services with a proposed $3.6 billion merger with home health and hospice firm Amedisys. That deal was scrapped when UnitedHealth Group outbid the company. That deal, valued at $3.7 billion, is still pending.