Industry Insight

Kaiser Permanente Launches Social Health Network

Kaiser Permanente, the nation’s largest nonprofit integrated health system, is launching Thrive Local, the most comprehensive, far-reaching social health network of its kind. Kaiser Permanente is partnering with Unite Us to connect health care and social services providers to address pressing social needs, including housing, food, safety, and utilities for millions of people across the United States.

With an ambitious timeline, the new Thrive Local network debuted in June in Oregon and southwest Washington. Within three years, it will be available to all of Kaiser Permanente’s 12.3 million members and the 68 million people in the communities Kaiser Permanente serves. These communities’ health care providers and caregivers will now have unparalleled capabilities to seamlessly match an individual’s social needs with the appropriate services from within a robust network of nonprofit, public, and private resources.

“Kaiser Permanente has long understood that total health can only be achieved through a combination of physical, mental, and social care,” says Kaiser Permanente Chairman and CEO Bernard J. Tyson. “In order to thrive, people need access to the things that are vital to health such as secure housing and nutritious food. Our unique mission to improve not only the health of our members but also that of our communities drives us to undertake impactful initiatives like Thrive Local to connect our communities with the services they need. This is one of our bold moves.”

Recent data indicate that in certain regions, up to 29% of Kaiser Permanente’s members that have the greatest medical challenges are dealing with food insecurity, and as many as 23% have concerns about housing stability—critical issues that are among the types of challenges that Thrive Local will address.

In addition to being integrated into Kaiser Permanente’s EHR system to comprehensively serve its members, Thrive Local’s network of resources will also be made available to community-based organizations to efficiently reach the broadest possible group of those in need.

“Where and how people live, work, and play drives more than half of health outcomes. To address total health, we, as physicians, need systems and networks that address our patients’ social needs,” says Imelda Dacones, MD, president and CEO of Northwest Permanente. “Health care in this country must continue to evolve—from acute episodic care to an integrated coordinated system focused on prevention and coordinated care management. This tool will accelerate our evolution as a sector to next-generation care delivery—a community-integrated model that connects physicians, our patients, and health care systems to community resources that address our patients’ socioeconomic needs.”

The network will track community partner referrals and service outcomes to measure the degree to which participants’ needs are met—gathering data to continuously improve service delivery and better address community conditions for health. Kaiser Permanente is partnering with and investing in Unite Us, a social care coordination platform, to build and power this transformative network.

— Source: Kaiser Permanente

Artificial Intelligence–Powered Care Coordination Software Gives Vendors Competitive Edge

Every year, across the United States, close to 50% of patients fail to understand treatment plans and care management guidelines, and approximately 20% of them switch providers due to a lack of trust in their care teams. Next-generation patients prefer having access to personalized clinical information on the go, requiring caregivers to coordinate medical insight across the care continuum more efficiently than ever. Almost 70% of patients reported feeling fully satisfied when they received coordinated care from a provider-designated team that appears confident in identifying the right intervention strategies and delivering episodic medical support compassionately. However, such services cannot be scaled without the contribution of progressive digital health solutions. As a result, the care coordination software market is poised to witness significant traction from payers, hospitals, and physician practices across the United States. This is expected to drive the $1.55 billion care coordination software market toward $3.18 billion by 2022 at a compound annual growth rate of 15.4%.

“The care coordination software market is embracing large-scale innovation, aided by advanced technologies such as AI and blockchain, which support data interoperability and normalization within a defined clinical network,” says Koustav Chatterjee, industry analyst for transformational health at Frost & Sullivan. “The growing need to autotrigger worklists and personalize intervention plans for complex patient populations will further drive investments in care coordination IT (CCIT).”

Frost & Sullivan’s recent analysis, US Care Coordination Software Market, Forecast to 2023, examines the adoption drivers across a variety of settings. It also presents the challenges impacting the market and the outlook for the adoption of care coordination software among three key customer segments. It presents forecasts for the overall market growth over a six-year period and opportunities within the total market.

Further information on this analysis is available at http://frost.ly/3ck.

“While regulatory hurdles had hindered the adoption of CCIT in the past, the latest US policies advocating the Promoting Interoperability initiative by Centers for Medicare & Medicaid Services, the cross-continuum interoperability, are expected to accelerate the adoption of both software and service solutions,” Chatterjee notes. “Business models will remain largely centered on transitional care management, and chronic condition management is highly regulated under various value-based reimbursement programs. Legacy EHR platforms, which allow third-party integration with CCIT to remain interoperable in the front end, will thrive. Collaboration with traditional [information and communications technology] vendors such as Microsoft, Apple, and Salesforce is also expected by both payers and providers.”

For additional growth opportunities, CCIT vendors are likely to do the following:

• Encourage the integration of disparate medical workflows by demonstrating accrued revenue, saved costs, and improved outcomes.

• Automate the process of matching patients with their care teams. Care managers need to employ IT enablers so that they can proactively reach out to patients’ caretakers and provide insights to help make more informed, data-driven decisions.

• Manage patients’ clinical and financial experience through IT, enabling the sharing or exchanging of information required to make favorable decisions.

• Deliver robust care coordination software products that offer end-to-end referral management capabilities.

• Highlight financial gaps in the network and identify patients who can generate incremental revenue for caregivers.

• Introduce a digital command center to autoattribute care managers, who will be responsible for delivering, monitoring, and benchmarking care plan adherence both manually and digitally for patients.

US Care Coordination Software Market, Forecast to 2023 is part of Frost & Sullivan’s global Digital Health Growth Partnership Service program.

— Source: Frost & Sullivan

Indiana Medical Records Service Pays $100,000 to Settle HIPAA Breach

Medical Informatics Engineering (MIE) has paid $100,000 to the Office for Civil Rights (OCR) and agreed to take corrective action to settle potential violations of the HIPAA privacy and security rules. MIE is an Indiana company that provides software and EMR services to health care providers.

On July 23, 2015, MIE filed a breach report with OCR following discovery that hackers used a compromised user ID and password to access the electronic protected health information (ePHI) of approximately 3.5 million people. OCR’s investigation revealed that MIE did not conduct a comprehensive risk analysis prior to the breach. The HIPAA rules require entities to perform an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of an entity’s ePHI.

“Entities entrusted with medical records must be on guard against hackers,” says OCR Director Roger Severino. “The failure to identify potential risks and vulnerabilities to ePHI opens the door to breaches and violates HIPAA.”

In addition to the $100,000 settlement, MIE will undertake a corrective action plan to comply with the HIPAA rules that includes a complete, enterprisewide risk analysis.

The resolution agreement and corrective action plan may be found at www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/mie/index.html.

— Source: Health and Human Services