Last month, the National Breast Cancer Foundation held a ceremony during which Exela proudly donated a check for $5,540, which Exela and its employees raised during Breast Cancer Awareness Month through the #ExelaGivesBack philanthropy program, under which Exela pledged to match the charitable donations made by employees on a dollar-for-dollar basis. The ceremony took place at the Foundation’s Dallas, Texas headquarters. Exela’s Senior Vice President of Human Resources, Carlos Mallen, and Katie Beezley, Marketing Event Manager, were on hand at the ceremony to present the check on behalf of Exela.

Accepting the check on behalf of the Foundation were its Senior Vice President of Strategic Partnerships and Charitable Giving, Ken Ramirez, and Manager of Charitable Gifting and Strategic Partnerships, Candice Boeck.“The National Breast Cancer Foundation is grateful for the support from Exela Technologies and their employees to our mission of Helping Women Now,” Boeck stated. “This donation will enable us to continue providing help and inspiring hope to women affected by breast cancer across the U.S.”

The Foundation’s mission is to provide help and inspire hope to those affected by breast cancer through early detection, education, and support services. According to the Foundation’s website, 1 in 8 women will be diagnosed with breast cancer during her lifetime, there is currently no known cure for breast cancer, and early diagnosis is critical to survival. One of the Foundation’s top priorities is educating women on what they can do to be proactive with their breast health. Learn some of the ways you can lower your risk of breast cancer, care of The Foundation.

“We are honored, blessed, and humbled to provide a gift to the Foundation, which has worked tirelessly for decades to support the fight against breast cancer by providing financial grants to research institutions and most importantly gifts of hope to patients and their families,” noted Mallen. Exela has worked with the not-for-profit in prior years and has plans to further its partnership with the Foundation in 2020 and beyond.

Exela’s global presence (basically, we’re everywhere) means two very important things to us. One is that we are wherever you need us to be to advance your digital journey. The other is that we care. We care about people and the work we do. And we care about the future of planet earth and the people who live here. Through our #ExelaGivesBack philanthropy initiative, we turn caring into action.

From the outside, the average billing cycle for a medical appointment looks pretty simple: Go to the doctor, pay for the visit (with your own money or insurance), repeat as necessary.

For healthcare providers, though, that couldn’t be further from the truth. The reality is more like this:

• Identify the patient
• Pre-register the patient
• Patient arrives, is treated
• Patient pays, or, in most cases, insurance claim is filed
• Claim is processed
• Insurance company may follow up to dispute claim, or deny coverage
• Office follows up with patient to receive disputed payment
• Payment may go into debt collection
• Account closed.

From a two-step process to a nine-step process, in the blink of an eye. The thing is, providers only really care about one thing: getting paid. And that’s where business process outsourcing can come in. Providers receive payments and explanations of benefits in a variety of forms, forms that vary from payer to payer. Aetna may have one form, while Medicaid and Medicare may have others. The manual matching of these forms, and syncing them to a specific provider’s system can take weeks, delaying payment along the way. According to industry data, 2.5 billion commercial payerhealthcare remittances are handled manually every year.

 It’s that number — 2.5 billion — that opens the door for business process outsourcing.BPO companies can match the claims, payments, and explanations of benefits instantly, whether they’re paper or electronic. After that, they convert the EOBs to a standardized form, eliminating any missing features. The electronic files are then rerouted to the provider, providing a real-time boost in revenue, and eliminating costly labor expenses associated with payment processing. According to the Medical Group Management Association, the cost of billing operations is 18 to 20 percent of a provider’s overhead, and each claim clips $5 to $7 from them.

Then take into account the interest that could be earned each day with speedier billing:

Average check size                        Value, per day, of lost interest revenue

$36                                                     $0.0059

$360                                                   $0.059

$3,600                                                $0.59

$36,000                                              $5.90

$360,000                                            $59.00

The federal government is incentivizing providers to switch to electronic records and billing; still many companies don’t think it’s worth it. But consider this: Providers can take weeks to process claims and remittances. A BPO company takes 24 hours. The difference is tens of thousands, hundreds of thousands, or millions of dollars each year in lost revenue. It’s not worth it to stay stuck in the paper age.

The Annual Enrollment Period (AEP) for healthcare insurance providers is fast approaching and now is a crucial time to prepare. The key factors to a successful AEP for your organization include meeting regulatory and compliance requirements and retaining current members while on-boarding new members.

In this article, Interim Vice President of Healthcare at Novitex, Kate Braschayko, offers some tips on how healthcare insurance companies can start preparing now:

Have you updated all of your Pre-enrollment and enrollment documents and templates?

Create documents and a template designed specifically with updates for your AEP. This small step will make the process much easier once AEP begins. Leveraging a template management system or customer communication management platform will help facilitate a streamlined and automated process to support your efforts for your comprehensive communications to members and potential members.

Do you have audit and tracking throughout your processes?

Mitigate errors and avoid compliance problems by providing full transparency and chain-of-custody from document composition through approvals and production into the outgoing member mail stream. This will be valuable, if not critical, during a regulatory audit and when self-reporting to regulatory agencies.

Are you sure you have correct mailing addresses for all of your members?

It costs at least $3 each time a piece of mail is marked as undeliverable. Implement address hygiene techniques to avoid unnecessary spending and get mail to your intended recipient on time.

Have you prepared for postage, sorting, and delivery processes and costs?

Presort your outgoing mail to lower your postage spend. There are opportunities for postage savings when using different services.

Will you meet the deadlines?

Executing the steps above may seem like extra work, but following Kate’s advice can save you time and money. Meet deadlines by avoiding unexpected hurdles by preparing enrollment documents, creating transparency and implementing best practices by for mail quality such as presorting and address hygiene.

Novitex can help you prepare for Annual Enrollment Period (AEP). For more information, visit https://www.exelatech.com/industries/healthcare

At the end of June, a shift in the healthcare industry took place to the tune of just under $1 billion – retail giant Amazon bought PillPack, an online pharmacy that allows customers to purchase their medications in pre-packaged doses. Already disruptors in their fields, PillPack and Amazon’s new joint venture has repercussions throughout healthcare, from big pharma to insurers to prescribers. One of the slowest-adopting and hardest to shift industries, healthcare, will need to re-examine the way it does business, putting a focus on the convenience that consumers have come to expect.

The end-to-end workflow automation of PillPack is so simple that it begs the question, “why didn’t anyone think of this before?” leaving many in healthcare scrambling to imitate or using it as a model for the intersection of technology and health knowledge. You might feel that pressure at your company as well, and for good reason – no one wants to be left behind when innovation moves forward. Let’s explore three areas – time, transparency, and patient experience - to see where you can help your business keep pace.

The Gift of Time

One thing that makes Amazon so successful is that its simplified purchase and delivery model gives consumers more of their time back to them. This gift of time is achieved through business process automation (BPA), in the PillPack case by streamlining the cumbersome process of handling prescriptions. Discovering ways to free up customers’ time is a concept that every company can embrace regardless of size or available resources – you don’t have to be Amazon to innovate in this area. When combined with personalization and convenience (which is what PillPack does), you have a winning combination for patients and the healthcare market.

Transparency

Mitigate risk with transparency. This is exactly what PillPack does. PillPack manages its workflow refilling prescriptions to delivery, including periodic review of patient profiles through surveys and conversations, thus preventing patients from taking more than their recommended dose or running out of medicine. It is better to be proactive than reactive, which is important from the perspective of both safety and patient satisfaction. This insight into patient needs through automation could prevent life-threatening mistakes. We are even just starting to see the power that AI has in diagnosing people, giving patients and providers more time needed to save lives – a gift with incalculable value.

Patient Experience

Delivering an effective healthcare solution is complex and can be fraught with obstacles, primarily around information privacy, regulations like HIPAA, and the disparate, siloed systems often in place at many companies. Everything from patient portals to staff scheduling to ordering supplies are likely handled by multiple systems. Sometimes, this complexity becomes a barrier to progress. However, this is where digital solutions thrive – interconnecting systems and breaking down silos for streamlined end-to-end process and workflow.

Technology can also be employed to identify patterns in data. These patterns can be used to make decisions and simplify the complexity of everyday work process to improve the overall patient experience. One example of this patient-focused application is medication adherence, one of the largest problems in pharmaceuticals today and a key source of value in PillPack’s model. Adherence to medication not only benefits the patient, but is cost-effective for providers. If patients take their medicine as directed, they will be healthier, may not develop chronic conditions, and experience less traumatic episodes that use high-cost services such as emergency room visits.

Kate Braschayko, Vice President of Healthcare at Exela, weighs in: “In this day and age, there can be a lot of uncertainty in the healthcare ecosystem. That is why it is important for organizations to be open to innovation and examine operations from an end-to-end perspective, leveraging technology for business process automation to drive positive results for all involved, and most importantly for patients.”

By examining the innovations of industry disruptors and boiling them down into these essential elements, your business can further innovate and provide customers and patients with a better experience, higher quality of service, and the efficiency they require in an app-driven, increasingly digital world. You can help bridge the gap between what exists in your current environment and the pace of innovation – all you need is the right mindset and the right digital tools.

Team Exela believes that raising awareness and funds for important causes is part of our corporate social responsibility and, more importantly, part of good citizenship. This month we are trying to do our part to raise funds for breast cancer research. Additionally, our team will wear pink on Wednesdays and champion the cause on social media and in our internal communications.

In 2018, Exela has participated in multiple fundraising efforts for causes that include disease research initiatives and Red Cross disaster relief assistance. Recently, the team participated in a 5K & 10K run and raised over $20,000 for the Orthopaedic Institute for Children, an organization comprised of medical professionals and volunteers that provides care for patients with musculoskeletal disorders, regardless of a family's ability to pay for the care.

This week we will be posting links from leading cancer research websites and campaigns. The first is "Know Your Lemons," a campaign started by Corrine Ellsworth Beaumont, PhD, for the Worldwide Breast Cancer charity completely focused on breast health education. We encourage you to visit the website and learn more: https://worldwidebreastcancer.org/

Exela’s global presence (basically, we’re everywhere) means two very important things to us. One is that we are wherever you need us to be to advance your digital journey. The other is that we care. We care about people and the work we do. And we care about the future of planet earth and the people who live here. Through our #ExelaGivesBack philanthropy initiative, we turn caring into action.

For example, on Thanksgiving Day of 2018, Exela raised funds and awareness for SOFOSH, a charity based out of Pune, India, by rounding up employees, friends, and families in Dallas, Texas, and Santa Monica, California to participate in local road races and/or make personal donations ( and, of course, no amount is ever too small or unappreciated). And here’s the coolest part: Exela matched all such donations dollar for dollar (our employees raised $7,200, bringing the grand total raised through our efforts to $14,400). But hey, that’s how we roll.

On May 19, 2019, we not only matched our employee contributions dollar for dollar, we worked hand-in-hand with the Bare Hands Initiative to turn urban space in Atlanta, Georgia into sustainable, edible greenspace. Our other philanthropic efforts this year have included the Stamford Boys & Girls Club 5K (May 22, 2019) and Relay For Life (June 14, 2019). Currently we are building awareness for and raising funds in support of Children’s House.

Run. Hear. Now.

For months now, Exela has been raising funds in support of children with hearing impairments, and those efforts will culminate at the 42nd Annual Will Rogers Pacific Palisades 5K/10K race and ½ -Mile Fun Run For Kids taking place on July 4, 2019 (U.S. Independence Day) in Pacific Palisades, California. In preparation, we’ve been rounding up all the employees, family members, and friends in the area, and getting the word out to our 22,000 employees all over the world about the awe-inspiring work being done by the Center for Early Diagnostics and Therapy of Children with Hearing Impairments (“Children’s House”) in Zvezdara, a municipality in Belgrade, Serbia.

Our hope is to raise at least $15,000 for Children’s House. And Exela has pledged to match employee donations up to that amount.

About the Children’s House

Established in 2006, Children’s House is dedicated to changing the lives of children with hearing loss—including the profoundly deaf—by providing a full range of treatments, from surgical to therapeutic to rehabilitative. Children’s House’s mission and greatest accomplishment is the integration of its children into hearing-society, no matter how much work or how long it takes.

To attain its lofty goals, including annually working with 9,000 children—from infants through teens—Children’s House needs our financial support. In particular, Children’s House is seeking to develop a program of universal neonatal hearing screening, build a room for multisensory stimulation, and purchase such needed equipment as audiometers and tympanometers.

We’re so excited about this, and about all of our upcoming #ExelaGivesBack events. Keep checking here for more on Exela’s philanthropic efforts (spoiler alert: there will be the wearing of pink in October, as is traditional here at Exela). We promise to keep you in the loop!

“It’s the prices, stupid.”

– a group of public health and policy experts in 2003, on

why U.S. healthcare spending is so high

The U.S. spends more per person on healthcare than any other developed nation, and it’s not because ours is higher quality or utilized more often by more people. Rather, it’s because the prices are higher.[1,2]” If only those higher prices correlated with higher life expectancy or lower rates of morbidity (i.e., illness and injury). Alas, they don’t, and the reason is widespread inefficiency in the U.S. healthcare system, and in particular healthcare administrative waste. For example:

• A staggering 60% of the U.S. healthcare industry is currently employed in administration, as opposed to providing patient care,^[3]
• The average physician spends approximately half their day on administrative tasks.^[4]

Such inefficiencies amount to approximately $935 billion in annual spending. It’s a terrifying figure, even before you consider it represents as much as one-quarter of all dollars spent on U.S. healthcare. With the U.S. still the world’s economic leader[5], the question is, what’s really going on here?

That, along with what can be done to turn things around before losing even more ground, is the focus of this quarter’s issue of Exela’s thought-leadership publication, PluggedIN: Tell Us Where It Hurts: How Tech Can Heal Healthcare. In it, we address the scope of the problem, its historical context, what’s been done thus far to address it, and why, as The Everest Group notes, “inefficiency remains pervasive in healthcare,” despite massive spending on both the part of the government and private interests.^[6] Ultimately, we offer solutions—real world solutions ready to be implemented right now.

How do we know? Because we at Exela have the solutions and are ready to deploy them. As Everest notes in its 2019 Healthcare Business Process Automation Solutions PEAK Matrix Assessment,^[7] Exela has been successfully prioritizing addressing healthcare’s inefficiencies—our innovative, AI-enhanced and well-priced solutions earning us a place at Everest’s “Major Contender” table in the healthcare space. Those solutions address the full gamut of challenges facing the healthcare industry, including:

• Medical coding
• Compliance
• Information release
• Claims processing
• Claims adjudication
• Patient access and communications
• Patient financial services
• Revenue integrity

Our solutions also address challenges common throughout all industries, including:

• Billing and presentment
• Collections
• Liquidity management
• Human capital management
• Lobby and reception management
• Mail services
• Print services
• Fixed asset management
• Marketing 

Perhaps most importantly, however, they address the fundamental first “mile” along any organization’s journey into the process of business process automation/digital transformation: turning the vast and ever-increasing abundance of information in that organization’s possession, in whatever form it exists, into productive assets that can enter automated workflows for cost savings and be leveraged for the increased revenues. That requires both a macro-level of information governance and implementation of a process for enterprise information management. In the healthcare space, Exela offers comprehensive health information management solutions, tailored to healthcare’s specific challenges and goals.

PluggedIN is Exela's thought leadership publication, providing fresh insights from the cutting edge every quarter. Subscribe. Plug in. Upgrade your mind.

Get PluggedIN Now

[1] https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.3.89

[2] https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05144

[3] https://www.exelatech.com/industries/automated-healthcare-solutions

[4] https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system/

[5] https://www.focus-economics.com/blog/the-largest-economies-in-the-world

[6] https://www.exelatech.com/report/healthcare-business-process-automation-solutions-peak-matrixtm-assessment-2019

[7] https://www.exelatech.com/sites/default/files/report/Everest-Group-Healthcare-Business-Process-Automation.pdf

U.S. healthcare is a model of inefficiency, with input (i.e., money spent) exceeding output (i.e, effectiveness of care). Experts cite administrative complexity as the number one reason. To wit, a staggering 60% of the health industry is employed in administering paperwork rather than in providing patient care. Even those employed in patient care can spend up to half their workday on administrative tasks. But improving health information management could make a significant impact by more effectively leveraging the vast and rapidly growing abundance of patient health data.

The federal government has already invested considerable time and money into encouraging health information management (HIM) reform to facilitate the seamless but secure transfer of patient information across discrete systems. Many acknowledge the need therefor.  Nevertheless, inefficiency continues to be pervasive.

The Everest Group has made a study of identifying those industry players who have successfully prioritized addressing information management and other issues affecting efficiency. Among them is Exela, whom Everest recognized in its 2019 Healthcare Business Process Automation Solutions PEAK Matrix Assessment for displaying strength in automation product development and AI-enabled solutions. In particular, Everest notes that “Exela’s solutions help drive better connectivity between the payer and provider systems.”

Those solutions address the full gamut of challenges specific to the industry, including:

• Medical Coding
• Compliance
• Information Release
• Claims Processing
• Claims Adjudication
• Patient Access and Communications
• Patient Financial Services
• Revenue Integrity

 They also address challenges common throughout all industries, including:

• Billing and Presentment
• Collections
• Liquidity Management
• Human Capital Management
• Lobby and Reception Management
• Mail Services
• Print Services
• Fixed Asset Management
• Marketing

Perhaps most importantly, of course, they address the fundamental first “mile” along any organization’s journey into the process of becoming digitally-enabled: taking control of the data deluge and transforming it into productive assets for entry into automated. That requires both a macro-level of information governance and implementation of a process for enterprise information management. Exela offers comprehensive healt information management solutions, tailored to the industry’s specific challenges and goals.

For more information on how health information management can address healthcare’s inefficiencies, you’ll want to read our Q4 Edition of PluggedIN: Tell Us Where It Hurts: How Tech Can Heal Healthcare.

Get PluggedIN Now

___________

Sources:

https://www.jhsph.edu/news/news-releases/2019/us-health-care-spending-highest-among-developed-countries.html

https://jamanetwork.com/journals/jama/fullarticle/2752664

https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-administrative-costs-burden-u-s-health-care-system/

https://med.stanford.edu/content/dam/sm/ehr/documents/EHR-Poll-Presentation.pdf

Our current body of medical knowledge began with notations made by those tasked with patient care going as far back as 3,000 B.C. It wasn’t until the 1920s, however, that healthcare professionals widely came to understand the benefits of carefully documented patient health records. Initially, patient record-keeping took the form of the “Problem Oriented Medical Record” (POMR), which as the name suggests, was organized around solving medical problems, as opposed to preventing illness and maintaining optimal health.

The birth of electronic medical records

Initially all patient information was recorded on paper (or parchment, in ancient times). However, the burgeoning computer age in the mid-1960s led to the birth of the first “Electronic Medical Records” (EMRs), which were essentially the equivalent of patient “charts,” except in electronic form. EMRs were an improvement over paper records. However, technology was significantly more expensive at this time, and the utility of EMRs was limited by their inherent lack of interoperability .Interoperability, in the context of health information, refers to the seamless and secure exchange of electronic health information between authorized users of such information. In other words, interoperability is as much about sharing, as it is about protecting the privacy of, patient health data, for the benefits of both patient and provider.

The birth of HIPAA

Nevertheless, legislation introduced that would have required uniform adoption of EMRs sputtered to a dead end in Congress. On the other hand, legislation addressing privacy of patient data gained enough traction to lead to the passage of HIPAA: the Health Insurance Portability and Accountability Act (HIPAA).

When HIPAA was introduced, its primary purpose was ensuring employees would continue to receive health insurance coverage when they were between jobs (hence, “portability”). Another purpose, however, was improving efficiency in the healthcare industry (hence, “accountability”). In furtherance thereof, HIPAA took aim at the vast amounts of paperwork generated in the course of the claims process, by, among other things, requiring providers and payers to adopt standardized treatment and diagnosis codes. As a result, the adoption of HIPAA was pivotal in the move toward adopting electronic patient records.

The birth of HITECH

As much as EMRs made good sense to providers post-HIPAA, the cost of transitioning from paper was proving prohibitively expensive. Congress responded in 2009 by passing the Health Information Technology for Economic and Clinical Health Act (HITECH), which introduced incentives for providers to “go electronic.”

The birth of Electronic Health Records

Over time, but particularly in the past two to three years, HITECH has shifted the EMR paradigm entirely. The process of optimizing patient data came to focus in content as much as form. POMRs gave way to records aimed at presenting a full picture of a patient’s total health: the Electronic Health Record (EHR). EHRs are, by law, the property of the patient, and only the patient can grant power to a provider to allow access by third parties. For more information on what should generally be contained in an EHR, please visit Tell Us Where It Hurts: How Tech Can Heal Healthcare.

Still so far to go

Electronic health records hold significant benefits over their predecessor systems for health information record-keeping. They hold enormous promise for addressing healthcare’s inefficiencies by turning an overabundance of underutilized data into assets that work synergistically to benefit providers, payers, and patients. However, the promise remains unfulfilled at present, in large part due to interoperability. We’ll be exploring the current state of interoperability in an upcoming post on the Exela Blog. Can’t wait? Check out the full story in our Q4 Edition of PluggedIN: Tell Us Where It Hurts: How Tech Can Heal Healthcare.

Get PluggedIN Now

Sources:

https://www.rasmussen.edu/degrees/health-sciences/blog/health-information-management-history/

https://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-difference

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2233232/

https://elearning.scranton.edu/resource/health-human-services/emr_the-progress-to-100-percent-electronic-medical-records

https://www.hipaajournal.com/what-is-the-hitech-act/

 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2016.1651