Regulatory Compliance in Healthcare

 The challenge is here. Implementing healthcare reform measures will impact every aspect of your operations. HIPAA-compliant electronic transactions are only one of many readiness considerations. Every system, interface or vendor application will need to be evaluated and adapted - including financial reporting, quality, disease/case management systems, management and operational reporting, even provider contracts - the list is long. It will take time and knowledgeable healthcare IT professionals. The healthcare technology experts at Perficient are prepared to lead you through this challenge. Assertive regulation of healthcare by the states and the federal government is the new norm.  This greater focus has been the source of numerous improvement programs, collectively referred to as Healthcare Reform, addressing the many areas that comprise healthcare delivery and consumption in this country.  A key enabling element underlying these programs is technology.  And not just the technology introduced by a provider or health plan into their organizations, but the ubiquity of it now within the general population with the explosion of smart phones and tablets.  It’s being driven into every corner of healthcare, whether it’s enhancing the patient encounter, facilitating the exchange of information amongst providers, making health insurance more accessible through Health Insurance Exchanges, sharing information with the patient, tracking performance through quality and use measures or directly engaging with the patient outside of the traditional healthcare setting.  To help your organization to live and thrive in such a demanding and chaotic environment, Perficient has teams of experienced healthcare and technology delivery experts available to help your organization navigate the many challenges and opportunities of complying and driving value through those efforts.

 

Information Exchange

Healthcare Reform is driving the healthcare community to leverage technology in a manner that provides for a timely and secure exchange of information related to patient care.  This push is resulting in the upgrading of existing data exchange services, deployment of new ones and the timely piggybacking on the explosion of mobile device usage in the hands of both the providers and patients.  Perficient can plug you into this greatly enhanced healthcare eco-system.  Whether you’re a provider in need of accessing your regional Health Information Exchange (HIE) to support the care coordination requirement of MU2, a health plan offering products through a state or the federal Health Insurance Exchange (HIX), or meeting CAQH phase I, II & III standards, we can put in place the information integration and exchange capability your organization needs.  The need to integrate and extend your capabilities and processes into the eco-system requires a partner like Perficient who has the people, experience and partnerships to ensure success.

 

ICD-10

Many health providers and plans are now turning their attention to ICD-10.  The compliance deadline is less than a year off and the date will not move again.  The time to effectively manage this change is running out.  Perficient can work with you and your organization to assess and drive remediation for the entire organization or focus on critical components, such as cross-walk development, Vendor Compliance, Enterprise Data Warehouse adjustments and an analytics strategy for handling the ICD-9 and ICD-10 data.  Our expert’s effort doesn’t end with the remediation.  ICD-10 will bring a greater dimensionality to the diagnosis side of encounters and claims.  We can work with you to define a strategy for taking advantage of the greater granularity, which will present opportunities in the areas of cost management and reimbursement.  Our focus on ICD-10 adoption is not only driving your organization’s compliance, but enabling you to take advantage of the situation to identify and introduce improvements that will generate value for you and your external stakeholders.

 

Meaningful Use Stage 2 (and beyond)

Common themes of Healthcare Reform are patient engagement and information exchange with external stakeholders. Meaningful Use Stage 2, or MU2, reinforces that theme through Core and Menu measures that drive engagement, secure communication with patients, collaboration with other providers and an exchange of information with registries.  A cornerstone established with MU1 and continued by MU2 is the requirement that each organization track, monitor and report on their efforts to meaningfully use technology, along with certain quality measures where the impact of the technology and patient engagement should be seen over the years through incremental improvement.  Perficient can bring to bear interoperability, portal, secure messaging, HIPAA privacy and security and analytic solutions to enable your organizations compliance.  For large and heterogeneous health systems with multiple EHRs and a variety of other platforms and locations, we have the size, scale, know-how and delivery capability to help your organization succeed.

Whether your Stage 1 compliance efforts are just getting underway or are focused on Stage 2, Perficient has subject-matter and technology experts that can work with your technology and business teams to assess your organizations current baseline, define the compliant future-state, identify improvement opportunities, develop the strategy and roadmap to compliance and work side-by-side with your organization to execute and achieve Meaningful Use compliance.  

 

Accountable Care Organizations

Accountable Care Organizations (ACOs) are designed to bring together hospitals, physicians, other healthcare providers and the patient in a holistic approach to healthcare consumption.  The goal is to create a synergy amongst all following the basic tenets of healthcare reform through the sharing of information about the patient with all involved, maximizing care efforts, all working on a common plan of care with a focus on the long-term outcome.  The effect of doing so is a more efficient, thus lower cost, consumption of care by the patient.  The ACO can be comprised of a single, large provider organization, an association of many separate providers or a combination of the two.  Beyond the need to comply with the other aspects of healthcare reform, such as Meaningful Use, ACO organizations need to be able to consolidate information from across the group to meet a collective annual reporting requirement.

Perficient can work with the ACO to put in place the individual buildings blocks enabling each provider to comply with healthcare reform in general and work with the ACO and participating providers to deploy a mechanism that supports the consolidation, analyses and submission of their measures.  Beyond regulatory compliance, this analytics capacity can be leveraged by the ACO to further drive patient engagement and satisfaction, case/mix efficiencies, cost improvement opportunities and outcomes.

 

Data Privacy and Protected Health Information

Health Insurance Portability and Accountability Act (HIPAA) provides for the definition and appropriate use of an individuals protected health information or PHI via the Privacy.  In recognition of the use of technology in healthcare, HIPAA defines electronic PHI and what covered entities and business associates must do to secure and protect it via the Security Rule.  With the implementations of EHRs, HIEs, HIXs, private exchanges, portals, e-prescriptions, and others, electronic PHI is the norm throughout healthcare and with that comes a responsibility by all to protect it.  This includes conducting annual assessments of your security and compliance with 42 specific safeguards, covering Administration, such as policies and procedures, Physical, such as access to the workplace where PHI is commonly used, and Technical, such as encrypting PHI data at rest and on the move.  With healthcare reform requiring organizations to share PHI with external stakeholders through portals, HIEs, private exchanges, secure messaging, EDI and other means, security compliance has taken on new meaning.  We are hearing and reading stories of a covered entity losing a computer with PHI on it with more and more frequency.  It’s not a privacy issue or breach if your organization (and the lost device(s)) is HIPAA security compliant and can demonstrate it.  If you aren’t, then you are subject to scrutiny and fine by CMS, and are now open civil accountability and liability.  Perficient has experts that understand privacy, security and the particular requirements of HIPAA for both that your organization must comply with.