J U LY 2 0 1 9

A N M G M A R E S E A R C H & A N A LY S I S R E P O R T

Optimization of healthcare technology to improve patient engagementACTION STEPS AND BEST PRACTICES

TA B L E O F C O N T E N T S

Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Introduction: An environment for change . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

The technologies: The players in the game . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Patient portals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Automated appointment reminder systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Check-in technologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Telehealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Digital payment options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Data analytics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Real time prescription pricing tools and electronic prior authorization . . . . . . 16

Next steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Conversation starter for your team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Dos and don'ts of new technology implementation . . . . . . . . . . . . . . . . . . . . . . 18

Research methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

MGMA 2018 Exploratory Survey on Healthcare Technology . . . . . . . . . . . . . . . . . . . . . . . . .20

MGMA healthcare technology qualitative interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

MGMA Stat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Click on the sections below to navigate directly to each part of the report.

© 2019 MGMA. All rights reserved.3

Executive summary

The MGMA 2018 Exploratory Survey on Healthcare Technology found the following technologies had the most positive impact

on healthcare organizations in recent years: patient portals, automated appointment reminder systems, check-in technologies,

telehealth, digital payment options and data analytics.

These six technologies can have profound impacts on both patient engagement and practice workflow. Implementing check-in

technologies that make sense for a practice's unique patient demographics, for example, can reduce the administrative burdens

and delays of processing paperwork, and simultaneously improve patient experience. While cost and adoption challenges still

exist, these technologies can lead to more efficient and effective care delivery when implemented strategically.

This report provides a point of entry into these and other patient-focused, healthcare technologies allowing practice leaders to

expedite technological improvements via these five steps:

1. Examine current practice environment to uncover opportunities for automation.

2. Review existing technologies to determine how they address patient engagement challenges.

3. Uncover best practices and common mistakes from peers.

4. Identify the top three “easy wins” to pursue to achieve greater patient engagement through technology.

5. Start the conversation among stakeholders and initiate change in a practice.

4© 2019 MGMA. All rights reserved.

INTRODUCTION:

AN ENVIRONMENT FOR CHANGE

Patient experience is influenced before, during and after each visit by how providers and staff use technology to engage patients. For customer-centric, value-based

care, building a data platform that helps practices

enhance patient engagement allows providers to

focus on what they do best — care for people.

Increased patient consumerism encourages practices to enhance their technological capabilities. Rising costs of patient care, especially administrative costs, can be mitigated with the appropriate technology. More important, patients can build closer relationships with their provider and practice staff when interactions such as portal messaging or filling out forms are digitized, freeing up time and space for building rapport and engagement.

With these pressures on the patient-provider experience, technology companies have revved up their offerings to create opportunities to enhance the patient experience. Payers expect patients to report a level of satisfaction commensurate with value-based care guidelines. Technological enablement will help

practices compete effectively in the marketplace. A survey of nearly 650 healthcare consumers found that the digital consumer experience is of high priority.i They’re engaged in their own care via mobile and online technology more than ever: An engaged digital consumer remains a top 10 challenge in the 2018

Healthcare Executive Group (HCEG) survey. Moreover, healthcare leaders surveyed in the most recent HCEG

poll shared a determination to explore how digital health solutions can help respond to consumer needs and improve the patient experience pre-, during and post-visit.

© 2019 MGMA. All rights reserved.5

THE TECHNOLOGIES: THE PLAYERS IN THE GAME

Who is focusing on technology? The majority of healthcare leaders. According to a 2018 MGMA Stat poll, 59% of healthcare organizations invested in technology to improve patient engagement in the past year alone.

AUGUST 21, 2018 POLL 1,125 APPLICABLE RESPONSES OUT OF 1,152 TOTAL RESPONSESMGMA.COM/STAT #MGMASTAT

IN THE PAST YEAR, HAVE YOU INVESTED IN ANY TECHNOLOGY TO IMPROVE PATIENT ENGAGEMENT?

59% YES

36% NO

5% UNSURE

Another MGMA Stat poll shows that 70% of healthcare leaders plan to adopt such technology in 2019 to make their practices more efficient.

IN 2019, WILL YOU ADOPT TECHNOLOGY TO MAKE YOUR PRACTICE MORE EFFICIENT?

NOVEMBER 27, 2018 POLL 1,050 RESPONSESMGMA.COM/STAT #MGMASTAT

TOP 5 TECHNOLOGIES

• NEW/UPGRADED EHR• KIOSK/IPAD CHECK-IN• TELEHEALTH• PATIENT PORTAL• AUTOMATED

REMINDER SYSTEM

YES70%

NO11%

UNSURE19%

These patient-focused investments often are based on competitive pressure to keep up with early adopters and for each specialty’s marketplace norms.

“Healthcare information technology platforms have changed how healthcare services are offered, thereby creating a diverse set of technological healthcare delivery models.”ii Patients must have access to the level of technology they are rapidly coming to expect when they contact your practice and interact with your teams prior to a visit. These six areas of

technology remain the most applicable to this outcome: patient portals, automated appointment reminder systems,

check-in technologies, telehealth, digital payment options, data analytics.

6© 2019 MGMA. All rights reserved.

PATIENT PORTALS

In 2017, Mainstreet Pediatrics opened in Parker, Colorado, with a commitment to having a “100% digital office.” A key reason for

making this commitment had to do with honoring the area’s demographics and their approach to healthcare.

Prior to opening the practice, Lorri Phipps, DNP, CPNP-PC, owner of Mainstreet Pediatrics, conducted a survey of the community

and discovered a millennial-heavy population in Parker and the surrounding area. This discovery provided a solid business case

for implementing a patient portal and creating a seamless digital experience.

Phipps searched for an end-to-end EHR solution to ensure medical chart management, billing, practice management and all

other processes were integrated with the patient portal. After reviewing their options, one company’s offering seemed to suit all

their needs. It allowed parents to conveniently schedule appointments, access their children’s medical records, pay their bills

and communicate with providers and staff.

With Mainstreet Pediatrics being 100% digital from the start, patient portal adoption is high. When new patients arrive for their

first visit, front desk staff send parents the portal link via email or text message. Parents also have the option to sign up on-site

using the iPads available in the office.

But as with everything new, this technology was not without its challenges. One such challenge they discovered early on was

difficulty linking multiple children to a single family’s account within the portal. This caused both staff and family frustration until

the Mainstreet Pediatrics team created a new workflow process to address the issue.

CAN PATIENTS REQUEST/MAKE APPOINTMENTS THROUGH YOUR PATIENT PORTAL?

JULY 19, 2016 POLL 837 RESPONDENTS

FOR MORE INFORMATION, VISIT MGMA.ORG/POLLS.

40%YES,

REQUEST

23%NO

13%NO

PORTAL

11%YES,

BOTH

7%N/A

3%YES,

MAKE

3%NOT SURE

Keep in mind: Have your staff test-drive the technology prior to implementation and continue to do so on a regular basis to

understand your patients’ experience.

R E S O U R C E S

■ Read a recent MGMA interview with Austin Regional Clinic representatives: The portal to success: Optimizing technology

to increase patient access.

■ Dive into this Carolina Health Specialists case study: Developing a framework for patient engagement and

accountability.

■ Learn how patient-focused technology improves practice efficiency at Peachtree Park Pediatrics.

© 2019 MGMA. All rights reserved.7

AUTOMATED APPOINTMENT REMINDER SYSTEMS

In 2003, appointment reminder systems (ARS) for telephones began saving practice staff valuable time while reminding patients

of their appointments 24 to 48 hours prior to a visit. In these older systems, patients were prompted to call back if they had to

cancel their appointment. Vendors can now offer automated systems that prompt text message or voice-activated responses

that instantly provide scheduling changes to practice staff. In many automated systems, the patient is connected to a live

operator after cancellation to reschedule an appointment, helping to fill all available appointments, including same-day opening

opportunities, which have been proven to contribute to patient satisfaction. For Mike Milewski, MBA, executive director, Lake

Forest Pediatric Associates, Lake Bluff, Ill., identifying ways for staff to use ARS to refill cancelled appointment slots started

with picking the right system and training.

“First we spoke to the most impacted staff to uncover their suggestions to use ARS to improve workflow. We followed that with

a long process of evaluating vendors and systems that would incorporate into our EHR properly,” Milewski says. The team paid

special attention to change management processes for staff and patients, ensuring that an email blast introduced the new

system and additional front desk personnel were available to manage communication preferences and ease the transition.

According to a 2019 MGMA Stat poll, nearly 90% of healthcare leaders said their organizations use automated appointment

reminders. Such was the case with Lake Forest Pediatric Associates, as these reminders resulted in more rescheduled

appointments, adding to revenue while eliminating missed revenue from no-show appointments.

FEBRUARY 26, 2019 POLL 1,475 RESPONSESMGMA.COM/STAT #MGMASTAT

DOES YOUR ORGANIZATION USE AUTOMATED APPOINTMENT REMINDERS?

88% YES 11%

NO

1% NOT SURE

Keep in mind: Take time to train staff prior to implementing the system, review vendors thoroughly and speak to practices that

use the system before investing in the technology.

Automated appointment reminder

systems keys to success:

#1 Engage key staff at the vendor review stage.

#2 Evaluate systems in relation to ease of integrating with an existing EHR. Make sure you can modify after initial implementation.

#3 The practice IT manager must work closely with the vendor and your EHR technician to ensure information is accurate and secure, and patient privacy is maintained.

R E S O U R C E S

■ Read more about how text message appointment reminders

can contribute to patient scheduling success.

■ “No-shows hurt patients as well as healthcare providers.” Learn

how an automated appointment reminder system can help.

■ Discover what one clinic learned from a year of texting

patients.

■ Explore strategies for improving appointment scheduling,

increasing patient portal adoption, reducing appointment wait

times and staffing for optimal patient access in Maximizing Patient Access & Scheduling, an MGMA Research & Analysis report.

8© 2019 MGMA. All rights reserved.

CHECK-IN TECHNOLOGIES

Online, kiosk and/or iPad/tablet check-in options have become

increasingly used by practices because they avoid the dreaded

clipboard and pen lag time, especially when patients do not show up

earlier than the scheduled appointment. During check-in, front desk

teams greet and guide patients to a kiosk where they can sign financial

responsibility and other forms and staff can flag patients who need

to re-sign or input new health insurance information. Joy Schwartz,

RN, DNP, MBA, HCA, office administrator, Atlantic Surgical Group,

Oakhurst, N.J., says her practice had more than a dozen documents for

new patients to sign. iPad tablets tethered to the waiting room seats

were integrated to EHR systems and prompted each patient for the

appropriate updates — freeing front desk staff to expedite check-in.

Patients can also log into patient portals prior to their visit to

preregister via their tablet, laptop or cell phone. Schwartz reports

75% patient uptake for preregistration vs. 20% of patients completing

registration when they come in for their visit. Patient engagement has

skyrocketed, and the system enabled the practice to implement an

electronic billing system, meaning more payments collected in a

timelier fashion.

Preregistration and in-office tablets helped the practice save money and freed staff from time-consuming paperwork

review and revision. They now focus on their patients, which has improved the practice-patient relationship. Patients

who preregister report feeling empowered and can get help from friends or family if they’re unable to use the system

themselves. The system itself will kick out missing or illegible fields until they are complete, resulting in more complete records

overall. Then, data analytics from the system provides insight and prompts staff to make additional improvements for better

usage statistics. Additionally, capturing patient medical information during preregistration can provide a more complete and

accurate look at medical history and medication, leading to improved patient care.

Within six months, 75% of patients preregistered online for visits, creating more complete forms and allowing

the practice to quickly incorporate electronic billing, resulting in a better bottom line .

Keep in mind: Develop a plan to address issues that may pose barriers to check-in technology adoption. Issues may include:

■ Privacy concerns as others may be able to see the entries on the iPad or kiosk

■ Technical barriers with patients who may not be comfortable using the new system

■ Maintenance costs of tablets/kiosks

■ Wi-Fi connectivity and security issues, especially in many rural settings

Schwartz also cautions that the testing and implementation phase must be carefully managed, as they can determine the

success of the integration. “Take your time,” warns Schwartz. “Don’t move forward until key stakeholders are totally satisfied and

have approved the new workflow process.”

R E S O U R C E S

■ Learn effective and simple patient registration best practices, as outlined by Kenneth T. Hertz, FACMPE, consultant,

MGMA Consulting.

■ Read “End of the line: Implementing patient registration kiosks” by Christie L. Dando, FACMPE, in MGMA Connection

magazine, March 2019.

■ Consider how healthcare kiosks can improve care delivery.

Check-in technologies keys

to success:

#1 Create a strategy for communicating to patients about the new process. Many vendors can help.

#2 Keep your super-user community front and center as the audience you need to please. These key stakeholders and the patients they serve will be interacting most frequently with the technology and should be solidly on board.

#3 Talk to a practice similar to your own that adopted the technology you are reviewing to find out what they would have done differently and what they suggest you replicate.

© 2019 MGMA. All rights reserved.9

TELEHEALTH

At one week old, Avery Griffiths was alarmingly sick — in severe circulatory distress — and rushed to the emergency room at

Sonora Regional Medical Center, Sonora, Calif. The transport team from UC Davis Children’s Hospital, where she could receive

specialty care, was two hours away.

Sonora’s Donald P. Dudley, MD, emergency medicine, and Kelley W. George, MD, pediatrics, used a telehealth cart at their

facility to connect with Francis Poulain, MD, pediatric neonatologist and associate professor, pediatrics, UC Davis Health, who

was working via laptop at his home.

In the time it would have taken the transport team to arrive, Poulain worked with the providers at Sonora to evaluate

Avery and begin treating her ailment, offering what all providers agreed was life-saving care.

Jim Marcin, MD, MPH, director of pediatric telemedicine and interim director, Center for Health and Technology, UC Davis Health,

has practiced pediatric critical care medicine since 1998 and has used telemedicine in his clinical work since 2000.

While the UC Davis telemedicine program first was intended to provide nonurgent, outpatient subspecialty consultations to rural

and underserved clinics, the clinical programs developed out of the needs and opportunities determined by the different clinical

departments. For example, the obstetrics and gynecology department started with remote fetal monitoring while the pediatrics

department started with critical care tele-emergency consultations to sick children in rural emergency departments. The

pediatric tele-emergency program network now includes more than 30 emergency departments throughout northern California.

The key uses of the telehealth program were for outpatient specialty consultations and remote consultations to keep patients in

their local communities. Marcin says that a pediatric endocrinology patient may travel five hours one way to see the specialist.

The ability for the specialist to connect with those patients and check a glucometer remotely has positive outcomes for the

patient in addition to decreasing emergency department utilization, decreasing patients’ reported A1C levels and improving care

against national benchmarks.

“You’re doing it to keep patients in their own clinics and out of the hospital, as well as [offering] a service to

referring practices, which provides marketing and a competitive edge. Working with other clinics and hospitals

strengthens a relationship with that hospital,” Marcin says.

WILL YOU OFFER TELEHEALTH SERVICES IN 2019?

FEBRUARY 19, 2019 POLL 1,220 RESPONSES

MGMA.COM/STAT #MGMASTAT

29%CURRENTLY

DO

17%PLANNING

TO

35%NO

19%UNSURE

10© 2019 MGMA. All rights reserved.

Keep in mind: Integrating telehealth into existing processes is a key

method to increase provider buy-in: The less change to implement, the

better. It also helps to understand which areas will be the easiest to add

telehealth services. Mental health often is an easily achieved, one-on-

one encounter, whereas multidisciplinary encounters such as diabetes

management are more difficult to implement via telemedicine because

of the number of providers, support staff and testing required.

R E S O U R C E S

■ The above was an excerpt from Telehealth: Adoption + Best Practices, an MGMA Research & Analysis report. Download the

full report to learn how to plan, implement and bill for telehealth

services, understand the operating requirements and billing

and reimbursement guidelines to ensure successful adoption of

telehealth services.

Telehealth keys to success:

#1 Review your reimbursement options.

#2 Consider how telehealth might apply to your specialty and current workflows.

#3 Understand your patient demographics. Practices with a largely rural and/or tech-savvy patient population may find telehealth offerings especially effective.

#4 Pilot the technology with one physician before investing in the technology for the entire practice.

© 2019 MGMA. All rights reserved.11

DIGITAL PAYMENT OPTIONS

It’s estimated that multispecialty practices collect only slightly more than half of accounts receivable (A/R) within 30 days and that

up to two-thirds of physician practice revenue is lost because of billing leakage.iii Digital payment options can permit practices

to close the gap between A/R and receiving payment directly from the patient. About two years ago, Roger Hovis, operations

manager, El Paso Pediatrics Associates, and his team implemented digital payment options for patients via credit card on file

(CCoF) pages in their patient portal. After working with the new portal payment process, the front desk freed up the

payment bottleneck they’d been experiencing as well as reduced seasonal A/R via mail, thanks to taking payment up

front via credit card as well as offering payment options on the portal.

In doing so, Hovis and his staff left the increasingly expensive paper trail for payments behind. In the 2018 Advisory Board

Research Annual Health Care CEO Survey, 58% of providers reported that paper statements were still the primary method

of collecting payment from patients. This “reliance on an outdated way of billing may be a major contributor to why 73% of

providers report that it takes longer than 30 days to collect from patients.”iv Further, most respondents in a 2017 MGMA Stat poll indicated that they collect a combination of payments up front (59%) to include copay (98%), deductibles (78%) and major

procedure estimates (54%).

COMBINATION

59%

COPAYS ONLY

34%

NOTHING

5%

DEDUCTIBLE ONLY

1%

MAJOR PROCEDURE ESTIMATE ONLY

1%

WHAT DO YOU COLLECT UP-FRONT?

98%

78%

54%

COPAYS DEDUCTIBLE MAJOR PROCEDURE

ESTIMATE

APRIL 4, 2017 POLL 1338 APPLICABLE RESPONSES OUT OF 1434 TOTAL RESPONSES.

FOR MORE INFORMATION, VISIT MGMA.ORG/POLLS.

“We have gained the ability to turn each wait station into a credit card processor,

which helped us reduce overhead we spent ‘chasing the money’ every month,”

Hovis says. He counsels practices to take their time while preparing for implementation.

Time well spent means everyone is included in the process of creating new workflows

for the payment system. The practice also conducted extensive research into the

bottom-line benefit of the portal payment option to gain buy-in. Payments automatically

post into the billing platform, removing personnel from manually posting into the system.

Parents of the patients report that they like to sign up directly through the portal

at home — it’s convenient and they appreciate being able to pay bills without

opening mail or mailing checks.

“We promoted the portal heavily with patients, who ended up really liking that they had

their kids’ vaccination records and other medical data such as refill requests in one

place,” Hovis says.

Today, 75%-80% of families in their pediatric practice have an account. They have such

high patient adoption, they plan to include check-in options on the portal soon, as well.

Hovis reports that the patients in his practice were eager to use digital bill payment.

They’re not alone: “Consumers are seemingly ready for healthcare to jump on the

digital revolution. While 79% of consumers still receive a paper medical bill, only

21% of consumers want to use checks to make healthcare payments.” v

Digital payment options

keys to success:

#1 Heavily promote the portal among patients for high adoption rates.

#2 Research workflows carefully and use change management best practices to ensure staff buy-in.

#3 Offer additional reasons patients would want to visit the portal, for vaccination and prescription refills, for example, to help with uptake in portal payments.

12© 2019 MGMA. All rights reserved.

PRACTICE SPOTLIGHT: PATIENT BILLING GAINS GROUND IN SATISFACTION, REVENUE

Westmed Medical Group, managed by Westmed Practice Partners, was tracking many billing-related complaints and questions on its patient relations service hotline. In the age of the empowered consumer, Westmed recognized that providing the best patient experience required new, updated payment methods. They evaluated multiple vendors and chose Cedar, a patient payment and engagement platform powered by machine learning to deliver a personalized, convenient digital experience. “We were very focused on choosing an innovation partner we could trust — one who was willing to incorporate our changing needs into their technology,” said Vicki McKinney, COO, Westmed Practice Partners.

Key Benefits and Features

■ Personalized communication driven by machine learning creates greater likelihood to engage: Once a claim is processed and the patient balance is identified, patients receive customized payment notifications and reminders about what they owe via their preferred method — email, text or a traditional paper statement. Algorithms are continually refined to ensure optimal outreach methods based on patient preferences and past behavior.

■ Patient-centered interface delivers a better, faster payment experience: Once patients are on the online bill-pay platform, they are able to view all items and services for their visit, as well as for other authorized family members associated with their account, all on one easy-to-read screen. Confusing billing codes are translated into clear human language, and patients can choose to pay the full amount using a variety of secure payment methods or click on a customized payment plan.

■ Online chat feature provides real-time support for patients: Westmed patients utilize the live chat functionality to get quick answers to their questions, helping to speed up the payment process and alleviate call center burden.

Results

After a successful pilot in spring 2018, the Cedar solution was rolled out to Westmed’s entire patient population. Patient satisfaction, online adoption rates and collection rates continue to surpass benchmark goals.

■ 95% patient satisfaction

■ 67% patient payments made digitally

■ 44% reduction in time to collect (from 39 to 22 days*)

“It’s important to remember that the patient experience extends beyond office visits and hospital stays. Unpleasant billing experiences can greatly impact patient satisfaction and revenue, so you want to make the process as easy and transparent as possible,” says McKinney.

*22 days to collect represents Q1 2019 average

Keep in mind: Practices that don’t have the staff to fully promote digital payment options will take longer to reap the benefits of

the new system. Some technology vendors have low-rated support for their solutions, are too expensive for smaller practices

(they only sell platform-based payment technologies with proprietary tech) or do not support debit payments. In addition, some

patient groups are wary of CCoF options due to highly publicized data breaches.

R E S O U R C E S

■ Explore the Eighth Annual Trends in Healthcare Payments Report.

■ Uncover opportunities in patient billing by examining the following areas: patient payment responsibility, transparency

and flexibility.

■ Listen to Sheila Augustine, director, patient financial services, Nebraska Medicine, Omaha, N.E., and Wendy Hanson,

support manager, Nebraska Medicine, Omaha, N.E., discuss how new patient financing options have improved patient

experience in the MGMA Industry Insider podcast: Utilizing patient financing to drive patient experience.

■ Read HIMSS19 practice insights: Deirdre Ruttle on convenient patient payment options.

■ Deliver a modern patient billing experience by taking cues from other industries.

© 2019 MGMA. All rights reserved.13

DATA ANALYTICS

When back-office decisions are enabled by a stream of actionable,

front office data, practices can uncover opportunities to enhance

the patient experience, uncover cost-saving opportunities in their

patient flow processes and increase employee morale. Wendy Disbrow,

MBA, RN, CMPE, vice president, physician network, Finger Lakes Health,

Geneva, N.Y., and her team understand the importance of data in powering

decision-making from experience. While completing certification as a

patient centered medical home (PCMH), Disbrow identified a need to

increase same-day appointment availability. After analyzing appointment

data from their EHR, she realized that while her providers' schedules were

booked each week, the practice was also experiencing high cancellation

and no-show rates. Disbrow knew they needed to make improvements to

their provider scheduling processes to streamline day-to-day operations

and better serve their patients. To address this need, she generated a

"prospective tool" in Excel to plan her providers' schedules and capacity as

far as one to two weeks in the future. The practice's front desk staff began utilizing the tool for scheduling patients and cancellations,

which has resulted in a dramatic improvement to balanced workloads and increased appointment availability for patients.

For many, data analytics might include everything from Excel spreadsheets to specially programmed technologies that capture

utilization hours and patient satisfaction metrics and help forge a clear path for using this information to improve practice

operations. Disbrow and the practices within Finger Lakes Health experienced increased patient satisfaction and more

consistent patient care as well as employees and providers reporting a more balanced workload and additional job satisfaction.

Data analytics keys to success:

#1 Create data programs to solve practice-specific issues such as same-day cancellations and provider scheduling.

#2 Have regular meetings with staff to review key performance indicators tracked by your analytics work.

#3 Find ways this technological enablement can grow into other programs that improve patient engagement such as portal technology.

REVENUE IMPROVEMENT WITH ANALYTICS YOU ALREADY HAVE

MGMA interviewed Nate Moore, CPA, MBA, FACMPE, president and chief executive officer, Moore Solutions Inc . Nate provides helpful tips on how to get started with data analytics .

Q: What types of data do you recommend collecting to analyze appointments?

A: A primary data point I concentrate on is unsold appointments. It’s key to regularly collect and report on this because in some systems, data is purged every thirty days. This metric should be tracked by provider, location, day of the week and appointment type to allow you to focus your efforts effectively and find a solution to this common issue.

Q: What is the best method to collect this data?

A: Your practice management (PM) system should do this— ask your IT team to help you find where the data is pulled and stored in the system.

Q: What should practices invest in, technologically speaking, to be able to collect and analyze data?

A: Most of this will be standard in your existing PM so an additional software investment is often not necessary. In the beginning, you may have to pay an external consultant to help you learn how to build and run reports to accurately capture the data that will help you solve problems moving forward.

Q: How can I calculate an ROI for an appointment analytics program (by slot fills and other metrics)?

A: Whether a patient shows up or not, you’re still paying the nurse the same amount and you pay the same rent. Because your expenses are fixed, even improving slot fills by one to two patients a day can substantially improve your bottom line.

Q: What are the best tips to achieve executive buy-in to get them to sign off on improved data analytics resources?

A: When doctors get their hands on the reports, they’re able to make decisions based on data. Show the doctors the data you have collected and the resulting improvements in patient access and the practice bottom line. Once providers see good data leading to good decisions, more reports will follow.

Q: “Predictive analytics” can be an intimidating term. What would you suggest practice managers frame these

activities as to make it easier for everyone involved?

A: Crawl before you walk! Don’t start anything too scientific at first — there are plenty of data points in the PM system to capture at first that show practical results. Then “play” with the data, slice it, dice it. Pivot tables are one way to analyze the data. You’ll uncover opportunities being extremely focused, first. Then, widen the net.

14© 2019 MGMA. All rights reserved.

Keep in mind: Plan to work closely with providers and staff so they understand the purpose of integrating a data analytics

system and feel engaged in the process.

R E S O U R C E S

■ Read “Leveraging machine learning for value-based operations” by Mel Gunawardena in MGMA Connection magazine,

March 2019.

■ Listen to Nate Moore, CPA, MBA, FACMPE, president and chief executive officer of Moore Solutions Inc., explain how

practices can improve operations and profitability in the MGMA podcast Executive Session: Getting the data you need

for better decision-making.

■ Read how Physician Sentiment to EHRs and Analytics Improves with Use.

■ Learn how to track, trend and triage open appointments.

■ Read the MGMA best-selling book: “Better Data, Better Decisions: Using Business Intelligence in the Medical

Practice,” by Nate Moore and Mona Reimers.

© 2019 MGMA. All rights reserved.15

REAL TIME PRESCRIPTION PRICING TOOLS AND

ELECTRONIC PRIOR AUTHORIZATION

When a health information network joins forces with EHR vendors,

pharmacy benefit managers (PBMs) and health plans to provide real-

time benefit tools (RTBTs) and prior authorization, both practices and

patients benefit. These tools deliver patient-specific benefit and pricing

information to prescribing clinicians in real time at the point of care.

Once integrated with the EHR, the solution also displays therapeutic

alternatives so that the prescriber and patient can collaborate in selecting

a medication that is both clinically appropriate and affordable.

The data is supplied directly from PBMs and health plans to ensure

accurate, up-to-date, patient-specific cost, coverage and therapeutic

alternative information. As the information is coming from the PBM, it

calculates the patient’s specific benefit copay and where they are in their

deductible for the year. RTBTs determine immediately if the medication

requires a prior authorization (PA) and, if it does, solutions may support

a real time electronic PA transaction. Practices deploying RTBTs can

improve patient satisfaction by eliminating surprises at the pharmacy and

improving medication adherence. Practices can decrease administrative

costs by reducing pharmacy callbacks and streamlining the PA process.

Case study: Charlotte Dermatology

Practice leaders at Charlotte Dermatology, with 50 employees in the

practice, knew their patients wanted medications they can afford, says

Gary B. Slaughter, MD. “They’d find out how much their prescription cost

only when they arrived at the pharmacy, which is thankfully changing,”

Slaughter says. “We had patients who would have sticker shock at the pharmacy counter if the cost was too high — they’d either

abandon their prescription or they’d change the prescription at the pharmacy counter.”

The problem could go unnoticed because clinicians know cost is important but “it’s challenging to navigate how much it will cost

or where the patient should go to fill their prescription,” Slaughter says.

Toward the end of 2018, the practice began using a prescription pricing tool built into the EHR it uses.

“Now we can see how much the prescription costs right … at the point of prescribing,” Slaughter says. “It is better for me as a

prescriber and saves both time and money for the patient.”

Slaughter says the practice has had a positive experience with this EHR tool, and that it has the potential to influence how

patients choose a provider. “For patients who can pick Dr. A, who uses a prescription price transparency tool, or Dr. B, who

doesn’t … the patients are picking Dr. A,” he says. To that end, Slaughter says he’d like there to be greater awareness that a

prescription price transparency tool exists for providers. “It trumps dealing with prior authorization at the pharmacy counter,”

Slaughter says.

RTBTs also allow clinicians to have more meaningful conversations with their patients, with patients feeling more

engaged and involved in their care by reviewing treatment options directly with their clinician during the encounter.

Keep in mind: On May 16, 2019, the Centers for Medicare & Medicaid Services issued its final rule: Medicare Advantage and

Part D Drug Pricing Final Rule (CMS-4180-F). The rule requires that by Jan. 1, 2021, each Medicare Part D plan adopt one or more

RTBT capable of integrating with at least one prescriber’s ePrescribing system or EHR. With this regulation in place, the hope is

that most if not all payers will support RTBT, making it easier for vendors to offer comprehensive solutions and practices to take

full advantage of this automation opportunity. For a full review, visit Federal Government Issues Final Rule: Part D Plans Must

Adopt a Real Time Benefit Tool.

Considering the implementation

of a prescription pricing tool?

■ Ask these questions from your

EHR vendor:

– Do they offer a RTBT?

– Is the solution built into the workflow?

– Does it provide therapeutic alternatives?

– Does it provide electronic prior authorization service?

– What payers does the solution support?

■ Review your payer mix to determine if

the product is a good fit

■ Assess the cost: are technology/

software upgrades necessary?

■ Network with MGMA peers on

the MGMA Member Community

to learn more about the benefits,

implementation process and cost

16© 2019 MGMA. All rights reserved.

Next steps

While you may not be ready to implement new technologies such as AI and blockchain, chances are you are using or evaluating technological solutions (e.g., automated appointment reminder system, EHR, patient portal, check-in kiosk, etc.) in your medical practice. Do any of these current technologies lend themselves to “add-ons” or provide direction in exploring new resources to build upon their positive outcomes? For example, new EHRs with billing capabilities can feed into a new data analytics program to tighten financial processes and provide insight into patient billing revenue/patient engagement opportunities.

What are your top three patient experience and practice efficiency challenges and which technologies will provide the best answer to these?

Conversation-starter for your team

Follow these steps when using the scoring table below. Take the time to thoroughly vet your needs with super-users and all stakeholders by having these conversations. This can help improve patient experience and technological enablement and take your practice to the next level.

1. Invite high-level leaders to liaise with managers/supervisors from the front desk, as well as other patient-facing individuals to discuss this report.

2. Have them identify key reasons why your practice would benefit from one or more of these technologies (or, if you have a form of these technologies that is not working as it should or is not aligned to your workflow, processes and goals, where you need to upgrade/retool the existing technology).

3. Create a workgroup to oversee vendor review, project management and solution implementation.

4. Score each category from 1-5 (where 5=highest, 1=lowest) and select the highest scores to provide possible entry point into one or more technologies.

TECHNOLOGY CHALLENGE1-5

(pain points to relieve)

CURRENT STATE

1-5(how close

to new implementation or in a current

satisfactory state)

CHANGE MANAGEMENT

1-5(not difficult

to adopt via user barriers/training/

resources)

PATIENT ENGAGEMENT TO SOLVE FOR

1-5 Perceived chance

for patient improvement

potential

FINANCIAL OPPORTUNITY

1-5 Best way to keep costs

under control

TOTALS:High score

first technology to implement

Patient portals

Automated appointment reminder systems

Check-in technologies

Telehealth

Digital payment options

Data analytics

© 2019 MGMA. All rights reserved.17

NEED HELP GETTING STARTED?

■ Network

– MGMA Member Community: Connect and share information with peers in the MGMA Member Community.

– MGMA Events: Learn and experience more from healthcare industry experts, peers and vendors at our conferences, networking events and webinars.

■ MGMA experts

– Government Affairs: Interact directly with the MGMA Government Affairs staff who have expertise in the details of federal legislative and regulatory issues and their effect on group practices.

– MGMA Consulting: Partner with MGMA Consulting to find a solution to your toughest challenges.

– Ask an Advisor: Ask our team of experts for answers, recommendations and tools you need to be successful.

DOs

DON’Ts

DO prioritize change management — explain the necessity to cross-train for each technology. Make

sure staff is comfortable talking to and training patients on

the technology.

DON’T worry about starting small — you can grow with

most technologies.

DO build time for pre-tech user engagement — allow input, create

open-ended meetings to share issues (without supervisors/with supervisors)

to ensure staff is encouraged to provide honest feedback.

DON’T downplay the cost of implementation — get solid

numbers and add one-third (home improvement projects model).

DO walk before you run — superusers must gain mastery of first-gen functions in any

solution prior to expanding its functionality. While deciding on which technologies to implement, identify your top three needs and leave room to fail and switch tactics.

DON’T wait to do at least one project —use this report to

pick the simplest effort for the most impact.

DOs AND DON’Ts OF NEW TECH IMPLEMENTATION

18© 2019 MGMA. All rights reserved.

MGMA thanks Cedar for their generous support in helping us deliver this Research & Analysis report .

About Cedar:

Cedar is a patient payment and engagement platform for hospitals, health systems and medical groups that elevates the

total patient experience beyond clinical care. The platform leverages advanced data science, machine learning and smart

segmentation to deliver modern intelligence and simplify the healthcare experience for patients. Learn more at cedar.com.

© 2019 MGMA. All rights reserved.19

1 . What is your organization’s specialty?

2. Which technological solutions have had the greatest positive

impact on your organization in the last five years? (Select up to three)

¡ Telehealth/virtual visits

¡ Check-in kiosks/tablets

¡ Data analytics

¡ Online patient portal

¡ Online appointment scheduling

¡ New EHR or PM systems

¡ Automated appointment reminder system

¡ Text message communication with staff and/or providers

¡ Improved cybersecurity

¡ Digital patient payment options

¡ Other (Please specify)

3. Please explain how these solutions have positively impacted your organization. (open ended)

MGMA 2018 Exploratory Survey on Healthcare Technology

Questions for the online survey were developed by MGMA. The target population was healthcare leaders who had

implemented a patient-focused technology in the last five years. The survey launched on Nov. 19, 2018, and closed

on Nov. 30, 2018. The survey was completed by a total of 79 healthcare leaders in the United States. Of this total,

37 were willing to participate in a follow-up qualitative phone interview on the topic.

Research methodology

20© 2019 MGMA. All rights reserved.

4. What is your level of awareness of the following technological solutions in a healthcare setting?

NOT AWARE SOMEWHAT AWARE VERY AWARE

Machine learning/artificial intelligence (AI)

Blockchain

Internet of Medical Things (IoMT)

Patient-generated health data (PGHD)

Predictive analytics

Remote patient monitoring

Of the technological solutions listed above, which are you most interested in learning more about?

¡ Machine learning/artificial intelligence (AI)

¡ Blockchain

¡ Internet of Medical Things (IoMT)

¡ Patient-generated health data (PGHD)

¡ Predictive analytics

¡ Remote patient monitoring

¡ Other (Please specify)

5. What is it about this topic that interests you? (open ended)

© 2019 MGMA. All rights reserved.21

MGMA healthcare technology qualitative interviews

Questions for the qualitative interviews were developed by MGMA. The target population was healthcare leaders

who had implemented a patient-focused technology in the last five years. Interviews were selected from the MGMA

2018 Exploratory Survey on Healthcare Technology, some were recommendations from MGMA’s subject matter

expert team and the remainder were selected based on their presence in the media or on their successes in

the industry.

The qualitative interviews were conducted from December 2018 to January 2019 by MGMA’s research and editorial

teams over the phone or in person.

Discussion guide

1. What interested you in this project?

2. What was your motivation for deciding to implement this specific patient-focused technology?

¡ How did you implement this technology into your practice?

– Where did you start? What were the major milestones?

¡ What was the impact of implementing this technology? (on patients, providers, staff, organization operations and financials)

¡ How do you measure the impact?

3. Can you share some lessons from going through this process (of implementing and working with patient-focused

technologies)?

¡ Did you have to overcome any burdens or pushback from staff? How did you achieve this?

4. Do you have any plans to utilize this technology differently in the near future?

5. Are there any other technologies you are looking into?

¡ What future technologies would you like to create an ideal state for how a medical practice functions? (Full computer automation for scheduling and revenue cycle, advanced AI, new diagnostic/treatment tools and equipment, etc.)

¡ If so, what are the drivers and what do you hope to achieve?

6. How do you stay informed of new/emerging technologies?

7. What resources/information could MGMA provide about patient-focused technologies that would be useful for your

organization and similar organizations?

22© 2019 MGMA. All rights reserved.

MGMA Stat

In addition to the aforementioned survey and interviews, MGMA also conducted polling research on the topic of healthcare

technology through MGMA Stat, a text message-based polling initiative. At the time of this research, the MGMA Stat participant

panel was composed of about 4,300 healthcare leaders across the United States. Polls that contributed to the report include:

■ In the past year, have you invested in any technology to improve patient engagement? (Aug. 21, 2018)

■ In 2019, will you adopt technology to make your practice more efficient? (Nov. 27, 2018)

■ Can patients request/make appointments through your patient portal? (July 19, 2016)

■ Does your organization use automated appointment reminders? (Feb. 26, 2019)

■ Will you offer telehealth services in 2019? (Feb. 19, 2019)

■ What do you collect up front? (April 4, 2017)

i Heath S. “What Do Patients, Consumers Want in Digital Health Tools?” Patient Engagement HIT. July 12, 2018. Available at: bit.ly/2zzkMBw.

ii Alvarado, Adiel. The Evolution of the EHR in Medical Practice. MGMA. May 21, 2018. Available at: bit.ly/2Dg9DFe.

iii “Medical practices facing woeful collection rates.” Bravado Health. February 13, 2017. Available at: bit.ly/2PiRxan.

iv Seib, Chris. “Healthcare can no longer afford to resist the digital revolution.” MGMA. Available at: bit.ly/2DiVXJL.

v Ibid.

©2019 MGMA. All rights reserved. No part of this document may be reproduced, stored in a retrieval system or transmitted in any form or by any other means — digital,

electronic, mechanical, photocopying, recording or otherwise — or conveyed via the Internet or a website without prior written permission from the Medical Group

Management Association.

Access all MGMA Research & Analysis reports: mgma.com/research-analysis.