News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
Sign In

Pew and Massachusetts eHealth Collaborative Find the Frequency of Patient Mismatches Exceeds ‘Desirable Levels for Effective Data Exchange’

EMPIs may help clinical laboratories ensure their patients and medical records are properly matched with medical laboratory test results and specimens

Mix-ups between patients and their medical records, known in the healthcare industry as “patient mismatching,” happen far too frequently in hospitals and clinics worldwide. When surgery is involved, such mismatches can lead to deadly errors. However, clinical laboratories and pathology groups also must take steps to ensure patients, their medical records, and their biological specimens remain properly matched.

Once horrific incident in 2016 involved Saint Vincent Hospital in Worcester, Mass. Believing they were operating on a patient with a kidney tumor, surgeons mistakenly removed a healthy kidney from the wrong patient. The cause of the patient mismatch was a mix-up with CT scans. The two patients shared similar names, Managed Care reported.

Sadly, patient mismatching is not a new or rare problem. Patient mismatches often lead to delays, extra costs to fix duplicate information, and tragically, unnecessary surgery and inappropriate care, Healthcare Dive noted.

According to Managed Care, organizations working on solutions include:

Extent of Patient Mismatching Unknown

A recent study by Pew Charitable Trusts (Pew) in collaboration with the Massachusetts eHealth Collaborative (MAeHC) revealed that the rate of patient mismatching is difficult to measure.

“Incorrect matches could result in patients getting the wrong medicine, and failure to link records could lead to treatment decisions made without access to up-to-date laboratory test results,” Pew noted in an issues brief.

Pew and the MAeHC interviewed 18 hospital, medical practice, and health information technology exchange leaders. The respondents admitted that they are uncertain about the extent of the matching problem.

“They don’t know all the records that should be related and thus cannot understand what percentage of those are unlinked,” the researchers wrote.

Nonetheless, the researchers found that patient/record match rates fall “far below the desired level” for effective data exchange among organizations, Healthcare Dive reported. 

For pathologists and clinical laboratory managers, the Pew/MAeHC study had several key takeaways, such as:

  • “Match rates are far below the desired level for effective data exchange.
  • “An increased demand for interoperability—the exchange of electronic data among different systems—is fueling the desire for improvements.
  • “Match rates are difficult to measure.
  • “The methods in which records are received can affect match results.
  • “Different types of healthcare providers vary in their perspectives on the extent of the problem.
  • “Effective opportunities exist for organizations to more accurately link individuals’ health records.”

Other research studies suggest that patient match rates can fall to 50% or 60% when organizations share patients’ records between disparate healthcare network electronic health record (EHR) systems, the Office of the National Coordinator for Health Information Exchange (ONC) noted in a final report on the ONC’s Patient Identification and Matching Initiative. From experience, medical laboratories understand the challenges of matching information on a clinical laboratory test requisition to the right patient and can often see patient mismatches on a daily basis.

About $1,950 in medical care costs per patient during a hospital stay, and $1.5 million annually in denied claims per hospital, are associated with inaccurate patient identification, reported a survey conducted by Black Book Research.

“Patient matching is a fundamental function of being able to get the right records, for the right person, at the right time, so that timely decisions can be made about his or her health. There has to be a mechanism to ensure that you’re actually getting a copy of the records for the right person,” Mariann Yeager (above), CEO of the Sequoia Project told Modern Healthcare. The Sequoia Project advocates for nationwide health information exchange (HIE). (Photo copyright: Value-based Care Summit.)

Why Patient-Matching is Difficult

Respondents to the Pew study reported that challenges to correctly matching patients with their records include:

  • Receiving patient records that an organization did not expect;
  • Urban health systems serving patients through multiple sites;
  • High costs associated with matching solutions; and
  • Differences in how organizations capture, use, and link medical records.

When humans manually input patient data, Mary Elizabeth Smith could be listed as M.E. Smith or Mary E. Smith or even Liz Smith. Such data, when filed differently, can result in duplicate records for the same person, or, as St. Vincent’s found out, patient mismatches that have dire consequences, Managed Care noted.

“If there’s some kind of error in entering fields (name, address, date of birth), either when the patient’s coming in or in a previous entry, the matching can go awry,” Brendan Watkins, Administrative Director of Enterprise Analytics at Stanford Children’s Health, told Modern Healthcare.

Patient-Matching Solutions at Clinical Laboratories    

Clinical laboratories also have tackled patient-mismatching and have devised processing software solutions that ensure patients are correctly identified and matched with the appropriate records and specimens.

For example, Sonora Quest Laboratories (SQL), a subsidiary of Laboratory Sciences of Arizona, developed an enterprise-wide master patient index (EMPI). As reported by The Dark Report, Dark Daily’s sister publication, “The EMPI underpins all the patient-centric services that tomorrow’s clinical laboratory must support to be successful at meeting the needs of ACOs, PCMHs [patient-centered medical homes], and other emerging models of integrated clinical care.”

Other solutions suggested by respondents to a previous 2018 Pew survey include:

  • Unique patient identifier: Adoption of a patient identification number could help matching efforts, though patients have expressed privacy concerns. The idea is to use smartphones to validate patient data using digit codes. However, respondents told Pew, not everyone has a smartphone.
  • Data standardization: Respondents said standardization of data elements and formatting could impact match rates. But agreement on which elements to use for the match would be needed.
  • Referential matching: Healthcare providers could follow the banking industry and use outside sources, such as credit bureaus, to verify addresses and other data. Respondents to the Pew survey balked at the cost. 

One other technology not mentioned in the Pew survey but previously reported on by Dark Daily is biometric facial recognition, which would aid providers in identifying patients and matching them with their records. (See “Canadian Company Prepares to Use Biometric Facial Recognition for Positive Patient Identification with an In-Home Prescription Drug Dispensing Device,” July 9, 2018.)

With advancements in technology and interoperability, medical laboratory leaders and other healthcare leaders may soon be expected to achieve patient and record match rates of 100%. Pathology laboratories with EMPIs and other solutions may be well prepared to meet those challenges.

—Donna Marie Pocius

Related Information:

A Mismatch Made in America

Provider Demand for Accurate Patient Matching is High, Pew Says

Enhanced Patient Matching Is Critical to Achieving Full Promise of Digital Health Records

Hospital and Clinical Executives See Rising Demand for Accurate Exchange of Patient Records

Patient Identification Matching Final Report

Improving Provider Interoperability Congruently Increasing Patient Record Error Rates: Black Book Survey

Care Continuum Expands and Patient Matching Remains Problem without Single Solution

Medicare and Medicaid Programs Patient Protection and Affordable Care Act Interoperability

Sonora Quest Builds EMPI to Serve Patients and ACOs

Canadian Company Prepares to Use Biometric Facial Recognition for Positive Patient Identification with an In-Home Prescription Drug Dispensing Device

Humana’s New Oncology Value-based Care Program Includes Quality and Cost Measurements of Provider Performance, Clinical Laboratories, and Pathology Groups

“Pathologists and medical laboratories may have to demonstrate efficiency and effectiveness to stay in the insurer’s networks and get paid for their services

In recent years, Medicare officials have regularly introduced new care models that include quality metrics for providers involved in a patient’s treatment. Now comes news that a national health insurer is launching an innovative cancer-care model that includes quality metrics for medical laboratories and anatomic pathology groups that deliver diagnostic services to patients covered by this program.

Anatomic pathologists and clinical laboratories know that cancer patients engage with many aspects of healthcare. And that, once diagnoses are made, the continuum of cancer care for these patients can be lengthy, uncomfortable, and quite costly. Thus, it will be no surprise that health insurers are looking for ways to lower their costs while also improving the experience and outcomes of care for their customers.

To help coordinate care for cancer patients while simultaneously addressing costs, Humana, Inc., (NYSE:HUM) has started a national Oncology Model-of-Care (OMOC) program for its Medicare Advantage and commercial members who are being treated for cancer, Humana announced in a press release.

What’s important for anatomic pathologists and clinical laboratories to know is that the program involves collecting performance metrics from providers and ancillary services, such as clinical laboratory, pathology, and radiology. These metrics will determine not only if doctors and ancillary service providers can participate in Humana’s networks, but also if and how much they get paid.

Anatomic pathologists and medical laboratory leaders will want to study Humana’s OMOC program carefully. It furthers Humana’s adoption of value-based care over a fee-for-service payment system.

How Humana’s OMOC Program Works

According to Modern Healthcare, “Humana will be looking at several measures to determine quality of cancer care at the practices including inpatient admissions, emergency room visits, medications ordered, and education provided to patients on their illness and treatment.”

As Humana initiates the program with the first batch of oncologists and medical practices across the US, it also will test performance criteria that anatomic pathologist groups will need to meet to participate in the insurer’s network and be paid for services.

The insurer’s metrics address access to care, clinical status assessments, and patient education. Physicians can earn rewards for enhancing their patients’ navigation through healthcare, while addressing quality and cost of care, reported Health Payer Intelligence.

“The experience for cancer care is fragmented,” Bryan Loy, MD (above), Corporate Medical Director of Humana’s Oncology, Laboratory, and Personalized Medicine Strategies Group, told Modern Healthcare. Loy is board-certified in anatomic and clinical pathology, as well as hematology. “Humana wants to improve the patient experience and health outcomes for members. We are looking to make sure the care is coordinated.” (Photo copyright: National Lung Cancer Roundtable/American Cancer Society.)

Humana claims its OMOC quality and cost measurements are effective in the areas of:

  • inpatient admissions,
  • emergency room visits,
  • medical and pharmacy drugs,
  • laboratory and pathology services, and
  • radiology.

To help cover reporting and other costs associated with participation in the OMOC program, Humana is offering physician practices analytics data and care coordinating payments, notes Modern Healthcare.

“The practices that improve their own performance over a one-year period will see the care coordination fee from Humana increase,” Julie Royalty, Humana’s Director of Oncology and Laboratory Strategies, told Modern Healthcare.

Value-Based Care Programs are Expensive

Due to the cost of collecting data and increasing staff capabilities to meet program parameters, participating in value-based care models can be costly for medical practices, according to Scottsdale, Ariz.-based Darwin Research Group (DRG), which studies emerging payer models.

Some of the inaugural medical practices in the Humana OMOC include:

  • Southern Cancer Center, Alabama;
  • US Oncology Network, Arizona;
  • Cancer Specialists of North Florida;
  • Michigan Healthcare Professionals;
  • University of Cincinnati Physicians Company; and
  • Center for Cancer and Blood Disorders, Texas.

Other Payers’ Value-Based Cancer Care Programs

“Depending upon which part of the country you’re in, alternative payment models in oncology are becoming the norm not the exception,” noted the DRG study. “Humana is a little late to the party.”

Darwin Research added that Humana may realize benefits from having observed other insurance company programs, such as:

Humana is not the only payer offering value-based cancer care programs. The Centers for Medicare and Medicaid Services (CMS) Oncology Care Model is a five-year model (2016 through 2021) involving approximately 175 practices and 10 payers throughout America (see above). The healthcare networks and insurers have made payment arrangements with their patients for chemotherapy episode-of-care services, noted a CMS fact sheet. (Graphic copyright: Centers for Medicare and Medicaid Services.)

Humana’s Other Special Pay Programs

Humana has developed other value-based bundled payment programs as well. It has episode-based models that feature open participation for doctors serving Humana Medicare Advantage members needing:

  • total hip or knee joint replacement (available nationwide since 2018); and
  • spinal fusion surgery (launched in 2019).

Humana also started a maternity episode-of-care bundled payment program last year for its commercial plan members.

In fact, more than 1,000 providers and Humana value-based relationships are in effect. They involve more than two-million Medicare Advantage members and 115,000 commercial members.

Clearly, Humana has embraced value-based care. And, to participate, anatomic pathology groups and medical laboratories will need to be efficient and effective in meeting the payer’s performance requirements, while serving their patients and referring doctors with quality diagnostic services.

—Donna Marie Pocius

Related Information:

Humana Launches Oncology Model of Care Program to Improve the Patient Experience and Health Outcomes in Cancer Care

Humana Launches Oncology Payment Model

Humana Launches Value-based Care Oncology Program for MA Members

Humana Launches New Oncology Payment Model

CMS Fact Sheet: Oncology Care Model

Humana Launches Value-based Model for Cancer Patients

Insurance Companies and Healthcare Providers Are Investing Millions in Social Determinants of Health Programs

Clinical laboratories could offer services that complement SDH programs and help physicians find chronic disease patients who are undiagnosed

Insurance companies and healthcare providers increasingly consider social determinants of health (SDH) when devising strategies to improve the health of their customers and affect positive outcomes to medical encounters. Housing, transportation, access to food, and social support are quickly becoming part of the SDH approach to value-based care and population health.

In “Innovative Programs by Geisinger Health and Kaiser Permanente Are Moving Providers in Unexplored Directions in Support of Proactive Clinical Care,” Dark Daily reported on two well-known companies that are investing millions in SDH programs to bring food and affordable housing to vulnerable patients. These activities are evidence of a new trend in healthcare to address social, economic, and environmental barriers to quality care.

For clinical laboratory managers and pathologists this rapidly-developing trend is worth watching. They can expect to see more providers and insurers in their communities begin to offer these types of services to individuals and patients who might stay healthier and out of the hospital as a result of SDH programs. Clinical laboratories should consider strategies that help them provide medical lab testing services that complement SDH programs.

Medical laboratories, for example, could participate by offering free transportation to patient service centers for homebound chronic disease patients who need regular blood tests. Such community outreach also could help physicians identify people with chronic diseases who might otherwise go undiagnosed.

Anthem Offers Social Determinants of Health Package

In fact, health benefits giant Anthem, Inc. (NYSE:ANTM) partly attributes its 2019 first quarter 14% increase of Medicare Advantage members to a new “social determinants of health benefits package” comprised of healthy meals, transportation, adult day care, and homecare, according to Forbes.

“Our focus on caring for the whole person is designed to deliver better care and outcomes, reduce costs, and ultimately accelerate growth,” Gail Boudreaux, Anthem President and CEO, stated in a call to analysts, Forbes reports.

An Anthem news release states that SDH priorities for payers, providers, and other stakeholders should focus on enhancing individuals’ access to food, transportation, and social support.

In the Anthem news release, which announced the publication of a white paper that “outlines key differences in how individuals and the public perceive social determinants of health,” Jennifer Kowalski (above), Vice President of the Anthem Public Policy Institute stated, “By better understanding how individuals view and talk about social determinants, payers and providers alike can identify new and improved ways to engage with them to more effectively improve their health and wellbeing and the delivery of healthcare.” (Photo copyright: LinkedIn.)

CMS Expands Medicare Advantage Plans to Include Social Determinants of Health

The Centers for Medicare and Medicaid Services announced that, effective in 2019, Medicare Advantage plans can offer members benefits that address social determinants of health. Medicare Advantage members may be covered for services such as adult day care, meal delivery, transportation, and home environmental services that relate to chronic illnesses.

Humana’s ‘Bold Goal’

Humana, Inc. (NYSE:HUM) calls its SDH focus the Bold Goal. The program aims to improve health in communities it serves by 20% by 2020.

“The social barriers and health challenges that our Medicare Advantage members and others face are deeply personal. This requires us to become their trusted advocate that can partner with them to understand, navigate, and address these barriers and challenges,” said William Shrank, MD, Humana’s Chief Medical Officer, in a news release.

UnitedHealthcare Investing More than $400 Million in Housing

Meanwhile, since 2011, UnitedHealthcare (NYSE:UNH) also has invested in affordable housing and social determinants of health, Health Payer Intelligence reported.

In a news release, UnitedHealthcare, the nation’s largest health insurer, described how it is investing more than $400 million in 80 affordable US housing communities, including:

  • $12 million, PATH Metro Villas, Los Angeles;
  • $11.7 million, Capital Studios, Austin;
  • $14.5 million allocated to Minneapolis military veterans housing;
  • $7.9 million, New Parkridge (in Ypsilanti, Mich.) affordable housing complex;
  • $21 million earmarked to Phoenix low- and moderate-income families needing housing and supportive services;
  • $7.8 million, Gouverneur Place Apartments, Bronx, New York; and
  • $7.7 million, The Vinings, Clarksville, Tenn.

“Access to safe and affordable housing is one of the greatest obstacles to better health, making it a social determinant that affects people’s well-being and quality of life. UnitedHealthcare partners with other socially minded organizations in helping make a positive impact in our communities,” said Steve Nelson, UnitedHealthcare’s CEO, in the news release.

Housing, Transportation, Food Insecurity Impact Health, Claim AHA, HRET

According to the American Hospital Association (AHA) and the Health Research and Educational Trust (HRET), housing, or lack of it, impacts health. In “Housing and the Role of Hospitals,” the second guide in the organizations’ “Social Determinants of Health Series,” AHA and HRET state that 1.48 million people are homeless each year, and that unstable living conditions are associated with less preventative care, as well as the propensity to acquire diabetes, cardiovascular disease, chronic obstructive pulmonary disorder, and other healthcare conditions.

The AHA and HRET also published SDH guides on “Transportation” and “Food Insecurity.”

Social determinants of health programs are gaining in popularity. And as they become more robust, proactive clinical laboratory leaders may find opportunities to work with insurers and healthcare providers toward SDH goals to help healthcare consumers stay healthy, as well as reducing unnecessary hospital admissions and healthcare costs.   

—Donna Marie Pocius

Related Information:

Anthem’s Social Determinants Benefits Package Boosts Medicare Enrollment

Bridging Gaps to Build Healthy Communities

New Anthem Public Policy Institute Report Outlines Key Differences in How Individual sand the Public Perceive Social Determinants of Health

CMS Finalizes Medicare Advantage and Part D Payment and Policy Updates to Maximize Competition and Coverage

Humana’s 2019 Bold Goal Progress Report Details Focus on Social Determinants of Health and Improved Healthy Days

Humana 2019 Bold Goal Progress Report

UnitedHealthcare Invests Over $400 Million in Social Determinants of Health

UnitedHealthcare Affordable Housing and Path Metro Villas

Social Determinants of Health Series: Housing

Innovative Programs by Geisinger Health and Kaiser Permanente are Moving Providers in Unexplored Directions in Support of Proactive Clinical Care

New AHA Report Finds Hospital Outpatient Revenue Nearing Inpatient Revenue, While CMS Proposes Paying Less for In-hospital Healthcare Services

Clinical laboratories that service both settings could be impacted as new CMS proposed rule attempts to align Medicare’s payment policies for outpatient and in-patient settings

Hospital outpatient revenue is catching up to inpatient revenue, according to data released from the American Hospital Association (AHA). This increase is part of a growing trend to reduce healthcare costs by treating patients outside of hospital settings. It’s a trend that is supported by the White House and Medicare and continues to impact clinical laboratories, which serve both hospital inpatient and outpatient customers.

The AHA published this study data in its annual Hospital Statistics, 2019 Edition. The data comes from a 2017 survey of 5,262 US hospitals. The report includes data about utilization, revenue, expenses, and other indicators for 2017, as well as historical data.

The AHA statistics on outpatient revenue suggest providers nationwide are working to keep people out of more expensive hospital settings. Hospitals, like medical laboratories, appear to be succeeding at developing outpatient and outreach services that generate needed operating revenue.

This aligns with Medicare’s push to make healthcare more accessible through outpatient settings, such as urgent care clinics and physician’s offices. A growing trend Dark Daily has covered extensively.

Outpatient Revenue Climbs

In its coverage of the AHA’s study, Modern Healthcare reported that 2017 hospital net inpatient revenue was $498 billion and net outpatient revenue was $472 billion.

The Becker’s Hospital CFO Report notes that gross inpatient revenue in 2017 was $92.7 billion higher than gross outpatient revenue. But in 2016, gross inpatient revenue was much further ahead—$129.5 billion more than gross outpatient revenue. The “divide” between inpatient and outpatient revenue is narrowing, Becker’s reports.


The graphic above illustrates the shrinking gap between hospital inpatient and outpatient revenues. “Outpatient revenue will ultimately eclipse inpatient revenue,” Chuck Alsdurf, Director of Healthcare Finance Policy and Operational Initiatives at the Healthcare Financial Management Association (HFMA), told Modern Healthcare. (Graphic copyright: Modern Healthcare/AHA.)

 The Becker’s report also stated:

  • Admissions increased by less than 1% to 34.3 million in 2017, up from 34 million in 2016;
  • Inpatient days were flat at 186.2 million;
  • Outpatient visits rose by 1.2% to 766 million in 2017; and,
  • Outpatient revenue increased 5.7% between 2016 and 2017.

Similar Study Offers Additional Insight into 2018 Outpatient Revenue

A benchmarking report by Crowe, a public accounting, consulting, and technology firm, which analyzed data from 622 hospitals for the period January through September of 2017 and 2018, showed the following, as reported by RevCycleIntelligence:

  • Inpatient volume was up 0.6% in 2018 and gross revenue per case grew by 5.3%;
  • Outpatient services rose 2.4% in 2018 and gross revenue per case was up 7.1%.

Physicians’ Offices Have Lower Prices for Some Hospital Outpatient Services

Everything, however, is relative. When certain healthcare services traditionally rendered in physician’s offices are rendered, instead, in hospital outpatient settings, the numbers tell a different story.

In fact, according to the Health Care Cost Institute (HCCI), the price for services was “always higher” when performed in an outpatient setting, as compared to doctor’s offices.

HCCI analyzed services at outpatient facilities as well as those appropriate to freestanding physician offices. They found the following differences in 2017 prices:

  • Diagnostic and screening ultrasound: $241 in physician’s office—$650 in hospital outpatient setting;
  • Level 5 drug administration: $254 in office—$664 in hospital outpatient setting;
  • Upper airway endoscopy: $527 in office—$2,679 in hospital outpatient setting.

One example where hospital outpatient settings provide similar services at increased costs is in drug administration, as the graphic above illustrates. “The difference was higher than I expected. With some services, the price is two or three times higher when rendered in the outpatient setting,” Julie Reiff, HCCI researcher and report author, told Fierce Healthcare. (Graphic copyright: HCCI.)

Medicare Proposed Rule Would Change How Hospital Outpatient Clinics Get Paid

Meanwhile, the Centers for Medicare and Medicaid Services (CMS) has released its final rule (CMS-1695-FC), which make changes to Medicare’s hospital outpatient prospective payment and ambulatory surgical center payment systems and quality reporting programs.

In a news release, CMS stated that it “is moving toward site neutral payments for clinic visits (which are essentially check-ups with a clinician). Clinic visits are the most common service billed under the OPPS [Medicare’s Hospital Outpatient Prospective Payment System). Currently, CMS often pays more for the same type of clinic visit in the hospital outpatient setting than in the physician office setting.”

“CMS is also proposing to close a potential loophole through which providers are billing patients more for visits in hospital outpatient departments when they create new service lines,” the news release states.

Hospitals are fighting the policy change through a lawsuit, Fierce Healthcare reported.

In summary, clinical laboratories based in hospitals and health systems are in the outpatient as well as inpatient business. Medical laboratory tests contribute to growth in outpatient revenue, and physician offices compete with clinical laboratories for some outpatient tests and procedures. Thus, a new site-neutral CMS payment policy could affect the payments hospitals receive for clinic visits by Medicare patients.

—Donna Marie Pocius

Related Information:

AHA Hospital Statistics 2019

AHA Data Show Hospitals’ Outpatient Revenue Nearing Inpatient

Hospitals’ Outpatient Revenue Inching Closer to Inpatient Revenue

“My Net Revenue is Stable,” said No CFO Ever . . .

Revenue Unable Despite Outpatient Volume Growth

Shifting Care from Office to Outpatient Settings: Services are Increasingly Performed in Outpatient Settings with Higher Prices

From Physician Offices to Outpatient Settings and Costs Go Up, HCCI Study Finds

CMS Empowers Patients and Ensures Site Neutral Payment Proposed Rule

How CRM Systems Help Home Healthcare Providers Treat Patients with Chronic Diseases in a Trend That May Be an Opportunity for Medical Laboratories

Customer relationship management (CRM) plays a critical role in helping providers care for patients with chronic diseases and clinical laboratories are part of those solutions

Home healthcare continues to boom in the US and more technology companies each year—including Salesforce—strive to expand their presence within the industry. This represents a significant shift in site of service for a substantial and growing number of Americans. Equally true is that home healthcare is an opportunity for clinical laboratories to serve this increasing proportion of the American population.

Statistics tell the tale behind the boom in home healthcare. The Centers for Disease Control and Prevention (CDC) estimates that six in 10 adults in the United States suffer from chronic diseases, such as cancer, and four in 10 adults live with two or more chronic illnesses.

This means that among medical laboratories and other providers servicing the home healthcare industry demand for clinical laboratory testing will increase.

Last year, approximately $103 billion was spent on home healthcare services and that number is expected to reach $173 billion by 2026, according to the Centers for Medicare and Medicaid Services (CMS). Approximately 7.6 million people in the US now require some level of in-home medical care. The overall employment of in-home healthcare providers is projected to grow 41% between 2016 and 2026.

Efficient tools that assist home healthcare organizations and their providers are critical. Customer Relationship Management (CRM) platforms that combine data gathered during office visits with patients’ living and economic situations are proving to be powerful allies for treating chronic disease populations.

Social Determinants of Health

One such CRM developer, Salesforce, is rising to the demand by adding new features to its existing Health Cloud platform. Originally introduced in 2016 as a way to improve how healthcare and life sciences organizations connect with patients, this product is one example of how Silicon Valley companies are attempting to make inroads within the healthcare sector. Health Cloud’s newest functional upgrades include:

  • Complete patient profiles,
  • Relevant patient communications, and
  • Connected in-home care.

This includes social determinants of health, such as:

  • Living conditions,
  • Socioeconomic status, and
  • Environmental factors.

These social determinants of health are typically not included in health records. But they can be vital information for healthcare providers. Clinical laboratory managers should pay attention to “social determinants of health” because this term describes a new dimension in medical care and how patients with chronic diseases are managed.


“A lot of people in healthcare know about the importance of social determinants of health, but the volume of information is so great that being able to display things clearly and concisely in front of the [providers who] are using it—when they need it—makes it more operant and more prominent in the care of that patient,” Joshua Newman, MD, Chief Medical Officer at Salesforce, told MedCity News. (Photo copyright: San Francisco Business Times/Biz Journals.)

This is a critical factor. Healthcare providers who use Salesforce’s Health Cloud can now record a patient’s social determinant information—such as, transportation issues, housing status, and care network—directly into that patient’s profile. Access to this type of information can give healthcare professionals a more complete understanding of each patient’s unique situation.

Here are some examples from a Salesforce press release that illustrate how social-determinants-of-health data can help patients and care providers:

  • “A care provider that wants to limit a patient’s risk for readmission can know if the patient has access to transportation or the ability to purchase healthy meals.
  • “A life science organization that wants to help patients adhere to their therapies, or properly use their medical devices, can see a patient’s employment status and living arrangements, and thus offer the necessary level of financial and in-home support.
  • “A payer organization can deliver personalized preventative or wellness material to members based on the member’s education or reading level.”

“Our industry continues to centralize and integrate patient data, but it is critical that we stay focused on improving the patient experience,” noted Ashwini Zenooz, MD, in the press release. Zenooz is Salesforce’s Senior Vice President and General Manager, Global Healthcare and Life Sciences. “By surfacing critical factors of a patient’s life in a single view, we empower care providers to personalize patient care experiences and improve outcomes.” 

Many existing CRM products cannot collect data from a variety of sources and then sort and analyze that information to provide users with actionable intelligence. Salesforce is attempting to fill that void among health and medical software products with Health Cloud. 

“Healthcare has been slower culturally, politically, and socially to share their data. But what we’re seeing now is even those organizations that have historically not shared their data are realizing they can do a better job if they do,” Newman told MedCity News.

Outside Hospital Care Increasing

Salesforce has also added a service it calls the Connected Patient Journey to its Health Cloud platform. This service is an integration between Health Cloud and Salesforce marketing, which can personalize information given to patients based on their unique health needs. Using this feature allows providers to build patient lists and use marketing techniques to reach patients who would most benefit from specific campaigns and information.

“The general overarching theme that unites all of these innovations is that care is gravitating increasingly toward the home or outside of the hospital and the doctor’s office,” said Newman.

Whether in-hospital or in-home, clinical laboratory tests play a critical role in healthcare services. The ability for clinical laboratories to enter patients’ test results data directly into CRM systems like Health Cloud could help providers utilizing those systems better assist patients with chronic diseases.

—JP Schlingman

Related Information:

Salesforce Launches New Healthcare Features to Manage Social Determinants and In-home Care

Salesforce Delivers New Health Cloud Innovations to Personalize Patient Experiences to Improve Outcomes

America’s $103 Billion Home Health-care System is in Crisis as Worker Shortage Worsens

The Rise of Home Health Care

Clinical Laboratories Turn to Healthcare-Focused CRM to Optimize Operations and Increase Market Share, Despite Decreasing Reimbursement

;