Interview with: Mike Doyle,
President & Chief Executive Officer,
QPID Health, Inc.
“Appropriate use of diagnostics and
pro...
About QPID Health
QPID Health’s clinical intelligence software automatically delivers relevant patient information from el...
of 2

How to Eliminate Procedure Preapproval to Save Billions in US Health Spending - Mike Doyle, QPID Health, Inc.

Mike Doyle of QPID Health, Inc., a solution provider at the marcus evans National Healthcare CMO/CMIO Summit 2015, talks about lowering healthcare costs by ensuring appropriate use. Interview with: Mike Doyle, President & Chief Executive Officer, QPID Health, Inc.
Published on: Mar 3, 2016
Published in: Business      
Source: www.slideshare.net


Transcripts - How to Eliminate Procedure Preapproval to Save Billions in US Health Spending - Mike Doyle, QPID Health, Inc.

  • 1. Interview with: Mike Doyle, President & Chief Executive Officer, QPID Health, Inc. “Appropriate use of diagnostics and procedures is a strategic imperative for providers focused on improving population health while lowering costs, says Mike Doyle, President & Chief Executive Officer, QPID Health, Inc. “With as much as a third of US healthcare spending wasteful or unnecessary, payers respond by requiring medical necessity reviews, especially for high-cost and high-volume procedures,” he adds. A solution provider at the marcus evans National Healthcare CMO/ CMIO Summit 2015, in Atlanta, Georgia, March 9-10, Doyle discusses how QPID Health’s customer Partners HealthCare achieves the highest possible rates of appropriate use and aligns with payers to waive prior authorization. Why did Partners HealthCare initiate the Q-Guide program? Partners HealthCare is a pioneer accountable care organization (ACO) that also operates under shared-risk contracts with private payers. Commit- ted to 100 percent appropriate care because it is the right thing for patients, Partners also was motivated to make sure that surgeons and other clinicians were applying evidence-based care standards to keep costs in check. What are some of the benefits of the program? Elimination of preapproval requirements in the US could increase billing efficiency by 50 percent and save hospitals USD 17 billion and physicians USD 6.9 billion, while ensuring better outcomes. Now ACOs and other providers who share risks with payers have additional incentives to be vigilant about costs. What is Q-Guide? Q-Guide is an application that delivers guidelines from the literature and synthesizes them with patient factors automatically gleaned from the medical record. It applies sophisticated decision criteria to patient medical profiles to produce an optimal procedure recom- mendation. Hospitals can forego the prior authoriza- tion process for some procedures where physicians have attested the appropri- ate use with Q-Guide. This eliminates a huge administrative burden for providers and reduces the pain and uncertainty for patients who tradition- ally must wait while medical necessity reviews are underway. And most importantly, healthcare decisions remain in the hands of medical providers and their patients. Q-Guide currently covers 15 procedures, seven of which account for 55 percent of the 20 most costly surgical proce- dures in the US. The technology frees up time spent mining electronic health records and data repositories, while dramatically shifting the patient/doctor conversation toward shared decision-making. Any final comments? Two major payers have agreed with this approach so far, and waived require- ments for manual prior authorization Q- Guide. The incorporation of patient- reported outcomes into the decision model is the latest development effort to improve care, engage patients, and track long-term outcomes. To view a webinar by Partners Health- care sharing their experience with Q-Guide, click here This eliminates what is a huge administrative burden for providers and causes grief for patients who must wait while medical necessity reviews are underway How to Eliminate Procedure Preapproval to Save Billions in US Health Spending
  • 2. About QPID Health QPID Health’s clinical intelligence software automatically delivers relevant patient information from electronic health records and other data sources into clinical and administrative workflows. With QPID, clinicians are more productive, patients benefit from decisions based on their complete health information, and hospitals gain cost efficiencies. The QPID solution was developed at Massachusetts General Hospital and usage spread virally throughout the Partners HealthCare system. QPID Health launched in late 2012 to bring the power of QPID to health systems nationwide. www.qpidhealth.com About marcus evans Summits marcus evans Summits are high level business forums for the world’s leading decision-makers to meet, learn and discuss strategies and solutions. Held at exclusive locations around the world, these events provide attendees with a unique opportunity to individually tailor their schedules of keynote presentations, case studies, roundtables and one-on-one business meetings. For more information, please visit: www.marcusevans.com Upcoming Events Long-Term Care CXO Summit - www.longtermcaresummit.com National Healthcare CFO Summit - www.nhcfosummit.com National Healthcare CXO Summit - www.nhcmiosummit.com To view the web version of this interview, please click here: www.nhcmiosummit.com/MikeDoyle3 To read previous interviews with Mike Doyle, please click here: www.nhcmiosummit.com/MikeDoyle1 and www.nhcmiosummit.com/MikeDoyle2 The marcus evans Healthcare Summits group delivers peer-to- peer information on strategic matters, professional trends and breakthrough innovations. Please note that the Summit is a closed business event and the number of participants strictly limited. About the National Healthcare CMO/CMIO Summit 2015 The National Healthcare CMO/CMIO Summit is the premium forum bringing senior level medical executives and solution providers together. Taking place at The Ritz- Carlton Buckhead, Atlanta, Georgia, March 9-10, 2015, the Summit includes presentations on succeeding under value based purchasing, implementing Meaningful Use Stage 2 into the healthcare organization, EHR implementation and discussion on merging clinical data and insurance data to improve quality and outcomes. www.nhcmiosummit.com Contact Sarin Kouyoumdjian-Gurunlian, Press Manager, marcus evans, Summits Division Tel: + 357 22 849 313 Email: press@marcusevanscy.com For more information please send an email to press@marcusevanscy.com All rights reserved. The above content may be republished or reproduced. Kindly inform us by sending an email to press@marcusevanscy.com

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