Posts Tagged ‘Sun Knowledge KPO Services’

Is US healthcare system still the best of its kind in the world?

Tuesday, February 1st, 2011

For ages, insurance companies and politicians have vehemently proclaimed that the US healthcare system is perhaps the best of its kind in the whole world. However, as its fatal flaws unfolded, the unfaltering faith of 42 million Americans in the entire system was badly shaken. There are scores of Americans, who are without proper health insurance. This gives vent to the fact that the American healthcare system may not be entirely invincible, infallible, as claimed by the healthcare pundits and political bigwigs. Astronomical healthcare costs, coupled with lack of access, pose a major threat to the US government. People are slowly coming to terms with this hard reality. Instead of taking the bull by its horns and addressing the problem head-on, the US government has been either shoving it under the carpet or proposing short-term, patch-work solution.

According to the comparative studies, conducted on the healthcare systems of various countries, the determinants of a good healthcare system are essentially its responsiveness and the extent to which it guarantees good health and financial protection to everyone. A sound, stable and unprejudiced healthcare system will, therefore, ensure:
i) Optimal good-health and an even distribution of the same across every population groups
ii) Even distribution of financing healthcare amongst all Americans, irrespective of class, creed, gender, race, age and color
iii) Tremendous, overall responsiveness and a fair distribution of the same in the society

The US healthcare, off late, falls short of everything that makes a sound, cost-effective, reasonably user-friendly and accessible healthcare system. Owing to the consistently rising costs of medical technology and prescription drugs, US boasts of the most expensive healthcare in the world. Moreover, the shift from not-for-profit providers to for-profit providers has triggered an abrupt rise in healthcare costs by a whopping percentage. The administrative costs at for-profit hospitals also attribute to the phenomenal healthcare spending. A large chunk of uninsured American population has also added to the woes, necessitating expensive healthcare.

US is the world’s only developed, industrialized country that does not promise universal healthcare coverage to all its citizens. Although quite a few employers take pains to insure their employees and the Government specifically offers insurance coverage to senior citizens (Medicare), the military as well as the unprivileged and disabled, a vast majority of the population still remains uninsured, wallowing in the woes, inflicted by this apparent “non-system”.

Lack of insurance coverage can pose a serious threat to a particular segment of the American population that does not have any access to the basic amenities of life, let alone a decent healthcare system. This shambolic system creates a gnawing gap in the coverage, which is hard to seal. As insurance rates go up, employers cannot help but stop their insurance benefits altogether and those who do not, are compelled to raise premiums and deductibles.

The US healthcare reform is indisputably a welcome relief, in these uncertain times. It will make healthcare accessible to millions of Americans, who have been regularly putting their health on hold because they cannot afford basic treatment or even the co-payment of a routine physical. The healthcare bill is believed to benefit more than 95% of legal American citizens. Even, those who have lost their jobs to recession and unfavorable times, will be able to make the best use of their coverage.

Giving unprecedented, uninhibited access to healthcare also beckons one pressing problem that all Americans have to brace for, whether they want to be covered or not. The dark clouds of recession have lifted from the face of America, with the nation successfully and bravely riding out tough times. However, it will be a “hard slog” for politicians to recover the money, lost during the credit crunch, in order to finance their health insurance scheme. This may lead the Government to consider increasing the tax of the US citizens in general and even, many businesses. As a result, people, who are not covered, can wind up paying more taxes than the ones, who are insured.

The Role of a Healthcare Chief Information Officer

Tuesday, November 16th, 2010

A chief information officer spearheads the operational activities in relation to Information Technology within a healthcare setting. Infact, a healthcare CIO has to take in stride all the challenges that the Information Technology unit of a health care organization encounters on a routine basis- right from supervising and structuring data entry and analysis and laying down the rules and regulations for effective handling of data to working in conjunction with vendors and contractors to develop and enhance IT tools, crafting the IT budget and collaborating with other bigwigs of the organization for its greater good.

However, these days, the responsibility of a healthcare CIO is much more than just overseeing and controlling the IT operations for a particular organization. In some organizations, the onus of managing its supply-chain and group purchasing is usually on the health care information officer. The role of a CIO is gradually evolving and expanding with more and more information officers foraying into areas related to biomedical engineering, imaging equipment management, performance evaluation process redesign etc.

Ideally, a healthcare CIO is a multi-tasker, adeptly juggling his priorities and delivering top-notch results within compressed timelines. He is also a multidimensional communicator, who is vocal about the issues and concerns of his immediate team, effectively explaining the broader strategic agendas to them at the same time. Organizational culture and individual background are also equally responsible for the changes that are creeping into the role of a healthcare CIO.

A chief information officer must be a peoples’ person, blending effortlessly with his team, as he steps into the role of a manager. He also has to have hands-on experience in both health care as well as business administration. He should be adept at crafting comprehensive training programs for the in-house IT professionals, while seamlessly handling and maintaining production levels, personnel records and other relevant documentation. A healthcare CIO has to shoulder the responsibility of managing even the minutest and most mundane aspects of a multifaceted IT program that includes but is not limited to teleconferencing, office automation, internet and imaging.

In larger hospital or health care set-ups, a chief information officer takes several subordinates under his wing. They ensure the effective and efficient functioning of the IT programs under the tutelage and strict supervision of their seasoned healthcare CIO, who primarily acts as a liaison between the top management and other departmental managers. Though the global spending on health care IT has fallen for the last couple of years, the health IT industry is certainly looking up. Despite financial crunch, they are much better-off, career-wise, at the moment because of the difficult compromises they made, during recession. Some health care IT projects faced inordinate delays, but things are back to normal for health care CIOs with a variety of stimulus incentives in place.

Major Steps in Image Data Entry Services

Wednesday, October 27th, 2010

Image Data Entry entails translation of scanned images to a desired format. Primarily of two types- online and offline, it usually comes in form of huge volumes of work. In case of an Image Data Entry project, after getting specific requirements from the consumers via fax and emails, the service providers process their requests, sending the images in their coveted formats. However, attention has to be paid to the quality of images and confidentiality of data has to be rigorously maintained.

Image Data Entry services are usually executed by highly skilled and competent professionals. When the project is still at its nascent stage, two or three professionals, simultaneously working at two terminals, suffice. They are usually responsible for keying in the images into the software that work in conjunction with industry standard imaging tools. If any discrepancy or mismatch occurs, during entry, the software immediately identifies it and responds accordingly, which entails sending the end-user an alert and prompting him/her to take instantaneous action.

If no mismatch is spotted, the data is stored in the software and undergoes a strict quality check to guarantee its impeccable accuracy. Organizations usually deploy advanced, high-speed scanners to ensure superior image quality and images can be scanned into a variety of digitized formats such as RTF, TIFF, PDF, GIF and JPEG. The scanned images are either submitted to consumers via CDs or are uploaded to FTP servers.

There are many Image Data Entry softwares available in the market that are platform independent and can run on any operating system. They enable data entry operators to adeptly and clearly delineate specific zones within a bigger image, while simultaneously shedding light on multiple zones. They also help set resolution on individual zones within an image and allow operators to zoom and pan an on-screen image at their own discretion.

Why Every Corporate House Should Install Document Management Systems

Tuesday, October 19th, 2010

Managing the documents of an office is no child’s play. If the windows of a typical corporate house are thrust open, all the important paper documents, carelessly heaped on the tables, will be blown away by a sudden gust of wind, reducing the office into a mess of loosely strewn papers. The office will be a picture of utter chaos with all employees going berserk over their lost documents and frenetically chasing the ones that are still within their office premises. If the office has a Document Management System in place, it will come to the fore, during such crisis, whipping it back into shape.

Document Management System revolutionizes the way in which an office operates. Whether it is all about decluttering papers or simply improving the way electronic files functions, a Document Management System will indisputably take preponderance over other systems that are already existent. However, a distinct difference persists between Document Management Software and Document Imaging Systems. Document Imaging Systems contain a portfolio of tools that helps translating paper records into electronic files, whereas Document Management Software comes in handy during effective management of electronic files.

Document Management Systems vastly improve business processes without drastically changing the same. These days, industries have to stringently abide by certain laws that require specific procedures for record keeping. As for instance, it is mandatory for providers of financial services to demonstrate that they have not tampered with information in order to comply with Sarbanes-Oxley. Against a volatile yet regulated industrial backdrop, Document Manage Systems enable corporate conglomerates to faultlessly comply with the rigid security and record-keeping rules. However, it is to be borne in mind that compliance can only be facilitated; but not guaranteed.

Document Management Systems have gained phenomenal popularity across many industries, these days. More and more accounting and human resources sectors, where paper-files are widely used, are turning towards Document Management Systems for respite and support. Many businesses, according to the Patriot Act, have to allow Government prompt and uninhibited access to their records. Since Document Management Systems help comply with certain Governmental rules and regulations, it is hugely popular with the manufacturing and Governmental sectors for regulatory protocols.

Document Management Systems have an obvious head start over other systems for certain benefits that they dole out to end-users. Cost-efficiency is one of the greatest advantages of Document Management Systems because it can totally obliterate the “lost document” costs, making up for the extra time that it takes to create a document from its scratch, after it is lost or misplaced. Document Management Systems significantly save office space, ridding it of cluttered paper records.

Document Management Systems guarantee unprecedented security of data, immaculately maintaining its integrity and integral value. They grant only authorized, password-protected access to certain individuals, while ensuring that the contents of all the documents are encrypted. A DMS also ensures that audit trails show the documents that have been accessed or updated.

Every organization must have a well-structured, streamlined infrastructure that ensures data back-up, during unpremeditated disasters. Data Management Systems shield paper records from disasters by creating their electronic versions that can be backed up in various ways, including offsite data backups. Document Management Systems even allow multiple users to simultaneously access the same record from any corner of the world.

A Document Management System reinforces a steady consistency of standards between various departments, especially in large companies. In presence of a Document Management System, all the departments can function hand-in-hand with unparalleled steadfastness and uniformity and consistency can be obtained to the degree it is wanted.

However, before acquiring Document Management Systems, one has to define the problem one is challenged with; otherwise it will be a sheer waste of time and resources. Document Management Systems can be tailored to the demands of a problem. If one is seriously contemplating on installation of a Document Management System in one’s office, one must first and foremost assess one’s problem and then, take the plunge.

Is Health Information Technology meant for all?

Monday, April 26th, 2010

Heath Information Technology (HIT), used to manage personal health information, has heralded a new change to the present health-care system. As health-care service providers and beneficiaries, all over the world, sing its praises and extol its virtues, they are turning a blind eye to its potential downsides. New Healthcare Information Technology is rapidly changing the patient/doctor relationship by facilitating communication and information-sharing between the two. But is this change for better or worse?

Computers and other electronic devices have certainly made it easier for doctors, health care providers (such as hospitals, labs, and X-ray facilities) and patients to store, share and access health information. But it fails to charm many, who may not have been impacted by Healthcare Information Technology at all. Greater accessibility to individualized health information- whether that is through a formal electronic medical record, a self-created personal health record or a quick instant-messaging session with a physician- has taken its toll on the traditional roles of patients and doctors. It will not be long, when more patients will access their electronic records, latest test results and recommended articles about their health-concerns, before visiting a hospital or doctor.

The element of human-touch, which once dominated a doctor-patient relationship, will slowly dwindle into oblivion as more patients, with full access to their electronic heath-records, will be able to skip their appointments with doctors altogether. They will instead randomly send a text message or email to their care-providers or go through their personal health records or smart-phone applications to seek answers to their questions.

Over-abundance of accessible data can also spell disaster for physicians and the health care industry in general. Moreover, potential liability and reimbursement questions may crop up, in the wake of increased flexibility in communication between doctors and health-savvy patients. Greater doctor/patient interaction may also intrude upon and foil the doctor’s capacity to assess data thoroughly in the interest of making accurate diagnoses.

While many people will certainly reap the benefits of the new Healthcare Information Technology, thus having greater control over their health care issues, the others, who are not so tech-savvy, may never know what all this fuss over HIT is about. In this age of often “irrational exuberance” over the latest technological advances, it is easier, for the majority of policy-makers and health-care stakeholders, to turn their backs upon people, who are not well-acquainted with technology. Moreover, health issues often come laden with emotional dimensions which the “efficiencies” of technology-based relationships will never be able to address.

Technology, through seamless and perfect health-care delivery, will indeed make lives easier for people. But it can never beat the humane elements of the relationship that exists between a real, live doctor and his patient.

Medication Therapy Management Providers and their eligibility

Thursday, April 15th, 2010

There aren’t any fixed educational or experiential criteria for pharmacists, or other health professionals, who are licensed to dish out Medication Therapy Management services. In most cases, a doctor of pharmacy (Pharm.D) is an eligible provider of Medication Therapy Management(MTM) services. The same rule applies to a fresh graduate. If he lacks sufficient professional experience to do his job effectively and efficiently, an extra training and education in geriatrics will help seal the gap.

If a pharmacist has a certification in a certain area, he is, inevitably, more adept in providing core MTM services in those specialty areas. Pharmacists, who are science graduates with years of professional experience under their belts, are also at par with the ones, who have certifications.

All drug-plan sponsors must employ people with versatile and complementary skills, experience and knowledge. Every plan should have a minimum educational and experiential standard which all MTM service-providers, including all community-based pharmacists and other health professionals, must meet, before they are recruited. Plans should also incentivize their work-force, encouraging them to work better and harder. The entry-level Pharm D degree and specialty certification have, indisputably, added a whole new dimension to this profession. Health-professionals are contemplating other forms of recognition, customized and tailored to the needs of MTM programs.

Drug Utilization Review

Thursday, April 8th, 2010

Drug utilization review is the process of assessment of drugs, consumed by  a population, in terms of their efficiency and potential risks, in order to dodge fraud, dangerous interactions and over-prescribing and therefore, inevitable disasters. In every US state, according to the mandates of the Omnibus Budget Reconciliation Act of 1990, many private drug utilization review boards, which supervise outpatient prescriptions for Medicaid patients, work for health insurance or pharmacy companies.

The Drug Utilization Review program, an inventive and computerized system, not only, puts prescription drugs of Medicare Plan under the microscope, but also, makes recommendations about best prescription drugs, drug problems and drug interactions, which are available to pharmacists and physicians.

The knowledge of the prescribed drugs is of utmost importance. People can easily access thousands of potential drugs in the market. Some random combinations of medications can have an enormously negative impact upon the health of consumers, making them horribly sick. As a result, medical costs spiral out of control. Many people have died an untimely death for consuming prescribed drugs that should not have been prescribed. Consumption of medicines inappropriately can also result in death. In some cases, drug utilization review board urges the pharmacists to speak to people when they are prescribed new medications. Although this will not entirely stop the consumption of potentially hazardous medicines, with a little bit of co-operation from the patient’s end, it will definitely help control the problem.

The Utilization review services include Prior Authorizations, reviewing of set quantity limitations and application of step therapy program. They track, flag and report on prescription drugs that need more scrutiny, thus enabling significant savings for both the member and payer.

All exception requests are processed within a standard time period of 48 hours, whereas expedited ones are processed faster, within 24 hours. The final decision or outcome is usually forwarded to the prescribing physician and pharmacist for their discretion.

Utilization review is the prime source of utilization management, which gauges and evaluates the suitability, aptness, medical need as well as competence of health care services procedures and facilities in terms of the established criteria or guidelines of an applicable health benefits plan. It begets new activities or decisions based upon the scrutiny of a case.


Thursday, April 1st, 2010

Medicare Part D plans often require the plan Member (or the Member’s Physician) to secure prior authorization for the use of certain medications.

Prior Authorization is a process that scrutinizes and therefore, optimizes the use of medications that have certain risk factors. In order to obtain a medication that requires a Prior Authorization, certain criteria have to be taken into consideration, before the particular health-plan agrees to pay for the medication or treatment. It is an approval, which can only be authorized by licensed pharmacists, nurses and doctors, issued by the insurance company before equipment /medication is dispatched. Authorizations can take place only after the doctor’s orders and other documentation are reviewed to ensure that a service is medically necessary. It is a conscious effort of health-plans to help their beneficiaries shun medical disasters. Prior Authorization (PA) programs are usually facilitated by pharmacists, supervised by experienced physicians. With restrictive and rigorous formularies and benefit design, the PAR function becomes indispensable, more operative and popular.

1. Prior Authorization Program usually helps cutting the turnover time, as mandated by the CMS
2. For expedited cases, the procedure is accelerated, where authorization can even be procured within 24 hours

In case of appeals against prior authorizations, the Appeals process, usually fast, dynamic and overseen by assorted, board-approved doctors, takes over. It entails preparation of approval and denial letters for the prescriber and the members. It also dispatches provider letters to all prescribers and doles out a report of approvals and denials. The reports can be accessed and used by the Clients to enter the authorizations into their respective system for online adjudication.

Medication Therapy Management Service and its Provision in Various Patient Care Settings

Thursday, March 25th, 2010

Medication Therapy Management services can be extended to prospective patients, who are in dire need of help. They can be spotted by a pharmacist, a physician or any other licensed healthcare professional, the health plan, when medication-related problems surface.

At times, the patients themselves seek medical attention, as soon as they become susceptible to medication-related problems, especially, in the wake of any healthcare setting changes or when they switch physicians. The problems may also appear, if the payer status of a beneficiary changes. These transitions of care pave the way for medication therapy changes, triggered by changes in the patient’s needs or location or resources or his health status or condition, or formulary requirements. Pharmacist-oriented MTM services must primarily dwell on reconciliation of the patient’s medications, thus providing appropriate medication management, during transitions of care. For ambulatory patients, Medication Therapy Management services are usually offered by appointments but, in exceptional circumstances, may also be provided on a walk-in basis.

Medication Therapy Management services, according to the mandates of the Health Insurance Portability and Accountability Act, must be delivered by pharmacists in a private or semiprivate area. In other patient care settings- acute care, home care and managed care, these services are dished out in a markedly different environment because of variability in structure and facilities design.

Types of Medicare Services

Wednesday, March 17th, 2010

Medicare is basically a term coined to denote the health coverage program run by the Center of Medicare and Medicaid Services (CMS) of the United States and basically falls under four categories as explained in the tabular structure below.

Medicare Part A covers the inpatient hospital bills and home healthcare Medicare Part B takes care of outpatient doctor visits and services
Medicare Part C includes Health Maintenance Organizations (HMOs) as well as Part A and Part B Medicare Part D covers prescription drugs broadly

Medicare also provides patients with an online Patient Health Record (PHR) system through which a patients medical history can be tracked anytime and anywhere.