Put simply, precision medicine has the potential to improve outcomes by matching a patient to a treatment option based on his/her/their tumor’s genetic or molecular profile. This approach enables patients to get the potentially “right” treatment, more quickly – which would result in a better treatment outcome at a lower total cost of care.

Compared to “traditional” medicine, precision medicine is a much more targeted approach. According to the Precision Medicine Initiative, precision medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle.” This approach means doctors and researchers focus on identifying  which treatment and prevention strategies are better suited for specific individuals It is in contrast to a one-size-fits-all approach, in which disease treatment and prevention strategies have less consideration for the inter-individual differences.

Yes, precision medicine offers a tremendous opportunity to shape the future of healthcare. While it is currently most advanced in oncology, precision medicine also has exciting applications beyond oncology.

According to the FDA, real-world data (RWD) is information related to a patient’s health status, while real-world evidence (RWE) pertains to "the clinical evidence about the usage and potential benefits or risks of a medical product derived from analysis of RWD."

Revenue cycle management (RCM) in healthcare is the process by which practices manage administrative and financial functions, including revenue generation, billing, and claims processing and payment. 

RCM is a holistic approach that can augment staff experience to improve operations, financial performance, and practice patterns.

Effective RCM allows healthcare providers to work at the “top of their license” by freeing up their time to focus on patient care and outcomes.

Oncology practices are committed to providing high-quality patient care. However, this doesn’t mean a practice can ignore its financial and operational performance. 

RCM services enables practices to: 

Reduce costs and improve efficiency

Augment staff and access expertise

Increase revenue yield

Understand and improve performance under VBC engagements and improve access to those APMs

Demonstrate improved performance under both VBC and fee-for-service reimbursement models

RCM can be improved through a deeper understanding of the processes of reimbursement for high-cost procedures and drugs and streamlining the day-to-day administrative tasks and complex calculations of a value-based revenue cycle. By doing this, a practice can boost collections, accelerate the billing process, and find hidden growth potential.

There are several ways to measure performance. Three metrics that practices should prioritize monitoring include: 

1. Charges vs. payments

2. Days to bill

Quality initiatives in healthcare refer to official measures by government or industry organizations that aim to improve the quality of care. The most well-known are those introduced and managed by the Department of Health and Human Services (DHHS) and the Centers for Medicare & Medicaid Services (CMS), including the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).

Getting the most out of quality initiatives requires a practice overhaul in two areas: 

1. Aligning your organization’s leadership and company culture with the value-based care approach such as Practice Transformation
2. Implementing IT solutions to facilitate and streamline the process 

Oncology alternative payment models feature bundled payment structures where medical practitioners get periodic payments to provide advanced health services to beneficiaries. Services may include evaluation of social needs related to their health, electronic patient-reported outcomes implementation, and care planning, among other services.

Many APMs still suffer from assumptions inherited from the fee-for-service model. Crafting a successful APM means building a structure appropriate for a VBC framework.  

This structure requires a way to organize, coordinate, and visualize all the relevant data: Electronic Health Records (EHR), (re)admissions rates, treatment results, imaging, appointment scheduling, drug trials, patient population data, revenue cycle, staffing, and more. There is no one-size-fits-all APM; each should be tailored according to its goals, stakeholders, and patient population. 

When establishing APMs, here are the top three things to keep in mind:  

1. Infrastructure requirements – You must determine the best quality measures for an effective APM. Network practices may have to set up new databases, collect information, and establish new workflows to effectively achieve the APM’s goals.
   
   
2. Integrate the data with network participants – Once you have the infrastructure to collect the data, you need to be able to use that data to optimize efficiency and performance. An electronic platform will use analytical tools to translate real-time clinical and claims data into actionable ways to progress in VBC.
   
   
3. Understand the requirements – What kind of insights are you looking for? Which service models are necessary to enable providers and members to advance the standard of value-based cancer care? There is no need to start from scratch—partner with a software vendor with experience in your specialty to benefit from established APM best practices.

An Electronic Health Record (EHR) is an electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports.

The EHR automates access to information and has the potential to streamline the clinician’s workflow.  The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

EHRs of yesterday are designed for fee-for-service, focusing more on billing and data entry than patient care or delivery of robust analytics. What providers seek now are seamless, easy to implement and use EHRs with limited data entry and clinical decision support – facilitating optimized patient care. They are looking to maximize the value of their investment in EHRs with key features such as clinical pathway support, care plans, quick access to answers, analytics, and enhanced patient engagement.

Speciality-specific EHRs are tailored to practice workflows, including specialty-specific content and templates, resulting in optimized workflow efficiency while supporting more personalized patient care.

Emergency Medical Services (EMS) billing is a service that manages fees for ambulance transport to a hospital or facility accompanied by an EMT and/or paramedic crew.

Medicare – Medicare is a government insurance plan that will generally cover all emergent, medically necessary transports to the nearest appropriate medical facility. For an EMS transport to be considered medically necessary, the use of any other form of transportation must be considered hazardous to the patient’s health or current condition. 

 
Medicaid – Medicaid is also a government insurance plan but is administered by the state. Coverage of EMS services varies from state to state, so it is important for the beneficiary to familiarize themselves with their individual benefits.  

Private Insurance – Private insurance also varies from policy to policy. The beneficiary is responsible for understanding what their individual plan covers. The beneficiary is also responsible for out-of-pocket expenses assigned by the plan including copayments and deductibles. 

Auto Insurance – Personal injury protection (PIP), uninsured motorist coverage, and comprehensive auto insurance will cover ambulance transportation if it is deemed medically necessary.