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Manufacturing Recovery? Who says?…

…well, it looks like several folks are saying it!

American Factories were going all out in September – is it a sign that the US economy is picking up?  Wall street certainly seemed to respond well to some key indicators at the beginning of October.

Take a look at some of the performance metrics below and you’ll get an indication of why…

  • The ISM (Institute for Supply Management) Index (PMI™)  rose to 51.5 for September from 49.6 in August. Anything above 50 shows growth (growing rather than contracting), and a nearly two point rise reverses previous months declines, the fastest pace since May.
  • Pace is slow, but signs are hopeful. The new orders index rose from 47.1 to 52.3 suggesting humming production this month, and suggests November will be good too.

However…

  • The economy isn’t growing as fast as the Fed Chairman would like. Hence an open-ended QE3 (Quantitive Easing 3) and a statement that interest rates will remain low until 2015.
  • JP Morgan Economists are saying that we’ve seen a slow down in US Manufacturing and it’s tracking more like the overall US economic growth – sluggish, suggesting the best may be behind us. Still growing though, but slowly.

Overall I’m a bull on US manufacturing. There are a number of US companies looking to bring back jobs from overseas. But the labor shortage in the US is getting worse. Baby Boomers retiring, not enough skilled or trained workers to take their place. A recent Deloitte and The Manufacturing Institute study stated that manufacturing sector can’t find workers with the right skills to fill around 600,000 jobs. Hopefully Cisco’s Remote Expert and Cisco’s other solutions will help. Check out Ron Kafka’s blog titled “Realize Business-Wide Benefits with Cisco’s Remote Expert” to find more about Remote Expert. Read More »

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How Cisco VXI Improves Contact Center Business Processes

In a recent interview, I discussed the importance of prioritizing business processes that have the most impact when deploying virtual desktops.  One common business process that can significantly benefit from a virtual desktop delivery model is in customer service.  Cisco offers an innovative contact center solution that creates the foundation for positive customer service, resulting in greater customer satisfaction, loyalty and competitive advantage. With the latest release of Cisco Virtualization Experience Infrastructure (VXI), we are able to support Cisco Unified Contact Center Enterprise, further improving the benefits to contact centers that are moving to desktop virtualization.

By deploying Cisco Contact Center Enterprise as part of Cisco VXI, IT can now  Read More »

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Next Step to a Unified Workspace with Cisco Virtualization Experience Infrastructure (VXI)

Two years ago, we, along with our partners, launched the Cisco Virtualization Experience Infrastructure (VXI) Smart Solution, with the vision of delivering a virtual desktop platform that enables our customers to achieve faster ROI, better user experience and greater control.  Since then, we’ve seen a major shift in the market. People are using a multitude of devices while businesses are now accepting and supporting BYOD initiatives, fueling the growth of new workspace models. Cisco has responded by rolling out the Cisco Unified Workspace, strategy, and the Cisco VXI Smart Solution is a key component.

Today, we introduced a new release of the Cisco VXI Smart Solution.

Cisco VXI has always been a solution that spans the Cisco architectures of Data Center, Borderless Networks and Collaboration. With this new release, we are continuing innovations across all three including: Read More »

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Session Management Fundamentals

The flexibility enabled by an IP based communication system is exemplified in how Cisco handles Session Management. In fact, the combination of ‘Session Management Edition and CUBE (Cisco Unified Border Element) remain the most cost effective way to transition from a traditional PBX environment without sacrificing previous investments.

The benefits can be grouped in three areas:

  • Save – Lower costs and improve efficiency by using SIP trunking to interconnect networks using Cisco Unified Border Element
  • Simplify – Reduce complexity by aggregating third-party PBXs, and easing migration to an all-IP environment.
  • Extend – Deploy collaboration applications at the network core and extend them to users, even those on third-party PBXs

In this latest in the Fundamentals series from TechWiseTV, we tackle the core technology hopefully explains it in a fun way. Get your head wrapped around Session Management and make sure you are not missing anything!

After you watch,

Read More »

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Accountable Care Organizations – Increase Shared Savings and ROI Through Video, Collaboration and Telehealth

The need to control healthcare expenditure (per capita Medicare expenditure at $8973) is no longer in doubt. With over 36% of the $599 Billion Medicare spend on inpatient care, almost 19% on post acute care and over 13% on outpatient services healthcare is looking to new business architectures to contain costs as well as maintain quality. Accountable Care Organizations (ACO’s) is one such business model structured from a fee for service to a pay for performance model.

The aim of an ACO is to reduce healthcare costs, improve quality as well enhance patient experience. ACO’s are legal entities that organize around the concept of a patient centered medical home with primary care physicians forming the core who become the focal point for engaging with the patients to participate in driving superior outcomes. The ACO’s enroll healthcare participants in the care continuum who collaborate together in concert to meet the goals of the ACO.  These participants would include specialists, extended care providers (skilled nursing, hospice, extended care), physicians, nurse, dieticians and social workers. Primary Care Physicians can participate in only one ACO; the others may participate in more than one ACO.

ACOs may be fully integrated or they may draw members from outside the organization into the legal structure through agreements to complete all needed participants in the care continuum.

ACO’s have shown benefits. Cigna has done a study showing significant savings in Accountable Care Organizations. Michigan’s Value Partnership Program or Blue Shield Blue Cross MA and others have shown promising savings.

Can this shared savings be increased using collaboration, video and Telehealth technologies? There are indicators that it can:

  • VA has shown a 19% reduction in hospitalization through its Telehealth program
  • Geisinger Health Plan has shown a 44% reduction in readmissions with Telehealth
  • Over 75% of Asthma admissions could have been avoided by using Telehealth

The payout to an ACO is calculated as:

Payout to ACO= (Cost Saving) x (Shared Saving %) x (Quality Performance)

An ACO is a business architecture where caregivers need to collaborate in the delivery of care, very closely, across the care continuum. The Primary Care physician needs to remain engaged with the patient as the patient transitions through different touch-points in the care continuum. Patients remain engaged and vested in their own well-being. The physicians will practice at the top of their license leaving certain functions to appropriately trained nursing.

Healthcare IT will play a major role; one of the requirements is for at least 50% of the primary care physicians to be meaningful use users. ACOs also have to demonstrate evidence-based practice. The ACO eco system should collaborate around an EMR that could be delivered on the cloud as a service to the ecosystem.

The ACO needs to identify at-risk patients and maintain close contact. Case Managers or care coordinators will leverage technology to keep the high touch with at risk patients.

Patients also need to have access to their trending health records as well as receive focused education

An ACO can increase its cost savings through immersive video and collaborations:

  • Care transitions managed through proactive video collaboration between caregivers help in reducing medical errors and re-admissions
  • With immersive video based collaboration where the specialists and the primary care physician examine a patient at the same time using multi-point Telehealth saves costs. Such interactions also allow the primary care physician to make more informed decisions over a period of time. ACOs can see huge savings through this provider partnership.
  • Care coordinators can maintain a video based touch with outpatients and direct nursing visits where needed or bring in physicians or specialists into a video consult with the patient avoiding unnecessary visits to an ER
  • Telehealth can provide specialist access to patients in skilled or extended care facilities cutting down avoidable ER visits
  • Telehealth solutions that create physician groups can allow the right care provider, based on specialty or language, to provide care where needed
  • Technology can be leveraged to manage chronic conditions.  “No show patients” is a huge drain in the operational waste in healthcare systems. Whether delivering virtual care in mental health situations, or examining patients who have difficulty traveling to clinics, video consults for movement disorder, neurologic or cardiac patients post operative consults – Telehealth can bring down healthcare costs.
  • Telehealth can allow specialists to avoid travel to remote clinic. The time saved provides efficiencies whereas the additional patients that a specialist can examine in the time saved provides transformational benefits
  • Structured collaborative education using technologies such as Webex can be more effective than a written brochure

Video, collaboration and Telehealth can also help in increasing the quality performance measures for ACOs:

  • The ability of a patient using immersive video and collaboration to stay in touch through care coordinators with physicians, specialists, nurses or social workers enhances the patient caregiver experience.
  • To succeed ACOs have to create appropriate team plays. Collaboration allows ACOs to dynamically build appropriate care teams to manage patients in different care settings. This helps in driving care coordination and patient safety metrics
  • Appropriate technologies as well as high touch virtual collaboration through immersive video can help with at-risk patients in any care setting. Structured education and trending personal health records drives adherence, compliance and better outcomes.

All that is good but is there an ROI for collaborative solution video and Telehealth? Yes, our ROI models have shown that such solutions can increase shared savings as well as improve the quality metrics.

 


However, the health of the ROI will depend on  a sound network architecture and the investment in appropriate Video and Telehealth solutions:

  • The Telehealth solution should be scalable. Statistically 20% of the patients are responsible for 80% of the costs. Even with the smallest ACO with 5000 patients that translates to at least 1000 patients that need closer care. Even if 20% of these are at-risk that translates to over 200 patients that need a high touch video collaboration. This besides the Telehealth network across the care continuum of the ACO eco-system.
  • The Telehealth solution should accommodate and adapt to a variety of tethered and untethered end points as well as bandwidths
  • The Telehealth solution should be resilient and stay alive in the case of server failure
  • The Telehealth/Video and Collaboration solution should be built on a medical grade network infrastructure with a solid foundational architecture
  • The Telehealth solution should be simpler than a telephone to use. Single click collaboration will widen adoption
  • Primary care physicians and specialist need to collaborate on patients. The Telehealth solution should allow physicians, specialists and radiologists seamless collaboration with medical images without having to exit out of the collaboration session
  • The Telehealth solution should have the ability to push or pull data to/from EMR’s
  • ACOs are team plays so the Telehealth solution should allow the primary care physician and a team of specialists or care givers to examine a patient at the same time with vitals being shared to providers that need to see or listen to the telemetry. A variety of telemetry devices will allow different specialist to take advantage of the solution and provide cost saving virtual care
  • The Telehealth solution should allow grouping of specialists from different systems by specialty, care team or language. The system should abstract all complexities of contact center, collaboration technology, presence, firewall traversal and build these virtual groups as if they existed in one physical organization
  • Physicians are not always available, the solution should indicate presence status of the care givers so that the available care provider can be brought into a consult when needed
  • Finally an ACO creates a virtual organization and the Telehealth solution should integrate into the business and IT architecture of the ACO

An ACO is a collaborative organization. Healthcare services will be delivered over the network. The business architecture will implement on the IT and Network architecture; it is important to ensure that the network architecture foundation is strong and secure.

There will be big ACO successes and some not so big. Factors that will drive success are:

  • Strong leadership
  • Healthcare ICT and careful architecture considerations
  • Immersive and pervasive collaboration and team play
  • Process

An ACO creates a new way to deliver care. Process will be key to ensure operational efficiencies. Mapping out the care process across the continuum for each condition, cardiac bypass or diabetes or any other condition, then creating a checklist and ensuring adherence and compliance with the process across the care continuum will help in predictable outcomes. A team of process designers to design these processes and then measure them through appropriate metrics will allow optimizing and realizing desired outcomes as well as shared savings. Success will depend on vision, strategy and execution.

 

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