5 Factors to Continue the Successful Shift to Value-Based Care

Guest post by Mark Ott, vice president of product, RoundingWell.

Mark Ott
Mark Ott

As 2016 unfolds, the move from fee-for-service to value-based care is entering a more advanced stage. As the process evolves, priorities for healthcare providers of resources, teams and tools becomes more convoluted. To keep on track, both for healthcare organizations and CMS changes, providers should keep in mind the following:

The care management/coordination record rises in importance, especially as team-based care models expand

Some call it a care management medical record and others call it a care coordination record. Regardless of the term, the concept is essentially the same. EHRs are basically encounter management systems, but as care expands beyond the in-person encounter, capturing and tracking what happens between patient visits will be of utmost importance. In addition, enabling care teams to stay on the same page about a patient’s care plan, track action steps, and reduce the friction of working together will be crucial to succeeding in a value-based world. Expect to see the Care Management Record concept start catching fire in 2016.

Demand will increase for consumer-grade user experiences in healthcare enterprise software

For so long, clinicians on the frontlines of care delivery have had to struggle with software that’s hard to use, difficult and downright frustrating. The biggest culprit for poor user experiences in healthcare software has to do with the enterprise purchasing process. Vendors build for buyers, like the C-suite, who aren’t also the end users. If the end user and the buyer were the same, you’d see healthcare software vendors value user experience like what we see in other B2B industries, not to mention B2C industries. Regardless, in 2016 we will see more buyers value products with consumer-grade user experiences. Much of this has to do with end users’ reluctance and sometimes outright resistance to adopting technology in their worklife. Clinicians often get a bad wrap for being technology averse. But in reality, it’s not that they’re averse to technology; it’s that they’re averse to bad technology.

Integrating wearables and their data into care delivery processes will remain a niche activity

The enthusiasm around wearables, trackers and remote monitoring is exciting and there is enormous potential for device data to impact the delivery of care in ways that benefit both patient and provider. But the technology hasn’t caught up with the promise of what they can be, and that won’t change in 2016. Not only is the technology not yet able to deliver, but the incentives and processes to support wide-scale deployment are not in place yet. Though all signs point to wearables becoming an integral part of delivery of care, this won’t happen next year.

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What to Expect at HIMSS 2016

Guest post by Drew Ivan, director of business technology, Orion Health.

Drew Ivan
Drew Ivan

With such an enormous cross-section of the healthcare industry in attendance, the HIMSS Conference and Exhibition represents a comprehensive snapshot of the state of the healthcare industry and a perfect trendspotting opportunity. Here’s a preview of what I expect will be this year’s conference highlights.

Care coordination and population health and process improvement, workflow and change management are tied for the most popular category, with 29 educational sessions focused on each.

Representing 22 percent of the total number of sessions, this is clearly a focus area for the year’s conference, and it’s easy to see why. Changes in healthcare payment models are now well underway, and they are impacting payer and provider operations where healthcare is delivered, managed and documented.

Providers and payers alike are seeking information about how best to operationalize business processes and provide high quality care under new payment models, but it may be even more interesting to visit the Exhibition Hall to see what innovations vendors are bringing to the market to meet these needs.

Another topic related to changes in healthcare delivery is clinical informatics and clinician engagement, which is all about how new technologies, such as big data and precision medicine, can impact care decisions. The ability to make data-driven clinical decisions is one of the many dividends of widely adopted electronic health records. This is likely to be an important area for many years to come.

With 100 million medical records hacked last year, privacy and security is a hot topic at this year’s conference. The number of educational sessions in this category nearly doubled from 13 last year to 25 this year.

While preventing unauthorized access to records is the top priority, security will be a simpler problem to solve than privacy. As more sources of clinical data go from paper to electronic systems and more types of users have legitimate access to patient data, the problem of providing appropriate, fine-grained access in accordance with patient preferences, clinical settings and laws that differ across jurisdictions becomes very difficult to untangle.

Privacy and security concerns will need to be addressed with a combination of open standards and vendor products that implement them. Technologies from other industries, like banking, are likely to start making their way into healthcare.

This year, health information exchange (HIE) and interoperability educational sessions are combined into a single category, reflecting the fact that interoperability within a single institution is, at this point, more or less a solved problem. The next frontier is to enable interoperability across institutions to support improved transitions of care.

HIEs have a role to play when it comes to moving data between organizations; however, many HIEs are struggling or disappearing because of sustainability challenges. This year’s conference will provide an opportunity to learn best practices from the most successful HIEs. It will also be interesting to see what strategies HIE vendors will pursue as their customer base consolidates. In the Orion Health booth alone, we will have executives from HIEs talking about these same issues.

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The Push to Telehealth Is On

Scott Zimmerman
Scott Zimmerman

Guest post by Scott Zimmerman, president, TeleVox.

If you caught Maria Bartiromo’s interview with ex-Apple CEO John Sculley in late December, you would have heard him say this to the Fox Business Network’s Global Markets Editor:

“Telehealth is going to be a booming industry.”

Why? Sculley pointed to consumers’ taking on more responsibility for their own healthcare, the result of a new awakening to its high costs. He sees this as a derivative effect of Obamacare, as patients confront greater out-of-pocket payments in the face of higher deductibles.

Sculley went on to compare his expectations for the success that he expects telehealth to experience to the success that ATMs and online banking have seen in the last 20 years: “People said, ‘I wonder if it will be successful. We all know it was. The same thing is going to happen in telehealth.”

The renowned tech titan is very much onto something here. Consumers – especially those with chronic conditions who grapple with the challenges of adhering to prescribed treatment plans – will want more efficient and lower-cost ways to more regularly engage with their healthcare providers as part of a continuous-care model. But there’s so much more that is influencing the move by medical professionals to complement in-office visits with remote patient engagement strategies and communications solutions.

One important reason is that healthcare providers and institutions have financial incentives for more aggressively managing patient cases. In the age of accountable care, hospitals want physicians who have ties to their healthcare systems to boost patient communications for care coordination, to help them steer clear of penalties for avoidable readmissions. The focus on rewarding quality of care delivered, rather than quantity of services provided, also increases the importance of doctors’ keeping closer tabs on how their patients are doing in between office visits.

It’s always better that physicians know as soon as possible if their patients are having problems complying with care instructions or experiencing other complications, but especially so under these new scenarios. By the time the next office visit rolls around, things may have worsened to a considerable extent, potentially leading to more tests, additional medications, or even the need for hospitalization – all of which can take its toll on meeting accountable care standards.

Progress Is Underway

Of course, it’s simply not possible for healthcare professionals to regularly call each patient who is suffering from a serious condition to see how he or she is doing between appointments.

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Population Health and High-Value Care Coordination

Guest post by Mark Hefner, CEO, Infina Connect Healthcare Systems.

Mark Hefner
Mark Hefner

Various forms of payment reform are in play throughout US healthcare today, and with good reason as we search for the right combination of incentives, alignment and engagement that produce systemically better health outcomes at lower overall cost.

As an example, providers are paying much more attention to the small percentage of patients with the highest costs, including patients with chronic conditions. As a result, they are identifying these patients, establishing care plans and engaging care coordinators and patients to improve outcomes. Less attention, however, is being focused on the powerful capability to better connect, communicate and coordinate care among the multiple providers that care for a patient. This caliber of care coordination has the potential to improve outcomes across the entire patient population and is rooted in results that suggest a coordinated network of providers, each capable of high quality and cost effective care, with appropriate information about the patient available to them, can deliver improved outcomes across large patient populations.

Patient populations may be systemically managed under various forms of accountable care, commercial shared savings, Medicare Advantage and full risk – or managed by episodes of care, bundled payments, etc. The shift from fee-for-service to “fee-for-value” incentivizes preventive care, best practice care, and high-value delivery of care and it puts a premium on the ability to coordinate care.

Therein lies a very significant challenge: The collective group of providers that interact with a large patient population are invariably part of different organizations, with different technology platforms or no platform at all and are dependent upon fax machines, phones, and paper to exchange documents and communicate. The provider groups also possess differing incentives: the “at-risk” provider attempts to influence improved health and financial outcomes while other providers may still be receiving fee-for-service payments.

Reconciling these challenges and harnessing the power of care coordination is now possible via referral coordination. One of the most powerful mechanisms for coordinating care are the hundreds of thousands of patient referrals made every day between various providers, with Primary Care Providers (PCP) being the largest initiator of consulting and diagnostic referrals on behalf of their patients. Providers need to communicate with each other when they are treating the same patient, and these patient transitions between providers represent a significant opportunity to realize high value care.

The referral itself is equivalent to a PCP or patient making a decision on which provider to “hire” to provide the needed care. This referral decision and the coordination of the referral are critical to the delivery of better health at lower cost, but improving the overall referral process requires key elements to be implemented consistently:

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Getting to Meaningful Use Stage 2 and Beyond

Michael Simpson
Michael Simpson

Guest post by Michael Simpson is the CEO of Caradigm.

It’s been five years since the HITECH Act was enacted as part of ARRA, and while there’s still a lot of debate about the technical details, rules and timelines involved with electronic health record (EHR) adoption and meaningful use, it’s clear that the focus on EHRs – and incenting hospitals and professionals to use EHRs in a meaningful way – represents a critical, foundational step in transforming health care in this country.

After all, meaningful use targets the right goals – goals that every hospital, health system and healthcare professional supports, including improved quality, safety and efficiency of care; reduced disparities; more engaged patients and families as core members of the care team; improved care coordination and population health; and more secure patient health information.

More important, the stages of meaningful use drive a set of progressively more advanced capabilities that are fundamental to achieving those goals. Digitizing data was the first critical step, and the good news is that according to a recent HHS press release, about 60 percent of all hospitals have adopted an advanced EHR, leaving the paper world behind. The next steps are sharing that data – securely – among providers and patients, reporting on quality to understand and improve it, using clinical decision support at the point of care, and many other capabilities critical to transforming care and outcomes. If providers and professionals meet meaningful use requirements, we should see more transparency, greater efficiency, reduced waste and more healthy people in our communities over time.

Stage 2 Challenges

It’s a long and challenging journey, and while hospitals and health systems are making good progress against Stage 1 requirements, very few are prepared for Stage 2. In fact, according to survey data from the American Hospital Association, fewer than 6 percent of hospitals have met the criteria for Stage 2, and only 10 percent have met the requirement for patients to be able to view, download and transmit their health information online.

Why are providers getting stuck as they try to move to Stage 2? Because as the requirements become more demanding – e.g., using clinical decision support, generating patient lists, protecting patient health information, engaging patients – these organizations need a new set of technology capabilities to meet those requirements.  These capabilities leverage and extend the functionality and benefits of the EHR.

Moreover, to reach the ultimate goals targeted by Meaningful Use — improved quality, efficiency, outcomes and population health — providers will need to aim even higher than meeting the requirements of meaningful use stages, strategically using data from EHRs and myriad other systems across the care continuum to enable a new level of capabilities.

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