Guest post by Christina Richards, vice president, AOptix.
In recent years, the healthcare industry has experienced a Renaissance of sorts with the development and adoption of mobile and connected technologies. As a result, healthcare facilities the world over are increasingly making use of smart technologies to drive better patient outcomes, track equipment, and support overall operations. In addition, the developing practice of telemedicine is becoming increasingly commonplace for doctors in healthcare settings across the United States, which is raising new concerns about the infrastructure needed to support these real-time doctor-patient experiences.
Although the development of these digital technologies for healthcare applications is only in its infancy, we are already beginning to see their wide range of benefits, including the potential to help organizations achieve the Institute for Healthcare Improvement’s (IHI) Triple Aim of bettering the patient experience, improving population health standings and reducing the cost of healthcare. For instance, a 2014 study by Dale H. Yamamoto of Red Quill Consulting, Inc. found that that the average estimated cost of a telehealth patient consultation was $40 to $50 per visit, compared to the average estimated cost of $136 to $176 for in-person acute care.
With the widespread adoption of any new technology however, there is a learning curve to ensure that they can be effectively integrated into existing operations to capture the greatest benefit without compromising the level of care. But what does this entail?
As healthcare facilities become more connected through the Internet of Things, adoption will continue across a broad spectrum of devices and sensors—from wearable tech that monitors patient location and vital signs to analytics platforms that track staff movements and create more efficient workflows. While these devices span a variety of applications, they all share a universal purpose, which is the constant collection and analysis of data.
Likewise, video conferencing and other mobile approaches to telehealth are highly data-intensive, requiring the transmission and processing of large amounts of information. As a result, many healthcare administrators have encountered the need for far more robust mobile networks in their facilities to support the massive amounts of data traveling across their systems.
In considering other data requirements on the horizon, take the case of rapid genomic sequencing. While the new technology allows researchers to quickly determine the complete DNA sequence of an organism to predict disease susceptibility and drug response, the process requires the transfer of massive amounts of data. To make this information more widely accessible, one company, NantHealth, is looking into a method of compressing the data into a more manageable size so it can be shared with other facilities through high-capacity wireless connections, rather than strictly relying on fiber. With ever-growing levels of data becoming necessary in the healthcare system, new technologies and methods for managing it across various networks will become even more important.
Under the traditional fee-for-service reimbursement model, providers and payers are natural adversaries. To maintain a steady source of revenue, providers are incentivized to render as many services as possible without running afoul of controls designed by payers to keep utilization in check. When healthcare costs inevitably creep up, providers demand higher reimbursements from payers. Payers, trying to keep claim in check and health insurance premiums competitive, respond by restricting members’ access to certain providers.
It’s this tension between payers and providers that forms the backbone of the U.S. healthcare system. At least, it has until recently. Policy and political leaders have come to realize that, absent of other factors such as quality, efficiency and patient satisfaction, healthcare costs will continue to rise, creating a weight under which the system will eventually collapse.
Enter the accountable care organization, a new model for healthcare delivery and reimbursement that exemplifies the key tenants of the Affordable Care Act and the healthcare Triple Aim: improving the patient experience of care, improving the health of populations and reducing per capita costs. Unlike the fee-for-service reimbursement model that rewards providers based on volume of services, the ACO model rewards providers for achieving specified quality objectives and constraining costs.
On their face, ACOs would seem to encourage cooperation between payers and providers. After all, to improve population health, providers need claims data and the type of technology solutions that payers have been investing in for decades. And to reduce healthcare costs, payers need to partner with quality providers with proven track records for keeping patients healthy. Ask any patient who has bounced back and forth between doctors’ offices and their health insurance company trying to sort out a medical bill, and the opportunity for improving the patient experience of care is tremendous.
So far, many ACOs are doing just that. Of the nearly 1,100 ACO contracts that Decision Resources Group is tracking today, more than half are commercial agreements involving 70 private payers. The largest private-payer ACO initiative in the country is led by Cigna, whose Collaborative Accountable Care program has 124 ACO agreements in 29 states encompassing more than 24,000 primary-care physicians and 27,000 specialists.
However, other aspects of healthcare reform are adding fuel to the payer-provider fire—and ACOs are a flashpoint. To keep health insurance premiums competitive, payers are excluding high-cost providers from their networks. Many of these narrow or exclusive provider networks also function as an ACO, with attached health plan products that are proving popular in public health insurance exchanges.
Guest post by Dr. Andrey Ostrovsky, co-founder and CEO, Care at Hand.
Seven-hundred-and-seventy billion dollars in Medicare and Medicaid spending and more than one fifth of the federal budget is going to be spent very differently in 2018 compared to today. In particular, Health and Human Services (HHS) secretary Sylvia Burwell declared that at least 50 percent of Medicare payments will be tied to value-based models, such as bundled payment or accountable care organizations, by the end of 2018. The majority of Medicaid dollars have already shifted from fee-for-service (FFS) to managed care. Providers, payers and even patients are increasingly being held accountable for health outcomes and cost of care. So how come there is no accountability for the health IT industry?
There is no 30-day readmission penalty for EHR vendors. There is no medical-loss ratio applied to population health management platforms. There is no shared savings for predictive analytics apps supporting bundles. The lack of accountability in the health IT industry is hampering the promising shift in the rest of the healthcare system from volume to value.
Technology has the potential to speed up adoption of payment-for-performance and achievement of the Triple Aim including improving outcomes, decreasing cost and improving patient experience. However, a recent analysis by the Institute for Healthcare Improvement (IHI) found major gaps in the current digital health ecosystem with only 2 percent of technologies achieving all three aims and only 23 percent of technologies having any peer-reviewed research evidence for their claims.
While regulation can slow tech innovation and the FDA should be commended for loosening its regulatory grip over apps, financial incentives and constraints should be put in place to spread the risk – and reward – that the entire healthcare system is facing to the HIT industry as well.
Before the federal government realizes that health IT has slipped under the radar of accountability, our industry has a chance to shape it’s own future by incorporating risk-bearing into our business models. More important than the viability of technology vendors is the implication of accountability on the lives of vulnerable consumers and sustainability of providers serving those consumers.
The following guiding principles can ensure that vendors are held accountable of supporting high-quality, patient-centric delivery models and achievement of the Triple Aim: