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:
1) Technology should be evidence-based
2) If technology is not evidence based, it needs to validate its claims through quality improvement within six months of deployment in order to be reimbursable
3) Technology should support quality measurement along all domains of healthcare, not just medical care, such as those being developed by National Quality Forum Committee on Home and Community-based Services
4) Reimbursement for technology should be tied to outcomes
5) Technology should facilitate early identification of risk factors for acute care utilization using the observations of the existing non-medical workforce already providing care
6) Technology should support improvement of workforce quality and satisfaction
7) Providers should have choice in the technology platforms they use rather than being mandated by the state to use a single platform
8) If interoperability is needed then technology should support interoperability along all domains of healthcare, not just medical care, such as those being developed by the electronic LTSS (eLTSS) workgroup from the Office of the National Coordinator (ONC)
9) Technology should support sustainability of services, especially by facilitating return-on-investment calculations
10) Users of technology, especially those that don’t have capacity for rapid system transformation, should be offered technical assistance to ensure they have a baseline capacity for business acumen, quality improvement, and design thinking
These 10 recommendations are a starting point. Incubators like Startup Health, Innovation Centers like NEHI, and Industry Organizations like HIMSS have a great opportunity to take a leadership role in ushering the digital health and HIT community into the inevitable world of risk-sharing before the government does it for us.