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Amanda Buie

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The Marriage of ACOs and Technology

ACOs are paving the way for a healthcare payment model that is based on quality and efficiency instead of volume.  They were created as a response to health reform initiatives that focus on improving patient safety, quality of care and affordability.  As the name suggests, ACOs are institutions that collectively share the risks associated with improving outcomes and patient satisfaction.  ACOs seek to make these improvements by improving the coordination of care amongst nurses, physicians, practitioners, hospitals and health care providers.

The goals of ACOs are to successfully provide three foundational elements:

  1. Continuum of Care:  These organizations rely heavily on the transfer of data to and from different institutions and areas of care to meet its objectives.
  2. Minimal Capacity Constraints:  ACOs must be able to provide care when care is needed, without pushing out care and threatening outcomes.  The constant ability to meet demands requires a delicate balance between efficiency and excess.
  3. Patient Centeredness:  Ability to engage and promote patients to take part in their care through the use of educational materials, patient monitoring, telemedicine or gamification.

To meet each of these characteristics, organizations will put forth substantial efforts and will rely heavily on technology for help.

Role of Technology

Solutions provided by Health Information Technology (HIT) are critical to the ACO delivery of care model, because it is the solution to integrating disparate data from multiple locations and care givers.  By investing in electronic medical records (EMRs), enterprise data warehouses (EDW) and health information exchanges (HIEs), data can and will be used to overcome the cost and quality healthcare hurdle.

An ACO must have an advanced HIT infrastructure to appropriately manage the entire population and connect with their members using tradition and alternative methods of communication.  As a result, we can expect ACOs to lead the way to healthcare solutions and serve as examples of what technology can do for healthcare.

Using Technology to Cure Healthcare Business Ailments

A recent article in the WSJ displayed how improving the health of patients is tied to being able to see the big picture. It just so happens that to improve the health of an organization, there is also a need to see the big picture, which requires having access to data. Research has shown that to remedy today’s healthcare problems, organizations must have a centralized home for data and up-to-date systems. According to the 2001 Institute of Medicines report, the healthcare system must evolve from a “highly decentralized, cottage industry, to one that is capable of providing primary and preventative care, caring for the chronically ill, and coping with acute and catastrophic services”. This requires a substantial investment in a myriad of advanced HIT systems that can provide risk stratifications, patient registries, education resources, alert services, prescription reminders, employee staffing, financial-outcome reports and overall decision support.

The problem here is that simply using EMRs will not do the trick. The real solution is to merge the data from EMRs with other data to paint the whole picture and avoid being “data rich but information poor”.  It results in a business that can use data to drive business and clinical decisions. Is it really worth the investment in an enterprise data warehouse, decision support and business intelligence? Simply stated, yes, because merging data allows organizations to develop solutions to overcome organization-wide issues, operational bottlenecks and provides a way to evaluate financial positions from an operations view.

Healthcare Efficiency
Efficiency is a key point in every organization. Alchian claimed that firms must have a positive profit to survive. While we don’t argue that point, it is important to note that firms strive to be profit maximizers, which requires educated business decisions that lead to specific outcomes. Those outcomes cannot be attained by taking a business-as-usual approach. Instead, it requires business intelligence systems to support defined and desired outcomes that promote profits and efficiency.

Healthcare providers who have a faint heart for efficiency and
investing in solutions to increase efficiency will be pressed to remain competitive in today’s landscape.  Efficiency and effectiveness are the key to the future.  They may come at a cost today, but without these solutions, organizations will struggle to provide quality services at affordable prices.  Is there really a choice anymore?

PHM: Making the Sum Greater than the Whole

Research suggests that an effective healthcare model focusing solely on evidence-based medicine or preventative does not impact cost and quality as well as programs that merge evidence-based medicine with a healthcare program that encourages preventative care and evidence-based medicine (Cohen, Neumann & Weinstein, 2008).    As a result, organizations that are focused on containing costs and increasing quality are turning to population health management (PHM) to meet their related objectives.

PHM relies heavily on the readiness of an organized and coordinated system, because it places an emphasis on primary care to provide preventative, acute and chronic illness care, which is coupled with efforts to educate patients and encourage behavior and lifestyle changes.  Because PHM uses robust data from the many sources to evaluate wellness, prevention and early detection of diseases and educational programs to support healthy behavior choices, it requires an organization have a technology infrastructure that can be utilized to influence clinical and business decisions to track patients and impact overall health costs and quality.

A myriad of advanced HIT systems are required to provide the necessary automated risk stratifications, patient registries, appropriate education resources, alert services and adequate reporting.     Providers are looking to HIT to provide them with the appropriate data to link care guidelines, disease registries, feedback about performance and patient communication.  Providers must have the right technologies to support PHM, which include solutions such as:

  1. Enterprise Data Warehouse:  A single repository that serves as the “truth” for multiple areas of an organization’s data.  Through the consolidation of multiple disparate sources, an enterprise data warehouse enables business intelligence and powerful analytics.
  2. Electronic Medical Records (EMRs): Computerized medical records that store historical and current patient data.  There are multiple EMR offerings to suit any needs and desires.  An organization that uses its EMR system well can capture nearly any piece of clinical information desired.
  3. Health Risk Assessments (HRAs):  Provide feedback on the wellness and risk factors threatening an individuals wellness.  They are comprised of three main elements: questionnaires, risk calculations and personal health advice, to increase awareness of risk factors and ensure that an individual knows the appropriate actions to take care of themselves.  HRAs require numerous systems speak to each other in a way that promotes efficiency and effectiveness for the patient, provider or payor and field personnel.
  4. Business Intelligence:  Takes an enterprise-wide approach to decision making.  It relies on data from all areas of an organization (financial, clinical, operational, etc.) to determine the solution to issues.  This is the distinguishing factor between a traditional “data rich but information poor” healthcare organization and a leading edge organization that uses data to drive clinical and business decisions.

These pieces of technology set the stage for PHM to improve the wellness of populations.  When cost and wellness is the issue, technology has provided a way for organizations to solve the problem.

Encouraging Accountability and Good Behavior

Patients are demanding affordable healthcare, providers are asking for fair reimbursements and payors are suggesting that rendered care should be medically necessary and of high quality to be reimbursed.  It is a rather convoluted situation where accountability lives with each player – but is legally placed on the provider (for the most part).  After all, taxpayers can’t file a suit against Medicare and Medicaid recipients for negligence because they made poor choices that led to exuberant healthcare expenditures which ultimately were paid for with taxpayer revenues.  Providers can’t claim gross negligence on behalf of patients for making poor choices that decreased a provider’s outcomes and overall ratings.  This disconnect between accountability and the players lends itself to an ineffective healthcare system.

Because healthcare providers and payors are both striving to increase the wellness of patients, it is reasonable to assume that they must work together to increase outcomes and decrease overall costs by holding patients/members accountable for decisions that impact their health.

Step I: Identify the problem (HRAs)
Suggestions to include patients in the accountability circle must begin with a health risk assessment (HRA).  According to the CDC, a HRA is “a systematic approach to collecting information from individuals that identifies risk factors, provides individualised feedback, and links the person with at least one intervention to promote health, sustain function and/or prevent disease.”  Patients voluntarily agree to participate in the assessment so that their care can be better suited to support them and their specific needs.

Step II: Classify the Problem (Population Health Management)
An HRA is the first step to population health management, which is known to increase outcomes and decrease health related costs by closing gaps in the care continuum.  By identifying and attaching the root cause (i.e. behavior and choices examined within the HRA), population health management uses evidence-based practices to change the overall health of individuals.  Population Health Management categorizes all individuals and suggests treatment for low and high-risk patients.  The result is a healthier population in the long run by encouraging preventative services and providing disease management.

Step III: Treat the Problem (Gamification)
In a recent WSJ article, Anna Mathews examines how payors are using digital gaming to impact member’s health.  These games are used to promote positive healthcare decisions by rewarding individuals based on choices that affect their health.  United Healthcare VP, Bob Plourde, claimed that digital games are used to get members “engaged and excited.” The Humana CEO also claims that the games make positive impacts and the members find them “motivational.”  An Aetna executive claims that their digital version leaves members eager to come “back for more.”

Gamification is emerging as a real care management solution, because it is tied to increases in outcomes.   Some groups claim that their games will help society overcome epidemics such as smoking and obesity by rewarding good behaviors which are associated with better health.  How does it work?  For the most part gamification relies on the compounding effect of small daily choices for its success.  It works because it gets patients accountable for the decisions they make and they are rewarded with positive reinforcement when good choices are made.  While not all of us are intrigued, it appears to be a step in the right direction and considering the overall health of our population – nothing is off the table.

ICD-9 to ICD-10: What’s in a Code Set Anyway?

While we discuss the ICD-9 to ICD-10 conversion mandate, many people are questioning the value of such a change.  Questioning change is a good thing, but by now we all know that updating from an outdated 1970s code set to a more modern 1990s code set is critical for providers to be accurately compensated for care rendered.  Why are ICD-9 codes not adequate?  Well, think institutionalization of the mentally ill.  In the late 1960s and early 1970s, mentally ill individuals began the transition from  state-run public mental hospitals to community homes where they were treated as individuals instead of as a population of sick people with no hope.  Today, the services and support provided to the mentally ill lends itself to establishing community tenure – It is a different world, yet we still use the out-of-date code set that was in effect during the age of institutionalization.  This example shows one small example of how healthcare has changed since the ICD-9 code set was introduced.  It exonerates the notion that an out-of-date code set cannot serve the industry well.

Costs
A thorough review of ICD-10 was conducted by the Rand Institute and confirmed that the change from ICD-9 to ICD-10 is a costly one for organizations, but adopting the ICD-10 code set will offset these costs by somewhere between $600 million and $7 billion over 10 years. On top of this, ICD-10 will provide more detailed clinical data for payers and providers – which can be used for reporting and to make more informed business and clinical decisions.  Yet, providers seem to be lagging behind when it comes to preparing for ICD-10 compliance.

Payers seem to be gearing up for the change and eager to utilize the ICD-10 code set to make adjustments to payments and care scenarios.  It is as if this segment of the healthcare industry is eager to begin using the more detailed claims data to influence the industry.  While this is fine and dandy – it does lend itself to wondering why providers have been so stand off-ish.

Providers
A recent Edifecs’ White Paper touches on the provider impacts and explains how providers; revenue stream and ability to meet Meaningful Use initiatives will be severely threatened if they do not comply.  The author suggests providers and payers alike need to seek ICD-10 “neutrality.”  This is an interesting but accurate way to view ICD-10 compliance.  If providers took this approach to ICD-10 compliance, they may better understand areas of impact and more importantly areas of opportunity from a financial and clinical perspective.   So meeting compliance is the necessary minimum, but extracting value from the data should be the goal of this change.

Answer
To wrap it up – we started with the question – “what’s in a code set?”  And, the frank answer is – your revenue.  However, at the end of the day will be provider revenue or payor profits?  This will be determined by the providers and how they the ICD-10 code set to increase the delivery of care, promote efficiencies in documentation and diagnoses.  In the end, prudent providers will “protect reimbursements”  by properly using the ICD-10 code set.

What does the Future of Healthcare Data Look Like?

Industry Today
Healthcare ranks as the largest industry in the world and is responsible for generating over $4.5 billion in revenue.    While the United States is home to only 5% of the total world population, US residences are responsible for nearly half ($2.2 billion) of annual healthcare expenditures. The industry provides employment to over 15 million Americans and ranks 8th for fastest growing occupation field.  It is highly regulated, requires tight technical security, is data rich and yet it is plagued with poor IT infrastructure that hampers communication and efficiencies.

Industry Moving Forward
Why do we care about infrastructure and communication?  Because data is at the crux of recent regulations and proposed solutions aimed at changing the industry.  How important is this health care data to solutions and regulation?  This image accurately captures why IT systems must be revamped to capture the appropriate data and how it can be used to drive business and clinical decisions.   It also reminds us that EMRs and HIEs are an obvious must, but that patient portals, mHealth, social media and cloud technologies are also sources for data – and will become more valuable in the future.

Portals
A colleague of mine recent displayed how data capture and transfer will change the FACE of healthcare.  He’s right – how care is delivered is changing and will continue to change as the more tech-savvy patients begin to force the industry to acknowledge them and the way to treat advanced illnesses changes.  This will force providers will embrace the power that alternative healthcare solutions provide.  While some are still leering and stuck on certain short-comings, others see the value in portals and understand when and how to use them.

mHealth
mHealth is a form of mobile health.  Essentially, it is a way to deliver healthcare via cell phones or tablets.  It is praised for cost savings, quality improvements and its success for managing chronic illnesses.  How important is this to healthcare?  Ask HHS, who has cited chronic illnesses as the most expensive, growing and troubling healthcare problem and has handed out grants for mHealth ventures.

Social Media
Social media is a medium that fits into the future models of care.  It serves as an information medium to reach better solutions with lower costs.  While it is thought that many shy away from using social media to collect health information, reports confirm that 58% of individuals use it to self-diagnose.  As these figures rise, providers must figure out how to get into this space and get the right information to patients and encourage patients who are “shopping” for services to get the right services.

The point here is simple – don’t focus on meeting government mandates.  No business gets a leg up by doing the bare minimum.  The goal of industries in a capitalistic society to stay far enough of government regulations to differentiate themselves from competitors but not to increase costs unnecessarily.  Those at operating organizations within this “zone”  will be poised for success.

Will Patient based EHRs and HIEs Dominate the Future?

When it comes to healthcare there are two main problems: Quality of care and cost.  It has been suggested that these issues can be solved with data – data that is available and useful but fails to be transferred and properly communicated to practitioners.  If this information is properly transferred amongst providers via HIEs then suggestions to change the structure of pay from fee-for-service to pay-for-performance would make sense. Now add in a way to drive accountability to patients and we see a true revolution.

If the future of healthcare includes patient owned EHRs and HIEs, then these two solutions will introduce a new realm of analytics – patient-perspective analytics.   Will the industry give patient-run EMRs another chance?

The benefits of sharing healthcare data in a usable form with patients completes the data circle and increases benefits.

Benefits of Sharing

  1. Continuum of Care:  Normally, we talk about the importance of the continuum of care from a provider perspective, but a true continuum of care means that information is shared between all parties – including the patient.  By sharing information with patients, providers can expect a more educated, involved patient and better care outcomes.
  2. Cost:  The price tag associated with unnecessary procedures is jaw-dropping.  While HIEs promise to lower healthcare costs by eliminating redundant tests and procedures, patient-driven HIEs provide another method for patients to ensure that they are receiving the right care and are involved advocates for themselves.
  3. Fewer Burdens for Providers:  The opt-in, opt-out and opt-in with restrictions burden will no longer be placed on organizations.  Instead, patients will be the owners and will be responsible for sharing what they choose to share.  By default they will be protecting their PHI and sharing information when appropriate.
  4. Financial Obligations and Sustainability:  In 2011, only 24 of the 255 HIEs were financially sustainable.  If patients are willing to pay minimal fees to have access to their medical records and take ownership of transfer requests, then the issue of financial solvency may be solved.

Despite the obvious benefits, there is still a slew of uncertainty around patient-based HIEs.  What the future holds is unclear, but without patient involvement how will healthcare meet its objectives?  Without driving accountability down to the patient how can we expect outcomes to increase?  Without including patients how can we call solutions “solutions”?

Why are Cloud Technologies Leaping to the Top?

Providers are increasing their reliance on cloud technology to better address organizational hiccups and bottlenecks.  Why?  Because cloud technology allows resources to be accessed on demand, which results in a more effective and efficient work force, stronger operations and better customer care.    It is a low-cost option that blows the competition out of the water.

Cloud-based EHRs
With the meaningful use mandate and new legislation, many organizations are “improving” operations by implementing new EHR systems.  These systems are costly but provide great value to organizations and patients.  However, cloud- based EHRs are leaps and bounds above the traditional pre-packaged EHRs, because cloud-based EHRs aggregate the data from multiple, disparate, internal and external sources into a single record or view.  This type of EHR is secure and accessible from anywhere, but more importantly – it puts the burden (and possibly liability) of security and maintenance on the vendor instead of the organization.

Consumers
Healthcare, believe it or not, is becoming a “social” business that connects, interacts and collaborates internally and externally to accomplish its goals (i.e. proper diagnosis, high outcomes and low costs).    To better connect and communicate the industry must rely on cloud technology to overcome the “information gap” – that is the gap between the “consumer” or patient and the information they need.

To date there are numerous “widgets” that will accurately capture the number of calories you burn in a day or steps you took.  There are also plenty of devices that will record the necessary indicators for serious health risks.  However, there are few (if any options) for a consumer who is not chronically-ill to get relevant health-related information and make more informed decisions about their healthcare choices.  Cloud-based EHRs could incorporate patient-centered BI solutions to inform and educate patients.  Basically, the suggestion here is that a “patient Watson” could be in the future and could positively impact outcomes more than any other factor.

Providers
Healthcare providers stand to benefit from implementing cloud technology by enabling providers to receive real-time information on patients from afar.  This translates into better care, because providers may be able to immediately respond to changes in conditions that require emergency medical attention.  By integrating cloud-based technologies throughout a healthcare system, the way healthcare is performed is immediately altered.  Important data that impacts care becomes more readily available and patient status becomes constantly traceable.  With this addition to the healthcare industry, communication and care becomes more timely, efficient and affordable over time – all without adding to the already high administration costs.

Coordinated care is a struggle for most organizations, but cloud technology minimizes the limitations of care given by numerous care givers and across multiple facilities.  We know that having a one stop repository for data minimizes unnecessary or duplicative tests.  We also know that portals to facilitate coordinated care are a must and clinical decision making tools that operate off of EHRs can improve disease and medication management as well as preventative care.  And finally, possibly the most important attribute, is cloud technology’s flexibility and adaptability.  As the federal government refines and changes regulatory mandates, cloud technology will be best suited for providers who don’t want to be bothered with updating and changing hardware.

The Future
The lure to the cloud is rightfully gaining momentum.   From a solution perspective it trumps the competition.  Therefore, the future of cloud technology in the in healthcare industry will be its ability to provide the right cloud at the right time.  Secure clouds will undoubtedly be important, but providing  semi-secure “community” clouds that encourage communication will be equally important.  At the same time, connecting and incorporating automation features and intelligence for customers, in addition to providers and payors, will be the distinguishing attribute of cloud technology.

Cloud, Digital Dictation & HIEs: The Future of Healthcare is More Data & Fewer Steps

The point of healthcare technology is to close the gap between quality, cost and access.  As we have said before, EMRs don’t close the gap, but they are a very necessary piece to closing the gap.  However, a gap still exists between the information in an EMR and the information a clinician needs in the EMR.  Technology must provide solutions that have little or no learning curve to avoid eating up physician’s time.  Simply stated – technology must allow those who focus on providing healthcare to devote as much time as possible to providing it by creating solutions that solve problems the way the user wants it solved.

For this reason it seems reasonable to assume that (1) cloud technology, (2) digital dictation and (3) HIEs have a strong future ahead of them.  Why pick these three solutions as the up-and-comers in healthcare – Because they help clinical workflows instead of hindering them.

Cloud Technology
The draw to cloud technology is simple – it improves patient outcomes and comes with a price tag far lower than other IT endeavors by placing the burden of migration and management upon the cloud provider instead of an organization’s infrastructure.  The result, according to Dave Wilson, allows “hospitals to get back to their primary intent of business – patient care.”  This would explain the high rate of adoption amongst providers (30%) and the abundance of offerings by vendors.

Cloud technology is poised to be the blow out solution for healthcare providers, because numerous other key healthcare solutions, such as EMRs, diagnostic imaging, clinical informatics, HIEs, digital dictation and pathology are all looking to cloud technology to maximize their impact.  Cloud technology can do this by eliminating the number of steps it takes to get data from one place to another.  By minimizing these steps, physicians and organizations can maximize efficiencies.

This topic will be explored more in the second blog in this series:  “Why are Cloud Technologies Leaping to the Top?”

Digital Dictation
Any way you slice and dice it, data entry is a process that requires time and is labor intensive. It opens the door to human errors, time delays and, in some cases, data limitations.  Digital dictation is fast, easy and requires no “learning time” from physicians.  Software solutions that can gather and transfer the necessary data for reporting, coding and billing will help providers save time and money by minimizing the efforts required to get data into the EMR.

How much time does digital dictation save?  Stefan Herm from Nuance Healthcare stated, “Editing speech-recognized documents is up to three times faster than manual transcription and thus frees up time for patient care”.  On top of time savings, the files can be easily stored and uploaded to a hard drive and can improve patient safety.  Digital dictation has emerged a way to minimize errors by improving record-keeping, streamlining procedures and minimizing the lag time it takes to get information to staff.

HIEs
There is a reason why the healthcare industry embraced Health Information Exchanges (HIEs) with open arms as a solution improve care safety and quality.  According to Health Affairs, there are 2,000 hospitals and over 41,000 physicians that have met the set standards for achieving “meaningful use” of HIT.  HIEs provide a way to ensure that personal health information is available anytime and anywhere it’s needed.  However, some hospitals poo-pooh the idea of sharing information freely with one another.   After all, this is a capitalistic society where businesses calculate their next move based on dollars – and sharing information freely means that patients have no reason be loyal or “frequent flyers”   to certain facilities.

Bill Crounse, M.D. from Microsoft, proposed a way to work around the reluctance to sharing information from providers by “aggregating personal health data round the patient, and allowing the patient to share his or her data with whoever needs to see it.”   This solution would require cloud technology that allowed patients to be in control of PHI held by their providers and payors.  The patient would then be responsible for transferring their data to their new provider – taking the cumbersome burden and responsibility off of the already bogged down providers.

This topic will be explored more in blog 3 of this series:  “Will Patient based HIEs Dominate the Future?”

While the changes in healthcare are exciting, they are also taxing.  Keeping up with the changes is imperative to the success of organizations.  To do this, organizations must be committed to getting the biggest bang for their buck.  Why these technologies are the right ones to invest in will be further explored in the rest of this series.  Stay tuned!

 

Is Stage II of Meaningful Use just what the Doctor Ordered?

The newest announcement regarding Meaningful Stage II requirements was made on February 22, 2012, and met an equal balance of fanfare and disappointment from the healthcare sector.  Apparently, a fair number of players were hoping that Stage II of Meaningful Use would raise the bar to better tie HIT adoptions, such as EHRs, to improvements in care.  However, the Office of the National Coordinator opted for less ambitious and more flexible Stage II.

Stage II of Meaningful Use proposes that eligible providers now meet 17 core objectives and 3 of 5 menu items versus Stage I requirements of 16 core objectives and 2 of 4 menu items.  Additionally, the timelines have been extended, giving providers more time to get into Stage 1 and a longer ramp-up into Stage 2.

While some may be frothing at the mouth with disappointment, it is important to remember a few things.

First, there important strides made with the proposed Stage II requirements.  The highlights include:

  1. Requirements made to include “safety-enhanced” EHRs.  Providers will be required to report on safety criteria relating to medications to minimize medical errors.  In essence they raised the bar for computerized provider order entry (CPOE) systems.   This means that providers will not be able to skim by with minimal EHR capacity.  Instead, they will have to use their technology to improve care.
  2. The newly introduced quality measures nail down how “meaningful” information captured in an EHR is.  These measures help healthcare evolve from implementation of EHR systems to getting value from their investment.
  3. Requirements about information exchange requires organizations to go from having the ability to transfer information through a Health Information Exchange (HIE) to actually transferring data through a HIE.  In doing so, an organization must meet certain privacy and security guidelines, which may be a noteworthy task for some.

Second, Stage II of Meaningful Use allows the sector and the many different players to get up-to-speed.  Too little, too late, you say?  Well, remember that the value of Meaningful Use comes from the insights that the analytics provide us.  Those insights must be digested and organizational changes implemented and realized before there will be a change in outcomes.  We cannot ask providers to change the entire forest without giving them time to examine each and every tree.

Stage II meaningful use may be considered lackluster by some, but we must remember three sayings:  “Rome wasn’t built in a day,” “the cheapest option isn’t always the least expensive,” and “if you don’t have time to do it right the first time, when will you have time to do it over?”  Let us all remember – the HIT journey is expensive and it isn’t going to happen overnight.  Let’s praise government officials and public organizations for giving organizations the time they need to do it right the first time.

Using BI to make Core Measures more useful

It’s been nearly 15 years since the Joint Commission launched their first national hospital quality program, which required hospitals report on performance measures.   The initial result of the performance measures was a hodgepodge of data gathered non-systematically and was rarely used to improve the quality of care.  Today’s landscape of quality measures looks much different.

There are currently over 600 quality measures endorsed by the National Quality Forum (NQF) that are used to benchmark clinical performance amongst hospitals.  The end goal of these measures is to improve the overall quality of care at all hospitals by encouraging “best practices” and making the results of the measure public.

While the results of core measures are indisputably impressive, the time and expenses associated with gathering the granular clinical data to report on core measures produce concerns.  The major concern facing providers today is how to make the most of their core measures.  This has come on strong since payors have found a way to use these publically reported measures to their advantage.  The time has come for providers to do the same.

Providers can maximize their investments by tapping into their data and using business intelligence (BI) to analyze data sets.  Providers must provide BI tools to their analysts and align their BI endeavors with the organizations strategic initiatives to get the entire organization on the same page.  By doing this, organizations will get more than automated core measures; they can begin to set the basis for what analytics should be used to evaluate performance and ensure that the organization’s initiatives and objectives are met.  From here, an organization can better identify if standardized solutions that come with EMRs will provide them with the analytics they need, or if a customized solution and data warehouse are needed to pack a punch and meet roadmap target.

Receiving Outcome Incentive Payments Requires more than “Outcomes” from Providers

Paying healthcare providers to meet defined quality goals has experienced an uptick in acceptance and appeal lately.  Given the fact that the quality of care in the United States has been unresponsive to decades worth of public reporting and benchmarking efforts, one can’t help but to wonder if a financial incentive to providers and physicians will be of much use. 

Within the past few months, heavy hitters such as UnitedHealth Group and WellPoint announced that they will change the way they pay providers and hospitals.  The goal of this effort is to overcome fee-for-service short-comings by making patient outcomes a part of payment structures. 

This is a concept that has long been hailed as a solution to overcome the rapidly inflating healthcare costs and unresponsive outcomes.  The 2001 Institute of Medicine (IOM) report titled, Crossing the Quality Chasm, discussed how U.S. healthcare quality failed to establish benchmarks to measure care based on the best available practice.  It stated that the problem with outcomes within the healthcare industry is based in the fact that provider practice patterns differand those differences in practice patterns are responsible for staggering differences in cost of care and outcomes.  Ultimately, the report suggests that providers who want to address outcome discrepancies should start by adhering to evidence-based practice patterns.

Provider Needs
This introduces two needs for providers:  Knowledge of Best Practice Patterns (Order Sets) and Business Intelligence. Providers who adhere to evidence-based order sets are expected to have increases in treatment outcomes.  However, before any provider changes their practice patterns there must be evidence that the change works.  For example, the Grey Bruce order set project   found that physicians using order sets were 143% more likely to order a specific life saving drug for heart attack patients if they used an order set.  If the proper evidence is supplied then the first hurdle is negated.

The second hurdle to improving outcomes and adhering to order sets is accessibility to a robust evidence-based clinical decision support system to improve outcomes and lower costs per case.  Part of this system should be a repository to keep physicians abreast of the relevant publications regarding order sets and other evidence based practice insight.  The second part of the system should track and report out on physician order sets within their facility.  By having access to the appropriate scholarly publications and facility physician practice patterns, physicians may find that certain “tweeks” to an order set improve outcomes at their facility or within a certain group of patients while other “tweeks” may hinder outcomes. 

Most of the necessary data is captured by systems within an organization, but many organizations are struggling to find a way to access and use the data.  Whether the goal is to meet the financial incentives offered by providers or to lower costs of care, it is impossible to address practice patterns and outcome issues without a business intelligence solution that provides insight into the business and/or physician.  Organizations investing in such systems will not only have a leg up on competitors, but they will also be more likely to meet the incentive payment requirements – and ultimately have healthier patients and receive more money from payors. 

The future of healthcare looks much different than yesterday.  For organizations and physicians who are nimble and stay in front of the curve, survival will be fairly painless.  The rest – they will learn to evolve.