Expertise on HIT competencies that enable value-based care
The number of providers transitioning from the traditional fee-for-service (FFS) model to value-based Accountable Care Organization (ACO) payment and delivery models continues to grow, with ACOs representing 49 states and the District of Columbia and serving nearly 8.9 million beneficiaries as of January 20161.
To successfully achieve the accountable care mission of the Triple Aim—improving quality and health outcomes while reducing the cost of care—health systems and hospitals are turning to new resources and practices to assist with and enable a more patient-centered paradigm. While the makeup of patient populations defers for each ACO, a health information technology framework that supports effective population health management (PHM) across the continuum of care sits at the core of a successful ACO.
“In order to be efficient in trying to manage the population, you really can’t do that with just warm bodies,” Howard M. Landa, MD, chief medical information officer of Alameda Health System, a health system based in Oakland, Calif., shared with Health System Management. “Technology is crucial to allowing ACOs to survive.”
“Accountable care organizations are predicated on people, processes and technologies,” Shelley Price, director of payer and life sciences at Healthcare Information and Management Systems Society (HIMSS), conveyed to HSM. “All of these are helping to delivery on the Triple Aim framework of delivering high quality, efficient care; stifling the growth of expenditures and the cost of care; and improving population health outcomes. This is the foundation of accountable care in a value-based health system.”
Technology, according to Price, is an essential component to connecting the people, processes and goals of an ACO, as “it’s the glue that enables the collaborative process.”
Five Pillars of PHM
PHM technology that incorporates five specific components will best position ACOs to meet Triple Aim goals, according to a whitepaper authored by Nandina Rangaswamy, executive vice president and chief strategy officer of ZeOmega, a PHM solution provider2.
1Program design and governance
As the road to achieving the Triple Aim is complex and multifaceted, outlining short- and long-term goals such as complying with specific regulations, reducing readmission costs and boasting patient satisfaction sets organizations up for success. A good PHM program design clarifies how each goal will and should be measured.
2 Data integration and aggregation
Pulling intelligence from both structured and unstructured data across the healthcare ecosystem enables value-based care. Some of the most relevant information for driving effective PHM is unstructured data found in systems such as electronic health record (EHR) notes that highlight physician’s differential diagnoses for a particular condition, history and physical information, discharge summaries and progress reports.
The advent of value-based care brought a need for a new brand of analytics that generates actionable intelligence capable of enabling hospitals and health systems to produce better outcomes while reducing costs. A comprehensive foundation of patient data layered with predictive and comparative analytics gives providers the opportunity to positively impact patient health by allowing them to stay in the know about potential outcomes and risks.
4Holistic, patient-centered care management
Technological resources can’t conform to a one-size-fits-all approach, as each patient brings different needs and backgrounds to providers. A care management platform that helps manage care on a person-by-person basis and provide patient data and evidence-based content to each team member where and when they need it can bring significant positive outcomes.
Active patient involvement is crucial for effectively meeting Triple Aim goals. A strategy that educates, engages and empowers via platforms like online education programs, health-related alerts or wearable biometric devices drives greater effectiveness.
Challenges and Solutions
While the aforementioned components can set an ACO up for value-based care success, this technology does not come without challenges. The biggest barrier, as Landa noted, in using these technologies is cost. “These systems are usually expensive, and being able to tie a real return on investment is a challenge.”
Depersonalization in the health system and hospital setting is an additional concern, according to Landa. “A lot of older physicians especially and also physicians in general are concerned technology is getting in the way of their relationships with patients,” Landa told HSM.
Dictation, voice recognition and natural language processing can assist with successful technology use, according to Landa. “You need discreet data in order to report on quality, and you need to be able to report on it and measure it so that you can turn around and impact it. One of the big challenges for electronic health records is trying to get clinicians to enter structured data,” claims Landa.
“I believe natural language processing is a way to augment this. I’m hopeful that will make physicians more comfortable with their records, as being able to dictate and use voice recognition to process information will make them more efficient, make their notes more readable to clinicians and produce structured data reliably,” Landa contends.
Another barrier to using technology that enables accountable care is consumers’ lack of knowledge on how to use engagement tools and that they are even available, according to Norman Chenven, MD, CEO of Austin Regional Clinic and vice-chair of the Council of Accountable Physician Practices, an affiliate of the American Medical Group Foundation that defines accountable care as a type of care that results from five specific attributes of healthcare — care coordination, integrated technology, 24-hour access, treatment according to evidence-based research and prevention.
Chenven referenced a recent survey from CAPP on accountable care, noting a significant gap in age groups in regards to interest in using digital tools for healthcare.3 The survey shows seniors are less open to using technologies like text message reminders, online scheduling tools, telephone advice or video visits. Responses reveal 57% of older patients don’t have and don’t want text reminders for medication refills and laboratory results, and only 4% of older patients say they have text messaging capabilities and use them. In addition, physicians reported they hesitate to make use of telemedicine, mostly due to a lack of reimbursement for these services. Younger patients, on the other hand, are twice as likely to utilize and want telemedicine capabilities.
“Healthcare consumers need education and experience with these new ways to access care so they see and value the convenience,” Chenven told HSM.
As technology solutions that enable information sharing remain integral to ACO success but expensive, a new process is needed to facilitate health information exchanges across disparate platforms and unassociated providers, according to John Norenberg, vice president, information systems, physician services, of Advocate Health Care, a health system based in Downers Grove, Ill. “We have a lot of work to do as industry and a lot of leadership is needed to convince ourselves that it’s time to start sharing data with one another in a more creative, sustainable way.”
In order to achieve this, Norenberg told HSM, health systems and hospitals need to chip away at the competitive control over electronic health information. “There are far too many providers that view their information as a competitive tool and not willing to believe that sharing information does not cut the pie differently; it makes the pie bigger,” said Norenberg. “It allows providers to actually make more money and have happier patients.”
- “New hospitals and health care providers join successful, cutting-edge federal initiative that cuts costs and puts patients at the center of their care.” U.S. Department of Health & Human Services. Available at http://www.hhs.gov/about/news/2016/01/11/new-hospitals-and-health-care-providers-join-successful-cutting-edge-federal-initiative.html
- “The Five Pillars of Population Health Management.” ZeOmega. Available at http://www.zeomega.com/insights/white-papers/five-pillars-of-population-health-management/
- “Nielsen Survey Shows Gaps in How Patients Are Experiencing Accountable Care.” Council of Accountable Physician Practices. Available at http://accountablecaredoctors.org/capp-in-the-news/nielsen-survey-shows-gaps-patients-experiencing-accountable-care/