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Is This Population Health’s Moment? Time for Data and Analytics

Is This Population Health’s Moment? Time for Data and Analytics | Healthcare and Technology news | Scoop.it

Every year, the annual HIMSS Conference, sponsored by the Chicago-based Healthcare Information and Management Systems Society, offers its attendees a kind of conference-based snapshot of where the U.S. healthcare industry is with regard to the forward evolution of healthcare information technology adoption, as well as a sense of the overall policy and operational landscape of healthcare. Attendees can get a sense of the healthcare IT Zeitgeist through attending keynote addresses, educational sessions, association meetings, and networking-focused gatherings, as well as by wandering the exhibit hall and simply by having meaningful conversations with fellow attendees.


HIMSS15, held at the vast McCormick Place Convention Center in Chicago the week of April 12, offered perhaps the clearest portrait of the current moment that has yet been offered to date. Session after session focused on the shift beginning to take place from volume-based healthcare reimbursement to value-based payment, across a very wide range of mechanisms, between providers and both the public and private purchasers and payers of healthcare, and the implications of that shift for healthcare IT leaders.


Further, as part of the keynote session on Thursday, April 16 in the Skyline Ballroom at McCormick Place, Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS), made the intentions of federal authorities crystal clear, when, referencing the statement of Health and Human Services Secretary Sylvia Mathews Burwell in January that she wanted the bulk of Medicare fee-for-service payments to providers to shift as quickly as possible over to quality- and value-based payment, Slavitt said, “Our priority is simple: to drive a delivery system that provides better care, smarter spending, and keeps people healthier. The success in the first five years since the Affordable Care Act has been very encouraging… Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”


What’s more, in his keynote address two days earlier, Humana CEO Bruce Broussard had told HIMSS attendees, “We have to change the conversation on what we are doing in healthcare from a supply-based system to a system around demand, a system where we put the customer first as opposed to the system. Over the years,” he added, “healthcare has been built by creating more and more supply. I hope I leave today by convincing you that we have to change the focus towards how we improve health for our customers, members, and patients.”


The good news on the solutions side of this landscape is that vendors are rushing forward to provide population health- and accountable care-driven analytics solutions, at a time when such solutions are most desperately needed. Certainly, the hype at HIMSS15 was all around population health, care management, and accountable care solutions. The only question now, as the U.S. healthcare industry hurtles forward into the near future, is, is this a breakthrough moment for population health efforts? And if so, are provider and health plan leaders ready to effectively leverage the tools to make pop health really happen?

The long journey ahead


Leaders from all sectors of healthcare understand that the journey to population health and value-driven care delivery and payment success is going to continue to be a long, challenging one. Donald W. Fisher, Ph.D., president and CEO of the Alexandria, Va.-based American Medical Group Association (AMGA), says he and his colleagues are putting the vast bulk of their efforts into helping prepare physician group leaders for the transition. “We’re not quite there yet, and as we change to a new reimbursement system, even the large, sophisticated medical groups are going to need a few years to make the transition,” Fisher says.  “You’ve got to put the infrastructure in place, and the large integrated health systems have been putting those elements in place—EHRs [electronic health records], alert systems, analytics systems, data warehouses—and some have teams of people mining the data to assess patient status.”

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Accountable Care, Quality Metrics Must Combine for Improvement

Accountable Care, Quality Metrics Must Combine for Improvement | Healthcare and Technology news | Scoop.it

The healthcare industry has taken many positive steps towards improving the measurement of quality and patient outcomes, says Margaret E. O’Kane, MHA, President of the National Committee for Quality Assurance (NCQA), but true improvement comes from the marriage of metrics with innovative reform of payment and care delivery systems.  In a commentary for the American Journal of Managed Care, O’Kane states that providers, payers, and regulators must continue to promote the business case for providing the highest possible quality of care for patients.

“The accomplishments of the last quarter-century are real and significant,” O’Kane says. NCQA is celebrating its 25 year anniversary in 2015, and the healthcare quality measurement landscape looks significantly different today.  “In 1990, measuring quality was just an idea—today it is an everyday reality. Most Americans—more than 171 million—are enrolled in health plans that report NCQA’s HEDIS (Healthcare Effectiveness Data and Information Set) clinical quality measures.”

HEDIS scores are now used by Medicare, the majority of state Medicaid plans, and numerous private insurers to benchmark performance, reward improvement, and pinpoint opportunities for change.  HEDIS, along with similar patient satisfaction and outcomes measures designed to drive quality improvement, will become increasingly important as more and more industry stakeholders adopt the principles and strategies of accountable care. As HHS and private industry set ambitious goals for cost and risk sharing, benefit structures for patients and provider networks should respond appropriately.

While high-deductible plans have become the norm for patients, who are now expected to shoulder a larger proportion of costs, patients do not always invest in necessary care when they feel unable to afford the large out-of-pocket bills that will result.

“Rather than the blunt instrument of the high deductible, a better approach is Value-Based Insurance Design (VBID)—low co-pays for high value services and medications, higher for those that don’t improve heath,” O’Kane suggests. “An interesting twist is to give a financial incentive to members with chronic conditions to choose a PCMH or accountable care organization with active care management.”

Quality measurement should also be used to distinguish high-quality, high-value providers from those with poorer outcomes in order to make it easier for patients to make better choices for their health and their wallets.  In order to ensure that providers deliver high-quality care, payers should create clear financial incentives.

“This is no small set of tasks,” O’Kane acknowledges. “Over the past 25 years, consumers have become accustomed to the paradigm of choice. Providers have been rewarded for doing more and for giving more complex care. These are deeply embedded cultural norms that need to change. Now, as payers look at what is being purchased, they can act as market makers who drive volume and rewards to the delivery systems that have accepted the challenge of delivering quality, patient-centered care that is affordable.”


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Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare

Reflecting on the Clash of Incentives Around “Information-Blocking” in the Push Towards the New Healthcare | Healthcare and Technology news | Scoop.it

As Healthcare Informatics reported last month, the Office of the National Coordinator for Health Information Technology (ONC) released a report in early April that highlighted what the federal healthcare IT agency referred to as “information-blocking.” As Senior Editor Gabriel Perna noted in his April 10 report immediately following the release of the ONC document, “The report’s authors and researchers detailed several examples of electronic health record (EHR) developers and health systems blocking health information sharing between each other. The act of information blocking occurs when an entity or person knowingly and unreasonably interferes with the exchange of electronic health information. Examples of this,” he noted, “are charging prices and fees for data exchange; creating terms of a contract that restrict individuals access to their health information; developing health IT in a non-standard way that dissuades information sharing; and developing health IT in a way that locks in information.”


The ONC cited examples in its report of anecdotal evidence suggesting that “EHR application developers are breaking several of the rules in this regard,” Perna’s report noted. “Using interviews with people at regional extension centers (RECs), the authors detailed complaints from industry sources on how developers are charging fees that make it cost-prohibitive to send, receive, or export electronic health information stored in EHRs. Some EHR developers even charge a substantial transaction fee any time a user sends, receives, or queries a patient’s electronic health information, the report says. The variation in prices reported to ONC suggests that some are taking advantage of the situation.”


In announcing the availability of the report, National Coordinator for Health IT Karen DeSalvo, M.D. noted in a blog on the agency’s website that it is difficult to pinpoint concrete evidence of information-blocking. “The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details,” she noted. “Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking,” she said.


Given all this, I read with interest a May 20 blog in Health Affairs online by Julia Adler-Milstein on this subject, because of the clear way in which she frames the dynamic tension taking place right now in the industry between the forces that would restrict information for profit or proprietary gain, and those that would advance it for the common good. AsAdler-Milstein, who is an assistant professor of information in the School of Information and an assistant professor of health management and policy at the School of Public Health at the University of Michigan, states very bluntly in her blog, “When it comes to sharing electronic patient health information, public good should trump private gain. While it may seem like an obvious statement, it represents a tectonic shift in the narrative surrounding health information exchange,” or HIE.


As Adler-Milstein notes, “For more than a decade, our federal strategy has largely left HIE to the market under the assumption that, if there is benefit to be created (and estimates suggest that there is), we should see the emergence of ways to capture that benefit. In practice, this means that HIE efforts have sprung up in various health care markets across the country, and where public money has been spent on HIE (largely at state and community levels), it has come in the form of one-time start-up funding, not a commitment of ongoing support or regulatory mandates for HIE participation.”


Here’s where Adler-Milstein really scores a home run on this, in my view: “What has been substantially underappreciated, however,” she writes, “is the fact that, for the key actors needed to enable HIE to occur—provider organizations and vendors—there might be more benefit, or at least more certain benefit, from not doing so. And as a result, these actors may behave in ways that interfere with the free-flow of patient information that is needed to improve health and health care.”


Instead, she says, “With the release of the information blocking report, which was produced in response to a 2015 Omnibus bill request that introduced the term ‘information blocking,’ ONC makes plain that this behavior will no longer be tolerated. This enormously exciting development means we might see real progress after decades of investment that has failed to convert into sustainable approaches to robust HIE. The key to such progress, however,” she warns, “lies in how well we can identify when information blocking is occurring. This will not be easy.”


And in those short paragraphs, we can see some of the core opportunities and challenges moving forward in this critical area. In this arena as in so many others in healthcare, we see a dynamic tension based on conflicting incentives within the U.S. healthcare system. On the one hand, there is broad consensus that data- and information-sharing will be essential to accountable care organization (ACO) development, population health management, bundled payment-facilitated care delivery, patient-centered medical home work, and indeed, every iteration of the new healthcare. Yet at the same time, there are many elements embedded even in those concepts that speak to at least short-term—and certainly arguably, medium-term as well—market advantages that can be gained through data- and information-hoarding.


It is this clash of incentives that we are collectively burdened with at this early stage of the trajectory towards the new healthcare. The rhetoric around healthcare policy right now is all about sharing for common gain, and yet the incentives in the moment are far from purely conducive to—well, purity.


That’s why it’s good to be reminded at times like this by elegantly concise writings like those of Julia Adler-Milstein. Adler-Milsteiin’s blog reminds us what the ultimate prize is, on which we should at least theoretically all be setting our eyes. This is not to engage in the laying of blame on those working for specific market advantage, but rather to affirm the need to continue to push forward collectively as an industry and indeed as a society, towards a more mature healthcare system—one in which all the incentives really all will be aligned. In other words, keep watching this space.

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Patient Engagement May Reduce Healthcare Reform Anxiety | EHRintelligence.com

Patient Engagement May Reduce Healthcare Reform Anxiety | EHRintelligence.com | Healthcare and Technology news | Scoop.it
How can greater adoption of patient engagement tools help to alleviate uncertainty about the future of healthcare reform?

Adopting more robust patient engagement technologies may help providers and patients alike find their way out of pervasive anxieties about the future of the healthcare industry – if physicians can lead the way.  According to a survey performed by Booz Allen Hamilton and Ipsos Public Affairs, few industry stakeholders are satisfied with the way healthcare is headed, but believe that preventative care, backed by patient engagement technologies, mobile apps, and care coordination, may help them find the way forward through a complicated maze of financial and administrative changes.

“Physicians, especially the older ones and the specialists, have to move into a whole new world, and they are concerned that it’s making their life a lot more complicated than it used to be,” said Nicolas Boyon, Senior Vice President at Ipsos Public Affairs, in an interview with HealthITAnalytics.  “It is partly generational.  The average age of practicing physicians in the US is actually slightly over 50, and specialists tend to be even older.  A lot of physicians started practicing when the world was very different.  They view their role, first and foremost, as caring for patients, and technology was not necessarily what they specialized in or learned a lot about in medical school.”

“It’s curious to see the level of anxiety out there,” added Grant McLaughlin, Vice President at Booz Allen.  “When you look at behavior change, anxiety is often lessened when there is a path.  We’re in a time of uncertainty as Affordable Care Act is being rolled out and new care models are being tested.  We may not necessarily have an endpoint clearly in view, and I think that causes anxiety.”

While physicians do not generally believe that current mobile apps and other patient engagement products are up to the challenge of providing valuable and medically sound information and tools to the patient population, there is a widespread interest in such technologies among consumers.  Patients are seeking a higher degree of convenience, more control over their own health, and more efficient ways to stay connected with their providers, conduct administrative tasks, and review their own health data, the survey revealed.

“Once you actually find an app that you can use, and you use it every day to help you do something, and you find the value in it, then it has become invaluable to you.  You absolutely cannot live without it,” McLaughlin said.  “That’s what we’re struggling with.  We’re seeing lots of technological inventions, but how do we add value in the context between the consumer and the provider?  If we can get to the crux of how to make the conversation between consumers and providers more valuable, and if technology can enable that, then I think we’ve struck gold.”

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