The United States Healthcare Industry is in a historic transformation era. Never in its history has it seen such a major upheaval of its processes and embracing of technology in its day-to-day operations.
Thanks to healthcare reform, healthcare IT is now all about electronic health records (EHR), HIEs, meaningful use, pay-for-performance, population health and business analytics all being managed in real-time, by every type of device. There is no doubt that a major part of this was driven by the HITECH Act, specifically the incentive from CMS to drive "Meaningful Use" of EHR adoption.
Among all these measures, one key transformation that is affecting the payers and the providers is the shift from volume-based payment system to a value-based payment system. In other words, providers will get paid by the payers on subjective metrics, rather than only objective metrics.
The providers used to be measured on a numeric based metric system i.e. how many patients did they serve, how many operations or how many tests did they perform. Now the providers will be measured on a system that emphasize the value they deliver to the patient in terms of the holistic patient outcome, the level of quality care delivered by hospital as evidenced by hospital-acquired infections and hospital readmissions. This would include detail documentation that not only includes selecting accurate ICD-9 or ICD-10 codes in the system, but also includes detail notes at every step of the care process.
Because of this, the payers will require accurate documentation from the providers before they can pay the providers. For example, a patient that has undergone a heart transplant may be expected to have hospital readmissions during the various stages of the healing process, which could be over many months. This case will require detailed and accurate documentation at every stage that needs to be exchanged between hospital and insurance company, in order for the hospital to be paid.
Current EHR systems and the ancillary software surrounding those EHR systems are based on abstracting large 'quantitative' data sets and performing big data calculations and analytics on top of it. What they are missing out is the content, which in many cases is unstructured data in the form of notes, large 3D image files, tele-video copies, audio and/or video scripts. This content is the basis of value based payment system. Without that, the providers will not get paid.
During a presentation at the HIMSS 2014 Conference about ways to help reduce future healthcare costs, AG Breitenstein, Chief Product Officer of Humedica asked a bold question regarding how the healthcare industry would address this change.
From an IT perspective, he said, the inability to securely share content is an asteroid heading our way. He asked the audience what steps are necessary to prevent chaos once the industry moves completely to value-based payment system – or, stop the asteroid before it hits the earth?
This content can be abstracted out, shared easily and most importantly securely and under compliance, with payers by using a secure content management platform. Using this technology, the content can also be collaborated by multiple stakeholders like specialists, doctors and lab technicians before it gets shared with the payers. All stakeholders can collaborate from their mobile devices on the go, and can literally update documentation of their patient's last visit either right after the visit or while they are reading emails or news on devices later in the day, without requiring A VPN.
Nimish Vora is the Head of Global Alliances and Industries at Accellion. Prior to Accellion, Nimish has led various leadership roles in Sales, Alliances and Product Management in large companies like SAP and webMethods as well as small start-up companies.
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