No matter a hospital's market, every healthcare provider in the U.S. faces a similar looming challenge: to bend the cost curve as a growing, aging population with more chronic conditions than ever before enter the healthcare system.
"That's the fundamental challenge. How do you deliver care equal or better than you do today with fewer resources available, and at the same time, at least try to bend that cost curve?" Tom Foley, director of worldwide health solution strategy at Lenovo Health, said in an executive roundtable discussion Sept. 22 at the Becker's Hospital Review 3rd Annual Health IT + Revenue Cycle Conference in Chicago.
Moving to a more efficient healthcare system based on value requires patient awareness and engagement — a concept simple in theory, but difficult in practice. About 30 percent of all prescriptions written are never filled, according to Mr. Foley, meaning today's patient population is fairly unengaged at the baseline. Patients spend money to receive a diagnosis, but they may not follow through with the care plan for a number of reasons, lowering the likeliness their health outcomes will improve. However, Mr. Foley believes this engagement issue stems from a missed opportunity. The average Medicare patient with five chronic conditions spends about 15 hours in front of a physician annually — meaning about 8,745 more hours per year are spent unengaged with the healthcare system. The delta is what Mr. Foley defines as the care gap — it's not always about what happens when you are in front of your physician that makes a difference — it's what happens when you are not in front of them that determines one's path to wellness.
"It's not that we have a broken healthcare system. It's that we have patients [who] are unengaged," Mr. Foley said. Therefore, the key is to engage patients in the places they regularly occupy outside the healthcare system. Enter the intelligent medical home — one in which connected medical devices allow a patient's home to become an integrated part of the healthcare ecosystem.
Lenovo's intelligent medical home is supported by a patient's mobile phone or tablet, outfitted with a medical device that can measure vitals as well as an app to connect directly with physicians who can provide patients with the education and resources necessary to make independent decisions about their health. In this type of intelligent medical home, patients could measure their blood pressure using the medical device connected to their phone or tablet. Once their vitals are taken, their phone can tell them what the results mean. If the results require provider intervention, the app alerts clinicians to get in touch through an e-appointment or schedule an in-person visit.
The intelligent medical home model faces its own set of challenges, including data management, patient flow and resource hurdles. Here are a few common concerns discussed by executives in the room and their potential solutions.
1. Data overload. Several executives in the room voiced concerns about the amount of data they are already collecting — and the challenges of hosting, managing and securing it — as well as an aversion to anything that might increase data input, such as the intelligent medical home. "One of the legacy challenges is data," said one health information manager. "I see my files getting bigger and bigger. When we are talking about memory, we have to purchase more equipment to store [the data] — I see more money going out the door that way — and protect it. There's a lot involved."
Executives discussed a two-pronged solution. First, hospitals can limit the amount of data they collect and alerts they receive. An intelligent assistant — something along the lines of Amazon's Alexa or Apple's Siri — can help coach patients through most of the encounters. Providers can be sent alerts only for abnormal vitals. One CMIO from a faith-based system in the Midwest said their hospitals use behavioral telehealth apps to help unburden their emergency departments, which originally created an overload of data. "We were able to override that… It only alerts the care team when there's some question with the data," he said.
The second part of the solution is simply to dive head-first into the deluge of data, turning it into a product to help drive savings. "What I would say is get data hungry as fast as you possibly can," said one executive from an analytics firm. "The value of data on the clinical side and financial management side cannot be overstated." As a strategic asset, data gives health systems the opportunity to identify cost savings and drive clinical value.
2. Restrictions on care. A more engaged patient means more patient-physician encounters will likely be necessary, but with limited ranks of clinicians, some executives were concerned by potential restrictions on care — either perceived restrictions or actual restrictions due to limited clinician availability.
A clinical intelligence leader from a large health system discussed issues his system faced when joining an ACO. When patients were told they didn't need to come in for minor issues that were likely to clear up in a few days, patients didn't like it — they felt it was restrictive, rather than efficient. "Patients don't want to hear that these are 'more efficient' ways to deliver care," he said.
Similar is the issue of actual limitations on access. One patient safety coordinator from a nonprofit health system in the Southeast discussed the challenges her system had when it was suddenly flooded with the need for subspecialty consults. "Patients were trying to see a new specialist, but the wait was nearly four months. It was unacceptable," she said.
Her system used telehealth to address access challenges. Telehealth can help increase capacity and address concerns about restrictions, while the intelligent assistant can help do a lot of the heavy lifting in terms of triage. The nonprofit system in the Southeast began using an e-consult model, where primary care providers could connect over the phone or through the EMR to specialists to help address a lot of the informational-based concerns from patients.
3. Patient access to devices. Another common concern among executives was ensuring patients actually had access to the devices they would need to make an intelligent medical home possible. A health information manager discussed the challenges around getting her hospital's patient population to use portals under meaningful use. "We serve a very high Medicaid population, a very sick population, many who have dementia — things that might not make it easy for them to use devices," she said.
Mr. Foley acknowledged this difficulty, noting it is important health systems choose the right intervention for the population, rather than spreading it across the entire patient population. "There might be some high value there, but if they can't use the technology, it's not a model that's going to work," he said. To address the issue of ensuring that a targeted population has access to a tablet or smartphone, Mr. Foley suggested bringing the device to the patient. Some hospitals have started giving patients tablets at the bedside and allowing it to go home with the patient. It is a financial risk, he said, but these hospitals often find it is paid for by eliminating even one visit to the emergency room. Other hospitals have improved access with a lesser financial risk through community partnerships, such as creating a kiosk to take patient vitals at the grocery store and rather than in the home.
"The challenge of the day is that connected ecosystem," Mr. Foley said.