Every C-suite healthcare leader is well aware of the shifting environment with payers and employers requiring physicians and health systems to assume greater financial exposure for the delivery of care. In this short article, the first of three, we explore some challenges and opportunities to leverage current health information technology infrastructure and innovate with some fresh approaches to improve the continuum of care, profitability and quality. We offer a few ideas for action and consideration.
In today’s environment, there are new challenges and opportunities for integrated delivery networks, ACOs, as well as independent mid-size providers who must lower readmissions and better manage patient populations to reduce costs and improve profitability. While CMS will continue to withhold reimbursements from low-performing hospitals and increase penalties, there are opportunities and incentives to help providers. Bundled initiatives will likely be ever more important for many hospitals that are looking to share risk and improve competitive position, profits and care.
In order to meet the challenges and secure opportunities, organizations need to leverage connected care information technology solutions.
Challenges
Reimbursement and risk reduction is top of mind for providers; however, many institutions, especially in the middle market, are challenged with limited IT staffing and informatics personnel. This makes it difficult to undertake complex and expensive new HIT initiatives that require data integration and customization of EMR applications. Customization can be expensive. Organizations need simple, fast and real-time decision support to help clinicians focus on process changes that impact readmissions and improve recovery.
CMS’ Bundled Payments for Care Improvement initiative enables hospitals to share risks and rewards with others, even if they are not in an ACO. However, this means a greater requirement to leverage data and processes beyond a hospital’s four walls. Historically, mid-market providers have been challenged, as noted above, with limited resources to execute shared IT strategies, even if their EMR systems, in principal, can share data. These institutions have needed lower-cost solutions to help support clinicians in managing the continuum of care across their patient populations.
New business intelligence, data technologies and IT architectures reduce some of these challenges, making it less expensive to gain insights and in turn improve care. We see great progress in areas around data organization, connectivity and analytics that help providers achieve results at lower costs.
Opportunities
Secured cloud access and patient data warehouse technologies are enabling better organization and connectivity. Better BI, complex case management software and predictive analytic tools are enabling faster insights and the ability to drive improvements through better work flow. These tools can be coupled with complex care paths to support mobile care teams with greater efficiency.
As technology costs have come down with cloud access and analytic tools are becoming more robust, solutions can be created that are more attractive to clinicians and CFOs.
Here are a few issues to consider when leveraging new technologies in today’s environment:
- If you are designing from ground up, do you want to implement a cloud accessible solution? If you are looking to buy as a service, will it enable total cost of ownership to be lower than an on-premise software and an IT support model?
- Are you able to design or buy a service that leverages your EMR and other data, not duplicate it? Can you implement in pieces?
- Can you use structured/unstructured data to better understand costs of patients and populations?
- If you don’t have a large internal data management staff, can you move toward a connected-care solution in stages without additional heavy customization of your EMR or need for additional training and IT staffing?
- Will you be able to leverage established BI and analytics tools and integrate to support role-based and real-time decision support?
All of these questions are important in creating the solution that is best for you. Depending on the institution, a connected-care solution can trigger case management to reduce operating costs and improve risk management based on an analysis taken from the data in real time.
Consider a solution driving complex case management from a single database collecting data across several providers. The system can use predictive analytics to trigger automated follow-ups, initiate calls to mobile staff and integrate telemonitoring. All of this can be done to support pre- and post-discharge case management. Here might be an example:
An elderly patient sees his or her attributed primary care provider after returning from hospitalization for a heart complication; this diagnosis (and patient) is part of a bundled initiative. The PCP prescribes medication, a follow-up care path is initiated, and complex case manager assigned. The patient will be tracked by the care nurse over the subsequent 90 days — the period of the bundled initiative agreement.
Medication and symptoms are closely managed. The engagement with the care team helps ensure follow-up appointments are kept. Any adjustments to care and improvements to proper care utilization are also monitored over the next critical high-risk months.
The cost of care across all providers (attributed physician, testing, diagnosis, skilled nursing facility, hospital, etc.) is monitored with feedback to the attributed physician and all other parties. BI software compares actual costs vs. targeted and normative data to improve performance and profitability.
Within a single hospital or across a group of providers sharing risk, a connected-care solution can pay for itself. The results: improved core metrics, lower readmissions, improved capacity utilization and higher revenue/reimbursement. Other benefits could include: lower total episode cost of care, improved financial performance and better quality. Here are a few ideas to consider in order to move opportunities forward.
Action
Technology is opening new doors and the market environment is creating favorable economics. To get started, we suggest working through the business case as a team with clinical, operational and financial leaders represented.
As you look forward beyond the business planning to some of the issues noted above, consider execution, change management, strategy and control of costs.
- Do you have deep IT and analytic resources? No? Then look to a design and delivery partner to help you build a roadmap for design and implementation.
- Assuming you already work with a partner to execute a cloud solution, look to stage implementation to test and deliver early wins.
David Dobkin, MBA, MSc, is the vice president of healthcare solutions at 4th Source. 4th Source’s healthcare practice employs teams of clinical, information architects, experienced programmers and platform software to deliver solutions and services in the U.S. and Latin America. He can be reached at david.dobkin@4thsource.com.
Dr. Mike Hunt graduated from the University of Osteopathic Medicine and Health Sciences in Des Moines, Iowa and completed his residency in pediatrics. During his military service, Dr. Hunt held key leadership positions. As Chief Medical Information Officer, he has implemented ‘Epic’ and ‘Cerner’ EMRs. He is board certified and received a master’s in medical informatics. In April 2013, Dr. Hunt was appointed CMO/CMIO of St. Vincent’s Health Partners, physician hospital organization with more than 350 providers, and St. Vincent’s Medical Center. Dr. Hunt provides physician leadership and direction for the planning, design and implementation of clinical information systems at St. Vincent’s Health Partners and oversees quality and utilization for its provider network. Under the leadership of Dr. Hunt, St. Vincent’s Health Partners was the first organization in the country to become accredited by URAC as a Clinically Integrated Network and is leading the charge in changing the face of healthcare in Connecticut. Currently, working with organizational leaders, Dr. Hunt is engaged to develop information system infrastructure to support a super clinically integrated network.
