Just when most hospitals and health networks have become somewhat technology-enabled — with electronic health records, workflow and revenue cycle management systems, and even health information exchanges — along comes accountable care.
To survive and thrive in this new fee-for-value environment, hospital providers not only must implement solutions that demonstrate meaningful use, they also need to employ a whole host of new technologies. And they need to understand how best to implement and sustain these technologies.
To achieve the triple aim of lowering cost, enhancing quality of care and improving outcomes, providers need to focus on four technological solutions:
- EHR, HIE and computerized provider order entry;
- population analytics;
- clinical transformation;
- care management solutions.
Strengthen the Foundation with EHR, HIE, CPOE
According to an IDC Health Insights survey, nearly 44 percent of hospitals accelerated their EHR deployment in 2010 in order to qualify for ARRA incentives.
But preparing for accountable care means more than just ensuring that EHR, HIE and CPOE technologies are worthy of ARRA funding. Hospitals need to demonstrate that they can analyze the effectiveness of care and performance of caregivers. The technologies not only must collect and digitize what's on paper today, but also normalize, extract, analyze and share the kind of data needed to automate the accountable care process — from pre-hospital to inpatient to posthospital and home care.
These systems also need to produce aggregated data on costs, trends, outcomes and operational issues. And, as most providers already know, not all systems are created equal. Viewing reports from a static system may be enough for today, but it won't even begin to scratch the surface of what will be required tomorrow. Strengthening these systems will be a critical step in readying for the next wave of IT investment for collaborative care.
Play Like a Payer: Population Analytics
The current EHRs are good at recording what happens to individual patients. But providers will need to stratify the patient population into registries that help clinicians focus on the highest risk patients. Population analytics will enable providers to uncover clinical care patterns and disease trends (e.g., genetic, environmental or racial) and offer a holistic view of the local patient population over time.
Most critically, using data from clinical, operational, financial and other applications, population analytics can identify incidence of the population's latent diseases and the costs associated with them. Like payers, providers will need to understand which of the most costly diseases — heart disease, cancer or diabetes — are affecting their patients and how to build care management strategies for them. By defining the patient population and disease outliers up front, hospitals and health networks can predict costs, budget more accurately, understand facility requirements and offer services that are tailored specifically to each population.
Change the Protocols: Clinical Transformation
Once providers have a better understanding of their patient population and the services they need to offer, the next step is implementing protocols to improve care in underperforming areas.
By integrating EHR and other clinical data, providers can identify points in the process that need improvement and develop best practice-based guidelines and strategies to address problems. For example, identifying the types of surgeries that result in the highest number of readmissions will enable clinicians to understand how to adjust patient discharge or follow-up procedures and significantly reduce costs.
Performance monitoring and feedback tools and analytics will ensure that clinicians are delivering care based on these protocols. Clinicians should help shape how these tools are implemented and used, but care improvements always should be made with an eye on achieving the triple aim of lowering cost, enhancing quality and improving outcomes.
Engaging Patients: Care Management Solutions
In any successful collaborative care model in which physicians, hospitals and health systems are reimbursed based on outcomes, it will be critical for patients and families to take an active role in their care — especially when it comes to chronic disease management. Patient noncompliance alone costs the U.S. health care system $100 billion annually, according to PwC's Health Research Institute. As a result, providers will need to invest in tools that will improve patient communication, education, compliance and adherence.
Features of these technologies include reminding nurses and care managers to call patients, tracking patient progress, and scheduling office visits. Providers need to understand how best to reach patients — by telephone, patient portal, mobile application, text messaging, and so forth. Call centers could help facilitate patient communication. Other care management tools can provide patients with feedback and educational content, upload information for remote monitoring and analysis, and facilitate communication between patients and their caregivers.
These tools can be more effective in a provider setting than as part of an employer benefits offering because patients view their care managers under the “brand” of the hospital or treating physician, not as an adjunct to their health plan.
This era of pay-for-performance or accountable care means that providers will have to think differently, especially when it comes to their IT strategies. In an accountable care environment, health care — from patient outcomes to physician performance to reimbursement — will be viewed and evaluated holistically; as a result, providers will need to take a holistic approach to their technology solutions. By enabling these technologies to work in concert, providers will be steps closer to reaching the triple aim.
Todd Cozzens is the CEO of the accountable care services division at Optum in Eden Prairie, Minn.