How technology is facilitating collaboration among members, providers and payers.
Today’s healthcare system is still dominated by a fee-for-service payment system. The resulting inefficiencies – high service volume and at times redundant or unnecessary care – are not only hard to ignore, they are also a detriment to clinical quality, according to data from Dartmouth Atlas. The research organization found that regions in which Medicare spending is the highest actually tend to produce worse patient outcomes.
Many experts have concluded that the problem stems from the current uncoordinated and highly fragmented nature of healthcare delivery. To realize the vision of improved quality and lower costs, however, payers, providers and patients must be inspired (and perhaps incentivized) to collaborate in new ways, including sharing appropriate information at all points along the care continuum – a challenge Don Berwick’s “Triple Aim” is designed to address.
The Triple Aim in a nutshell
Devised by the former Centers for Medicare and Medicaid Services (CMS) administrator, the Triple Aim emphasizes three objectives:
1. To improve the overall health of the population being served. This is best accomplished by not only obtaining information directly from patients, but also by leveraging both payer and clinical data and analyzing it using sophisticated technologies to risk-stratify the population. These tools can help identify which patients require special services, such as complex care management or coordination of services – activities that have traditionally been provided by health plans but will likely shift back to the provider community as they share risk with payers in an accountable care environment.
2. To improve the care experience, which goes beyond simply providing the right type of care. The patient-centered medical home (PCMH) will play a critical role in the care experience by designating a personal provider and care team who are responsible for coordinating each patient’s medical and behavioral healthcare activities.
3. To provide the best care possible while lowering the per-capita costs of care over time. While this will be difficult to accomplish, applying evidence-based care and eliminating duplicative or unnecessary procedures – with help from information management technologies such as electronic health records (EHRs) – will give the industry the best chance of success.
Challenges, opportunities emerge
As healthcare embraces a shared-risk payment system, payers and providers that exchange cost, utilization, clinical quality, patient experience and provider benchmarking data with each other will achieve the highest outcomes. But it doesn’t end there. To truly impact population health, these constituents must collaboratively address the broad range of environmental, health literacy, social structure and resource distribution factors by providing individuals with information to support health and wellness and empower patients with chronic illnesses to better understand their conditions and respond in meaningful ways to stabilize or improve their health.
The industry must become more technically sophisticated, utilizing analytics to help identify important diagnostics and metrics, interrogate data for gaps in care, set health goals and program elements, and integrate delegated care models and chronic care management, among other capabilities. Integrated with the EHR, this information can leverage timely patient data and deliver intelligence at the point of care, where it can be used most effectively.
Fortunately, technology is being adopted on a wider scale than ever before. The EHR, for example, has received a significant boost by CMS’ meaningful-use criteria that provide incentives to physicians who leverage the technology in patient care. With the prospect of receiving substantial financial assistance from the federal government, more and more physicians today are successfully using their EHR system to capture information from the patient encounter; send prescription, radiology and laboratory orders; and share vital data with their colleagues.
But analytics and EHRs cannot solely facilitate change. To truly realize the benefits of a value-based, patient-focused healthcare system, payers, providers and patients must share accountability, become more transparent and utilize information on a new scale. This level of collaboration can only be achieved by the right application of incentives, governance structures and technologies – factors being established in the industry today.
About the author
Dr. Mathews is the chief medical officer at ZeOmega and a board-certified internist and physician executive with more than 25 years experience in healthcare delivery systems and managed care. Find out more at www.zeomega.com.