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14 predictions for healthcare in 2014 By Mansoor Khan, CEO, Alere Analytics

Although it has been said before, this next year in healthcare is truly going to be a transformative year. Here are 14 predictions that highlight the exciting times ahead. 1. Physician-led IPAs will matter in 2014, will become a significant presence as risk-bearing entities. Independent Physician Associations (IPAs) are starting to put together the tools and strategies that will allow them to carry risk and remain independent of hospital systems. IPAs that can make this move successfully will wield significant influence over healthcare delivery and spending. The National Health Service of the UK has also made a similar move and now channels most spending through ambulatory physicians.

2. Rip-and-replace HIS vendors will move out of favor with hospital systems. Hospital systems will seek strategies that allow them to keep existing investments while upgrading to capabilities that help meet meaningful-use requirements and manage risk. The cost of rip- and-replace systems has gotten prohibitive for all but the largest and richest hospital systems. Other less affluent hospital systems need to be cognizant of the cost of system and capability upgrades. Platforms that allow hospitals to protect existing investments while acquiring the needed capabilities to manage risk and move to an outcomes-based business model will start to gain momentum in 2014.

3. Health insurance exchanges will create huge influx of new patients and greater need to manage big data. Providers and payers will have an influx of new patient populations who newly have access to care thanks to public health insurance exchanges. These patients, who may be interacting with the healthcare system for the first time, must be engaged and educated on the steps to treat current conditions and maintain wellness. Public health departments, providers and payers must critically analyze the data on these new patient populations in order to identify gaps in care, track emerging health trends, and meet their goal of improving citizen health and reducing national healthcare costs. 4. Population analytics and risk stratification in ACOs. Providers, particularly those in accountable care organizations, are realizing the necessity and importance of using real-time clinical decision support and analytics in order to improve their patient population’s outcomes and lower the cost of delivering care. With the ability to identify high-risk patients, providers will be able to uncover those patients within the high strata that have the most actionable clinical opportunities for improvement and tightly focus their outreach efforts. 5. The importance of mHealth. Mobile health monitoring now allows healthcare providers to continue tracking their patients’ conditions after they leave their offices. By using mobile devices and Web-based applications, patients can administer tests such as blood pressure, glucose levels and weight checks themselves. Devices can also transmit patient answers to their healthcare providers, which is especially important when monitoring chronic conditions such as diabetes or heart failure. Mobile health monitoring is also a critical component of avoiding adverse events, shortening length of stay, reducing hospital readmissions and studies have shown that patients who are empowered by self-tracking make healthier choices. 6. Reducing hospital readmissions and hospital-acquired infections (HAIs) key to avoiding CMS penalties. Many patients leave the hospital or primary care physician’s office not fully understanding what is wrong with them, how to properly administer their prescribed medications and the importance of attending scheduled follow-up visits. The lack of patient engagement and provider follow-up leads to readmissions, higher costs and, eventually, Centers for Medicare and Medicaid (CMS) penalties (up to 2 percent of reimbursements in 2014). By implementing an automated, integrated solution, hospitals can significantly improve care coordination between practitioners, pharmacists and laboratory personnel and provide the necessary data needed to identify problem areas, measure progress of prevention efforts and ultimately reduce or eliminate readmissions and hospital-acquired infections (HAIs). 7. Infection control and clinical surveillance key to reducing risk of future infections. Antimicrobial resistance is a growing worldwide problem, prompting necessary guidelines and recommendations to help battle this issue. Hospitals need to consider implementing automated clinical surveillance to track, reduce and/or prevent HAIs and avoid the CMS penalties mentioned above. Infection control and clinical surveillance tools provide real-time information, including antibiotic

de-escalation, patient monitoring and automated antibiograms. This will encourage the optimal use of antibiotics to minimize bacterial resistance, increase patient safety protocols and reduce unnecessary costs. It can also empower infection control personnel to not only prevent HAIs, but to identify those at risk of new infections and take appropriate action in real time to reduce adverse events. 8. Making data actionable. Now with a wealth of patient and population-level data currently in the healthcare system, it is more important than ever to make this data meaningful. Analyzing clinical data through decision support tools is critical to improving how patient information is utilized. CDS provides clinicians with knowledge and patient-specific information that is intelligently filtered to enhance health and clinical outcomes. It also provides the ability to identify gaps in care so patients can receive the best treatment, physicians can offer the highest quality of care and payers can be sure that only the most appropriate procedures and services are being recommended. 9. Successful deployment of ICD-10 codes; deadline of October 1, 2014, is fast approaching. Successfully replacing ICD-9 codes and upgrading to ICD-10 will take time, resources and a good deal of preparation. This is driven in part by the shift in the healthcare industry to focus on performance and value, rather than the traditional fee-for- service model. Providers and healthcare organizations need to plan and coordinate efforts in order to make the transition to using ICD-10 codes as smooth as possible by the October deadline. Once the transition is made, the new coding system will allow for more accurate, specific reporting on patient diagnoses, the procedures healthcare providers are conducting and more streamlined billing processes. 10. Focus on patient engagement and empowerment. With the

increased use of mobile health devices and Web-based applications mentioned above, individuals will begin to manage their healthcare similarly to the way we engage as consumers in other areas of our lives, such as banking and retail shopping, remotely and without having to visit a brick-and-mortar location. This power to track and manage one’s own health data will lead to improved patient health and empowered healthcare consumer populations.

11. Interoperability is the next hurdle healthcare needs to clear.

We’ve been working as an industry to digitize all patient data, but that isn’t enough anymore. Data needs to flow freely to all points of care. Information needs to be exchanged with existing systems that can employ all commonly used standards, languages and messaging modalities. Utilizing standard industry formats such HL7v2.X, CCD and CDA is also key to achieving interoperability. A "one-patient, one record" view can also eliminate discrepancies that occur with multiple vendor systems, and provide access to information at the point of care, pre-encounter and post-encounter. 12. Managing alert and alarm fatigue. While intended to be helpful

reminders for busy physicians, alerts and alarms can feel like an overload of unnecessary information and pop-up windows. When physicians begin to become desensitized to the alerts and alarms, they may ignore or close them, potentially leading to an adverse event or dangerous drug interaction. Customization of clinical decision support systems is one method to combat alert/alarm fatigue. Eliminating alerts/alarms in the system that are irrelevant to a particular healthcare organization/system will reduce the number of notices – and hopefully physician fatigue. 13. Hospitals move toward becoming healthcare data HUBs. The challenge that most hospitals face today is that their technology networks are too vast and often include separate systems for pharmacy, laboratory, pathology, diagnosis and billing. A goal for 2014 and beyond for all hospitals should be implementing a bi-directional data exchange that is customizable, adaptable and contains enterprise-wide scalability. Once these separate technology systems have been broken down, hospitals can operate as communication HUBs, exchanging data across the continuum of care and incorporating information from billing, claims, clinical and even patient device and mobile technologies. 14. We must improve outcomes above all. The ultimate goal of all the efforts and actions among healthcare providers, system administrators and government regulations in 2014 (and every year) should be simply this: Empowering patients and clinicians to more clearly communicate and maintain wellness post-discharge will ultimately lead to improved outcomes.


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