It's been quite a year for health IT.
While a great proportion of the Advisory Board Company's research this year has focused on parsing out the implications of "meaningful use" requirements for hospitals and physicians, we've continued to emphasize that it's important not to lose sight of the longer-term imperative for these investments -- strengthening the health IT foundation that will allow hospitals to be successful under evolving health and payment reforms and finding a way to start accruing benefits from these significant capital outlays.
With health IT industry leaders caught up in the feeding frenzy around the stimulus dollars, many have ignored the implications of payment reform -- a market force that will place even greater demands on health IT than the meaningful use requirements. The stimulus package's incentives for health IT use are just one piece of the larger health care reform ambition that is working towards expanding coverage, promoting efficiency and ultimately reducing demand to inflect the total cost curve.
We see hospitals moving through three principle stages to capture the most value from their IT systems.
- Organizations will be focused on getting their clinical IT systems in shape to meet meaningful use requirements -- either to capture incentive payments, or at the very least, avoid the penalties.
- Organizations must overcome significant technical and organizational hurdles to create a robust analytics infrastructure.
- Finally, organizations can capitalize on the ever-expanding storehouse of clinical data to elevate care at the bedside, manage care across the continuum, and ultimately, prevent disease by leveraging sophisticated data mining and predictive modeling tools.
But How Do We Get There?
Payment models such as episodic bundling and shared savings arrangements are contingent on providers across the care continuum achieving a level of connectivity between their systems that seems unimaginable today.
Yet, while we may not know the exact timing of this migration toward provider accountability, one thing is certain: health care costs across the board need to be reined in. And insurers, both public and private, are seeking to increase hospital accountability for costs as a means to justify that end.
As reimbursement is increasingly tied to risk, the necessity of managing total cost of care for patients will be critical to ensuring financial solvency.
As a result, analytics will be needed not only to bolster the hospital's operational efficiency but also to improve outcomes by ensuring delivery of recommended care, preventing readmissions and even shifting the focus from treatment to prevention.
It's no accident that policymakers are pushing providers to establish the technical foundation now that will be necessary for migrating toward more accountability for care in the future.
So, how do you unlock the power of data in these systems to glean insights and provide new evidence that can be used to truly transform the way we treat, manage and prevent disease?
In Northern California, Sutter Health has developed a tool for identifying patients at risk of pneumonia. The tool, called the "core measure manager," pulls data from the hospital's information systems and runs a risk assessment for all patients within the first 24 hours of arrival. The tool fires off real-time alerts to providers to initiate treatment for vulnerable patients at the earliest onset of the disease and helps prevent potential complications.
Dallas-Fort Worth's Hospital Council offers an example of the advanced analytics potential in community information exchanges.
Using a first-of-its-kind regional patient index, more than 70 member hospitals that serve a 100-mile radius in North Texas have access to information in a claims repository, which can create a composite picture of the care chronically ill patients are receiving throughout the community.
Although still undergoing refinement, this tool will be able to generate reports on things like readmissions and ED utilization, helping hospitals pinpoint "boomerang" patients who require better care management.
Using IT To Move Into New Business Areas
Many hospitals and hospital systems have been investing heavily in IT for the better part of a decade, not because of the strategic value, but because it's viewed as "right thing to do." That justification won't cut it anymore.
Hospitals are devoting more and more of our scarce capital dollars to IT -- a shift that was occurring prior to the introduction of federal incentives, but one that's been accelerated by the stimulus bill.
In these times of economic and reform uncertainty, it's even more critical that hospitals figure out how to unlock the clinical and strategic value of this very costly and rapidly expanding set of assets.
Providers are shouldering virtually all of the ongoing cost for health IT, yet payers and other purchasers enjoying the lion's share of the benefits, in the form of fewer duplicative tests, avoided hospitalizations and the like.
The EHR stimulus incentives will offset some of the initial implementation costs, but the fundamental imbalance of costs and benefits won't change, sparking some health care providers to transform the business model to make their clinical and analytical investments deliver both strategic and financial value.
In Indiana, Clarian Health is offering new products that strike into what traditionally has been the domain of insurers -- selling wellness interventions directly to employers.
Clarian's Healthy Results division has set itself apart from other provider-based wellness programs by offering a robust data mining infrastructure with a capability insurers can only dream of -- pulling data directly from patients' EHRs.
We realize to some of you this may seem like too radical a departure.
No doubt, health IT isn't the only key ingredient for success here. Other assets like clinically integrated specialists and strategically aligned medical homes will be critical also to excelling in a risk-based payment environment.
But consider this -- the health IT assets you'll be required to install as part of meaningful use will position you to manage the total cost and quality of care delivered to patients. Why not capitalize on that by going at risk?