It has been an interesting few years in the healthcare IT (HIT) industry and no doubt it will continue to be so moving forward. Not too long ago the Federal stimulus package went into effect to support Meaningful Use (MU) and most everyone was supportive of the goals and cautiously optimistic of the goals. Optimism was high in part because new funding was available, but also because there was a realization that the technology had finally reached a sustainable level. But as these early stages of Meaningful Use have been executed and providers move from getting funding to a state of “now what?”, pessimism has started to creep in. Rollouts like Healthcare.gov do not help this negative thinking. By Greg Chittim, Senior Director of Strategic Marketing, Arcadia Solutions
By Greg Chittim, Senior Director of Strategic Marketing, Arcadia Solutions
It has been an interesting few years in the healthcare IT (HIT) industry and no doubt it will continue to be so moving forward. Not too long ago the Federal stimulus package went into effect to support Meaningful Use (MU) and most everyone was supportive of the goals and cautiously optimistic of the goals. Optimism was high in part because new funding was available, but also because there was a realization that the technology had finally reached a sustainable level. But as these early stages of Meaningful Use have been executed and providers move from getting funding to a state of “now what?”, pessimism has started to creep in. Rollouts like Healthcare.gov do not help this negative thinking.
The way the industry performs in the next 12 months will be very telling, and I hope it will point us towards the continued optimism around HIT and we’ll see an upswing again. The multitude of data that has been collected in the early stages of MU will start to prove very useful and will have a profound impact on physicians’ lives as well as the lives of the patients, so the industry will finally see the fruits of its labor. Reflecting back on 2013 here are my top three HIT trends of this past year that I’m most thankful for that are setting us up for an exciting 2014:
The Move from Meaningful Use to meaningful use – What most people have come to learn is that MU stage 1 did not prove to be all that meaningful to providers in 2013. The incentive part of MU was just about getting the technology in place, not about providing a real impact on patients and providers. However, it did focus them on proper (and hopefully sustainable) documentation of health information. Practices focused on making sure every patient that comes in has a proper set of vitals, medications are prescribed electronically, problem lists are documented, etc. This focus on documentation has and will help enable real meaningful actions to be performed with health data via analytics and care management.
MU stage 2 and beyond will drive the focus towards lower case “meaningful use”, which refers to actually using the EHR meaningfully and using the information now stored in the right places and in the right way to effect the operations of the practice towards better outcomes for the patient. Not just reporting a problem list but using it effectively to position the patient from a primary care setting to a specialist setting and sending the whole patient record to these specialists so they have the background on the patient before recommending a treatment path.
This, combined with a multitude of quality improvement initiatives spurred by PCMH, state and payer influence, will enable pay for performance programs that aren’t self-reported but backed by a concrete set of documentation to objectively prove patients have made improvements. The industry is going to see more ambulatory organizations start to realize the benefits of all this work. Once these benefits start to become real, the adoption rate for additional health IT will increase significantly. We will start to see this come to life in 2014 far more than it was seen in 2013.
Increased Collaboration among HIT vendors and Between Providers and Health Plans – Working in walled gardens will not work without some level of trust and data sharing, even with more agreement on data standards. As we begin to see collaboration that goes beyond standards to the quality and use of data and the resulting analytics, we will begin to see real, measurable movement in quality and cost.
One of the biggest challenges in the HIT industry is getting the different players to cooperate and find an outcome that is mutually beneficial to all of them. Health plans and health system providers are notoriously reluctant to share data with each other. Health providers feel if they share data with the health plans they’ll use it to hammer them down during contracting. And, similarly, health plans don’t want to make all their claims public to providers for competitive and contractual reasons.
However, with the advancements made in MU stages 1 and 2, we’re starting to see some movement here. Health plans are starting to provide more lucrative contracts in return for access to some clinical data and providers are more willing to oblige because with these technology advancements they are able to provide this subset of data without exposing their entire patient panel. It is also a lot less burdensome with these technology advancements. On the HIT vendor side there are also alliances like the CommonWell Health Alliance, which counts many of the most influential EHR vendors across the country – with Epic conspicuously absent.
Focus on Consolidation – This is both a positive and a negative - but the extreme version of collaboration is done by merger and acquisition. Having fewer players on the board allows for fewer variables and increased collaboration. Right now there are so many different players that even if you have collaboration it doesn’t have that big of an effect. Consolidation can make it a more manageable sized market. However, you do want to be mindful not to swing too far and have the competition become so fierce that any possibility of cooperation between them isn’t possible.
These are all really important trends that developed in the past year and as a result, the industry will begin to see that the ambulatory networks are where the greatest benefits are going to come in the next five years. Hospitals have gone from growing at a rapid rate to capture revenue to a targeted center of cost. They are very lean but they are starting to have diminishing returns from cost control and quality improvement programs.
Ambulatory networks are operating on so many different EHR systems that are being used infrequently, trying to pull this data together from 500 physicians using five different EHRs and allowing them to have consistent quality improvement programs and total medical expense control programs is a daunting challenge. However, these great networks of primary care and specialty practices are where there is the greatest opportunity to provide better and less expensive care and I predict that we’ll see more physicians from these practices taking a bigger leadership role in efficiently influencing the operational measures needed to improve the quality of care for their patients.