Healthcare and health IT are plagued by conundrums. Providers long have been the ones asked to make hefty investments in EMRs and other IT systems to help remove costs from the healthcare system, but payers and plan sponsors tend to enjoy most of the financial benefits. Clinicians wish their organizations would share data with others, but those in the executive suite have been reluctant to cooperate with competitors for fear of losing revenue. And, let’s face it, medical errors can be profitable if a routine procedure turns into an expensive inpatient admission.
Portions of the American Recovery and Reinvestment Act and the Patient Protection and Affordable Care Act are intended to address these problems by providing financial incentives for “meaningful use” of EMRs (including health information exchange) and by encouraging the creation of Accountable Care Organizations
I’m just back from the Institute for Health Technology Transformation health IT summit in Fort Lauderdale, Fla., where I moderated panels on how health IT underpins ACOs and how business intelligence can create a framework for health information exchange.
The panelists did great job of articulating some of these conundrums and strategies to overcome them, but none better than Kevin Maher, director of clinical innovations for Horizon Healthcare Innovations, a new affiliate of Horizon Blue Cross Blue Shield of New Jersey tasked with testing new care models, and Victor Freeman, M.D., quality director in the Health Resources and Services Administration‘s Office of Health IT and Quality.
The patient-centered medical home is a great idea for managing care, promoting prevention and, ultimately reducing costs. “We view the base of the ACO as the patient-centered medical home,” Maher said. But what exactly does an ACO look like? “An ACO is like a unicorn,” Maher said. “We can all describe it, but we’ve never seen one.”
He noted that Horizon has started paying some physicians a care coordination fee to manage populations that potentially could add $60,000 or more to a doctor’s annual income. But there are plenty of factors outside a physicians’ control.
“Potentially the No. 1 focal point of a patient-centered medical home or an ACO is patient behavior,” Maher said. A doctor can’t force a patient to exercise more, quit smoking or get a mammogram or PSA test. There’s pay-for-performance for doctors, but what about paying for patient performance?
In January 2012, Horizon will launch a pilot to offer incentives to members who get recommended tests and choose providers that meet the health plan’s quality standards. That’s right, the Blues plan in New Jersey will pay people to go to the doctor and to make informed choices about which doctors they see. (“Everyone says she’s a great doctor” won’t cut it as an informed choice anymore.)
Freeman called the Horizon experiment “P4P that makes sense.”
Let’s just hope the technology can support making the right choices. “People in government get more involved in quality measurement, not necessarily quality,” Freeman said. Incentive programs these days still tend to be more pay-for-reporting than pay-for-quality, and the technology hasn’t fully matured in that area.
“EMRs were designed for billing, not quality reporting,” noted Freeman, who has a background in public and population health. Information often isn’t stored in discrete form, such as with images generated by specialists flagged as being abnormal, so even with HIE, it’s hard for primary care physicians to identify patients who might be candidates for early interventions before they actually exhibit symptoms of a disease.
“My biggest interest in HIE is how clinicians communicate with each other,” Freeman said.
But is the technology ready to help them do so? “HIE now reminds me of what EMRs were five years ago,” said another panelist, Bruce Metz, Ph.D., newly hired senior VP and CIO at the Lahey Clinic in Massachusetts. It’s viewed as an IT project that’s not necessarily linked to a business or clinical strategy. “You can’t force the technology to mature that fast,” he added.
And so the ride continues on what Metz called “a fast-moving train.” Have we even had time to see if the right people are on board?
[…] Click here to read the whole post. Related Articles:Health Wonk Review: Reform edition […]
I found this short article interesting and mirrored my own thoughts. I tend to think negatively about proposals with gimmicks of adding to doctors salaries.
http://thehill.com/blogs/healthwatch/health-reform-implementation/160577-group-practice-physicians-collectively-reject-key-healthcare-reform-proposal
I would love to see posts on “how health IT underpins ACOs” and “how business intelligence can create a framework for health information exchange”. Perhaps you could provide highlights from your sessions.
This is far from my specialty area, but a health attorney friend of mine yesterday sent me a few links to articles on this which give a different feel than this post:
The AP: http://hipa.us/j7gSns “…so complex it’s unworkable…”
The Hill: http://hipa.us/msZSrz “…incentives are too difficult to achieve…”
Dr. West,
The problem with organizational comments like the one you posted is that it’s often hard to see if they really think it’s too hard or if that’s just posturing to try and make the money as easy as possible to get. Of course it’s in their interest to lobby for simple ways to get paid higher. So, it’s hard to know if they really believe that it’s too cumbersome or not.
At least it’s a voluntary program and not some mandate.
John, I agree with the cited difficulty. My thoughts regarding ACOs stem from my frustrations in dealing with the PQRI incentive program (i.e. I still can’t get the answers to my questions from CMS even after having submitted PQRI data last year). ACOs appear to me to be a much more complex type of an incentive program with a lot more hoops to jump through just by their description, which is practically nonexistent. No detailed descriptions seem to be discoverable. I suppose that that is a blessing, since without details, there can’t be any implementation.
“I suppose that that is a blessing, since without details, there can’t be any implementation.”
Until you learn that they’re holding you to all the details for which they didn’t define or make known.
[…] Maybe I am exagerrating, but my friend and health IT guru John Lynn over at EMRandHIPAA.com had a comment conversation back and forth with me about Accountable Care Organizations (ACOs) recently. After a post by Neil […]