- The House Ways and Means Subcommittee is challenging health IT and big data analytics vendors to bring the “outdated” healthcare system into the modern age while focusing on translating technical innovations into quality care improvements for Medicare patients.
In a hearing last week, Subcommittee Chairman Rep. Pat Tiberi (R-OH) praised the industry for its innovation, but was quick to point out that many Medicare beneficiaries are unable to benefit from the quality and technology advances more commonly available in the commercial payer arena.
“The commercial sector of health care is utilizing many of these new innovations on a yearly basis to improve systems, medical facilities, beneficiary care, and collaborative care efforts,” Tiberi said. “To date, Medicare has fallen significantly behind.”
“We are here today to kick off discussions about the innovative and technological aspects of health care, and explore how we can use already available and burgeoning technologies to increase efficiency, reduce waste, improve outcomes, and create greater access to care for beneficiaries in the Medicare space.”
The hearing attracted testimony from top vendor and provider executives, who largely agreed that the industry still faces many challenges, including a lack of interoperability, widespread operational inefficiencies, and the difficulties of navigating a shifting payment landscape.
Paul Black, CEO of Allscripts, acknowledged that “in recent years the healthcare industry has experienced the expected headaches that occur with the introduction of change agents.”
However, innovation quickly follows disruption, he added. Federal initiatives like the EHR Incentive Programs have produced “huge leaps forward” that may not have occurred without the financial levers included in the regulatory framework. Meaningful use has also promoted a new reliance on data standards, big data analytics, and a population health management approach to healthcare.
“Given the tremendous progress in standards development made by the private sector in recent years, as well as the additional motivation for our clients to continue this impressive momentum thanks to the passage of the Medicare Access and CHIP Reauthorization Act, we believe that there is still very real upside ahead,” he said in his testimony.
“This is a great start, even where more work will need to be done to move as many clinicians as possible to advanced payment models, and we applaud your support for this continued progress.”
Black cited several examples of how Allscripts products have worked to improve efficiencies, interoperability, and patient outcomes. Jared Short, Chief Operating Officer of Cambia Health Solutions, followed suit by detailing the health insurance navigation and care coordination tools available from his organization, including a collaborative dashboard, telehealth services, and payer transparency solutions.
“We understand that health care is complex and deeply personal, which is why we’re focused on putting the consumer at the center of everything we do,” he said. “Seniors are just as eager for timely, consumer-friendly access to comparisons of clinical quality and price. They do not want to go in and out of the hospital if they do not need to, and our system can no longer afford this level of inefficiency.”
“Cambia looks forward to helping members of this Committee transition Medicare into the next-generation of data analytics, health care coordination and patient engagement.”
But Rep. Mike Kelly (R-PA) was not convinced that provider investments in health IT tools are being converting into true quality improvements.
“It’s not about the money that we spend, it’s about the money that we spend inefficiently and ineffectively,” he said. “It is hard for me to sit here and look at who we are and where we have been. We can put a guy on the moon but we can’t get him through the emergency room. We can invent the Internet but we can’t get people through the hospital system. What is wrong with us? Look at the spending. It isn’t for lack of investment.”
Michael Gallup, CEO of patient flow analytics company TeleTracking, replied that big data analytics can help to foster communication between hospital departments to streamline patient transfers, prevent avoidable harm from delays in care, and improve overall satisfaction.
“There’s enough money in the system to get the patients through and give them the care that they need if we cut out the inefficiencies,” he said. “We have a doctor shortage, a nurse shortage, we have all these shortages out there. How do we fix that? Well, let’s make them more productive.
“If we can take labor and help them get more productive, we can get more patients through at the same price … If we can get more [patients] through at the same price, we can solve many of our problems.”
Productivity is a sore point for providers, not only when transferring patients. Physicians have repeatedly slammed electronic health records for taking too much time and effort to manage while producing little genuine return on the investment, and traditional fee-for-service models may not provide sufficient incentive to continue developing health IT infrastructure that has not proven its worth.
But some provider organizations, like Wisconsin-based ThedaCare, have made it a point to push through these technical and workflow barriers, said Greg Long, CMO and Senior Vice President of Systems of Care.
With seven hospitals and 34 clinics serving more than 240,000 patients each year, investing in big data analytics, care coordination, and population health management tools was a requirement for this Pioneer ACO and Next Generation ACO.
Using data analytics and risk stratification techniques, ThedaCare has leveraged its Epic Systems EHR capabilities to overhaul the way it approaches care for high-risk “super-utilizers” with complex chronic disease management needs.
Starting in 2014, a pilot program generated risk scores for more than 7000 patients based on utilization histories, clinical factors, and psychosocial needs, Long explained. The model identified 600 patients who qualified as “high risk,” and the healthcare system enrolled 282 of those individuals in a team-based care coordination program.
Patients received case management services, tailored education, and individualized support for their chronic disease, which has resulted in an 8 percent drop in patients with uncontrolled diabetes in just one year.
Other data-driven projects at ThedaCare include telehealth visits for common conditions, as well as telestroke and remote psychiatry options, which may help to improve access to care while reducing burdens on patients, staff members, and the healthcare system as a whole.
“From my perspective as a clinician, it is exciting to see the ways that technology and innovation can transform care and improve outcomes for patients,” Long said. “Of course, like other healthcare providers, we continue to be challenged by traditional reimbursement structures like fee-for-service that do not always support technology and innovative care models.”
“For this reason, we have and will continue to explore alternative payment models like the Next Generation ACO program and private payer contracting strategies that better support the types of initiatives described above. We believe these innovations are critical to improving patient experience and health outcomes.”
The Committee hopes that more healthcare providers will join ThedaCare in seeing measurable results from health IT and big data analytics investments, and noted that Congress will need to become a better partner in helping providers and vendors achieve their goals.
“There are better ways to deliver care if we can lift barriers and incentivize greater efficiencies amongst all providers,” Chairman Tiberi concluded. “Rather than create more bureaucratic layers, Congress should continue to remove some of the regulatory burdens and barriers constricting advanced partnerships between technology and health care.”