From the January/February 2019 issue of HealthCare Business News magazine
Patient “preflight requirements” in a value-based world will require having real-time access to a patient’s longitudinal health record in addition to eligibility and enrollment data. Patient “takeoff” will require transparency about treatment alternatives, and cost and quality differentials. Patient “flight planning” will demand understanding of and compliance with care protocols, and a clinician’s ability to trigger the “fasten seat belt sign” in between physical encounters.
In a value-based world, a physician’s ultimate “landing requirement” for a patient will be a satisfactory outcome. Optimizing profitability of medical practices in a world of performance-based payments will require new and different “navigational systems” to guide patients on their healthcare journey.
In order to truly replicate an air traffic control system for population health management, clinical data must be extracted from disparate patient record systems, and curated into longitudinal patient records that enable providers to identify gaps in care with an ability to trigger a course correction on a real-time basis.
A road paved with evidence-based protocols
While the HITECH Act was a central catalyst for EHR implementation, legislators and regulators will increasingly turn to quality and value initiatives, rather than mandatory adoption of technology. For example, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Merit-based Incentive Payment System (MIPS) will drive change in the healthcare reimbursement landscape with the objective of delivering more value for the same cost, realize improved outcomes, or same outcome at a lower cost. The mandated assumption of risk (e.g. payment for value) will drive the use of technology as a practical matter.
Quality will ultimately be assessed by measuring adherence or deviation from evidence-based protocols, which will help eliminate unwarranted care – the greatest driver of cost.
Payment transformation will drive innovation in the ways that care is delivered – as more providers assume financial risk, which is inherent in outcome-based payment methodologies, demand for health IT solutions that increase productivity and deliver clinical decision support should increase. Healthcare technology’s promise will be the efficient and effective delivery of care so that providers that assume risk embrace quality-based payment methodologies.
In such an environment, emerging health IT vendors should explore indirect commercialization opportunities such as partnering with larger, well-established firms that have existing customers, but may lack the specific capabilities and solutions that emerging firms possess. Speed to scale will be a success driver, and firms that are willing to collaborate versus a “go it alone” mentality, will willingly trade margin for volume in order to acquire customers in as efficient a manner as possible.
