The Unstoppable March Forward of Technology in Healthcare

As 2013 kicks off, a sampling of news and information pieces confirms what is known by just about anyone in healthcare.  The Medicare SGR “fix” again came at the last minute and, in large part, at the expense of the hospitals.  More and more money is being shifted from specialists to primary care physicians.  There’s no denying primary care deserves to be properly compensated but the specialists need their share too.  So, providers are fighting over dollars, pay for performance (P4P) plans continue to develop and patients are getting more information, clear or not, on quality.  The message here is, the focus for groups wishing to stay as providers in changing markets needs to be on information, both internal and external.

In a December 2012 report titled “Farewell to Fee-for-Service? “A Real World” Strategy for Health Care Payment Reform”, UnitedHealth Group, Inc. (UHC) outlines its vision and plans for payment reform.  The report offers that the nation could save up to $1 trillion over the next decade in healthcare costs if it were possible to “unleash the potential of payment reform initiatives”.  Payer-Fusion, a health care insurance Third Party Administrator (TPA), working in thirteen states in the US provides information in a December 13, 2012 report offering that “Pay for Performance is defined as “a method of improving efficiency or the quality of care by providing direct financial incentives to physicians and healthcare provider organizations” using “performance measures that can cover various aspects of care delivery including clinical quality, safety, efficiency, patient experience, use of health information technology and a variety of other specific measures”.  Five potential benefits of P4P programs are identified by Payer Fusion as “1) Reducing Clinical Practice Variation, 2) Reducing Errors, 3) Ensuring Appropriate Care Settings, 4) Increasing Transparency of Payer Performance for Price and Quality Conscious Customers and Flexibility of Incorporation.”

Of course, in Alabama, we have a different payer set up than most states.  A dominate commercial payer, several commercial payers with a smaller market presence, Medicare and Medicaid provide payments for health care benefits.  BCBS has taken significant steps to report on quality, UHC and the other commercial payers are looking at their next steps and Medicare and Medicaid and going to play off of national reform actions.  In addition, while we have yet to see new P4P models in any significance, you can bet this model will be presented in the Accountable Care Organization (ACO) or similar plan in the near future.

So, what about the data issue?  A January 11, 2013 New York Times Article has a headline that states “Electronic health records yet to deliver, study finds”.  The article states that “The conversion to electronic health records has failed so far to produce the hoped-for savings in health care costs and has had mixed results, at best, in improving efficiency and patient care, according to a new analysis by the influential Rand Corporation.”  Indeed, the article states that “available systems seem to be aimed more at increasing billing by providers than improving care or saving money”.  That may be true, but it’s because the ideas outlined in the previous paragraph are just getting traction.  Until there are rewards, the real power of these systems will not be realized.

Today, in Alabama, a consumer, or payer, can go to the BCBS website to look up provider quality and satisfaction information, www.HealthGrades.com for a less intensive look at providers but more in depth info on hospitals and the new Physician Compare information being rolled out by Medicare looking at cost and quality based on the already influential Hospital Compare program. In addition The Commonwealth Fund has a website at www.whynotthebest.org that provides an interactive map offering data on patient satisfaction and healthcare quality across the US.  So information, however clear or accurate, exists today.

So physicians, repeating what has been said before, if they are going to be leaders in the delivery systems of the future, need to be diligent about preparing for the new world.  Electronic Medical Records are a given, particularly when they can be funded in large part by the Medicare bonus plan, and need to expand to where patient specific information can be shared by common providers.  Primary care providers need to be aggressive about learning about the quality and cost effectiveness of the specialists to whom they refer patients and those same specialists need to understand the importance of providing that same information.  Finally at some point, physicians need to work together, in the structures available for new delivery systems, on how to use this information to provide a benefit to their patients, and themselves.