According to the Office of the National Coordinator (ONC), hospitals have almost doubled their capacity to exchange information with providers outside their organization. Only 41% of hospitals had that ability in 2008 and 76% could do so in 2014. Unfortunately this growing hospital capacity is not equally matched among primary care providers or in post-acute care. Significant barriers to interoperability remain in those care settings, creating uneven access to data across the continuum.
While many providers cite the need for costly interfaces as their foremost obstacle, a potpourri of hurdles hinder the care coordination needed to transition U.S. healthcare from volume to value. That potpourri is too multidimensional for the hospital industry or any single sector to tackle alone. Diverse health IT partnerships are needed to promote a free-flowing data exchange that includes the patient and all members of the care team.
Managed care has long seen the value of providing care through community and home-based services that are less costly and more convenient for individuals. But those services must be linked in a way that facilitates access to accurate, timely health information.
We all know that health is predominantly determined by social circumstances and activities that occur outside any health care institution—especially outside a hospital. If we are to influence those activities and truly participate in population health, we must engage individuals in their own health and we must stop thinking of health IT as the exclusive purview of healthcare institutions.
Government promoting coordination with bundled payments
New policies set in motion by the Affordable Care Act have introduced changes in how care should be delivered and success measured. In April, CMS introduced bundled payments for joint replacement as the first mandatory program in the plan to shift at least 50% of Medicare spending to alternative payment models by 2018.
Currently about half of the Medicare joint replacement patients receive ongoing care in a post-acute facility like a skilled nursing facility or rehabilitation hospital and another 33 percent receive home care. More often than not there is little coordination between the acute and post-acute care teams.
Under the new program, hospitals in 67 randomly selected metropolitan areas are now responsible for all costs of care for a full 90 days after the surgery. If patients do well and recover quickly, the hospitals and partners will reap the monetary benefit. If not, the hospitals could end up owing Medicare.
The program does not mandate data exchange, but it’s clear that effective communications and data analytics is essential to success.
Of course, bundled payments aren’t the only reimbursement program to reward disparate providers for care coordination. According to a Leavitt Partners report at the end of 2015, the number of accountable care organizations had grown to 782, covering 23 million lives.
This partial shift of financial risk from payer to provider is good news for payers, but only if quality outcomes are met and health improves. The need for timely data exchange seems obvious but unfortunately the solutions for assuring it are less so. Consider the fact that when multiple physicians are treating an individual following a hospital discharge, 78% of the time information about the individual’s care is missing. We know too, that poor care coordination increases the chance by 140% that an individual will suffer from a medication error or other healthcare mistake.