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Aine Cryts is a freelancer based in Boston. She is a frequent contributor to Managed Healthcare Executive on topics such as diabetes, oncology, hospital admissions and readmissions, senior patients, and health policy.
Several changes and transitions will have a huge impact on health IT in 2017 and in future years.
All eyes are on Washington, D.C., as the nation looks to see the imprint President Trump puts on healthcare and other issues that face the country and the world.
Meanwhile, provider executives need to focus on delivering high-quality patient care and payer executives need to continue to retain members-all with an eye on quality, cost, and patient and member satisfaction. To be sure, both payer and provider executives will continue to plan for the projected 80 million Medicare beneficiaries in 2030. Still, seniors will soon be outnumbered by millennials as the patients demanding care from the U.S. healthcare system.
All of these potential changes and transitions will have a huge impact on health IT in 2017 and in future years.
According to a 2016 Partners HealthCare study, few seniors are going online to obtain information or accomplish healthcare-related tasks. Only 16% of seniors said they used the Internet to obtain health information, 8% filled prescriptions, 7% contacted physicians, and 5% attended to their insurance needs online. Younger patients, particularly millennials, are not surprisingly, further along when it comes to incorporating technology into their healthcare. Sixty percent support the use of telehealth (i.e. sharing health information via mobile health applications and engaging in video chats with their physicians), and 71% want their physicians to adopt mobile health applications, according to a Salesforce report.
While different demographics are accepting technology at different rates, managed care executives can bet that more patients and members, including the elderly, will start demanding telehealth services.
Pam Jodock, senior director of health business solutions at the Healthcare Information and Management Systems Society (HIMSS), uses the Center for Connected Health Policy’s definition of telehealth; namely, that it’s “a collection of means or methods for enhancing healthcare, public health, and health education delivery and support using telecommunications technologies.” Examples of this type of care include a physician answering patient questions via secure e-mail or a patient portal, or a live video conversation in which a clinician serves as an intermediary between the patient who’s there in person with a specialist located miles away, says Jodock.
Consumers are much more digitally attuned than ever before, and they want the delivery of their healthcare to be convenient and easy, says Jodock. Still, telehealth visits are reimbursed at lower rates than “brick-and-mortar-based” visits, largely because it’s easier for providers to administer such visits. There are upfront costs, of course, and that’s for the investment in technology to enable remote visits with patients, she says.
For providers who remain hesitant to embrace telehealth, alternative payment models could be a motivator. For example, providers that face value-based measures related to diabetic patient care may need to embrace telehealth devices, such as remote glucose monitors, that provide real-time patient monitoring capabilities. “The success of ACOs will hinge upon their ability to increase their use of connected health technologies and convert that information into action,” says Jodock, who points out that 98% of outcomes are based on what happens outside the physician’s office-and, therefore, outside the physician’s control. “Physicians need to develop partnerships with patients to allow them to have real-time information about their health status so that [their physician] can intervene in a more rapid and efficient way,” she says. “This also allows patients to be more engaged in their own outcomes and helps them do a better job of adhering to their blood pressure medications or their insulin for diabetes.”
That’s why Mitch Morris, MD, vice chair and global healthcare sector leader at consulting firm Deloitte, expects 2017 to be a “breakout year” for telehealth solutions-despite budgetary pressures. He says that access to real-time data about illnesses such as diabetes or chronic obstructive pulmonary disease or asthma will be a must for providers. In addition, there will be a continuing drive toward care provided outside of the hospital and into home and school environments.
More employers are also recognizing the benefits of telehealth. Deloitte, for example, offers to its employees in all 50 states the option to pay a $25 copay for a virtual visit with a doctor via a tablet or a smartphone.
Tools that provide consumers with cost information about healthcare are in greater demand for two reasons, says Morris, who notes that Deloitte is studying this behavior. For one, consumers are accustomed to an online retail experience where they can comparison shop across 10 online vendors in less than a minute if they want to buy a pair of Nike sneakers, for example. The second reason is, increasingly, consumers have high-deductible plans that can hold them responsible for $5,000 or more of their healthcare spending. From the consumer’s point of view, this is “their” money, so they want to ensure that they’re getting a good deal on their MRI or specialist visit or blood panel, he says. Morris, who prefers to use the more consumer-friendly “price” terminology-rather than “cost”-anticipates that providers will increasingly provide pricing for various healthcare services in 2017.
One such tool, the MyHealthcare cost tool, was developed by UnitedHealthcare about five years ago. Today, the tool covers 875 different services, which means that members have access to personalized estimates of the costs of care, says Craig Hankins, vice president of digital products at UnitedHealthcare.
One of the payer’s new initiatives is to integrate that cost information into members’ searches for individual providers. That means when a member searches for a particular physician, in addition to learning about their credentials and location, they’ll also learn how that physician compares to other specialists in terms of cost and quality.
If, for example, a member is experiencing knee pain, when they go into the search tool, they can find out about outpatient facilities, physical therapy, and compare physicians-and that includes information about the likelihood that the physician will order a lot of tests. Also included are consumer reviews from HealthGrades.
Members who use UnitedHealthcare’s transparency resources are more likely than non-users to save money and select high-quality healthcare providers, according to studies conducted by the payer, says a company spokesperson. The resources enable members to more frequently select high-quality healthcare providers across all specialties, including primary care physicians (7% more likely) and orthopedists (9% more likely). UnitedHealthcare members who use the transparency resources before receiving care pay, on average, 36% less than non-users, according to a 2015 claims analysis.
Providers across the country are feeling that “their EHR vendor promised them the moon and delivered a rock quarry,” says Jodock. Still, she questions whether even the most successful EHRs can serve all the needs of today’s providers. Often, policymakers and healthcare industry leaders assume that the technology requirements in mandates such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) can be supported through EHRs, but that’s not always the case, she says.
For example, not all EHRs can provide the level of reporting that’s required to support the meaningful use of pay-for-performance programs. In addition, inherent within changing payment models is the assumption that clinical and financial data can be shared among providers, she says. “EHRs don’t have the functionality to track these types of contractual arrangements or measure the percentage of responsibility any one provider involved in an episode of care should bear for the quality of care associated with that episode of care or the healthcare outcomes.”
While providers are increasing their adoption of alternative payment models, vendors are struggling to keep up with the type of functionality required to support the administration of these models. What healthcare vendors need is clear direction on how to build platforms that will support these new payment models, she says.
Morris, who once served as chief technology officer at MD Anderson Cancer Center, expects that MACRA requirements will mean that providers put additional pressure on EHR vendors to improve existing systems through improved work flow and software improvements (i.e., removing “bugs” from the systems). One specific area where providers will increasingly place demands on their EHR vendors is on functionality that will help them demonstrate quality and capability of embracing alternative payment models.
While in the past, the industry has witnessed the consolidation of EHR vendors, Morris anticipates that there will be less of this behavior. It was once common practice for a large EHR vendor to acquire a smaller specialty EHR that caters to gastroenterology, for example. Going forward, there’s a greater likelihood that the large EHR vendor will focus on developing this capability in-house.
While EHR vendors are facing more pressure from providers, providers are not necessarily in a position to invest more in EHR systems. Morris expects there to be modest investment in EHRs this year, as reflected in new sales reported by the major vendors in the third quarter of 2016.
Healthcare systems face a lot of uncertainty regarding the future of health insurance exchanges and the Medicaid expansion, which could impact patient cost-sharing responsibilities and patient volumes. Both could have a negative impact on healthcare systems’ finances, says Morris. As a result, healthcare CEOs and CFOs will likely wait to see what happens-and, in the meantime, they’ll conserve cash and not increase debt levels, which means fewer capital expenditures and less investment on EHRs.
While it’s unclear how the Trump administration will impact value-based care, payers across the country continue moving forward with these new care models. Thus, Morris notes that providers will be under increased pressure to use data to drive decision-marking around new payment models, lower unit costs, and engage with consumers.
Still, as with EHRs, the limiting factor is the needed capital investment for these types of platforms. While vendors could make a strong argument that investments in these solutions today will lead to savings and enhanced revenue tomorrow, a Deloitte Center for Health Solutions survey of 50 large provider chief information officers indicated that healthcare IT spending will be flat in 2017, says Morris.
What complicates matters is providers will continue to be under pressure to measure performance on population health measures, specifically. “There is a new age of expectations for dashboard builds from both customer and analytics team perspectives,” says Morris. “Gone are the days of lengthy report requests, aged data, and untimely information.”
Users today are demanding access to drillable, interactive, and current information, he says. That’s everything from basic Excel-based platforms, to machine-learning, voice recognition, real-time data analytics on a mobile device-and having that information on one, easy-to-use dashboard.
Morris is starting to notice some payers and providers working to better share data and data analysis. What matters to both payers and providers is the ability to jointly deliver high-quality care and drive down costs, while driving market share. That’s their goal, which is incenting both parties to collaborate, he says.
Risk is going to continue to shift from payers to providers, and the only way for providers to manage that risk is through prevention, says Tony Jones, MD, chief commercial officer at Lumiata, which provides analytics tools to help payers and providers assess risk. For example, to prevent patients with diabetes and chronic kidney disease from progressing to fairly advanced diabetes or stage 3 or 4 kidney disease, providers need to be able to easily access lab and claims data.
But that’s not the extent of the data providers and payers will need going forward. “There’s some truth to the fact that you can tell more about the health of a person by their zip code than by their claims history,” says Jones. “If a patient is living in a neighborhood where they’re surrounded by Fast Food restaurants and no good supermarkets, you can make pretty good predictions about their health, especially when you combine it with lab and claims data. Access to this data gives you a much better indication [that] they’re likely to have diabetes or kidney disease.”
It’s in payers’ interest to work together to develop and share this data with providers because it goes back to the macroeconomic shift or the trend associated with risk, says Jones.
“Whether it’s an ACO or a shared savings plan, payers and providers are asking the same question: How do I avoid costs?” he says. “There’s a fairly big shift, in that there are doctor groups within ACOs that are hungry for this data because they want to know how to treat these patients. They want to be able to identify who’s at risk; these are people they may not see until they show up [in their hospitals or clinics].”
Aine Cryts is a writer based in Boston.