By: Carol Murdock, Chief Marketing Officer
Many of us remember the days of integrated delivery systems, global capitation and huge physician organizations. If you were not working in healthcare in the early 90s, I am sure you hear people talk about the failures associated with those models, including accusations of poor quality and challenges with patient access. The failure of hospital-owned physician practices, large physician practice management models and independent practice associations (IPAs) were all well-publicized. Part of the debate, and frankly the criticism, around the current health and payment reform is the concern that what we are doing now feels an awful lot like “back to the future.”
So, what makes payment reform different this time? You may question, and rightly so, what is so different about an accountable-care organization (ACO) versus an IPA that took capitation risk and failed? One of the major differences that everyone is counting on this time is information technology. That is a simple statement but a complex issue. It is not just the data that was late or missing in the 90s, it was the lack of a care-coordination model for managing a patient throughout the delivery system. Information technology allows information, not just data, to be shared and utilized.
Why do I make that distinction? We had data before, but it wasn’t timely or easily shared. Physicians in the IPA might have had the data, and it may have been timely, but it couldn’t be shared with the hospital or home health agency or anyone else for that matter, and certainly not the patient. This time physicians and hospitals will be able eventually to share quite a bit of information. Integration tools allow physician EMRs to “talk to” hospital EHRs. Non-affiliated physicians in a market can share information through local IT networks sponsored by hospitals, health plans or health-information exchanges (HIEs). New business intelligence tools will be able to extract the data and turn it into actionable information for both hospitals and physicians. Understanding if diabetic patients have received all their quality measures in the hospital or practice(s) can help both physicians and administrators manage to the standard of care. For the patient, Stage 2 meaningful use requires a patient portal, where the same information can be shared and acted upon by the patient. In turn, that data can be effectively utilized when communicating with payors about the collective efforts of the healthcare team.
Research has shown better utilization of services will result in lower costs and better quality care. Payors and the federal government will begin to pay based on the performance they see from the healthcare team, leading to payment reform. Those that have the information exchange and the tools to track and manage performance will be victors.
Frank Newlands, M.D.