Healthcare is in a golden age of opportunity as payment models shift and data is freed, according to Dr. Farzad Mostashari. And it’s happening at just the right time.
The national coordinator for health information technology gave a colorful and candid talk to the physicians, entrepreneurs and business executives at Singularity University’s annual FutureMed event on Friday afternoon, touching on his hopes, worries and questions about the near future of healthcare reform.
Mostashari expressed his hope by recalling a conversation he had with a venture firm who had designated its first three funds to, as he called it, “stuff that works.” But the firm saw such a change coming that it is focusing its fourth fund entirely on “things that will make healthcare cheap,” he said. “They think there are billions of dollars to be made in taking costs out of the system.”
Change in the model for reimbursement is giving way to innovation that challenges the traditional, fee-for-service thinking that the only way to cut costs in care delivery is by serving fewer patients or reducing the per-unit spend on them.
“Innovative thinking lies in data, not only for population health management and to predict things, but data that gets shared within the ecosystem,” he said. “We’re just scratching the surface on having patients be the aggregators of their own information.”
While stage 2 of Meaningful Use requires providers to put the technology they implemented in stage 1 to good use in delivering care, the real magic lies in stage 3. (Providers, by the way, have pushed back against the drafting of preliminary stage 3 recommendations, urging the government instead to focus on resolving challenges in stages 1 and 2.) “I hope stage 3 is really about outcomes and not just sharing data but sharing knowledge, sharing outcomes, sharing protocol, sharing decision support and sharing quality measures,” Mostashari said.
Despite his optimism, the health IT chief recognizes the serious hurdles that must be jumped between now and the time when, years from now, the majority of providers demonstrate stage 3 Meaningful Use.
Mostashari said his biggest worry right now isn’t so much about implementation of technology but about how small practices will – or will not – re-design their care processes around them.
“We’re going to have the technology in place, and it’s getting better and more interoperable. We can figure that stuff out,” he said. “I’m worried about the re-engineering of those one- and two-doc offices.”
Some state and local governments, like New York City, have offered resources to support the transition process for primary-care providers making the switch to EHRs. But the “early adoption” period has come and gone, and those who have resisted thus far have done so for a reason – maybe because they think EMRs are too clunky or don’t see the long-term benefits outweighing the short-term costs.
“Are those docs going to pay $10,000 to $20,000 for someone come to help them with the process redesign?” he questioned. “I don’t know.”
Along those same lines, Mostashari said he worries about whether practices will be nimble enough to shift their culture around the availability of so much electronic data. “What I worry about is the culture of science and the scientific method applied to medicine,” he said. “We know science when it comes to 10-year arcs, but we don’t know science when it comes to 10-day cycles. Show me a doctor’s office that applies the scientific method to reducing their no-show rates.”
That culture change will require experimentation and instrumentation to improve their operations.
Mostashari said he learned a tough lesson from U.S. Chief Technology Officer Todd Park: that, quite simply, nothing sells itself. Despite all the excitement and attention around open health data at the federal level, and all of the opportunity it presents for providers and patients, that alone isn’t going to make people buy in.
“People have to know about it to be able to take advantage of it,” he said to the physicians in the room.” So that’s my question for you – how can we improve communication with you?”