This post is sponsored by Vree Health.
2014 will continue to be a year of transformation as the implementation of the Affordable Care Act and the changes it represents ripple through the healthcare industry. From conversations with healthcare providers across the country, Vree Health has identified four key issues providers face in the coming year–and beyond.
1. Healthcare reimbursement is due for a reboot
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Healthcare systems, hospitals and providers are caught between two widely divergent business models: fee-for-service versus pay-for-performance. While dependent on the former, they must restructure their businesses to improve quality and manage costs across the entire care continuum to prepare for the latter. It’s an about face that Dr. David Nash, Founding Dean of the Jefferson School of Population Health, likened to turning an aircraft carrier around in the Panama Canal, when he spoke at MedCity CONVERGE last year.
Consider the challenge:
- Fee-for-service rewards billable infrastructure and man hours, while pay-for-performance rewards streamlined efficiency.
- Fee-for-service rewards in-house capabilities. Pay-for-performance rewards community teamwork.
- Fee-for-service rewards failure. Pay-for-performance rewards results.
Straddling both models is akin to Van Damme’s epic split in a recent Volvo Truck commercial–in other words, virtually impossible without steady hands at the wheel.
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Immediate pressures for change in 2014 will come from:
- The Centers for Medicare & Medicaid Services (CMS) plan to expand the number of services that are reimbursed through bundled payments
- Another CMS proposal to reduce the grading codes for the complexity of visits from the current five to two, thereby incentivizing providers to prevent complications
And watch out for the sleeping giant of the states, who will soon cover, directly or indirectly, nearly one-third of all Americans. PriceWaterhouseCoopers estimates that 26 states will have managed care programs to help contain Medicaid costs in 2014. Innovators like the Geisinger Health System realize that if states put their muscle behind fee-for-value, it would be transformational.
The Takeaway:
Smart providers will focus on healthcare consumers’ needs—patients and payers alike—to build new models of care that deliver maximum value.
2. Healthcare technology will help drive connected care
All of these changes in payment structure advance a highly integrated healthcare system. Spurred by the HITECH Act, the adoption of electronic health records (EHR) in acute care hospitals more than tripled between 2009 and 2013. Now, healthcare organizations (HCOs) must build upon these systems to break out of their four walls and integrate with the entire community to:
- Connect with providers
- Connect with patients
- Connect with populations
Health system and payer partnerships, such as the HealthShare Exchange of Southeastern Pennsylvania, represent one step toward connected care. It will allow insurers and healthcare providers to share discharge history and medication information with patients’ physicians to improve care transitions.
Meanwhile, meeting the requirements of Meaningful Use (MU) Stages two and three remains a pressing reality for many HCOs. Proactive organizations will aim to build a technology platform that not only meets the MU requirements, but also enhances the patient experience. The design and functionality of patient portals is critical. To be successful, they must truly engage and empower patients to be active participants in their own care.
Finally, as we steer toward population health management, the value of healthcare data increases exponentially. HCOs must concentrate on HIT systems that enable them to aggregate and analyze data from disparate sources to identify best practices for improving care quality and population health.
The Takeaway:
Maximize the value of information with open-ended technologies that integrate with the entire spectrum of patient-provider touch points–mobile health apps, telehealth and medical devices–to create a consumer-friendly health and wellness ecosystem.
3. Growth of Accountable Care Accelerates
ACOs, or accountable care organizations, are one of the underpinnings of health reform. ACOs now serve more than 5.3 million Medicare beneficiaries, and many other patients are served by non-ACO organizations deploying similar strategies.
We expect the growth of these systems to continue in 2014 as health reform drives toward integration. Innovative healthcare IT solutions and effective use of health data across partnering organizations—and even caregivers and patients—will be critical to accountable care’s success in reducing the operational and financial inefficiencies that plague our current system.
Especially important will be new models of care that enable healthcare providers and patients to connect and collaborate on preventative (rather than reactive) healthcare issues, such as obesity and diabetes. New digital health tools—whether social, mobile or cloud-based—may play a significant role in patient engagement and adherence. Integrating patient goals and personal health tools into treatment regimens is essential to the evolution of a truly patient-centric healthcare system.
The Takeaway:
ACOs must find new and effective ways to engage, educate and encourage their patient populations to become involved in preventative care.
4. Individual relationships with patients are increasingly important
In 2014, more institutions will realize that patient-provider communication and relationships are critical to economic success. According to a study in the Journal of Family Practice, physicians who score highest on measures of patient-centered communication incur lower costs in diagnostic testing, without compromising health outcomes.
Innovative technologies provide opportunities to build and expand the patient-provider relationship through personalized experiences with the potential to drive change in patient behavior. It is at the point where patients are making daily health decisions that information, motivation and regular behavioral skills advice can create a real difference in the health choices they make. The way patient relationships are managed throughout the care continuum may even influence patients’ ability to take control of their own health–a responsibility that too many patients today feel unempowered to tackle.
The Takeaway:
Healthcare administrators that find ways to improve the patient experience may improve their bottom line, too.
