A successful transition to value-based reimbursement depends on getting people and technology working intelligently and efficiently together. The dramatic shift to value-based reimbursement requires all providers to completely disrupt their care processes and workflows to ensure the delivery of high quality, safe care at a reasonable cost.
For more than four decades, these same providers thrived in an environment where providing more care easily generated higher prices and profits. In that former reimbursement model, a serious and dangerous moral hazard existed where the instinct to “do no harm” clashed mightily with a similarly powerful driver to maximize income. Due to this shift forced by provisions of the Affordable Care Act (ACA), hospitals, clinics, physicians and others in the healthcare marketplace find themselves scrambling to reinvent the way they provide care to survive.
Organizations that will survive under the new realities of ACA recognize the power of healthcare information technology (HIT) to assist them in reworking their business processes and clinical workflows to achieve the goal of high quality, affordable care.
Physicians, nurses, aides, first responders, therapists and pharmacists often work from limited patient records lacking the complete information they require to make optimal patient care decisions. Although some electronic medical record products fill this gap by offering comprehensive records within organizations, the limitations of current healthcare information exchange governance in most regions prevents the easy and complete exchange of patient information among all institutions.
When clinicians work from an incomplete patient record, patients receive suboptimal care and resources are wasted on duplicate or unnecessary tests and procedures. Applications that gather patient health information from multiple sources deliver complete medical information to caregivers thereby allowing for effective and efficient healthcare.
Care collaboration – a comprehensive clinical team approach to providing care – requires the synchronization of all clinical activities by a HIT tool that delivers the right information, in the right format, at the right time, to the right person. This solution employs innovative analytics to provide a holistic approach to patient care in which clinicians can easily access and automatically analyze or review a patient’s condition. By combining information from electronic medical records, claims, medication lists, lab data and medical devices, clinicians can make more complete and accurate decisions about patient care. This improves care qualitywhile reducing the incidence of medical errors, and avoiding unnecessary and ineffective treatments—ultimately lowering costs.
Analysis of transactional data sources, such as those available from administrative and clinical systems, allows organizations to better understand and manage their processes and workflows, leading to an iterative approach to continuous improvement of those activities and related outcomes. More importantly, utilizing these data sources within an environment that emphasizes the user experience allows for the development and implementation of processes and workflows that can quickly and dramatically impact outcomes while delivering a HIT tool that compels its use.
Other examples of effective use of new information technology tools include the application of customer relationship management systems that impact consumer behavior through text messages, outbound calling, and emails, to change patient behaviors to more healthy ones. These can take the form of variously parsed reminders to seek flu vaccine, follow medication instructions, or visit a primary care physician for a quarterlyHbA1c test.
To facilitate care collaboration that delivers high quality, cost effective patient-centered care requires meaningful and efficient clinical workflows and the use of cutting-edge technologies that utilize ALL patient data. Only by using these innovative information technology tools and platforms can healthcare professional satisfy the demands inherent in value-based reimbursement driven care.
Excerpts from “Care Collaboration in a Value-Based World” published in HITECH Answers,