AMGA requests funds and policies to support care for chronically ill
In a letter to members of the Senate Finance Committee Chronic Care Workgroup, the AMGA asks Congress to consider policies and financial and operational technologies that support care for the chronically ill. The AMGA stressed that clinical data from EHRs and details from administrative claims are valuable for analyzing trends on utilization and outcomes.
The AMGA supports the development and use of sophisticated predictive analytic software that have the potential to improve care coordination, cut hospital re-admissions, and reduce the overall cost of patient care. The organization is also encouraging the use of telehealth to care for the chronically ill, as well as financial incentives to encourage provider investment in care management tools.
And now back to us
On the heels of the Supreme Court ruling on the ACA, several health IT organizations express hope that Congress will renew its focus on interoperability, telehealth, Meaningful Use, and other HIT-related issues. Politico reports that Health IT Now Coalition executive Joel White is hoping for a “continued bipartisan focus on interoperability and telemedicine,” while HIMSS believes the decision will create more predictability in the healthcare sector, which may facilitate the advancement of its IT agenda.
It’s great to be optimistic, but I’m sure no one will be shocked if lawmakers find alternative distractions.
ONC Plans for the Future
The ONC releases an updated five-year strategic plan that stresses interoperability, patient engagement, and the expansion of IT across the care continuum. The document updates the previous strategic plan released in 2011that focused heavily on the Meaningful Use program. Maybe the ONC is not quite dead yet after all.
McKesson Ventures Into Startups
McKesson announces the creation of McKesson Ventures, a venture capital fund that will invest in early-stage and growth-stage healthcare companies attacking healthcare business challenges. Tom Rodgers, who was most recently with Cambia Health, was named managing director of the fund’s investment portfolio.
Stage 2 Attestations Still Lagging
Fewer than four percent of eligible physicians and 35 of hospitals have attested to Stage 2 Meaningful Use, according to the newly released numbers from CMS. The AMA, CHIME, HIMSS and MGMA quickly reiterated the call to shorten the reporting period for 2015 to 90 days. As of November, 2014 CMS has paid $16.6 billion in EHR incentives since the program’s inception.Continue reading…
The Health Care Blog recently featured our Open Letter to Primary Care Physicians,generating quite a bit of reaction. A commenter made the point that “we cannot expect” primary care physicians “to act differently until and unless they get paid differently.” [Emphasis added]
The comment refers to a doctor in solo practice and notes that “the first step is changing how you are paid, in one way or another. And there are many ways that work better than the current code-driven fee-for-service model.”
Does waiting for payment reform make sense? Or should primary care practices act now to change the way they practice in anticipation of payment shifts?
Moving Toward Value-based Care
Some physicians groups seem somewhat frozen – unsure exactly where health care payment is headed and thus waiting until there is a clearer signal.
But it seems to us that the payment reform signal grows louder and clearer and support for that contention comes in a recent research report* from McKesson, the international consultancy:
We can now say with certainty that healthcare delivery is moving in one direction: towards value-based care.
This is care that is paid for based on results – on measurable quality – as opposed to the traditional fee-for-service approach that pays for volume. McKesson notes that
The affordability crisis is causing unprecedented changes in the healthcare landscape, the most significant of which is the transition from the current volume-based model [fee-for-service] to myriad models based on measures of value.
To remain relevant and competitive, payers, hospitals, health systems, and clinicians must respond now to integrate value-based models into their existing systems.
One of the most critical issues facing our healthcare system is the fact that the IT systems we’ve put in place have not yet led to a more connected, intelligent approach to patient care.
While we have made notable headway toward interoperability through health information exchange solutions, we must dramatically accelerate our progress to support the transition to value-based care and realize our full potential as an industry.
With this vision in mind, McKesson, Cerner and other leading healthcare IT companies announced the CommonWell Health Alliance last year at HIMSS13. Members of the Alliance are united by a shared commitment to develop a core set of interoperability services and standards that will enable patient data to be shared securely across care settings and electronic health record (EHR) platforms.
In the twelve months since, tremendous progress has been made in making this aspiration a reality. CommonWell is running robust initial projects and collaborating with a myriad of practices. We’re also continuing to expand with new members who share our ideal of the trusted exchange of patient data, regardless of vendor, system, or setting.
Now, the Alliance is welcoming its first pharmacy member in CVS Caremark. This is a watershed event for several reasons.
CVS Caremark is one of the nation’s largest retail pharmacy chains and pharmacy benefit management companies. Few organizations in any segment of healthcare have more access to patient data and more trusted influence.
But CVS Caremark’s role in driving innovation in our healthcare system, and its importance to the goal of interoperability, is vital for other reasons.
Anyone who understands the importance of continuity of care knows that health information exchange is essential. How are we supposed to cut waste and duplication from the healthcare system and truly focus on patient welfare if doctor B has no idea what tests doctor A conducted, or what the results were?
The predominant proprietary HIT vendors know this, yet have engaged in prolonged foot-dragging on interoperability and even basic data interfacing. Yes healthcare IT is their business, but interoperability is not in their nature.
As we’ve seen before, the problem is with the business model.
The proprietary business model makes the vendor the single source of HIT for hospital clients. Complexity and dependence are baked into both solutions and client relationships, creating a “vendor lock” scenario in which changing systems seems almost inconceivable.
In the proprietary world, interfacing with third-party products is a revenue generation strategy and technical challenge; the latter, though unnecessary, justifies the former. When we go looking for the reasons that healthcare is a laggard compared with other industries, this single-source model—the obstacle to much-needed competition and innovation—is a primary culprit.
To be fair, provider organizations, with little if any incentive to exchange patient data before the advent of Meaningful Use, haven’t shown much collaborative spirit either. In the fee-for-service model, why would a healthcare organization let patients slip from their grasp? Health reform is finally mandating needed change, but when will proprietary vendors actually enable the interoperability hospitals and practices soon have to demonstrate?
Recent rumblings from Washington, DC, suggest the feds are losing patience.
All too frequently I get the question:
When will we see the EHR market consolidate?
Not an unreasonable question considering just how many EHRs there are in the market today (north of 300) and all the buzz regarding growth in health IT adoption. There was even a recent post postulating that major EHR consolidation was “on the verge.” Even I have wondered at times why we have not seen any significant consolidation to date as there truly are far more vendors than this market can reasonably support.
But when we talk about EHR consolidation, let’s make sure we are all talking about the same thing. In the acute care market, significant consolidation has already occurred. Those companies that did not participate in consolidating this market (Cerner, Epic & Meditech) seem to have faired well. Those that pursued a roll-up, acquisition strategy (Allscripts, GE, McKesson) have had more mixed results.
It is the ambulatory sector where one finds a multitude of vendors all vying for a piece of the market and it is this market that has not seen any significant consolidation to date and likely will not see such for several years to come for two dominant reasons.
According to CMS, through May of this year, 2,400 hospitals and 110,000 eligible professionals have received $5.7 billion in incentive payments for ensuring meaningful use of electronic health records, representing about half of all eligible hospitals and about 20% of all eligible providers.
Despite this widespread adoption EHRs, reliable market share data by vendor is still very hard to come by. So, when CMS recently updated its attestation data for midyear 2012, we took notice. Attestation, remember, is the process by which practitioners legally verify that they have used an EHR in way that merits one of those incentive payments. The data set includes more than 77,000 different attestations from 2011 through May of 2012 (note that it is not immediately clear why the data set has different totals than the CMS press release).
The sheer number of options for hospitals and providers stood out to us immediately. There are 405 separate EHR vendors that hospitals or providers have used to attest to meaningful use, with 336 of these providing ambulatory EHR products. It’s worth pausing here to note that by our count of the data found on the CMS Certified Health IT Product List, there are more than 550 separate ambulatory vendors with complete EHRs approved by CMS, meaning that despite the huge number of options, there were still well over 200 approved ambulatory vendors that have not had a single user qualify for an incentive payment yet!
Despite this enormous number of options, users attesting were fairly concentrated in the top vendors. Of these 336, the top 15 vendors represented 75% of all providers attesting. On the inpatient side, this concentration was even more pronounced, with the top 6 representing 75% of the total hospital attestations.
When we organize and dig into the data, a few other points stand out.
Matthew Holt sat down with McKesson at the World Health Care Congress 2012. Medical Director of McKesson Health Solutions Douglas Moeller, MD and McKesson VP of Enterprise Architecture and Technology Bob Franceschini explained what they’re doing to keep up with evolving payment methods.
At the AHIP Conference I got a chance to sit down with McKesson Health Solution's Senior VP of Care Management Jim Hardy and VP of Product Development Kevin Maher. The two men were more than happy to share with me some new products that McKesson HS has developed. One product is the Personal Health Advisor that was introduced in the beginning of this year.