If accountable care is going to work and providers and insurers are actually going to partner to cut costs, then one of the first orders of business is to tackle the laundry list of information technology requirements needed to make it work, according to Joseph Gifford, M.D., executive medical director at Regence BlueShield in Washington.

At the AHIP Institute 2011 in San Francisco, Gifford explained how a medical home pilot program that included Regence, airplane maker Boeing Inc. and Seattle-based provider groups requires Regence to merge into the clinical care process through a series--a seemingly endless series--of I.T.-driven events. For example, the trigger for patients to be eligible for high-touch care management are health risk scores created by Regence, scores that have to be put in front of providers at the point of care. Then come pharmacy and diagnosis data, hospital admission notifications, notices of coverage changes and other bits and pieces of information that need to flow from insurer to provider.

Information like LDL counts have to go the other way, but then comes more data from Regence, such as refreshed risk scores that might indicate a patient no longer needs a high level of management, and scores on depression surveys. And the list goes on and on, Gifford said, adding that Regence and provider partners are trying to find a way to track body mass index readings. "I can't believe, in the midst of an obesity epidemic, we haven't found a place to put BMI results."

There's also a need to keep track of the myriad patient registries that are seemingly sprouting like weeds. And now that providers are being asked to follow the money, some of the payer data has been eye opening for physicians. "The medical home model requires doctors to bear responsibility for overall care costs, and they didn't realize before how money goes out the door. For example, they didn't realize a dermatologist they refer patients to is giving a biopsy to everyone who walks in the door. There have been a lot of 'I.T. interventions' in that sense."

 

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