It’s the accountable care era, and the healthcare world is changing rapidly, according to Nancy Ham, CEO at health information exchange vendor Medicity. Implications for health IT executives will be significant, and coming soon.
Medicity, an Aetna subsidiary, provides health information exchange technology solutions for hospitals, physicians and health information exchanges. It’s been on the front lines of facilitating changes within delivery mechanisms. While accountable care offers some challenges, it provides opportunities for all participants to rein in expenses and improve care for patients.
Ham, who’s been CEO at Medicity since February 2013, recently shared some thoughts about the rapidly evolving healthcare market and IT’s role in assisting in the transition.
From your perspective, how quickly is the transition to accountable care occurring?
To steal a quote from the CEO at Allina Health, the barn has already burned down. Different organizations are moving at different speeds on accountable care. What I see at Aetna and a number of the big Blues is that they expect 75 percent of their membership to be covered by value-based contracts by 2020. Medicare aims to have 30 percent of its payments in value-based care next year and 50 percent two years after that. We are in the accountable care era. About 28 million Americans are in value-based care contracts, and most of those are in commercial plans. The real story is that the commercial payers have been going along very quickly.
For a commercial payer such as Aetna, what are the implications of this?
It’s completely transformative. Aetna has made it the foundation of our corporate strategy. How can we collaborate with providers? How can we bring what we know about what we’ve learned about risk, bring that to our provider partners to complement what they have? The best way to transform healthcare is through the structure of the local health systems. That’s where the patients are. You have a long or lifetime relationship. This change is finally going to be what works, what bends the cost curve and includes health and outcomes. Through this payment mechanism, we’re better able to realign care from being episodic to being truly horizontal, coordinated care. And we have some fabulous ROI examples. For example, we work with the state of North Carolina, providing coordinated care management for several hundred thousand people. Those efforts have saved more than $150 million a year for three years running. All these new things really do work.
What are the technology implications for providers who are increasingly seeing accountable care in their futures?
From a technology perspective, if you’re in a clinically integrated network, you have to share information in real time. If a patient comes to see you and is diabetic and has COPD, you can’t be effective if all you have is the information in your own EHR. That means technology has to connect – how do you share all that information so you have a completely informed view of the patient and have a risk-stratified view of patients? Their data, the actionable point of view, follows them around. You don’t have to ask the patient to be the historian. I can see what’s been done, and I see that I’m sharing in your complete care plan. Data is organized to provide superior care. We can do that now, in these clinically connected communities.
Beyond pure technology, what other major changes should providers anticipate?
As providers assume more risk, they need to have a new culture and want to work together in this new operating model. They need a new kind of staff. They don’t have medical directors assigned to these programs to work with the technology and to work with the providers to effect change. Most providers are not investing enough in the people side of the change. Technology alone is not going to help us make the switch. It’s hard work; we’re trying to radically change the largest industry in our society. We know that it works, though. Health plans have done care management because they’ve had the financial risk. They have done it from telephone call centers and have had a response rate in the teens [percentage]. When we take the same services and embed them in physician offices, engagement rates more than double just from that.
Is personalization of care being incorporated into this as well?
We’re doing a lot of work to bring in data sources, to create personas, so that we’re just dealing with someone who is generally a diabetic, but we start to understand more about the person and be more targeted. We might have eight diabetic personas, and each has a different willingness to be engaged. Are you someone who wants to get on the phone, for example? In an early pilot of this approach, engagement rates were up above 80 percent, but it makes sense. Every other industry segments consumers, so why not healthcare?
Some of patients’ risk factors have little to do with their care or type of condition. For example, two of the best predictors of whether a Medicare beneficiary will be readmitted to an acute care setting are whether they have a family member living within 10 miles of them and whether they have food in the fridge. As we go local and take on these risks, those are the kinds of factors that providers can have more awareness of.
What are the challenges to doing a better job of caring for patients as individuals?
We tend to think patients are like us, all of us who are fully immersed in the healthcare industry. We’re well educated, we’re advocates for our families. Think about the millions of people who are not like us. They don’t know what questions to ask. What will it take to impact that population? With so many more people coming into Medicaid, maybe we have a chance to have effective clinical engagement with them. But to do that, providers have to change; they do need technology. You can’t do this without data, without analytics, without workflow tools to help to see what’s happening with the patient.
Are there providers who are ahead of this change?
I think there’s a wide spectrum. In California and Massachusetts, providers have been at risk a long time. In the heartland of the country, providers are still in this transition. We have made more progress in hospitals working with their closely affiliated or owned physicians. A lot of the work that hasn’t happened is with the rest of the community where there is lower technology adoption and lower levels of automation. That’s where we at Medicity are spending a lot of time. We’re also connecting behavioral health providers, because behavioral problems often underlie a lot of these conditions. They have very legitimate privacy concerns – how do you protect that level of privacy and how do you share necessary information?
In terms of IT, what do providers need to have in order to succeed with accountable care?
It absolutely starts with data, and not just inpatient information but also financial and biometric. The question is, what is their strategy to create a strategic data asset that they can use for many purposes? If you can get your hands on the data, it means having it in a real-time breathing ecosystem, with data being enriched and normalized, incorporating patient identity management. A lot of those infrastructure projects are hard to do. Organizations need an analytics tool to figure out things, like who are my efficient providers? They need physician workflow tools to bring that information to them; they need supportive care management to create personalized care plans in an effective way. And then, engage the patient. If we don’t get the data right, before you engage the physician, if they look at it and see it’s not complete or correct, you have to get that before you can drive change.
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