Creating the IT Foundations for Healthcare Reform

And are you actually bending the cost curve on those contracts, so that you actually have some savings to share? And what if you have to set bundled pricing, or per-member, per-month pricing? You’ll need to use analytics to do all those things. And those things are all new for us. And you have to use analytics to understand the cost of care, with cost plus quality being value. You’ll have to figure out what the lowest-cost setting is where you can get equal or better outcomes, and who the lowest-cost provider is for providing those quality outcomes. If a nurse can provide something as well or better was a doctor, you have to look to that. And what is the difference between inpatient and outpatient settings. If we can provide equally good care in the outpatient setting, by providing transportation to patients, that might be an answer in that area.

What do you mean by integration?

Typically, in healthcare, we don’t do a great job of coordinating care across all the settings of care. So a large part of that is doing better coordination of care. So that may mean that there’s a person who coordinates the patient’s care in the hospital, or makes sure they get into a good nursing home, and that their records get transferred back into the electronic patient record. So we’re going to be using a lot of new tools to improve those processes. And the more we can use health information exchange, the better. We’re looking hard at several different HIEs. The problem that we have is that the HIE cannot be a unilateral decision; it really needs to be a community decision. So we’re not quite ready to proceed on this. There aren’t any active HIEs in the Triad yet; there’s a nearby health system that’s putting in an HIE for their own ACO network.

The other way I would think about integration is, trying to get the right information to the right person at the right time. And a great example is understanding where there are gaps in care, and getting the information to the doctor at the right point in care. And the EMR systems do a pretty lousy job of that today.

Also, there are some really non-traditional ways of thinking about integrating the healthcare environment as well. We’re looking into remote health, the home monitoring of patients. We’re also looking to how to get patients better engaged in their care; and a lot of that is IT-related, through tools.

What would your advice be for other medical group CIOs?

I would say that they need to look seriously at investing in information systems and analytics systems that are going to support healthcare reform.

It will take several years to lay the IT foundations for the new healthcare, yes?

Yes, it will, and there are a tremendous number of challenges. And the movement towards ACOs, and what is going to happen with the health insurance exchanges, will cause this change to happen faster than people think.

Obviously, the Supreme Court's ruling upholding the constitutionality of the Affordable Care Act provided some policy clarity, correct?

It did. And I think we’re starting to see some in the payer community beginning to respond to doing value-based contracts with a lot more interest than they had a few months ago.