During a U.S. House of Representatives Ways and Means subcommittee on Health hearing Wednesday, Congressional leaders sought insights from the digital health industry and leading healthcare providers on how to use digital health solutions to cut costs, increase efficiency and access and improve quality in the healthcare system.
Specifically, the Health subcommittee members were keenly focused on how digital health technology and innovation could be applied to federal healthcare programs such as Medicare.
According to Health subcommittee Chairman Rep. Pat Tiberi (R-Ohio), while there are a myriad of companies in the commercial sector inventing and developing groundbreaking products, those innovations are not yet seen in federal programs like Medicare.
“The commercial sector is utilizing these innovations to improve systems, beneficiary care and collaborative care efforts. To date, Medicare has fallen significantly behind these efforts,” he said.
The focus of the hearing likely signals that the Ways and Means subcommittee on Health will continue examining the uses of digital health into 2017. In fact, at the conclusion of the hearing, Tiberi said the subcommittee planned to dig deeper into the issues of improving efficiency and quality in healthcare through digital health.
“This hearing kicks off discussion about the innovative aspects of healthcare and emerging technology to enhance efficiencies, reduce waste, improve outcomes and create greater access to care for beneficiaries in the Medicare space. It’s about using existing dollars in the program more efficiently,” Tiberi said.
“We have clinician shortages jeopardizing access for Medicare beneficiaries who need access to care, and that is unacceptable and untenable. We need to lift the barriers and incentivize greater efficiency,” he said.
Tiberi also said Congress should learn lessons from steps that have already been taken, such as the Health Information Technology for Economic and Clinical Health (HITECH) Act, and continue to build on payment reform efforts such as the Medicare Access and CHIP Reauthorization Act (MACRA), “rather than create more bureaucratic layers.”
During the hearing, Rep. Jim McDermott (D-WA) said innovation will be central to efforts to address rising healthcare costs. “Innovation through electronic health records (EHRs), telemedicine, payment reform must be part of the discussion,” he said.
McDermott mentioned the challenges faced by many accountable care organizations (ACOs) as one example of healthcare innovation, specifically recent news that Dartmouth College was dropping out of the ACO model it helped to develop. “This doesn’t mean ACOs are failures, but there are questions we need to ask. Where are we going as a country and how can we turn investments in innovation into sustainable models moving forward?”
“I’m looking forward to hearing about what works, what hasn’t worked and where we are heading. We can all agree that without meaningful action on cost containment we will continue down an unsustainable path for healthcare in this country,” McDermott said.
The Health subcommittee members heard from Michael Gallup, president of Pittsburgh-based TeleTracking Technologies; Jared Short, chief operating officer at Portland, Ore.-based Cambia Health Solutions; Paul Black, Allscripts’ chief executive officer and Greg Long, chief medical officer, senior vice president, Systems of Care at ThedaCare, a health system in Wisconsin.
Long shared with subcommittee members a pilot project that ThedaCare began in 2014 to identify the health system’s most complex patients, or “super utilizers,” using data and a team-based care approach. ThedaCare is a health system in northeastern Wisconsin consisting of seven hospitals and 34 clinics serving eight counties. The system cover more than 240,000 patients annually.
ThedaCare leaders were able to identify high-risk patients using a risk calculator program developed in its EHR system and based on clinical factors, utilization of services and psychosocial needs, Long said. The pilot project involved 282 high-risk patients being enrolled in a new, decentralized, team-based model. The model was comprised of three care coordinators, one registered nurse, one clinical pharmacist, one behavioral health clinician, one nurse practitioner and one medical assistant, Long said.
Long further explained that care plans were developed for patients in the model with each patient receiving supportive services and intensive case management including chronic disease monitoring and management skills, behavioral health screening, psychotherapy and other behavioral health care, medication consultation and counseling and life skills classes. Patients also received assistance with obtaining housing and other basic needs, Long said. And, the care teams have begun exploring the use of technology with some patients uploading blood sugar results to a smartphone or iPad and submitting the results to clinics.
As a result of the pilot project, the percentage of patients with uncontrolled diabetes decreased from 12 percent to 3.8 percent. The percentage of patients who visited the emergency department more than three times in a six-month period fell from 11.8 percent to 2.6 percent, he said. The program saw a number of other positive results as well.
Long also shared other technology projects at ThedaCare, such as an e-visit platform to enables patients to consult with primary care physicians through a web-based portal, which has achieved a 98 percent satisfaction rate from patients. The health system has a telepsychiatry program and has plans to implement a tele-stroke program, funded by a grant award, in the next six months. The health system also is exploring alternative payment models and is participating in the Next Generation ACO model.