Earlier this month, the Health Research Institute at PriceWaterhouseCoopers consulting firm released a new report, “Top health industry issues of 2013: Picking up the pace on health reform.”
As the authors of the report note in their introduction, “It is almost a cliché to observe that healthcare in America is changing rapidly. Yet the pace of the transformation is certain to quicken in 2013 with the effects of technology, consumerism, budgetary pressures and the Affordable Care Act (ACA) converging on a sector that represents nearly one-fifth of the economy.”
Among the numerous topics covered in the report: advances in healthcare system development being spurred by the ACA; advances being made in caring for the so-called “dual-eligibles”—individuals qualified to receive both Medicare and Medicaid benefits; issues around the changing perspectives and roles of healthcare purchasers and consumers; and issues around getting beyond cost reduction and towards transformation of care delivery.
John Edwards, director of the Healthcare Advisory Division at PWC, spoke recently with HCI Editor-in-Chief Mark Hagland, about some of the implications of the report for the HCI audience. Excerpts from the interview with the Detroit-based Edwards are below.
Were you the lead author of the new white paper?
I’m one of the contributors. This paper really pulls from many of our practitioners out in the field. This is our seventh year of doing a Top Health Issues report, and it’s one of our most-read papers. It’s really read all through the year, because we really are trying to offer a point of view on the top ideas that are going to be influencing healthcare business and technical decision-making throughout the year. One of the elements that I found striking was the presence of analytics in eight of the top ten issues. It’s no longer just about collecting the codes or being compliant with specific things; it’s about the need to use analytics to transform healthcare, not just developing a data warehouse, but really approaching the new challenges and opportunities. And eight of the ten items had analytics involved in them. The BYOD [bring your own device] security issue was the only one, really.
The key to success going forward for providers will be that you will need to be able to understand your numbers and use them effectively, regardless of your sector.
What are the implications in all this for CIOs, CMIOs, and other healthcare IT leaders?
In the coming year, payers are going to be asking providers to sign up for more risk, whether it’s through accountable care or readmissions reduction. And there are already measures out there that affect aspects of their care [including the value-based purchasing program under the ACA that has been mandated for Medicare-participating providers]; but I think in 2013, we’ll see an increased use of those types of measures, to ask providers to share the risk in the context of population health, in order to bring costs under control. And as providers are being asked to face those risks, they need to first understand where their proficiency is, and then, how they can take on the risk with a plan in mind. If they take on the risk without a plan, it’s like taking on a semi-trailer when you’ve only driven a passenger car.
So the game is changing, and in the coming year, we’re going to see more and more requests for participation in measurement programs and in programs under the ACA, translated into the commercial world as well. There have already been programs designed to reduce labor and supply costs; but here, we’re really talking about understanding the efficiency and effectiveness of your system; and achieving that understanding requires a completely different level of analysis, because this is about care delivery itself. And for some hospitals that don’t employ their physicians, they’re being asked to take responsibility for information that relates to care delivery that they don’t control, including care delivered outside the hospitals by non-employed physicians.
So the requests from your business partners are outpacing capabilities; and it’s going to make it very difficult for some hospitals and medical groups to take on these kinds of risks. So some organizations will sign up for these programs, but not be prepared for what’s involved. Because this is not just a new transaction system; it’s a completely different perspective, in looking at population health, and thinking about how to align behaviors. And these programs require multiple years to become successful.
What technical building blocks might be missing from the toolboxes of some patient care organizations?
Many hospital organizations lack interoperability and integration. Most have ERP [enterprise resource planning] -based data, and now they have an electronic medical record that gives them information about individual patients; but they lack the integrated data coming from both the financial and clinical arenas, to give them an integrated view. Because they’re often being asked to improve clinical quality to bring costs under control. And today, they don’t have integrated data and information systems. The percentage of patient care organizations with truly integrated data is very low. Often, they can present some very basic summary-view data, but people lack the detailed information to make this all real. I think that the systems that are actually prepared to be able to do this type of informational analysis are very low, because it’s taken all their smartest people to put their electronic medical records in place. So they took some of their brightest IT and clinical people in order to focus on getting the EMR right. And though they may have seen the reporting needs and the transformational models coming, they had to put their best, most talented people on the EMR implementation projects. And so the timeframe is very tight. But this is also very time-intensive.
In fact, they’re still very much focused on meaningful use, and that’s sucking up a lot of resources, right?
Exactly. We are finding a small number of organizations that are doing all those things, that are finding a way to be able to accomplish everything, but they’re a small minority, of course. But we’re seeing an increase in discussions around data governance, and greater understanding of data and how it needs to be integrated. And often, people have used similar or even the same terms for different phenomena. And this is very technical, but it also requires broader understandings of processes and of types of data. So we’ve an increased number of discussions around data governance, which is essential, because without that governance, you only get a lot of data. You need the business, clinical, and IT people to come together, and you need their time in order to make this happen.
And the additional challenge is that many of these initiatives require the obtaining of data from outside your system as well. And this makes you start to think about prioritizing these cases, and not trying to build it all at once, because it’s too big; but being very specific about analytic uses, so that you can create the data collection required to support the changing business needs. The good news is that the amount of data shouldn’t be mammoth; it should be very specific in focus. And you need to move to a prioritize-it-and-they-will-use-it mentality; because if you gain their buy-in, you have a much better chance of people using that data effectively. And going back to our top ten, it’s figuring out how to plan all this and get to agile, skilful use of data across those silos.
And what’s happened is that in some cases, the HIT implementation has resulted in new data and analytic capabilities. The reporting solution that might have come packaged with your electronic medical record might have pushed data into your data mart, and if you implement it and give people access to it, there are collections of data departmentally, but that process won’t have provided your organization with integrated information across the multiple data systems. And if you give people free access to large piles of data, you make the IT people wonder why they have access to that data, and what they’re doing with it. The reality is that many people have access to data in organizations; and you don’t always know how people are actually using the information. So it creates a different type of data governance and decision-making. Because we can’t turn everything off until we figure it all out at once.
But these new reporting capabilities exist, and they change what people could do with this information.
Per the report’s section on “BYOD” [bring your own device policies], do you have any thoughts?
Yes, 20 percent of breaches reported nationally were associated with BYOD situations. So it’s not an insignificant issue, and is worthy of some mention. But I think the bigger story in the paper really is the requirements around integrated analytics to drive so many different business purposes, and understanding that you can’t do everything at once, and that you have to prioritize. And data security policies naturally flow out of that. Because 2013 is the year of data, no longer the time of information systems—perhaps the year of integrated data. And I think within the year, you’ll see the leaders pull away significantly from the laggards in their use of data analytics.