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?