To mark the Beacon Communities one-year anniversary, the Engelberg Center for Health Care Reform at Brookings (Washington, D.C.) in collaboration with The Office of the National Coordinator for Health IT (ONC) hosted “Health IT in an Era of Accountable Care: Update from the Beacon Communities,” a half-day meeting, to highlight the progress Beacon communities were making around health system improvement and payment reform.
Aneesh Chopra, CTO, White House Office of Science and Technology Policy, said that physicians in Beacon communities and beyond were now “open to dream the dreams [they] dreamt in medical school” because meaningful use allowed the possibilities to coordinate patient care more effectively and optimize billing that past siloed systems didn’t support. Chopra encouraged healthcare leaders and companies to partner with Silicon Valley entrepreneurs, who see the healthcare industry more desirable for investing now that federal funding through the HITECH Act has been appropriated.
Farzad Mostashari, M.D., the National Coordinator for Health Information Technology at the ONC, urged healthcare IT leaders and clinicians to keep their “eyes on prize” by “having that specific goal that you can work backwards toward,” which he says includes employing patient-centered design to workflows, not just within IT systems, but with population health management. Mostashari said that through true behavior changes during implementation “change happens a step at a time.”
“I am humbled by the work of these Beacon communities, and I am reminded by these cameras that I am speaking to all these folks out there doing this too,” said Mostashari. “There’s a whole nation of Beacons out there.”
Mostashari emphasized the importance of governance when setting up communities of practice, which he believes is key to create transparency and engage multiple community stakeholders. He also urged the clinical and IT leaders to connect to resources and critical allies like federally qualified health centers, state Medicaid offices, regional extension centers (RECs), and others to augment leadership. He also stressed Beacon communities to engage their populations to communicate goals and how their care transformation efforts affect them.
Joe McCannon, senior advisor to the administrator at the federal Centers for Medicare & Medicaid Services (CMS) said that for health IT implementation “there is no set approach so there needs to be some stratification,” and that one of the main goals for the Beacon community program was to capture the stories of how their organizations achieved their aims. McCannon forecasted that when the industry looks back 15 years from now, it will see today as “creating a context for change driven by the consumer,” which ultimately spurred healthcare reform.
Aaron McKethan, director of the Beacon Communities Program at the ONC noted that the Beacon Communities focused on six directives in the first year which included:
- Deciding who was included within the community and what the most pressing healthcare issues were
- Enacting a system of governance in the community to engage multiple stakeholders and deciding on the leadership body
- Creating a few key objectives to pursue
- Deciding on which performance measures to track achievement and how to collect that data
- Creating an IT infrastructure and the necessary care interventions to achieve the objectives, plus creating process improvements
- Figuring out how to analyze results and to share them
McKethan said that Beacon Communities report on a quarterly basis and CMS would augment the communities’ data with CMS claims data. The panels in the meeting brought together a variety of voices from communities from San Diego, Cincinnati, Colorado, among others to share their progress focusing on populations including asthmatics, diabetics, and congestive heart failure patients.
Herbert C. Smitherman, Jr., M.D., assistant dean of community and urban health, and assistant professor of internal medicine and Karmanos Cancer Institute, Wayne State University School of Medicine in Detroit, said that the biggest challenge facing the Southeast Michigan Beacon Community Collaborative (SMBCC) was the lack of a health information exchange (HIE). He also noted that his state faced the highest unemployment rate, 28 percent, of all states in the country. He said SMBCC has start enrolling diabetics in the program, with the goal to reach 4,000 patients. SMBCC will employ care managers and mobile health interventions to help improve care coordination and reduce hospital readmissions.
Another challenge discussed was the decreasing numbers primary care physicians in the market. Smitherman said that in Detroit there has been a 25 percent decrease in medical students going into primary care. He noted that with the Affordable Care Act, steps have been taken to mitigate this problem. He also suggested that primary care providers could receive higher reimbursements and be granted medical school loan forgiveness to offset the desire to go into higher-paying specialty fields. Sherry Reynolds, executive director of Alliance4Health (Seattle) and the Beacon Community of the Inland Northwest (Spokane, Wash.), said that health IT makes primary care more attractive, and half-jokingly proffered that Detroit could be a “hotbed for health IT” top offset its high unemployment.