During the first day of the Health IT Summit in San Diego, being held Jan. 21-22 at the Manchester Grand Hyatt Hotel in San Diego, the opening panel discussion, titled “Healthcare 2020: The Hurdles and Opportunities Ahead,” healthcare IT leaders discussed a broad range of urgent issues facing healthcare in the next several years. The event is sponsored by the Institute for Health Technology Transformation, which since December has been a partner with Healthcare Informatics and its parent company, Vendome Group LLC.
Among the many issues covered during the session: the panelists’ perceptions of the biggest opportunities and challenges facing them in the next half-decade; payer-provider collaboration and new payment models; mobile health and virtual care management; and new relationships between patients and providers.
The session was initially introduced by Jay Srini, one of the Summit’s three co-chairs. Srini is chief strategist at the Sherman Oaks, Calif.-based SCS Ventures and an adjunct faculty assistant professor at the University of Pittsburgh. Following her introduction, as well as introductory remarks by Raymond Lowe, senior director, information technology, at the San Francisco-based Dignity Health, Daniel Ruppar, the moderator of the session, and the San Antonio-based global research director, connected health, in the Healthcare & Life Sciences division of Frost & Sullivan, initiated the discussion.
panel members (l. to r.): Ruppar, Kenagy, Anderson,
The panelists were Robert Slepin, vice president and CIO at the Phoenix-based Scottsdale Lincoln Health Network; John Jay Kenagy, Ph.D., senior vice president, CIO, and chief information security officer, at the Portland-based Legacy Health System; Frank Ingari, president and CEO at the Boston-based NaviNet, Inc.; and Hans Anderson, healthcare practice director at the Sunrise-, Fla.-based IT service provider Synechron. Below are a small number of excerpts from the discussion.
Daniel Ruppar: What is something you are excited about, and what is something you are afraid of, in terms of changes in the system, in the next several years?
John Jay Kenagy, Ph.D.: My answer to both would be the same; it’s the shift from payment for volume to payment for value. I think that is exciting, the opportunity to really incentivize the healthcare system to work towards value and the Triple Aim.
Crossing the Quality Chasm was published over 14 years ago, and we’re still talking about changes that need to be made. At the same time, the payment system is such a blunt instrument. I have concerns about the ability to create that change; this is a big system to change. But at Legacy, there is an excitement, an exuberance around size, and growth. We’re a $1.5 billion organization; some are saying you need to be a $10 billion to really create change. The thing is that healthcare is local; and I worry some about this excitement around growth and acquisition; one, from an IT organization, this will be difficult to accomplish.
Hans Anderson: My biggest excitement is integration to promote the continuum of care, care. The flip side is identification of patients for care management and health information exchange. There’s a lot of work that still needs to be done to normalize data and normalize the identification of the actual patient.
Frank Ingari: I’m most excited about the millennials, the fact that they’re used to using technology. It’s shocking the extent to which we do not coordinate and collaborate across healthcare; and this new generation takes for granted that we’ll use technology. The thing I’m most concerned about is the failure of the Affordable care Act, to date, to attract the “invincibles”—the healthy young millennials—to purchase health insurance [through the state health insurance exchanges]. This relates to the fear that the ACA will simply move the uninsured into exchanges.
Robert Slepin: I share the same excitements and fears. I’m excited to see our incentives across stakeholders in the system be aligned in a way that’s rational for the first time in the system—not just hospitals and doctors, but also the payers and consumers. That’s a rate-limiting factor in terms of our ability to transform healthcare, to make sure that incentives are aligned. Another excitement for me is the convergence of various trends—connectedness, social, mobile, genomics, big data, interoperability; and we’re not there yet, but there’s great potential.
Another concern for me is, I agree that healthcare is local. We can talk about population health, but at the end of the day, it’s behavioral change among patients that will change things. And if patients don’t trust the system because of fear of big-government control or because of NSA surveillance or whatever, we’ll have problems. So data privacy and security are very important.
Healthcare needs to operate like any other industry that provides value. There’s a trend now of healthcare organizations adopting Lean, because they’re recognizing that they need to get waste out and produce real value for the consumer, who will increasingly be the purchaser.
Kenagy: From my vantage point at Legacy, we’ve been a successful hospital company for 135 years. What’s happening now is a fundamental change in paradigm. We are in that transition now as an organization. We don’t have an insurance plan, but we know that having more risk-based contracting is important for the hospital; but the mindset of many hospital administrators is still that an empty bed represents revenue loss. Also, trust among the triad—hospitals, physicians, and health plans—that will be very important.
Slepin: I completely agree. We’re still being rewarded for primarily doing things the old way. We have 10,000 ACO [accountable care organization] lives, and it’s great and it’s important, and we’re throwing ourselves into it and believe it’s the future, but 90-plus percent of our money is still coming from fee-for-service [reimbursement]. And for us to survive under Medicare sequestration and everything else that’s happening, we still need to fill beds and perform surgeries, and so on. I was CIO of a provider-sponsored health plan at Sutter Health until 1997, when they decided to shut it down. And a year or two ago, they started it back up.
I do think in the next decade, we’ll see a surge in providers wanting to look like Kaiser or Geisinger or Group Health. And we’re seeing health plans like United Healthcare wanting to now also become the back office for providers. They’re buying and building IT solutions and preparing themselves for the future. And Humana is investing in urgent care and primary care. So the distinction between provider and payer is blurring, and I think people will be picking their spots but remaining flexible as they move forward in the market. Just like providers, they’re finding new ways to provide value.
Ingari: The payer world is under tremendous pressure to create change. Overall, there is the tremendous pressure around fragmentation. For one of our biggest customers in the East, ten years ago, their contracts were primarily cost-plus contracts. Now, the same companies are having to invest in Medicare Advantage, managed Medicaid, patient-centered medical homes, bundled payment programs; they’re seeing disintermediation. These guys are used to doing big contracts, but they’re having to move forward into ACOs, etc. I see a lot of opportunity but also fear, on the payer side. But these guys being rewarded for value, it’s huge. And you see the old-timers still wanting to beat up on doctors, and the newer people really working on collaboration. You see all sorts of things all at once right now.
Anderson: What gets put into the [EHR] electronic health record? We have to deal with changes not only technologically, but also in terms of medical-legal issues, in terms of what’s put into the record. We want to make things engaging to the patient and have them be a partner and foster dialogue through new types of available technology, including via secure messaging.
Ruppar: When it comes to virtual care management via mobile health monitoring, and so on, what needs to happen, to make that work?
Slepin: I think we’re headed in the right direction, with meaningful use, innovative care models, and interoperability. We need to step up the integration; we need to find a way to integrate these devices in with the systems, and redesign the workflow. So it’s the people, processes, and technology, all holistically being redesigned. And I think the technology is largely there now. There’s obviously room for further innovation.
Anderson: Yes, I agree with that focus on doing no harm to the patient. So part of any type of adoption of technology has to focus on the integrity of the data and on the normalization of the data. We’re still not interoperable by design but by mandate. So we have to get to the point where the data terminologies are the same and the vocabulary is codified.
Kenagy: As we create Skype visits and other forms of communication, I don’t want miscommunications or gaps in care management to worsen as we move forward with this.
Ingari: I don’t think that virtual care models will achieve maturity until the shift to value-based payment moves forward into capitation or shared-care models.
Ruppar: “Connected healthcare” was the buzz term in 2012; “patient engagement” was the key buzz term in 2013. How do you see things needing to change in the patient-provider relationship, with regard to this type of concept?
Anderson: With my provider, I’m using the MyChart portal in Epic with my provider. I have essentially 24/7 capabilities. I actually have a portal with my Aetna insurance that allows me to sue a blue button to pull down all my data. This isn't about calling my doctor’s office and calling my secretary. I’m messaging my doctor, who is able to message back. And I think that’s where we’re going. And all of us as patients, which we all are, will enjoy that new connectivity. And any messaging going beyond what I have now will be an enhancement, and will be a benefit to everybody, including payers.
Slepin: I agree. And in addition, training the physicians and other providers in skills like motivational interviewing or empathy, will help drive behavioral change. And enabling the patients to take responsibility through technology enhancements, will also be big.
Kenagy: This is a period of great transformation and change, and it’s discomfiting. We’ve begun to unplug from the old system, but we haven’t completely plugged into the new system. And I think it will be a wild ride. But I think it’s a great time to be in the industry.