This summer, HCI’s Editor-in-Chief Mark Hagland interviewed leaders of medical group organizations from across the country to get a sense of where their leaders are right now with regard to laying the strategic information technology foundations for the “new healthcare,” as it’s being called: the shift away from volume-based fee-for-service patient care delivery and reimbursement, and towards a more measured, standardized, responsive, accountable, and transparent healthcare system. Among the numerous emerging vehicles for that care are accountable care organizations (both within the Medicare Shared Savings Program, and between private health insurers and providers), bundled payment-based contracts, patient-centered medical homes, population health initiatives, value-based purchasing programs, and others.
Fortunately, the Supreme Court’s affirmation in June of the constitutionality of the federal Affordable Care Act (ACA) has created greater policy clarity around many of these vehicles, with the ACA’s provisions for accountable care organizations (ACOs), bundled payment-based contracts, patient-centered medical homes (PCMHs), and value-based purchasing now moving forward with renewed certainty.
In this virtual roundtable, medical group leaders share their views on the challenges they face as the industry shifts from the volume-based fee-for-service model to more accountable and responsive patient care. See the participants’ biographies on page 10.
What are you all seeing as the most significant strategic IT issues facing medical group leaders like yourselves in the current and emerging operating environment at the moment?
Francis X. Solano, M.D.: We’ve been extremely successful in rolling out the electronic record, which is a wonderful tool. The next priority is to utilize that tool to the fullest, so we get maximum benefit. Personally, I think meaningful use is actually forcing us to go backwards a bit in order to satisfy government regulations. Our capabilities in report-writing are already advanced. Our challenge really is in the area of specialty care, which everyone in the industry is struggling with.
You can get lots of crude data on outcomes, including length of stay, etc., but is that really helpful? In primary care, there are a lot of outcomes measures, process measures like controlling hemoglobin A1C, lipid management, blood pressure control, smoking query, anti-platelet and statin use in heart disease care, colonoscopy rates, immunization rates, etc., and we’ve actually done things like ranking our physicians on those elements. Some of the meaningful use requirements were well-intentioned. But in some cases, it’s kind of a step backward for us to spend all the time, energy, and resources, to figure out what the government wants and satisfy those wants.
Jeffrey Weinstein: Our biggest challenge is taking the data that we’ve collected and starting to put it into a format so that we can use it to help manage populations, to improve the health of our communities.
Glenn Mamary: At some point it’s really being predictive in our analysis as well. Because we’ve been on our EMR for so many years now, we’ve got a database that we could leverage, because the tools are so mature out there.
Tim Terrell: Overall, for us, it’s the challenges presented by healthcare reform, in its broadest sense.
From your perspective, what unites all these healthcare reform-related programs in terms of the strategic IT foundations required for them?
Terrell: Number one is analytics, and number two is integration. Those two things will be the biggest elements of it, and both are enormous.
Where are you on those two elements?
Terrell: We’re actually investing pretty heavily in analytics. We’re working with Teradata, one of the three biggest data warehouse vendors (the other two are IBM and Oracle); also, we’ve got Humedica for the clinical analytics and clinical predictive modeling. We’re in the process of implementing the OptumImpact suite from OptumInsight, to give us claims-based analytics.
Are you live on all three yet?
Terrell: Right now, we’re live on one, Humedica; we’ll be live on Teradata by October, and will be very close on the Optum.
Dr. Solano, your umbrella organization, UPMC, has long been a pioneer in leveraging clinical IT to address core issues in patient care delivery. Where do you see the nexus between performance improvement in care delivery right now in the medical group setting, and what IT can do to improve that performance?
Solano: Getting rid of the variability in care is what’s keeping me awake at night. I just don’t realize why so many physicians are so variable in their care in so many ways, or why so many physicians are still not optimally using some of the tools in the electronic record. Some of it has to do with such elements as best practice alerts, preventive maintenance screens, and allergy-allergy checking: if you ignored them in the paper world and you ignore them in the electronic world now, you’re going to be mediocre. The thing is, this transparency train is coming, and physicians have to be ready for it and be aware that it’s coming.