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One Industry Expert’s View of How State Efforts to Manage the Opioid Crisis Will Affect HIT Leaders

February 23, 2018
by Mark Hagland
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Connie Sinclair of the Point-of-Care Partners consulting firm has been tracking state-level requirements around the prescribing of opioids

As everyone involved in U.S. healthcare knows, the United States is mired in a broad and intense crisis around opioid abuse and addiction. Much of the action taking place has involved state governments, but the actions of state governments have been extremely diverse, and often, for providers, confusing and overly complex—especially for the leaders of patient care organizations with patient care presence in more than one state.

With regard to all of that, last month, leaders at the Coral Springs, Fla.-based Point-of-Care Partners consulting firm released a broad report looking at what actions state governments have been taking in order to address the opioid crisis. Under the title, “Fighting the Opioid Epidemic at the State- and Rx-Level Report,” the new report examines the diversity of efforts and actions, in considerable detail.

As explained on the consulting firm’s website, “The 33-page report includes details of state responses to opioid prescribing organized around three main trends: 1) prescribing, 2) curbing fraud and abuse, and 3) preventing and treating addiction.” And, it “explains overarching trends across the states on opioid prescribing and provides the latest summary details on a state-by-state basis,” based on original research and data collection by Point of Care Partners researchers in 2017.

There are many implications of all this activity, for healthcare IT leaders. One of the report’s co-authors, Connie Sinclair, R.Ph., the director of POCP’s Regulatory Resource Center, spoke recently with Healthcare Informatics Editor-in-Chief Mark Hagland, about the implications for CIOs, CMIOs, clinical informaticists, and other healthcare IT leaders in patient care organizations. Below are excerpts from that interview.

Overall, what were your team’s high-level findings, as detailed in the report?

There are lots of avenues of attack for this opioid crisis—the federal level, the state level, the provider level, the idea of law enforcement, of getting more people into treatment—but what we’re saying in the report is that if you want to reduce the number of addicts, which really is the long-term goal, you have to impact this at the point of prescribing—it’s at the moment when that prescriber is writing that prescription. And states have a lot to say about this—treating addicts, dealing with the fallout of all of that, is very expensive for the states, especially as Medicaid payers. Their Medicaid populations are very heavily hit by this crisis. And states have a lot to gain from solving this. And of course, there are task force recommendations, and activity is taking place on the part of the FDA [Food and Drug Administration], DEA [Drug Enforcement Administration], and other agencies.  But states have been at this for a long while, really dealing with this since 2012; so they’ve been passing lots of new laws and adopting new rules, to curb this.

Meanwhile, at POCP, our Regulatory Center has been tracking all these rules and regulations, including anything that ties into e-prescribing or EHR [electronic health record] regulations. Hundreds of elements are involved—from whether e-prescribing is allowed, whether it’s mandated, and if so, for which schedules; and hundreds of data elements are involved. How do you prevent generic substitution of drugs? And so on. And our work has exploded over the past few years. I have a team of pharmacists who are also informaticists—I’ve been an e-prescribing product manager many times—I’ve spent more than 30 years in HIT.

I’ve been a product manager, a product marketing person, and a business analyst, before I became a consultant. So that’s the lens we’re looking at all this through: what’s the impact of all of this on healthcare systems, and healthcare information systems? So the whole report is relevant to that; but we’re really zeroing in on the regulations and laws that impact that prescriber at the moment of prescribing. It might be a limit on quantity. Is it a first-time patient who’s never had an opioid before, just broke their arm and needs a few pills? Or is it a cancer patient? And states are doing things like quantity limits. But they’re all doing all different things, and in different ways.

And in many cases, that means curbs on how much quantity of any opioid can be prescribed, correct?

Yes, that’s right, it means quantity limitations, and also the mandated use of state prescription drug monitoring programs, or PDMPs. The state-run databases of controlled substances, etc. There are many new requirements—over 30 states now require the prescriber to look at the PDMP before writing the prescription. And then the pharmacist dispensers may have that requirement as well. And then things like mandating electronic prescriptions to prevent fraud and abuse—we have several states in process. That is to prevent paper prescriptions from being manipulated.

About how many states have done that?

It’s about nine right now, but there are several that are debating that in legislatures right now. And of course, some have already implemented, and others have future deadlines.

And the other piece of the PDMP is the profiles. And it might be just for opiates, or for anti-anxiety drugs like Xanax, and opiates, or for all Schedule 2 drugs. But the other challenge with those profiles is that these state-run databases are accessed via portals. So for a physician to stop in the middle of a prescription and have to log into a new portal, that takes an average of four-and-a-half minutes. Every patient has a profile of controlled substances that they’ve had prescriptions filled for, from all pharmacies. That is available to prescribers, but typically, by exiting their EHR and logging into a specific state site.

Do all 50 states have PDMPs now?

Yes. Missouri is kind of in that gray area, but everybody else has one, and it’s up and running.

So the IT challenge is, if you’re going to mandate that prescribers do this, it needs to be integrated into their workflow. So there are many efforts underway to facilitate that integration. And as you know, there are so many EHRs. At least the top ten EHRs are trying to figure out this integration piece; they may only be working on this for a particular client or particular state—it’s a nascent thing to figure out this integration piece. There are some standards, but it’s a huge area. And states are starting to realize that their mandate is not enough, that they need to put this into prescribers’ workflows. Most are not mandating yet that EHRs put them into the workflow, but they’re encouraging the large EHRs do do something about this.

How quickly will that process happen?

It’s already happening. There was a pilot done in Washington state, and pilots in a couple of other states. There’s a vendor called Appriss. They’ve been gradually taking over the management of these PDMPs on behalf of the states; they’re basically running these PDMPs for some 40 of the states. A lot of the efforts I’m aware of are involving some of the leading EHRs working with them.

The National Association of Boards of Pharmacy, in conjunction with Appriss, has developed a network of states, called PMP Interconnect. These states have agreed to share PDMP data. Appriss offers an API gateway that facilitates EHRs and pharmacy systems to connect multi-state PDMP access into clinician workflow. States are subsidizing, via grant programs, for their largest health systems, to get connected through this gateway. There are other things that can go along with that. Appriss also provides a risk assessment to help the prescriber determine which patients are more likely to be using too many opiates.

Nebraska’s state legislature passed a law requiring that all electronic prescriptions be entered in that state’s HIE.

Yes, and California will charge the EHR vendors for the privilege of connecting to their PDMP. So it’s kind of all over the map. I will say that the NABP/Appriss collaboration brings a lot of bang for the buck; but that doesn’t apply in every state.

Another piece of this is that the states are beginning to mandate that prescribers do counseling about the risk of addiction before they prescribe, or have them sign an informed consent, or the patient could be offered that they could sign a form saying they don’t ever want to be prescribed opiates. In most cases, this has to be noted in the EHR. And when you add in requirements that they can only prescribe a seven-day set of doses, for example, it gets very complex.

For HIT leaders, it’s the level of complexity in dealing with all these different cross hatches and dimensions that is most challenging, correct?

Yes. There is, though, a lot of commonality among the various state requirements. Limits are usually by number of days, or there’s a calculation called morphine milligram equivalence. Those are the two primary ways for limiting the quantity. So if your EHR can handle those two elements—parameter for default of day’s supply or MME, you can limit the complexity. Or it might not even be a default. There are various ways to handle it. Every state has a different print template for how a printed prescription should look. So the EHRs have adapted to those variations. So these might be new types of edits, pop-ups, or even guidelines.

So in our report, we cover these trends at a high level and their impact, but then we also have a fair amount of detail at the state level; it’s not the 500 data elements we track at the consulting firm. But with this report, we’ve picked out and culled some of those, especially where you can see a trend or commonality, and we’ve put those state-by-state data elements in this report. Another piece is, who can prescribe? Are you a physician assistant or advanced nurse practitioner? Your rules may be different from an MD’s.

So the point of the report really is—for an EHR manager, or someone who manages this, it’s, what do people need to be planning for? This provides an introduction to that, but with a fair amount of detail.

What are the two or three things that CIOs and CMIOs should be doing right now, per all this?

The number-one thing is to make sure that the version of the EHR they have running is fully certified for EPCS, electronic prescribing of controlled substances, because the DEA has very stringent rules and a certification process, in order to clear a vendor to process controlled-substance prescriptions. So you want to make sure that you have something installed that can actually do that. The problem is that most vendors are certified, but provider organizations may be three versions behind. And certainly the states that are mandating it are getting more attention from the vendors. So if you really want to make a difference, make sure your prescribers can prescribe controlled substances.

The second would be this PDMP integration: you can try this with your state government, and with your vendor. Who can you call? What do you need to do to make sure your EHR is fully integrated with the PDMP—make sure both your state and vendor are able to do that.

And the third thing would be the limits on prescribing, whether a quantity or day’s supply, or certain types of prescriptions—all those limits, as well as all the consent forms, etc.—to be aware that prescribers are being mandated in various ways, and to do what they can to help them comply. That may be working with their vendor, so that they have mechanisms to help their prescribers—and understanding their state requirements. Hopefully, their prescribers do know, but they might not.

Will state governments move towards some broadly consistent themes or areas of focus in the next few years, around all of this?

You would think that the formats of printed prescriptions would be the same across the country, but they’re not; you’d think that the DEA controlled substance schedules for what’s in Schedule 2 and Schedule 3, would be consistent; but they’re not. Many times, states are the leaders. They’re seeing what’s going on, and so the states are kind of in the forefront of things. Given all of that, there will be some variability always, for some reasons. But I do think there’s the potential for activity at the federal level—a mandate for electronic prescribing, or a mandate for how PDMPs operate; and maybe federal guidelines for what kinds of day’s supply is allowed. But even if those things happen, states will always have their own twists on things. Because what might pass at the federal level would probably be less restrictive than what some states might choose to do. There will always room for some variability.

 

 

 


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CMS: 93% of Clinicians Get Positive Payment Adjustments for MIPS Year 1

November 8, 2018
by Rajiv Leventhal, Managing Editor
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Ninety-three percent of MIPS (Merit-based Incentive Payment System)-eligible clinicians received a positive payment adjustment for their performance in 2017, and 95 percent overall avoided a negative payment adjustment, according to a CMS (Centers for Medicare & Medicaid Services) announcement today.

The first year of MIPS under MACRA’s Quality Payment Program (QPP) was dubbed by CMS as a “pick your pace year,” which essentially enabled clinicians to avoid payment penalties as long as they submitted at least the minimum amount of quality data. As such, in its announcement, CMS did admit that the overall performance threshold for MIPS was established at a relatively low level of three points, and the availability of “pick your pace” provided participation flexibility through three reporting options for clinicians: “test”, partial year, or full-year reporting.

CMS said that 93 percent of MIPS-eligible clinicians received a positive payment adjustment for their performance in 2017, and 95 percent overall avoided a negative payment adjustment. CMS specifically calculated that approximately 1.06 million MIPS-eligible clinicians in total will receive a MIPS payment adjustment, either positive, neutral, or negative. The payment adjustments for the 2017 program year get reflected in 2019.

Breaking down the 93 percent of participants that received a positive payment adjustment last year, 71 percent earned a positive payment adjustment and an adjustment for exceptional performance, while 22 percent earned a positive payment adjustment only. Meanwhile, just 5 percent of MIPS-eligible clinicians received a negative payment adjustment, and 2 percent received a neutral adjustment (no increase or decrease).

Of the total population, just over one million MIPS-eligible clinicians reported data as either an individual, as a part of a group, or through an Alternative Payment Model (APM), and received a neutral payment adjustment or better. Additionally, under the Advanced APM track, just more than 99,000 eligible clinicians earned Qualifying APM Participant (QP) status, according to the CMS data.

CMS Administrator Seema Verma noted on the first pick-your-pace year of the QPP, “This measured approach allowed more clinicians to successfully participate, which led to many clinicians exceeding the performance threshold and a wider distribution of positive payment adjustments. We expect that the gradual increases in the performance thresholds in future program years will create an evolving distribution of payment adjustments for high performing clinicians who continue to invest in improving quality and outcomes for beneficiaries.”

For 2018, the second year of the QPP, CMS raised the stakes for those participating clinicians. And in the third year of the program, set to start in January 2019, a final rule was just published with year three requirements. Undoubtedly, as time passes, eligible clinicians will be asked for greater participation at higher levels. At the same time, CMS continues to exempt certain clinicians who don’t meet a low-volume Medicare threshold.

Earlier this year, CMS said that 91 percent of all MIPS-eligible clinicians participated in the first year of the QPP, exceeding the agency’s internal goal.

What’s more, from a scoring perspective in 2017, the overall national mean score for MIPS-eligible clinicians was 74.01 points, and the national median was 88.97 points, on a 0 to 100 scale. Further breaking down the mean and median:

  • Clinicians participating in MIPS as individuals or groups (and not through an APM) received a mean score of 65.71 points and a median score of 83.04 points
  • Clinicians participating in MIPS through an APM received a mean score of 87.64 points and a median score of 91.67 points

Additionally, clinicians in small and rural practices who were not in APMs and who chose to participate in MIPS also performed well, CMS noted. On average, MIPS eligible clinicians in rural practices earned a mean score of 63.08 points, while clinicians in small practices received a mean score of 43.46 points.

Said Verma, “While we understand that challenges remain for clinicians in small practices, these results suggest that these clinicians and those in rural practices can successfully participate in the program. With these mean scores, clinicians in small and rural practices would still receive a neutral or positive payment adjustment for the 2017, 2018, and 2019 performance years due to the relatively modest performance thresholds that we have established. We will also continue to directly support these clinicians now and in future years of the program.”

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HHS Secretary Azar: HHS Is Planning New Mandatory Bundled Payment Models

November 8, 2018
by Heather Landi, Associate Editor
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The Centers for Medicare & Medicaid Services (CMS) is revisiting mandatory bundled payment models, possibly for radiation oncology and cardiac care, according to Health and Human Services Secretary Alex Azar, which signals a strong about-face in the Trump Administration’s policy about bundled payment initiatives.

HHS is reexamining the role that mandatory bundled payment models can play in the transition to value-based care, Azar said in a keynote speech at the Patient-Centered Primary Care Collaborative Conference on Thursday. HHS published Azar’s comments.

In the published remarks, Azar said the Trump Administration is revisiting mandatory bundled payments and exploring new voluntary bundled payments as part of the Administration’s goal of paying for outcomes, rather than process.

“We need results, American patients need change, and when we need mandatory models to deliver it, mandatory models are going to see a comeback,” Azar said.

In his speech, Azar said, “Imagine a system where physicians and other providers only had to worry about the outcome, rather than worrying about their staffing ratios and the individual reimbursements for every procedure they do and every drug they prescribe. That kind of payment system would radically reorient power in our healthcare system—away from the federal government and back to those closest to the patient.”

He continued, “One way we can do that is through bundling payments, rather than paying for every individual service. This is an area where you have already seen testing from CMMI for several years now—and I want to let you know today that you are going to see a lot more such ideas in the future.”

Azar highlighted the Bundled Payments for Care Improvement (BPCI), which, he said, has shown significant savings in several common inpatient episodes, including joint replacement and pneumonia.

During his speech on Thursday, Azar said, “I want to share with all of you for the first time today: We intend to revisit some of the episodic cardiac models that we pulled back, and are actively exploring new and improved episode-based models in other areas, including radiation oncology. We’re also actively looking at ways to build on the lessons and successes of the Comprehensive Care for Joint Replacement model.

“We’re not going to stop there: We will use all avenues available to us—including mandatory and voluntary episode-based payment models,” he said.

One industry group, the American Society for Radiation Oncology (ASTRO), already has voiced concerns about a mandatory payment model. In a statement issued Thursday afternoon, Laura Thevenot, CEO of ASTRO, made it clear that the organizaiton strongly supports a radiation oncology alternative payment model (RO-APM). "ASTRO has worked for many years to craft a viable payment model that would stabilize payments, drive adherence to nationally-recognized clinical guidelines and improve patient care. ASTRO believes its proposed RO-APM will allow radiation oncologists to participate fully in the transition to value-based care that both improves cancer outcomes and reduces costs."

Thevenot said ASTRO has aggressively pursued adoption of this proposed model with the Center for Medicare and Medicaid Innovation (CMMI). However, Thevenot said the group has concerns "about the possibility of launching a model that requires mandatory participation from all radiation oncology practices at the outset."

Further, Thevenot said any radiation oncology payment model will represent "a significant departure from the status quo." "Care must be taken to protect access to treatments for all radiation oncology patients and not disadvantage certain types of practices, particularly given the very high fixed costs of running a radiation oncology clinic," Thevenot stated.

Back in January, CMS announced the launch of the voluntary BPCI Advanced model, noting that it “builds on the earlier success of bundled payment models and is an important step in the move away from fee-for-service and towards paying for value.” The BPCI Advanced model includes more than 1,000 participants that are receiving episode-based payments for over 30 clinical areas, Azar said.

“BPCI Advanced is a voluntary model, where potential participants can select whether they want to join. But we’re not going to stick to voluntary models. Real experimentation with episodic bundles requires a willingness to try mandatory models. We know they are the most effective way to know whether these bundles can successfully save money and improve quality,” Azar said.

The Obama Administration introduced mandatory bundled payment for care for heart attacks and for cardiac bypass surgery in July 2016.

In the past, CMS Administrator Seema Verma has said that she does not support making bundled payments mandatory, and former HHS Secretary Tom Price, M.D. had strongly opposed mandatory bundles, going so far as to direct the end of two mandatory bundled payment programs—one existing and one previously announced. In November 2017, CMS finalized a rule, proposed in August 2017, that cancelled mandatory hip fracture and cardiac bundled payment models.

As per that final rule, CMS also scaled back the Comprehensive Care for Joint Replacement Model (CJR), specifically reducing the number of mandatory geographic areas participating in CJR from 67 areas to 34 areas. And, in an effort to address the unique needs of rural providers, the federal agency also made participation voluntary for all low-volume and rural hospitals participating in the model in all 67 geographic areas.

On Thursday, Azar acknowledged that his statements signaled HHS was reversing course on its previous stance, noting that last year the administration reduced the size of the CJR model and pulled back the other episode payment models, including those on cardiac care, before they could launch.

Azar, who was confirmed as HHS Secretary earlier this year, signaled early on that he diverged from Verma and Price on his views about mandatory bundled payments. During a Senate Finance Committee hearing in January on his nomination for HHS Secretary, he said, on the topic of CMMI [the Center for Medicare and Medicaid Innovation] pilot programs, “I believe that we need to be able to test hypotheses, and if we have to test a hypothesis, I want to be a reliable partner, I want to be collaborative in doing this, I want to be transparent, and follow appropriate procedures; but if to test a hypothesis there around changing our healthcare system, it needs to be mandatory there as opposed to voluntary, then so be it.”

During his speech Thursday, Azar pointed to the Administration’s first mandatory model, which was unveiled two weeks ago, called the International Pricing Index (IPI) Model for payments for Part B drugs. Azar said the model is a “mandatory model that will help address the inequity between what the U.S. and other countries pay for many costly drugs.”

Further, Azar said CMMI also will launch new primary care payment models before the end of the year, with the aim of introducing a spectrum of risk for primary care providers, Azar said.

“Before the end of this year, you will see new payment models coming forth from CMMI that will give primary care physicians more flexibility in how they care for their patients, while offering them significant rewards for successfully keeping them healthy and out of the hospital,” he said.

“Different sizes and types of practices can take on different levels of risk. As many of you know, even smaller practices want to be, and can be, compensated based on their patients’ outcomes,” he said. “We want to incentivize that, with a spectrum of flexibility, too: The more risk you are willing to take on, the less we’re going to micromanage your work.”

Azar also noted HHS’ efforts to examine impediments to care coordination, such as examining the Stark Law, the Anti-Kickback Statute, HIPAA, and 42 CFR Part 2. CMS has already launched and concluded a request for information on the Stark Law, and the Office of the Inspector General has done the same on the Anti-Kickback Statute, he noted.

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Dr. Sanjay Gupta’s Heartening Speech at CHIME18 Should Inspire U.S. Healthcare Leaders

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The story of an Amazonian tribe could serve as a motivational lesson for U.S. healthcare stakeholders

It was inspiring to hear Sanjay Gupta, M.D., the well-known neurosurgeon and medical reporter, give the closing keynote at the College of Healthcare Information Management Executives (CHIME) 2018 Fall CIO Forum in San Diego last week. Dr. Gupta, who serves as associate chief of the neurosurgery service at Grady Memorial Hospital in Atlanta, while also best known as CNN's multiple Emmy Award-winning chief medical correspondent, discussed the fascinating balance that he strikes between medicine and media.

“Oftentimes, I see people at their best, and sometimes at their worst. I get to travel the world, where I learn so much, but also teach others. Sometimes the dance between medicine and media can be awkward and emotionally challenging. But almost always, the stories we do have a significant impact,” Gupta told the Fall CIO Forum attendees.

What was perhaps most captivating about Gupta’s speech was when he spoke about visiting a primitive Amazonian tribe that appears to have the best heart health in the world. The Tsimane people of Bolivia do not speak a language, live a simple existence, and are disease-free, explained Gupta. So he went to visit the tribe with the goal to understand its lifestyle and what led to its members having such healthy hearts.  

Sanjay Gupta, M.D.

“I went spearfishing with one [tribe member], who thought he was 84-years-old, but he really didn’t know for sure. His shirt was off, and he was ripped, balancing himself on the canoe, just looking at the water, spearing fish. His eyesight was perfect. The entire indigenous tribe was just like this,” Gupta recalled.

After examining the Tsimane tribe’s diet, Gupta noted it was a hunter-gatherer society, meaning there was nothing technological. “The most mechanical thing I saw was a pulley for the well,” he said. Seventy percent of what they eat is carbohydrates—unrefined and unprocessed—while 15 percent of their diet is protein, and 15 percent fat, he added. “You need farmed food because oftentimes you don’t have successful hunting days, so the farmed food was the food in the bank. And they would do intermitting fasting, too. These are the people with the healthiest hearts in the world,” Gupta exclaimed.

When it comes to activity, when hunters are hunting, they’re not ever outrunning their prey, but rather outlasting it, noted Gupta. “We found that they walked about 17,000 steps per day. But they didn’t run; they only walked. They are active, but not intensively active. They also hardly every sit—they are either lying or standing all the time. And they would get nine hours of sleep per night, waking up to the rooster’s crow. There are no devices. Again, these are the people who have the healthiest hearts in world. They don’t have a healthcare system and don’t spend a dollar on healthcare,” Gupta stated.

What’s even more interesting about this tribe is that each of its members lives with some degree of a parasitic infection, which they usually get it early in life, have a few days of illness, and then just live with these parasites in their bodies for their entire lives. “The belief is that so much of the disease we talk about—that leads to this $3.3 trillion price tag [the total cost of U.S. healthcare spending in 2016]—is actually ignited or worsened by our immune systems. So the parasitic infections could be part of the reason they are protected from all types of diseases,” Gupta offered.

Essentially, it’s living this basic, undeveloped life that “inadvertently provides them extraordinary protection against heart disease,” noted a report in HealthDay last year. “Thanks to their unique lifestyle, most Tsimane [members] have arteries unclogged by the cholesterol plaques that drastically increase the risk of heart attack and stroke in modern Americans,” Gregory Thomas, M.D., medical director of the Memorial Care Heart & Vascular Institute at Long Beach Memorial, in California, said in that report.

Tsimane tribe (source: University of New Mexico)

You might be asking what the story of the Tsimane tribe has to do with U.S. healthcare since its lifestyle would obviously never be replicated in a developed country. And while that is true, it’s tough to ignore the $1 billion per day that our healthcare system spends on heart disease—compared to the Tsimane tribe that doesn’t spend a single dime, yet has the healthiest hearts in the world.

In this sense, perhaps we can use the Tsimane story to push ourselves to develop a greater understanding of why we spend so much money on healthcare and don’t have the results to show for it. Gupta asked this $3.3 trillion-dollar question in his speech—why does healthcare in the U.S. cost so much and what do we get in return?

“If you look at the statistics, it’s not impressive. More people die from preventable disease in the U.S. than in 12 other nations. People live longer in 30 other countries compared to the U.S.—including places like Chile and Costa Rica. We still have tens of millions of people who don’t have access, and we still spend all this money on healthcare. Why?” he asked.

Gupta explained that the nation’s high healthcare costs come down to the following: high administrative costs, technology, new drugs and development, and the cost of chronic disease—the last which is incredibly self-inflicted. About 70 to 80 percent of chronic disease is self-preventable, he said.

Indeed, as most of us know, about 5 percent of the U.S. population accounts for 50 percent of the healthcare costs. These are folks who are defined by illness, not by health, Gupta stated. This is why the modern-day healthcare system has proactively taken to targeting that 5 percent to improve their chances of preventing disease and staying healthy. “Data shows that home visits, nutritional counseling, one-on-one coaching, and diligent follow-up care can go a long way in preventing someone from getting sick in the first place, and from turning a disease into something more chronic. Some of these interventions can actually reverse disease. The die is not cast,” Gupta said.

For me, Gupta’s keynote highlighted the need for efforts around value-based care, care management, and population health to be intensified. A big part of that, as noted in the speech, is addressing patients’ social and environmental factors. It’s not at all surprising to see studies such as this one from earlier this year, conducted by researchers at the University of South Florida (USF) College of Public Health, Tampa, and WellCare Health Plans, and published in Population Health Management, which found that healthcare spending is substantially reduced when people are successfully connected to social services that address social barriers, or social determinants of health, such as secure housing, medical transportation, healthy food programs, and utility and financial assistance.

And with that, there is also an enormous opportunity for data and IT to play a role. Information sharing, so that providers have access to the right information at the point of care—no matter where the patient is—will be critical to reducing unnecessary costs. As will the robust use of data analytics, so that patient care organizations can be proactive in predicting which patients are at highest risk, when they might need services, and how to intervene at the appropriate time.

But to this point, Gupta, who noted that our society can get too caught up in high-tech, also suggested that “medicine seems to play by slightly different rules when it comes to innovation as opposed to other sectors. Sometimes, innovation moves painstakingly slow in respect to medicine.” At the end of the day, he said, it will be “the innovations that make us, [as a society], healthier, happier, and connect us in frictionless ways, that will be the biggest winners.”

So, will the U.S. population suddenly turn off their iPhone alarms, wake up to the rooster’s crow, and become a hunter-gatherer society? No, I would say that’s quite unlikely to happen. But hearing stories such as the one of the Tsimane tribe might just serve as good enough motivation to bring down the astronomical and unsustainable costs of U.S. healthcare.

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