During a U.S. House of Representatives Ways and Means subcommittee on Health hearing Wednesday, Congressional leaders sought insights from the digital health industry and leading healthcare providers on how to use digital health solutions to cut costs, increase efficiency and access and improve quality in the healthcare system.
Specifically, the Health subcommittee members were keenly focused on how digital health technology and innovation could be applied to federal healthcare programs such as Medicare.
According to Health subcommittee Chairman Rep. Pat Tiberi (R-Ohio), while there are a myriad of companies in the commercial sector inventing and developing groundbreaking products, those innovations are not yet seen in federal programs like Medicare.
“The commercial sector is utilizing these innovations to improve systems, beneficiary care and collaborative care efforts. To date, Medicare has fallen significantly behind these efforts,” he said.
The focus of the hearing likely signals that the Ways and Means subcommittee on Health will continue examining the uses of digital health into 2017. In fact, at the conclusion of the hearing, Tiberi said the subcommittee planned to dig deeper into the issues of improving efficiency and quality in healthcare through digital health.
“This hearing kicks off discussion about the innovative aspects of healthcare and emerging technology to enhance efficiencies, reduce waste, improve outcomes and create greater access to care for beneficiaries in the Medicare space. It’s about using existing dollars in the program more efficiently,” Tiberi said.
“We have clinician shortages jeopardizing access for Medicare beneficiaries who need access to care, and that is unacceptable and untenable. We need to lift the barriers and incentivize greater efficiency,” he said.
Tiberi also said Congress should learn lessons from steps that have already been taken, such as the Health Information Technology for Economic and Clinical Health (HITECH) Act, and continue to build on payment reform efforts such as the Medicare Access and CHIP Reauthorization Act (MACRA), “rather than create more bureaucratic layers.”
During the hearing, Rep. Jim McDermott (D-WA) said innovation will be central to efforts to address rising healthcare costs. “Innovation through electronic health records (EHRs), telemedicine, payment reform must be part of the discussion,” he said.
McDermott mentioned the challenges faced by many accountable care organizations (ACOs) as one example of healthcare innovation, specifically recent news that Dartmouth College was dropping out of the ACO model it helped to develop. “This doesn’t mean ACOs are failures, but there are questions we need to ask. Where are we going as a country and how can we turn investments in innovation into sustainable models moving forward?”
“I’m looking forward to hearing about what works, what hasn’t worked and where we are heading. We can all agree that without meaningful action on cost containment we will continue down an unsustainable path for healthcare in this country,” McDermott said.
The Health subcommittee members heard from Michael Gallup, president of Pittsburgh-based TeleTracking Technologies; Jared Short, chief operating officer at Portland, Ore.-based Cambia Health Solutions; Paul Black, Allscripts’ chief executive officer and Greg Long, chief medical officer, senior vice president, Systems of Care at ThedaCare, a health system in Wisconsin.
Long shared with subcommittee members a pilot project that ThedaCare began in 2014 to identify the health system’s most complex patients, or “super utilizers,” using data and a team-based care approach. ThedaCare is a health system in northeastern Wisconsin consisting of seven hospitals and 34 clinics serving eight counties. The system cover more than 240,000 patients annually.
ThedaCare leaders were able to identify high-risk patients using a risk calculator program developed in its EHR system and based on clinical factors, utilization of services and psychosocial needs, Long said. The pilot project involved 282 high-risk patients being enrolled in a new, decentralized, team-based model. The model was comprised of three care coordinators, one registered nurse, one clinical pharmacist, one behavioral health clinician, one nurse practitioner and one medical assistant, Long said.
Long further explained that care plans were developed for patients in the model with each patient receiving supportive services and intensive case management including chronic disease monitoring and management skills, behavioral health screening, psychotherapy and other behavioral health care, medication consultation and counseling and life skills classes. Patients also received assistance with obtaining housing and other basic needs, Long said. And, the care teams have begun exploring the use of technology with some patients uploading blood sugar results to a smartphone or iPad and submitting the results to clinics.
As a result of the pilot project, the percentage of patients with uncontrolled diabetes decreased from 12 percent to 3.8 percent. The percentage of patients who visited the emergency department more than three times in a six-month period fell from 11.8 percent to 2.6 percent, he said. The program saw a number of other positive results as well.
Long also shared other technology projects at ThedaCare, such as an e-visit platform to enables patients to consult with primary care physicians through a web-based portal, which has achieved a 98 percent satisfaction rate from patients. The health system has a telepsychiatry program and has plans to implement a tele-stroke program, funded by a grant award, in the next six months. The health system also is exploring alternative payment models and is participating in the Next Generation ACO model.
When Rep. Mike Kelly (R-PA) asked how the government can learn from the private sector to improve health care without adding to the deficit, Gallup with TeleTracking responded, “There’s enough money in the system to get the patients through and give them the care that they need if we cut out the inefficiencies. We have a doctor shortage, a nurse shortage, we have all these shortages out there. How do we fix that? Well, let’s make them more productive. If we can take labor and help them get more productive, we can get more patients through at the same price. If we can get more through at the same price, we can solve many of our problems.”
TeleTracking Technologies developed automated patient solutions to improve hospital patient flow, and during the hearing Gallup provided examples of how TeleTracking's real-time enterprise visibility and automation solutions had improved efficiency and operatiosn at a number of hospitals.
“Each year nearly two million people walk into hospital ERs and walk back out because they are frustrated with waiting. Millions more wait more than six hours to get a hospital bed and every minute of every day, an ambulance is diverted from its intended hospital, yet there are seven open beds for every two admitted patients, and why? Because little innovation or attention has been given to the logistical flow of patients, caregivers, assets, and materials,” he said.
Cambia’s Short highlighted the company’s HealthSparq solution, a transparency tool that allows people to shop for healthcare services by showing price and quality of healthcare services, and GNS Healthcare, which collects patient data, analyzes it and determines which treatment is the best match for patients. According to Short, GNS Healthcare solutions also can predict which patients are most likely to stop taking medications. “This process helps people have more success with care plans and helps organizations lower costs,” he said.
During the hearing, Black detailed Allscripts’ interoperability platform, db Motion, delivers a single patient record view across multiple systems and settings with a focus on workflow and adaptability. Black also mentioned Allscripts’ 2BPrecise solution for genomic sequencing. The platform makes genomic sequencing data available and actionable at the point of care. The National Institutes of Health is an early adopter of 2BPrecise as part of the Cancer Moonshot efforts, Black said.
Black said “despite bumps in the road,” there has been substantial progress in healthcare technology. “It wouldn't have happened if Congress hadn’t provided the impetus for ubiquitous adoption of EHRs. These changes disrupted paper records and created a new digital ecosystem of caregivers and software developers and patients. Following disruption there is innovation and opportunity,” he said.
The subcommittee asked the digital health leaders and Long what Congress should be doing to increase adoption of information exchange solutions and tools to support interoperability.
With regard to data blocking, Allscripts’ Black said that while data blocking has occurred in the past, “those issued have been removed.” “Whether behaviorally, economically or because someone can call a hotline and report somebody for data blocking, a lot of reports suggest that the problem has been solved.”
The subcommittee members appeared keenly interested in gaining insights about incentivizing innovation and how Medicare can better collaborate with the private sector.
Short pointed to payment reforms that have passed to date and urged Congressional leaders to “continue to see those through.” “The next two to three years, look at ACOs and how they perform, what works or doesn’t work, and see through the current innovation and then deploy and scale some of them. There’s tremendous innovations on interoperability to come,” Short said.
Long said, “I think if you piece together the great work by organizations, the road map is out there. We all see the waste and are trying to improve it. The ones doing the best work can create the road map. The information is out there if we can piece it together.”