As the number of insured Americans increases under the provisions of the Affordable Care Act, how is healthcare IT playing to make sure that this new population is getting the quality of healthcare they need and are entitled to? After all, nationally the number of Americans who are newly enrolled in private health insurance plans through the health insurance marketplace now exceeds 8 million.
At the state level, there have been wins and misses. In April, the board of Cover Oregon voted to shut down that state’s enrollment site and let the federal exchange manage new enrollees in that state. It reportedly signed up only about 69,000 by the end of March. On the other hand, as of April 16, NY State of Health, New York’s insurance marketplace, signed up 960,762 people for coverage since October 1, 2013—a good start of attaining its goal of 1.1 million people by the end of 2016.
While those numbers are encouraging, they also present a challenge that health IT plays a central role in meeting. According to Frank Winters, a regional representative of the Centers for Medicare and Medicaid Services (CMS) at the HIMSS New York State Chapter Conference in New York City last month, many of the new enrollees have health insurance for the first time or for the first time in many years. “These people will have to be educated,” he told hundreds of people at the conference. “They are not used to going to see the primary care physician, and they will have to be sold on the idea of prevention, and providing consent to participate in information sharing as part of these networks,” he said.
Some of the best examples of how IT is being used to reach out to underserved populations come from community-based healthcare organizations. According to Mary Ann Christopher, president and CEO of the Visiting Nurse Service of New York (VNSNY), the nation’s largest not-for-profit community-based health system, who presented at the same conference, “As 30 million people come into the system, we should not stop at their being insured, because that is not enough,” she said. “We are called to make sure that everything we do is driving toward best-in-class care quality outcomes for patients and communities.”
It is using IT in many of its programs to make that happen. Just one of them is to examine social determinants in marginalized neighborhoods that impact the health of the population, such as immunization status, diabetes, cardiovascular disease, crime, and substance and alcohol abuse. It uses this model and geo-mapping the community to identify “hot spots” that require a unique level of intervention; and deploys community wellness coaches, nurses and social workers who collaborate with community-based coalitions in the area to address those needs. She said the program, which is being followed by CMS, the Institute for Healthcare Improvement and the New York State Department of Health, has reduced the number of people accessing the emergency departments for conditions that are better served by primary care access.
In the Midwest, the Access Community health Network (ACCESS), a network of 40 health centers across greater Chicago, has adopted the patient-centered medical home (PCMH) as the centerpiece of its care strategy. Julie Bonello, CIO of ACCESS, explains that the organization has set up call centers and follow-up work queues for patients who need appointments, based on preventative maintenance, and documents every patient in its recently-installed electronic health record system, according to clinical guidelines for chronic conditions such as diabetes, asthma and hypertension.
Bonello views the primary care physician as central to its PCMH strategy. ACCESS has set up patient portals that allow providers and their patients to discuss their patient care goals. While she says that only a small percentage of patients currently use the patient portal, the organization has initiatives to get the patients educated on the portal, and assess their readiness to use it.
To be sure, community-based healthcare organizations are not the only ones using healthcare IT in innovative ways to improve care, but they have undertaken the job of proving care to patient populations that have been outside the mainstream when it comes to healthcare. To me they provide inspiring examples of how healthcare IT is driving home the vision embodied in the Affordable Care Act.