Every year at the annual HIMSS Conference, there is talk, there is buzz, there is a Zeitgeist. Well, HIMSS15, held in Chicago, set a new standard for clarity and consistency. For, as attendees dashed from presentation to presentation, meeting to meeting, it seemed patently clear where healthcare and healthcare IT were headed. In contrast to, say, ten to 15 years ago, where one had to thoughtfully parse all the predictions and prognostications, there was no ambiguity or vagueness this time. Indeed, the signs and signals this year were as clear as the ginormous banners hung in the main foyer of the vast McCormick Place Convention Center, where the conference was held, welcoming 43,143 attendees, as of Thursday morning, an all-time record. Yes, everything about HIMSS this year was big—really big.
There were numerous appearances by federal healthcare officials, not only from ONC (the Official of the National Coordinator for Health IT), but also from CMS (the Centers for Medicare & Medicaid Services), and their overarching agency, HHS (the Department of Health and Human Services). And those federal healthcare officials couldn’t have been clearer in their pronouncements.
Most stark of all was the address by Andy Slavitt, Acting Administrator for CMS, as part of the closing keynote session held Thursday morning, April 16. Slavitt, who addressed an audience of about 4,000 attendees, immediately following a speech by Karen DeSalvo, M.D., the National Coordinator for Health IT, made it absolutely clear where he and other federal officials intended for the U.S. healthcare system to go in the next several years.
“Our priority is simple,” Slavitt told his audience: “to drive a delivery system that provides better care, smarter spending, and keeps people healthier. The success in the first five years since the Affordable Care Act has been very encouraging,” he said. “We’ve moved lack of insurance from 20 percent to less than 13 percent. We’ve reduced patient harm in the last four years in hospitals by 17 percent. And we’re not doing this by breaking the bank. Health inflation is at its lowest rate of increase in four years. Our agenda now,” he said, “is to get busy strengthening these gains. That will mean that more providers in more communities will need to be able to transform the care they provide so that they will benefit from value-based reimbursement. And they will need technology to help them get there.”
Slavitt cited three key goals he wanted CMS to help providers accomplish in the coming years. “One, care providers and patients should begin to feel the benefit from all that investment in care technology, what I call the care dividend,” he said. “Second,” he said, “we have a great need for a more modern infrastructure in healthcare. For the healthcare industry to become truly as great as we deserve… we need a Moore’s law effect in healthcare productivity to care for our dual-eligible patients and aging Baby Boomers, and we need technology to do that. I think we could do with a little less emphasis on shareable and wearable and more infrastructure emphasis.” In that regard, he cited new grants coming out of CMS for technology investments by state Medicaid programs. With regard to what Medicaid programs and other initiatives need, he said, “We need off-the-shelf, easy-to-maintain, modular systems that are faster to stand up and use.”
Importantly, Slavitt added that “We are moving to a place where it’s not about adoption of technology, but where, when you are walking the halls of a clinic, are patients feeling the improvement, and are caregivers feeling the improved productivity? The good news is that we have momentum, but I fear that if we don’t get very urgent about it, it won’t move fast enough.”
Honestly, it doesn’t get much clearer than that. Slavitt even referenced the statement of intention that Health and Human Services Secretary Sylvia Mathews Burwell had made back in January, when the Secretary had said she wanted to see 50 percent of Medicare fee-for-service reimbursement being paid out via alternative payment models such as accountable care organization (ACO) or bundled payments, within three years. That is an exceptionally ambitious goal by any standard; and as we at HCI had reported back in January when Mathews Burwell made her statement, there were several other goals embedded in the same statement. The HHS Secretary had called for 30 percent of all traditional Medicare payments to be tied to form of quality-driven or value-based payment by the end of next year. She had also said she wanted 90 percent of Medicare payments tied to some form of alternative payment by 2018.
(And, fortunately, right in the middle of HIMSS, the U.S. Senate passed, and then President Obama signed, the SGR repeal legislation, freeing healthcare from the long shadow of the SGR patch ongoing nightmare, while simultaneously, that legislative development added to the overall policy clarity by creating an entirely new physician payment incentive program that will revolutionize doctor incentives nationwide in the coming decade.)
What’s more, private payer leaders said more or less the exact same thing about where they wanted their reimbursement to providers to go. In his keynote address on Tuesday, April 14, Humana president and CEO Bruce Broussard told HIMSS attendees, “We have to change the conversation on what we are doing in healthcare from a supply-based system to a system around demand, a system where we put the customer first as opposed to the system. Over the years,” he added, “healthcare has been built by creating more and more supply. I hope I leave today by convincing you that we have to change the focus towards how we improve health for our customers, members, and patients.”
Meanwhile, Antonio Linares, M.D., regional vice president and medical director at Anthem Blue Cross, in a presentation offered as part of the New Provider-Payer Environment Symposium, one of numerous specialized symposia held on Sunday, April 12, said, in describing a nationwide Blue Cross Blue Shield Association-sponsored initiative called the Blue Distinction Total Care Program, designed to push physician groups much further into value-based payment, “Right now, more than $71 billion in value-based care delivery is under contract across all Blues plans nationwide. This is the future.”
But it’s not only the payers, both public and private, who see the future, and who are driving providers forward towards that future through payment system changes; healthcare futurists of all types see the future, too. In his opening keynote address at the CHIME CIO Spring Forum held on Sunday, Daniel Kraft, M.D., executive director of the Exponential Medicine program, and chair of the Medicine track for Singularity University, told his audience of the explosion taking place in technology—both information technology and other types of technology, such as wearables, “Start thinking exponentially. Start realizing that many of these technologies like Google Glass are already here,” they just need to be applied more fully to healthcare. “And it’s up to all of us to get involved to help create the future.”
Of course, it’s easy to become mesmerized and bewildered by all the leading-edge technologies being developed, and by the policy mandates and pronouncements coming out of Washington. How are healthcare IT leaders to translate the high-level dicta and prognostications from policy leaders and healthcare futurists into effective to-do lists for the next few years? And that’s where interoperability, usability, data exchange, and analytics come in, as those areas were top-of-mind for so many attendees at this year’s HIMSS and the focus of most of the discussions.
The challenge, of course, remains that the core clinical IT vehicles for the continuous improvement and optimization of healthcare processes—electronic health records—were never originally designed to support all the truly important tasks they’re being harnessed for—supporting population health management, accountable care, patient-centered home models, value-based care delivery and purchasing regimens, and the like. EHRs were designed purely as data repositories, in the most literal conceptual transfer from what had been in paper records. And not a single EHR solution on the market, whether inpatient- or outpatient-focused, can deliver what providers, and payers, need, to move towards the new healthcare, without considerable customization.
What’s more, the lack of interoperability remains an immense stumbling block in so many areas going forward. Yet one greeted with hope the report by David Raths, our Senior Contributing Editor, on Wednesday, April 15, on the session in which leaders of the Argonaut Project gave an update on their progress to acceleration adoption of HL7’s FHIR (Fast Healthcare Interoperability Resources) standards framework. As David reported, “Joshua Mandel, M.D., lead architect for SMART on FHIR at Boston Children’s Hospital, offered up some quick demonstrations of the kinds of apps that are being developed, many of them visualization tools or tools that pull data from multiple sourcs to help patients and providers better understand conditions and see data in new ways.”
Meanwhile, in another important area, analytics, our Associate Editor, Rajiv Leventhal, was granted an interview with Anil Jain, M.D., CMO of the Cleveland-based Explorys, which it was announced at the HIMSS Conference was being acquired, along with the Dallas-based Phytel, by IBM, as part of a massive deal to turbocharge analytics capability under the Watson Health banner at IBM. As Dr. Jain told Rajiv, “Since its spin-off from the Cleveland Clinic in 2009, Explorys has secured a robust healthcare database derived from numerous and diverse financial, operational and medical record systems comprising 315 billion longitudinal data points across the continuum of care. This powerful body of insight,” he added, “will help fuel IBM Watson Health Cloud, a new open platform that allows information to be securely de-identified, shared and combined with a dynamic and constantly growing aggregated view of clinical, health and social research data.”
And providers are indeed moving forward, even as some learn from early stumbles, among them the St. Joseph Hospital, a Nashua, N.H. facility that’s part of Covenant Health, a Tewksbury, Mass.-based Catholic health system. St. Joseph Hospital was forced to drop out of the Pioneer ACO last year, in which it had participated as a member of the Dartmouth-Hitchcock Pioneer ACO. Delays in leveraging data quickly enough to make needed clinical outcomes improvements dogged St. Joseph’s participation in the Pioneer ACO, but much was learned, and improvements are now steadily taking place at their organization, its president and CEO, Rich Boehler, M.D., told Senior Editor Gabriel Perna. “We refined our medical home model and the wholesale deployment of care coordination, which has been the most significant change for us,” he noted. “The care coordinators in practices linked with the hospital, the ability to proactively manage care has been good.”
So what’s the bottom line in all this? The policy map is quite clear, even if certain details remain “TBD” (to be determined), such as some key elements of Stage 3 of the meaningful use program. But overall, there is no question about where the public and private payers of healthcare want to go, and what kind of U.S. healthcare system they want to create. What’s more, the tools are now being developed to genuinely take providers where they need to go. The work ahead will be grueling; everyone already knows that.
But, leaving HIMSS15, one had a sense of absolute clarity and also of purpose. I’ve never experienced a HIMSS Conference at which attendees seemed more clear-headed, purposeful, and energized. It will be fascinating to see how much progress can be made in all areas of endeavor in healthcare and healthcare IT before we all reconvene again next February in Las Vegas at HIMSS16. I hope everyone can enjoy the rocket ride in the next ten-and-a-half months before our next annual blowout gathering, as I have the irresistible temptation here to quote Bette Davis as Margo Channing: “Fasten your seat belts, it’s going to be a bumpy night!”